胎盘早剥产妇、新生儿血及脐血中组织因子和组织因子途径抑制物的变化

目的:检测胎盘早剥产妇血、新生儿血及脐血组织因子及组织因子途径抑制物蛋白的变化,以及这些变化对其凝血功能的影响。方法:收集2006-10/2007-04在中山大学附属第一医院产科的胎盘早剥产妇血(足月或早产不限)、分娩胎儿的脐带血及新生儿血标本各11例,4例为足月产,其余均为胎龄29～36周早产标本,男婴5份,女婴6份。正常对照15份来自同期广州市妇婴医院产妇及分娩胎儿。标本收集时间母亲血为分娩前24h内、脐血为分娩即刻、新生儿血为出生后2h内抽取,排除标准为产妇本次分娩前无血液系统疾病史,未使用过对凝血功能产生影响的药物,采用酶联免疫吸附方法测定血浆组织因子及组织因子途径抑制物抗原水平,并与正常分娩产妇对照组进行比较。病理及正常标本均经产妇及家属知情同意后获得。结果:①胎盘早剥产妇血、新生儿血及脐血血浆中组织因子测定值明显高于正常对照组(P<0.05)。②胎盘早剥产妇血、新生儿血浆及脐血中组织因子途径抑制物测定值较正常分娩产妇降低,差异具有显著性意义(P<0.01)。③胎盘早剥产妇血、新生儿和脐血组织因子途径抑制物/组织因子比值均较正常分娩产妇明显降低(P<0.01)。结论:胎盘早剥时产妇血、脐血及新生儿血促凝血活性增强,抗凝血活性降低,与其高凝状态相关。     

膳食补充剂黑醋与红曲单用及联用对中老年人血脂的影响

目的:观察并比较黑醋与红曲单用及联用对中国中老年人降低血脂的效能。方法:试验于2003-10/11在大连医科大学中日合作医药科学研究所进行。选择30名年龄为45￣65岁的中老年人。30名受试者被随机分为3组,每组10人,分别服用黑醋丸6粒,红曲丸6粒或黑醋 红曲丸6粒,1次/d,连续4周;3种膳食补充剂黑醋丸、红曲丸及黑醋 红曲丸由含有不同剂量的黑醋固形物、红曲粉末K-F、柠檬酸钠、大豆油、蜂蜡、脂肪酸甘油脂组成(由日本国第一药品工业株式会社提供)。各组服用剂量分别为每天黑醋固形物360mg,红曲粉72mg及黑醋固形物360mg 红曲粉72mg。服用2和(或)4周后,检测血脂和血糖,同时用血清样品检测肝功与肾功能。实验结果用SPSS统计软件进行方差分析。结果:30名中老年人全部进入结果分析。①受试者连续3d每日营养素摄入量:3组之间热量、胆固醇、膳食纤维、宏量或微量营养素摄入量差距均无显著性。②血清脂质浓度和计算的脂质比:2,4周血清三酰甘油含量,黑醋 红曲组低于基础值(分别下降(24.6±4.9)%,(27.6±3.4)%,P<0.05);红曲组与基础值比较,差异无显著性[分别下降(6.5±3.4)%,(11.6±4.5)%];黑醋组与基础值比较,差异无显著性[分别下降(10.2±7.3)%,(12.4±8.2)%]。2,4周血清胆固醇、低密度脂蛋白胆固醇含量,黑醋 红曲丸、红曲丸和黑醋丸组均比基础值降低,差异无统计学意义。3种膳食补充剂对血清高密度脂蛋白胆固醇及计算的脂质比值无明显改变。血糖含量无变化。未发现对受试对象产生明显不良反应。结论:服用黑醋 红曲丸能明显降低受试者血清三酰甘油含量。黑醋与红曲合用对高脂血症者可能有健康效益。     

人参皂甙Rb_1和Rg_1对小鼠中枢神经递质受体和脑内蛋白质合成的影响

应用放射配基结合法测定了人参皂甙Rb_1和Rg_1对α_1,α_2,β肾上腺素能受体、M胆碱能受体、5-羟色胺、多巴胺及GABA等七种受体的作用。结果均不能证明它们对这七种受体有亲和力。但给动物ip药物连续5天,Rb_1和Rg_1均能使中枢M胆碱受体密度显著增高。Rb_1及Rg_1还能显著增加脑内蛋白质的含量。上述实验结果对解释人参的中枢作用提供了重要证据。     

楤木根皮中皂甙化学成分的研究

楤木根皮中的主要成分是皂甙。将总皂甙以柱层析分离,得到三个化合物(Ⅰ～Ⅲ),经光谱分析和化学方法证明,Ⅰ为楤木皂甙A(araloside A);Ⅱ为银莲花甙(narcissiflorine);Ⅲ是3-O-[β-D-吡喃葡萄糖-(1→2)-β-D-吡喃木糖-(1→)2)-α-L-阿拉伯糖]-齐墩果酸。Ⅲ为一新皂甙,命名为楤木皂甙D(araloside D)。     

Assessing the impact of a gynaecomastia assessment and treatment infographic in primary care in Greater Manchester

IntroductionMen with gynaecomastia are routinely referred to breast clinics, yet most do not require breast surgical intervention. The aim of this study was to assess the impact of a novel point-of-care gynaecomastia decision infographic in primary care on the assessment, management and referral practices to tertiary breast surgical services.MethodsA study was carried out of male patient referrals from primary care in Greater Manchester to a tertiary breast centre between January and March in 2018–2020. Referral patterns were compared before and after the infographic went live in general practices in Greater Manchester in January 2020. Data were collected for gynaecomastia referrals, including aetiology, investigation and management.ResultsIn total, 394 men were referred to a tertiary breast centre from 163 general practices, of which 271 (68.8%) had a diagnosis of gynaecomastia. Use of the decision infographic by primary healthcare providers was associated with a decrease in male breast referrals with gynaecomastia (79.6% to 62.0%). Fewer gynaecomastia patients were referred with a benign physiological or drug-related cause after implementation of the infographic (52.2% vs 41.8%). Only 10 (3.7%) patients with gynaecomastia underwent breast surgery during the study period.ConclusionImplementation of a gynaecomastia infographic in primary care in Manchester was associated with a reduction in gynaecomastia referrals to secondary care. We hypothesise that implementation of the infographic into primary care nationally may potentially translate to hundreds of patients receiving more specialty-appropriate referrals, improving overall management of gynaecomastia. Further study is warranted to test this hypothesis.     

模拟教学法可改善成人糖尿病患者的血糖控制

初级保健医师(primary care physicians,PCPs)对继续医学教育的需求很大.为了评估以病例为基础的模拟教学法是否可以提高初级保健医师对糖尿病的诊疗水平,美国明尼苏达州健康合作者研究基金会和医疗集团进行了相关的研究. 研究选择了美国明尼苏达州健康合作者研究基金会和医疗集团旗下的11个诊所的41名初级保健医师,随机分为参与模拟教学组和不参与模拟教学组.在模拟教学组中,给每位初级保健医师派发了1 2个2型糖尿病的模拟病例,这些病例都是针对研究人员在电子病历中观察到的初级保健医师诊疗水平的不足之处所专门设计的,每个模拟病例都需要初级保健医师在15分钟内完成诊疗过程.