丹参酮ⅡA对压力超负荷大鼠肥厚心肌一氧化氮合酶基因表达及细胞内游离钙离子浓度的影响

目的 通过研究丹参酮ⅡA对压力超负荷大鼠肥厚心肌一氧化氮(NO)及内皮型一氧化氮合酶(eNOS)基因表达和细胞内游离钙离子浓度([Ca2 ]I)的影响,探讨丹参酮ⅡA抑制高血压左心室肥厚的分子生物学机制.方法 SD大鼠行腹主动脉缩窄术建立压力超负荷左室心肌肥厚模型,术后4周将手术大鼠随机分为手术对照组(B组)、丹参酮低剂量组[C组,10 mg/(kg·d),腹腔注射]、丹参酮高剂量组[D组,20 mg/(kg·d),腹腔注射]及缬沙坦组[E组,10 mg/(kg·d),灌胃],另有8只SD大鼠作为假手术组(A组).用药8周后检测各组尾动脉压,取左心室组织检测左心室质量指数(LVMI), 采用苏木精-伊红染色法测量心肌纤维直径(MFD),硝酸还原法测定心肌组织NO的含量,逆转录-聚合酶链式反应(RT-PCR)、免疫印迹法(Western blot)分别检测eNOS 的mRNA和蛋白表达水平,利用激光共聚焦显微镜测定心肌细胞[Ca2 ]I浓度的变化.结果 ①B、C、D组的血压显著高于A、E组(均P<0.01),C、D组与B组间血压的差异无显著性意义(均P>0.05).②C、D、E组LVMI、MFD均高于A组(均P<0.05),显著低于B组(均P<0.01).③C、D、E组的NO含量明显高于B组(均P<0.01),但仍低于A组(均P<0.05).④B组eNOS蛋白和mRNA表达水平明显低于其他各组(均P<0.01);E组eNOS蛋白和mRNA表达水平显著低于A、C、D组(均P<0.05);C、D组eNOS蛋白和mRNA表达水平与A组比较,差异无显著性意义(均P>0.05).⑤B组细胞内[Ca2 ]i明显高于其他各组(均P<0.01);E组和C组[Ca2 ]i仍高于A、D组(均P<0.05);D组[Ca2 ]i与A组比较,差异无显著性意义(P>0.05).结论 丹参酮ⅡA对心肌肥厚的抑制作用是非血压依从性的,丹参酮ⅡA通过降低心肌细胞[Ca2 ]i浓度,促进心肌局部NO的产生及eNOS基因表达,起到对高血压心肌肥厚的防治作用.     

PICK1基因敲除小鼠的繁育及子代基因型的鉴定

目的 探讨蛋白激酶Cα相互作用蛋白(PICK1)基因敲除小鼠的优化繁育方法及 PICK1 基因敲除小鼠子代鼠的鉴定方法,为进一步研究 PICK1蛋白的功能奠定基础.方法 用 6 种不同的交配方式观察子代鼠的各表型比率及雌、雄性PICK1 基因突变纯合子小鼠的繁殖能力;从子鼠鼠尾中提取基因组 DNA,用 PCR 方法扩增 PICK1 基因片段,电泳后观察结果.结果 PICK1 / 、PICK1 /-、PICK1-/-各表型小鼠互交繁殖结果基本符合孟德尔遗传规律,且雌性PICK1 基因突变纯合子小鼠有繁殖能力,雄性PICK1 基因突变纯合子小鼠无繁殖能力.琼脂糖凝胶电泳显示PCR 产物分子量大小为 400 bp 和 200 bp,与目的 基因片段相对分子质量大小一致.结论 雌、雄性PICK1 基因突变杂合子小鼠交配是繁育PICK1 基因突变纯合子子鼠的较好方法;实验所用PCR方法能够精确鉴定PICK1 基因突变纯合子子鼠,为PICK1 蛋白功能的实验研究提供了较理想的动物模型.     

Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial

Context  Weight gain, a common adverse effect of antipsychotic medications, is associated with medical comorbidities in psychiatric patients. Objective  To test the efficacy of lifestyle intervention and metformin alone and in combination for antipsychotic-induced weight gain and abnormalities in insulin sensitivity. Design, Setting, and Patients  A randomized controlled trial (October 2004-December 2006) involving 128 adult patients with schizophrenia in the Mental Health Institute of the Second Xiangya Hospital, Central South University, China. Participants who gained more than 10% of their predrug weight were assigned to 1 of 4 treatment groups. Interventions  Patients continued their antipsychotic medication and were randomly assigned to 12 weeks of placebo, 750 mg/d of metformin alone, 750 mg/d of metformin and lifestyle intervention, or lifestyle intervention only. Main Outcome Measures  Body mass index, waist circumference, insulin levels, and insulin resistance index. Results  All 128 first-episode schizophrenia patients maintained relatively stable psychiatric improvement. The lifestyle-plus-metformin group had mean decreases in body mass index (BMI) of 1.8 (95% confidence interval [CI], 1.3-2.3), insulin resistance index of 3.6 (95% CI, 2.7-4.5), and waist circumference of 2.0 cm (95% CI, 1.5-2.4 cm). The metformin-alone group had mean decreases in BMI of 1.2 (95% CI, 0.9-1.5), insulin resistance index of 3.5 (95% CI, 2.7-4.4), and waist circumference of 1.3 cm (95% CI, 1.1-1.5 cm). The lifestyle-plus-placebo group had mean decreases in BMI of 0.5 (95% CI, 0.3-0.8) and insulin resistance index of 1.0 (95% CI, 0.5-1.5). However, the placebo group had mean increases in BMI of 1.2 (95% CI, 0.9-1.5), insulin resistance index of 0.4 (95% CI, 0.1-0.7), and waist circumference of 2.2 cm (95% CI, 1.7-2.8 cm). The lifestyle-plus-metformin treatment was significantly superior to metformin alone and to lifestyle plus placebo for weight, BMI, and waist circumference reduction. Conclusions  Lifestyle intervention and metformin alone and in combination demonstrated efficacy for antipsychotic-induced weight gain. Lifestyle intervention plus metformin showed the best effect on weight loss. Metformin alone was more effective in weight loss and improving insulin sensitivity than lifestyle intervention alone. Trial Registration  clinicaltrials.gov Identifier: NCT00451399      

Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study

Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronchoscope, which is difficult to manipulate within the pleural cavity. The semi-rigid thoracoscope combines the best features of the flexible and rigid instruments. Since the practice with this instrument is limited in China, the diagnostic utility of semi-rigid thoracoscopy （namely medical thoracoscopy） under local anesthesia for undiagnosed exudative pleural effusions was evaluated . Methods In 50 patients with undiagnosed pleural effusions who were studied retrospectively, 23 received routine examinations between July 2004 and June 2005 and the rest 27 patients underwent medical thoracoscopy during July 2005 and June 2006. Routine examinations of the pleural effusions involved biochemistry and cytology, sputum cytology, and thoracentesis. The difference in diagnostic sensitivity, costs related to pleural fluid examination and complications were compared directly between the two groups. Results Medical thoracoscopy revealed tuberculous pleurisy in 6 patients, adenocarcinoma in 7, squamous-cell carcinoma in 2, metastatic carcinoma in 3, mesothelioma in 2, non-Hodgkin＇s lymphoma in 1, and others in 4. Only 2 patients could not get definite diagnoses. Diagnostic efficiency of medical thoracoscopy was 93% （25/27）. Only 21% patients were diagnosed after routine examinations, including parapneumonic effusion in 2 patients, lung cancer in 2 and undetermined metastatic malignancy in 1. Twelve patients with tuberculous pleurisy were suspected by routine examination. Costs related to pleural effusion testing showed no difference between the two groups （P=0.114）. Twenty-three patients in the routine examination group underwent 97 times of thoracentesis. Two pleural infection patients and 2 pneumothorax patients were identified and received antibiotic treatment and drainage. Medical thoracoscopy cou     

脑外伤急性期血清前白蛋白与视黄醇结合蛋白的测定及临床意义

目的通过检测脑外伤患者血清前白蛋白(PA)、视黄醇结合蛋白(RBP)、白蛋白(ALB)及总体蛋白(TP)水平,前瞻性分析内脏蛋白质反映脑外伤后应激状态的灵敏性及其与预后的相关性。方法对138例急性脑外伤患者于伤后12h内进行血清PA、RBP、ALB及TP水平检测,并结合格拉斯哥昏迷评分(GCS评分),采用多因素Logistic回归分析其与预后的关系。并选择60名健康体格检查者作为对照组。结果病例组血清PA、RBP、ALB及TP分别为(0.222±0.057)、(0.030±0.008)、(39.75±5.66)和(63.44±8.56)g/L,均明显低于对照组[(0.297±0.046)、(0.049±0.010)、(43.95±5.50)和(68.97±4.96)g/L,P值均<0.01]。重型亚组(GCS评分≤8分)PA、RBP、ALB及TP水平分别为(0.217±0.059)、(0.028±0.009)、(37.66±6.62)和(59.70±8.69)g/L,轻型亚组(GCS评分>8分)分别为(0.225±0.055)、(0.031±0.008)、(40.84±5.04)和(65.37±7.87)g/L;重型亚组血清RBP、ALB、TP水平均显著低于轻型亚组(P值分别<0.05、0.01),两亚组间PA水平的差异无统计学意义(P>0.05)。伤后的血清ALB(OR=0.858)和PA(OR=0.979)水平与预后呈显著相关(P值均<0.01)。预后不良的概率为P,建立回归方程P(1-P)=EXP(9.53-0.15x_2-0.02x_3)(x_2为ALB,x_3为PA),方程拟合优度似然比检验P=0.7019。提示伤后血清ALB和PA水平越低,预后越不良。结论与传统检测项目ALB相比,PA和RBP能更灵敏地反映脑外伤后机体的应激状态。     

糖尿病患者白内障超声乳化吸除联合折叠式人工晶体植入术189例

目的:探讨糖尿病患者白内障超声乳化吸除联合折叠式人工晶体植入术的疗效和并发症。方法:对189例糖尿病性白内障行超声乳化吸除联合折叠式人工晶体植入术。结果:术后1周裸眼视力≥0.7者24例,占13%;0.6～0.4者117例,占61%;≤0.3者24例,占26%。结论:糖尿病患者采用超声乳化白内障吸除联合折叠式人工晶体植入术,术后并发症明显减少,术后视力恢复快,对糖尿病患者是一种安全有效、实用的手术方式。更重要的是有利于眼底观察,为及时治疗视网膜病变提供了条件。     

社区护理人员工作满意度调查

目的了解社区护理人员对目前护理工作的满意度状况,为提高护士工作积极性提供依据。方法对本院社康中心58名在职护士采用问卷调查,根据量表要求计分,数据采用SPSS 10.0软件处理。结果社区护士对薪资水平、工作环境、管理模式、工作内容均有不同程度不满。不满的对象与学历、职称、年龄、婚姻状况有关。结论护理管理应以人为本,体现民主管理,尊重护士的利益和需要。认同护士的工作价值,有助于提高护士的工作满意度。     

SPECIFIC IDENTIFICATION OF HERPES SIMPLEX VIRUS IN HUMAN ESOPHAGUS WITH RAPID IN SITU HYBRIDIZATION IN 5 CASES

HUMAN herpes simplex virus esophagitis （HSVE） was first reported in 1940 by Johnson. ^1HSVE usually occurs in immunocompromised patients,such as those with acquired immunodeficiency syndrome （AIDS）, 2-4 malignancies, cutaneous burns, connective tissue diseases, inflammatory bowel disease, those taking immuno-suppressive therapy, and those undergoing organ transplantation,5 etc. In the immunocompetent individuals, HSVE is rare, having been reported in 39 cases and mainly affecting young males^6,7 The aim of this study was to delineate the clinical experience in the diagnosis of HSVE using rapid in situ hybridization and assess the various detection methods.     

手部肌腱损伤病人手术护理及功能锻炼

目的探讨手部肌腱损伤术后护理,术后观察及功能锻炼。方法通过对126例手部肌腱损伤手术患者,术前加强心理护理,做好各项准备工作,术后密切观察伤口与末梢血运情况,预防并发症,加强有效功能锻炼。结果本组优良率达90%。结论周到细致的护理与有效的功能锻炼是配合手术成功的保障。     

藏药二十味沉香散抗慢性低氧的实验研究

目的探讨藏药二十味沉香散是否能够防治慢性低氧对机体造成的损伤。方法将30只Wistar大鼠随机分为常氧对照组、高原对照组和给药组。常氧对照组（海拔2260m）就地测定Ppa、RV／（LV＋S）、Hb和Hot等指标；高原对照组和给药组是将大鼠从西宁（海拔2260m）运至花石峡（海拔4500m）分别用0．9％生理盐水和藏药二十味沉香散水剂灌胃，30天后，测定与常氧组相同的各项指标。结果给药组平均Hb、Hot分别为（17．1±1．9）g／dl、（57．6±5．5）％，与高原对照组[（23．0±2．1）g／dl、（71．6±7．5）％]相比，有显著性差异（P〈0．01）；平均Ppa和RV／（LV＋S）分别为（26．8±6．6）mmHg、0．45±0．05，显著低于高原对照组[（36．1±9．2）mmHg、0．56±0．07]，P〈0．01；两低氧组与常氧组相比，上述各项指标均有显著性差异（P〈0．05）。结论二十味沉香散通过防止红细胞过度增生和肺动脉压升高,发挥预防慢性低氧对机体损伤的作用．