新冠肺炎疫情背景下麻醉实习阶段教学改革新思考

在新冠肺炎疫情背景下,针对麻醉学专业学生培养现状和特殊性,提出教学改革的新思考,使学生更好地完成从医学生向临床医师的角色转变。     

我国社区护理学实践教学研究进展

为培养应用型社区护理人才,推动我国基本公共卫生事业的发展,国内社区护理教育者积极探索,通过多种方法开展社区护理实践教学,并取得一定效果。本文回顾国内社区护理学实践教学的研究进展,总结实践教学的目标、内容、教学模式、教学方法、带教管理和评价方法,以期为社区护理教育者开展实践教学提供参考,推动社区护理发展。     

Hyperlipidemia affects neuronal nitric oxide synthase expression in brains of focal cerebral ischemia rat model★

BACKGROUND: Hyperlipidemia, a risk factor for ischemic cerebrovascular disease, may mediate production of neuronal nitric oxide synthase (nNOS) to induce increased nitric oxide levels, resulting in brain neuronal injury. OBJECTIVE: To investigate effects of hyperlipidemia on brain nNOS expression, and to verify changes in infarct volume and pathology during reperfusion, as well as neuronal injury following ischemia/reperfusion in a rat model of focal cerebral ischemia. DESIGN, TIME AND SETTING: Complete, randomized grouping experiment was performed at the Laboratory of Physiology, Shanxi Medical University from March 2005 to March 2006. MATERIALS: A total of 144 eight-week-old, male, Wistar rats, weighing 160-180 g, were selected. A rat model of middle cerebral artery occlusion was established by suture method after 4 weeks of formulated diet. Nitric oxide kit and rabbit anti-rat nNOS kit were respectively purchased from Nanjing Jiancheng Bioengineering Institute, China and Wuhan Boster Biological Technology, Ltd., China. METHODS: The rats were equally and randomly divided into high-fat diet and a normal diet groups. Rats in the high-fat diet group were fed a high-fat diet, consisting of 10% egg yolk powder, 5% pork fat, and 0.5% pig bile salt combined with standard chow to create hyperlipidemia. Rats in the normal diet group were fed a standard rat chow. A total of 72 rats in both groups were randomly divided into 6 subgroups: sham-operated, 4-hour ischemia, 4-hour ischemia/2-hour reperfusion, 4-hour ischemia/4-hour reperfusion, 4-hour ischemia/6-hour reperfusion, and 4-hour ischemia/12-hour reperfusion, with 12 rats in each subgroup. MAIN OUTCOME MEASURES: nNOS expression was measured by immunohistochemistry, and pathomorphology changes were detected by hematoxylin-eosin staining. Infarct volume and nitric oxide levels were respectively measured using 2, 3, 5-triphenyltetrazolium chloride (TTC) and immunohistochemistry. RESULTS: In the ischemic region, pathology changes were significant in the 4-hour ischemia/4-hour, 4-hour ischemia/6-hour reperfusion, and 4-hour ischemia/12-hour reperfusion subgroups fed on a high-fat diet compared to the same groups fed on a normal diet. In each ischemia subgroup, nNOS expression in brain tissues was higher than in the sham-operated subgroups fed on either the high-fat diet or normal diet (P< 0.01). At each ischemia/reperfusion time point, rats fed on a high-fat diet expressed higher levels of nNOS compared to rats fed on the normal diet (P<0.05). When tissue was stained with TTC, a white infarction area was detected in the ischemic hemisphere, demonstrating that the infarct volume gradually increased with prolonged reperfusion time in each ischemia subgroup. At each ischemia/reperfusion time point, the infarct volume was larger in rats fed on a high-fat diet compared to those fed on a normal diet. CONCLUSION: nNOS expression was greater in hyperlipidemia rats following ischemia/reperfusion. Cerebral ischemia/reperfusion injury is aggravated with prolonged reperfusion time.     

减体重对女子举重运动员运动能力的影响及营养干预的效果

目的探讨在运动训练中的慢速减体重、赛前快速降体重和赛前体能恢复期间实施营养学干预对运动员减重后运动能力的影响.方法12名女子举重运动员随机分成实验组和对照组,每组6人.实验组和对照组运动员进行统一的运动训练并采用等同能量的饮食.实验组减重期间服用减重棒、维生素和电解质等运动营养食品,在减重后的恢复期服用快速能量补充制剂和维生素电解质强化运动营养补充;对照组服用相应的安慰剂.分别在减重前后对两组对象进行有氧能力和无氧能力测试.运动员在减重实验前与实验期间填写饥饿度自评表.结果实验组运动员体重从实验前的67.4±14.2 kg下降到快速减重后的64.6±14.1 kg,对照组从67.4±15.5 kg下降到64.3±15.4 kg.实验组在快速减重后的恢复阶段,6分钟乳酸稳态实验后即刻血乳酸浓度、心率以及主观疲劳评分显著低于对照组.两组在慢减期后、快减期后和恢复阶段,30秒Wingate测试单位体重的最大功率、平均功率和最小功率均无显著性差异,但实验组在快速恢复第1天和第3天单位体重的最大功率显著高于实验前.结论科学地减少饮食热量摄入能够按照既定的目标减轻体重;快速能量补充制剂和维生素、电解质的复合补充制剂能够明显促进运动员减体重后身体快速恢复,保持无氧能力和有氧能力;以魔芋为主要成分的减重棒能明显减轻减体重期间的饥饿感.     

Seroprevalence of pandemic (H1N1) 2009 influenza and effectiveness of 2010/2011 influenza vaccine during 2010/2011 season in Beijing, China

Please cite this paper as: Yang et al. (2011) Seroprevalence of pandemic (H1N1) 2009 influenza and effectiveness of 2010/2011 influenza vaccine during 2010/2011 season in Beijing, China. Influenza and Other Respiratory Viruses 6(6), 381–388. Background In the post‐pandemic period, pandemic (H1N1) 2009 virus was expected to circulate seasonally and was introduced into trivalent influenza vaccine during 2010/2011 season in the Northern Hemisphere. Objectives The aim of this study was to examine the evolution of herd immunity against pandemic (H1N1) 2009 virus in Beijing, China, during 2010/2011 season and effectiveness of the 2010/2011 trivalent vaccine. Methods Two serological surveys were conducted before and after 2010/2011 season in Beijing. A case–control study was used to investigate vaccine effectiveness against influenza‐like illness (ILI) and lower respiratory tract infection (LRI). Results A total of 4509 and 4543 subjects participated in the pre‐ and post‐season surveys, respectively. The standardized seroprevalence of pandemic (H1N1) 2009 influenza increased from 22·1% pre‐season to 24·3% post‐season (P < 0·001). Significant elevation in seroprevalence appeared in the ≥60 years age‐group (P < 0·001), but not in others. The 2010/2011 trivalent vaccine contributed to the higher post‐seasonal seroprevalence in unvaccinated individuals (P = 0·024), but not in those vaccinated with monovalent pandemic vaccine (P = 0·205), as well as in those without prior immunity versus those with immunity. The adjusted effectiveness of the 2010/2011 trivalent vaccine was 79% protection against ILI (95% CI, 61–89%) and 95% against LRI (95% CI: 59–99%). Conclusions A slight increase in herd immunity against pandemic (H1N1) 2009 influenza was observed in Beijing, China, during the 2010/2011 season. Prior vaccination and immunity had a suppressive impact on immune response toward this novel influenza virus, elicited by 2010/2011 trivalent vaccine. This trivalent vaccine conferred good protection against ILI and LRI.     

新型胸骨环抱器结合钢丝固定胸骨的临床效果

目的探讨新型胸骨环抱器结合钢丝固定胸骨在成人心脏正中切口直视手术中的应用效果。 方法回顾性分析2016年1月至2017年12月期间在临沂市人民医院心脏血管外科接受手术治疗的328例心脏大血管疾病患者临床资料,按胸骨固定方法不同分为对照组159例和研究组169例。其中对照组采用传统的钢丝将锯开的胸骨左右两侧缝合,后收紧钢丝、合拢胸骨并拧紧钢丝,予以固定胸骨;研究组采用钢丝对合锯开胸骨的基础上放置新型环抱器固定胸骨。分析2组患者关胸时间(关胸开始到皮肤切口缝合结束的时间)、二次开胸止血(胸骨相关)率、术后24 h引流量、术后切口、胸骨感染或胸骨裂开率、术后胸痛不适发生率以及术后住院时间。患者出院后通过门诊、电话询问进行随访。数据比较采用t检验和χ²检验。 结果关胸术后,对照组1例患者因急性A型主动脉夹层术后急性肾功能衰竭死亡,其余所有患者均痊愈出院。研究组患者关胸时间(32.3±7.3) min,明显少于对照组(51.5±8.4) min,差异有统计学意义(t＝－22.113,P<0.05)。胸骨相关的二次开胸止血,研究组发生1例,而对照组发生6例,2组比较差异有统计学意义(χ²＝3.969,P＝0.046)。研究组术后24 h引流量(372.8±213.1) mL,少于对照组(538.9±202.6) mL,2组比较差异有统计学意义(t＝－7.224,P<0.05)。研究组术后未见切口和胸骨感染和(或)裂开,而对照组感染和(或)裂开共7例,其中胸骨裂开4例,早期予以新型环抱器重新固定胸骨,治愈出院;切口感染2例,予以换药后重新缝合切口后治愈;胸骨感染1例,予以胸骨清创加胸大肌肌瓣转移手术后康复出院,2组比较差异有统计学意义(χ²＝7.599,P<0.05)。研究组术后出现胸痛不适2例,而对照组7例,2组比较差异有统计学意义(χ²＝4.101,P＝0.043)。研究组患者术后住院时间(8.6±4.1) d,少于对照组(10.5±3.4) d,2组比较差异有统计学意义(t＝－4.467,P<0.05)。患者出院后随访(11.3±4.9)个月,所有患者均未见胸骨感染及裂开。 结论新型胸骨环抱器结合钢丝固定胸骨手术切口,与传统手术相比操作简单、固定牢固,在缩短关胸手术时间、减少术后切口并发症、缩短住院时间等方面优势明显,可以广泛使用于成人心脏外科正中手术切口。     

Persistent neurobehavioral effects of early postnatal domoic acid exposure in rats

Domoic acid (DA) is a marine biotoxin, produced by the diatom Pseudo-nitzchia spp., which has been shown to cause cognitive impairment in adults who are exposed via contaminated seafood. The neurobehavioral consequences of developmental exposure are much less well understood. In a previous study, we showed that a single prenatal exposure to DA in rats at mid-gestation caused neurobehavioral changes that persist into adulthood including increased susceptibility to the benchmark amnestic drug scopolamine. In the current study, we examined the lasting neurobehavioral consequences of DA exposure on the first day of postnatal life, a time in rats marking the completion of the major phase of neuroproliferation and corresponding to week 24 of human gestation. The effects of DA exposure at doses from 0.025–0.1 mg/kg (s.c.) twice per day on each of postnatal days 1 and 2 were compared with vehicle-treated controls and rats treated by the same protocol with 1 mg/kg of kainic acid. Following kainic acid exposure, a sex-selective effect was seen with females but not males showing a significant slowing of response latency in the radial-arm maze. The high DA dose of 0.1 mg/kg was quite toxic causing lethality in all of the offspring exposed and this group was excluded from further analysis. When the offspring in the 0.05 mg/kg DA dose group were tested, significant hypoactivity in the Figure-8 maze was observed during adolescence. No significant DA effects were seen in response latency or choice accuracy on the radial-arm maze during either acquisition or with challenge of the amnestic drug scopolamine. Early postnatal DA exposure in the rat can be lethal and sublethal exposure can cause neurobehavioral effects manifest in modest hypoactivity during the adolescent period. However, the sublethal persistent neurobehavioral toxicity appears to be less pervasive than reported effects following DA administered mid-gestation.     

Worldwide experience in newborn screening for classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency

The need for a reliable screening test for classical congenital adrenal hyperplasia prompted development of newborn screening programs. Worldwide incidence of classical congenital adrenal hyperplasia in this report was taken from newborn screening programs in France, Italy, Japan, New Zealand, Scotland, and the United States. Two populations in which the occurrence of congenital adrenal hyperplasia among live births has been reported with greater than usual frequency are the Yupik Eskimos of southwestern Alaska (1:282) and the people of La Reunion, France (1:2,141). Aside from these populations, 1,093,310 newborns were screened between 1980 and 1988, of whom 77 had congenital adrenal hyperplasia. Thus, worldwide incidence of this disorder was estimated at 1:14,199 live births for homozygous patients, 1:60 for heterozygous subjects, with a gene frequency of 0.0083. Incidence of congenital adrenal hyperplasia among whites was estimated to be 1:11,909 (41:488,279) for homozygous patients, 1:55 for heterozygous subjects with a gene frequency of 0.0091. Incidence for the salt-wasting form of congenital adrenal hyperplasia was 1:18,850 (58:1,093,310) compared with 1:57,543 (19:1,093,310) for congenital adrenal hyperplasia in the simple virilizing form. Thus, salt-wasting congenital adrenal hyperplasia was three times more common than simple virilizing congenital adrenal hyperplasia. Estimated incidence of congenital adrenal hyperplasia in white populations in Italy and France (1:10,866) was higher than in Scotland (1:17,098), New Zealand (1:14,500). The incidence in an Asian population (Japan) (1:15,800) did not differ significantly from that of the white population. In four of five populations, overall incidence was higher than previously reported, as was the frequency of the salt-wasting form (75% v 50% to 66%), suggesting improved case detection by newborn screening.(ABSTRACT TRUNCATED AT 250 WORDS)     

地塞米松预处理对氧糖剥夺大鼠血脑屏障通透性的影响

目的探讨地塞米松(dexamethasone,DEX)对氧糖剥夺(oxygen glucose deprivation,OGD)条件下大鼠血脑屏障通透性的影响。方法提取纯化大鼠脑微血管内皮细胞,建立血脑屏障OGD模型。在OGD不同时间点(0、30、60 min),以及DEX预处理OGD 60min时,应用辣根过氧化物酶渗漏实验分析血脑屏障的通透性;应用RT-PCR和western blot法分析大鼠脑微血管内皮细胞的紧密连接相关蛋白claudin-5的mRNA和蛋白的表达变化;同时应用免疫荧光方法观察细胞膜上claudin-5的变化。结果与对照组相比,OGD 30、60min,辣根过氧化物酶流量均显著升高;与OGD 60min相比,DEX预处理显著降低了辣根过氧化物酶流量。与对照组相比,OGD30、60min,claudin-5的mRNA和蛋白表达水平均显著降低;与OGD 60min相比,DEX预处理显著增加了claudin-5的mRNA和蛋白表达。免疫荧光观察claudin-5在细胞膜上的表达,与对照组相比,OGD 60min时claudin-5的表达明显减少,DEX预处理后显著增加了claudin-5的表达。结论 DEX预处理降低了OGD条件下的血脑屏障通透性,其机制之一是DEX增加紧密连接相关蛋白claudin-5的表达。     

三例肾脏原发少见肿瘤的临床特征及诊治分析

目的总结分析3例肾脏原发少见肿瘤的临床特征及诊治方法,提高对肾脏原发少见肿瘤的认识。 方法回顾性分析2018年5月至9月于中山大学附属第七医院泌尿外科诊治的术后病理证实的3例肾脏原发少见肿瘤的临床资料。 结果3例患者分别为：（1）54岁女性,因体检发现左肾占位1周入院,CT提示左肾巨大软组织肿块及肾门多个肿大淋巴结,行腹腔镜下根治性左肾切除术+淋巴结清扫术,术后病理：肾黏液管状与梭形细胞癌,术后3个月随访肿瘤无复发转移;（2）44岁男性,因左侧腰腹部胀痛1个月入院,MR提示左肾巨大占位病变,开放探查见肿瘤与降结肠粘连明显,遂行根治性左肾切除+降结肠部分切除术,术后病理：肾脏癌肉瘤,术后1个月局部复发并腹腔内多发转移,入肿瘤内科后辅以紫杉醇+多柔比星化疗及阿帕替尼靶向治疗,目前未观察到肿瘤继续恶化;（3）70岁男性,因左侧腰痛伴肉眼血尿3个月入院,CT提示左肾上极不规则低密度灶及腹膜后多发肿大淋巴结,行腹腔镜下根治性左肾切除+淋巴结清扫术,术后病理：高级别浸润性尿路上皮癌,拟二次手术,患者拒绝,术后6个月随访肿瘤无复发转移。 结论肾脏原发少见肿瘤临床症状及影像学表现常无明显特异性,容易误诊,应注意鉴别诊断,治疗以根治性切除为主,部分肿瘤预后不良,术后需密切随访,必要时尽早辅以放化疗及靶向治疗。