静脉止血贴替代传统指压干棉球用于献血穿刺针眼止血探讨

目的:探讨献血穿刺后针眼止血使用静脉止血贴替代指压干棉球的可行性。方法:(1)通过实验组278例使用静脉止血贴与对照组280例使用指压干棉球止血,进行效果观察,对比分析;(2)实验组中筛出献血两次以上的152例献血员,对献血后愿意选择其中哪一种止血方式进行情况调查,了解满意度。结果:使用静脉止血贴止血较指压干棉球止血更方便、快捷、安全、可靠,绝大多数献血员更愿意选用静脉止血贴。结论:献血穿刺针眼止血使用静脉止血贴较指压干棉球止血效果更安全,使用更方便,具省时节力的优点;静脉止血贴具有推广应用价值。     

Effects of Diet and Sodium Reduction on Cardiac Injury,Strain, and Inflammation: The DASH-Sodium Trial

BackgroundThe DASH (Dietary Approaches to Stop Hypertension) diet has been determined to have beneficial effects on cardiac biomarkers. The effects of sodium reduction on cardiac biomarkers, alone or combined with the DASH diet, are unknown.ObjectivesThe purpose of this study was to determine the effects of sodium reduction and the DASH diet, alone or combined, on biomarkers of cardiac injury, strain, and inflammation.MethodsDASH-Sodium was a controlled feeding study in adults with systolic blood pressure (BP) 120 to 159 mm Hg and diastolic BP 80 to 95 mm Hg, randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks. Body weight was kept constant. At the 2,100 kcal level, the 3 sodium levels were low (50 mmol/day), medium (100 mmol/day), and high (150 mmol/day). Outcomes were 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) (measure of cardiac injury), N-terminal pro–B-type natriuretic peptide (NT-proBNP) (measure of strain), and high-sensitivity C-reactive protein (hs-CRP) (measure of inflammation), collected at baseline and at the end of each feeding period.ResultsOf the original 412 participants, the mean age was 48 years; 56% were women, and 56% were Black. Mean baseline systolic/diastolic BP was 135/86 mm Hg. DASH (vs. control) reduced hs-cTnI by 18% (95% confidence interval [CI]: ?27% to ?7%) and hs-CRP by 13% (95% CI: ?24% to ?1%), but not NT-proBNP. In contrast, lowering sodium from high to low levels reduced NT-proBNP independently of diet (19%; 95% CI: ?24% to ?14%), but did not alter hs-cTnI and mildly increased hs-CRP (9%; 95% CI: 0.4% to 18%). Combining DASH with sodium reduction lowered hs-cTnI by 20% (95% CI: ?31% to ?7%) and NT-proBNP by 23% (95% CI: ?32% to ?12%), whereas hs-CRP was not significantly changed (?7%; 95% CI: ?22% to 9%) compared with the high sodium-control diet.ConclusionsCombining a DASH dietary pattern with sodium reduction can lower 2 distinct mechanisms of subclinical cardiac damage: injury and strain, whereas DASH alone reduced inflammation. (Dietary Patterns, Sodium Intake and Blood Pressure [DASH – Sodium]; NCT00000608)     

Research Priorities in Post-acute and Long-term Care: Results of a Stakeholder Needs Assessment

ObjectivesConduct a needs assessment among post-acute and long-term care (PA-LTC) stakeholder groups to identify (1) research topics of highest priority and (2) perspectives on research, including concerns/barriers to conducting research in the PA-LTC setting.DesignMixed methods multistakeholder engagement process. Needs assessment conducted with tailored strategies per stakeholder group: interview, survey, and focus group.Setting and ParticipantsFour stakeholder groups—medical directors/providers (n = 89), administrative leadership (n = 5), frontline staff (n = 17), and family members of residents and residents themselves (n = 11)—were recruited from the Colorado PA-LTC community through an academic-community partnership between the University of Colorado and Colorado Medical Directors Association.Main Outcome(s)Stakeholder perspectives on research and high priority PA-LTC research topics.ResultsResearch priorities common across stakeholder groups included polypharmacy (overuse of medication generally and overuse of antibiotics specifically), care transitions, mental health (including dementia, Alzheimer's disease, behaviors), chronic pain, urinary tract infection, and quality of life issues. Providers specifically prioritized heart failure, Parkinson's, and other chronic illnesses. Administrators and directors of nurses emphasized hospitalizations. Staff prioritized medication/therapy compliance. Families/residents prioritized neurologic disease. Concerns included staff burden, consenting process, privacy, and family involvement.Conclusions/ImplicationsPA-LTC patients have a lot to offer as participants and decision makers in research, frontline staff are enthusiastic about participation, family members want to be involved, and providers value research findings in their practice but need a more supportive environment to produce and participate in research.     

Self-reported practices, attitudes and levels of training of practitioners in the English NHS Stop Smoking Services

The primary aim of the current study is to investigate the self-reported practices, attitudes and levels of training of stop smoking practitioners (SSPs) working at the English National Health Service's (NHS) Stop Smoking Services (SSSs). A secondary aim was to investigate differences between 'Specialist' and 'Community' SSPs. An online survey was conducted with 484 SSPs. Most (94%) SSPs offered one-to-one appointments to smokers, only 43% always used the abrupt quit model and 30% reported ever recommending particular medication to clients. SSPs reported an average of 3.7 days training when starting work and 26% reported never observing an experienced practitioner before seeing clients of their own. Over half (56%) never received clinical supervision. SSPs reported having generally positive attitudes towards their jobs, but reported feeling less positive about their prospects for future employment within the field. 'Specialist' SSPs reported receiving more days training (4.1 vs. 3.0, p=0.002), more days observing an experienced practitioner when starting work (12.9 vs. 6.6, p<0.001) and were more likely to receive clinical supervision (48.9% vs. 34.9%, p<0.05) than 'Community' SSPs. Gaps between SSPs' current practices and evidence-based guidelines may be due to inadequate training. Similarly, differences in training between specialist and community SSPs may contribute to the observed difference in these practitioners' success rates. As recommended by the Department of Health for England, standardized training in evidence-based smoking cessation interventions should be implemented for both specialist and community SSPs.     

Stop codon read-through of a Methylmalonic aciduria mutation

A stop codon defect in methylmalonyl-CoA mutase (resulting in a truncated unstable protein) accounts for up to 14% of mutations identified as causes of Methylmalonic aciduria. There are currently limited treatment regimes for patients with this inherited condition. We aimed to investigate the use of stop codon read-through drugs in a genomic reporter assay cell line with a defect in the mutase gene. A single C–T base change was introduced into exon 6 of the human MUT sequence in the BAC clone RP11-463L20 resulting in an arginine residue being replaced with a TGA stop codon. An enhanced green fluorescent protein reporter gene was introduced in-frame with exon 13 of the MUT gene. The construct was transfected into HeLa cells to produce the genomic reporter assay cell line. To test the suppression of nonsense mutations, cells were incubated in the presence of different compounds for a period of 72 h then analysed by flow cytometry. Treatment of the cells with gentamicin resulted in a 1.6-fold increase in reporter protein, whilst G418 treatment resulted in no change, however the two drugs together acted synergistically to increase the production of methylmalonyl-CoA mutase 2.0-fold (confirmed by mRNA, flow cytometry and enzyme activity). Zidovudine, adefovir and cisplatin were also found to have some activity in the stop codon read-through genomic reporter assay. These results encourage further testing of compounds as well as follow up animal studies. This is the first study to demonstrate the use of stop codon read-through drugs for the potential treatment of Methylmalonic aciduria.     

Association between the MnSOD Ala-9Val polymorphism and development of schizophrenia and abnormal involuntary movements in the Xhosa population

Reactive oxygen species (ROS)-mediated damage has been hypothesized to play a role in the development and poor outcome of schizophrenia, as well as the development of neuroleptic-induced abnormal involuntary movements. Recently, the functional polymorphism (Ala-9Val) in the manganese superoxide dismutase (MnSOD) gene (part of the antioxidant defense mechanism) was found to be associated with schizophrenia in a Turkish population. This study was aimed at replicating this finding in a Xhosa population. In addition, the role of Ala-9Val in abnormal involuntary movement and tardive dyskinesia development in the Xhosa population was also investigated. The schizophrenic patient group (n=286) and a healthy control group (n=243) were genotyped for the Ala-9Val polymorphism using heteroduplex-single stranded conformational polymorphism (HEX-SSCP) analysis. No significant difference in genotype or allele frequency could be observed between the schizophrenia and control group (P=0.294 and P=0.528 respectively). In addition no association could be found between the polymorphism and symptom severity (SANS and SAPS). The Xhosa schizophrenia patient group with abnormal involuntary movements (n=54) and a subgroup with tardive dyskinesia (n=30) was found to significantly differ in Ala-9Val genotype frequency (P=0.008 and P=0.011 respectively) compared to the Xhosa schizophrenia patient group without abnormal involuntary movements (n=204). However, no significant difference was found for the allele frequencies (P=0.955 and P=0.161). Further, using ANCOVA no association was found between AIMS score and genotype in the group with abnormal involuntary movements (P=0.1234). However, in the patient group with tardive dyskinesia an association was observed between genotype and AIMS score (P=0.0365). These results do not support a major role of the MnSOD Ala-9Val polymorphism in the development of schizophrenia or symptom severity in the Xhosa population. Yet it seems to be involved in the development of abnormal involuntary movements and tardive dyskinesia and may even modulate the severity of tardive dyskinesia.     

Association of the DRD2 and DRD3 polymorphisms with response to pramipexole in Parkinson’s disease patients

Objective  To evaluate the impact of the DRD2 TaqIA and DRD3 Ser9Gly polymorphisms on the efficacy of pramipexole in treating patients with Parkinson’s disease (PD). Methods  Thirty patients with PD prospectively received pramipexole 0.25 mg three times daily for 2 months. Unified Parkinson Disease Rating Scale (UPDRS) assessments were conducted at baseline and 2 months after treatment initiation. Improvement by 20% or more in the total score on the UPDRS was considered to indicate responsiveness. The PCR–restriction fragment length polymorphism analysis was used to analyze the DRD2 Taq1A and DRD3 Ser9Gly genotype. Results  The DRD2 Taq1A allele frequencies were A141.7 (A1) and 58.3% (A2), and the DRD3 Ser9Gly allele frequencies were 68.3 (Ser) and 31.7% (Gly). When the subjects were grouped by the DRD3 Ser9Gly polymorphism, the response rates for pramipexole treatment were significantly higher in the Ser/Ser group (60%) than in the group containing the Gly allele (13%). There was a significant association between the DRD3 Ser9Gly polymorphism and response rate to pramipexole in PD patients (P = 0.024). When the subjects were grouped by the DRD2 Taq1A polymorphism, there were no significant differences among the three Taq1A genotypes. Conclusions  DRD3 Ser9Gly polymorphisms are significantly associated with the therapeutic efficacy of pramipexole in Chinese patients with PD. A large-scale and multi-dose group study in patients with PD is necessary for evaluating the impact of the genetic polymorphisms of the dopamine receptor on the therapeutic effects of pramipexole.     

Acute alcohol decreases performance of an instrumental response to avoid aversive consequences in social drinkers

Background  Recent studies demonstrated that alcohol impairs inhibitory control of behavioural responses. Aims  We questioned whether alcohol via its disinhibiting effects would also impair the inhibition of an instrumental avoidance response in the presence of a safety signal. Design  Thirty-six moderate social drinkers were randomly allocated to receiving either alcohol (0.8 g/kg) or placebo before performing an instrumental avoidance procedure. White noise of 102 db was used as aversive outcome presented at a variable interval schedule in S+ trials, while no noise was presented in S− trials. An instrumental response (repeated space bar presses to avoid the noise presented at a variable interval) abolished the noise. The Stop Signal task and the affective Go/No-Go task were administered as inhibitory control tasks. Results  Alcohol did not change the avoidance response rate in the presence of S− (safety signal). However, participants under alcohol performed the avoidance response to a lower extent than placebo subjects in S+ trials. Alcohol impaired performance in the Stop Signal task and increased the number of commission errors in the affective Go/No-Go task. Conditioned attentional and emotional responses to the S+ as well as knowledge of stimulus–response outcome contingencies were not affected by alcohol. Conclusions  Acute alcohol may decrease the motivation to avoid negative consequences and thus might contribute to risky behaviour and binge drinking.