甘精胰岛素对延迟复苏烧伤大鼠心脏肾脏损伤的影响

目的：探讨甘精胰岛素对延迟复苏烧伤大鼠心脏、肾脏组织的保护作用。方法24只雄性SD大鼠按随机数字表法分为假伤组、烧伤对照组、烧伤＋胰岛素组,每组各8只。假伤组浸入37℃温水中15 s模拟烫伤。烧伤对照组、烧伤＋胰岛素组（95．0±0．5）℃热水中15 s制作烧伤总面积（ TBSA）30％、Ⅲ度烫伤模型,伤后6 h腹腔注射生理盐水（40 mL／kg）。烧伤＋胰岛素组于伤后2 h皮下注射甘精胰岛素[1．0 U／（kg· d）],烧伤对照组同法注射等量生理盐水。烧伤各组于伤后24 h采集腹主动脉血及心脏、肾脏组织标本。采用分光光度法测定血糖、乳酸脱氢酶（LDH）、α－羟丁酸脱氢酶（α－HBDH）、肌酸激酶（CK）、尿素氮（BUN）、肌酐（Cr）、丙二醛（MDA）、黄嘌呤氧化酶（XO）、髓过氧化物酶（MPO）、超氧化物歧化酶1（SOD1）、过氧化氢酶（ CAT）、谷胱甘肽过氧化物酶（ GPx）、总抗氧化能力（ T－AOC）;免疫抑制法测定肌酸激酶同工酶（ CK－MB）。结果①烧伤对照组LDH、α－HBDH、CK、CK－MB、BUN、Cr均显著高于假伤组（P＜0．05）;与烧伤对照组比较,烧伤＋胰岛素组LDH、α－HBDH、CK、CK－MB、BUN、Cr均显著降低（P＜0．05）。②与假伤组比较,烧伤对照组心脏、肾脏组织的MDA、XO、MPO均显著升高（P＜0．05）,SOD1、CAT、GPx、T－AOC均显著降低（P＜0．05）;与烧伤对照组比较,烧伤＋胰岛素组心脏、肾脏组织的MDA、XO、MPO均显著降低（P＜0．05）,SOD1、CAT、GPx、T－AOC均显著升高（ P＜0．05）。③烧伤对照组、烧伤＋胰岛素组血糖水平均显著高于假伤组,而烧伤＋胰岛素组显著低于烧伤对照组（ P＜0．05）。结论甘精胰岛素对延迟复苏烧伤大鼠心脏、肾脏组织的保护作用可能与早期血糖控制、减轻组织脂质过氧化损伤有关。     

经皮直接冠状动脉介入治疗急性ST段抬高性心肌梗死术后迟发性心脏压塞

目的 总结直接经皮冠状动脉介入治疗术(PPCI)治疗急性ST段抬高性心肌梗死(STEMI)后迟发性心脏压塞的临床特点、早期诊断、早期处理和救治结果.方法 分析解放军第306医院自2011年8月至2014年3月共503例STEMI行PPCI后并发迟发性心脏压塞3例(0.6％)的临床表现及诊疗经过.结果 3例迟发性心脏压塞发生在STEMI后18 ～54 h内,PPCI术后14～46 h.梗死部位均为前壁,靶血管均为前降支.其中2例首发症状为血压突然降低,1例表现为与呼吸有关的胸痛,并可闻及心包摩擦音.3例均在床旁超声引导下经心包穿刺引流,并保留引流管2～3d,均痊愈出院.结论 PPCI治疗STEMI后迟发性心脏压塞最易发生在术后3d内,故需强化早期识别此类患者的临床表现,而急诊床旁心脏超声检查是快速诊断的关键,及时行心包穿刺引流,可改善预后.     

The acute myocardial infarction in very elderly

A total 325 patients were studied at admission for myocardial infarction, measuring plasma fibrinogen (FBG), creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) and automatized hemocromocytometric parameters in order to contribute to explain the excess mortality reported in very elderly patients. It was found that age positively correlated with fibrinogen and LDH values and inversely with CPK, hemoglobin concentration and lymphocyte count. The unpaired comparison of the variables studied in age subgroups showed no differences between patients aged 65 or less than 65 years and patients aged 66–75 years. In patients aged over 75 years FBG, neutrophile count and LDH were significantly higher in respect to 65 or less and 66–75 years age subgroups and hemoglobin concentration, red blood cell count, hematocrit and lymphocyte count were lower. In the very elderly patients the study shows a biochemical feature suggesting delayed hospitalization for myocardial infarction, that may contribute to their poorer prognosis.     

19所乡镇卫生院喹喏酮类药物的使用及其对肺结核诊断延误的影响

目的了解乡镇卫生院因呼吸道疾病住院的患者喹喏酮类药物的使用,以及其使用对肺结核患者诊断的影响;为将来的结核病防治工作提供可行性建议。方法从开展耐多药防治工作的一个市和未开展耐多药防治工作的2个市所辖的所有县区中,分别随机抽取一个乡镇,调查2013年上半年所有因呼吸道疾病住院患者的抗生素使用情况,及结核诊断情况。结果调查的759例患者中,左氧氟沙星的使用率为38.47%,开展耐药工作的市和未开展耐药工作的市,左氧氟沙星的使用率无显著性差异(P0.05)。最终确诊的23例肺结核患者,其诊断延误时间的四分位数间距为18.05 d,住院期间使用头孢和使用左氧抗炎的患者诊断延误时间无统计学差异(P0.05)。结论应加强乡镇卫生院喹喏酮类药物规范使用的管理,避免耐药结核病的产生。     

Changes in government spending on healthcare and population mortality in the European union, 1995–2010: a cross-sectional ecological study

Objective

Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries.

Design

Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted.

Setting and Participants

European Union countries 1995–2010.

Main outcome measures

Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality.

Results

A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient −0.1217, p = 0.0001), postneonatal mortality (coefficient −0.0499, p = 0.0018), one to five years of age mortality (coefficient −0.0185, p = 0.0002), under five years of age mortality (coefficient −0.1897, p = 0.0003), adult male mortality (coefficient −2.5398, p = 0.0000) and adult female mortality (coefficient −1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics.

Conclusions

Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening population health.     

A regulatory governance perspective on health technology assessment (HTA) in France: The contextual mediation of common functional pressures

The new regulatory governance perspective has introduced several insights to the study of health technology assessment (HTA): it has broadened the scope for the analysis of HTA; it has provided a more sophisticated account of national diversity and the potential for cross-border policy learning; and, it has dissolved the distinction between HTA assessment and appraisal processes. In this paper, we undertake a qualitative study of the French process for HTA with a view to introducing a fourth insight: that the emergence and continuing function of national agencies for HTA follows a broadly evolutionary pattern in which contextual factors play an important mediating role. We demonstrate that the French process for HTA is characterised by distinctive institutions, processes and evidential requirements. Consistent with the mediating role of this divergent policy context, we argue that even initiatives for the harmonisation of national approaches to HTA are likely to meet with divergent national policy responses.     

TRANSVAC research infrastructure – Results and lessons learned from the European network of vaccine research and development

TRANSVAC was a collaborative infrastructure project aimed at enhancing European translational vaccine research and training. The objective of this four year project (2009–2013), funded under the European Commission's (EC) seventh framework programme (FP7), was to support European collaboration in the vaccine field, principally through the provision of transnational access (TNA) to critical vaccine research and development (R&D) infrastructures, as well as by improving and harmonising the services provided by these infrastructures through joint research activities (JRA). The project successfully provided all available services to advance 29 projects and, through engaging all vaccine stakeholders, successfully laid down the blueprint for the implementation of a permanent research infrastructure for early vaccine R&D in Europe.     

Effect of kn93 on delayed afterdepolarization and calcium ion in ventricular myocytes of rabbits with heart failure北大核心CSCD

Objective To observe the effect of KN93, a CaMK II inhibitor, on delayed afterdepolarization (DAD) and calcium ion in ventricular myocytes of rabbits with heart failure, and to investigate the effect of CaMK II signaling pathway on trigged arrhythmia after heart failure. Methods Thirty male New Zealand White rabbits were randomized(random number) into the sham operated group (sham group), heart failure group (HF group) and heart failure with KN93 group (HF+KN93 group) (n=10 each group). The rabbit heart failure model was established by abdominal aortic constriction combined with aortic valve regurgitation. The ventricular myocytes were isolated by double enzyme digestion. The action potential and the transient inward current (/J were recorded by the whole-cell patch-clamp. The intracellular calcium transient was measured by the ion concentration measurement system. The main calcium transporter protein was detected by Western blotting. Data were analyzed by pCLAMP10.2. Statistical analysis was performed using SPSS 17.0. Comparisons among groups were conducted using ANOVA, and SNK-? multiple comparison procedure was utilized for post-hoc analysis. Results (1) After induction of heart failure, DAD and increment of trigger activity (TA) were observed in rabbit ventricular myocytes. Treatment of K.N93 with 1.0 nmol/L reduced the events of DAD and TA. (2) After induction of heart failure, Iti densities were increased from -0.12±0.02 pA/pF to -0.95±0.06 pA/pF at the polarization potential of -50 mV (n=10, /><0.01). The current densities were reduced to -0.44±0.04 pA/pF after application of 1.0 nmol/L of KN93 (=10, P<0.01). (3) KN93 led to decrement of intracellular calcium ion concentration and calcium transient amplitude, and acceleration of the decay process of calcium transient. (4) KN93 upregulated the expression of pPLN and SERCA2a, increased the uptake of intracellular calcium ion, downregulated the expression of NCX, decreased the Iti, and reduced the occurrence of DAD and TA. Conclusions KN93 can reduce the intracellular calcium ion concentration of the heart failure animal model, and the occurrence of the DAD and TA. CaMK II may be a new therapeutic target for arrhythmias in the heart failure. © 2018 Chinese Medical Association. All rights reserved.     

Research output after participants complete a Structured Operational Research and Training (SORT IT) course

Eighteen months after successfully completing one of six Structured Operational Research and Training Initiative (SORT IT) courses, e-mail questionnaires assessing post-course research output were returned by 63 participants (100% response rate). Thirty-two (51%) participants had completed new research projects, 24 (38%) had published papers, 28 (44%) had presented abstracts at conferences, 15 (24%) had facilitated at further OR courses, and 21 (33%) had reviewed scientific papers. Seven (11%) had secured further research funding and 22 (35%) stated that their institutions were involved in implementation or capacity building in operational research. Significant research output continues beyond course completion, further endorsing the value of the SORT IT model.