两种方法治疗复治涂阳肺结核疗效观察

目的评价两种治疗方案对复治涂阳肺结核的疗效。方法将60例抗酸杆菌阳性复治肺结核患者分成治疗组（n=30）和对照组（n=30）。治疗组采用2CDLZ／6DL方案；对照组采用2SDLZ／6DL方案。结果治疗12个月后治疗组与对照组痰菌阴转率分别为82．76％和60．00％（P〈0．05）；治疗组与对照组治疗有效率分别为93．10％和70．00％（P〈0．01）。结论2HRZSL／6HRL方案治疗复治涂阳肺结核有助于痰菌阴转和病灶吸收。     

Influence of Tricuspid Bioprosthetic Mitral Valve Orientation Regarding the Flow Field Inside the Left Ventricle: In Vitro Hydrodynamic Characterization Based on 2D PIV Measurements

The flow patterns of a prosthetic heart valve in the aortic or mitral position can change according to its type and orientation. This work describes the use of 2D particle image velocimetry (PIV) applied to the in vitro flow fields characterization inside the upper part of a left ventricular model at various heart rates and as a function of two orientations of stented tricuspid mitral bioprostheses. In the ventricular model, each mitral bioprosthesis (27 and 31 mm diameter) was installed in two orientations, rotated by 180°, while the aortic bileaflet mechanical valve (27 mm diameter) remained in a fixed orientation. The results (N = 50) showed changes in the intraventricular flow fields according to the mitral bioprostheses positioning. Also, changes in the aortic upstream velocity profiles were noticed as a function of mitral orientations.     

From the Cover: Salt stress-induced Ca2+ waves are associated with rapid,long-distance root-to-shoot signaling in plants

Their sessile lifestyle means that plants have to be exquisitely sensitive to their environment, integrating many signals to appropriate developmental and physiological responses. Stimuli ranging from wounding and pathogen attack to the distribution of water and nutrients in the soil are frequently presented in a localized manner but responses are often elicited throughout the plant. Such systemic signaling is thought to operate through the redistribution of a host of chemical regulators including peptides, RNAs, ions, metabolites, and hormones. However, there are hints of a much more rapid communication network that has been proposed to involve signals ranging from action and system potentials to reactive oxygen species. We now show that plants also possess a rapid stress signaling system based on Ca²⁺ waves that propagate through the plant at rates of up to ∼400 µm/s. In the case of local salt stress to the Arabidopsis thaliana root, Ca²⁺ wave propagation is channeled through the cortex and endodermal cell layers and this movement is dependent on the vacuolar ion channel TPC1. We also provide evidence that the Ca²⁺ wave/TPC1 system likely elicits systemic molecular responses in target organs and may contribute to whole-plant stress tolerance. These results suggest that, although plants do not have a nervous system, they do possess a sensory network that uses ion fluxes moving through defined cell types to rapidly transmit information between distant sites within the organism.Plants are constantly tailoring their responses to current environmental conditions via a complex array of chemical regulators that integrate developmental and physiological programs across the plant body. Environmental stimuli are often highly localized in nature, but the subsequent plant response is often elicited throughout the entire organism. For example, soil is a highly heterogeneous environment and the root encounters stimuli that are presented in a patchy manner. Thus, factors including dry or waterlogged regions of the soil, variations in the osmotic environment, and stresses such as elevated levels of salt are all likely to be encountered locally by individual root tips, but the information may have to be acted on by the plant as a whole.In animals, long-range signaling to integrate activities across the organism occurs through rapid ionic/membrane potential-driven signaling through the nervous system in addition to operating via long-distance chemical signaling. Plants have also been proposed to possess a rapid, systemic communication network, potentially mediated through signals ranging from changes in membrane potential/ion fluxes (1–3) and levels of reactive oxygen species (ROS) (4, 5) to altered hydraulics in the vasculature (6). Even so, the molecular mechanisms behind rapid, systemic signaling in plants and whether such signals indeed carry regulatory information remains largely unknown. Suggestions that Ca²⁺ channels play a role in signals that occlude sieve tube elements (7), or that mediate systemic electrical signaling (2) in response to remote wounding, highlight Ca²⁺-dependent signaling events as a strong candidate for mediating some of these long-range responses. Similarly, cooling of roots elicits Ca²⁺ increases in the shoot within minutes (8), suggesting systemic signals can elicit Ca²⁺-dependent responses at distal sites within the plant. However, despite extensive characterization of Ca²⁺ signals (reviewed in ref. 9), their roles in a possible plant-wide communication network remain poorly understood. Therefore, to visualize how Ca²⁺ might act in local and systemic signaling, we generated Arabidopsis plants expressing the highly sensitive, GFP-based, cytoplasmic Ca²⁺ sensor YCNano-65 (10). We observed that a range of abiotic stresses including H₂O₂, touch, NaCl, and cold shock triggered Ca²⁺ increases at the point of application. However, NaCl also elicited a Ca²⁺ increase that moved away from the point of stress application. Propagation of this Ca²⁺ increase was associated with subsequent systemic changes in gene expression. We also report that this salt stress-induced long-distance Ca²⁺ wave is dependent on the activity of the ion channel protein Two Pore Channel 1 (TPC1), which also appears to contribute to whole-plant stress tolerance.     

常州市第二批国家药品集中采购政策实施效果研究——基于双组间断时间序列分析

目的：我国于2019年12月开展了第二批国家药品集中采购工作,本研究旨在探讨第二批国家集采政策实施效果。方法：使用江苏常州医疗机构2019年1月—2021年3月间36万条药品采购数据,以25种国家集采品种和20种在临床使用中与国家集采品种有替代关系的品种为研究样本,采用描述性统计和双组间断时间序列,分析药品使用频度、采购金额、日均费用、价格指数、仿制药数量替代率及金额替代率6个指标的变化。结果：国家集采政策下集采品种使用频度上涨、日均费用下降、价格指数下降、采购金额下降、仿制药数量和金额替代率均明显提高,替代品种使用频度略有增长、日均费用、价格指数、采购金额略为下降、同时仿制药数量和金额替代率有所增长。但模型运行结果显示,国家集采政策对集采品种影响显著,对替代品种影响不显著。结论：建议推行国家集采政策过程中,应当加强用药监测和合理用药管理,并在考虑临床用药实际情况下将更多品种纳入集采范围,真正实现惠及民生的政策目标。     

Two-minute walk tests demonstrate similar age-related gait differences as a six-minute walk test

BackgroundThe six-minute walk test (6MWT) is used within clinical and research settings to assess gait performance across a variety of conditions and populations. Commonly, the test is used to identify specific aspects of gait that affect functional mobility. With the advancement of new technologies such as wireless inertial sensors, it has become possible to collect reliable, sensitive, and objective measures of gait. While the 6MWT has been accepted and used for many years, a more concise, while still objective gait analysis would likely benefit clinicians, researchers and patients.Research QuestionDoes a concise 2-minute walk test (2MWT) provide similar information regarding gait performance and gait differences as the 6MWT in healthy young (YA) and older adults (OA)?MethodsA total of thirty-one participants (sixteen young adults and fifteen older adults) conducted a continuous 6MWT at their self-selected pace. All participants wore six wireless inertial sensors which were placed on each foot, at the lumbar, sternum, and on each wrist. Once completed the 6MWT data was spliced into three, distinct two-minute segments. Spliced data was analyzed and compared between groups and segments.ResultsResults demonstrate significant age-related differences in several gait metrics, primarily with older adults showing increased spatiotemporal variability. Additionally, no significant differences were observed between the three, two-minute segments and the continuous 6MWT, with the exception of total number of strides completed.SignificanceThese results demonstrate that the 2MWT may provide a preferable alternative to assessing gait performance by reducing confounds such as fatigue while maintaining sensitivity of measuring gait performance. These improvements may be particularly beneficial when studying populations of advanced age or with neurological disorder.     

社区外来工孕产妇保健模式的调查研究

目的:调查研究深圳外来工孕产妇保健管理模式、保障外来人口的母婴健康。方法:政府增加投入,引进高级人才设备,以社区为基础,社康中心为核心,建立1790名外来工孕产妇个人健康档案,实行社康与医院双向转诊模式,孕产妇保健、产前检查、高危妊娠筛查、健康教育由社康中心完成;产前检查、高危孕妇管理、住院分娩、社区医务培训等转由公立综合医院服务,产妇档案转社区,社康中心负责产妇访视、全面管理上报。结果:1790例外来工孕产妇建卡率由77.87%增加到99.10%,产检率由66.67%增长到95.59%,住院分娩率由84.95%增长到100%,产妇死亡率由132.74/10万降至18.0/10万,围产儿死亡率147.49/10万降至35.97/10万,初步达到同期866例常住孕产妇保健指标。结论:本方法适合深圳外来工孕产妇保健模式,外来孕产妇母婴健康可得到保障。