临床路径管理对改进医疗质量的作用分析

目的分析临床路径管理对医疗质量的影响。方法将595例实施临床路径管理的7个病种病例作为路径组,将2009年入院采用传统方法治疗的7个病种1284例作为对照组,对两组进行比较。结果7个病种实施临床路径管理后,组平均住院日、平均术前住院日缩短,外科围手术期抗生素使用天数和内科抗生素费用比显著降低,其中6个病种的药占比降低,平均住院费用有下降趋势,患者满意度提高。结论临床路径管理能缩短平均住院日,提高床位周转率,规范抗生素使用,控制医疗费用的增长,提高医疗质量水平。     

组织因子途径抑制物基因转移对血管平滑肌细胞迁移的影响

目的研究组织因子途径抑制物基因转移对兔血管平滑肌细胞迁移的影响,探讨其抑制再狭窄的机制。方法将含有人组织因子途径抑制物基因的重组腺病毒和含β-半乳糖苷酶基因的重组腺病毒在体外分别转染兔血管平滑肌细胞,用X-gal染色法检测腺病毒的转染率,用逆转录聚合酶链反应方法检测转染后平滑肌细胞中组织因子途径抑制物mRNA的表达,于第13、、5及7天用玻片法检测血管平滑肌细胞迁移距离。结果感染指数为100,腺病毒的转染率可达到95%;基因转移后3天在血管平滑肌细胞中检测到组织因子途径抑制物mRNA的表达;同一浓度下转染组织因子途径抑制物基因重组腺病毒组和对照组相比迁移距离显著减少(P<0.001),并具有浓度依赖性。结论腺病毒具有较高的转染培养的血管平滑肌细胞的能力,组织因子途径抑制物基因转移能够显著抑制体外培养的兔血管平滑肌细胞迁移,并且这种抑制作用具有浓度依赖性。     

NF-κB信号通路对大鼠深低温缺血再灌注后肺组织水通道蛋白5表达的影响

目的:探讨大鼠深低温缺血再灌注后肺组织水通道蛋白5(AQP5)的变化及核因子kappa B(NF-κB)信号通路对大鼠肺组织AQP5表达的影响。方法:30只Wistar大鼠随机分为假手术组(sham组)、深低温缺血再灌注损伤组(I/R组)、PDTC干预组(I/R+PDTC组)。I/R组大鼠体表降温至深低温后阻断左下肺门30min后开放、复温;sham组只开胸但不降温阻断左下肺门;PDTC组于实验前2d腹腔注射PDTC,其余操作同I/R组;各组于再灌注复温后1h或相应时间段取肺组织行病理学观察、测肺湿/干重(W/D)比值,实时PCR及Western-blot检测肺组织中AQP5及NF-κB p65的表达。结果:I/R组与Sham组比较肺组织NF-κB p65表达增多(P<0.01),AQP5表达减少(P<0.01)、W/D比值增高(P<0.01),肺组织形态及结构明显受损;PDTC干预组与I/R组比较肺组织NF-κB p65表达减少(P<0.01),AQP5表达增加(P<0.01)、W/D比值减低(P<0.01),肺组织病理形态学改变轻于I/R组,与Sham组比较NF-κB p65表达增多(P<0.01),AQP5表达减少,W/D比值增高(P<0.01)。结论:NF-κB p65表达增加和AQP-5表达下降可能与深低温缺血再灌注造成的急性肺损伤有关,NF-κB信号通路可能负向调控AQP-5的表达。     

动脉粥样硬化“痰瘀”演变的内在机制研究

目的：探讨动脉粥样硬化模型大鼠随着造模时间的推移“痰瘀”演变规律.方法：采用维生素D3复合高脂饲养复制大鼠模型,动态检测血脂、血液流变学、主动脉形态学、脂质代谢相关通路基因表达的变化.结果：随着动脉粥样硬化大鼠由痰到瘀的变化即血脂、血液流变学、主动脉形态学等指标均随病情加重而变化,脂质代谢相关通路基因表达也在逐渐改变.结论：脂质代谢相关通路基因的异常表达是动脉粥样硬化大鼠由痰到瘀的分子机制.     

Assessing the Quality of Care for Dying Patients From the Bereaved Relatives' Perspective: Further Validation of “Evaluating Care and Health Outcomes–for the Dying”

ContextEvaluating Care and Health Outcomes–for the Dying (ECHO-D) is a post-bereavement questionnaire that assesses quality of care for the dying and is linked with the Liverpool Care Pathway for the Dying Patient (LCP).ObjectivesTo further assess the validity and reliability of the ECHO-D, namely the construct validity, internal consistency, and test-retest reliability of key composite scales.MethodsSelf-completion questionnaires were mailed to 778 next-of-kin of consecutive deceased patients who had died an “expected” cancer death in a hospice or acute tertiary hospital. For those willing to complete ECHO-D for a second time, another copy was sent a month later. Maximum likelihood factor analysis and Cronbach's alpha test were conducted for four key composite scales. Test-retest reliability was assessed using percentage agreement, Kappa statistic, and Spearman's correlation coefficient (ordinal data). Comparisons between hospice and hospital groups were conducted using one-way between-groups analysis of variance.ResultsFollowing exclusions (n = 52), 255 of 726 next-of-kin agreed to participate (35.2% response rate). Maximum likelihood factor analysis showed a single factor for three of the scales, and all had good internal consistency (Cronbach's alpha >0.78). Barring two questions, all showed good or moderate stability over time. Overall, hospice participants reported the best quality of care, and hospital participants, where care was not supported by the LCP, reported the worst quality of care.ConclusionThese findings support ECHO-D as a valid and reliable instrument to assess quality of care for the dying and assess the effectiveness of interventions such as the LCP.     

Sirt1在心脏疾病中的作用机制

Sirt1是依赖煳碱胺腺嘌呤二核什酸（NAD＋）的第Ⅲ类组蚩白去乙酰化酶,在能量调节、代谢、衰老、凋亡等过程中起到重要作用。在心肌细胞中,Sirt1通过去乙酰化相关因子增强细胞抵抗氧化应激的能力、减少细胞凋亡、减轻炎症反应、调节能量代谢、协调心脏舒缩功能,从而在心血管疾病中发挥重要作用。本文主要对Sirt1在心脏疾病中的作用、研究进展及Sirt1的相关信号通路进行综述。     

肿瘤坏死因子受体2突变载体对巨噬细胞炎症反应的影响

目的 探讨肿瘤坏死因子受体超家族1B（TNFRSF1B）196位基因多态性（T突变为G）与巨噬细胞TNF/TNFR2信号通路介导炎症反应的相关性。方法 运用基因重组技术构建真核表达载体pcDNA6.0-TNFR2196Met和pcDNA6.0-TNFR2196Arg,采用脂质体转染法分别转染至巨噬细胞中,转染48 h后使用杀稻瘟菌素抗性筛选4周,建立稳定转染细胞系。将酶消化法培养的巨噬细胞分为四组：空白对照组、pcDNA6.0空质粒组、pcDNA6.0-TNFR2196Met组及pcDNA6.0-TNFR2196Arg组。采用酶切及测序法鉴定重组质粒,RT-PCR检测肿瘤坏死因子受体2（TNFR2）、cIAP₁、cIAP₂ mRNA的变化;Western blot检测p-JNK、cIAP₁、cIAP₂、TNFR2及核因子κB（NF-κB）的蛋白表达;ELISA检测细胞上清液可溶性TNFR2（sTNFR2）、白细胞介素1β（IL-1β）和白细胞介素6（IL-6）水平。结果酶切测序结果显示成功构建了TNFR2基因196Met和196Arg表达载体。转染到巨噬细胞后,与空白对照组和pcDNA6.0空质粒组比较,pcDNA6.0-TNFR2196Arg组、pcDNA6.0-TNFR2196Met组TNFR2、cIAP₁、cIAP₂、IL-1β、IL-6和p-JNK的表达增高（P<0.05）;与pcDNA6.0-TNFR2196Met组比较,pcDNA6.0-TNFR2196Arg组TNFR2、cIAP₁、cIAP₂、IL-1β、IL-6和p-JNK的表达明显降低（P<0.05）,TNFR2196Arg介导的NF-κB活性显著降低。结论 成功构建稳定表达TNFR2196Met、TNFR2196Arg载体,TNFR2突变通过TNF/TNFR2信号通路介导炎症反应,可能是参与慢性炎症性疾病的作用机制。     

保靖、秀山地区燃煤氟污染调查

对秀山、保靖燃煤氟中毒流行地区的环境氟和食品氟进行了调查。在对水氟、土壤氟、煤氟、气氟、尘氟、玉米氟、辣椒氟和其他蔬菜氟测定的基础上,首次阐明氟从煤进入人体导致当地氟中毒流行的迁移、转运途径是氟从煤-烟尘-玉米-人,该病流行的原因是煤烟尘污染玉米后经口摄入所致。证明了煤烟尘含氟量与玉米含氟量显著相关,并建议选用尘氟或空气氟作为室内环境质量和评价改灶降氟、预防氟病流行的监控指标。     

A simple, low cost hydraulic pressure device for making microinjections in the brain

A device for making small (10 nl) injections of pathway tracing compounds through glass micropipettes into the CNS is described. The device is rugged, reliable and fabricated entirely of commercially available parts. Its construction requires no machining and its use requires little practice.