人格特质对二胎返岗护士产适应水平的影响

目的 了解二胎返岗护士适应水平现状,并探讨人格特质对其返岗适应水平的影响。方法 2018年1-12月,采用便利抽样法选取山东省3所三级甲等医院360名护士为研究对象,采用一般资料调查表、艾森克人格问卷、护士产后返岗适应问卷对其进行调查。结果 护士产二胎后返岗适应水平均分为(2.16±0.51)分;外向型人格特征与返岗适应水平呈正相关(r=0.540,P<0.001),精神质、神经质人格特征与返岗适应水平均呈负相关(r=-0.410,P<0.001;r=-0.350,P<0.001)。多元线性回归分析结果显示,年龄、返岗时间、工作负荷、返岗培训、内-外倾向、精神质、神经质是护士产二胎后返岗适应的独立影响因素。结论 护士产二胎后返岗适应处于中等偏下水平,人格特质、生育年龄、返岗时间、工作负荷、返岗培训为其影响因素,护理管理者可结合人格特质等特点采取管理策略,提高护士产二胎后返岗适应的水平。     

子宫内膜功能亢进性疾病的“异病同治”诊治研究思路＊

笔者根据现代临床子宫内膜的病理演变过程结合中医“异病同治”理念，提出“子宫内膜功能亢进性疾病”概念，涵盖5种常见的子宫内膜疾病：无排卵性异常子宫出血（Abnormal Uterine Bleeding Ovulatory dysfunction，AUB-O），子宫内膜息肉（Endometrial Polyp，EP），子宫内膜异位症（Endometriosis，EMs），子宫腺肌病（Adenomyosis，AM），子宫内膜癌（Endometrial Carcinoma，EC）。基于文献的汇总，分析得到此类疾病的子宫内膜病理演变与中医病因病机的关联性，为寻找关键通路、创新性治疗此类疾病提供了重要的参考方向，对深化中医妇科学常见疾病的共性病因病机提供了理论依据和探索思路。     

内听动脉闭塞综合征的临床与发病机理

目的：探讨内听动脉闭塞综合征的临床与发病机理。方法：分析24例患者年龄、性别及所伴发疾病如高血压病、糖尿病、冠心痛及椎-基底动脉供血不足等。结果：50岁以上，有高血压病、冠心病、糖尿病、椎-基底动脉供血不足者内听动脉闭塞发病明显增加。结论：高血压病、冠心病、糖尿病、椎基底动脉供血不足是内听动脉闭塞综合征的主要危险因素。     

骨形成蛋白2基因修饰的老年大鼠骨髓间充质干细胞成骨分化能力的研究

目的观察年龄因素对骨髓间充质干细胞(marrow mesenchymal stem cells, MSCs)成骨分化能力的影响;了解基因治疗对老年大鼠MSCs成骨分化能力的影响. 方法 1月龄(幼年组)、9月龄(成年组)及24月龄(老年组)雄性Wistar大鼠各6只,取MSCs经体外分离、培养及携带骨形成蛋白2(bone morphogenetic protein 2,BMP-2)基因的腺病毒载体(Ad-BMP-2)转染后,定量检测BMP-2、碱性磷酸酶(alkaline phosphate,ALP)表达,以及成骨细胞标志性蛋白:Ⅰ型胶原、骨涎蛋白(bone sialoprotein,BSP)和骨桥素(osteopontin, OPN)的表达.将转染的各组MSCs分别与磷酸三钙(tricalcium phosphate, TCP)复合后植入裸鼠体内,3周后取材,比较各组诱导异位成骨能力. 结果 ELISA检测表明BMP-2基因修饰的MSCs可以有效表达BMP-2,且表达量在各年龄组间差异无统计学意义(P>0.05);各组ALP于诱导后第9天达高峰,但组间差异均无统计学意义(P＞0.05);诱导后第7天,RT-PCR半定量检测示各组均有成骨细胞特征性蛋白,即:Ⅰ型胶原、OPN及BSP的明显表达,表达量在各组间差异无统计学意义(P>0.05);BMP-2基因转染的MSCs与TCP复合后可诱导裸鼠体内异位成骨,各组成骨量差异无统计学意义(P>0.05). 结论 BMP-2基因修饰的老年大鼠MSCs可以恢复成骨分化能力,基因治疗可能为老年性骨骼疾病提供一种新的治疗途径.     

Recapitulation of fast skeletal muscle development in zebrafish by transgenic expression of GFP under the mylz2 promoter.

A 1,934-bp muscle-specific promoter from the zebrafish mylz2 gene was isolated and characterized by transgenic analysis. By using a series of 5' promoter deletions linked to the green fluorescent protein (gfp) reporter gene, transient transgenic analysis indicated that the strength of promoter activity appeared to correlate to the number of muscle cis-elements in the promoter and that a minimal -77-bp region was sufficient for a relatively strong promoter activity in muscle cells. Stable transgenic lines were obtained from several mylz2-gfp constructs. GFP expression in the 1,934-bp promoter transgenic lines mimicked well the expression pattern of endogenous mylz2 mRNA in both somitic muscle and nonsomitic muscles, including fin, eye, jaw, and gill muscles. An identical pattern of GFP expression, although at a much lower level, was observed from a transgenic line with a shorter 871-bp promoter. Our observation indicates that there is no distinct cis-element for activation of mylz2 in different skeletal muscles. Furthermore, RNA encoding a dominant negative form of cAMP-dependent protein kinase A was injected into mylz2-gfp transgenic embryos and GFP expression was significantly reduced due to an expanded slow muscle development at the expense of GFP-expressing fast muscle. The mylz2-gfp transgene was also transferred into two zebrafish mutants, spadetail and chordino, and several novel phenotypes in muscle development in these mutants were discovered.     

Teriparatide increases bone formation in modeling and remodeling osteons and enhances IGF-II immunoreactivity in postmenopausal women with osteoporosis.

Transiliac bone biopsies were obtained from 55 women treated with teriparatide or placebo for 12-24 months. We report direct evidence that modeling bone formation at quiescent surfaces was present only in teriparatide-treated patients and bone formation at remodeling sites was higher with teriparatide than placebo. INTRODUCTION: Recombinant teriparatide [human PTH(1-34)], a bone formation agent for the treatment of osteoporosis when given once daily subcutaneously, increases biochemical markers of bone turnover and activation frequency in histomorphometry studies. MATERIALS AND METHODS: We studied the mechanisms underlying this bone-forming action of teriparatide at the basic multicellular unit by the appearance of cement lines, a method used to directly classify surfaces as modeling or remodeling osteons, and by the immunolocalization of IGF-I and IGF-II. Transiliac bone biopsies were obtained from 55 postmenopausal women treated with teriparatide 20 or 40 microg or placebo for 12-24 months (median, 19.8 months) in the Fracture Prevention Trial. RESULTS: A dose-dependent relationship was observed in modeling and mixed remodeling/modeling trabecular hemiosteons. Trabecular and endosteal hemiosteon mean wall thicknesses were significantly higher in both teriparatide groups than in placebo. There was a dose-dependent relationship in IGF-II immunoreactive staining at all bone envelopes studied. The greater local IGF-II presence after treatment with teriparatide may play a key role in stimulating bone formation. CONCLUSIONS: Direct evidence is presented that 12-24 months of teriparatide treatment induced modeling bone formation at quiescent surfaces and resulted in greater bone formation at remodeling sites, relative to placebo.     

如何增强高职学生对思想政治课的兴趣

中等专业学校学生重视专业课,而淡化非专业课程,尤其对政治课不感兴趣。兴趣是最好的教师,学生学习兴趣是构成学习动机中最现实、最活跃的成分,对于提高学习效果、智力发展、能力培养及教学质量的全面提高有着巨大的作用。1创设情境,激发学习热情思想政治学科,向学生传授的是马列主义、毛泽东思想、邓小平理论的基本观点、基本方法,以及党和国家在现阶段的路线、方针、政策等。因其理论性较强,故有其严肃性、枯燥性的一面。如若教师没有真挚情感的投入,照本宣科,依葫芦画瓢,则必然出现“听者昏昏然”的局面,学生的学习情绪必然陷于低谷,这种…     

Regional left atrial voltage in patients with atrial fibrillation

BACKGROUND: Regional differences in fibrosis, particularly related to the posterior wall and septum, may be important in atrial fibrillation (AF). Using electroanatomic mapping, voltage can be used as a measure of fibrosis. OBJECTIVES: The purpose of this study was to determine if patients with AF have disproportionately lower voltage in the septal and posterior walls of the left atrium. METHODS: Sinus rhythm left atrial electroanatomic maps were used in serial patients presenting for left atrial ablation of AF (8-mm tip). Patients undergoing left atrial mapping for focal atrial tachycardia (AT) were used as a comparison group (4-mm tip). Animal experiments were performed to assess the influence of ablation catheter tip size on voltage amplitude. RESULTS: The posterior and septal walls exhibited the lowest voltages in both groups. Compared with the anterior wall, there was a 3.78-fold greater odds of finding a low-voltage point (<0.5 mV) in the septum (P <.001) and a 3.37-fold greater odds of finding a low-voltage point in the posterior wall (P <.001) in the AF patients; the proportion of low-voltage points by region were not significantly different in the AT group. In the animal model, the mean voltage obtained from an 8-mm ablation catheter was significantly higher (0.30 +/- 0.17 mV) than that obtained from the same points using a 4-mm catheter (0.22 +/- 0.17, P = .05). CONCLUSION: Regional differences in voltage are present in patients with atrial arrhythmias, with AF patients exhibiting significantly more low-voltage areas in the septum and posterior walls.     

血中原卟啉一级标准物质的研制及其应用

血中原卟啉（EP）是一项评价铅接触人群健康危险度的生物监测指标，也是筛查缺铁性贫血的敏感和特异性指标。为了保证EP测定的准确度，控制分析误差，在分析中应用血EP的标准物质进行质量控制是很有必要的。根据国家计量局颁布的国家一级标准物质技术规范要求，进行了EP冻干血标准物质的研制工作。收集新鲜牛血，加入EP标准，混匀后分装，冷冻干燥，密封后辐射灭菌，低温避光保存。对样品的均匀性及稳定性进行了检验，结果符合国家一级标准物质的规定。并按照国家一级标准物质的要求，组织了9个实验室，使用灵敏、准确的方法进行定值，取得了准确的特性量值。该标准物质经过国内有关实验室试用，通过专家审查鉴定，已被国家技术监督局批准为国家一级标准物质，样品编号为GBW09136、GBW09137。     

饮食模式防治代谢性心血管病——基于中医药理论的解读与思考

代谢性心血管病（CMD）是一组代谢异常和心血管损害存在因果关系的临床综合征。尽管采取了强有力的药物干预和临床治疗方法,其发病率和死亡率仍居高不下。迫切需要有效的、以证据为基础的综合管理措施,以提高患者的寿命和生活质量。从《黄帝内经》中提出“食养尽之”的食养概念到饮食限制、植物性饮食、江南饮食等现代饮食模式的广泛应用,饮食调养在未病先防、已病早治、瘥后调摄中均发挥着重要作用。该文系统梳理了饮食模式的中医理论渊源,阐述了饮食限制等现代饮食模式防治CMD的前沿证据与机制,探索将传统中医药理论与饮食模式相结合的防治策略,以期建立食养医三位一体的中西医结合饮食新模式,为CMD的临床管理提供新思路和新方向。