Management of atrial fibrillation with integrated general-specialty model within medical consortium / 中华全科医师杂志

In order to effectively manage the atrial fibrillation patients, West China Hospital has established an integrated general-specialty management model within medical consortium. This model takes the atrial fibrillation-stroke integrated management outpatient clinic as the platform, combines general practice and specialty to provide standardized care for atrial fibrillation patients. The model was characterized by primary diagnosis, two-way referral, up and down linkage, and differential management for acute and chronic conditions. This article, taking West China Hospital as an example, introduces the integrated team of cardiologists and general practitioners in the tertiary hospital with general practitioners in the community, and the preliminary accomplishment in the management of atrial fibrillation within the medical consortium. It would provide a reference for the long-range management of atrial fibrillation in other provinces and cities.

Efficacy Observation of Carboxymethyl Starch in the Treatment of Recurrent Respiratory Infection Chil-dren / 中国药房

OBJECTIVE:To observe clinical efficacy of carboxymethyl starch in the treatment of recurrent respiratory infection (RRI)children. METHODS:110 RRI children were selected and randomly divided into observation group and control group,with 55 children in each group. Control group was given routine treatment,such as anti-infection,anti-virus,abatement of fever,reliev-ing cough,phlegm transformation and etc. Observation group was additionally given Carboxymethyl starch sodium solution (7 ml for 7 year-old)on the basis of control group. Both groups received consecutive treatment for 3 months. The changes of cellular immunity function index CD4+,CD8+ and CD4+/CD8+ and humoral immunity index IgG,IgA and IgM were observed in 2 groups before and after treatment,and clinical efficacy was evaluated in 2 groups. RE-SULTS:There was no statistical significance in CD4+,CD8+and CD4+/CD8+levels of control group before and after treatment(P>0.05);after treatment,CD4+ and CD4+/CD8+ of observation group obviously increased,while CD8+ level obviously declined;the observation group was better than control group,with statistical significance (P0.05);after treatment,IgG,IgA and IgM levels of control group increased significantly,and the observation group was better than control group,with statistical significance (P<0.05). Total effective rate of observation group was 92.73%,which was much higher than that in control group (78.18%),with statistical significance(P<0.05). CONCLUSIONS:Carboxymethyl starch has definite therapeutic efficacy on RRI,and can obvi-ously improve cellular and humoral immunity function.

Research on expression and function of phosphorylated DARPP-32 on pentylenetetrazol-induced epilepsy model of rat / 生物医学工程学杂志

The present study is to explore the change process and distribution of phosphorylated DARPP-32 (p-DARPP-32) in rat brain including cortex, hippocampus and striatum and to further deduce whether p-DARPP-32 was possibly involved in epilepsy induced by repetitive low doses of pentylenetetrazol (PTZ). PTZ-induced epilepsy model in rat was established with 30 male SD rats randomly divided into 6 groups, control group and five trial groups [PTZ 1 h, PTZ 6 h, PTZ 24 h, PTZ 48 h and PTZ 72 h respectively, after onset of status epilepticus (SE)]. Immunohistochemistry and immunofluorescence double-labeling were used to detect the temporal time change and distribution of p-DARPP-32 expression and to analyze the coexpression of DARPP-32 and p-DARPP-32 in rat brain after the onset of PTZ-induced generalized SE. The results showed that there was a temporal time change of p-DARPP-32 expression in rat brain after the onset of SE. The number of p-DARPP-32-positive cells increased significantly and reached the peaks at the ends of 1 hour and 6 hours after the onset of SE, but decreased at the end of 24 hours. The moderate to strong p-DARPP-32-immunopositive neurons were observed in cortex, hippocampus and striatum, and located in cell cytoplasm and cell nucleus. Further immunofluorescence double-labeling revealed that denser colocalization of p-DARPP-32 and DARPP-32 in the neurons existed in the area mentioned above. Therefore, PTZ-induced SE may cause phosphorylation of DARPP-32 in rat brain. The temporal time change and distribution of p-DARPP-32 suggest that phosphorylation of DARPP-32 may be involved in PTZ-induced epilepsy in rat brain including cortex, hippocampus and striatum, and p-DARPP-32 may play a central role in the onset of SE.

Different effects of imipramine and fluoxetine on depression and anxiety-related behavior induced by stress in adolescent rats / 中国神经精神疾病杂志

Objective To establish chronic stress model of depression in adolescent rats and to examine the effects of different antidepressant treatment on depression and anxiety-related behaviors.Methods Male Wistar rats were given 21-day chronic mild stress (CMS) during their adolescence (postnatal day 30～50, PND30～50).During stress period, rats were treated with fluoxetine (10 mg/kg i.p.) or imipramine (10 mg/kg i.p.), respectively.After stress, rats were tested for behavioral observation using body weight gain, saccharine test, open field and elevated plus-maze (EPM).Results Compared with control/vehicle (n=10) group, stress/vehicle (n=11) group displayed lower weight gain, saccharine preference index and the number of rearing in open field (P<0.05).Antidepressant fluoxetine, but not imipramine reversed anhedonia and the decrease of the number of rearing induced by stress.In addition, compared with early adolescent(PND29) rats, late adolescent (PND52) rats in control/vehicle group exhibited less open arm entries and open arm time, more closed arm time in EPM (P<0.05).Rats in stress/vehicle group showed more open arm entries and less closed arm time than controls(P<0.05).Both fluoxetine and imipramine had no effects on such changes.Conclusions Stress can induce the depression-like behavior in adolescent rats.Fluoxetine, but not imipramine,can effectively reverse anhedonia induced by stress.However, Both antidepressants have no significant effects on stress-induced decrease in developmental increment of anxious behavior during adolescence.These data suggest that chronic mild stress have complicated effects on depressive and anxious behavior in adolescent rats.

Effects of combined action of serum interferon alpha and interleukin-6 from systemic lupus erythematosus patients on the differentiation and maturation of dendritic cells derived from hematopoietic precursor cells / 中国组织工程研究

BACKGROUND:Systemic erythematosus lupus (SLE) is closely associated with activity of dendritic cells (DCs) function.DCs derive from hematopoietic precursor cells (HPCs) in vivo and many factors might affect the differentiation and maturation of DCs.The cytokine network was in disturbance and the levels of various cytokines were anomalous in SLE serum.Previous studies mainly addressed effects of single factors.OBJECTIVE:To investigate the effects of joint action of serum interferon (IFN)-α and interieukin (IL)-6 in the serum of SLE patients on the differentiation and maturation of DCs derived from CD34~+ HPCs.DESIGN,TIME AND SETTING:The grouping,controlled and completely random designed study was performed at the Department of Microbiology and Immunology,Nanjing Medical University from May 2006 to October 2008.MATERIALS:Peripheral blood samples were collected from 50 SLE patients from the Department of Rheumatology,First Affiliated Hospital of Nanjing Medical University and 30 healthy volunteers from Nanjing Medical University.Cord blood samples were collected from 15 full-term normal delivery neonates from Nanjing Maternity and Children Health Care Hospital Affiliated to Nanjing Medical University.Informed consent was obtained from all patients and their family members.METHODS:Peripheral blood samples were collected from SLE patients and healthy volunteers.According to serum IFN-α and IL-6 concentrations of normal person,95% reference value range of serum IFN-α and IL-6 concentrations were calculated by the method of percentiles.Above this range represented abnormal increase.Cord blood mononuclear cells were harvested by Ficoll-Hypaque density gradient centrifugation.CD34~+HPCs were purified from cord blood by magnetic cell sorting system (MACS),and cultured to differentiate to DCs.There were 6 groups in this study.Normal serum,SLE serum with elevated levels of IFN-α,SLE serum with elevated levels of IL-6,SLE serum with elevated levels of IFN-α and IL-6,SLE serum with anti-IFN-α and anti-IL-6 neutralizing antibodies,or normal serum with exogenous IFN-α and IL-6 were respectively added to the culture medium in each group.10% volume fraction serum was used in each group,for totally 14 days incubation.MAIN OUTCOME MEASURES:The phenotype of DCs was analyzed by flow cytometry (FCM).Cytokine production was assessed by ELISA.The capacity of DCs to stimulate allogenic T lymphocyte proliferation and to regulate T cell differentiation was evaluated in a mixed lymphocyte reaction (MLR).RESULTS:Compared with normal serum,HLA-DR,CD80 and CD86 expression was significantly increased in the medium containing SLE serum with elevated levels of IFN-α,SLE serum with elevated levels of IL-6,SLE serum with elevated levels of IFN-α and IL-6 and normal serum with exogenous IFN-α and IL-6 (P＜0.05),whereas IL-12 levels were significantly decreased (P＜0.05),and capacity of DCs to stimulate allogenic T lymphocyte proliferation was significantly enhanced (P＜0.05).Above-mentioned indexes recovered to a normal level in the medium containing SLE serum with anti-IFN-α and anti-IL-6 neutralizing antibodies.Compared with normal serum,proportion of both CD3~+CD8~-IFN-γ~+ and CD3~+CD8~+IFN-γ~+ T cell subsets was significantly reduced in the medium containing SLE serum with elevated levels of IL-6 (P＜0.05).However,proportion of both CD3~+CD8~-IFN-γ~+ and CD3~+CD8~+IFN-γ~+ T cell subsets was significantly increased in the medium containing SLE serum with elevated levels Of IFN-α,SLE serum with elevated levels of IFN-α and IL-6,normal serum with exogenous IFN-α and IL-6 (P＜0.05).CONCLUSION:The joint action of IFN-α and IL-6 in SLE serum promotes the differentiation and maturation of DCs derived from CD34+HPCs and affects the DC-mediated T cell differentiation,which might contribute to the pathogenesis of SLE.

The effect of apomorphine on visual discrimination learning and reversal learning in rats / 中华行为医学与脑科学杂志

Objective Using apomorphine, a potent dopamine receptor agonist and rotating T-maze, the effect of apomorphine on the visual discrimination learning and reversal learning in rats was investigated. Methods All rats were trained in a visual discrimination task (food reward and light stimulus) in rotating T-maze. After reaching the acquisition criterion, rats were trained in a reversal task (food reward and without light stimulus) in the same maze. During the period of visual discrimination task, apomorphine was administrated either 30 minutes prior to learning or after learning immediately. Results The results showed that apomorphine, which was given either 30 minutes prior to visual discrimination learning or after learning, could impair the acquisition of discrimination learning( 259.20±26.29 and 264.00±16.97, compared to 168.00±16.97 and 163.20±20.08) and apomorphine, which was given only after visual discrimination learning, could impair the acquisition of reversal learning (451.20±39.44 compared to 360.00±29.39). Conclusion The results showed that apomorphine, which was given either 30 minutes prior to visual discrimination learning or after learning, could impair the acquisition of discrimination learning and apomorphine, which was given only after visual discrimination learning, could impair the acquisition of reversal learning.

AmpC ?-lactamases producing escherichia coli and klebsoella pneumoniae:a survey and analysis / 中国基层医药

Objective To detect AmpC ?-lactamases from clinical isolates of escherichia coli and klebsoella pneumoniae in our hospital.Methods Using confirmatory test recommended by the NCCLS to detect ESBLs producing escherichia coli and klebsoella pneumoniae.Adopting three dimensional extract test and three dimensional depression test to detect AmpC ?-lactamases.Results Among 236 escherichia coli strains collected,104 were ESBLs producing strains.Among 135 klebsoella pneumoniae strains collected,29 were ESBLs producing strains.Among 106 cefoxitin-resistant strains,AmpC ?-lactamases producing strains were found in 3 strains.Conclusion ESBLs are the most important resistant mechanisms of the two bacteria isolates in our hospital.The strains cefoxitin-resistant may result from the loss of the membrane porin.

The discussing of nurses collocating and training in clinical health education / 医学研究生学报

To find a way to improve the effects of clinical health education,the clinical health education nurses collocating qualifications to hold their posts, job duties, examinations of training, and practical efficacies were recommended. The setup of clinical education nurses had the advantages as follow: First, the clinical health education with high levels and high qualities can effectively strengthen the patients attending consciousness;second,scientific trainings of health education nurses were useful to pre control the qualities of the health education and improve the level; At last, respecting and caring for patients were the key points to make the patients satisfy the health education.

Theoretical and practical investigation on the perioperative nursing diagnosis / 医学研究生学报

Objectives:To evaluate the nursing diagnostic items in perioperative patients, its indication and clinical directive effect. To explore the conception and goal of perioperative nursing diagnosis and the method of making diagnosis from theories, identifying and using them from theories and practice, and to discuss the training method and positive outcomes from quality management. Methods: One thousand and fifty items of nursing diagnosis were collected from 10 surgical units and 20 items were screened from them. Continuous practice and improvement was done by a cycling model: training nurses use items examine nurses analyze outcome find out problems and causes plan and apply interventions. The consistency of the diagnosis and the outcomes of the patients were also compared. Results: The nursing quality of 10 surgical units was improved markedly from 2001 to 2002. Conclusions:The screened 20 items are commonly used in perioperative patients. If used correctly, they could play a strong pragmatic and directive role in nursing practice. Theoretical training and practice are the key to the correct diagnosis and nursing care.