我国医养结合服务发展现状分析与政策建议

随着我国老龄化进程加快,医养结合在卫生政策与管理实践上已经成为普遍共识。现有研究主要从养老服务角度分析医养结合的概念、内涵以及实现路径,或从医学护理、医疗照护等方面探讨技术问题。医养结合模式,既不单纯是一种养老模式,也不单纯是一种医疗模式,而是医疗和养老融合的新模式,将改变传统的养老和医疗服务提供理念和方式,是解决我国老年人养老、医疗的创新之举,是建设健康中国的重要组成内容。本文从政策分析的角度出发,通过对医养结合概念的阐述、深入分析我国目前医养结合模式和存在的问题,提出政策建议。

     

物联网环境下,智能医养融合电子平台设计

为缓解"医养融合"发展模式中养老者电子健康档案、电子病历实时传输和不同服务主体间信息共享的难题,本文提出智能医养融合电子平台模型。系统利用使用物联网技术的智能医疗设备采集养老者的生理信息数据,使用Map Reduce挖掘数据,快速有效的完成养老者生理数据的分析和整理。     

公立医院医养结合养老模式的运行分析及思考

目的 推进公立医院医养结合养老模式更加科学、规范、有序运行。方法 描述性统计法、比较分析法。结果 首家由国家发展与改革委员会批准的公立医院兴办的医养结合养老机构重庆医科大学附属第一医院青杠老年护养中心入住老人人次呈上升趋势,已扭亏为盈,实现“医护养”全面融合,“急慢分治、双向转诊”,护理院医保覆盖,信息化助力养老与安全,逐步形成较为规范的老人综合评估体系。结论 公立医院医养结合养老模式是一种成功的养老模式,其市场需求前景好,但运营成本高、服务收费较高,不能满足大量老人的养老需求,需要政府做好顶层设计、完善相关制度、加大资金投入、分层建设以完善养老服务体系。     

公立医院改革下护理管理的创新思路

公立医院改革是新医改的核心。加强护理工作是实现医改目标的重要措施之一,是构建和谐医患关系的客观要求。在推进公立医院改革的进程中,从医院层面开展“文化护理管理”、建立护理后勤、创新护理服务等方面的工作,探索公立医院护理管理创新思路。     

PACE4对异丙肾上腺素诱导的心肌细胞凋亡的影响及其机制

目的:研究前体蛋白转化酶枯草溶菌素(PACE4)对异丙肾上腺素(ISO)诱导的心肌细胞凋亡的作用及其可能的作用机制。方法:构建pFLAG-PACE4重组表达载体并转染H9c2心肌细胞。将心肌细胞分为四组:正常对照组(无任何干预因素)、ISO组(10μmol/L ISO)、ISO+pFLAG组(空载质粒pFLAG转染+10μmol/LISO)、ISO+pFLAG-PACE4组(pFLAG-PACE4重组表达质粒转染+10μmol/LISO)。采用AnnexinV-FITC/PI双染法测定心肌细胞凋亡率;蛋白免疫印迹法检测活性半胱氨酸蛋白酶(caspase)-3、caspase-12、钙网蛋白、葡萄糖调节蛋白78(GRP78)、CCAAT/增强子结合蛋白同源蛋白(CHOP)、活化转录因子4(ATF4)和PERK的表达以及真核起始因子2α(eIF2α)的磷酸化水平。结果:与正常对照组相比,ISO组中PACE4表达水平明显降低,而转染pFLAG-PACE4质粒后,其表达水平显著增加。PACE4过表达可以显著抑制ISO诱导的细胞凋亡和caspase-3以及caspase-12的蛋白表达。ISO处理显著增加内质网应激分子钙网蛋白、GRP78和CHOP的表达,而PACE4过表达则可以抑制这些蛋白的表达。ISO诱导的PERK、eIF2α和ATF4的表达可以显著被PACE4过表达抑制。结论:PACE4过表达可以抑制ISO诱导的H9c2心肌细胞凋亡,其机制可能与PERK信号通路介导的内质网应激反应有关。     

基于电子文件的分级诊疗模式研究

目的 了解我国分级诊疗现状和业务流程，提出基于电子文件的分级诊疗服务模式。方法 采用描述分析法对当前分级诊疗业务及所产生的电子文件进行研究，结合电子文件的特性，探索分级诊疗服务模式。结果 从电子文件中心构建、双向转诊、远程医疗、慢性病管理等方面构建了基于电子文件的分级诊疗模式。结论 基于电子文件开展分级诊疗服务能优化现有的业务流程，为分级诊疗进程的不断推进提供信息化支撑。     

MAR结合蛋白及其调控功能

核基质结合区 （MAR)是真核生物中能与核基质结合的DNA片段.MAR通过与特异的MAR结合蛋白相互作用,在提高转基因表达水平、降低转基因个体之间表达水平差异以及染色体包装等方面具有重要的调控作用.目前,已在不同物种分离MAR结合蛋白,分别为核基质成分、核仁蛋白、组蛋白、叶绿体蛋白等,它们在调控基因表达、细胞发育、细胞凋亡、染色体包装等方面具有重要的功能.本文综述了目前分离出的MAR结合蛋白及其功能,并对MAR-结合蛋白研究作一展望.     

昆虫信息素结合蛋白的研究概况

在昆虫感受信息素的嗅觉反应中,信息素结合蛋白发挥了重要的作用。它作为脂溶性信息素的溶剂和载体,在亲水性淋巴液中起着运载信息素和使之失活的双重作用。由于它在昆虫识别信息素物质中起着重要的作用,近1 0年来,国内外对其进行了广泛、深入的研究。文章从信息素结合蛋白的生化特点、表达情况、代谢以及生理功能等方面的概况进行综述。     

昆虫触角气味结合蛋白的研究进展

昆虫触角气味结合蛋白是一类亲水性的酸性蛋白,在触角感器淋巴液中浓度很高,主要分为4种,即性外激素结合蛋白、普通气味结合蛋白1、普通气味结合蛋白2和气味结合蛋白类似蛋白。由于它们在昆虫识别外界气味物质中起着重要的作用,近10年来,国外对其进行了广泛、深入的研究。该文从气味结合蛋白的研究方法、生化特性、分子结构和生理功能等方面进行综述。     

小菜蛾气味结合蛋白OBP2基因的克隆、表达谱及其结合特性分析

【目的】气味结合蛋白(odorant binding proteins,OBPs)在昆虫寄主定位、产卵地选择等行为中发挥重要作用,克隆与鉴定小菜蛾Plutella xylostella OBP基因、明确其与配体化合物的结合特性有助于阐明小菜蛾嗅觉识别的分子机制。【方法】利用PCR技术克隆小菜蛾OBP2,对获得的编码序列全长进行信号肽及跨膜区域预测,用DNAMAN与其他昆虫的OBP2进行多序列比对,采用MEGA5.0邻接法(neighbor-joining method,NJ)构建进化树。通过实时定量PCR(qRT-PCR)分析Pxyl OBP2在小菜蛾不同发育阶段和不同组织中的表达模式。构建原核表达载体p ET28aPxyl OBP2,进行原核表达及蛋白纯化。利用荧光竞争结合实验对Pxyl OBP2蛋白与39种配基化合物的结合特性进行分析。【结果】成功获得小菜蛾OBP2基因Pxyl OBP2(Gen Bank登录号:KT070562)的编码序列全长,其完整开放阅读框大小为546 bp,编码182个氨基酸,具有气味结合蛋白典型的6个保守半胱氨酸结合位点。荧光定量PCR结果表明,发育表达模式显示,Pxyl OBP2在未交配雄性成虫中的表达量均明显高于雌性成虫和已交配雄虫;组织表达模式显示,Pxyl OBP2在足中的表达量高于其他组织。经预测成熟蛋白大小为22.24 k Da,等电点5.69。SDS-PAGE结果显示融合蛋白成功表达。荧光竞争结合实验对3种性信息素和36种植物挥发物结合发现,Pxyl OBP2与性信息素Z-11-16:Ald可以结合,解离常数48.951μmol/L;可以和11种寄主植物挥发物有效结合,其中,与芳樟醇、正壬醇结合能力最强,解离常数分别为4.733和6.861μmol/L。【结论】本研究明确了Pxyl OBP2的核苷酸、氨基酸序列,并根据qRT-PCR和荧光竞争结合实验结果,推断Pxyl OBP2与小菜蛾雄虫寻求配偶有关,且寄主挥发物芳樟醇、正壬醇起协同促进作用。     

Polysaccharide analysis using carbohydrate gel electrophoresis: a method to study plant cell wall polysaccharides and polysaccharide hydrolases.

A method to characterize plant cell wall polysaccharides is presented. The complexity of the polymer structures and the large number of different charged and uncharged monosaccharides that make up plant polysaccharides have previously made analysis technically demanding and laborious. Polysaccharide analysis using carbohydrate gel electrophoresis (PACE) relies on derivatization of reducing ends of sugars and oligosaccharides with a fluorophore, followed by electrophoresis under optimized conditions in polyacrylamide gels. We show that PACE is a sensitive and simple tool for studying the monosaccharide composition of polysaccharides and of cell wall preparations. In combination with specific hydrolases, it can be used to analyze the structure of polysaccharides. Moreover, the specificity and kinetics of the plant polysaccharide hydrolases themselves can be quickly and effectively studied. PACE can detect as little as 500 fmol of monosaccharides and 100 fmol of oligosaccharides, and it is fast and quantitative.     

Secretory proprotein convertases PACE4 and PC6A are heparin-binding proteins which are localized in the extracellular matrix. Potential role of PACE4 in the activation of proproteins in the extracellular matrix

PACE4, PC6 and furin are potent subtilisin-like proprotein convertases (SPCs) which are responsible for the activation of transforming growth factor-beta (TGFbeta)-related factors such as bone morphogenetic proteins. Heparan sulfate proteoglycan within the extracellular matrix (ECM) is known to regulate the biological activity of various differentiation factors including TGFbeta-related molecules. PACE4 binds tightly to heparin and its heparin-binding region was found to be a cationic stretch of amino acids between residues 743 and 760. Furthermore, PACE4 was detected in the extracellular material fraction of the HEK293 cells, defined as the material remaining on the culture plate following the removal of the cells from the plate. PACE4 bound to the extracellular fraction was selectively dislodged by heparin into the culture medium. Heparin has no inhibitory activity against PACE4. Similarly, PC6A is also able to bind to heparin, whereas soluble furin does not. In human placenta, PACE4 is mainly present in syncytiotrophoblasts and can be released by heparin. These results suggest that PACE4 and PC6 are unique SPC family proteases that anchor heparan sulfate proteoglycans at the ECM. The interaction between PACE4 and heparan sulfate proteoglycans might play an important role in the delicate spatiotemporal regulation of TGFbeta-related factors' biological activity.     

Secretory proprotein convertases PACE4 and PC6A are heparin-binding proteins which are localized in the extracellular matrix: Potential role of PACE4 in the activation of proproteins in the extracellular matrix

PACE4, PC6 and furin are potent subtilisin-like proprotein convertases (SPCs) which are responsible for the activation of transforming growth factor-β (TGFβ)-related factors such as bone morphogenetic proteins. Heparan sulfate proteoglycan within the extracellular matrix (ECM) is known to regulate the biological activity of various differentiation factors including TGFβ-related molecules. PACE4 binds tightly to heparin and its heparin-binding region was found to be a cationic stretch of amino acids between residues 743 and 760. Furthermore, PACE4 was detected in the extracellular material fraction of the HEK293 cells, defined as the material remaining on the culture plate following the removal of the cells from the plate. PACE4 bound to the extracellular fraction was selectively dislodged by heparin into the culture medium. Heparin has no inhibitory activity against PACE4. Similarly, PC6A is also able to bind to heparin, whereas soluble furin does not. In human placenta, PACE4 is mainly present in syncytiotrophoblasts and can be released by heparin. These results suggest that PACE4 and PC6 are unique SPC family proteases that anchor heparan sulfate proteoglycans at the ECM. The interaction between PACE4 and heparan sulfate proteoglycans might play an important role in the delicate spatiotemporal regulation of TGFβ-related factors' biological activity.     

Developmental expression of a novel Kexin family protease, PACE4E, in the rat olfactory system

 PACE4 is a mammalian Kexin family protease that is involved in the maturation of precursor proteins. Four PACE4 isoforms have been identified. We identified a novel PACE4 isoform, PACE4E, from a human cerebellum cDNA library, which possesses a hydrophobic cluster in its C-terminus participating in membrane association. The size of PACE4E mRNA from adult rat brain was estimated by Northern blotting to be 4.4 kb. In situ hybridization histochemistry revealed that the highest level of PACE4E mRNA was expressed in the mitral cells of the adult rat olfactory bulb (OB). The OB is a unique sensory organ in that it has a lifelong regenerating capacity and it affects brain development. We further analyzed the expression of PACE4E mRNA in the developing olfactory system. On day 13.5 of gestation, PACE4E mRNA was expressed at high levels in the neuroepithelium of the forebrain vesicle (FV), olfactory epithelium, and cells in the fiber bundles projecting to the FV. As development proceeded, PACE4E mRNA was expressed in developing mitral cells but decreased in the olfactory epithelium. In the newborn, its expression was confined to the mitral cells in both the main and accessory OB and in some periglomerular cells, as shown in adult rats. The spatio-temporal expression of PACE4E suggests that it plays a role in the establishment and maintenance of the olfactory receptor system. Accepted: 15 April 1997     

Inactivation of proprotein convertase, PACE4, by alpha1-antitrypsin Portland (alpha1-PDX), a blocker of proteolytic activation of bone morphogenetic protein during embryogenesis: evidence that PACE4 is able to form an SDS-stable acyl intermediate with alpha1-PDX.

PACE4 (SPC4), a member of the subtilisin-like proprotein convertase (SPC) family of proteases that cleave at paired basic amino acids, exhibits a dynamic expression pattern during embryogenesis and colocalizes with bone morphogenetic proteins (BMPs). Recently Cui et al. reported that the ectopic expression of alpha1-antitrypsin variant Portland (alpha1-PDX), an engineered serpin that contains the minimal SPC consensus motif in its reactive loop, blocks the proteolytic activation of BMP4, leading to abnormal embryogenic development [Cui, Y. et al. (1998) EMBO J. 17, 4735-4743]. TGFbeta-related factors such as BMPs are synthesized as inactive precursors and activated by limited proteolysis at multibasic amino acids. Therefore, an alpha1-PDX-inhibitable protease is thought to participate in BMP activation. However, conflicting properties, including sensitivity to alpha1-PDX, have been reported for PACE4. In this study, we examined whether alpha1-PDX is responsible for the inhibition of PACE4 by measuring the protease/inhibitor complex directly. Here we show that alpha1-PDX has the ability to form an SDS-stable acyl-intermediate (180 kDa) with PACE4 in vivo and in vitro. Further, we characterized the PACE4 secreted into the culture medium from Cos-1 cells by a specific immunological assay. An alpha1-PDX-insensitive and decanoyl-RVKR-chloromethylketone-sensitive 60-kDa protease(s) is greatly activated in conditioned medium by PACE4 overexpression, suggesting that the activation of an unknown protease(s) other than PACE4 is the cause of the variation in the properties of PACE4. PACE4 is a Ca(2+)-dependent protease with an optimal Ca(2+) requirement of 2 mM, and shows its highest activity at weakly basic pH. PACE4 activity is completely inhibited by EDTA and EGTA, but not by leupeptin. These results show that PACE4 activity can be inhibited by alpha1-PDX as well as furin (SPC1) and suggest that the inhibition of PACE4-mediated activation of factors such as BMPs by alpha1-PDX causes abnormal embryogenic development.     

The expression of proprotein convertase PACE4 is highly regulated by Hash-2 in placenta: possible role of placenta-specific basic helix-loop-helix transcription factor, human achaete-scute homologue-2

PACE4 is a member of the mammalian subtilisin-like proprotein convertase (SPC) family, which contribute to the activation of transforming growth factor (TGF) beta family proteins. We previously reported that PACE4 is highly expressed in syncytiotrophoblasts of human placenta [Tsuji et al. (2003) BIOCHIM: Biophys. Acta 1645, 95-104]. In this study, the regulatory mechanism for PACE4 expression in placenta was analyzed using a human placental choriocarcinoma cell line, BeWo cells. Promoter analysis indicated that an E-box cluster (E4-E9) in the 5'-flanking region of the PACE4 gene acts as a negative regulatory element. The binding of human achaete-scute homologue 2 (Hash-2) to the E-box cluster was shown by gel mobility-shift assay. The overexpression of Hash-2 caused a marked decrease in PACE4 gene expression. When BeWo cells were grown under low oxygen (2%) conditions, the expression of Hash-2 decreased, while that of PACE4 increased. In both cases, other SPCs, such as furin, PC5/6, and PC7/8, were not affected. Further, PACE4 expression was found to be developmentally regulated in rat placenta. By in situ hybridization, Mash-2 (mammalian achaete-scute homologue 2) mRNA was found to be expressed in the spongiotrophoblast layer where PACE4 was not expressed. In contrast, the PACE4 mRNA was expressed mainly in the labyrinthine layer where Mash-2 was not detected. These results suggest that PACE4 expression is down-regulated by Hash-2/Mash-2 in both human and rat placenta and that many bioactive proteins might be regulated by PACE4 activity.     

Inhibition and transcriptional silencing of a subtilisin-like proprotein convertase, PACE4/SPC4, reduces the branching morphogenesis of and AQP5 expression in rat embryonic submandibular gland

The submandibular gland (SMG) develops through the epithelial-mesenchymal interaction mediated by many growth/differentiation factors including activin and BMPs, which are synthesized as inactive precursors and activated by subtilisin-like proprotein convertases (SPC) following cleavage at their R-X-K/R-R site. Here, we found that Dec-RVKR-CMK, a potent inhibitor of SPC, inhibited the branching morphogenesis of the rat embryonic SMG, and caused low expression of a water channel AQP5, in an organ culture system. Dec-RVKR-CMK also decreased the expression of PACE4, a SPC member, but not furin, another SPC member, suggesting the involvement of PACE4 in the SMG development. Heparin, which is known to translocate PACE4 in the extracellular matrix into the medium, and an antibody specific for the catalytic domain of PACE4, both reduced the branching morphogenesis and AQP5 expression in the SMG. The inhibitory effects of Dec-RVKR-CMK were partially rescued by the addition of recombinant BMP2, whose precursor is one of the candidate substrates for PACE4 in vivo. Further, the suppression of PACE4 expression by siRNAs resulted in decreased expression of AQP5 and inhibition of the branching morphogenesis in the present organ culture system. These observations suggest that PACE4 regulates the SMG development via the activation of some growth/differentiation factors.