多巴丝肼联合普拉克索治疗帕金森病的临床疗效

目的:探讨多巴丝肼联合普拉克索治疗帕金森病的临床疗效。方法:以入院病历号为编号,根据随机数字表,将106名帕金森病患者随机分成分两组,每组53例。治疗过程中,给予多巴丝肼片治疗的患者记为对照组(53例);给予多巴丝肼联合普拉克索治疗的患者记为观察组(53例)。连续治疗12周,观察两组患者总疗效、UPDRS评分、HAMD评分及不良反应,探讨其临床治疗价值。结果:1观察组总有效率明显高于对照组总有效率,差异有统计学意义(P0.05)。2与治疗前相比,治疗后两组UPDRS各项评分均明显改善(P0.05),且观察组UPDRS各项评分明显优于对照组(P0.05)。3与治疗前相比,治疗后两组HAMD评分均明显改善(P0.05),且观察组HAMD评分明显优于对照组(P0.05)。结论:多巴丝肼联合普拉克索治疗帕金森病疗效确切,安全可靠,值得临床推广应用。     

舒血宁注射液联合多巴丝肼治疗帕金森病的临床疗效及对脑区血流量与血清炎性因子的影响

目的:探讨舒血宁注射液联合多巴丝肼治疗帕金森病的疗效及对脑区血流量与血清炎性因子的影响。方法:选择我院2014年9月～2017年9月收治的94例帕金森病患者,按随机数表法分为对照组和研究组,每组47例。对照组予以多巴丝肼治疗,研究组在对照组基础上加以舒血宁注射液治疗。比较两组临床疗效,治疗前后UPDRSⅡ评分、UPDRSⅢ评分、UPDRS评分、脑区血流量、血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平的变化和不良反应的发生情况。结果:治疗后,研究组总有效率显著高于对照组(P0.05)。两组治疗后UPDRSⅡ评分、UPDRSⅢ评分、UPDRS评分、血清IL-1β、IL-6、hs-CRP和TNF-α水平均较治疗前显著下降,且研究组以上指标均明显低于对照组(P0.05)。两组治疗后脑区血流量均较治疗前显著增加,且研究组明显高于对照组(P0.05)。两组均有恶心、头晕、失眠及呕吐发生,组间不良反应的发生率比较差异无统计学意义(P0.05)。结论:舒血宁注射液联合多巴丝肼治疗帕金森病的临床疗效明显优于单用多巴丝肼,其能够促进脑部血流循环,调节脑区血流量,降低炎性因子的水平。     

盐酸普拉克索联合美多巴对老年帕金森病的临床疗效及对运动功能的影响

目的:研究盐酸普拉克索联合美多巴对老年帕金森病的临床疗效及对运动功能的影响。方法:选择2014年3月~2015年8月在我院进行诊治的老年帕金森病患者210例,随机分为观察组和对照组,对照组给予美多巴,观察组给予盐酸普拉克索联合美多巴,比较两组的临床疗效,治疗前后运动功能、生活质量的变化情况和不良反应的发生情况。结果:观察组的治疗有效率为85.71%,明显高于对照组的65.71%(P0.05);治疗12周后,观察组UPDRS评分与治疗前和对照组相比均明显降低(P0.05);治疗12周后,观察组生理、心理、独立性、社会关系和环境等方面的评分与治疗前和对照组相比均明显升高(P0.05);两组间恶心、呕吐、开关现象、精神症状等不良反应发生率相比无明显差异(P0.05)。结论:盐酸普拉克索联合美多巴对老年帕金森病疗效显著,能明显改善运动功能,且用药安全,值得推广应用。     

阿托伐他汀对冠心病大鼠心肌细胞的凋亡及caspase-12表达的影响

目的:探讨阿托伐他汀对冠心病大鼠心肌细胞的凋亡及caspase-12表达的影响。方法:21只清洁剂SD大鼠经高脂饮食冠心病造模成功后随机分为空白组、对照组和阿托伐他汀组每组7只。空白组大鼠未经处理,对照组给予生理盐水10 m L/kg体重灌胃,1天一次连续4周;阿托伐他汀组大鼠给予阿托伐他汀10 mg/kg体重灌胃,1天一次连续4周。4周后处死大鼠并取大鼠心肌组织采用TUNEL法检测细胞凋亡情况,Western-blot法检测caspase-12表达情况。结果:三组大鼠心肌凋亡比较空白组、对照组及阿托伐他汀组大鼠细胞凋亡比例分别为(3.72±0.89)%、(3.84±1.01)%和(1.47±0.62)%,阿托伐他汀大鼠心肌细胞凋亡比例明显低于空白组和对照组(P0.05);阿托伐他汀组大鼠心肌细胞Caspase-12表达水平显著低于空白组与对照组(P0.05),而空白组与对照组比较无统计学差异(P0.05)。结论:阿托伐他汀可能通过抑制大鼠心肌细胞caspase-12表达来阻断心肌细胞凋亡途径的激活。     

幽门螺杆菌根除治疗对帕金森病患者运动症状的影响

目的:探讨幽门螺杆菌(HP)根除治疗对帕金森病(PD)患者运动症状的影响及其安全性,为临床治疗提供参考。方法:选取2013年1月-2015年10月医院收治的PD患者120例,根据尿素呼吸试验(UBT)检测结果,将PD患者分为HP组(n=32)和非HP组(n=88),两组均进行抗PD的常规治疗,HP组在此基础上采用HP根除治疗(奥美拉唑+克拉霉素+阿莫西林),采用帕金森病评定量表(UPDRS)评估两组患者治疗前后的运动症状,并对治疗过程中的不良反应进行统计分析。结果:120例PD患者中,HP感染32例占26.67%,经HP根除治疗后,HP检测阴性者26人,成功根除率81.25%。组间比较,治疗前两组UPDRS Ⅳ评分有统计学差异(P0.05),而UPDRS Ⅲ评分、Hoehn-Yahr分级、"开"期和"关"期时间无统计学差异(P0.05);治疗后两组"开"期和"关"期时间存在统计学差异(P0.05),而UPDRS Ⅲ评分、UPDRS Ⅳ评分、Hoehn-Yahr分级无统计学差异(P0.05)。组内比较,治疗后,HP组UPDRS Ⅲ评分和UPDRS Ⅳ评分均较治疗前下降,差异有统计学意义(P0.05),且"开"期时间明显延长,"关"期时间明显缩短,差异均有统计学意义(P0.05),而非HP组治疗前后上述各项指标比较,差异均无统计学意义(P0.05)。HP根除组不良反应发生率与非HP组相比,差异无统计学意义(P0.05)。结论:HP感染与PD的发生有关,HP根除治疗能显著改善PD患者的运动症状,安全有效,值得临床推广使用。     

阿托伐他汀抑制PI3K/AKT/FoxO1通路及高糖诱导的足细胞增殖、凋亡及氧化应激损伤

目的 基于磷脂酰肌醇-3激酶/蛋白激酶B/转录因子叉头框转录因子O亚族1(PI3K/AKT/FoxO1)通路研究阿托伐他汀对高糖诱导的足细胞增殖、凋亡、迁移、炎症因子[肿瘤坏死因子-α(TNF-α)、白介素（IL）-6]及氧化因子超氧化物歧化酶（SOD）、丙二醛（MDA）水平的影响。方法 体外培养人肾小球足细胞HGPC,分为对照组、高糖组、阿托伐他汀组、PI3K/AKT/FoxO1信号通路抑制剂组、阿托伐他汀+抑制剂组及阿托伐他汀+PI3K/AKT/FoxO1信号通路激活剂组。分别测定细胞增殖、凋亡、迁移能力、炎症因子（TNF-α、IL-6）水平、氧化因子（SOD、MDA）水平及PI3K/AKT/FoxO1信号通路相关蛋白表达水平。结果 10μmol/L阿托伐他汀为干预细胞活力的最佳浓度。高糖组细胞增殖率、SOD水平降低,凋亡率、迁移率、TNF-α、IL-6、MDA水平、p-PI3K/PI3K、p-AKT/AKT和p-FoxO1/FoxO1比值升高;阿托伐他汀组和抑制剂组细胞增殖率、SOD水平升高,凋亡率、迁移率、TNF-α、IL-6、MDA水平、p-PI3K/PI3K、p-AKT/A...     

左旋多巴/ 卡比多巴联合恩他卡朋治疗帕金森病的临床研究

目的:观察左旋多巴/卡比多巴联合恩他卡朋(levodopa/carbidopa combined with entacapone,LC+E)治疗帕金森病(Parkinson's disease,PD)的临床效果。方法:选择我院2013年1月~2014年6月收治的112例PD患者,随机分为两组。其中对照组52例采用左旋多巴/卡比多巴(LC)治疗,观察组60例采用左旋多巴/卡比多巴联合恩他卡朋(LC+E)治疗。观察并比较两组治疗前后帕金森病评分量表(Unified Parkinson's Disease Rating Scale,UPDRS)的评分变化情况。结果:与治疗前比较,治疗后两组UPDRS-II日常生活能力评分,UPDRS-III运动能力评分显著下降,而UPDRS-VI SCHWABENGLAND日常活动能力评分显著上升,差异有统计学意义(P0.05);观察组各项变化情况比对照组明显,差异有统计学意义(P0.05)。两组UPDRS-I精神、行为、情绪和Hoehn与Yahr分级均无显著改善,差异无统计学意义(P0.05)。结论:左旋多巴/卡比多巴联合恩他卡朋可明显缓解PD症状,疗效优于左旋多巴/卡比多巴治疗,且安全性高,值得临床推广。     

艾司西酞普兰添加治疗对帕金森病患者非运动症状的临床疗效

目的：考察普拉克索添加艾司西酞普兰治疗对帕金森病患者非运动症状的临床疗效。方法: 将60 例帕金森病患者按收治顺序单双号分为观察组和对照组,每组30 例。对照组采用口服盐酸普拉克索治疗,观察组则在口服盐酸普拉克索基础上添加艾司西酞普兰治疗,连续治疗8 周后,分别以帕金森病综合评分量表（UPDRS）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表(HAMA)、匹兹堡睡眠质指数(PQSI ) 和生活质量综合评定量表(GQOLI-74) 的评分为指标,对比考察2 组患者的综合症状、抑郁和焦虑症状、睡眠和生活质量等的变化。结果: 与治疗前相比,2 组患者治疗后,UPDRS 总分、运动检查以及精神、行为和情感评分均显著降低（P <0.05）,治疗并发症和日常生活评分无显著差异（P >0.05）,其中观察组患者的UPDRS 总分以及精神、行为和情感评分较对照组显著降低（P <0.05）,而2 组患者的治疗并发症、日常生活和运动检查评分无显著差异（P >0.05）;且2 组患者治疗后,HAMD、HAMA 和PQSI 评分均显著降低（P <0.05）,其中观察组患者的HAMD、HAMA 和PQSI 评分较对照组显著降低（P <0.05）,而2 组患者的GQOLI-74 评分均显著升高（P <0.05）,其中观察组患者GQOLI-74 评分显著高于对照组（P <0.05）。结论: 普拉克索添加艾司西酞普兰治疗可有效改善帕金森病患者抑郁、焦虑、睡眠障碍等非运动症状,从而提高患者生活质量,具有重要的临床意义。     

康复训练联合阿托伐他汀对SIVD患者认知功能及日常行为能力的影响

目的:研究康复训练联合阿托伐他汀对SIVD患者认知功能及日常行为能力的影响。方法:选取97例确诊为SIVD的患者,根据随机数表法将所有患者分为观察组(n=48)和对照组(n=49),对照组给予口服多奈哌齐,观察组给予口服阿托伐他汀和康复训练。结果:治疗1个月后,观察组和对照组的MMSE、Mo CA、BI评分与治疗前差异均无统计学意义(P0.05);治疗6个月后,观察组的MMSE、Mo CA、BI评分显著高于治疗前(P0.05);观察组的MMSE、Mo CA、BI评分显著高于对照组(P0.001);观察组治疗1个月与6个月后总有效分别为16.6%与87.5%,高于同期对照组的12.24%(x~2=0.363,P=0.547)与53.06%(x~2=27.523,P0.001),差异无统计学意义。结论:康复训练联合阿托伐他汀能有效治疗SIVD,值得在临床中推广。     

匹伐他汀钙与阿托伐他汀钙治疗冠心病的临床疗效及安全性比较

目的:观察和比较匹伐他汀钙与阿托伐他汀钙治疗冠心病的临床疗效及安全性。方法:选取2016年3月到2018年12月于我院就诊的冠心病患者共100例,将其按照入院编号随机分为两组,匹伐他汀钙组(50例)与阿托伐他汀钙组(50例)。在服药前及服药后第6、12个月,检测和比较两组血糖(Glu)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hsCRP)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、谷丙转苷酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、肌酸激酶(CK)水平的变化。结果:治疗后6、12个月,匹伐他汀钙组血清HDL-C水平较治疗前显著升高(P0.05),而血清hsCRP水平明显降低(P0.05),阿托伐他汀钙组HDL-C、hsCRP与治疗前比较差异均没有统计学意义(P0.05)。治疗后12个月,阿托伐他汀钙组HbA1c较治疗前显著升高(P0.05),而匹伐他汀钙组与治疗前比较差异没有统计学意义(P0.05)。治疗后6、12个月,两组患者血清TC、LDL-C水平均较治疗前明显降低(P0.05),两组患者血清TG、Glu、ALT、AST、Cr、CK水平较治疗前差异无明显统计学意义(P0.05)。结论:匹伐他汀钙和阿托伐他汀钙治疗均能够降低冠心病患者的血清LDL-C、TC、TG水平,而匹伐他汀钙同时可升高HDL-C,降低血清hs CRP水平,并且不增加新发糖尿病的风险。     

Morphological variations in a widely distributed Eastern Asian passerine cannot be consistently explained by ecogeographic rules

Ecogeographic rules that describe quantitative relationships between morphologies and climate might help us predict how morphometrics of animals was shaped by local temperature or humidity. Although the ecogeographic rules had been widely tested in animals of Europe and North America, they had not been fully validated for species in regions that are less studied. Here, we investigate the morphometric variation of a widely distributed East Asian passerine, the vinous‐throated parrotbill (Sinosuthora webbiana), to test whether its morphological variation conforms to the prediction of Bergmann''s rule, Allen''s rules, and Gloger''s rule. We at first described the climatic niche of S. webbiana from occurrence records (n = 7838) and specimen records (n = 290). The results of analysis of covariance (ANCOVA) suggested that the plumage coloration of these parrotbills was darker in wetter/warmer environments following Gloger''s rule. However, their appendage size (culmen length, beak volume, tarsi length) was larger in colder environments, the opposite of the predictions of Allen''s rule. Similarly, their body size (wing length) was larger in warmer environments, the opposite of the predictions of Bergmann''s rule. Such disconformity to both Bergmann''s rule and Allen''s rule suggests that the evolution of morphological variations is likely governed by multiple selection forces rather than dominated by thermoregulation. Our results suggest that these ecogeographic rules should be validated prior to forecasting biological responses to climate change especially for species in less‐studied regions.     

Effects of increasing the number of players and memory size in the iterated Prisoner's Dilemma: a numerical approach

The Prisoner''s Dilemma has become a paradigm for the evolution of altruistic behaviour. Here we present results of numerical simulations of the infinitely iterated stochastic simultaneous Prisoner''s Dilemma considering players with longer memory, encounters of more than two players as well as different pay-off values. This provides us with a better foundation to compare theoretical results to experimental data. We show that the success of the strategy Pavlov, regardless of its simplicity, is far more general by having an outstanding role in the iterated N-player N-memory Prisoner''s Dilemma. Besides, we study influences of increased memory sizes in the iterated two-player Prisoner''s Dilemma, and present comparisons to results of experiments with first-year students.     

Myotonia congenita: novel mutations in CLCN1 gene

Myotonia congenita belongs to the group of non-dystrophic myotonia caused by mutations of CLCN1gene, which encodes human skeletal muscle chloride channel 1. It can be inherited either in autosomal dominant (Thomsen disease) or recessive (Becker disease) forms. Here we have sequenced all 23 exons and exon-intron boundaries of the CLCN1 gene, in a panel of 5 unrelated Chinese patients with myotonia congenita (2 with dominant and 3 with recessive form). In addition, detailed clinical analysis was performed in these patients to summarize their clinical characteristics in relation to their genotypes. Mutational analyses revealed 7 different point mutations. Of these, we have found 3 novel mutations including 2 missense (R47W, V229M), one splicing (IVS19+2T>C), and 4 known mutations (Y261C,G523D, M560T, G859D). Our data expand the spectrum of CLCN1 mutations and provide insights for genotype–phenotype correlations of myotonia congenita in the Chinese population.     

斜纹夜蛾核多角体病毒VP39-GST融合蛋白的原核表达

用PCR的方法扩增得到斜纹夜蛾核多角体病毒（Spodoptera litura multicapsid nucleopolyhedrovirus,SpltMNPV）vp39全长基因。将其克隆至原核表达载体pGEX-4T-1上,构建重组表达质粒pGEX-4T-vp39,转化大肠杆菌BL21（DE3）,在1 mmol/L异丙基硫代-β-D-半乳糖苷（IPTG）诱导下超量表达了与理论预测值相符的一个约60 kD的VP39-GST融合蛋白。VP39-GST融合蛋白的成功表达为进一步研究VP39在病毒侵染过程中与宿主细胞成分或病毒粒子蛋白间的相互作用奠定了基础。     

城市小尺度生态基础设施的设计方法——以雄安新区启动区为例

高速的城市化进程带来一系列生态破坏和环境污染等可持续发展挑战,需要在城市规划阶段尽量规避这些风险。生态基础设施建设倡导生态系统修复和环境协同治理的理念,是新兴城市化背景下指导城市规划的一种有效手段。目前,国内外生态基础设施建设在宏观尺度研究比较系统,而在小尺度的研究相对欠缺。我国社区等小尺度生态基础设施建设,由于规模较小,缺乏网络化构建,导致了建设后雨水内涝、面源污染问题仍层出不穷。构建了一种城市小尺度生态基础设施的设计方法和技术流程,以雄安新区启动区为研究区开展生态基础设施设计：（1）基于实际调研与理论研究分析场地现状,综合考虑自然要素、物理感知、心理感知、生态过程等相关因素构建"廊道为骨,斑块为节"的生态基础设施体系;（2）辨识区域主要动物活动、迁徙以及保护植物多样性等功能生态斑块,构建串联全城提供多种功能的系统性廊道、增加城市内部生态系统服务的结构性廊道、将生态系统服务渗入城市肌理的局部功能性廊道;（3）从景感满意度和年径流总量控制率2个方面进行生态基础设施建设预期效果评估。研究结果有助于缓解雄安新区建设所面临生态环境问题,保障人居生活环境品质,并为今后城市建设工作提供参考。     

NAD/NADP及其介导氧化应激在神经退行性疾病中的作用

神经退行性疾病如阿尔茨海默病、帕金森病、亨廷顿病等疾病的发生与氧化应激紧密相关。NAD和NADP是维持氧化系统和抗氧化系统平衡的两个关键物质。NAD和NADP的生物合成和降解有多种途径,参与其生物途径的物质如NAMPT、NADK、PARP1、SIRT1、CD38等,均报道在神经退行性疾病发挥一定的作用。因此,本文分别从NAD和NADP的合成和降解途径中的一些关键物质出发,结合氧化应激总结并探讨它们在神经退行性疾病的作用,以期为临床治疗神经退行性疾病提供新思路。     

巨噬细胞特异性启动子/抗菌肽PR39基因腺病毒载体的构建及其表达

旨在构建由巨噬细胞特异性启动子调控的抗菌肽PR39基因腺病毒表达载体,检测目的基因在小鼠巨噬细胞RAW264.7中的表达。PCR扩增巨噬细胞启动子/抗菌肽PR39成熟肽基因序列,插入腺病毒穿梭载体pAdTrack中,重组穿梭质粒(pAdTrack-SP/PR39)与腺病毒骨架(pAdEasy-1)共转化大肠杆菌BJ5183,通过细菌内同源重组产生重组腺病毒载体(pAd-SP/PR39)。pAd-SP/PR39经PacI线性化后转染293细胞,包装出重组腺病毒(Ad-SP/PR39)。Ad-SP/PR39感染小鼠巨噬细胞RAW264.7,经RT-PCR和免疫细胞化学检测PR39的靶向表达特异性。成功构建了由巨噬细胞特异性启动子调控的抗菌肽PR39基因腺病毒表达载体。包装出的重组腺病毒仍然能感染小鼠巨噬细胞且高效表达抗菌肽PR39。构建的重组腺病毒能够在巨噬细胞中表达抗菌肽PR39基因,为靶向表达抗菌肽在胞内菌感染治疗中的应用奠定了基础。     

Age and annual growth rate cause spatial variation in body size in Phrynocephalus przewalskii (Agamid)

Whether or not biogeographic rules dealing with spatial patterns of animal body sizes are valid for ectotherms is controversial. As the ectotherms grow all their lives, we explored the role of age and annual growth rate in body size variation in Phrynocephalus przewalskii in northern China. Morphological data were collected from 11 populations across a broad geographic gradient. Correlations between age, sex, climatic factors, and body size were analyzed using generalized linear model (GLM) and generalized linear mixed model (GLMM). GLM analysis indicated that the general body size of both sexes and the appendage size of females increased significantly with increasing temperature; however, the coefficient of determination was very small. GLMM analysis indicated that body size only correlated with age, whereas appendage size was affected by age, temperature, rainfall, and sunshine. Annual growth rates were positively correlated with temperature. We concluded that body size variation was mainly caused by age structure and plasticity of the growth rate in P. przewalskii and did not follow Bergmann''s rule; however, females followed Allen''s rule. Future studies to investigate the effect of energy restriction are needed to further understand the relationship between growth rate and body size. We also suggest that further studies on thermal advantage and sexual selection may be helpful to understand appendage size variation in P. przewalskii.     

假性高血压的研究进展

高血压是心脑血管疾病重要的危险因素,可损伤重要脏器如心、脑、肾的结构和功能,最终导致这些器官的功能衰竭,是危害人类健康的一大杀手。假性高血压(Pseudohypertension,PHT)是指普通袖带测压法所测血压值高于动脉穿刺直接测得的血压值的一种特殊现象,也是难治性高血压的一个主要原因。已有研究表明,假性高血压在老年人、动脉硬化、肾功不全及糖尿病患者中较为多见。目前国内外有限的研究显示假性高血压发病率1.7%-50%。在临床治疗中如不能准确识别假性高血压而对患者行过度降压治疗,将会造成严重的灌注不足事件如中风,甚至死亡。因此,假性高血压日益受到重视,本文就其诊断标准、产生机制、流行病学等方面作一综述。     

Identification of patient's requirements in quality management system in health care institutions

AimTo present the solutions implemented in health care institution in the context of identification of patient's requirements, and evaluation of the level of patients’ satisfaction in accordance with the requirements of ISO norm 9001:2008 based on the experience of GPCC.BackgroundThe fundamental mechanisms behind the free market, such as competition, start applying also to the public health sector. Health service providers are gradually realising that patients are actual clients of health care institutions, with physicians, nurses, supporting personnel, registration officers and other staff responding to patients demand for medical and auxiliary services (e.g. exam registration, provision of information).Material and methodsPN-EN ISO 9001:2009 “Quality Management Systems. Requirements”, relevant literature and documentation of quality management system from the GPCC.The review of relevant literature and legal requirements; interpretation of provisions in relation to the functioning of health care institutions.ResultsModel of identification of patient's requirements and satisfaction in accordance with the requirements of ISO 9001:2008 has been elaborated and implemented in the GPCC.ConclusionThe identification of patient's requirements is much more complicated than evaluating the same parameters in manufacturing companies. In the context of medical services one should be aware of the subjectivity of patient's feelings, the psycho-social status and the general state of health during his or her treatment. Therefore, the identification of patient's requirements and satisfaction must be carefully thought out, implemented and regularly improved.