复杂性眼外伤患者玻璃体切割围手术期护理体会

目的:玻璃体切割术是眼科手术中比较复杂精细显手术,主要应用于治疗眼外伤导致的玻璃体出血,玻璃体浑浊,复杂性视网膜脱离以及增殖性玻璃体视网膜病变。本文主要探讨玻璃体切割术治疗复杂性眼外伤患者的围手术期护理的临床效应。方法:总结作者所在科室多年来护理眼外伤患者的临床经验,对2013年3月至2013年7月入院的75例(75只眼)复杂性眼外伤患者进行悉心的术前心理护理,完善的用药指导,充分的术前准备,术后特殊卧位的指导,预防并发症的护理及出院指导。结果:术后视力提高57例(76.0%),视力不变13(17.3%)例,视力下降5例(6.7%),28例眼内异物患者均经手术顺利取出异物。相关手术并发症经医护人员的对症治疗后均得到有效控制。患者术后满意度达98%以上,医生满意度达100%。结论:复杂性眼外伤患者玻璃体切割手术围手术期进行全方位的护理服务,对促进病人康复起到至关重要的作用。     

浮游细菌群落变化对锥状斯氏藻藻华的影响

目的:本实验以大亚湾原发性锥状斯氏藻为例,采集野外样品,分析藻华不同时期主要菌群的结构和环境样品的硫化物与赋存形态。方法:应用末端限制性片段长度多态性技术和主成分分析方法,分析藻华发生过程中浮游细菌群落相似程度的情况,得到差异显著的浮游细菌类群。选出代表类群的样品进行16S r DNA高变区测序,获取浮游细菌的分类结果及相对丰度。采用Pearson相关性分析浮游细菌、藻、硫化物两两间的相互关系。结果:早期藻华以Enterobacteriaceae为主导,各优势菌群(Enterobacteriaceae:Alteromonadaceae:Rhodobacteraceae)的比例约为8:1:21,硫元素主要以DMS形式存在;而后期Alteromonadaceae成为优势物种,各优势菌群的比例转变为3:5:25,硫的赋存形态由DMS转变为DMSO;Rhodobacteraceae在藻华的前期与后期均以优势种存在。本实验还发现藻华不同时期4种与藻呈正向相关的细菌,以及8种对藻起负向调节作用的细菌,它们在藻华生消的过程中扮演着不同的角色。结论:菌群的组成性改变与藻华生消具有一定的相关性,并对藻类的硫代谢产生影响。结果的获得有助于认识藻华微生物学过程中硫代谢的生态学功能,拓展锥状斯氏藻藻华的理论认识。     

胸腺五肽显著增强干扰素在抗病毒治程中的特异性CTL效应

目的:探究在e抗原(HBe Ag)阳性的慢性乙型肝炎患者采用聚乙二醇干扰素-2a(peg-2a)联合核苷类药物治疗过程中,加用胸腺五肽对细胞免疫应答的影响。方法:选择采用聚乙二醇干扰素α-2a联合核苷类药物(拉米夫定+阿德福韦酯)治疗48周,HBe Ag仍为阳性,且HLA-A2阳性的慢性乙型肝炎患者18例,分为两组。一组原方案延长联合治疗作为对照,另一组在原方案基础上再加用胸腺五肽治疗(10 mg/次,2次/周,共24周)治疗,所有病人均治疗至96周。并做体外HBV特异性细胞毒T淋巴细胞(HBV specific CTL)培养增殖,通过Elispot技术分析其分泌细胞因子(肿瘤坏死因子-α,干扰素-γ,白介素-10)的功能。结果:HBe Ag转阴率,治疗96周时联合胸腺五肽组为44.4%(4/9),原方案对照组为22.2%(2/9)。HBs Ag滴度,48周时,HBs Ag为4571±3772 IU/m:;96周时,联合胸腺五肽组为1962±2869 IU/m L,转阴1人,原方案对照组为3490±3124 IU/m L,P=0.093。HBV特异性CTL培养增殖,96周时联合胸腺五肽组高于原方案对照组,且联合胸腺五肽组TNF-的分泌也高于原方案对照组,P0.05。结论:胸腺五肽显著增强干扰素抗病毒治疗过程中的特异性CTL效应。     

基于人类信号网络和表达谱数据研究静脉血栓复发机制

目的:静脉血栓是一种高复发风险和高致死率的疾病,其形成和复发的分子机制尚不明确。基于人类信号网络和基因表达谱数据可针对静脉血栓经华法令抗凝治疗后的复发机制进行研究。方法:结合表达谱数据和人类信号网络,设计差异模块筛选策略,通过功能分析、差异表达分析和已知血栓相关基因及药物靶基因的互作关联研究,获得与静脉血栓复发相关的显著差异模块。结果:最终获得8个与静脉血栓复发密切相关的显著差异模块,评估了华法令治疗静脉血栓的效能,提出了联合用药的3种可能途径。结论:应用本文提出的整合筛选策略,能识别与静脉血栓复发相关的模块,探究静脉血栓复发的分子机制和评估华法令的治疗效能。还提供了潜在的联合用药途径,这对治愈血栓、防治血栓复发及复发机制的研究具有重要意义。     

人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床分析

目的:探讨人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床疗效。方法:对2009年7月至2012年7月入住我院的60例成人髋关节发育不良并骨性关节炎患者行人工全髋关节置换术治疗。分析治疗优良率、手术前后不同Crowe分型Harris评分、手术前后行走及疼痛情况、手术前后生活质量。结果:1根据Harris评分,本组治疗优良率91.67%(55/60);2术后各Crowe分型患者Harris评分均显著高于术前,差异均具有统计学意义(P<0.05);3本组术前自行行走及辅助行走例数分别为23及37例,术后分别为39例及21例;术前疼痛情况:无、轻、中及重度疼痛例数分别为1例、6例、22例及31例,术后分别为18例、28例、12及2例,手术前后行走情况及疼痛情况差异均具有统计学意义(P<0.05);4根据SF-36生活质量评价标准,术后生活质量评分为(142.16±10.32)分,显著高于术前(115.24±7.34)分,差异具有统计学意义(P<0.05)。结论:人工全髋关节置换治疗成人髋关节发育不良并骨性关节炎的临床疗效显著,术后患者髋关节功能及生活质量明显改善,应在临床上加以推广。     

Spatial and temporal variation in harvest probabilities for American black duck

Assessing spatial variation in waterfowl harvest probabilities from banding data is challenging because reporting and recovery probabilities have distinct spatial patterns that covary temporally with harvesting regulations, hunter effort, and reporting methods. We analyzed direct band recovery data from American black ducks banded on the Canadian breeding grounds from 1970 through 2010. Data were registered to a 1‐degree grid and analyzed using hierarchical logistic regression models with spatially correlated errors to estimate the annual probabilities of band recovery and the proportion of individuals recovered in Canada. Probability of harvest was estimated from these values, in combination with independent estimates of reporting probabilities in Canada and the USA. Model covariates included estimates of hunting effort and factors for harvest regulation and band reporting methods. Both the band recovery processes and the proportion of individuals recovered in Canada had significant spatial structure. Recovery probabilities were highest in southern Ontario, along the Saint Lawrence River in Quebec, and in Nova Scotia. Black ducks breeding in Nova Scotia and southern Quebec were harvested predominantly in Canada. Recovery probabilities for juveniles were correlated with hunter effort, while the adult recoveries were weakly correlated with the implementation of stricter harvest regulations in the early 1980s. Mean harvest probability decreased in the northern portion of the survey area but remained stable or even increased in the south. Harvest probabilities for juveniles in 2010 exceeded 20% in southern Quebec and the Atlantic provinces. Our results demonstrate fine‐scale variation in harvest probabilities for black duck on the Canadian breeding ground. In particular, harvest probabilities should be closely monitored along the Saint Lawrence River system and in the Atlantic provinces to avoid overexploitation.     

阴囊黄癣痂样石膏样小孢子菌感染1例

报道1例石膏样小孢子菌感染引起阴囊黄癣痂样皮损。患者,男,20岁,阴囊黄色痂皮3周。皮损取材真菌镜检可见分隔菌丝,培养为石膏样小孢子菌。口服伊曲康唑200mg/d,连续2周。停药时皮损消退,真菌学检查阴性。     

近平滑念珠菌的形态转换观察

目的观察近平滑念珠菌在不同培养基的形态转换现象,以及温度对其形态转换的影响。方法收集近平滑念珠菌正常人皮肤携带株及临床致病株和标准株,接种于改良Lee培养基和含桃红B的YPD培养基,观察其不同形态转换,以及温度变化对光滑(W)与皱褶(O)形态转换的影响。结果近平滑念珠菌在Lee培养基和含桃红B的YPD培养基上,均可以出现多种形态以及一定频率W-O转换现象。在观察W向O形态转换过程中发现,与25℃培养温度相比,37℃条件下光滑菌落形态占更多的比例。结论近平滑念珠菌体外培养时存在形态转换及W-O转换现象,且于37℃时更易保持光滑形态。含桃红B的YPD培养基也可以用于基本的W-O形态转换观察。     

ST段抬高型心肌梗死患者血钾水平与原发性恶性室性心律失常的相关研究

目的:探讨ST段抬高型心肌梗死(STEMI)患者与冠状动脉造影阴性的对照组血钾水平以及低血钾发病率的差异;探讨STEMI患者中原发性恶性室性心律失常组和非原发性恶性室性心律失常组血钾水平的差异.方法:选取2007年1月至2009年11月间STEMI并行直接经皮冠状动脉介入术(直接PCI)患者371例,其中男303例,女68例,平均年龄(56.1±11.7)岁.同时选取冠状动脉造影阴性患者(对照组)161例,其中男性131人,女性30人,平均年龄(56.8±10.3)岁.两组基线资料无显著性差异.将血钾含量＜3.5mmol/l定义为低血钾,比较2组间血钾含量及低血钾发病率.根据直接PCI之前是否发生原发性室颤和持续性室速,将STEMI患者分为原发性恶性室性心律失常组和非原发性恶性室性心律失常组,本组数据所指原发性恶性室性心律失常仅包括直接PCI之前发生的原发性室颤和持续性室速,其中原发性室颤24例,持续性室速11例.比较2组间血钾水平.结果:血钾含量STEMI患者(3.81±0.49)低于对照者(4.03+0.41)mmol/L,差异有统计学意义(t=5.08,P＜0.001).低血钾发病率STEMI(22.6%)高于对照者(6.83%),差异有统计学意义(X2=19.13,P＜0.001).STEMI患者中原发性恶性室性心律失常组和非原发性恶性室性心律失常组的血钾水平差异无统计学意义.结论:STEMI患者急性期存在血钾的下降,我们需要积极纠正低血钾,但低血钾与原发性恶性室性心律失常有无必然联系仍需更深入的研究.     

Merged trees in second-growth, fire-origin forests in Patagonia, Chile: positive spatial association patterns and their ecological implications

?Premise of the Study: Negative density-dependent processes have been thought to be the primary cause of shifting spatial patterns of tree populations through time. The existence of adult tree clusters might challenge this classical prediction. Here, we document the prevalence of merged stems (clustering of mature trees leading to stem fusion) in second-growth forests of Nothofagus pumilio and hypothesize that it is nonrandom but predictable in space. ?Methods: We stem-mapped nine sites in second-growth edge and interior forests of fire origin and in mature forests of N. pumilio (>3500 trees) in central Patagonia, Chile. The spatial structure of stand-level and individual-level features was estimated with spatial analyses (pair-correlation function and nearest-neighbor distances). ?Key Results: Multistemmed trees were merged clusters of separate individuals. Merged trees were predominantly found at the edge of the second-growth forests. We found strong clustering (≤5 m) at forest edge sites and none at interior sites. Nearest-neighbor distance distributions were unimodal for unmerged trees and monotonically decreasing for merged trees; interstem distances were much smaller at the edge sites than at the interior sites. ?Conclusions: The occurrence of merged trees at the forest edge, and the resulting high spatial aggregation of stems, is consistent with the hypothesis that establishment was probably aggregated. The spatial pattern found at the forest edge changes the standard spatial pattern sequence through time in temperate forests, altering traditional forest-stand-dynamics models.