基于HEART沟通模式的“态度-定义-开放思维-计划-实施”护理方案在数字化导板种植中的应用

目的探讨分析数字化导板种植患者实施基于HEART沟通模式的“态度-定义-开放思维-计划-实施”护理方案的应用效果。方法选取2021年1月至2023年1月广东省中山市口腔医院种植修复中心收治的108例数字化导板种植患者作为研究对象,按照随机数字表法分为护理A组(54例)与护理B组(54例)。护理A组采用常规临床护理方法,护理B组则在A组护理方案上采用基于HEART沟通模式的“态度-定义-开放思维-计划实施”护理方法。比较两组患者的护理满意度、焦虑评分、疼痛程度、种植体边缘骨吸收状态、临床指标改善情况、自我效能、疾病知晓率与治疗依从性。结果护理B组患者干预后的总满意度高于护理A组,差异有统计学意义(P<0.05);护理B组患者干预后的焦虑评分低于护理A组,差异有统计学意义(P<0.05);护理B组患者干预后的疼痛程度指标低于护理A组,差异有统计学意义(P<0.05);护理B组患者在术后1、3、5个月的种植体边缘骨吸收状态低于护理A组,差异有统计学意义(P<0.05);护理B组患者干预后的并发症总发生率低于护理A组,差异有统计学意义(P<0.05)。结论数字化导板种植患者实施基于HEART沟通模式的护理干预的效果显著,不仅可提高患者的满意度,还可减轻其焦虑与疼痛程度,有利于改善骨吸收状态,并发症少,值得推广。

I-123 metaiodobenzylguanidine imaging for predicting ventricular arrhythmia in heart failure patients

Compared to antiarrhythmic drugs, implantable cardioverter defibrillator （ICD） leads to a more significant im- provement in preventing ventricular arrhythmia in heart failure patients. However, an important question has been raised that how to select appropriate patients for ICD therapy. 1-123 metaiodobenzylguanidine （MIBG） planar and SPECT imaging have shown great potentials to predict ventricular arrhythmia in heart failure patients by as- sessing the abnormalities of the sympathetic nervous system. Clinical trials demonstrated that several parameters measured from 1-123 MIBG planar and SPECT imaging, such as heart-to-mediastinum ratio, washout rate, defect score, and innervation/perfusion mismatch, predicted ventricular arrhythmias in heart failure patients. This paper introduces the current practice of ICD therapy and reviews the technical background of 1-123 MIBG planar and SPECT imaging and their clinical data in predicting ventricular arrhythmia.

Dose-dependent effect of parathyroid hormone 1-34 fragment and its influence mechanism on the functional activity of isolated heart

The present investigation is the continuation of our prior clinical studies on the content of parathyroid hormone (PTH), its paracrine analog, parathyroid hormone-related protein (PTHrP) and electrolytes in blood of patients with heart failure. The results of these studies formed the basis for the nomination of the hypothesis on PTH and PTHrP compensatory-modulating effect on the contractile activity of heart. The objective of this study is to elucidate the mechanism of the compensatory-modulating effect of PTH on heart functional activity, which is realized by the study of effective doses of PTH by pharmacological analysis, using different inhibitors. The dose-dependent effect of PTH on the heart contraction rate and amplitude is studied on the frog isolated heart by the method of non-invasive registration of heart contractile activity. The method is based on the photoelectric principle of the reflected from the contractile object light ray transformation into an electric signaling. It is shown that the most effective dose that has positive chronotropic and inotropic effects on heart is 10–10 M hormone. To clarify the mechanism of PTH physiological dose action on the contractile activity of heart PTH 1-34 is combined with Ca-channel as well as phosphodiesterase blockers. The mentioned substances are applied based on the fact that PTH effect on target cells is mediated by secondary messengers, particularly calcium ions and cAMP. Based on the data obtained by combination of hormone with Verapamil (10–5 M) and Theophylline (10–4 M), we concluded on the involvement of calcium ions in the realization of chronotropic and cAMP in the inotropic effects on the heart.

Screening of NKX2-5,GATA4,ZIC3 gene mutations in sporadic congenital simple heart disease in Hainan Province

Objective:Congenital heart disease(CHD)is caused by abnormal cardiac development,which is the most common congenital malformation at home and abroad.NKX2-5,GATA4 and ZIC3 have been shown to be associated with CHD.This experiment explored the relationship between NKX2-5,GATA4 and ZIC3 gene mutations and sporadic CHD in Hainan Province.Methods:To collect 210 sporadic CHD patients in Hainan,the DNA of patients was extracted from blood,and the target gene fragments were amplified.Using high-resolution melting(HRM)and DNA sequencing technology,and we analyzed the sequences of NKX2-5,GATA4 and ZIC3 genes.Results:NKX2-5,GATA4 and ZIC3 genes were sequenced in 210 CHD patients,and seven gene mutations were found,including NKX2-5 heterozygous missense mutation(c.178G>T)and three heterozygous mutations in GATA4(c.677C>T,c.928A>G,c.1123G>A),three heterozygous mutations in ZIC3(c.19G>C,c.1255C>G,c.1348C>T),in which NKX2-5(c.178G>T),GATA4(c.1123G>A),and ZIC3(c.1255C>G,c.1348C>T)are new mutation sites.These gene mutations were predicted to be pathogenic mutations by bioinformatics software.Conclusion:Conclusion:Seven gene mutations were found in 210 patients,and it was the first report that the gene mutations of NKX2-5,GATA4 and ZIC3 in Hainan Province associated with the pathogenesis of CHD.

Prognostic Potential of B - type Natriuetic Peptide and Quality of Life in Patients with Chronic Heart Failure

Objectives To study wheth- er change of BNP levels reflect the change of cardiac function and to investigate the short - term prognostic potential of BNP and QOL in patients with CHF. Methods 96 consecutive patients admittedwith CHF between September 2002 and January 2003 were stud- ied , upon entry the study, BNP levels were measured, Patients administered the disease - specificquality of life questionnaire Minnesota living with heart failure questionnaire (LiHFe) within 1 day. BNP levels and administering LiHFe were repeated three months later. Results BNP levels were increased proportional to the severity of cardiac function. Physical domain and total score of LiHFe were significantly correlated to the severity of CHF ( p < 0. 05 ). BNP levels were de- creased in improving group(p =0. 032) . In deteriora- ting group BNP levels increased (P = 0. 043 ) . Kaplan - meier analysis according to BNP level cutoff point 150 ng/1, the life curve of higher BNP level group was significantly lower than the lower group ( p = 0. 001 ) . In univariate logistic regression, NYHA class, BNP, LVEF, LVEDD, heart size, total score of LiHFe, phys- ical domain of LiHFe and the emotional domain of LiH- Fe were all significant prognostic factors of CHF ( p < 0. 05 for all). While in multiple regression, only BNP level( p = 0. 036) and the emotional domain of LiHFe ( p = 0. 025 ) were independent prognostic factors. Conclusions Change of BNP reflects the treatment efficacy of CHF. BNP and QOL are the two major short - time prognostic factors of the chronic heart failure patients.

象性合参论远志效用特色与优势

采用药性与法象理论合参方法,融合现代药理与临床认识,阐释远志双调心神的作用机制,为远志治疗难治性病证提供药学与临床依据。研究发现,远志的特殊药象是其宁心安神功效的药材学基础,结合其“辛烈开窍”的性能特点,采用象性合参的方法,不仅有助于理解远志双调心神的特殊功效及其“安神不闭窍,开窍不动神”的药效特点,而且对认识用其治心神疾患、睡眠紊乱以及惊风、中风、癫痫等病证的作用优势,也提供了“象思维”的路径。象性合参还可揭示远志交通心肾的作用机制,并与其双调心神作用结合,拓展治疗心神失常之应用范围。因此,运用象性合参阐释远志的多重药理效用,是探析其治疗疑难杂病机制的重要方法。

Functional role of circRNA CHRC through miR-431-5p/KLF15 signaling axis in the progression of heart failure

Pathological myocardial hypertrophy is a common early clinical manifestation of heart failure,with noncoding RNAs exerting regulatory influence.However,the molecular function of circular RNAs(circRNAs)in the progression from cardiac hypertrophy to heart failure remains unclear.To uncover functional circRNAs and identify the core circRNA signaling pathway in heart failure,we construct a global triple network(microRNA,circRNA,and mRNA)based on the competitive endogenous RNA(ceRNA)theory.We observe that cardiac hypertrophy-related circRNA(circRNA CHRC),within the ceRNA network,is down-regulated in both transverse aortic constriction mice and Ang-II--treated primary mouse cardiomyocytes.Silencing circRNA CHRC increases cross-sectional cell area,atrial natriuretic peptide,andβ-myosin heavy chain levels in primary mouse cardiomyocytes.Further screening shows that circRNA CHRC targets the miR-431-5p/KLF15 axis implicated in heart failure progression in vivo and in vitro.Immunoprecipitation with anti-Ago2-RNA confirms the interaction between circRNA CHRC and miR-431-5p,while miR-431-5p mimics reverse Klf15 activation caused by circRNA CHRC overexpression.In summary,circRNA CHRC attenuates cardiac hypertrophy via sponging miR-431-5p to maintain the normal level of Klf15 expression.

徐凤芹从“心主神明”辨治失眠经验

失眠病位主要在心,涉及肝、脾、肾。心神失养或实邪内扰、心神不宁皆可导致失眠。临证宜分清脏腑病位、标本虚实。肝郁血虚、心神失养者,常以柴胡加龙骨牡蛎汤或解郁合欢汤加减;痰热内盛,扰动心神者,常以半夏秫米汤或十味温胆汤加减;心脉瘀阻、心神不宁者,常以血府逐瘀汤加减。老年人作为特殊的群体,失眠病位多在心肾,常合并脾胃虚弱,可选用交泰丸或合用归脾汤加减,并强调对于原发病的治疗和药物因素。失眠患者也需适当使用安神药物。在安神药物配伍上,多基于辨证论治角度,结合现代药理研究精妙施用安神药物。

王暴魁教授辨治失眠临证经验浅析

王暴魁教授认为失眠的直接病机为心神不安,与脏腑营卫气血亏虚,五脏无以藏神,卫气无以入营密不可分。年老久病体虚之人还可责之阳虚阴格。而脏腑虚衰、情志不遂、饮食不宜等因素导致痰湿、湿热、肝火、气滞、食积等邪客于脏腑间,阻滞卫气出入阴阳之道,从而导致失眠。结合临证实践经验,王暴魁教授以补五脏、宁心神、调阴阳为要,不忘逐客邪,通阴阳,使阴阳既济,互根互用,寤寐得安。

陈意教授“以和统之”理论治疗不寐临床经验探讨

[目的]总结陈意教授“以和统之”理论指导下治疗不寐的临证经验。[方法]通过师承学习、整理归纳相关文献及陈意教授的论述与案例,详细阐述对不寐病因病机的认识,探讨基于“以和统之”理论的独特辨治思路和经验,并举以医案验证。[结果]陈意教授认为不寐的发生是由于脏腑阴阳失衡、气血失和,提出以和法统摄八法,采取分而治之的策略,并强调养、疏、清、宁,形成了独特的安神助眠治疗特色。所附医案为值绝经前后的不寐患者,以阴阳失衡、阴不敛阳而致阴虚火旺为主病机,予滋阴降火、宁心安神治法,进一步调和气血,恢复脏腑功能,达到“阴平阳秘”的状态,“致中和”、人安寐。[结论]陈意教授以“以和统之”理论治疗不寐,疗效显著,值得学习与推广。

养心安神汤联合耳穴压豆干预大鼠脑卒中后失眠的研究

目的探讨养心安神汤联合耳穴压豆干预大鼠脑卒中后失眠的作用机制及疗效。方法构建大鼠脑卒中后失眠模型,造模成功后随机分成假手术组、模型组、西药组及实验组,连续干预14d。在治疗前、治疗后第7d与第14d行水迷宫实验记录大鼠逃避潜伏期、高架十字迷宫实验记录大鼠进入中央区次数。治疗14 d后处理大鼠,ELISA法检测各组大鼠血清及海马组织中脑源性神经营养因子(BDNF)、褪黑素(MT)、5-羟色胺(5-HT)、去甲肾上腺素(NE)的表达情况。Western blot方法检测各组大鼠NE转运蛋白和MT受体蛋白相对表达水平。结果实验组大鼠进入中央区次数、血清中BDNF、5-HT的表达水平、海马组织中BDNF、MT、5-HT、NE、多巴胺转运体(SLC6A3)、褪黑素受体蛋白1B(MTR1B)表达水平均高于模型组(P<0.05)。结论养心安神汤联合耳穴压豆对大鼠脑卒中后失眠的症状具有一定的改善作用,其作用机制可能是通过升高机体内5-HT、BDNF及加强SLC6A3、MTR1B蛋白表达来实现的。

THE CENTRAL DISTRIBUTION OF ADRENOMEDULLIN AND ITS EFFECTS ON BLOOD PRESSURE AND HEART RATE IN RATS

The present study was designed to make certain whether there exists adrenomedullin (ADM) in the rat central nervous system and evaluated the hemodynamic actions of intracerebroventricular administration (ICVA) of human ADM[13-52]. By immunohistochemistry (ABC method),We found that there was a discrete localization of ADM-positive immunoreactivity in the rat central system including cerebral cortex,paraventricular tissues, hypothalamus, cerebella cortex, mesencephalon and medulla oblongata. By reverse transcription-polymerase chain reaction(RT-PCR) analysis, rat ADM mRNA was found to be expressed in rat brain. These above results of immunohistochemistry and RT-PCR suggest that ADM exists in the rat brain. We also found that centrally administered ADM[13-52]in a dose of 0.4 to 3. 2 nmol/kg provoked marked, prolonged and dosedependent increases in mean arterial blood pressure (MABP) and heart rate (HR). To clarify the mechanisms of the hemodynamic changes induced by centrally administered ADM [13-52]. the effect of centrally administered ADM [13-52] on renal sympathetic nerve activity (RSNA) was studied. The result showed that centrally administered ADM [13-52] ( 1. 6 nmol/kg) provoked a marked increase in RSNA .therefore .the increases in MABP and HR induced by centrally administered ADM [13-52]might be due to the stimulation of central sympathetic mechanism. In addtion,we also compared the relationship of activity and structure among the different fragments of ADM. In conclusion, ADMexists in the rat brain, and it may play an important role in the central control of cardiovascular system.

李文杰从虚(血-阳)实(痰)情志辨治心悸

李文杰教授认为痰、虚(不论血虚,阳虚)、情志不调或原发脏腑疾病相互作用,影响肝脾功能,脾失运化或肝失疏泄,扰及心神,发为心悸;提出"心悸之诊治应究其根本,实则泻之,虚则补之"的独到见解,实证(痰热内扰、肝郁化火)心悸,重在理气消痰,疏肝化火;虚者(心血不足、心阳不振),治疗以益气养血,温补心阳,宁心安神为主;情志不调,当疏肝解郁,清火安神,逍遥散主之;组方遣药配伍体现药对相须相使,注意药味、剂量比例;根据证型,采取相应治法方药。

Heart Rate Variability, Standard of Measurement, Physiological Interpretation and Clinical Use in Mountain Marathon Runners during Sleep and after Acclimatization at 3480 m

Fluctuations in autonomic cardiovascular regulation during exposure to high altitude may increase the risk of heart attack during waking and sleep. This study compared heart rate variability (HVR) and its components during sleep at low altitude and after 30 - 41 hours of acclimatization at high altitude (3480 m) in five mountain marathon runners controlled for diet, drugs, light-dark cycle and jet lag. In comparison to sea level, RR-intervals during sleep at high altitude decreased significantly (P 0.001). The significant increase in sympathetic autonomic cardiovascular modulation at high altitude protects against excessive oxygen deprivation during sleep. Increases in R-R intervals can require longer periods of acclimatization at3480 m to mitigate the effects of altitude/hypoxia on sympathetic tone, thus reducing cardiovascular distress at rest during waking and sleep and probably before during and after athletic performance at altitude.

(-)-Stepholodine induced enhancement of cardiac muscle contractions mediated by D_1 receptors

Objective To investigate the effect of(-)-Stepholidine(SPD)on enhancing D1 receptor mediated contraction of cardiac muscle in isolated rat heart and to examine whether SPD has a direct effect on the heart dopamine D1 receptors.SPD an active ingredient of the Chinese herb Stephania intermedia,binds to dopamine D1 and D2 like receptors.Biochemical,electrophysiological and behavioural experiments have provided strong evidence that SPD is both a D(1/5)agonist and a D(2/4)antagonist,which could indicate unique antipsychotic properties.Methods Normal adult rat working hearts were isolated by Langendorff technique.Results SPD significantly increased the cardiac muscle contraction in a dose-dependent manner.The selective D1 dopamine receptor antagonist SCH23390(1 μM)blocked the SPD induced heart contraction,however,neither the β-receptor antagonist propranolol(1 μM)nor the α1-receptor antagonist prazosin(1 μM)had any effect on blocking SPD induced heart contractions.Moreover,the L-type Ca2+ channel inhibitor nimodipine(1 μM)completely blocked the effect of SPD on cardiac muscle contraction.Conclusions SPD show the effect on enhancing contraction of isolated rat heart through activating L-type Ca2+ channel mediated by heart D1 receptors.

Role of Coagulation Factor Ⅶ in Pathogenesis of Ischemic Heart Disease

To study the variation and significance of plasma coagulation factor Ⅶ （FⅦ） in different kinds of ischemia heart disease （IHD） and examine its relation with plasma lipid and gene polymorphism. FⅦa was determined with one stage clotting assay by using a recombinant soluble tissue factor （rsTF）. FⅦc was measured with one stage clotting assay. FⅦag was quantified with an enzyme-linked immunosorbent assay （ELISA）. Polymorphism was analyzed with PCR-urea-polyacrylamide gel electrophoresis. Our results showed that FⅦa in stable angina （SA）, unstable angina （UA）, obsolete and acute myocardial infraction （OMI, AMI） patients was higher than those of normal group with the differences being significant within any two groups. FⅦag in UA, OMI and AMI was higher than those in SA and normal groups. There were positive correlations between FⅦa and serum triglycerides, FⅦa and FⅦc, FⅦc and FⅦag. FⅦ-323 0/10 bp polymorphism analysis was performed in 60 patients and 0/10 bp polymorphism was found in 5 cases. FⅦc and FⅦag were much lower in cases of 0/10 bp groups than those in cases of 0/0 bp groups. It is concluded that there was activation of extrinsic coagulation pathway in every kind of IHD to different extent. FⅦa was the risk factor in the development of IHD, and more sensitive in reflecting the severity of cardiovacutar disease than FⅦc or FⅦag. FⅦa was higher in OMI, which may be one of the risk factors of re-infraction. Serum triglyceride may indirectly lead to the development of IHD by increasing the level of FⅦa, FⅦ-323 0/10 bp polymorphism was present in Chinese patients with IHD and it was correlated with the level of FⅦc, FⅦag in plasma. 10 bp allelomorphic gene was a protective factor against thrombogenesis.

Complete Coronary Revascularization with on Pump Beating Heart

Background Off-pump coronary artery bypass grafting (CABG) is becoming increasingly popular world - wide. But it is not always feasible. Current cardioplegic techniques do not consistently avoid myocardial ischemic damage. So we use on pump beating heart technique to supplement off-pump CABG. Methods Based on 860 off-pump CABG cases between Aug 1998 to Aug 2000. From Aug 1999 to Aug 2000, 46 CABG cases were performed with on pump beating heart technique at Mani-pal Hospital Heart Foundation, Bangalore, India. All surgeries were performed through a median sternotomy. Exposure techniques were tailored to individual vessels and cardiac regions and local immobilization was performed with octopus. Vascular control was achieved with occluders and shunts. Total cardiopulmonary bypass (CPB) was established before or during CABG and normolthemia was used. Results Among 46 on -pump beating heart CABG patients, 26 patients used CPB before or during OP - CABG because of unstable hemodynamics and electric instability , 7 had very deep intramyocardial left anterior descending arteries, 5 patients had poor LV function (LVEF < 30 % ), 8 patients had cardiomegaly. The average number of grafts was 3.5. No operative mortality. Three patients had postoperative myocardial infarction. Anesthetic time 4. 5±1. 2 hours, extubation time 10±2. 5 hours, blood lost 680±230 mL, blood requirement 540±150 mL, preoperative LVEF 50. 3±13 % , postoperative LVEF 64. 1±14 %, ICU stay 1. 5±0. 5 days, hospi- tal stay 9.2±1.8 days. Conclusion Complete coronary revascularization with on pump beating heart is a supplement for off - pump CABG when it is not feasible. It eliminates intraoperative globe myocardial ischemia and avoids transient myocardial injury during cardioplegic arrest and myocardial reperfusion.

从心、肝、肾论治子宫内膜异位症伴焦虑、抑郁

子宫内膜异位症(EMs)常伴随焦虑、抑郁等异常情绪,同时,焦虑、抑郁等精神心理异常可能与EMs发生、发展有关,二者相互影响。EMs患者长期处于负面情绪可加重痛经、月经不调等症状,影响治疗效果,并给患者造成极大的身心负担,严重降低生活质量。本文从中医理论出发,结合女性生理特点及该病症状,基于中医心、肝、肾功能异常与EMs伴焦虑、抑郁的关系,重点阐述从心、肝、肾论治EMs伴焦虑、抑郁的思路和方法。

Compound Danshen Dripping Pill inhibits hypercholesterolemia/atherosclerosis-induced heart failure in ApoE and LDLR dual deficient mice via multiple mechanisms

Heart failure is the leading cause of death worldwide.Compound Danshen Dripping Pill(CDDP)or CDDP combined with simvastatin has been widely used to treat patients with myocardial infarction and other cardiovascular diseases in China.However,the effect of CDDP on hypercholesterolemia/atherosclerosis-induced heart failure is unknown.We constructed a new model of heart failure induced by hypercholesterolemia/atherosclerosis in apolipoprotein E(ApoE)and LDL receptor(LDLR)dual deficient(ApoE^(–/–)LDLR^(–/–))mice and investigated the effect of CDDP or CDDP plus a low dose of simvastatin on the heart failure.CDDP or CDDP plus a low dose of simvastatin inhibited heart injury by multiple actions including anti-myocardial dysfunction and anti-fibrosis.Mechanistically,both Wnt and lysine-specific demethylase 4A(KDM4A)pathways were significantly activated in mice with heart injury.Conversely,CDDP or CDDP plus a low dose of simvastatin inhibited Wnt pathway by markedly up-regulating expression of Wnt inhibitors.While the anti-inflammation and anti-oxidative stress by CDDP were achieved by inhibiting KDM4A expression and activity.In addition,CDDP attenuated simvastatin-induced myolysis in skeletal muscle.Taken together,our study suggests that CDDP or CDDP plus a low dose of simvastatin can be an effective therapy to reduce hypercholesterolemia/atherosclerosis-induced heart failure.

养血安神汤治疗心脾两虚型失眠症临床研究

目的:观察自拟养血安神汤治疗心脾两虚型失眠症的临床疗效。方法:选取2019年10月至2021年10月天津市和平区五大道街社区卫生服务中心治疗的心脾两虚型失眠症患者120例,按照随机数字表法分为观察组和对照组,每组60例。对照组给予艾司唑仑片治疗,观察组给予养血安神汤治疗。观察两组患者治疗前后睡眠质量[兹堡睡眠质量指数(Pittsburgh Sleep Quality Index, PSQI)、Epworth困倦量表(Epworth sleepiness score, ESS)评分]、中医证候积分、焦虑症状积分[焦虑症状自评量表(self-rating anxiety scale, SAS)评分、汉密尔顿焦虑量表(hamilton anxiety scal, HAMA)评分]、神经递质表达水平[促甲状腺激素(thyroid-stimulating hormone, TSH)、皮质醇(Cortisol, Cor)、生长激素(growth hormone, GH)、游离甲状腺素(free thyroxine 4,FT4)]及临床疗效。结果:观察组有效率为96.7%,对照组有效率为83.3%,观察组有效率高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后PSQI评分、ESS评分、中医证候积分、SAS评分、HAMA评分、TSH、GH、Cor、FT4均低于治疗前,且观察组PSQI评分、ESS评分、中医证候积分、焦虑评分、SAS评分、HAMA评分、TSH、GH、Cor、FT4均低于对照组,差异有统计学意义(P<0.05)。结论:自拟养血安神汤治疗心脾两虚型失眠症,可改善患者睡眠质量、焦虑症状、中医证候,其改善作用可能与调节神经递质TSH、GH、Cor、FT4的表达有关。