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。

Progress and Developing Trend of Purging Plugs for Refining Ladle

Damage reasons of purging plugs for refining ladle and research progress on thermal shock resistance of corundum- spinel purging plugs were summarized. Research achievements and application results of nonoxides bonded corundum purging plugs for refining ladle were briefly reviewed. The further research and developing trend of purging plugs was proposed.

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.

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.

基于“苦欲补泻”从脾论治慢性心力衰竭

慢性心力衰竭是各种心脏疾病的严重和终末阶段。中医概括其病机为“虚”“瘀”“水”,以心之气阳亏虚为本,以血瘀、水停为标,病位涉及五脏,尤以心脾关系密切。苦欲补泻理论源于《黄帝内经》,是指导临床组方用药的重要原则。本文结合脾苦欲补泻理论,探讨慢性心衰病机,论述苦温燥湿、甘淡补脾、甘温补虚的治疗原则,以期为慢性心衰治疗提供新的方法及思考。

难治性胃食管反流病的原因和中医药诊治策略

胃食管反流病是临床常见病,病理机制复杂,临床症状多样,采用单一治疗方式对部分患者难以奏效,易导致病情迁延而发展成为难治性胃食管反流病。目前国内外对难治性胃食管反流病并无确切的定义和诊断标准,也无统一的治疗方案。中医辨证治疗能够改善患者精神心理状态,提高生命质量,疗效较好。

真武汤与葶苈大枣泻肺汤在肺心病急性发作期中的应用效果

目的研究在肺心病急性发作期中使用真武汤与葶苈大枣泻肺汤的效果。方法选取2022年1—12月本院收治的70例肺心病急性发作期患者进行研究,并按照随机分组法分为对照组和研究组,每组35例。其中,对照组在治疗中使用常规西药治疗,研究组在常规治疗的基础上加用真武汤与葶苈大枣泻肺汤,治疗后,对比两组治疗效果。结果研究组治疗效果明显更高,血气分析结果均明显更优,组间差异有统计学意义(P<0.05)。结论在肺心病急性发作期,应用真武汤与葶苈大枣泻肺汤联合治疗,疗效显著。

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.

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.

探讨“五脏苦欲补泻”理论对治疗冠心病组方遣药的指导

“五脏苦欲补泻”理论起源于《内经》,是在基于法象思维的藏象理论基础上,根据五脏功能失调的病理状态,通过药物的五味属性,结合其自身生理特性,顺应其生理特性为补,逆其生理特性为泻,以指导临床遣方用药来调整五脏功能,使五脏顺应四时之气。中医学认为人是一个有机的整体,五脏中任何一脏功能失调都可以导致冠心病,临证之时,应从肝、心、脾、肺、肾入手,以“五脏苦欲补泻”为用药的指导原则对其进行辨证论治。

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.

《活幼心书》治疗惊风的思路及用药规律探讨

探讨元朝医家曾世荣所著《活幼心书》治疗惊风的思路及用药规律。《活幼心书》诊治惊风重视心火肝风的病机特点和调理脾胃的治疗宗旨,善用攻法分期辨证治疗急惊风。急惊风初期需清解表邪,邪去则正安;中期需清利小便以通心气,泻火安神;对惊风后仍存有痰热之邪、预后不佳的患儿,可针对性地运用化痰逐水的中药,阻断患儿病情进展;对受惊而惊风的患儿,应重视行气法调整气机。在攻邪的同时,注重以寒温并用的方式固护脾胃。用药规律分析结果显示:治疗惊风使用频次较高的药物有甘草、生姜、人参、茯苓、肉桂,用药多选用药性为温性与寒性及药味为辛甘的药物,且多归脾胃二经;挖掘得到2个新方组合,新方组合1(大黄、防风、茯神)具有清热泻火、平肝熄风、宁心安神的作用,可用于急惊风中期以平肝清心;处方2(大黄、防风、生姜)具有发散表邪、清热泻火、温中解毒化痰的作用,可用于急惊风初期以解表合营。《活幼心书》治疗惊风的思路及用药规律可为现代中医临床提供参考。

少府穴的临床运用浅析

少府穴为历代医家常用穴之一,其穴性特殊,取穴简便,疗效广泛。根据《难经六十四难》中“阴井木,阳井金”的五行属性规律,少府作为手少阴心经荥穴,其属性为火,位于掌心,与劳宫为邻;“病变于色者取之荥”,以及“实则泄其子”的子母补泻法拓展了少府穴的效用范围。文章拟以少府穴的作用机制为切入点,结合其穴性、归经、脏腑联系等特点,通过分析其功效,从强心、泻热、疏肝、安神、益肾5个方面梳理其主治范围,旨在丰富少府穴的临床应用思路。

清肝泻心汤对2型糖尿病胰岛素抵抗相关因素影响的研究

目的探讨清肝泻心汤对2型糖尿病患者血清多种脂肪细胞因子水平变化的影响及其与胰岛素抵抗的关系。方法按随机数字表法将60例患者分为2组并进行均衡性检测,治疗组30例采用清肝泻心汤治疗,对照组30例采用文迪雅(马来酸罗格列酮)治疗2个月。用ELISA法检测并比较治疗前后两组的抵抗素、脂联素、瘦素、肿瘤坏死因子-α、白介素-6水平。检测并比较治疗前后两组的总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、C反应蛋白、胰岛素抵抗指素。结果治疗组及对照组均能降低T-Cho及TG水平,但2组治疗前后及两组间比较无差异(P>0.05),2组治疗后能升高HDL-C水平及降低LDL-C水平(P<0.05),但2组比较无明显差异性(P>0.05)。在改善胰岛素抵抗疗效方面,2组治疗后均能升高胰岛素敏感性指数,胰岛素抵抗明显改善,但两组间差值比较差异不显著(P>0.05)。2组治疗后血清抵抗素水平明显降低(P<0.01),脂联素水平明显升高(P<0.01),但2组间差值比较差异不显著(P>0.05)。治疗后治疗组能明显降低瘦素、肿瘤坏死因子-α、C反应蛋白、白介素-6水平(P<0.01),对照组能明显降低C反应蛋白、白介素-6水平(P<0.01),治疗前后有显著差异(P<0.01),两组间比较有显著性差异(P<0.01)。结论清肝泻心汤及文迪雅治疗2型糖尿病均能降低患者血清抵抗素水平、升高脂联素水平,这些脂肪细胞因子的改变可能与2型糖尿病患者胰岛素抵抗的改善有关。