miRNA-208a-3p过表达致慢性心衰大鼠心肌细胞线粒体钙超载和功能障碍的机制研究

目的观察miRNA-208a-3p在慢性心力衰竭大鼠心肌中的表达水平,探讨其在线粒体钙稳态和线粒体功能方面的调节机制。方法35只健康SD大鼠,随机分为模型组(n=20)和对照组(n=15),模型组采用腹主动脉直径缩窄法建立慢性心衰模型,对照组行假手术。通过心功能和组织病理学检测评价模型,测定心肌miR-208a-3p表达,心肌线粒体去乙酰化酶3(SIRT3)蛋白和NADH脱氢酶亚基1(ND1)蛋白表达、线粒体Ca2+水平、心肌细胞活性氧(ROS)生成。结果模型组大鼠心肌miR-208a-3p表达水平显著高于对照组(P<0.05),SIRT3蛋白表达显著低于对照组(P<0.001),且miR-208a-3p与SIRT3表达呈显著负相关;模型组ND1蛋白表达显著低于对照组(P<0.05),且ND1与SIRT3表达呈显著正相关;模型组心肌细胞线粒体内Ca2+水平显著高于对照组(P<0.05),心肌细胞ROS生成也显著高于对照组(P<0.05)。结论慢性心衰心肌组织miR-208a-3p过度表达与SIRT3/ND1活性降低相关,抑制线粒体呼吸链活性,此外,心肌细胞出现线粒体钙超载和ROS生成增加,进一步加剧线粒体呼吸功能障碍,是慢性心衰线粒体功能障碍的重要机制。

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

BACKGROUND: Hospital emergency department(ED) use by patients from residential aged care facilities(RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home(Hi NH) program.METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics.RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio(95%CI): 0.09(0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio(95%CI): 0.22(0.07, 0.66); P=0.007].CONCLUSION: The Hi NH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

Personal recovery and involuntary mental health admissions: The importance of control, relationships and hope

Purpose: Involuntary mental health admissions remain a highly contested area in law, policy and practice. There are growing concerns about the effectiveness and potential harms of using coercion to enable treatment. These concerns are heightened by the worldwide shift to recovery oriented care, which emphasizes the importance for mental health consumers experiencing self- sufficiency, control and having input into their own treatment. Involuntary treatment challenges these very principles. Methods: For this study we adapted Noblit and Hare Meta Ethnography methods and synthesized the themes of seven qualitative studies which focused on the experiences of involuntary mental health admission. Results: Seven overarching dimensions were identified as either hindering or facilitating recovery, namely: 1) having input into own treatment;2) shared humanity;3) power imbalance/ balance;4) freedom and control;5) ability/inability to incorporate the episode/experience;6) treatment factors;and 7) importance of relationships. Conclusions: The findings of this study indicate that the recovery framework, in particular the concepts of hope, relationships and control are very relevant in the context of involuntary settings.

PreEMPT (Preterm Infant Early Intervention for Movement and Participation Trial): The Feasibility of a Novel, Participation-Focused Early Physiotherapy Intervention Supported by Telehealth in Regional Australia—A Protocol

Background: Early intervention is beneficial for improving preterm infant motor and cognitive outcomes in early childhood;however, little is known about whether early intervention can influence a preterm infant’s participation. Additionally, many studies investigating the impact of early intervention for preterm infants have been conducted in large metropolitan centres, leaving preterm infants who reside in regional areas underrepresented in the literature to date. Consequentially, it is not yet known whether there are service delivery models, such as using telehealth as an adjunct to face-to-face intervention, that might cater to the needs of preterm infants residing outside metropolitan centres. PreEMPT (Preterm infant Early intervention for Movement and Participation Trial) is a novel early physiotherapy intervention that has been designed to use a participation goal-directed intervention approach via a mixture of face-to-face clinic sessions and telehealth sessions to improve the motor and participation outcomes of preterm born infants. Methods: This study aims to evaluate the feasibility of PreEMPT using an assessor-blinded, randomised controlled trial to compare PreEMPT to Usual Physiotherapy Care (UPC) for preterm infants residing in a regional Australian hospital catchment area. Twenty-six preterm infants (≤34 + 6 weeks gestational age) will be recruited prior to term corrected age from the special care nursery of a regional hospital. Following informed consent and baseline assessments, infants will be randomly allocated to receive either PreEMPT, a novel participation-focused early physiotherapy intervention delivered weekly for 14 forty-five-minute sessions alternating face-to-face sessions with telehealth into the infant’s home, or UPC, two - three physiotherapy sessions in the 4-month intervention period. Outcome measures relating to infant neuromotor development, motor performance, general development, and parental mental health and well-being will be assessed at 4-, 6- and 8-months corrected age. Feasibility will be evaluated by acceptability (parental satisfaction), demand and practicality (recruitment rate and telehealth session implementation), implementation (attendance at assessment and treatment sessions), and limited efficacy testing (comparing outcomes listed above for infants in PreEMPT and UPC). Discussion: This study will be the first of its kind to use the participation of preterm infants in meaningful life situations as the foundation for intervention delivered via alternating face-to-face clinic sessions with telehealth into the home. The feasibility of this approach will be evaluated and used to inform future iterations of research about PreEMPT’s efficacy for improving preterm infant motor and participation outcomes.

Obstructive uropathy-acute and chronic medical management

Obstructive uropathy is an important cause of acute and chronic kidney disease.Decompression of the urinary tract is an essential aspect of treatment.The cause and aetiology of obstruction typically determine the surgical approach.Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance.Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy.This narrative review summarises the early and long-term medical management of obstructive uropathy.

The Association of Overweight and Obesity with Blood Pressure among Chinese Children and Adolescents

Objective To examine the association between obesity and high blood pressure （BP） in Chinese children and adolescents. Methods Body mass index （BMI） and blood pressure measurements of 197 191 children aged 7-17 years were obtained from a Chinese national survey in 2010. Obesity and high BP were defined according to the reference values for Chinese children. Adjusted odds ratios （ORs） and 95% confidence intervals （CIs） of different BMI categories for high BP, as well as the population attributable risk percent （PAR%）, were also calculated. Results The prevalence of high BP was 16.1% for boys and 12.9% for girls in 2010. Overweight and obese children had a significantly higher prevalence of high BP than non-overweight children in both boys and girls in each age group. ORs （95% CI） for high BP were 4.1 （3.9, 4.4） in obese boys and 4.0 （3.7, 4.3） in obese girls. The overall PAR% for high BP due to overweight and obesity was 14.4%. Conclusion Overweight and obese children have a significantly higher risk of high BP than non-overweight children. Eliminating overweight and obesity could reduce 14.4% of high BP cases.

Brazilin from Caesalpinia sappan heartwood and its pharmacological activities:A review

Caesalpinia sappan L.(CS) is a plant of Leguminosae family,commonly known as Brazil or Sappan wood.CS is distributed in Southeast Asia and its dried heartwood has been used as traditional ingredient of food or beverages and has a wide variety of medicinal properties.Higher extraction yield of CS wood was achieved with 95% ethanol for 2 h.Chemical constituent's investigation of sappan wood resulled in the isolation of various structural types of phenolic components including one xanihone,one coumarin,three chalcones,two flavones three homoisoflavonoids and brazilin.Brazilin[(6a S-cis)-7,11b-dihydrobcnz[b]indeno[1.2-d]pyran-3.6a.9.10(6H)- tetroll.a major and active compound found in CS heartwood.Most of the folkloric uses of brazilin were validated by the scientific studies such as antioxidant,antibacterial,anti-inflammatory,anti-photoaging.hypoglycemic,vasorelaxant,hepatoproteetive and anti-acne activity.CS heartwood extract is safe and did not produce any acute or subacute toxicity in both male and female rats.Brazilin is the safe natural compound having potential to develop as a medicinal compound with application in food,beverage,cosmetics and pharmaceutical industries to screen its clinical use in modern medicine.The information gained could provide the important and potential approach for pharmaceutical researcher to implicate the knowledge of brazilin in the formulation of new drug and to reveal therapeutic and gaps requiring future research opportunities.More studies are needed to evaluate the potential application of brazilin as preservative and coloring agent in food processing industries.

Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China

Objective: To identify clinical and pathologic factors that were associated with the survival of stage IB upper lobe non-small cell lung cancer (NSCLC) patients. Methods: A retrospective study of 147 subjects who had undergone curative resection for stage IB upper lobe NSCLC was performed. Patients who had received any adjuvant or neo-adjuvant chemotherapy were excluded. Survival function curves were estimated using the Kaplan-Meier procedure. Crude and adjusted hazard ratios (HRs) of potential prognostic factors were estimated using Cox proportional hazards models. Results: Five factors, including age, tumor size, histologic grade of differentiation, number of removed superior mediastinal lymph node stations and presence of visceral pleura invasion, were significantly and independently associated with mortality risk. Adjusted HRs were 2.6 [95% confidence interval (95% CI): 1.1?6.5] and 4.6 (95% CI: 1.9?11) for those aged 58?68 years and those >68 years, respectively, relative to those aged <58 years. HRs for those with poorly and moderately differentiated tumors were 6.4 (95% CI: 2.3?18) and 1.4 (95% CI: 0.7?2.8), respectively. HRs for those with tumor size 3.1?5 cm and >5 cm (vs ?3.0 cm) were 2.3 (95% CI: 1.1?4.9) and 4.3 (95% CI: 1.9?10), respectively. The presence of visceral pleura invasion also increased the risk of mortality (HR=4.0, 95% CI: 1.3?12). Conclusion: Advanced age, larger tumor size, poorly differentiated histology, smaller number of removed superior mediastinal lymph node stations, and presence of visceral pleura invasion were associated with poor survival of surgically treated stage IB upper lobe NSCLC patients.

Temporal variation in cardiovascular disease risk predicted by albuminuria: An opportunity for clinical intervention?

Albuminuria predicts cardiovascular disease (CVD) events but it is likely to vary over time in a nonlinear fashion. The aim of this study was to estimate the potentially differing predictive effect of albuminuria on the risk of CVD or related death over time. Data were from a cohort study of 3505 predominately indigenous adults from remote communities in Queensland,Australia, 1999-2006. Cox Proportional Hazards model analysis of the predictive effects of urinary albumin creatinine ratio on the risk of CVD or CVD-related death was undertaken for incident and prevalent CVD. Analyses sequentially removed those who had a cardiovascular event or related death for the first year through to six years. The baseline prevalence of microalbuminuria was 21.2% and for macroalbuminuria 6.7%. The incidence of CVD was92 in13,812 person-years. Microalbuminuria predicted incident CVD with a Hazard Ratio (HR) of 3.0 (95% CI 1.83 - 4.96) and for macroalbuminuria HR 10.8 (95% CI 6.58 - 17.68) and for those with pre-existing CVD, HR 2.6 (95% CI 1.65 - 3.97) and HR 9.7 (95% CI 6.38 - 14.82) respectively. People with macroalbuminuria who survived the first three years had a crude HR of an incident cardiovascular event or death of 13.0 (95% CI 6.45 - 26.39) to a peak of 32.3 (95% CI 8.55 - 121.77) for those who survived the first five years. The hazard appeared to drop in the 6th year although this is based on small numbers.The first three years after finding macroalbuminuria provide a potential window opportunity to actively manage the risk of incident CVD before the risk elevates.

General Practitioners, Patients, and Care Givers Support the Use of a Telegeriatric Memory Disorder Consultation for Older Adults

Evidence has shown that diagnosis of dementia is reliable via video conference, but uptake of telehealth in this field has been slow. The aim of this paper was to consider the feasibility of implementing a telegeriatric memory disorder consultation as a standard clinical service and to assess stakeholder satisfaction with such a service. Method: The focus was on patient population located some distance from access to specialist services. General Practitioners (GPs) located in a remote area referred patients for a video consultation (VC) for cognitive assessment. A satisfaction survey was completed by referring GPs, patients or care givers, and the geriatrician. Results: Seven GPs agreed to participate in the pilot. Nine patients were referred for assessment, eight were diagnosed with dementia. GPs identified the specialist input as significant to patient care. Participants interacted with the specialist on a level that was comparable to a face-to-face assessment. Conclusion: It was clinically feasible to implement a telegeriatric memory disorder clinic. GPs, patients and their families living in a remote area found that a telegeriatric memory consultation was a highly satisfactory alternative to traveling to a major city for a memory assessment. Key Points: 1) GPs judged the diagnosis and recommendations by the specialist to be reliable and would recommend the service;2) Rather than travel a long distance to see a specialist, attending the appointment via video conference is a suitable alternative for geriatric cognitive assessment.

The Implications of the Timing of Diagnosis of Dementia on the Dementia Caregiver

This is a consumer-reference feedback and feasibility testing of a protocol to obtain qualitative responses of co-residing caregivers to questions regarding the timing of dementia diagnosis and their experience of the disclosure of a diagnosis of dementia. Data collection involved focus group discussions and individual phone interviews of a convenience sample (N = 5) of an Alzheimer’s Australia state based Consumer Advisory Committee. Thematic analysis utilised the Leximancer software. Consumer feedback suggested a reordering of the interview questions and reversing the data collection sequence to reduce the emotional impact on participants. Suggestions were offered to limit the number of participants in the focus group to shorten the duration of the focus group session to prevent fatigue and to provide a support person to improve participant focus group comfort. Responses to the interview questions indicated caregivers retrospectively considered a timely diagnosis would have provided useful dementia-focused planning, reduced the difficulties of living with uncertainty and would have provided more time to obtain information and support. There were strong expectations for medical practitioners to be sensitive to the possibility of dementia and to be cognisant of the diagnostic concerns of caregivers. The diagnosis of dementia and its timing is important to the dementia caregiver in providing an explanation of the problems experienced and allowing earlier organisation of care, future planning and caregiver education to reduce the difficulties of living with undiagnosed and unrecognised dementia.

Food supply and the obesity scourge: Is there a relationship?

This paper reviews literature on the relationship between food supply and obesity. The focus is on the supply, cost, and variety of food through various types of food outlets and the impact of these factors on obesity in developed countries. The article reveals complex relationships between food supply factors and obesity. A numer of factors related to lifestyles including the mobility of populations and the use of motor vehicles greatly reduce the impact of the local environment on family and individual eating patterns. However, obesity is also affected by factors such as the type and density of food outlets, the cost of food, the travel distance and means of transport to the food outlet. While the relationship between food supply and obesity in the literature reveals complex and mixed findings, this paper concludes obesity is complex and food supply is only part of this phenomenon’s predictors. Because the relationship between food supply and obesity is mediated by such multiple and complex factors including population behaviours, beliefs, lifestyles, knowledge and both food and physical environments;multiple strategies including policy development and other strategies aimed at manipulating food environments, physical environments, populations’ beliefs, behaviours and practices must be considered in searching for evidence to effectively combat obesity.

Enhanced Gene Expression Following Vaccination in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Vaccines have been shown to cause differential expression of genes and increase antibody titers against antigens. Influenza vaccines may have an effect on unexplained disorders such as Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). Immunological changes have been identified following immunization with trivalent influenza vaccine (TIV). The objective of this pilot study was to examine the consequences of TIV on cytokine and cytotoxic genes in CFS/ME. Peripheral blood mononuclear cells were preferentially isolated from whole blood of 7 CFS/ME patients and 8 controls. Following total RNA extraction and synthesis of cDNA, reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) was used to determine the expression levels of mRNAs for cytotoxic genes (perforin (PRF1), granzyme A (GZMA), granzyme B (GZMB) and cytokine genes. GZMB was significantly increased overall in the CFS/ME patients compared to the controls. GZMA was significantly increased 28 days after vaccination while PRF1 was reduced prevaccination but increased 14 days post-vaccination in the CFS/ME patients. There were no significant changes in cytokine genes pre or post vaccination. Administration of TIV may increase the expression of lytic genes in CFS/ME and this may contribute to the increase in cytotoxic activity we observed in these patients post vaccination.

澳大利亚新南威尔士悉尼市流行性感冒相关性住院治疗情况的研究

Background: Routine influenza vaccination for children aged 6-23 months has r ecently been recommended in the United States. Accurate assessment of influenza related burden of illness in children could support similar recommendations in o ther settings. However, routinely available data underestimate the role of influ enza in causing hospitalisation, and indirect estimation methods face difficulti es controlling for the concurrent circulation of respiratory syncytial virus (RS V). Recent studies from Hong Kong and the United States have used differing meth ods to estimate the true burden of influenza related hospitalisation, with dispa rate results. Methods: Retrospective population based study of children less tha n 18 years of age from Sydney, Australia, 1994 to 2001. Using two previously rep orted methods, estimates of annual hospitalisation rates attributable to influen za were derived by comparison of mean hospitalisation rates for acute respirator y disease during periods of high influenza activity and low RSV activity (define d using virological surveillance data) and periods where both influenza and RSV activity were low. These estimates were compared to rates of hospitalisation whe re influenza was recorded as the principal discharge diagnosis. Results: Hospita lisation rates attributable to influenza were up to 11 times higher, depending o n the age group and method used, compared to rates calculated from principal dis charge diagnosis codes. Conclusions: Although there remains considerable uncerta inty in estimating influenza related morbidity by methods using excess hospitali sations, even minimum estimates of disease burden warrant consideration of routi ne influenza immunisation for all children less than 2 years of age. Such estima tes, derived from principal discharge diagnosis codes, are available in most set tings.