肝衰竭是指多种因素引起的严重肝脏损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以凝血机制障碍和黄疸、肝性脑病、腹水等为主要表现的一组临床症候群.

目的:探讨三七总皂甙(TPNS)对新生鼠窒息致脑损伤时脑细胞凋亡率及血红素氧合酶-1(HO-1)表达的影响.方法:取7日龄新生SD大鼠88只,随机分为对照组(Ⅰ组)、常压窒息模型+生理盐水组(Ⅱ组)和常压窒息模型+TPNS干预组(Ⅲ组),对照组8只,余每组40只.将新生鼠分别放人55 ml的磨口瓶中(瓶中装5g钠石灰),待新生鼠安静后,Ⅱ组及Ⅲ组紧塞瓶盖0.5h,取出后复氧2h,窒息后Ⅲ组立即腹腔注射TPNS 100 mg·kg-1、Ⅱ组腹腔注射相同容积生理盐水,以后每隔12 h腹腔注射1次,注射后放回母鼠身边继续喂养,分别在窒息后6h、24 h、48 h、72 h和7天处死;Ⅰ组放入55 ml磨口瓶中0.5h,不盖瓶盖,取出后复氧2h,放回母鼠身边继续喂养,6h后全部处死.用TUNEL法测定脑细胞凋亡率,行免疫组化检测HO-1.结果:①Ⅱ组和Ⅲ组细胞凋亡率高于对照组(P＜0.05),在48 h达高峰.②Ⅲ组(除6h组外)细胞凋亡率表达水平明显低于Ⅱ组,差异有统计学意义(P＜0.05).③Ⅱ组及HO组HO-1高于对照组(P＜0.05),在24h达高峰.④Ⅲ组HO-1的表达高于Ⅱ组(P＜0.05).结论:TPNS可降低新生鼠窒息致脑损伤时脑细胞凋亡率的表达(P≤0.01),增加H0-1蛋白的表达,对窒息导致的新生鼠缺氧缺血性脑损伤具有明显保护作用.

目的 了解云南省边境一线乡村医生(村医)的基本情况,分析儿童疾病综合管理(IMCI)培训后的效果,为进一步扩展儿童疾病综合管理的培训以及探索适合我国村医的培训模式提供依据.方法 选取云南省普洱市所有边境一线村医,集中在普洱市,分2期进行为期3d的短期儿童疾病综合管理的培训.培训严格按照由卫生部、WHO、UNICEF编写的IMCI教材、练习册、图册、教学录像进行.培训前对村医进行问卷调查了解其基本信息；IMCI情景病例考核,以及IMCI基本知识测试,了解其临床知识能力.培训3个月后,随访小组对村医进行随访、调查,在所属乡镇卫生院按照相同考核过程评估培训效果.结果 思茅市边境一线村医以少数民族为主,受教育水平绝大多数为初中及中专.根据情景病例考核,村医识别危重症、及时转诊的知识水平培训后与培训前比较有明显统计学差异(p＜0.001).对于腹泻并轻度脱水的评估、ORS及锌剂的使用认知水平亦有明显统计学差异(P＜0.001).结论 IMCI是加强儿童卫生服务的一个有效策略,对边境一线村医实行的短期培训效果显著,值得进一步扩展应用.

OBJECTIVE:Evaluate the clinical competency in detection and management complicated pneumonia, diarrhea, and measles cases of trainees who were village doctors in Puer city of Yunnan province, China.MATERIAL AND METHOD:One hundred fifty four village doctors working in the border areas were trainedfor 5-day Integrated Management of Childhood Illness (IMCI) training, which was adapted to World Health Organization (WHO) guidelines. Pre- and post-training assessment based on a modified WHO package was carried out.RESULTS:Statistically significant improvements in almost allperformances were observed. However, the level of post-training achievement was still low. Correct classifications of severe pneumonia, measles, and diarrhea were found in 63.0% 54.3% and 83.5%, respectively in the post-training periodCONCLUSION:The training package needs to be further strengthened.

Objective To investigate the prevalence,epidemiology and clinical features of Human Bocavirus(HBoV)and Human Metapneumovirus(hMPV)infection in children with respiratory tract infection in Kunming.Methods From October 2009 to December 2010,550 nasal swab samples were collected from children under 5 years with respiratory tract infection.Multiplex polymerase chain reaction was used to detect 21 common pathogens including HBoV and hMPV.At the same time,the baseline characteristics of children and clinical manifestation were recorded by researchers through structure questionnaire.SPSS software was used to analyze data.Results Out of 550 nasopharyngeal swab specimens,18 specimens were detected with HBoV infection and 29 samples were detected with hMPV infection.The positive rate of HBoV and hMPV was 3.3% and 5.3%,respectively.Among 18 HBoV positive samples,there were 17 samples mixed other pathogen infection.The mixed infection rate of HBoV accounted for 94.4%.Meanwhile,among 29 hMPV positive specimens,the co-infection rate was 58.6%.The most common pathogens of mixed infection with HBoV and hMPV were respiratory syncytial virus,rhinovirus,influenza A virus and Haemophilus influenza.Infant got higher HBoV infection.There was no significant difference between different age groups of hMPV infection.The peak of positive infection rate of HBoV and hMPV were both in autumn and winter.Fever,cough and wheezing were the major clinical manifestation of children with HBoV and hMPV infection.Conclusions HBoV and hMPV are important pathogens of acute respiratory tract infection in children in Kunming.The prevalent seasons are autumn and winter for the two virus infection.

BACKGROUND:Under-5-years child mortality remains high in rural China. Integrated management of childhood illness (IMCI) was introduced to China in 1998, but only a few rural areas have been included. This study aimed at assessing the current situation of the health system of rural health care and evaluating the clinical competency of village doctors in management of childhood illnesses prior to implementing IMCI programme in remote border rural areas.METHODS:The study was carried out in the border areas of Puer prefecture of Yunnan province. There were 182 village doctors in the list of the health bureau in these border areas. Of these, 154 (84.6%) were recruited into the study. The local health system components were investigated using a qualitative approach and analyzed with triangulation of information from different sources. The clinical component was assessed objectively and quantitatively presented using descriptive statistics.RESULTS:The study found that the New Rural Cooperative Medical Scheme (NRCMS) coordinated the health insurance system and the provider service through 3 tiers: village doctor, township and county hospitals. The 30 RMB per person per year premium did not cover the referral cost, and thereby decreased the number of referrals. In contrast to available treatment facilities and drug supply, the level of basic medical education of village doctors and township doctors was low. Discontent among village doctors was common, especially concerning low rates of return from the service, exceptions being procedures such as injections, which in fact may create moral hazards to the patients. Direct observation on the assessment and management of paediatric patients by village doctors revealed inadequate history taking and physical examination, inability to detect potentially serious complications, overprescription of injection and antibiotics, and underprescription of oral rehydration salts and poor quality of counseling.CONCLUSION:There is a need to improve health finance and clinical competency of the village doctors in the study area.

Objective To learn health HR status quo of front-line village clinics in the border of four counties,such as: Lancang,Ximeng,Menglian and Jiangchen in Puer.For exploring country health workers training model which is suited in minority nationality regions.Methods We do the questionnaire surveys to all registered health workers in 20 border townships in above four counties by WHO investigation methods and relevance questionnaire data.Results There are 87 village clinics and 137 village health workers.The average is 1.57 country health workers per village,94% of them are minority nationality health workers,village health workers sex ratio is 1.45:1.Most of them are graduated from the middle school and health school.Average age is 34 years old.Their medical professional level is low,especially to children’s disease and prevention health care.Conclusions The number of health workers are satisfied the requirement in front-line village clinics in Puer of Yunnan province.Age structure and sex ratio are reasonable.The gaps of their medical professional level is large,and the low education background has not be solved too.It’s necessary that the health workers professional training should be expanded and strengthened.

Objective To observe efficacy and safety of traditional Chinese medicine in Yunnan-GanMaoXiaoYan tablets in treatment of children with influenza A(H1N1)infection.Methods According to the case inclusion criteria,we collected influenza A(H1N1)suspected cases and randomly divided them into treatment group and control group.Patients in treatment group and control group were given treatment drug and control drug,respectively.We detailedly recorded the clinical information,collected nasal swabs before and after treatment and continuously followed up with real-time RT-PCR on nasal swabs for pathogen detection.Results The thermal annealing time(h)of patients in treatment group and control group was 13.09±7.02,and 22.13± 15.55(P<0.05),respectively.The sore throat relief time(h)was 20.36±7.91 and 27.20±12.30(P<0.05),respectively.The cough relief time(h)was 51.20±13.81 and 53.25±16.50(P>0.05),respectively.There was significant difference in the H1N1 quantitative PCR results and positive to negative rate between treatment group and control group(P<0.05).Conclusions GanMao XiaoYan tablets with the main characteristics of Chinese medicine in Yunnan Province is safe and efficient in the treatment of influenza A(H1N1)infection,able to quickly alleviate the influenza-induced fever,sore throat and other symptoms.It can reduce the viral load in respiratory secretions quickly,and speed up the virus turn to negative.

目的 探讨不同程度足月新生儿高间接胆红素血症(简称高胆)血清CK-MB的变化及意义.方法 对218例足月新生儿高胆(轻度高胆红素血症组73例;中重度高胆红素血症组145例)和20例对照组测定血清CK-MB.结果 轻度高胆红素血症组CK-MB高于对照组,但差异无统计学意义(P>0.05),而中重度高胆红素血症组CK-MB高于轻度黄疸组及对照组,差异有统计学意义(P<0.05).结论 部分足月新生儿不明原因高胆存在CK-MB增高,且中重度黄疸患儿CK-MB升高明显,应注意保护心肌.

Objective To explore the expression of heme oxygenase-1 (HO-1) mRNA in myocardium of neonatal rats with hypoxic-ischemic encephalopathy (HIE) as well as the relationship with apoptosis in myocardium. Methods Seven-day-old SD rats were randomly divided into HIE group, HIE+Znpp group and control group. Expression of HO-1 mRNA as well as the relationship with apoptosis after HIE in neonatal rats in 3 groups were determined by in situ hybridization and terminal deoxynucleotidy transferase mediated UTP-biotin nicr end labeling. Results 1.In the myocardium, expression of HO-1 mRNA increased sharply at 6 h(P＜0.05), and after HIE 12 h reached the peak from 12 h to 24 h, and then decreased gradually after 48 h, which was still higher than that in control group at 72 (P(subscript a)＜0.01). In HIE+Znpp group, HO-1 mRNA decreased compared with that in control group, and increased gradually after 48 h(P＜0.05). 2. In HIE group, apoptosis of myocardial cells increased gradually after 6 h, and reached highest at 48 h, but from 72 h it decreased gradually. In HIE+Znpp group, apoptosis of myocardial cells was increased gradually after 6 h, at 12 h was highest, after 24 h decreased gradually, but compared with control group and HIE group, it was still higher (P＜0.01, 0.05). Conclusions Expressions of HO-1 in neonatal rats myocardial cells may increase after HIE, which suggests that HO-1 mRNA is associated with asphyxia myocardial cells apoptosis.

目的:探讨新生大鼠脑缺氧缺血再灌注（HIR）发生后不同时段三七总皂甙（PNS）对心肌过氧化物歧化酶（SOD）、丙二醛（MDA）、谷光甘肽过氧化酶（GSH-PX）、黄嘌呤氧化酶（XOD）、核转录因子-kB（NF-kB）的影响。方法:结扎7日龄大鼠右颈总动脉后放入8%低氧舱2 h制成HIR模型,采用黄嘌呤氧化酶法、硫代巴比妥酸法、化学比色法、免疫组化法测大鼠脑HIR后用PNS干预HIR模型组心肌6、24、48、72 h SOD、MDA、GSH-PX、XOD、NF-kB变化,并做相应病理切片以对比。结果:HIR模型组心肌SOD、GSH-PX活性明显低于对照组,MDA、XOD、NF-kB明显高于对照组,P＜0.01;HIR后采用PNS干预组SOD、GSH-XP活性明显高于HIR模型组;MDA、XOD、NF-kB明显低于HIR组,P＜0.01;与对照组比较P＞0.05,差异无统计学意义。病理组织切片评分显示,脑HIR模型组与采用PNS治疗组在6、24、48 h,差异无统计学意义,P＞0.05;72 h差异有统计学意义,P＜0.05。结论:新生大鼠脑HIR后6～72 h内心肌细胞出现SOD、GSH-PX活性下降,MDA、XOD含量增高,NF-kB表达增高,并出现相应病理学变化,PNS对脑HIR后心肌损伤有保护和治疗作用。