目的 观察社区康复护理对地震伤截瘫患者的疗效。 方法 2008年12月－2009年6月，选取都江堰市多家医院共87例康复期地震伤截瘫患者，其中观察组选取在社区采取康复护理措施的患者，对照组选取在住院期间进行健康宣教和出院时按常规进行出院指导的患者，比较两组研究对象的日常生活活动能力、并发症发生率和治疗效果。 结果 观察组日常生活活动能力优于对照组（F=8.042，P=0.009），并发症发生率低于对照组（泌尿系统感染：χ2=6.464，P=0.011），治疗效果优于对照组（U=598.500，P=0.001）。 结论 社区康复护理有利于改善地震伤截瘫患者的日常生活活动能力并预防并发症，对提高患者的生存质量有着十分重要的意义。
In order to standardize and improve the level of TCM diagnosis and treatment of uterine prolapse, the Gynecology Branch of China Association of Traditional Chinese Medicine and the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine took the lead in initiating the revision of the "Guidelines for the TCM diagnosis and treatment of uterine prolapse". Based on the existing relevant literature, the guideline revision working group strictly abides by the principles and steps of evidence-based guideline revision, and establishes a multi-disciplinary and multi-field expert team to standardize the guideline revision work. This plan focuses on the necessity of guideline revision, the establishment and division of labor of the guideline project team, the determination of clinical problems, the screening and evaluation of evidence, and the formation of recommendations.
ObjectiveTo explore the role of joint regulation of Wnt and bone morphogenetic protein (BMP) signaling pathways in the differentiation of human induced pluripotent stem cells (hiPSCs) into cardiomyocytes.MethodsHiPSCs were cultured and observed under inverted phase contrast microscope. Immunofluorescence staining was used to observe the expressions of hiPSCs pluripotent markers (OCT3/4, NANOG, and TRA-1-60). HiPSCs were passaged which were taken for subsequent experiments within the 35th passage. When the fusion degree of hiPSCs was close to 100%, the CHIR99021 (Wnt pathway activator) was added on the 0th day of differentiation. Different concentrations of IWP4 (inhibitor of Wnt production) were added on the 3rd day of differentiation, and the best concentration of IWP4 was added at different time points. The optimal concentration and the best effective period of IWP4 were obtained by detecting the expression of troponin T (TNNT2) mRNA by real-time fluorescence quantitative PCR. Then, on the basis of adding CHIR99021 and IWP4, different concentrations of BMP-4 were added on the 5th day of differentiation, and the best concentration of BMP-4 was added at different time points. The optimal concentration and best effective period of BMP-4 were obtained by detecting the expression of TNNT2 mRNA. Finally, hiPSCs were divided into three groups: Wnt group, BMP group, and Wnt+BMP group. On the basis of adding CHIR99021 on the 0th day of differentiation, IWP4, BMP-4, and IWP4+BMP-4 were added into Wnt group, BMP group, and Wnt+BMP group respectively according to the screening results. Cells were collected on the 7th and the 15th days of differentiation. The expressions of myocardial precursor cell markers [ISL LIM homeobox 1 (ISL1), NK2 homeobox 5 (NKX2-5)] and cardiomyocyte specific markers [myocyte enhancer factor 2C (MEF2C), myosin light chain 2 (MYL2), MYL7, and TNNT2] were detected by real-time fluorescent quantitative PCR. Cells were collected on the 28th day of differentiation, and the expression of cardiac troponin T (cTnT) was detected by flow cytometry and immunofluorescence staining.ResultsThe results of cell mophology and immunoflurescence staining showed that the OCT3/4, NANOG, and TRA-1-60 were highly expressed in hiPSCs, which suggested that hiPSCs had characteristics of pluripotency. The optimal concentration of IWP4 was 10.0 μmol/L (P<0.05) and the best effective period was the 3rd day (P<0.05) in inducing hiPSCs to differentiate into cardiomyocytes. The optimal concentration of BMP-4 was 20.0 ng/mL (P<0.05) and the best effective period was the 3rd day (P<0.05). The relative expressions of ISL1, NKX2-5, MEF2C, MYL2, MYL7, and TNNT2 mRNAs, the positive expression ratio of cTnT detected by flow cytometry, and sarcomere structure detected by immunofluorescence staining of Wnt+BMP group were superior to those of Wnt group (P<0.05).ConclusionJoint regulation of Wnt and BMP signaling pathways can improve the differentiation efficiency of hiPSCs into cardiomyocytes.