孕前体质指数 孕期体质指数增长幅度与妊娠并发症及新生儿结局的关系

目的 探讨孕前体质指数（BMI）及孕期体质指数增长幅度（△BMI）与妊娠并发症及新生儿结局的关系。方法 将2014年12月至2015年12月在安徽医科大学第一附属医院产检并住院分娩的1 261例产妇按孕前BMI分为消瘦、正常、超重及肥胖组,按孕期△BMI分为△BMI<3.8 kg/m²组（A组）、3.8 kg/m²≤△BMI<7.5 kg/m²组（B组）和△BMI≥7.5 kg/m²组（C组）,分析比较各组妊娠并发症及新生儿结局的情况。结果 超重及肥胖组的妊娠高血压综合征（PIH）、妊娠期糖尿病（GDM）、剖宫产、巨大儿的发生率均高于正常及消瘦组（P<0.05）;C组的PIH、GDM、剖宫产、巨大儿的发生率均高于A及B组（P<0.05）;消瘦组及A组早产率、低体质量儿发生率高于其他各组（P<0.05）;在消瘦、正常、超重及肥胖组和A、B、C组的胎膜早破、产后出血发生率差异无统计学意义（P>0.05）。结论 孕妇体质量是妊娠并发症及新生儿结局的重要影响因素,临床应重视孕期体质量的增加,将其控制在适宜的范围内。     

利拉鲁肽对超重及肥胖2型糖尿病患者体质量和胰岛素抵抗的影响

目的 观察利拉鲁肽对超重及肥胖2型糖尿病患者体质量和胰岛素抵抗的影响。方法 选取安徽医科大学第二附属医院2012年6月至2014年1月住院治疗的2型糖尿病患者，将口服药物血糖控制不佳且体质量指数（BMI）≥24 kg/m²的90例2型糖尿病患者按系统随机化法分成治疗组（45例）和对照组（45例），对照组在原方案上加用基础胰岛素，治疗组加用利拉鲁肽，治疗组根据BMI进一步分为超重亚组（BMI<28 kg/m²）24例，和肥胖亚组（BMI≥28 kg/m²）21例，连续治疗12周。比较治疗后各项指标（BMI、收缩压、空腹血糖、餐后血糖等）变化。结果 治疗组BMI及稳态模型胰岛素抵抗指数（HOMA-IR）治疗后较治疗前显著降低（P<0.05），对照组治疗后增加（P<0.05）；收缩压（SBP）、空腹血糖（FBG）、餐后2 h血糖（2 h PG）、糖基化血红蛋白（HbA1C）、三酰甘油（TG）、总胆固醇（TCH）在两组中均较前下降（P<0.05），治疗组SBP、TG、TCH下降优于对照组（P<0.05），FBG、2 h PG、HbA1C下降，组间差异无统计学意义（P>0.05）；治疗组中肥胖亚组BMI下降程度优于超重亚组（P<0.05）；治疗过程中两组均未发生严重低血糖。结论 利拉鲁肽在降糖的同时也可以降低患者体质量并改善患者胰岛素抵抗；随着BMI增加，利拉鲁肽降低体质量及改善胰岛素抵抗作用越强。     

复方斑蝥胶囊联合TAC方案治疗三阴性乳腺癌的临床研究

目的 探讨复方斑蝥胶囊联合TAC方案治疗三阴性乳腺癌的疗效。方法 选取2020年4月—2023年3月在东台市中医院就诊的100例三阴性乳腺癌患者，根据随机数字表法将100例患者分为对照组（50例）和治疗组（50例）。对照组给予TAC方案治疗，第1天静脉注射多西他赛注射液75 mg/m²、静脉滴注注射用环磷酰胺600 mg/m²、静脉注射注射用盐酸表柔比星80 mg/m²。治疗组在对照组基础上口服复方斑蝥胶囊，3粒/次，2次/d。以21 d为1个化疗周期，两组在持续治疗6个周期后分析疗效。比较两组的临床疗效、生活质量、淋巴细胞相关指标、肿瘤标志物、血清指标和不良反应的情况。结果 治疗后，治疗组的总有效率（94.00%）高于对照组（80.00%），组间比较差异显著（P＜0.05）。治疗后，两组的乳腺癌生活质量量表（QLSBC）评分低于治疗前（P＜0.05），且治疗组QLSBC评分低于对照组（P＜0.05）。治疗后，治疗组的CD8⁺比治疗前小，LMR、CD4⁺、CD4⁺/CD8⁺比治疗前大（P＜0.05）；治疗组的CD8⁺比对照组小，LMR、CD4⁺、CD4⁺/CD8⁺比对照组大（P＜0.05）。治疗后，两组的血清糖蛋白抗原（CA153）、癌胚抗原（CEA）水平均比治疗前低（P＜0.05）；治疗组血清CA153、CEA水平比对照组低（P＜0.05）。治疗后，两组的血清脂联素（ADP）水平高于治疗前，血清白细胞介素-8（IL-8）水平低于治疗前（P＜0.05）；治疗组的血清ADP水平高于对照组，血清IL-8水平低于对照组（P＜0.05）。治疗期间，治疗组的不良反应发生率比对照组低，组间比较差异显著（P＜0.05）。结论 复方斑蝥胶囊联合TAC方案有助于提高三阴性乳腺癌的疗效，有助于改善患者的免疫功能和生活质量，降低肿瘤标志物的水平和药物不良反应的发生。     

孕前体重指数及孕期体重变化量对妊娠并发症及妊娠结局的影响

目的 探究孕前体重指数（BMI）及孕期体重变化量（GWG）对妊娠并发症和妊娠结局的影响。方法 选择2022年1～12月在我院建档并分娩的孕产妇1 019例为研究对象,其中高龄孕产妇204例。根据孕前BMI分为孕前肥胖组、孕前超重组、孕前正常体重组、孕前低体重组;根据GWG分为过少GWG组、适宜GWG组和过多GWG组,统计分析临床资料,比较组间妊娠并发症和妊娠结局情况。结果 孕前BMI越高,妊娠期糖尿病（GDM）、妊娠期高血压疾病（HDP）及巨大儿的发病率越高;不同GWG组间GDM、早产（PTB）的发病率比较差异有统计学意义（P<0.05）,过少GWG组GDM及PTB的患病率最高;在高龄患者中,各组间HDP及PTB的发病率比较差异有统计学意义（P<0.05）,孕前超重组HDP及PTB的发病率高于孕前正常体重组;高龄孕产妇中PTB的发病率在不同GWG组间有统计学差异（P<0.05）,过少GWG组PTB的发病率最高。结论 孕前减重及适宜的GWG对降低孕前肥胖及超重的女性不良围产期并发症及子代肥胖等代谢性疾病的发病率至关重要,应充分发挥营养门诊的作用,通过健康宣教提高孕产妇依...     

孕前体质指数联合孕中期母血清学筛查及口服葡萄糖耐量试验对子痫前期的预测价值探讨

目的 探讨孕前体质指数（BMI）联合孕中期母血清学筛查及糖耐量试验（OGTT）对子痫前期（PE）的预测价值。方法 收集2014年12月至2016年9月于安徽医科大学第一附属医院妇产科门诊就诊的1 496例孕妇资料，将孕期罹患PE的177例孕妇纳入PE组，随机匹配177例正常妊娠孕妇作为对照组，对两组孕妇资料做比较分析；对所有孕妇资料进行筛检试验，评价所选取的各指标对PE的单项及联合预测价值。结果 两组孕妇年龄差异无统计学意义（P>0.05）；而孕前BMI、人绒毛膜促性腺激素（hCG）、甲胎蛋白（AFP）、游离雌三醇（uE3）及OGTT 3个时间点的血糖差异均有统计学意义（P<0.05）。孕前BMI、hCG和OGTT 3个时间点的血糖对PE有预测价值（AUC>0.5），AFP、uE3对PE无预测价值（AUC<0.5）。联合孕前BMI、hCG、2 h-Glu对PE进行预测，AUC=0.79，预测灵敏度为78.41%，特异度为73.38%。结论 联合不同来源的指标可以提高对PE的预测价值。     

胃切除术后小肠套叠的危险因素分析

目的 分析成人胃切除术后小肠套叠的危险因素。方法 选择2010年1月至2018年12月安徽医科大学第一附属医院普外科确诊为胃部疾病并行手术的患者9 825例作为研究对象。将术后发生小肠套叠的9例患者作为病例组,从其余患者中选择36例患者（1：4）作为对照组,要求性别相同、年龄相差不超过1岁。分析术后小肠套叠与性别、体质指数（BMI）、吻合方式等因素的关系。结果 病例组患者中位BMI为21.67（19.81,23.09）kg/m²,低于对照组,差异有统计学意义（P<0.05）。病例组3例（33.33%）患者发生术中吻合器上肠管套叠,对照组2例（5.56%）,两组患者术中吻合器上肠管套叠发生率的差异有统计学意义（P<0.05）。多因素logistics回归分析显示,术中吻合器上肠管套叠是胃切除术后小肠套叠的危险因素（OR=7.508）,而BMI则是术后小肠套叠的保护因素（OR=0.609）,差异均有统计学意义（P<0.05）。结论 术前BMI高的患者术后发生小肠套叠的风险更低,而术中吻合器上肠管套叠的患者更容易出现术后小肠套叠。     

孕妇血清FABP4 PTEN及新生儿脐血中FABP4在妊娠期糖尿病患者中的表达

目的 探讨孕妇血清、新生儿脐血中FABP4与血清PTEN在妊娠期糖尿病患者中的表达。方法 选取2014年1月至12月保定市妇幼保健院收治的妊娠期糖尿病孕妇30例为妊娠期糖尿病（GDM）组,选取同期正常妊娠孕妇30例对照组。临产前检测两组孕妇血清PTEN、FABP4及其两组新生儿脐血中FABP4的水平,空腹血糖（FBG）、血清胰岛素（FINS）、三酰甘油（TG）、总胆固醇水平;计算胰岛素抵抗指数（HOMA-IR）、胰岛素敏感指数（HOMA-ISI）,分析比较两组对象上述指标,采用Pearson相关分析法分析PTEN、FABP4、HOMA-IR、新生儿体质量、孕妇血脂水平、孕前BMI相关性。结果 GDM组孕妇临产前BMI、TG、FBG、FINS、HOMA-IR、HOMA-ISI、FABP4、PTEN、新生儿体质量与对照组比较,差异有统计学意义（P<0.05）。血清PTEN与血清FABP4、HOMA-IR存在正相关（P<0.05）,血清FABP4与HOMA-IR存在正相关（P<0.05）。GDM组孕妇血清及新生儿脐血FABP4与新生儿体质量呈正相关（P<0.05）。结论 FABP4、PTEN参与妊娠期糖尿病的发展,在孕期产生胰岛素抵抗过程中发挥了重要的作用。     

双源CT 80 kV低管电压在冠状动脉CT血管成像中的可行性研究

目的 探讨双源CT 80 kV低管电压在冠状动脉CT血管成像（CCTA）中的可行性。方法 对2014年12月至2015年11月亳州市人民医院收治的行CCTA检查、体质指数（BMI） ≤ 30 kg/m²的56例患者,按检查顺序分成A组（100 kV、碘克沙醇320 mgI/mL）及B组（80 kV、碘克沙醇320 mgI/mL）,每组各28例。比较两组患者的辐射剂量;测量升主动脉（AO）根部的CT值及噪声（SD）、图像的信噪比（SNR）;测量左冠状动脉主干（LM）、左冠状动脉前降支（LAD）近段、左冠状动脉回旋支（LCX）近段、右冠状动脉（RCA）近段的CT值及邻近组织的CT值,计算LM、LAD、LCX、RCA近段的对比度噪声比（CNR）。采用Likert4分法对每组患者容积重组（VR）及最大密度投影重组（MIP）图像进行双盲主观分级评分,并作统计学分析。结果 A组辐射剂量（4.36±0.71） mSv高于B组（1.75±0.40） mSv,差异有统计学意义（P<0.05）;B组AO、RCA、LM、LAD、LCX近段的CT值高于A组,差异有统计学意义（P<0.05）。B组图像的噪声（47.17±7.76） HU较A组（29.73±4.21） HU大,差异有统计学意义（P<0.05）;两组图像的SNR、LM、LAD、LCX、RCA近段的CNR差异均无统计学意义（P>0.05）;两组图像质量主观评分、用于诊断的冠脉节段数比较,差异无统计学意义（P>0.05）。结论 对于BMI ≤ 30 kg/m²的患者,在80 kV低管电压条件下行CCTA,能明显降低患者X线辐射剂量,且图像质量能够满足临床诊断要求。     

卡瑞利珠单抗联合化疗方案治疗晚期胃癌的临床研究

目的 探讨卡瑞利珠单抗联合化疗方案治疗晚期胃癌的临床疗效。方法 选择2020年1月—2021年1月重庆市开州区人民医院收治的80例晚期胃癌患者,根据治疗方法将患者分为对照组和观察组,每组各40例。对照组第1天静脉滴注多西他赛注射液,75 mg/m²;第2天静脉滴注盐酸伊立替康注射液,75 mg/m²;第3～16天分2次口服替吉奥胶囊80 mg/m²,连续诱导化疗3个周期。观察组在对照组基础上静脉注射注射用卡瑞利珠单抗,200 mg,21 d为1个周期,连续免疫治疗3个周期。比较两组疗效及安全性,以及治疗前后血清肿瘤标志物和生活质量差异。结果 治疗后,观察组总有效率达52.50%,显著高于对照组的30.00%（P<0.05）。两组治疗后健康状况调查简表（SF-36）各项评分和总分均较治疗前增加（P<0.05）,且观察组治疗后SF-36各项评分和总分均显著高于对照组（P<0.05）。两组治疗后血清癌胚抗原（CEA）、糖类抗原199（CA199）水平均较治疗前降低（P<0.05）,且观察组治疗后血清CEA、CA199水平明显低于对照组（P<0.05）。治疗期间,观察组Ⅲ度及以上反应性毛细血管增生症发生率高于对照组（P<0.05）。结论 卡瑞利珠单抗联合化疗方案治疗可提高晚期胃癌治疗疗效,不良反应较低,并能降低血清CEA、CA19-9水平,改善患者生活质量。     

老年2型糖尿病患者血清维生素D与T细胞亚群水平及胰岛素抵抗的关系

目的 探讨老年2型糖尿病（T2DM）血清维生素D（VitD）与T细胞亚群水平及胰岛素抵抗的关系。方法 根据VitD水平,将2013年11月至2018年7月中国科学技术大学附属第一医院老年医学科收治的128例T2DM患者根据VitD水平分为正常组（29例）、不足组（40例）、缺乏组（28例）与严重缺乏组（31例）。比较T细胞亚群水平,分析VitD与T细胞亚群水平及胰岛素抵抗的关系。结果 严重缺乏组HOMA-IR、CD3⁺T、CD8⁺T细胞水平均高于缺乏组、不足组和正常组,差异均有统计学意义（P<0.05）;缺乏组HOMA-IR、CD3⁺T、CD8⁺T细胞水平均高于不足组、正常组,差异均有统计学意义（P<0.05）;正常组HOMA-IR、CD3⁺T、CD8⁺T细胞水平最低,差异均有统计学意义（P<0.05）。lgHOMA-IR、CD3⁺T、CD8⁺T细胞水平与VitD呈负相关（P<0.05）。HOMA-IR的多元线性回归分析的回归方程为：Y_lgHOMA-IR=0.480X_CD8+T+0.605X_BMI-27.875（R²=15.103,P=0.006）。结论 老年T2DM血清VitD影响T细胞亚群水平导致胰岛素抵抗加重。     

Affective and Anxiety Disorders and Alcohol and Drug Dependence:

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examiens the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors will also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.     

Modelling and simulation of variability and uncertainty in toxicokinetics and pharmacokinetics

Two important methodological issues within the framework of the variability and uncertainty analysis of toxicokinetic and pharmacokinetic systems are discussed: (i) modelling and simulation of the existing physiologic variability in a population; and (ii) modelling and simulation of variability and uncertainty when there is insufficient or not well defined (e.g. small sample, semiquantitative, qualitative and vague) information available. Physiologically based pharmacokinetic models are especially suited for separating and characterising the physiologic variability from the overall variability and uncertainty in the system. Monte Carlo sampling should draw from multivariate distributions, which reflect all levels of existing dependencies in the intact organism. The population characteristics should be taken into account. A fuzzy simulation approach is proposed to model variability and uncertainty when there is semiquantitative, qualitative and vague information about the model parameters and their statistical distributions cannot be defined reliably.     

Synthesis and anti-nociceptive and anti-inflammatory effects of gaultherin and its analogs

The synthesis of gaultherin (1) and its analogs was carried out to provide 11 glycosides under phase-transfer catalytic conditions. The activities of all synthesized compounds were evaluated by nitric oxide production inhibitory assay in vitro. Methyl 2-O-(4-O-β-d-galactopyranosyl)-β-d-glucopyranosylbenzoate (5f) showed significantly anti-nociceptive and anti-inflammatory effects by the evaluation in vivo. Structure–activity relationships within these compounds were discussed.     

Antiinfective and encrustation-inhibiting materials--myth and facts

Catheters, urethral and ureteral stents and other urological implants are frequently affected by encrustration and infection due to their permanent contact with urine. Indwelling urinary catheters provide a haven for microorganisms and thus require extensive monitoring. Several surface modification techniques have been proposed to improve the performance of devices including the immobilization of biomolecules, the incorporation of hydrophilic grafts to reduce protein adsorption, the creation of hydrophobic surfaces, the creation of microdomains to regulate cellular and protein adhesion, new polymers and antimicrobial coatings. Physico-chemical explanation to elucidate the mechanism of such encrustation or infection inhibiting materials is still not available. Our series of experiments showed a marked decrease of silver-activity in biological fluids which corresponds with the controversial clinical results obtained with silver coated urinary catheters. Rifampicin/minocycline coated catheters had very low activity against Gram-negative rods, enterococci and Candida spp., the main causing organisms of urinary catheter infection. Surface engineered materials and antimicrobial drug delivery systems will be the next generation of sophisticated urinary catheters and stents, if both efficacy as well as efficiency has been proved clinically.     

成骨细胞的功能与损伤和骨质疏松的防治

骨质疏松是一种全身性骨骼疾病,导致骨折风险增加。成人的骨量通过破骨细胞的骨吸收和成骨细胞的骨形成作用来维持动态平衡,治疗骨质疏松症的理想策略是抑制破骨细胞的骨吸收和/或增强成骨细胞的骨形成功能。目前针对保护成骨细胞及增强其功能的骨质疏松疗法相对较少。因此,本文针对成骨细胞相关功能蛋白、各种细胞损伤机制（内质网应激、氧化应激、机械过载、微小RNA和长链非编码RNA的影响等）及骨质疏松的治疗与预防作一综述,以期为针对增强成骨细胞功能的骨质疏松治疗策略提供新思路。     

Self-stimulation and amphetamine: Tolerance to d and l isomers and cross tolerance to cocaine and methylphenidate

The effects of the d and l isomers of amphetamine on self-stimulation responding were tested following acute and chronic administration. Tolerance and post-drug depression of responding occurred in tests with both isomers, indicating no role for p-hydroxynorephedrine (PHN) which is one of the metabolites of d-amphetamine. In the second experiment, d-amphetamine, methylphenidate and cocaine all produced quantitatively and qualitatively similar effects on self-stimulation responding following acute administration. Following chronic administration of d-amphetamine, animals showed tolerance to all three drugs, indicating cross-tolerance among them. These data are consistent with an hypothesis that tolerance and post-drug depression following chronic amphetamine treatment are the result of decreases in postsynaptic receptor sensitivity, which would lead to a decreased effectiveness of all three drugs, regardless of their pre-synaptic mechanisms.     

益生菌与肿瘤防治

益生菌广泛存在于自然界中,通过维持宿主体内菌群平衡、影响肠屏障功能和调节免疫应答等作用,提高宿主健康水平,被公认为"肠道健康卫士".一些益生菌可以增强机体的免疫功能,抑制致癌物质,影响肿瘤细胞的基因表达,对肿瘤具有拮抗作用.大量研究表明,益生菌在未来的肿瘤防治中有很好的应用和发展前景.     

Interaction of estrone and estradiol with DNA and protein of liver and kidney in rat and hamster in vivo and in vitro

[6,7-³H] Estrone (E) and [6,7-³H]estradiol-17 (E₂) have been synthesized by reduction of 6-dehydroestrone and 6-dehydroestradiol with tritium gas. Tritiated E and E₂ were administered by oral gavage to female rats and to male and female hamsters on a dose level of about 300 g/kg (54 mCi/kg). After 8 h, the liver was excised from the rats; liver and kidneys were taken from the hamsters. DNA was purified either directly from an organ homogenate or via chromatin. The radioactivity in the DNA was expressed in the units of the Covalent Binding Index, CBI = (mol chemical bound per mol DNA-P)/(mmol chemical administered per kg b.w.). Rat liver DNA isolated via chromatin exhibited the very low values of 0.08 and 0.09 for E and E₂, respectively. The respective figures in hamster liver were 0.08 and 0.11 in females and 0.21 and 0.18 in the males. DNA isolated from the kidney revealed a detectable radioactivity only in the female, with values of 0.03 and 0.05 for E and E₂, respectively. The values for male hamster kidney were < 0.01 for both hormones. The minute radioactivity detectable in the DNA samples does not represent covalent binding to DNA, however, as indicated by two sets of control experiments. (A) Analysis by HPLC of the nucleosides prepared by enzyme digest of liver DNA isolated directly or via chromatin did not reveal any consistent peak which could have been attributed to a nucleoside-steroid adduct. (B) All DNA radioactivity could be due to protein contaminations, because the specific activity of chromatin protein was determined to be more than 3,000 times higher than of DNA. The high affinity of the hormone to protein was also demonstrated by in vitro incubations, where it could be shown that the specific activity of DNA and protein was essentially proportional to the concentration of radiolabelled hormone in the organ homogenate, regardless of whether the animal was treated or whether the hormone was added in vitro to the homogenate.Carcinogens acting by covalent DNA binding can be classified according to potency on the basis of the Covalent Binding Index. Values of 10³–10⁴ have been found for potent, 10² for moderate, and 1–10 for weak carcinogens. Since estrone is moderately carcinogenic for the kidney of the male hamster, a CBI of about 100 would be expected. The actually measured limit of detection of 0.01 places covalent DNA binding among the highly unlikely mechanisms of action. Similar considerations can be made for the liver where any true covalent DNA binding must be below a level of 0.01. It is concluded that an observable tumor induction by estrone or estradiol is unlikely to be due to DNA binding.Paper presented at the Satellite Symposium of the European Society of Toxicology, Rome, March 29, 1983     

Isolation and characterization of glycosylated and non-glycosylated prolactins from alligator and crocodile

Two molecular forms of prolactin (PRL). glycosylated and non-glycosylated, were isolated from pituitary glands of two reptiles, alligator and crocodile. The reptilian PRLs were extracted under alkaline conditions from the precipitate obtained after pituitaries were first extracted with 0.25 m sucrose, 1 mM NH₄HCO₃, pH 6.3. Purification was performed by ion exchange chromatography on DE-52, gel filtration on Sephadex G-75 superfine, and reversed phase high performance liquid chromatography. Two forms of both alligator and crocodile PRL, designated PRLI and PRLII, with molecular weights of 26000 and 24000 were isolated. Alligator and crocodile PRLI and PRLII were stained specifically in immunoblots with anti-sea turtle PRL and anti-ostrich PRL. Sequence analysis revealed that both forms of alligator and crocodile PRLs consisted of 199 amino acid residues with a glycosylation consensus sequence (Asn-Ala-Ser) at position 60 in alligator and crocodile PRLs with a molecular weight of 26000 (PRLI). In contrast, Thr was substituted for Asn at position 60 in the PRLs with a molecular weight of 24000 (PRLII). The sequences of alligator PRLs differed from crocodile PRLs only in position 134: Val for alligator PRLs and He for crocodile PRLs. There is a high degree of structural conservation between the reptilian PRLs isolated in this study and avian PRL; each showed 92% sequence identity with chicken PRL and 89% with turkey PRL.