Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways

We previously identified the major pathological changes in the respiratory and immune systems of patients who died of severe acute respiratory syndrome (SARS) but gained little information on the organ distribution of SARS-associated coronavirus (SARS-CoV). In the present study, we used a murine monoclonal antibody specific for SARS-CoV nucleoprotein, and probes specific for a SARS-CoV RNA polymerase gene fragment, for immunohistochemistry and in situ hybridization, respectively, to detect SARS-CoV systematically in tissues from patients who died of SARS. SARS-CoV was found in lung, trachea/bronchus, stomach, small intestine, distal convoluted renal tubule, sweat gland, parathyroid, pituitary, pancreas, adrenal gland, liver and cerebrum, but was not detected in oesophagus, spleen, lymph node, bone marrow, heart, aorta, cerebellum, thyroid, testis, ovary, uterus or muscle. These results suggest that, in addition to the respiratory system, the gastrointestinal tract and other organs with detectable SARS-CoV may also be targets of SARS-CoV infection. The pathological changes in these organs may be caused directly by the cytopathic effect mediated by local replication of the SARS-CoV; or indirectly as a result of systemic responses to respiratory failure or the harmful immune response induced by viral infection. In addition to viral spread through a respiratory route, SARS-CoV in the intestinal tract, kidney and sweat glands may be excreted via faeces, urine and sweat, thereby leading to virus transmission. This study provides important information for understanding the pathogenesis of SARS-CoV infection and sheds light on possible virus transmission pathways. This data will be useful for designing new strategies for prevention and treatment of SARS.     

Fuzzy rules to predict degree of malignancy in brain glioma

The current pre-operative assessment of the degree of malignancy in brain glioma is based on magnetic resonance imaging (MRI) findings and clinical data. 280 cases were studied, of which 111 were high-grade malignancies and 169 were low-grade, so that regular and interpretable patterns of the relationships between glioma MRI features and the degree of malignancy could be acquired. However, as uncertainties in the data and missing values existed, a fuzzy rule extraction algorithm based on a fuzzy min-max neural network (FMMNN) was used. The performance of a multi-layer perceptron network (MLP) trained with the error back-propagation algorithm (BP), the decision tree algorithm ID3, nearest neighbour and the original fuzzy min-max neural network were also evaluated. The results showed that two fuzzy decision rules on only six features achieved an accuracy of 84.6% (89.9% for low-grade and 76.6% for high-grade cases). Investigations with the proposed algorithm revealed that age, mass effect, oedema, post-contrast enhancement, blood supply, calcification, haemorrhage and the signal intensity of the T1-weighted image were important diagnostic factors.     

The PKD1 gene product, "polycystin-1," is a tyrosine-phosphorylated protein that colocalizes with alpha2beta1-integrin in focal clusters in adherent renal epithelia.

Mutations in the PKD1 gene are responsible for autosomal dominant polycystic kidney disease (ADPKD). Although PKD1 has been cloned and shown to be expressed at high levels in the fetal ureteric bud and ADPKD cystic epithelia in the human kidney, the function of its encoded protein, "polycystin-1" is unknown. In this study we used primary and immortalized human renal epithelial cell lines derived from normal fetal, adult, and ADPKD kidneys, that endogenously express PKD1, to study the biologic function of the polycystin-1 protein. ADPKD renal epithelial cells expressed high levels of polycystin-1 protein and showed increased adhesion to type I collagen by comparison with normal adult human renal epithelia that expressed little polycystin. Adherent ADPKD cells also expressed high levels of alpha2beta1-integrin and their attachment was inhibited by a functional monoclonal antibody to alpha2-integrin. Double labeling and confocal microscopy as well as coimmunoprecipitation analysis showed overlapping colocalization of polycystin-1 with alpha2beta1-integrin as well as with the focal adhesion proteins vinculin and paxillin in multiprotein clusters localized to focal areas of cell membrane contact with type I collagen matrix after short periods of attachment. Immunoprecipitation and Western immunoblot studies also showed that polycystin-1 was posttranslationally modified by tyrosine phosphorylation. These studies suggest that the PKD1-encoded protein is part of a large multiprotein complex in epithelial cells that functions in the regulation of extracellular matrix interactions with the plasma membrane and cell cytoskeleton.     

“一院两区”医疗质量管理信息平台的研制与应用

医疗质量同质化是“一院多区”医院管理工作中的难点。同济大学附属东方医院通过搭建“一院两区”医疗质量管理信息平台,充分借助信息化手段,实现医疗质量管理委员会、医疗质量管理部门、临床科室三级联动的闭环管理模式,助力提升院区间医疗质量同质化水平。     

重症先天性膈疝患儿的临床治疗策略

目的探讨重症先天性膈疝(CDH)患儿的临床治疗策略。 方法选择2015年1月至2019年10月,西北妇女儿童医院小儿外科收治的7例重症CDH患儿为研究对象。采用回顾性研究方法收集受试儿一般临床资料、治疗、转归及术后随访结果等进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。 结果本组7例重症CDH患儿临床资料分析结果如下。①一般临床资料：7例患儿中,男、女性患儿分别为4例(No.2、5～7)与3例(No.1、3～4);1例(No.4)为足月单纯低出生体重儿,1例(No.7)为足月低出生体重合并多系统畸形儿,5例(No.1～3、5～6)为低出生体重早产儿;2例(No.2、7)为采取辅助生殖技术出生婴儿,均合并染色体异常。娩出方式：5例(No.1～4、7)经剖宫产术娩出,2例(No.5～6)自然分娩。4例孕母(No.1～2、6～7)有流产史。②治疗情况：除No.6患儿出生后1、5、10 min Apgar评分均为10分外,其余6例在手术室或产房采取气管插管、高频振荡通气(HFOV)、禁食、胃肠减压治疗。No.1患儿因合并多发复杂畸形,患儿家属放弃手术治疗,3例(No.4～6)经左侧胸后外侧切口入路手术,3例(No.2～3、7)经左上腹切口入路手术进行CDH修补术。③转归：1例(No.1)术前放弃治疗后死亡,3例(No.3～4、7)术后死亡。这4例死亡患儿中,除No.4患儿外,No.1、3、7患儿均合并复杂先天性心脏病及其他系统畸形。3例(No.2、5～6)患儿采取手术治疗后治愈出院,均合并早产、低出生体重、其他非复杂畸形。对这3例痊愈患儿术后随访结果显示,1例(No.2)术后1个月CDH复发,经再次CDH修补术治疗后,膈肌完整,截至随访时未见复发;No.5～6患儿截至随访时,均生长发育良好。 结论合并复杂先天性心脏病,可能是影响重症CDH患儿预后的主要因素之一。对重症CDH患儿娩出后采取即时气管插管、HFOV、延迟手术修复(DSR)等治疗策略,有助于提高该病患儿手术治愈率。     

逊克县边疆俄罗斯民族村蜱携带斑点热群立克次体的调查

目的 调查黑龙江逊克县边疆俄罗斯民族村蜱携带斑点热群立克次体的调查.方法 采集2017年4-6月418只活蜱样本,利用PCR方法分别扩增斑点热群立克次体(SFGR)3种不同目的 基因的特异性片段,通过基因测序进一步鉴定.结果 在所有蜱中共检出斑点热群立克次体核酸阳性样本93例,经SFGR 3种不同目的 基因测序对比确定所有样本均属于同一种斑点热群立克次体,且为日本立克次体(Rickettsia japonica),感染率为22.25％(93/418).其中在全沟硬蜱中检测阳性样本62例,感染率为21.68％ (62/286);在嗜群血蜱中检测到阳性样本31例,感染率为23.48％(31/132).结论 Rickettsia japonica是该地区主要蜱携带病原体,并存在潜在威胁人类健康的风险,应加强对黑龙江逊克县边疆俄罗斯民族村地区媒介蜱的防治防控.     

孕妇睡眠质量与焦虑、抑郁的相关性研究

目的,了解孕妇在妊娠期睡眠质量与焦虑抑郁情绪状态的相关关系。方法：采用匹茨堡睡眠质量指数量表,症状自评量表,状态－特质焦虑问卷,焦虑自评量表,抑郁自评量表定,对83例孕妇的睡眠质量,状态－－特质焦虑,焦虑和抑郁状态水平进行调查分析。结果：孕妇的睡眠质量,入睡时间,睡眠时间,白天功能与焦虑和抑郁情绪症状呈正相关（P＜0．05）;孕妇睡眠质量与状态焦虑呈正相关关系（P＜0．05）,而入睡时间与特质焦虑呈正相关关系（P＜0．05）,结论;孕妇妊娠期睡眠质量与焦虑和抑郁情绪症状有正相关关系。     

脂多糖对大鼠肺微血管内皮细胞Gsα和Giα蛋白亚型的影响*

目的：观察脂多糖（LPS）对大鼠肺微血管内皮细胞（RPMVECs)G蛋白的影响及甲基强的松龙的干预作用。方法：用流式细胞技术（FCM）检测G蛋白亚型的变化。结果：①10μg/ml LPS作用于RPMVECs30和90min后,Gsα蛋白水平较对照组显著下降。甲基强的松龙干预30和90min后,对LPS致RPMVECs膜Gsα蛋白水平的变化有显著抑制作用。②10μg/ml LPS作用于RPMVECs30和90min后,Giα蛋白水平较对照组显著下降。甲基强的松龙干预30和90min后,对LPS致RPMVECs膜Giα蛋白水平的变化有显著抑制作用。结论：①LPS诱导RPMVECS Gsα和Giα蛋白水平的变化可能是LPS诱导RPMVECs单层通透性增加的机制之一。②甲基强的松龙参与抑制LPS诱导RPMVECs单层通透性增加的作用。     

实验性肺纤维化肺灌洗液磷脂组分分析

对博莱霉素肺纤维化大鼠模型不同时期作支气管肺泡灌洗液(BALF)细胞计数与分类、蛋白含量测定和磷脂及其组分测定,并与肺病理变化作对照分析。结果发现BALF细胞计数和分类与肺组织细胞浸润基本一致,BALF蛋白含量增加,磷脂酰甘油(PG)随病变进展而下降,磷脂酰肌醇(PI)和磷脂酰乙醇胺(PE)升高。PG／PI比值下降,PG／PI比值可作为肺纤维化的一种标志。