Risk Factors Predicting Severe Asthma Exacerbations in Adult Asthmatics: A Real-World Clinical Evidence

PurposeMinimizing the future risk of asthma exacerbation (AE) is one of the main goals of asthma management. We investigated prognostic factors for risk of severe AE (SAE) in a real-world clinical setting.MethodsThis is an observational study evaluating subjects who were diagnosed with asthma and treated with anti-asthmatic medications from January 1995 to June 2018. Risk factors for SAE were analyzed in 2 treatment periods (during the initial 2 years and the following 3–10 years of treatment) using the big data of electronic medical records.ResultsIn this study, 5,058 adult asthmatics were enrolled; 1,335 (28.64%) experienced ≥ 1 SAE during the initial 2 years of treatment. Female sex, higher peripheral eosinophil/basophil counts, and lower levels of forced expiratory volume in 1 second (FEV1; %) were factors predicting the risk of SAEs (P < 0.001 for all). Higher serum total immunoglobulin E levels increased the risk of SAEs among the patients having ≤ 2 SAEs (P = 0.025). Patients with more frequent SAEs during the initial 2 years of treatment had significantly higher risks of SAEs during the following years of treatment (P < 0.001, for all) (patients with ≥ 4 SAEs, odds ratio [OR], 29.147; those with 3 SAEs, OR, 14.819; those with 2 SAEs, OR, 9.867; those with 1 SAE, OR, 5.116), had higher maintenance doses of systemic steroids, and showed more gradual decline in FEV1 (%) and FEV1/forced vital capacity levels maintained during the following years of treatment (P < 0.001 for all).ConclusionsAsthmatics having risk factors for SAEs (female sex, higher peripheral eosinophil/basophil counts, and lower FEV1) should be strictly monitored to prevent future risk and improve clinical outcomes.     

盆腔肿瘤调强与三维适形放疗肠道勾画与剂量-体积限制的研究进展

在盆腔肿瘤的放射治疗过程中,肠道损伤是重要的不良反应。随着调强放射治疗（IMRT）等精准放疗技术的广泛应用,正常组织器官的受照剂量已大幅下降。然而,肠道的不良反应仍限制了靶区剂量的提高。故在给予病灶足够照射剂量的同时,对肠道等重要危及器官（OAR）的保护变得更加重要。目前多数研究采用基于肠管的勾画方法,采用小肠+结肠勾画,对于2级急性不良反应,有意义的剂量-体积预测指标包括V_{45 Gy}<50 cm³,V_{50 Gy}<13 cm³,V_{55 Gy}<3 cm³;采用肠袋勾画,对于2级不良反应,有意义的预测指标包括V_{40 Gy}< 170 cm³,V_{45 Gy}< 100 cm³,V_{50 Gy}< 33 cm³。     

携带式远程实时心电监测仪在心律失常诊断中的应用

目的通过与动态心电图（Hoher）记录的心电图比较,检验携带式远程实时心电检洲仪（AKM—N1型,简称心电检测仪）临床应用的价值。方法选取2011年10～11月存北京安贞医院心内科住院和门诊以心律失常为主要表现的心脏病患者36例,其中男性2l例,女性15例,平均年龄（43．0±14．8）岁。所有人选患者同时行心电检测仪和Holier监测,比刈’两行同步记录的心电蚓数据（包括P波时限、PR间期、QRS波群时限、QT间期、RR间期、有无伪差与干扰、有无心律失常及心律失常类,型）足否一致。两组分别选取相同时间点比对上述参数,包括记录的第10分钟、第20分钟、第30分钟、筇40分钟和第50分钟开始的30S心电数据,以及在受试者心脏不适或临床医生指示的情情下,2次同步按压两者的“捕捉键”进行心电捕捉的30S记录。结果36例入选患者有29例检测到心律失常。两种榆测方法得到的不同时间的P波时限、QRS波群时限、PR间期、QTM期与RR间期无差异,两种方法检出心律失常的情况高度关联（P〈0．001）,检出心律失常的比例无差异（P=1．0）。两种检测方法出现伪差与干扰的比例无差别,但出现伪差与干扰情况的关联性不肯定。临床试验过程无不良反应。结论携带式远程实时心电监测仪（AKM—N1型）获得的心电数据准确,对心律失常的诊断能力与Holter相当,借助网络传输,可及时指导患者治疗。     

4.1蛋白家族成员merlin与ezrin在青海藏族胃癌中表达及对胃癌细胞功能的影响

目的 研究4.1蛋白家族成员merlin和ezrin在青海藏族胃癌组织中突变与表达特点,同时研究二者对胃癌细胞增殖、黏附侵移能力的影响.方法 用PCR及DNA测序检测merlin突变,免疫组化检测ezrin蛋白表达,用MTT方法检测胃癌细胞增殖与黏附侵移.结果 青海藏族胃癌组织中检测到merlin蛋白基因NF2外显子17两个位点突变率较高,超过50％.而ezrin蛋白表达在青海藏族胃癌组织中比正常胃黏膜组织中为高(P＜0.05),其表达水平与胃癌分化程度、淋巴结转移及组织学分型有关(P＜0.05).此外,MTT检测结果显示,FERM蛋白结构域、merlin-2对胃癌细胞增殖与细胞黏附侵染无明显影响,并且ezrin对胃癌细胞黏附侵移能力亦无明显影响,但对细胞增殖具有一定抑制能力.抑癌基因蛋白merlin-1不但抑制细胞增殖,而且也对细胞黏附侵移具有抑制作用,其中抑癌基因蛋白merlin-1对细胞增殖抑制能力比ezrin蛋白更加明显.结论 Merlin和ezrin蛋白表达与青海藏族胃癌易感性具有一定关系,且两种因子参与调节胃癌细胞增殖和细胞黏附能力.     

Potential Roles of Bone Morphogenetic Protein 9 in the Odontogenic Differentiation of Dental Pulp Cells

IntroductionThe differentiation of dental pulp cells (DPCs) plays an important role in the repair of dental pulp injury. Bone morphogenetic protein 9 (BMP9) is one of the most effective BMPs to induce the differentiation of stem cells. However, the role of BMP9 in promoting the odontogenic differentiation of DPCs and dentinogenesis is worth knowing.MethodsFluorescence in situ hybridization and immunohistochemistry staining were performed to detect the BMP9 expression in human dental pulp. BMP9 was overexpressed in human DPCs (hDPCs), and the mineralization of hDPCs was tested by alkaline phosphatase staining and alizarin red staining. The expression of odontogenic differentiation-related genes was examined by quantitative real-time polymerase chain reaction and western blotting. The subcutaneous transplantation experiment was performed to test the odonto-induction ability of BMP9 in vivo. The rat direct pulp-capping experiment was performed to test the function of BMP9 in promoting dentin formation.ResultsBMP9 showed an increased expression in odontoblast layer at both the mRNA and protein levels. BMP9 enhanced the mineralization and induced the expression of odontogenic differentiation-related genes in hDPCs. More mineralized nodules, and increased expression of dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP1) were detected in the beta-tricalcium phosphate scaffold/cells composites of BMP9 group compared with the control group. Meanwhile, there was thicker reparative dentin formation in the BMP9 group in the rat pulp exposure experiment.ConclusionsBMP9 participates in the process of DPC differentiation and promotes DPC mineralization and dentinogenesis. BMP9 might be a potential therapeutic target in the repair of dental pulp injury.     

父母教养方式、羞怯与负面评价恐惧的关系

目的 考察父母教养方式、羞怯和负面评价恐惧之间的关系.方法 以580名中学生为被试,采用量表法进行考察.结果 ①人口统计学变量(地域、是否独生子女、是否班干部)对中学生羞怯水平具有显著影响(F=7.51,P＜0.01;F=4.99,P＜0.05;F=6.80,P＜0.01);②父母的情感温暖因子与羞怯、负面评价恐惧呈显著负相关,父母惩罚、严厉因子与羞怯则呈显著正相关,父亲过分干涉因子与负面评价恐惧则呈显著正相关;③在控制了人口统计学变量后,父母情感温暖理解因子,母亲惩罚严厉因子和负面评价恐惧可以对羞怯进行有效预测(解释率16％);④负面评价恐惧在父母情感温暖因子对羞怯的影响上起到了中介作用.结论 父母在教养子女过程中给予的情感温暖和理解越多、严厉惩罚的越少,子女对负面评价的恐惧程度便会越少,从而降低羞怯水平.     

Effect of chamfer design on load capacity of reattached incisors

ObjectiveThis study aimed to evaluate the effect of different chamfer preparations on the load capacity of reattached fractured incisors under lingual loading.MethodsEighty #8 typodonts were randomly assigned to four groups (n = 20 each). They were sectioned to simulate crown fracture, and reattached with a self-etch adhesive and a resin composite. The preparation for each group was: (1) no chamfer; (2) buccal chamfer; (3) lingual chamfer; and (4) circumferential chamfer. Forty-eight human lower incisors were grouped and prepared similarly (n = 12 each). These teeth were tested for their load capacity under a lingual load on a universal testing machine. Finite element models were used to examine the stresses on the reattached surfaces to help interpret the experimental results.ResultsThe buccal chamfer did not increase the load capacity when compared with the no-chamfer group. Lingual and circumferential chamfers respectively increased the fracture load by 36.9% and 32.3% in typodonts, and 78.5% and 33.3% in human incisors. The increase was statistically significant (p < 0.05). A higher fracture load tended to be accompanied by a larger area of deflected cohesive fracture. Finite element analysis showed that lingual and circumferential chamfers reduced the fracture-causing tensile stress at the lingual margin of the reattachment interface by approximately 70% and 60%, respectively, in human upper incisors.SignificanceIt was the joint design, and not the size of the bond area, that affected the load capacity of reattached incisors. Among the preparations considered, only those with a lingual chamfer could increase the load capacity of reattached incisors under a lingual load.     

青藤碱对切口痛模型大鼠的镇痛效应及其中枢神经系统中P物质含量的影响

目的观察青藤碱对切口痛模型大鼠疼痛敏感行为及其脑脊液、脊髓中P物质含量的影响。方法 SD大鼠30只,随机分为模型组（Model）、氯诺昔康组（Lornoxicam,8mg·Kg-1）、青藤碱高剂量组（Sin-H,20mg·Kg-1）和青藤碱低剂量组（Sin-L,10mg·Kg-1）。采用机械痛敏和热痛敏测试,评价大鼠的疼痛行为。放免法检测大鼠脑脊液及脊髓L6-L8中P物质含量。结果切口痛模型大鼠的机械撤足阈值、热刺激痛感缩足时间明显改变。青藤碱高、低剂量和阳性药投与后均显示了明显的镇痛效果,其中青藤碱高剂量组镇痛效应指标优于阳性对照药氯诺昔康;给药各组大鼠脑脊液、脊髓中的P物质含量与模型组相比都下降显著,差异有统计学意义（P〈0.05）,而以青藤碱高剂量组的脑脊液P物质浓度抑制最为明显。结论青藤碱能够减轻切口痛模型大鼠疼痛敏感行为,减少P物质在中枢神经系统的释放,后者可能是青藤碱产生镇痛作用的重要机制之一。     

两种TESA方法在腮腺炎致无精子症患者取精中的比较

目的探讨腮腺炎致无精症患者两种睾丸活检取精（TESA）即开放性睾丸活检和显微切割睾丸活检取精的优劣。方法每组24例患者,分别用开放性睾丸活检和显微切割睾丸活检取精,观察取精成功率、术后并发症发生率,术后并发症包括术后血肿的形成,术后3月睾丸萎缩、睾酮下降。结果开放性睾丸活检取精组,能找到活动的精子14例,取精成功率58．3％,术后并发症10例,约41．7％,分别为血肿2例、三月后睾丸萎缩3例、睾酮下降5例;显微切割睾丸活检取精组,能找到活动的精子18例,取精成功率75％,术后并发症5例,约20．8％,分别为血肿0例、三月后睾丸萎缩1例、睾酮下降4例。取精成功率和开放性睾丸活检取精组比较（P〈0．05）,术后并发症和开放性睾丸活检取精组此较（P〈0．01）。结论显微切割睾丸活检取精较开放手术睾丸活检取精成功率高、术后并发症少,值得推广。     

Longitudinal Standards for Height and Height Velocity in Korean Children and Adolescents: the Kangwha Cohort Study

Longitudinal standards for height and height velocity are essential to monitor for appropriate linear growth. We aimed to construct standards in Korean children and adolescents through the population-based longitudinal Kangwha study. Our study was a part of a community-based prospective cohort study from 1986 to 1999 with 800 school children. Height and height velocity were recorded annually from age 6 until final height. Results were compared with cross-sectional data from the 2007 Korean National Growth Charts. Final height was 173.5 cm in boys and 160.5 cm in girls. Although final height was similar between longitudinal and cross-sectional standards, the mean height for age was higher in the longitudinal standard by 1-4 cm from age 6 until the completion of puberty. Using the longitudinal standard, age at peak height velocity (PHV) was 12 in boys and 10 in girls; height velocity at PHV was 8.62 cm/yr in boys and 7.07 cm/yr in girls. The mean height velocity was less than 1 cm/yr at age 17 in boys and 15 in girls. Thus, we have presented the first report of longitudinal standards for height and height velocity in Korean children and adolescents by analyzing longitudinal data from the Kangwha cohort.