肺纤维化鼠Ⅰ型前胶原和Ⅲ型前胶原mRNA表达及芪丹颗粒剂的干预效应

目的:观察芪丹颗粒对博莱霉素致肺纤维化鼠的Ⅰ型前胶原和Ⅲ型前胶原mRNA表达的影响,探讨其作用机制。方法:实验于2004-10/2006-10在山东省医学科学院基础所病理实验室完成。实验材料:清洁级雄性SD大鼠160只,体质量180～210g。氢化可的松琥珀酸钠50mg/支;芪丹(颗粒剂)是由黄芪、丹参、川芎等中草药加工提纯后的粗提取物制成的颗粒剂,10g/包(1g干粉相当于原生药8g)。实验分组:160只SD大鼠按随机区组设计分为正常组20只、模型组40只、芪丹颗粒剂50只、氢化可的松50只。实验干预:正常组20只气管内灌注和灌胃均用生理盐水。其余大鼠经气管内一次性灌注博莱霉素A5按0.25mL左右(5mg/kg体质量)诱导大鼠肺间质纤维化。随机取40只为模型组。取芪丹颗粒剂组和氢化可地松组大鼠各30只,分别从造模后第2天灌注芪丹颗粒剂(3125mg/kg)和腹腔注射氢化可的松(25mg/kg),药物干预后第7,14,28天麻醉下处死动物。两组各余20只分别从造模14d后灌注芪丹颗粒剂和腹腔注射氢化可的松(用量同前),于第28、42天分别处死动物。实验评估:用苏木精-伊红评价肺组织病理学变化和原位杂交方法检测各组大鼠肺Ⅰ型和Ⅲ型前胶原mRNA表达。结果:160只大鼠全部进入结果分析。①大鼠肺脏大体标本观察:对照组肺组织各观察时间点无明显改变,模型组肺组织表面凸凹不平,部分肺叶体积缩小,表面见灰白色结节。氢化可的松组与模型组相似。芪丹颗粒剂组见部分肺叶表面不光滑及大小不等结节。②肺组织病理学观察:模型组7d肺泡腔内大量巨噬细胞淋巴细胞中性粒细胞浸润,肺间质成纤维细胞增殖,28d肺泡结构破坏肺泡内见大量胶原纤维和成纤维细胞。芪丹颗粒剂组肺泡炎及肺纤维化程度均明显轻于模型组和氢化可的松组(P<0.05)。③肺间质纤维化形成中Ⅰ型、Ⅲ型前胶原mRNA表达:原位杂交显示两种前胶原mRNA表达呈动态变化,早期肺泡炎以Ⅲ型前胶原mRNA大量增生为主,晚期纤维化期以Ⅰ型前胶原mRNA增生为主。芪丹颗粒剂组Ⅲ型前胶原mRNA的表达在第14天处于最高,至28d仍维持较高的水平,芪丹颗粒剂组Ⅲ型前胶原mRNA的表达高于模型组和氢化可的松组(P<0.05)。28d,Ⅰ型前胶原mRNA的表达在第二天给药芪丹颗粒剂组和氢化可地松组及第14天给药芪丹颗粒剂组和氢化可的松组组间差异均有显著性(P<0.05)。结论:大鼠肺纤维化的早期以Ⅲ型前胶原mRNA的表达为主,晚期纤维化期以Ⅰ型前胶原mRNA的大量表达为主。芪丹颗粒可减轻博莱霉素诱导的大鼠肺泡炎及肺纤维化的程度,其机制可能通过影响了Ⅰ型和Ⅲ型前胶原mRNA的代谢和表达,从而减慢肺间质纤维化的进程。芪丹颗粒对肺间质纤维化有治疗作用,且优于氢化可的松。     

Correlation between surgical timing and postoperative ocular motility in orbital blowout fractures

Graefe's Archive for Clinical and Experimental Ophthalmology - The study reports the correlation between surgical timing and postoperative ocular motility in orbital blowout fractures. This was...     

Topical non-steroidal anti-inflammatory drugs for the treatment of cystoid macular edema post Descemet’s stripping automated endothelial keratoplasty

Purpose

To investigate the effectiveness of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular edema (CME) post Descemet’s stripping automated endothelial keratoplasty (DSAEK).

Study design

Retrospective observational study

Methods

In this study of 334 patients who underwent DSAEK at the Baptist Eye Institute, Kyoto, Japan between July 2011 and December 2015, 18 patients with postoperative CME (determined by optical coherence tomography) treated with topical NSAIDs after the onset of CME were included.

Results

At CME onset, 17 of the 18 patients were treated with bromfenac eye drops and 1 was treated with nepafenac eye drops. Post initiation of treatment with topical NSAIDs, CME in 17 (94.4%) of the 18 patients improved at 1 month and all cases completely recovered within 3 months. At 12-months post initiation of treatment, 61.1% (n?=?11) of patients achieved a visual acuity (VA) of 20/40 or better, and there was no significant difference of VA between the patients with or without an episode of postoperative CME (P?=?0.55).

Conclusion

The administration of topical NSAID eye drops was found to be effective in treating patients with CME post DSAEK.

     

Computerized Weight Loss Intervention Optimizes Staff Time: The Clinical and Cost Results of a Controlled Clinical Trial Conducted in a Managed Care Setting

OBJECTIVE: To evaluate the costs and effects of incremental components of a weight-loss program. DESIGN: A 3-arm, 12-month randomized controlled clinical trial to evaluate 3 incremental levels of intervention intensity. SUBJECTS/SETTING: The study included 588 individuals (BMI > 25 kg/m2) in a freestanding health maintenance organizalion and achieved an 81% completion rate. INTERVENTION: Using a cognitive behavioral approach for tailoring lifestyle modification goals, the incremental levels of intervention included a) a workbook alone, b) the addition of computerized tailoring using onsite computer kiosks with touch screen monitors, and c) the addition of both computers and staff consultation. MAIN OUTCOME MEASURES: Endpoints included weight parameters, lipid profile, plasma glucose, blood pressure, intervention costs, dietary intake, and physical activity. STATISTICAL ANALYSIS PERFORMED: Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences. Regression and correlation analysis assessed the relationship between weight loss and other variables. RESULTS: For the increasing levels of intervention intensity, the mean 12-month weight losses were 2.2, 4.7, and 7.4 pounds, with the respective cost per participant being $12.33, $41.99, and $133.74. The decreases in mean BMIs for these respective intervelation levels were 0.4, 0.9 and 1.2. All groups reported a decrease in energy and fat intake and an increase in blocks walked (P<.01). Intervention variables that correlated with weight loss included more computer log-ons, achieving computer-selected goals, more self-monitoring, increased walking, and decreased energy and fat intake, as well as higher attendance in staff consultation group sessions for that treatment condition. Weight loss correlated with decreases in fasting glucose and blood pressure. APPLICATIONS/CONCLUSIONS: In a weight-loss program, computers can facilitate selecting behavioral change goals. More frequent usage resulted in greater weight loss. Staff counseling to augment the computer intervention achieved the most weight loss.     

An evidence-based evaluation of intradialytic parenteral nutrition

Malnutrition is a well-recognized comorbid condition in dialysis patients that contributes to the increased mortality seen in these patients. Multiple interventions have been tried in an effort to decrease mortality. The most controversial of these is intradialytic parenteral nutrition. In an era of high costs and shrinking budgets, it is important to critically examine published data to determine the quality of the data and to determine whether the reported results are valid and clinically applicable. Using an evidence-based approach, all published literature concerning intradialytic parenteral nutrition was reviewed, quality of the data determined, number needed to treat (NNT) calculated, and potential costs of treatment determined. Twenty-four studies that met the search criteria were identified. Only three studies were randomized; one of these was a feasibility study, and the other two were only of level B quality. The remaining studies were either case reports or observational studies of level C quality. The absolute risk reduction in mortality with intradialytic parenteral nutrition (IDPN) usage ranged from 0.12 to 0.65; relative risk reduction ranged from 0.48 to 0.74; NNT ranged from 2 to 17; cost ranged from $150,000,000 to $877,500,000; and 588 to 9,750 patients might be expected to experience a decrease in mortality. The results of this review indicate that the data supporting the use of IDPN are weak and a clear recommendation cannot be made. IDPN use in hemodialysis patients seems to be associated with decreased mortality. IDPN should be available for use in patients who meet previously published guidelines and who are not normoalbuminemic.     

非创伤性治疗技术充填和窝沟封闭年轻恒牙2年效果观察

评价非创伤性治疗技术充填和窝沟封闭的效果及其可接受性,探索适合我国学校和农村开展龋病防治的方法。方法采用德国ＥＰＳＥ公司生产的Ｋｅｔａｃ－Ｍｏｌａｒ玻璃离子材料完成４８６颗受试牙的充填和窝沟封闭,治疗后１年、２年复查,记录ＡＲＴ充填体,封闭物及继发龋坏情况。     

Three germline mutations in the TP53 gene

Three germline mutations in the TP53 tumor-suppressor gene are reported, two of which are not reported previously. A missense mutation at codon 265 of TP53 was found in three patients of a family that complied with the definition of the Li-Fraumeni syndrome. A nonsense mutation in codon 306 was found in a woman who had had a rhabdomyosarcoma at age 4 and a subsequent breast cancer at age 22. She was part of a Li-Fraumeni-like family, but the parental origin of the mutation could not be traced. Finally, while screening for somatic alterations in TP53 in a series of 141 sporadic breast tumors, we detected a constitutional missense mutation in codon 235 in a woman diagnosed with breast cancer at age 26 and a recurrence 4 years later. The recurrence, but not the primary tumor, showed an additional missense mutation at codon 245 as well as loss of the wild-type allele. This suggests that the 245 mutation was particularly important for tumor progression and that there might exist heterogeneity in terms of cancer predisposition potential among the various germline TP53 mutations. Hum Mutat 9:157–163, 1997. © 1997 Wiley-Liss, Inc.     

Multi-modality parathyroid imaging: A shifting paradigm

The goal of parathyroid imaging in hyperparathyroidism is not diagnosis, rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach. Hence, the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration. The common causes include solitary parathyroid adenoma, multiple parathyroid adenomas, parathyroid hyperplasia and parathyroid carcinoma. It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging. The various imaging modalities available include high resolution ultrasound of the neck, nuclear imaging studies, four-dimensional computed tomography (4D CT) and magnetic resonance imaging. Contrast enhanced ultrasound is a novel technique which has been recently added to the armamentarium to differentiate between parathyroid adenomas and its mimics. Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.