严重多发伤患者机械通气的危险因素分析

目的: 探讨严重多发伤患者机械通气和机械通气时间延长的危险因素。方法: 选取2016年12月至2019年12月北京大学人民医院创伤救治中心所收治的严重多发伤患者作为研究对象进行回顾性研究,按照住院期间有无机械通气对患者进行分组,进一步将机械通气患者按照通气时间是否≥7 d分成机械通气时间延长组和非延长组。对收集的临床资料进行单因素和多因素分析,明确机械通气和机械通气时间延长的危险因素。结果: 共纳入患者112例,其中男性82例、女性30例,中位年龄52岁(16~89岁),中位创伤严重程度评分(injury severe score,ISS)34分(16~66分)。车祸伤和坠落伤是最常见的受伤类型。使用机械通气患者62例,未使用机械通气患者50例,多因素分析表明,格拉斯哥昏迷评分(Glasgow coma scale,GCS)(OR=0.72,95%CI:0.53~0.92,P=0.03)、血液碱剩余(OR=0.56,95%CI:0.37~0.88,P=0.002)、肋骨骨折(OR=1.72,95%CI:1.60~2.80,P=0.012)是启动机械通气的独立危险因素。本组机械通气时间≥7 d者38例,<7 d者24例,结果显示ISS评分越高,GCS评分越低,患者机械通气时间越长。结论: GCS评分、血液碱剩余和肋骨骨折是机械通气的独立危险因素,同时,ISS评分高和颅脑损伤重可能会延长机械通气时间,患者气管切开的发生率高。     

气候变化下的新发传染病风险

近年来新发传染病频发,在全球范围内造成了巨大的经济和社会损失。气候变化驱动的地球环境改变打破了生态系统平衡,使得野生动物栖息地丧失,并影响病原体及其中间宿主的繁殖、存活、传播及分布范围,从而加剧了新发传染病的风险。由于气候变化、人类活动、生态环境、野生动物与病原体之间的复杂联系,未来应通过多学科和多领域的合作以应对新发传染病的重大挑战。     

机器人手术系统联合血管切除重建行胰十二指肠切除术的17例疗效评价（附手术视频）

  目的  探讨机器人手术系统下联合血管切除重建行胰十二指肠切除术治疗进展期胰腺癌的临床疗效。  方法  回顾性分析自2011年8月?2018年9月上海交通大学医学院附属瑞金医院完成的17例机器人手术系统下联合血管切除重建（操作见视频1）行胰十二指肠切除术的局部进展期的胰腺癌患者的临床资料。  结果  17例患者中4例胰腺癌患者由于肿瘤侵犯严重、胰腺质地软中转开腹,13例患者手术顺利完成。16例（94%）患者手术达到R0切除。14例联合静脉重建,3例联合动脉重建。平均手术时间（401±170） min,平均术中出血（647±345） mL,术后平均住院天数（20±8） d,无围手术期死亡。术后病理及随访结果:1例为胰腺导管内乳头状黏液肿瘤,1例为胰腺神经内分泌肿瘤（G1级）,目前情况良好,8例胰腺导管腺癌及1例胰腺神经内分泌癌患者于随访期间因肿瘤复发转移死亡,中位（最小值～最大值）生存期12（8～26）个月。5例胰腺导管腺癌及1例恶性胰腺导管内乳头状黏液肿瘤患者目前继续随访中,其中1例已存活了38个月（截止至2019年7月）。  结论  机器人手术系统下联合血管切除重建行胰十二指肠切除术难度较大,但安全可行,局部进展期的胰腺癌患者经谨慎评估患者病情和医院手术能力后可以采用。     

Pinellia Total Alkaloids Modulate the GABAergic System in Hippocampal Formation on Pilocarpine-Induced Epileptic Rats

Objective: To investigate the neuromodulatory effect of pinellia total alkaloids(PTA) on the gamma-aminobutyric acidergic(GABAergic) system in epileptic rats, and preliminarily evaluate the anti-epileptic effect of PTA. Methods: Ninety-one male Sprague-Dawley rats were randomized to a control group(n=17) or an epileptic group(n=74) using computer-generated random numbers. Status epilepticus(SE) was induced with pilocarpine in the epileptic group. Epileptic rats that survived SE were randomly divided into 4 groups, namely an epilepsy group(n=13), a topiramate(TPM, 60 mg/kg) group(n=12), a high-dose PTA(800 mg/kg) group(n=12), and a low-dose PTA(400 mg/kg) group(n=10). Treatments were given intragastrically once daily for 14 days. The control group and epilepsy group received normal saline. Spontaneous recurrent seizures(SRSs) were monitored 8-h daily for 7 days after treatment. Then, the hippocampal formation tissues were collected. GABA level was measured using enzyme-linked immunosorbent assay. Protein and mRNA expression levels of glutamate decarboxylase 65(GAD65), GABA transporter-1(GAT-1), GABA transaminase(GABA-T), and GABAA receptor(GABAAR) α4, α5, γ2 and δ subunits were measured using Western-blotting analysis and quantitative polymerase chain reaction. Results: PTA lowered the incidence and frequency of SRS(both doses vs. the TPM group, P0.05). Compared with the epilepsy group, PTA increased the levels of GABA(both doses P0.01) and GAD65(mRNA, 800 mg/kg, P0.01), and suppressed the levels of GAT-1(mRNA, 800 mg/kg, P0.01; 400 mg/kg, P0.05), GABA-T(mRNA, both doses P0.01), and GABAAR δ subunit(protein, 800 mg/kg, P0.05) and γ2 subunit(protein, both doses P0.01). PTA upregulated the low-expressed mRNA levels of GABAAR α5 subunit(400 mg/kg, P0.01), δ subunit(800 mg/kg, P0.05), and γ2 subunit(400 mg/kg, P0.05). Conclusions: PTA regulated the GABAergic system through modulating GABA levels and the expression levels of GAD65, GAT-1, GABA-T, and GABAAR α4, α5, γ2 and δ subunits. PTA may exert antiepileptic effects on the pilocarpine-induced epilepsy model.     

Effect of Compound Laser Acupuncture-Moxibustion on Blood Glucose, Fasting Insulin and Blood Lipids Levels in Type 2 Diabetic Rats

Objective: To investigate the effect of compound laser acupuncture-moxibustion on blood glucose, fasting insulin and blood lipids levels in type 2 diabetes mellitus(T2DM) rats. Methods: Forty male Wistar rats were randomly divided into 4 groups, including the normal group, model control group, laser group and sham laser group(n=10 per group). The rats in the normal group were fed with a standard diet. Rats in other groups were fed with a high-sugar and high-fat diet for 4 weeks, then intraperitoneally injected with 1% streptozotocin to induce T2 DM model. The laser group was irradiated by 10.6 μm and 650 nm compound laser on bilateral Pishu(BL 20), Shenshu(BL 23) and Sanyinjiao(SP 6) for 5 min, 6 times a week for 5 weeks. The sham laser group received the same treatment as the laser group, but without laser output. The model control group and normal group were not treated. Blood glucose levels were measured before and after 1, 2, 3, 4 and 5 weeks of treatment. The serum levels of fasting insulin, total cholesterol(TC), triglyceride(TG), low-density lipoprotein(LDL), and high-density lipoprotein(HDL) were analyzed after the last treatment. Results: The blood glucose levels in the model control group increased during the 5 weeks of treatment compared with the normal group(P0.05), while those in the laser group were significantly lower than the model control group after weekly treatment(P0.01 or P0.05). After 1, 2 and 3 weeks of treatment, the blood glucose levels in the laser group decreased obviously compared with the sham laser group(P0.01 or P0.05). Compared with the normal group, the levels of fasting insulin, TC and LDL in the model control group notably increased(P0.01 or P0.05), while their levels in the laser group were significantly lower than the model control group after 5 weeks of treatment(P0.05 or P0.01). However, no statistically significant differences were observed in TG or HDL levels among the 4 groups(P0.05). Conclusion: The compound laser acupuncture-moxibustion of 10.6 μm and 650 nm had positive effects on the regulation of hyperglycemia and insulin resistance in T2 DM rats, which may be a potential treatment for T2 DM, and also provide an alternative to the traditional acupuncture and moxibustion therapy.     

基于网络药理学对黄连治疗多囊卵巢综合征高雄激素血症的分子机制研究

目的 基于网络药理学阐述黄连治疗多囊卵巢综合征高雄激素血症（PCOS-HA）的可能分子机制。方法 借助TCMSP收集黄连的化合物及有效靶点,运用Cytoscape软件构建化合物-靶点网络;合并GeneCards、OMIM及CTD三库数据筛选的疾病靶点,与药物的有效靶点进行韦恩分析,确定交集靶点;用String数据库构建靶点蛋白互作网络;利用DAVID数据库进行基因功能GO分析和KEGG通路富集分析。结果 获得11个活性化合物,药物靶点111个,疾病靶点370个,交集靶点37个。蛋白互作网络（PPI）涉及30个蛋白节点,关键靶点包括FOS、JUN、IL-6、MAPK1、NCOA2、CCL2、ESR1、PPARA、CYP1A1、ESR2等。GO功能分析主要与转录调控、药物反应、RNA聚合酶Ⅱ启动子的调控、老化、类固醇激素介导的信号通路等相关。KEGG通路46条,主要涉及TNF信号通路、FoxO信号通路等。结论 通过网络药理学证实了单方中药黄连多成分、多靶点、多途径的作用特点,预测了黄连治疗PCOS-HA的可能作用机制,为进一步研究其活性成分和作用机制提供理论依据。      

花姜酮对Hela细胞株细胞生物学特性的影响

【摘要】目的 探究花姜酮对Hela细胞株增殖、迁移、侵袭及凋亡的影响。方法 购买人宫颈癌Hela细胞株,进行培养并分为空白组、花姜酮5 μmol/L组、花姜酮10 μmol/L组、花姜酮20 μmol/L组4组。空白组使用常规细胞培养液培养,其他三组分别使用相对应浓度的花姜酮进行培养。观察4组细胞的增殖、迁移、侵袭、凋亡情况及上皮细胞间充质（EMT）相关蛋白相对表达量。结果 24、48、72 h花姜酮20 μmol/L组细胞增殖率低于花姜酮5 μmol/L组、花姜酮10 μmol/L组及空白组（P＜005）;24、48、72 h花姜酮20 μmol/L组细胞凋亡率高于花姜酮5 μmol/L组、花姜酮10 μmol/L组及空白组（P＜005）;花姜酮20 μmol/L组细胞迁移、侵袭数均低于花姜酮5 μmol/L组、花姜酮10 μmol/L组及空白组（P＜005）;花姜酮20 μmol/L组细胞波形蛋白（Vimentin）、组蛋白甲基转移酶同源序列2增强子(EZH2)相对表达量均低于花姜酮5 μmol/L组、花姜酮10 μmol/L组空白组;花姜酮20 μmol/L组细胞α 连环蛋白（α cat）、上皮性钙粘蛋白(E cadherin)相对表达量均高于花姜酮5 μmol/L组、花姜酮10 μmol/L组及空白组（P＜005）。结论 花姜酮能够促进HeLa细胞株的凋亡,抑制Hela细胞株的增殖、迁移及侵袭能力,其能力呈现浓度依赖。     

结直肠癌中LncRNA介导的内源性竞争性RNA调控网络

【摘要】 目的 构建结直肠癌RNA调控网络,探讨结直肠癌中分子调控机制。方法 从TCGA数据库中提取结直肠癌转录水平表达数据,筛选差异表达RNAs,结合miRDB, miRcode, miRTarBase和TargetScan数据库靶基因预测 结果,整合LncRNA- miRNA.miRNA-mRNA关系对,基于ceRNA假说及LncRNA细胞内定位,筛选出胞质表达并介导该网络调控的LncRNA,重建结直肠癌中IncRNA-miRNA-mRNA作用网络。结果 在结直肠癌差异表达基因分析中初步筛选出119个LncRNA、32个m沢NA以及59个mRNA;识别777对LncRNA-miRNA与77对miRNA-mRNA, 基于ceRNA假说以及LncRNA在细胞内定位,最后筛选出15个上调LncRNA、3个下调miRNA(hsa-mir-145, hsa-mir- 193b, hsa-mir-150)以及5个上调mRNA重建ceRNA网络。结论 成功构建结直肠癌中LncRNA介导调控的ceRNA 网络,识别出预后相关的潜在靶点,为结直肠癌治疗研究提供了新的参考依据。     

SOX4基因抑制肝癌细胞增殖与侵袭能力

【摘要】目的 探讨小干扰RNA技术（siRNA）沉默SOX4基因对肝癌细胞增殖、侵袭能力的影响。方法 构建siRNA转染人肝癌细胞株SMMC 7721,按转染质粒区别分为siRNA SOX4组、siRNA NC组,并设立空白对照组。实时荧光定量聚合酶联反应（RT PCR）检测各组细胞SOX4 mRNA,蛋白印迹法（WB）测定SOX4蛋白水平,噻唑蓝法（MTT）测定转染不同时间肝癌细胞增殖能力,流式细胞术测定肝癌细胞凋亡率,Transwell小室实验测定肝癌细胞侵袭能力。结果 转染后siRNA SOX4组SOX4 mRNA相对表达量低于空白对照组和siRNA NC组（P＜005）;转染后siRNA SOX4组SOX4蛋白表达量为低于空白对照组和siRNA NC组（P＜005）;转染不同时间siRNASOX4组细胞增殖活性均低于空白对照组和siRNA NC组（P＜005）;转染后siRNA SOX4组细胞凋亡率高于空白对照组和siRNA NC组（P＜005）;转染后siRNASOX4组穿膜细胞比例低于空白对照组和siRNA NC组（P＜005）。结论 siRNA技术沉默SOX4基因可降低肝癌细胞增殖及侵袭能力,促进癌细胞凋亡。