重症急性呼吸综合征患者康复期肺功能变化临床观察

目的　通过观察重症急性呼吸综合征 (SARS)患者康复期肺功能的变化 ,了解SARS患者是否遗留有肺功能的长期损害。方法　对 82例SARS患者出院 3个月后进行肺功能检查 (实验组 ) ,并对肺功能异常者出院6个月后再次行肺功能检查 ,并以 2 8例健康人的肺功能做为对照组进行比较分析。结果　实验组肺功能检测发现一氧化碳弥散量 (DLCO % )为 (78 4± 17 4 ) % ,对照组为 (93 8± 13 6 ) % (P <0 0 1)。出院后 3及 6个月实验组中分别有 4 6例和 30例存在弥散功能障碍 (DLCO % <80 % ) ,37例和 16例有小气道功能障碍 ,2 8例和 11例残总比增加 (RV/TLC >35 % ) ,9例和 5例有限制性通气功能障碍。按照患者住院期间胸片肺部阴影的范围 ,将患者分为轻、中、重 3组 ,其轻重程度与出院后 3个月及 6个月肺弥散功能损害呈正相关。重症患者使用机械通气治疗组与未使用机械通气治疗组肺功能损害差异不明显。结论　SARS患者治愈出院 3个月及 6个月后 ,部分患者遗留有肺功能损害 ,主要以弥散功能障碍为主 ,少数有小气道阻塞、残气增加和限制性通气功能障碍。     

CHA2DS2-VASc评分对急性心肌梗死患者院内结局事件的预测价值——China PEACE回顾性急性心肌梗死研究

目的评估CHA₂DS₂-VASc评分对急性心肌梗死(AMI)患者院内结局事件的预测价值。方法回顾性分析冠心病医疗结果评价和临床转化研究(China PEACE)回顾性急性心肌梗死研究中23728例AMI患者的病历信息,按CHA₂DS₂-VASc评分分为低(0~3分)、中(4~6分)、高(7~9分)分值组。院内结局包括主要不良心血管事件、死亡、死亡或放弃治疗、再发心肌梗死、缺血性卒中等。采用多因素Cox回归分析CHA₂DS₂-VASc评分对AMI患者院内结局的影响。通过受试者工作特征(ROC)曲线,评估CHA₂DS₂-VASc评分对AMI患者院内死亡与死亡或放弃治疗的预测价值。结果入组患者年龄66(56,75岁)岁,女性占30.7%。CHA₂DS₂-VASc评分高分值组患者院内结局事件发生率更高,基础疾病更多(P值均<0.001);多因素logistic回归中,院内病死率(OR=6.13,95%CI 4.77~7.87,P<0.001)、院内死亡或放弃治疗率(OR=6.43,95%CI 5.16~8.00,P<0.001)、主要心血管事件发生率(OR=4.94,95%CI 4.06~6.01,P<0.001)明显高于其他两组。ROC曲线分析显示,无论院内病死率,还是死亡或放弃治疗率,CHA₂DS₂-VASc评分与简化版全球急性冠状动脉事件登记(global registry of acute coronary events,mini-GRACE)评分相比差异无统计学意义(ROC曲线下面积:0.699与0.696,P=0.752;0.708与0.713,P=0.489)。结论CHA₂DS₂-VASc评分是一种有效预测AMI患者院内风险的评估工具,该评分操作简单,预测价值与mini-GRACE评分相当。     

Prolongation of liver allograft survival by dendritic cells modified with NF-κB decoy oligodeoxynucleotides

AIM: To induce the tolerance of rat liver allograft by dendritic cells (DCs) modified with NF-κB decoy oligodeoxynucleotides (ODNs).METHODS: Bone marrow (BM)-derived DCs from SD rats were propagated in the presence of GM-CSF or GM-CSF+IL-4 to obtain immature DCs or mature DCs. GM-CSF+IL-4-propagated DCs were treated with double-strand NF-κB decoy ODNs containing two NF-κB binding sites or scrambled ODNs to ascertain whether NF-κB decoy ODNs might prevent DC maturation. GM-CSF-propagated DCs, GM-CSF+NF-κB decoy ODNs or scrambled ODNs-propagated DCs were treated with LPS for 18 h to determine whether NF-κB decoy ODNs could prevent LPS-induced IL-12 production in DCs. NF-κB binding activities, costimulatory molecule (CD40, CD80, CD86) surface expression, IL-12 protein expression and allostimulatory capacity of DCs were measured with electrophoretic mobility shift assay (ENSA),flow cytometry, Western blotting, and mixed lymphocyte reaction (MLR), respectively. GM-CSF-propagated DCs, GM-CSF+IL-4 -propagated DCs, and GM-CSF+NF-κB decoy ODNs or scrambled ODNs-propagated DCs were injected intravenously into recipient LEW rats 7 d prior to liver transplantation and immediately after liver transplantation.Histological grading of liver graft rejection was determined 7 d after liver transplantation. Expression of IL-2, IL-4 and IFN-γ, mRNA in liver graft and in recipient spleen was analyzed by semiquantitative RT-PCR. Apoptosis of liver allograft-infiltrating cells was measured with TUNEL staining.RESULTS: GM-CSF-propagated DCs, GM-CSF+NF-κB decoy ODNs-propagated DCs and GM-CSF+ scrambled ODNs-propagated DCs exhibited features of immature DCs, with similar low level of costimulatory molecule(CD40, CD80,CD86) surface expression, absence of NF-κB activation,and few allocostimulatory activities. GM-CSF+IL-4-propagated DCs displayed features of mature DCs, with high levels of costimulatory molecule (CD40, CD80, CD86) surface expression, marked NF-κB activation, and significant allocostimulatory activity. NF-κB decoy ODNs completely abrogated IL-4-induced DC maturation and allocostimulatory activity as well as LPS-induced NF-κB activation and IL-12 protein expression in DCs. GM-CSF+NF-κB decoy ODNs-propagated DCs promoted apoptosis of liver allograft-infiltrating cells within portal areas, and significantly decreased the expression of IL-2 and IFN-γ mRNA but markedly elevated IL-4 mRNA expression both in liverallograft and in recipient spleen, and consequently suppressed liver allograft rejection, and promoted liverallograft survival.CONCLUSION: NF-κB decoy ODNs-rnodified DCs canprolong liver allograft survival by promoting apoptosis of graft-infiltrating cells within portal areas as well as down-regulating IL-2 and IFN-γ mRNA and up-regulating IL-4 rnRNA expression both in liver graft and in recipient spleen.     

A carbonised sieve-like corn straw cellulose–graphene oxide composite for organophosphorus pesticide removal

The development of efficient adsorbents for the removal of organophosphorus pesticides from water is a major challenge. In this work, we prepared an activated carbon derived from sieve-like cellulose/graphene oxide composites (ACCE/G) for the removal of several organophosphorus pesticides. We employed corn straw to produce a sieve-like cellulose–graphene oxide composite (CCE/G); then, by treating CCE/G with potassium hydroxide at high temperatures, the efficient adsorbent ACCE/G was prepared. The adsorption capacity of ACCE/G is higher than those of other sorbents, including a multi-wall carbon nanotube, graphitised carbon black, activated carbon, C18, and primary secondary amine adsorbent. The ACCE/G structure has been fully characterised via scanning electron microscopy, Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction and Brunauer–Emmett–Teller analysis. The maximum adsorption capacity of ACCE/G is 152.5 mg g⁻¹ for chlorpyrifos. The mechanism, the thermodynamic properties, and the kinetics of the adsorption process have been investigated as well. Our findings demonstrate that the adsorption mechanism depends on the electron-donating abilities of the S and P atoms. Moreover, the Langmuir model gives the best fit for the isotherm data, and the adsorption efficiency of the ACCE/G is still over 80% after eight times of recycling, making ACCE/G a valuable candidate for the removal of OPPs.

Synthesizing a reusable adsorbent from waste corn straw is a sustainable way to utilize secondary resources and purify water.     

Combined spectroscopy methods and molecular simulations for the binding properties of trametinib to human serum albumin

Trametinib is a novel anticancer drug for treating metastatic cutaneous melanoma. The present study probed into the binding of trametinib to human serum albumin (HSA) through spectroscopy methods and molecular simulations. Trametinib could quench the fluorescence of HSA through static quenching which could be probed via fluorescence spectroscopy and time-resolved fluorescence. Thermodynamic parameters and docking results indicated that hydrogen bonds and van der Waals forces play crucial roles in this binding process, which exerts almost no effect on the HSA conformation under synchronous fluorescence, three-dimensional fluorescence, circular dichroism spectra, and molecular dynamics simulations. Site marker displacement experiments and molecular docking reveal that trametinib primarily binds to Sudlow site I of HSA. In addition, the trametinib–HSA interaction was hardly influenced by varying amino acid (glutamine, alanine, glycine, and valine) concentrations. This study can provide useful information for the pharmacokinetic properties of trametinib.

Probing the binding properties of trametinib to human serum albumin.     

不同剂量的1，25（OH）2D3对大鼠Thy1肾炎系膜细胞凋亡的影响

目的：探讨不同剂量的1,25（OH）2D3对大鼠抗胸腺细胞抗体（Thy1）肾炎系膜细胞凋亡的影响。方法将SD大鼠120只分为空白对照组（A组）、肾炎模型组（B组）、低剂量1,25（OH）2D3组（C组）和高剂量1,25（OH）2D3组（D组）,每组30只。C、D两组造模成功后给药干预,4组分别于干预后第1、3、7、14、21天每组随机处死6只大鼠,取肾组织标本经HE及PAS染色后确定肾脏病理损害分级;免疫组化法检测肾组织中半胱氨酸天冬氨酸蛋白酶3（Caspase‐3）的表达;TUNEL试剂盒检测其肾小球内细胞凋亡。结果与A组比较,B组Caspase‐3表达增强（P＜0．05）;与B组比较,C、D组Caspase‐3表达增强,但差异无统计学意义（P＞0．05）;D组表达最高,但与C组比较差异无统计学意义（P＞0．05）。与A组比较,B组肾小球内凋亡细胞明显增多（P＜0．05）,且随时间推移逐渐增强;与B组比较,C、D两组凋亡明显增多（P＜0．05）,并在3d达高峰,7、14d逐渐下降,21d趋于正常（P＜0．05）;C、D两组比较,D组凋亡细胞增多明显,但差异无统计学意义（P＞0．05）。结论1,25（OH）2D3具有诱导大鼠肾小球系膜细胞凋亡的作用,其参与了对Caspase‐3的调节,诱导系膜细胞凋亡,促进肾炎的修复,可延缓肾脏疾病进展。     

山西省41家医院胃癌住院日影响因素分析

目的了解胃癌患者住院日的影响因素,为医院及卫生主管部门管理决策提供参考依据。方法收集山西省41所三级医院2014年一季度胃癌患者出院首页数据,利用多重线性回归统计学方法,回顾性分析胃癌患者住院日与患者性别、年龄、地区、付费方式、伴随诊断数量、手术、医院类型7因素的相关性。结果不同性别组、年龄组、付费方式组住院日比较无统计学意义(t=0.210,P=0.834;F=1.342,P=0.252;2χ=5.945,P=0.312),是否手术、医院类型、伴随诊断数量、不同地区(Mann-Whitney检验)组住院日比较有统计学意义(2χ=52.489,P<0.001;2χ=32.924,P<0.001;t=-21.026,P<0.001;Z=-8.149,P<0.001)。结论医院加强手术患者的管理、严格把握手术适应症、优化手术患者诊疗流程设计与管理、开展与基层医院双向转诊服务等对降低患者住院日水平有帮助;同时,卫生主管部门应引导患者理性选择就医地点,不盲目追求名医名院,避免出现少数医院患者过度集中现象,这不仅可有效缓解患者看病难看病贵,而且对缩短患者住院日也有实际意义。     

山西省三级医院胃癌患者住院费用影响因素分析

目的了解山西省三级医院胃癌患者住院费用的影响因素,为卫生、医保等管理部门制定相关政策与措施提供依据。方法采用多重线性回归统计学方法回顾分析山西省41所三级医院胃癌患者住院费用与性别、年龄组、地区、付费方式、伴随诊断数目、住院日、药费占比的相关性。结果回归模型有统计学意义(F=557.06,P<0.001),标准化偏回归系数显示,影响住院费用的因素从大到小依次为:是否手术(0.505)、住院天数(0.409)、医院类型(-0.177)、地区(-0.114)、药品费比例(0.110)、年龄组(0.028),R2=0.709。结论设法降低手术患者药费水平、住院日与药费占比,缩小地区间三级医院医疗技术水平差距、引导患者理性选择就医地点,可有效降低胃癌患者医疗费用负担。     

Seminar合案例教学法在中医诊断教学中的应用效果分析

目的 探讨案例教学法在中医诊断学教学中的应用与效果.方法 在本校中医专业学生中,对2012级至2013级2个年级4个班的中医诊断学进行Seminar合案例教学法尝试.并设同年级同类型4个班用传统教学法作对照.结果 实验班学生认同率达98％;实验班与对照班比较,老师的评价及理论考试成绩实验班与对照班比较差异有统计学意义(P＜0.01或0.05),试验班明显为优.结论 案例教学法对提高中医诊断学的教学质量和锻炼老师教学水平有积极意义.     

基质金属蛋白酶/组织金属蛋白酶抑制物表达失衡在大鼠肾脏衰老过程中的意义

目的:探讨基质金属蛋白酶(MMPs)及其抑制物(TIMPs)在大鼠肾脏衰老过程中的作用。方法:选用3、12和24月龄大鼠，采用免疫组化技术分别检测基质金属蛋白酶—2、9(MMP—2、9)、组织金属蛋白酶抑制物—1、2(TIMP—1、2)、转化生长因子—β1(TGF—β1)等在不同月龄大鼠肾组织中的表达。结果TIMP—1、TIMP—2及TGF—β1主要表达在肾小球、肾小管、间质及血管，并随增龄表达增强(P＜O．01)；MMP—9、MMP—2主要表达在肾小管上皮细胞，随增龄表达无变化；TIMP—1与TGF—β1与肾小球硬化面积有相关性(r分别为O．751、O．771，P＜O．05)；TIMP—1与TIMP—2与小管间质纤维化面积有相关性(r分别为O．783、O．766，P＜O．O5)。结论:MMPs／TIMPs表达失衡在肾脏衰老过程中可能起重要作用。