肾综合征出血热患者血清CRP、β2-M的变化及意义

目的:探讨肾综合征出血热(HFRS)患者血清C-反应蛋白(CRP)、β2-微球蛋白(β2-M)的变化及其临床意义.方法:选取本院收治的不同病期HFRS患者222例,采用胶乳法、放射免疫法分别检测患者血清中CRP、β2-M水平,并与正常健康人进行对比分析.结果:HFRS患者发热第2日CRP阳性率为83.3％,同期尿蛋白阳性率为33.3％;HFRS患者发热期、低血压期、少尿期CRP、β2-M均较正常人明显增高,差异具有统计学意义(P＜0.05),多尿期、恢复期,逐渐下降并恢复正常.重危型患者CRP明显高于中型患者.血清β2-M在发热期、低血压期、少尿期、多尿期均高于正常人.结论:HFRS患者检测血清CRP、β2-M有助于的早期诊断,病情分析和预后判断.     

松龄血脉康对大鼠脑动脉粥样硬化血管内皮功能的影响及其脑保护机制

目的 探究松龄血脉康对大鼠脑动脉粥样硬化(CAS)血管内皮功能的影响和脑保护机制。方法 将SD大鼠分为对照组、CAS组和松龄血脉康组。CAS组和松龄血脉康组大鼠建立高血压和高血脂诱导的CAS模型,松龄血脉康组大鼠以松龄血脉康灌胃干预。比较各组大鼠血压和血脂指标。苏木精-伊红染色(HE)检测基底动脉和脑组织病理形态学变化。酶联免疫吸附法检测血清一氧化氮(NO)和内皮素1(ET-1)水平。Western blot检测Notch1和Hes1蛋白表达水平。结果 CAS组大鼠血压和血脂水平均显著高于对照组(P＜0.05),松龄血脉康组血压和血脂水平显著低于CAS组(P＜0.05)。对照组基底动脉形态学正常,CAS组血管内膜出现损伤,动脉中膜平滑肌细胞排列紊乱,松龄血脉康组的病理形态介于对照组和CAS组之间。CAS组NO水平显著低于对照组而ET-1显著高于对照组(P＜0.05),松龄血脉康组NO水平显著高于CAS组而ET-1显著低于CAS组(P＜0.05)。对照组大鼠脑组织结构完整,细胞正常,核仁明显,胞质丰富;CAS组大鼠脑组织细胞排列异常,核仁不明显,细胞质出现空晕;松龄血脉康组形态和排列基本正常。CAS组Notch1和Hes1水平显著高于对照组(P＜0.05),松龄血脉康组Notch1和Hes1水平显著低于CAS组(P＜0.05)。结论 松龄血脉康具有保护高血压和高血脂引起的血管内皮细胞和拮抗脑损伤的作用,这种作用可能与抑制Notch通路有关。     

门冬胰岛素注射液强化治疗对急诊经皮冠状动脉介入治疗后急性心肌梗死并应激性高血糖患者的影响

目的探讨门冬胰岛素注射液强化治疗对急诊经皮冠状动脉介入治疗(PCI)后急性心肌梗死(AMI)并应激性高血糖(SHG)患者的影响。方法选取2017年12月—2018年12月河北北方学院附属第二医院心内科收治的急诊PCI后AMI并SHG患者106例,根据胰岛素治疗方案分为对照组和观察组,每组53例。两组患者急诊PCI后均接受标准AMI药物治疗和内科综合治疗,对照组患者PCI后随机血糖>18.0 mmol/L时给予门冬胰岛素注射液皮下注射,观察组患者PCI后立即采用微量泵持续静脉泵注门冬胰岛素注射液,同时每晚睡前给予甘精胰岛素皮下注射;两组患者均连续治疗7 d。比较两组患者PCI后无复流发生情况及心肌灌注情况〔包括ST段抬高总和回落百分比(sumSTR)、TIMI心肌组织灌注分级(TMPG)、肌酸激酶同工酶(CK-MB)峰值〕,PCI前及PCI后7 d炎性因子〔包括白介素16(IL-16)和白介素18(IL-18)〕,PCI前及PCI后7、30 d左心功能指标〔包括左心室射血分数(LVEF)、左心室舒张末容积指数(LVEDVI)、左心室收缩末容积指数(LVESVI)〕,并记录两组患者治疗期间不良心血管事件发生情况。结果观察组患者PCI后无复流发生率低于对照组(P<0.05)。观察组患者PCI后sumSTR>50%者所占比例及CK-MB峰值高于对照组,TMPG优于对照组(P<0.05)。观察组患者PCI后7 d血清IL-16、IL-18水平低于对照组(P<0.05)。时间与方法在LVEF、LVESVI、LVEDVI上无交互作用(P>0.05),时间、方法在LVEF、LVESVI、LVEDVI上主效应显著(P<0.05)。观察组患者PCI后7、30 d LVEF高于对照组,LVESVI、LVEDVI小于对照组(P<0.05)。两组患者治疗期间不良心血管事件发生率比较,差异无统计学意义(P>0.05)。结论门冬胰岛素注射液强化治疗可有效减少急诊PCI后AMI并SHG患者无复流的发生,改善患者心肌灌注及左心功能,减轻炎性反应,且安全性较高。     

Vertebroplasty increases compression of adjacent IVDs and vertebrae in osteoporotic spines

Background contextApproximately 25% of vertebroplasty patients experience subsequent fractures within 1 year of treatment, and vertebrae adjacent to the cemented level are up to three times more likely to fracture than those further away. The increased risk of adjacent fractures postaugmentation raises concerns that treatment of osteoporotic compression fractures with vertebroplasty may negatively impact spine biomechanics.PurposeTo quantify the biomechanical effects of vertebroplasty on adjacent intervertebral discs (IVDs) and vertebral bodies (VBs).Study designA biomechanics study was conducted using cadaveric thoracolumbar spinal columns from elderly women (age range, 51–98 years).MethodsFive level motion segments (T11–L3) were assigned to a vertebroplasty treated or untreated control group (n=10/group) such that bone mineral density (BMD), trabecular architecture, and age were similar between groups. Compression fractures were created in the L1 vertebra of all specimens, and polymethylmethacrylate bone cement was injected into the fractured vertebra of vertebroplasty specimens. All spine segments underwent cyclic axial compression for 115,000 cycles. Microcomputed tomography imaging was performed before and after cyclic loading to quantify compression in adjacent VBs and IVDs.ResultsCyclic loading increased strains 3% on average in the vertebroplasty group when compared with controls after 115,000 cycles. This global strain manifested locally as approximately fourfold more compression in the superior VB (T12) and two- to fourfold higher axial and circumferential deformations in the superior IVD (T12–L1) of vertebroplasty-treated specimens when compared with untreated controls. Low BMD and high cement fill were significant factors that explained the increased strain in the vertebroplasty-treated group.ConclusionsThese data indicate that vertebroplasty alters spine biomechanics resulting in increased compression of adjacent VB and IVD in severely osteoporotic women and may be the basis for clinical reports of adjacent fractures after vertebroplasty.     

腹腔镜下食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝及长期疗效的评估

目的观察分析腹腔镜下食管裂孔疝修补联合Nissen/Dor胃底折叠术治疗食管裂孔疝临床疗效及食管测压与pH值监测对长期疗效的预估意义。 方法回顾性分析2018年1月至2020年1月于河北北方学院附属第二医院收治的120例食管裂孔疝患者的临床资料,其中64例行腹腔镜下食管裂孔疝修补联合Nissen胃底折叠术（Nissen组）,56例行腹腔镜下食管裂孔疝修补联合Dor胃底折叠术（Dor组）。术后随访1年,对比观察2组患者手术情况、住院时间、术后并发症、记录食管测压及pH检测等指标变化情况、Gerd Q、DeMeester评分等。 结果Nissen组术程以及术中出血量明显高于Dor组（P<0.05）,2组总住院时间差异无统计学意义（P>0.05）。2组患者术后总并发症发生率比较,差异无统计学意义（P>0.05）;2组患者术后1年食管反流情况与DeMeester评分较术前均得到明显改善。Nissen组在减少反流次数、长反流次数和最长反流时间方面均优于Dor组（P<0.05）。2组在反流时间、酸反流时间百分比与DeMeester评分比较,差异均无统计学意义（P>0.05）;术后2组患者食管下括约肌压力、静息呼吸平均值、食管残余压较术前均显著提升（P<0.05）,但2组间术后比较无明显差异（P>0.05）。术后2组患者食管松弛率、无效吞咽与Gerd Q评分均较术前也均明显降低,但2组间差异无统计学意义（P>0.05）。 结论腹腔镜疝修补术联合Nissen或Dor胃底折叠术治疗食管裂孔疝均有明显效果,临床应根据患者自身情况选择合适的手术方式。     

BRAFV600E突变蛋白及β-catenin、cyclin D1在cN0期甲状腺微小乳头状癌中的表达及意义

背景与目的 虽然甲状腺微小乳头状癌（PTMC）进展缓慢,但仍常伴有颈部淋巴结转移。有研究提示,BRAF^V600E突变及Wnt/β-catenin信号通路中相关蛋白表达异常,可能与PTMC发生发展、颈部淋巴结转移有关。因此,本研究进一步探讨临床淋巴结阴性（cN0）PTMC病变组织中BRAF^V600E突变及β-catenin、cyclin D1表达及意义。方法 收集2018年3月—2021年9月120例确诊为cN0期PTMC患者的手术标本及临床病理资料,用免疫组化法检测BRAFV600E突变及β-catenin、cyclin D1蛋白在标本中的表达,并分析其与患者临床病理特征的关系。结果 BRAFV600E突变蛋白、β-catenin、cyclin D1蛋白表达阳性率在PTMC组织中阳性表达均明显高于癌旁组织（70% vs. 31.7%、35.8% vs. 20.8%、57.5% vs. 34.2%,均P<0.05）。cyclin D1蛋白阳性表达与肿瘤直径有关,BRAFV600E突变蛋白阳性表达与病灶数目有关,BRAFV600E、β-catenin、cyclin D1蛋白阳性表达均与中央区淋巴结转移有关（均P<0.05）。结论 cN0期PTMC组织中BRAFV600E突变及β-catenin、cyclin D1蛋白表达明显增强,它们的表达可能是PTMC进展及中央区淋巴结转移的重要原因。     

A systematic review and meta-analysis of fall incidence and risk factors in elderly patients after total joint arthroplasty

Background:Falls in the elderly have become a serious social problem worldwide. Approximately a third of persons fall at least once in the year after total joint arthroplasty (TJA), but preventing and treating falls is still challenging in clinical practice. Until now, no formal systematic review or meta-analysis was performed to summarize the risk factors of falls after TJA. The present study aimed to quantitatively and comprehensively conclude the risk factors of falls after TJA in elderly patients.Methods:The electronic databases to be searched include CNKI, Embase, Medline, and Cochrane central database (all up to November 2018). All studies on the risk factors of falls after TJA in elderly patients without language restriction were reviewed. Process of evaluation of identified studies and extraction of data were independently conducted by 2 reviewers, qualities of included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled and a meta-analysis completed. All analyses were performed by the software Stata 11.0.Results:A total of 14 studies were included, which altogether included 1284456 patients with TJA, of them 12879 cases of falls occurred after surgery, suggesting the accumulated incidence of 13.1% and the prevalence of in-hospital falls was 1.0%. This study has provided evidence for the preventing of falls in the elderly patients who were underwent TJA. Outcome measures include advanced age, female, Overweight (BMI≥25 kg/m²), falls history, use of walking aid, diabetes, cardiac disease, hypertension, COPD and depressive symptoms. The ABC Scale was significantly negatively correlated with falls after lower extremity joint replacement.Conclusions:Related prophylaxis strategies should be implemented in elderly patients involved with above-mentioned risk factors to prevent falls after TJA.     

A genetic program theory of aging using an RNA population model

Aging is a common characteristic of multicellular eukaryotes. Copious hypotheses have been proposed to explain the mechanisms of aging, but no single theory is generally acceptable. In this article, we refine the RNA population gene activating model (Lv et al., 2003) based on existing reports as well as on our own latest findings. We propose the RNA population model as a genetic theory of aging. The new model can also be applied to differentiation and tumorigenesis and could explain the biological significance of non-coding DNA, RNA, and repetitive sequence DNA. We provide evidence from the literature as well as from our own findings for the roles of repetitive sequences in gene activation. In addition, we predict several phenomena related to aging and differentiation based on this model.     

Diagnostic value of FDG-PET versus magnetic resonance imaging for detecting spondylitis: a systematic review and meta-analysis

BACKGROUND CONTEXT

Spondylitis is a rare infection in bone requiring multiple diagnostic strategies for verification.

Wingspan支架治疗症状性颅内动脉狭窄90例临床疗效分析

目的探讨Wingspan支架治疗症状性颅内动脉狭窄的安全性、可行性和并发症。方法应用Wingspan支架治疗90例(92个部位)症状性颅内动脉狭窄患者,观察其症状改善、狭窄率及严重不良事件的发生率。术后行脑血管造影术或CTA血管成像观察支架内再狭窄发生率。结果患者术前平均狭窄率为(83.4±9.5)%,Wingspan支架置入后平均残余狭窄率为(21.8±9.8)%。临床随访1～40个月,平均(16.7±10.3)个月,围手术期总并发症发生率为6.5%(6/92),30d内任何脑卒中和31d～1年内同侧缺血性卒中的发生率为10.9%。30例患者接受了血管造影复查,6个月再狭窄率为10.0%(3/30)。结论 Wingspan支架治疗症状性颅内动脉狭窄具有较好的安全性和临床疗效,围手术期总的并发症发生率较低。