Étude de faisabilité : l’utilisation de l’imagerie médicale en éducation thérapeutique en radiothérapie

PurposeAssess the feasibility of a randomized controlled trial (RCT) exploring the use of medical imaging as a therapeutic education (TPE) intervention in external radiation therapy.Materials and methodsExperimental feasibility trial of “RCT” type carried out in a single-center, between November 2019 and March 2020, following adult patients treated by thoracic radiotherapy. In addition to the information usually given, the experimental group benefited from an intervention consisting in the visualization of their own medical images using the open-source software “Stone of Orthanc”.ResultsForty-nine patients were recruited with a refusal rate of 8.16% (4/49). 20 patients were withdrawn from the study for health reasons (COVID), 10 for medical reasons. All the remaining 15 participants completed the process. Although not significant, the experimental group showed a median gain in the perception of knowledge compared to the control group (+ 1.9 (1.6 – 2.2)) vs (+ 1.4 (1.4 – 1.8)), as well as a decrease in scores related to anxiety (? 3.0 (?4.5 - (?2.0)) vs ? 1.0 (?5.0 - 0.0)) and emotional distress ((? 5.0 (? 7.5 - (? 3.5)) vs (? 2.0 (? 5.0 - (? 1.0)) A significant reduction (p = 0.043) is observed for the depression score ((? 2.0 (?3.0 - (?1.5)) vs (0.0 (0.0 – 0.0)).ConclusionThis study demonstrates the feasibility of the project, with promising preliminary results. Some adaptations in order to conduct a larger-scale RCT are highlighted.     

药学技术信息服务模式的实践和思考

目的：探讨药学服务模式转型中药学技术信息服务的切入点和方法。方法：通过我院药师在药学技术信息服务中的具体做法及取得的效果,进行分析思考。结果：在药品不良反应监测与报告、不合理处方干预、处方点评、临床药师制、合理用药宣传、用药咨询等方面,药师对安全、合理用药可发挥积极作用。结论：药师要有紧迫感和责任感,以“合理用药、安全用药、对药疗结果承担相应责任”为目标,主动投身并开展多种形式的药学技术信息服务,自觉成为医、药、护医疗团队中一员。     

Alterations in event-related potential responses to empathy for pain in Parkinson’s disease on and off medication

ObjectiveHow Parkinson’s disease (PD) affects an individual’s empathic capacity remains poorly understood. By using the event-related potential (ERP) technique, we sought to: (1) study the temporal dynamics of empathic responses in patients with PD; (2) explore whether dopaminergic medication modulates empathic processing.MethodsTwenty-six patients with early-to-moderate PD (13 on– and 13 off-medication) and 14 healthy controls performed an empathy-for-pain paradigm test while we recorded their electroencephalography. The participants responded to neutral or painful pictures during an active empathic condition (pain judgment task) and a control condition that was manipulated by task demands (laterality judgment task).ResultsThe ERP results demonstrated an early automatic frontal response and a late controlled parietal response to pain in healthy elderly controls. The observed early and late ERP responses were detected in the on-medication patients but not in the off-medication patients.ConclusionsPD is associated with deficits in both affective and cognitive empathic responses, dopaminergic medication may have the potential to alleviate these deficits.SignificanceThis study helps to understand empathic deficits in patients with PD. Within-subject studies are required to reliably assess the effect of dopaminergic medication on empathic processing.     

MYNN rs10936599基因多态性与急性心力衰竭患者短期预后的相关性

目的探讨MYNN基因的rs10936599位点多态性与急性心力衰竭（AHF）患者预后的关系。 方法选取2012年3月至2016年3月于南京医科大学第一附属医院心血管内科住院的AHF患者328例,采用TaqMan探针法对MYNN基因的SNP位点rs10936599（T/C）进行基因多态性检测,记录并比较不同基因型患者（TT基因型、CT基因型、CC基因型）住院期间的人口学特征、临床资料、病因和伴随疾病、住院期间治疗用药等基线资料,并对所有患者进行12个月的前瞻性随访,随访终点为全因死亡。分析rs10936599位点多态性对AHF预后的影响。 结果（1）rs10936599基因型频率分布：TT基因型100例（占30.5%）,CT基因型162例（占49.4%）,CC基因型66例（占20.1%）;rs10936599位点的基因型和等位基因频率在死亡患者和存活患者间比较,差异有统计学意义（χ²=9.749,P=0.0076;χ²=9.641,P=0.0019）。（2）心率、血清钾水平及住院期间地高辛和醛固酮拮抗剂使用情况在不同基因型患者间比较,差异有统计学意义（H=7.714,P=0.021;F=3.254,P=0.040）;其他基线资料在不同基因型患者间比较,差异无统计学意义（P＞0.05）。（3）Kaplan-Meier曲线分析显示携带等位基因C（CC/CT）的AHF患者12个月生存率较TT基因型患者明显下降,差异有统计学意义（TT vs CT,P=0.026;TT vs CC,P=0.002）。（4）进一步Cox回归分析结果显示杂合子CT基因型和纯合子CC基因型是影响AHF患者预后的独立危险因素（HR=2.10,95%CI：1.07~4.12;HR=2.96,95%CI：1.42~6.19）。 结论MYNN基因rs10936599位点多态性与AHF患者预后有关,CC和CT基因型是预测AHF患者12个月不良预后的独立危险因素。     

Modulation of microRNAs by aspirin in cardiovascular disease

Aspirin is among the most widely prescribed drugs in cardiovascular and cerebrovascular diseases for both primary and secondary prevention. The major mechanisms underlying its benefits are the inhibitory effects on platelet activation and prostanoid biosynthesis induced by COX-1 and COX-2 inactivation. MicroRNAs (miRNAs) are newly proposed mediators of the effects of aspirin. In this review, we summarize the evidence on the links between miRNAs and aspirin use in relation to cardiovascular diseases. In addition, we discuss the studies suggesting a possible role for miRNAs as biomarkers of aspirin resistance, a condition during which atherothrombotic events occur despite aspirin use, and which affects a considerable proportion of patients with cardiovascular disease.     

肺部超声与纤维支气管镜用于支气管封堵器定位的比较

目的：比较肺部超声技术与纤维支气管镜用于支气管封堵器定位方面的优劣。方法：择期经左侧开胸行食管癌根治术患者90例,采用随机数字表法分为2组,每组45例。麻醉诱导后,经口插入7.5#加强型气管导管,之后采用盲法放置支气管封堵器至一侧支气管。2组患者分别采用肺部超声检查(L组)和纤维支气管镜检查(B组)方法定位封堵器位置并判断肺隔离效果,确定套囊位置良好后,摆放右侧卧位,之后再次判断肺隔离情况。记录L组和B组2次判断肺隔离情况所需要的总时间、术中封堵器调整的次数、术中肺萎陷满意度评分以及患者2次定位前及定位过程中的平均动脉压(mean arterial pressure, MAP)、心率(heart rate,HR)及气道峰值压(peak airway pressure,PAW)的水平。结果：L组和B组确定肺隔离时间、肺萎陷满意度评分术中套囊调整次数差异无统计学意义(P ＞ 0.05)。L组2次判断肺隔离时的HR、MAP及PAW较判断前无明显变化(P ＞ 0.05),B组2次判断肺隔离时的HR、MAP及PAW明显高于纤维支气管镜置入前(P ＜ 0.05)。结论：肺部超声判断支气管封堵器肺隔离效果与纤维支气管镜相近,但肺部超声对血流动力学的影响小于纤维支气管镜。     

药学服务新模式下药师职责核心——合理用药

探讨药学服务模式转型中我院药师在不合理处方干预、处方点评、药师参与临床治疗、药品不良反应监测、合理用药宣传和咨询等方面开展多种形式的药学技术信息服务,自觉成为医、药、护医疗团队中的一员。     

PARP-1 inhibitor-AG14361 suppresses acute allograft rejection via stabilizing CD4+FoxP3+ regulatory T cells

Acute allograft rejection is the most common complication in organ transplantation leading to organ loss. Treg cells play an important role in preventing acute rejection, but they are unstable and easily lose function. Poly(ADP-ribose) polymerase 1(PARP-1) is involved in the differentiation stabilization of Treg cells, it has been suggested that PARP-1 inhibition could prevent acute rejection and prolong allograft survival. This study investigated AG14361 effects on acute allograft rejection. We used a fully MHC-mismatched murine heart transplantation model to compare the effect of PARP-1 inhibitor-AG14361 on alloimmunity to the control. Mice treated with PARP-1 inhibitors showed a longer median survival time of allografts (MS14 compared with the control group, MST was 8 days, and AG14361 was 6 days, P = 0.019). The combination of sirolimus and AG14361 significantly delayed allograft MST (AG14361 + sirolimus for 30 days, sirolimus for 16 days, P = 0.002). AG14361 markedly augmented the number of the CD25+FoxP3+ Treg cells in the graft and periphery. In addition, it could enhance the suppressive function of Treg cells by upregulating the level of CTLA-4, PD-1 and ICOS. In vivo, the Treg/Th17 ratio increased significantly in the AG14351 group compared to the control. In the combination with sirolimus treatment, AG14361 promoted the long-term allograft survival. Our results highlight novel effects of a PARP-1 inhibitor. PARP-1 inhibitor AG14361 may be a promising agent to attenuate acute allograft rejection as it can maintain the number and function of Treg cells in allografts.     

贝达喹啉治疗药物浓度监测方法的建立与应用

目的：建立贝达喹啉人体血药浓度的测定方法并应用。方法：血浆样本以舍曲林为内标经甲醇沉淀蛋白后,采用C₁₈色谱柱甲醇^-10 mmol·L^-1甲酸铵溶液梯度洗脱分离,电喷雾正离化,多反应监测模式(MRM)定量测定贝达喹啉和舍曲林的离子反应分别为m/z 555.2→229.0和m/z 306.2→159.0。结果：贝达喹啉检测质量浓度的线性范围为0.010～3.0μg·mL^-1(r=0.9995),定量下限为0.010μg·mL^-1;方法经验证符合生物样本分析要求。用于6例耐多药结核病(MDR-TB)患者贝达喹啉治疗血药浓度监测,患者在治疗第7天血浆中贝达喹啉血药峰浓度C_max为(3.48±0.70)μg·mL^-1,峰时间t_max为(5.33±1.03)h,半衰期t_1/2为(18.73±6.39)h;血药浓度曲线下面积AUC_last为(50.16±9.74)μg·h·mL     

丙泊酚辅助麻醉下行腹腔镜手术气腹体位对呼吸及循环功能的影响

目的：探讨丙泊酚辅助麻醉下行腹腔镜手术气腹体位对呼吸及循环功能的影响。方法108例腹腔镜手术患者根据手术类型随机分为观察组与对照组,每组54例,两组患者采取不同体位进行手术治疗,采集两组患者气腹前（T0）、气腹后10min（T1）、体位改变后15min（T2）、体位改变后30min（T3）及撤除气腹并恢复体位10min （T4）时的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、血氧饱和度（SpO2）及PETCO2、气道峰压（Ppeak）并进行比较。结果 T1、T2、T3时点两组患者MAP、HR、Ppeak及PETCO2与T0期比较存在显著差异（P＜0.05）,观察组T2、T3时点MAP、Ppeak、PETCO2明显高于对照组,T4时点观察组MAP及HR明显高于对照组（P＜0．05）。结论腹腔镜手术中体位是影响呼吸及循环功能的主要因素,应根据患者的实际病情及手术操作选择最为适宜的体位进行腹腔镜手术治疗。