痛风的遗传基础

痛风是一种常见的由尿酸盐沉积引起的慢性炎症性关节炎。该文总结了最新的痛风遗传学基础,发现痛风的高风险基因多数与肾脏和肠道尿酸盐转运系统相关。糖酵解基因是一种异于肾和肠道尿酸排泄的血清尿酸调控路径,也为痛风和其他相关的代谢性疾病提供了新的病因学线索。基因之间的相互作用、基因与环境危险因素之间的相互作用均与痛风的发病风险相关。     

黄葵和银杏叶提取物对实验性肾病综合征的疗效比较及机理探讨

目的观察黄葵和银杏叶提取物(ECB761)对实验性肾病综合征的疗效,并探讨可能机理。方法按体重将大鼠随机分为正常组、模型组、模型 EGB761组、模型 黄葵组；正常组一次性注射生理盐水,其余各组一次性尾静脉注射阿霉素(ADR)制成微小病变型肾病综合征(MCNS)模型；两治疗组于造模2周后开始用药,各组每2周测定24 h尿蛋白,实验8周末测定血清TP、Alb、总SOD、MDA含量；肾组织作光镜、电镜检查。结果(1)两治疗组尿蛋白量下降幅度均显著大于模型组(P＜0．01)；(2)实验8周末,两治疗组血清TP、Alb升高幅度均显著大于模型组(P＜0．01和P＜0．05)。(3)两治疗组总SOD水平均显著高于模型组(P＜0．01),MDA显著低于模型组。结论黄葵和EGB761能显著降低MCNS模型大鼠的蛋白尿；其减轻尿蛋白的作用与清除氧自由基有关。     

加速康复外科理念在青少年特发性脊柱侧凸围术期的应用

目的 探讨加速康复外科（ERAS）在手术治疗青少年特发性脊柱侧凸（AIS）病人中的应用效果。方法 收集2016年1月至2020年12月在我院接受AIS手术治疗的138例病人的病例资料。将2016年1月至2018年6月给予常规围术期管理措施的69例病人纳入对照组,2018年7月至2020年12月进行ERAS理念管理的69例病人纳入观察组,进行对照研究。记录两组病人手术时间、出血量、术后输血人数等指标,以及手术前后疼痛程度、心理状况、生活质量和炎症因子变化。结果 观察组手术时间、出血量、术后输血人数、并发症发生率和住院时间均低于对照组（P＜0.05）,观察组护理满意度高于对照组（92.75% vs. 73.91%,P=0.003）。观察组术后24 h、3 d的疼痛视觉模拟量表（VAS）评分低于对照组（P＜0.05）;而术后7 d的VAS评分与对照组比较,差异无统计学意义（P＞0.05）。两组术后7 d的焦虑自评量表、抑郁自评量表、简体中文版脊柱侧凸研究学会22项问卷表评分,以及血清白细胞介素-6、肿瘤坏死因子α水平与术前比较,差异均有统计学意义（P均＜0.05）;两组间比较,观察组明显低于对照组,差异均有统计学意义（P均＜0.05）。结论 ERAS能减少AIS病人围术期失血和不良反应,有利于疼痛的早期控制,降低炎症因子,减轻不良情绪,提高生活质量,进而促进病人早期康复。     

Coordinate Bonding Strategy for Molecularly Imprinted Hydrogels: Toward pH-Responsive Doxorubicin Delivery

Molecularly imprinted hydrogel (MIH) as drug delivery system has been studied. It still remains a challenge to construct the stimuli-responsive MIH. Here, we report a coordinate bond strategy for imprinting doxorubicin (Dox) in hydrogel capable of pH-responsive and sustained drug delivery. The imprinting condition such as template–monomer interactions induced by metal ion was carefully investigated by spectroscopic methods. The obtained Dox–MIH was evaluated by absorption and in vitro release experiments. It has been demonstrated that the cupric ion mediated interaction between Dox and 4-vinyl pyridine via coordination and the optimal coordinate ratio of Dox/Cu²⁺ was 2:1. The rebinding amount of MIH to Dox was 2.7-fold that of nonimprinted hydrogel and the Dox-loaded MIH showed a pH-responsive release property. Not more than 10% of loaded drug was released from Dox–MIH at pH 7.2 during a time course of 7 days. However, near to 60% of loaded drug was sustainedly released at pH 5.0 during the same period. These results indicated that Dox–MIH with pH-responsive behavior possessed great promising as sustained-release delivery system of anticancer drug.     

Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

靶向纳米级免疫偶联物诱导检查点抑制剂抗体治疗颅内胶质瘤的可行性实验研究

目的 探讨靶向纳米级免疫偶联物(Nanoscale immunoconjugates,NCI)诱导检查点抑制剂抗体治疗颅内胶质瘤的可行性。方法 无特定病原体级(Specific pathogen free,SPF)级、雌性大鼠168只,随机分为磷酸缓冲盐溶液(Phosphate buffer saline,PBS)组(24只),游离组(72只)及NIC组(72只); 所有大鼠均进行颅内胶质瘤细胞植入,构建颅内胶质瘤大鼠模型; PBS组不进行治疗; 游离组给予T淋巴细胞相关抗原4(Cytotoxic T lymphocyte associated antigen-4,a-CTLA-4)和程序性细胞死亡1(Anti programmed cell death protein-1,a-PD-1)及两者联合注射,每种各24只; NCI组给予纳米级免疫偶联物诱导检查点抑制剂抗体[分别为聚苹果酸/ T淋巴细胞相关抗原4(Polymalic malic acid/ Cytotoxic T lymphocyte associated antigen-4,P/a-CTLA-4)、聚苹果酸/程序性细胞死亡1(Polymalic malic acid/Anti programmed cell death protein-1,P/a-PD-1)及两盒联合注射]注射,每种各24只; 使用荧光素标记法观察不同组大鼠药物血脑屏障穿透效率,比较不同治疗方式大鼠治疗后CD3+T细胞(CD3+Pan T Cells,CD3+)、CD4+,CD8+、调节性T细胞(Regulatory T cells,Treg)、巨噬细胞(MΦ)、自然杀伤细胞(Natural killer cell,NK)细胞、自然杀伤T细胞(Natural killer T cell,NKT)细胞、干扰素γ(Interferon-γ,IFNγ)水平及大鼠CD4+,CD8+增殖活跃程度、生存期。结果 荧光实验显示,NIC组各治疗方式大鼠脑部荧光面积均显著高于游离组及PBS组; NCI各组CD3+、CD4+、CD8+、Treg、CD4+ki67、CD8+ki67、MΦ、M1MΦ、M2MΦ、NK细胞、NKT细胞、IFNγ每孔计数及总体生存期显著高于游离组及PBS组(P<0.05)。结论 NCI诱导检查点抑制剂抗体能促进药物透过血脑屏障,刺激大脑驻留的免疫系统,促使CD8+ T细胞增殖并触发多种免疫细胞因子的释放,增加M1型巨噬细胞的产生,从而协调针对GBM的免疫反应,提高颅内胶质瘤大鼠存活时间。     

心肌梗死伴二尖瓣返流影响因素的心脏MR研究

目的:采用心脏磁共振成像探究伴或不伴二尖瓣返流的心肌梗死患者的左心室结构和功能差异,并分析可能促使心肌梗死患者发生二尖瓣返流的影响因素。方法:回顾性分析心肌梗死患者131例,并将其分为不伴二尖瓣返流组(56例)以及伴二尖瓣返流组(75例),分析比较两组的一般临床资料、左心室结构功能数据及钆对比剂延迟强化数据。结果:与不伴二尖瓣返流组相比,伴二尖瓣返流组年龄更高;左心室收缩末期容积、左心室舒张末期容积、梗死面积更大、下壁梗死发生率更大(P均<0.05),并且左室射血分数更低(P<0.001)。结论:与不伴二尖瓣返流患者相比,伴二尖瓣返流患者左室结构与功能障碍更严重,年龄、下壁心肌梗死以及梗死面积可能是心肌梗死患者发生二尖瓣返流的影响因素,心脏磁共振成像能够为心肌梗死伴二尖瓣返流患者提供更多有助于诊疗的影像学信息。