一例2型糖尿病肥胖患者的治疗方案优化

2型糖尿病肥胖患者多伴有高胰岛素血症和胰岛素抵抗,二甲双胍是这类人群用药的首选方案.本文通过对一例2型糖尿病肥胖病例进行分析,明确这类患者血糖的管理目标、药物治疗方案制订和生活方式调整建议.     

Ipsilateral versus bilateral limb-training in promoting the proliferation and differentiation of endogenous neural stem cells following cerebral infarction in rats

We investigated the effects of ipsilateral versus bilateral limb-training on promotion of endogenous neural stem cells in the peripheral infarct zone and the corresponding cerebral region in the unaffected hemisphere of rats with cerebral infarction. Middle cerebral artery occlusion was induced in Wistar rats. The rat forelimb on the unaffected side was either wrapped up with tape to force the use of the paretic forelimb in rats or not braked to allow bilateral forelimbs to participate in training. Daily training consisted of mesh drum training, balance beam training, and stick rolling training for a total of 40 minutes, once per day. Control rats received no training. At 14 days after functional training, rats receiving bilateral limb-training exhibited milder neurological impairment than that in the ipsilateral limb-training group or the control group. The number of nestin/glial fibrillary acidic protein-positive and nestin/microtubule-associated protein 2-positive cells in the peripheral infarct zone and in the corresponding cerebral region in the unaffected hemisphere was significantly higher in rats receiving bilateral limb-training than in rats receiving ipsilateral limb-training. These data suggest that bilateral limb-training can promote the proliferation and differentiation of endogenous neural stem cells in the bilateral hemispheres after cerebral infarction and accelerate the recovery of neurologic function. In addition, bilateral limb-training produces better therapeutic effects than ipsilateral limb-training.     

聚乙二醇干扰素α-2a联合恩替卡韦治疗慢性乙型肝炎患者疗效及血清Pygo2和GP73水平变化

目的 分析聚乙二醇干扰素α-2a联合恩替卡韦治疗慢性乙型肝炎(CHB)患者的疗效及血清人尾肢同源蛋白2(Pygo2)和高尔基体糖蛋白73(GP73)水平的变化。方法 2018年2月~2019年2月我院收治的77例CHB患者,采用随机数字表法分为对照组36例和观察组41例,分别给予恩替卡韦或恩替卡韦联合聚乙二醇干扰素α-2a治疗24 w。采用聚合酶链式反应检测血清HBV DNA,采用化学发光法检测血清HBeAg和抗HBe,采用ELISA法检测血清Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、透明质酸(HA)和Ⅳ型胶原(Ⅳ-C)及Pygo2和GP73水平。结果 在治疗结束时,两组血清HBV DNA转阴率均为100.0%,但观察组血清HBeAg转阴率为36.6%,显著高于对照组(19.4%,P<0.05),HBeAg血清转换率为22.0%,显著高于对照组(8.3%,P<0.05);观察组血清ALT水平为(32.3±13.5)U/L,显著低于对照组【(46.1±19.7)U/L,P<0.05】;观察组患者血清LN水平为(84.7±31.5)μg/L,显著低于对照组【(117.6±40.3)μg/L,P<0.05】,Ⅳ-C水平为(79.8±16.1)μg/L,显著低于对照组【(97.4±19.5)μg/L,P<0.05】,PC-Ⅲ水平为(94.5±21.2)μg/L,显著低于对照组【(140.8±29.7)μg/L,P<0.05】,和HA水平为(107.1±25.2)μg/L,显著低于对照组【(160.5±35.0)μg/L,P<0.05】;观察组患者血清Pygo2水平为(50.8±5.9)μg/L,显著低于对照组【(55.4±7.3)μg/L,P<0.05】,GP73水平为(108.6±10.6)ng/mL,显著低于对照组【(121.5±13.2)ng/mL,P<0.05】。结论 联合应用恩替卡韦和聚乙二醇干扰素α-2a治疗CHB患者可取得比单用恩替卡韦更好的短期疗效,可能与联合治疗能有效降低血清Pygo2和GP73水平,缓解肝纤维化进程,从而显著改善肝功能和提高了血清学应答有关。     

Ultra-Low-Dose Decitabine Combined With Autologous Cytokine-Induced Killer Cells for Elderly Patients With Acute Myeloid Leukemia Transformed From Myelodysplastic Syndrome

Purpose

Elderly acute myelocytic leukemia (AML) patients have limited treatment options because they poorly tolerate standard-dose chemotherapy. The present article describes our experience with ultra-low-dose decitabine combined with infusion of autologous cytokine-induced killer (CIK) cells for 2 elderly patients with myelodysplastic syndrome–transformed AML.

Methods

Decitabine (10 mg) was given on days 1 to 5, and CIK cells on day 14 with 2 to 8 × 10⁹ cells per infusion.

Findings

The therapeutic regimen resulted in marked hematologic recovery and was associated with better than expected survival in both cases.

Implications

Our experience suggests that the combination therapy is safe and effective for elderly patients with myelodysplastic syndrome–transformed AML.     

阿魏酸钠对ox-LDL诱导血管内皮细胞凋亡的影响

目的观察阿魏酸钠(SF)对氧化修饰的低密度脂蛋白(ox-LDL)诱导血管内皮细胞凋亡的保护作用。方法将体外培养的人脐静脉内皮细胞(HUVEC)分为5组,分别为对照组,ox-LDL(50mg/L)组,SF低浓度(5μmol/L)组,SF中浓度(10μmol/L)组及SF高浓度(20μmol/L)组。SF低、中、高浓度组在加入含相应浓度的SF培养1h后,加入终浓度为50mg/L的ox-LDL。采用MTT比色法确定SF的作用浓度。分别采用Hochest 33258细胞核荧光染色法(定性)和流式细胞仪(定量)检测SF对ox-LDL致内皮细胞凋亡的影响。结果一定浓度的SF能够抑制ox-LDL引起的HUVEC存活率降低,对HUVEC损伤具有拮抗作用,40μmol/L以下是SF拮抗细胞损伤的最佳浓度范围。Hochest33258染色后ox-LDL组细胞核显示较强蓝色荧光,可见核固缩、凋亡小体等典型的凋亡形态学特征;加入20μmol/L SF后,细胞核基本恢复其正常形态。流式细胞术结果显示,加入低、中、高浓度的SF后,其细胞凋亡率分别为25.21%±4.07%、12.45%±2.65%、10.85%±1.23%,与ox-LDL组(31.14%±4.29%)比较均明显降低(P<0.05),且存在量效关系。结论 SF具有拮抗ox-LDL诱导的HUVEC损伤,减少血管内皮细胞凋亡的作用。     

Rab5 GTPase对膀胱癌细胞自噬及增殖的调控

目的探讨Rab5 GTPase对膀胱癌细胞自噬及增殖的影响。方法采用实时定量PCR检测60例膀胱癌组织以及相应正常膀胱组织中Rab5 mRNA的表达水平,并检测Rab5 mRNA在膀胱癌细胞系及正常膀胱细胞系中的表达情况。通过pcDNA3.1-Rab5转染膀胱癌细胞系BIU-87、RT4过表达Rab5;免疫荧光、Western blot检测自噬相关蛋白LC3Ⅱ/Ⅰ、LC3斑点数目变化情况以及自噬相关蛋白Vps34的表达变化;采用CCK-8检测膀胱癌细胞的增殖改变情况。结果Rab5 mRNA在膀胱癌组织中的表达高于正常膀胱组织,Rab5 mRNA在膀胱癌细胞中的表达高于正常膀胱细胞系,差异有统计学意义(P<0.05);免疫荧光显示过表达Rab5后LC3荧光斑点明显增多,且过表达Rab5促进膀胱癌细胞中Vps34的表达增加及LC3-Ⅰ向LC3-Ⅱ的转化;过表达Rab5能促进膀胱癌细胞增殖(P<0.05)。结论膀胱癌组织中Rab5 mRNA的表达高于正常膀胱组织,Rab5提高膀胱癌细胞自噬水平并促进膀胱癌细胞增殖,且与自噬相关蛋白Vps34相关。     

辛伐他汀通过MEK/ERK信号转导通路上调突触素表达

目的研究辛伐他汀(SV)对体外培养大鼠大脑皮层神经元突触素(SYP)的影响及信号转导机制。方法从新生Sprague-Dawley大鼠大脑皮层分离和培养神经元,4 d后分为对照组、SV处理组(2、4、8μmol/L作用48 h)、PD98059处理组和SV+PD98059处理组(先加入10μmol/L阻断剂PD98059作用30 min,再加入10μmol/L SV作用48 h)。应用免疫荧光检测法检测SYP表达,Western blot检测磷酸化丝裂原细胞外激酶(p-MEK)、磷酸化细胞外调节蛋白激酶1(p-ERK1)和磷酸化细胞外调节蛋白激酶2(p-ERK2)水平。结果免疫荧光检测显示,4μmol/L SV可明显增强SYP免疫反应性。Western blot检测显示,8μmol/L SV可显著增高SYP、p-MEK、p-ERK1和p-ERK2水平。应用PD98059可显著降低SV引起的SYP、p-MEK、p-ERK1和p-ERK2水平上调。结论SV可通过激活MEK/ERK信号转导通路上调SYP表达。     

腹腔镜胆囊切除术Calot三角的解剖变异及处理

目的:总结腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中Calot三角解剖变异的处理经验,以减少LC手术并发症。方法:回顾性分析146例LC中Calot三角的解剖变异及处理方法。结果:胆囊管变异占2.7%,胆囊动脉变异占11.6%,胆囊缺如占0.69%,144例成功实施LC,成功率为98.6%,中转开腹2例(1.4%)。结论:胆道变异极常见,正确分析处理胆囊管和胆囊动脉解剖变异是减少并发症的关键。     

大鼠心肌缺血再灌注早期PARP-1的表达及其抑制剂3-AB对心肌梗死面积的影响

目的 探讨1型多聚ADP核糖聚合酶(PARP-1)在大鼠心肌缺血再灌注损伤早期心肌组织中的蛋白表达,观察其抑制剂3-氨基苯甲酰胺(3-AB)对心肌梗死面积的影响.方法 将164只大鼠随机分为:(1)手术组:又分7个小组,每组12只大鼠;(2)假手术组:又分7个小组,每组6只大鼠;(3)手术干预组(n=14);(4)手术对照组(n=12);(5)假手术干预纽(n=6);(6)假手术对照组(n=6).手术组:结扎冠状动脉左前降支近端45 min,打开系拌,建立心肌缺血再灌注损伤模型,分别于再灌注15 min、30 min、1h、2h、4h、6h、24 h各时间点处死大鼠,检测各时间点心肌组织PARP-1的表达.假手术组:开胸,在冠状动脉左前降支近端穿线但不结扎,分别于与缺血再灌注组相同各时间点(1h、1h 15 min、1 h45 min、2 h 45 min、4 h45 min、6 h 45.min、24 h 45 min)相同方法检测心肌组织PARP-1的表达.手术干预组:建立缺血再灌注模型,分别于再灌注前15 min及再灌注后45 min给予3-AB(20 mg/kg,静脉注射),于再灌注2h处死大鼠,然后检测心肌组织PARP-1的表达(n=8),及心肌梗死面积(n=6).手术对照组:建立缺血再灌注模型,分别于再灌注前15 min及再灌注后45 min给予等体积生理盐水静脉注射,用相同方法检测心肌组织PARP-1的表达(n=6)及心肌梗死面积(n=6).结果 手术组于再灌注不同时间点(15 min、30 min、1h、2h、4h、6h、24 h)PARP-1表达灰度值(分别为176±7、180±8、190 +9、207±15、198±13、196±9、190±5)与假手术组比较有显著差异(P＜0.05).手术干预组灰度值(171±7)与手术对照组灰度值(205±17)比较有显著差异(P＜0.05).手术干预组梗死面积(20％±2％)与手术对照组(33％±4％)比较有显著差异(P＜0.05).结论 心肌缺血再灌注早期心肌组织中PARP-1有明显表达,并呈动态变化,再灌注2h最明显.3-AB明显抑制PARP-1表达,减小心肌梗死面积.有效抑制心肌缺血再灌注早期PARP-1表达可以减轻再灌注心肌损伤,保护心肌.     

Gender disparity in early death after ST-elevation myocardial infarction

Background Females with acute myocardial infarction （AMI） have a higher risk of adverse outcomes because of receiving less evidence-based medical care. Our aim was to investigate the gender disparity in early death after ST- elevation myocardial infarction （STEMI） in the current era. Methods A total of 1429 consecutive patients with STEMI in the Liaoning district were analyzed. We compared hospital care and cardiac event data by sex for in-patients with acute STEMI within 24 hours of symptom onset. Results In the emergency reperfusion group （n=754）, in-hospital mortality occurred in 4.2% of the males and 11.2% of the females （P=-0.001）. In the non-emergency reperfusion group （n=675）, in-hospital mortality occurred in 13.0% of the males and 22.9% of the females （P=-0.001）. Multivariate Logistic regression analysis revealed female sex as an independent risk factor of death for STEMI patients during hospitalization （OR=1.691, P=0.007）. After controlling for patients who died within 24 hr after admission, female sex was no longer an independent risk factor （OR=1.409, P=0.259）. Conclusion Female sex was an independent risk factor for in-hospital mortality of STEMI patients, which is explained by an excess of very early deaths.