气溶胶对实验室安全的危害及防护研究进展

2020年伊始,新型冠状病毒肺炎疫情在世界范围内迅速蔓延。我国新型冠状病毒肺炎防治指南指出在相对密闭的环境中,长时间暴露于高浓度气溶胶下存在经气溶胶传播疾病的可能,提醒医务工作人员应重视气溶胶对实验室安全的危害。本文将以此为切入点,分析实验室病原微生物气溶胶的来源和危害,介绍微生物气溶胶的检测方法,探讨针对实验室感染的生物安全防护措施。     

开放性胃癌根治术围术期营养支持治疗现状调查

目的:分析开放性胃癌根治术围术期营养支持治疗的现状及可能存在的不足,为进一步改善围术期营养支持治疗提供依据。方法:回顾性分析复旦大学附属中山医院2019年1月至12月择(限)期完成开放性胃癌根治术的1 304例患者的临床资料,比较围术期营养支持比例、途径及成分、相关指标水平等。结果:仅接受术前营养支持者、仅接受术后营养支持者、术前术后均接受营养支持者分别占1.7%、56.9%、8.6%,共占67.2%(876/1 304)。术前采用完全肠外营养支持(total parenteral nutrition, TPN)与肠内营养支持(enteral nutrition, EN)者分别为112、21例(5.3∶1),术后采用TPN、EN、PN+EN者分别为558、102、194例(5.5∶1∶1.9)。术后进行TPN的558例患者中,采用全合一(all in one, AIO)营养液者107例,其总热量、每千克体质量热量、每千克体质量蛋白质补充量、热氮比分别为(1 256.7±169.4)kcal/d、(20.7±4.0)kcal·kg~(-1)·d~(-1)、(1.2±0.5)g·kg~(-1)·d~(-1)、(101.1±53.8)∶1;采用单瓶营养素者451例,总热量、每千克体质量热量、每千克体质量蛋白质补充量、热氮比分别为(325.2±79.2)kcal/d、(5.4±1.7)kcal·kg~(-1)·d~(-1)、(0.4±0.1)g·kg~(-1)·d~(-1)、(58.0±23.7)∶1。术后仅采用AIO进行TPN者术前白蛋白[(39.7±5.0)g/L]、前白蛋白[(211.2±55.6)mg/L]显著低于仅采用单瓶营养素支持者[(41.3±4.0)g/L、(222.4±52.0)mg/L,P0.05],术后血糖[(6.3±2.0)mmol/L]高于采用单瓶营养素支持者[(5.5±1.3)mmol/L,P0.01]。结论:营养支持已得到重视,围术期营养支持较高,但术后TPN中蛋白质/氨基酸供给量未达到指南要求。     

Cyclic helix B peptide alleviates sepsis-induced acute lung injury by downregulating NLRP3 inflammasome activation in alveolar macrophages

Acute lung injury (ALI) exhibits high clinical morbidity and mortality rates. Our previous study has indicated that the novel proteolysis-resistant cyclic helix B peptide (CHBP) exerts an anti-inflammatory effect in mice with AKI. In the present study, we evaluated the effect of CHBP in an in vivo sepsis-induced ALI model and in vitro using lipopolysaccharide (LPS) and ATP stimulated bone marrow-derived macrophages (BMDMs). For in vivo experiments, mice were randomly divided into three groups: 1) sham; 2) LPS; and 3) LPS + CHBP (n = 6). All relevant data were collected after 18 h. Following CHBP treatment, the lung function of the mice was significantly improved compared to the LPS group. CHBP administration inhibited interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α production at both the protein and mRNA levels. Additionally, following CHBP treatment, the population of pulmonary macrophages decreased. Simultaneously, the proportion of caspase-1-activated alveolar macrophages was also decreased after CHBP treatment. The protein levels of NLRP3 and cleaved caspase-1 were attenuated in the lung tissue following CHBP treatment. In in vitro experiments, CHBP treatment decreased NLRP3 inflammasome expression and downstream IL-1β secretion, consistent with the in vivo results. In addition, CHBP reversed nuclear factor (NF)-κB and I-κB phosphorylation with a significant dose-dependent effect. Therefore, these findings suggest the potential of CHBP as a therapeutic agent in sepsis-induced ALI owing to inhibition of the NLRP3 inflammasome via the NF-κB pathway in macrophages.     

Prognostic value of soluble urokinase plasminogen activator receptor in patients presenting to the emergency department with chest pain suggestive of acute coronary syndrome

IntroductionSoluble urokinase plasminogen activator receptor (suPAR) is a prognostic biomarker of cardiovascular disease. Objectives: We aimed to evaluate the early prognostic value of suPAR in patients presenting to the emergency department (ED) with chest pain suggestive of acute coronary syndrome (ACS).Patients and methodsIn a post-hoc analysis from a multicenter study including patients with a chest pain < 6 h, suPAR concentrations at ED admission were studied according to the outcome at 30-days.Results198 patients (median age 56 years) in whom 16% had an ACS, were included. Fifteen (7.3%) patients presented a 30-day event. At ED admission, median (IQR) suPAR concentrations were higher in patients with a 30-day event in comparison to patients without event (4.54 (3.09–8.61) vs. 2.72 (2.10–3.43) ng/mL, p < 0.001). The ROC curve AUC of suPAR for the prediction of a 30-days event was 0.775 [95%CI: 0.710–0.831]. The optimal threshold was 3.3 ng/mL, with a sensitivity of 73 [45–92] % and a specificity of 72 [65–79] %. The association of a suPAR < 3.3 ng/mL AND a NT-proBNP < 160 ng/L AND a HEART score < 4 had a negative predictive value of 99 [91–100] %. A suPAR value at admission above 3.3 ng/mL was independently and significantly associated with a 30-day event in chest pain emergency patients (OR 4.87 [1.35–17.51], p = 0.015).ConclusionsuPAR is a promising biomarker for early prediction of events in chest pain emergency patients.     

阿帕替尼治疗中晚期肝癌疗效与安全性的系统评价

目的系统评价阿帕替尼治疗中晚期原发性肝癌的疗效及安全性。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、SinoMed、CNKI、VIP、万方数据库,收集阿帕替尼治疗中晚期肝癌的随机对照研究,检索年限均为建库开始至2019年7月,由2位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用Rev Man 5.2软件进行Meta分析。结果共纳入12项研究,合计823例患者。Meta分析显示,在疗效方面,试验组(阿帕替尼组)患者总有效率[RR=1.72, 95%CI(1.45, 2.04),P<0.01]、疾病控制率[RR=1.45, 95%CI(1.17,1.80),P<0.01]、半年生存期[RR=1.49, 95%CI(1.11,1.99),P<0.01]、1年生存期[RR=1.49, 95%CI(1.20,1.86),P<0.01]、 2年生存期[RR=1.69, 95%CI(1.20, 2.39),P<0.01]明显高于对照组(非阿帕替尼组);治疗后血清血管内皮生长因子(VEGF)[SMD=-3.37, 95%CI(-4.84,-1.90),P<0.01]和基质金属蛋白酶9(MMP-9)[SMD=-3.16, 95%CI(-5.30,-1.02),P<0.01]水平试验组明显低于对照组。在安全性方面,手足综合征[RR=16.73, 95%CI(6.27,44.6),P<0.01]、蛋白尿[RR=17.27,95%CI(5.52, 54.05),P<0.01]和瘙痒[RR=2.73, 95%CI(1.25,5.99),P=0.01]的发生率,试验组高于对照组且差异有统计学意义,但不影响治疗;高血压、骨髓抑制、腹痛腹泻、恶心呕吐和发热的发生率组间差异均无统计学意义。结论当前证据显示,阿帕替尼能提高中晚期肝癌的临床疗效,不良反应可以耐受,但该结论仍有待高质量、大样本的临床随机对照研究进一步验证。     

老年冠心病患者PCI相关造影剂肾病的危险因素分析

目的：分析老年冠心病患者行经皮冠状动脉介入术（Percutaneous Coronary Intervention，PCI）发生造影剂肾病（contrast induced nephropathy, CIN）的危险因素。方法：选择2015.01-2017.12于复旦大学附属中山医院心内科住院行PCI术的378例老年患者的临床资料，包括基本信息、合并症、实验室指标以及药物治疗，应用单因素和多因素分析发生造影剂肾病的危险因素，应用Kaplan-Meier曲线分析CIN对再住院的影响。结果：378例老年冠心病患者中有58例（15.3%）发生CIN。多因素分析结果显示术前肌酐（P=0.010, OR=0.721, 95%CI: 0.622-0.834），术后肌酐（P=0.023, OR=1.207, 95%CI: 1.094-1.332），肾小球滤过率（P=0.024, OR=0.755, 95%CI: 0.630-0.905）以及应用利尿剂（P=0.032, OR=1.206, 95%CI: 0.904-1.364）是导致老年冠心病患者行PCI发生CIN的重要危险因素。生存曲线显示CIN的发生将显著增加老年冠心病患者PCI术后再住院率（P=0.0009, HR=2.359, 95%CI: 1.192-4.668）。结论：术前肌酐、术后肌酐、肾小球滤过率以及应用利尿剂是导致老年冠心病患者行PCI发生CIN的重要危险因素。     

腘动脉瘤开放手术与腔内修复术的对比研究

目的:比较腘动脉瘤(PAA)开放手术与腔内修复术的治疗效果。方法:回顾性分析2008年1月—2017年12月收治的33例PAA患者的临床资料,其中22例(23条肢体)行开放手术(开放手术组),11例(13条肢体)行腔内修复术(腔内修复组),分析、比较两组患者的一般资料、围手术期情况、随访结果。结果:腔内修复组患者年龄与高血压病合并症比例明显大于开放手术组(χ~2=8.250,P=0.008;χ~2=6.203,P=0.024),而两组在其他合并症、术前瘤体直径、术后伤口并发症方面均无统计学差异(均P0.05)。开放手术组均在全麻下完成手术,腔内修复组6例(54.5%)全麻下完成腔内手术(χ~2=12.257,P=0.002)。腔内修复组术后住院时间与总住院时间明显少于开放手术组(t=-4.221,P=0.000;t=-3.090,P=0.002)。中位随访时间36个月(1~120个月),开放手术组有5例再次干预,其中2例行截肢术;腔内修复组有2例再次干预。Kaplan-Meier分析显示两组患者免于再次干预率的差异无统计学意义(P0.05)。结论:对于高龄、外科手术风险高、解剖学条件合适、流出道情况良好的PAA患者,腔内修复术短中期疗效确切、住院时间短、围手术期恢复快,可替代外科手术成为首选治疗方案。