某教学医院重症监护病房与普通病房细菌分布及耐药性比较分析

收集2016年医院重症监护病房（ICU）与普通病房（非ICU）患者临床首次分离出的12 307株病原菌,分析其细菌分布构成及耐药性差异。 ICU和非ICU排在首位的分别是鲍曼不动杆菌（25.50%）和铜绿假单胞菌（16.68%）。 ICU抗菌药物的耐药率明显高于非ICU,呈高水平的多重耐药,应规范抗菌药物的使用,加强医院感染防护措施,以控制ICU病区的耐药流行。     

尼美舒利通过PPA Rγ途径抑制结肠癌细胞增殖

目的：观察过氧化物酶增殖物激活受体γ（PPARγ）抑制剂GW9662干预后,尼美舒利（N）对结肠癌细胞凋亡和增殖的影响,探讨PPARγ途径在N抗癌机制中的作用。方法体外培养结肠癌SW480细胞,设立不加药对照组、单用PPARγ抑制剂GW9662组（GW9662组,药物浓度0．1、0．5、1．0、5．0μmol／L）、单用N组、GW9662＋N组共4组。MTT检测各组细胞生长抑制率;流式细胞术（FCM）检测细胞凋亡及细胞周期的变化。Westernblot检测各组中PPARγ、p21Waf1、p27Kip1、Bcl‐2、Bax、VEGF蛋白的表达。结果MTT检测结果：GW9662组较对照组细胞增殖差异无统计学意义（P＞0．05）;N组呈时间依赖性抑制SW480细胞增殖（P＜0．01）;在GW9662＋N组中GW9662呈剂量及时间依赖性减弱N抑制细胞增殖的作用。FCM检测结果：细胞凋亡率在GW9662组与对照组之间差异无统计学意义（P＞0．05）;N组与对照组比较,SW480细胞凋亡率显著增加,差异有统计学意义（P＜0．01）,G0／G1期细胞比例明显增加,S期及G2／M期细胞比例显著减少;GW9662＋N组细胞凋亡率较N组明显降低（P＜0．01）,细胞在G0／G1期的比例降低,S期和G2／M期细胞的比例升高。Westernblot检测结果：N组与对照组比较SW480细胞的PPARγ、p21Waf1、p27Kip1、Bax蛋白表达率显著增加（P＜0．05或P＜0．01）,Bcl‐2、VEGF的表达率则明显下调（P＜0．01）;GW9662＋N组与N组比较,SW480细胞的PPARγ、p21Waf1、p27Kip1、Bax蛋白显著表达下调（P＜0．05或P＜0．01）,而Bcl‐2、VEGF的表达则上调（P＜0．05）。结论N在体外能有效抑制结肠癌细胞SW480的增殖,促进其凋亡。PPARγ通路在N影响结肠癌细胞增殖、凋亡中发挥重要作用。     

The GLP-1 Receptor Agonist Liraglutide Increases Myocardial Glucose Oxidation Rates via Indirect Mechanisms and Mitigates Experimental Diabetic Cardiomyopathy

BackgroundType 2 diabetes (T2D) increases risk for cardiovascular disease. Of interest, liraglutide, a therapy for T2D that activates the glucagon-like peptide-1 receptor to augment insulin secretion, reduces cardiovascular-related death in people with T2D, though it remains unknown how liraglutide produces these actions. Notably, the glucagon-like peptide-1 receptor is not expressed in ventricular cardiac myocytes, making it likely that ventricular myocardium-independent actions are involved. We hypothesized that augmented insulin secretion may explain how liraglutide indirectly mediates cardioprotection, which thereby increases myocardial glucose oxidation.MethodsC57BL/6J male mice were fed either a low-fat diet (lean) or were subjected to experimental T2D and treated with either saline or liraglutide 3× over a 24-hour period. Mice were subsequently euthanized and had their hearts perfused in the working mode to assess energy metabolism. A separate cohort of mice with T2D were treated with either vehicle control or liraglutide for 2 weeks for the assessment of cardiac function via ultrasound echocardiography.ResultsTreatment of lean mice with liraglutide increased myocardial glucose oxidation without affecting glycolysis. Conversely, direct treatment of the isolated working heart with liraglutide had no effect on glucose oxidation. These findings were recapitulated in mice with T2D and associated with increased circulating insulin levels. Furthermore, liraglutide treatment alleviated diastolic dysfunction in mice with T2D, which was associated with enhanced pyruvate dehydrogenase activity, the rate-limiting enzyme of glucose oxidation.ConclusionsOur data demonstrate that liraglutide augments myocardial glucose oxidation via indirect mechanisms, which may contribute to how liraglutide improves cardiovascular outcomes in people with T2D.     

64排螺旋CT血管造影和冠状动脉造影诊断冠心病的临床比较

目的 :对比分析CT血管成像(computed tomography angiography,CTA)与数字减影血管造影(digital subtraction angiography,DSA)成像,探讨64排螺旋CT冠状动脉成像技术在冠心病临床诊断中的价值。方法 :随机选取32例疑似或确诊为冠心病的住院患者,进行CTA及DSA检查(CTA检查均在DSA前1周内完成),对结果进行对比分析。结果:共分析了32例患者的全部血管节段(243个),DSA检测到病变节段138处,无病变节段105处,CTA检测到病变节段129处,无病变节段114处;CTA诊断冠状动脉狭窄的敏感性为91.3%,特异性为97.1%,阳性预测值为97.7%,阴性预测值为89.5%,准确率为93.8%;CTA检查发现59支冠状动脉血管有斑块,DSA检查发现62支有斑块,二者之间比较无显著性差异;CTA与DSA对狭窄程度<50%、50%~75%、>75%的所有部位病变的检出数目分别为18、24处,35、32处,6、6处,二者比较均无显著性差异。结论 :64排螺旋CT冠状动脉成像技术对冠状动脉狭窄的诊断较为准确,是诊断冠心病和评价冠状动脉狭窄的一种有效的无创性检查方法。     

Endovascular treatment of symptomatic intracranial atherosclerotic stenosis with low profile visualized intraluminal support stent

ObjectiveSevere intracranial atherosclerotic stenosis has become one of the main causes resulting transient ischemic attack and stroke. This study aimed to evaluate the efficacy and safety of low profile visualized intraluminal support (LVIS) stent in treating symptomatic intracranial atherosclerotic stenosis.MethodsData of 31 patients with at least 70% stenosis treated with LVIS stent in our center were retrospectively collected between July 2017 and November 2020. Further evaluation of lesion characteristics, technical success rate, preoperative complication, clinical and angiographic follow-up outcome, delayed in-stent stenosis were conducted.ResultsStent delivery and deployment were successfully achieved in all 31 patients (100%). 22 cases (71%) were located in anterior circulation and 9 cases (29%) were located in posterior circulation. The mean degree of stenosis lesion before stent deployment was 85.6 ± 9.4%, while after stenting was 11.2 ± 11.8%. One patient suffered from ischemic complication in stenting procedure, and timely delivery of rt-PA successfully recanalized the artery. Clinical follow-up was available in all 31patients (100%) with mean follow-up time 15.0 ± 12.1(3–45) months. No patients experienced the recurrence of stroke or TIA or death after discharge. Angiographic follow-up was available in 21patients (67.7%) with mean follow-up time 11.43 ± 6.8 (6–36) months. 19 patients (90.5%) were stable while 2 patients (9.5%) developed ISR in their last angiographic follow-up. The 2 patients received balloon angioplasty and reached satisfactory results after retreatment.ConclusionThis preliminary study suggests that LVIS stent deployment was a feasible approach in treating intracranial atherosclerotic stenosis with satisfactory procedure success rate, low complication rate and favorable long-term outcome.     

血清IL-32、IL-33、IL-35在不同亚型Hp感染者及胃癌患者中的水平及意义

目的观察血清白细胞介素-32(interleukin-32,IL-32)、白细胞介素-33(interleukin-33,IL-33)、白细胞介素-35(interleukin-35,IL-35)水平与不同亚型幽门螺杆菌(Helicobacter pylori,Hp)感染之间的关系,并探讨胃癌患者血清IL-32、IL-33、IL-35水平的变化及意义。方法选取胃癌(GC)患者46例、慢性萎缩性胃炎(CAG)患者40例及慢性非萎缩性胃炎(CNAG)患者114例作为研究对象。采用酶联免疫吸附试验(ELISA)定量检测患者血清IL-32、IL-33、IL-35水平。比较各组患者血清IL-32、IL-33、IL-35水平与Hp感染率及其亚型之间的关系。结果1)3组患者血清IL-32、IL-33、IL-35水平的比较:GC组患者血清IL-32、IL-33、IL-35水平均明显高于CAG组及CNAG组(P<0.01);CAG组患者血清IL-32、IL-33水平均明显高于CNAG组患者(P<0.05);CAG组患者血清IL-35水平与CNAG组患者比较无明显差异(P>0.05)。2)3组患者Hp感染率的比较:GC组患者Hp感染率及Ⅰ型Hp感染率均明显高于CNAG患者(P<0.05),Hp感染率及Ⅰ型Hp感染率在GC组与CAG组、CAG组与CNAG组之间比较无显著统计学差异(P>0.05)。3)血清IL-32、IL-33、IL-35水平与不同亚型Hp感染之间的关系:在3组患者中,Ⅰ型Hp感染组血清IL-32、IL-33、IL-35水平均明显高于Ⅱ型Hp感染组及Hp阴性组(P<0.05),Ⅱ型Hp感染组血清IL-32、IL-33水平与Hp阴性组比较均无明显差异(P>0.05)。在CNAG组患者中,Ⅱ型Hp感染组血清IL-35水平明显高于Hp阴性组(P<0.05)。结论1)Ⅰ型Hp感染者发生GC的风险增加。2)在CNAG、CAG及GC患者中,Ⅰ型Hp感染者血清IL-32、IL-33、IL-35水平均显著升高。3)血清IL-32、IL-33、IL-35水平在GC患者中明显升高,其水平变化有利于提高GC的确诊率。     

不同肥胖程度阻塞性睡眠呼吸暂停低通气综合征患者的临床特征研究

背景　肥胖是阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的常见危险因素,绝大多数OSAHS患者超重或肥胖,不同肥胖程度的OSAHS患者临床特征可能存在差异。目的　比较不同肥胖程度OSAHS患者的临床特征,进一步明确不同肥胖程度对OSAHS病情的影响。方法　选择自2014年1月-2018年9月在徐州医科大学睡眠医学中心经多导睡眠监测（PSG）检查确诊的OSAHS患者为研究对象,收集患者的临床资料包括一般人口学资料、临床合并症和主要睡眠参数等。参照中国人肥胖标准,根据体质指数（BMI）将OSAHS患者分为正常体质量（<24.0 kg/m2）、超重（24.0~27.9 kg/m2）和肥胖组（≥28.0 kg/m2）。比较三组患者的临床特点、合并症和主要睡眠参数的差异,并分析BMI与主要睡眠参数的相关性。结果　共纳入研究对象1 586例,男1 259例（79.38%）,有1 062例（66.96%）吸烟,平均BMI（28.20±4.19）kg/m2。高血压（44.89%,712/1 586）、脑血管疾病（20.62%,327/1 586）、心脏疾病（13.55%,215/1 586）是OSAHS的常见合并症。根据BMI将患者分为正常体质量组206例、超重组616例和肥胖组764例。 3组患者年龄、BMI、Epworth嗜睡量表（ESS）评分、合并高血压者占比、合并糖尿病者占比、合并心脏疾病者占比、合并脑血管疾病者占比、氧减饱和指数（ODI）、呼吸暂停低通气指数（AHI）、平均血氧饱和度（MSaO2）、最低血氧饱和度（LSaO2）及微觉醒指数比较,差异有统计学意义（P<0.05）。进一步两两比较可知：超重组患者MSaO2、LSaO2低于正常体质量组（P<0.05）,BMI、ODI、AHI及微觉醒指数高于正常体质量组（P<0.05）,合并脑血管疾病者占比高于正常体质量组（P<0.016 7）;肥胖组患者平均年龄小于正常体质量组（P<0.05）,合并脑血管疾病者占比高于正常体质量组（P<0.016 7）;肥胖组患者MSaO2、LSaO2低于正常体质量组和超重组（P<0.05）,BMI、ESS评分、ODI、AHI及微觉醒指数高于正常体质量组和超重组（P<0.05）,合并高血压、糖尿病、心脏疾病者占比高于正常体质量组和超重组（P<0.016 7）。Pearson相关分析显示,OSAHS患者BMI与AHI呈线性正相关（r=0.312,P<0.001）;与MSaO2和LSaO2呈线性负相关（r=-0.501和-0.566,P<0.001）。结论　OSAHS患者的BMI与AHI呈正相关,肥胖和超重患者病情重且合并症更多见,提示肥胖增加OSAHS的严重程度。     

肠道与肺中ILC2细胞不同免疫反应特性研究

目的：探讨肠道与肺中固有淋巴细胞2（innate lymphoid cell2,ILC2）的不同免疫反应特性。方法：使用real-time PCR检测肠道和肺中ILC2细胞转录因子及细胞因子的表达;EdU方法检测肠道和肺中ILC2细胞对不同细胞因子刺激的增殖反应;观察Notch信号抑制剂GSI对肠道和肺中ILC2细胞体外增殖的影响。结果：与肺ILC2细胞相比,肠道ILC2细胞IL-13、IL-17、IFN-γ及IL-25受体IL17RB表达显著升高,而IL-5、IL-33受体IL1RL1显著降低。IL-25能显著提高肠道ILC2体外增殖能力;GSI抑制Notch信号后显著降低IL-25促进肠道ILC2体外增殖能力。结论：肠道与肺中ILC2表达不同的细胞因子,依赖于IL-25的肠道ILC2增殖能力受Notch信号影响。     

RFTVR术、新型光纤CO_2激光术对早期喉癌患者症状改善情况和QOL评分、VAS评分的影响

目的:研究RFTVR术、新型光纤CO_2激光术对早期喉癌患者症状改善情况和QOL评分、VAS评分的影响。方法:选择2015年1月～2016年12月诊断治疗的喉癌患者120例作为研究对象,随机分为观察组和对照组各60例,观察组采取RFTVR术治疗,对照组采取新型光纤CO_2激光术治疗。比较两组围手术期指标、吞咽功能、发音功能、生存期、QOL评分、VAS评分之间的差异。结果:两组术中出血量、手术时间以及住院时间之间比较,差异无统计学意义(P>0.05);观察组无误咽情况高于对照组,经过治疗后,两组jitter、shimmer、HNR均明显改善,且观察组jitter、shimmer低于对照组,HNR高于对照组(P<0.05);两组QOL评分、VAS评分均明显改善,且观察组的QOL评分高于对照组、VAS评分低于对照组(P<0.05);观察组的总生存期以及无瘤生存期高于对照组。结论:相比CO_2激光治疗,低温等离子射频消融手术治疗的患者吞咽功能以及发音功能明显改善,同时通过对患者生存期的延长,改善患者的生命质量。     

Molecular Cloning and Characterization of Rhesus Monkey Platelet Glycoprotein Ibα, a major ligand-binding subunit of GPIb-IX-V complex

Introduction

Through binding to von Willebrand factor (VWF), platelet glycoprotein (GP) Ibα, the major ligand-binding subunit of the GPIb-IX-V complex, initiates platelet adhesion and aggregation in response to exposed VWF or elevated fluid-shear stress. There is little data regarding non-human primate platelet GPIbα. This study cloned and characterized rhesus monkey (Macaca Mullatta) platelet GPIbα.

Materials and Methods

DNAMAN software was used for sequence analysis and alignment. N/O-glycosylation sites and 3-D structure modelling were predicted by online OGPET v1.0, NetOGlyc 1.0 Server and SWISS-MODEL, respectively. Platelet function was evaluated by ADP- or ristocetin-induced platelet aggregation.

Results

Rhesus monkey GPIbα contains 2,268 nucleotides with an open reading frame encoding 755 amino acids. Rhesus monkey GPIbα nucleotide and protein sequences share 93.27% and 89.20% homology respectively, with human. Sequences encoding the leucine-rich repeats of rhesus monkey GPIbα share strong similarity with human, whereas PEST sequences and N/O-glycosylated residues vary. The GPIbα−binding residues for thrombin, filamin A and 14-3-3ζ are highly conserved between rhesus monkey and human. Platelet function analysis revealed monkey and human platelets respond similarly to ADP, but rhesus monkey platelets failed to respond to low doses of ristocetin where human platelets achieved 76% aggregation. However, monkey platelets aggregated in response to higher ristocetin doses.

Conclusions

Monkey GPIbα shares strong homology with human GPIbα, however there are some differences in rhesus monkey platelet activation through GPIbα engagement, which need to be considered when using rhesus monkey platelet to investigate platelet GPIbα function.