fliR基因与问号钩端螺旋体黏附及损伤细胞功能相关性的研究

目的：了解问号钩端螺旋体（简称钩体）fliR基因的致病性。方法：分别从问号钩体黄疸出血群56601株DNA和pET42a质粒中扩增fliR基因和kana基因。构建fliR基因自杀质粒，并设计和合成特异性siRNA。采用分别基于自杀质粒的基因敲除、基于siRNA的基因沉默技术构建问号钩体fliR基因突变株，并用PCR、测序、半定量RT-PCR进行鉴定。采用小鼠单核-巨噬细胞J774A．1黏附试验和流式细胞术，检测敲除fliR基因的问号钩体突变株56601^fliR-Kana、siRNA阻断fliR基因的问号钩体突变株56601^siRNA-R2株黏附细胞，及诱导细胞坏死或凋亡能力的变化。结果：所克隆的fliR基因与GenBank中相应基因的核苷酸和氨基酸序列相似性分别为99．9％和100％，所克隆的kana基因核苷酸序列与pET42a图谱完全相同。56601^fliR-Kana可在含氨苄青霉素和卡那霉素的EMJH培养基中生长，PCR和测序结果证实56601^fliR-Kana株fliR基因中插入了kana基因。56601“睢‰“株fliR基因mRNA水平明显下降（P〈0．01），56601”RNA。砣株fliR基因mRNA水平也低于野生株（P〈0．05）。56601^fliR-Kana和56601^siRNA-R2黏附J774A．1细胞的能力基本消失，诱导J774A．1细胞坏死或凋亡的能力也明显减弱（P〈0．01）。结论：fliR基因是问号钩体毒力相关基因，其功能与问号钧体黏附细胞、诱导细胞凋亡或坏死密切相关。     

Attenuation of hepatic fibrosis through ultrasound-microbubble-mediated HGF gene transfer in rats

ObjectiveThe objective was to explore the feasibility of ultrasound-microbubble-mediated hepatocyte growth factor (HGF) gene transfer for treating rat hepatic fibrosis induced by CCl₄.MethodsForty-eight male SD rats were divided into ultrasound-microbubble-HGF group (U-M-HGF group), ultrasound-HGF group (U-HGF group), microbubble-HGF group (M-HGF group), HGF group (HGF group), CCl₄ group (control group), and normal group. The serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total protein, albumin (ALB), and globulin (GLB) and the ratio of ALB/GLB were determined after treatment. The degree of hepatic fibrosis was evaluated by histopathological numerical scores. The protein expressions of HGF, collagen I, collagen III, and α-smooth muscle antibody (α-SMA) were detected by immunohistochemistry.ResultsUltrasound-microbubble-mediated HGF therapy significantly reduced the serum level of ALT and AST to 59.88% and 49.18% of the control group, respectively. Ultrasound-microbubble-mediated HGF therapy prevented liver fibrosis, with an obvious decrease in fibrosis areas and extracellular matrix production of collagen I, collagen III, and α-SMA. The gene therapy could induce HGF delivery into the fibrotic liver effectively.ConclusionsUltrasound-microbubble-mediated HGF gene therapy can reduce liver fibrosis, which provides a novel strategy for gene therapy of chronic liver disease.     

Predicting intertrochanteric extension of greater trochanter fractures of the hip on plain radiographs

IntroductionIt is important to distinct between isolated greater trochanter (GT) fractures and complete intertrochanteric (IT) extension to prevent unwanted morbidities. Aim of this study was to determine if there was any particular fracture pattern, of GT fractures on a plain radiograph of the hip which could predict IT extension.MethodRetrospective review of radiographs of 49 patients with a GT fracture who presented in the last 10 years (January 2005–December 2015). All images were reviewed by a consultant musculoskeletal radiologist and an orthopaedic surgeon. The AP plain radiographs were assessed to look for fracture angle and length of the fracture. The fracture length was taken as a percentage and was measured as the length of the fracture crossing the intertrochanteric line/the total length of the intertrochanteric line. The fracture angle was measured as the angle between a line drawn from the most superior point of the fracture on the lateral cortex of the GT, to a perpendicular line along the medial cortex of the femoral shaft. The subsequent MRI and CT scans were assessed to see if there was true intertrochanteric extension.Results32 patient were female and 17 male. 27 CT scans of which 8 showed complete IT extension. 22 had MRI scan of which 6 showed complete extension. The mean fracture length of patients with complete extension was 56% with a range of 50%–63%. The mean fracture length of patients with incomplete extension was 33% with a range of 12%–55%. The mean fracture angle for patients with complete extension was 39 ° with a range of 35–42°. The mean fracture angle for patients with incomplete extension was 58 ° with a range of 44–124°.ConclusionFor greater trochanter fractures that do not cross >50% of the IT line and do not have a fracture angle between 35 and 42° do not require further imaging as they will not have complete intertrochanteric extension.     

神经管缺陷高发区母亲相关行为因素研究

目的 在对预防出生儿神经管缺陷(neural tube defects,NTDs)实施以叶酸作为有效干预的情况下,研究其仍然高发的影响因素.方法 采用1∶1配比的病例对照研究方法,选取生育过NTDs患儿的210例产妇组成病例组,从同年、同地市、同医院生育健康儿的产妇中选取对照.针对上述研究对象收集母亲围孕期相关行为因素并进行分析.结果 孕期被动吸烟(OR=11.203,P＜0.001)、孕期服药(OR=10.137,P=0.039)、孕前配偶接触有害物质(OR=6.231,P=0.003)为NTDs的危险因素,计划怀孕(0R=0.265,P=0.008)、服用叶酸(OR=0.158,P＜0.001)、孕期精神状态好(OR=0.434,P＜0.001)为保护因素.结论 被动吸烟、孕期服药、配偶在妻子孕前接触有害物质可使NTDs发生的危险性增加,而计划怀孕、服用叶酸以及孕期精神状态好可降低NTDs的发生率.     

应用PDCA护理模式对晚期肝癌患者经外周静脉穿刺中心静脉置管护理的效果评价

目的对PDCA护理模式在晚期肝癌患者经外周静脉穿刺中心静脉(PICC)置管护理中的应用效果进行评价。方法对2012年7月~2013年6月在绍兴第二医院行PICC置管应用PDCA护理模式进行护理的晚期肝癌患者68例,作为本次研究的实验组;另外取2011年7月~2012年6月在绍兴第二医院行PICC置管晚期肝癌进行常规护理的患者68例,作为对照组。观察并统计两组患者并发症发生情况,并在护理结束后对患者进行护理满意度调查。结果实验组发生导管堵塞4例,静脉炎3例,导管发热1例,并发症率为11.8%;对照组发生导管堵塞7例,静脉炎8例,导管发热2例,并发症率为25.0%,实验组并发症率低于对照组,差异有统计学意义(P<0.05)。实验组满意率为92.6%;对照组满意率为80.9%,实验组满意率高于对照组,差异有统计学意义(P<0.05)。结论在晚期肝癌患者PICC置管护理中的应用PDCA护理模式能显著减少患者的置管并发症,且患者满意率高,值得在临床上进一步推广。     

Early osteopontin levels predict mortality in patients with septic shock

BackgroundInflammatory biomarkers could be useful to stratify the risk of sepsis adverse outcome and potentially improving the clinical management. Here, we investigated the prognostic role of the inflammatory molecule osteopontin (OPN) in patients with severe sepsis with and without septic shock.Material and methodsThis is a sub-analysis of 957 patients with sepsis/septic shock from the Albumin Italian Outcome Sepsis (ALBIOS) study. Alongside demographic, clinical, and laboratory data, we assessed plasmatic values of OPN at day 1, 2 and 7 after enrolment. The primary outcome was the predictive role of OPN values at day 1on death for any cause at 28 days after enrolment.ResultsPlasma OPN values at day 1 were higher in patients with septic shock and correlated with the severity of multi-organ dysfunction. Once categorized for 28-day mortality, survivors were characterized by lower OPN levels at each time point and statistically significant drop overtime (p<0.001 for all). Similarly, OPN reduction during the first 7 days was associated with reduced hospitalization and mortality overtime. Multivariate logistic and Cox regression models confirmed plasma OPN at day 1 as predictor of both 28- and 90-day mortality and infection resolution as well, independently of demographic, clinical and therapeutic variables. However, this prognostic value was limited to septic shock patients.ConclusionsIn patients with septic shock, OPN plasma levels at day 1 predict a poor clinical outcome. These results provide the rationale for future pathophysiological studies aimed at clarifying the mechanisms triggered by OPN in septic shock (ALBIOS ClinicalTrials.gov Identifier: NCT00707122).     

Simultaneous implant placement and bone grafting with particulate mineralized allograft in sites with buccal wall defects,a three-year follow-up and review of literature

ObjectivesTo assess the relationship between the vertical buccal defect size and the outcome of single-stage (non-submerged) implant placement and simultaneously augmentation of sites with mineralized particulate allograft (Puros Cancellous) using collagen membranes (Ossix Plus).Subjects and methodsRecords of 108 partially edentulous patients with localized, buccal bone defects in the posterior maxilla and/or mandible [156 tissue-level Straumann implants, 38 male, 70 female, average age = 46.7 (6.4) years] were used for this study. Sectional CBCT scans were used to evaluate ridge forms before implant placement and after bone grafting (36 ± 2.2 months). The initial vertical buccal wall defect was recorded by measuring the amount of vertical Implant Platform's Rough Surface Exposure (IPRSE) when implants were placed [small (<3 mm), medium (3–5 mm), and large (>5 mm)]. The ridge contour at 36 (±2.2) months was classified into 3 categories [completely corrected (no IPRSE seen on CBCT), partially improved (some IPRSE seen on CBCT), no difference/worse].ResultsComplete defect correction occurred in 66 (61.1%) patients followed by improved ridge contours in 38 patients. Significant differences were observed in the outcome of simultaneous grafting of sites with different pre-treatment vertical defect sizes (chi-square = 69.394, df = 4, P < 0.001). Two graft failures (one needed regrafting) and 2 implant failures were also seen. Treatment was effective in complete correction of 100% and 79.3% of small and medium-sized vertical defects, respectively. Large-sized defects showed only partial improvement in 90% of cases, without any complete correction. Cumulative implant and graft survival was 98.1%.ConclusionsSingle-stage implant placement and simultaneous grafting with mineralized particulate allograft showed promising outcome in correcting small and medium sized vertical buccal wall bone defects (<5 mm).     

Serum chitinase-3-like protein 1 is a biomarker of liver fibrosis in patients with chronic hepatitis B in China

BackgroundSerum chitinase-3-like protein 1 (CHI3L1) is a potential biomarker for fibrosis assessment. We aimed to evaluate serum CHI3L1 as a noninvasive diagnostic marker for chronic hepatitis B virus-related fibrosis.MethodsSerum CHI3L1 levels were measured by ELISA in 134 chronic hepatitis B (CHB) patients. Significant fibrosis was defined as a liver stiffness > 9.7 kPa. The performance of CHI3L1 was assessed and compared to that of other noninvasive tests by receiver operating characteristic (ROC) analysis.ResultsSerum CHI3L1 levels were significantly higher in CHB patients with significant hepatic fibrosis (≥ F2) than in those without significant hepatic fibrosis (< F2) (56.5 ng/mL vs. 81.9 ng/mL, P < 0.001). In CHB patients, the specificity and sensitivity of CHI3L1 for predicting significant fibrosis were 75.6% and 59.1%, respectively, with a cut-off of 76.0 ng/mL and an area under the ROC curve of 0.728 (95% CI: 0.637–0.820).ConclusionsSerum CHI3L1 levels could be an effective new serological biomarker for the diagnosis of liver fibrosis. Moreover, CHI3L1 is feasible in monitoring disease progression.