RGD-rAAV2提高卵巢癌细胞体外基因转导效率的研究

目的 进一步证实精氨酸-甘氨酸天冬氨酸-重组腺相关病毒2（RGD-rAAV2）基因表达系统靶向卵巢肿瘤的能力。方法 用流式细胞仪（FACS）检测6种卵巢癌细胞株的硫酸肝素蛋白多糖（HSPG）、整合素（integrin）α，β3和integrin αvβ5的表达；以及野生型腺相关病毒2（wt-AAV2）对上述卵巢癌细胞感染并介导基因转导的能力；通过配体竞争结合实验进一步验证突变体RGD-rAAV2基因转导的特异性。结果 wt-AAV2感染不同卵巢癌细胞的能力各有不同；卵巢癌细胞表达HSPG水平差异很大，而80％卵巢癌细胞表达integrin αvβ3或（和）integrin αvβ5；RGD-rAAV2病毒载体可以有效地感染对wt—rAAV2耐受的卵巢癌细胞SKOV-3ip并介导基因的表达，该效果是非HSPG依赖性的。结论 RGD-rAAV2病毒载体具有较高的卵巢肿瘤靶向性，为卵巢癌基因靶向治疗提供了一种新的策略。     

深圳市2002年急诊住院死亡病例调查

目的　查找急救各环节存在的问题 ,降低急救死亡率和伤残率 ,为进一步建设和完善急救网络提供客观依据。方法　对照 2 0 0 2年全市 6 0个急救网络医院急诊入院急救的 14 4 6份死亡病历填写调查表 ,用Profox6 0建立数据库 ,用SPSS 11 0统计分析。结果　各项急救处置用时中位数 :下达首次医嘱、执行首次医嘱和上级医师到场均为 5min ,二线医师到场 10min ;病情讨论和院内会诊时间分别为入院后 12 0min和 180min ;开始输血时间为入院后 6 0min。调查中发现一些医师对急救技术和程序掌握不到位 ,医疗文书时间因素记录不详细 ,存在制度不落实的现象 ;急诊住院死亡和院前死亡的死因谱有差别。结论　急诊住院急救在时间因素、技术因素和质量因素等方面需进一步提高 ,要提高对急救工作的重视程度     

Cassane-type diterpenes from Caesalpinia minax induce apoptosis in pituitary adenoma: structure–activity relationship,ER stress and Wnt/β-catenin pathways

Plant-derived natural products have been the highly significant sources of novel antitumor agents. The cassane-type diterpenes of genus Caesalpinia have been reported to bear antiproliferative activities toward different types of cancer cells. In this study, we evaluated the antineoplasmic activities of 16 natural origin cassane-type diterpenes isolated from the CHCl₃ extract of the seeds of C. minax in pituitary adenomas cells and identified caesalpin G (CAG) showed the strongest cytotoxicity. Moreover, we further investigated the structure–activity relationship and molecular mechanism of these derivatives systematically. The results confirmed the unsaturated lactone-type ring, hydroxyl at C-7, and alkenyl at C-11 or C-14 functionality as critical for anticancer activity in this family of natural products. In addition, the mechanism experiments also demonstrated unfolded protein response and ER stress and Wnt/β-catenin pathway were involved in the CAG-induced apoptosis.     

孕妇应用硫酸镁对早产儿生长及预后的合理性评价

目的调查在孕妇应用硫酸镁和早产儿发生大脑性瘫痪及死亡等的关联，评价产前应用硫酸镁对早产儿的安全性及可行性。方法检索有关产前使用硫酸镁与早产儿发生大脑性瘫痪及死亡的病例对照研究文献进行Meta分析。结果符合研究纳入标准的文献9篇，共3800个研究例数，其中有5项研究是对孕妇应用硫酸镁有无导致早产儿发生死亡进行病例对照分析，4项研究对孕妇应用硫酸镁有无导致早产儿发生大脑性瘫痪进行病例对照分析。通过Meta分析，发现产前使用硫酸镁可以降低早产儿发生死亡的概率（OR：0．75；95％CI：0．59—0．95），而与早产儿发生大脑性瘫痪则无相关（OR：0．79；95％CI：0．60—1．04）。结论研究提示产前应用硫酸镁对早产儿发生死亡的几率有降低作用。     

中国汉族人群鼻咽癌患者HLA-DQB1等位基因多态性分析

背景：目前开展HLA-DQB1基因与鼻咽癌疾病相关性研究一方面受昂贵的进口试剂所制约,另一方面单纯做HLA-DQB1第2外测序分型,模棱两可,结果较少。目的：采用HLA-DQB1基因第2至第3外显子双向测序分型检测技术方法。方法：纳入286份中国汉族健康人群血液样本,46例鼻咽癌患者样本,使用Gentra DNA提取试剂制备基因组DNA,取100份健康人群样本作为平行对照组进行基因分型,选择及自行设计HLA-DQB1基因第2至3外显子扩增引物及测序引物,探索最适合PCR扩增及测序反应条件。采用商品化HLA-DQB1基因单向测序分型试剂盒作对照。结果与结论：100份平行对照组样本与HLA-SBT测序分型结果一致。286例健康个体中共检出13种等位基因,27例样本的等位基因为纯合子。鼻咽癌人群共检出DQB1等位基因11种,5例样本的等位基因为纯合子。鼻咽癌患者DQB1＊02等位基因频率高于对照组,但所有等位基因频率比较,差异无显著性意义（χ2〈3.84,P〉0.05）。未发现HLA-DQB1基因与鼻咽癌有相关性。说明采用的中国汉族人群HLA-DQB1基因测序分型方法具有操作方便、结果稳定和低成本消耗等优势。     

Imaging of anal fistulas

There are many radiological imaging techniques for perianal fistulas; the choice of modality may depend on several factors other than simply diagnostic accuracy. Equipment availability and financial constraints vary between healthcare systems. Inexperienced clinical assessment may miss secondary extensions; the resulting recurrence is expensive and upsetting for patients. Fistulography no longer has a role in fistulas arising from the anus itself, but it may be useful in identifying extra-sphincteric tracts arising from abdominal organs, such as appendix, terminal ileum, and sigmoid colon. CT has a limited role acutely but otherwise there are better methods. In the right hands, Endo-anal ultrasonography is still more accurate than clinical examination alone, but requires considerable skill in interpretation, is operator dependent, and may not be suitable for all patients. magnetic resonance imaging scans are the gold standard for fistula.     

胎儿主肺动脉窗产前超声心动图特征

目的 探讨胎儿主肺动脉窗（APW）的产前超声心动图特点。方法 回顾性分析经产前超声诊断的16胎APW胎儿的超声心动图特点,包括APW缺损部位、大小、分型、分流情况及合并其他心内、心外畸形情况。结果 胎儿超声心动图诊断的16胎APW胎儿中,引产10胎,出生2胎,失访4胎。4胎接受尸体解剖的胎儿引产标本中,3胎超声心动图结果与病理结果一致,1胎病理证实为共同动脉干。2例出生后接受手术治疗,其超声心动图结果均与手术结果一致。15胎APW中,Richardson Ⅰ型2胎（2/15,13.33%）,Ⅱ型9胎（9/15,60.00%）,Ⅲ型4胎（4/15,26.67%）。APW超声心动图特点为三血管切面或左心室流出道、右心室流出道切面可见主动脉与肺动脉之间的间隔回声失落,CDFI示大动脉水平可见双向分流信号。15胎均合并其他心内、心外畸形,包括主动脉弓异常6胎（6/15,40.00%）、室间隔缺损6胎（6/15,40.00%）、肺动脉异常6胎（6/15,40.00%）、动脉导管异常5胎（5/15,33.33%）、静脉异常4胎（4/15,26.67%）、圆锥动脉干畸形3胎（3/15,20.00%）、Berry综合征3胎（3/15,20%）、法洛四联症1胎（1/15,6.67%）、单脐动脉1胎（1/15,6.67%）。结论 产前超声心动图对APW具有诊断价值,能准确评估APW缺损部位、大小、分型及血流情况,可作为首选检查方法。     

Direct and indirect costs of heart failure in relation to diabetes status - A nationwide study

Background and aimHeart failure (HF) and diabetes mellitus (DM) are burdensome chronic diseases with high lifetime risks and numerous studies indicate associations between HF and DM. The objective of this study was to investigate the direct and indirect costs of HF patients with and without DM.Methods and resultsPatients with a first-time diagnosis of HF from 1998 to 2016 were identified through nationwide Danish registries and stratified according to DM status into HF with or without DM. The economic healthcare cost analysis was based on both direct costs, including hospitalization, procedures, medication and indirect costs including social welfare and lost productivity. The economic burden was investigated prior to, at, and following diagnosis of HF. Patients with concomitant HF and DM were younger (median age 74 vs. 77), had more comorbidities and fewer were female as compared to patients with HF but without DM. The socioeconomic burden of concomitant HF and DM compared to HF alone was substantially higher; 45% in direct costs (€16,237 vs. €11,184), 35% in home care costs (€3123 vs. €2320), 8% in social transfer income (€17,257 vs. €15,994) and they had 27% lower income (€10,136 vs. €13,845). The economic burden peaked at year of diagnosis, but the difference became increasingly pronounced in the years following the HF diagnosis.ConclusionPatients with concomitant HF and DM had a significantly higher economic burden compared to patients with HF but without DM.     

Associations of serum cystatin C and its change with new-onset cardiovascular disease in Chinese general population

Background and aimsThe relation of serum cystatin C with new-onset cardiovascular disease (CVD) remains uncertain. We aimed to evaluate the prospective associations of serum cystatin C and its change with new-onset CVD in Chinese general population.Methods and resultsA total of 7064 participants free of CVD at baseline were enrolled from the China Health and Retirement Longitudinal Study. The change in serum cystatin C was calculated as cystatin C concentration at 2015 wave minus that at baseline (2011 wave). The primary outcome was new-onset CVD, defined as self-reported physician-diagnosed heart disease, stroke, or both during follow-up. The secondary outcomes were new-onset heart disease, and new-onset stroke. During a median follow-up duration of 7.0 years, a total of 1116 (15.8%) subjects developed new-onset CVD. Overall, after the adjustments for eGFR and other important covariates, there was a positive association between serum cystatin C and new-onset CVD (per SD mg/L increment; adjusted HR, 1.13; 95%CI: 1.08,1.18). When cystatin C was assessed as quintiles, the adjusted HRs for participants in the second, third, fourth and fifth quintiles were 1.15 (95%CI: 0.93, 1.41), 1.37 (95%CI: 1.11, 1.68), 1.47 (95%CI: 1.19, 1.81), and 2.03 (95%CI: 1.60, 2.56), respectively, compared with those in quintile 1 (P for trend<0.001). Furthermore, there was a positive association between the increase in cystatin C concentration and the subsequent new-onset CVD (per SD mg/L increment; adjusted HR, 1.14; 95%CI: 1.02,1.27).ConclusionBoth serum cystatin C and its increase were positively associated with new-onset CVD among Chinese general population.