骨质疏松性与肿瘤转移性椎体骨折患者代谢指标的比较

目的比较分析骨质疏松性与肿瘤转移性椎体骨折患者相关代谢指标及其关系。方法回顾从2003年01月至2011年06月期间在我院介入血管外科行椎体成形术的146例骨质疏松性椎体骨折患者与111例肿瘤转移性椎体骨折患者的相关代谢指标,运用统计学方法进行统计。统计内容为:性别、年龄、椎体骨折数、手术次数、超敏C-反应蛋白、纤维蛋白原含量、血清总钙、磷、碱性磷酸酶(ALP)、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白。结果两组患者在性别、年龄、手术次数、血清碱性磷酸酶、甘油三酯、总胆固醇、高密度脂蛋白水平间有统计学差异(P<0.05)。结论骨质疏松性与肿瘤转移性椎体骨折患者在骨代谢及脂代谢方面存在差异,可帮助临床医生及时找出骨折病因,制定合理的治疗方案。     

Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: meta-analysis of randomised controlled trials

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Compared with glycopeptide antibiotics, linezolid achieves higher lung epithelial lining fluid concentrations, which may have an advantage in treating nosocomial pneumonia patients. The objective of this study was to evaluate the efficacy and safety of linezolid versus vancomycin or teicoplanin for the treatment of nosocomial pneumonia. Data were obtained from the Cochrane Central Register of Controlled Trials and the EMBASE and MEDLINE databases. Randomised controlled studies involving the use of linezolid versus vancomycin or teicoplanin in nosocomial pneumonia patients were included in the study. Twelve linezolid trials were included. There was no statistically significant difference between the two groups in the treatment of nosocomial pneumonia regarding the clinical cure rate [relative risk (RR)?=?1.08, 95 % confidence interval (CI)?=?1.00–1.17, p?=?0.06]. Linezolid was associated with better microbiological eradication rate in nosocomial pneumonia patients compared with glycopeptide antibiotics (RR?=?1.16, 95 % CI?=?1.03–1.31, p?=?0.01). There were no differences in the all-cause mortality (RR?=?0.95, 95 % CI?=?0.83–1.09, p?=?0.46) between the two groups. However, the risks of rash (RR?=?0.41, 95 % CI?=?0.24–0.71, p?=?0.001) and renal dysfunction (RR?=?0.41, 95 % CI?=?0.27–0.64, p?<?0.0001) were higher with glycopeptide antibiotics. Although linezolid was more effective in eradicating microbiology than glycopeptide antibiotics for nosocomial pneumonia patients, it did not demonstrate superiority in clinical cure. The incidences of renal dysfunction and rash are higher in the glycopeptide antibiotics group.     

拉克替醇治疗便秘的多中心随机单盲平行对照试验

拉克替醇在国外已作为治疗肝性脑病和便秘的药物上市,但在国内尚未被推荐用于治疗便秘。目的：评价拉克替醇治疗便秘的疗效和安全性。方法：从4个临床医学中心随机纳入符合便秘诊断标准和研究要求的患者．随机分为试验组和对照组。试验组起始剂量（第1d）为拉克替醇20g,维持剂量（第2．7d）为每天10g：对照组起始剂量（第1d）为乳果糖20g,维持剂量（第2～7d）为每天10g。每天早餐时一次服完,疗程7d。排便次数≥3次,d或粪便性状呈Bristol6、7型时,可减半用量。结果：纳入疗效分析的病例数为129例,试验组63例．对照组66例。试验组与对照组治疗前一般情况无明显差异,便秘病情严重程度分布均衡。试验组和对照组用药3d后有效排便次数转正常率分别为77．8％和77．3％,粪便性状转正常率分别为62．2％和56．5％,用药7d后分别为95．2％和95．5％、60．4％和60．8％,两组间差异均无统计学意义。两组不良反应发生率分别为4．8％和4．5％,差异亦无统计学意义。结论：拉克替醇治疗便秘有效、安全．可在临床上推广使用。     

cAMP产生的兔股动脉舒张部分由NO介导

目的:研究cAMP产生的周围血管扩张作用是否与激活一氧化氮合酶(NOS)有关。方法:利用家兔股动脉恒流灌注模型,观察股动脉内灌注不同浓度的dbcAMP(膜渗透性cAMP)或腺苷酸环化酶的直接激动剂forskolin后灌注压的变化及NOS抑制剂L-NAME对其作用的影响。结果:dbcAMP和forskolin均产生浓度依赖的周围血管舒张,NOS抑制剂L-NAME部分阻断这种作用。结论:cAMP产生的周围血管扩张作用部分通过激活NOS实现。     

Risk factors of acute kidney injury after acute myocardial infarction

Objectives: To study the risk factors for acute kidney injury (AKI) in-patients with acute myocardial infarction (AMI).

Methods: A total of 1371 cases of adult in-patients with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were retrospectively analyzed. Based on the occurrence of AKI diagnosed according to the 2012 KDIGO AKI criteria, they were divided into AKI group and non-AKI group and further into conservative treatment groups, coronary angiography (CAG) groups, and coronary artery bypass grafting (CABG) groups based on the timing of AKI occurrence, respectively. Related risk factors of AKI were analyzed by univariate and multivariate logistic regressions.

Results: 410 (29.9%) developed AKI. Patients with AKI had significantly increased in-hospital mortality than patients without AKI. Multivariate logistic regression analysis showed that decreased baseline eGFR, increased fasting plasma glucose (FPG), use of diuretics and Killip grade IV were independent risk factors of AKI, while increased DBP on admission was a protective factor for patients in conservative treatment group. Decreased baseline eGFR, increased FPG, use of diuretics, intraoperative hypotension and acute infection were independent risk factors of AKI for patients in the CAG group. Decreased baseline eGFR, increased FPG, use of diuretics and low cardiac output syndrome after operation were independent risk factors of AKI for patients in the CABG group.

Conclusions: AKI is a common complication and associated with increased mortality after AMI. Decreased baseline renal function, increased FPG and use of diuretics were common independent risk factors of AKI after AMI.     

树突细胞联合细胞因子诱导的杀伤细胞对耐药K562细胞的体外杀伤作用

目的研究细胞因子诱导的杀伤(CIK)细胞与同源树突细胞(DC)共培养后CIK细胞的增殖活性及表型的变化,并观察其对K562、K562/ADM细胞毒作用的影响。方法采集健康供者外周血单个核细胞(MNC)用于诱导培养CIK细胞及成熟DC,将成熟DC和CIK细胞混合培养,用MTT法检测DCCIK共培养细胞杀伤K562细胞及其耐药株的活性。结果在2.5～20.0效靶比范围内,CIK细胞对K562和K562/ADM细胞的杀伤率分别为(20.0±1.2)%～(61.1±2.2)%和(17.5±2.1)%～(45.2±3.3)%;DCCIK共培养细胞对K562和K562/ADM细胞的杀伤率分别为(25.2±2.3)%～(70.9±4.1)%和(22.4±2.7)%～(62.3±5.0)%。CIK细胞对K562敏感株和耐药株杀伤率的差异无统计学意义,DCCIK细胞对敏感株和耐药株的杀伤作用差异亦无统计学意义;DCCIK细胞对K562和K562/ADM细胞的杀伤活性均高于单纯CIK细胞组,差异有统计学意义(P<0.05)。结论DC与CIK共培养细胞的增殖活性和细胞毒活性高于CIK细胞。     

活化血浆凝固时间对血小板输注疗效评价的研究

本研究探讨活化血浆凝固时间(APCT)对评价血小板输注疗效的价值,用血小板聚集凝血因子分析仪检测了20例血液病患者血小板输注前后APCT的变化,并与血小板计数增加校正指数(CCI)和实际血小板回收率(PPR)进行了对比研究。结果表明:输注1小时、24小时后的APCT均明显缩短,APCT由血小板输注前的(103.7±11.3)秒分别缩短为输注后1小时、24小时的(60.0±9.7)秒、(68.5±9.8)秒,(P<0.01),而正常对照的APCT为(42.0±3.4)秒;按照CCI和PPR的判断标准(输注后1小时和24小时CCI分别为<7500和<5000,PPR分别为<30%和20%为输注无效),有2例为血小板输注无效,其输注1小时、24小时的CCI值分别为7415、2966和6913、4988,PPR值分别为28.0%、11.2%和25.2%、14.1%。1例PPR均达血小板输注无效标准,而CCI值均显示血小板输注有效;2例PPR均达血小板输注无效标准,而输注1小时的CCI值表示为血小板输注有效,24小时的CCI值表示为血小板输注无效。结论:APCT可以反映血小板数量和质量的变化,也能较全面的评估血小板的输注疗效。     

Human bone marrow mesenchymal stem cells-derived exosomes protect against nerve injury via regulating immune microenvironment in neonatal hypoxic-ischemic brain damage model

Neonatal hypoxic-ischemic (HI) brain injury is a serious injury caused by various perinatal factors, which has become a heavy mental burden to the family. The molecular mechanism underlying neonatal hypoxic-ischemic brain injury remains largely unknown. Human bone marrow mesenchymal stem cells (hBMSCs) have caused wide public concern due to the immunomodulatory properties. Exosomes can polarize human microglia and thus changed it into an anti-inflammatory phenotype to reduce the release of pro-inflammatory factors. However, it is unclear whether hBMSCs-exosomes have effect on neonatal hypoxic-ischemic brain injury. In this study, we aimed at investigating the role of hBMSCs-exosomes in regulating immune response and nerve injury in neonatal hypoxic-ischemic brain damage model. In the research, we identified the exosome secretion of hBMSCs could transferred into human microglia (HMC). Moreover, we determined the importance of hBMSCs-exosomes in regulating HMC polarization and inflammatory response. Our research findings might provide a new insight into slowing the disease progression of neonatal hypoxic-ischemic brain injury.     

Transjugular Intrahepatic Portosystemic Shunts Reduce Variceal Bleeding and Improve Survival in Patients with Cirrhosis: A Population-Based Analysis

PurposeTo investigate from a population health perspective the effects of transjugular intrahepatic portosystemic shunt (TIPS) creation on recurrent variceal bleeding and survival in patients with cirrhosis.Materials and MethodsPatients with cirrhosis who presented to outpatient and acute-care hospitals in California (2005–2011) and Florida (2005–2014) with variceal bleeding comprised the study cohort. Patients entered the study cohort at their first presentation for variceal bleeding; all subsequent hospital encounters were then evaluated to determine subsequent interventions, complications, and mortality data.ResultsA total of 655,577 patients with cirrhosis were identified, of whom 42,708 (6.5%) had at least 1 episode of variceal bleeding and comprised the study cohort. The median follow-up time was 2.61 years. A TIPS was created in 4,201 (9.8%) of these patients. There were significantly greater incidences of coagulopathy (83.9% vs 72.8%; P < .001), diabetes (45.5% vs 38.8%; P < .001), and hepatorenal syndrome (15.3% vs 12.5%; P < .001) in TIPS recipients vs those without a TIPS. Following propensity-score matching, TIPS recipients were found to have improved overall survival (82% vs 77% at 12 mo; P < .001) and a lower rate of recurrent variceal bleeding (88% vs 83% recurrent bleeding–free survival at 12 months,; P < .001) than patients without a TIPS. Patients with a TIPS had a significant increase in encounters for hepatic encephalopathy vs those without (1.01 vs 0.49 per year; P < .001).ConclusionsTIPS improves recurrent variceal bleeding rates and survival in patients with cirrhosis complicated by variceal bleeding. However, TIPS creation is also associated with a significant increase in hepatic encephalopathy.