脾氨肽（复可托）治疗小儿反复呼吸道感染的临床疗效观察

目的：分析探讨脾氨肽（复可托）治疗反复呼吸道感染的临床疗效。方法：选取本院近年来收治的60例反复呼吸道感染患者作为研究对象,按照数字抽签法将其随机分为研究组与对照组,每组30例,研究组在常规治疗的基础上行复可托治疗,对照组仅行常规治疗,比较两组治疗效果。结果：研究组治疗显效率为56.7%,总有效率为90.0%,对照组治疗显效率为23.3%,总有效率为50.0%,研究组患者治疗效果明显优于对照组（P〈0.05）。与治疗前相比,研究组患者治疗后CD8指标出现明显下降,CD3、CD4、CD4/CD8指标出现明显上升,治疗前后研究组患者T细胞亚群指标比较差异有统计学意义（P〈0.05）。结论：复可托治疗反复呼吸道感染可改善患者免疫失衡状态,具有显著的临床疗效。     

免疫性血小板减少症患者协同刺激分子的表达及意义

目的：探讨特发性血小板减少性紫癜（ITP）患者外周血淋巴细胞CD28、CD80及CD86的表达及意义。方法：采用免疫荧光标记和流式细胞术检测30例ITP患者和30例健康对照者外周血CD28细胞、CD80细胞和CD86细胞分别占淋巴细胞的比例及血小板表面相关抗体水平,并进行对比、分析。结果：与正常对照组相比,ITP患者外周血CD28细胞增多,差异有统计学意义（P〈0.05）;CD80细胞增多,但差异无统计学意义（P〉0.05）;CD86细胞显著增多,差异有统计学意义（P〈0.05）,此结果与ITP是否急慢性无关。治疗前后患者的CD28、CD80及CD86的表达率比较差异无统计学意义（P〉0.05）。患者与正常对照组PAIg A、PAIg G和PAIg M的水平比较差异有统计学意义（P〈0.05）;CD80、CD86表达与PAIg G水平之间存在显著的相关性,比较差异有统计学意义（P〈0.01）。结论：ITP患者外周血淋巴细胞CD28、CD80及CD86表达均异常,可能与其发病相关。     

地塞米松冲击疗法治疗成人原发免疫性血小板减少症的疗效观察

目的：观察地塞米松冲击疗法治疗成人原发免疫性血小板减少症（ITP）的临床疗效。方法：自2006年7月-2013年9月间笔者所在医院收治成人ITP患者38例,患者均给予胸腺肽α1联合大剂量维生素C治疗,其中19例同时应用4 d地塞米松冲击治疗,观察临床症状、血小板计数和不良反应。结果：胸腺肽α1＋大剂量维生素C治疗组总有效率78.9%,平均起效时间（16.8±3.2）d;胸腺肽α1＋大剂量维生素C联合地塞米松冲击治疗组总有效率84.2%,平均起效时间（6.7±2.7）d。两种治疗方案的不良反应均较轻微。结论：胸腺肽α1联合大剂量维生素C与冲击量地塞米松联合应用治疗成人ITP疗效较好,副作用少,可缩短起效时间。     

比较美沙拉嗪与柳氮磺吡啶治疗溃疡性结肠炎的疗效与安全性的meta分析

目的比较美沙拉嗪与柳氮磺吡啶2种药物治疗溃疡性结肠炎（UC）的疗效与安全性。方法计算机检索PubMed、Cochrane Library、EMbase、CNKI、CBM和万方数据库,查找所有比较2种药物治疗UC的随机对照试验（RCT）,检索时限均为建库至2014年2月12日。按照纳入与排除标准选择文献、评价质量并提取资料后,采用RevMan 5.2软件进行meta分析,并采用Jadad评价量表进行质量评价。结果共纳入13个RCT,其研究质量均为中等。合计1 104例UC患者。Meta分析结果显示,美沙拉嗪对比柳氮磺吡啶治疗UC总有效率差异有统计学意义[RR=1.21,95%CI（1.12,1.32）,P〈0.01],美沙拉嗪组总有效率高于柳氮磺吡啶组;共有3个RCT报道了复发率,结果显示,美沙拉嗪对比柳氮磺吡啶治疗UC,在复发率方面,差异有统计学意义[RR=0.60,95%CI（0.37,0.96）,P=0.03],美沙拉嗪组复发率低于柳氮磺吡啶组。共有9个RCT报道了不良反应,采用随机效应模型,meta分析结果显示：两组差异有统计学意义[RR=0.45,95%CI（0.33,0.59）,P〈0.01],美沙拉嗪组不良反应发生率低于柳氮磺吡啶组。结论现有证据显示,美沙拉嗪治疗UC的疗效和安全性均优于柳氮磺吡啶。     

Life after colectomy for fulminant Clostridium difficile colitis: a 7-year follow up study

Background

The long-term prognosis of patients undergoing colectomy for fulminant Clostridium difficile colitis has not been well studied. The authors present 7-year survival trends in such patients.

Methods

Patients were identified through a pathologic database. Medical records were reviewed and follow-up phone calls made to determine relevant patient history, longevity, and quality of life.

Results

The 61 patients identified had mean and median survival of 18.1 and 3.2 months, respectively, and 1-year, 2-year, 5-year, and 7-year mortality of 68.5%, 79.6%, 88.9%, and 90.7%, respectively. Previous C difficile infection, hypotension, requirement of vasopressors, mental status changes, elevated arterial lactate, decreased platelet counts, intubation, and longer duration on nonoperative therapy were associated with in-hospital mortality. There were no factors correlated with long-term survival.

Conclusions

Patients who require colectomy for fulminant C difficile colitis have a poor prognosis with poor long-term survival and significant morbidity. Although there are several factors associated with in-hospital mortality, there were no factors correlated with long-term survival.     

Obesity Has Minimal Impact on Clinical Outcomes in Children with Inflammatory Bowel Disease

Purpose

Childhood obesity is an increasing problem in affluent societies throughout the world. We sought to identify the impact of obesity on the outcome of inflammatory bowel disease (IBD) and determine differences (if any) between ulcerative colitis (UC) and Crohn’s disease (CD).

Methods

The 2009 Kids’ Inpatient Database was explored for all children (≤ 20 years) admitted with IBD. ICD-9 codes were used to identify obesity and complications, including hemorrhage, perforation, and complex fistulas. Logistic regression analysis accounting for demographics, underlying disease, surgical procedures, and obesity was performed to identify factors associated with complication development. Data are expressed as odds ratios (OR) and a 95% confidence interval (CI). A P value of 0.05 was regarded as significant.

Results

From 12,465 admissions, 164 children were obese (1.3%), with no difference between CD and UC (1.3% vs. 1.4%; P = 0.60). Girls had a two-fold increase in obesity (OR: 2.06, CI: 1.48–2.86; P < 0.01). Obesity had no effect on elective/emergent admission rate (OR: 0.85, CI: 0.54–1.35; P = 0.49), perforation (OR: 0.76, CI: 0.13–4.46; P = 0.76), hemorrhage (OR: 0.64,CI: 0.34–1.21; P = 0.17), complex fistula (OR: 1.19, CI: 0.45–3.17; P = 0.72), or requirement for surgery (OR: 0.80, CI: 0.48–1.31; P = 0.37). While the overall clinical morbidity rate was 10.7%, obesity was not associated with the development of overall complications (OR 1.20, CI: 0.75–1.93; P = 0.45) or length of stay (6.36 vs. 6.10 days; P = 0.61). Obesity increased the rate of central venous catheter (CVC) infections (OR: 10.98, CI: 2.50–48.20; P < 0.01).

Conclusions

Obesity was more prevalent in girls with IBD. While obesity did not alter disease severity, rate of surgical intervention, or hospital length of stay, it was associated with higher CVC infections.     

载脂蛋白C1在甲状腺乳头状癌中的临床表达及生物信息学分析

目的 研究载脂蛋白C1（APOC1）在甲状腺乳头状癌（PTC）和癌旁（PC）组织的表达水平及临床意义。方法 利用UALCAN数据库比较PTC及PC组织APOC1 mRNA的表达差异;Kaplan-Meier Plotter数据库预测APOC1对PTC的预后价值;HPA数据库预测APOC1在蛋白层面的表达情况;TIMER数据库研究APOC1与免疫细胞的相关性;Linked Omics数据库和GeneMANIA数据库研究与APOC1密切相关的基因;GSCALite数据库对PTC中前5关键基因的药物靶标和癌症相关通路进行分析;最后对APOC1基因进行单基因GSEA分析。结果 PTC组织中APOC1 mRNA表达水平显著高于PC组织;APOC1 mRNA表达水平在不同临床分期、年龄、性别、淋巴结转移的PTC中显著升高;APOC1 mRNA表达水平与预后和免疫浸润相关;APOC1与多条癌症通路相关,并可受到abiraterone、GSK-J4、SR8278抑制调节;GSEA单基因的功能富集分析显示,APOC1功能富集在丙酸代谢、缬氨酸和异亮氨酸、三羧酸循环、牛磺酸代谢、JAK-STAT信号通路、自身免疫性甲状腺病、凋亡、癌症信号通路、NOTCH信号通路、MAPK信号通路（P<0.05）。结论 APOC1基因在PTC中高表达,与预后、免疫浸润相关,可以作为PTC诊断、预后、药物治疗的潜在靶点。     

The role of prenatal immune activation in the pathogenesis of autism and schizophrenia: A literature review

Autism spectrum disorder (ASD) and schizophrenia (SZ) are two neurodevelopmental disorders that, despite having distinct diagnostic criteria, share certain clinical and etiological features. The genetic origin of the two disorders is beyond doubt, with evidence for unique and overlapping genetic risk factors. However, lower estimates of heritability have recently been reported for both disorders, lending support to a significant contribution from non-genetic factors. Notably, there is increasing evidence that immune activation during prenatal life may act as a risk factor for ASD and SZ. In this review, evidence supporting the hypothesis that prenatal immune activation (PIA) influences the onset and progression of ASD and SZ is analyzed. Results show that the detrimental effects of PIA on neurodevelopment include morphological changes in various brain regions, with perhaps the most notable being the hippocampus and prefrontal cortex, as well as altered activity of neurotransmitter systems such as the serotonergic system and impairments in working memory and prepulse inhibition. An examination of the risk factor of PIA offers new insight into the pathophysiology of ASD and SZ, and in this way opens up new possibilities for the treatment of these two disorders.     

循证护理在溃疡性结肠炎中的应用

目的：探讨循证护理在溃疡性结肠炎中应用的意义。方法选取2011年1月-2012年12月的76例UC患者作为观察组实施循证护理,同时加强护理人员的培训和学习,2009年1月-2010年12月68例UC患者作为对照组实施常规护理。将两组患者对治疗效果、满意度、依存性进行统计比较。结果循证护理干预后观察组显效60（78.95%）、有效60（78.95%）、无效2（2.63%）,总有效率为74（97.37%）,且满意度和依存性分别为72（94.73%）、65（85.52%）;对照组显效48（70.59%）、有效16（23.53%）、无效（4（5.88%）,总有效率为64（94.12%）,且满意度和依存性分别为50（73.52%）、43（63.23%）,两组相比,观察组不仅疗效提高,而且患者的满意度和依存性均优于对照组（P〈0.05）,差异有统计学意义。结论经循证护理干预后,观察组的临床效果、满意度和依存性均明显优于对照组,由此表明,运用循证护理的方法,不仅提高疗效、促进康复,而且增加患者的满意度和依存性,延长了缓解期、改善患者的生活质量。     

半乳糖凝集素 1 与妊娠的相关性研究

半乳糖凝集素1（Galectin-1,Gal-1）在妊娠时的蜕膜、胎盘、滋养细胞表达具有时空特异性,在异常及正常妊娠时表达也有差异。Gal-1的表达状态由其基因启动子的甲基化状态决定,同时也受到血激素水平的调节。Gal-1通过介导细胞-细胞,细胞-细胞外基质之间的黏附、促进细胞浸润及合体细胞形成、影响动脉形成等参与妊娠时细胞的浸润、增殖和分化。通过将免疫细胞、细胞因子、免疫蛋白向免疫抑制方向转化,Gal-1建立和维持了母胎之间的免疫耐受。胎盘局部及母体全身的氧化应激状态可能改变Gal-1结构,进而影响其生物活性以及功能的发挥。Gal-1在妊娠的起始、发展及维持中发挥巨大作用,有望运用于病理性妊娠及妊娠相关疾病的治疗中。