Factors that influence parents’ experiences with results disclosure after newborn screening identifies genetic carrier status for cystic fibrosis or sickle cell hemoglobinopathy

Objective

Newborn screening (NBS) identifies genetic carriers for sickle cell hemoglobinopathy and cystic fibrosis. We aimed to identify factors during initial NBS carrier results disclosure by primary care providers (PCPs) that influenced parents’ experiences and reactions.

Methods

Open-ended responses from telephone interviews with 270 parents of carriers were analyzed using mixed-methods. Conventional content analysis identified influential factors; chi-square tests analyzed relationships between factors and parent-reported reactions.

Results

Parents reported positive (35%) or negative (31%) reactions to results disclosure. Parents’ experiences were influenced by specific factors: content messages (72%), PCP traits (47%), and aspects of the setting (30%). Including at least one of five specific content messages was associated (p < 0.05) with positive parental reactions; omitting at least one of four specific content messages was associated (p < 0.05) with negative parental reactions. Parents reported positive reactions when PCPs avoided jargon or were perceived as calm. Parents reported negative reactions to jargon usage and results disclosure by voicemail.

Conclusion

Parents identified aspects of PCP communication which influenced their reactions and results disclosure experiences.

Practice implications

Our findings suggest ways PCPs may improve communication of carrier results. PCPs should provide specific content messages and consider how their actions, characteristics, and setting can influence parental reactions.     

基于体外溶出度与体内生物利用度的西罗莫司增溶技术研究

目的 评价不同增溶技术对西罗莫司（sirolimus,SRL）的体外溶出与体内吸收的影响。方法 选取固体分散体（SD）、包合物（IC）、自微乳（SMEDDS）和纳米结构脂质载体（NLC）为SRL的增溶技术。SRL-SMEDDS和SRL-NLC已在前期研究中获得最优处方。另外,以包封率、体外溶出度等为指标,筛选SRL-SD和SRL-IC的处方工艺。分别采用0.4% SDS,水,及pH 1.2、pH 4.5、pH 6.8、pH 7.4缓冲液为溶出介质,考察市售制剂Rapamune^®,以及自制的各增溶制剂的溶出曲线。采用比格犬体内药动学试验,考察上述制剂的体内吸收度。结果 在0.4% 十二烷基硫酸钠（SDS）中,各制剂在2 h的溶出度均超过80%。在pH 1.2的介质中,无法测得SRL-SD的溶出度,而IC、SMEDDS和NLC的溶出度呈先增大后减小的趋势。在其他介质中,SRL的溶出度均有所降低,而SRL-IC显示了最佳的溶出度,未出现明显的降低趋势。体内药动学试验结果显示,原料药、SRL-SD、SRL-IC、SRL-NLC和SRL-SMEDDS的相对生物利用度分别为9.1%、18.7%、33.2%、78.0%、97.6%。结论 SD、SMEDDS、NLC、IC均可提高SRL的体外溶出度和体内吸收度,其中,SMEDDS对SRL的生物利用度改善最为明显。     

纳米结构脂质载体在脑靶向传递体系的研究进展

随着全球环境不断恶化以及社会老龄化程度不断加深,中枢神经系统疾病已经成为社会关注的热点话题,而血脑屏障是治疗多种中枢神经系统疾病的主要障碍。纳米技术已被证明有效用于脑靶向的治疗,而纳米结构脂质载体是一种极具发展前景的新型纳米载体给药系统。通过查阅近年来的相关文献,本文介绍了纳米结构脂质载体和血脑屏障的结构特点,总结了药物透过血脑屏障的评价方法,并对纳米结构脂质载体在治疗中枢神经系统疾病中的应用进行综述。笔者对近年来纳米结构脂质载体在脑靶向传递体系的研究进展进行归纳和总结,同时对其发展前景进行展望,以期为今后纳米结构脂质载体用于中枢神经系统疾病的临床治疗提供更理想的治疗方案,为更深层次的理论研究和机制探索开拓思路。     

慢性HBsAg携带者及非活动性HBV感染状态的病理学研究

目的观察临床诊断为慢性HBsAg携带者及病理诊断为非活动性HBV感染状态患者的临床病理特点。方法总结慢性HBsAg携带者41例、非活动性HBV感染状态患者65例的临床资料,通过HE、组织化学及免疫组织化学染色观察其肝穿刺组织切片的病理变化。结果慢性HBsAg携带者41例无明显异常的症状体征,各项肝功能检查基本正常;但肝穿组织病理检查仅有10例无明显病变,30例为轻度慢性乙型肝炎,1例为静止性肝硬化。非活动性HBV感染状态患者65例中,少数患者有较轻的肝功能异常改变;病理检查无明显炎症和纤维化。结论慢性HBsAg携带者主要是一组以轻度慢性乙型肝炎表现为主的患者,非活动性HBV感染状态患者也仅有轻度的肝功能异常;慢性HBsAg携带者及非活动性HBV感染状态是临床医师和病理医师对同一类病变的不同诊断用词,对其诊断应结合临床和病理资料综合判断。     

多西紫杉醇-海豹油纳米结构脂质载体的抗肿瘤活性评价

目的探讨多西紫杉醇(docetaxel,DTX)海豹油脂质体的抗肿瘤活性以及与脂肪乳的比较。方法采用正交试验设计法筛选处方,通过高压乳匀法制备多西紫杉醇海豹油脂质体。测定其粒径、电位、包封率、体外释药、血浆中稳定性等。并采用四甲基偶氮唑盐〔3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide,MTT〕进行体外抗肿瘤活性研究,以及采用荷肉瘤S180小鼠进行体内抗肿瘤活性研究,考察各组抑瘤率和存活率。结果多西紫杉醇海豹油脂质体的粒径在200 nm左右,Zeta电位为-30~-50 m V,包封率达95%以上。体外释放研究证明多西紫杉醇脂肪乳与多西紫杉醇海豹油脂质体具有一定的p H敏感性,且推测多西紫杉醇海豹油脂质体具有更强的缓释作用。血浆中稳定性研究证明多西紫杉醇脂肪乳与多西紫杉醇海豹油脂质体在血浆中较稳定,释放行为缓慢。结论由MTT法结果得多西紫杉醇海豹油脂质体、多西紫杉醇脂肪乳与DTX均表现出较强的细胞毒性作用,且多西紫杉醇海豹油脂质体具有一定的缓释作用。以荷肉瘤S180小鼠为模型的体内抗肿瘤活性研究表明多西紫杉醇脂肪乳与多西紫杉醇海豹油脂质体在血浆中12 h内累积释放量分别为(13.82±0.59)%与(12.91±0.60)%。说明剂型在血浆中较稳定,释放行为缓慢。另外,DTX组小鼠9 d存活率为0,多西紫杉醇脂肪乳组于9 d存活率为93.3%,而多西紫杉醇海豹油脂质体组小鼠9 d存活率为100%,说明多西紫杉醇海豹油脂质体使得耐受剂量提高,降低了药物的不良反应,提高用药安全性与用药的顺应性。     

Clinical and genetic analysis in a family with familial renal glucosuria: Identification of an N101K mutation in the sodium–glucose cotransporter 2 encoded by a solute carrier family 5 member 2 gene

We report the identification of a mutation in the solute carrier family 5 member 2 (SLC5A2) gene, which encodes sodium–glucose cotransporter 2, in a family with familial renal glucosuria. The proband was a 26‐year‐old Japanese man referred to the diabetes division with repeated glucosuria without hyperglycemia. His mother, uncle and grandfather also had a history of glucosuria. A heterozygous missense mutation (c.303T>A:p.N101K) in SLC5A2 was identified in the patient and his mother, but not in 200 chromosomes from 100 healthy and unrelated individuals, or in 3,408 Japanese individuals in the Tohoku Medical Megabank. Furthermore, bioinformatics software predicted that this lesion would be pathogenic. We infer that the mutation led to clinically relevant sodium–glucose cotransporter 2 dysfunction. The patient showed no symptoms of hypoglycemia, but continuous glucose monitoring confirmed asymptomatic hypoglycemia.     

聚乙烯亚胺非病毒基因载体结构修饰研究进展

聚乙烯亚胺（PEI）作为最经典的非病毒基因载体之一,由于其高转染效率,在基因递送领域受到极大的关注,但其毒性限制了聚乙烯亚胺的应用。本文综述了对聚乙烯亚胺进行不同的结构修饰,如多糖修饰、PEG修饰和低分子聚乙烯亚胺衍生物等,以实现在不显著降低转染效率的前提下减少细胞毒性。     

Influence of Carrier Gas Composition on the Stress of Al2O3 Coatings Prepared by the Aerosol Deposition Method

Al₂O₃ films were prepared by the aerosol deposition method at room temperature using different carrier gas compositions. The layers were deposited on alumina substrates and the film stress of the layer was calculated by measuring the deformation of the substrate. It was shown that the film stress can be halved by using oxygen instead of nitrogen or helium as the carrier gas. The substrates were annealed at different temperature steps to gain information about the temperature dependence of the reduction of the implemented stress. Total relaxation of the stress can already be achieved at 300 °C. The XRD pattern shows crystallite growth and reduction of microstrain while annealing.     

叶酸修饰载丹参酮ⅡA纳米结构脂质载体的制备及其理化表征

[目的]制备载丹参酮ⅡA纳米结构脂质载体,将含有叶酸的PEG链配体修饰于制剂表面获得叶酸修饰载丹参酮ⅡA纳米结构脂质载体(FA-TanⅡA-NLC),使其具有肿瘤靶向作用,并对制剂进行理化表征。[方法]采用乳化蒸发-低温固化法制备制剂,以粒径、电位和包封率等为指标对制剂进行初步评价,采用透射电子显微镜(TEM)、差示扫描量热法(DSC)和X射线衍射法(XRD)对制剂进行进一步的表征。[结果]制备的叶酸修饰载丹参酮ⅡA纳米结构脂质载体(FA-TanⅡA-NLC)粒径为(19.14±0.43)nm,PDI为0.424±0.01,电位为(-11.67±0.25)mV,DSC以及XRD结果均表明丹参酮ⅡA以无定型形式被包载于纳米结构脂质载体中。[结论]本研究制得的FA-TanⅡA-NLC粒径分布均一,体系稳定,包封率高。     

SLC1A1基因多态性与中国汉族人群强迫症的相关性

目的：探讨谷氨酸转运体基因（SLC1A1）与中国汉族人群强迫症（OCD）的关系。方法：采用病例对照研究,以125例患者（OCD组）和125例正常人（对照组）作为研究对象,检测SLC1A1基因的3个位点（rs301430、rs301434、rs301979）,分析这些位点等位基因、基因型分布,以及单倍体与OCD之间的关系。结果：3个位点的等位基因和基因型频率分布在OCD组和对照组中的差异无统计学意义（P＞0.05）。经性别分层分析,相较于对照组,女性患者rs301979位点等位基因和基因型频率分布与对照组差异有统计学意义（χ2=7.875,P=0.019;χ2=7.331,P=0.007）,而男性患者中所有位点的等位基因和基因型频率分布差异均无统计学意义（P＞0.05）。三位点单倍体T-A-G在2组中的差异有统计学意义（χ2=6.206,P=0.013）。结论：SLC1A1基因rs301979位点可能是女性OCD的易感基因位点,rs301430、rs301434、rs301979的单倍体T-A-G可能与中国汉族人群OCD发病相关。