卡泊芬净治疗儿童血液病合并侵袭性真菌病的临床评价

目的探讨卡泊芬净治疗儿童血液病合并侵袭性真菌病(IFD)的疗效及安全性。 方法选择2013年6月至2016年6月，于中山大学孙逸仙纪念医院儿科血液肿瘤病区诊断为合并IFD，并且接受卡泊芬净治疗的57例血液病患儿为研究对象。回顾性分析其临床病例资料。采用χ²检验及t检验，对本组血液病合并不同诊断级别IFD患儿的卡泊芬净治疗有效率、各诊断级别IFD卡泊芬净一线及二线治疗的有效率及不同诊断级别IFD的血液病患儿卡泊芬净治疗后12周生存率，卡泊芬净治疗有效和无效患儿的疗程，以及不同中性粒细胞缺乏时间患儿的卡泊芬净治疗有效率，进行统计学比较，并评价卡泊芬净治疗血液病合并IFD的安全性。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求，并且与所有患儿监护人均签署卡泊芬净使用知情同意书。 结果①本组血液病患儿中，91.2%(52/57)为单一部位合并IFD，以肺部最为常见(78.9%，45/57)；确诊IFD为5例(8.8%)，临床诊断IFD为38例(66.7%)，拟诊IFD为14例(24.5%)。②卡泊芬净治疗57例血液病合并IFD患儿的总有效率为86.0%(49/57)。临床诊断和拟诊IFD患儿的卡泊芬净治疗有效率为90.4%(47/52)，高于确诊IFD患儿的40.0%(2/5)，并且差异有统计学意义(χ²＝9.597，P＝0.001)。③确诊和临床诊断IFD患儿的卡泊芬净一线治疗有效率为96.7%(29/30)，显著高于二线治疗的76.9%(10/13)，并且差异有统计学意义(χ²＝4.190，P＝0.041)。拟诊IFD患儿卡泊芬净一线治疗有效率为90.0%(9/10)，亦显著高于二线治疗的25.0%(1/4)，并且差异有统计学意义(χ²＝5.915，P＝0.015)。④确诊、临床诊断及拟诊IFD的血液病患儿卡泊芬净治疗后12周的生存率比较，差异无统计学意义(P>0.05)。⑤卡泊芬净治疗有效患儿的疗程为(16±7) d，显著长于治疗无效患儿的(8±6) d，并且差异有统计学意义(t＝3.730，P＝0.032)。⑥卡泊芬净对中性粒细胞缺乏时间≥14 d患儿的治疗有效率为66.6%，显著低于中性粒细胞缺乏时间<14 d患儿的92.9%，并且差异有统计学意义(χ²＝6.284，P＝0.012)。⑦本组患儿无一例发生与使用卡泊芬净相关的不良反应。 结论卡泊芬净治疗儿童血液病合并IFD疗效确切，患儿中性粒细胞缺乏可影响其疗效。该药无明显药物不良反应，推荐应用于血液病合并IFD儿童一线抗真菌治疗，治疗疗程建议>14 d。     

Expression of Girdin in primary hepatocellular carcinoma and its effect on cell proliferation and invasion

Girdin has been proven to play a vital role in the process of proliferation, apoptosis, and invasion in various cancer cells, yet the underlying molecular mechanism in primary hepatocellular carcinoma (HCC) has not yet been clarified. Thereafter, we performed immunohistochemistry to detect the expression of Girdin in 40 primary HCC tissues and 30 matched adjacent tissues using hepatic carcinoma tissue microarray. Our data showed that the positive expression rate of Girdin in hepatocellular carcinoma tissues was 67.5%, higher than that found in adjacent tissues of 16.7% (P < 0.05). It closely correlates to tumor size, T stage, TNM stage and Edmondson-Steiner stage (P < 0.05) of HCC patients. After specific small interfering RNA of Girdin was transfected into HepG2 and Huh7.5.1 cells, the proliferation and invasion ability of tumor cells were significantly inhibited. In summary, we suggest that the oncogenic role of Girdin could provide new molecular target for the treatment of HCC.     

Decoding attention control and selection in visual spatial attention

Event‐related potentials (ERPs) are used extensively to investigate the neural mechanisms of attention control and selection. The univariate ERP approach, however, has left important questions inadequately answered. We addressed two questions by applying multivariate pattern classification to multichannel ERPs in two cued visual spatial attention experiments (N = 56): (a) impact of cueing strategies (instructional vs. probabilistic) on attention control and selection and (b) neural and behavioral effects of individual differences. Following cue onset, the decoding accuracy (cue left vs. cue right) began to rise above chance level earlier and remained higher in instructional cueing (~80 ms) than in probabilistic cueing (~160 ms), suggesting that unilateral attention focus leads to earlier and more distinct formation of the attention control set. A similar temporal sequence was also found for target‐related processing (cued target vs. uncued target), suggesting earlier and stronger attention selection under instructional cueing. Across the two experiments: (a) individuals with higher cue‐related decoding accuracy showed higher magnitude of attentional modulation of target‐evoked N1 amplitude, suggesting that better formation of anticipatory attentional state leads to stronger modulation of target processing, and (b) individuals with higher target‐related decoding accuracy showed faster reaction times (or larger cueing effects), suggesting that stronger selection of task‐relevant information leads to better behavioral performance. Taken together, multichannel ERPs combined with machine learning decoding yields new insights into attention control and selection that complement the univariate ERP approach, and along with the univariate ERP approach, provides a more comprehensive methodology to the study of visual spatial attention.     

盐酸贝那普利联合硝苯地平治疗高血压的疗效及对血管内皮功能的影响

目的:探讨盐酸贝那普利联合硝苯地平治疗高血压的疗效及对血管内皮功能的影响。方法:回顾性分析某院于2017年6月~2019年6月间收治的106例高血压患者的临床资料,所有患者均采用盐酸贝那普利联合硝苯地平治疗方案,治疗后对血压控制效果及血管内皮功能进行综合评价。结果:患者治疗后24h收缩压和舒张压均较治疗前降低(P<0.05);患者治疗后血管内皮功能显著改善,内皮素(ET)、一氧化氮(NO)和神经肽Y(NPY)水平均优于治疗前(P<0.05)。结论:盐酸贝那普利联合硝苯地平治疗高血压的效果较好,不仅能够有效控制血压水平,还能够改善患者血管内皮功能,可作为一种理想的治疗方案在临床推广应用。     

鼠巨细胞病毒感染C57BL/6小鼠急性肝炎动物模型的建立与鉴定

目的：建立鼠巨细胞病毒（MCMV）感染C57BL/6小鼠急性肝炎模型并对其感染特点进行分析及鉴定。方法：将24 只C57BL/6小鼠随机分为阴性对照组（n =12）及病毒感染组（n =12），病毒感染组腹腔注射1.0×106 PFU（200 μL）MCMV悬液，阴性对照组注射等体积小鼠胚胎成纤维细胞（MEF）悬液。于感染后第3天和第7天取外周血分离血清检测谷丙转氨酶（ALT）及谷草转氨酶（AST）。同时进行肝组织病毒分离、组织病理学及MCMV IE和M55基因、细胞因子白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）、肿瘤坏死因子α（TNF-α）的检测。结果：病毒感染组肝组织匀浆病毒分离均为阳性，肝炎发生率为100%。在感染后第3天即发生肝炎病理改变，病毒感染组血清ALT及AST较阴性对照组明显升高（P ＜0.01）；病毒感染组肝脏HE染色第3天可见局灶性炎性细胞浸润及肝脏点灶状坏死，持续至第7天，Ishak评分较阴性对照组明显升高（P ＜0.01）；在感染后第3天病毒感染组肝组织内可检测到MCMV IE及M55基因，且在感染后第7天仍可测得IE基因；感染后第3天及第7天病毒感染组炎性细胞因子IL-6、TNF-α及IL-1β mRNA表达水平明显升高（P ＜0.05）。 结论：成功建立MCMV感染C57BL/6小鼠急性动物肝炎模型，其感染表现主要集中在急性感染前期。     

New onset acute promyelocytic Leukemia during pregnancy: report of 2 cases

Acute promyelocytic leukemia (APL) is one of the most fatal hematological malignancies. APL during pregnancy is a rare comorbidity and can lead to adverse outcomes, such as maternal and/or fetal death, without timely and appropriate management. Medical management for APL during pregnancy remains challenging. We reported 2 patients with no regular prenatal visits who were diagnosed with APL during pregnancy. One presented with typical hematological abnormalities related to infection, while the other presented with intracranial hemorrhage, which is rare. Although supportive measures and chemotherapy were administered after APL was diagnosed, these two patients had completely different outcomes. The pregnancy outcomes of APL patients depend greatly on the timely diagnosis and appropriate management of the disease. Physicians should pay more attention to APL during pregnancy and thus may save more maternal and fetal lives. Further study of the management of APL during pregnancy is warranted.

Abbreviations: AML: acute myeloid leukemia; APL: acute promyelocytic leukemia; WBC: white blood cell; RBC: red blood cell; Hb: hemoglobin; PT: prothrombin time; TT: thrombin time; APTT: activated partial thromboplastin time; TP: total protein; ALB: albumin; AST: aspartate transaminase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; ATRA: all-trans retinoic acid; ICH: intracranial hemorrhage; DIC: disseminated intravascular coagulation