支架置入冠状动脉分叉病变后的生物相容性

背景:通过检测CYP2C19基因分型可评估冠状动脉内支架置入患者对氯吡格雷反应性的高低,但目前国内尚缺乏通过检测CYP2C19基因分型指导分叉病变部位支架置入后抗血小板治疗的临床应用。目的:根据CYP2C19基因分型结果,优化冠状动脉分叉病变支架置入后抗血小板治疗方案的效果。方法:纳入136例冠状动脉分叉病变支架置入患者,于支架置入前进行阿司匹林联合氯吡格雷抗血小板治疗,7 d后检测CYP2C19基因分型。若CYP2C19基因分型为*1/*1的作为合格组,支架置入后服用氯吡格雷75 mg/d;若CYP2C19基因分型为*2/*2、*2/*3、*3/*3的作为不合格组,再随机分为2组,一组为常规剂量组,支架置入后即保持氯吡格雷75 mg/d治疗不变,另一组为大剂量组,即增加氯吡格雷剂量为150 mg/d长期服用。随访9个月记录主要心脏不良事件和出血事件发生情况。结果与结论:发生主要心脏不良事件14例中,合格组6例(7.9%)、常规剂量组6例(17.7%)、大剂量组2例(7.7%),合格组发生率明显低于常规剂量组(P<0.05),提示CYP2C19基因分型有较好预测主要心脏不良事件的价值;大剂量组发生率明显小于常规剂量组(P<0.05),说明在CYP2C19基因分型监测下增加抗血小板药物剂量,能明显降低主要心脏不良事件的发生率;大剂量组发生率与合格组比较差异无显著性意义(P>0.05),提示通过检测CYP2C19基因分型,优化氯吡格雷剂量可达到与合格组相同的临床效果。3组出血事件发生率比较差异无显著性意义(P>0.05),提示通过检测CYP2C19基因分型抗血小板治疗不会增加出血风险。     

植入物内固定修复老年下肢骨折:不同麻醉方法对血流动力学及镇痛的影响

背景：目前腰麻-硬膜外联合麻醉中,其用药方式与单独腰麻和硬膜外麻醉用药无太大差别,即先以较大剂量腰麻,而硬膜外用于确保效果和术后镇痛。近年来国内外有学者提出一些新的观点：腰麻先给予小剂量、低浓度的局麻药,再予硬膜外衔接以小剂量、低浓度的局麻药,真正发挥腰麻与硬膜外的联合作用,可以达到完善麻醉效果,以减少不良反应和并发症。
　　目的：分析小剂量低密度腰麻-硬膜外联合麻醉在老年下肢骨折修复手术中的应用效果。
　　方法：选取惠州市中心人民医院择期行单侧下肢手术患者68例,按照麻醉方式分为对照组与观察组,各34例。对照组采用连续硬膜外麻醉,观察组采用小剂量低密度腰麻-硬膜外联合麻醉。对比分析两组患者麻醉阻滞起效时间、阻滞完善时间、麻醉药物用量、下肢改良Bromage评分及血流动力学变化。
　　结果与结论：观察组麻醉阻滞起效时间、阻滞完善时间、麻醉药物用量及下肢改良Bromage评分与对照组比较,观察组优于对照组,差异有显著性意义(P <0.05)。两组患者麻醉后5,10 min平均动脉压显著低于麻醉前(P <0.05),其余指标差异无显著性意义。两组患者术后生命体征平稳,且无术后认知功能障碍发生。提示采用小剂量低密度腰麻联合硬膜外麻醉具有起效快、用量少、阻滞完全、镇痛效果好等优点。临床将其应用于老年下肢骨折修复手术,对患者血流动力学影响较小,且可达到较为完善的镇痛效果。     

同种异体骨与自体骨填充椎间融合修复脊髓型颈椎病的比较

背景:目前用于颈椎前路的填充材料较多,以自体骨、同种异体骨多见,但自体骨取材引发供骨区出血、感染、术后疼痛等并发症被临床工作者逐渐重视。同种异体骨具有良好的生物相容性及安全性,可作为一种比较理想的融合器填充材料。目的:对比异体骨与自体骨填充椎间融合器结合钢板内固定在脊髓型颈椎病患者颈椎前路融合中的临床修复效果。方法:2012年1月至2013年6月对44例脊髓型颈椎病共44节段实施前路椎间盘摘除、椎间融合联合钢板内固定治疗,取颈前斜切口2.0-3.0 cm,切除椎间盘及后纵韧带,尽量保留终板。其中24例取自体髂骨填充椎间融合器,20例采用同种异体骨填充,以JOA评分、Odom’s疗效评定标准及X线射片评定两组疗效。结果与结论:两组患者均获得12-18个月随访。两组间术后并发症及JOA评分差异无显著性意义。临床疗效评定(Odom’s标准)优良率,同种异体骨组高于自体骨组,差异有显著性意义(P<0.05)。术后3,6个月同种异体骨组融合率较自体骨组低,12个月时两组融合率均为100%。影像学结果提示,术后3,6,12个月同种异体骨组与自体骨组融合节段椎间隙高度、前凸Cobb角之间差异无显著性意义(P>0.05)。提示同种异体骨作为椎间融合器填充材料,融合率与自体髂骨相似,并可维持颈椎生理曲度及恢复椎间隙高度,可作为理想的骨填充材料应用于颈椎前路手术。     

口腔鳞状细胞癌和癌旁组织的基因表达分析

目的利用来自美国国立生物信息技术中心(NCBI)基因表达数据库(GEO)的基因芯片数据,分析基因在口腔鳞状细胞癌(OSCC)中癌和癌旁组织的差异表达情况,为寻找癌和癌旁组织双边的抑癌靶标提供依据。方法选取来自NCBI-GEO数据库中OSCC患者的癌和癌旁组织,以及正常人口腔组织的基因芯片数据,分别计算得到前两者相对后者的差异表达基因,并进行功能聚类与特定基因的通路分析。结果大部分差异基因为癌与癌旁所共有,其中多数基因的差异表达方向在两者中一致,少部分方向不一致。如WIF1基因在癌组织中表达下调,但在癌旁组织中表达上调。这种差异表达行为的不同与基因的功能相关,因此,差异表达行为可能为抑癌靶标的发现提供线索。结论基因在癌和癌旁组织中的差异表达行为与基因的功能相关,具有特定差异表达行为的基因可能成为潜在的抑癌靶标。     

基于PubMed 数据库的直升机紧急医疗服务 热点的共词聚类分析

目的 通过文献计量学方法归纳直升机紧急医疗服务研究领域的热点方向。方法 制定检索策 略,搜索PubMed 数据库中近10 年直升机紧急医疗服务相关的研究,将研究的书目信息下载后导入到书目共 现分析系统进行统计分析,并将书目数据中的主题词共现矩阵导入图形聚类工具进行聚类分析。结果 检索 到2 365 篇文献,通过整理,最终得出直升机紧急医疗服务研究的时间分布、国家分布、高频主题词分布,主 题词双向聚类分析共显示出11 个聚类。结论 直升机紧急医疗服务研究热度逐年上升,相关的热点词汇主要 包括：创伤、组织管理、标准、心脏骤停、气管插管、心肌梗死、心肺复苏等。研究热点主要包括：直升机 紧急医疗服务在院外心脏骤停等疾病中应用的可行性;直升机紧急医疗服务救援人员技能培训;直升机紧急 医疗服务气管插管人员技能及插管工具的选择对插管质量的影响;创伤、心肌梗死等疾病直升机紧急医疗服 务的转运效果;直升机紧急医疗服务实施的影响因素;直升机紧急医疗服务相关指南6 个方面。     

湖南省郴州市一起新型冠状病毒肺炎聚集性疫情流行病学调查

目的 通过分析郴州市一起新冠肺炎聚集性疫情相关病例发病确诊过程,探讨新冠病例早发现、早报告以及病例诊断和隔离观察解除的策略依据。 方法 对该起新冠肺炎聚集性疫情的病例和密切接触者进行现场流行病学调查,描述性分析流行病学史、临床和实验室资料。 结果 利用大数据比对监测,在转送监测对象至集中场所隔离医学观察时发现了新冠肺炎确诊病例何某华,由此发现一起新冠肺炎家庭聚集性疫情,何某的5名密切接触者中有3人发病确诊（包含1名重症病例）,其中重症病例黄某第7次新型冠状病毒核酸检测阳性进而确诊,密切接触者中胡某有流行病学史、血常规白细胞下降和肺炎影像学改变,但是5次咽拭子核酸检测阴性,未确诊。 结论 大数据比对监测对发现传染病有积极作用;早期对有流行病学史人员单独隔离医学观察对防止聚集性疫情发生有重要意义;将2次核酸检测阴性作为新冠肺炎病例的排除标准和将核酸检测阳性作为确诊新冠肺炎病例的必备条件,值得探讨,这都可能放走传染源,导致新冠肺炎传播。     

Direct binding of GABAA receptor β2 and β3 subunits to gephyrin

GABAergic transmission is essential to brain function, and a large repertoire of GABA type A receptor (GABA_AR) subunits is at a neuron's disposition to serve this function. The glycine receptor (GlyR)‐associated protein gephyrin has been shown to be essential for the clustering of a subset of GABA_AR. Despite recent progress in the field of gephyrin‐dependent mechanisms of postsynaptic GABA_AR stabilisation, the role of gephyrin in synaptic GABA_AR localisation has remained a complex matter with many open questions. Here, we analysed comparatively the interaction of purified rat gephyrin and mouse brain gephyrin with the large cytoplasmic loops of GABA_AR α1, α2, β2 and β3 subunits. Binding affinities were determined using surface plasmon resonance spectroscopy, and showed an ~ 20‐fold lower affinity of the β2 loop to gephyrin as compared to the GlyR β loop–gephyrin interaction. We also probed in vivo binding in primary cortical neurons by the well‐established use of chimaeras of GlyR α1 that harbour respective gephyrin‐binding motifs derived from the different GABA_AR subunits. These studies identify a novel gephyrin‐binding motif in GABA_AR β2 and β3 large cytoplasmic loops.     

The Adhesion Between a Microvillus-Bearing Cell and a Ligand-Coated Substrate: A Monte Carlo Study

In biology, specific cell adhesion is mediated by receptor–ligand interactions. Consequently, its strength correlates with the strength of single receptor–ligand bonds that can be measured with a variety of techniques. However, whether single receptor–ligand bonds are truly present in an experiment is often a concern. In this paper, we present a Monte Carlo simulation of the adhesion between a microvillus-bearing cell and a ligand-coated substrate. In the simulation, ligands were immobilized on the substrate either uniformly or in clusters of three and seven, while receptors were distributed uniformly on the microvillus tip and they moved randomly on the cellular surface. How ligand clustering affects the adhesion frequency and forward rate constant was studied. Other factors that were studied include receptor aggregation on the microvillus tip, ligand density, receptor density, contact time, and binding pocket size. In the case of uniformly distributed ligands, our simulation results agree well with those obtained from probabilistic analysis. We found that, even with clustered ligands on the substrate, most of the adhesion events were mediated by a single bond if the total adhesion frequency was less than 20%. Besides, ligand clustering decreased the total adhesion frequency and forward rate constant, but increased the single-bond adhesion frequency under comparable conditions. These findings should lend us some assistance in identifying single bonds in cell–substrate or cell–bead adhesion measurements and in illustrating some biological mechanisms that involve clustered ligands.     

Spatial clusters of daytime sleepiness and association with nighttime noise levels in a Swiss general population (GeoHypnoLaus)

Introduction

Daytime sleepiness is highly prevalent in the general adult population and has been linked to an increased risk of workplace and vehicle accidents, lower professional performance and poorer health. Despite the established relationship between noise and daytime sleepiness, little research has explored the individual-level spatial distribution of noise-related sleep disturbances. We assessed the spatial dependence of daytime sleepiness and tested whether clusters of individuals exhibiting higher daytime sleepiness were characterized by higher nocturnal noise levels than other clusters.