超声引导PVNB对老年食道癌开胸患者术后镇痛、应激及炎性因子水平的影响

目的 探讨超声引导下连续椎旁神经阻滞(PVNB)对老年食道癌开胸手术患者术后镇痛、应激及炎性因子水平的影响。方法 选取我院拟实施全麻下开胸手术的90例食道癌开胸手术患者作为研究对象,其中45例患者术前采用超声引导下PVNB麻醉复合全身麻醉(PVNB组)、对照组45例患者采用全身麻醉；两组患者术后均采用静脉自控镇痛(对照组)；对比两组患者术后2h、6h、24h及48h静息状态、咳嗽状态下的视觉模拟疼痛评分(VAS),术后镇痛药物用量及镇痛药物不良反应发生情况,术前及术后24h血清去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)差异及术后肺部感染发生情况。结果 PVNB组患者和对照组在术后2h～术后48h的静息VAS评分及咳嗽VAS评分组间比较,差异具有统计学意义(P<0.05),PVNB组术后2h、6h及24h静息VAS评分及咳嗽VAS评分均高于对照组(P>0.05)。PVNB组患者术后的镇痛泵按压次数、舒芬太尼用量均低于对照组(P<0.05),PVNB组患者术后的镇痛泵按压次数、舒芬太尼用量均低于对照组(P<0.05),术前两组患者的血清NE、E、Cor水平差异无统计学意义(P>0.05)；术后两24h两组患者血清NE、E、Cor水平均较术前增高(P>0.05),术后24h PVNB组的血清NE、E、Cor水平低于对照组(P<0.05),术前两组患者的血清IL-6、TNF-α水平差异无统计学意义(P>0.05)；术后24h两组患者血清IL-6、IL-10、TNF-α水平均较术前增高(P<0.05),PVNB组的血清IL-6、TNF-α水平低于对照组(P<0.05),PVNB组术后发生肺部感染2例,发生率为4.4%,对照组术后发生肺部感染6例,发生率为13.3%,PVNB组术后肺部感染发生率低于对照组(P<0.05)。结论 超声引导下PVNB能够改善老年食道癌开胸患者术后镇痛效果,减轻手术创伤所致的应激反应,较少患者术后肺部感染的发生。     

转录调节因子c-Myb通过炎症因子Ccl2抑制乳腺癌肺转移的实验研究

目的:研究乳腺癌细胞中转录调节因子c-Myb的表达对肺转移的影响及其分子机制。方法:构建c-Myb高表达的4T1乳腺癌细胞株，种植小鼠构建乳腺癌动物模型，检测实验动物肺转移情况，通过荷瘤抑制试验检测肺转移抑制效果。提取组织进行荧光PCR检测相关炎症因子的表达。利用Medisapiens数据库的生物信息学资源，对c-Myb和Ccl2的表达与乳腺癌患者的预后进行分析。结果:高表达c-Myb的荷瘤小鼠肺部转移灶明显减少，其中炎症相关因子表达受限。由数据库分析得出，c-Myb高表达患者生存期得以延长。结论:乳腺癌中c-Myb的表达能够通过炎症因子Ccl2抑制肺转移从而延长患者生存期。     

Peripheral blood inflammatory markers in predicting prognosis in patients with COVID‐19. Some differences with influenza A

BackgroundTo evaluate the ability of peripheral blood inflammatory markers in predicating the typing of COVID‐19, prognosis, and some differences between COVID‐19 and influenza A patients.MethodsClinical data on 285 cases laboratory‐confirmed as SARS‐CoV‐2 infection were obtained from a Wuhan local hospital''s electronic medical records according to previously designed standardized data collection forms. Additional 446 Influenza A outpatients’ hematologic data were enrolled for comparison.ResultsNLR, SII, RLR, PLR, HsCRP, and IL‐6 were significant higher and LMR was lower in severe COVID‐19 patients than in mild COVID‐19 patients (p < .001). PLR and LMR were lower in the individuals with influenza A than those with COVID‐19 (p < .01). COVID‐19 patients with higher levels of NLR, SII, RLR, PLR, HsCRP, and IL‐6 and lower LMR were significantly associated with the severe type. AUC of NLR (0.76) was larger while the specificity of IL‐6 (86%) and sensitivity of HsCRP (89%) were higher than other inflammatory markers in predicating the typing of COVID‐19. PT had obvious correlation with all the inflammatory markers except RPR. NLR showed positive correlations with AST, TP, BUN, CREA, PT, and D‐dimer. Patients with high IL‐6 levels have a relatively worse prognosis (HR = 2.30).ConclusionPeripheral blood inflammatory markers reflected the intensity of inflammation and associated with severity of COVID‐19.NLR was more useful to predict severity as well as IL‐6 to predict prognosis of COVID‐19. PLR and LMR were initially found to be higher in SARS‐CoV‐2 virus‐infected group than in influenza A.     

Physical activity as a proxy to ameliorate inflammation in patients with type 2 diabetes and periodontal disease at high cardiovascular risk

While the beneficial impact of physical activity has been ascertained in a variety of pathological scenarios, including diabetes and low-grade systemic inflammation, its potential remains still putative for periodontal health. Periodontal disease has been associated with inflammatory systemic alterations, which share a common denominator with type 2 diabetes mellitus and cardiovascular disease. Physical exercise, along with nutritional counseling, is a cornerstone in the treatment and prevention of type 2 diabetes, also able to reduce the prevalence of periodontal disease and cardiovascular risk. In addition, considering the higher incidence of periodontitis in patients with type 2 diabetes compared to healthy controls, the fascinating research question would be whether physical activity could relieve the inflammatory pressure exerted by the combination of these two diseases. This multi-disciplinary viewpoint discusses available literature in order to argument the hypothesis of a “three–way relationship” linking diabetes, periodontitis, and physical activity.     

逐瘀止血汤加减治疗慢性子宫内膜炎气虚血瘀证的疗效观察

目的 评价逐瘀止血汤加减对慢性子宫内膜炎（CE）气虚血瘀证患者妊娠结局的影响及对免疫炎症因子的调节作用。方法 将144例患者随机按数字表法分为观察组和对照组各72例。观察组脱落、失访4例，剔除2例，完成66例；对照组脱落、失访3例，剔除5例，完成65例。两组均给予抗感染治疗14 d。对照组口服妇科千金片，6片/次，3次/d。观察组内服逐瘀止血汤加减，1剂/d。两组疗程均为3个月，并随访6个月。记录治疗前后月经经量、经期和周期变化情况；进行治疗前后宫腔镜和阴道彩色多普勒超声检查，评价子宫内膜形态、子宫内膜容受性（CP）［子宫内膜厚度、阻力指数（RI），搏动指数（PI）和血流指数（FI）］等，并进行子宫内膜病理检查；进行治疗前后气虚血瘀证评分；检测治疗前后月经血白细胞介素-1β（IL-1β），IL-6和肿瘤坏死因子-α（TNF-α）水平和外周血测T淋巴亚群（CD3⁺，CD4⁺，CD8⁺）水平；随访记录妊娠情况和流产情况。进行安全性评价。结果 治疗后观察组经量、经期、周期和月经完全正常率均高于对照组（P<0.05）；观察组子宫内膜厚度和FI均高于对照组（P<0.01），RI和PI均低于对照组（P<0.01）；观察组月经血IL-1β，IL-6和TNF-α水平均低于对照组（P<0.01）；观察组CD3⁺，CD4⁺水平和CD4⁺/ CD8⁺均高于对照组（P<0.01），CD8⁺水平低于对照组（P<0.01）；在6个月随访期间，观察组妊娠率46.97%（31/66），高于对照组的27.69%（18/65）（χ²=5.197，P<0.05）；观察组子宫内膜形态疗效总有效率为96.97%（64/66），高于对照组的86.15%（56/65）（χ²=4.981，P<0.05）；观察组子宫内膜病理组织疗效总有效率为95.45%（63/66），高于对照组的84.62%（55/65）（χ²=4.304，P<0.05）；观察组综合临床疗效总有效率为93.94%（62/66），高于对照组的81.54%（55/65）（χ²=4.696，P<0.05）；两组治疗期间均未发现与中药相关不良反应。结论 逐瘀止血汤加减治疗CE气虚血瘀证患者，可调经月经、减轻临床症状，改善宫腔镜下内膜形态，调节全身和局部的免疫炎症反应，提高了CP，从而改善了妊娠结局，有着较好的综合疗效，且安全。     

Anti-tumor and Phenotypic Regulation Effect of Matrine on Dendritic Cells through Regulating TLRs Pathway

Objective: To investigate the effects of matrine on antigen presentation of dendritic cells (DCs), and to explore the pharmacological mechanism of matrine on anti-tumor effect. Methods: Different concentrations (0, 1, 2, 4, 8 and 16 μ g/mL) of matrine were co-cultured with DCs, the harvested DCs were co-cultured with antigens of Lewis lung cancer (LLC) cells, and then DCs and T cells were co-cultured to produce DCs-activated killer (DAK) cells, which have significant tumor-killing activity. The expression of cytokines, mRNA and protein of toll-like receptors (TLRs) in DCs were detected by enzyme linked immunosobent assay, polymerase chain reaction and Western blot, respectively. And the killing effect of DAK were measured by MTT assay. Results: Matrine significantly increased the mRNA expression of TLR7, TLR8, myeloid differentiation factor 88 (MyD88), tumor necrosis factor receptor-associated factor 6 (TRAF-6) and Iκ B kinase (IKK), as well as the protein expression of TLR7 and TLR8, and up-regulated the levels of interleukin-12 (IL-12), IL-6 and tumor necrosis factor-α (TNF-α ), meanwhile, it also increased the expressions of MHC-Ⅱ , CD54, CD80 and CD86 in DCs. DCs-activated effector T cells had significant tumor-killing activity. When the concentration of matrine was more than 4 μ g/mL, all indices had significant difference (P<0.01 or P<0.05). Conclusion: Matrine plays an anti-tumor role by regulating TLRs signal transduction pathway, promoting the secretion of inflammatory cytokines and enhancing immune function.     

阿奇霉素序贯给药辅助治疗小儿大叶性肺炎的效果及对患儿血清炎症因子水平的影响

目的探讨阿奇霉素序贯给药辅助治疗小儿大叶性肺炎的效果及对患儿血清炎症因子水平的影响。方法回顾性分析我院2014年10月至2019年10月收治的120例大叶性肺炎患儿的临床资料,根据治疗方式的不同将其分为对照组(60例,阿奇霉素静脉滴注治疗)和观察组(60例,阿奇霉素序贯给药治疗)。比较两组的治疗效果、不良反应情况、血清炎症因子及肺功能指标水平。结果观察组的治疗总有效率显著高于对照组,不良反应总发生率显著低于对照组(P<0.05)。治疗后,两组的TNF-α、PCT、IFN-γ、TM水平均降低,FVC、TLC、Cdyn水平均升高,且观察组显著优于对照组(P<0.05)。结论阿奇霉素序贯给药辅助治疗小儿大叶性肺炎的效果显著,可有效改善患儿血清炎症因子水平和肺功能指标水平,降低不良反应发生率,值得临床推广应用。