Cardiovascular effects and mechanisms of sodium-glucose cotransporter-2 inhibitors

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a new type of drug for the treatment of diabetes, and they have been proven to have a good hypoglycemic effect. Several lines of clinical evidence have shown that SGLT2 inhibitors can significantly reduce the risks of atherosclerosis, hospitalization for heart failure, cardiovascular death, and all-cause mortality and delay the progression of chronic kidney disease. Because of the protective effects of SGLT2 inhibitors on the heart and kidney, they are being studied for the treatment of heart failure and chronic kidney disease in patients without diabetes. Therefore, it is necessary for cardiologists, patients with diabetes, and nephrologists to fully understand this type of drug. In this review, we summarize the following three aspects of SGLT2 inhibitors: the recent clinical evidence of their cardiovascular benefits, their mechanisms of action, and their safety.     

热疗对肿瘤免疫微环境中免疫细胞及免疫相关细胞因子的影响

随着对肿瘤热疗和肿瘤免疫微环境(TIME)的深入研究,近年来热疗对TIME的作用越来越受到学者们的重视。本文就目前国内外研究进展,对热疗与TIME中几类主要免疫细胞和免疫相关细胞因子的影响及作用机制作一综述。全面而透彻的了解热疗对TIME的调控作用,有助于为肿瘤治疗提供新的思路和方法。     

“5+3”背景下医学生感官系统技能培训体系建设

为探索以器官-系统为中心的整合课程的教学改革，本项目在“5＋3”医学生中进行了针对感官系统的临床技能培训新体系建设。根据当前医学教育改革发展的趋势和要求，结合目前临床技能教学的现状，项目整合了包括耳鼻咽喉科、眼科及皮肤科的基础与临床教学内容，设计了新的临床技能培训体系，其中包括编写新的教材，制定新的教学大纲，由专门的教学组负责实施，培训方式包括模拟训练和床旁实战训练，考核方法包括操作能力考核和临床病例考核，培训内容则涵盖各专业常规操作技能。经过实践运用，证实该培训体系能快速有效地提升学生的临床操作技能，取得了良好的教学效果。     

枇杷叶紫珠化学成分及其细胞毒活性和抗炎活性

目的研究枇杷叶紫珠Callicarpa kochiana的化学成分及其细胞毒活性和抗炎活性。方法枇杷叶紫珠90%丙酮提取物采用硅胶、Sephadex LH-20、MCI、ODS、重结晶、半制备HPLC进行分离纯化,根据理化性质及波谱数据鉴定所得化合物的结构。采用CCK8法、Griess法、ELISA法测定化合物4~5的细胞毒活性和抗炎活性。结果从中分离得到5个化合物,分别鉴定为3,7,3’,4’-tetramethyl-quercetin (1)、pachypodol (2)、14α-hydroxyisopimaric acid(3)、14α-hydroxy-7,15-isopimaradien-18-oic acid (4)、(16R)-16,17-dihydroxyphyllolladan-3-one (5)。化合物4在一定浓度范围内对7种肿瘤细胞具有不同程度的抑制作用,并可以减少RAW264. 7细胞NO、IL-10、MCP-1、TNF-α的释放量。结论化合物1~5均为首次从该植物中分离得到,化合物4具有细胞毒活性和抗炎活性。     

Comparison of microtransplantation,chemotherapy and allogeneic transplantation in post-remission therapy for Philadelphia chromosome-positive acute lymphoblastic leukemia

Patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL) have poor prognosis, and the efficacy of chemotherapy plus tyrosine kinase inhibitors (TKIs) followed by mismatched donor stem cell infusion (microtransplantation, MST) has not been determined. We retrospectively summarized 45 patients including 11 undergoing MST with TKIs, 17 receiving allogeneic transplant and 17 undergoing chemotherapy with TKIs. Improved 4-year overall survival rate was observed in the MST group (91%) compared with either transplant group (31%, P = .005) or chemotherapy group (36%, P = .013). The MST group also had higher 2-year and 4-year leukemia-free survival rates (91% and 72%, respectively) compared with either transplant group (33%, P = .005 and 33%, P = .021, respectively) or chemotherapy group (41%, P = .017 and 31%, P = .023, respectively). 2-year and 4-year cumulative incidences of hematologic relapse were lower in the MST group (9% and 28%, respectively) compared with those in the chemotherapy group (56%, P = .025 and 67%, P = .034, respectively). In patients undergoing MST, donor microchimerism was detected (1.07 × 10^-5 to 6.6 × 10^-4 copies from 9 to 1499 days) in 7 patients, and donor/patient-derived HLA*0201/2402⁺WT1⁺CD8⁺ T cells were found from 0.05% to 0.67% in 6 patients. MST may provide a favorable treatment for patients with Ph⁺ ALL.     

改良体位联合中医护理对PICC置管治疗妇科肿瘤患者满意率及依从性的影响

目的：探究改良体位和中医护理对经外周静脉穿刺中心静脉置管（PICC）治疗妇科肿瘤患者满意率及依从性的影响情况。方法：将 85 例 PICC 置管治疗妇科肿瘤患者，依据随机数字表法分为 2 组，对照组 42 例予以 PICC 置管治疗常规护理；观察组 43 例在对照组的基础上予以改良体位和中医护理。对比 2 组患者护理后护理质量、满意率、依从性以及并发症发生情况和生活质量。结果：观察组护理后，人员素质、病情观察、健康指导、服务态度、服务项目以及护理满意率优于对照组，差异有统计学意义（P＜0.05）。观察组护理后在遵医嘱用药、注意饮食、合理运动、自我检测方面的依从性高于对照组，差异有统计学意义（P＜0.05）。观察组护理后并发症发生率、生活质量评分优于对照组，差异有统计学意义（P＜0.05）。结论：改良体位联合中医护理可以有效提高 PICC 置管治疗妇科肿瘤患者的满意率和依从性，降低 PICC 置管治疗的并发症发生率，改善生活质量。     

miR-149与肿瘤关系的研究进展

miRNAs是一类长度约为20~25个核苷酸，参与基因调控表达的内源性非编码RNA。miR-149作为miRNAs的重要成员，在多种肿瘤中表达异常，其表达水平与肿瘤细胞增殖、转移、凋亡、耐药、患者的早期诊断及预后密切相关。因此，miR-149有望成为新一类抗肿瘤治疗的靶点。     

广西高校新生对HIV尿液自助采样包的使用意愿及关注因素调查

目的 了解广西高校新生对HIV尿液自助采样包的使用意愿及关注因素,为进一步在高校开展HIV尿液自我采样传递检测提供依据和参考。 方法 采取整群随机抽样方法,分别选取广西A、B两所高校新生进行匿名问卷调查,其中,A校在健康教育讲座前问卷调查,B校在健康教育讲座后问卷调查。 结果 本次调查中,共发放问卷500份,A、B两所高校新生的问卷回收率分别是88.0%(132/150),96.9%(339/350),差异有统计学意义(P<0.001)。A、B两所高校新生艾滋病基本知识平均知晓率分别为73.7%,87.7%,差异有统计学意义(P<0.001)。受访的大学新生中有2.3%(11/471)曾接受过HIV检测。A、B两所高校新生对HIV尿液自助采样包的使用意愿率分别是63.6%(84/132),88.5%(300/339),差异有统计学意义(P<0.001)。男生对HIV尿液自助采样包的使用意愿率均要稍高于女生,但差异无统计学意义(P>0.05)。在阻碍HIV尿液自助采样包的使用因素调查中,54.0%(47/87)认为操作流程不方便,37.9%(33/87)怀疑结果的准确性,8.1%(7/87)认为容易污染。此外,在大学新生对HIV尿液自助采样包的关注因素调查中,首要关注的是保密性(85.4%,402/471),其次是准确性(72.4%,341/471)。超过一半的新生认为100~150元是HIV尿液自助采样包的可接受价格范围,高达97%的新生认为检测结果的反馈时长应小于7 d。 结论 广西高校新生对HIV尿液自助采样包的态度积极,使用意愿较高,对HIV尿液自我采样传递检测持相对开放态度。HIV尿液自助采样包的保密性和准确性是大学新生最为关注的两个因素。举办健康教育讲座对HIV尿液自助采样包进行适当的介绍和宣传,可有效提高使用意愿。     

Liver Transplantation Following Life-threatening Abdominal Trauma: A Case Series of 5 Patients at a Single Institution

Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.