基于PBPK模型混苯作业职业病危害的风险评估方法与应用

目的 研究苯、甲苯、二甲苯、乙苯等混合性有机物职业暴露所致健康危害的定量风险评估方法，预测混苯作业职业暴露所致职业病危害的风险，为实施风险管理提供技术依据。方法 选取某涂料生产企业作为研究对象，依据健康风险评估的基本步骤，考虑苯、甲苯、二甲苯及乙苯在人体内代谢的交互作用，基于PBPK模型模拟上述化学物质混合物同时在人体内的代谢过程，并利用计算机软件求解结果。结果 通过计算得到长期混苯作业有关苯的终生致癌风险值：水性涂料生产线工人7.43×10-3，溶剂型涂料生产线工人1.21×10-4，两者致癌风险均高于可接受风险水平1×10-4；影响中枢神经系统的非致癌风险指数（HI）：水性涂料生产线工人1.45~19.06，溶剂型涂料生产线工人0.15~1.69；混苯作业造成中枢神经系统损伤的风险较高，尤其是水性涂料生产线风险极高。结论 本研究建立的工作场所混苯作业职业病危害的风险评估方法可预测苯致癌风险及混合有机物对中枢神经系统影响的非致癌风险范围，为混合性有机物职业暴露所致职业病危害的预防控制提供了技术支持。     

Stapled transperineal repair for low- and mid-level rectovaginal fistulas: A 5-year experience and comparison with sutured repair

BACKGROUNDCurrently, rectovaginal fistula (RVF) continues to be a surgical challenge worldwide, with a relatively low healing rate. Unclosed intermittent suture and poor suture materials may be the main reasons for this.AIMTo evaluate the efficacy and safety of stapled transperineal repair in treating RVF.METHODSThis was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included. Among the 82 total patients, 37 underwent repair with direct suturing and 45 underwent repair with stapling. Patient demographic data, Wexner faecal incontinence score, and operative data were analyzed. Recurrence rate and associated risk factors were assessed.RESULTSThe direct suture and stapled repair groups showed similar clinical characteristics for aetiology, surgical history, fistula features, and perioperative Wexner score. The stapled repair group did not show superior results over the suture repair group in regard to operative time, blood loss, and hospital stay. However, the stapled repair group showed better postoperative Wexner score (1.04 ± 1.89 vs 2.73 ± 3.75, P = 0.021), less intercourse pain (1/45 vs 17/37, P = 0.045), and lower recurrence rate (6/45 vs 17/37, P = 0.001). There was no protective effect from previous repair history, smaller diameter of fistula (< 0.5 cm), better control of defecation (Wexner < 10), or stapled repair. Direct suture repair and preoperative high Wexner score (> 10) were risk factors for fistula recurrence. Furthermore, stapled repair gave better efficacy in treating complex RVFs (i.e., multiple transperineal repair history, mid-level fistula position, and poor control of defecation).CONCLUSIONStapled transperineal repair is advantageous for management of RVF, providing a high primary healing rate and low recurrence rate.     

The Acute Effects of Aerobic Dance Exercise with and without Face Mask Use on Attention,Perceived Exertion and Mood States

The present study aimed to determine the effect of wearing a face mask during aerobic dance exercise on cognitive function, more specifically on attention, as well as on perceived exertion and mood states. Thirteen healthy college students (9 males and 4 females: mean age = 17.5 years, height = 1.72 m, weight = 71.00 kg) volunteered to participate in this study. They were randomized to perform aerobic dance exercise while wearing a cloth face mask or no mask or a control condition (sitting on a comfortable chair and reading information about the health benefits of aerobic dance exercise) on three separate occasions (with at least one week of interval). Rate of perceived exertion (RPE), the Brunel Mood Scale (BRUMS) and d2 Attention assessment were assessed before and immediately after each condition. The results demonstrated higher concentration performance for the aerobic dance exercise without face mask than the control condition (p = 0.05). Post RPE and BRUMS fatigue subscale values were significantly higher in the aerobic dance exercise with face mask as compared to the aerobic dance exercise without face mask and control condition (all, p < 0.05). BRUMS vigor subscale value significantly differed across conditions (F = 113.84, p < 0.001, ES = 0.86) and was significantly higher in the aerobic dance exercise group without face mask as compared to the aerobic dance exercise with face mask and the control conditions (both, p < 0.001). This study suggests that face mask use during aerobic dance exercise with moderate intensity did not affect attention. Practitioners, students and athletes should avoid wearing face mask while practicing physical activity or aerobic dance exercise with moderate intensity to improve its acute effect on cognitive function.     

生物指示剂用于压力蒸汽灭菌监测成本效益分析

目的选择合适的生物指示剂,降低医院灭菌运行成本,保障灭菌质量。方法使用48 h生物指示剂、3 h快速生物指示剂、1 h极速生物指示剂对2019年1月至2019年9月的灭菌循环进行监测。结果①该实验共使用48 h生物指示剂监测26次,使用3 h生物指示剂监测501次,使用1 h生物指示剂监测302次,试验管监测均为阴性,灭菌合格率达到100%。②三组监测方法单次监测费用比较,A组为46.47元,B组为53.33元;C组为49.51元。③A组对植入器械监测放行和其它两组比较有差异(P<0.05);B组和C组之间比较差异无统计学意义(P>0.05)。结论对灭菌器的生物监测是灭菌物品质量的保障,合理选用生物指示剂类型,可以有效控制生物监测的成本,提高物品无菌保障,从环节上控制医院感染的发生。     

Advancement of chimeric antigen receptor-natural killer cells targeting hepatocellular carcinoma

With the advance of genome engineering technology, chimeric antigen receptors (CARs)-based immunotherapy has become an emerging therapeutic strategy for tumors. Although initially designed for T cells in tumor immunotherapy, CARs have been exploited to modify the function of natural killer (NK) cells against a variety of tumors, including hepatocellular carcinoma (HCC). CAR-NK cells have the potential to sufficiently kill tumor antigen-expressing HCC cells, independent of major histocompatibility complex matching or prior priming. In this review, we summarize the recent advances in genetic engineering of CAR-NK cells against HCC and discuss the current challenges and prospects of CAR-NK cells as a revolutionary cellular immunotherapy against HCC.     

基于NF-κB信号通路探讨中医药治疗脓毒症的研究进展

脓毒症（sepsis）是重症医学科常见的急危重症，具有高发病率和高病死率的特点。目前，临床上针对脓毒症的治疗用药多以西药为主，长期使用存在抗生素耐药、激素不良反应和费用高昂等问题。因此，探寻新型、高效、安全、廉价的药物和治疗模式是现阶段研究的重点方向。中医药凭借其“整体观念、辨证论治、一人一方”的独特优势，在脓毒症的预防和治疗中积累了相当丰富的临床经验。近年来，中医药与脓毒症核转录因子-κB（NF-κB）信号通路的研究较多。该文通过筛选相关临床研究与文献，从脓毒症的病因病机，辨证论治，发病机制，NF-κB信号通路和中医药对脓毒症的干预等方面进行系统归纳整理，研究发现一些单味中药及其提取物、中药复方和中药注射液可以通过调控NF-κB信号通路的激活，调节巨噬细胞的免疫功能，有效抑制NF-κB介导的肿瘤坏死因子-α（TNF-α），白细胞介素-1（IL-1），IL-6等炎症因子及其蛋白的表达，显著减轻全身炎症反应和各脏器损伤，改善预后。但囿于客观条件的限制，部分研究也存在促炎-抗炎平衡机制模糊、药代动力学不明及药物安全性评价较低等问题，有待进一步研究与探索，以期为中医药治疗脓毒症提供新的理论基础和诊疗思路。     

针刀调整脊柱区带治疗原发性失眠临床随机对照研究

目的:观察应用针刀调整脊柱区带治疗原发性失眠临床疗效。方法:将122例原发性失眠患者随机分为3组,分别为:针刀治疗组40例、真针刺对照组41例和安慰针对照组41例。针刀治疗组采用针刀调整脊柱区带法,真针刺对照组采用常规针刺法,安慰针对照组采用安慰针法,评价治疗前后匹兹堡睡眠质量指数量表评分、焦虑自评量表评分、贝克抑郁量表评分、总睡眠时间、入睡潜伏期的变化,评价临床疗效。结果:经配对秩和检验,针刀治疗组、真针刺对照组治疗前后焦虑自评量表、贝克抑郁量表、匹兹堡睡眠质量指数量表比较,差异有统计学意义(P0.05)。安慰针对照组治疗前后焦虑自评量表、贝克抑郁量表比较,差异有统计学意义(P0.05),匹兹堡睡眠质量指数量表比较,差异无统计学意义(P0.05)。经多组独立样本秩和检验,治疗后3组间匹兹堡睡眠质量指数比较,差异有统计学意义(P0.05),而焦虑自评量表、贝克抑郁量表比较,差异无统计学意义(P0.05)。经两组独立样本秩和检验,匹兹堡睡眠质量指数量表,针刀治疗组与真针刺对照组、针刀治疗组与安慰针对照组、真针刺对照组与安慰针对照组比较,差异均有统计学意义(P0.0167)。经配对秩和检验,针刀治疗组、真针刺对照组治疗前后入眠潜伏期、总睡眠时间比较,差异均有统计学意义(P0.05)。安慰针对照组治疗前后入眠潜伏期比较,差异有统计学意义(P0.05);安慰针对照组治疗前后总睡眠时间比较,差异无统计学意义(P0.05)。经多组独立样本秩和检验,治疗后3组间入眠潜伏期和总睡眠时间比较,差异均有统计学意义(P0.05)。经两组独立样本秩和检验,入眠潜伏期和总睡眠时间指标,针刀治疗组与安慰针对照组、真针刺对照组与安慰针对照组比较差异均有统计学意义(P0.016 7)。以匹兹堡睡眠质量指数评价临床疗效,经等级资料多组样本秩和检验,针刀治疗组疗效优于真针刺对照组和安慰针对照组(Z=53.78,P=0.0010.05)。结论:针刀调整脊柱区带治疗原发性失眠安全高效。