中西医结合护理干预妊娠晚期合并急性单纯性阑尾炎患者的临床观察

目的:探讨中西医结合护理干预妊娠晚期合并急性单纯性阑尾炎的临床疗效。方法:将2017 年9 月—2018 年12月于我院接受中西医结合保守治疗的31 例妊娠晚期合并急性单纯性阑尾炎患者作为研究对象，按随机数表法随机分为中西医结合护理组(观察组16 例)与常规护理组(对照组15 例)，对照组采取常规护理措施，观察组在对照组的基础上增加中西医结合护理措施，对比两组患者的临床疗效。结果:观察组患者的心理状态变化、新生儿体质状况以及临床疗效等指标等情况均明显优于对照组，且组间对比差异显著有统计学意义(P ＜ 0.05)。结论:中西医结合护理对妊娠晚期合并急性单纯性阑尾炎有较好的临床效果，可减少、甚至避免孕妇因合并急性阑尾炎而造成的打击和创伤。     

The introduction of BCG vaccination to neonates in Northern Sweden, 1927–31: Re-analysis of historical data to understand the lower mortality among BCG-vaccinated children

BackgroundFollowing the introduction of oral Bacille Calmette-Guérin (BCG) a century ago, Albert Calmette suggested that BCG both provided protection against death from tuberculosis (TB) and other causes. The findings were not pursued. Today, there is considerable evidence that intradermal BCG have beneficial non-specific effects (NSEs). We re-analyzed data from BCG’s introduction 1927–1931 in Sweden hypothesizing that BCG reduced infectious deaths.MethodsIn three papers published by Dr Carl Näslund, the progress of oral neonatal BCG rollout provided free-of-charge and the effects on child mortality in the highly TB-prevalent region Norrbotten was sequentially updated. We analyzed cause-specific post-neonatal mortality by vaccination status excluding deaths from congenital conditions. Due to apparent differences in effects during study years, effects were assessed overall and separately in two periods (1927–1929, 1930–1931).ResultsAccording to Näslund, TB households were slightly more likely to accept vaccination; fewer newborns that were sick or had congenital problems were vaccinated. BCG coverage was 28.3% (5659/20,012); 8.7% (1746/20,012) died. The BCG/unvaccinated Risk Ratio (RR) of post-neonatal childhood death was 0.53 (0.45–0.62). BCG was associated with 80% (49–92%) reduced mortality from TB. From 1927 to 29, BCG appeared to protect strongly against deaths from all diseases, including the non-infectious, RR = 0.09 (0.02–0.36), presumably reflecting selection bias. From 1930 to 1931, there was no protection against non-infectious deaths, RR = 0.92 (0.49–1.70) indicating less bias (p = 0.004 for same effect). During 1930–1931, BCG was associated with reductions in non-TB infectious deaths (RR = 0.75 (0.58–0.97)); 2/3 were caused by respiratory infections, against which the BCG/unvaccinated RR was 0.61 (0.43–0.84). Other causes of death were less frequent and provided no clear pattern, except that BCG was associated with more meningitis deaths, RR = 6.85 (2.20–21.4).ConclusionHealthy vaccinee bias, particularly in 1927–1929, resulted in strongly beneficial overall BCG effects. However, the 1930–1931 data provided some support that BCG both protected against TB deaths and deaths from respiratory infections.     

糖皮质激素受体 GRα／GRβ在慢性鼻－鼻窦炎治疗中的作用

目的:探讨糖皮质激素受体GRα/GRβ在慢性鼻-鼻窦炎治疗中的作用。方法:本研究共纳入2013年5月至2015年5月在上海交通大学医学院附属瑞金医院耳鼻咽喉科行鼻内镜手术治疗的慢性鼻-鼻窦炎患者150例,根据治疗效果分为有效组和无效组,通过免疫组织化学方法检测糖皮质激素受体GRα和GRβ在慢性鼻-鼻窦炎鼻息肉组织中的表达情况,同时选取无鼻-鼻窦炎及变应性疾病史患者中鼻甲黏膜作为阴性对照。分析GRα和GRβ表达水平与Lund and Kennedy内镜评分和生活质量评价的相关性。结果:在有效组、无效组和对照组的鼻黏膜(鼻息肉)中均有较高程度的GRα阳性细胞的表达,各组间的GRα积分无统计学意义;另外,有效组和无效组的GRβ积分均明显高于对照组,有效组GRβ积分明显低于无效组,两两比较,其差异均具有统计学意义(P<0.01)。相关性分析显示,将150例患者GRα的表达与Lund and Kennedy内镜评分无明显相关性,而GRβ的表达与Lund and Kennedy内镜评分呈现正相关。另外,GRα的表达与术后VAS评分、SNOT-20评分及SF-36评分之间无明显的相关性,而GRβ的表达与术后VAS评分和SNOT-20评分均呈正相关,而与术后SF-36评分无明显相关性。结论:GRβ的高表达可能是导致慢性鼻-鼻窦炎患者临床疗效不佳的重要因素。     

Relation between active mediation,exposure to Daniel Tiger’s Neighborhood,and US preschoolers’ social and emotional development

This study explored the relationship between active mediation, exposure to Daniel Tiger’s Neighborhood, and key indicators of preschoolers’ social and emotional development. One hundred and twenty-seven children aged 2–6 either watched or did not watch 10 episodes of Daniel Tiger’s Neighborhood over a two-week period. Results revealed that preschoolers who watched the program exhibited higher levels of empathy, self-efficacy, and emotion recognition when their regular TV-watching experiences are frequently accompanied by active mediation. This was especially true for younger preschoolers and preschoolers from low-income families. Implications for policy-makers, parents, producers of prosocial programming, and educators are discussed.     

子宫下段暂时性环扎在中央型前置胎盘术中出血处理的应用价值

目的探讨子宫下段暂时性环扎在中央型前置胎盘术中出血处理的应用效果及安全性。方法回顾性分析2011年6月至2015年6月绵阳市妇幼保健院收治的中央型前置胎盘患者90例的临床资料,根据止血方式将其分为观察组(54例)与对照组(36例),对照组产妇采取常规止血治疗,观察组产妇在剥离胎盘前及子宫局部处理或全切除前,迅速使用一次性硅胶尿管环扎子宫下段阻断子宫体血液供应,在子宫体血运阻断后进行常规止血操作,术后放开环扎尿管恢复子宫血供(排除子宫已切除患者),比较两组产妇治疗效果及临床结局。结果两组产妇干预前出血量比较差异无统计学意义(P0.05);观察组产妇卡前列素氨丁三醇用量、术中总出血量、总输血量、子宫切除率明显低于对照组,差异有统计学意义(P0.05);两组患者止血成功率均为100%;两组患者子宫坏死、切口感染、宫腔积血等并发症发生率比较,差异无统计学意义(P0.05)。结论子宫下段暂时性环扎术治疗前置胎盘分娩术中出血患者,止血效果较好,能迅速降低术中出血量,有效减少患者药物应用及输血量,止血成功率较高,同时子宫坏死等并发症发生率较低,应用安全性较高。     

Bayesian bent‐cable growth mixture tobit models for longitudinal data with skewness and detection limit: application to AIDS studies

This paper presents a new Bayesian methodology for identifying a transition period for the development of drug resistance to antiretroviral drug or therapy in HIV/AIDS studies or other related fields. Estimation of such a transition period requires an availability of longitudinal data where growth trajectories of a response variable tend to exhibit a gradual change from a declining trend to an increasing trend rather than an abrupt change. We assess this clinically important feature of the longitudinal HIV/AIDS data using the bent‐cable framework within a growth mixture Tobit model. To account for heterogeneity of drug resistance among subjects, the parameters of the bent‐cable growth mixture Tobit model are also allowed to differ by subgroups (subpopulations) of patients classified into latent classes on the basis of trajectories of observed viral load data with skewness and left‐censoring. The proposed methods are illustrated using real data from an AIDS clinical study. Copyright © 2016 John Wiley & Sons, Ltd.     

依维莫司联合全反式维甲酸逆转急性早幼粒细胞白血病细胞耐药的研究

目的探讨依维莫司联合全反式维甲酸(简称维甲酸)逆转急性早幼粒细胞白血病(APL)细胞株NB4-R1耐药的作用。方法应用CD11b染色流式细胞术及硝基四唑氮蓝(NBT)还原实验检测两药联合应用对细胞分化的影响, 流式细胞术检测细胞周期情况, Annexin V/PI双染色检测细胞凋亡情况, 蛋白质印迹法检测自噬相关蛋白微管结合蛋白轻链3(LC3)、Beclin 1及早幼粒白血病-维甲酸受体融合蛋白(PML-RARα)、磷酸化核糖体S6激酶(P-P70S6K)、磷酸化4E结合蛋白1(P-4E-BP1) 等表达水平。结果与维甲酸组比较, 联用组能诱导耐药细胞株NB4-R1细胞的分化, 并将细胞增殖阻止在G ₁期而对细胞凋亡无明显影响。100 nmol/L依维莫司组、1μmol/L维甲酸组、联用组、对照组NB4-R1细胞培养48 h后分化百分率分别为(2.29±0.57)%、(17.06±2.65)%、(54.47±4.91)%、(2.54±0.53)%; 处于G ₁期的细胞百分率分别为(35.20±11.97)%、(33.54±6.25)%、(53.70±8.73)%、(27.40±6.01)%; 四组细胞凋亡细胞百分率分别为(2.30±0.14)%、(2.25±0.21)%、(2.40±0.28)%、(1.95±0.07)%。与维甲酸组比较, 联用组mTOR信号通路下游的P70S6K、4E-BP1分子磷酸化水平下降, LC3-II和Beclin 1的表达上调, 且能部分降解融合蛋白PML-RARα。 结论依维莫司联合维甲酸能诱导NB4-R1细胞分化, 且能阻滞细胞周期而不致细胞凋亡, 其机制可能与依维莫司联合维甲酸抑制mTOR信号通路激活自噬作用从而降解PML-RARα蛋白有关。     

乌司他丁对冠状动脉搭桥术后患者认知功能障碍的影响

目的探讨不同剂量乌司他丁对冠状动脉搭桥术患者术后认知功能障碍的影响及其可能的作用机制。方法选择2013年1月至2014年6月在南京医科大学附属南京医院就诊择期行冠状动脉搭桥术的老年患者127例, 分为三组:大剂量乌司他丁组(1.6万U/kg)、小剂量乌司他丁组(0.8万U/kg)和对照组(等容量的生理盐水)。所有患者在手术当日和次日晨8时测血浆皮质醇浓度, 并在术前、开胸、术毕、术后6 h和术后24 h分别检测IL-6、IL-10、TNF-α和S100β蛋白水平。术前1 d、术后1周和3个月分别应用精神神经测试组合量表评估患者认知功能的变化判定有无术后认知功能障碍, 计算各组患者术后认知功能障碍的发生率, 并且比较术后1周是否发生术后认知功能障碍患者S100β蛋白水平。结果最终93例患者完成研究, 三组患者一般资料比较差异均无统计学意义(均 P>0.05)。与术前相比较, 对照组患者术后24 h血浆皮质醇浓度升高明显( P < 0.01), 且大剂量和小剂量乌司他丁组患者术后血浆皮质醇浓度均较对照组低(均 P < 0.01);三组患者术毕、术后6 h和24 h血浆IL-6、IL-10、TNF-α水平及S100β蛋白水平均高于术前(均 P < 0.05);大剂量和小剂量乌司他丁组患者在术毕、术后6 h和24 h血浆IL-6、TNF-α水平浇以及在术后6 h S100β蛋白水平均比相对应时间点的对照组患者降低(均 P < 0.05), 但大剂量和小剂量乌司他丁组患者组间差异无统计学意义( P>0.05)。大剂量和小剂量乌司他丁组患者术后1周认知功能障碍发生率(25.8%和23.3%)均低于对照组(50.0%), 差异有统计学意义(均 P < 0.05);而大剂量和小剂量乌司他丁组术后3个月的术后认知功能障碍发生率(12.9%和16.7%)与对照组(28.1%)比较, 差异均无统计学意义( P>0.05)。术后认知功能障碍组( n=31) 在术后24 h血清S100β蛋白水平高于非术后认知功能障碍组( n=62), 其差异具有统计学意义( P < 0.05)。 结论乌司他丁可降低冠状动脉搭桥术患者术后1周的术后认知功能障碍的发生率, 其机制可能与减轻炎性反应及脑损伤有关。     

DNA excision repair and double-strand break repair gene polymorphisms and the level of chromosome aberration in children with long-term exposure to radon

Purpose: To study polymorphic variants of repair genes in people affected by long-term exposure to radon. The chromosome aberration frequency in peripheral blood lymphocytes was used as the biological marker of genotoxicity.

Materials and methods: Genotyping of 12 single nucleotide polymorphisms in DNA repair genes (APE, XRCC1, OGG1, ADPRT, XpC, XpD, XpG, Lig4 and NBS1) was performed in children with long-term resident exposure to radon. Quantification of the aberrations was performed using light microscopy.

Results: The total frequency of aberrations was increased in carriers of the G/G genotype for the XpD gene (rs13181) polymorphism in recessive model confirmed by the results of ROC-analysis (‘satisfactory predictor’, AUC?=?0.609). Single chromosome fragments frequency was increased in carriers of the G/G genotype in comparison with the T/T genotype. In respect to the total frequency of aberrations, the G/G genotype for the XpG gene (rs17655) polymorphism was also identified as a ‘satisfactory predictor’ (AUC?=?0.605). Carriers of the T/C genotype for the ADPRT gene (rs1136410) polymorphism were characterized by an increased level of single fragments relative to the T/T genotype.

Conclusion: The relationships with several types of cytogenetic damage suggest these three SNP (rs13181, rs17655 and rs1136410) may be considered radiosensitivity markers.