ω-3多不饱和脂肪酸对急性肺损伤炎症反应及免疫功能影响的机制研究进展

烧(创)伤、吸入性损伤、严重感染以及休克等疾病过程中,机体内多种炎性介质的释放,引发炎性细胞向肺组织迁移,激活呈级联放大的炎症反应,常常可造成以肺毛细血管内皮细胞和肺泡上皮细胞损伤为主的急性肺损伤(ALI),严重者短时间内可迅速发展为急性呼吸窘迫综合征(ARDS),病死率极高。ω-3多不饱和脂肪酸(ω-3PUFA)作为药理性免疫营养素的重要组成部分,目前已经超越了以往单纯提供能量、恢复正氮平衡的范畴,发挥着调控机体炎症反应、免疫功能的全面作用,并逐渐演变为现代危重性肺损伤治疗的重要组成部分。因此,本文就ω-3PUFA对ALI炎症反应及免疫功能影响的机制作一综述,旨在为临床治疗ALI提供理论依据。     

少腹逐瘀汤联合孕三稀酮治疗子宫内膜异位症前瞻性研究

目的:探讨少腹逐瘀汤联合西药保守治疗子宫内膜异位症的临床价值。方法:我院诊治的80例子宫内膜异位症患者为研究对象,按随机双盲分组原则分为观察组和对照组,各40例。两组均给予孕三稀酮进行治疗,观察组在此基础上加用少腹逐瘀汤。对比两组临床疗效,记录两组治疗前后中医症状评分、血液流变学(血浆黏度、全血高切黏度、全血低切黏度、红细胞沉降速率、红细胞聚集指数、纤维蛋白原)及外周血糖类抗原125(CA125)含量,并观察两组在治疗期间不良反应发生情况。结果:观察组临床总有效率90.00%显著高于对照组72.50%,差异有统计学意义(P<0.05)。两组治疗后痛经、腰骶肛门坠胀、月经周期、经期、形寒肢冷症状评分较治疗前显著降低(P<0.05); 观察组治疗后痛经、腰骶肛门坠胀、月经周期、经期、形寒肢冷症状评分显著低于对照组(P<0.05)。观察组治疗后血液流变学指标及外周血CA125含量显著低于对照组(P<0.05)。结论:采用少腹逐瘀汤联合孕三稀酮治疗子宫内膜异位症,能提高临床疗效,减轻患者临床症状,加快病情康复。     

Effect of propanal and diacetyl on quantity of remaining double bonds of chemically cured BisGMA/TEGDMA resins

The aim of the present study was to determine the effect of propanal and diacetyl addition on the quantity of remaining double bonds of chemically cured dental resins. Propanal (propionaldehyde) or diacetyl (2.3-butanedione) was added to monomer mixtures, which were then made chemically curable. The monomer mixtures were varied with respect to content of propanal or diacetyl. Addition of propanal or diacetyl to chemically curable resins resulted in a decrease in the quantity of remaining double bonds from 19.6% to 1.9% and from 19.6% to 11.4%, respectively. A negative correlation of statistical significance was found between content of propanal and quantity of remaining double bonds, while the relationship between content of diacetyl and quantity of remaining double bonds was found not to be linear. Propanal was equally effective in reducing the quantity of remaining double bonds in chemically cured and in the light cured resins studied previously. As regards diacetyl, a more pronounced effect on quantity of remaining double bonds was noted for light cured resins as compared with chemically cured resins. The most likely common reaction mechanism of propanal and diacetyl seemed to be that of chain transfer reactions. Furthermore, analysis of the data indicated a possible additional photoinitiating function of diacetyl.     

Effect of micro-roughening of poly(ether ether ketone) on bone marrow derived stem cell and macrophage responses,and osseointegration

Poly(ether ether ketone) (PEEK) has emerged as a candidate to replace metal implants because of its satisfactory mechanical properties, radiolucency, and lack of metal allergy. However, PEEK lacks osseointegration ability limiting its clinical applications. To overcome this problem, we prepared PEEK with a micro-rough surface using the sandblast method to modulate its osseointegration property; the sandblast method is simple, cost-effective, and is already applied to clinical metal implants. The surface roughness of the sandblasted PEEK was about 2.3 μm, whereas that of mirror-polished PEEK was 0.06 μm. Rat bone marrow-derived mesenchymal stem cells (RMSCs) showed higher proliferation, osteocalcin (OC) expression and bone-like nodule formation on micro-roughened PEEK compared with those cultured on mirror-polished PEEK, suggesting that micro-roughening facilitated RMSCs proliferation and differentiation. The micro-roughened surface slightly mitigated secretion of inflammatory C-C motif chemokine 2 (CCL-2) from lipopolysaccharide (LPS)-stimulated macrophages, but not of tumor necrosis factor α (TNFα) and interleukin-6 (IL-6). Finally, to compare osseointegration, specimens were implanted in rat femur bone marrow cavities, and then the pull-out force was measured. The pull-out force of micro-roughened PEEK was about four times higher than that of the mirror-polished PEEK. These results showed that micro-roughening of PEEK using the sandblast method was able to improve osseointegration, partly through elevating proliferation and differentiation of RMSCs.     

Upstream Effect for Atrial Fibrillation: Still a Dilemma?

Atrial fibrillation is the most common arrhythmia in clinical practice. Ion channel blocking agents are often characterized by limited long-term efficacy and several side effects. In addition, ablative invasive procedures are neither easily accessible nor always efficacious. The "upstream therapy," which includes angiotensin-converting enzyme inhibitors, aldosterone receptor antagonists, statins, glucocorticoids, and ω-3 poly-unsaturated fatty acids, targets arrhythmia substrate, influencing atrial structural and electrical remodeling that play an essential role in atrial fibrillation induction and maintenance. The mechanisms involved and the most important clinical evidence regarding the upstream therapy influence on atrial fibrillation are presented in this review. Some open questions are also proposed.     

氢吗啡酮治疗的临床应用及不良反应分析

目的：探讨氢吗啡酮治疗难治性神经病理性疼痛的疗效及不良反应分析。方法将2013年1月—2014年1月该院收治的60例难治性神经病理性疼痛患者随机分为对照组和观察组(各30例),观察组用氢吗啡酮治疗,对照组给予普瑞巴林,分析两组方案治疗4周后的疼痛缓解程度,睡眠情况并记录不良反应。结果观察组的疼痛总缓解率和明显缓解率均高于对照组(P＜0.05)。对照组和观察组治疗后的睡眠干扰评分分别为(4.2±1.3)分和(2.8±0.8)分,低于对照组(P＜0.05)。观察组不良反应少于对照组,差异有统计学意义(P＜0.05)。结论氢吗啡酮治疗难治性神经病理性疼痛的疗效较好,不良反应少,可在临床进行推广。     

Titanium and polyether ether ketone (PEEK) patient-specific sub-periosteal implants: two novel approaches for rehabilitation of the severely atrophic anterior maxillary ridge

The aim of this study was to assess two new protocols for single-stage rehabilitation of the severely atrophic maxillary ridge using customized porous titanium or polyether ether ketone (PEEK) sub-periosteal implants. Ten patients with a severely atrophic anterior maxillary alveolar ridge were divided randomly into two groups (five patients in each) to receive customized sub-periosteal implants fabricated via CAD/CAM technology: group 1, porous titanium implants; group 2, PEEK implants. Prosthetic loading with fixed acrylic bridges was performed 1 month postoperative. The implants were followed-up for 12 months and evaluated for the presence of any sign of radiographic bone resorption, mobility, infection, prosthetic fracture, or implant exposure. The immediate postoperative period was uneventful except for one case complicated by wound dehiscence in group 1. At 12 months, all implants were functionally stable and the patients were comfortable with the prostheses. No signs of radiographic bone resorption, mobility, infection, or prosthetic fracture were observed. Within the limitations of this study, the application of customized porous titanium and PEEK sub-periosteal implants produced through CAD/CAM technology appears to be an acceptable method for single-stage prosthetic rehabilitation of the severely atrophic edentulous anterior maxilla.This study was awarded the best case study at the academy of osseintegration annual meeting 2017, Orlando, Florida.     

Urinary Excretion of Aminoacetone following Administration of L-Threonine in Man

A glucose diet and complete starvation resulted in a 30–40 per cent decrease of the urinary aminoacetone in man, whereas the excretion of δ-amino-levulinic acid remained unchanged. Oral and parenteral administration of L-threonine significantly enhanced the urinary excretion of aminoacetone. Threonine loading also produced a slight increase in the excretion of glycine, but no change in the excretion of δ-aminolevulinic acid.     

Transcatheter Hepatic Arterial Drug Infusion Therapy for Hepatocellular Carcinoma: Effect on the Arterial Ketone Body Ratio

The arterial ketone body ratio (acetoacetate to β-hydroxybutyrate) was measured in 15 patients with chronic liver disease before and after the infusion of anticancer drugs or embolic agents (gelatin sponge or iodized oil) into the hepatic artery. The arterial ketone body ratio decreased after hepatic angiography and decreased further at 15 min after infusion therapy. When the arterial ketone body ratio decreased to 1.0 or less on at least one occasion after infusion therapy, the ratio after hepatic angiography was always 1.35 or less. Such patients developed marked systemic symptoms like fever and severe liver dysfunction. Ascites also developed in three patients in whom the arterial ketone body ratio was reduced to 0.7 or less at 24 h after infusion therapy. The arterial ketone body ratios improved at 3–7 days after infusion therapy. In the seven patients treated with gelatin sponge embolization, the ratio at 3–7 days after therapy was actually higher than that before angiography.     

Comparison of capillary blood ketone measurement by electrochemical method and urinary ketone in treatment of diabetic ketosis and ketoacidosis in children

We aimed to compare the recent practical method of capillary β-hydroxy butyrate (βOHB) measurement with the widely used urinary ketone measurement in monitoring metabolic status of the patient during treatment of diabetic ketoacidosis (DKA) and diabetic ketosis (DK). Patients with DKA and DK admitted to the hospital were followed with simultaneous measurements of capillary βOHB by electrochemical method (Medisense Optium, Abbott), and urinary ketone by semi-quantitative method. Blood gases were measured in 2–4 h intervals. Fourteen patients with DKA/DK (7 males and 7 females, age: 9.2 ± 4.2 years) were included with 50 simultaneous measurements of capillary and urinary ketone. No correlation was detected between urinary ketone and blood pH (P = 0.06) and HCO₃ (P = 0.79), whereas a significant negative correlation was found between capillary βOHB and blood pH (r = −0.41, P < 0.05) and HCO₃ (r = −0.35, P < 0.05). Capillary βOHB and urinary ketone levels did not correlate at the beginning and 3.3 ± 1.4 h after treatment, but did correlate in the third samples taken 7.8 ± 2.0 h after treatment (r = 0.8, P < 0.05). Capillary βOHB levels show good correlation with the degree of acidosis (pH and HCO₃). Capillary βOHB measurement is more sensitive than urinary ketone measurement in reflecting the patient’s metabolic status and improvement during treatment.