探讨基于近红外脑成像技术的阈下抑郁情志刺激反应机制研究可行性

近红外脑功能成像技术是近几年发展起来用于动态检测脑功能的方法,能够很好地反映抑郁人群认知活动期间大脑有氧代谢的变化,为阈下抑郁研究提供了一个新思路。本研究通过文献综述,结合中医情志理论,在过往研究的基础上基于近红外脑功能成像技术探讨中医情志刺激对阈下抑郁的反应机制,为后期研究提供理论与实践可行性的依据。     

Hypocholesterolaemic mechanism of bitter melon aqueous extracts via inhibition of pancreatic cholesterol esterase and reduction of cholesterol micellar solubility

This study investigated the hypocholesterolaemic effects of bitter melon aqueous extracts (BMAE) in vitro, the inhibitory effects of BMAE on pancreatic cholesterol esterase (CEase) and incorporation of cholesterol into micelles were investigated. BMAE decreased the in vitro micellar solubility of cholesterol in a dose-dependent manner. The conformation of CEase was investigated by means of circular dichroism (CD) and fluorescence. The result revealed the decrease of α-helix contents, increase of β-sheet and exposure of aromatic amino acid residuals. The incorporation of cholesterol into micelles was inhibited by BMAE. A complex was observed by transmission electron microscopy (TEM), which indicated interaction between cholesterol and BMAE. The result revealed that BMAE can play a role in decreased intestinal cholesterol absorption via inhibition of CEase, and of micelle formation.     

Racial differences in characteristics and prognoses between Asian and white patients with nonsmall cell lung cancer receiving atezolizumab: An ancillary analysis of the POPLAR and OAK studies

This study aimed to compare the differences in characteristics and prognoses between Asian and white patients receiving immunotherapy for nonsmall cell lung cancer (NSCLC). We studied 390 patients who received atezolizumab as part of the POPLAR or OAK trial, and analyzed the differences in baseline characteristics, outcomes and genetic mutations in blood samples between Asian and white patients. Overall survival (OS) was longer in Asian compared to white patients (median OS: 18.7 vs. 11.1 months; p = 0.005). Race was identified as an independent prognostic factor for OS (Asian vs. white: hazard ratio 0.647, 95% confidence interval 0.447–0.936, p = 0.021), together with performance status, histology, baseline sum of the longest tumor diameters (BLSLD) and number of metastatic sites. The two groups also differed in terms of characteristics including smoking history, BLSLD, epidermal growth factor receptor (EGFR) mutation frequency, programmed death-ligand 1 expression and blood-based tumor-mutation burden. Blood mutations of STK11, EGFR, KEAP1, POLE, GRM3, ATM and STAG2 were associated with treatment response, and TP53, KEAP1, APC, RB1, CREBBP, EPHA5 and STAG2 mutations were associated with OS. The blood-based mutation profiles differentiated between Asian and white patients, especially in relation to EGFR (23.8 vs. 8.5%), TP53 (30.2 vs. 46.9%) and STK11 (1.6 vs. 12.3%) mutations (all p < 0.05). The different clinicopathological features and mutation profiles in Asian and white patients may explain the superior outcome following atezolizumab treatment in Asian patients with NSCLC. The results of this study have important implications for further studies on racial disparities in relation to immunotherapy.     

水针疗法联合清热祛毒汤治疗寻常型银屑病(血热证)的疗效及其作用机制分析

目的观察分析水针疗法联合清热祛毒汤治疗寻常型银屑病(血热证)的疗效及其作用机制。方法选择2018年8月—2019年7月在我院接收治疗的112例寻常型银屑病患者作为分析对象,采取随机分组的办法将其分为对照组56例和研究组56例,对照组患者采取水针疗法治疗,研究组在对照组的基础上联合清热祛毒汤治疗。比较分析2组患者的疗效;治疗前后的中医证候评分、皮肤病生活质量指数(DLQI)评分;治疗前后皮损面积、浸润、鳞屑、红斑等评分;治疗前后肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、血管内皮生长因子(VEGF)水平变化情况。结果研究组患者治疗总有效率89.29%明显高于对照组73.21%(P<0.05);治疗前,2组患者的中医证候评分、DLQI评分、皮损面积、浸润、鳞屑、红斑等评分及TNF-α、IL-6、VEGF等水平比较(P>0.05);研究组患者治疗后的中医证候评分与DLQI评分明显低于治疗前(P<0.05);研究组患者治疗后的皮损面积、浸润、鳞屑、红斑等评分明显低于对照组(P<0.05);研究组患者治疗后的TNF-α、IL-6、VEGF等水平明显低于对照组(P<0.05)。结论对寻常型银屑病患者采取水针疗法联合清热祛毒汤治疗的疗效显著,能有效改善中医证候表现,提高生活质量,减轻皮损程度,降低炎症反应,其作用机制可能与炎症因子水平、皮损血管增生相关。     

肝肾胰联合移植手术的麻醉及围术期管理

目的探讨肝、肾、胰联合移植手术的麻醉及围术期管理方法。方法肝肾胰联合移植患者1例，行充分术前准备，改善肝功能，减轻尿毒症症状，控制血糖水平，使患者各脏器功能处于最佳状态。选用异氟烷、咪唑安定、芬太尼和维库溴铵行静脉吸入复合麻醉，维持合适麻醉深度和充分供氧。行桡动脉和颈内静脉穿刺置管，用于监测血压和维持静脉通道；选用食管超声多普勒行血流动力学监测；定时检测肝、肾功能指标、凝血参数、动脉血气、血糖浓度以及血、尿淀粉酶等生化参数，根据上述检测结果调整治疗。结果术中循环稳定，血气结果正常。术毕时血糖浓度较术前升高。患者肝脏及胰腺功能在术后1周恢复正常。肾脏功能恢复不良，予以二次肾移植术，两次手术期间行血液透析。肾功能于二次肾移植术后第3天恢复正常。目前患者各脏器功能正常。结论肝胰肾联合移植麻醉及管理的重点是充分术前准备，选择静吸复合麻醉，兼顾各脏器功能，维持血流动力学和内环境稳态的平衡。     

竹林区村庄白纹伊蚊孳生特点的调查

白纹伊蚊在竹林里孳生的阳性比为75.4%;而在竹林包围的居民区阳性比为15.3%。白纹伊蚊在居民区孳生密度布雷图指数为19.4,容器指数为6.2%。居民区孳生蚊虫的主要场所是泡菜坛,泡菜坛主要孳生蚊种是骚扰阿蚊,阳性比为73.7%,其次是淡色库蚊为20.2%,贪食库蚊为14.0%,白纹伊蚊最低,为9.1%。     

Integrating PET and CT information to improve diagnostic accuracy for lung nodules: A semiautomatic computer-aided method.

Our objective was to develop and evaluate 3 semiautomatic computer-aided diagnostic (CAD) schemes for distinguishing between benign and malignant pulmonary nodules by use of features extracted from CT, 18F-FDG PET, and both CT and 18F-FDG PET. METHODS: We retrospectively collected 92 consecutive cases of pulmonary nodules (<3 cm) in patients who underwent both thoracic CT and whole-body PET/CT. Forty-two of the nodules were malignant and 50 benign, as confirmed by pathologic examination and clinical follow-up. The interval between CT and PET was less than 1 mo. Four clinical parameters, including patient age, sex, smoking status, and history of previous malignancy, were used for the CAD schemes. Sixteen CT features based on size, shape, margin, and internal structure of nodules were independently rated subjectively by 2 chest radiologists. Four PET features were viewed on a PET/CT workstation. CAD schemes based on clinical parameters together with CT features, PET features, and both CT and PET features were then used to differentiate benign from malignant nodules. Finally, the output from the CAD schemes was evaluated by use of receiver-operating-characteristic analysis. RESULTS: When we used clinical parameters and CT features as input units (CAD scheme 1), the area under the receiver-operating-characteristic curve (A(z) value) of the CAD scheme was 0.83. When we used clinical parameters and PET features as input units (CAD scheme 2), the A(z) value for the computer output was 0.91. However, when we used all data as input units (CAD scheme 3), the A(z) value for the computer output was 0.95. The performance of CAD scheme 3 was better than that of CAD scheme 1 or 2. A statistically significant difference existed between the A(z) values of CAD schemes 3 and 2 (P = 0.037) and between those of CAD schemes 3 and 1 (P = 0.015). CONCLUSION: Our CAD scheme based on both PET and CT was better able to differentiate benign from malignant pulmonary nodules than were the CAD schemes based on PET alone and CT alone.     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

两厂头孢米诺钠治疗泌尿系感染成本-效果分析

目的:分析不同厂生产的头孢米诺钠治疗泌尿系感染的疗效和用药费用,从而指导临床更合理选择和应用药物。方法:将64例随机分为A组和B组各32例,分别给予静脉滴注进口的头孢米诺钠1g和国产的头孢米诺钠1g,bid,连续用药7d。结果:A组临床有效率为93.8%,B组为90.6%,两组安全性较好;A组药费为1 820.0元,B组药费为1 030.4元,B组要比A组节省789.6元。结论:在两组治疗效果无显著性差异情况下,B组治疗泌尿系感染是一种经济有效的治疗方案。     

脑梗死急性期降压治疗对预后的影响

目的 研究脑梗死急性期降压及在不同时间进行降压治疗对患者近期预后的影响.方法 据发病后是否降压及进行降压的时间,将198例急性脑梗死患者分为6组,观察各组患者神经功能缺损程度及心脑血管事件的再发生率和病死率.结果 在发病后进行降压治疗的患者中其心脑血管事件再发率和病死率明显低于未降压组（P＜0.01） 3d后降压组患者神经功能恢复的程度明显好于未降压组（P＜0.01）.结论 降压治疗可以降低患者心脑血管事件的发生率和病死率3d后进行降压治疗的患者神经功能恢复明显要好.