妊高征患者尿纤维蛋白肽A的检测及其临床意义

目的：探讨妊高征患者尿纤维蛋白肽水平变化及其临床意义。方法：应用高效液相色谱法检测９６例正常妊娠妇女（正常妊娠组）、４９例妊高征患者（妊高征组）及４１例健康育孕妇女尿ＦＰＡ水平。     

Benefits and risks of additional ablation of complex fractionated atrial electrograms for patients with atrial fibrillation: A systematic review and meta-analysis

Background

The benefits and risks of additional complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) remain unclear.

Methods

Trials were identified in PubMed, Embase, Web of Science, and Cochrane Database, reviews, and reference lists of relevant papers. The primary end point was the recurrence of atrial arrhythmias after a single ablation.

Results

We meta-analyzed 11 studies (total, n = 983) using random-effects model to compare PVI (n = 478) with PVI plus CFAE ablation (PVI + CFAE) (n = 505). Additional CFAE ablation reduced recurrence of atrial tachyarrhythmia after a single procedure (pooled RR 0.73; 95% CI 0.61, 0.88; P = 0.0007) at ≥ 3-month follow-up. There was no evidence of heterogeneity among studies (I² = 33%). Subgroup analysis demonstrated that additional CFAE ablation reduced rates of recurrence in nonparoxysmal AF (RR 0.68; 95% CI 0.47, 0.99; P = 0.05), whereas had no effect on patients with paroxysmal AF (RR 0.79; 95% CI 0.59, 1.06; P = 0.12). Eight studies reported results of post-procedure ATs. The addition of CFAE ablation increased the rate of post-procedure ATs (RR 1.77; 95% CI 1.02, 3.07; P = 0.04). Additional CFAE ablation significantly increased mean procedural times (245.4 + 75.7 vs. 189.5 + 62.3 min, P < 0.001), mean fluoroscopy (72.1 + 25.6 vs. 59.5 + 19.3 min, P < 0.001), and mean RF energy application times (75.3 + 38.6 vs. 53.2 + 27.5 min, P < 0.001).

Conclusions

The adjunctive CFAE ablation could provide additional benefit in terms of reducing recurrence of atrial tachyarrhythmia for patients with nonparoxysmal AF but not for patients with paroxysmal AF after a single procedure with or without antiarrhythmic drugs (AADs). The main risk of adjunctive CFAE ablation is the increasing rate of untraceable postablation ATs.     

脑内微小脓肿的MRI诊断(附26例分析)

目的:探讨脑内微小脓肿的MRI特征及MRI对其诊断的准确性和可靠性。方法:对26例经手术或抗菌素治疗痊愈的脑内微小脓肿的MRI平扫和强化表现,信号特点进行分析。结果:MRI清晰地显示了脓腔内的的脓液,脓肿壁和周围水肿,检出示率为100％,脓肿壁信号有一定特点,呈等T_1短T_2信号。结论:MRI对脑内微小脓肿的诊断准确可靠,要明显优于CT。     

电针复合七氟烷麻醉对断尾大鼠急性应激反应调控的影响

目的：探讨不同穴位电针刺激复合七氟烷麻醉对断尾大鼠急性应激反应调控作用的影响。方法健康成年雄性SD大鼠50只,体质量280～320 g ,分为正常组（Ⅰ组）、模型组（Ⅱ组）、七氟烷吸入组（Ⅲ组）、七氟烷吸入加体针组（Ⅳ组）和七氟烷吸入加耳针组（Ⅴ组）,每组10只。Ⅰ组不作处理置于氧流量30％的混合气体玻璃箱中（流量2 L／min）,Ⅱ组断尾后置于氧流量30％的混合气体玻璃箱中（流量2 L／min）,Ⅲ、Ⅳ、Ⅴ组断尾后置于含体积分数为2％的七氟烷麻醉箱中（流量2 L／min）,Ⅳ组持续刺激双侧“足三里”穴30 min （刺激参数3 V ,3 Hz ,2 ms）,共4次,每次间隔30 min ,Ⅴ组刺激双侧“耳尖”穴,刺激参数及时间同Ⅳ组。各组治疗方法结束后,处死各组大鼠,取断颈血采用ELISA测促肾上腺皮质激素（ACT H ）和外周血皮质酮（CORT ）水平。采用Western blot法测定下丘脑组织c‐fos蛋白的表达水平。结果与Ⅰ组相比,Ⅱ组血清ACT H、CORT水平、下丘脑c‐fos蛋白表达明显升高（P＜0．01）;与Ⅱ组相比,Ⅲ、Ⅳ、Ⅴ组大鼠外周血ACTH、CORT 水平均有所下降,差异有统计学意义（P＜0．05）;Ⅲ组与Ⅳ组的ACTH和CORT水平差异无统计学意义（P＞0．05）;Ⅴ组的ACTH水平与Ⅲ组相比明显下降（P＜0．05）,Ⅴ组CORT水平与Ⅳ组相比明显下降（P＜0．05）。Ⅲ、Ⅳ、Ⅴ组c‐fos表达与Ⅱ组相比均降低（P＜0．05）,Ⅲ、Ⅳ、Ⅴ组3组组间差异有统计学意义（P＜0．05）。结论七氟烷吸入复合电刺激“耳尖”穴治疗时,对应激的作用优于单纯的七氟烷治疗和七氟烷复合电刺激“足三里”穴。电针复合吸入全身麻醉对应激的调控机制可能与下丘脑调节室旁核c‐fos蛋白分泌并影响下丘脑‐垂体‐肾上腺（H PA ）轴有关。     

快速康复外科在胰腺癌术后对血清IL-6、IL-10、TNF-α水平的影响

目的：探讨快速康复外科（FTS）在胰腺癌手术后对血清IL‐6、IL‐10及TNF‐α水平的影响及其临床意义。方法入选胰腺癌手术患者80例,分为验组40例和对照组40例,检测并比较两组手术前后不同时段血浆中各指标水平。结果（1）两组术前血清IL‐6、IL‐10、TNF‐α水平差异无统计学意义（P＞0．05）;试验组术后1、3d血清IL‐6水平高于术前,差异有统计学意义（P＜0．05）,而术后5d血清IL‐6水平与术前比较,差异无统计学意义（P＞0．05）;对照组术后3d血清IL‐6水平均高于术前（P＜0．05）;试验组术后同一时间段IL‐6水平均低于对照组（P＜0．05）。（2）试验组术后IL‐10水平均高于术前（P＜0．05）;对照组术后1、3d血清IL‐10水平高于术前（P＜0．05）;试验组术后同一时间段IL‐10水平均高于对照组（P＜0．05）;（3）试验组术后1d血清TNF‐α水平明显高于术前（P＜0．05）;术后3、5dTNF‐α水平与术前差异无统计学意义（P＞0．05）;对照组术后1、3d血清TNF‐α水平高于术前（P＜0．05）,而术后5d与术前差异无统计学意义（P＞0．05）;术后1、3d血清TNF‐α,试验组明显低于对照组（P＜0．05）。结论FTS疗法能明显降低胰腺癌术后的炎性反应,改善免疫抑制,加速患者术后康复。     

尿粘康酸作为苯内接触剂量的应用

为将尿粘康酸（ＴＴＭＡ）应用于苯接触人群的检测，应用高效液相色谱－紫外检测器系统检测苯接触人群尿ＴＴＭＡ。结果显示，尿ＴＴＭＡ在苯接触人群中有显著增加，随着空气苯浓度的增加，尿ＴＴＭＡ增加显著，显示出良好的相关关系（ｒ＝０．９４０，Ｐ＜０．０５）。当苯接触浓度为均值２．４６２ｍｇ／ｍ３时，接触人群尿ＴＴＭＡ与对照组相比，其差异具有统计学意义。提示，尿ＴＴＭＡ可作为苯接触特异、灵敏的生物检测指标，尤其对于低苯接触。尿ＴＴＭＡ在男女苯接触人群中差异无显著性。甲苯可抑制尿ＴＴＭＡ的形成。应用协方差分析可粗略校正甲苯的混杂作用。     

Phage-displayed specific polypeptide antigens induce significant protective immunity against Trichinella spiralis infection in BALB/c mice

Trichinellosis is a public health problem and is considered an emerging/re-emerging disease in various countries. The etiological agent of trichinellosis is the nematode Trichinella, which infects humans, domestic animals and wildlife. A veterinary vaccine could be an option to control the disease in domestic animals. Although several vaccine candidates have shown promising results, a vaccine against trichinellosis remains unavailable to date. Phage particles are especially ideal vaccine delivery vehicles because they do not interfere with the immune response against the displayed peptide antigens, and, if anything, are more likely to efficiently direct antigen expression to professional antigen-presenting cells. In this study, Tsp10 polypeptide, which was encoded by a cDNA fragment of Trichinella spiralis intestinal infective larvae and was found to bind to normal mouse intestinal cells, was displayed on the surface of T7 phage. Anti-Tsp10 antibodies were able to recognize the native Tsp10 protein mainly localized to the stichosome of T. spiralis. Mice immunized with the recombinant phage T7-Tsp10 showed a 62.8% reduction in adult worms and a 78.6% reduction in muscle larvae following challenge with T. spiralis muscle larvae. Our results demonstrate that the vaccination with Tsp10 polypeptide displayed by T7 phage elicits the Th2-predominant immune responses and produces a significant protection against T. spiralis infection in mice. These findings suggest that phage display is a simple, efficient, and promising tool to express candidate vaccine antigens for immunization against T. spiralis.     

ST段抬高急性心肌梗死合并2型糖尿病患者PCI前后CTFC和TMPG的变化

目的探讨ST段抬高的急性心肌梗死(STEMI)合并2型糖尿病(DM)患者经皮冠状动脉介入治疗(PCI)前后校正的心肌梗死溶栓治疗临床实验(TIMI)帧数(CTFC)及TIMI心肌灌注分级(TMPG)的变化以及对其预后的影响。方法回顾性分析行PCI的STEMI患者97例,其中STEMI合并DM组34例(DM组),单纯STEMI组63例(对照组),测定2组梗死相关动脉(IRA)的TIMI、CTFC和TMPG,并分析两组住院期间和PCI治疗6个月后的主要心脏不良事件(MACE)的发生率。结果与对照组比较,DM组的年龄、体重指数、既往心梗史、多支血管病变和高血压发生率均明显升高(P<0.05),肌酸激酶(CPK)显著增加(P<0.05),前降支病变明显增多(P=0.01),CTFC明显增加(P<0.001),TMPG明显减少(P=0.008),左室射血分数(LVEF)显著降低(P<0.01)。住院期间2组MACE发生率无显著差异,6个月随访期间DM组较对照组明显增加(P<0.05)。结论STEMI合并2型DM患者行PCI治疗后的心肌再灌注明显改善,但与无DM的STEMI患者相比心肌灌注减少,梗死范围大,心功能降低,远期预后差。     

苯,甲苯,二甲苯暴露人群遗传毒性生物标志物的研究

为研究苯系物职业接触人群的生物标志物，应用高效液相色谱－电化学检测系统（ＨＰＬＣ－ＥＣ）分析８７名苯接触工人及３０名对照人群外周血淋巴细胞８－羟基－２－脱氧鸟苷（８－ＯＨｄＧ），同时检测工人个体接触空气苯浓度及尿粘康酸（ＴＴＭＡ）、外周血淋巴细胞微核（ＭＮ）及白细胞（ＷＢＣ）值。结果显示：外周血淋巴细胞８－ＯＨｄＧ、ＭＮ、尿ＴＴＭＡ在苯接触人群增高显著，８－ＯＨｄＧ与空气苯、尿ＴＴＭＡ存在良好相关，且８－ＯＨｄＧ与ＭＮ之间存在一定相关性。结果提示：苯可诱导职业接触人群ＤＮＡ氧化损伤，苯的遗传毒性机理可能是通过多位点、多作用机理、多遗传后果所致。８－ＯＨｄＧ可作为苯系物职业接触人群的生物标志物，影响苯接触人群外周血淋巴细胞８－ＯＨｄＧ形成的因素有性别和甲苯。