Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

PurposeThe purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).Materials and methodsFour databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.ResultsFive eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).ConclusionsOur results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.     

试论医学院校的转型和发展战略

我国医学院校的发展道路有通过“强强联合”并入综合性大学和通过学科多样化“转型”为多科性大学两种类型。“转型”方式虽然不受广泛的关注，却正在低调而广泛地运行，成为独立设置医学院校自我发展和提高的主要方式。转型期医学院校在发展战略上有明显共性，如专业学科布局的优化、大力扶植基础学科、整合临床资源凸显医学主体、校园规划和建设体现多科性大学的包容性等，应予以重视。     

中国Leber遗传性视神经病变G11696A突变两个家系分析

目的对两个中国Leber遗传性视神经病变(Leber’shereditary optic neuropathy,LHON)家系的临床和分子遗传学特征进行分析。方法眼科临床检查发现在这两个家系中只有先证者1人出现视力障碍,发病年龄分别为10岁和17岁。对这两个家系先证者使用24对有部分重叠的引物进行线粒体DNA(mitochondrial DNA,mtDNA)全序列扩增分析。结果没有发现mtDNAG11778A、G3460A和T14484C3个常见的突变位点,而发现了与LHON相关的ND4G11196A同质性突变位点的存在,在167名正常对照只发现1例G11696A突变。结论线粒体DNA全序列分析发现两个家系呈现独特的mtDNA多态性,都属于东亚单体型D4。不完全外显率和正常对照频率(1/167)表明G11696A突变本身不足以导致LHON的发生,说明其它因素在这两个LHON家系的表型表达中也起一定的作用。在这些家系mtDNA中缺乏影响重要功能突变位点的存在,排除了线粒体背景对LHON临床表型的影响。因此,核修饰基因、环境因素可能对两个中国G11696A突变家系的外显率和发病严重程度起促进作用。     

N-乙酰半胱氨酸和氯胺酮联用对脑缺血再灌注损伤的影响

目的:研究巯基供体物质N 乙酰半胱氨酸(NAC)和非竞争性NMDA受体拮抗剂氯胺酮(KT)联用对小鼠脑缺血再灌注损伤的影响。方法:雄性ICR小鼠,随机分为假手术组、生理盐水组(0 .0 1L·g- 1)、氯胺酮组(15mg·kg- 1)、N 乙酰半胱氨酸组(75mg·kg- 1)和联合组(KT 15mg·kg- 1 NAC75mg·kg- 1)。参照蒋晓帆等建立的方法,制备局灶性短暂性脑缺血再灌注模型(tMCAO) ,再灌注后6、2 4h测定神经行为缺陷评分,处死TTC染色测定脑梗死面积百分比;制备不完全性脑缺血再灌注模型(2 VO) ,在再灌注0 .5、2和6h时取全脑制成10 %匀浆,比色法测定MDA含量、SOD和GSH Px活力。结果:(1)短暂性局灶性脑缺血再灌注后6、2 4h ,各组小鼠脑组织均有不同程度梗死灶、神经行为缺陷明显,与生理盐水组比较,药物联合组可显著改善缺血再灌注小鼠的神经行为缺陷(均为P <0 .0 1) ,减少脑梗死面积百分比(均为P <0 .0 1) ,药物单用对以上指标有轻度的改善作用(P >0 .0 5 )。(2 )联合用药可明显改善脑细胞损伤。(3)与假手术组比较,不完全性全脑缺血再灌注损伤0 .5、2和6h后,生理盐水组小鼠MDA含量显著升高(均为P <0 .0 1) ,SOD活性(均为P <0 .0 1)和GSH Px活性均显著降低(均为P <0 .0 1)。与生理盐水组比较,联合组可显著地降低缺血再灌注小鼠脑组织     

别孕烯醇酮对6-羟基多巴胺损伤的细胞系SH-SY5Y的保护作用

目的 明确别孕烯醇酮（APα）对6-羟多巴胺（6-OHDA）损伤的SH-SY5Y细胞系的保护作用，并阐明可能的分子机制。方法 向体外培养的SH-SY5Y细胞系中分别加入6-OHDA、APα、γ-氨基丁酸A受体（GABAAR）拮抗剂荷包牡丹碱（Bic）和电压门控L型Ca²⁺通道拮抗剂硝苯地平（nifedipine），采用免疫荧光细胞化学染色方法观察不同组别酪氨酸羟化酶（TH）阳性细胞的变化，Western blotting检测胞质钙调蛋白（CaM）、钙离子 钙调蛋白依赖性蛋白激酶Ⅱ δ3（CaMKⅡδ3），胞核CaMKⅡδ3、脑源性神经营养因子（BDNF）和细胞周期蛋白依赖性激酶（CDK1）表达的变化，采用蛋白质免疫共沉淀验证CaMKⅡδ3与CDK1/BDNF的相互作用。 结果 APα作用后，6-OHDA损伤的SH-SY5Y细胞TH和5-溴脱氧尿嘧啶核苷（BrdU）阳性细胞数目均明显增加，而TH/BrdU双阳性细胞数目无显著变化；同时Western blotting结果表明，SH-SY5Y细胞胞质和胞核上述蛋白的表达与单纯 6-OHDA 组相比也明显上升，经Bic处理后各蛋白增加更为明显。免疫共沉淀结果表明，CaMKⅡδ3与CDK1/BDNF存在相互作用。 结论 APα对6-OHDA损伤的SH-SY5Y细胞的保护中，GABAAR发挥负性调控作用，通过稳定细胞的内环境达到增加TH阳性神经元数量的目的，其中Ca²⁺ -CaM-CaMKⅡδ3信号通路和BDNF与CDK1发挥了关键作用。     

Imaging of anal fistulas

There are many radiological imaging techniques for perianal fistulas; the choice of modality may depend on several factors other than simply diagnostic accuracy. Equipment availability and financial constraints vary between healthcare systems. Inexperienced clinical assessment may miss secondary extensions; the resulting recurrence is expensive and upsetting for patients. Fistulography no longer has a role in fistulas arising from the anus itself, but it may be useful in identifying extra-sphincteric tracts arising from abdominal organs, such as appendix, terminal ileum, and sigmoid colon. CT has a limited role acutely but otherwise there are better methods. In the right hands, Endo-anal ultrasonography is still more accurate than clinical examination alone, but requires considerable skill in interpretation, is operator dependent, and may not be suitable for all patients. magnetic resonance imaging scans are the gold standard for fistula.