急性冠脉综合征中妊娠相关蛋白-A与斑块不稳定性

目的探讨妊娠相关蛋白-A(PAPP-A)在急性冠脉综合征(ACS)中的变化及其与斑块不稳定性的关系。方法26例冠脉正常者作为对照组,稳定性心绞痛(SA)组22例,ACS组40例,包括不稳定性心绞痛(UA)20例、急性心肌梗死(AMI)20例。定量检测外周血PAPP-A、C-反应蛋白(CRP)、肌酸激酶MB同工酶(CK-MB)。对所有冠脉造影显示狭窄≥30%的病变进行影像学分析。结果ACS中PAPP-A含量(13·19±4·04)mIU/L明显高于SA(5·47±3·00)mIU/L(P<0·01)及对照组(5·09±2·19)mIU/L(P<0·01);并且与CRP(r=0·62P<0·01)、复杂性狭窄的数量(r=0·45P<0·05)有显著的正相关。结论PAPP-A在ACS患者外周血中明显升高,可能与斑块的不稳定性有关,对ACS的危险度分层可能具有一定的价值。     

湖北省输入性皮肤利什曼病一例并文献复习

患者,男,37岁。左下肢皮疹4周,伴轻压痛。无发热等全身症状。患者曾在伊拉克援外工作。皮肤科专科检查：左小腿屈侧见3个暗红色斑块,中央见浅溃疡面,上覆淡黄色分泌物。皮损组织病理学检查：皮肤溃疡形成及散在小灶状微脓肿形成,伴淋巴细胞、组织细胞浸润,组织细胞内可见直径2～4μm嗜碱性圆形小体。Giemsa染色(+)。皮损组织PCR检测提示硕大利什曼原虫。特比萘芬片口服6周治疗无效后,改为氟康唑胶囊口服,8周后皮损基本痊愈。治疗期间未出现严重不良反应。     

运用自拟连陈汤健脾祛湿、调畅气机治疗肥胖经验浅析

本文通过总结笔者于临床当中观察、剖析肥胖患者的病因病机,提出肥胖产生的中心环节在于脾虚湿阻,重要的发病条件当为气络瘀滞、三焦气机不畅,治疗当健脾祛湿、调畅气机.以此为病机依据,将以二陈汤为基础方组成的连陈汤,于临床中灵活运用以治疗此型肥胖患者,并佐以验案说明,为治疗肥胖患者提供新的诊疗思路.     

Impact of Ocular Residual Astigmatism on Visual Outcomes of Myopic Astigmatism Correction after Small Incision Lenticule Extraction

Objective: To calculate ocular residual astigmatism (ORA) by vector analysis and to evaluate the impact of ocular residual astigmatism on refractive and visual outcomes after correction of myopic astigmatism by small incision lenticule extraction (SMILE). Methods: In this prospective case-series study, 115 eyes with myopic astigmatism were treated with SMILE from Jauary 2019 to August 2019 atRefractive Center of Ophthalmology Department, Shengjing Hospital, China Medical University. ORA was calculated by vector analysis and patients were divided into two groups according to the magnitude of ORA: high ORA group (ORA≥1.00 D) with 42 eyes and low ORA group (ORA<1.00 D) with 73 eyes. The follow-up period was 3 months after the operation. Uncorrected visual acuity (UCVA) and pythagorean length were measured and compared after the operation. The following measurements were compared: refractive outcomes, total higher order aberrations (tHOAs), vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, and vertical quadrafoil. Contrast sensitivity was compared between the high and low ORA groups under either 85 cd/m2 or 3 cd/m2 illumination from 1.5 c/d to 18 c/d. The data were analyzed by an independent-samples t test and Mann-Whitney U test to compare the differences between the two groups. Results: Three months postoperatively, refractive outcomes showed that postoperative residual astigmatism in the high ORA group was significantly higher than in the low ORA group (t=3.293, P=0.001). Vector analysis showed that the error vector (EV), absolute error of angle (absolute EA) and index of success (SI) were higher in the high ORA group (t=-3.235, P=0.001; t=-2.326, P=0.020; t=-2.587, P=0.010). After SMILE，all cases had achieved a desirable visual acuity: high ORA group: -0.15±0.05, low ORA group: -0.15±0.05. There were no statistically significant differences in visual acuity, pythagorean length, tHOAs, vertical trefoil, vertical coma, horizontal coma, oblique trefoil, oblique quadrafoil, oblique secondary astigmatism, spherical aberration, vertical secondary astigmatism, or vertical quadrafoil between the two groups. An obvious difference was found in contrast sensitivity, which showed a higher contrast sensitivity at a spatial frequency of 18 c/d with 85 cd/m2 in the low ORA group than in the high ORA group (t=-2.877, P=0.005), but this tendency was not present at 3 cd/m2 . Conclusions: Ocular residual astigmatism impacts the precision of SMILE in correcting myopic astigmatism. This leads to a tendency of more residual astigmatism in refractive outcomes, and reduces contrast sensitivity at high spatial frequencies. However, it does not affect the outcome of obtaining good visual quality in both visual acuity and higher order aberrations.     

电泳法与高压液相亲和层析法测定HbA1c的方法学比较

目的对电泳法测定HbA1c进行方法学评价。方法收集56份标本分别用高压液相亲和层析法(HPLC)和电泳法检测。按照HPLC法检测结果将样本分为低、中、高三组,再使用电泳法测定。结果低值组中两种方法检测结果分别为(6.31±0.32)和(6.11±0.41),差异有统计学意义(P<0.05),相关分析Y=0.94X+0.73(r=0.940,r2=0.884);中值组中两种方法检测结果分别为(8.49±0.75)和(8.35±0.77),差异有统计学意义(P<0.05),相关分析Y=0.96X+0.94(r=0.962,r2=0.925);高值组中两种方法检测结果分别为(12.77±1.77)和(12.69±1.70),差异无统计学意义(P>0.05)。结论电泳法具有较好的精密度,两种方法相关性较好。     

Analysis of the tumor microenvironment and mutation burden identifies prognostic features in thymic epithelial tumors

Thymic epithelial tumors (TETs) are one of the rarest adult malignancies in the anterior mediastinum. Thymic carcinomas (TCs) are less prevalent among TETs, but they are more clinically aggressive. Immunotherapy has emerged as a promising therapeutic approach for refractory TETs, even though chemotherapy remains the conventional treatment for the advanced disease. However, limited attention has been paid to the features of the tumor microenvironment (TME) which might provide clinically relevant information and guide treatment regimen design. Especially, to date, there have been only a few studies focusing on the differences between the TME and genomic features preserved by TETs and TCs. We analyzed the TME and genomic characteristics of TETs using RNA sequencing and whole-exome sequencing, finding that distinct characteristics of TME in different pathogenic subtypes of TETs. According to those findings, we found that thymic carcinomas had significantly lower expression of HMGB1, a pro-inflammatory cytokine-related gene, than thymomas, and low HMGB1 expression was linked to a poor prognosis. Additionally, higher mutation burdens were significantly associated with the later stage and more advanced pathological types. Thymoma patients with lower mutation burdens tended to relapse within 3 years. In summary, different characteristics of TME and genomic features between thymoma and thymic carcinoma were associated with clinical outcomes of TETs and presented promisingly predictive value for efficacy and toxicity of immunotherapy.     

青蒿素对糖尿病大鼠肾脏保护作用机制研究

目的探讨青蒿素对糖尿病大鼠肾基质金属蛋白酶-2（MMP-2）及其抑制物金属蛋白酶-2组织抑制物（TIMP-2）表达的调节作用。方法将大鼠随机分为对照组（A组）、糖尿病非治疗组（B组）及糖尿病青蒿素治疗组（C组）,采用腹腔单剂量注射链脲佐菌素（STZ）65 mg/kg方法以建立糖尿病大鼠模型。C组给予青蒿素300 g/（kg·d）腹腔注射。实验进行到第3周、第6周时3组分别宰杀大鼠6只,检测肾质量/体质量、24 h尿白蛋白排泄率（UAER）及肌酐清除率（Ccr）。用免疫组化染色方法分别检测肾小球Ⅳ型胶原、TIMP-2、MMP-2和纤维连接蛋白（FN）表达情况。结果 C组大鼠Ccr、UAER、肾质量/体质量均显著低于B组（P〈0.05或0.01）。免疫组化染色证明糖尿病大鼠肾小球Ⅳ型胶原、FN和TIMP-2表达都明显上调（P〈0.05或0.01）,C组上述指标的表达都被显著抑制（P〈0.05）。MMP-2在B组大鼠肾小球的表达显著下调（P〈0.01）,C组其表达显著上调（P〈0.05）。结论青蒿素通过抑制糖尿病大鼠肾小球TIMP-2表达及增加MMP-2表达,从而保护糖尿病实验大鼠肾脏功能。     

RNA沉默HMGN5基因对肺癌A549细胞增殖的影响及意义

目的 通过RNA干扰技术(RNAi)沉默HMGN5基因,探讨其对肺癌A549细胞增殖的影响.方法 培养人肺癌A549细胞株,HMGN5基因合成慢病毒载体感染A549细胞,RT-PCR和Western blot检测A549细胞中HMGN5沉默率;设阴性对照组及RNA干扰组,MTT法检测A549细胞的增殖能力;Brdu法检测沉默HMGN5的表达;流式细胞仪检测其细胞周期.结果 与对照组比较,RNA干扰组HMGN5基因的mRNA及蛋白表达均降低,差异有统计学意义(P＜0.05);A549细胞的增殖能力明显下降,两组比较差异有统计学意义(P＜0.05);细胞增殖率为29.70％,较对照组降低,差异有统计学意义(P＜0.05);G1期细胞为53.50±0.30,高于对照组,差异有统计学意义(P＜0.05).结论 采用RNAi能够沉默HMGN5基因,人肺癌A549细胞增殖能力显著降低,HMGN5基因可能参与肺癌的发生、发展、增殖过程.     

Operando unraveling photothermal-promoted dynamic active-sites generation in NiFe2O4 for markedly enhanced oxygen evolution

The ability to develop highly active and low-cost electrocatalysts represents an important endeavor toward accelerating sluggish water-oxidation kinetics. Herein, we report the implementation and unraveling of the photothermal effect of spinel nanoparticles (NPs) on promoting dynamic active-sites generation to markedly enhance their oxygen evolution reaction (OER) activity via an integrated operando Raman and density functional theory (DFT) study. Specifically, NiFe₂O₄ (NFO) NPs are first synthesized by capitalizing on amphiphilic star-like diblock copolymers as nanoreactors. Upon the near-infrared light irradiation, the photothermal heating of the NFO-based electrode progressively raises the temperature, accompanied by a marked decrease of overpotential. Accordingly, only an overpotential of 309 mV is required to yield a high current density of 100 mA cm⁻², greatly lower than recently reported earth-abundant electrocatalysts. More importantly, the photothermal effect of NFO NPs facilitates surface reconstruction into high-active oxyhydroxides at lower potential (1.36 V) under OER conditions, as revealed by operando Raman spectroelectrochemistry. The DFT calculation corroborates that these reconstructed (Ni,Fe)oxyhydroxides are electrocatalytically active sites as the kinetics barrier is largely reduced over pure NFO without surface reconstruction. Given the diversity of materials (metal oxides, sulfides, phosphides, etc.) possessing the photo-to-thermal conversion, this effect may thus provide a unique and robust platform to boost highly active surface species in nanomaterials for a fundamental understanding of enhanced performance that may underpin future advances in electrocatalysis, photocatalysis, solar-energy conversion, and renewable-energy production.

Motivated by the need for accelerating sluggish reaction kinetics at the anode (1, 2), the focus of water electrolysis has been centered heavily on oxygen evolution reaction (OER) toward sustainable hydrogen fuel production. To date, there has been much effort in developing low-cost yet high-performance earth-abundant transition-metal alternatives to commonly used noble metals for OER. Intriguingly, many Ni-, Co-, Fe-, and Mn-based oxides experience a dynamic surface-reconstruction process to form more active oxyhydroxides, which are recognized as true catalytically active species for OER in alkaline media (3, 4). Among various transition metal-based OER catalysts, bimetal spinel-structured oxides in the form of AB₂O₄ (A and B are different metal ions) have garnered much attention due to their rich compositions, electron configurations, and valence states (5). Interestingly, inverse spinel NiFe₂O₄ (NFO), in principle, exhibits enhanced catalytic activity toward OER because of the presence of multivalent elements (i.e., Ni³⁺/Ni²⁺ and Fe³⁺/Fe²⁺) (6). It is important to note that studies on facilitating the surface reconstruction of NFO to achieve high-performance OER are relatively few, and a fundamental understanding as to what makes the derived OER catalysts perform well remains elusive.Recently, introducing thermal energy to promote electrocatalytic conversion has attracted significant interest (7–10). The thermal energy could accelerate the motion of reactant molecules, promote their effective collisions during the reaction, and thus make it easier to overcome the activation barrier (11, 12). Moreover, the use of thermal energy could also promote the surface reconstruction of catalysts into highly active species and accelerate the electrocatalytic kinetics, thereby leading to improved efficiency (13). Electrocatalysts with photothermal effect (referred to as photothermal electrocatalysts) enable in situ heating due to photo-to-thermal conversion under illumination with visible or near-infrared (NIR) light, thereby dispensing with the need for extra devices required to provide thermal energy. More importantly, in sharp contrast to common approaches where the entire solution is heated (14), the photothermal effect is localized on electrocatalysts themselves (15), thus effectively enabling heat modulation to a defined region (i.e., the working electrode). Despite recent impressive advances in transition metal oxides (e.g., Fe₃O₄ and Co₃O₄) as photothermal agents for cancer therapy (15), their implementations for photothermal-assisted OER, in particular spinel oxides, are comparatively few and limited in scope. Moreover, it has been reported that Ni- and Co-based OER catalysts are prone to surface reconstruction into highly active oxyhydroxides (16, 17). Surprisingly, the photothermal effect on promoting surface reconstruction in spinel oxide catalysts has yet to be explored.Herein, we report an integrated operando Raman and density functional theory (DFT) plus Hubbard U (DFT + U) study to exercise and unveil the photo-to-thermal conversion of inverse spinel oxide nanoparticles (NPs) in promoting the generation of dynamic active sites via surface reconstruction into oxyhydroxides and thus greatly enhancing their OER activity. First, a series of amphiphilic star-like poly(acrylic acid)-block-poly(styrene-co-acrylonitrile) (denoted PAA-b-PSAN) diblock copolymers with a well-defined molecular weight (MW) and low polydispersity index (PDI) are exploited as nanoreactors to synthesize a set of PSAN-ligated NFO NPs with different sizes and PSAN chain lengths. The effects of the NFO NP sizes and the outer PSAN chain lengths on catalytic activity of NFO NPs are then scrutinized. Interestingly, NFO NPs of the largest size (∼12 nm) ligated with the shortest PSAN chains (M_n = 7K) display the best OER reactivity on a glassy carbon (GC) electrode in alkaline media as a result of the high fraction of the exposed electrochemically active surface area and the fastest electrocatalytic kinetics. Subsequently, the photothermal effect of PSAN-ligated NFO NPs is exploited to promote their surface reconstruction and thus boost OER. More importantly, an operando Raman spectroelectrochemistry study is performed to unveil the mechanism of photothermal-assisted enhancement in OER reaction, revealing the emergence of electrocatalytically active γ-NiOOH at a lower potential (1.36 V) during the surface-reconstruction process with a photothermal effect. Finally, the first-principle calculations substantiate that the reconstructed surface, i.e., (Ni,Fe)oxyhydroxides, plays a pivotal role as the active site for electrocatalytic reaction. As such, photothermal electrocatalysts (e.g., metal oxides, sulfides, phosphides, etc.) may render significantly low overpotential and fast OER kinetics, representing an array of important materials that couple the localized heating with electrochemistry for effective renewable-energy production.