HL7 V3通用封装程序的设计与实现

目的分析现状,提出卫生信息交换标准v3.0版本(HL7 V3)通用封装程序的设计方案并予以实现.     

整合素αVβ3在子宫内膜异位症中表达的意义

目的:通过检测子宫内膜异位症患者整合素αVβ3的表达,探讨它在子宫内膜异位症发生发展中的作用.方法:采用免疫组织化学sP方法检测20例异位内膜组织、在位内膜组织中整合索αVβ3的表达,并和20例正常子宫内膜组织作对照.结果:异位内膜组、在位内膜组整合素αVβ3的表达分别与对照组比较显著增高(P<0.05),异位内膜与在位内膜相比差异无统计学意义(P0.05).结论:整合素αVβ3的异常表达可能在子宫内膜异位症的发生发展中起重要的作用.     

维生素D3及钙剂治疗2型糖尿病骨质疏松的临床观察

目的探讨维生素D3(Vit D3)及钙剂治疗2型糖尿病合并原发性骨质疏松症的临床效果。方法 86例2型糖尿病合并原发性骨质疏松症的患者用不同方法的钙剂(钙剂;钙+Vit D3)治疗12个月。结果钙剂组(碳酸钙1 200mg,2次/d)46.7%的患者症状改善,但骨量仍继续下降,而钙+Vit D3治疗组(钙尔奇碳酸钙D3)77.2%的患者症状缓解,且骨量明显上升。结论补钙可作为2型糖尿病合并原发性骨质疏松症防治的基本方法,但钙剂使用时要强调与Vit D3的联合应用,Vit D3不仅是钙在人体被骨骼吸收、利用的载体,而且可以减轻钙剂对人体所致的副作用,改善并提高骨骼质量。     

基因3型丙型肝炎病毒感染的抗病毒治疗方案、临床效果及影响因素

泛基因型直接抗病毒药物（DAAs）,如索磷布韦/韦帕他韦、格卡瑞韦/哌仑他韦及索磷布韦/韦帕他韦/伏西瑞韦等,明显提高了难治性基因3型感染患者的抗病毒效果。但基因3b型、肝硬化、经治及存在耐药相关性突变的患者,DAAs的抗病毒效果相对较差。对于基因3b型合并肝硬化患者,可以考虑加用利巴韦林或延长治疗疗程以提高抗病毒效果;对于干扰素联合利巴韦林或DAAs经治的基因3型患者,可使用索磷布韦/韦帕他韦/伏西瑞韦治疗。与DAAs治疗后未获得持续病毒学应答（SVR）的患者相比,获得SVR可明显降低肝细胞癌（HCC）的发生风险,但仍有部分丙型肝炎病毒（HCV）感染患者即使获得SVR,仍可发生HCC,尤其是合并肝硬化患者。因此,对于DAAs治疗后未获得SVR,且存在肝硬化疾病的患者需要密切监测HCC的发生。DAAs的使用与HCC的发生及复发风险无关     

补充微量营养素对2型糖尿病患者感染及血清3-硝基酪氨酸水平的影响

目的观察补充微量营养素对2型糖尿病患者感染发生率及其蛋白质硝基化的影响。方法选取2型糖尿病患者76例,按随机方法分为对照组和干预组,干预组给予微量营养素补充剂,对照组给予安慰剂,每日口服2片,观察时间为6个月。每月随访一次,了解受访者饮食、运动和感染发生情况。研究前后对受访者均进行一般情况的调查、血液生化检查和血清3-硝基酪氨酸水平(3-NT)测定。研究结束后对干预组人群血清3-NT水平与感染发生情况进行回归分析。结果 6例患者退出研究,获得70例有效数据,干预组33例,男性14例(42.4%),女性19例(57.6%);对照组37例,男性14例(37.8%),女性23例(62.2%),两组性别分布差异无统计学意义(χ2=0.15,P0.05)。研究前后受访者一般情况、血糖、糖化血清蛋白、糖化血红蛋白等化学检验指标及平均每日能量及各营养素摄入量,轻体力运动时间两组之间差异均无统计学意义(P0.05)。研究期间受访者的发热率、发热时体温、发热持续天数、皮肤脓肿与破溃发生率、阴道炎或尿路感染发生率、胆囊炎和牙龈炎发生率干预组低于对照组,差异有统计学意义(P0.05)。研究结束时干预组血清3-NT水平显著低于对照组,差异有统计学意义(P0.05)。回归分析结果显示进入回归方程的有发热及其持续情况,皮肤脓肿与破溃、牙龈炎四项指标(P0.05),其中关系最密切的指标是发热情况(β=0.541,P=0.027)。结论补充微量营养素可降低2型糖尿病患者感染发生率,并降低其蛋白质硝基化水平。     

PI3K抑制剂对肝星状细胞PI3K/AKT通路及Ⅲ型胶原表达的影响

目的探讨PI3K抑制剂(PI103)对肝星状细胞(HSC)PI3K/AKT通路及Ⅲ型胶原表达的影响,为肝纤维化的治疗提供理论基础。方法将液氮保存下的HSC株,于37℃,5%CO2孵育箱中复苏传代培养,同步化后将细胞分为3组:空白对照组、CCl4组、CCl4+PI3K抑制剂组。QPCR方法检测PI3K、AKT信号分子mRNA水平的变化;免疫细胞化学方法测定HSC的PI3K、AKT信号分子和Ⅲ型胶原表达情况。结果 CCl4组和空白对照组比较,PI3K、AKT信号分子mRNA水平和蛋白表达均增多,Ⅲ型胶原生成增多,差异有统计学意义(P0.05)。CCl4组和CCl4+PI103组比较,PI3K、AKT信号分子mRNA水平和蛋白表达均减少,III型胶原生成减少,差异有统计学意义(P0.05)。结论 PI3K抑制剂可降低PI3K、AKT信号分子及Ⅲ型胶原的表达,进而阻断肝纤维化进程。     

R,S及R/S型3-氯-1,2-丙二醇的急性毒性研究

目的探讨R,S和R/S型3-氯-1,2-丙二醇(3-MCPD)对ICR小鼠的急性毒性。方法选用健康性成熟ICR小鼠,对R,S及R/S型3-MCPD染毒剂量依次为176.78、198.43、222.73、250、280.61、314.98和353.55、396.84、445.44和499.99mg/kg,89.09,100,112.25,125.99,141.42,158.74和178.18mg/kg及130.25、150、172.75、198.95、229.13、263.88和303.91mg/kg。经口一次灌胃染毒观察14天,以改良寇式法计算LD50,计算脏体比并进行肝肾病理学检查。结果R,S及R/S型3-MCPD的LD50及95%可信区间(95%CI)分别为290.54mg/kg(280.74~300.68),117.57mg/kg(113.82,121.45),190.73mg/kg(177.76~204.59)。R型异构体在250mg/kg及以上剂量组动物肾体比显著增加(P<0.05),脑体比在353.55mg/kg、445.44mg/kg及最高剂量组亦显著增大(P<0.05);S型3-MCPD染毒组动物各脏体比与对照组比均无显著差异;R/S型3-MCPD,在198.95mg/kg及以上剂量组动物肾体比明显增加,在229.13mg/kg及以上剂量动物脑体比亦明显增加,与对照组比有差异显著(P<0.05)。在353.55mg/kg及以上剂量R型异构体引起肝细胞肿胀、肝窦扩张和明显充血,在229.13mg/kg及以上剂量(R/S)型3-MCPD也引起肝细胞肿胀和肝窦充血,S型则未引起。R、S及(R,S)型均未引起肾脏明显的病理改变。结论三种3-MCPD急性毒性大小依次为S型>R/S型>R型,R、S型异构体均显示出神经毒性。     

FoxP3在高危型人乳头瘤病毒呈阳性的宫颈上皮内瘤变组织中的表达及意义

目的 研究FoxP3在高危型人乳头瘤病毒(HR-HPV)呈阳性宫颈上皮内瘤变(CIN)组织中的表达及与宫颈黏膜HR-HPV负荷量间的关系.方法 选取2008年1月至2011年8月在本院行手术治疗的90例HR-HPV呈阳性CIN患者的石蜡包埋组织为研究对象,其中CIN Ⅰ,Ⅱ,Ⅲ各为30例,分别纳入CINⅠ,Ⅱ,Ⅲ组.3组患者的年龄等比较,差异无统计学意义(P＞0.05).另选取同期在本院就诊的HR-HPV呈阴性的正常宫颈组织20例纳入对照组(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试者的知情同意,并与其签署临床研究知情同意书).HR-HPV负荷量采用第二代杂交捕获(HC2)法进行检测,FoxP3的检测采用免疫组织化学法Elivision二步法.结果 ①FoxP3在CIN Ⅰ组与CINⅡ组中比较,差异无统计学意义(P=0.469),在CIN Ⅰ组和CINⅡ组中比较,差异有统计学意义(P=0.014),在CINⅡ组与CINⅢ组中比较,差异亦有统计学意义(P=0.044);FoxP3在各CIN组宫颈上皮中的表达水平与对照组比较,差异均有统计学意义(P＜0.05).FoxP3在各CIN组宫颈间质中表达水平比较,差异无统计学意义(P＞0.05),但各CIN组与对照组比较,差异均有统计学意义(P＜0.05).②FoxP3在CIN宫颈上皮、间质组织中的表达与宫颈黏膜HR-HPV负荷量呈正相关关系(rs =0.651,P＜0.001;rs=0.310,P=0.003).结论 转录因子FoxP3可考虑作为CIN的预后因子.     

1,25(OH)2D3对2型糖尿病大鼠肾功能损伤的保护作用及SIRT4表达水平影响研究

目的 观察1,25羟基维生素D₃[1,25(OH)₂D₃]在2型糖尿病大鼠中对肾脏的保护作用及沉默信息调节蛋白4(sirtuin 4,SIRT4)在肾脏组织中的表达情况,探讨1,25(OH)2D3改善糖尿病肾病的相关机制。方法 将24只SD大鼠随机分为对照组(n=6)、糖尿病组(n=18),对照组每日普通大鼠饲料喂饲,糖尿病组使用高脂高糖饲料喂饲,8周后,糖尿病组大鼠腹腔注射链脲佐菌素40 mg/kg,继续给予高脂高糖饲料喂养1周,采血检测血糖,随机将12只成功建立糖尿病的大鼠分为糖尿病组(n=6)和糖尿病+骨化三醇组(n=6),之后对照组和糖尿病组大鼠每日使用花生油灌胃,糖尿病+骨化三醇组大鼠每日使用骨化三醇灌胃,持续4周,麻醉后取血检测相关生化指标,取下两肾脏,制作病理切片并检测SIRT4表达水平。结果实验后各组大鼠尿酸、肌酐、尿素氮和血糖水平比较差异均有统计学意义(均P<0.01),其中尿酸[(180.20±11.56)、(161.69±7.80)、(142.25±14.51)mmol/L]、肌酐[(36.6...     

血清NT-proBNP、Gal-3水平与急性ST段抬高型心肌梗死患者病情及近期预后的关系

目的 探讨血清N末端脑钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）、半乳糖凝集素-3(Galectin-3,Gal-3)水平与急性ST段抬高型心肌梗死（Acute ST-segment elevation myocardial infarction,ASTEMI）患者病情及近期预后的关系。方法 选取2019年1月至2020年12月本院行PCI治疗的ASTEMI患者112例为ASTEMI组,依据术后是否出现主要不良心脏事件（Major adverse cardiac events,MACE）分为MACE组和非MACE组,另选取56例健康志愿者为对照组。检测血清NT-proBNP、Gal-3水平,ASTEMI患者术后随访1年,采用logistic回归分析ASTEMI患者术后出现MACE的危险因素。结果 ASTEMI组患者血清NT-proBNP、Gal-3水平显著高于对照组（P <0.05）,Gensini积分> 50分的ASTEMI患者血清NT-proBNP、Gal-3水平又高于Gensini积分≤50分患者（...     

HL7 V3开发体系和我国医疗信息标准化建设

文章从我国医疗卫生系统的信息交换和集成的迫切需求出发，简要介绍了HL7（Heah Level7）标准，讨论了HL7 V2．X的不足和HL7 V3的改进和好处，提出应积极研究HL7 V3，从根本上发展中国的信息交换标准和科学的开发体系。介绍了HL7 V3的开发方法和消息的创建和解析．提出了实现我国医疗信息交换标准的几点建议。     

A new method for the determination of vitamin D3 and 25-hydroxyvitamin D3 in meat

The total vitamin D content in meat, i.e., vitamin D₃ and 25-hydroxyvitamin D₃, was determined by HPLC after alkaline hydrolysation, solid-phase extraction and semi-preparative HPLC. For detection, a DAD detector between 220 and 320 nm was used and quantification was performed at 265 nm. Vitamin D₂ was used as internal standard for vitamin D₃ as well as for 25-hydroxyvitamin D₃. Precision for vitamin D₃ was determined in lean meat and lard to 9.1% and 7.1%, respectively. The corresponding values for 25-hydroxyvitamin D₃ were 8.9% and 9.9%. Accuracy was determined in spiked samples, which showed a recovery of 94.7% and 99.0% for vitamin D₃ and 25-hydroxyvitamin D₃, respectively. The method is applicable for establishing data for food composition tables.     

Antigenicity and immunogenicity of HIV-1 gp140 with different combinations of glycan mutation and V1/V2 region or V3 crown deletion

The carbohydrate moieties on HIV-1 envelope glycoprotein (Env) act as shields to mask conserved neutralizing epitopes, while the hyperimmunogenic variable regions are immunodominant in inducing non-neutralizing antibodies, representing the major challenge for using Env as a vaccine candidate to induce broadly neutralizing antibodies (bNAbs). In this study, we designed a series of HIV-1 gp140 constructs with the removal of N276/N463 glycans, deletion of the V1/V2 region and the V3 crown, alone or in combination. We first demonstrated that all the constructs had a comparable level of expression and were mainly expressed as trimers. Following purification of gp140s from mammalian cells, we measured their binding to bNAbs and non-NAbs in vitro and capability in inducing bNAbs in vivo. Antibody binding assay showed that removal of N276/N463 glycans together with the deletion of V1/V2 region enhanced the binding of gp140s to CD4-binding site-targeting bNAbs VRC01 and 3BNC117, and CD4-induced epitopes-targeting non-NAbs A32, 17b and F425 A1g8, whereas further deletion of V3 crown in the gp140 mutants demonstrated slightly compromised binding capability to these Abs. Immunogenicity study showed that the above mutations did not lead to the induction of a higher Env-specific IgG response via either DNA-DNA or DNA-protein prime-boost strategies in mice, while neutralization assay did not show an apparent difference between wild type and mutated gp140s. Taken together, our results indicate that removal of glycans at N276/N463 and deletion of the V1/V2 region can expose the CD4-binding site and CD4-induced epitopes, but such exposure alone appears incapable of enhancing the induction of bNAbs in mice, informing that additional modification or/and immunization strategies are needed. In addition, the strategies which we established for producing gp140 proteins and for analyzing the antigenicity and immunogenicity of gp140 provide useful means for further vaccine design and assessment.     

NDV-3, a recombinant alum-adjuvanted vaccine for Candida and Staphylococcus aureus, is safe and immunogenic in healthy adults

The investigational vaccine, NDV-3, contains the N-terminal portion of the Candida albicans agglutinin-like sequence 3 protein (Als3p) formulated with an aluminum hydroxide adjuvant in phosphate-buffered saline. Preclinical studies demonstrated that the Als3p vaccine antigen protects mice from oropharyngeal, vaginal and intravenous challenge with C. albicans and other selected species of Candida as well as both intravenous challenge and skin and soft tissue infection with Staphylococcus aureus. The objectives of this first-in-human Phase I clinical trial were to evaluate the safety, tolerability and immunogenicity of NDV-3 at two different antigen levels compared to a saline placebo. Forty healthy, adult subjects were randomized to receive one dose of NDV-3 containing either 30 or 300 μg of Als3p, or placebo. NDV-3 at both dose levels was safe and generally well-tolerated. Anti-Als3p total IgG and IgA1 levels for both doses reached peak levels by day 14 post vaccination, with 100% seroconversion of all vaccinated subjects. On average, NDV-3 stimulated peripheral blood mononuclear cell (PBMC) production of both IFN-γ and IL-17A, which peaked at day 7 for subjects receiving the 300 μg dose and at day 28 for those receiving the 30 μg dose. Six months after receiving the first dose of NDV-3, nineteen subjects received a second dose of NDV-3 identical to their first dose to evaluate memory B- and T-cell immune responses. The second dose resulted in a significant boost of IgG and IgA1 titers in >70% of subjects, with the biggest impact in those receiving the 30 μg dose. A memory T-cell response was also noted for IFN-γ in almost all subjects and for IL-17A in the majority of subjects. These data support the continued investigation of NDV-3 as a vaccine candidate against Candida and S. aureus infections.     

液相色谱-串联质谱法检测人血清25羟维生素D_3水平及条件控制分析

目的人血清25羟维生素D3[25-(OH)D3]测定对于评价体内维生素D的水平十分重要。本文拟建立液相色谱-串联质谱法(LC-MS/MS)测定人血清25-(OH)D3的方法。方法人血清样本(400μl)用纯甲醇去蛋白,离心后用正己烷进行液-液萃取。采用大气压化学离子源(APCI源),正离子多反应监测模式。色谱柱:Waters ACQUITY UPLC BEH C18色谱柱(50mm×2.1mm,1.7μm);流动相:100%甲醇;流速:0.2ml/min。结果 LC-MS/MS的检出限为1.0ng/ml,25-OHD3浓度在6～120ng/ml范围内,峰面积与浓度线性关系良好(r=0.999),平均回收率为99.5%(范围:97.1%～103.4%),RSD为4.7%。分别用LC-MS/MS和放射免疫法检测53例血清样本,两种方法的平均浓度分别为23.69ng/ml和20.1ng/ml,LC-MS/MS比放射免疫法(RIA)平均高17.69%(P=0.083)。二者的相关性良好,RIA=LC-MS/MS-3.57,相关系数为0.883。结论本方法具有良好的灵敏度、准确度、精确度,易于操作,与放射免疫法相关性好,可用于测定人血清中25-(OH)D3的含量。     

α1- and α2-containing GABAA receptor modulation is not necessary for benzodiazepine-induced hyperphagia

Benzodiazepines increase food intake, an effect attributed to their ability to enhance palatability. We investigated which GABA_A receptor subtypes may be involved in mediating benzodiazepine-induced hyperphagia. The role of the α2 subtype was investigated by observing the effects of midazolam, on the behavioural satiety sequence in mice with targeted deletion of the α2 gene (α2 knockout). Midazolam (0.125, 0.25 and 0.5 mg/kg) increased food intake and the amount of time spent feeding in α2 knockout mice, suggesting that BZ-induced hyperphagia does not involve α2-containing GABA_A receptors. We further investigated the roles of α1- and α3-containing GABA_A receptors in mediating BZ-induced hyperphagia. We treated α2(H101R) mice, in which α2-containing receptors are rendered benzodiazepine insensitive, with L-838417, a compound which acts as a partial agonist at α2-, α3- and α5-receptors but is inactive at α1-containing receptors. L-838417 (10 and 30 mg/kg) increased food intake and the time spent feeding in both wildtype and α2(H101R) mice, demonstrating that benzodiazepine-induced hyperphagia does not require α1- and α2-containing GABA_A receptors. These observations, together with evidence against the involvement of α5-containing GABA_A receptors, suggest that α3-containing receptors mediate BZ-induced hyperphagia in the mouse.