Notch2高表达可使人主动脉平滑肌细胞骨形态发生蛋白4表达增加促进钙化

目的观察并验证人主动脉平滑肌细胞(HASMC)Notch2蛋白表达的变化对其细胞钙化的影响,并探讨其机制。方法体外培养HASMC,将其分为两组,分别为正常对照组与诱导钙化组。前者常规培养,后者在常规培养的基础上加用钙化诱导剂β-甘油磷酸(5 mmol/L)、抗坏血酸(50μg/mL)和地塞米松(100 nmol/L),两组细胞均培养7 d。另取上述方法诱导钙化的HASMC为钙化对照组,再设钙化抑制组,即在钙化对照组的基础上加入Notch特异性抑制剂γ-内分泌酶抑制剂(50μmol/L),两组细胞均培养7 d。四组均用白介素-6诱导细胞的炎症反应。采用免疫印迹法检测各组细胞内Notch2、磷酸化核转录因子STAT3(p-STAT3)和骨形态发生蛋白4(BMP-4)的蛋白表达水平;酶联免疫法测定各组细胞培养上清液中BMP-4蛋白的含量;逆转录-聚合酶链反应检测诱导钙化组和正常对照组中HASMC Notch2 mRNA的表达;免疫荧光染色法观察钙化对照组与钙化抑制组中HASMC BMP-4蛋白的表达。结果 (1)诱导钙化组中HASMC Notch2、p-STAT3和BMP-4蛋白表达水平明显...     

阻断Notch信号通路后补益营卫方对衰老皮肤表皮干细胞Notch1、Jagged1、RBP-Jκ和Hes1表达的影响

目的 探讨γ分泌酶抑制剂(DAPT)阻断跨膜受体蛋白(Notch)信号通路后，补益营卫方对衰老皮肤表皮干细胞Notch1、Notch配体蛋白(Jagged1)、重组信号结合蛋白(RBP)-Jκ和毛发分裂增强因子(Hes)1表达的影响及其延缓皮肤衰老的机制。方法 消化分离出年轻小鼠和衰老小鼠的表皮，进行表皮干细胞的传代培养。将年轻组细胞分为A组(常规培养基培养)和B组(含5μmol/L DAPT的完全培养基培养);老年组细胞分为C组(常规培养基培养)、D组(含5μmol/L DAPT的完全培养基培养)和E组(含5μmol/L DAPT+2.5%药物血清浓度的完全培养基培养),采用实时荧光定量聚合酶链反应(PCR)和Western印迹检测Notch1、Jagged1、RBP-Jκ和Hes1表达水平。结果 与A组比较，B组和C组Notch1、Jagged1、RBP-Jκ和Hes1 mRNA及蛋白表达水平差异显著(P<0.05);与C组比较，D组和E组Notch1、Jagged1、RBP-Jκ和Hes1 mRNA及蛋白表达量均明显降低(P<0.05);与D组比较，E组Notch1、...     

细胞外酸碱环境对主动脉瓣膜间质细胞钙化的影响及相关机制研究

目的探究细胞外酸碱环境对主动脉瓣膜间质细胞钙化的影响及相关机制。方法主动脉瓣膜来源于2017年1—6月在第二军医大学附属长海医院心血管外科接受心移植手术的患者,采用二次胶原酶消化法分离主动脉瓣膜间质细胞,采用细胞免疫荧光法和流式细胞术鉴定主动脉瓣膜间质细胞。将传代的主动脉瓣膜间质细胞随机分为A、B、C、D 4组,A组采用普通培养基培养,p H值为7.4,B、C、D组均采用普通培养基+钙化培养基培养,p H值分别为7.1、7.4、7.7。采用实时荧光定量聚合酶链反应(PCR)检测4组细胞骨形态发生蛋白2(BMP-2)、Runt相关转录因子2(Runx2)和碱性磷酸酶(ALP)mRNA表达情况,采用Western Blot法检测4组细胞BMP-2、Runx2蛋白表达情况,采用比色法检测4组细胞ALP活性,采用茜素红染色观察4组细胞钙化结节情况。结果 (1)细胞免疫荧光法检测结果显示,波形蛋白(Vimentin)阳性率接近100%。流式细胞术检测结果显示,细胞CD31阳性率为1.17%。(2)将A组作为对照,C、D组细胞BMP-2、Runx2和ALP mRNA相对表达量高于B组,D组细胞BMP-2、Runx2和ALP mRNA相对表达量高于C组(P0.05)。(3)B、C、D组细胞BMP-2、Runx2蛋白相对表达量高于A组,C、D组细胞BMP-2、Runx2蛋白相对表达量高于B组,D组细胞BMP-2、Runx2蛋白相对表达量高于C组(P0.05)。(4)B、C、D组细胞ALP活性高于A组,C、D组细胞ALP活性高于B组,D组细胞ALP活性高于C组(P0.05)。(5)茜素红染色结果显示,A组细胞钙化结节较少,B、C、D组细胞钙化结节逐渐增多;与C组相比,B组钙化结节明显减少,D组钙化结节明显增多。结论细胞外酸性环境可抑制主动脉瓣膜间质细胞钙化,碱性环境则可促进主动脉瓣膜间质细胞钙化,其机制可能与细胞外酸碱环境影响BMP-2信号通路有关。     

主动脉瓣体外钙化模型的建立

目的:探讨一种体外分离、扩增瓣膜间质细胞并诱导钙化的方法,建立体外瓣膜细胞钙化模型。方法:采用胶原酶消化法从新鲜猪主动脉瓣膜上分离并体外扩增瓣膜间质细胞,免疫荧光染色行细胞鉴定。4～8代间质细胞以含β-甘油磷酸的钙化培养基钙化诱导培养2周。钙化结节计数,茜素红S染色观察并检测钙沉积。实时定量逆转录聚合酶链反应(Real Time rt-PCR)检测α-平滑肌波动蛋白(α-SMA)及钙化相关因子骨钙素、骨桥蛋白、核心结合因子a1(Cbfa1)表达。结果:胶原酶消化法可从猪主动脉瓣膜上成功分离并体外扩增瓣膜间质细胞,α-SMA和波形蛋白(Vimentin)免疫荧光染色阳性,血管性血友病因子(vWF)染色阴性。钙化培养基体外钙化诱导培养1～2周可成功诱导钙化,间质细胞自发形成钙化结节,茜素红S染色阳性,钙沉积明显增加(P0.05)。实时定量逆转录PCR提示钙化间质细胞α-SMA表达上调,并相对高表达钙化相关因子(P0.05)。结论:胶原酶法联合钙化培养基可成功体外构建主动脉瓣膜细胞钙化模型。     

白细胞介素17促进主动脉瓣膜间质细胞向成骨样细胞转化

目的研究白细胞介素17(IL-17)是否促进主动脉瓣膜钙化形成及其可能机制。方法利用体外主动脉瓣膜间质细胞培养技术,瓣膜间质细胞培养传代3⁵次后,采用简单随机抽样法分为两组:(1)对照组,细胞培养基中添加2 ml RPMI-1640完全培养液;(2)实验组,细胞培养基中添加2 ml RPMI-1640完全培养液和IL-17(50 ng/ml)。继续孵育48 h后,用细胞茜素红钙染色检测两组瓣膜间质细胞钙化情况,用Western blot和RT-PCR检测两组瓣膜间质细胞碱性磷酸酶(ALP)及骨形态蛋白2(BMP-2)的表达情况。结果实验组细胞中明显钙结节形成,对照组细胞中少量钙结节形成;与对照组比较,实验组细胞ALP和BMP-2蛋白(0.741±0.063比0.184±0.032;0.900±0.060比0.396±0.030,均为P<0.01)与基因(0.236±0.004比0.106±0.003;0.523±0.052比0.194±0.047,均为P<0.01)表达量均明显升高。结论 IL-17可促进主动脉瓣膜间质细胞向成骨样细胞转化。     

LPS诱导的HepG2细胞NOTCH与LPS-TLR4-NF-κB炎症信号通路的“会话”研究

目的探讨在脂多糖(LPS)刺激下HepG2细胞Notch与LPS-TLR4-NF-κB炎症信号通路的相互影响。方法给予LPS处理HepG2细胞,提取细胞RNA,采用qRT-PCR法检测HepG2细胞Notch信号通路受体及其配体m RNA水平,给予γ分泌酶抑制剂(DAPT)、LPS或LPS联合DAPT处理细胞,采用Western blot法检测Notch受体胞内区域(NICD)和LPS-Toll样受体4(TLR4)蛋白表达水平。结果经LPS处理HepG2细胞后,Notch 1和Jag 1 m RNA水平分别升高了2.25倍(P0.001)和2.47倍(P0.001),NOTCH 3仅增加的0.0700倍(P0.05),Jag 2仅增加了0.420倍(P0.05),Dll 4增加了0.947倍(P0.01),而NOTCH 2却降低了0.857倍(P0.01),NOTCH 4降低了0.283倍(P0.05),Dll 1降低了0.750倍(P0.01)、Dll 3降低了0.393倍(P0.05);与对照组比,LPS处理组NICD和NF-κB蛋白表达水平显著增加,而DAPT处理组NICD和NF-κB蛋白表达显著减少。结论本研究结果揭示了在LPS刺激下,HepG2细胞Notch与TLR4-NF-κB信号通路之间的相互作用,抑制Notch信号通路可以显著改善LPS-TLR4引起的炎症反应。     

Toll样受体2对人主动脉瓣间质细胞炎症反应的调控作用

目的探讨Toll样受体(TLR2)调控Notch1信号通路对人主动脉瓣间质细胞炎症反应的作用。方法从正常主动脉瓣组织及主动脉瓣狭窄病人的主动脉瓣组织中分离出主动脉瓣间质细胞,酶联免疫吸附(ELISA)检测200 ng/ml的TLR2激活物脂多糖(LPS)干预细胞24 h后白细胞介素(IL)-6、巨细胞趋化因子(MCP)-1和细胞间黏附因子(ICAM)-1浓度;Western印迹检测200 ng/ml的LPS干预细胞2、4、8、12 h后NICD1蛋白表达,ELISA检测Jagged1浓度;60 nmol/L的人Notch1特异性siRNA沉默Notch1及200 ng/ml的LPS刺激细胞24 h后,Western印迹检测NICD1及ICAM-1蛋白表达;5μg/ml的Jagged1及200 ng/ml的LPS处理细胞,ELISA检测IL-6、MCP-1和ICAM-1浓度。结果正常主动脉瓣组织及主动脉狭窄病人瓣膜组织的主动脉瓣间质细胞经LPS刺激后IL-6、MCP-1和VCAM-1的浓度均显著高于无LPS刺激组,主动脉狭窄病人瓣膜组织的主动脉瓣间质细胞中IL-6、MCP-1和VCAM-1的浓度均显著高于正常组(P<0.01);LPS刺激能诱导NICD1的生成及增加,具有时间依赖性,且主动脉狭窄病人瓣膜组织的主动脉瓣膜间质细胞中NICD1生成量多于正常组;主动脉狭窄病人瓣膜组织的主动脉瓣膜间质细胞中Jagged1浓度显著高于正常组,且随着时间延长增加;沉默Notch1信号通路能减弱NICD1的蛋白表达,且能减少炎症因子ICAM-1的蛋白表达;Jagged1激活Notch信号通路能诱导产生低水平的IL-6、MCP-1、ICAM-1,而能明显增强TLR2诱导的IL-6、MCP-1、ICAM-1的水平。结论 TLR2能诱导人主动脉瓣间质细胞的炎症反应及活化Notch1信号通路,主动脉瓣狭窄的主动脉瓣组织间质细胞炎症反应更明显,沉默Notch1信号通路可减弱TLR2诱导的炎症反应,激活Notch信号通路则增强TLR2诱导的炎症反应。     

高磷对大鼠胸主动脉血管环中骨形成蛋白2表达的影响

目的:探讨骨形成蛋白-2(Bone morphogenetic protein 2,BMP-2)在高磷诱导的大鼠胸主动脉血管环钙化中的作用。方法:选取8~10周龄健康雄性SD大鼠,体外培养大鼠胸主动脉血管环,血管环按随机数字表法随机分为2组:正常对照组和高磷组。血管环培养7d和14d后,采用von Kossa染色及邻甲酚酞络合酮比色法检测大鼠胸主动脉血管环钙化情况;免疫组织化学方法检测血管环BMP-2的表达。体外采用组织块贴壁法培养原代大鼠胸主动脉平滑肌细胞,利用10mmol/Lβ-甘油磷酸制备血管平滑肌细胞钙化模型,细胞随机分为2组:正常对照组、高磷组(10mmol/Lβ-甘油磷酸)。采用茜素红染色及邻甲酚酞络合酮比色法检测细胞钙化情况,RT-PCR和Western blot方法检测细胞培养7d和14d的BMP-2mRNA及蛋白表达,并观察短时间内不同时间点BMP-2蛋白表达情况。结果:体外血管环培养7d、14d后,与正常对照组相比,高磷组钙含量明显增加(P0.05);与7d高磷组血管环钙含量相比,14d高磷组血管环钙含量明显增加(P0.05)。免疫组织化学结果显示,与正常对照组相比,高磷组BMP-2表达增加(P0.05);与7d高磷组相比,14d高磷组血管环钙含量明显增加(P0.05)。细胞培养7d、14d后,与正常对照组相比,高磷组钙盐沉积及钙含量明显增高(P0.05);RTPCR和Western Blot显示,与正常对照组相比,高磷组BMP-2mRNA及蛋白表达增加。进一步动态观察BMP-2蛋白的表达变化,结果显示正常对照组及高磷组BMP-2蛋白表达随时间延长呈增强趋势(P0.05)。结论:BMP-2可能参与了高磷诱导的血管钙化的发生发展。     

γ-分泌酶抑制剂干预对鼠心脏成纤维细胞平滑肌肌动蛋白-α及MMP-1/TIMP-1表达的影响

目的:探讨γ-分泌酶抑制剂(DAPT)抑制Notch信号通路对心肌成纤维细胞(CFs)平滑肌肌动蛋白-α(α-SMA)的表达及细胞外基质(ECM)降解平衡变化的影响。方法:采用胰酶消化法和差速贴壁法分离和纯化SD乳鼠CFs进行体外培养,将CFs分为正常组(N组,培养时不加干预药物)和尾加压素Ⅱ组(U组,加UⅡ10~(-8) mol/L)和DAPT+尾加压素Ⅱ组(D组,同时加入UⅡ10~(-8) mol/L和DAPT 75μmol/L),培养干预48h后采用RT-PCR法测基质金属蛋白酶-1(MMP-1)、组织金属蛋白酶抑制剂-1(TIMP-1)、α-SMA和Notch蛋白胞内段(Notch1)mRNA的表达;Western Blot检测α-SMA及Notch1蛋白的表达。结果:U组TIMP-1、α-SMA及Notch1的mRNA表达水平明显高于N组(均P0.01),MMP-1mRNA的表达和MMP-1mRNA/TIMP-1mRNA比值低于N组(均P0.01);D组TIMP-1、α-SMA、Notch1的mRNA表达以及α-SMA和Notch1蛋白的表达均较U组下调(均P0.01),MMP-1mRNA的表达和MMP-1mRNA/TIMP-1mRNA比值较U组上调(P0.01);但D组上述指标与N组相比差异无统计学意义。结论:DAPT可通过阻断Notch信号通路抑制尾加压素Ⅱ诱导的CFs表型转换,激活胶原降解途径,并可重调MMP-1/TIMP-1平衡,此作用有助于抑制心肌纤维化。     

Notch1信号通路在人脑胶质瘤U87细胞增殖、凋亡中的作用及机制探讨

目的 观察Notch1信号通路在人脑胶质瘤U87细胞增殖和凋亡中的作用,并探讨其机制.方法 将U87细胞随机分为A、B、C组,分别加入Notch信号激活剂rhNF-κB、抑制剂DAPT及PBS共培养48 h.用MTT法检测细胞吸光度值(A值)观察细胞增殖情况,流式细胞术检测细胞凋亡率,RT-PCR、Western blot法分别检测U87细胞中的Notch1、Hes1、Bcl-2 mRNA及其蛋白.结果 培养24、48、72、96 h,A组细胞A值分别为0.185±0.007、0.398±0.012、0.735±0.015、1.083±0.031,B组分别为0.102±0.003、0.130±0.004、0.161±0.006、0.194±0.003,C组分别为0.167±0.005、0.265±0.008、0.496±0.011、0.737±0.016,A、B组与C组比较,P均＜0.05.A、B、C组细胞凋亡率分为0.96％±0.17％、26.51％±3.74％、8.76％±1.40％,A、B组与C组比较,P均＜0.05.与C组比较,A组细胞中Notch1、Hes1、Bcl-2 mRNA及其蛋白表达量均显著增加(P均＜0.05),B组细胞中Notch1、Hes1、Bcl-2 mRNA及其蛋白表达量均显著降低(P均＜0.05).结论 Notch1信号通路在人脑胶质瘤U87细胞增殖、凋亡中发挥了重要的调控作用,其机制可能与调节靶基因Hes1、抗凋亡蛋白Bcl-2表达有关.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。