重组人生长激素对肝硬化患者肝功能的影响

目的观察重组人生长激素(rhGH)对肝硬化患者血清白蛋白(Albumin)减少,丙氨酸转氨酶(ALT),门冬氨酸转氨酶(AST),胆红素(TBil)异常的治疗效果.方法选择血清白蛋白低于35g/L,肝功能异常的肝硬化病人20例,其中乙型肝炎肝硬化18例,丙型肝炎肝硬化1例,酒精性肝硬化1例.方法rhGH 4～8 IU,皮下注射,1次/d,10d为1个疗程.观察用药前后Alb、ALT、AST、TBil、α-FP、PTA和血糖的变化.结果血清白蛋白由治疗前(28.32士3.86)g/L增加到(30.86±3.91) g/L(P＜0.001);ALT由(59.99±28.97)IU降至(43.90士20.43)IU(P＜0.05),AST由(77.25士34.37)IU降至(59.32士31.08)IU(P＜0.05).其他指标无变化.结论重组人生长激素(rhGH)可以增加肝硬化病人的白蛋白合成,降低ALT、AST水平,改善肝功能,无明显不良反应.     

重组人脑利钠肽对慢性肾脏病患者行PCI后造影剂肾病的预防价值

目的:探讨重组人脑利钠肽对慢性肾脏病(CKD)患者行冠状动脉介入(PCI)治疗后造影剂肾病(CIN)的预防作用.方法:选择我科2017年1月-2021年1月行PCI治疗的CKD患者108例,随机分为重组人脑利钠肽组(52例)和对照组(56例),重组人脑利钠肽组在行PCI前12h给予重组人脑利钠肽0.005 μg·kg-...     

重组改构人肿瘤坏死因子对人胃癌细胞的药效学及其机制研究

背景:重组改构人肿瘤坏死因子(rmhTNF)与原型TNF-α相比具有高抗肿瘤活性和低毒性的特点。目的:研究注射用rmhTNF对人胃癌细胞的药效学及其机制。方法:体外培养人胃癌细胞株BGC-823和人脐静脉内皮细胞株HUVEC-12,分别以不同浓度的rmhTNF和rhTNF-α进行处理,以MTT实验、软琼脂克隆形成实验、TUNEL染色和流式细胞术分析细胞增殖、凋亡情况和细胞周期分布;以蛋白质印迹法检测BGC-823细胞凋亡相关蛋白表达;以免疫共沉淀技术检测rmhTNF与死亡受体5(DR5)间的相互作用。建立BGC-823细胞裸鼠皮下移植瘤模型,分别予rmhTNF、rhTNF-α、5-氟尿嘧啶和0.9%NaCl溶液腹腔内注射,以CD34免疫组化染色检测移植瘤组织微血管密度(MVD)。结果:rmhTNF和rhTNF-α对BGC-823和HUVEC-12细胞均有抑制增殖和诱导凋亡作用,并能使G0/G1期细胞进入S期,rmhTNF的作用强于rhTNF-α(P0.05)。rmhTNF组移植瘤组织MVD显著低于其他各组(P0.05)。rmhTNF能使BGC-823细胞procaspase-3、Bax表达上调,Bcl-2表达下调,并能与DR5相互作用。结论:rmhTNF对人胃癌细胞具有抑制增殖、诱导凋亡、影响细胞周期分布和抑制肿瘤血管形成的作用,其机制可能为rmhTNF与DR5结合,从而改变细胞内凋亡相关蛋白水平。     

Pulmonary Mechanics Following Albuterol Therapy in Mechanically Ventilated Infants with Bronchiolitis

Background and aims. Bronchiolitis is a common cause of critical illness in infants. Inhaled β₂-agonist bronchodilators are frequently used as part of treatment, despite unproven effectiveness. The purpose of this study was to describe the physiologic response to these medications in infants intubated and mechanically ventilated for bronchiolitis. Materials and methods. We conducted a prospective trial of albuterol treatment in infants intubated and mechanically ventilated for bronchiolitis. Before and for 30 minutes following inhaled albuterol treatment, sequential assessments of pulmonary mechanics were determined using the interrupter technique on repeated consecutive breaths. Results: Fifty-four infants were enrolled. The median age was 44 days (25–75%; interquartile range (IQR) 29–74 days), mean hospital length of stay (LOS) was 18.3 ± 13.3 days, mean ICU LOS was 11.3 ± 6.4 days, and mean duration of mechanical ventilation was 8.5 ± 3.5 days. Fifty percent (n = 27) of the infants were male, 81% (n = 44) had public insurance, 80% (n = 41) were Caucasian, and 39% (n = 21) were Hispanic. Fourteen of the 54 (26%) had reduction in respiratory system resistance (Rrs) that was more than 30% below baseline, and were defined as responders to albuterol. Response to albuterol was not associated with demographic factors or hospitalization outcomes such as LOS or duration of mechanical ventilation. However, increased Rrs, prematurity, and non-Hispanic ethnicity were associated with increased LOS. Conclusions. In this population of mechanically ventilated infants with bronchiolitis, relatively few had a reduction in pulmonary resistance in response to inhaled albuterol therapy. This response was not associated with improvements in outcomes.     

胞二磷胆碱联合重组人促红素治疗新生儿缺氧缺血性脑病的临床疗效及其对患儿神经功能的影响

背景 新生儿缺氧缺血性脑病(HIE)具有较高的病死率、致残率,临床主要采用胞二磷胆碱治疗新生儿HIE并取得了一定疗效,但该药物不良反应较多,一定程度上影响了临床疗效,因此探寻新的治疗方式对提高新生儿HIE的治疗效果具有重要的临床意义.目的 探讨胞二磷胆碱联合重组人促红素治疗新生儿HIE的临床疗效及其对患儿神经功能的影响...     

重型颅脑损伤早期应用生长激素对其代谢及预后的影响研究

目的探讨重组人生长激素（rhGH）对重型颅脑损伤患者代谢调控作用的应用价值。方法将40例重型颅脑损伤患者在早期肠内、肠外营养支持的基础上随机分成rhGH治疗组（20例）与对照组（20例）,rhGH治疗组伤后或术后第2～3天开始每日皮下注射重组人生长激素4 IU,共10～14d。应用后第7、14天检测血清总蛋白、白蛋白、转铁蛋白及前白蛋白。结果 rhGH治疗组第14天后血清总蛋白、白蛋白、转铁蛋白及前白蛋白浓度高于对照组,体质量改变率低于对照组,预后优于对照组。结论重型颅脑损伤患者应用rhGH能改善机体对营养底物的利用率,促进蛋白合成、减轻重型颅脑损伤后低蛋白血症,改善预后。     

Calcium Current in Single Human Cardiac Myocytes

Calcium Current in Human Heart. Introduction: Significant species-, issue-, and age-dependent differences have been described for the L-type calcium current (I_Ca). Therefore, extrapolation data obtained from the many animal models to human cardiac physiology is difficult. In this study, we have characterized the voltage-dependent properties of I_Ca from pediatric and adult, atrial and ventricular human heart tissue. Methods and Results: I_Ca, was measured in single human heart muscle cells using the “whole cell,” voltage clamp method. Single myocytes were isolated from myocardial specimens obtained intraoperatively from both pediatric and adult patients (ages 3 months to 75 years) undergoing cardiac surgery. Cells obtained for these experiments appeared to be healthy; the resting potential was between -80 and -85 mV. The action potential shape and duration and current-voltage relationship for 1_Ca were similar to that reported by others for human heart cells. The steady-state activation variable, d_x was found to be similar in both pediatric atrial and ventricular cells but shifted approximately 5 mV negative in the adult atrial and ventricular cells. I, of all cells displayed biex-ponential inactivation and steady-state inactivation was incomplete at positive potentials (steady-state inactivation curves turned up at positive potentials) consistent with inactivation arising from voltage-dependent and calcium-dependent processes as reported in heart cells from many species. The potential of maximal inactivation was more negative for adult cells (around -10 mV) than pediatric cells (around 0 mV). Estimates of the calcium “window” current, using a modified Hodgkin-Huxlcy model, could explain measured differences in action potential shape and duration. Conclusion: Human cardiac I, can be investigated using whole cell, voltage clamp methods and a modified Hodgkin-Huxley model. Quantitative characterization of many of the properties of I_Ca in human heart tissue suggests that important species differences do exist and that further investigations are required to characterize the dependence of inactivation on [Ca²⁺]_i in human heart cells. Since the array of characteristics of I_Ca in different species varies, the study of human myocardial cells per se continues to be important when examining human cardiac physiology.     

重组人血管内皮抑素联合GP方案治疗非小细胞肺癌的疗效观察

目的 观察重组人血管内皮抑素联合吉西他滨+顺铂方案(GP方案)治疗非小细胞肺癌的临床疗效.方法 53例非小细胞肺癌患者随机分为对照组(26例)和治疗组(27例).对照组采用GP方案治疗;治疗组采用重组人血管内皮抑素联合GP方案治疗.治疗结束后观察两组治疗总有效率及不良反应.结果 治疗组临床总有效率为66.7%,对照组临床总有效率为46.2%,差异有显著性(P<0.05);两组毒副反应比较差异无显著性差异(P>0.05).结论 重组人血管内皮抑素联合GP方案治疗非小细胞肺癌疗效显著,能明显改善患者的生活质量,值得临床推广应用.     

重组人碱性成纤维细胞生长因子对缩小兔急性心肌梗死面积作用的观察

目的 :探讨重组人碱性成纤维细胞生长因子 (rhbFGF)对缩小兔急性心肌梗死面积的作用。方法 :将 3 6只日本大耳白兔分为 2组 :①生理盐水对照组 (n =11) ,②rhbFGF组 (n =2 5 )。在无菌条件下开胸结扎兔冠状动脉左前降支 ,建立急性心肌梗死动物模型 ;制备rhbFGF蛋白 ,将其直接 4点注入兔缺血心肌内 ,通过心肌酶学及心电图QRS积分观察rhbFGF对兔急性心肌梗死面积的影响。结果 :①血清心肌酶学观察 :2组左前降支结扎后 2 4h与基础值比较血清谷草转氨酶、乳酸脱氢酶、乳酸脱氢酶同工酶、肌酸激酶、肌酸激酶MB同工酶、α 羟丁酸脱氢酶均明显增高 ,有非常显著性差异 (P <0 0 1) ,2组左前降支结扎后48h与基础值比较 ,除生理盐水组的谷草转氨酶和rhbFGF组的谷草转氨酶及乳酸脱氢酶同工酶外 ,其它均明显增高 ,有非常显著性差异 (P <0 0 1)。左前降支结扎后 48h ,rhbFGF组较生理盐水对照组乳酸脱氢酶、乳酸脱氢酶同工酶、肌酸激酶及肌酸激酶MB同工酶明显降低 ,有显著性差异 (P <0 0 5 )。生理盐水对照组乳酸脱氢酶同工酶 ,左前降支结扎后48h与左前降支结扎后 2 4h比较升高 ,而在rhbFGF组降低 ,均有显著性差异 (P <0 0 5 )。②心电图QRS积分 :左前降支结扎后 6周rhbFGF组QRS积分 (4 3 0± 0 95 )较生理盐水对     

Middle Lobe Syndrome in Children with Asthma: Review of 56 Cases

Objective. Middle lobe syndrome (MLS) is one of the complications of asthma. Its signs and symptoms are often nonspecific, causing delay in appropriate treatment. We aimed to review our pediatric asthmatic patients and provide differential characteristics between MLS and asthma worsening in order to target early diagnosis. Method. File records of all asthmatics (n = 3528) seen in our clinic during the last 2 years were retrospectively reviewed to identify the patients with MLS, and a case‐control study was undertaken. Files of 56 asthmatic children diagnosed as MLS, with a total of 63 episodes, and 63 matched controls with asthma worsening were analyzed and compared. Results. The incidence of MLS was 1.62% and half were below or at the age of 6. All cases with MLS were documented radiologically, and only 5 of the 63 episodes had physical findings suspicious for MLS. The most affected segments were right middle lobe (50%) and left lingula (26.2%). Although in all cases symptoms cleared, in 23 (36.5%) cases, atelectasis persisted radiologically. Compared to controls, patients with MLS included less atopics (34.9% vs. 59.4%, p < 0.05) and fewer boys (52.4% vs. 71.4%, p < 0.05), and they reported less frequent dyspnea (57.1% vs. 85.9%), more frequent sputum production (49.2% vs. 7.8%), and longer duration of complaints (22.0 ± 6.23 vs. 2.4 ± 0.31 days) (p < 0.001, for each). Furthermore, the resolution of symptoms took significantly longer (45.2 ± 9.3 vs. 3.3 ± 0.4 days, p < 0.001). Conclusion. We conclude that complicating MLS in childhood asthma is more frequent in younger ages, girls, and nonatopics. In most cases, physical findings are not informative, and chest radiographs diagnose most but not all cases. The most suggestive symptoms are unresolving/persisting symptoms during admission and/or following treatment.     

Cardiac Medical Conditions Have Become the Leading Cause of Death in Children with Heart Disease

Objective. Mortality among children with congenital and acquired heart disease has decreased significantly over the past decades. We sought to determine whether the underlying problems leading to death in these patients had changed over the past decade. Methods. We reviewed medical records for 100 deaths of cardiac patients in 2004–2005 and 100 deaths in 1995–1996. Demographic, clinical, and procedural data as well as circumstances of death were collected. A consensus committee reviewed each case and sought to identify the condition leading to death. These conditions were classified as predominantly surgical or medical. Results. General patient characteristics (age, gender, cardiac history, comorbidities, proportion of surgical patients) did not change significantly between the two time periods. However, in 1995–1996, 64% of deceased surgical patients had died within 30 days of surgery. This rate was nearly halved to only 38% by 2004–2005 (P= .003). Furthermore, the conditions leading to death changed significantly: 51% of patient deaths in 1995–1996 resulted from a surgical problem, 29% from a medical condition. This ratio was reversed in 2004–2005: Only 31% of patient deaths were due to a surgical problem, while 50% of deaths resulted from a medical condition (P= .005). The most common medical conditions resulting in death were pulmonary vein stenosis, pulmonary arterial hypertension, and primary myocardial failure. Conclusions. The proportion of deaths within 30 days of cardiac surgery decreased significantly over the past decade. While surgical causes accounted for the majority of these deaths in 1995–1996, most patient deaths in 2004–2005 resulted from cardiac medical causes.     

人类心脏遗传病相关基因——腺甘酸单磷酸活化蛋白激酶γ2亚基功能研究进展

腺甘酸单磷酸活化蛋白激酶γ2亚基基因与人类心脏发育息息相关,研究表明其突变后可以导致心脏多种异常表现,与家族性心肌肥厚合并传导系统异常及心室预激家系发病密切相关。现就近年来腺甘酸单磷酸活化蛋白激酶γ2亚基基因的功能研究现状作一综述。     

Inhibition of HA Synthase 3 mRNA Expression, with a Phosphodiesterase 3 Inhibitor, Blocks Lung Injury in a Septic Ventilated Rat Model

Low-molecular-weight hyaluronan produced by hyaluronan synthase 3 (HAS3) has been shown to play a role in acute lung injury secondary to high-tidal-volume ventilation. Phosphodiesterase 3 inhibitors have been shown to decrease HAS3 expression. We hypothesized that low-molecular-weight hyaluronan (LMW HA) produced by HAS3 mediates LPS-induced lung injury in the mechanically ventilated rat and that milrinone (MIL), by blocking HAS3 mRNA expression, would prevent the injury. Rats were randomized to four groups: controls with mechanical ventilation at 7 cc/kg MV, MV+LPS, MV+MIL, and MV+LPS+MIL. Rats were intubated and ventilated without PEEP for 4 h. Lipopolysaccharide (LPS) (1 mg/kg) was infused into the arterial line 1 h prior to MV. MIL 10 μg/kg/min (or an equivalent volume of saline) was infused through the venous line at the beginning of MV. Bronchoalveolar lavage fluid (BAL) was collected after 4 h of ventilation and lungs were saved for histopathology. LPS significantly increased neutrophil infiltration and protein concentration in the BAL and augmented lung injury score on histology. MIL significantly lowered alveolar protein and neutrophil infiltration as well as lung injury in response to LPS. Furthermore, MIL decreased the mRNA expression for HAS3 and MIP2 in lung tissue and decreased the protein content in BAL. MIL, a commonly used inotropic agent, inhibited LPS-induced lung inflammation and lung injury in mechanically ventilated rats. The anti-inflammatory properties of MIL may be mediated by inhibition of HAS3 and/or MIP2 and could be beneficial in the treatment of sepsis.     

重组人促红细胞生成素治疗结肠和直肠癌化疗相关贫血

目的 :观察重组人促红细胞生成素 (rhEPO)治疗结、直肠癌化疗相关贫血的疗效。方法 :选择 6 2例结、直肠癌采用以奥沙利铂为主联合方案化疗所致贫血患者 ,随机分为两组 :rhEPO治疗组 34例 ,给予皮下注射rhEPO 4 0 0 0 0U/周。对照组 2 8例 ,不给予rhEPO治疗 ,仅给予五参芪口服液。结果 :治疗后 4周起治疗组患者血红蛋白 (Hb) ,红细胞压积 (HCT)、红细胞总数 (RBC)均明显上升 ,与对照组相比差异有统计学意义 (P <0 .0 1)。rhEPO治疗组总有效率为 79.4 % ,对照组为 2 1.7% ,差异有统计学意义 (P <0 .0 1)。结论 :rhEPO 4 0 0 0 0U/周对晚期结、直肠癌联合方案化疗相关贫血有肯定的疗效     

Respiratory Effects of Halothane in a Patient with Refractory Status Asthmaticus

We describe the case of a 36 year old patient who was admitted to the intensive care unit (ICU) for an acute asthma attack that failed to respond to conventional treatment and required mechanical ventilation. The patient's condition improved after halothane was administered; treatment with this inhalational anaesthetic lasted 7 h, and the beneficial effect was obtained by employing concentrations between 0.5 and 2%. Under constant mechanical ventilator settings, a highly significant linear correlation between peak airway pressure and arterial pCO(2)(r: 0.98 P<0.001) was observed. The decrease in p(a)CO(2)induced by halothane may be explained by the diminished dead space that results from the drop in peak airway pressure. Arterial hypotension, which improved with inotropic agents, was the only complication that seemed related to the inhaled anaesthetic. The patient was extubated 24 h after her arrival to the ICU and discharged 72 h later. A causal relationship between the administration of halothane and clinical improvement is suggested. Copyright Academic Press.     

机械通气脓毒症休克患者下腔静脉管径/呼吸变异指数与中心静脉压的关系

目的:探讨机械通气脓毒症休克患者下腔静脉管径/呼吸变异指数与中心静脉压的关系。方法:选择机械通气脓毒症休克患者97例为脓毒症休克组,另选择脓毒症休克已达复苏目标的患者93例作为对照组。分别于液体复苏前、液体复苏2、6 h测量中心静脉压、下腔静脉最大径-下腔静脉最小径,计算下腔静脉呼吸变异指数[(下腔静脉最大径-下腔静脉最小径)/下腔静脉最大径×100%],分析下腔静脉最大径、下腔静脉最小径、下腔静脉呼吸变异指数与中心静脉压的相关性。结果:机械通气脓毒症休克患者下腔静脉管径显著小于对照组(P0.05),下腔静脉呼吸变异指数显著大于对照组(53.63%±10.58%vs 12.75%±1.67%,P=0.017);在液体复苏过程中,下腔静脉最大径、下腔静脉最小径、下腔静脉呼吸变异指数与中心静脉压均有明显的相关性(r分别为0.841、0.897、-0.812,均P0.01)。结论:对于机械通气脓毒症休克患者,下腔静脉管径/呼吸变异指数与中心静脉压具有很好的相关性,床边超声检测下腔静脉管径,有助于无创、快速、动态判断患者的容量反应性。     

封闭负压引流术结合重组人表皮生长因子治疗老年性糖尿病溃疡创面疗效分析

目的 探讨封闭负压引流术(VSD)结合重组人表皮生长因子(rhEGF)治疗老年性糖尿病溃疡创面的临床疗效.方法 选择2017年8月—2019年6月64例老年性糖尿病慢性溃疡创面患者为研究对象,随机分成观察组32例与对照组32例,观察组采用封闭负压引流术+重组人表皮生长因子的方法,对照组采用封闭负压引流术+常规换药的方法...     

Autonomic Dysfunction in Children with Hirschsprung's Disease

During embryogenesis, two differenttransmembrane receptors, Ret and Ednrb, together withtheir ligands, respective, GDNF and endothelin-3, areinvolved in the migration and differentiation of entericganglion cells, sympathetic neurons and melanocytes fromthe neural crest. Mutations in these genes have beenfound in a number of human and murineneurocristopathies, including Hirschsprung's disease.RET and GDNF knockouts suggest that they are involved in acorrect autonomic nervous system formation. The aim ofthis study is the evaluation of the autonomic nervoussystem in patients with Hirschsprung's disease. Seventeen children (mean age: 8.6 years) withHirschsprung's disease and 19 age- and sex-matchedcontrol children (mean age: 9.9 years) underwentpupillary and cardiovascular testing of sympatheticadrenergic and cholinergic function and cardiovagalcholinergic function. Seven of 17 patients withHirschsprung's disease were affected by autonomicdysfunction. Three of seven patients had evidence ofsympathetic denervation, two showed a parasympatheticdysfunction, whereas the remaining two had dysfunctionof both sympathetic and parasympathetic tests. Our datain a small number of patients with Hirschsprung's disease show that a subset of these patientsexhibits measurable autonomic dysfunction. A RETmutation has been found in one of them. As for theabsence of the enteric ganglion cells, autonomicdysfunction in these subjects seems to bepolygenic.     

人激肽释放酶腺相关病毒载体的构建及其在人脐静脉内皮细胞中的表达

目的研究人激肽释放酶腺相关病毒载体的构建,观察重组病毒感染人脐静脉内皮细胞株后人激肽释放酶基因的表达。方法将人激肽释放酶基因定向克隆入AAV载体质粒pAAV-MCS中,并与两种辅助质粒pAAV-RC和pHelper共转染293细胞,包装成带有人激肽释放酶基因的重组腺相关病毒(rAAV);收集病毒颗粒并测定病毒滴度。以不同滴度的病毒分别感染人脐静脉内皮细胞,逆转录聚合酶链反应定量检测人激肽释放酶在该细胞中的表达。酶联免疫吸附法测定人脐静脉内皮细胞内人激肽释放酶的含量。结果成功获得了重组人激肽释放酶基因AAV载体,重组病毒滴度为6.2×1010个/L。以滴度分别为1×109个/L、1×108个/L和1×107个/L的病毒感染人脐静脉内皮细胞,与空白对照组比较,人激肽释放酶的表达均有增加(P<0.05),但以1×109个/L组升高最明显(P<0.001)。结论带有人激肽释放酶的重组腺相关病毒滴度可以稳定地达到1010个/L以上,感染人脐静脉内皮细胞后,人激肽释放酶基因在宿主细胞中的表达明显增强。