益生菌对妊娠期糖尿病的影响及相关机制

妊娠期糖尿病(gestational diabetes mellitus, GDM)可对母体及其后代产生近期和远期的不良影响,GDM患者的肠道菌群与正常孕妇存在差异,肠道菌群结构及功能的改变影响了其发生发展。近年来,国外研究发现,益生菌可不同程度地影响GDM患者糖脂代谢,但具体机制不甚明确,短链脂肪酸、过氧化物酶体增殖...     

Vitamin D Enhances Neutrophil Generation and Function in Zebrafish (Danio rerio)

Vitamin D (VD) is a major regulator of calcium metabolism in many living organisms. In addition, VD plays a key role in regulating innate and adaptive immunity in vertebrates. Neutrophils constitute an important part of the first line of defense against invading microbes; however, the potential effect of VD on neutrophils remains elusive. Thus, in this study zebrafish in different developmental stages were utilized to identify the potential role of VD in the basal homeostasis and functions of neutrophils. Our results showed that addition of exogenous VD₃ promoted granulopoiesis in zebrafish larvae. Reciprocally, neutrophil abundance in the intestine of adult zebrafish with a cyp2r1 mutant, lacking the capacity to 25-hydroxylate VD, was reduced. Moreover, VD-mediated granulopoiesis was still observed in gnotobiotic zebrafish larvae, indicating that VD regulates neutrophil generation independent of the microbiota during early development. In contrast, VD was incapable to influence granulopoiesis in adult zebrafish when the commensal bacteria were depleted by antibiotic treatment, suggesting that VD might modulate neutrophil activity via different mechanisms depending on the developmental stage. In addition, we found that VD₃ augmented the expression of il-8 and neutrophil recruitment to the site of caudal fin amputation. Finally, VD₃ treatment significantly decreased bacterial counts and mortality in zebrafish infected with Edwardsiella tarda (E. tarda) in a neutrophil-dependent manner. Combined, these findings demonstrate that VD regulates granulopoiesis and neutrophil function in zebrafish immunity.     

医疗机构前置审方系统运行实践与初期效果评价

目的:结合上海市松江区中心医院前置审方系统运行实践,探讨前置审方系统在医院处方质量管理中的作用,为完善医院自定义处方审核规则提供理论依据及数据支持,进一步规范医师处方行为,促进临床合理用药.方法:通过上海市松江区中心医院HIS系统及前置审方系统分别调取2019年3月-8月(前置审方前)、2020年3月-8月(前置审方后...     

Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review

Intussusception mostly occurs in childhood and is rare in adults. Although intussusception can occur in any part of the gastrointestinal tract, gastroduodenal intussusception caused by a gastric tumor is relatively uncommon in clinical practice. A PubMed search identified 24 published cases of gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor (GIST); however, it is possible that we missed other cases not included in PubMed. Here we report a case of gastroduodenal intussusception caused by gastric GIST in an 85-year-old man. He came to the hospital because of recurrent black stools. Plain computed tomography (CT) scan indicated a mass in the gastric antrum, with slight enhancement in the arterial phase on enhanced CT scan. He was diagnosed with GIST. In addition, images indicated that the mass overlapped into the duodenum, and gastroduodenal intussusception was thus considered. Gastroscopy showed a huge mass in the gastric body. According to the gastroscopy and CT results, gastroduodenal intussusception caused by a gastric tumor was considered. The patient underwent complete surgical removal, which revealed a mass originating from the gastric antrum and overlapping into the duodenum. The postoperative pathological diagnosis was intermediate-risk gastric GIST. The patient was followed up for 4 months without tumor recurrence.     

Effectiveness,nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patients

ObjectivesWe aimed to assess the effectiveness and nephrotoxicity of polymyxin B in critically ill patients with nosocomial pneumonia and to evaluate the utility of its therapeutic drug monitoring (TDM).MethodsWe retrospectively analyzed patients who received polymyxin B treatment for ≥48 h since the establishment of polymyxin B TDM in a 26‐bed tertiary referral intensive care unit. Univariate and multivariate analyses were conducted to assess the variables associated with polymyxin B effectiveness and nephrotoxicity.ResultsA total of 62 patients were enrolled. Most (56.5%) of the patients performed TDM, 54.3% of them reached the therapeutic target of area under curve across 24 h at steady state (AUC_ss,24h) of 50–100 mg h L⁻¹, and 10 patients had an AUC_ss,24h value of <50 mg h L⁻¹. Thirty‐six (58.1) and 31 (50.0%) patients had favorable clinical and microbiological responses, respectively. Reaching the therapeutic target of AUC_ss,24h (odds ratio [OR] = 13.15, p = 0.015), a favorable microbiological response (OR = 40.80, p = 0.00), and complicated with septic shock (OR = 0.12, p = 0.021) were independently associated with favorable clinical outcomes of polymyxin B treatment. The incidence of acute kidney injury (AKI) was 45.2%. A lower creatinine clearance (OR = 0.96, p = 0.008) and concomitant treatment with loop diuretics (OR = 5.93, p = 0.046) were predictive of nephrotoxicity.ConclusionOur findings show that TDM of polymyxin B is a valuable intervention, and the achievement of its optimal pharmacodynamic target can improve treatment outcome. Renal insufficiency and concomitant treatment with loop diuretics were found to be associated with the risk of nephrotoxicity.     

中药配方颗粒发展现状与临床推广应用面临的主要问题分析

通过文献研究和市场调查,阐明中药配方颗粒国内外市场获得了较好发展,产业的规模和效益都在提高,产品逐步得到医生和患者接受,在医院诊疗中占据了越来越重要的地位.与国外市场相比,国内市场的发展相对缓慢,原因主要包括对中药配方颗粒与饮片是否等效的质疑和价格比较高等问题,进而提出加强临床应用研究以检验其疗效、加快推行电子调配方式...     

石榴皮、石榴子质量标准提高研究

目的：提高石榴皮、石榴子的质量标准。方法：采用显微鉴别法、薄层色谱法鉴别石榴子药材;按照《中国药典》2010年版（一部）附录方法,测定石榴子药材水分、总灰分、酸不溶性灰分、醇溶性浸出物含量;采用HPLC法测定石榴皮、石榴子的鞣花酸含量。结果：确定了石榴子药材的显微特征,建立了石榴子的薄层鉴别方法,建立了石榴皮、石榴子的鞣花酸含量测定方法。结论：本研究建立的定性、定量方法,可用于石榴皮、石榴子药材质量控制。     

“明阴阳 医道之纲也”之明其用——名老中医陈业强学术思想研究

中医学通过将阴阳学说与五行学说相结合,而提出了整体观念,并构筑了中医学的理论体系。从整体观出发,强调人生命机体要"天人合一"与"形神合一",从而达到"阴阳冲和"的最佳生命活动状态。并以此来解释复杂的生命现象,把握生命运动的变化规律,而指导生命的各种活动。并通过治病必求其本的原则,指导着中医学防治疾病,养生保健。这正是《黄帝内经》应用阴阳学说作为世界观与方法论的根本与发挥。     

发展广东中药工业的思路

通过对广东中药工业现状的分析,提出大力调整产业结构,实施“大广药”名牌战略,注重改善中药品种、技术结构和剂型结构,提高产品外向度,提升医药投资引力,进一步完善中药产业发展政策措施等发展思路。     

消水方联合顺铂治疗恶性胸腔积液的临床观察

目的:观察口服消水方联合顺铂胸腔灌注治疗恶性胸腔积液的临床疗效。方法:118例恶性胸腔积液患者随机分为两组,治疗组65例采用口服中药消水方联合顺铂胸腔灌注,对照组53例单用顺铂胸腔灌注。以恶性胸腔积液的近期疗效、生活质量评分及临床症状积分为指标进行临床观察。结果:治疗组和对照组近期有效率分别为72.3%和66.1%,两组无显著性差异,但治疗组较对照组生活质量显著改善(P<0.05),症状明显缓解(P<0.05)。结论:消水方联合顺铂胸腔灌注治疗恶性胸腔积液,近期疗效未见明显提高,但可减轻症状,提高生活质量。