止血镇痛冰块的研制及临床应用效果观察

目的 寻找扁桃体摘除术后局部止血镇痛的有效方法。方法 自行研制了止血镇痛冰块(下称药冰)。100例扁桃体摘除术后患者(观察组)术后2小时起含化药冰,每1～2小时1次,每日8～12次;对照组(50例同期行扁桃体摘除术的患者)术后2小时舌根部含化冰淇淋或雪糕。观察两组术后出血疼痛、伤口愈合等情况。结果 观察组术后疼痛明显减轻,24小时出血量少,进食情况较好,与对照组相关指标比较,P均<0.01。结论药冰制作简单、价格低廉、无异味,止血、镇痛、促伤口愈合效果可靠,优于传统方法。     

Peer environment mediates parental history and individual risk in the etiology of cannabis use disorder in boys: a 10-year prospective study

Previous research has shown that a trait termed neurobehavior disinhibition (ND) measured in childhood predicts substance use disorder by young adulthood. The present investigation extends these findings by determining the degree to which peer environment mediates the association between ND and development of cannabis use disorder (CUD). ND was measured in a sample of 216 boys 10-12 years of age. The peer environment was assessed at age 16. Current CUD was determined at age 22. Paternal and maternal SUD predicted son's ND which, in turn, predicted son's peer environment and, subsequently, son's cannabis use frequency and CUD. Peer environment mediated the association between ND and cannabis use and ND and CUD. Maternal and paternal SUD predicted the peer environment. Parental SUD, son's ND, and son's peer environment predicted CUD at age 22 with 84% accuracy.     

Distinct architecture and composition of mouse axonemal radial spoke head revealed by cryo-EM

The radial spoke (RS) heads of motile cilia and flagella contact projections of the central pair (CP) apparatus to coordinate motility, but the morphology is distinct for protozoa and metazoa. Here we show the murine RS head is compositionally distinct from that of Chlamydomonas. Our reconstituted murine RS head core complex consists of Rsph1, Rsph3b, Rsph4a, and Rsph9, lacking Rsph6a and Rsph10b, whose orthologs exist in the protozoan RS head. We resolve its cryo-electron microscopy (cryo-EM) structure at 3.2-Å resolution. Our atomic model further reveals a twofold symmetric brake pad-shaped structure, in which Rsph4a and Rsph9 form a compact body extended laterally with two long arms of twisted Rsph1 β-sheets and potentially connected dorsally via Rsph3b to the RS stalk. Furthermore, our modeling suggests that the core complex contacts the periodic CP projections either rigidly through its tooth-shaped Rsph4a regions or elastically through both arms for optimized RS–CP interactions and mechanosignal transduction.

The majority of motile cilia and flagella are composed of nine dynein arm-containing peripheral doublet microtubules (DMTs) surrounding a central pair (CP) of MTs (the “9+2” axoneme). The radial spoke (RS) is a T-shaped protein complex with an orthogonal head pointing toward the CP and a stalk anchored on each A-tubule of the DMTs (1–5). It acts as the mechanochemical transducer between the CP and axonemal dynein arms to regulate flagellar/ciliary motility (6–11). The flagella of Chlamydomonas reinhardtii, a widely used model organism, contain two full-size RSs (RS1 and RS2) in each 96-nm repeat unit of the axoneme. In contrast, motile cilia/flagella of Tetrahymena thermophila and metazoa possess triplet RSs (RS1 to RS3) (2–4, 11). The Chlamydomonas RS is composed of at least 23 subunit proteins (RSP1 to RSP23) (2, 12, 13). Seventeen of them have mammalian homologs (14). Mutations leading to the loss of the entire RS or RS head result in immotile flagella in Chlamydomonas (6–8) but in rotatory ciliary beat in mammals, causing primary ciliary dyskinesia (PCD), a genetic syndrome characterized by recurrent respiratory infections, situs inversus, infertility, and hydrocephalus (4, 15–21).The most striking morphological differences in the RS lie in the RS head, the key structural domain that mediates the mechanosignaling by directly contacting projections of the CP (9–11). The heads of RS1 and RS2 consist of two structurally identical, rotationally symmetric halves that differ largely from that of RS3 (3, 4). Furthermore, their morphologies differ dramatically between protozoa and metazoa. In Chlamydomonas and Tetrahymena, for instance, the heads of RS1 and RS2 are rich in lateral branches that also form a connection between the two heads (2, 4). In contrast, in sea urchin (Strongylocentrotus purpuratus) and human, the heads of RS1 and RS2 resemble a pair of ice skate blades with many fewer interfaces toward the CP (3, 4). Despite the importance of the RS and RS head in cilia/flagella motility, the structural details of the RS and the RS–CP interactions remain poorly understood, especially in mammals.The RS heads have probably been remodeled to comply with both structural and functional alterations of the axoneme during evolution. How the morphological changes occurred, however, remains unclear. The Chlamydomonas RS head is composed of RSP1, -4, -6, -9, and -10 and part (the C terminus) of the stalk component, RSP3. Each of the symmetrical halves of the head contains one copy of these components (2, 10, 22). All the head components have mammalian orthologs (Rsph1, -4a, -6a, -9, -10b, and -3b) (11, 14). In sharp contrast to the markedly reduced surface area of metazoan RS heads, the peptides of human RSPH4A, -6A, and -10B are longer than their Chlamydomonas orthologs by 1.5-, 1.3-, and 4-fold, respectively (11). Only RSPH1 (309 amino acids [aa]) is shorter than RSP1 (814 aa) (11). The lengths of mouse RS head proteins are also similarly changed as their human counterparts (SI Appendix, Fig. S1A). Furthermore, while murine Rsph4a is essential for the head formation of RS1 to RS3 in motile multicilia of the trachea, ependyma, and oviduct (15), Rsph6a is specifically expressed in sperm for their normal flagellar formation (23). RSP4/Rsph4a and RSP6/Rsph6a are paralogs: RSP4 and RSP6 share 48% sequence identity (24), whereas murine Rsph4a is 63% identical to Rsph6a (SI Appendix, Fig. S1B). Sea urchin and Ciona, however, have only one ortholog (11, 25). These results suggest that, unlike the protozoan RS heads, the metazoan ones may not simultaneously contain Rsph4a and Rsph6a. The general shapes of the RS structure in axonemes have been determined by conventional electron microscopy (EM) (26–28) and cryo-electron tomography (cryo-ET) (2–5). Recently, a 15-Å-resolution RS structure of Chlamydomonas was resolved by cryo-EM single-particle analysis (29). The resolutions, however, do not suffice for the delineation of the locations of individual RS subunits.In the present study, by biochemical and structural analyses, we show the murine RS head is both compositionally and morphologically distinct from that of Chlamydomonas. Our study suggests that the RS head has experienced profound remodeling to probably comply with both structural and functional alterations of the axoneme during evolution for coordinated ciliary or flagellar motility.     

单克隆抗体ELISA检测班氏丝虫病人血清循环抗原

应用抗马来微丝蚴抗原4B_1株单克隆抗体(McAb)和抗马来成虫代谢抗原4B_7株McAb酶联免疫吸附试验(ELISA)检测班氏微丝蚴血症者血清中循环抗原,阳性率分别为78.46％(102/130)和87.13％(88/101);检测51例晚期丝虫病人血清,阳性率分别为3.92％和1.96％;36例经治疗后微丝蚴血症阴转者血清,阳性率分别为13.89％和8.33％。丝虫病非流行区99例肠道蠕虫感染者阳性率分别为16.16％和5.05％。结果表明抗马来成虫代谢抗原4B_7株McAb应用于诊断班氏丝虫感染的效果优于抗马来微丝螺4B_1株McAb。     

Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey

OBJECTIVE: Sugar-sweetened soft drinks contain large amounts of fructose, which may significantly increase serum uric acid levels and the risk of gout. Our objective was to evaluate the relationship between sugar-sweetened soft drink intake, diet soft drink intake, and serum uric acid levels in a nationally representative sample of men and women. METHODS: Using data from 14,761 participants age>or=20 years from the Third National Health and Nutrition Examination Survey (1988-1994), we examined the relationship between soft drink consumption and serum uric acid levels using linear regression. Additionally, we examined the relationship between soft drink consumption and hyperuricemia (serum uric acid level>7.0 mg/dl for men and >5.7 mg/dl for women) using logistic regression. Intake was assessed by a food-frequency questionnaire. RESULTS: Serum uric acid levels increased with increasing sugar-sweetened soft drink intake. After adjusting for covariates, serum uric acid levels associated with sugar-sweetened soft drink consumption categories (<0.5, 0.5-0.9, 1-3.9, and >or=4 servings/day) were greater than those associated with no intake by 0.08, 0.15, 0.33, and 0.42 mg/dl, respectively (95% confidence interval 0.11, 0.73; P<0.001 for trend). The multivariate odds ratios for hyperuricemia according to the corresponding sweetened soft drink consumption levels were 1.01, 1.34, 1.51, and 1.82, respectively (P=0.003 for trend). Diet soft drink consumption was not associated with serum uric acid levels or hyperuricemia (multivariate P>0.13 for trend). CONCLUSION: These findings from a nationally representative sample of US adults suggest that sugar-sweetened soft drink consumption is associated with serum uric acid levels and frequency of hyperuricemia, but diet soft drink consumption is not.     

电子喉镜在咽喉部肿物活检中的临床应用及病理分析*

目的探讨电子喉镜下对咽喉部肿物活检的临床应用,并分析病理结果。方法回顾性分析声带白斑、喉部肿瘤、下咽部肿瘤3类咽喉部常见肿物的患者资料共199例,均在门诊电子喉镜下表面麻醉后进行组织活检,送病理检查。分析3类病变患者的性别、年龄分布及病理意义。评价电子喉镜下活检咽喉部肿物的价值和意义。结果 3类病变的男性患者均明显多于女性,声带白斑患者年龄段分布明显比喉部和下咽部肿瘤患者年轻化(P0.05)。67例声带白斑病理:慢性炎伴鳞状上皮增生35例(52.24%),低度上皮内瘤变17例(25.37%),高度上皮内瘤变12例(17.91%),可疑浸润癌2例(2.99%),浸润癌1例(1.49%)。97例喉部肿瘤病理:高度上皮内瘤变/原位癌35例(36.08%),可疑浸润癌14例(14.43%),浸润癌48例(49.48%)。35例下咽部肿瘤病理:高度上皮内瘤变/原位癌6例(17.14%,),可疑浸润癌4例(11.43%),浸润癌25例(71.43%)。结论电子喉镜下表面麻醉活检咽喉部肿物,麻醉风险低,操作灵活,明显减少了患者经济成本,为后续治疗提供了病理学依据,是方便、快捷、有效的活检方法。     

胸腔镜下二尖瓣手术的体外循环管理（附80例报告）

目的总结胸腔镜下二尖瓣心脏外科手术的体外循环(CPB)管理经验和方法。方法 2013年1月-2017年6月80例胸腔镜下二尖瓣置换术,CPB采用中、浅低温,全部采用股动静脉插管,并在CPB中予以负压辅助静脉吸引,术中全部采用HTK液灌注心肌予以心肌保护,对CPB建立方法、CPB过程及手术后结果进行评价。结果 80例心脏二尖瓣疾病患者全部予以痊愈出院。全部患者CPB转流时间为97~308(192.2±54.2)min;升主动脉阻断时间为50~233(130.8±46.9)min;辅助转流时间为30~53(41.8±8.1)min。术后呼吸辅助时间6~24(20.6±14.1)h;术后ICU时间为2~6(3.3±2.6)d;术后住院时间7~10 d;术中及术后无股动静脉插管相关并发症,患者术后均恢复良好,脱机良好,无严重并发症。出院随访时间3~12个月,结果满意。结论胸腔镜下二尖瓣手术中,CPB方法安全、可行,开展此手术的初期CPB时间和主动脉阻断时间较传统手术时间较长,应加强CPB的管理,避免术中术后产生CPB相关性并发症。     

内镜下金属钛夹对比药物治疗上消化道出血疗效的Meta分析

目的评价内镜下金属钛夹治疗上消化道出血的临床价值。方法通过计算机检索Pubmed、CNKI数据库、Web of Knowledge、Cochrane图书馆对照试验注册库、万方数据库从建库至2017年的有关内镜下金属钛夹对比药物注射治疗上消化道出血的相关文献,采用Cochrane协作网提供的RevMan 5.0版软件进行统计处理,对纳入资料的异质性进行分析,计算OR值和95%可信区间。结果按照入选标准,纳入了7项临床试验,共704例患者。Meta分析结果显示,钛夹治疗上消化道出血有效率更高(OR=5.74,95%CI:3.28~10.04)、72 h再出血率低(OR=0.24,95%CI:0.14~0.43)、转外科手术率低(OR=0.14,95%CI:0.05~0.37)。结论目前的研究结果显示,内镜下金属钛夹治疗上消化道出血的疗效优于单纯采用药物治疗,且该方法具有止血有效率高、72 h再出血率低和转外科手术率低等优点,具有临床推广及应用价值。     

Preparation and characterization of chitosan membranes

The present study investigates a new solvent system for the dissolution of chitosan and a new method for preparing chitosan membranes. First, aqueous tartaric acid was used to pretreat chitosan. Then, the chitosan was precipitated with ethanol or other regenerating agents, and 1.5 mL of 1-ethyl-3-methylimidazolium acetate ([EMIM]AC) was added to obtain translucent suspensions. The chitosan membranes were prepared by casting the suspensions on glass plates and allowing solvent evaporation. The structure and properties of the films were investigated by SEM, FT-IR, XRD and TGA. Also, the mechanical properties, as well as physical and chemical characteristics, of the chitosan films were evaluated. The results indicated that the optimum dissolution time was 10 min and the most suitable drying temperature was 60 °C. The thus-prepared film was moderately thick (about 0.02 mm) and had a smooth surface, without curling. The chitosan film prepared by ethanol regeneration had a tensile strength of up to 24 MPa, a minimum swelling degree of 78%, and a water vapor transmission rate of 270 g m⁻² d⁻¹ without the addition of plasticizer.

The present study investigates a new method for preparing chitosan membranes. The thus-prepared film was moderately thick and had a smooth surface, without curling.