应用循证医学的模式和理念,治疗老老年高血压病

自1991年循证医学（evidence-based medicine,EBM）在加拿大Mcmaster大学Gordon Guyatt教授首先使用后,EBM在各个医学领域迅猛发展,对临床医学和医师培训起了跨时代的作用。EBM的概念也逐渐完善,与临床关系更为接近。最新的EBM定义为,帮助临床医生综合最新或最好的研究成果,临床医生的临床专长和经验,患者的选择,     

SD大鼠羊水间充质干细胞向神经样细胞体外诱导分化

目的:探讨体外诱导羊水间充质干细胞(AF-MSCs)分化成神经干细胞.方法:10只SD怀孕大鼠,180-240 g,胎龄16d,过量腹腔麻醉致死,开腹全部切除子宫,在无菌的条件下抽取全羊水,采用贴壁法分离AF-MSCs,体外培养扩增,观察细胞生长特性,流式细胞仪检测AF-MSCs表面抗原表达及细胞周期.取第3代AF-MSCs,加入预诱导液(DMEM/F12、100 mL/L FBS、1 mmol/Lβ-MEM)诱导24 h,然后加入诱导液(DMEM/F12、100 mL/L FBS、5 mmol/L β-MEM)诱导24 h,最后在分化维持培养液(DMEM/F12、20μg/L EGF、20μg/L bFGF)中培养,行免疫荧光染色,检测NSE和GFAP的表达.结果:成功分离、培养和传代SD大鼠AF-MSCs,流式细胞术检测提示大鼠AF-MSCs的G0/G1期细胞比例约为87.5%、S+G2+M期比例为12.5%,表达CD44为98.3%、GD29为70%、和CD105为33.2%、不表达CD45为0.5%,CD34为1%,DLA-DR(MHC class Ⅱ)为0.1%.诱导后,AF-MSCs能表达神经细胞标示物NSE和GFAP,且可在体外继续存活2 wk左右.结论:羊水中也存在MSCs,与其他来源的MSCs特点相符:羊水可以作为一种新的胎儿MSCs来源,而且能在体外诱导分化为神经细胞.     

扩大经腹膜前修补手术治疗成人获得性腰疝的临床研究

目的探讨扩大经腹膜前(Sublay)手术修补治疗成人获得性腰疝的有效性及手术要点。方法回顾性分析2010年1月至2014年12月华中科技大学同济医学院附属武汉中心医院疝与腹壁外科采用扩大经腹膜前手术方式治疗的24例成人腰疝病人的临床资料。其中男性17例,女性7例;年龄47~79岁,平均(59.6±11.2)岁;右侧19例,左侧5例;初发22例,复发疝2例;开放行肾脏切除术病人12例,开放肾脏切开取石术病人3例,开放耻骨截骨术病人1例,腹腔镜肾囊肿开窗术病人2例,腹腔镜肾上腺瘤切除术病人2例,腰部闭合外伤病人4例。结果 24例腰疝扩大经腹膜前修补手术均顺利完成,术中无肾脏、输尿管及肠管损伤,术后疼痛需使用镇痛剂辅助治疗病人2例,使用时间1周;术后住院时间为7~15 d,平均(10.3±1.2)d;术后7 d时所有病人均未见局部血肿、伤口感染及脂肪液化发生。术后随访时间为6~48个月,平均随访时间为(15.3±3.2)个月,所有病人均获得随访,未见腰疝复发,无慢性疼痛及补片感染发生。结论扩大经腹膜前修补手术证实是治疗成人获得性腰疝的一种安全有效的手术方式。     

Distinct roles for two synaptotagmin isoforms in synchronous and asynchronous transmitter release at zebrafish neuromuscular junction

An obligatory role for the calcium sensor synaptotagmins in stimulus-coupled release of neurotransmitter is well established, but a role for synaptotagmin isoform involvement in asynchronous release remains conjecture. We show, at the zebrafish neuromuscular synapse, that two separate synaptotagmins underlie these processes. Specifically, knockdown of synaptotagmin 2 (syt2) reduces synchronous release, whereas knockdown of synaptotagmin 7 (syt7) reduces the asynchronous component of release. The zebrafish neuromuscular junction is unique in having a very small quantal content and a high release probability under conditions of either low-frequency stimulation or high-frequency augmentation. Through these features, we further determined that during the height of shared synchronous and asynchronous transmission these two modes compete for the same release sites.     

功能练习与康复促进在治疗肩关节周围炎病人中的效果分析

肩关节周围炎,是临床常见的由于肩关节周围软组织退变基础上发生的以疼痛、活动受限为主的疾病.多发生于50岁左右的中老年人,女性病人多见.本病病程较长,治疗方法较多.经过临床实践,采取了综合康复的治疗方法,并根据病期配合循序渐进的、有针对性的功能练习与康复促进,疗效较好,现报告如下.     

Tid1 functions as a tumour suppressor in head and neck squamous cell carcinoma

Human tumourous imaginal disc (Tid1), a human homologue of the Drosophila tumour suppressor protein Tid56, is involved in multiple intracellular signalling pathways such as apoptosis, cell proliferation, and cell survival. Here, we investigated the anti‐tumourigenic activity of Tid1 in head and neck squamous cell carcinoma (HNSCC) in vitro and in vivo. Firstly, the clinical association between Tid1 expression and progression of HNSCC was explored. It was found that expression of Tid1 was negatively associated with tumour status, recurrence, and survival prognosis using immunohistochemical analysis of primary HNSCC patient tumour tissue. Secondly, ectopic expression of Tid1 in HNSCC cells was shown to significantly inhibit cell proliferation, migration, invasion, anchorage‐independent growth, and xenotransplantation tumourigenicity. Thirdly, we showed that overexpression of Tid1 attenuated EGFR activity and blocked the activation of AKT in HNSCC cells, which are known to be involved in the regulation of survival in HNSCC cells. On the other hand, ectopic expression of constitutively active AKT greatly reduced apoptosis induced by Tid1 overexpression. Together, these findings suggest that Tid1 functions as a tumour suppressor in HNSCC tumourigenesis. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Bacterial infection in deep paraspinal muscles in a parturient following epidural analgesia

We report a case of paraspinal muscle infection shortly after epidural analgesia for labor pain in a nulliparous parturient who was subjected to emergent Cesarean section because of fetal distress. Epidural morphine was administered for 3 days for postoperative pain control. She began to have constant lower back pain on postpartum Day 4. Magnetic resonance image study revealed a broad area of subcutaneous edema with a continuum along the catheter trajectory deep to the paraspinal muscles. An injection-related bacterial infection was suspected; the patient was treated with intravenous antibiotics and was soon cured uncomplicatedly. Epidural analgesia is effective to control labor pain and, in general, it is safe. However, the sequelae of complicated infection may be underestimated. We herein report a case complicated by iatrogenic infection, discuss the causes, and give suggestions for prevention.     

一次随机尿碘在碘缺乏病监测中应用的可行性

同步采集了１００名７～１４岁儿童一次随机尿和２４ｈ尿，结果显示：１１～１４岁儿童２４ｈ尿量接近１１，一次随机尿碘与２４ｈ尿碘呈统计学显著正相关，并有良好的线性回归关系。证明在一定范围内，可通过监测一次随机尿碘推测２４ｈ尿碘．还分两个季节对１１名成人进行了一次随机尿的连续采集，发现各次采样人群尿碘平均水平无统计学显著差异，说明就群体而言，一次随机尿碘可以代表一个时期内人群碘营养状况。     

Two polymorphisms in NEDD4L gene and essential hypertension in Chinese Hans - a population-based case-control study

Neural precursor cell expressed developmentally down-regulated 4-like (NEDD4L) gene may play an important role in the development of hypertension by regulating the amiloride-sensitive epithelial sodium channel for sodium reabsorption. Recently, a functional polymorphism located at the last nucleotide of exon 1 (rs4149601) of the NEDD4L gene were found to be associated with hypertension both in African Americans and whites, and a "flip-flop" association with hypertension was found in two white samples for a polymorphism located at intron 13 (rs3865418). In this study, we aimed at examining the role of these two variants on essential hypertension in Chinese Hans. In a population-based association study, we observed significantly higher prevalence of T allelic frequencies (p = 0.023) in hypertensives than normotensives. In logistic regression analysis, the stronger association was found under the additive model with an odds ratio of 1.31 (1.04-1.67) for T allele (p = 0.025). The association remained significant (p = 0.039) with an odds ratio of 1.29 (1.01-3.66) when adjusting for age and sex. We also constructed an ANCOVA factorial model by using clinical parameters as the dependent variable for rs3865418 polymorphisms. A significantly higher diastolic blood pressure was observed at rs3865418 in the dominant model for the T allele (p = 0.009). The positive association still exist after controlling age and sex (p = 0.013). For rs4149601 polymorphism, however, we did not observe a positive association with hypertension by implicating either logistic regression models or ANCOVA models. Thus, our results support rs3865418 but not rs4149601 polymorphism of NEDD4L gene implicated in the prevalence of hypertension in Chinese Hans.