含CpG基序的单链寡核苷酸增强感染人轮状病毒乳鼠的细胞免疫应答

目的 探讨含CpG基序的单链寡核苷酸(CpG ODN)干预对感染人轮状病毒(HRV)乳鼠细胞免疫应答的影响.方法 将40只ICR乳鼠随母鼠按窝随机均分为对照组、HRV感染组、CpG ODN预处理组和CpG ODN治疗组,每组10只.病毒攻击后第4天处死乳鼠,无菌取小肠、脾,对小肠组织按统一损伤标准评分,测定乳鼠脾脏指数,噻唑蓝(MTT)比色法检测脾淋巴细胞刺激指数,ELISA法检测脾淋巴细胞培养上清液中IFN-γ、IL-4的含量,流式细胞仪检测脾T淋巴细胞亚群.采用单因素方差分析比较各组数据.结果 HRV感染组、CpG ODN预处理组和CpG ODN治疗组肠黏膜损伤评分分别为4.00±1.31、2.75±1.28和2.87±0.99,各组间比较,差异有统计学意义(F=11.32,P＜0.01),与HRV感染组比较,CpG ODN预处理组、CpG ODN治疗组的小肠组织黏膜损伤评分显著降低,差异有统计学意义(P＜0.05).与对照组比较,HRV感染组脾淋巴细胞刺激指数、CD8+T淋巴细胞所占百分比升高,CD4+T淋巴细胞所占百分比、CD4+/CD8+降低,Th1细胞因子IFN-γ表达增强,CpG ODN预处理组、CpG ODN治疗组的脾脏指数、脾脏淋巴细胞刺激指数、CD4+T淋巴细胞、CD8+T淋巴细胞所占百分比、IFN-γ均升高(P＜0.05);与HRV感染组比较.CpG ODN预处理组、CpG ODN治疗组的脾脏指数、脾脏淋巴细胞刺激指数、CD4+T淋巴细胞所占百分比、CD4+/CD8+和IFN-γ均升高(P＜0.05).结论 CpG ODN增强感染HRV乳鼠的细胞免疫应答,以Th1型细胞免疫应答为主.

Abstract：

Objective To investigate the effects of CpG oligodeoxynucleotide (ODN) on cellular immune responses in suckling mice infected with human rotavirus (HRV). Methods Forty ICR suckling mice were randomly divided into four groups: control group. HRV infection group, CpG ODN pretreatment group and CpG ODN treatment group. Suckling mice were sacrificed four days after rotavirus challenge. Small intestine and spleen samples were collected under sterile condition. Thedegree of small intestinal mucosal injures was evaluated with standard scoring criteria. The spleen index was calculated and spleen lymphocyte stimulation index was detected by methyl thiazolyl tetrazolium ( MTT) assays. Levels of gamma interferon (IFN-γ), interleukin-4 ( IL-4) in the supernatant of spleen lymphocyte culture were detected by enzyme linked immunosorbent assay (ELISA). T lymphocyte subsets were analyzed by flow cytometry. The data was compared by one way ANOVA. Results The scores of mucosal injures of mice in HRV infection group, CpG ODN pretreatment group and CpG ODN treatment group were 4. 00 ±1. 31, 2. 75 ±1. 28 and 2. 87 ±0. 99, respectively, and the differences among groups were statistically significant (F=ll. 32,P＜0. 01). The scores of mucosal injures in CpG ODN pretreatment group and CpG ODN treatment group were both lower than that in HRV infection group (P＜0. 05). Compared with control group, spleen lymphocyte stimulation index and the percentage of CD8+ T lymphocytes were higher, the percentage of CD4+ T lymphocyte and ratio of CD4+ /CD8+ T cells were lower, levels of T helper (Th)1 type cytokine IFN-y increased significantly in HRV infection group; while the spleen index, spleen lymphocyte stimulation index, percentages of CD4+ and CD8+ T lymphocytes, IFN-y levels were all increased in CpG ODN pretreatment group and CpG ODN treatment group (P＜0. 05). The spleen index, spleen lymphocyte stimulation index, the percentage of CD4+ T lymphocytes, CD4+/CD8+ ratios and IFN-y levels in CpG ODN pretreatment group and CpG ODN treatment group were all significantly higher than HRV infection group (P＜0. 05). Conclusion CpG ODN potently enhances cellular immune responses in ICR suckling mice infected with HRV and CpG ODN could induce dominant Th1 response.     

基于智能手机的慕课学习联合CBL教学模式在眼科教学中的应用

目的探索基于智能手机的慕课学习联合CBL教学模式在眼科学临床教学中的应用效果。方法将80名在附属盛京医院眼科进行临床见习的医学本科生分为试验组40名(基于智能手机的慕课学习联合CBL教学模式)和对照组40名(传统临床教学模式),比较两组的病例分析成绩、理论成绩、临床技能成绩及调查问卷结果。结果与对照组相比,试验组的各项平均成绩显著增高,差异具有统计学意义(P<0.05)。调查问卷结果显示,多数学生认为基于智能手机的慕课学习联合CBL教学模式较传统教学模式能激发学习兴趣、培养良好的医学思维方式,差异具有统计学意义(P<0.05)。结论基于智能手机的慕课学习联合CBL教学模式优于传统教学模式,可提升学生的学习效果,建立科学的临床思维,提高教学质量。     

4种酰胺类合成大麻素在人肝微粒体中Ⅰ相代谢规律研究

研究4种近来滥用的酰胺类合成大麻素ADB-4en-PINACA、4CN-CUMYL-BUTINACA、5F-EMB-PICA和4F-MDMB-BUTICA的体外人肝微粒体代谢规律。取人肝微粒体，加合成大麻素使成1 mg/mL，模拟人体代谢过程孵育10 min、60 min或3 h，用液相色谱-四极杆-飞行时间串联质谱（LC-QTOF-MS）分析技术检测并鉴定代谢产物的结构，探索代谢途径。结果显示，5F-EMB-PICA、4F-MDMB-BUTICA、ADB-4en-PINACA和4CN-CUMYL-BUTINACA存在羟基化、羧基化、N-脱烷基和酯水解等27种Ⅰ相代谢途径，其中主要的Ⅰ相代谢途径为酯水解、双键氧化成邻二醇、氧化脱氟羧基化、单羟基化（烷基侧链或吲哚/吲唑环）和N-脱烷基。本研究可为司法鉴定4种酰胺类合成大麻素的滥用和污水毒情评估提供潜在的检测标志物。     

某三级综合医院医护人员多重耐药菌防控现状调查分析△

目的：调查某三级综合医院全院医生与护士多重耐药菌（MDRO，multidrug-resistant organism）感染防控知识掌握现状，提高MDRO防控依从性。方法：采用方便抽样法，应用自行设计的MDRO防控评估调查问卷，将调查二维码发送至该院感控群，填写时间期限为一周，分析MDRO防控现状并收集建议，应用Logistic回归分析影响因素并利用受试者工作特征曲线（ROC，receiver operating characteristic curve）评价模型。结果：研究回收问卷954份，经过筛选后剩余933份，护士占79.74%，医生占20.26%；本次调查平均成绩为（70.51±24.63）分，≥80分者占34.94%，护士的及格率（χ2=26.337，P＜0.001）高于医生；Logistic回归分析显示，专业背景、科室和工作年限均为是否及格的影响因素（均P < 0.05），ROC曲线下面积为0.643；问卷结果显示目前获取MDRO知识以与同事交流为主要方式，占84.75%；MDRO消毒不到位以缺乏具体的操作流程图为主要原因，占73.98%。调查共收集建议267条，其中加强培训学习所占比例最高达18.35%；重新设计醒目标识比例达15.36%，尤其提到标识应能够区分不同种类MDRO细菌等。结论：需加强临床医生和低年资医护人员，尤其是医技人员及工作年限≤5年者MDRO防控知信行方面的培训及考核。通过采取将患者MDRO信息加入转接单和检查单，以便于科室之间互通信息，重新设计醒目隔离标识和MDRO防控标准流程图等防控措施，降低MDRO检出率和感染率。     

免疫治疗在头颈鳞癌中的研究进展

摘要： 尽管近年来外科手术和综合治疗手段在不断进步和发展， 但头颈鳞癌患者的5年生存率并未得到显著提高。因此， 提高头颈鳞癌治疗效率， 改善头颈鳞癌治疗手段迫在眉睫。作为一种颇具前景的新型疗法， 免疫治疗具有较低的毒性及高度特异性， 并且已逐渐被应用到包括头颈鳞癌在内的多种肿瘤的临床治疗之中。在头颈鳞癌的免疫治疗之中， 研究人员在单一细胞因子治疗的基础上进一步开发出了复合性系统疗法并取得了不错的疗效。另一方面， 包括蛋白/多肽-树突细胞疫苗在内的多种肿瘤疫苗治疗方法进入了大量临床试验研究中。此外， 针对PD-1 等免疫检查点的免疫疗法受到了广泛关注， 相关的抑制性抗体也已获批进行复发或转移性头颈鳞癌的治疗。本文旨在对以上多种免疫治疗手段在头颈鳞癌中的相关研究进展作一简要综述。     

Feasibility and Safety of Using an Esophageal Protective System to Eliminate Esophageal Thermal Injury: Implications on Atrial-Esophageal Fistula Following AF Ablation

Background: Ablation for atrial fibrillation (AF) requires energy delivery in close proximity to the esophagus (Eso) which has accounted for the LA-Eso fistula, a rare but life-threatening complication.
Purpose: We evaluated an Eso cooling system to protect the Eso during RF ablation.
Methods and Results: An " in vitro " heart-Eso preparation was initially used to test a temperature-controlled fluid-circulating system (EPSac [esophageal protective system]—RossHart Technologies Inc.) and an expandable compliant Eso sac during cardiac RF delivery (4 mm tip, perpendicular to the heart, 15 g pressure) at 25, 35, and 45 W, 100 ± 5 Ω for 30 seconds with the EPSac at 25, 15, 10, and 5°C. All cardiac lesions were transmural. Eso thermal injury could only be avoided with the EPSac at 10 and 5°C. The system was then tested in 6 closed chest dogs, each receiving 12 RFs (LA aiming at the Eso) for 30 seconds: without EPSac (control) at 35 W (1 dog); at 45 W with EPSac at 25°C (1 dog), 10°C (2 dogs), and 5°C (2 dogs). The EPSac volume was intentionally increased to displace the Eso toward the LA (2 dogs 5 and 10°C). Eso injured control and EPSac at 25°C; Eso spared EPSac at 5 and 10°C, without Eso displacement. Shallow external Eso injury noted when intentionally displacing the Eso toward the LA.
Conclusions: The EPSac spares the Eso from collateral thermal injury. It requires circulating fluid at 5 or 10°C and a compliant sac to avoid displacement of the Eso. Its safety and efficacy remain to be demonstrated in patients undergoing AF ablation.     

肺腺癌患者18F-FDG PET/CT半定量参数与EGFR基因突变亚型的关系

目的探讨肺腺癌患者~(18)F-FDG PET/CT半定量参数与表皮生长因子受体(EGFR)基因突变亚型间(19号外显子缺失突变和21号外显子点突变)的关系。方法收集64例肺腺癌患者术前~(18)F-FDG PET/CT及EGFR基因突变资料。葡萄糖代谢显像原发灶半定量参数包括最大标准化摄取值(SUV_(max))、平均标准化摄取值(SUV_(mean))、肿瘤代谢体积(MTV)和总糖酵解量(TLG)。经单因素和多因素Logistic回归分析评估各参数与突变亚型间的关系,通过AUC评估关联效能。结果 19号、21号外显子突变比例为23∶41。单因素分析显示,作为连续变量,原发灶最大径较小[OR=0.942,95%CI(0.890,0.998)]及低水平原发灶MTV(pMTV)[OR=0.957,95%CI(0.923,0.991)]更可能是21号外显子点突变;作为分类变量,原发灶最大径较小[26.5 mm:OR=3.759,95%CI(1.284,11.005)]、高水平SUV_(mean)[≥4.35:OR=4.267,95%CI(1.088,16.726)]及低水平pMTV[11.2 cm~3,OR=7.000,95%CI(1.798,27.253)]更易发生21号外显子点突变。多因素分析仅发现分类变量低水平pMTV更易发生21号外显子点突变(OR=8.093,P=0.041)。结论 EGFR基因突变肺腺癌患者原发灶~(18)F-FDG PET/CT半定量参数可能与19和21号外显子突变亚型存在一定相关性,但关联程度有限。     

河北省中医药学科技查新项目及科研发展状况的分析

目的 分析河北省中医药学科技查新项目及科研发展状况。方法 采用Microsoft EXCEL构建2018年1月－2021年12月年河北省医学情报研究所完成的中医药学查新项目数据库,统计项目的数量、鉴定查新、国内外查新、不同性质机构申请查新项目的数量,及不同研究类型和学科方向的查新项目数量。结果 2018－2021年中医药学查新呈逐年降低的趋势,而鉴定查新呈逐年升高的趋势;国内外查新较少,均未超过2%。中医药医疗机构和综合医疗机构是申请中医药学查新的主体。中医药学查新项目主要集中在临床研究、临床及实验和实验研究,中医学的查新项目较多,但是呈逐年降低的趋势,而中药学和中西医结合医学的查新比例呈逐年升高的趋势。结论 本省中医药学科研水平显著提升,而2021年呈显著下降的趋势,但是成果转化明显增多,临床研究和中医学是中医药学科研的主体,而中药学和中西医结合医学的科研能力逐渐加强,高水平创新的科研需要进一步提升。