腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后疗效比较中的系统评价

目的评价腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后的临床疗效。方法计算机检索Co-chrane Library、PubMed、Embase、SCI、CNKI、CBM、VIP、WANFANG DATA,纳入腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后疗效比较的随机对照试验,对纳入研究的方法学质量进行评价,用Cochrane协作网提供的RevMan 5.1软件对数据进行统计分析,并对统计结果进行系统评价。结果共纳入6个随机对照试验,共计1 885例患者。Meta分析结果显示:腹膜外切口单层缝合与常规分层缝合法在手术时间[MD=-17.09,95%CI(-19.32,-14.87)],术后切口感染率[RR=0.06,95%CI(0.03,0.12)],7 d内出院率[RR=1.17,95%CI(1.13,1.22)]方面差异均具有统计学意义,但两者在术后疼痛程度(需应用镇痛药物比率)[RR=1.05,95%CI(0.91,1.20)]方面的差异无统计学意义。结论目前研究表明,与常规分层缝合法相比,腹膜外切口单层缝合法能显著缩短化脓性或坏疽性阑尾炎患者的手术时间,降低术后切口感染率,提高7 d内出院率,但本研究纳入的样本量小且质量不高,因此,有必要开展更多高质量、多中心的随机盲法对照试验进一步予以证实其疗效。     

不同呼吸机湿化管道系统在老年机械通气患者中的应用效果对比

目的:探讨不同呼吸机湿化管道系统在老年机械通气患者中的应用效果。方法:选取老年机械通气患者140例,随机分为3组,其中A组(n=43)使用MR410型湿化管道系统,B组(n=47)使用MR730型湿化管道系统,C组(n=50)采用MR 850型一次性双加热式、自动加水加湿湿化管道系统。观察3组湿化效果、并发症发生情况、通气时间及管道护理情况。结果:C组湿化效果适中比例最高,其次为B组,A组最低,3组间差异有统计学意义(P<0.01)。C组无导管痰痂和气道痉挛的发生,A组发生率最高,3组间差异有统计学意义(P<0.01)。C组通气时间、管道总更换次数、呼吸机管道护理时数均低于A、B组,差异有统计学意义(P<0.01)。结论:使用MR850型一次性双加热式、自动加水加湿湿化管道系统湿化效果最好,能降低并发症发生率,缩短通气时间和护理工作量。     

湖北省接受艾滋病HAART患者CD4+T淋巴细胞变化趋势及影响因素

目的 分析湖北省接受艾滋病HAART患者CD4⁺T淋巴细胞变化趋势及影响因素。 方法 筛选2012年1月1日以后接受HAART的成年患者,利用一般线性模型、重复测量方差分析来分析患者的基线、治疗后6、12个月的CD4⁺T淋巴细胞计数情况及影响因素。 结果 1 843例研究对象基线CD4⁺T淋巴细胞计数均值为(218.94±143.96)个/μl,接受HAART后6个月为(334.31±188.62)个/μl,12个月后为(382.79±204.44)个/μl,差异有统计学意义(F=6 856.98,P=0.000)。影响HAART治疗后CD4⁺T淋巴细胞计数上升的主要因素是:性别、开始治疗年龄、WHO临床分期、初始治疗方案、基线CD4⁺T淋巴细胞计数。受性别、基线CD4⁺T淋巴细胞计数、开始治疗年龄、初始治疗方案等影响,治疗后CD4⁺T淋巴细胞计数随时间推移呈线性上升趋势;其中,女性、开始治疗年龄越小、基线CD4⁺T淋巴细胞计数越高、初始治疗方案含二线药物的患者上升较快。受WHO临床分期因素影响,治疗后CD4⁺T淋巴细胞计数随时间推移上升趋势符合二次方曲线方程,WHO临床分期越靠前,上升速度较快。 结论 湖北省艾滋病患者接受HAART后CD4⁺T淋巴细胞计数上升受多种因素影响,建议针对不同的患者及早开展HAART,提高抗病毒治疗的效果和患者生命质量。     

Cross-sectional analysis of the implant-abutment interface

The purpose of this study was to develop a technique to evaluate the implant-abutment gap of an external hexagon implant system as a function of radius. Six implants of 3.75 mm in diameter (Conexao Sistema de Protese Ltda, Sao Paulo, Brazil) and their respective abutments were screw connected and torqued to 20 N cm(-1). The implants were mounted in epoxy assuring an implant long-axis position perpendicular to the vertical axis. Each implant was grounded through its thickness parallel to implant long-axis at six different distance interval. Implant-abutment gap distances were recorded along the implant-abutment region for each section. Individual measurements were related to their radial position through trigonometric inferences. A sixth degree polynomial line fit approach determined radial adaptation patterns for each implant. Micrographs along implant sections showed a approximately 300 mum length implant-abutment engagement region. All implants presented communication between external and internal regions through connection gaps and inaccurate implant-abutment alignment. Average gap distances were not significantly different between implants (P > 0.086). Polynomial lines showed implant-abutment gap values below 10 mum from 0 mum to approximately 250 mum of the implant-abutment engagement region. Gap distances significantly increased from approximately 250 mum to the outer radius of the implant-abutment engagement region. The technique described provided a broader scenario of the implant-abutment gap adaptation compared with previous work concerning implant-abutment gap determination, and should be considered for better understanding mechanical aspects or biological effects of implant-abutment adaptation on peri-implant tissues.     

Pediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare

The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID-19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families.     

一种西地那非类似物的合成工艺研究

目的 探讨合成一种西地那非类似物的新方法.方法 设计以WG 001-01-08和五硫化二磷为原料,经过硫化得到目标化合物（一种西地那非类似物）的合成路线,并以收率和杂质为指标考察反应试剂、反应温度、加料顺序对反应的影响.结果 成功制备了目标化合物,收率为90％;较佳反应条件为以4-甲基吡啶为溶剂,120℃反应4h,先加WG001-01-08后加五硫化二磷.结论 新方法收率较高,杂质少,反应条件温和,适合工业化生产.     

自体外周血造血干细胞和自体骨髓移植治疗急性髓性白血病的临床疗效比较研究

目的：比较自体外周血干细胞移植（APBSCT）与自体骨髓移植治疗CR1期急性髓性白血病（AML）的临床疗效。方法：用APBSCT治疗AML患者27例，用非净化自体骨髓移植（ABMT）治疗AML患者13例，用净化自体骨髓移植（PABMT）治疗AML患者25例。结果：（1）APBSCT组造血重建校其他两组显著加快；（2）APBSCT组的3年无病生存率（DFS）和复发率（RR）分别为51．％和42．2％，与ABMT组的46．2％、46．7％相当，但与净化ABMT组的72．9％、23．7％相比差异有显著性意义。（3）三组的移植相关死亡率（TRM）差异无显著性意义，死亡的主要原因为感染和内脏出血。结论：APBSCT治疗CR1期AML，其造血重建显著快于ABMT，其疗效与ABMT相当，而显著低于PABMT。     

Elimination of myeloma cells from bone marrow by using monoclonal antibodies and magnetic immunobeads

The efficacy of immunomagnetic beads to purge human myeloma cells from bone marrow ex vivo was evaluated. The optimal conditions for purging were studied first by using three myeloma cell lines: RPMI-8226, SKO- 007, and SKMM-2. Myeloma cells labeled with the vital fluorescent dye Hoechst 33342 were admixed with normal bone marrow cells, and two monoclonal antibodies reactive with the myeloma cells (PCA-1 and BL-3) were added alone or in combination with the cells. Magnetic beads coated with goat antimouse immunoglobulin G were then added, and the tumor cells to which beads were attached were separated from the mixture with a magnet. The efficacy of tumor cell removal was dependent on the bead-to-tumor ratio; a ratio of more than 500 was optimal in the presence of excess normal marrow cells. The combination of monoclonal antibodies PCA-1 and BL-3 increased the tumor cell removal as compared with either antibody alone. Two cycles of treatment were more effective than one cycle was. Under optimal conditions, 2.3 to 4 logs of tumor cells could be removed from the mixture containing 10% myeloma cells without a significant loss of normal hematopoietic progenitors as measured by CFU-GM, CFU-GEM, and BFU-E. When the efficacy of this procedure was tested on fresh bone marrow from patients with multiple myeloma (MM) by using the combination of PCA-1, BL-3, and J-5, 1.6 to 2.5 logs of tumor cells could be removed by one cycle of treatment, even from marrows containing less than 10% myeloma cells. These observations support the use of monoclonal antibody combinations and immunobeads as a reliable and nontoxic method to eliminate contaminating myeloma cells ex vivo in preparation for autologous bone marrow transplantation in patients with MM.     

Oxidative metabolism of the human eosinophil

We have compared the oxidative metabolism of human eosinophils (80%-90% purity) to that of neutrophils. Hexose monophosphate (HMP) shunt activity of eosinophils was higher than that of neutrophils under either resting or phagocytizing conditions. Eosinophil HMP shunt activity also was stimulated by phorbol myristate acetate, a membrane- active agent. Eosinophils showed a marked incorporation of 125I into trichloroacetic acid-insoluble material under resting conditions, which increased markedly during phagocytosis. Eosinophils likewise showed a greater reduction of nitroblue tetrazolium dye during phagocytosis than did neutrophils. Measurement of other parameters of oxidative metabolism indicated that eosinophils generated superoxide anion following phagocytosis and also elicited a burst of chemiluminescence similar to that observed during phagocytosis by neutrophils. Measurement of NADPH oxidase activity demonstrated that this enzyme was 3-6 times more active in fractions isolated from eosinophils than in corresponding fractions isolated from neutrophils; this was observed over a range of substrate concentrations. The eosinophil enzyme sedimented differently than the neutrophil enzyme with differential centrifugation; neither showed sedimentation characteristics of peroxidase. These data indicate that eosinophils possess a similar, although in some ways more potent, oxidative burst than neutrophils and are consistent with a role for NADPH oxidase in the initiation of that burst.     

Studies with the Folate Binding Protein in Chronic Granulocytic Leukaemia Cells: I. SYNTHESIS AND RELEASE OF BINDER BY CELLS IN SHORT-TERM CULTURE

Chronic granulocytic leukaemia (CGL) cells which contained a high concentration of unsaturated folate binding protein were incubated in suspension culture for a period of 5 h. Cell samples were periodically assayed for binder and these demonstrated active synthesis which was inhibited by puromycin, cyclo heximide, N-ethylmaleimide, and by incubation at 4 degrees C, but not by actinomycin D. Folate binding activity could also be demonstrated in the culture medium and this increased with the duration of incubation. This release of binder was inhibited by culturing the cells at 4 degrees C and by the addition of N-ethylmaleimide, but not by actinomycin D, puromycin, or cycloheximide. When the pre- and post-culture cell lysates were saturated with tritiated folic acid ([3H]PteGlu) and subjected to chromatography on DEAE-agrarose, approximately half of the bound folate eluted with 0.001 M phosphate buffer at pH 6.0 and the other half eluted with 0.2 M buffer at pH 7.2. The culture medium and plasma from this patient with CGL was well as serum from two normal subjects saturated with [3H]PteGlu and similarly chromatographed contained primarily the acidic binder and much less of the binder eluting with the low molarity buffer. Since a folate binding protein immunochemically similar to the binder in CGL cells has been identified in the serum of non-leukaemic subjects, these experiments suggest that the source of circulating folate binding protein may be the immature granulocyte.