“5+3”背景下神经外科专业学位硕士研究生培养改革与思考

目前,我国神经外科住院医师规范化培训处于初级阶段,神经外科专业学位硕士研究生是我院神经外科规培主要对象之一。当前神经外科专业学位硕士研究生住院医师规范化培训还没有形成系统的健全的培训体系和教学机制,探索适应时代和社会需求的神经外科专业学位研究生培养模式势在必行。依据我院神经外科现有培养模式中存在的问题,提出注重专业基础理论知识、临床实践能力、临床思维及创新能力的培养,建立专业的考核团队等改革措施,以期更好地推进神经外科专业学位硕士研究生教育,提高规培质量。     

脓毒症急性肾损伤患者早期肾功能恢复的影响因素分析研究

目的：旨在分析脓毒症诱导的急性肾损伤（SA-AKI）患者肾功能早期恢复的影响因素。 方法：回顾性分析2021年1月至2022年12月在复旦大学附属中山医院重症医学科治疗的86例同时符合脓毒症3.0诊断标准和AKI诊断标准的SA-AKI患者。根据其是否在7天内恢复肾功能将其分为恢复组（37例）和未恢复组（49例）。对两组患者的临床资料和实验室检查进行比较,采用单因素和多因素分析筛选变量,确定影响SA-AKI患者肾功能恢复的危险因素,使用ROC曲线评估各因素对SA-AKI早期肾功能恢复的预测价值。 结果：SA-AKI的恢复率为43.02%（37/86）。与早期恢复组相比,未恢复组患者肾脏替代治疗率、住院死亡率和28天死亡率均更高（P<0.001）。年龄（P=0.047）、APACHE II评分（P=0.034）、尿量（P=0.025）、尿NGAL（P=0.038）、去甲肾上腺素剂量（P=0.035）是影响SA-AKI患者肾功能恢复的独立危险因素,用以上5个指标拟合出最终模型logit(P)=-4.091+0.001*尿NGAL-0.001*尿量+0.040*年龄+0.073*APACHEII评分+1.906*去甲肾上腺素剂量。该模型预测SA-AKI恢复的AUC为0.823,敏感度为73.5%,特异度为81.1%。 结论：SA-AKI患者早期肾功能未恢复与预后不良相关。年龄、APACHE II评分、尿量、尿NGAL、去甲肾上腺素剂量为影响SA-AKI患者肾功能早期恢复的独立危险因素,联合指标的综合判断对SA-AKI患者早期肾损伤恢复具有预测价值。     

牛磺酸治疗高血压病的疗效及对血管内皮细胞功能的影响

目的观察牛磺酸对原发性高血压病(EH)病人的疗效及血管内皮活性物质内皮素1(ET-1)、血栓素A2(TXA2)、一氧化氮(NO)和降钙素基因相关肽(CGRP)的影响。方法56例EH病人用牛磺酸治疗2个月,观察用药前后血中ET-1、NO、CGRP和TXA2的变化。结果牛磺酸治疗EH总有效率为71.4%。牛磺酸治疗后血中NO、CGRP浓度均较治疗前显著升高(P<0.01),血中ET、TXA2浓度显著下降(P<0.01)。结论牛磺酸有较好的降压作用,可明显改善EH病人血管内皮功能。     

The attenuation effect of potassium 2‐(1‐hydroxypentyl)‐benzoate in a mouse model of diabetes‐associated cognitive decline: The protein expression in the brain

Aims dl‐PHPB (potassium 2‐(1‐hydroxypentyl)‐benzoate) has been shown to have neuroprotective effects against acute cerebral ischemia, vascular dementia, and Alzheimer''s disease. The aim of this study was to investigate the effects of dl‐PHPB on memory deficits and preliminarily explore the underlying molecular mechanism.MethodsBlood glucose and behavioral performance were evaluated in the KK‐A^y diabetic mouse model before and after dl‐PHPB administration. Two‐dimensional difference gel electrophoresis (2D‐DIGE)‐based proteomics was used to identify differentially expressed proteins in brain tissue. Western blotting was used to study the molecular mechanism of the related signaling pathways.ResultsThree‐month‐old KK‐A^y mice were given 150 mg/kg dl‐PHPB by oral gavage for 2 months, which produced no effect on the level of serum glucose. In the Morris water maze test, KK‐A^y mice treated with dl‐PHPB showed significant improvements in spatial learning and memory deficits compared with vehicle‐treated KK‐A^y mice. Additionally, we performed 2D‐DIGE to compare brain proteomes of 5‐month KK‐A^y mice treated with and without dl‐PHPB. We found 14 altered proteins in the cortex and 11 in the hippocampus; two of the 25 altered proteins and another four proteins that were identified in a previous study on KK‐A^y mice were then validated by western blot to further confirm whether dl‐PHPB can reverse the expression levels of these proteins. The phosphoinositide 3‐kinase/protein kinase B/glycogen synthase kinase‐3β (PI3K/Akt/GSK‐3β) signaling pathway was also changed in KK‐A^y mice and dl‐PHPB treatment could reverse it.ConclusionsThese results indicate that dl‐PHPB may play a potential role in diabetes‐associated cognitive impairment through PI3K/Akt/GSK‐3β signaling pathway and the differentially expressed proteins may become putative therapeutic targets.     

克罗恩病患者焦虑抑郁状况及其影响因素分析

目的 分析克罗恩病（Crohn’s disease, CD）患者的焦虑和抑郁状况、相关影响因素及其对患者健康生命质量的影响。方法 选择2021年2月至2022年2月就诊于复旦大学附属中山医院的CD患者共100例,采集其人口学资料及疾病相关信息。研究对象填写焦虑自评量表(SAS)、抑郁自评量表（SDS）、患者报告结局（PRO）、炎症性肠病患者生活质量问卷（IBDQ）和慢性病治疗功能评估-疲劳量表（FACIT-F）。采用卡方检验和logistic回归分析焦虑、抑郁相关影响因素;采用独立样本t检验分析焦虑、抑郁对IBDQ和FACIT-F评分的影响。结果 CD患者合并焦虑、抑郁的比例明显高于健康对照组（焦虑：58.0%vs 9.4%,P<0.001;抑郁：43.0%vs 11.8%,P<0.001）,SAS和SDS评分升高。患者为女性、具有肠外表现、疾病处于活动期（PRO2=1）为焦虑危险因素（P<0.05）;文化程度较高和疾病处于活动期（PRO2=1）是抑郁危险因素（P<0.05）。具有焦虑和抑郁情绪患者的IBDQ和FACIT-F评分明显降低（P<0.05）。结...     

Use of the optimized sodium thiosulfate regimen for the treatment of calciphylaxis in Chinese patients

BackgroundSodium thiosulfate (STS) can be used to treat patients diagnosed with calciphylaxis, which is a rare life-threatening syndrome. However, our patients treated with the recommended STS regimen presented with serious adverse events, resulting in treatment withdrawal. Then an optimized STS regimen was used to increase the tolerance of patients to STS and improve treatment continuation. The curative effect of the new regimen is not yet definite. Therefore, this study aimed to evaluate the response to the use of the optimized STS regimen for the treatment of calciphylaxis in Chinese patients during the first three courses of treatment.MethodsDemographic, clinical, and laboratory data were retrospectively collected on 31 calciphylaxis patients with chronic kidney disease (CKD) or end-stage kidney disease (ESKD) treated with the optimized STS regimen. The primary outcome was a clinical improvement. The secondary outcomes included survival rate and adverse events.ResultsTwenty-five patients (over 80%) achieved clinical improvement considering improvement or nonspecific changes of skin lesions (80.65%) and pain relief (100%). Furthermore, 54.84% of patients did not experience any adverse events and none died from complications. During a median follow-up of 9 months (interquartile range 4‒19), 27 patients (87.10%) survived; additionally, 13 patients (41.94%) survived after a one-year follow-up period.ConclusionThe optimized STS regimen is relatively safe, associated with satisfactory outcomes, and well tolerated by patients for short to medium treatment duration. Hence, it is a promising approach for the treatment of patients diagnosed with calciphylaxis.     

网状软柳珊瑚化学成分研究

从南海网状软柳珊瑚中分离鉴定了9个化合物:胆甾醇(1)、ergostra-7,22diene-3β,5α,6β-triol(2)、cholesta7,22diene-3β,5α,6β-triol(3)、5,8-epidioxycampesta6,22-dien3-ol(4)、鲨肝醇(5)、咖啡碱(6)、胸腺嘧啶(7)、尿嘧啶(8)、鸟嘌呤(9),所有化合物均为首次从软柳珊瑚属中分离得到。     

槐白皮951对组织中TXB_2和6-Keto-PGF_1α的影响

用放射免疫技术对灌服槐白皮９５１大鼠的血管和肾组织内ＴＸＢ２、６－Ｋｅｔｏ－ＰＧＦ１α的含量进行测定。结果表明，该药具有降低大鼠血管、肾组织内ＴＸＢ２及提高６－Ｋｅｔｏ－ＰＧＦ１α的作用。由此分析，槐白皮９５１对心血管和血液系统疾病的防治将大有作为。     

血清中晚期糖基化终产物及其受体对妊娠期糖尿病围产儿结局的预测价值

目的探讨妊娠期糖尿病孕妇(GDM)血清中晚期糖基化终产物(AGEs)-晚期糖基化终产物受体(RAGE)轴所介导的氧化应激反应与围产儿结局间的关系。方法选择2011年1月至12月在广州市妇女儿童医疗中心产科检查,孕24～28周产前检查被诊断患有GDM的孕妇100例为研究对象(GDM组),另选择同期、相应年龄的正常妊娠妇女50例作为正常对照组。抽取两组孕妇的血样,测量空腹血糖、糖化血红蛋白(HbA1c)和AGEs、可溶性RAGE(sRAGE)水平。分娩后收集胎盘,分析组织中RAGE蛋白的表达。并收集母婴临床信息,根据围产儿结局异常与否分为GDM正常围产儿结局组和GDM不良围产儿结局组。结果 GDM组治疗前孕妇血清AGEs水平(50.44±16.21)ng/L,明显高于正常对照组(32.69±10.13)ng/L(P<0.01)。GDM组经干预治疗后其空腹血糖和HbA1c水平与正常对照组比较,差异无统计学意义(P>0.05);但血清AGEs水平仍然高于正常对照组(P<0.01)。GDM组孕母血清AGEs与sRAGE水平呈负相关(r=-0.582,P<0.01)。GDM不良围产儿结局组孕妇血清AGEs水平(67.39±14.75)ng/L明显高于GDM正常围产儿结局组(41.59±12.26)ng/L(P<0.05)。Logistic回归分析显示高AGEs水平是GDM不良围产儿结局的危险因子(OR=6.197,P<0.01,95%CI2.514～15.453);低sRAGE水平也是GDM不良围产儿结局的危险因子(OR=0.498,P<0.05,95%CI0.217～0.925)。GDM不良围产儿结局组(0.993±0.085)高于GDM正常围产儿结局组(0.611±0.047)和正常对照组(0.247±0.018)(P均<0.01)。结论血清高AGEs水平是GDM围产儿结局的一个不利因素,高AGEs水平可作为GDM不良围产儿结局的预测指标。血循环中sRAGE可通过竞争结合方式中和AGEs,抑制其下游信号的传递,血清低sRAGE水平可作为GDM病变中AGEs-RAGE轴过度活跃的生物标记。     

山东省447例精神药物严重不良反应报告分析

目的了解我院精神药物严重不良反应（ADR）发生的特点,为临床合理用药提供依据。方法收集我院2012年1月至2012年12月共447例精神药物严重不良反应报告,进行回顾性分析。结果非典型抗精神病药物以利培酮引起的不良反应最多见,抗抑郁药物以5-羟色胺抑制剂帕罗西汀引起的不良反应最多见,主要表现为白细胞减少、肝功能异常;心境稳定剂以碳酸锂引起的不良反应最多见,主要表现为震颤;镇静催眠药以地西泮引起的不良反应最多见,主要表现为药物中毒、呼吸抑制。结论应加强精神药物严重不良反应监测,确保临床安全、有效、合理的用药。