载碱性成纤维细胞生长因子温敏水凝胶对大鼠骨髓间充质干细胞体外成骨分化的作用研究

目的:实验合成载碱性成纤维细胞生长因子(bFGF)壳聚糖/β-甘油磷酸钠/明胶温敏水凝胶,研究其对骨髓间充质干细胞(BMMSCs)成骨分化的作用.方法:制备壳聚糖/β-甘油磷酸钠/明胶水凝胶,冻干后电子显微镜下观察其表征;检测水凝胶毒性;CCK-8法筛选出载bFGF温敏水凝胶促BMMSCs增殖最适浓度并用于后续研究;碱性磷酸酶染色、茜素红染色及钙结节半定量分析观察其对BMMSCs成骨向分化能力的作用;实时荧光定量PCR检测其对BMMSCs成骨相关基因表达的影响.结果:(1)成功制备壳聚糖/β-甘油磷酸钠/明胶温敏水凝胶,扫描电镜下冻干后的水凝胶孔径为20～80μm.(2)活/死细胞染色结果显示壳聚糖/β-甘油磷酸钠/明胶温敏水凝胶具有良好的生物相容性.(3)载bFGF温敏水凝胶能显著促进BMMSCs增殖,并呈剂量依赖性,最适浓度为100 ng/mL(P<0.01).(4)载bFGF温敏水凝胶组碱性磷酸酶表达增多,钙结节形成增多(P<0.05).(5)载bFGF温敏水凝胶组成骨相关基因(ALP、BMP-2、Runx2)表达增高.结论:载bFGF温敏水凝胶能促进大鼠BMMSCs成骨分化.     

新型冠状病毒肺炎患者的治疗及不良反应监护

目的探讨新型冠状病毒肺炎患者药物治疗与药物不良反应监护。方法隔离收治明确诊断的15例新型冠状病毒感染的肺炎患者,分轻型、普通型、重型及危重型,使用重组人干扰素α-2a、洛匹那韦/利托那韦片、盐酸阿比多尔片、磷酸氯喹、利巴韦林注射液等抗病毒药物治疗,联合抗病毒用药≤3种,同时进行对症支持治疗,在药物治疗过程中实施药学监护,及时发现药物不良反应并对症处理。结果截至2020年3月5日,治愈出院患者9例,在院患者6例,3例患者临床症状及胸部CT均好转,核酸检测为阳性,1例重型患者转为普通型,2例危重型患者转为重型;治疗过程中11例患者出现不同症状、不同程度的不良反应,不良反应发生率达73.33%,8例患者出现消化系统症状,2例患者出现皮疹伴瘙痒,1例患者治疗过程中肝酶轻微升高,根据国家不良反应监测中心分级,2例为新的不良反应,9例为一般的不良反应。结论目前没有经过临床验证有效的治疗方法治疗新型冠状病毒肺炎,在有限的诊疗方案推荐下需要摸索相关的药物治疗,包括药物选择、用法用量及疗程,药物在临床治疗时需进行不良反应监护,及时发现并对症处理,避免因药物引起的机体损害。     

The FRED Flow-Diverter Stent for Intracranial Aneurysms: Clinical Study to Assess Safety and Efficacy

BACKGROUND AND PURPOSE:Flow-diverter stents are emerging for the endovascular treatment of difficult-to-treat or otherwise untreatable cerebral aneurysms (wide-neck, fusiform, dissecting, blisterlike, or giant). We assessed the clinical safety and efficacy of the Flow-Redirection Endoluminal Device.MATERIALS AND METHODS:This was an institutional review board–approved single-center observational clinical study in 29 patients with 34 aneurysms elected to be treated by endovascular intervention. After providing informed consent, patients were included according to the following criteria: aneurysm fundus-to-neck ratio <2 or neck diameter >4 mm, fusiform, dissecting, or giant aneurysms. The primary end point for clinical safety was the absence of death, absence of major or minor stroke, and absence of transient ischemic attack. The primary end point for treatment efficacy was complete angiographic occlusion according to the O''Kelly Marotta grading scale immediately after the procedure and at follow-up after 3 and 6 months (O''Kelly Marotta D: complete occlusion).RESULTS:The Flow-Redirection Intraluminal Device deployment was technically successful in all cases. In 26/29 (89%) of patients, the primary end point of safety was reached; in the 3 remaining patients, 1 disabling ischemic stroke and 2 minor strokes with complete recovery at follow-up were observed. Angiographic (DSA and MRA) and clinical follow-up were available after 3 months in 29/29 (100%) and after 6 months in 25/29 (86%) patients (after 6 months, only MRA follow-up was performed according to our study protocol and institutional standard). At 3-month follow-up, complete occlusion was reached in 19/34 aneurysms (O''Kelly Marotta D: 19/34; 56%). At 6-month follow-up, aneurysm occlusion was complete in 22/30 aneurysms (O''Kelly Marotta D: 22/30; 73%).CONCLUSIONS:Deployment of the Flow-Redirection Intraluminal Device flow-diverter stent is safe and effective in the treatment of difficult-to-treat or otherwise untreatable intracranial aneurysms.

Endovascular treatment of intracranial aneurysms by coiling has become an accepted alternative to surgical clipping, with increasing evidence for lower morbidity and mortality rates, especially in clinical equipoise.^1–3 However, especially in wide-neck, fusiform, dissecting, and giant aneurysms, incomplete coiling and reperfusion are still a major limitation preventing stable long-term occlusion. Aneurysm recanalization and/or neck remnants may be observed despite further refinement in coil technology such as coated platinum coils⁴ and/or procedural modification such as the balloon-remodeling technique⁵ or stent-assisted coil embolization.⁶The development of flow-diverter (FD) stents has offered the potential of aneurysm occlusion through thrombosis triggered by the disruption of flow into the aneurysm sac.^7–16 As a key element of construction, these stents have a braided mesh with a densely covered surface. Once the FD is expanded to cover the aneurysm neck, thrombosis is induced by stasis of flow within the aneurysmal sac. The porosity of the FD mesh and the pressure gradient between parent and smaller adjacent branch vessels preserve flow and patency of the latter even if covered. The Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, California) is a new generation of FDs for reconstruction of the parent artery and aneurysm occlusion. Its unique dual-layer design composed of a low-porosity inner mesh and a high-porosity outer stent may provide potential advantages over other available FDs in safe deliverability and effective occlusion of the target lesion. We report our analysis of the clinical safety and efficacy of the FRED in 29 patients with 34 aneurysms.     

DTI技术在四肢软组织肿瘤良恶性鉴别中的价值

目的探讨扩散张量成像(diffusion tensor imaging,DTI)技术在四肢软组织肿瘤良恶性鉴别中的价值。方法回顾性分析22例经手术病理证实的四肢软组织肿瘤的DTI资料(恶性肿瘤12例,良性肿瘤10例),定量分析良恶性肿瘤部分各向异性值(fractional anisotropy,FA)、相对各向异性值(relative anisotropy,RA)及表观弥散系数值(apparent diffusion coefficient,ADC),并对可疑肿瘤侵犯部位进行肌纤维示踪,评估肌纤维形态。结果四肢软组织恶性肿瘤的FA值、RA值及ADC值分别为0.30±0.11、0.25±0.10、(0.91±0.16)×10-3 mm2/s,良性肿瘤的FA值、RA值及ADC值分别为0.11±0.09、0.12±0.08、(1.39±0.25)×10-3 mm2/s,良恶性肿瘤的FA值、RA值及ADC值均有统计学差异(P0.05)。良性肿瘤周围肌纤维形态学改变为水肿、移位,恶性肿瘤的周围肌纤维主要为侵犯、破坏。结论 DTI通过显示肿瘤周围肌纤维形态变化并对肿瘤实质进行定量测量,可提高四肢软组织肿瘤正确诊断率。     

Effect of cytokines on liver necrosis

AIM To investigate the effect of cytokines on the liver necrosis.METHODS rIL (interleukin)-1, rIL-6, rIFN (interferon), rTNF (tumor necrosis factor) α with or without D-galactosamine (D-GAL) were injected into the abdominal cavity of mice separately. ALT, TBIL (total bilirubin) and histological changes were observed.RESULTS There was no effect on hepatocyte of normal mice after injection of rIL-1, rIL-6, rIFN alone or together. The serum total bilirubin (TBIL) and liver necrosis of mice increased after rTNFα, rIL-6 or rIFN were used separately with D-GAL. The TBIL level (μmol/L) was 46.19±10.62, 44.55±12.9 and 41.94±14.9, higher than that caused by D-GAL alone (TBIL, 26.67μmol/L±11.14μmol/L). The serum TBIL of mice and the degree of liver necrosis increased after injection of IL-1, IL-6 with D-GAL and rTNFα.CONCLUSION Cytokines, like IL-1,IL-6, IFN and TNFα joined in the process of hepatocyte necrosis. They can enhance the degree of liver necrosis induced by D-GAL.     

Functional and binding studies of the roles of prothrombin and beta 2- glycoprotein I in the expression of lupus anticoagulant activity

We present functional and binding data relevant to the reported roles for prothrombin and beta 2-glycoprotein I (beta 2GPI) in the expression of lupus anticoagulant activity. In a purified system containing human prothrombin, Xa, Va, and a rate-limiting concentration of phosphatidylserine (PS)/phosphatidylcholine (PC) vesicles, the preliminary incubation of vesicles with protein A separated IgG preparations from 10 lupus anticoagulant plasmas, calcium, and prothrombin enhanced the inhibitory effect of all IgG preparations upon thrombin generation. Experiments in a purified factor X activation system provided supporting data that a similar preliminary incubation with prothrombin enhanced the inhibitory effect of many of the IgG preparations upon factor X activation. However, we could not obtain unequivocal evidence that prothrombin was an obligatory cofactor for lupus anticoagulant IgG to inhibit procoagulant phospholipid function, because lupus anticoagulant IgG separated by protein A chromatography contained traces of prothrombin. The binding of many IgG preparations to immobilized PS was enhanced by prothrombin when calcium ions were present. beta 2GPI enhanced binding of many of the IgG preparations to immobilized PS both in the presence and absence of calcium, yet beta 2GPI failed to enhance the ability of the IgG preparations to inhibit phospholipid function in purified prothrombin and factor X assays. Moreover, the IgG preparations prolonged the dilute Russell's viper venom time (dRVVT) of beta 2GPI-depleted normal plasma. Nine of 10 IgG preparations bound to prothrombin on Western blots in the absence of calcium and phospholipid, whereas no preparation bound to beta 2GPI. Passage of five citrated lupus anticoagulant plasmas through a prothrombin affinity column in the absence of added calcium and phospholipid removed most of the activity prolonging the dRVVT of normal plasma, and IgG in the pass-through plasma no longer bound to PS in the presence of prothrombin and calcium ions. IgG in prothrombin column eluates had strikingly enhanced specific lupus anticoagulant activity and also specific PS binding activity in the presence of prothrombin and calcium ions. Thus, lupus anticoagulant plasmas were shown to contain IgG binding to prothrombin, in the absence of calcium ions and phospholipid, which could also, in the presence of calcium ions and prothrombin, bind to PS and express lupus anticoagulant activity.     

胆道联合静脉超声造影在恶性梗阻性黄疸中的价值

目的:评价胆道联合静脉超声造影检查在恶性梗阻性黄疸治疗中的临床价值。方法:43例患者经增强CT或MRI诊断为恶性梗阻性黄疸,在手术前行经皮经肝胆管穿刺置管,并予以常规超声、静脉超声造影和胆道超声造影检查。以手术结果为金标准,分析常规超声、静脉超声造影、胆道超声造影、胆道联合静脉超声造影对恶性梗阻性黄疸的诊断符合率。结果:43例患者中,常规超声、静脉超声造影、胆道超声造影、胆道联合静脉超声造影的诊断符合率分别为72.1%(31/43)、83.7%(36/43)、81.4%(35/43)及93.0%(40/43)。其中胆道联合静脉超声造影的诊断符合率明显优于常规超声(P=0.021),而单独的静脉或胆道超声造影与常规超声之间的差异无统计学意义(P=0.194和0.307)。结论:胆道联合静脉超声造影可全面评估梗阻部位胆管的腔内和腔外的情况,提高超声对恶性梗阻性黄疸诊断符合率,有效判断手术的可切除性,具有较好的临床价值。     

睾丸原发性淋巴瘤2例

睾丸原发性淋巴瘤是一类较为罕见的结外淋巴瘤,其临床进展迅速,预后较差。本文回顾性分析我院2例经病理证实的睾丸原发性淋巴瘤的MRI表现,以提高对该病的认识。病例例1,男,44岁,右侧睾丸进行性增大伴酸胀2月余。患者于2月前无明显诱因出现右侧睾丸增大,伴酸胀,久站或活动后加重,平躺休息后可缓解。查体:右侧睾丸增大,大小约4 cm×2 cm,可触及肿物,质硬,有沉重感,肿物与睾丸     

结核分枝杆菌FtsZ抑制剂的筛选和活性研究

目的筛选结核分枝杆菌FtsZ的特异性抑制剂,为抗结核药物的研发提供先导化合物。方法应用本实验室已经建立的结核分枝杆菌FtsZ抑制剂筛选模型对化合物库进行筛选,获得能够抑制FtsZ的化合物202E,对其进行IC50以及分子水平活性测定,并利用DS 4.0软件将化合物202E与FtsZ的活性位点进行对接。结果化合物202E能够抑制结核分枝杆菌FtsZ的GTP酶活性,其IC50为15.46μmol/L。202E还能够抑制FtsZ蛋白的聚合。通过分子对接,发现202E能够与FtsZ的GTP结合位点结合,抑制FtsZ的GTP酶活性。结论化合物202E是活性较好的结核分枝杆菌FtsZ抑制剂。     

同型半胱氨酸在巨幼细胞贫血诊断中的临床意义

目的探讨血清同型半胱氨酸(HCY)在巨幼细胞贫血(MA)诊断中的临床意义。方法回顾性研究了60例初诊MA患者入院时HCY、血清叶酸(folic acid,FA)、维生素B12(Vit B12)检测值情况。结果 MA患者HCY显著升高,(x±s)为(47.12±9.80)μmol/L,阳性率为93.33%;与血清FA/Vit B12敏感度比较差异有统计学意义(χ2=4.20,P<0.05)。HCY与血清FA、Vit B12相关性分析分别为(r=-0.648,P=0.02)、(r=-0.756,P=0.006),相关性检验差异有统计学意义。结论 HCY对帮助诊断MA,特别是血清FA/Vit B12检测值正常时,有着重要的意义。