住院患者入院时血糖水平与医疗费用、疾病预后的相关研究

目的探讨住院患者人院时不同血糖水平与住院时间、医疗费用及疾病预后的关系。方法选取2009年11月至2011年7月期间人院的4868例患者,按入院24h内测得的血糖水平分为非高血糖组3429例、高血糖组1439例,后者包括糖尿病和应激性高血糖患者;根据患者年龄分为非老年组（年龄〈60岁）2532例和老年组（年龄≥60岁）2336例;其中278例冠心病患者再分为高血糖组120例和非高血糖组158例。各组间进行有关数据比较。结果高血糖组患者的住院天数、医疗费用和总病死率均显著高于非高血糖组（中位数住院日：15vs10d,P〈0．01;中位数医疗费用：14064．7vs8980．9元,P〈0．01;死亡率：2．92％vs0．61％,P〈0．01）。按年龄分组后,无论是非老年组还是老年组中糖尿病和应激性高血糖患者的医疗费用均明显高于非高血糖患者,住院日明显延长;应激性高血糖患者的医疗费用明显高于糖尿病患者;非老年组中应激性高血糖患者的死亡率明显高于非高血糖患者,但与糖尿病患者相比无明显差异,老年组糖尿病和应激性高血糖患者的死亡率无明显差异,但均明显高于非高血糖患者。冠心病患者中糖尿病和应激性高血糖患者与非高血糖患者的年龄无明显差异,前两组的医疗费用明显高于非高血糖组,住院日更长（分别为14,15和12d）、死亡率更高（分别为6．41％,7．14％和0．63％）。结论入院时高血糖水平预示患者有更高的医疗花费、更长的住院时间和更高的死亡率。     

Nuclear gyrB encodes a functional subunit of the Plasmodium falciparum gyrase that is involved in apicoplast DNA replication

The DNA replication machinery of the Plasmodium falciparum apicoplast is a validated drug target. Nuclear-encoded gyrase subunits are predicted to play a critical role in maintaining DNA topology during the D-loop/bi-directional ori replication process of the parasite. We show the presence of P. falciparum gyrase subunits in parasite lysates by using antibodies generated against recombinant gyrase A and B. The ATPase activity of PfGyrB was inhibited by novobiocin that also caused parasite death in culture. Reduction of apicoplast/nuclear DNA ratio in the presence of novobiocin indicated that the drug targets apicoplast DNA replication. Molecular modeling of gyrase A and B subunits revealed extensive fold conservation with the Escherichia coli counterparts as well as the presence of a long disordered loop adjacent to the ATPase domain of PfGyrB. Our results have implications for development of PfGyrB as a drug target against malaria.     

室壁应力与应变的关系评价高血压病左室收缩功能

目的　探索用室壁应力 (stress)与应变 (strain)的关系评价高血压病左室收缩功能的临床价值。方法　研究对象为 5 5例高血压病患者和 3 0例健康人。应用超声心动图计算左室射血分数 (EF)、心指数 (CI)、重量指数 (LVMI)和相对室壁厚度 (RWT) ,并联合袖带肱动脉血压值计算左心室收缩期室壁经线峰值应力 (Pσm)。根据LVMI和RWT将高血压病分为左室正常构型和左室重构两组。在数字化超声工作站中应用定量组织速度成像 (QTVI)获取左室前壁心肌 2个节段长轴应变曲线和峰值收缩应变值 (PSS)。结果　①以EF ,CI表示的心脏收缩功能 ,在高血压病左室正常构型组值中无明显变化 ;而在高血压病左室重构组中下降 ,差异具有极显著意义 (P <0 .0 1)。②Pσm在高血压病两组中较对照组均有增高 (P <0 .0 5～ 0 .0 1) ,两组间比较差异具有极显著意义 (P <0 .0 1)。③高血压病两组左室前壁基底段 (Bas)和中段 (Mid)的 pSS值均显著下降 (P <0 .0 1) ,两组间比较差异具有极显著意义 (P <0 .0 1)。④直线相关分析结果显示高血压病两组Pσm与PSSBas和PSSMid均呈显著负相关。根据正常构型组Pσm与PSSBas直线回归方程计算 ,在相同Pσm水平 ,左室重构组PSSBas的实测值显著低于预测值及实测值与预测值的比值较正常构型组显著下降 ,差     

Kümmell病的临床治疗进展

目的:系统评价自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合相关指标,为成人长骨骨折不愈合治疗提供参考依据。方法:计算机检索PuMed、Embase、Cochrane图书馆、中国知网(CNKI)、万方数据期刊全文数据库及中国生物医学文献数据库(CBM)发表的对于自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合的随机对照试验,检索时间从建库至2019年3月。由2名研究者按照纳入和排除标准独立进行筛选文献,提取资料,并采用Jadad评价量表对纳入的文献进行质量评价。采用RevMan 5.3统计学软件对两种方法的感染发生率、成功愈合率、二次手术率、住院时间及术中失血量进行Meta分析。结果:共纳入7个随机对照试验研究,共652例患者,自体骨移植组有410例,骨形成蛋白组有242例。Meta分析结果显示:自体骨移植组与骨形成蛋白组在感染发生率[RR=1.32,95%CI(0.90,1.93),P=0.16],成功愈合率[RR=0.95,95%CI(0.84,1.08),P=0.43],二次手术率[RR=1.16,95%CI(0.43,3.12),P=0.76]及住院时间[MD=0.69,95%CI(-0.38,1.75),P=0.21]方面比较差异无统计学意义。自体骨移植组术中失血量明显高于骨形成蛋白组[MD=223.00,95%CI(32.72,413.28),P=0.02]。结论:对于成人长骨骨折不愈合的治疗,骨形成蛋白可以获得和自体骨移植一样的骨折愈合率,同时可以明显减少术中失血量。骨形成蛋白可能更适合成人长骨骨折不愈合的治疗。     

Surgical ventricular reconstruction and subendocardial resection for the treatment of refractory ventricular tachycardia

We describe a case of 64-year-old female patient with ventricular tachycardia intractable to medical treatment and acute heart failure following myocardial infarction. Emergency surgical ventricular reconstruction and subendocardial resection was undertaken. We discuss the option of surgical intervention in this difficult and unusual clinical scenario.     

高效液相色谱法测定多维元素片中泛酸的含量

目的建立复合多维元素片中泛酸的含量测定方法。方法高效液相色谱法,C18色谱柱(250mm×4.6mm,5μm);流动相:乙腈-1mL·L-1磷酸水溶液(5∶95);流速:1.0mL·min-1;柱温:25℃;检测波长:200nm。结果泛酸质量浓度在1.32¹32.32μg·mL-1范围内具有良好的线性关系,相关系数r=0.999 9,平均回收率为99.3%,RSD为1.4%(n=12)。结论该方法快速简便,结果准确,适用于多维元素片中泛酸含量测定。     

提高医学院校文科生生物化学教学质量策略探讨

生物化学是医学院校学生一门重要的公共基础课。大多数学生认为生物化学这门课程内容庞杂、名词术语繁多、抽象难懂、学习难度大,尤其对于生物学科与化学学科基础薄弱的文科生来讲,学习过程吃力,学习效果不理想,期末挂科率较高。本研究从文科生学习生物化学遇到的困难及教师面临的教学现状出发,找出问题,探讨具体应对策略,旨在提高学生学习生物化学课的兴趣和效果。     

Antidiabetic drugs and non-alcoholic fatty liver disease: A systematic review,meta-analysis and evidence map

BackgroundThe efficacy of antidiabetic agents for the treatment of non-alcoholic fatty liver disease (NAFLD) remains unclear.AimTo conduct a meta-analysis to study the efficacy of pioglitazone and three novel anti-diabetic agents: glucagon-like peptide-1 (GLP-1) agonists, sodium-glucose co-transporter-2 (SGLT2) inhibitors, and dipeptidyl-peptidase-4 (DPP4) inhibitors in treating NAFLD.MethodsOnline databases were searched in May 2020 for randomized clinical trials. Results from random-effects meta-analysis are presented as weighted mean differences (WMDs) or standard mean differences (SMDs) and corresponding 95% confidence intervals (CIs).ResultsTwenty-six studies (n=946 NAFLD patients) were included. Reductions in ALT were seen with all four drugs: pioglitazone (MD -38.41, p<0.001), SGLT2 inhibitors (MD -16.17, p<0.001), GLP-1 agonists (MD -27.98, p=0.04) and DPP-4 inhibitors (MD -7.41, p<0.001). Pioglitazone (SMD -1.01; p<0.001) and GLP-1 agonists (SMD -2.53, p=0.03) also demonstrated significant improvements in liver steatosis. SGLT2 inhibitors (SMD -4.64, p=0.06) and DPP-4 (SMD -2.49, p=0.06) inhibitors trended towards reduced steatosis; however, these results were non-significant.ConclusionPioglitazone demonstrates significant improvements in transaminases and liver histology in both diabetic and non-diabetic NAFLD patients. Early evidence from diabetic NAFLD patients suggests that novel antidiabetics may lead to improvements in liver enzymes and hepatic steatosis, and this should encourage further research into possible utility of these drugs in treating NAFLD.     

Regulation of neutrophil migration and superoxide production by recombinant tumor necrosis factors-alpha and -beta: comparison to recombinant interferon-gamma and interleukin-1 alpha

We compared the ability of recombinant human tumor necrosis factor- alpha (rHuTNF-alpha) and tumor necrosis factor-beta (rHuTNF-beta) to stimulate polymorphonuclear neutrophil (PMN) migration and superoxide production. Significant PMN migration occurred across polycarbonate filters after stimulation with rHuTNF-alpha at concentrations ranging from 10(-7) to 10(-10) mol/L and at 10(-7) to 10(-8) mol/L for rHuTNF- beta and N-formylmethionyl-leucyl phenylalanine (FMLP), whereas recombinant human interferon-gamma was only minimally active at 10(-7) mol/L and recombinant human interleukin-1 alpha was inactive at the doses tested. In addition, antibodies to rHuTNF-alpha completely inhibited rHuTNF-alpha but not rHuTNF-beta or FMLP-induced PMN migration. Combinations of rHuTNF-alpha and rHuTNF-beta (at similar molar concentrations) stimulated PMN migration levels comparable to that obtained with rHuTNF-alpha alone. Checkerboard analyses performed by placing different concentrations of rHuTNF-alpha and rHuTNF-beta above and below polycarbonate filters of microchemotaxis chambers demonstrated that rHuTNF-alpha and rHuTNF-beta stimulated both chemotactic and chemokinetic responses by PMN. Additional studies demonstrated that 1 X 10(-8) mol/L rHuTNF-alpha and 3 X 10(-9) mol/L rHuTNF-beta (which represents 10(4) U/mL of each cytokine) were similar in their ability to induce superoxide production by PMNs; however, at ten- to 100-fold lower molar concentrations (10(3) and 10(2) units), rHuTNF-alpha was significantly more active than rHuTNF-beta. At the doses tested, both cytokines were less active than phorbol myristate acetate at stimulating O2- release. The results demonstrate that rHuTNF- alpha and rHuTNF-beta differ quantitatively but not qualitatively in their effects on PMN functions in vitro and suggest that rHuTNF-beta may be less toxic than rHuTNF-alpha in vivo.