密蒙花黄酮类化合物的分离和鉴定

从密蒙花(Buddleia officinalis Maxim)的花蕾中分离得到8个黄酮类化合物,其小3个甙元:刺槐素(acacetin,1),芹菜素(apigenin,2),木犀草素(luteolin,3);5个甙:密蒙花新甙(neobudofficide,4),蒙花甙(linarin=acaciin,5),木犀草素7-O-芸香糖甙(6),木犀草素-7-O-葡萄糖甙(7),秋英甙(cosmosiin,8)。化合物4为新化合物,用化学和波谱法确定其结构为5.7-二羟基-4'-甲氧基黄酮-7-O-α-L-吡喃鼠李糖基-(1→2)-[α-L-吡喃鼠李糖基-(1→6)]-β-D-吡喃葡萄糖甙,除化合物1和5以外,其它化合物均为首次从密蒙花中得到。     

长春市儿童医院1998～2001年轮状病毒哨点监测分析

目的 为在中国开发和应用轮状病毒疫苗提供流行病学背景资料。方法 以医院为基础的哨点监测,在长春市儿童医院5岁以下腹泻患儿中进行,收集患儿临床资料和粪便标本,轮状病毒检测用聚丙烯酰胺凝胶电泳(PAGE)和／或酶联免疫吸附试验(ELISA),毒株分型用ELISA和／或逆转录-聚合酶链反应(RT—PCR)。所有资料录入计算机进行数据分析。结果 3年监测中共调查2343例腹泻患儿,收集便样1211份,轮状病毒检出率门诊患儿和住院患儿分别为31．0％和52．9％。轮状病毒感染95．0％发生于2岁以下儿童。每年寒冷季节流行(11月到次年3月)。流行的轮状病毒G血清型依次为G1(82．4％)、G2(5．0％)、G3(3．3％)和G4(0．9％),P基因型以P[8]和P[4]为常见。共检出9种P～G结合的毒株,其中世界常见的4种流行株占75．6％。结论 轮状病毒流行毒株呈现超常多样性,轮状病毒是长春地区儿童重症腹泻的主要原因。     

IS BETA CELL DYSFUNCTION RESPONSIBLE FOR FLAT GLUCOSE TOLERANCE CURVE IN PRIMARY HYPOTHYROIDISM? (A HYPOTHESIS)

An intimate relationship between thyroid hormones and carbohydrate metabolism has long been recognised and oral glucose load produces flat glucose tolerance curve in patients with primary hypothyroidism. Although delayed glucose absorption was proposed to explain flat glucose tolerance curve exact mechanism remains to be elucidated. Hence this study was undertaken to assess glucose and insulin response to OGTT and IVGTT in 25 freshly detected cases of hypothyroidism and 25 healthy control. The cases were matched for sex, age, BMI, and waist hip ratio with controls. Cases and controls with past or family history of obesity, diabetes mellitus, or hypertension were excluded from study. The biochemical profile of the cases and controls was also comparable except for haemoglobin (11.2±0.31 vs 12.9±0.22 gm/dl)(p=0.0004). Serum cholesterol and triglyceride levels were higher in the cases but difference was not statistically significant Fasting plasma glucose level was significantly lower in hypothyroid patients (78±2.2 vs88±4.4 mg/dl, p=0.049). The oral glucose tolerance curve was flat with plasma glucose levels significantly lower at 30 minutes. The insulin levels during OGTT were found to be higher in the cases at all stages. There was loss of first phase insulin response to the glucose load during the IVGTT, which was blunted at all stages and the difference was statistically significant at 0 and 3 minutes. Loss of first phase insulin response to IV glucose suggests that there is evidence of beta-cell dysfunction. Patients with hypothyroidism were more insulin sensitive than control and insulin secretion was comparable with controls. Therefore flat glucose tolerance curve can be explained by absence of insulin priming effect leading to decreased glucose absorption followed by increased glucose disposal because of higher insulin levels following OGTT and increased glucose disposal caused by increased insulin sensitivity.KEY WORDS: Beta-cell function, Hypothyroidism, Insulin resistance, Insulin sensitivity     

骨髓干细胞动员治疗脑缺血损伤

学术背景：近来的研究表明，来源于骨髓的干细胞具有横向分化潜能和成神经分化特性，对脑缺血损伤后神经功能恢复和神经细胞的修复具有保护作用。 目的：通过回顾近年来骨髓干细胞动员对脑缺血损伤保护作用的文献，对骨髓干细胞的特性及动员过程、途经,可能的作用机制、影响因素进行阐述，以期完善骨髓干细胞动员防治脑缺血损伤的基础与临床研究。 检索策略：应用计算机检索Medline1997—01／2007—01与骨髓干细胞动员和脑缺血相关的文章。检索词“bone marrow stem cells，cerebral ischemia”并限定语言种类为English，同时计算机检索CNKI数据库1997—01／2007—01相关文章，并限定文章语言种类为中文，检索词为“骨髓干细胞，脑缺血”。就检索到的300余篇文献进行筛选，选择以骨髓干细胞动员和脑缺血损伤的基础研究为主要内容的文献63篇，其中研究内容相似的，以近5年且发表在较权威杂志者优先。 文献评价：将入选的30篇文献进行分类，11篇研究骨髓干细胞的生物学特性，19篇与骨髓干细胞动员治疗脑缺血损伤的过程．途经,可能的作用机制、影响因素相关。 资料综合：来源于骨髓的干细胞具有很强的“可塑性”，自我更新和高度增殖能力，其可能通过修复和替代脑缺血损伤后的神经细胞，促进或直接参与缺血区新生血管生成，分泌神经营养因子等，对脑缺血损伤后神经功能恢复发挥保护作用，其作用机制和作用方式目前尚不确切，有待于建立完整的动物模型技术平台，通过基础研究进行解决。 结论：骨髓干细胞对脑缺血损伤具有修复作用，采用骨髓干细胞动员的干预策略，方法简便、安全有效,无创伤且可避免干细胞移植的免疫排斥反应，具有较好的发展潜力，有望成为治疗脑缺血性疾病的研究重点。     

信号转导子与转录激活子3在豚鼠形觉剥夺性近视发展中的表达特征

目的:观察高度近视眼眼球后壁组织信号转导子与转录激活子3的动态表达及意义。方法:实验于2005-10/2006-08在郑州大学基础医学院完成。选用健康1周龄豚鼠30只,雌雄不拘,无眼部疾患,实验前对豚鼠进行检影验光,排除先天性近视。右眼遮盖作为实验组,将直径为15mm的半透明眼罩用502胶粘于豚鼠眼周围的皮肤上,分别以1,3,6周3个不同时间点持续遮盖,每个时间点10只。左眼不做任何处理作为对照组。两组均采用检影验光检测屈光度;眼科A超测定眼轴长度;对两组3个时间点眼球后壁行S-P法免疫组织化学染色,检测信号转导子与转录激活子3的动态表达。结果:纳入豚鼠30只,均进入结果分析,模型制备过程无眼罩脱落。①生后1周豚鼠均呈远视状态,眼轴短;随时间延长,对照组远视度数减低,眼轴延长;实验组由实验前远视眼快速演变为高度近视眼,并随遮盖时间延长,近视度数加深,眼轴延长,两组之间实验前眼屈光度数、眼轴长度无明显差异(P>0.05)。实验组形觉剥夺后,两组之间眼屈光度数、眼轴长度进行比较,差异有非常显著性意义(P<0.01)。②视网膜光感受器外节、色素上皮-脉络膜均有信号转导子与转录激活子3阳性表达、巩膜弱阳性表达;而对照组表达主要位于神经节细胞,随出生时间延长,两组信号转导子与转录激活子3表达均逐渐下调。与对照组相比,实验组信号转导子与转录激活子3表达明显上调,但两组之间比较,自实验第1周开始,实验组信号转导子与转录激活子3较对照组明显上调,差异有显著性意义(P<0.01)。结论:形觉剥夺可导致高度近视;在近视中信号转导子与转录激活子3表达主要位于视网膜光感受器外节、色素上皮层和脉络膜,可能参与了近视眼的形成与发展。     

儿科重症监护病房(ICU)患儿的输血方案

50%以上的ICU住院患儿曾输注红细胞,但病情稳定的患儿有可能耐受中度贫血引起的携氧能力不足.一方面,输注含白细胞的血液对患儿益处不大,输注的白细胞激活炎症级联反应,可能引起多器官功能障碍.另一方面,输血改善了携氧力可能会使ICU患儿受益,就像输血使成人在败血症休克早期受益一样.     

Emergency department utilization among HIV‐infected patients in a multisite multistate study*

Objective

The aim of this study was to examine Emergency Department (ED) utilization and clinical and sociodemographic correlates of ED use among HIV‐infected patients.

Methods

During 2003, 951 patients participated in face‐to‐face interviews at 14 HIV clinics in the HIV Research Network. Respondents reported the number of ED visits in the preceding 6 months. Using logistic regression, we identified factors associated with visiting the ED in the last 6 months and admission to the hospital from the ED.

Results

Thirty‐two per cent of respondents reported at least one ED visit in the last 6 months. In multivariate analysis, any ED use was associated with Medicaid insurance, high levels of pain (the third or fourth quartile), more than seven primary care visits in the last 6 months, current or former illicit drug use, social alcohol use and female gender. Of those who used ED services, 39% reported at least one admission to the hospital. Patients with pain in the highest quartile reported increased admission rates from the ED as did those who made six or seven primary care visits, or more than seven primary care visits vs. three or fewer.

Conclusions

The likelihood of visiting the ED has not diminished since the advent of highly active antiretroviral therapy (HAART). More ED visits are to treat illnesses not related to HIV or injuries than to treat direct sequelae of HIV infection. With the growing prevalence of people living with HIV infection, the numbers of HIV‐infected patients visiting the ED may increase, and ED providers need to understand potential complications produced by HIV disease.     

Definitions of antiretroviral treatment failure for measuring quality outcomes

Objectives

Our aim was to compare three different definitions of treatment failure and discuss their use as quality outcome measures for a clinical service.

Methods

Data for treatment‐naïve patients who attended the Melbourne Sexual Health Centre (MSHC) between 1 January 2000 and 31 December 2008 were analysed. Definition 1 was the strict Food and Drug Administration (FDA) definition of treatment failure as determined using the time to loss of virological response (TLOVR) algorithm. Definition 2 defined treatment failure as occurring in those whose viral load never fell to <400 HIV‐1 RNA copies/mL or who developed two consecutive viral loads ≥400 copies/mL on any treatment (switching or stopping treatment with a viral load <400 copies/mL was permitted). Definition 3 was the same as definition 2 except that individuals were also deemed to have failed if they stopped treatment for 6 months or longer.

Results

There were 310 antiretroviral‐naïve patients who started treatment in the study period. Of these, 156 [50.3%; 95% confidence interval (CI) 42.1–53.3%] experienced treatment failure under definition 1, 10 (3.2%; 95% CI 1.5–5.8%) experienced treatment failure under definition 2, and 16 (4.5%; 95% CI 2.5–7.4%) experienced treatment failure under definition 3 over the 108 months of follow‐up. The probability of failing definition 1 was statistically different from the probability of failing definition 2 or 3 (P=0.01).

Conclusion

There were significant differences in treatment failure for the three definitions. If definition 1 were used, the outcomes would be sufficiently common to enable clinics to be compared but would be less meaningful. If definition 2 or 3 were used, the events would be too rare to enable clinics to be compared, but it would be possible to set a benchmark level of success that clinics could aim to reach.     

Antimicrobial peptides and the gut microbiome in inflammatory bowel disease

Antimicrobial peptides (AMP) are highly diverse and dynamic molecules that are expressed by specific intestinal epithelial cells, Paneth cells, as well as immune cells in the gastrointestinal (GI) tract. They play critical roles in maintaining tolerance to gut microbiota and protecting against enteric infections. Given that disruptions in tolerance to commensal microbiota and loss of barrier function play major roles in the pathogenesis of inflammatory bowel disease (IBD) and converge on the function of AMP, the significance of AMP as potential biomarkers and novel therapeutic targets in IBD have been increasingly recognized in recent years. In this frontier article, we discuss the function and mechanisms of AMP in the GI tract, examine the interaction of AMP with the gut microbiome, explore the role of AMP in the pathogenesis of IBD, and review translational applications of AMP in patients with IBD.