动态对比增强磁共振对急性脑梗死患者血脑屏障通透性的研究

目的通过动态对比增强(dynamic contrast-enhanced,DCE)MRI定量评估血脑屏障(blood-brain barrier,BBB)的通透性,探讨急性缺血性脑卒中患者BBB通透性的变化及相关影响因素。方法将50例急性缺血性脑卒中患者根据不同治疗方案,分为常规药物组12例,静脉溶栓组19例和取栓组19例,患者在发病72 h内完成DCEMRI(基线时),8例患者发病14 d复查影像检查,发病3个月随访时行改良的Rankin量表(mRS)评分,将mRS评分0~2分为预后良好。使用T1DCE-MRI Extend模型计算BBB通透性指标容积转运常数(Ktrans)值,并计算脑梗死侧与脑梗死对侧Ktrans值的比值(Ki/c)。比较所有患者脑梗死侧与脑梗死对侧、发病14 d复查与基线时、3组Ktrans值和Ki/c值差异,用多因素线性回归分析lg(Ki/c)值的相关影响因素。结果所有患者脑梗死侧Ktrans值较脑梗死对侧明显增高[0.0047(0.0019,0.0087)/min vs 0.0011(0.0003,0.0016)/min,P=0.000];发病14 d复查Ki/c值较基线时明显增高[70.77(13.43,399.43)vs 5.31(3.58,12.64),P=0.012]。常规药物组lg(Ki/c)值为0.42±0.49,静脉溶栓组lg(Ki/c)值为0.77±0.32,取栓组lg(Ki/c)值为0.85±0.41,静脉溶栓组和取栓组lg(Ki/c)值较常规药物组明显升高(P=0.021,P=0.005),静脉溶栓组与取栓组lg(Ki/c)值比较,差异无统计学意义(P=0.534)。常规药物组、静脉溶栓组和取栓组发病3个月预后良好比例比较,差异无统计学意义(66.7%vs 52.6%vs 52.6%,P=0.695)。多因素线性回归分析显示,lg(Ki/c)值与治疗方案(P=0.017)和脑梗死病史(P=0.030)有关。结论急性缺血性脑卒中患者BBB通透性与不同治疗方法、既往脑梗死病史有关,并且发病14 d BBB通透性较72 h内明显增高。     

结合新型冠状病毒肺炎疫情议“三山医院”的建设要领

新型冠状病毒肺炎疫情引起全球关注,病毒的高度传染性致使疫情迅速蔓延和大规模暴发。在应对突发的迅速蔓延的疫情过程中,快速建设一个安全性能高的应急传染病专科医院,对于患者治疗、医护人员防护和疫情的控制十分重要。笔者结合“三山医院”建设的经验和温州医科大学附属第一医院应急传染病治疗中心改造的实际经验,系统地对医院选址、医院规划和设计、暖通系统、给排水系统、医用气体要求及医疗废物处置进行阐述,并对关键环节进行探讨。     

注射用丹参多酚酸联合甲磺酸倍他司汀片治疗后循环缺血性眩晕的疗效

目的 观察注射用丹参多酚酸联合甲磺酸倍他司汀片治疗后循环缺血性眩晕病人的临床疗效。方法 将96例患者随机分为2组,各48例,对照组采取常规治疗,口服甲磺酸倍他司汀片,6 mg/次,3次/d,观察组加用注射用丹参多酚酸治疗,0.13 g加入到0.9%氯化钠注射液250 mL中静滴,1次/d,14 d后比较两组椎基底动脉供血和血流变指标、临床疗效和不良反应。结果 观察组治疗后椎基底动脉血流速度（收缩期峰流速、舒张期末流速、平均流速）和血流变学指标（全血比黏度、血浆比黏度、纤维蛋白原）改善情况明显优于治疗前,且治疗后观察组优于对照组的,差异具有统计学意义（P<0.05）;观察组痊愈率和总有效率均明显高于对照组,差异具有统计学意义（P<0.05）,且两组均无不良反应发生。结论 注射用丹参多酚酸联合甲磺酸倍他司汀片治疗椎后循环缺血性眩晕具良好的疗效,值得临床推广应用。     

Nuclear factor of activated T cells as a marker of in vivo low-dose dibenzo[a,h]anthracene exposure

We previously demonstrated that particulate matter ≤2.5 μm (PM2.5) suppresses the immune response in the spleen in vivo. Although PM2.5 includes the polycyclic aromatic hydrocarbon (PAH) such as dibenzo[a,h]anthracene (DBA), it is unclear whether PAH has a direct effect on the responses of splenocytes. In our study, the concentration of DBA used was approximately 0.8 μm , which is much lower than concentrations used in other toxicological studies of DBA. Although exposure to high concentrations of DBA is implicated in carcinogenesis, the effects of low doses of DBA on immune cells in vivo remain unclear. Here, we investigated the effects of low DBA doses on mouse splenocytes in vivo. Mice were administered dimethyl sulfoxide or DBA (0.4 or 0.8 μm ) intratracheally. Twenty-four hours after treatment, the mice were killed and their splenocytes were collected. DBA treatment enhanced mitogen-induced cell proliferation and cytokine production in the mouse splenocytes. Furthermore, DBA enhanced splenic CD4⁺ and CD8⁺ cell proliferation and cytokine production. The nuclear factor of activated T cells (NFAT) was activated in CD4⁺ cells. DBA also activated nuclear factor-kappa B and CCAAT enhancer-binding protein pathways in CD11b⁺ cells. DBA-enhanced splenocyte activation was Toll-like receptor 2-, 4-, 9- and MyD88-independent. These results suggest that NFAT represents a promising marker for evaluation of the effects of DBA on T cells and T-cell-dependent antibody responses.     

Association of the recurrence and canceration rate of vocal leukoplakia with interleukin-10 promoter variants over a 2-year period

Conclusion This study indicates that IL-10 promoter polymorphism variants, smoking, and alcohol consumption increase the risk of recurrence and canceration in vocal leukoplakia.

Objective This prospective, clinical trial was performed to evaluate the association of interleukin (IL)-10 promoter polymorphism variants and canceration and recurrence rates in vocal leukoplakia (a pre-cancerous laryngeal carcinoma lesion) over a 2-year period.

Participants and method Sixty-one post-operative patients with vocal leukoplakia were enrolled in this prospective, observational study and genotyped for the IL-10 promoter gene (IL-10-1082 A/G, -819 T/C and -592 A/C) using pyrosequencing, and responded to a 2-year follow-up survey. Recurrence and canceration rates were used to evaluate the association between the genotype variants and the clinical outcome.

Results There was an increased canceration rate in the variant genotype group compared to that in the normal genotype group in the 2-year follow-up period (18.4% vs 0%, p-value?=?0.038). Compared with the non-smoker group, the smoker group had a higher recurrence rate of vocal leukoplakia (29.3% vs 5%, p-value =0.044). Likewise, the recurrence rate in the alcohol consumption group was also higher (30.6% vs 8%, p-value =0.034). The percentage of cancerization in the alcohol consumption group was significantly higher than that in the non-alcohol consumption group (19.4% vs 0%, p-value =0.035).     

苦豆子多糖对小鼠体内外免疫功能的调节作用

目的 考察苦豆子多糖对小鼠免疫功能的体内外调节作用。方法 MTT 法体外观察苦豆子多糖在不同浓度对小鼠脾淋巴细胞增殖的影响;腹腔注射环磷酰胺建立免疫低下小鼠模型,通过碳粒廓清和血清溶血素实验测定非特异性免疫功能和体液免疫功能,测定小鼠巨噬细胞的碳粒廓清指数 K 、吞噬指数 α和小鼠血清中溶血素的含量。结果 不同浓度苦豆子多糖可不同程度地促进小鼠脾淋巴细胞的增殖;苦豆子多糖能在一定程度上提高小鼠腹腔巨噬细胞的廓清能力、吞噬速度及血清中溶血素的含量,提高小鼠机体免疫能力。结论 苦豆子多糖能够通过多种免疫途径增强小鼠免疫功能。