我院老年患者用药现状及合理性分析

目的:利用处方审查系统调查老年患者临床用药的合理性.方法:集中整理高干药房2004年3月4日一天的处方共计2 023张,按照患者的姓名、性别等档案信息及处方信息逐一录入到"e药通"用药指南软件的处方录入与检查系统中,同时检查处方的合理性.结果:我院高干药房的老年患者有63.17%为70岁以上的老年人;所审查的2 023张处方涉及964例患者,且49.59%的老年患者服用5种以上的药物(这里不包括中成药和草药);所审查的964例患者服用的药物中,有不良相互作用的62例(6.43%),62例患者的处方中共有67例次不良相互作用.结论:老年患者仍存在服药种类多、潜在的不良相互作用发生率较高的现状,医务工作者一定要树立起以患者为中心的服务意识,充分利用处方审查系统提供的用药指南指导患者,确保患者的用药安全.     

手指外伤邻指皮瓣与腹部皮瓣修复效果比较

目的观察手指外伤邻指皮瓣与腹部皮瓣修复效果。方法手指外伤55例58指,根据软组织缺损情况,分别选择邻指皮瓣、腹部皮瓣修复术,术后比较两组皮瓣成活情况及皮瓣颜色、形状、局部浅感觉、两点位置觉。结果 55例皮瓣均成活,邻指皮瓣颜色、形状与周围皮肤相似,局部浅感觉、位置觉较好,但修复面积小;腹部皮瓣颜色深褐,形状臃肿,局部浅感觉、位置觉较差,但修复面积大。结论邻指皮瓣较腹部皮瓣修复手指软组织缺损效果更好。用其他部位皮瓣取代腹部皮瓣修复手指软组织大面积创伤值得探索。     

Isolation and biological analysis of tumor stem cells from pancreatic adenocarcinoma

AIM： To explore the method of isolation and biological analysis of tumor stem cells from pancreatic adenocarcinoma cell line PANC-1. METHODS： The PANC-1 cells were cultured in Dulbecco modified eagle medium F12 （1：1 volume） （DMEM-F12） supplemented with 20% fetal bovine serum （FBS）. Subpopulation cells with properties of tumor stem cells were isolated from pancreatic adenocarcinoma cell line PANC-1 according to the cell surface markers CD44 and CD24 by flow cytometry. The proliferative capability of these cells in vitro were estimated by 3-[4,5-dimehyl-2-thiazolyl]-2, 5-diphenyl- 2H-tetrazolium bromide （MTT） method. And the tumor growth of different subpopulation cells which were injected into the hypodermisof right and left armpit of nude mice was studied, and expression of CD44 and CD24 of the CD44^＋CD24^＋ cell-formed nodules and PANC-1 cells were detected by avidin-biotin-peroxidase complex （ABC） immunohistochemical staining. RESULTS： The 5.1%-17.5% of sorted PANC-1 cells expressed the cell surface marker CD44, 57.8% -70.1% expressed CD24, only 2.1%-3.5% of cells were CD44^＋ CD24^＋. Compared with CD44-CD24- cells, CD44^＋CD24^＋ cells had a lower growth rate in vitro. Implantation of 104 CD44 CD24 cells in nude mice showed no evidenttumor growth at wk 12. In contrast, large tumors were found in nude mice implanted with 103 CD44^＋CD24^＋ cells at wk 4 （2/8）, a 20-fold increase in tumorigenic potential （P 〈 0.05 or P 〈 0.01）. There was no obvious histological difference between the cells of the CD44^＋CD24^＋ cell-formed nodules and PANC-1 cells. CONCLUSION： CD44 and CD24 may be used as the cell surface markers for isolation of pancreatic cancer stem cells from pancreatic adenocarcinoma cell line PANC-1. Subpopulation cells CD44^＋CD24^＋ have properties of tumor stem cells. Because cancer stem cells are thought to be responsible for tumor initiation and its recurrence after an initial response to chemotherapy, it may be a very promising target for new dr     

Components of the anti-Müllerian hormone signaling pathway in gonads

Anti-Müllerian hormone (AMH) is a member of the Transforming Growth Factor-beta (TGF-beta) family implicated in the regression of Müllerian ducts in male fetuses and in the development and function of gonads of both sexes. Members of the TGF-beta family signal through two types of serine/threonine kinase receptors called type I and type II, and two types of Smad proteins, receptor-regulated Smad (R-Smad) and common Smad, Smad4. Components of the AMH signaling pathway have been identified in gonads and gonadal cell lines. The AMH type II receptor is highly specific. In contrast, the identity of the AMH type I receptor is not clear; three type I receptors of Bone Morphogenetic Proteins (BMPs), Alk2, Alk3 and Alk6 may transduce AMH signals, but none of them has all the characteristics of an AMH type I receptor. AMH activates BMP-specific R-Smads and reporter genes.     

Four categories of gamma-globin gene triplications: DNA sequence comparison of low G gamma and high G gamma triplications

The human fetal gamma chains are produced by closely linked G gamma and A gamma genes, and unequal crossing over between them leads to gamma gene deletions and triplications. Nine gamma gene triplications from seven ethnic groups were analyzed for G gamma and hemoglobin F (Hb F) values of heterozygotes and for the presence of polymorphic XmnI restriction sites 5' to the gamma genes. Four categories of triplication were found: I had low G gamma and low Hb F values and lacked XmnI sites 5' to the three gamma genes [---]. II had high G gamma and slightly elevated Hb F values but was also [---]. III was similar to II, except that XmnI was [+--]. IV had very high G gamma and slightly elevated Hb F values, and XmnI was [++-]. One case each of triplications I and IV were cloned into Charon 35. For both, the two 5' gamma gene code for G gamma chain, while the 3' gamma gene codes for A gamma chain. DNA sequencing showed that the unequal crossover occurred between 472 and 398 base pairs (bp) 5' to the gamma gene Cap sites (- 472 and -398) for the type IV triplication and between -271 and codon 136 for the type I triplication. In addition, type I had a 4-bp deletion of AGCA from -225 to -222. The high G gamma values of the type IV triplication are explained by its -G gamma-G gamma-A gamma-gene arrangement and the XmnI sites 5' to the G gamma genes. We hypothesize that the low G gamma value of the type I triplication, which is also -G gamma-G gamma-A gamma-, is due to inactivation of the middle G gamma gene by the AGCA deletion at -225 to -222.     

The research for the function evaluation of facial nerve and the mechanisms of rehabilitation training

Background:Peripheral facial paralysis (PFP) is a common peripheral neural disease. Acupuncture treatment combined with PFP rehabilitation exercises is a routine method of PFP treatment. This article is to provide a new visual and objective evaluation method for exploring the mechanism and efficacy of acupuncture treatment on PFP, and develop an interactive augmented facial nerve function rehabilitation training system with multiple training models.Methods:This prospective and observational trial will recruit 200 eligible participants for the following study. In the trial, the laser speckle contrast analysis (LASCA) technology will be applied to monitor the microcirculation of facial blood flow during acupuncture, and real-time monitoring algorithms, data sampling, and digital imaging methods will be conducted by machine learning and image segmentation. Then, a database of patient facial expressions will be built, the correlation between surface blood flow perfusion volume and facial structure symmetry will be analyzed, combined with scale assessment and electrophysiological detection. In addition, we will also explore the objectivity and effectiveness of LASCA in the evaluation of facial paralysis (FP), and the changes in blood flow microcirculation before and after acupuncture treatment will be analyzed.Results:The standard image of the facial target area with facial nerve injury will be manually segmented by the convolutional neural network method. The blood flow images of the eyelid, cheek, and mandible of the patients’ affected and healthy side will be compared and evaluated. Laser speckle blood flow symmetry Pr and its changes in FP condition evolution and prognosis outcome will be measured, and relevant characteristic signals values will be extracted. Finally, COX regression analysis method is conducted to establish a higher accuracy prediction model of FP with cross-validation based on laser speckle blood flow imaging technology.Conclusions:We use modern interdisciplinary high-tech technologies to explore the mechanism of acupuncture rehabilitation training in PFP. And we will provide evidence for the feasibility of using the LASCA technique as a typing diagnosis of FP in the acupuncture rehabilitation treatment of PFP.Registration number:ChiCTR1800019463     

透明帽辅助内镜下取出食管异物疗效的Meta分析

目的评价透明帽辅助内镜下取出食管异物的临床价值。方法通过计算机检索Pubmed、CNKI数据库、Web of Knowledge、Cochrane图书馆对照试验注册库和万方数据库从建库至2017年的有关透明帽辅助内镜取出食管异物的相关文献,采用Cochrane协作网提供的RevMan 5.0版软件进行统计处理,对纳入资料的异质性进行分析,计算OR值和95%可信区间。结果按照入选标准,纳入了9项临床试验,共1 103例患者。Meta分析结果显示:透明帽辅助内镜异物取出术成功率更高(OR=8.58,95%CI:4.49～16.38,P 0.05)、视野更清晰(OR=7.35,95%CI:5.20～10.40,P 0.05)、并发症发生率低(OR=0.34,95%CI:0.25～0.46,P 0.05)、患者耐受性好(OR=2.78,95%CI:2.08～3.72,P 0.05)。结论透明帽辅助内镜下食管异物取出术是一种安全有效的内镜下取异物的方法,其患者耐受性好,可提供更好的内镜下操作视野,有利于提高手术成功率,值得进一步推广应用。     

基于报告基因检测的PXR、FXR和LXRα激动剂高通量筛选模型的建立

目的建立基于报告基因法的高通量筛选细胞模型,用来发现PXR、FXR和LXRα受体激动剂。方法利用Real-time定量PCR方法比较HEK293、Hep G2和LS174T细胞中内源性核受体PXR、FXR和LXRα的表达量,将p SG5-h PXR和p GL3-XREM-CYP3A4、p EGFP-N3-h FXR和EcRETK-Luc、p CMX-FLAG-h LXRα和p GL3-XREM-CYP3A4等质粒分别共转染到工具细胞中,优化共转染比例,并考察阳性药与萤光素酶报告基因表达强度的量效关系、模型特异性和稳定性。结果 1根据Real-time定量PCR结果,模型选用低表达PXR、FXR和LXRα的HEK293细胞作为工具细胞;2根据不同共转染比例对报告基因活性的结果,PXR、FXR和LXRα报告基因药物筛选模型的报告基因和过表达质粒比例,最终分别选择1∶1、2∶1和2∶1;3模型中,报告基因活性均与相应阳性药物(PXR/Rif、FXR/CDCA和LXRα/T0901317)呈剂量依赖性增长;4仅PXR激动剂Rif、FXR激动剂CDCA和LXRα激动剂T0901317可分别明显增加相应筛选模型的报告基因活性,分别重复5次试验后,计算得Z'值分别为0.58、0.66和0.63。结论该研究建立的PXR、FXR和LXRα激动剂高通量筛选模型,具有良好的特异性和稳定性,适用于对PXR、FXR和LXRα受体激动剂的筛选,进而开发以核受体作为药物靶点的药物。     

Persistence of side population cells with high drug efflux capacity in pancreatic cancer

AIM： To investigate the persistence of side population （SP） cells in pancreatic cancer and their role and mechanism in the drug resistance. METHODS： The presentation of side population cells in pancreatic cancer cell line PANC-1 and its proportion change when cultured with Gemcitabine, was detected by Hoechst 33342 staining and FACS analysis. The expression of ABCB1 and ABCG2 was detected by real- time PCR in either SP cells or non-SP cells. RESULTS： SP cells do exist in PANC-1, with a median of 3.3% and a range of 2.1-8.7%. After cultured with Gemcitabine for 3 d, the proportion of SP cells increased significantly （3.8% ± 1.9%, 10.7% ± 3.7%, t = 4.616, P = 0.001 〈 0.05）. ABCB1 and ABCG2 expressed at higher concentrations in SP as compared with non-SP cells （ABCB1： 1.15 ± 0.72, 5.82 ± 1.16, t = 10.839, P = 0.000 〈 0.05; ABCG2： 1.16 ± 0.75, 5.48 ± 0.94, t = 11.305, P = 0.000 〈 0.05）, which may contribute to the efflux of fluorescent staining and drug resistance. CONCLUSION： SP cells with inherently high resistance to chemotherapeutic agents do exist in pancreatic cancers, which may be candidate cancer stem cells contributing to the relapse of the tumor.     

Clinical significance of the serum IgM and IgG to SARS‐CoV‐2 in coronavirus disease‐2019

ObjectiveTo explore the clinical value of serum IgM and IgG to SARS‐CoV‐2 in COVID‐19.Methods105 COVID‐19 patients were enrolled as the disease group. 197 non‐COVID‐19 patients served as the control group. Magnetic chemiluminescent immunoassay (MCLIA) was used to detect the IgM and IgG.ResultsThe peak of positive rates of SARS‐CoV‐2 IgM was about 1 week earlier than that of IgG. It reached to peak within 15–21 days and then began a slowly decline. The positive rates of IgG were increased with the disease course and reached the peak between 22 and 39 days. The differences in sensitivity of the three detection modes (IgM, IgG, and IgM + IgG) were statistically significant. The largest group of test cases (illness onset 15–21 days) showed that the positive rate of IgG was higher than IgM. Also, the sensitivity of IgM combined with IgG was higher than IgM or IgG. IgM and IgG were monitored dynamically for 16 patients with COVID‐19, the results showed that serological transformation of IgM was carried out simultaneously with IgG in seven patients, which was earlier than IgG in four patients and later than IgG in five patients.ConclusionThe detection of SARS‐CoV‐2 IgM and IgG is very important to determine the course of COVID‐19. Nucleic acid detection combined with serum antibody of SARS‐CoV‐2 may be the best laboratory indicator for the diagnosis of SARS‐CoV‐2 infection and the phrase and predication for prognosis of COVID‐19.