热敏灸联合身痛逐瘀汤治疗腰椎间盘突出症微创术后残留症状的临床研究

[目的]观察热敏灸联合身痛逐瘀汤治疗腰椎间盘突出症微创术后残留腰腿痛的临床疗效。[方法]将2019年3月至2019年12月浙江省中西医结合医院66例符合纳入标准的患者随机分为A组、B组、C组,每组各22例,A组予热敏灸联合身痛逐瘀汤治疗,B组予身痛逐瘀汤治疗,C组予热敏灸治疗。14d治疗结束后,合格病例计66例,采用视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、健康量表评分(36-Item Short Form Survey,SF-36)评估疗效,同时以安全性指标评价治疗安全性。[结果]A组、B组、C组总有效率分别为95-5%、77-3%、81-8%,三组间差异具有统计学意义(P=0-027),A组显著优于B组与C组(P=0-023,P=0-015)。与治疗前比较,三组治疗后的JOA评分均明显升高、VAS评分显著降低(P＜0-05);组间比较,A组JOA评分显著高于B组与C组(P＜0-05),VAS评分明显低于B组和C组(P＜0-05),而B组与C组之间差异无统计学意义(P＞0-05)。除情感功能和社会职能两项,A组SF-36评分均优于B组、C组(P＜0-05),B组与C组间比较各有优劣,但差异无统计学意义(P＞0-05)。本研究过程中无任何明显不良事件的报告。[结论]热敏灸配合身痛逐瘀汤对缓解腰椎间盘突出症微创术后残留症状的疗效显著,明显优于单独使用热敏灸或身痛逐瘀汤,并能有效提高患者术后的生活质量。     

不同密度胸腺囊肿CT表现差异及其病理基础

目的：探讨不同密度胸腺囊肿CT表现差异及其病理基础。方法：回顾分析手术病理证实的45例实性密度胸腺囊肿和23例液性密度胸腺囊肿CT表现及其病理改变。结果：胸腺囊肿密度与囊肿大小有相关性（P＜0.01）。实性密度囊肿形态多较规则,液性密度囊肿以不规则、沿大血管间隙塑形多见,组间分布差异有统计学意义（P＜0.01）。泪滴状及三角状在2组均可见,组间分布差异无统计学意义（P＞0.05）。实性密度囊肿多不膨隆于胸腺轮廓,与液性密度相比差异有统计学意义（P＜0.01）。实性密度胸腺囊肿病理表现为有分泌功能的假复层纤毛柱状上皮或纤毛柱状上皮覆盖,囊壁上皮细胞排列较密实,囊液多浑浊;液性密度胸腺囊肿被覆表面为无分泌功能扁平或柱状上皮为主,排列稀疏甚至缺失,基层薄弱,囊液往往较清亮。囊肿密度与被覆上皮类型有相关性（P＜0.05）。结论：胸腺实性密度囊肿与液性密度囊肿影像学表现有差异,病理基础对理解不同表现胸腺囊肿有帮助。     

Bacterial expression of mutant argininosuccinate lyase reveals imperfect correlation of in-vitro enzyme activity with clinical phenotype in argininosuccinic aciduria

Background

The urea cycle defect argininosuccinate lyase (ASL) deficiency has a large spectrum of presentations from highly severe to asymptomatic. Enzyme activity assays in red blood cells or fibroblasts, although diagnostic of the deficiency, fail to discriminate between severe, mild or asymptomatic cases. Mutation/phenotype correlation studies are needed to characterize the effects of individual mutations on the activity of the enzyme.

Methods

Bacterial in-vitro expression studies allowed the enzyme analysis of purified mutant ASL proteins p.I100T (c.299?T?>?C), p.V178M (c.532?G?>?A), p.E189G (c.566A?>?G), p.Q286R (c.857A?>?G), p.K315E (c.943A?>?G), p.R379C (c.1135?C?>?T) and p.R385C (c.1153?C?>?T) in comparison to the wildtype protein.

Results

In the bacterial in-vitro expression system, ASL wild-type protein was successfully expressed. The known classical p.Q286R, the novel classical p.K315E and the known mutations p.I100T, p.E189G and p.R385C, which all have been linked to a mild phenotype, showed no significant residual activity. There was some enzyme activity detected with the p.V178M (5 % of wild-type) and p.R379C (10 % of wild-type) mutations in which K_m values for argininosuccinic acid differed significantly from the wild-type ASL protein.

Conclusion

The bacterially expressed enzymes proved that the mutations found in patients and studied here indeed are detrimental. However, as in the case of red cell ASL activity assays, some mutations found in genetically homozygous patients with mild presentations resulted in virtual loss of enzyme activity in the bacterial system, suggesting a more protective environment for the mutant enzyme in the liver than in the heterologous expression system and/or in the highly dilute assays utilized here.     

Assessing the Validity of Western Measurement of Online Risks to Children in an Asian Context

Before the advent of the Internet, television and film was the only audio-visual medium to which most children were exposed. The risks were primarily limited to children being exposed to sexual and violent materials, the nature of which were known and easy to control. Nowadays, children are surrounded by a variety of digital media and are exposed to different risks, many of which are still unknown. The Internet is fully integrated into children’s daily lives, along with the potential risks. The present study aimed to (i) describe the level of risks children are exposed to, and (ii) test the measurement validity of a total of 45 items assessing nine scales of online risk to children that were adapted from studies carried out in Europe and the United States. The study comprised 420 schoolchildren. The results showed that children were more exposed to ‘unwanted exposure to pornography’ and less to ‘conduct risk’ (e.g., accidental illegal downloading; creating profiles on inappropriate websites). Boys and older children were more exposed to the risks compared to girls and younger children. The study validated five dimensions (inappropriate materials, sexting, contact-related risks, risky online sexual behavior, and bullying/being bullied) assessing online risk to children by using exploratory and confirmatory factor analyses. The study found that scales developed in Europe and the United States are not wholly suitable to an Asian context and needed to be modified. Further investigation to classify online risks to children and offer a solutions to reducing the online risks.     

Metabonomics analysis of serum from rats given long-term and low-level cadmium by ultra-performance liquid chromatography–mass spectrometry

1. This study evaluated the toxicity of chronic exposure to low-level cadmium (Cd) in rats using ultra-performance liquid chromatography–mass spectrometry (UPLC–MS). Forty male Sprague–Dawley rats were randomly assigned to four groups, namely, the control group, low-dose group (0.13?mg/kg·bw), middle-dose group (0.8?mg/kg·bw) and high-dose group (4.89?mg/kg·bw). The rats continuously received CdCl₂ via drinking water for 24?weeks. Serum samples were collected for metabonomics analysis. The data generated from the UPLC–MS was analysed using principal components analysis (PCA) and partial least-squares discriminant analysis (PLS-DA). PLS-DA model with satisfactory explanatory and predictive ability is capable of discriminating the treatment groups from the control group.

2. Finally, the 10 metabolites were identified and showed significant changes in some treatment groups compared with that in the control group (p?p?3. Results suggest that exposure to Cd can cause disturbances in the lipid metabolism, amino acid metabolism, nervous system, antioxidant defence system, liver and kidney function.     

Evaluating biapenem dosage regimens in intensive care unit patients with Pseudomonas aeruginosa infections: a pharmacokinetic/pharmacodynamic analysis using Monte Carlo simulation

This study was conducted to identify optimal dosage regimens and estimate pharmacokinetic/pharmacodynamic (PK/PD) characteristics of short-infusion (SI) versus extended-infusion (EI) biapenem against Pseudomonas aeruginosa infections in Chinese intensive care unit (ICU) patients. A total of 85 strains of P. aeruginosa were collected, and the minimum inhibitory concentration (MIC) of biapenem was measured by the serial two-fold agar dilution method. We designed four frequently used clinical regimens: biapenem 300?mg I.V. q12h, q8h, and q6h, and 600?mg q12h. The Monte Carlo Simulation (MCS) was performed using previously published pharmacokinetic data to calculate the probability of target attainment (PTA) and the cumulative fraction of response (CFR) of these regimens as an SI (0.5?h) and an EI (1?h, 2?h, 3?h, and 4?h).For a target of 40%fT_>MIC (serum drug concentration remains above the MIC for a dosing period), none of the regimens achieved any CFRs>90% for P. aeruginosa, multidrug–resistant P. aeruginosa (MDR-PA) and even non–MDR-PA. The traditional biapenem SI regimens most commonly seen in clinical practice were insufficient in treating both MDR and non-MDR P. aeruginosa in ICU patients. However, biapenem 600?mg q12h over 2–4?h EI regimens could achieve CFR>90% with 20%fT_>MIC. Clinical trials should aim to validate the potentially greater PK/PD index with higher, more frequent doses and longer extended infusions.