人乙型肝炎病毒感染与原发性肝癌──—在树忽的实验研究

用人乙肝病毒（ＨＢＶ）接种树的，建立ＨＢＶ感染动物模型，实现连续传代感染，并用乙肝疫苗预防其感染。以此模型研究ＨＢＶ及（或）黄曲霉毒素Ｂ１（ＡＦＢ１）在诱发肝癌中的作用。结果肝癌诱发率在同时接受两种因子者显著高于单一因子者，癌前病变的发生与肝癌诱发率相关，被感染树的肝组织及（或）肝癌中检出ＨＢＶＤＮＡ可整合于宿主肝ＤＮＡ。提示ＨＢＶ和ＡＦＢ１起协同致癌作用并支持ＨＢＶ与肝癌的病因学关系。     

Interactions among the beta2- and beta3- adrenergic receptor genes and total body fat and abdominal fat level in the HERITAGE Family Study

OBJECTIVE AND SUBJECTS: Interactions between markers in the beta2- and beta3-adrenergic receptor (ADR) genes and total body fat and computerized tomography-measured abdominal fat phenotypes were studied in the HERITAGE Family Study cohort of Black (n=205; 81 males and 124 females) and White (n=415; 198 males and 217 females) subjects before and after an endurance training program. RESULTS: In Black subjects, beta2- and beta3-ADR gene variants showed evidence of interactions on changes in total body fat mass and abdominal fat area (P<0.005 and =0.010, respectively). Black subjects who were carriers of both beta2-ADR Arg16 and beta3-ADR Arg64 alleles had a greater decrease in total fat mass as well as abdominal total and subcutaneous, but not visceral fat areas in response to endurance training than subjects with other genotype combinations (P from 0.011 to 0.047). After correction for multiple tests, the findings remained essentially unchanged for total body fat mass and abdominal fat area, but became nonsignificant for subcutaneous fat area. The changes in abdominal fat correlated positively with the changes in fat mass (P<0.0001). The interactions between beta2 and beta3-ADR gene markers accounted for a maximum of 3% of the variances in the response of total fat mass and abdominal fat area to endurance training in Black subjects but it was not significant in White subjects. CONCLUSION: Interactions between sequence variants in the beta2-beta3-ADR gene contributed to the changes in fat mass and abdominal adiposity in response to endurance training in Black subjects.     

Immediate effect of Biosense guided percutaneous direct myocardial revascularization with holmium:yttrium aluminium garnet laser on myocardial contractility assessed by transesophageal echocardiography

OBJECTIVE: To evaluate immediate changes in left ventricular wall motion in patients treated using Biosense direct myocardial revascularization laser system. METHODS: Regional wall motion in 10 patients undergoing catheter-based direct myocardial revascularization using a holmium:yttrium aluminium garnet laser was assessed by transesophageal echocardiography before and immediately after the procedure. RESULTS: Mild deterioration in wall-motion score occurred rarely for only three of 160 (1.9%) segments and did not induce clinical heart failure. CONCLUSION: With the current catheter-based laser myocardial revascularization strategy, mild deterioration in wall motion of treated segments was rarely observed and did not effect overall left ventricular function or induce clinical congestive heart failure.     

中西医结合治疗脑卒中后焦虑障碍45例临床研究

目的：观察中西医结合治疗脑卒中后焦虑障碍（PSAD）的临床疗效。方法；对45例PSAD病人于治疗前后进行SAS测评，并对所获资料进行统计学分析。结果：焦虑症状消失率为88．89％；SAS标准分均数值经治疗后明显下降，有统计学意义（P＜0．001）；各项目所引起的症状得分均数值亦明显下降。结论：中西医结合治疗PSAD可取得较好疗效。     

Toothpick impaction with sigmoid colon pseudodiverticulum formation successfully treated with colonoscopy

Foreign bodies in the colon are encountered with increasing frequency, but only sporadic reports concerning their management have appeared in the literature. While most ingested foreign bodies usually pass through the gastrointestinal tract uneventfully, sharp foreign bodies such as toothpicks infrequently cause intestinal perforation and may even result in death. We report our experience with a patient with a sigmoid colon pseudodiverticulum formation, a complication of accidental ingestion of a toothpick that was diagnosed and successfully managed colonoscopically.     

Changes in the contractile response of arteires and veins from hypertensive rabbits to sympathetic nerve activity: assessment of some postsynaptic influences.

Contractile responses to field stimulation of intramural nerves of arteries and veins taken from rabbits made hypertensive by partial constriction of the abdominal aorta have been related to the carotid artery pressure. The increase in contraction of cephalic and short saphenous veins with rise in carotid artery pressure can be accounted for by an increase in sensitivity of the alpha-adrenergic receptor. The neurogenic contraction of the ear artery increased with carotid artery pressure rise. Changes in some of the extraneuronal factors that influence transmitter distribution and disposition in the tunica media were examined. In hypertensive animals, the percentage of released adrenergic transmitter entering the vessel wall might be expected to decrease due to an increase in medial thickness. However, this percentage was not significantly altered in the ear artery probably due, in part, to a concomitant increase in medial permeability to the transmitter. Extraneuronal transmitter disposition factors, i.e. extraneuronal uptake, monoamine oxidase, and catechol-O-methyltransferase activity are directly related to the wet weight of the vessel wall. Thus, their contribution to transmitter disposition would be expected to increase with increase in vessel wall thickness and tend to reduce the response to sympathetic activity. As the contractile response increased in the hypertensive vessels despite such changes, the increase in effector cell mass and density of neuronal terminal plexus, shown previously to increase with hypertension, are more important than these other considerations.     

Prospective study reveals a microbiome signature that predicts the occurrence of post-operative enterocolitis in Hirschsprung disease (HSCR) patients

ABSTRACT

Hirschsprung disease (HSCR) is a birth defect with an approximate incidence of 1/5,000 live births, and up to one-third of HSCR patients develop Hirschsprung-associated enterocolitis (HAEC), the leading cause of HSCR-related death. Very little is known about the pathogenesis, prevention, and early diagnosis of HAEC. Here, we used a prospective study to investigate the enteric microbiome composition at the time of surgery as a predictor for developing postoperative HAEC. We identified a microbiome signature containing 21 operational taxonomic units (OTUs) that can potentially predict postoperative HAEC with ~85% accuracy. Furthermore, we identified exclusive breastfeeding as a novel protective factor for total HAEC (i.e., preoperative and postoperative HAEC combined). In addition, we discovered that breastfeeding was associated with a lowered risk for HAEC potentially mediated by modulating the gut microbiome composition characterized by a lower abundance of Gram-negative bacteria and lower LPS concentrations. In conclusion, modulating the gut microbiome by encouraging breastfeeding might prevent HAEC progression in HSCR patients.     

巨噬细胞影响骨质疏松性骨折骨愈合的研究进展

骨质疏松性骨折愈合缓慢,预后差。募集的巨噬细胞极化为促炎M1型巨噬细胞及抑炎M2型巨噬细胞,两种亚型的动态平衡影响骨折愈合速度和预后。但在原发性骨质疏松性骨折及继发性骨质疏松性骨折中,M1型和M2型巨噬细胞极化失衡,严重影响骨折愈合。研究表明,通过一些生物学方法重建巨噬细胞极化平衡,如生物医用仿生材料和外泌体携载miRNA治疗等,可有效改善巨噬细胞表型极化,减少骨吸收,促进成骨分化,加速骨质疏松性骨折骨愈合。因此,笔者从巨噬细胞在骨折愈合过程中的作用、巨噬细胞极化失衡导致骨质疏松性骨折延迟愈合及重建巨噬细胞极化平衡加速骨质疏松性骨折骨愈合等方面,就巨噬细胞对骨质疏松性骨折骨愈合影响的研究进展进行综述,为临床治疗骨质疏松性骨折提供新的思路。     

乳腺导管原位癌伴微浸润与导管原位癌的临床病理及X线表现对比分析

目的对比分析乳腺导管原位癌伴微浸润(DCISM)与导管原位癌(DCIS)的X线及临床病理表现及DCISM的预测因子。方法收集2016年1月至2020年7月在青岛大学附属医院经手术病理证实的DCISM及DCIS患者626例,患者术前均接受乳腺X摄影检查。参照乳腺影像报告和数据系统(BI-RADS)标准对DCISM与DCIS患者X线表现进行分类诊断。采用χ²检验或Fisher确切概率法分析DCISM与DCIS患者临床病理及X线表现的差异性,应用单因素和多因素二元logistic回归分析探讨与DCISM相关的危险因素。结果626例患者中,DCISM患者171例,DCIS患者455例。单因素回归分析表明,肿瘤直径≥2.7cm、高核级别、粉刺性坏死、淋巴结阳性、Ki67高表达、雌激素受体及孕激素受体阴性是DCISM的预测因子(P<0.05)。多因素回归分析显示,肿瘤直径≥2.7cm(OR 2.229,95%CI 1.505~3.301,P<0.001)、高核级别(OR 1.711,95%CI 1.018~2.875,P=0.043)、淋巴结阳性(OR 4.140,95%CI 1.342~12.773,P=0.013)是DCISM的独立预测因子(P<0.05)。乳腺X线摄影中,DCIS与DCISM患者的病变类型、有无钙化及钙化分布差异具有统计学意义(χ²分别为17.42、9.65、9.10,P<0.05),17.6%(80/455)的DCIS患者表现为隐匿性病变,49.1%(84/171)的DCISM表现为钙化伴肿块、非对称致密、结构扭曲。团簇状钙化多见于DCIS(41.5%,120/289),而区域性钙化在DCISM中更普遍(35.9%,47/131)。结论乳腺X线摄影表现为钙化性病变及区域性钙化在DCISM中更常见。肿瘤直径≥2.7cm、高核级别、淋巴结阳性是DCISM的独立预测因子。     

静脉造影在完全植入式静脉输液港植入术中导引和并发症诊断、预测中的作用

【摘要】 目的 探讨静脉造影在经腋静脉完全植入式静脉输液港（TIVAP）植入术中导引和术后并发症诊断、预测中的作用。方法 收集2018年1月至2020年12月在上海市公共卫生临床中心就诊并经腋静脉近侧段植入TIVAP的342例患者临床资料。分析静脉造影导引穿刺成功率、置港成功率、术后并发症、静脉造影在并发症诊断和预测中的作用。 结果 静脉造影导引下腋静脉穿刺成功率97.4%（76/78）,所有患者TIVAP植入均获成功。误穿动脉3例,气胸1例。术前应用静脉造影预测夹闭综合征2例。术后应用静脉造影诊断导管阻塞3例,纤维蛋白鞘2例。随访确诊5例症状性静脉血栓,36例无症状性静脉血栓,发生率12%（41/342）。单因素分析显示,年龄、左心室射血分数（LVEF）、血栓弹力图（TEG）、腋静脉显影延迟、同侧经外周穿刺中心静脉导管（PICC）植入史与静脉血栓发生相关;多因素回归分析显示,年龄、LVEF、腋静脉显影延迟、同侧PICC植入史是静脉血栓独立预测因素。结论 静脉造影导引下经腋静脉近侧段植入TIVAP安全可行,静脉造影在并发症诊断和预测中起重要作用。