COX-2mRNA在重症急性胰腺炎内分泌功能变化中的作用

目的:研究重症急性胰腺炎大鼠胰腺内分泌功能的变化,探讨胰腺内分泌功能损伤中COX-2mRNA的作用。方法:使用3.5%牛磺胆酸钠制作大鼠重症急性胰腺炎动物模型,对胰腺病理损伤评分;检测脂肪酶,血糖水平;分离胰岛细胞,进行葡萄糖刺激胰岛素分泌试验;应用逆转录聚合酶链反应技术,检测胰岛细胞COX-2mRNA的表达情况。结果:重症急性胰腺炎大鼠造模后1h,病理学评分、血糖、血清脂肪酶升高。胰岛葡萄糖刺激胰岛素分泌试验显示,胰岛素分泌量较正常对照组明显减少,差异有显著意义;逆转录聚合酶链反应提示重症急性胰腺炎组胰岛的COX-2mRNA表达增强,差异有显著意义。结论:3.5%牛磺胆酸钠诱导的重症急性胰腺炎对胰腺内分泌有较大影响。胰岛COX-2mRNA表达明显增强,在重症急性胰腺炎对胰腺内分泌功能影响中发挥作用。     

Immunity in young adult survivors of childhood leukemia is similar to the elderly rather than age‐matched controls: Role of cytomegalovirus

Many treatment complications that occur late in childhood cancer survivors resemble age‐related comorbidities observed in the elderly. An immune phenotype characterized by increased immune activation, systemic inflammation, and accumulation of late‐differentiated memory CD57⁺CD28^? T cells has been associated with comorbidities in the elderly. Here, we explored if this phenotype was present in young adult leukemia survivors following an average of 19 years from chemotherapy and/or radiotherapy completion, and compared this with that in age‐matched controls. We found that markers of systemic inflammation—IL‐6 and human C‐reactive protein and immune activation—CD38 and HLA‐DR on T cells, soluble CD (sCD)163 from monocytes and macrophages—were increased in survivors compared to controls. T‐cell responses specific to cytomegalovirus (CMV) were also increased in survivors compared to controls while CMV IgG levels in survivors were comparable to levels measured in the elderly (>50years) and correlated with IL‐6, human C‐reactive protein, sCD163, and CD57⁺CD28^? memory T cells. Immune activation and inflammation markers correlated poorly with prior chemotherapy and radiotherapy exposure. These data suggest that CMV infection/reactivation is strongly correlated with the immunological phenotype seen in young childhood leukemia survivors and these changes may be associated with the early onset of age‐related comorbidities in this group.     

封闭负压引流技术治疗口腔颌面间隙感染的临床应用

目的 评价封闭负压引流（VSD）技术持续负压引流并生理盐水持续冲洗治疗口腔颌面间隙感染的疗效。方法 对116例颌面间隙感染病例进行回顾性分析,收集患者临床资料,比较常规手术切开引流（传统治疗组,58例）和手术切开VSD（VSD组,58例）这2种治疗方法的治疗效果。结果 VSD组患者的住院时间、白细胞计数、瘢痕长度、换药次数、疼痛程度均低于传统治疗组,张口改善度优于传统治疗组（P<0.05）。结论 封闭负压引流技术是治疗口腔颌面间隙感染的更为有效的一种方法。     

静脉滴注免疫球蛋白对肾移植患者群体反应抗体的影响(英文)

背景:很多方法可降低群体反应抗体致敏患者的群体反应抗体水平,其中血浆置换或免疫吸附法脱敏法是比较常用的,但这些方法副作用较多。目的:拟观察肾移植前静脉滴注免疫球蛋白对肾移植患者血清群体反应抗体的影响。设计、时间及地点:以2003-01/2006-11重庆医科大学附属第一医院肾移植中心的57例等待肾移植的群体反应抗体致敏患者为对象的前后对照,病例分析。对象:群体反应抗体致敏患者57例,年龄21～65岁,群体反应抗体值平均(46.7±29.5)%。方法:所有患者在接受肾移植前以5g/d剂量静脉滴注免疫球蛋白,2周为1个疗程。2个疗程之间间隔1周。在给予静脉滴注免疫球蛋白前和疗程结束立即应用酶联免疫吸附反应方法各检测1次血清群体反应抗体水平。主要观察指标:血清群体反应抗体水平。结果:应用免疫球蛋白后群体反应抗体降为非致敏84%(48/57),完全未降5%(3/57),部分下降11%(6/57)。用药后群体反应抗体下降0～61%,平均(38.4±16.3)%。57例患者肾脏移植前淋巴细胞毒试验<10%,均未出现超急性排斥反应。结论:静脉滴注免疫球蛋白预治疗是理想的降低肾移植致敏性的方法,且副作用小。     

乙醇对股骨头髓内脂肪细胞的作用**☆

背景：乙醇已成为股骨头缺血性坏死的致病因素,其所致的骨髓内脂质代谢异常可能是股骨头缺血性坏死起病的重要原因,但机制尚未完全明确。
　　目的：从分子水平观察在乙醇作用下脂肪细胞结构功能的变化,以期分析酒精性股骨头坏死的发病机制。
　　方法：采用原代脂肪细胞体外培养技术,取大白兔股骨头髓内脂肪组织,分离获取脂肪细胞,以油红O染色行细胞表型鉴定。取传代稳定的髓内脂肪细胞,将盖玻片切割成10 mm×10 mm,种植前置入24孔培养板孔内,分为乙醇组和对照组,每组24孔,每孔为1个样本。对照组不加乙醇,乙醇组加入0.15 mol/L乙醇,分别于4,6,8,10 d 更换培养液,换液时不再加入乙醇,均培养至10 d。培养终止后,取出盖玻片行油红O染色,光镜下观察脂肪细胞形态并计数。
　　结果与结论：随着时间延长,乙醇组脂肪细胞数量明显多于对照组(P<0.001),2组小脂滴均逐渐增多、增大,但乙醇组更明显。培养4,6,8,10 d的髓内脂肪细胞数量乙醇组分别为(200.90±24.60),(1102.30±76.73),(1160.30±28.37),(1199.70±44.74)个/cm2;对照组分别为(99.80±10.82),(0.40±94.71),(1000.20±41.85),(1059.80±26.79)个/cm2,脂肪细胞数量随乙醇作用的时间延长而增多。提示乙醇能够促进髓内脂肪细胞增殖肥大,这可能是长期酗酒后股骨头骨髓内脂肪组织增多,骨内压增加,血流灌注减少,导致缺血,从而发生股骨头坏死的主要原因。     

降落伞型二尖瓣合并主动脉瓣畸形1例

病例女,25岁,自述心脏有杂音,病因未明,日常活动无明显不适.查体未见阳性体征.实验室检查无异常.经胸心脏彩超所见：二尖瓣前、后叶发育略厚,回声略强,前后叶均分别通过腱索与同一组（后内侧）乳头肌相连,开放时前向血流速度轻度加快约1.6 m/s,平均跨瓣压差约5 mmHg（1 mmHg=0.133 kPa）,关闭时探及少量返流.主动脉瓣“二叶式”,呈斜裂,开放时前向血流速度加快约3.1 m/s,平均跨瓣压差约23 mmHg,关闭时探及少量返流.各房室腔径大小、比例正常.室间隔、左室壁心肌厚度、运动正常.主动脉根部及升主动脉内径正常.主动脉弓降部血流速度略加快约1.9 m/s,未探及明确狭窄部位.心脏彩超提示：先天性心脏病：降落伞型二尖瓣、二尖瓣轻度狭窄、单组乳头肌、主动脉瓣二叶畸形、主动脉瓣轻度狭窄、主动脉弓降部轻度狭窄.     

影响椎弓根螺钉固定强度的相关因素

背景：椎弓根螺钉作为一种较为优良的脊柱内固定手段,近几年来已越来越广泛应用于临床实践中。目的：探讨影响椎弓根螺钉固定强度的相关因素,为临床选择椎弓根螺钉类型提供生物力学依据。方法：通过检索近年来文章内容与椎弓根螺钉的生物力学相关文献,从椎弓根螺钉器械自身几何形态因素、植入技术因素、椎弓根解剖因素、椎体的骨密度因素、螺钉的制作工艺及材料性能因素等对固定强度的影响相关研究成果作回顾性分析,为临床提供理论依据。结果与结论：文章结果显示椎弓根螺钉的自身形态如螺钉大小、螺纹形状、疲劳特性是影响固定强度的主要因素,椎体的骨密度、螺钉的制作工艺及材料性能也是影响固定强度不可忽视的因素。通过增加螺钉的直径、改进螺钉形态设计、强化骨质、改进操作技术可以提高螺钉的拔出力,提高螺钉的稳定性。     

Inflammatory Markers and Risk of Type 2 Diabetes: A systematic review and meta-analysis

OBJECTIVE

There has been growing evidence that inflammatory markers play a role in the development of type 2 diabetes. We aimed to systematically review prospective studies on the associations of elevated levels of interleukin-6 (IL-6) and C-reactive protein (CRP) with increased risk of type 2 diabetes by conducting a meta-analysis.

RESEARCH DESIGN AND METHODS

A systematic search of the PubMed, EMBASE, ISI Web of Knowledge, and Cochrane Library databases up until 10 February 2012 was conducted to retrieve prospective studies matched to search terms. We used generalized least-squares trend estimation to assess dose-response relationships. The summary risk estimates were pooled using either fixed-effects or random-effects models to incorporate between-study variation.

RESULTS

The meta-analysis, including 10 prospective studies, with a total of 19,709 participants and 4,480 cases, detected a significant dose-response association of IL-6 levels with type 2 diabetes risk (relative risk [RR] 1.31 [95% CI 1.17–1.46]). For CRP, the meta-analysis involving 22 cohorts, with a total of 40,735 participants and 5,753 cases, showed that elevated CRP levels were significantly associated with increased risk of type 2 diabetes (1.26 [1.16–1.37]), with the absence of publication bias. Sensitivity and subgroup analyses further supported the associations.

CONCLUSIONS

This meta-analysis provides further evidence that elevated levels of IL-6 and CRP are significantly associated with increased risk of type 2 diabetes.The rapid worldwide increase in the prevalence of type 2 diabetes has become a serious public health problem (1). Type 2 diabetes may be accompanied by long-term microvascular and macrovascular complications, which lead to both morbidity and mortality (2). In addition, as many as one-third of individuals with type 2 diabetes are undiagnosed. However, accumulating evidence shows that inflammation may play a crucial intermediary role in the pathogenesis of type 2 diabetes, thus relating diabetes to a number of commonly coexisting conditions thought to originate via inflammatory mechanisms (3). In this regard, more recent data suggest that interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with type 2 diabetes (4–10). IL-6, a pleiotropic proinflammatory cytokine, is produced by a variety of cells, including activated leukocytes, endothelial cells, and adipocytes (11). CRP is an acute-phase plasma protein synthesized by the liver and has been shown to be a sensitive, systemic biomarker of inflammation (3). The stability of this protein during long-term frozen blood storage and the availability of inexpensive, precise, and standardized assays have assisted studies of CRP (12).One potential implication of the many studies suggesting a relation between inflammation and diabetes is that inflammatory markers may be used to refine diabetes risk prediction and thus better target individuals for lifestyle interventions. However, the results reported on the association between IL-6 and diabetes risk have varied across studies (13–16). To date, no systematic review has been performed to evaluate the available evidence on the association of IL-6 levels with the risk of type 2 diabetes. Two previous meta-analyses evaluating the association of CRP and diabetes risk have yielded contradictory results. One previous meta-analysis (17) suggested that a positive association exists between CRP and diabetes risk. In contrast, another meta-analysis (18) concluded that CRP may not be an independent risk factor for the development of diabetes.The objective of the current study was to estimate the magnitude of the relationships between IL-6 and CRP levels and the risk of type 2 diabetes in prospective studies and to quantify these relationships in a meta-analysis.     

PICC置管后日常护理实施状况的调查与分析

目的：探讨护理人员对PICC置管后日常护理知识的掌握情况和护理实施情况。方法采用自制问卷调查表对本院120名从事或近半年内从事PICC置管后日常护理护理人员进行调查,主要内容包括护理人员一般资料,对PICC置管后日常护理知识掌握情况及护理实施情况,观察分析结果。结果本组120名护理人员PICC置管后日常护理标准得分平均为(68.65⑨12.65)分,掌握程度最好的前三位依次为贴膜更换时间91.67%(110/120),无菌敷料揭去的方向84.17%(101/120),日常护理的注意事项83.33%(100/120),而掌握程度最差的三位依次为无菌贴膜固定的方式25.00%(30/120),消毒剂的性质31.67%(38/120)及皮肤消毒的范围35.00%(42/120)。 PICC置管后日常护理行为自评标准得分为(60.65⑨11.65)分。观察得分为(49.68⑨8.75)分,自评得分与观察得分比较差异具有统计学意义( P<0.05)。而且,知识得分与行为得分呈明显正相关。本组120名护理人员中仅56.67%护理人员经过PICC专科培训,41.67%护理人员获得PICC护士资质。结论PICC置管后日常护理是降低导管相关性感染的重要措施,应加强护理人员PICC相关知识与技能培训,提高护理人员PICC置后管日常护理理论与实践水平的提高,降低感染发生率,提高护理质量。