代谢组学在多环芳烃诱发儿童哮喘中的应用

多环芳烃是一类广泛存在于环境中的持久性有机污染物。随着我国工业化进程加速，化石燃料的使用增加，多环芳烃在大气中的含量也随之升高。已有报道证明多环芳烃是儿童哮喘发病的潜在危险因素，但其具体致病机制尚未完全阐明。近年来，代谢组学的发展为揭示环境污染物的毒理机制和疾病病因学提供了有力的研究手段。文章从代谢角度，特别是一碳代谢和色氨酸代谢两个方面综述多环芳烃通过改变表观遗传模式和激活芳烃受体，介导炎症并诱发儿童哮喘的机制。     

早期胰管支架置入治疗急性坏死性胰腺炎的疗效：附57例报告

背景与目的 急性坏死性胰腺炎（ANP）的病情复杂多变，病理进展迥异，继发感染时病死率可达20%~30%。目前对于ANP的治疗主要是早期给予禁食、补液、镇痛、抑酸、抑酶等对症治疗，后期形成并发症时，进行外科干预的升阶梯治疗。而ANP后期局部并发症发生率和病死率较高，预后较差。相关研究表明，胰管高压和胰管梗阻在急性胰腺炎（AP）的发病过程中起着重要作用，AP合并胰液渗漏的概率可高达90%以上。因此，本研究探讨早期胰管支架置入治疗ANP的有效性和安全性。方法 回顾性收集宁夏医科大学总医院2019年6月1日—2021年12月30日期间入院后48 h之内行胰管支架置入术治疗的ANP患者临床资料。结果 按照纳入标准和排除标准，共纳入57例患者，其中中度重症34例，重症23例。所有患者入院到手术等待时间为8（3~21）h，均成功完成胰管支架置入。18例患者在手术中可见胰管蛋白栓，其中中度重症8例（23.53%）、重症10例（43.48%）。患者手术后腹痛、腹胀等症状均有不同程度的缓解；患者入院48 h后，白细胞、血淀粉酶、血脂肪酶、血糖水平及APACHE Ⅱ评分均较入院时明显降低（均P<0.05）。患者首次经口进食时间和住院时间的中位数分别为72（48~144）h和9（6~16.5）d。进一步分析显示，中度重症转入ICU患者数量、首次经口进食时间、住院时间、住院费用和CT严重程度指数方面均明显优于重症患者（均P<0.05）。大部分患者入院时有严重的胰周渗出，胰管支架置入后，胰周渗出都有不同程度的吸收。无严重手术相关不良事件发生，后期形成感染性坏死8例、包裹性坏死7例，其中5例通过胰管支架引流后治愈，其余10例行经皮穿刺置管引流，未进行开腹清创等其他外科干预。结论 早期胰管支架置入治疗ANP可以快速缓解患者的症状，降低局部并发症的发生率，减少后期反复的外科干预，是临床有效的治疗方法和策略。     

初次与再次动静脉内瘘术血液透析患者血管TGF-β1/Smad3的表达及临床意义

目的 比较维持性血液透析初次与再次动静脉内痿术患者血管TGF-β1/Smad3的表达差异,并探讨其临床意义.方法 收集我院2017年6月～2019年6月期间肾内科行初次(A组)与再次(B组)动静脉内痿术患者拟废弃的静脉血管标本及相关临床参数,随访6个月,记录两组患者动静脉内痿结局(成熟或未成熟),据此分为瘘成熟组及癌未...     

Efficacy and safety of laser-related therapy for melasma: A systematic review and network meta-analysis

Background

Melasma is a prevalent, persistent hyperpigmentation disorder that negatively affects the psychological health of patients. However, the treatment outcome remains unsatisfactory due to the complexity of pathogenesis, recurrence characteristics, and relatively high morbidity.

Objectives

To compare the performance of laser-related therapies in improving the melasma area severity index (MASI) score of melasma and the occurrence of adverse effects by network meta-analysis (NMA).

Methods

From the inception to November 2022, eligible randomized controlled trials were identified. Two investigators independently searched relevant studies from PUBMED, EMBASE, and the Cochrane Library database.

Results

A total of 39 clinical studies with 1394 participants were eligible for enrollment. For efficacy, the NMA demonstrated that Q-switched Nd: YAG laser + topical medications (QSND+TM) was superior to Q-switched Nd:YAG laser (QSND) [MD = −4.21 (−6.80, −1.63)], Er: YAG laser + topical medications (ERYL+TM) [MD = -3.52 (−6.84, −0.19)], and picosecond laser + topical medications (PICO+TM) [MD = −4.80 (−9.33, −0.27)]. The microneedling + topical medications (MN+TM) was superior to picosecond laser (PICO) [MD = −5.26 (−10.44, −0.08)] and topical medications (TM) [MD = −5.22 (−9.20, −1.23)]. The top five of the surface under the cumulative ranking curve value (SUCRA) are Q-switched Nd:YAG laser + topical medications (QSND+TM 85.9%), oral tranexamic acid (oTA 80.1%), microneedling + topical medications (MN+TM 79.7%), Q-switched Nd:YAG laser + intense pulse light (QSND+IPL 78.9%), and fractional carbon dioxide laser + topical medications (FCDL+TM 70.5%).

Conclusions

In conclusion, the Qs-Nd:YAG laser with topical medications is the first choice for treating melasma according to the SUCRA value. Among the three treatment modalities, namely MN + TM, PICO, and TM, our recommendation favors MN+TM as the superior choice for enhancing the curative efficacy in melasma. However, the actual clinical choice should also take into account the adverse effects, the skin type of the patient, the duration of the disease, and other relevant factors.     

A two-stage genome-wide association study identified four potential early-onset nonsmall cell lung cancer risk loci based on 26,652 participants in Chinese population

Early-onset lung cancer is rare with an increasing incidence rate. Although several genetic variants have been identified for it with candidate gene approaches, no genome-wide association study (GWAS) has been reported. In this study, a two-stage strategy was adopted: firstly we performed a GWAS to identify variants associated with early-onset nonsmall-cell lung cancer (NSCLC) risk using 2556 cases (age ≤ 50 years) and 13,327 controls by logistic regression model. To further discriminate younger cases from older ones, we took a case–case analysis for the promising variants with above early-onset cases and 10,769 cases (age > 50 years) by Cox regression model. After combining these results, we identified four early-onset NSCLC susceptibility loci at 5p15.33 (rs2853677, odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.36–1.60, P_case-control = 3.58 × 10⁻²¹; hazard ratio [HR] = 1.10, 95% CI: 1.04–1.16, P_case–case = 6.77 × 10⁻⁴), 5p15.1 (rs2055817, OR = 1.24, 95% CI: 1.15–1.35, P_{case–control} = 1.39 × 10⁻⁷; HR = 1.08, 95% CI: 1.02–1.14, P_case–case = 6.90 × 10⁻³), 6q24.2 (rs9403497, OR = 1.24, 95% CI: 1.15–1.35, P_{case–control} = 1.61 × 10⁻⁷; HR = 1.11, 95% CI: 1.05–1.17, P_case–case = 3.60 × 10⁻⁴) and 12q14.3 (rs4762093, OR = 1.31, 95% CI: 1.18–1.45, P_{case–control} = 1.90 × 10⁻⁷; HR = 1.10, 95% CI: 1.03–1.18, P_case–case = 7.49 × 10⁻³). Except for 5p15.33, other loci were found to be associated with NSCLC risk for the first time. All of them had stronger effects in younger patients than in older ones. These results provide a promising overview for early-onset NSCLC genetics.