伊马替尼治疗不能切除和（或）转移性胃肠道间质瘤的系统评价

目的系统评价伊马替尼治疗不能切除和（或）转移性胃肠道问质瘤的有效性和安全性。方法计算机检索PubMed（1989～2009．4）、EMbase（1989～2009．4）、Cochrane图书馆（2009年第3期）、CBM（1989～2009．4）、CNKI（1989～2009．4）、VIP（1989～2009．4）。同时手工检索其引文,以便发现新的可纳入文献。按Cochrane协作网推荐的方法进行系统评价。结果共纳入5个RCT,包括1845例患者。meta分析结果显示：与标准剂量组（400mg／d）相比,高剂量组（600mg／d或800rag／d）依马替尼虽然增加2年无疾病进展生存率[RR=1．15,95％CI=1．01～1．30,P=0．03],但在2年总生存率（RR=1．00,95％CI=0．92—1．08,P=0．93）、完全肿瘤反应率（RR=1．02,95％CI=0．66～1．59,P=0．93）、部分肿瘤反应率（RR=1．06,95％CI=0．96～1．17,P=0．28）方面两组相似。在安全性方面,高剂量组依马替尼增加了血液毒性反应（RR=1．08,95％CI=1．03—1,14,P=0．003）和各种非血液毒性反应（RR：1．18～2．07,95％CI=1．06～3．32,P均〈0．05）,特别是增加了3级以上毒性反应（RR=1．48,95％CI=1．33～1．65,P〈0．00001）。依马替尼间断治疗的患者出现疾病进展的风险明显增高（RR=0．27,95％CI=0．13～0．58,P〈0．05）,而生存质量未见改善（MD=3．50,95％CI=-11．17～18．17,P〉0．05）。结论对不能切除和（或）转移性的胃肠道间质瘤患者,增加剂量,病人未见明显临床获益;依马替尼治疗胃肠道间质瘤取得疗效后,应持续服药,以免引起疾病进展的风险增加。     

Poly I:C prevents T cell-mediated hepatitis via an NK-dependent mechanism

BACKGROUND/AIMS: T cell immune responses play key roles in the pathogenesis of viral hepatitis, and innate immunity is known to be also activated during this process, however, the effects of innate immunity activation on T cell-mediated hepatitis remain obscure. Here we examined the effect of the activation of NK cells induced by toll-like receptor 3 (TLR3) ligand, polyinosinic-polycytidylic acid (poly I:C), on concanavalin A (Con A)-induced T cell-mediated liver injury. METHODS: Mice received nontoxic intraperitoneal poly I:C injection before Con A intravenous administration. The liver injury was examined by measuring serum transaminase and pathology, and the function of hepatic lymphocytes was detected by FACS analysis. RESULTS: Poly I:C pretreatment protected against T cell-mediated hepatitis, as evidenced by decreased mortality, hepatic necrosis, serum transaminase levels and inflammatory cytokines (IL-4, IFN-gamma). The protective effect of poly I:C was diminished in NK-depleted mice, which could be partially restored by adoptive transfer of NK cells. Administration of poly I:C caused NKT and T cell apoptosis via enhancing expression of Fas protein on these cells and expression of Fas ligand on NK cells. CONCLUSIONS: These findings suggest that activation of NK cells by poly I:C prevents Con A-induced T cell-hepatitis via downregulation of T/NKT cells and subsequent reduction of inflammatory cytokines.     

糖尿病患者全程健康教育模式的探讨

目的：探讨糖尿病患者全程健康教育最佳模式,帮助患者正确认识糖尿病,建立有利于健康的良好行为。方法：对406例糖尿病患者采取护患及家属参与的健康教育模式实施全程健康教育,并于患者入院时及出院后3个月进行糖尿病知识、机体状况、自我管理、生活质量、健康行为的评估。结果：全程健康教育前后患者的机体状况、自我管理、生活质量、健康行为各项指标比较,经统计学分析,均P〈0.01,差异有统计学意义。结论：全程健康教育可明显提高糖尿病患者的知识水平和自我管理能力,增加患者服药的依从性,改变不良的生活方式,建立良好的健康行为,改善患者糖代谢。     

黄芪对大鼠心肌梗死后左室胶原的影响

目的观察黄芪对大鼠急性心肌梗死后左室胶原的影响。方法结扎大鼠冠状动脉制成急性心肌梗死模型,随机分组,分别予黄芪,开搏通,黄芪加开搏通,空白治疗,每组又按观察时间分为２周组和６周组,并于观察时间末测血浆血管紧张素Ⅱ和醛固酮及心脏局部血管紧张素Ⅱ的浓度,于观察时间末测左室非梗死区心肌羟脯氨酸含量及心肌Ⅰ型、Ⅲ型胶原蛋白的比值。结果发现黄芪可以降低大鼠心梗６周后血浆和心脏血管紧张素Ⅱ及血浆醛固酮的浓度。结论黄芪可降低左室非梗死区胶原含量,降低Ⅰ型、Ⅲ型胶原蛋白比值     

The exosome of platelet endothelial cell adhesion molecule-1 (PECAM1) protein: A potential risking star in high blood pressure patients (HBPP)

A number of studies have demonstrated that exosomes were involved in important physiological and pathological processes through cell-to-cell communication in cardiovascular disease, which contained nucleic acids, proteins, and lipid contents. In our study, we found that the protein platelet endothelial cell adhesion molecule-1 (PECAM1) was an extracellular vesicle in the blood of high blood pressure patients (HBPP).Isolated the vesicles from the blood of HBPP and health examiners and detected its size and morphology with nanoparticle tracking analysis, then we identified its surface protein CD63, CD81, and the protein expression of PECAM1 in the exosome with western blot. Furthermore, we analyzed the correlation between the expression of PECAM1 and the high blood degree with linear regression analysis.Our results showed that the morphology of extracellular vesicles was more evident in high blood pressure groups than healthy controls, and the protein expression of PECAM1 was also abundant in the vesicles of HBPP, however, there were no extracellular vesicles in the blood samples of healthy controls. Besides, linear regression showed the linear correlation coefficient R = 0.901, P < .01 between the expression of PECAM1 and the systolic blood pressure of the high blood patients. Therefore, the exosome of protein of PECAM1 was a potential risking star in HBPP.     

急性心肌梗死合并二尖瓣反流的外科治疗

目的:初步探讨急性心肌梗死(AMI)合并二尖瓣反流(MR)的外科治疗方法。方法:2008年8月至2011年8月,收治AMI合并MR患者34例。男性25例,女性9例;年龄42～75岁,平均(61.5±10.4)岁。EuroScore评分4～12分,平均5.8分。所有患者均经冠状动脉造影证实,为冠状动脉多支病变无法行介入治疗。心功能平均3.1级(NYHA),心源性休克2例,术前主动脉球囊反搏(IABP)3例。体表超声Doppler检查,根据反流面积及缩流径宽度,将MR分为1+～4+级,其中1+～2+级12例,3+级16例,4+级6例;根据反流部位及室壁运动情况结合冠状动脉造影进行Carpentier二尖瓣反流功能分型:Ⅰ型8例,Ⅱ型4例,Ⅲb型22例;根据左心室舒张末期径线及射血分数(LVEF),判断心肌梗死对心脏结构造成的损伤程度,34例左心室舒张末径37～70 mm,平均(51±7.8)mm,其中>65 mm 6例。综合MR分型、分级及左心室径线决定是否同期行二尖瓣手术。本组采用以下标准:(1)CarpentierⅠ型患者,如MR达到4+级;(2)Carpentier II型,MR为3+～4+级患者;(3)CarpentierⅢb型、MR为4+级同时左心室舒张末径>65 mm患者,同期矫正二尖瓣反流。余均采用单纯冠状动脉搭桥手术。本组单纯冠状动脉搭桥手术28例,冠状动脉搭桥合并二尖瓣成型或替换6例。随访时间1～36个月,平均(20.5±8)个月。结果:全组死亡2例(5.9%),其中围手术期死亡1例,术后1年死亡1例。搭桥根数平均为2.3根/例。完全再血管化27例(79.1%),不完全血管化7例(21.9%)。心功能分级平均1.06级(NYHA)。二尖瓣反流随访结果:28例单纯冠状动脉搭桥组,12例MR完全消失或微量,13例MR为3+级患者手术后减少为微量到少量,MR矫正成功率为89.3%;3例MR无改善或恶化,均为不完全血管化患者。冠状动脉搭桥合并二尖瓣成型或替换组,围手术期死亡1例,1例术后为MR 2+级,4例MR消失。结论:通过综合分析MR分型、分级及左心室舒张末期径线,决定对于急性心肌梗死合并二尖瓣反流的患者是否同期矫正二尖瓣反流,可获得满意的临床疗效。完全再血管化是手术的关键。体外循环辅助下不停跳搭桥,是心肌损伤最小化的前提下,保证完全再血管化的重要手段。     

Schisandrin B attenuates epidural fibrosis in postlaminectomy rats by inhibiting proliferation and extracellular matrix production of fibroblasts

Laminectomy has been widely considered one of the most common treatments for lumbar disorders. Epidural fibrosis (EF) is a common complication after laminectomy, causing recurrent postoperative pain. Schisandrin B (Sch.B), the active ingredient extracted from Schisandra chinensis Fructus, has been found to have potent antiproliferative and antifibrotic effects on several cells. This study aimed to investigate the effects of Sch.B on the prevention of postlaminectomy EF formation. In vitro, we studied the effects of Sch.B on transforming growth factor beta 1 (TGF‐β1)‐induced proliferation and extracellular matrix (ECM) production of primary fibroblasts, as well as its underlying mechanism. We found that Sch.B not only inhibited the proliferation of fibroblasts but also reduced ECM production, including that of connective tissue growth factor, fibronectin, and type I collagen, in a dose‐dependent manner. Mechanistically, we found that Sch.B suppressed TGF‐β1‐stimulated activation of the Smad2/3 and mitogen‐activated protein kinase pathways. Moreover, the in vivo study demonstrated that Sch.B treatment attenuated the progression of EF in a postlaminectomy rat model via reducing the cell number and ECM production of scar tissue. Taken together, these data suggested that Sch.B possesses great potential value as a preventative agent for EF.     

喉癌及癌旁组织端粒酶活性检测在喉癌手术切缘定界中的意义

目的探讨喉鳞状细胞癌、相应癌旁切缘组织的端粒酶活性表达及其在喉癌手术定界研究中的意义.方法采用多聚酶链反应-酶联免疫吸附法(PCR-ELISA)对47例喉鳞状细胞癌、21例不同距离的相应癌旁组织、20例喉炎性息肉组织的端粒酶活性进行定量检测.结果47例喉癌组织中39例端粒酶呈阳性(83%),而20例喉炎性息肉组织端粒酶均为阴性,两组具有显著性差异(P＜0.001).21例癌旁5 mm处的切缘组织中有6例端粒酶呈阳性(28.6%),但其活性水平均低于相应原发肿瘤组织.而10 mm处的切缘组织端粒酶均呈阴性,两组差异有显著性(P＜0.001).结论端粒酶在喉癌组织中有较高的表达,在不同距离的癌旁切缘组织中有不同程度的表达.喉癌及癌旁组织端粒酶活性可能作为预测喉癌浸润性的指标.可望从分子水平评估喉癌手术的切缘状态,以期为指导喉癌手术分子定界提供客观而有价值的资料.     

经冠状动脉自体骨髓单个核细胞移植对阿霉素心肌病兔心功能的影响

目的建立经冠状动脉输注自体骨髓单个核细胞(BMNNCs)治疗阿霉素诱导的扩张型心肌病(DCM)新西兰兔的移植模型,评价BMMNCs移植对心肌间质重塑的影响,初步探讨移植后心肌间质重塑与心功能改善的内在联系。方法经耳缘静脉注射盐酸阿霉素建立新西兰兔DCM模型,将存活的DCM模型兔随机分为冠状动脉移植亚组(10只,经冠状动脉输注自体BMNNCs)和对照亚组(10只,假手术)。半定量分析左心室心肌胶原容积分数(CVF)、基质金属蛋白酶(MMP)-2和MMP-3,以评价心肌间质重塑;测定血流动力学指标和血清脑钠素(BNP),以评价心功能的改变。结果BMMNCs移植术4周后,冠状动脉移植亚组的心肌组织MMP-2和MMP-3表达呈下降趋势(P值均<0.01);左心室CVF的增幅为(0.97±1.94)%,显著低于对照亚组的(11.58±2.82)%(P<0.05)。冠状动脉移植亚组移植后8周的血清BNP为(172.16±15.28)μg/L,显著高于移植后14周的(128.46±10.02)μg/L(P<0.01)。结论经冠状动脉的自体BMMNCs移植,可能通过抑制MMPs的应激性改变而延缓心肌间质重塑中胶原代谢进程,有助于改善新西兰兔DCM模型的心功能。