Assessment of heavy metal characteristics and health risks associated with PM<Subscript>2.5</Subscript> in Xi’an,the largest city in northwestern China

Fine particulate matters (PM_2.5) samples were collected in Xi’an, northwestern China, from May 2015 to April 2016. The concentrations, seasonal variations, potential sources, and health risks for personal exposure for ten metallic elements (i.e., Ba, Zn, Cu, As, Ni, Pb, Mn, Cr, Cd, and Hg) bounded to PM_2.5 were determined and assessed in this study. The results showed that the average PM_2.5 mass concentration in Xi’an was 62.1?±?35.0 μg m^?3 during the sampling period. The annual concentration of the total quantified elements was 2459.5?±?1789.8 ng m^?3, with relatively higher values in winter (3334.9?±?1690.9 ng m^?3) and spring (2809.4?±?2465.4 ng m^?3), in comparison of those in summer (1857.6?±?1162.7 ng m^?3) and autumn (1252.5?±?842.4 ng m^?3). Two elements of Ba (678.0?±?684.9 ng m^?3) and Zn (1264.8?±?725.3 ng m^?3) had greater fluctuations in concentrations and were accounted for more than 80% of the concentration of total quantified elements for each season. The concentrations of As in Xi’an exceeded the national standard in China. The enrichment factors (EFs) of most target heavy metals were high, exceeding 100 for Zn, As, Pb, Cd, and Hg, attributed to strong influences from human activities. Moreover, the largest enrichment of heavy metals in PM_2.5 occurred in Xi’an in winter. Principle component analysis (PCA) was applied for source apportionment. Coal and other fuel combustion, vehicle exhaust, and industrial activities were the three major pollution sources which contributed 43.6, 29.9, and 15.3%, respectively, of the total variance of PM_2.5. The health risk assessment showed that the non-cancer risks of As, Pb, and Cr for children were greater than 1, as well as of As for adults. The cancer risks of As and Cr were higher than 1?×?10^?6, indicating that the two elements had high potentials for both non-cancer and cancer risks. Our finding suggests that the PM_2.5 and related heavy metal pollutions in Xi’an were serious and posed high potential health risks. Effective controls and measures should be established in the studied area.     

河南省二级医院临床医生对循证医学的认知现状

目的通过了解基层工作人员对循证医学的认知和实践现状以及实施时遇到的困难,为循证医学在基层的推广提供依据。方法对河南省县二级医院的136名临床医生进行问卷调查。内容包括个人基本情况,循证医学实践情况,证据检索能力,临床医生对循证医学的态度、了解影响临床应用循证医学的其他因素。结果临床医生对循证医学的了解和实践情况不尽如人意。大多数医务人员已经认识到临床工作中应用循证医学的重要性,但仅仅只是停留在了解阶段,很少将循证医学应用于临床工作中。对循证医学的检索能力欠缺、受单位条件限制、应用EBM费时以及对循证医学认知不够成为基层推广循证医学的主要阻力。结论基层医务人员对循证医学的认知程度并不理想,临床中的某些理论和观念比较陈旧。循证医学运用于临床工作的过程中仍存在诸多的困难。     

临床药师对1例PCI术后房颤合并抗结核治疗的药学监护

摘 要临床药师通过发挥自己的专业特长,结合1例PCI术后房颤合并抗结核治疗患者具体情况,在胸腔置管围术期抗栓药物的应用及与抗结核药物的联用上,从药物选择、药物疗程、方案调整及用药监护方案等方面提出个体化优化建议,为临床提供相关药学信息,辅助临床做出决策并制定监护计划,保障了患者用药安全。     

踝关节运动损伤的MRI表现

运动造成的踝关节损伤的发病率有升高的趋势。MRI是目前诊断踝关节损伤的主要手段,可以明确踝关节骨及软骨、韧带和肌腱的损伤,同时还能评估损伤的程度及范围。就踝关节运动损伤所致的骨损伤、骨软骨损伤、韧带损伤、肌腱损伤的影像表现及其损伤程度的评估进行综述。     

DLX5对牙源性间充质干细胞迁移及趋化作用的研究

目的 探究distal-less homeobox 5 (DLX5)对牙源性间充质干细胞(dental tissue-derived mesenchymal stem cells, DT-MSCs)迁移及趋化的作用。方法 利用逆转录病毒对根尖牙乳头干细胞(stem cells from apical papilla, SCAPs)进行转染,构建稳定过表达及敲减DLX5的细胞系。通过体外细胞划痕实验、transwell实验,探究DLX5对SCAPs迁移及趋化的影响。进一步观察DLX5过表达的SCAPs的条件培养基对牙周膜干细胞 (periodontal ligament stem cells, PDLSCs)迁移及趋化的影响。结果 ①逆转录病毒转染DLX5过表达的质粒后,DLX5在SCAPs中有效过表达;逆转录病毒转染DLX5敲减的质粒后,有效抑制了DLX5在SCAPs中的表达,与对照组相比,差异具有显著性。②过表达DLX5能明显促进SCAPs的迁移及趋化能力。③敲减DLX5能明显抑制SCAPs的迁移及趋化能力。④过表达DLX5的SCAPs的条件培养基促进了PDLSCs的迁移及趋化能力。结论 DLX5对SCAPs的迁移及趋化具有正向调控作用,过表达DLX5的SCAPs条件培养基可以促进PDLSCs的迁移及趋化能力。     

Double filtration plasmapheresis combined with rituximab for donor-specific antibody desensitization in haploidentical haematopoietic stem cell transplantation

Donor-specific anti-HLA antibodies (DSA) are a major cause of engraftment failure in patients receiving haploidentical haematopoietic stem cell transplantation (Haplo-HSCT). Double filtration plasmapheresis (DFPP) avoids the unnecessary loss of plasma proteins and increases the efficiency of purification. To investigate the effectiveness of the desensitization protocol including DFPP and rituximab, we conducted a nested case–control study. Thirty-three patients who had positive DSA were desensitized by the protocol and 99 patients with negative DSA were randomly matched as control. The median DSA mean fluorescence intensity values before and after DFPP treatment were 7505.88 ± 4424.38 versus 2013.29 ± 4067.22 (p < 0.001). All patients in DSA group achieved haematopoietic reconstitution and the median neutrophils and platelets engraftment times were 13 (10–21) and 13 (10–29) days respectively. Although the cumulative incidence of II–IV aGVHD (41.4% vs. 28.1%) and 3-year moderate to severe cGVHD (16.8% vs. 7.2%) were higher in DSA cohort than in the control, no statistical significance was observed. The 3-year non-relapse mortality and the overall survival were 6.39% and 72.0%, respectively, in the DSA cohort, which were comparable to the negative control. In conclusion, DFPP and rituximab could be effectively used for desensitization and overcome the negative effects of DSA in Haplo-HSCT.     

美洲大蠊抗肝纤维化活性提取物的酶解制备工艺研究

目的 优选中性蛋白酶酶解美洲大蠊脱脂膏制备抗肝纤维化活性提取物的工艺。方法 以美洲大蠊脱脂膏的水解度、活性提取物的得率和体外活性为评价指标,在单因素考察（酶用量、酶解时间、pH值、酶解温度、底物浓度）的基础上,采用L₉（3⁴）正交试验优化中性蛋白酶酶解制备抗肝纤维化活性提取物的工艺。结果 最佳酶解工艺为酶用量0.3%,酶解时间2 h,pH值8.5,酶解温度45℃,底物密度1.07 g·mL^-1。工艺验证试验结果表明,美洲大蠊脱脂膏的水解度为15.8%,活性提取物的得率从0.54%提高到0.72%,其24,48,72 h的IC₅₀值分别为（118.37±3.12）,（115.16±2.48）,（105.00±6.35）μg·mL^-1。结论 研究得到美洲大蠊抗肝纤维化活性提取物的酶解制备工艺,该工艺得率较高,简单可行,为美洲大蠊抗肝纤维化药物的研发奠定基础。     

130例万古霉素血清药物浓度检测与用药结果分析

目的:探讨万古霉素血清药物浓度检测方法,分析对于万古霉素临床应用的重要影响.方法:选取我院2013年9月~2015年12月收治的130例耐药革兰氏阳性菌感染患者作为研究对象,使用万古霉素进行治疗,通过对万古霉素血清药物浓度的检测,分析应用效果.结果:血清药物浓度为10~20μg/mL的万古霉素,治疗效果更为显著.万古霉素血清药物浓度越高,不良反应发生率越高.结论:通过万古霉素血清药物浓度检测,合理控制万古霉素的用药剂量,可以获得更好的治疗效果.