Combined prognostic value of preoperative serum thyrotrophin and thyroid hormone concentration in papillary thyroid cancer

BackgroundA growing number of studies have found a close association between thyroid hormones and thyrotrophin (TSH), and they also have prognostic significance in some cancer types; this study aimed to investigate the prognostic value of free triiodothyronine (fT3), free thyroxine (fT4), fT3/fT4, TSH, and their combination in patients with papillary thyroid carcinoma (PTC).MethodsThis study retrospectively analyzed the relevant data of 726 newly diagnosed PTC patients. Both univariate and multivariate analyses were used to predict the recurrence rate, and a risk score was established. In addition, with the use of a random survival forest, a random forest (RF) score was constructed. After calculating the area under the curve (AUC), the diagnostic efficacy of risk score, RF score, and four indicators was compared.ResultsfT3, fT4, fT3/fT4, and TSH were strongly associated with some invasive clinicopathological features and postoperative recurrence. Patients with high expression of fT4 and TSH have a high risk of recurrence. By contrast, patients with high expression of fT3 and fT3/fT4 have a low risk of recurrence. At the same time, the combined use of various indicators is more helpful for establishing an accurate diagnosis. By comparison, we found that the RF score was better than the risk score in terms of predicting the recurrence of PTC.ConclusionThe diagnostic accuracy of a combination of fT3, fT4, fT3/fT4, and TSH can help improve our clinical estimate of the risk of recurrent PTC, thus allowing the development of a more effective treatment plan for patients.     

138例晚期食管癌的化疗疗效和预后因素分析

背景与目的:晚期食管癌患者预后差,目前仍无标准的治疗方案,影响其预后的独立因素也不明确。本研究旨在分析晚期食管癌的化疗疗效,并探讨影响其预后的因素。方法:回顾性分析中国医学科学院中国协和医科大学肿瘤医院1984年12月至2006年4月收治的、经病理和/或细胞学确诊的138例初治晚期食管鳞癌患者的临床资料。全组患者分为新药组(含紫杉醇、健择或草酸铂)和非新药组(不含紫杉醇、健择或草酸铂)。新药组有68例,其中化疗方案中含顺铂64例(94.1%);非新药组有70例,其中化疗方案中含顺铂48例(68.6%)。对可能影响生存因素的比较采用log-rank检验,死亡相对风险的比较采用Cox比例风险模型进行计算。结果:全组138例患者的化疗有效率47.8%,中位疾病进展时间4个月,中位生存时间10个月。采用含紫杉醇或健择化疗新药组患者有效率(58.8%)明显高于非新药组(37.1%)(P=0.011)。单因素分析表明,年龄、治疗前血红蛋白水平、化疗周期数、化疗近期疗效、疾病进展时间以及治疗手段与预后相关。多因素分析表明,疾病进展时间、治疗手段、疗前血红蛋白水平是影响生存的独立预后因素。结论:紫杉醇或健择联合顺铂方案用于晚期食管癌化疗有较高的有效性。疾病进展时间、治疗手段、疗前血红蛋白水平是影响生存的独立预后因素。     

形成性评价在临床医学专业学位硕士研究生临床能力培养中的应用效果

目的 比较分析形成性评价在临床医学专业学位硕士研究生临床能力培养中的应用效果,旨在为临床能力的培养模式和考评体系的规范建立提供依据。方法 本研究采用问卷调查的方式,选取2020年1月至2021年3月在昆明医科大学第二附属医院急诊重症医学科轮转的全部临床医学专业学位硕士研究生为研究对象,基于形成性评价体系和临床能力内容自制调查问卷,分析形成性评价在临床能力培养过程中的应用效果。结果 形成性评价能提高研究生各方面的临床能力,按入学年级进行统计学分析,差异均无统计学意义（P>0.05）;考核评估工具迷你临床演练评估（Mini-CEX）、临床技能直接观察法（DOPS）和病例分析法（SOAP）的应用能提高研究生的诊疗能力、临床操作技能和临床思维,按入学年级进行统计学分析,差异均无统计学意义（P>0.05）;临床专业研究生对教学质量评价总体为优。结论 形成性评价应用于临床医学专业学位硕士研究生临床能力的培养取得较好效果,学生满意度、认可度高,教学质量好,培训趋于同质化。     

Addition of terlipressin to norepinephrine in septic shock and effect of renal perfusion: a pilot study

PurposeTerlipressin improves renal function in patients with septic shock. However, the mechanism remains unclear. Here, we aimed to evaluate the effects of terlipressin on renal perfusion in patients with septic shock.Materials and MethodsThis pilot study enrolled patients with septic shock in the intensive care unit of the tertiary hospital from September 2019 to May 2020. We randomly assigned patients to terlipressin and usual care groups using a 1:1 ratio. Terlipressin was intravenously pumped at a rate of 1.3 μg/kg/hour for 24 h. We monitored renal perfusion using renal contrast-enhanced ultrasound (CEUS). The primary outcome was peak sonographic signal intensity (a renal perfusion parameter monitored by CEUS) at 24 h after enrollment.Results22 patients were enrolled in this study with 10 in the terlipressin group and 12 in the usual care group. The baseline characteristics of patients between the two groups were comparable. The peak sonographic signal intensity at 24 h after enrollment in the terlipressin group (60.5 ± 8.6 dB) was significantly higher than that in the usual care group (52.4 ± 7.0 dB; mean difference, 7.1 dB; 95% CI, 0.4–13.9; adjusted p = .04). Patients in the terlipressin group had a lower time to peak, heart rates, norepinephrine dose, and a higher stroke volume at 24 h after enrollment. No significant difference in the urine output within 24 h and incidence of acute kidney injury within 28 days was found between the two groups.ConclusionsTerlipressin improves renal perfusion, increases stroke volume, and decreases norepinephrine dose and heart rates in patients with septic shock.     

等离子与汽化电切术治疗前列腺增生的效果及术后膀胱颈挛缩的影响因素

目的 探究经尿道等离子前列腺电切术(TUPKRP)与经尿道前列腺汽化电切术(TUVP)治疗前列腺增生(BPH)的效果,并分析术后膀胱颈挛缩(BNC)的影响因素。方法 前瞻性的选取2018年1月至2020年1月我院泌尿外科收治的90例BPH患者作为研究对象。数字表法随机分成对照组(45例,TUVP)和观察组(45例,TUPKRP),对比两组患者治疗前、治疗3个月后的临床资料,以是否发生BNC为分组依据,分析术后BNC的影响因素。结果 组内比较,两组患者治疗3个月后IPSS、PSA、表皮生长因子(EGF)及前列腺素E2(PGE2)均显著低于治疗前(P<0.05),Q_max显著高于治疗前(P<0.05);组间同时点比较,治疗后观察组患者IPSS、PSA、EGF及PGE2均显著低于对照组患者(P<0.05),且Q_max显著高于对照组患者(P<0.05)。发生BNC组患者合并前列腺炎、冲洗温度<34℃、导管灌注量≥40 ml以及TUVP术式占比均显著高于未发生BNC组患者(P<0.05);且Logistic分析结果显...     

Alendronate modified mPEG-PLGA nano-micelle drug delivery system loaded with astragaloside has anti-osteoporotic effect in rats

Astragaloside (AS) has an anti-osteoporotic effect, but its poor water solubility and low bioavailability limit its application. In this study, a novel nano-carrier with bone targeting was prepared by modifying mPEG-PLGA with alendronate (AL) before incorporation into astragaloside nano-micelles (AS-AL-mPEG-PLGA) to enhance the oral bioavailability, bone targeting and anti-osteoporosis effect of AS. The release behavior of AS-AL-mPEG-PLGA in vitro was investigated via dialysis. The pharmacokinetics of AS-AL-mPEG-PLGA was studied in Sprague-Dawley (SD) rats. The cytotoxicity of AS-AL-mPEG-PLGA in vitro (via MTT method), coupled with bone targeting ability in vitro and in vivo were evaluated. The therapeutic effects of free AS and AS-AL-mPEG-PLGA (ELISA, micro-CT, H&E staining) were compared in osteoporotic rats. AS-AL-mPEG-PLGA with smaller particle size (45.3 ± 3.8 nm) and high absolute zeta potential (−23.02 ± 0.51 mV) were successfully prepared, wherein it demonstrated higher entrapment efficiency (96.16 ± 0.18%), a significant sustained-release effect for 96 h and acceptable safety within 10–200 μg/mL. AS-AL-mPEG-PLGA could enhance the hydroxyapatite affinity and bone tissue concentration of AS. The relative bioavailability of AS-AL-mPEG-PLGA was 233.90% compared with free AS. In addition, the effect of AS in reducing serum levels of bone metabolism-related indicators, restoring the bone microarchitecture and improving bone injury could be enhanced by AS-AL-mPEG-PLGA. AS-AL-mPEG-PLGA with small particle size, good stability, remarkable sustained-release effect, safety and bone targeting was successfully constructed in this experiment to potentially improve the oral bioavailability and anti-osteoporosis effect of AS. Thus, AS-AL-mPEG-PLGA may be a promising strategy to prevent and treat osteoporosis.     

抗MRSA感染新药的应用与研究进展

抗耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)感染和对多重耐药金黄色葡萄球菌的治疗一直是临床的严峻挑战.头孢洛林、达巴万星、特地唑胺和奥利万星是美国FDA最新批准的用于抗MRSA感染的药物,本文将对它们的结构特点与作用机制、体内外抗菌活性、不良反应以及临床应用与未来发展进行综述,并着重分析其特性和优劣势.     

紫金牛地上和地下部位挥发性成分比较研究

目的:研究紫金牛生药地上部位、地下部位挥发油成分。方法:采用水蒸气蒸馏法分别提取紫金牛地上部分和根部的挥发油。用GC毛细管柱进行分离分析,并用气相色谱及气相-质谱法对化学成分进行鉴定。色谱条件:Varian 3300气相色谱仪,HP-innowax型石英毛细管柱(30 m×0.25cm×0.25μm)。载气为高纯氦气,FID检测器。质谱条件:Saturn 2000质谱仪(Varian,USA),EI电离源,电离电压70 eV,离子源温度200℃,接口温度240℃,扫描范围:40-450 amu,进样量1.0μL,分流比10:1。结果:本研究从紫金牛地上部分鉴定出了61个组分,占挥发油总量的87.65％,含量在4％以上的组分有:芳樟醇(4.20％)、石竹烯(4.26％)、苯乙醇(4.38％)、水杨酸甲酯(4.47％)、兰桉醇(5.07％)、α-石竹烯(5.14％)、己酸(9.10％)、3,7,11-三甲基-1,6,10-十二碳三烯-3-醇(14.07％)。从根部共鉴定出45个组分,占挥发油总量的88.17％,含量在4％以上的组分有:丁子香基乙醇(4.22％)、兰桉醇(6.02％)、α-杜松醇(8.90％)、龙脑(9.16％)、α-石竹烯(12.89％)、石竹烯(30.13％)。结论:从其不同部位成分比较来看,紫金牛地上部分和地下部分要区别对待,分别人药。     

地塞米松对大鼠肝脏微粒体细胞色素P-450的诱导效应

目的:观察地塞米松(dexamethasone,DEX)对细胞色素P-450(cytochrome P450,CYP450)的诱导效应,并探讨其诱导机制.方法:雄性Wistar大鼠分别以DEX 0,25,50和100mg·kg-1·d-1诱导处理(ip)4d后,测定大鼠肝脏总CYP450含量,CYP3A1,CYP3A2和CYP2B 1/2的mRNA及蛋白的表达水平,肝脏ERD(CYP3A活性),PROD(CYP2B活性)和BROD(总CYP450活性).结果:CYP450含量、ERD、PROD和BROD活性在DEX多次诱导后都有升高.CYP3A1 mRNA表达水平、蛋白含量和酶活性有明显的升高,剂量效应关系明显;CYP3A2蛋白明显升高,但mRNA表达水平却无明显变化.PROD和CYP2B1/2的mRNA表达水平以及总CYP450含量均在50mg·kg-1·d-1剂量组达到最高值.结论:DEX对雄性大鼠主要诱导CYP3A1和CYP3A2两个CYP450成员表达上调,对CYP2B1/2也有一定的诱导作用,其诱导作用主要表现在酶活性、酶蛋白含量和mRNA表达水平的升高.CYP3A1和CYP3A2的诱导方式可能不同.     

归脾丸（浓缩丸）质量标准研究

目的建立归脾丸（浓缩丸）的质量标准。方法用薄层色谱法（TLC法）对归脾丸（浓缩丸）中黄芪甲苷、远志、木香进行定性鉴别；用高效液相色谱法（HPLC）测定归脾丸中甘草酸的含量，色谱柱为C18柱（250mm×4．6mm，5μm），流动相为甲醇-水-乙酸（65：30：5）．流速为1．0mL／min，柱温40℃，检测波长250nm。结果TLC法色谱斑点清晰，空白无干扰；HPLC法的甘草酸平均回收率为100．18％。RSD为1.22％。结论方法准确，重现性好，可用于归脾丸（浓缩丸）的质量控制。