间接型药物性肝损伤:新类型与新挑战

间接型药物性肝损伤是由药物的治疗作用所引起的肝损伤,而不是因为药物固有的肝毒性或免疫原性所导致的一类新型药物性肝损伤(DILI)。目前临床常见的间接型DILI主要有3种临床表型,即免疫检测点抑制剂相关肝损伤、药物引起肝炎病毒再激活和药物影响肝细胞代谢所致的脂肪肝或原有脂肪肝加重。由于间接型DILI是一类新型DILI,临床对其认识不足,诊治经验缺乏。尤其是随着免疫检测点抑制剂在临床快速推广应用,间接型DILI迅速增加,给临床诊断和治疗带来更大的挑战。因此,对间接型DILI常见类型的临床特点、发病机制及诊断治疗等研究进展等进行综述,具有重要的临床意义。     

肺双重血供的CT灌注技术及其应用于肺结核的初步研究

目的肺是双重血供脏器,其血供来自体循环和肺循环;肺实质及肺部病变(包括肺结核)的双重血供在活体中至今未被研究及报道。本文介绍一项基于320排CT的肺双重血供灌注测量技术,并对活动性肺结核进行初步研究。方法灌注技术:采用东芝公司320排CT进行肺部动态容积灌注扫描,以肺动脉干、降主动脉作为输入动脉;以左心房的峰值时间点为肺、体循环的分界线,采用双入口灌注(DICTp)模式进行灌注分析得到肺动脉血流量(PF)、支气管动脉血流量(BF)及血流灌注指数[PI=PF/(PF+BF)];肺结核灌注研究:前瞻性纳入25例活动型肺结核患者行双入口灌注研究。由两名观察者单独进行灌注测量,采用Bland-Altman统计分析法评判观察者间的可重复性,两者之平均值作为最终结果;比较结核病灶肺循环和体循环的强弱。结果灌注扫描过程顺利,DICTp分析模式能够处理肺部灌注数据并得到相应的灌注参数图;Bland-Altman分析提示此项灌注技术在观察者间的可重复性良好;平均两名观察者所产生的数据后,肺结核的灌注参数为:PF(46.41±19.84)ml·min-1·(100ml)-1;BF(20.91±11.98)ml·min-1·(100ml)-1;PI0.68±0.16。PF>BF(P<0.001)。结论我们首次报道了一项基于320排CT的肺双入口灌注技术,它能定量评价肺部病灶的体循环和肺循环,是研究肺部病灶血流动力学的有力工具;对肺结核的初步研究提示,结核性病变同时接受肺循环和体循环供血,其中肺循环占优势。     

护士心理护理知识、意识及实施现状的调查分析

目的了解护士所具有的基本心理护理知识、心理护理的意识、一般心理护理及专业心理护理的实施情况。方法采用自行设计问卷,对某三级医院内、外科70名护士进行调查。结果护士基本心理护理知识得分(8.57±2.39)分(总分为22分),心理护理意识得分(49.81±6.00)分(总分为60分),一般心理护理实施情况得分(38.61±5.72)分(总分为45分),专业心理护理实施情况得分(31.36±8.91)分(总分为60分)。不同工作年限的护士比较,工作年限越长专业心理护理的实施情况越好(F=5.21,P<0.05);而基本心理护理知识、心理护理的意识、一般心理护理实施得分差异无统计学意义(F=1.83～2.48,P>0.05)。结论护士心理护理的意识及一般心理护理的实施情况较好,但基本心理护理知识及临床专业心理护理的实施还有待提高。     

砂仁挥发油抗炎活性谱效关系研究

目的:研究7批不同产地砂仁挥发油气象色谱-质谱联用(GC-MS)指纹图谱与抗炎活性的关系,为揭示砂仁挥发油抗炎物质基础提供依据。方法:7批不同产地的砂仁分别为广西、吴川、蟠龙、春城、永宁的阳春砂,云南、缅甸的绿壳砂,采用GC-MS建立不同产地砂仁挥发油指纹图谱。取昆明种小鼠90只,随机分为9组,分别为模型组,地塞米松组(12.5 mg·kg-1),广西组、吴川组、蟠龙组、春城组、永宁组、云南组、缅甸组(均为3.2 g·kg-1的砂仁挥发油),每组10只,ig给予相应剂量药物,模型组给予等体积的生理盐水,每天1次,连续ig 4 d,经二甲苯造模,测定耳肿胀。数据统计分析后,采用灰色关联度分析法研究谱效关系。结果:建立7批不同产地砂仁挥发油GC-MS指纹图谱,确定了其中13个色谱峰为共有峰,并对各共有峰进行了化学成分鉴定;7批砂仁挥发油均有不同程度的抗炎作用,与模型组比较,广西和春城的砂仁无明显的抗炎作用,其他产地和地塞米松均有明显的抗炎作用(P0.05,P0.01)。13个共有峰与抗炎活性均存在一定的关联度,关联度在0.857~0.734,关联度大小依次为:龙脑芳樟醇樟脑α-松油醇α-香柠烯醇D-柠檬烯乙酸龙脑酯α-檀香醇月桂烯匙叶桉油烯醇α-杜松醇莰烯α-蒎烯。结论:砂仁挥发油抗炎作用为"多成分"共同起效的结果,其中抗炎作用较好的吴川和永宁的阳春砂其龙脑、芳樟醇含量均较高,具有明显的关联度。     

体外受精-胚胎移植患者卵巢颗粒细胞卵泡刺激素受体启动子突变与卵巢反应不良的关系

Objective To sequence follicle stimulating hormone receptro (FSHR) promoter of the ovarian granulocyte and initially research the molecular mechanism of the poor ovarian response. Methods To study the relationship between FSHR promoter mutation of ovarian granulocyte and ovarian respone. The 263 bp DNA fragments before FSHR 5'initiation site in 70 cases of patients with poor ovarian respone and 88 cases of patients with ovarian normal respone who were in the cycle of IVF-ET were sequenced, Results There were 63 cases which occurred 29th site G → A point mutation in 158 women and the mutation rate was 40. 0%. Mutation rate [ 60. 0% ( 42/70 ) ] of 29th site G → A in group of poor ovarian respone was significantly higher(χ2 = 21. 450,P < 0. 01 ) than normal response group [ 23.9% ( 21/88 ) ]. There was no obviously variability ( t = 0. 457, P 0. 05 ) of basic FSH values between two groups [ G/G group was (7.2 ± 2. 3) U/L, G/A & A/A group was (7. 1±2. 0) U/L];there was obviously variability (t = 35. 81 ,P < 0. 05 ) in the number of follicles sinus between two groups ( G/G group was 14. 2±1.3, G/A & A/A group was 4. 5±0. 8 ) ;there was obviously variability ( t = 40. 35, P < 0. 05 ) in the number of ovum pick-up between two groups ( G/G group was 14. 0±1.2, G/A & A/A group was 4. 5±1.1 ) ;there was obviously variability (t =25. 80,P <0.05) of FE2-peak value between two groups [G/G group was (2 865±557) pmol/L, G/A & A/A group was (880±211 ) pmol/L] ;there was obviously variability (t =40. 22 ,P <0. 05) in the number of mature eggs ( G/G group was 13.6±1.2, G/A&A/Agroupwas4.3±0. 9).Conclusion The 29th site of FSHR promoter significantly affect the activity of FSHR promoter. Mutation of G→A can weaken promoter activity, so that ovarian granulocyte poor respone to FSH.     

散发性帕金森病患者γ-synuclein基因的研究

目的 探讨γ-synuclein基因C243G和A377T多态在散发性帕金森病(Parkinson’s disease，PD)的疾病易感性中的意义。方法 采用聚合酶链反应-限制性片段长度多态法，对上海汉族人中145例PD患者和184名正常人进行γ-synuclein基因C243G和A377T多态分型，并作与PD的遗传关联研究。结果 PD患者与正常对照间γ-synuclein基因C243G和A377T多态分布的差异无显著性，两种多态与PD亦无关联(P值均大于0．05)。结论 上海地区汉族人群中γ-synuclein基因C243G和A377T多态与散发性PD无关。     

Hydrocelectomy under local anaesthesia in a Nigerian adult population

Background

Hydrocele is abnormal collection of serous fluid in the tunica vaginalis or a patent processus vaginalis. It is commonly encountered in our practice and often requires surgical treatment. However in our setting and in many underdeveloped countries, availability of general anaesthetic service is poor due to lack of trained personnel and equipment.

Objectives

To ascertain the practicability and acceptability of hydrocelectomy under sedation and local anaesthesia in Nigerian adults with hydrocele

Patients and Methods

A prospective study was carried out over a two year period on patients that had hydrocelectomy at the surgery unit of the Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa. Consecutive patients with diagnosis of hydrocele who consented had hydrocelectomy using intramuscular diazepam sedation and spermatic-cord block with 0.5% plane xylocaine and the scrotum infiltrated with same along the line of incision.

Results

Fifty adult patients were studied: age range 15–94 years. Eighty percent of the patients had unilateral hydrocele and the commonest type was vaginal hydrocele (94%). All patients had hydrocelectomy, 96% were under local anaesthesia while 4% were converted to general anaesthesia. All patients except one prefer to have future surgery under such local anaesthesia and sedation.

Conclusion

Hydrocelectomy under local anaesthesia and sedation is practicable and was tolerated and accepted by the adults patients studied.     

Cell division patterns and chromosomal segregation defects in oral cancer stem cells

Oral squamous cell carcinoma (OSCC) is a serious public health problem caused primarily by smoking and alcohol consumption or human papillomavirus. The cancer stem cell (CSC) theory posits that CSCs show unique characteristics, including self‐renewal and therapeutic resistance. Examining biomarkers and other features of CSCs is critical to better understanding their biology. To this end, the results show that cellular SOX2 immunostaining correlates with other CSC biomarkers in OSCC cell lines and marks the rare CSC population. To assess whether CSC division patterns are symmetrical, resulting in two CSC, or asymmetrical, leading to one CSC and one cancer cell, cell size and fluorescence intensity of mitotic cells stained with SOX2 were analyzed. Asymmetrical SOX2 distribution in ≈25% of the mitoses analyzed was detected. Chromosomal instability, some of which is caused by chromosome segregation defects (CSDs), is a feature of cancer cells that leads to altered gene copy numbers. We compare chromosomal instability (as measured by CSDs) between CSCs (SOX2+) and non‐CSCs (SOX2−) from the same OSCC cell lines. CSDs were more common in non‐CSCs (SOX2−) than CSCs (SOX2+) and in symmetrical CSC (SOX2+) mitotic pairs than asymmetrical CSC (SOX2+/SOX2−) mitotic pairs. CSCs showed fewer and different types of CSDs after ionizing radiation treatment than non‐CSCs. Overall, these data are the first to demonstrate both symmetrical and asymmetrical cell divisions with CSDs in OSCC CSC. Further, the results suggest that CSCs may undergo altered behavior, including therapeutic resistance as a result of chromosomal instability due to chromosome segregation defects. © 2016 Wiley Periodicals, Inc.     

中学生焦虑、抑郁与生活事件和应对方式研究

中学生处于心理发育的重要时期 ,也是各种心理问题的高发阶段[1- 2 ] 。初三毕业生面临升学的压力 ,这部分同学的心理状况更应引起关注。在各种心理问题中 ,焦虑、抑郁是常见的症状 ,本文拟调查初三毕业生的焦虑、抑郁状况 ,并通过生活事件和应对方式调查 ,以便发现焦虑、抑郁的影响因素 ,这对初三毕业生心理问题的预防和干预将有重要意义。1　对象和方法1.1　对象选取一所普通中学 ,以所有初三毕业生为调查对象 ,发放 35 2份调查表 ,共收集 331名资料完整者 ,资料回收率 94 .0 3%。 331名学生中 ,男生 171名 ,女生 16 0名 ,平均年龄 15 .4 …     

胸腹水组织因子及组织因子途径抑制物的检测及其意义

目的研究三组疾病胸腹水组织因子(Tissue factor,TF)及组织因子途径抑制物(Tissue factor pathway inhibitor,TFPI)的表达及其鉴别诊断意义。方法TF和TFPI采用ELISA法测定抗原表达。结果胸腹水TF水平和TFPI水平,恶性肿瘤组(570.04±627.53)ng/L,(28.60±15.57)μg/L和结核病组(283.82±143.16)ng/L,(31.16±12.26)μg/L明显高于肝硬化组(60.83±66.87)ng/L,(7.84±5.45)μg/L,P<0.01。TF/TFPI比值则为恶性肿瘤组(32.17±44.19)明显高于结核病组(13.55±13.15)和肝硬化组(11.22±9.05,P<0.05)。在恶性肿瘤组中,胸腹水癌细胞阳性组的TF表达(1106.92±1244.28)ng/L高于阴性组(331.08±295.84)ng/L,P<0.05。而阳性组的TFPI水平(27.35±17.75)μg/L与阴性组(30.34±13.20)μg/L无明显差异(P>0.05)。TF/TFPI比值则为阳性组(59.59±65.10)明显高于阴性组(11.54±8.37,P<0.01)。结论检测胸腹水TF和TFPI并分析TF/TFPI比值可以作为临床实验室有鉴别诊断意义的辅助指标,同时还可了解疾病的某些病理机制,尤其是肿瘤的某些生物学行为。