丹参酮ⅡA磺酸钠对环境细颗粒物诱导的大鼠肺部损伤的保护作用

目的： 探讨丹参酮ⅡA磺酸钠（STS）对大气细颗粒物（PM_2.5）诱导的大鼠肺部损伤的保护作用及可能机制。方法： 24只清洁级雄性SD大鼠,随机分为4组,每组6只,分别为对照组（生理盐水）、PM_2.5染毒组（模型组）、丹参酮ⅡA磺酸钠组（STS组）、地塞米松组（阳性对照）。采用气管滴注PM_2.5悬液染毒,除对照组外,其余3组染毒剂量均为5.4 mg/kg,每3 d滴注1次,共10次,于染毒第1天起STS组和地塞米松组分别以浓度15 mg/kg和0.5 mg/kg腹腔注射,每天1次,持续28 d。末次染毒后24 h采用整体体积描记法（WBP）检测大鼠呼吸频率（f值）和被迫呼吸间隙（Penh）;末次染毒后2 d,经腹主动脉采血2 mL,流式细胞术检测外周血淋巴细胞亚群;处死大鼠后灌洗左肺,收集肺泡灌洗液5 mL,ELISA法测定肺泡灌洗液中白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）和白细胞介素6（IL-6）含量;Western blot检测肺组织核因子κB （NF-κB）蛋白表达。结果： 与对照组相比,模型组呼吸f值和Penh值均明显升高（P<0.01）;CD4⁺细胞百分率和CD4⁺/CD8⁺比值降低（P<0.05）;肺泡灌洗液中IL-1β、TNF-α和IL-6浓度升高（P<0.01）;肺细胞浆中P65含量降低而胞核中p-P65含量升高（P<0.01）。与模型组相比,STS组f值和Penh值均降低（P<0.05或P<0.01）;CD4⁺细胞百分率和CD4⁺/CD8⁺比值均升高（P<0.01或P<0.05）;IL-1β、TNF-α、IL-6浓度降低（P<0.01或P<0.05）;细胞浆中P65含量升高而胞核中p-P65含量降低（P<0.01）。结论： STS对PM_2.5诱导的大鼠肺部炎症有抑制作用,并具有调节肺功能和免疫功能的作用。     

程序性死亡配体-1及其抑制剂在非小细胞肺癌中的研究进展

程序性死亡配体-1（PD-L1）以细胞膜型 PD-L1和可溶性 PD-L1两种形式在 NSCLC 中高表达,通过与其受体结合参与肿瘤免疫逃逸。目前 PD-L1抑制剂已进入 NSCLC 的Ⅰ期临床试验并反应良好,其治疗敏感性与肿瘤组织 PD-L1的表达状态显著相关,因而 PD-L1有望成为预测其药物疗效的生物学标志物。     

A Method to Visualize and Quantify the Intraosseous Arteries of the Femoral Head by Vascular Corrosion Casting

ObjectiveTo describe a method to display the three‐dimensional distribution of intraosseous arteries in the femoral head by vascular corrosion casting.MethodsAn experimental study was done to expose the intraosseous arteries of the femoral head by a microperfusion corrosion method between January 2021 and May 2021. Specimens were 23 swine femoral heads (12 female specimens and 11 male specimens, where age of swine ranged from 8 to 12 months, and the weight was approximately 150 kg). The femoral heads were microperfused with the vascular casting resin through retinacular arteries, and the bone of the femoral head was dissolved with 50% sodium hydroxide and 10% hydrochloric acid and rinsed under the microscope until the vessel casts were completely exposed. The distribution and anastomosis of the arteries in the femoral head were observed under direct vision and microscopy. The diameter of the artery in the femoral head was measured at 0.5 cm after its entry into the bone of the femoral head with a microscale under the microscope. The number of internal arteries with diameter ≥0.05 mm was counted. The number and diameter of the main trunk of the epiphyseal arteries in the femoral head between male and female swine were compared.ResultsThe vascular casting specimen of the swine femoral head was successfully produced by using epoxy resin as a casting agent, and the three‐dimensional intraosseous vascular structures were clearly visible. The number of epiphyseal arteries in male and female swine was 8.55 ± 2.15 and 8.83 ± 2.15 (t = −0.31, p = 0.38), respectively. The diameters of the superior epiphyseal arteries in male and female swine were 0.35 ± 0.09 and 0.31 ± 0.08 mm (t = 1.03, p = 0.16), the diameters of the inferior epiphyseal arteries were 0.47 ± 0.05 and 0.49 ± 0.09 mm (t = −0.57, p = 0.29), and the diameters of the anterior epiphyseal arteries were 0.34 ± 0.08 and 0.33 ± 0.13 mm (t = 0.32, p = 0.37). There was no significant difference in the number and diameter of the main trunk of intraosseous arteries between male and female swine (p > 0.05). The main trunk of intraosseous arteries formed an anastomosis in the center of the femoral head. Among 23 swine femoral head samples, three types of intraosseous anastomosis were observed, including 13 (57%) posterior superior‐posterior inferior, seven (30%) posterior inferior‐anterior, and three (13%) uniform intraosseous anastomosis.ConclusionThe microperfusion corrosion method can produce the vascular casting specimen of swine femoral head revealing the three‐dimensional structure of the intraosseous artery, which clearly shows the origin, course and branches, and diameter, as well as the anastomosis, of nutrient arteries in the femoral head. This method provides a simple and rapid technique for quantifying and visualizing intraosseous arteries.     

美国哈佛大学BWH医院神经外科专科医师培养过程及借鉴

以美国哈佛大学附属布列根与女子医院神经外科专科培训为例,介绍美国神经外科专科培训体系,阐释其逐年递增的临床知识、技能、决策、人文关怀、职业规范、沟通技巧等培训措施,以及注重神经科学科研思维与产出的培养模式,以期为促进我国神经外科专科培养提供借鉴。     

25例儿童多发囊性肺疾病病因的临床分析

【摘要】目的：探讨儿童多发囊性肺疾病（Multiple cystic lung disease,MCLD）的病因及临床特点。方法：回顾性分析我院2004年3月~2012年12月收治的25例MCLD患儿的临床资料。结果：1、25例儿童MCLD中,支气管肺发育不良12例（48%）,朗格汉斯细胞组织细胞增生症7例（ 28%）,特发性肺纤维化3例（12%）,病因不明3例（12%）。2、25例患儿呼吸系统表现：气促22例（88%）,持续或反复咳嗽16例（64%）,呼吸困难15例（60%）。肺外表现：耳溢脓3例（12%）,头部包块2例（8%）,贫血6例（24%）,淋巴结肿大5例（20%）,肝脾肿大7例（28%）,皮疹3例（12%）,杵状指1例（4%）。3、胸部CT均有囊腔病变。4、3例IPF的患儿行肺功能检查,结果均提示有限制性通气功能障碍。结论：儿童MCLD的常见病因为BPD、LCH、IPF,其伴随的肺外表现有诊断价值。胸部CT是诊断及鉴别囊性肺疾病的重要手段。     

Phase angle is a useful bioelectrical marker for skeletal muscle quantity and quality in hospitalized elderly patients

To analyze whether phase angle (PhA) can be a useful bioelectrical marker for skeletal muscle quantity and quality in hospitalized elderly patients. Two hundred hospitalized elderly patients were included in this retrospective observational study. PhA was obtained by Bioelectrical Impedance Analysis, skeletal muscle area index (SMI) and skeletal muscle density (SMD) were measured at the third lumbar vertebra level in computed tomography images using SliceOmatic software. PhA was positively associated with SMD and SMI, with correlation coefficients of 0.629 and 0.674, respectively. Multiple logistic regression analysis showed that 1° reduction of PhA was significantly associated with low SMI [odds ratio (OR) = 4.331 (1.681–11.161)] and low SMD [OR = 6.418 (2.963–13.899)]. Receiver operating characteristic curve analysis showed that the area under the curve (AUC) for PhA to identify patients with low SMI was 0.772 for male and 0.784 for female; the AUC for PhA to identify low SMD patients was 0.829 for male and 0.812 for female; the AUC for PhA to identify low SMD combined with low SMD patients was 0.801 for male and 0.773 for female. The results of this study showed that PhA was highly related to SMI, which can indicate the quantity of skeletal muscle in the entire body, and was highly related to SMD, which can be used to assess skeletal muscle quality. Therefore, PhA may be a useful bioelectrical marker for skeletal muscle quantity and quality.     

Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Orthostatic hypotension (OH) is a common autonomic disorder. This study aimed to investigate the influencing factors and hemodynamic mechanisms of initial and sustained OH in middle‐aged and elderly patients. The authors analyzed the clinical characteristics and hemodynamic variables of patients aged ≥ 50 years according to the various forms of OH, diagnosed by an active orthostatic test using the CNAP monitor. The study included 473 participants; 119 (25.2%) patients had initial (54, 45.4%) or sustained (65, 54.6%) OH. Age, comorbidities, or medications did not differ significantly between the initial OH and non‐OH groups. Sustained OH was associated with age and diabetes (p = .003 and p = .015, respectively). Hemodynamic analysis revealed higher cardiac output (CO) in the sustained OH group within 15 s than in the non‐OH and initial OH groups (both p < .001); no difference in CO was observed between the initial OH and non‐OH groups. The systemic vascular resistance (SVR) in both initial OH and sustained OH groups within 15 s was lower than that in the non‐OH group (both p < .001). No differences in SVR at 3 min were observed between the initial OH and non‐OH groups. The SVR at 3 min in the sustained OH group was significantly lower than in non‐OH and initial OH groups (both p < .001). Age and diabetes emerged as the independent risk factors associated with sustained OH. Initial OH is associated with a mismatch of increase in CO and decrease in SVR. Sustained OH is mainly associated with sustained inadequate adjustment in SVR.     

Analysis of Key Factors Associated with Response to Salvage High-Dose Methotrexate Rechallenge in Primary Central Nervous System Lymphoma with First Relapse

Background: Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin’s lymphoma that occurs in the central nervous system. Although sensitive to chemotherapy, 35–60% of PCNSL patients still relapse within 2 years after the initial treatment. High-dose methotrexate (HD-MTX) rechallenge is generally used in recurrent PCNSL, especially for patients who have achieved a response after initial methotrexate (MTX) treatment. However, the overall remission rate (ORR) of HD-MTX rechallenge is about 70–80%. Additionally, the side effects of HD-MTX treatment endanger the health of patients and affect their quality of life. Methods: This is a retrospective study of patients with first relapse PCNSL at Huashan Hospital, Fudan University between January 2000 and November 2020. By comparing the clinical characteristics and radiological manifestations of first relapsed PCNSL patients with remission and non-remission after receiving HD-MTX rechallenge, we screened out the key factors associated with HD-MTX rechallenge treatment response, to provide some help for the selection of salvage treatment strategies for patients with recurrent PCNSL. Additionally, patients with remission after HD-MTX rechallenge were followed up to identify the factors related to progression-free survival of the second time (PFS2) (time from the first relapse to second relapse/last follow-up). The Kruskal–Wallis and Pearson chi-square tests were performed to examine the univariate association. Further, multivariable logistic regression analysis was used to study the simultaneous effect of different variables. Results: A total of 207 patients were enrolled in the study based on the inclusion criteria, including 114 patients in the remission group (RG) and 81 patients in the non-remission group (nRG), and 12 patients were judged as having a stable disease. In Kruskal–Wallis and Pearson chi-square tests, progression-free survival rates for first time (PFS1) and whether the initial treatment was combined with consolidated whole brain radiotherapy (WBRT) were related to the response to HD-MTX rechallenge treatment, which was further validated in regression analysis. Further, after univariate analysis and regression analysis, KPS was related to PFS2. Conclusions: For PCNSL patients in their first relapse, HD-MTX rechallenge may be an effective salvage treatment. PFS1 and whether initial treatment was combined with consolidation WBRT were associated with HD-MTX rechallenge treatment response. In addition, patients with higher KPS at the time of the first relapse had a longer PFS2 after HD-MTX rechallenge treatment.     

Task difficulty rather than reward method modulates the reward boosts in visual working memory

Both monetary and notional rewards are important to motivate individuals to prioritize specific items in visual working memory (VWM). However, whether the reward method and task difficulty are the key factors that modulate the reward boosts in VWM is unclear. In this study, we designed two experiments to explore this question. Experiment 1 examined whether the reward method modulates reward boosts in VWM by manipulating the item type (high reward, low reward, equal reward) and reward method (monetary and notional). Experiment 2 examined whether task difficulty modulates reward boosts in VWM by manipulating the number of high-reward items (1, 2, 3), reward method, and item type. The results indicated reward boosts for high-reward items compared to low- and equal-reward items. Moreover, the VWM performance was higher in the monetary reward condition than in the notional reward condition; however, there was no interaction between the reward method and item type. Additionally, a significant interaction was found between the reward number and item type: Reward boosts on VWM performance occurred only when one or two higher reward items were present. In conclusion, reward boosts in VWM tasks are modulated by task difficulty but not the reward method.