Clonotypic Dominance and Variable Gene Elements of Pathogenic Anti-DNA Autoantibodies from a Single Patient with Lupus

This study explores the usage and diversity of the variable gene elements expressed by human lupus antibodies to DNA bearing the 0–81 idiotype, a marker of pathogenic anti-DNA autoantibodies. Rather than studying DNA-specific clonotypes from different patients, a panel of idiotype positive anti-DNA autoantibody-secreting clones from a single individual were analysed. By cloning and nucleotide-sequeneing the heavy-chain variable gene segments, evidence was found for dominance of clonotypic patterns. Also noted was a high rate of diversification among the variable (V_H), diversity (D_h) and junctional (J_H) gene segments utilized, with a pattern of mutations indicative of antigenic selection. These features suggest that the clones secreting the lupus pathogenic autoantibodies have been selected over multiple generations through an affinity-maturation process that is reminiscent of antigen-driven immune responses.     

胰岛移植用免疫隔离微胶囊的牢固度、生物相容性和通透性研究

目的为了探讨用于胰岛移植的海藻酸钠-聚赖氨酸-海藻酸钠（APA）生物膜的免疫隔离效果。方法采用高压静电成囊装置,制备APA微胶囊和微囊化胰岛,微囊直径为0.25～0.55mm;取空微囊,利用恒温振荡仪振荡后测定其破损率;将空微囊移植至小鼠腹腔,分别于不同时间由腹腔中灌洗出微胶囊,记数并观察其形态;取一定量空微囊分别与IgG、BSA和胰蛋白酶孵育,测量其浓度变化确定APA微胶囊的通透性。结果采用高压静电成囊技术制成的APA微胶囊呈球形,大小均匀、表面光滑,具有较好的生物相容性;粒径为0.25～0.35mm的微胶囊其牢固度大于粒径为0.45～0.55mm的微胶囊;葡萄糖、胰岛素等小分子物质能够自由通过微囊膜,胰蛋白酶也可通过,但速度较慢;大分子物质牛血清白蛋白和免疫球蛋白则不能透入APA微囊。结论采用高压静电成囊技术可制备高质量粒径为0.25～0.35mm的微胶囊;这是具有良好免疫隔离性能的APA微胶囊。     

丁甘仁外科病辨治经验探析

孟河丁氏,名扬沪上,门生后裔,多传内科,挖掘丁甘仁外科疾病辨治思想,总结内重托补、顾护正气,善辨经络、重视痰湿,成药入汤,露剂代水的四大特色。     

金属对金属全髋关节表面置换治疗中青年中晚期股骨头缺血性坏死

目的评价金属对金属全髋关节表面置换治疗中青年中晚期股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的早期疗效,并与同期治疗单纯骨性关节炎疗效比较。方法回顾分析2006年7月-2008年10月行金属对金属全髋关节表面置换的33例45髋ONFH患者(ONFH组)临床资料,并与同期行金属对金属全髋关节表面置换的39例45髋骨性关节炎患者(骨性关节炎组)进行疗效比较。ONFH组:男18例27髋,女15例18髋;年龄19～58岁,平均42.7岁。有创伤史4例,糖皮质激素治疗史25例,吸毒史2例,酗酒史1例,银屑病1例。左侧22髋,右侧23髋。按Steinberg分期:Ⅲ期10髋,Ⅳa期18髋,Ⅳb期13髋,Ⅳc期4髋。Harris评分为(52.0±4.6)分。病程为1～12年。骨性关节炎组:男26例30髋,女13例15髋;年龄42～65岁,平均47.1岁。左侧17髋,右侧28髋。退行性骨性关节炎23例,创伤后骨性关节炎11例,强直性脊柱炎继发骨性关节炎5例。Harris评分为(57.0±3.8)分。病程为3～17年。两组患者一般资料比较差异均无统计学意义(P0.05),具有可比性。结果术后切口均Ⅰ期愈合,无感染、下肢深静脉血栓等并发症发生。患者均获随访,ONFH组随访时间平均26个月,骨性关节炎组平均28个月。术后4个月骨性关节炎组1例发生股骨颈骨折,改行人工全髋关节置换。其余患者均无明显假体松动、脱位,切口感染,骨坏死、吸收等并发症发生。末次随访时ONFH组Harris评分为(93.0±5.5)分,骨性关节炎组为(94.0±2.4)分;两组术后组间比较,差异无统计学意义(P0.05);组内手术前后比较,差异有统计学意义(P0.01)。结论金属对金属全髋关节表面置换治疗中青年中晚期ONFH近期临床效果满意,与治疗骨性关节炎效果相似,但仍需积累更多病例及长期临床随访验证中远期疗效。     

Impact of Pharmacological Autonomic Blockade on Complex Fractionated Atrial Electrograms

Autonomic Blockade During Atrial Fibrillation . Introduction: The influence of the autonomic nervous system on the pathogenesis of complex fractionated atrial electrograms (CFAE) during atrial fibrillation (AF) is incompletely understood. This study evaluated the impact of pharmacological autonomic blockade on CFAE characteristics. Methods and Results: Autonomic blockade was achieved with propanolol and atropine in 29 patients during AF. Three‐dimensional maps of the fractionation degree were made before and after autonomic blockade using the Ensite Navx^® system. In 2 patients, AF terminated following autonomic blockade. In the remaining 27 patients, 20,113 electrogram samples of 5 seconds duration were collected randomly throughout the left atrium (10,054 at baseline and 10,059 after autonomic blockade). The impact of autonomic blockade on fractionation was assessed by blinded investigators and related to the type of AF and AF cycle length. Globally, CFAE as a proportion of all atrial electrogram samples were reduced after autonomic blockade: 61.6 ± 20.3% versus 57.9 ± 23.7%, P = 0.027. This was true/significant for paroxysmal AF (47 ± 23% vs 40 ± 22%, P = 0.003), but not for persistent AF (65 ± 22% vs 62 ± 25%, respectively, P = 0.166). Left atrial AF cycle length prolonged with autonomic blockade from 170 ± 33 ms to 180 ± 40 ms (P = 0.001). Fractionation decreases only in the 14 of 27 patients with a significant (>6 ms) prolongation of the AF cycle length (64 ± 20% vs 59 ± 24%, P = 0.027), whereas fractionation did not reduce when autonomic blockade did not affect the AF cycle length (58 ± 21% vs 56 ± 25%, P = 0.419). Conclusions: Pharmacological autonomic blockade reduces CFAE in paroxysmal AF, but not persistent AF. This effect appears to be mediated by prolongation of the AF cycle length. (J Cardiovasc Electrophysiol, Vol. pp. 766‐772, July 2010)     

重新认识aVR导联在心律失常诊断中的价值

体表心电图是一种快速、廉价、无创的临床检查方法.aVR导联是心电图（ECG）六轴系统中惟一位于右上象限的导联（图1）,这一导联的设置在心电图设计之初具有重要的作用,但随着现代心电学的发展,人们更加关注左胸导联,aVR导联的作用被逐渐忽略,许多心电工作者认为aVR导联仅是Ⅰ、Ⅱ导联平均值的翻转,它所提供的心电信息已经包含在Ⅰ、Ⅱ导联中,但实际上aVR导联却有其不容忽视的重要价值,aVR导联指向-150°的位置,它反映了心脏右上部如右心室流出道与室间隔基底部的心电活动,     

原位凝胶新型给药系统的现代研究进展

原位凝胶新型给药系统,由于具有组织兼容、缓控释释放、靶向给药、多途径给药等独特优势,成为药剂学与生物技术领域的研究热点之一。参阅近几年相关研究报道,本文从制备与体外评价、剂型与给药途径、成型材料等几个方面进行概述,了解药学领域原位凝胶新型给药系统的研究动态。     

The effectiveness of a shared conference experience in improving undergraduate medical and nursing students’ attitudes towards inter-professional education in an Asian country: a before and after study

Background

In recent years, increasing emphasis has been placed on the importance of collaboration within multi-disciplinary healthcare teams, so as to facilitate holistic patient care and thus allow improved treatment outcomes. There is hence an urgent need to educate healthcare undergraduates early in their professional careers on the importance of and complexities involved in cooperating with counterparts from other allied healthcare professions. In conjunction with this, a milestone student-led conference for undergraduate students, the 9th Student Medical-Nursing Education Conference (SMEC), was organised in 2013 to provide a unique opportunity for shared learning among the entire cohort of undergraduate medical and nursing students in Singapore matriculating in that year.

Methods

This study evaluated the effectiveness of the 9th SMEC 2013 as a shared conference experience in improving the attitudes of undergraduate medical and nursing students in Singapore towards inter-professional education (IPE). A 19-point Readiness for Inter-Professional Learning Scale (RIPLS) questionnaire comprising three subscales was administered to participants both before and after the conference. 352 responses were collected, giving a response rate of 75.1 %. Results were analysed using paired-samples t-tests with statistical significance set at p?=?0.05.

Results

Improvements in overall scores for both medical and nursing students were reported for all three RIPLS subscales. Examining the RIPLS items individually, significant improvement in scores for both medical and nursing students was obtained in all 19 items. Prior exposure to IPE activities was not a predictor of improvement in IPE attitudes.

Conclusion

The authors propose that student-led jointly-organised conference experiences are effective in improving healthcare students’ attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to allow for the rapid and effective promotion of cooperation and collaboration between students across various healthcare disciplines.

     

α-细辛脑原位凝胶初步稳定性的研究

目的:考察α-细辛脑原位凝胶的稳定性。方法:通过考察温度、湿度、光照、离心力对制剂的外观形状和含量变化,确定该制剂的保存方法及有效期限。结果:在4℃冰箱避光密封保存,该制剂在6个月内稳定性良好。结论:该制剂稳定性符合要求。