IL-21在ITP中的表达及大剂量地塞米松对其调控的研究

目的:探究免疫性血小板减少症(immunologic thrombocytopenia,ITP)与IL-21表达异常的相关性,同时探究大剂量地塞米松(high-dose dexamethasone,HD-DXM)冲击治疗ITP的疗效是否与IL-21有关。方法:抽取26例初诊ITP患者及24例健康人的外周血10 ml,密度梯度离心法获得血清及单个核细胞,分别采用流式细胞术和实时荧光定量PCR法检测单个核细胞IL-21的表达,采用酶联免疫吸附实验(ELISA)检测ITP治疗前后及正常对照者血浆中IL-21,IFN-γ和IL-4的水平。结果:流式细胞术测定发现,ITP患者单个核细胞表面分子IL-21表达明显高于健康对照(13.07%vs 8.2%);ITP患者IL-21 mRNA(9.524±0.97)与健康对照组(3.701±0.60)存在显著统计学差异,经HD-DEX治疗后IL-21 mRNA的比率值(5.87±1.21)较治疗前显著降低(P0.01);ITP患者血清中IL-21和IFN-γ水平与健康对照组和HD-DEX治疗组相比均具有显著的统计学差异(P0.01);而IL-4在治疗后含量却上调,与治疗前相比有统计学意义。结论:IL-21的表达异常参与了ITP发病过程,地塞米松对ITP的疗效与下调IL-21表达有关。     

冠心病合并糖尿病患者可降解涂层雷帕霉素洗脱支架置入术后5年随访研究

目的探讨冠心病合并糖尿病患者经皮冠状动脉介入（PCI）置入EXCEL可降解涂层雷帕霉素洗脱支架（SES）治疗的远期疗效。方法回顾性随机入选2007年1月至2007年12月住院期间冠心病合并糖尿病患者行PCI162例,并入选同时期150例无糖尿病的冠心病患者行PCI为对照组。随访5年,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果两组支架术成功率均为100％。随访率100％,随访5年,糖尿病组与非糖尿病组术后并发症发生率（8．8％、7．0％）、卒中发生率（3．9％、3．0％）、心源性死亡率（0．0％、0．0％）差异无统计学意义（均为P〉0．05）。再次血运重建率（30．4％、14．0％）、心绞痛复发率（42,1％、30．0％）、全因死亡率（9．8％、2．0％）糖尿病组高于非糖尿病组;但心源性病死率均为0．0％。结论选择性冠脉内置入药物洗脱支架安全,成功率高,远期疗效尚好,但糖尿病仍是远期不良预后的独立预测因素。     

Normalization of cellular zinc levels in patients with Down's syndrome does not always correct low thymulin levels

Retrospective analysis of five Down's syndrome (DS) patients who presented with recurrent infection revealed that all had initial low thymulin levels. Three patients had low cellular zinc levels that normalized after zinc replacement. Contrary to previous studies, thymulin levels were persistently low in four of five DS patients despite maintaining or achieving normal cellular zinc levels. A primary thymic epithelial defect may be responsible for the persistent thymulin deficiency in DS patients.     

The smear layer: a phenomenon in root canal therapy

When the root canals are instrumented during endodontic therapy, a layer of material composed of dentine, remnants of pulp tissue and odontoblastic processes, and sometimes bacteria, is always formed on the canal walls. This layer has been called the smear layer. It has an amorphous, irregular and granular appearance under the scanning electron microscope. The advantages and disadvantages of the prescence of smear layer, and whether it should be removed or not from the instrumented root canals, are still controversial. It has been shown that this layer is not a complete barrier to bacteria and if delays but does not abolish the action of endodontic disinfectants. Endodontic smear layer also acts as a physical barrier interfering with adhesion and penetration of sealers into dentinal tubules. In turn, it may affect the sealing efficiency of root canal obturation. When it is not removed, the durability of the apical and coronal seal should be evaluated over a long period. If smear layer is to be removed, EDTA and NaOCI solutions have been shown to be effective, among various irrigation solutions and techniques, including ultrasonics, that have been tested. Once this layer is removed, it should be borne in mind that there is a risk of reinfecting dentinal tubules if the seal fails. Further studies are needed to establish the clinical importance of the absence or presence of smear layer.     

血清Cys-C、β2-MG联合Ccr检测对2型糖尿病患者早期肾损伤的诊断价值

目的 分析血清胱抑素C（Cys C）、β2微球蛋白（β2 MG）联合内生肌酐清除率（Ccr）诊断2型糖尿病（T2DM）早期肾损伤的价值。方法 回顾性收集2017年1月~2019年3月我院收治的T2DM病例147例,依据尿白蛋白排泄率（UAER）分为单纯T2DM组62例、微量蛋白尿组59例及临床蛋白尿组26例,比较各组外周血Cys C、β2 MG、Ccr的差异,受试者工作曲线（ROC）分析三者单独及联合诊断T2DM早期肾损伤的价值。结果 单纯T2DM组UAER、Cys C、β2 MG低于微量蛋白尿组与临床蛋白尿组（P＜0.05）,Ccr高于微量蛋白尿组与临床蛋白尿组（P＜0.05）,微量蛋白尿组UAER、Cys C、β2 MG低于临床蛋白尿组,Ccr高于临床蛋白尿组（P＜0.05）;Cys C诊断T2DM早期肾损害曲线下面积（AUC）为0946,约登指数最大时对应敏感性、特异性分别9014%、9032%;其次为Ccr,AUC为0945,约登指数最大时对应敏感性、特异性分别为8475%、9194%,三者联合诊断T2DM早期肾损伤效能最高,AUC为0.951,约登指数最大时对应敏感性、特异性分别为9214%、9232%。结论 T2DM早期肾损害伴明显Cys C、β2 MG上升,Ccr降低表现,且三者水平变化与肾损害进展有关,共同参与T2DM肾损害进程,单独Cys C诊断T2DM早期肾损害效能最高,三者联合诊断效能优于单独诊断。     

Effect on renin release of inhibiting renal nitric oxide synthesis in anaesthetized dogs

Nitric oxide plays an important role in the regulation of basal renal blood flow. This study was performed to examine whether selective inhibiti± of renal nitric oxide synthesis affects renin release in vivo. Accordingly, in six barbiturate-anaesthetized dogs renin release was examined before and after intrarenal infusion of the selective inhibitor of nitric oxide synthesis, N^G-nitro-l -arginine (NOARG). NOARG was infused into the renal artery to yield a renal arterial blood concentration of 0.4 μmol ml^-1. NOARG did not change systemic arterial blood pressure and glomerular filtration rate, but reduced basal renal blood flow by 26 ± 2%. Urine flow, sodium and potassium excretion were reduced after inhibition of renal nitric oxide synthesis. Basal renin release (3 ± 2 μg AI min^-1) was not altered by NOARG infusion (1 ± 1 μg AI min^-1). To stimulate renin release the renal artery was constricted to a renal perfusion pressure of 50 mmHg. At this perfusion pressure infusion of NOARG reduced renin release significantly from 48 ± 11 μg AI min^-1to 14 ± 4 μg AI min^-1. In conclusion, inhibition of renal nitric oxide synthesis reduces basal renal blood flow and reduces renin release stimulated by renal arterial constriction. These findings indicate that renal nitric oxide modulates both renal blood flow and renin release in vivo.     

Breast cancer risk associated with being treated for infertility: results from the French E3N cohort study

BACKGROUND: The use of fertility drugs (FDs) is steadily increasing in Western countries and concern has been raised as to the possible impact of fertility treatments on breast cancer risk. METHODS: We analysed this association in the French E3N study. In this prospective cohort, data on treatment against infertility, duration and time of administration were collected at entry through self-administered questionnaires. Cox regression analysis was used to estimate adjusted relative risks (RRs). RESULTS: Among the 92 555 women from the study population, 6602 women were treated for infertility. During the 10 year follow-up period, 2571 cases of primary invasive breast cancer were diagnosed (183 in treated women). Our study showed no overall significant association between breast cancer risk and treatment for infertility (RR = 0.95, confidence interval 0.82-1.11), after surgery or FDs, and whatever the type, the duration of use and the age at first use of FDs. However, infertility treatment was associated with an increased risk, of borderline significance, of breast cancer among women with a family history of breast cancer. This last result had limited statistical power. CONCLUSIONS: Our study provides evidence that treatment for infertility does not influence breast cancer risk overall. An interaction with a familial history of breast cancer is possible but should be investigated further.