肝硬化少见并发症的诊治

乳糜性及血性腹水、肝性胸水、少见病原菌感染的自发性腹膜炎、肝硬化心肌病、门静脉性肺动脉高压、肝硬化神经系统损伤等肝硬化少见并发症,临床医生尚缺乏充分的认识和/或及时有效的诊治。现介绍上述肝硬化少见并发症的临床特征、治疗及预后,以提高临床医生的认识和诊疗水平。     

南通市血吸虫病疫情预警监测研究

目的探索建立南通市血吸虫病疫情预警监测系统,为及时处置突发疫情提供依据。方法全市设立13个监测点,开展当地居民和外来流动人员监测查病,监测调查历史有螺区和输入性钉螺等。结果当地居民查病23426人,血检阳性率为0.38%,居民感染率为0;外来渔船民等流动人员监测查病3401人,血检阳性率为0.62%,外来居民感染率为0.029%,发现1例输入性急性感染病人。查出钉螺复现面积1.38hm^2,未发现感染性钉螺。未查到输入性钉螺。历史有螺环境改造率为34.90%。结论南通市仍有一定数量的残存钉螺孳生;有外来输入性病人存在,对本市血吸虫病的再流行将会构成潜在威胁,今后应加强疫情预警监测。     

5-脂氧合酶抑制TNF-α诱导的胰腺癌细胞凋亡

目的:检测胰腺癌细胞中5-脂氧合酶(5-lipoxygenase,5-LOX)及其代谢产物的表达情况,分析高表达5-LOX及LTB4对胰腺癌细胞生长凋亡的影响.方法:体外培养人胰腺癌细胞株ASPC-1,PANC-1和SW1990,并构建5-LOX基因稳定转染细胞株.用RT-PCR和Western blot检测细胞5-LOX mRNA和蛋白的表达,ELISA检测细胞培养上清中LTB4的含量,采用流式细胞仪、Annexin V/PI双染法检测TNF-α诱导细胞的细胞凋亡.结果:三种胰腺癌细胞株均表达5-LOX mRNA和蛋白,细胞上清中也都检测到一定量LTB4分泌.5-LOX基因稳定转染细胞株表达5-LOX和LTB4的水平上升.TNF-α(20μg/L)处理野生型SW1990细胞,12和24 h后凋亡率分别为25.4%±3.65%和43.5%±5.23%,但该效应在高表达5-LOX的细胞株中明显减弱,分别为13.2%±2.01%和21.7%±3.65%.在野生型SW1990细胞培养中加入外源性LTB4(10 nmol/L)能抑制TNF-α诱导的细胞凋亡,野生型与处理组细胞24 h后凋亡率有显著性差异(47.6%±5.32%vs 18.5%±5.69%,P<0.01).用LTB4受体阻断剂处理5-LOX高表达细胞株,能恢复其对凋亡诱导的敏感性.结论:胰腺癌细胞均能表达5-LOX并产生LTB4,高表达5-LOX能抑制TNF-α诱导的胰腺癌细胞凋亡.     

碱性成纤维细胞生长因子对自发性高血压大鼠血管平滑肌细胞肾素-血管紧张素系统的作用

以培养的自发性高血压大鼠（SHR）和正常血压（WKY）大鼠主动脉平滑肌细胞（ASMC）为模型,采用Northern印迹和逆转录-聚合酶链式反应（RT-PCR）技术分别检测ASMC中血管紧张素原（Ang N）和血管紧张素Ⅱ（Ang Ⅱ）的AT_1型受体的基因表达,并用紫外法和放射免疫法分别测定培养液中的血管紧张素Ⅰ转换酶（ACE）活性和AngⅡ的含量。结果表明,基础状态及给予外源性碱性成纤维细胞生长因子（bFGF,10 ng/ml）刺激后,SHR的ASMC中上述4种实验参数的水平均明显高于WKY大鼠。提示SHR ASMC中的肾素—血管紧张素系统（RAS）处于高功能状态;bFGF能促进Ang N基因表达、激活ACE,进而导致Ang Ⅱ生成增加,同时它对AT_1受体基因表达也有调节作用,bFGF的上述作用可能是高血压时血管RAS高功能状态发生和维持的一个重要机制。     

Interleukin 1 beta (IL-1 beta) processing in murine macrophages requires a structurally conserved homologue of human IL-1 beta converting enzyme.

Murine interleukin 1 beta (IL-1 beta) convertase (mICE) was identified in cytosolic extracts of peritoneal exudate cells (PECs) and macrophage cell lines. mICE cleaves both the human and mouse IL-1 beta precursors (pIL-1 beta) at sites 1 and 2 but fails to cleave a human pIL-1 beta (Asp116 to Ala) mutant at site 2, indicating that Asp is required to the left of the scissile bond. Ac-Tyr-Val-Ala-Asp-amino-4-methyl coumarin, patterned after site 2 of human pIL-1 beta, is a fluorogenic substrate for mICE, while the tetrapeptide aldehyde Ac-Tyr-Val-Ala-Asp-CHO is a potent inhibitor (Ki = 3 nM) that prevents generation and release of mature IL-1 beta by PECs (IC50 = 7 microM). Cloning of a full-length 1.4-kb cDNA shows that mICE is encoded as a 402-aa proenzyme (p45) that can be divided into a prodomain (Met1-Asp122), followed by a p20 subunit (Gly123-Asp296), a connecting peptide (Ser297-Asp314), and a p10 subunit (Gly315-His402). At the amino acid level, p45, p20, and p10 are 62%, 60%, and 81% identical with human IL-1 beta convertase (hICE). The active site Cys284 lies within a completely conserved stretch of 18 residues; however, Ser289 in hICE, which aligns with the catalytic region of serine and viral cysteinyl proteases, is absent from mICE. Expression in Escherichia coli of a truncated cDNA encoding Asn119-His402 generated active enzyme, which was autocatalytically processed at three internal Asp-Xaa bonds to generate a p20 subunit (Asn119-Asp296) complexed with either p11 (Ala309-His402) or p10. Recombinant mICE cleaves murine pIL-1 beta accurately at the Asp117-Val118 bond. The striking similarities of the human and murine enzymes will make it possible to assess the therapeutic potential of hICE inhibitors in murine models of disease.     

胃癌术后肠内营养应用方法及耐受性分析

目的探讨胃癌术后肠内营养（EN）耐受性影响因素及EN具体实施方法。方法选取2011年11月至2012年9月在青岛大学医学院附属医院普外科行胃癌手术的患者54例为研究对象,以序贯、渐进的方法实施EN,观察EN耐受情况,对患者EN耐受性进行单因素和多因素Logistic回归分析,记录患者EN期间的消化道症状。结果54例患者中,49例（90．74％）能耐受EN。肿瘤分期（单因素分析：X2=7．287,P=0．007;多因素分析：t=2．559,P=0．014）、手术方式（单因素分析：X2=7．825,P=0．005;多因素分析：t=2．254,P=0．043）是影响EN耐受性的因素。在耐受患者中,EN期间胃肠道症状以腹胀为主（19／49,38．8％）。结论序贯、渐进的EN方法适合胃癌术后患者,可在临床推广应用。     

造血干细胞移植患者肠外营养支持的临床观察

目的探讨肠外营养（PN）支持对造血干细胞移植患者的重要性及各种营养素的作用。方法回顾性分析2008年1月至2009年9月106例接受造血干细胞移植患者的临床资料,根据营养支持方式不同分为PN组（n=42）和非PN组（n=64）,比较两组患者在造血重建时间、口腔黏膜炎、肝功能异常、感染及移植物抗宿主病（GVHD）发生率等方面的差异;进一步分析核黄素、谷氨酰胺、结构脂肪乳等营养素的作用。结果接受PN支持的42例患者中,包含接受核黄素的患者33例,谷氨酰胺24例,结构脂肪乳26例。PN组患者的口腔黏膜炎发生率显著低于非PN组（31．0％比51．6％,P=0．036）,而两组的感染率（42．9％比46．9％,P=0．898）、GVHD发生率（21．4％比31．3％,P=0．267）、丙氨酸氨基转移酶（ALT）水平[（49．5±9．8）U／L比（69．9±10．9）U／L,P=0．196]、粒系重建时间[（11．6±0．3）d比（12．3±0．3）d,P=0．187]及血小板重建时间[（14．1±0．9）d比（13．3±0．4）d,P=0．386]差异均无统计学意义。核黄素组的口腔黏膜炎发生率为27．3％,有低于无核黄素组（44．4％）和非PN组（51．6％）的趋势,但差异无统计学意义（P=0．073）。谷氨酰胺组、无谷氨酰胺组和非PN组在口腔黏膜炎发生率、感染率、GVHD发生率、ALT水平及造血重建时间方面的差异均无统计学意义（P均〉0．05）。结构脂肪乳组的ALT平均值为（38．7±4．9）U／L,有低于物理混合的中长链脂肪乳组[（68．5±23．0）U／L]和非PN组[（69．9±10．9）U／L]的趋势,但差异无统计学意义（P=0．243）。结论造血干细胞移植患者可从合理的PN中获益。核黄素对口腔黏膜炎的预防可能有益。结构脂肪乳与中长链脂肪乳对于肝脏功能具有同样的安全性。谷氨酰胺的作用有待进一步研究。     

A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people

Introduction

The SARC-F scale is a newly developed tool to diagnose sarcopenia and obviate the need for measurement of muscle mass. SARC-F ≥ 4 is defined as sarcopenia. The questions of SARC-F cover physical functions targeting sarcopenia or initial presentation for sarcopenia. The aim of the study is to explore the application of SARC-F in the Chinese people.

Methods

Two hundred thirty Chinese people over 65 years old were assessed by the SARC-F scale, PSMS, Lawton IADL and the shortened version of the falls efficacy scale-international (the short FES-I). Hospitalization was investigated. Physical performance and strength were measured. The association of SARC-F with other scales or tests was analyzed.

Results

Poor physical performance and grip strength were associated with SARC-F ≥ 4 independently (P<0.005). The value for agreement of SARC-F ≥ 4 and cutoff points of tests were 0.391 to 0.635. The short FES-I were correlated to SARC-F scores (Spearman’s coefficient 0.692). Poor PSMS and Lawton IADL scores were associated with SARC-F ≥ 4(P=0.000) and SARC-F ≥ 4 was associated with hospitalization in the past 2 years (P=0.000).

Conclusion

The SARC-F scale can identify old Chinese people with impaired physical function who may suffered from sarcopenia. SARC-F judgment reflects fear of falling, indicates the hospitalization events and is associated with ability of daily life. Thus, SARC-F may be a simple and useful tool for screening individuals with impaired physical function. Further studies on SARC-F in Chinese people would be worthy.