成年健康女性外周血免疫相关指标的分析

目的 探讨成年健康女性外周血中多项免疫相关指标合适的参考范围和临床价值.方法 采集21～40岁的356例成年健康女性外周血,测定血常规、T淋巴细胞亚群、自然杀伤(NK)细胞和B细胞的数量及百分比,采用免疫比浊法对免疫球蛋白(Ig)进行分析,采用95％ 置信区间表示各指标参考范围.结果 21～40岁成年健康女性白细胞计数的参考范围为(3.71～9.47)×109/L;CD3+CD4+绝对数参考范围为378.21～1170.02个/微升,百分比参考范围为23.73％ ～51.05％;NK细胞数参考范围为94.4～660.4个/微升;IgA、IgG、IgM的参考范围分别为1.10～4.01 g/L、9.51～15.80 g/L和0.64～2.57 g/L.结论 该研究全面评估了成年健康女性外周血免疫相关指标的均数和中位数,为基础研究和临床实验提供了较为规范的反映成年健康女性身体免疫状况的参考范围.     

动态监测血清相关指标对重型颅脑损伤术后肺部感染的预测价值

目的分析动态监测重型颅脑损伤术后患者血清降钙素原(PCT)、可溶性髓样细胞表达的激发受体-1(sTREM-1)及C反应蛋白与白蛋白比值(CRP/ALB)的变化对肺部感染的早期预测价值。方法选取手术治疗的196例重型颅脑损伤患者,监测并记录术后1、3、5 d的血清PCT、CRP、ALB、sTREM-1及CRP/ALB水平,记录患者术后肺部感染情况。分析重型颅脑损伤术后肺部感染的危险因素,通过绘制受试者工作特征(ROC)曲线分析相关指标对肺部感染的早期预测价值。结果重型颅脑损伤术后发生肺部感染者76例(38.78%),感染发生时间为术后6~13 d,中位数为7 d。无肺部感染组术后3、5 d血清PCT、sTREM-1及CRP/ALB低于肺部感染组,差异有统计学意义(P0.05);肺部感染组术后5 d血清ALB低于无肺部感染组,差异有统计学意义(P0.05)。机械通气时间、术后格拉斯哥昏迷量表(GCS)评分、术后急性生理与慢性健康评分Ⅱ(APACHEⅡ)以及术后5 d血清PCT、sTREM-1及CRP/ALB是术后肺部感染的独立危险因素(P0.05)。ROC曲线显示,单独检测时,术后5 d血清CRP/ALB预测肺部感染的曲线下面积(AUC)值、约登指数、特异度最高,sTREM-1预测的敏感度最高;联合检测的AUC、约登指数、灵敏度、特异度均高于单独检测。肺部感染诊断时临床肺部感染评分(CPIS)、全身炎症反应综合征修正(ASS)评分均与术后5 d PCT、sTREM-1、CRP/ALB水平呈显著正相关(P0.05)。结论术后5 d血清PCT、sTREM-1及CRP/ALB水平均可作为重型颅脑损伤术后肺部感染早期预测的有效依据,而联合检测的预测价值更高,更有利于早期对肺部感染程度及病情进展的评估。     

1例误诊尿崩症的Gitelman综合征病例分析

Gitelman综合征(GS)是一种常染色体隐性遗传所致的失盐性肾小管疾病,以低钾性碱中毒、低镁血症、低钙尿症和继发性醛固酮增多症为主要表现。本研究报道了1例误诊尿崩症的GS患儿的诊治过程,同时通过文献复习的方式探讨GS的临床表现、诊断方法、治疗及随访策略,并强调基因检测在本病诊断过程中的重要性。临床医师在工作中应提高对GS的认识水平,做到早期诊断并治疗GS。     

血清可溶性髓样细胞触发受体1、高敏C反应蛋白联合急性生理和慢性健康状况评分Ⅱ对肺炎合并呼吸衰竭患者预后评估的价值

目的 研究血清可溶性髓样细胞触发受体1(sTREM-1)、高敏C反应蛋白(hs-CRP)联合急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)对重症肺炎合并呼吸衰竭患者预后评估的价值.方法 选取重症肺炎合并呼吸衰竭患者106例为观察组,另外随机选取同期轻症肺炎患者108例为对照组;根据106例肺炎合并呼吸衰竭患者30 d预后情况分为生存组82例和死亡组24例.检测所有患者sTREM-1、hs-CRP水平并评估APACHEⅡ评分情况,分析血清sTREM-1、hs-CRP联合APACHEⅡ评分对肺炎合并呼吸衰竭患者不良预后的诊断效能,分析影响肺炎合并呼吸衰竭患者不良预后的危险因素.结果 观察组患者血清sTREM-1、hs-CRP水平及APACHEⅡ评分均高于对照组,差异有统计学意义(P＜0.05).死亡组患者血清sTREM-1、hs-CRP水平及APACHEⅡ评分均高于生存组,差异有统计学意义(P＜0.05).受试者工作特征(ROC)曲线分析显示,sTREM-1、hs-CRP、APACHEⅡ评分诊断肺炎合并呼吸衰竭患者不良预后的曲线下面积(AUC)分别为0.835、0.796、0.866,敏感度分别为82.80％、93.10％、75.90％,特异度分别为80.50％、58.40％、89.60％.联合检测诊断肺炎合并呼吸衰竭患者不良预后的AUC为0.938,敏感度为79.20％,特异度为93.10％.sTREM-1、hs-CRP、APACHEⅡ评分是肺炎合并呼吸衰竭患者不良预后的独立影响因素(P＜0.05).结论 sTREM-1、hs-CRP联合APACHEⅡ评分对肺炎合并呼吸衰竭患者预后具有较好的诊断价值,可为临床及时调整治疗方案提供理论依据.     

From “S” to “O”: experimental and theoretical insights into the atmospheric degradation mechanism of dithiophosphinic acids

Dithiophosphinic acids (DPAHs, expressed as R₁R₂PSSH) are a type of sulfur-donor ligand that have been vastly applied in hydrometallurgy. In particular, DPAHs have shown great potential in highly efficient trivalent actinide/lanthanide separation, which is one of the most challenging tasks in separation science and is of great importance for the development of an advanced fuel cycle in nuclear industry. However, DPAHs have been found liable to undergo oxidative degradation in the air, leading to significant reduction in the selectivity of actinide/lanthanide separation. In this work, the atmospheric degradation of five representative DPAH ligands was investigated for the first time over a sufficiently long period (180 days). The oxidative degradation process of DPAHs elucidated by ESI-MS, ³¹P NMR, and FT-IR analyses is R₁R₂PSSH → R₁R₂PSOH → R₁R₂POOH → R₁R₂POO–OOPR₁R₂, R₁R₂PSSH → R₁R₂PSS–SSPR₁R₂, and R₁R₂PSSH → R₁R₂PSOH → R₁R₂POS–SOPR₁R₂. Meanwhile, the determination of pK_a values through pH titration and oxidation product by PXRD further confirms the S → O transformation in the process of DPAH deterioration. DFT calculations suggest that the hydroxyl radical plays the dominant role in the oxidation process of DPAHs and the order in which the oxidation products formed is closely related to the reaction energy barrier. Moreover, nickel salts of DPAHs have shown much higher chemical stability than DPAHs, which was also elaborated through molecular orbital (MO) and adaptive natural density portioning (AdNDP) analyses. This work unambiguously reveals the atmospheric degradation mechanism of DPAHs through both experimental and theoretical approaches. At the application level, the results not only provide an effective way to preserve DPAHs but could also guide the design of more stable sulfur-donor ligands in the future.

The oxidation behavior and mechanism of five typical DPAH ligands in the air was systematically studied through experimental and theoretical methods.     

单、双侧椎弓根钉内固定结合椎间融合术对腰椎间盘突出症脊柱稳定性的影响

目的对比单、双侧椎弓根钉内固定结合椎间融合术对腰椎间盘突出症病人症状及脊柱稳定性的影响。方法选取 2014年10月至 2016年 6月中国人民解放军第九二医院住院的腰椎间盘突出症接受手术治疗的病人 60例,采用随机数字表法分为观察组和对照组各 30例。观察组接受单侧椎弓根钉内固定结合椎间融合术,对照组接受双侧椎弓根钉内固定结合椎间融合术。对比两组围手术期相关指标;对比两组手术前后的疼痛视觉模拟评分( VAS)、 Oswestry功能障碍指数( ODI)评估结果;对比两组椎体融合时间及融合率;对比两组术后脊柱稳定性指标的变化。结果观察组的手术时间、术中出血量、术后引流量、住院费用均显著少于对照组( P＜0.05);两组病人术后的 VAS评分、 ODI评分均显著低于术前( P＜0.05);观察组术后 10 d、术后 3个月的 VAS评分、 ODI评分均显著低于对照组( P＜0.05);两组病人的椎体融合时间、融合率的对比,均差异无统计学意义( P＞     

甲下穿刺治疗甲下血肿 51例

目的介绍一种穿刺引流治疗甲下血肿方法,并分析其治疗效果。方法选取 2015年 3月至 2018年 3月苏州明基医院甲下血肿病人 51例,用 5 mL无菌注射器针头,于病指(趾)尖末端进针,挤压,穿刺引流,观察症状缓解情况。结果 51例疼痛及肿胀即刻缓解,术后随访 1周,无感染及复发。结论甲下穿刺治疗甲下血肿操作简单,安全性高,是一种行之有效的方法。     

Cardiac protection of Bauhinia championii against reperfusion injury

This study aims to investigate the protective effects of the Bauhinia championii (BC) against ischemia/reperfusion (I/R)‐induced injury in an isolated heart model. Langendorff‐perfused C57BL/6JNarl mice hearts were performed with 30 minutes ischemia and 60 minutes reperfusion by left anterior descending artery ligation. Before reperfusion, boiling water extracts of BC (10 mg/L) was pretreated for 15 minutes. During reperfusion, BC significantly decreased the occurrence of ventricular arrhythmias by lead II electrocardiogram (ECG). Electrophysiological effect of BC was further determined in isolated ventricular myocytes by whole‐cell patch clamp technique. The underlying mechanism may result from its Na⁺ channel blocking activity characterized with reduced rise slope of action potential and Na⁺ current density. Moreover, BC dramatically reduced I/R‐caused infarct size, which was accessed by 2,3,5‐triphenyltetrazolium chloride (TTC) assay. Since BC decreased I/R‐induced myoglobin release and oxidation of Ca²⁺‐calmodulin‐dependent protein kinase, inhibition of myocardial necroptosis may account for the protective effects of BC on myocytes lose. This study indicated that BC may prevent I/R induced ventricular arrhythmias and myocyte death by blocking Na⁺ channels and decreasing necroptosis, respectively. Since most of the available antiarrhythmic remedies have unwanted adverse actions, BC could be a novel candidate for the treatment of myocardial infarction and ventricular arrhythmia.