中西医结合治疗卵巢储备功能减退患者成功妊娠二例并文献复习

卵巢储备功能减退（diminished ovarian reserve,DOR）是卵巢因素所致不孕症的主要原因之一,西医临床治疗方法主要依赖于口服提高卵巢储备功能的药物、人工激素周期替代疗法和辅助生殖技术助孕,中医运用补肾健脾法治疗DOR具有不良反应少、疗效持久、治疗手段多样化等优势。报告2例在常规西医治疗基础上应用中医补肾健脾法综合治疗DOR患者成功妊娠的情况,强调个体化中西医结合治疗方案对于解决疑难病证的重要性,为临床应用中医药治疗DOR患者提供证据。     

Point-of-Care Tests for Rapid Detection of Porcine Epidemic Diarrhea Virus: A Systematic Review and Meta-Analysis

The timely and accurate diagnosis of porcine epidemic diarrhea virus (PEDV) infection is crucial to reduce the risk of viral transmission. Therefore, the objective of this review was to evaluate the overall diagnostic accuracy of rapid point-of-care tests (POCTs) for PEDV. Studies published before 7 January 2022 were identified by searching PubMed, EMBASE, Springer Link, and Web of Science databases, using subject headings or keywords related to point of care and rapid test diagnostic for PEDV and PED. Two investigators independently extracted data, rated risk of bias, and assessed the quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The bivariate model and the hierarchical summary receiver operating characteristic (HSROC) model were used for performing the meta-analysis. Threshold effect, subgroup analysis, and meta-regression were applied to explore heterogeneity. Of the 2908 records identified, 24 eligible studies involving 3264 specimens were enrolled in the meta-analysis, including 11 studies on evaluation of lateral flow immunochromatography assay (ICA)-based, and 13 on nucleic acid isothermal amplification (NAIA)-based POCTs. The overall pooled sensitivity, specificity and diagnostic odds ratio (DOR) were 0.95 (95% CI: 0.92–0.97), 0.96 (95% CI 0.88–0.99) and 480 (95% CI 111–2074), respectively; for ICA-based POCTs and the corresponding values for NAIA-based, POCTs were 0.97 (95% CI 0.94–0.99), 0.98 (95% CI 0.91–0.99) and 1517 (95% CI 290–7943), respectively. The two tests showed highly comparable and satisfactory diagnostic performance in clinical utility. These results support current recommendations for the use of rapid POC tests when PEDV is suspected.     

Synthesis and Anticancer Activity of Bagasse Xylan/Resveratrol Graft-Esterified Composite Nanoderivative

Biomass materials are high-quality raw materials for the preparation of natural, green and highly active functional materials due to their rich active groups, wide sources and low toxicity. Bagasse xylan (BX) and resveratrol (Res) were used as raw materials to introduce ethylene glycol dimethacrylate (EGDMA) via grafting reaction to obtain the intermediate product BX/Res-g-EGDMA. The intermediate was esterified with 3-carboxyphenylboronic acid (3-CBA) to obtain the target product 3-CBA-BX/Res-g-EGDMA. The BX/Res-composite-modified nanoderivative with antitumor activity was synthesized with the nanoprecipitation method. The effects of the reaction conditions on the grafting rate (G) of BX/Res-g-EGDMA and the degree of substitution (DS) of 3-CBA-BX/Res-g-EGDMA were investigated using single-factor experiments. The results showed that under the optimized process conditions, G and DS reached 142.44% and 0.485, respectively. The product was characterized with FTIR, XRD, TG-FTC, ¹H NMR and SEM, and its anticancer activity was simulated and tested. The results showed that 3-CBA-BX/Res-g-EGDMA had a spherical structure with an average particle size of about 100 nm and that its crystalline structure and thermal stability were different from those of the raw materials. In addition, 3-CBA-BX/Res-g-EGDMA showed the best docking activity with 2HE7 with a binding free energy of −6.3 kJ/mol. The inhibition rate of 3-CBA-BX/Res-g-EGDMA on MGC80-3 (gastric cancer cells) reached 36.71 ± 4.93%, which was 18 times higher than that of BX. Therefore, this material could be a potential candidate for biomedical applications.     

Thermodynamic and Kinetic Binding Behaviors of Human Serum Albumin to Silver Nanoparticles

A nanoparticle, under biological milieu, is inclined to be combined with various biomolecules, particularly protein, generating an interfacial corona which provides a new biological identity. Herein, the binding interaction between silver nanoparticles (AgNPs) and human serum albumin (HSA) was studied with transmission electron microscopy (TEM), circular dichroism (CD), and multiple spectroscopic techniques. Due to the ground state complex formed mainly through hydrophobic interactions, the fluorescence titration method proved that intrinsic fluorescence for HSA was probably statically quenched by AgNPs. The complete thermodynamic parameters were derived, indicating that the interaction between HSA and AgNPs is an entropy-driven process. Additionally, synchronous fluorescence and CD spectrum results suggested the conformational variation it has upon binding to AgNPs and the α-helix content has HSA visibly decreased. The kinetic experiments proved the double hysteresis effect has in HSA’s binding to the AgNPs surface. Moreover, the binding has between HSA and AgNPs follows the pseudo-second-order kinetic characteristic and fits the Freundlich model for multilayer adsorption. These results facilitate the comprehension about NPs’ underlying biological effects under a physiological environment and promote the secure applications of NPs biologically and medically.     

内窥镜在脑神经外科手术中的应用(附40例报告)

脑内窥镜手术是近年微创伤神经外科的一个重要发展方向.本文报告应用CT引导立体定向技术,施行脑内窥镜手术40例.包括脑肿瘤切除25例,脑囊肿摘除5例,脑内异物摘除4例.脑脓肿摘除3例,脉络丛烧的治疗脑积水2例,脑内寄生虫取出1例.病变均位于脑深部或重要功能区,其中鞍区18例、大脑半球8例、基底节区6例、侧脑室内5例、小脑半球3例.手术有效率97.5%(术后1月).术后无昏迷、偏瘫、颅内感染等严重并发症.本文介绍了内窥镜的手术方法,对于如何术中应用激光及防治并发症等问题进行了讨论.     

小鼠肺、肝和肾间质树突状细胞的形态与组织分布

目的:了解小鼠肺、肝和肾间质树突状细胞的形态与分布特点。方法:电镜形态学观察及表面分子CD11c、CD205与共刺激分子CD80、CD86和MHC-Ⅱ类分子免疫组织化学标记,观察研究C57BL/6小鼠肺、肝和肾间质树突状细胞的形态和分布特点。结果:间质树突状细胞具有特征性的胞质突起,广泛分布于肺、肝与肾间质中,数量较少,大部分处于非成熟状态,低表达CD205、CD80、CD86和MHC-Ⅱ类分子。结论:间质树突状细胞是脏器免疫微环境的重要组成部分和免疫前哨细胞。     

住院医师规范化培训之“333”制管理模式运行与思考

调查本院103名“333”制人员,主要是临床类研究生和住院医师的“333”制活动出勤情况,结合我院以往住院医师规范化培训的相关情况,对取得的经验进行总结,探讨规范化管理“333”制人员的方法和最佳运行机制。     

PTCD在高龄恶性梗阻性黄疸患者治疗中的临床应用

目的评价透皮经肝胆造影及引流术（PTCD）对高龄恶性梗阻性黄疸患者的治疗效果。方法63例经CT,MRI和超声或活检证实的恶性梗阻性黄疸患者（男性34例,女性29例,年龄68～96岁,平均78.5岁）,其中,胆管癌20例,胆囊癌8例,肝癌8例,肝转移瘤10例,以及胰头癌17例,均接受了PTCD,19例又经胆道内支架植入。对全部患者的临床资料进行了回顾性分析。结果PTCD在所有患者中获得了技术成功。介入治疗后,患者的主要症状与体征,诸如黄疸、发热、皮肤瘙痒等均得到有效控制和明显缓解,血清总胆红素（STB）与谷丙转氨酶（ALT）水平均较治疗前显著降低。本组患者中PTCD引起的并发症有胆道少量出血,发热,肝区疼痛等,但这些症状经对症治疗后很快消失,未发生与该治疗操作有关的严重并发症。结论PTCD是姑息性治疗高龄恶性梗阻性黄疸患者的一种安全、有效方法。     

PET／MR一体机操作优化的初步经验

目的通过比较PET／CT和PET／MR,初步探索PET／MR一体机的操作流程和成像优化方案。方法228例患者同日内接受PET／CT和PET／MR检查,通过6种不同MR序列与PET采集组合方案,比较图像质量的优劣,以在保证诊断信息基础上缩短患者扫描时间的原则分析判断,并初步确定最优PET／MR一体机采集方案。结果PET／MR结果与PET／CT相近,但其操作流程和注意事项有独特之处;在6种方案中,以躯干和头部各有独立序列组合、兼顾各向同性结构显示与突出病灶特点的方案6效果最优;PET／MR比PET／CT更易产生伪影。结论在优化方案基础上,PET／MR可获得与PET／CT一致的诊断级图像,但PET／MR采集时间长、伪影多,有待进一步完善。