没食子酸抑制人神经母细胞瘤增殖作用的实验研究

目的研究没食子酸抑制小鼠模型中人神经母细胞瘤增殖的作用以及对化疗药物的协同作用。方法建立人神经母细胞瘤SK-N-SH细胞株免疫活性C57BL/6j小鼠移植瘤模型,随机分配成4组,每组10只:①PBS荷瘤对照组,按PBS0.5ml/只,腹腔注射,作为阴性对照;②没食子酸组,按250mg/kg,1次/2d给药,连续2周;③环磷酰胺组,按75mg/kg给药,每周2次,连续2周,作为阳性对照;④没食子酸+环磷酰胺组,没食子酸在环磷酰胺给药前24h给药,没食子酸与环磷酰胺独立给药,剂量和时间同前。药物均9:00腹腔注射给药,每周监测相对肿瘤体积(RTV),治疗时间共2周,次日处死小鼠,称体质量和瘤质量(Wt)、计算抑瘤率(IR),BrdU标记检测移植瘤细胞增殖。结果没食子酸组、环磷酰胺组、没食子酸+环磷酰胺组在2周的移植瘤瘤质量分别为(4559.0±677.7)、(2117.0±749.6)、(637.7±319.6)mg,平均抑瘤率分别为36.94%、70.72%、91.18%,与PBS组比较差异有显著性(P<0.01),没食子酸+环磷酰胺组瘤质量与环磷酰胺组比较差异有显著性(P<0.01)。各给药组肿瘤增殖指数分别为0.1229±0.0219、0.1076±0.0156、0.0413±0.0130,与PBS组肿瘤增殖指数(0.2308±0.0759)比较差异有显著性(P<0.01),同时没食子酸+环磷酰胺组与没食子酸组或环磷酰胺组比较差异有显著性(P<0.01)。结论没食子酸具有抑制人神经母细胞移植瘤增殖、协同环磷酰胺抗肿瘤生长的作用。     

Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum

The factors influencing the incidence of common complications(pneumothorax and pulmonary hemorrhage) of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax(13 cases, 27.1%) and pulmonary hemorrhage(14 cases, 20.24%). ?2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases(17.5%) out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases(60%) out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases(41.4%) out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases(70%) out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words: biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage     

2型糖尿病伴非酒精性脂肪肝与胰岛素抵抗及血脂异常的研究

目的:探讨2型糖尿病(T2DM)伴非酒精性脂肪肝(NAFLD)与胰岛素抵抗(IR)及血脂异常的关系。方法:随机选取T2DM患者68例,按是否并发NAFLD分为脂肪肝组38例和非脂肪肝组30例,测定两组患者的甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FIns)及餐后2h血浆胰岛素(2hIns),计算并比较两组之间的体重指数(BMI)、腰臀比(WHR)以及胰岛素抵抗指数(HOMA-IR)。同时检测肝功能。结果:脂肪肝组TG、LDL-C、Fins、2hIns、BMI、WHR、HOMA-IR、ALT、AST的平均水平均显著高于非脂肪肝组,而HDL-C则显著低于非脂肪肝组。两组FPG、2hPG及HbA1c水平则无显著差异。结论:T2DM伴NAFLD患者存在着明显的胰岛素抵抗及脂质代谢异常。     

人肾微血管内皮细胞转分化在移植肾间质纤维化形成中的作用

目的:探讨人肾微血管内皮细胞-间充质细胞转分化(endothelial-mesenchymal transition,EndMT)在移植肾间质纤维化形成中的意义及相关机制?方法:通过对南京医科大学第一附属医院25例慢性移植肾失功能(chronic allograft dysfunction,CAD)患者和25例正常人血生化指标进行分析,对移植肾组织标本和正常肾组织标本进行糖原(PAS)和马松三色(Masson)染色检查分析,观察两组肾功能?肾小管萎缩?肾小球塌陷及肾间质纤维化程度的差异?用免疫组织化学和间接免疫荧光双重染色方法检测两组肾组织标本中血管内皮细胞标志物CD34和肌成纤维细胞标志物α-平滑肌细胞肌动蛋白(α-smooth muscle actin,α-SMA)以及转化生长因子-β1(transforming growth factor-β1,TGF-β1)的表达和分布特点?进一步以原代人脐静脉内皮细胞(human umbilical vein endothelial cells,HUVECs)为体外研究对象,以TGF-β1(5 ng/ml)作用0~72 h,采用免疫印迹方法观察细胞中CD34和α-SMA的表达变化?结果:与正常人相比,CAD患者血清肌酐水平明显升高,PAS和Masson三色染色结果显示CAD患者移植肾组织中出现明显肾小管萎缩?肾小球塌陷及肾间质纤维化改变;半定量统计分析结果表明两者间存在统计学差异(P < 0.01)?免疫组织化学及间接免疫荧光染色结果表明,与正常组相比,CAD组中CD34阳性表达率降低而α-SMA及TGF-β1阳性表达率显著升高,CAD组中部分肾小球和间质微血管内皮细胞呈CD34和α-SMA双重染色阳性?体外研究显示,TGF-β1作用于HUVECs细胞后,随着时间延长,CD34表达逐渐降低而α-SMA表达逐渐增多,与对照组相比,具有统计学差异(P < 0.01)?结论:人肾微血管内皮细胞可能在TGF-β1介导下通过发生EndMT现象进而在移植肾间质纤维化形成中起重要作用?     

语言哲学揭示中医概念分析的逻辑框架：以对“肾精”的分析为例

中医概念的分析亟需一个广为接受的逻辑框架,而不是用概念解释概念,或与现代医学的物质简单对应。语言哲学认为语言具有一种逻辑结构,该结构正与世界的逻辑结构一致,即语言是世界的＂逻辑图像＂。本文采纳了该思想,并以对＂肾精＂的分析为例,通过分析古代关于＂肾精＂描述的文献,逐一找出＂肾精＂之所以成为＂肾精＂的若干必要条件,直至形成一个充分条件,希以此例表明这种基于语言哲学的逻辑框架在解析中医核心概念中的有效性。     

桌面虚拟现实技术在医学多媒体课件中的设计与应用

介绍了桌面虚拟现实技术在课件制作中的设计思路及实现方法。指出将虚拟现实技术与课件教学内容的知识点相整合,可强化课件的学习自主性和知识交互性,从而提高学习效率和教学质量。     

糖尿病病人胰岛素泵应用及相关知识调查

[目的]探讨糖尿病病人应用胰岛素泵强化治疗的相关知识及需求情况.[方法]采用自行设计的问卷调查表,对60例糖尿病胰岛素泵强化治疗病人进行调查.[结果]病人对胰岛素泵了解甚少,相关知识缺乏,希望接受胰岛素泵知识教育.[结论]胰岛素泵应用现状存在较多问题,影响病人血糖的良好控制,应提高病人对胰岛素泵的认可程度和依从性,提高生活质量.     

国外医院绩效评价对我国的启示

绩效评价是促进公立医院公益性、引导其医疗服务质量持续改进的有效方法。然而目前国内尚无一套统一、科学、合理的公立医院绩效考核制度, 对医改背景下的公立医院绩效进行考核, 已成为困扰我国卫生事业发展的重要问题。本文在借鉴国外医院绩效评价先进经验措施的基础上, 结合我国现状, 对医院绩效评价提出了一些针对性的建议和意见。     

Acute toxicity is a dose-limiting factor for intravenous polymyxin B: A safety and pharmacokinetic study in healthy Chinese subjects

ObjectivesPolymyxin B is a last-line antibiotic for multidrug-resistant gram-negative bacterial infections. However, limited safety and pharmacokinetic information is available. We investigated the safety and pharmacokinetics of intravenous polymyxin B in healthy subjects.MethodsAn open-label, single-dose clinical trial was conducted in healthy Chinese subjects. Polymyxin B (sulphate) was administered intravenously at 0.75 or 1.5 mg/kg (n = 10 per dose, 5 males and 5 females) to examine the safety and pharmacokinetics.ResultsOne female subject in the 1.5-mg/kg group discontinued due to abdominal pain during administration. The most frequently reported adverse events were perioral paraesthesia, dizziness, and numbness of extremities (7/10 subjects in the 0.75-mg/kg group, all subjects in the 1.5-mg/kg group). All neurotoxicity-related events dissipated without treatment within a maximum of 23 h. Notably, abdominal pain (3/5) and vulvar pruritus (2/5), colpitis (2/5) or abnormal uterine bleeding (1/5) were reported in female subjects receiving the 1.5-mg/kg dose. In the 0.75-mg/kg group, the total clearance, volume of distribution and half-life of polymyxin B were 0.028±0.002 L/h/kg, 0.219±0.023 L/kg and 5.44±0.741 h, respectively; similar values were observed in the 1.5-mg/kg group. Urinary recovery was 3.7 ± 1.1% and 8.1 ± 1.3% in the 0.75- and 1.5-mg/kg groups, respectively. Population pharmacokinetics of polymyxin B was consistent with a three-compartment model. The clearance and distribution of the central compartment were 0.027 L/h/kg and 0.071 L/kg, respectively.ConclusionsThis study is the first to examine the safety and pharmacokinetics of polymyxin B in healthy subjects. Our results highlight that acute toxicity is a dose-limiting factor for intravenous polymyxin B.