S100蛋白、神经元特异性烯醇化酶对心肺复苏后脑损伤的评估

目的 探讨心肺复苏(CPR)后早期血清S100蛋白(S100)、神经元特异性烯醇化酶(NSE)水平对脑损伤的评估作用.方法 研究对象为2004年8月至2006年12月院外、院内发生CA,经CPR成功恢复自主循环后收入解放军第401医院ICU的患者共36例,其中8例因存活不足24 h剔除,剩余28例.以格拉斯哥预后评分(Glasgow outcome scale COS)将患者分为A组(包括COS 1～2分)19例和B组(包括COS 3～5分)9例.健康对照12例为C组.所有患者均在ROSC后2 h、12 h、24 h、48 h、72 h分别采取静脉血,用电化学发光免疫法检测S100、NSE.同时收集入ICU后24 h内临床资料,计算各时间段和急性生理学与慢性健康状况Ⅱ、Ⅲ评分及存活概率(APACHEⅡ、Ⅲ、PS).计量资料数据以均数±标准差((x)±s)表示,所有数据用SPSS 11.5统计软件分析.组间比较采用Maim-Whitney U检验;ROSC时间与各时间点的S100、NSE水平相关性采用双变量相关分析.P＜0.05为差异具有统计学意义.结果 A组APACHE Ⅱ、Ⅲ评分明显高于B组(P≤0.01),A组的PS、GCS评分明显低于B组(P≤0.01),A组的开始通气时间、ROSC时间比B组明显长(P＜0.05).A组在2 h、12 h、48 h、72 h的S100水平明显高于B组(P≤0.01),而12h、24 h、48 h、72 h NSE水平明显高于B组(P＜0.05),B组在48 h S100、NSE水平与健康对照组无明显差异(P＞0.05).2 h、12 h S100水平与ROSC时间显著相关(P＜0.05);12 h、24 h、48hNSE水平与ROSC时间显著相关(P＜0.05).结论 血清S100、NSE均可作为判断CPR后早期缺氧性脑损伤的生化标志物,两者联合动态检测对于估计ROCS时间、判断继发性脑损伤、指导脑复苏具有一定的临床意义.     

体外反搏对动脉粥样硬化猪血管舒张功能的影响

目的 探讨长期体外反搏对动脉粥样硬化猪内皮依赖和非内皮依赖血管舒张功能的影响.方法 猪龄20 d雄性乳猪18头随机分为正常饲养组(n=6)、高脂饲养组(n=6)及高脂饲养+体外反搏组(n=6).后两组通过高脂饲养复制动脉粥样硬化猪疾病模型,对高脂饲养+体外反搏组进行为时36 h的长期体外反搏治疗,取各组动物颈动脉血管环,测定离体颈动脉血管环对不同浓度梯度乙酰胆碱和硝普钠的舒张反应,用单因素方差分析法比较三组动物血管舒张率的差异.结果 在乙酰胆碱10-8～10-5mol/L浓度范围内,高脂饲养组和高脂饲养+体外反搏组的血管舒张率较正常饲养组显著降低(P＜0.05);在10-7～10-5mol/L浓度范围内,高脂饲养+体外反搏组的血管舒张率较高脂饲养组明显提高(P＜0.05).在硝普钠10-8～10-5mol/L浓度范围内,高脂饲养组和高脂饲养+体外反搏组的血管舒张率较正常饲养组显著降低(P＜0.05);在10-8～10-5mol/L浓度范围内,高脂饲养+体外反搏组的血管舒张率较高脂饲养组明显提高(P＜0.05).结论 高脂饲养组和高脂饲养+体外反搏组内皮依赖血管舒张功能和非内皮依赖血管舒张功能较正常饲养组明显受损,长期体外反搏干预可以显著改善动脉粥样硬化猪内皮依赖和非内皮依赖血管舒张功能,这可能是长期体外反搏具有抗动脉粥样硬化作用的机制之一.     

3种白细胞介素与结核病免疫水平的关系

目的 研究白细胞介素-12(IL-12)、IL-18和IL-10 在结核病免疫发病机制中的作用,为设计新的疫苗和开展辅助性免疫疗法提供依据.方法 用ABC-酶联免疫吸附试验(ABC-ELISA)及双抗体夹心ELISA试剂盒检测39例结核性胸腔积液患者胸水中和血清中的IL-12、IL-18、IL-10水平.对结果进行显著性检验及相关性分析,并对治疗好转过程中的10例继发型肺结核和5例结核性胸膜炎患者的这3种细胞因子在胸水中的变化进行观测.结果 除IL-18外,其他两种细胞因子在胸水中与血清中含量差异有统计学意义;只有IL-12与IL-10之间有相关关系.治疗好转过程中,绝大多数患者有IL-12、IL-18水平增高和IL-10水平降低.结论 IL-18用作疫苗佐剂可能优于IL-12,这3种细胞因子均可用于开展免疫疗法,但不可一概而论.     

乙二胺四乙酸2钾盐等渗体溶液对全血细胞影响的研究

目的探讨添加乙二胺四乙酸（EDTA）2钾盐等渗体溶液的EDTA真空采血管对检测白细胞（WBC）、红细胞（RBC）、血红蛋白（Hb）、红细胞比容（HCT）、血小板（PLT）等主要血常规指标是否有影响。方法随机选取23例和68例患者的血液标本,以患者血液标本为对照管,摇匀后定量在对照管中吸取1mL血液加入到盛有25μL浓度为12％的等渗体管中作为实验管,立刻摇匀,静置2h后分别在雅培CD3700和东亚XE-2100全自动血细胞分析仪上检测。结果实验管与对照管检测WBC、RBC、Hb、HCT、PLT等指标未见明显差异,且WBC、RBC、Hb、HCT、PLT等指标均达到临床可接受性能要求。结论EDTA2钾盐等渗体的添加对全血细胞分析无影响。     

溧水县高中学生健康危险行为现状调查

目的:了解南京市溧水县高中学生健康危险行为现状,为制定相关伤害的预防控制措施提供依据。方法:根据《江苏省青少年健康相关行为调查问卷》内容,对6所高中2 482名学生进行问卷调查。结果:调查中有17.1%的学生想过自杀,32.0%的学生发生过严重受伤,28.2%的学生尝试过吸烟,58.4%的学生尝试过饮酒,学生中使用过网络的达92.5%,2.9%的学生有过性行为。结论:南京市溧水县高中学生健康危险行为发生状况不容忽视,迫切需要开展各种行为干预措施。     

Effect of Ca and Zr Additions on Microstructure and Mechanical Properties of As-Extruded Mg-3Sn Alloy

In this paper, the effect of Ca and Zr additions on microstructure and mechanical properties at room temperature of Mg-Sn alloys was investigated by comparison of Mg-3Sn (wt.%) (T3), Mg-3Sn-1Ca (wt.%) (TX31), and Mg-3Sn-1Ca-1Zr (wt.%) (TXK311) alloys under extrusion. The results show that the main phases of as-extruded T3 alloy were α-Mg and Mg₂Sn phases, while the CaMgSn phase was formed and the precipitation of Mg₂Sn phase was inhibited in the TX31 and TXK311 alloys due to the addition of the Ca element. Zr did not form intermetallic compounds with other elements but dissolved in the grains of the matrix and became nucleating particles. Incomplete dynamic recrystallization (DRX) occurred in all alloys during hot extrusion. The coarse rod-like and fine block-like mixed CaMgSn phase was observed in α-Mg matrix of as-extruded samples of the TX31 alloy, and the dispersed granular CaMgSn phase was observed in the TXK311 alloy. Ca inhibited the dynamic recrystallization behavior of the alloys, while Zr promoted the dynamic recrystallization behavior. All the as-extruded alloys exhibit typical fiber texture of {0001} basal//ED. With the addition of Ca and Zr elements, the particle stimulated nucleation (PSN) effect excited by the second phase particles gradually weakened the texture. TXK311 alloy has good comprehensive mechanical properties at room temperature, with tensile strength, yield strength, and elongation of 261 MPa, 244 MPa, and 11%, respectively, and the average grain size was 1.8 μm. Grain refinement and second phase dispersion strengthening are considered to play critical roles in the strength optimization of the TXK311 alloy.     

Pillar[n]arene-Mimicking/Assisted/Participated Carbon Nanotube Materials

The recent progress in pillar[n]arene-assisted/participated carbon nanotube hybrid materials were initially summarized and discussed. The molecular structure of pillar[n]arene could serve different roles in the fabrication of attractive carbon nanotube-based materials. Firstly, pillar[n]arene has the ability to provide the structural basis for enlarging the cylindrical pillar-like architecture by forming one-dimensional, rigid, tubular, oligomeric/polymeric structures with aromatic moieties as the linker, or forming spatially “closed”, channel-like, flexible structures by perfunctionalizing with peptides and with intramolecular hydrogen bonding. Interestingly, such pillar[n]arene-based carbon nanotube-resembling structures were used as porous materials for the adsorption and separation of gas and toxic pollutants, as well as for artificial water channels and membranes. In addition to the art of organic synthesis, self-assembly based on pillar[n]arene, such as self-assembled amphiphilic molecules, is also used to promote and control the dispersion behavior of carbon nanotubes in solution. Furthermore, functionalized pillar[n]arene derivatives integrated carbon nanotubes to prepare advanced hybrid materials through supramolecular interactions, which could also incorporate various compositions such as Ag and Au nanoparticles for catalysis and sensing.     

Existing tests vs. novel non-invasive assays for detection of invasive aspergillosis in patients with respiratory diseases

Background:Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays.Methods:Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed.Results:The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) (χ² = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) (χ² = 24.65, P < 0.001), and fungal culture (33% [84/253]) (χ² = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher''s exact P = 1.000) to and slightly lower specificity (87% [77/89]) (χ² = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812–0.953]) and BAL GM (0.901 [0.824–0.977]) (P = 0.734). Sputum LFD had similar specificity (91% [81/89]) (χ² = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) (χ² = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) (χ² = 6.95, P = 0.008), BDG (χ² = 10.43, P = 0.001), and fungal culture (χ² = 12.70, P < 0.001).Conclusions:Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.     

双培养法提高涂片阴性分枝杆菌检出率的回顾性研究

目的 探讨双培养法对提高涂片阴性分枝杆菌检出率的应用价值。方法 收集某院2019年1月—2021年9月送检住院首诊患者的普筛标本,并按固体培养、液体培养、固-液双培养进行分组。另选取涂片分枝杆菌阴性,固体、液体或固-液双培养阳性的患者,将其按送检标本部位分为肺分枝杆菌组和肺外分枝杆菌组,分析两组患者的临床特征。结果 共调查涂片阴性患者6 492例,其中固体组3 234例,液体组1 938例,双培养组1 320例,253例培养阳性,检出率3.90%,固体组、液体组、双培养组培养阳性检出率分别为2.35%(76例)、4.54%(88例)、6.74%(89例);肺分枝杆菌检出率分别为3.11%、6.02%、7.13%,肺外分枝杆菌检出率分别为1.02%、2.68%、6.09%。253例涂片阴性培养阳性的患者中男性143例、女性110例;平均年龄(58.34±18.47)岁;检出时间中位数分别为34.65、10.45、9.89 d。肺分枝杆菌组中男性、咳嗽咳痰、呼吸道基础疾病、胸部CT有炎性渗出、结核感染T细胞斑点试验结果阳性所占比例较肺外分枝杆菌组高,差异均有统计学意义(均P<0.05...     

二氮嗪预处理对幼龄大鼠深低温脑缺血/再灌注损伤的影响

目的 探讨二氮嗪预处理对幼龄大鼠深低温脑缺血/再灌注损伤脑保护作用.方法 将3周龄SD大鼠90只随机分为假手术组、模型组及二氮嗪组,缺血/再灌注后1、6、24、72 h和7 d,建立深低温脑缺血/再灌注模型,采用免疫组织化学检测不同时点脑组织细胞色素C的蛋白表达,并观察脑组织病理变化.结果 与假手术组比较,模型组于再灌注后6和24 h显示明显的病理变化,其脑组织胞浆细胞色素C于灌注后6 h后即明显升高(P＜0.05),24 h达到高峰(P＜0.01).二氮嗪组病理改变较轻,细胞色素C含量于再灌注后24和72 h显著低于模型组(P＜0.05). 结论 二氮嗪预处理可抑制线粒体细胞色素C的释放,对幼龄大鼠深低温脑缺血/再灌注损伤具有一定脑保护作用.