复方黄黛片对 Solt-Farber 原发性肝癌大鼠血管新生作用的影响

目的：研究复方黄黛片对 Solt-Farber 原发性肝癌大鼠血管新生作用的影响。方法：将 50 只 SD 大鼠随机分为正常组、模型组、复方黄黛片高剂量组、中剂量组及低剂量组,每组 10 只。采用 Solt-Farber 二步法对除正常组外各组大鼠进行原发性肝癌造模,高（280 mg/kg）、中（140 mg/kg）及低剂量组（70 mg/kg）大鼠同时灌胃给予相应剂量的复方黄黛片,正常组与模型组则给予等量生理盐水,连续灌胃 18 周。末次灌胃 12 h 后取血,分离血清,检测其中肝功能指标水平（ALT、AST 及 TBIL）。取血完成,取各组大鼠肝脏,平均分为 4 份,分别进行病理组织学观察,采用免疫荧光法检测 HIF-1α、 VEGF 及 VEGFR-2 的表达情况,计算其相对表达量并进行 4 组比较。结果：与模型组 [ALT,（163.74±16.45）IU/L ;AST,（331.24±31.35）IU/L ;TBIL,（86.11±8.51）IU/L] 比较,各组大鼠中血清肝功能指标均明显降低,其差异具有统计学意义（P<0.05）;各组指标分别为高剂量组 [ALT,（71.43±7.83）IU/L ;AST,（112.52±12.58）IU/L ;TBIL,（34.23±3.23）IU/L],中剂量组 [ALT,（105.32±10.13）IU/L ;AST,（223.52±36.58）IU/L ;TBIL,（42.93±4.02）IU/L],低剂量组 [ALT,（122.34±12.11）IU/L ;AST,（254.21±25.14）IU/L ;TBIL,（51.27±5.26）IU/L]。高剂量组、中剂量组及低剂量组大鼠肝组织均出现不同程度的癌变,癌细胞呈梁状排列,但癌变程度均不及模型组。与模型组（HIF-1α,14.23±1.28 ; VEGF,11.52±1.10 ;VEGFR-2,16.34±1.65）比较,各组大鼠肝组织 HIF-1α、VEGF 及 VEGFR-2 的阳性表达情况均明显减轻,且相对表达量均明显降低,其差异具有统计学意义（P<0.05）;各组指标分别为高剂量组（HIF-1α,3.92±0.29 ;VEGF,2.87±0.26 ;VEGFR-2,3.45±0.40）、中剂量组（HIF-1α,6.36±0.65 ;VEGF,5.34±0.51 ;VEGFR-2,5.87±0.60）及低剂量组（HIF-1α,8.53±0.81 ;VEGF,7.76±0.74 ;VEGFR-2,8.12±0.87）。结论：复方黄黛片用于 Solt-Farber 原发性肝癌大鼠,可有效改善肝功能,抑制 HIF-1α、VEGF 及 VEGFR-2 等血管新生相关蛋白的表达。     

胰十二指肠切除术中连续胰肠吻合和Y形空肠内引流的应用

目的评价连续胰肠吻合和Y形空肠内引流在胰十二指肠切除术中的应用,并与传统的胰十二指肠切除术进行比较。方法本组回顾2004年12月至2006年12月间行胰十二指肠切除患者103例,其中接受连续胰肠吻合和Y形空肠内引流的患者55例作为观察组,传统胰十二指肠切除术后捆绑式胰肠吻合的患者48例作为对照组。对两组的手术时间、术中出血量、术后胰漏、术后并发症和术后住院时间以及住院费用等方面的差异进行前瞻性研究。结果两组在手术中出血量及手术后并发症比较没有统计学意义,但在手术时间、术后胰瘘、术后住院时间等方面有统计学意义(P<0.05)。结论相对于传统的胰十二指肠切除术中捆绑式胰肠吻合重建方式,连续胰肠吻合和Y形空肠内引流手术方式较容易掌握,且在术后管理上具有较为明显的优势。     

骨髓间充质干细胞对大鼠肺组织胶原的影响

目的:观察骨髓间充质干细胞(MSCs)对博来霉素(BLM)引起的肺损伤大鼠肺组织胶原的影响,初步探讨其作用机制。方法:将SD大鼠MSCs异体注入受体大鼠体内,2周后观察肺组织病理学变化,同时检测肺组织羟脯氨酸含量及转化生长因子β1(TGFβ1)、血小板源性生长因子-A、B(PDGF-A,B)、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)mRNA的变化。结果:MSCs的植入可使增生的大鼠肺泡间隔、基质胶原及Ⅰ、Ⅲ型胶原明显降低,使升高的肺组织羟脯氨酸及TGFβ1、PDGF-A,B、及IGF-ⅠmRNA的表达显著降低。结论:MSCs可减少肺损伤大鼠肺组织中的胶原含量,此作用与MSCs降低了多种促纤维化细胞因子的表达有关。     

腔镜与传统甲状腺手术对机体创伤的比较

目的 探讨胸乳路径腔镜甲状腺手术对机体的创伤性。方法 将2009年1月至2010年12月收治的60例甲状腺良性肿瘤依据患者意愿分成腔镜手术组(A组=32例)及传统手术组(B组=28例),分别比较术后2h、1d和3d3个时点外周血白细胞介素-2( IL)-2、IL-6、C-反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)检测值。结果 腔镜组术后3个对应时点血清IL-2值[(12.6±2.1)、(11.8±1.9)、(11.8±3.0) ng/L]、CRP值[(1.6±0.7)、(2.4±0.9)、(2.5±0.9) mg/L]、TNF-α值[(53.2±6.8)、(49.1±5.5)、(46.5±5.0) ng/L]与传统组术后相对应3个时点血清IL-2值[(10.6±1.1)、(11.2±2.6)、(12.0±3.2) ng/L]、CRP值[(0.8±0.6)、(2.4±0.5)、(2.4±0.7) mg/L]、TNF-α值[(48.5±7.1)、(51.3±6.2)、(41.5±13.7)ng/L]组间差异无统计学意义(P值均＞0.05);腔镜组术后3个对应时点血清IL-6值[(4.8±2.4)、(4.3±2.1)、(5.4±5.6)ng/L]与传统手术组术后相对应时段血清IL-6值[(6.4±2.4)、(7.1±4.1)、(4.9±0.8)ng/L]组间术后2h、1d差异有统计学意义(P＜0.05)。结论 腔镜甲状腺手术对机体的创伤与传统甲状腺手术比较属相对微创,在不给机体带来更大创伤同时,可获得美容效果,是一种值得推广的术式。     

地塞米松对体外嗜酸粒细胞白介素3、白介素5和GM-CSF受体的共同β受体mRNA表达的影响及意义

目的 观察地塞米松对哮喘豚鼠体外不同密度嗜酸粒细胞(EOS)凋亡及IL-3、IL-5和粒细胞-巨噬细胞集落刺激因子受体的共同β受体(βcR)mRNA表达的影响.探讨地塞米松促进哮喘EOS凋亡的机制.方法 卵蛋白激发哮喘豚鼠动物模型48 h后行支气管肺泡灌洗,分离低密度EOS(HEOS)及正常密度EOS(NEOS).HEOS及NEOS分别与地塞米松(10-10～10-5mol/L)共培养24 h,以原位杂交方法检测不同密度EOS的βcR mRNA表达,3'末端脱氧核苷转移酶介导的脱氧三磷酸尿苷缺口末端标记法检测细胞凋亡.结果 地塞米松干预24 h后,可见EOS凋亡增加的同时,不同密度EOS中βcR mRNA表达下降,并与地塞米松浓度呈剂量依赖性.βcR表达与EOS凋亡呈负相关(P<0.05).结论 地塞米松可抑制不同密度EOS表达βcR,抑制其细胞因子活动,促进EOS凋亡.地塞米松可以通过增加EOS中βcR表达调节EOS凋亡.     

早期氧气面罩雾化给氧对纠正重型颅脑损伤患者低氧血症的影响效果观察

目的 探讨氧气面罩雾化给氧方式对重型颅脑损伤患者低氧血症的可行性及安全性,以促进患者早日康复.方法 将收治98例重型颅脑损伤患者随机分为观察组48例和对照组50例,在常规治疗的同时,观察组采用氧气面罩接雾化器给氧方式进行给氧;对照组采用鼻塞导管湿纱布覆盖口鼻进行给氧.结果 观察组其动脉血氧饱和度、氧分压明显提高.2组病死率比较差异明显,而2组患者的心率、血压、pH、PaCO2比较差异不明显.结论 氧气面罩雾化器给氧能快速、有效纠正重型颅脑损伤患者缺氧状态,纠正低氧血症.     

The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis

BackgroundMedication adherence (MA) is critical to successful chronic disease management. It is not clear how social determinants of health (SDH) impact MA. We conducted a systematic review and meta-analysis to summarize the evidence on the relationship between SDH and MA.MethodsWe conducted a systematic review of the literature using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format. A literature search was performed using three databases: PubMed, Scopus, and Cochrane Clinical Trials Register in December of 2018. Included studies were completed in the USA, included adults aged 18 years and older, measured at least one social determinant of health, and medication adherence was the primary outcome measure. Data from included full texts were independently extracted using a standardized data extraction form. We then conducted a meta-analysis and pooled the odds ratios from the included studies for each social determinant as well as for all SDH factors collectively.ResultsA total of 3137 unduplicated abstracts were identified from our database searches. A total of 173 were selected for full text review after evaluating the abstract. A total of 29 articles were included for this systematic review. Economic-related SDH factors and MA were mostly commonly examined. The meta-analysis revealed a significant relationship between food insecurity (aOR = 0.56; 95% CI 0.42–0.7), housing instability (aOR = 0.64; 95% CI 0.44–0.93), and social determinants overall (aOR = 0.75; 95% CI 0.65–0.88) and medication adherence.DiscussionFood insecurity and housing instability most consistently impacted medication adherence. Although included studies were heterogenous and varied widely in SDH and MA measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06447-0.KEY WORDS: social determinants of health, medication adherence     

克山病病区玉米及酱块对大鼠心肌损伤的实验研究

Objective To investigate the myocardial damage in rats fed with corn from Keshan disease area added with bean puree. Methods Male Wistar rats were randomly divided into 3 groups according to their body weights, and fed with corn, corn from Keshan disease area added with bean puree, corn from non-endemic area. The GSH-Px activity of vena cardalis blood was examined in 1 and 3 months, rats were sacrificed after being fed for 6 months to examine the heart changes with HE stain. Results The three groups of GSH-Px activity were different in 1 and 3 months respectively(F=23.60,72.46, all P<0.01); GSH-Px activity was (181.58±22.15), (44.76±28.59)U/L in rats fed with corn, was (195.03±17.66), (30.38±3.35)U/L in those fed with corn added with bean puree from Keshan disease area, lower than the group fed with corn of non-endemic area[(340.90±95.42), (125.17±13.64)U/L, all P < 0.01]. But the difference of GSH-Px activity between simple corn group and corn adding bean puree groups of Keshan disease area was not obvious(P>0.05). Myocardial damage incidence of the three groups was 3/9,1/9,2/7. Difference among three groups did not have statistical significance(χ2=1.33, P> 0.05). Conclusions Only corn from Keshan disease area may induce myocardial damage pathology change. Adding bean puree into corn does not increase damage.     

克山病病区玉米及酱块对大鼠心肌损伤的实验研究

Objective To investigate the myocardial damage in rats fed with corn from Keshan disease area added with bean puree. Methods Male Wistar rats were randomly divided into 3 groups according to their body weights, and fed with corn, corn from Keshan disease area added with bean puree, corn from non-endemic area. The GSH-Px activity of vena cardalis blood was examined in 1 and 3 months, rats were sacrificed after being fed for 6 months to examine the heart changes with HE stain. Results The three groups of GSH-Px activity were different in 1 and 3 months respectively(F=23.60,72.46, all P<0.01); GSH-Px activity was (181.58±22.15), (44.76±28.59)U/L in rats fed with corn, was (195.03±17.66), (30.38±3.35)U/L in those fed with corn added with bean puree from Keshan disease area, lower than the group fed with corn of non-endemic area[(340.90±95.42), (125.17±13.64)U/L, all P < 0.01]. But the difference of GSH-Px activity between simple corn group and corn adding bean puree groups of Keshan disease area was not obvious(P>0.05). Myocardial damage incidence of the three groups was 3/9,1/9,2/7. Difference among three groups did not have statistical significance(χ2=1.33, P> 0.05). Conclusions Only corn from Keshan disease area may induce myocardial damage pathology change. Adding bean puree into corn does not increase damage.     

经胸微创封堵术治疗继发孔房间隔缺损109例分析

目的 探讨经胸非体外循环房间隔缺损微创封堵术治疗房间隔缺损的疗效.方法 全组109例患者,年龄3～63岁,ASD直径6～36 mm,均在全麻下经右胸第4肋间隙小切口进胸在经食管心脏彩超引导下经输送器置入封堵器闭合ASD.结果 106例手术成功封堵,手术时间（1.5±0.3）h,术中失血量平均（41.5±10.3）ml.3例患者因术中封堵失败改为体外循环下修补.全组无死亡,术后3～9d恢复后出院.随诊3～36个月.B超示封堵伞没有残余漏,没有移位,心功能改善显著.结论 经胸微创房间隔缺损封堵手术简单、创伤小、安全性高、患者恢复快、疗效满意.