针刺督脉穴用于海洛因依赖脱毒治疗的临床对照观察

目的:观察督脉穴在海洛因依赖脱毒治疗中的有效性.方法:将70例海洛因依赖患者随机分为治疗组和对照组,每组各35例.治疗组采用美沙酮10 d递减疗法,配合针刺督脉穴治疗;对照组单纯采用美沙酮10 d递减疗法.两组均采用戒断症状评定量表进行评定记分和症状分级.结果:治疗组实际完成脱毒治疗31例,对照组26例.两组治疗前后自身比较戒断症状记分,差异有非常显著性意义(P<0.01).两组逐日戒断症状记分,治疗后出汗、焦虑和肌肉骨骼疼痛症状的分级,治疗组优于对照组(P<0.05或P<0.01).结论:针刺督脉穴对海洛因依赖戒断综合征症状有辅助治疗作用,能有效缓解戒断症状.     

肝细胞癌NF κ-B表达与CT表现的相关性

目的 探讨核因子（NF κ-B）在肝细胞癌组织中的表达与CT影像特点间的关系。方法 收集华西医院有完整临床资料和全肝CT扫描图像并经手术完整切除的肝癌组织标本患者80例,采用免疫组织化学方法染色定量分析癌组织中NF κ-B表达情况和在不同的临床参数中表达的差异;再分别以肿瘤坏死、血供、瘤体直径和瘤周子灶的有无分四组,探讨NF κ-B表达量在不同CT影像特征中有无差异。结果 CT检测80例患者中肝癌细胞核内NF κ-B表达阳性有74例（92.5%）。肝细胞癌NF κ-B表达与临床参数,包括性别、肝炎病史无相关性,瘤体大小与NF κ-B表达无统计学差异。CT检测肿瘤血供、坏死及瘤周子灶的有无与NF κB表达相关（P＜0.05）,富血供肝细胞癌NF κ-B表达较乏血供者明显增高,而瘤体有坏死者较未发生坏死者低,瘤周出现子灶的病例NF κ-B表达也增高,且差异有统计学意义（P＜0.05）。结论 肝癌血供、坏死及瘤周子灶CT影像特点与NF κ-B水平密切相关。瘤体血供丰富、瘤内无坏死、瘤周伴有子灶的肝癌组织NF κ-B表达水平明显增高,NF κ-B表达水平量可能与肿瘤的生物学特性,疾病的转归和预后相关,CT检测可为肝癌的治疗及预防评估提供重要依据。     

联合微信群对院外2型糖尿病患者实施同伴教育的效果评价

【摘要】 目的 分析联合微信群对院外2型糖尿病（T2DM）患者实施同伴教育的效果,并探讨新型的同伴教育模式对患者自我管理效能和生活质量的影响。方法 采用便利抽样的方法选取2016年1～6月在某三甲医院内分泌科门诊就诊的T2DM患者142例,按照随机数表法将对象分为对照组与试验组各71例。对照组行常规健康教育,试验组在常规健康教育基础上接受为期3个月的联合微信群同伴教育。采用糖尿病自我管理量表（DSMS）、糖尿病自我效能量表（DMSES）、中文版糖尿病生活质量特异性量表(CN ADDQOL）测量并分析患者干预前后自我管理、自我效能及生活质量情况。结果 最终试验组纳入66名,对照组纳入65名患者完成整个研究。两组一般情况、DSMS、DMSES以及CN ADDQOL三个量表干预前基线评估处于同一水平,差异无统计学意义（P＞005）。经过联合微信群的同伴教育进行为期3个月的干预后,试验组DSMS、DMSES以及CN ADDQOL三个量表总得分均明显高于对照组,差异有统计学意义（P＜001）。结论 联合微信群对院外T2DM患者实施同伴教育可以增加患者管理疾病的信心,有效改善患者自我管理行为,从而提高患者生活质量。     

Prediction of Hidden Blood Loss During Posterior Spinal Surgery

Objective Identification of the risk factors for extraordinary hidden blood loss (HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.     

Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta‐Analysis

As more high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are performed, orthopaedic surgeons realize that more HTO and UKA failures will require revision to total knee arthroplasty (TKA) in the future. To systematically evaluate the clinical outcomes of TKA after HTO and TKA after UKA, the Embase, PubMed, Ovid, Web of Science, and Cochrane Library databases were searched for studies investigating revision TKA after HTO and UKA published up to June 2021. RevMan version 5.3 was used to perform the meta‐analysis. The revision TKA after HTO and revision TKA after UKA groups were compared in terms of operative time, range of motion (ROM), knee score, postoperative complications, postoperative infection, revision, and revision implants used. Nine studies were ultimately included in the meta‐analysis. Results revealed that the knee score for the revision TKA after HTO group was better than that of the revision TKA after UKA group (MD 4.50 [95% CI 0.80–8.20]; p = 0.02). The revision TKA after HTO group had a lower revision rate (OR 0.65 [95% CI 0.55–0.78]; p < 0.00001) and fewer revision implants used (OR 0.11 [95% CI 0.05–0.23]; p < 0.00001). There were no statistical differences in operation time (MD ‐2.00 [95% CI −11.22 to 7.21]; p = 0.67), ROM (MD ‐0.04 [95% CI ‐3.69–3.61]; p = 0.98), postoperative complications (OR 1.41 [95% CI 0.77–2.60]; p = 0.27), or postoperative infections (OR 0.89 [95% CI 0.61–1.29]; p = 0.53). To conclude, the revision rate of revision TKA after UKA was greater, and more revision implants were required. It is important for orthopaedic surgeons to preserve bone during primary UKA.     

不同启动子指导的HSV1-sr39TK/GCV系统对小鼠淋巴细胞的敏感性研究

目的观察慢病毒载体中不同启动子指导的突变型单纯疱疹病毒1型胸苷激酶(HSV1-sr39TK)基因在小鼠T淋巴细胞内的表达差异,并进一步比较对丙氧鸟苷(ganciclovir,GCV)的敏感性。方法用亚克隆技术将PCR扩增的HSV1-sr39TK基因分别连接至慢病毒载体不同启动子后,然后在HSV1-sr39TK基因后以内部核糖体进入位点(internal ribosome entry sites,IRES)连接绿色荧光蛋白(green fluorescent pro-tein,GFP)报告基因;采用三质粒包装系统包装病毒,将病毒感染刀豆蛋白A(concanavalin,ConA)激活的小鼠淋巴细胞,分别用流式细胞术、RT-PCR法鉴定HSV1-sr39TK和GFP基因在小鼠淋巴细胞的表达,用Cell Counting Kit-8(CCK-8)法观察感染不同病毒的淋巴细胞对前体药物GCV的敏感性。结果不同启动子指导的HSV1-sr39TK及GFP基因均可在小鼠淋巴细胞表达,巨细胞病毒(cytomegalovirus,CMV)启动子驱动表达能力最强,磷酸甘油激酶(phosphoglycerokinase,PGK)启动子最弱。感染含CMV启动子病毒的淋巴细胞对GCV的IC50值最小。结论在小鼠淋巴细胞内CMV启动子驱动的慢病毒载体HSV1-sr39TK基因表达最强,对前体药物GCV敏感性最高。     

腭器官培养在腭裂发病机制研究中的应用

唇腭裂是人类最常见的出生缺陷之一,其发病机理复杂.多学科的研究表明,唇腭裂的病因涉及众多因素,受到多个因素的调控.其中导致腭裂发生的原因之一是腭板未能融合,而对于腭板融合过程的研究,在体内受诸多因素的限制,因此可以采用体外腭器官培养的方法进行研究.长期实践证明,与体内实验相比,体外腭器官培养模型可以模拟体内腭裂形成的过程.本文就腭器官培养方法在腭裂发病机制研究中的作用作一综述.     

检出3株携带新型基因盒组合形式Ⅰ类整合子的铜绿假单胞菌

目的 研究整合子介导铜绿假单胞菌耐药及多重耐药的机制。方法 整合子PCR法扩增整合子的可变区;联合限制性片段长度多态性分析（RFLP）和DNA测序技术分析整合子可变区的耐药基因。结果 98株南京地区铜绿假单胞菌中有35株（35．7％）整合子可变区扩增阳性,扩增片段大小1．0-4．0kb。共检出6种不同的可变区,含有编码对氨基糖苷类、β-内酰胺类和磺胺类抗菌药耐药的基因,其中有3例为新型基因盒组合形式,包括aadA6-orfD、aadB-blaP1和aadB-aac（6′）-Ⅱa-blaCARB-8,Genbank基因号分别为DQ 091179、DQ 141316和DQ 288251。结论 整合子参与了铜绿假单胞菌的耐药和多重耐药,主要携带氨基糖苷类耐药基因,首次报道了3种携带新型基因盒组合形式的Ⅰ类整合子。     

六味银杏胶囊的毒理学研究

目的观察动物口服六味银杏胶囊的急性毒性和长期毒性反应。方法采用最大给药量法测定小鼠口服六味银杏胶囊的急性毒性;以20.0,10.0,5.0 g生药.kg-1.d-13个剂量的六味银杏胶囊(相当于临床用量68、34、17倍)灌胃SD大鼠,连续24周,观察服药24周及停药4周后,大鼠的生长发育、血液学、血液生化学、组织病理指标的变化。结果小鼠1天内口服六味银杏胶囊最大给药量为190.0 g生药/kg,相当于临床用量的700倍。长期毒性实验中,各剂量组与空白对照组比较,大鼠一般状况,体重增长,血液学、血液生化指标,主要脏器系数,肉眼观察及镜下组织形态学观察均无明显差异或异常。结论六味银杏胶囊临床用药范围内应用是比较安全的。     

Differential Associations of Intakes of Whole Grains and Coarse Grains with Risks of Cardiometabolic Factors among Adults in China

There is a lack of studies on the association between whole grain intake and cardiometabolic risk factors in China and the current definition of whole grains is inconsistent. This study defined whole grains in two ways, Western versus traditional, and examined their associations with the risks of major cardiometabolic factors (CMFs) among 4706 Chinese adults aged ≥18 years, who participated in surveys both in 2011 and in 2015. Diet data were collected by consecutive 3 d 24 h recalls, together with household seasoning weighing. Whole grains were defined as grains with a ratio of fiber to carbohydrate of ≥0.1, while coarse grains were defined as grains except for rice and its products, and wheat and its products. Multivariable logistic regressions were modeled to analyze the associations of intakes of whole grains and coarse grains, respectively, with risks of major CMFs including obesity-, blood pressure-, blood glucose- and lipid-related factors, which were defined by International Diabetes Federation and AHA/NHLBI criteria. After adjusting for potential confounders, the odds of elevated LDL-C decreased with the increasing intake levels of whole grains (OR 0.64, 95% CI 0.46–0.88, p-trend < 0.05). Moreover, adults with the whole grain intake of 50.00 to 150.00 g/day had 27% lower odds of overweight and obesity (OR 0.73, 95% CI 0.54–0.99) and 31% lower odds of elevated LDL-C (OR 0.69, 95% CI 0.49–0.96), as compared with non-consumers. In conclusion, given the significant nutrient profiles of whole grains and coarse grains, the adults with higher intakes of whole grains only may have a lower risk of LDL-C and overweight and obesity.