左心房压和肺动脉楔压监测在心脏术后的应用

目的评价心脏直视术后合并肺动脉高压患者经颈内静脉安置左心房测压管和肺动脉漂浮导管对于成人心脏外科术后患者监护的可行性、安全性及准确性。方法前瞻性选择2010～2012年于武汉亚洲心脏病医院行心内直视手术的18岁以上患者100例,男43例、女57例,年龄46～65（47±16）岁。将患者分为两组：合并淤血性重度肺动脉高压患者行瓣膜置换术50例（A组）,合并淤血性轻中度肺动脉高压患者行瓣膜置换术50例（B组）。两组患者均经颈内静脉入路置入ARROW5Fr三腔导管,尖端经房间隔穿刺行持续左心房压（LAP）监测;同时经同侧颈内静脉安置ARROW 8Fr高流量鞘管放置肺动脉漂浮导管,入室即监测LAP和肺动脉楔压（PAWP）。观察两组患者中LAP和PAWP的相关性及准确性。结果两组患者均成功行持续LAP及PAWP监测,无严重导管相关并发症发生。A组和B组患者手术时间和体外循环时间差异无统计学意义（P〉0．05）,术后机械通气时间和ICU留置时间差异有统计学意义（P〈O．05）。A组患者平均肺动脉压（PAPMean）、平均左心房压（LAPmean）、平均肺动脉楔压（PAWPmean）、PAWP与LAP差值平均值（PAWP-LAPmean）均显著高于B组（P〈0．01）。两组患者中PAWP与LAP均具有良好相关性,A组患者相关性低于B组,差异有统计学意义（P〈0．01）。结论经颈内静脉入路行LAP监测及肺动脉漂浮导管监测是安全、可行的。PAWP不能准确反映左心室前负荷,在合并淤血性重度肺动脉高压的患者中使用LAP监测对于判断左心室前负荷更准确。     

Q开关和长脉宽1064nm Nd:YAG激光真皮胶原重建疗效的比较性研究

目的:本研究拟定量地比较Q开关和长脉宽1064 nm掺钕:钇-铝石榴石(neodymium-yttrium-aluminum garnet,Nd:YAG)激光诱导真皮胶原重建的疗效。方法:应用Q开关和长脉宽1064 nm Nd:YAG激光分别对36只雌性昆明小鼠左侧后背皮肤进行连续4次治疗,每次间隔1周,右侧相应的部位作为自身对照。分别于第1次治疗后1h、1天、7天、21天、30天和60天对小鼠皮肤行活组织取材。应用免疫组化方法分别对皮肤组织样品中真皮I、III型胶原进行检测,染色结果应用Motic医学数字图像分析系统进行定量分析。结果:与正常对照组相比,Q开关1064 nm Nd:YAG激光治疗后7天、21天、30天和60天,真皮I型胶原及III型胶原水平明显增高(均P0.01)。长脉宽1064 nm Nd:YAG激光治疗后21天、30天和60天,真皮I型胶原水平明显增高(均P0.01);激光治疗后7天、21天、30天和60天,真皮III型胶原水平明显增高(分别为P0.01、P0.05、P0.01、P0.01)。两组激光的比较:激光治疗后7天、21天和30天,Q开关1064nm Nd:YAG激光治疗组真皮I型胶原水平较长脉宽1064nm Nd:YAG激光治疗组明显增高(均P0.01),而激光治疗后60天明显降低(P0.05);激光治疗后7天和21天,Q开关1064nm Nd:YAG激光治疗组较长脉宽1064nm Nd:YAG激光治疗组真皮III型胶原水平明显增高(分别为P0.05、P0.01)。结论:Q开关和长脉宽1064nm Nd:YAG激光均可引起真皮胶原重建,但二者的作用效果不尽相同。     

毛细支气管炎的临床护理分析

目的探究和讨论关于毛细支气管炎患者的临床护理的分析。方法随机选取在2011年1月——2013年2月来我院治疗毛细支气管炎的患者104例作为本次研究的对象。然后随机将其分为人数相等的两组,研究组和对照组。然后给予研究组我们在长期的工作中探索出的一套较为科学、有效的护理手段,而对照组患儿实施常规的护理手段,然后在治疗结束后比较两组患儿的临床护理效果。结果在治疗结束之后,对照组患儿的总有效率明显低于研究组的患儿的总有效率,而且两组患儿的总有效率差异具有统计学意义。而且在治疗过程中患儿的气喘情况、孝鸣音及咳嗽等情况都较对照组患儿的改善时间短。而且差异具有统计学意义。结论对患有毛细支气管炎的患者施以有效的科学的护理手段,可以明显缩短患者的临床症状改善时间和提高临床疗效。     

Expanding the chemical diversity of an endophytic fungus Bulgaria inquinans,an ascomycete associated with mistletoe,through an OSMAC approach

An endophytic fungus Bulgaria inquinans (isolate MSp3-1), isolated from mistletoe (Viscum album), was subjected to fermentation on solid Czapek medium. Chromatographic workup of the crude EtOAc extract yielded five new natural products (1–5). Subsequent application of the “One Strain, MAny Compounds” (OSMAC) strategy on this strain by the addition of a mixture of salts (MgSO₄, NaNO₃ and NaCl) to solid Czapek medium induced the accumulation of nine additional new secondary metabolites (6–13, 16), with most of them (8, 10–12) not detectable in cultures lacking the salt mixture. The structures of the new compounds were established on the basis of the 1D/2D NMR and HRESIMS data. The TDDFT-ECD method was applied to determine the absolute configurations of the new compounds 1, 4 and 6 as well as of the previously reported bulgarialactone B (14), for which the absolute configuration was unknown so far. The modified Mosher''s method was performed to assign the absolute configurations of 12 and 13. TDDFT-ECD analysis also allowed determining the absolute configuration of (+)-epicocconone, which had an enantiomeric absolute configuration in the tricyclic moiety compared to that of bulgarialactone B (14). All the isolated metabolites were evaluated for their cytotoxic activity. Compound 2 was found to possess strong cytotoxic activity against the murine lymphoma cell line L5178Y with an IC₅₀ value of 1.8 μM, while the remaining metabolites were shown to be inactive.

OSMAC approach on endophytic Bulgaria inquinans by addition of a mixture of salts (MgSO₄, NaNO₃ and NaCl) to solid Czapek medium induced the accumulation of new secondary metabolites.     

Changes in Spectral Characteristics and Copper (II)-Binding of Dissolved Organic Matter in Leachate from Different Water-Treatment Processes

The aim of the present study was to investigate the fluorescence properties of dissolved organic matter (DOM) from four leachate samples, which were disposed by regulating tank (RTK), anaerobic treatment (ATT), oxidation ditch (ODH), and membrane bioreactor and to assess their binding capacities and stability constants by Cu(II). The results showed that five fluorescent peaks, including three humic-like peaks (peaks A, C, and E) and two protein-like peaks (peaks B and D), were identified. Most fluorescent components can be degraded after ODH. Fluorescence-quenching titration showed that the modified Stern–Volmer model can be used to fit the quenching data and calculate conditional stability constants (log K) and the % of fluorophores (f %) between DOM and Cu(II). DOM–Cu(II) complexes had relatively high log K values in the RTK and ATT disposals. After the ODH-treatment process, log K values showed a marked decrease. The f % values of protein-like materials were evidently greater than those of humic-like substances. The results showed the impact of the water treatment on the metal-binding ability of various fractions.     

Urinary netrin-1 and KIM-1 as early biomarkers for septic acute kidney injury

Background: Acute kidney injury (AKI) during sepsis is associated with poor outcome. However, diagnosis of AKI with serum creatinine (SCr) level change is neither highly sensitive nor specific. Therefore, identification of novel biomarkers for early diagnosis of AKI is desirable. Aims: To evaluate the capacity of combining urinary netrin-1 and human kidney injury molecule type 1 (KIM-1) in the early diagnosis of septic AKI. Methods: We prospectively recruited 150 septic patients from Jun 2011 to Jun 2013 at Zhejiang Provincial People's Hospital, China. SCr, urinary netrin-1, and KIM-1 levels were recorded at 0, 1, 3, 6, 24, and 48?h of ICU admission and compared between AKI and non-AKI patients. In addition, we investigated the prognostic value of netrin-1 and KIM-1 between non-survivors and survivors in septic AKI patients. Results: SCr levels started to show elevation after 24?h of ICU admission. However, netrin-1 levels increased significantly as early as 1?h, peaked at 3–6?h and remained elevated up to 48?h of ICU admission in septic AKI patients. KIM-1 increased significantly by 6?h, peaked at 24?h and remained significantly elevated until 48?h of ICU admission. Furthermore, we observed significant higher urinary KIM-1 levels at 24?h and 48?h in non-survivors compared to survivors in AKI patients. Conclusions: Our results suggest that both netrin-1 and KIM-1 are clinically useful as early biomarkers in the diagnosis of septic AKI. In addition, persistent elevation of urinary KIM-1 level may be associated with poor prognosis.