运动对小肠铁吸收及一氧化氮的调节作用

目的:运动性低铁状态在运动员中发生率明显高于一般人群,但补铁效果很不理想。运动时一氧化氮对铁代谢的调节活动以及功能关系已成为近年研究的热点,对了解运动导致铁缺乏的原因以及运动对铁代谢影响的生理或病理生理机制尤为关键,且有利于运动员铁状态的改善。资料来源:应用计算机检索PUBMED1994-01/2005-10期间的相关文章,检索词为“exercise,iron,nitricoxide”,并限定文章语言种类为“English”。同时计算机检索万方数据库2000-01/2005-10期间的相关文章,检索词为“运动,铁,一氧化氮”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与运动时一氧化氮对铁代谢的调节活动以及功能关系的研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到60篇相关文献,28篇文献符合纳入标准,排除的32篇文献为内容陈旧或重复。符合纳入标准的28篇文献中,4篇涉及铁代谢与一氧化氮的联系,8篇涉及运动过程中铁代谢与一氧化氮的关系,8篇涉及一氧化氮对小肠生理和病理研究的意义,7篇涉及小肠黏膜细胞对铁的吸收情况。资料综合:铁是生命体中不可缺少的过渡金属,在对运动员及动物运动模型的铁代谢研究中发现,运动可导致运动性铁缺乏,甚至发生铁缺乏性贫血。小肠黏膜是机体铁转运的第一步,弄清楚铁在小肠黏膜处的吸收机制是解决这个问题的关键,几个与铁吸收有关的大分子蛋白的结构的掌握,为研究运动状态下小肠黏膜铁吸收情况奠定了理论基础。虽然运动性低铁状态在运动员中发生率明显高于一般人群,但运动员补铁效果不理想,耐力运动员体内铁储存量是否趋向于低水平仍有争议。运动对铁代谢的影响,一方面认为是很多原因引起的铁负平衡的结果,若是这种缺铁状况,对机体进行补铁应是有效的,应对运动员进行常规补铁。另一方面认为是机体正常的铁调节结果,应当尽量减少补铁,以免增加铁毒性。结论:血清中的铁含量与一氧化氮水平呈负相关,补充一氧化氮合成酶抑制剂L-NAME可明显改善低铁状态,由此假设一氧化氮可能是改善铁代谢的因素之一。小肠黏膜上皮是机体铁转运的第一步,一氧化氮是否影响此处铁的转运有待于进一步分析。     

新生儿缺氧缺血性脑病的发生原因及护理

阐述了新生儿缺氧缺血性脑病的病因及临床诊断依据 ,重点综述了新生儿缺氧缺血性脑病的护理。     

电针分型预测结合面神经肌电图治疗周围性面神经麻痹80例

目的:观察电针穴位分型预测与面神经肌电图检查相结合,治疗周围性面神经麻痹的临床疗效。方法:选择2002-09/2005-02济南第四人民医院门诊及住院80例周围性面神经麻痹患者,按电针穴位分型法划分为一般型和顽固型,一般型为电针1组,顽固型分为电针2组、综合治疗组。电针1组、电针2组均都采用电针治疗:取穴阳白、太阳、地仓、下关、风池、翳风、迎香、攒竹、承浆。均取患侧。同时取健侧的合谷。针刺得气后采用电针治疗仪治疗,频率120～250次/min,每次留针30min,治疗1次/d,10次为1个疗程,休息两天,再行第2个疗程。综合治疗组:在常规电针治疗的同时,针刺时均采用中等手法刺激,同时加取双侧足三里穴,均采用补法,每10min行针1次,面部患侧采用特定电磁波照射,以下关、翳风穴为主进行局部照射,距离30～40cm,温度舒适为宜,每次电针加照射40min,1次/d,10次为1个疗程,休息两天再进行第2个疗程。所有患者均行面部面神经肌电图检查。结果:80例患者进入结果分析,无脱落者。①各组疗效的比较:电针1组43例中42例痊愈,占95%,顽固型37例仅痊愈15例,电针2组和综合治疗组分别占30%,53%,差异明显(P<0.05)。②各分型患者有效病例疗程长短比较:电针1组基本上在两个疗程内痊愈,电针2组,综合治疗组多在两三个疗程或3个疗程后好转,治疗时间较长。③不同分型患者面神经潜伏期M波比较:80例患侧面神经运动潜伏期有不同程度的延长,M波波幅降低,与健侧比较差异有极显著性(P<0.01)。其中患健侧M波波幅比值>505例、50%～302例,<30例,3个月后随访,M波波幅比值<30%中的5例仍有明显面瘫体征,>30%的67例中面瘫体征基本恢复。④按肌电图分型标准各型所占比例数比较:按肌电图分类的一般型43例中治愈41例,占95%,而顽固型中,按肌电图分类的轻中型31例中痊愈15例,占48%,无效的5例均提示为重度失神经性损害。虽然面神经肌电图,从面神经运动潜伏期是否延长及根据其失神经性损害进行分类,判断患者预后有一定的准确性,但同电针穴位分型两法合用,分型预测更直接明确。结论:电针分型可以预测该病的预后,对比面神经肌电图情况,判断其预后基本一致。同时根据分型,及时调整治疗方案,可减少后遗症的发生。     

Validation of the Brief Pain Inventory in a Taiwanese population

Assessment of pain in cancer patients is very important to all health care professionals. This paper describes the development of a Taiwanese version of the Brief Pain Inventory (BPI-T) and discusses its psychometric properties in Taiwan. The BPI-T was developed from the original BPI using back-translation and committee review. A total of 534 cytologically or pathologically diagnosed cancer patients in three medical centers in Taiwan were interviewed between July 1992 and October 1997. The intraclass correlation coefficient for the test-retest reliability was 0.79 for the pain severity scale and 0.81 for the pain interference scale. The explained variance for the within-scale factor analyses was larger than 60% in both scales. The coefficient alpha for the internal reliability was 0.81 for the severity scale and 0.89 for the interference scale. Confirmatory factor analysis of the BPI-T clearly identified the same two scales (severity and interference scales) in the 299 adult patients (age between 20-64) with high education (education years > 9) or patients at an early stage of disease. However, in the 235 nonadult patients with distant metastasis or low education patients with distant metastasis, the "most severe pain" item loaded more to the interference scale than the severity scale. Convergent validity of the pain severity was demonstrated by significant correlations with stage of disease (National Cancer Institute's Surveillance, Epidemiology, and End Results Program [SEER]), performance status (Eastern Cooperative Oncology Group [ECOG]), and pain interference. In conclusion, interviewer-administered BPI-T was a reliable instrument for cancer pain severity and its interference in Taiwan. Additionally, it was a valid instrument on adult cancer patients with high education or patients at an early stage of disease.     

Oridonin induces ferroptosis by inhibiting gamma‐glutamyl cycle in TE1 cells

Oridonin (Ori) is a natural tetracyclic diterpenoid active compound with excellent antitumor activity, but the mechanism of Ori on esophageal cancer cell, TE1, remains unclear. In this study, we examined the levels of intracellular iron, malondialdehyde, and reactive oxygen species after Ori treatment, while interfering with the effects of Ori with ferroptosis inhibitor, demonstrating that Ori's inhibition of TE1 cell proliferation is associated with ferroptosis. To understand the molecular mechanism of Ori, we performed UPLC–MS/MS metabolomics profiling on TE1 cells, which show that gamma‐glutamyl amino acids (gamma‐glutamylleucine, gamma‐glutamylvaline), 5‐oxoproline, glutamate, GSH, and GSSG are changed significantly after Ori treatment. Meanwhile, the activity of gamma‐glutamyl transpeptidase 1 (GGT1) decreased. This revealed that Ori inhibited the gamma‐glutamyl cycle in TE1 cells. Furthermore, we found that Ori can covalently bind to cysteine to form the conjugate oridonin‐cysteine (Ori‐Cys), resulting in the inhibition of glutathione synthesis, which is consistent with the decrease in the enzymatic activity of glutamate cysteine ligase catalytic subunit (GCLC). Eventually, the value of intracellular GSH/GSSG was reduced, and the enzymatic activity of the glutathione peroxidase 4 (GPX4) was significantly decreased. In conclusion, our experiments indicated that Ori can inhibit the gamma‐glutamyl cycle, thereby inducing ferroptosis to exert anti‐cancer activity.     

先天性二叶主动脉瓣畸形27例临床分析

27例住院治疗的先天性二叶主动脉瓣(CBAV)临床分析,结果显示:合并心功能不全21例(78%),合并感染性心内膜炎(IE)12例(44%),与其它心血管畸形并存7例(26%).IE为CBAV的主要死亡原因.本文认为,并发IE或存在明显血流动力学障碍时外科换瓣术为CBAV治疗的根本措施,结果还提示,CBAV一旦心功能失代偿发展迅速,准确掌握外科治疗指征及尽早手术至关重要.     

Usefulness of contrast enhanced FLAIR imaging for predicting the severity of meningitis

The aim of this study was to evaluate whether contrast enhanced fluid attenuated inversion recovery (CE-FLAIR) imaging can be used to predict the severity of meningitis based on leptomeningeal enhancement (LE) score and cerebrospinal fluid signal intensity (CSF-SI) on CE-FLAIR. We retrospectively analyzed data collected from 43 consecutive patients admitted to our hospital due to meningitis. Clinical factors including initial Glasgow Coma Scale (GCS) score, CSF glucose ratio, log CSF protein, log CSF WBC, and prognosis were evaluated. The LE score was semi-quantitatively scored, and we evaluated CSF-SI ratio at the interpeduncular or quadrigerminal cisterns on CE-FLAIR. We evaluated the differences in clinical variables, LE scores and CSF-SI ratios between the recovery and the complication group. We assessed the correlation between clinical variables, LE scores and CSF-SI ratios. The values of log CSF protein, CSF-SI ratio, and LE score were significantly higher in the complication group (p value <0.05). GCS score and CSF glucose ratio were significantly lower in the complication group (p value <0.01). The LE scores had significant negative correlation with GCS scores and CSF glucose ratios (p value <0.001). The LE score was significantly positively correlated with the value of log CSF protein and CSF-SI ratio (p value <0.01). The CSF-SI ratio was negatively correlated with GCS score and CSF glucose ratio (p value <0.01). The CSF-SI ratio was positively correlated with the value of log CSF protein (p value <0.05). Our results suggest that LE score and CSF-SI ratio are well correlated with clinical prognostic factors. We may predict the clinical severity of meningitis by using LE scores and CSF-SI ration on CE-FLAIR imaging.