还原型谷胱甘肽对大鼠肝脏缺血再灌注损伤的保护作用

目的:探讨缺血前经门静脉注射还原型谷胱甘肽(GSH)对大鼠肝脏缺血再灌注损伤的保护作用.方法:20只雄性SD大鼠随机均分为2组,生理盐水处理组(IR组)和GSH预处理组(GPC组),缺血前分别经门静脉主干注射生理盐水或GSH 3 ml/kg,15 min后阻断左、中叶肝蒂45 min,再开放肝蒂40 min,建立约70%肝脏缺血再灌注损伤模型.缺血前及再灌注末经下腔静脉穿刺抽血,测血清ALT、AST含量;取左叶肝组织,测丙二醛(MDA)含量和P-选择素表达情况.结果:缺血前2组血清ALT、AST水平、左叶肝组织MDA含量差异无统计学意义(P均＞0.05).再灌注末,GPC组血清ALT、AST水平、缺血肝组织MDA含量和P-选择素蛋白表达低于IR组(P均＜0.05).结论:缺血前经门静脉途径注射GSH可以有效减轻肝脏缺血再灌注损伤程度,该作用可能与减少血循环中自由基含量、抑制肝组织P-选择素表达有关.     

Location-specific strategies for eliminating US national racial-ethnic [... formula ...] exposure inequality

Air pollution levels in the United States have decreased dramatically over the past decades, yet national racial-ethnic exposure disparities persist. For ambient fine particulate matter (PM2.5), we investigate three emission-reduction approaches and compare their optimal ability to address two goals: 1) reduce the overall population average exposure (“overall average”) and 2) reduce the difference in the average exposure for the most exposed racial-ethnic group versus for the overall population (“national inequalities”). We show that national inequalities in exposure can be eliminated with minor emission reductions (optimal: ~1% of total emissions) if they target specific locations. In contrast, achieving that outcome using existing regulatory strategies would require eliminating essentially all emissions (if targeting specific economic sectors) or is not possible (if requiring urban regions to meet concentration standards). Lastly, we do not find a trade-off between the two goals (i.e., reducing overall average and reducing national inequalities); rather, the approach that does the best for reducing national inequalities (i.e., location-specific strategies) also does as well as or better than the other two approaches (i.e., sector-specific and meeting concentration standards) for reducing overall averages. Overall, our findings suggest that incorporating location-specific emissions reductions into the US air quality regulatory framework 1) is crucial for eliminating long-standing national average exposure disparities by race-ethnicity and 2) can benefit overall average exposures as much as or more than the sector-specific and concentration-standards approaches.

The Clean Air Act has dramatically reduced outdoor air pollution levels in the United States, with (during 1990 through 2020) aggregate benefits exceeding costs 30-to-1 ($2 trillion versus $65 billion) (1). Important regulatory strategies include the National Ambient Air Quality Standards (NAAQS) and sector-specific emission-reduction technology requirements (e.g., Best Achievable Control Technology [BACT] standards). However, exposure inequalities persist (2–7). Disparities by race-ethnicity are larger than, and distinct from, those by income (4–6, 8, 9). Racial-ethnic inequalities in US ambient air pollution and subsequent exposures are attributable in part to racist planning, including historical, race-based housing segregation and land-use practices (10–18). Environmental racism scholars have suggested that strategies and policies for eliminating disparities will be most effective when racial-ethnic injustices are centered and directly addressed (19–22).The existing literature documents exposure inequities (3–7, 9, 23–26) and investigates the impacts on inequities of emission changes for specific sources (e.g., refs. 27–36) or locations (37–43). However, the scientific literature has not investigated how to eliminate national racial-ethnic inequalities in air pollution or what level of emission reduction would be required to do so (44).We examine three potential approaches to reduce or eliminate national exposure inequalities: 1) location-specific emission reductions (hereafter, “location”), 2) sector-specific emission reductions (“sector”; analogous to BACT-type approaches), and 3) requiring regions to meet a concentration standard (“NAAQS-like”). Approaches 2 and 3 mirror aspects of current regulations; approach 1 would be a new regulatory approach. We find that the location approach is by far the most effective (can eliminate national disparities with only small absolute emission reductions); the sector approach is poor (can reduce disparities, but requires substantially larger emission reductions; cannot eliminate disparities except by eliminating nearly all emissions); and NAAQS-like is the least effective (does not eliminate disparities). The location approach is also the strongest of the three for reducing population-average exposures.To quantitatively compare the three approaches, we use the publicly available InMAP (Intervention Model for Air Pollution) source-receptor matrix (ISRM) (45) to estimate long-term average ambient fine particulate matter (PM2.5) concentrations across the contiguous United States caused by anthropogenic emissions in 2014. Disparity here refers to the difference between population-weighted average PM2.5 concentrations for the most exposed racial-ethnic group minus the overall population (in sensitivity analyses, we instead investigate government-designated “high vulnerability” [HV] locations; Materials and Methods). ISRM predicts the concentration of primary PM2.5 and secondary PM2.5 formed from nitrogen oxides (NOx), sulfur oxides (SOx), ammonia (NH3), and volatile organic compounds (VOCs). We employ the 2014 US Environmental Protection Agency (EPA) National Emission Inventory, grouped into 14 source sectors (see Fig. 2B, SI Appendix, and below). ISRM contains 52,411 grid cells (locations) with size (i.e., spatial resolution) ranging from 1 km in densely populated urban centers to 48 km in sparsely populated rural areas; the average spatial resolution is 2.6 km in Urban Areas and 22.6 km in non-Urban Areas (13.2 km overall). Emissions reductions for location and sector are an optimization to maximally reduce disparities for the most exposed group relative to the overall population average. They use the spatial resolution of the simulation grid and the 14 source sectors, respectively. Thus, our results inform what that method could optimally do to reduce or eliminate racial-ethnic exposure disparities. The NAAQS-like approach simulates successive, proportional emission reductions in each region violating the hypothetical NAAQS (e.g., 6 µg/m3), until the NAAQS-like standard is met.Open in a separate windowFig. 2.Emission reductions for the three approaches: by location (i.e., corresponding to the green lines, Fig. 1) (A), by sector (corresponding to blue lines, Fig. 1) (B), and NAAQS-like (orange lines, Fig. 1) (C). A displays national results (Left) and zoomed-in results for 10 large areas (Right). Spatial units displayed in C are CBSAs, the geographic unit for NAAQS evaluation. The three approaches offer fundamentally different ways of formulating and prioritizing emission reductions. Ag., agriculture; Const., construction; Elec., electricity; HD, heavy duty; LD, light duty; Misc., miscellaneous; Res., residential; Veh., vehicle.     

双切口3至4块钢板固定治疗累及后内侧柱的复杂胫骨平台骨折15例疗效分析

目的 探讨双切口3至4块钢板固定治疗累及后内侧柱的Schatzker Ⅴ、Ⅵ型复杂胫骨平台骨折的临床疗效.方法 2013年1月至2015年12月采用前外侧联合后内侧倒L形双切口,外侧1块3.5 mm锁定钢板,内侧及后内侧2至3块3.5mm小钢板固定治疗累及后内侧柱的Schatzker Ⅴ、Ⅵ型复杂胫骨平台骨折患者15例,分析术后复位效果及随访时膝关节功能情况,评估手术临床疗效.结果 15例均获随访,随访时间18 ～30个月,平均24个月.术后骨折复位效果满意,末次随访时复位无丢失,骨折均愈合,膝关节活动度0 ～135°,平均115..膝关节功能采用HSS评分标准评定:优10例,良2例,可3例,差0例,优良率80％.结论 对于累及后内侧柱的SchatzkerⅤ、Ⅵ型复杂胫骨平台骨折,采用双切口,3至4块3.5 mm钢板固定,可以获得有效固定,膝关节功能恢复良好,并发症少,疗效满意.     

仲黄颗粒配合手术治疗骨量减少的腰椎间盘突出症临床疗效及对BMD、血清OPG水平的影响

目的观察仲黄颗粒配合腰椎后路椎间融合术(posterior lumbar interbody fusion,PLIF)治疗合并骨量减少的肝肾亏虚型腰椎间盘突出症的临床疗效,进一步探讨该方法的临床作用机理。方法选取自2014年5月至2017年6月,日照市中医医院共收治的合并骨量减少的肝肾亏虚型腰椎间盘突出症患者96例,其中治疗组48例采用PLIF术后配合仲黄颗粒口服治疗;对照组48例采用PLIF术治疗。分别记录治疗前和治疗后6个月、12个月Oswestry功能障碍指数(oswestry disability index,ODI)评分、骨密度T值及血清骨保护素(osteoprotegerin,OPG)水平三方面的变化及末次随访时不融合、融合器沉降及螺钉松动不良事件。结果治疗组和对照组分别有42例、40例患者获得随访,两组患者对临床疗效均较为满意,但治疗组满意度高于对照组,两组间差异有统计学意义(P0.05)。结论仲黄颗粒可能通过升高血清OPG提高患者骨密度及术后长期临床疗效,从而减少术后植骨不融合、融合器沉降和螺钉松动不良事件的发生。     

全胸腔镜肺叶切除术在临床早期肺癌的应用价值

目的 通过比较全胸腔镜肺叶切除与常规开胸肺叶切除在手术根治性、安全性及患者术后康复方面的差异,探讨全胸腔镜肺叶切除在临床早期肺癌治疗中的应用价值.方法 选取2007年1月-2008年12月在上海交通大学附属胸科医院胸外科行全胸腔镜肺叶切除术的80例临床早期肺癌患者为VATS组,同时选取同期行常规开胸肺叶切除术的62例临床早期肺癌患者为OT组.两组患者术前的临床分期均为Ⅰ期.比较两组淋巴结清扫组数、手术时间、术中出血量、术后置管引流时间、术后住院时间、术后并发症发生率及术后第5天的口述疼痛评分的差异.结果 两组间淋巴结清扫组数、手术时间、术中出血量、术后住院时间及术后并发症发生率的差异均无统计学意义(P值均>0.05).VATS组术后置管引流的时间为(3.71±0.56)d、术后第5天的口述疼痛评分为(5.31±1.21)分,均显著低于OT组的(4.82±0.73)d和(7.01±1.65)分(P值均<0.05).结论 对于临床早期肺癌患者,全胸腔镜肺叶切除术的手术根治性、安全性与开胸肺叶切除术相仿,术后康复明显优于开胸肺叶切除术.全胸腔镜肺叶切除术可作为早期肺癌患者的推荐治疗方式.     

匹多莫德治疗儿童过敏性紫癜疗效评价

目的：评价匹多莫德对儿童过敏性紫癜的治疗效果。方法选取90例过敏性紫癜患儿,随机分为实验组(n=45)和对照组(n=45),实验组使用匹多莫德联合常规方法治疗过敏性紫癜,对照组予常规方法治疗,比较两组患儿临床症状消失时间,以及IgG、IgA、IgM和T淋巴细胞亚群变化情况。结果(1)实验组临床症状消失时间及住院时间较对照组明显缩短,差异有统计学意义(P<0.01);实验组皮肤紫癜反复发生率显著低于对照组,差异有统计学意义(P<0.05)。(2)治疗前两组外周血IgG、IgA、IgM水平以及T淋巴细胞亚群差异无统计意义(孕>0.05);治疗结束后,实验组IgA和CD8+水平较对照组显著降低,其IgG、IgM、CD4+和CD4+/CD8+水平较对照组显著升高,差异有统计学意义(P<0.05)。(3)实验组病情复发率较对照组明显降低,差异有统计学意义(P<0.05)。结论匹多莫德联合常规方法治疗HSP效果好,临床治疗中值得借鉴参考。     

人表皮生长因子慢病毒载体的构建及表达

目的:构建人表皮生长因子(hEGF)慢病毒(LV)载体.方法:酶切并收集pcDNA 3.1-hEGF载体中的hEGF目的基因片段,克隆进入含有绿色荧光蛋白(GFP)基因的慢病毒载体内,将所得重组体LV-GFP-hEGF与辅助载体pA8.2和pVSVG共同转染人胚肾293T细胞,进行病毒包装.收集上清液,按按10-1～10-7倍比稀释后培养,检测病毒滴度;裂解细胞,进行Western Blot分析.结果:PCR扩增、HindⅢ酶切鉴定及测序结果均证实LV-GFP-hEGF构建成功.将LV-GFP-hEGF转染293T细胞,紫外光下检测可见绿色荧光;LV滴度达5×108TU/mL,转染效率＞75%,Western Blot证实转染细胞町表达hEGF.结论:成功构建了含有GFP报告基因的hEGF慢病毒载体,包装后的慢病毒可在293T细胞内高效表达.     

同步放化疗联合辅助化疗治疗局部晚期鼻咽癌的疗效观察

目的：探讨同步放化疗联合辅助化疗治疗局部晚期鼻咽癌的临床效果。方法：将在我院治疗的局部晚期鼻咽癌患者56例随机分为观察组和对照组,对照组给予单纯放射治疗,观察组给予同步放化疗联合辅助化疗治疗,随访观察治疗效果。结果：治疗后观察组患者鼻咽肿瘤、颈部肿大淋巴结CR率与对照组比较差异无统计学意义（P〉0．05）。治疗后观察组1年、3年后生存率明显高于对照组,两组比较差异具有统计学意义（P〈0．05）。观察组患者治疗顺应性与对照组比较差异无统计学意义（P〉0．05）。观察纽发生3级以上急性治疗毒性反应明显高于对照纽,两组比较差异具有统计学意义（P〈0.05）。结论：同步放化疗联合辅助化疗治疗局部晚期鼻咽癌能明显提高患者生存率,近期效果确切。     

络合碘预防导尿伴随性感染的效果观察

目的:探讨络合碘预防导尿伴随性感染的效果。方法:对200例经皮肾穿刺气压弹道碎石取石术后常规留置导尿管患者,随机分组,实验组在插管中采用络合碘涂擦导尿管所插长度,对照组采用常规石蜡油涂擦导尿管前端。结果:实验组发生尿路感染病例明显少于对照组(P<0.01)。结论:络合碘对导尿伴随性感染有预防作用。