建立中医特色卒中单元模式探讨

卒中单元是目前治疗卒中的最有效的方法 ,中医的特色是整体观念和辨证论治 ,把二者结合起来 ,建立有中医特色的卒中单元模式 ,从而提高我国脑卒中病人的生存率和生活质量。     

急性心肌缺血时高频心电图时域频域分析的实验研究

结扎家兔冠状动脉左室支的不同部位，用高频心电图时域频域法观察中高频成分、甚高频成分的变化。结果表明:缺血面积小于３５％时，中高频成分、甚高频成分随缺血范围的增大而增加；若缺血面积大于３５％时，中高频成分、甚高频成分减少。     

加贝酯治疗急性胰腺炎的临床研究

目的 探讨国产加贝酯对急性水肿型胰腺炎的疗效和不良反应。 方法 应用加贝酯和一般常规治疗方法对158例年龄在20-60岁的急性水肿型胰腺炎患者进行多中心、随机、对照临床研究,其中加贝酯组81例,一般常规治疗(对照组)77例。 结果 加贝酯组显效率(74.1％)及总有效率(100％)均高于对照组(41.5％及94.8％),加贝酯组疗效显著优于对照组(P<0.01和P<0.05),且不良反应少而轻,除3例(3.7％)注射局部皮肤发红、疼痛,2例(2.4％)静脉炎,1例皮疹外,未发现肝、肾、心及血液损伤。 结论 国产加贝酯治疗急性胰腺炎起效迅速,疗效肯定,副反应少而轻。对60-80岁的急性胰腺炎患者亦有较好疗效。     

隐匿性肝性脑病的诊疗进展

隐匿性肝性脑病(minimal hepatic encephalopa-thy,MHE)又称亚临床肝性脑病(subclinicalhepatic encephalopathy,SHE),是慢性肝病和肝硬化最常见的严重并发症,是一种具有渐进性、可逆性的神经精神病学异常和运动功能失调特点的疾病.尽管其发病机制仍未明确,血清和中枢神经系统(central nervoussystem,CNS)血氨升高仍被认为是肝性脑病(hepatic encephalopathy,HE)的致病机制和治疗核心,并受血脑屏障改变、神经递质紊乱、氨基丁酸和苯二氮异常等因素影响.因此明确其诱发因素是HE治疗的关键.治疗药物包括抗生素、二糖类、益生菌、门冬氨酸鸟氨酸(L-ornithine-L-aspartate,LOLA)、苯甲/苯乙酸盐等.因此,对MHE的发病机制、临床诊断和治疗研究进展进行归纳,为临床诊疗提供前沿性、系统性信息,具有重要意义.     

A phase II,single-centre trial of neoadjuvant toripalimab plus chemotherapy in locally advanced esophageal squamous cell carcinoma

BackgroundEsophageal squamous cell carcinoma (ESCC) remains a challenging malignancy with poor prognosis and limited therapeutic methods. However, recent clinical trials of immune checkpoint inhibitors (ICIs) have shown promising results in the treatment of lethal malignancies. The second-line treatment of late-stage ESCC was approved based on the results of KEYNOTE-180, KEYNOTE-181 and ATTRACTION-1, ATTRACTION-3. Combining ICIs with chemotherapy in neoadjuvant therapy may benefit patients with locally advanced, resectable ESCC.MethodsA two-arm phase II trial was launched in July 2019 in Henan Cancer Hospital. The primary outcome measure will be completed within 21 months. The pathological complete response (pCR) rate is the primary endpoint, and the secondary endpoints include overall survival (OS), disease-free survival (DFS), the toxicities of the neoadjuvant toripalimab plus chemotherapy, the relationship between combined positivity score (CPS) of specimen and the treatment response, the relationship between lymphocyte infiltration and the treatment response, the progression-free survival (PFS) rate, and adverse events (AEs). It was assumed that the pCR rate of this trial might be 25%. Therefore, the 30 enrolled patients could reject the hypothesis at 75% (α=0.1).DiscussionThe study will determine the safety and efficacy of neoadjuvant immunochemotherapy for ESCC and provide enough evidence for phase III clinical trials.Trial registrationClinical Trials.gov, {"type":"clinical-trial","attrs":{"text":"NCT03985670","term_id":"NCT03985670"}}NCT03985670, Registered: October 24, 2019, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0008Z9D&selectaction=Edit&uid=U0002MIY&ts=2&cx=-i71o4q. Registry name: “Teripalimab Plus Chemotherapy in Local Advanced Esophageal Cancer”.     

123例敌鼠钠中毒的临床和血液学分析

本文报道123例敌鼠钠中毒病例。主要临床表现为皮肤、粘膜、内脏出血、凝血时间(CT,试管法)、凝血酶原时间(PT),简易凝血活酶生成时间(STGT)延长,但以PT和STGT较敏感。作者认为,只有同时检测PT和STGT才能较全面地反映敌鼠钠中毒患者的凝血功能。用维生素K_1治疗效果满意,本组病例全部治愈。     

艰难梭菌毒素B诱导结肠癌细胞凋亡及相关机制研究

目的检测艰难梭菌毒素B(TcdB)对结肠癌SW480细胞增殖与凋亡的影响,研究其引起细胞凋亡的相关机制。方法采用不同浓度的TcdB处理SW480细胞,采用MTT法检测细胞增殖情况;用流式细胞术检测细胞的凋亡及线粒体膜电位变化情况。结果TcdB显著抑制了结肠癌SW480细胞的增殖,作用48 h后的抑制率为46.36%,呈一定的时间-浓度相关性;流式细胞仪检测结果表明,浓度为800 ng/ml的TcdB作用48 h,SW480细胞凋亡率为20.83%,呈一定的时间-浓度相关性。结论艰难梭菌毒素B能够抑制结肠癌SW480细胞增殖、诱导细胞凋亡,其机制可能与启动线粒体凋亡途径有关。     

Role of FGF10 on tumorigenesis by MS‐K

Murine MS‐K and NFSA cell lines formed tumor after inoculation into mouse and both cell lines expressed high level of vascular endothelial growth factor‐A (vegf‐A) and produced same level of VEGF‐A. However, poor blood vessel formation, and necrosis was significantly observed in NFSA‐tumor, contrary to well‐developed blood vessel formation in MS‐K tumor. The microarray analysis showed high expression of fibroblast growth factor‐10 (fgf‐10) in MS‐K than NFSA. In this report, the role of fgf‐10 on tumor growth was studied. MS‐K enhanced more proliferation of endothelial cells by direct co‐culture than NFSA, and rFGF10 supported the proliferation of HUVEC in combination with VEGF‐A. fgf‐10‐knocked down MS‐K, MS‐K (fgf‐10‐KD), proliferated slower in vitro and the tumorigenicity of them was also slower than control. The blood vessel formation in these MS‐K (fgf‐10‐KD) clones was reduced compared with the MS‐K (normal). qPCR analysis showed the suppression of vegf‐A, vegf‐C and fgfr‐1‐expression in the MS‐K (fgf‐10‐KD) clones. Taken together, these results indicated that FGF10, which was produced from tumor cells, was essential for the proliferation of tumor cell itself and also supports proliferation of endothelial cells. Thus, FGF10 plays an important role for tumor growth by both paracrine and autocrine manner.     

吗啡对外周刺激诱导的大鼠海马CA1区长时程增强(LTP)的抑制作用

目的观察吗啡急性中枢应用,对外周电刺激坐骨神经诱导的海马CA1区LTP及海马痛觉调制作用的影响,并探讨其可能的机制。方法25只雄性SD大鼠200～260g,随机分为5组。单刺激坐骨神经,各组侧脑室给药后给予强直刺激,观察场电位的变化。结果单刺激坐骨神经可在海马CA1区诱导出场电位(21.43±4.54)μV,其潜伏期较长(169.94±14.65)ms及阈值较高(平均15V),据此,推断是C类纤维诱发的;强直刺激后海马CA1区可出现持续时间在2h以上LTP现象;中、大剂量吗啡侧脑室注射可抑制海马CA1区LTP,纳洛酮可阻断这种作用。结论LTP是海马痛觉调制的生物学机制之一,阿片受体在其中起重要作用。吗啡对C-类纤维诱导的海马CA1区LTP的抑制作用可能通过阿片受体实现。     

卡维地洛对充血性心力衰竭患者心功能的影响

目的　探讨卡维地洛对充血性心力衰竭患者心功能的影响。　方法　充血性心力衰竭患者 6 2例(其中扩张性心肌病心力衰竭患者 15例 ,缺血性心脏病心力衰竭患者 4 7例 ) ,左室射血分数 (LVEF)≤ 4 0 % ,心功能(NYHA)Ⅱ～Ⅳ级 ,常规治疗 (洋地黄 ,利尿剂 ,ACEI)基础上随机分为卡维地洛试验组和安慰剂对照组。应用心脏彩色超声仪测定治疗前及治疗后 1个月 ,3个月左室结构和功能指标的变化。观察卡维地洛治疗三个月后对心功能的影响。　结果　卡维地洛平均用量为 2 1 1mg d± 9 6mg d。经过 3个月治疗 ,试验组症状和心功能改善 ,与对照组比较左室射血分数上升 (P <0 0 0 2 ) ,左室收缩末容积下降 (P <0 0 5 ) ;左室舒张末容积与对照组比较虽无统计学差异但与治疗前比较亦明显下降 (P <0 0 5 )。　结论　在洋地黄、利尿剂、ACEI的治疗基础上 ,应用卡维地洛能显著改善充血性心力衰竭患者的心功能 ,改善心室结构 ,且疗效与应用剂量无关。