Combined Effect of Smoking and Obesity on Coronary Heart Disease Mortality in Male Veterans: A 30-year Cohort Study

Objective Evidence is lacking regarding the combined effects of smoking and obesity on mortality from coronary heart disease in male veterans.This study aimed to explore the combined effect of smoking and obesity on coronary heart disease mortality in male veterans in China.Methods A cohort of 1,268 male veterans from 22 veteran centers in Xi’an(Shaanxi Province,China)were followed up once every 2 years from February 1,1987 to October 30,2016.The endpoint was death from any cause.The hazard ratio(HR)of each risk factor and the 95%confidence interval(CI)were calculated using a multivariate Cox proportional hazard model.Results The total follow-up was 24394.21 person-years;each subject was followed up for a mean duration of 19.24 years.By the end of the study,of the 1,268 veterans,889 had died,363 were alive,and 16 were lost to follow-up.Cox regression analysis results revealed that current smoking(HR:1.552,95%CI:1.074–2.243),obesity(HR:1.625,95%CI:1.024–2.581),and the combined effect of the two factors(HR:2.828,95%CI:1.520–5.262)were associated with coronary heart disease mortality.Conclusion Our results suggest that obese veterans who smoke might be an important target population for coronary heart disease mortality control.     

真皮乳头细胞促毛发生长和黑素生成的分子调节机制研究进展

越来越多的证据显示真皮乳头细胞(DPC)是毛囊周期性更新的组织中心。一方面它通过旁分泌的方式分泌大量的细胞因子,刺激隆突区上皮干细胞和黑素细胞干细胞(MeSC)分化、增殖和移行,启动毛发生成。另一方面DPC通过调节干细胞的微环境,譬如真皮乳头的大小、真皮乳头与隆突区的距离以及毛囊隆突区周围的淋巴引流与神经支配等协调完成对毛发生长周期的调节。最新研究显示DPC至少有4个细胞亚群,分别诱导单谱系瞬时扩增上皮细胞形成多层同心圆排列的毛干与毛鞘。还发现持续的心理应激可导致支配隆突区的交感神经过度活跃,交感神经末梢释放大量的去甲肾上腺素可诱导MeSC快速增殖,导致MeSC库耗竭和毛干色素脱失。通过对DPC促毛发生长和黑素生成的分子调节机制的认识,有望在体外大规模培养DPC用于细胞移植治疗人类秃发疾病。     

《黄帝内经》"手"相关术语研究

"手"是人体四肢部位的核心概念,"手"相关术语是人体术语的重要组成部分.本研究在术语学视角下,检讨《黄帝内经》中与"手"相关的术语,选取"腕骨"等17个术语加以考辨.部分术语仍属于专业术语,保留在中医学专业词汇中,可归入"纯术语"中,如"锐骨""本节"等.部分则进入普通词汇,已经渗透到人们的生活中,逐渐和一般词汇相融合,成为"一般术语"或"准术语",如"鱼际""小指"等.研究肢体类术语可以丰富人体术语系统,为准确地描写和阐释中医术语提供借鉴,同时对大型辞书编纂和中医标准化系统建设提供用例补充.     

补肺化积汤治疗晚期非小细胞肺癌

目的 观察中药支持和补肺化积汤治疗晚期非小细胞肺癌的效果.方法 将60例非小细胞肺癌患者随机分为治疗组与对照组,各30例.对照组采用艾迪注射液做支持疗法,治疗组在此基础上配合补肺化积汤治疗.治疗3个疗程后观察2组临床疗效.结果 治疗组瘤体的缓解程度、Karnofsky评分等均优于对照组.结论 补肺化积汤对正虚毒结型非小细胞肺癌具有良好的治疗效果.     

食管压指导呼气末正压滴定对急性呼吸窘迫综合征患者早期预后影响的Meta分析

背景　急性呼吸窘迫综合征（ARDS）是常见的引起重症监护室内患者死亡的疾病,机械通气是维持患者生命的主要支持手段。通气策略与患者预后密切相关,目前通过食管压指导呼气末正压（PEEP）滴定的机械通气策略对ARDS患者早期预后的影响尚存争议。目的　评价食管压指导PEEP滴定与高PEEP相比对ARDS患者早期预后的影响。方法　计算机检索PubMed、EMBase、The Cochrane Library、中国知网、万方数据知识服务平台及维普数据库自建库至2020-06-18所有公开发表的关于食管压指导PEEP滴定方案治疗ARDS患者的随机对照试验（RCT）,并对纳入文献的参考文献进行引证索引。试验组为常规治疗加食管压指导PEEP滴定方案的机械通气,对照组为常规治疗加临床推荐的高PEEP指导的机械通气;结局指标：主要结局指标（28 d死亡风险）、次要结局指标（氧合指数、PEEP、机械通气天数）。按照纳入和排除标准筛选文献并对纳入的文献进行质量评价,数据分析应用Stata 16.0软件及Rev Man5.3软件。结果　共13篇文献符合纳入标准,中文文献9篇、英文文献4篇,其中12篇单中心RCT,1篇多中心RCT,共800例患者。试验组患者28 d死亡率低于对照组〔OR=0.55,95%CI（0.39,0.79）,P=0.001〕。试验组患者氧合指数高于对照组〔SMD=1.86,95%CI（1.65,2.08）,P<0.000 01〕。试验组患者PEEP高于对照组〔SMD=1.27,95%CI（1.04,1.51）,P<0.000 01〕。试验组患者机械通气天数少于对照组〔SMD=-1.51,95%CI（-1.79,-1.22）,P<0.000 01〕。结论　食管压指导PEEP滴定可以降低ARDS患者28 d的死亡风险,改善患者临床症状,对ARDS患者早期预后具有积极意义,推荐在ARDS患者机械通气管理中使用食管测压。     

儿童自身免疫性癫痫脑病预后的研究进展

自身免疫性癫痫脑病（AEE）是一种潜在的、可治疗的神经系统疾病。其通常指在有脑病的情况下发作的急性或亚急性癫痫。与儿童有关的AEE的神经元靶点主要有NMDA受体、GABA受体、LGI1受体、AMPA受体、甘氨酸受体、MOG等。目前判断儿童AEE预后主要是通过改良的Rankin量表（mRS）和儿童脑功能分类量表（PCPC）。通过量表评估85%的患儿有良好的预后,但有研究显示有一部分患儿存在学习能力下降、认知障碍及社交障碍等后遗症,然而在量表中没有明显的体现。本文将对儿童AEE预后方面的最新研究进展做综述,旨在为临床医师早期随访、识别及预防提供一定的理论基础。     

Assessing the quality of clinical and administrative data extracted from hospitals: the General Medicine Inpatient Initiative (GEMINI) experience

ObjectiveLarge clinical databases are increasingly used for research and quality improvement. We describe an approach to data quality assessment from the General Medicine Inpatient Initiative (GEMINI), which collects and standardizes administrative and clinical data from hospitals.MethodsThe GEMINI database contained 245 559 patient admissions at 7 hospitals in Ontario, Canada from 2010 to 2017. We performed 7 computational data quality checks and iteratively re-extracted data from hospitals to correct problems. Thereafter, GEMINI data were compared to data that were manually abstracted from the hospital’s electronic medical record for 23 419 selected data points on a sample of 7488 patients.ResultsComputational checks flagged 103 potential data quality issues, which were either corrected or documented to inform future analysis. For example, we identified the inclusion of canceled radiology tests, a time shift of transfusion data, and mistakenly processing the chemical symbol for sodium (“Na”) as a missing value. Manual validation identified 1 important data quality issue that was not detected by computational checks: transfusion dates and times at 1 site were unreliable. Apart from that single issue, across all data tables, GEMINI data had high overall accuracy (ranging from 98%–100%), sensitivity (95%–100%), specificity (99%–100%), positive predictive value (93%–100%), and negative predictive value (99%–100%) compared to the gold standard.Discussion and ConclusionComputational data quality checks with iterative re-extraction facilitated reliable data collection from hospitals but missed 1 critical quality issue. Combining computational and manual approaches may be optimal for assessing the quality of large multisite clinical databases.     

小鼠耳蜗核因子-κB P50的表达

核因子-κB(nuclear factor-kappa B,NFκ-B)是许多细胞对各种刺激反应起重要作用的转录因子之一,NF-κB P50是其家族成员。为了显示NF-κB P50在耳蜗的表达,给实验组小鼠皮下注射卡那霉素(kanamycin,KA),或鼓室注射脂多糖(lipopolysaccharides,LPS),对照组小鼠注射等量生理盐水,用NFκ-B P50兔多克隆抗体(PcAb)免疫组化染色(DAB显色),观察NFκ-B P50在小鼠耳蜗的表达。结果显示:在小鼠耳蜗各圈螺旋韧带、盖膜(TM)、螺旋突、螺旋神经节和神经纤维可观察到较强的表达;Corti器的内毛细胞(inner hair cells,IHC)、外毛细胞(outer hair cells,OHC),内柱细胞(inner pillar cell,IP)、外柱细胞(outer pillar cell,OP)、Deiter细胞(DC)、Hensen细胞(HC)和Claudious细胞的细胞质也有NF-κB P50的表达;IHC、OHC和上述细胞的核及基底膜(B)和对照组均未见表达。注射LPS和KA处理的小鼠耳蜗NFκ-B P50的表达,都比对照小鼠明显增强。注射LPS和KA后3d和7d的小鼠,NF-κB P50的表达没有显著性差别。注射LPS和KA可使NFκ-B P50在小鼠耳蜗产生急性免疫反应。