夜交藤的化学成分研究

目的:研究夜交藤的化学成分.方法:用色谱方法分离得到13个化合物.根据理化性质及波谱测试鉴定结构.结果:13个化合物分别是:大黄酚(Ⅰ)、大黄素甲醚(Ⅱ)、大黄素(Ⅲ)、芦荟大黄素(Ⅳ)、大黄酸(Ⅴ)、大黄素甲醚8-O-β-D-葡萄糖苷(Ⅵ)、大黄素-8-O-β-D-葡萄糖苷(Ⅶ)、2,3,5,4'-四羟基二苯乙烯-2-O-β-D-葡萄糖苷(Ⅷ)、新丁香色原酮(Ⅸ)、芹菜素(Ⅹ)、胡萝卜苷(Ⅺ)、β-谷甾醇(Ⅻ)、硬脂酸(Ⅻ).结论:以上化合物中,Ⅰ、Ⅳ～Ⅵ、Ⅷ～Ⅺ、ⅩⅢ共9个化合物是首次从夜交藤中得到.     

人脐血间充质干细胞的分离培养与向神经元样细胞诱导分化的实验研究

目的 探讨来源于人脐血的间充质干细胞(mesenchymal stem cells，MSCs)分化成神经元样细胞的可行性，以及在体外分离、纯化和扩增的条件。方法 无菌条件下收集正常足月剖腹产胎儿的脐带血，经肝素抗凝，用淋巴细胞分离液分离脐血的单个核细胞，以偏酸性的Mesencult^TM作为培养基进行培养和纯化，获得贴壁细胞，取扩增第三代后的MSCs向神经元样细胞诱导分化。用免疫荧光标记方法检测神经元特异性标记物。结果 来源于脐血的单个核细胞种植于特定的培养基中后，可产生贴壁细胞，主要表现为破骨样和间充质样细胞；传3代后，这些细胞可得到纯化、扩增；免疫组化标记显示经诱导后的MSCs表达神经丝蛋白(NF)和神经元特异性烯醇化酶(NSE)。结论 源于脐血的MSCs在体外可以培养、扩增，并向神经元样细胞分化，可作为神经干细胞的来源而用于实验研究和临床。     

人白细胞介素－2基因真核表达载体pDORIL－2的构建

目的：构建逆转录病毒载体介导的人白细胞介素－２（ＩＬ－２）基因真核细胞表达载体．方法：合成带有和表达载体克隆位点相匹配酶切位点的聚合酶链式反应（ＰＣＲ）引物，用ＰＣＲ方法从质粒ｐＨＩＧ５３中扩增出人的ＩＬ－２ｃＤＮＡ，将其定向克隆人表达载体ｐＤＯＲ－ｎｅｏ．结果：ＰＣＲ扩增出的ＩＬ－２ｃＤＮＡ片段约４７５ｂｐ，酶切鉴定该片段已被克隆人ｐＤＯＲ－ｎｅｏ的多克隆位点，构建成人ＩＬ－２基因真核表达载体ｐＤＯＲＩＬ－２．结论：用ＰＣＲ扩增目的基因片断，有快速、获得量大、可改变酶切位点等优点；ｐＤＯＲＩＬ－２的构建成功，为开展基因治疗的研究打下了基础。     

苏拉明对体外培养视网膜色素上皮细胞增殖的影响

目的　研究苏拉明 (suramin)对培养人视网膜色素上皮细胞 (retinal pigm ent epithelium,RPE)增殖的影响 .方法　将不同质量浓度的苏拉明 (1.5 ,15和 15 0 mg· L- 1 )加入RPE细胞培养液 ,采用四甲基偶氮唑盐 (tetrazolium,MTT)比色法 ,细胞分裂指数计数和核仁组成区嗜银染色(Ag NORs)检测苏拉明对 RPE增殖活力的影响 .结果　含有10 0 m L· L- 1小牛血清的培养液可以显著刺激 RPE的增殖(P<0 .0 1) ,无血清组 A值为 0 .19± 0 .0 1、含血清组 A值为0 .30± 0 .0 1;苏拉明抑制了 10 0 m L· L- 1血清条件下 RPE的增殖 ,呈剂量依赖性 ,最大抑制率达 5 1% ,3种浓度组 A值分别为 0 .2 9± 0 .0 1,0 .2 4± 0 .0 1和 0 .14± 0 .0 1,对细胞的形态无明显影响 .结论　苏拉明对血清刺激 RPE增殖有显著非毒性抑制作用     

Pilon骨折的手术治疗体会

目的回顾性分析治疗P ilon骨折的适宜手术方法、最佳手术时机及其手术疗效。方法对2001年至2004年接受手术治疗的52例单侧P ilon骨折患者进行随访,平均年龄36.5岁,伤后至手术时间平均6.8 d。骨折类型:Ⅰ型4例、Ⅱ型36例、Ⅲ型12例。40例行切开复位三叶型(或T型)钢板内固定;12例行有限切开内固定并辅以外固定,其中应用外固定支架者2例,辅以石膏托者10例。术后平均随访16个月。结果采用Mazur评分系统评估手术疗效,52例患者中,优43例,良6例,可3例。术后并发症包括创面不愈合4例,感染2例,延迟愈合1例和关节退行性变7例。结论正确选择手术时机,根据骨折类型和条件灵活选择固定方式是取得良好手术效果的关键。     

食管癌调强放疗靶区与肺体积比和处方剂量的关系

目的 研究食管癌调强放射治疗中能够做出既定目标的放疗计划时,靶区体积与肺体积比值和处方剂量的关系,从而帮助临床医生根据靶区情况,选择适合的处方剂量.方法 随机选取临床上己进行放射治疗的食管癌患者80例;其中病变范围包括全部食管癌类型,靶区根据ICRU(International Commission Radiologi...     

社区慢性肾脏病的筛查与管理现状

目的：了解社区成年慢性肾脏病(chronic kidney disease, CKD)高危人群的筛查及CKD患者的管理现状,探讨社区卫生机构CKD管理的改善措施。方法：基于西城区卫生健康委员会下辖79家社区卫生服务站的全部医疗信息数据,建立西城区社区CKD一体化大数据平台,基于该数据平台纳入2015年7月21日至2021年11月20日期间就诊的社区患者,分析肾脏损伤相关指标的检测情况、肾脏病危险因素控制达标率、用药情况,并对社区卫生服务站的肾脏病检验能力进行评估。结果：在374 498例社区患者中,70.6%为CKD高危人群,其CKD危险因素最常见的为高血压(62.3%)、冠心病(43.3%)和糖尿病(30.4%),仅17.2%的CKD高危人群进行过肾脏病筛查,其中CKD检出率为24.2%(10 992/45 377例)。进行过肾脏病筛查的所有社区患者中(49 908例,13.3%),CKD检出率为22.7%(11 338/49 908例),42.6%存在估算肾小球滤过率(estimated glomerular filtration rate, eGFR)<60 mL/(min...     

苦参半仿生提取法与水提取法的比较

目的:选择苦参药效物质较佳的提取方法。方法:以苦参碱、氧化苦参碱、苦参总碱、HPLC总面积、干浸膏为指标,综合评判,对苦参半仿生提取法与水提取法进行比较。结果:5种指标成分及综合评价Y值顺序皆为:半仿生提取法>水提取法。结论:苦参药材提取用半仿生提取法优于水提取法。     

Using machine learning to aid treatment decision and risk assessment for severe three-vessel coronary artery disease

BACKGROUNDThree-vessel disease (TVD) with a SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score of ≥ 23 is one of the most severe types of coronary artery disease. We aimed to take advantage of machine learning to help in decision-making and prognostic evaluation in such patients.METHODSWe analyzed 3786 patients who had TVD with a SYNTAX score of ≥ 23, had no history of previous revascularization, and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) after enrollment. The patients were randomly assigned to a training group and testing group. The C4.5 decision tree algorithm was applied in the training group, and all-cause death after a median follow-up of 6.6 years was regarded as the class label.RESULTSThe decision tree algorithm selected age and left ventricular end-diastolic diameter (LVEDD) as splitting features and divided the patients into three subgroups: subgroup 1 (age of ≤ 67 years and LVEDD of ≤ 53 mm), subgroup 2 (age of ≤ 67 years and LVEDD of > 53 mm), and subgroup 3 (age of > 67 years). PCI conferred a patient survival benefit over CABG in subgroup 2. There was no significant difference in the risk of all-cause death between PCI and CABG in subgroup 1 and subgroup 3 in both the training data and testing data. Among the total study population, the multivariable analysis revealed significant differences in the risk of all-cause death among patients in three subgroups.CONCLUSIONSThe combination of age and LVEDD identified by machine learning can contribute to decision-making and risk assessment of death in patients with severe TVD. The present results suggest that PCI is a better choice for young patients with severe TVD characterized by left ventricular dilation.

Coronary artery disease (CAD) is the leading cause of death and disability worldwide.^[1] Three-vessel disease (TVD) is the most severe form of CAD and is characterized by significant stenosis in all three major coronary arteries. The application of myocardial revascularization techniques, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), has significantly improved the clinical outcomes of patients with severe CAD. CABG has traditionally been the standard therapy for complex coronary lesions, including TVD.^[2] In recent years, with the advancements in PCI technology and the accumulation of operators’ experience, the incidence of periprocedural and long-term adverse events of PCI has substantially decreased, and PCI has been gradually applied in the treatment of TVD.^[3,4] Current guidelines recommend use of the SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score and diabetes status to guide the revascularization strategy for patients with TVD.^[5,6] Current practice guidelines do not recommend PCI for patients with TVD with a SYNTAX score of ≥ 23. However, using the SYNTAX score to guide clinical decision-making between PCI and CABG remains controversial, and its reasonability has been questioned since a newly published meta-analysis showed no significant association between the SYNTAX score and the comparative effectiveness of PCI and CABG.^[7] Moreover, the SYNTAX score is a quantitative indicator of the anatomical complexity of TVD and does not include clinical variables that may have significant effects on the patient’s prognosis. Whether some patients with specific clinical characteristics can obtain a comparable or even greater survival benefit from PCI than from CABG is unclear. Moreover, risk assessment for patients with TVD after revascularization therapy remain challenging.^[8–10]Machine learning has recently emerged as an important research method and has been successfully applied in many scientific fields, including clinical medicine.^[11–13] The decision tree algorithm, a common approach in machine learning, can handle non-linearity, heterogeneous effects, and high-dimensional features and partition a trial population into subgroups characterized by multiple simultaneous characteristics.^[14] In the present study involving a large cohort of patients with TVD with a SYNTAX score of ≥ 23, we employed a decision tree algorithm to generate specific subgroups, compared the long-term prognosis between patients who underwent PCI or CABG in each subgroup, and conducted a comparative analysis of the long-term prognosis between subgroups generated by machine learning. We evaluated whether machine learning can help in selecting the optimal revascularization method and assessing risk in patients with severe TVD.     

绝经后Luminal B型乳腺癌的内分泌治疗

目的 探讨芳香化酶抑制剂和三苯氧胺对绝经后Luminal B型乳腺癌患者的疗效.方法 收集天津市肿瘤医院2002年7月至2005年3月间733例术后接受辅助内分泌治疗的原发性乳腺癌患者资料,肿瘤性质均经手术切除病理组织学证实.患者均为绝经后且ER阳性,其中501例接受三苯氧胺治疗,232例接受芳香化酶抑制剂治疗.采用免疫组化SP法进行ER、PR、HER2检测.随访时间36～90个月,中位随访时间46个月.结果 芳香化酶抑制剂治疗组Luminal B型乳腺癌患者三年无瘤生存率高于三苯氧胺组(90.6% vs.88.6%,P=0.038).三苯氧胺组亚组分析显示:LN+/HER2+患者三年无瘤生存率低于LN+/HER2-患者(88.2% vs 90.4%,P=0.037);HER2+/PR+患者高于HER2+/PR-患者(90.8% vs.89.5%,P=0.032).芳香化酶抑制剂组内LN(+)和LN(-)亚组中,HER2(+)患者与HER2(-)患者的三年无瘤生存率差异均无统计学意义(P>0.05);而HER2+/PR+组高于HER2+/PR-组(91.9% vs.90.5%,P=0.029).芳香化酶抑制剂组潮热、阴道出血、静脉血栓形成的发生率低,肌肉骨骼疼痛、骨折的发生率则高于三苯氧胺组(P<0.05).结论 芳香化酶抑制剂对绝经后Luminal B型患者疗效好于三苯氧胺,此效果不受患者腋窝淋巴结状态的影响,且耐受性和安全性较好.