缺血性卒中病人CYP2C19基因多态性与个体化抗血小板治疗的临床观察

目的 研究小样本缺血性卒中病人的CYP2C19基因型,根据其CYP2C19基因型指导个体化抗血小板治疗并观察其临床预后.方法 入选急性缺血卒中病人300例,对入选病人采用随机数字表法分为个体化治疗组150例和常规治疗组150例.个体化治疗组在入选后立即检测CYP2C19基因,按照不同的基因型采用个体化的抗血小板治疗方案,即快代谢型按照氯吡格雷负荷量300 mg、维持量50 mg·d-1口服;中间代谢型按照氯吡格雷负荷量300 mg、维持量75 mg·d-1口服;慢代谢型按照氯吡格雷负荷量300 mg、维持量75 mg·d-1,联合阿司匹林100 mg·d-1口服.常规治疗组直接按照氯吡格雷负荷量300 mg、维持量75 mg·d-1口服治疗,不检测CYP2C19基因.通过随访观察两组病人治疗30 d及180 d不良事件发生率之间的差异.结果 随访6个月,再发缺血性卒中的发生率在个体化治疗组显著降低(P<0.05),出血事件的发生率在个体化治疗组明显低于常规治疗组(P<0.05).结论 根据CYP2C19基因型采取不同的治疗方案可以及时发现慢代谢病人,进而调整抗血小板聚集治疗方案,降低不良事件发生率并可以减少药物的不良反应.     

肝硬化合并细菌感染患者的临床特征

目的 研究肝硬化合并细菌感染患者主要病原菌的分布及其耐药性,为指导临床合理用药提供依据.方法 回顾性分析2011年8月至2016年8月期间南京医科大学第一附属医院感染病科收治的临床诊断为肝硬化合并细菌感染的471例患者的临床资料,统计分离出的病原菌种类、分布及其对常用抗菌药物的耐药性.结果 471例患者中61例细菌培养阳性,共分离出74株细菌,其中革兰阴性菌45株,革兰阳性菌29株.大肠埃希菌(8株)和肺炎克雷伯菌(13株)是主要的革兰阴性菌.大肠埃希菌对氨苄西林和头孢唑啉耐药率较高(8/10和11/18),肺炎克雷伯菌对头孢唑啉和头孢曲松耐药率较高(7/13和3/8).金黄色葡萄球菌(15株)、凝固酶阴性葡萄球菌(5株)为主要的革兰阳性菌,对青霉素的耐药率均为80.0％,但对利萘唑胺、替加环素、万古霉素等抗菌药物均未产生耐药.分离到的细菌中,共检出9株多重耐药菌,其中2株鲍曼不动杆菌为广泛耐药菌(XDR),1株肺炎克雷伯菌为耐碳青霉烯类肠杆科细菌(CRE),3株产超广谱β-内酰胺酶(ESBLs)大肠埃希菌,1株产ESBLs肺炎克雷伯菌,2株耐甲氧西林凝固酶阴性葡萄球菌(MRCNS).结论 肝硬化合并细菌感染病原菌目前仍以革兰阴性菌为主,并有多重耐药菌出现,临床工作中应加强细菌耐药性监测和管理,合理、正确使用抗菌药物.     

影响社区稳定期精神分裂症患者认知功能的相关因素分析

目的 探索影响社区稳定期精神分裂症患者认知功能的相关因素.方法 采用修订版韦氏成人智力分量表数字广度、数字符号、语言流畅性、连线测验A评估78例社区稳定期精神分裂症患者认知功能,家庭负担量表(FBS)、用药依从性问卷(MMAS)评定家庭负担、服药依从性,分析认知功能与有关资料的相关性.结果 受教育年限与数字广度、语言流畅性正相关(r=0.562、0.525,P=0.019、0.018),家庭月收入与数字符号正相关(r=0.601,P=0.005),二者与连线测验A负相关(r=-0.565、-0.519,P=0.010、0.019);吸烟与数字符号正相关(r=0.518,P=0.019);饮酒与语言流畅性正相关(r=0.465,P=0.039).FBS得分与MMAS得分负相关(r=-0.346,P＜0.001),数字广度、数字符号、语言流畅性、连线测验A与FBS得分负相关(r=-0.254、-0.243、-0.350、0.188,P=0.003、0.004、0.000、0.029),与MMAS得分正相关(r=0.254、0.325、0.339,P=0.003、0.000、0.000).受教育年限、吸烟、饮酒进入各因变量回归方程,差异有统计学意义(P＜0.05).结论 受教育年限、家庭月收入、吸烟、饮酒、家庭负担、服药依从性是影响社区稳定期精神分裂症患者认知功能的因素.     

音频转换听觉训练结合社会关系质量干预对脑出血患者认知功能及生活质量的影响

目的 探究音频转换听觉训练结合社会关系质量干预对脑出血患者认知功能及生活质量的影响.方法 选取2017年1月至2019年12月该院神经外科确诊为脑出血患者86例,采用随机数字表法分为对照组和干预组,每组43例.对照组给予常规护理,干预组给予音频转换听觉训练结合社会关系质量护理.观察并分析两组患者认知功能恢复情况及生活质量改善情况.结果 与对照组比较,干预组患者美国国立卫生研究院卒中量表评分降低更明显,简易智力状态检查评分、一般自我效能感量表评分、日常生活活动能力评分、简明健康状况调查问卷(SF-36量表)评分升高更明显,差异均有统计学意义(P<0.05).结论 脑出血患者可利用音频转换听觉训练结合社会关系质量干预护理,最终可达到改善患者认知功能、提高自我效能评价、改善生活质量的目的.     

Inverted U-Shaped Associations between Glycemic Indices and Serum Uric Acid Levels in the General Chinese Population: Findings from the China Cardiometabolic Disease and Cancer Cohort (4C) Study

Objective The relationship between serum uric acid(SUA)levels and glycemic indices,including plasma glucose(FPG),2-hour postload glucose(2 h-PG),and glycated hemoglobin(HbA1 c),remains inconclusive.We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.Methods The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study.A total of 105,922 community-dwelling adults aged≥40 years underwent the oral glucose tolerance test and uric acid assessment.The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.Results A total of 30,941 men and 62,361 women were eligible for the current analysis.Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels,but with different inflection points in men and women.The thresholds for FPG,2 h-PG,and HbA1 c for men and women were 6.5/8.0 mmol/L,11.0/14.0 mmol/L,and 6.1/6.5,respectively(SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).Conclusion An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes,while the inflection points were reached earlier in men than in women.     

后适应缺血时间窗的选择对小鼠心肌再灌注损伤的影响

目的 观察SHIV-B''whu感染中国猕猴的组织病理学变化. 方法 SHIV-B''whu感染中国猕猴,4次传代(P1～P4),定时测量动物体温变化,对各代感染的猴在第14天处死,进行病理学解剖观察,并且对全身主要脏器以及多处淋巴结组织取材做病理分析.结果 中国猕猴在感染急性期体温有短暂升高,经病理分析,4代感染猴均有典型的间质性肺炎特征,肝组织有点状或灶性坏死,淋巴窦扩张,淋巴滤泡萎缩,淋巴细胞减少,淋巴结出现噬红细胞现象,组织巨噬细胞免疫组化染色阳性率从P1到P4逐步增加,从3.5%到22%.结论 SHIV-B''whu能成功感染中国猕猴,引起与HIV感染人后所相似的免疫病理学变化.     

Rapid control of malaria by means of indoor residual spraying of alphacypermethrin in the Democratic Republic of São Tomé and Príncipe

A nationwide yearly cycle of indoor residual spraying (IRS) with a pyrethroid, alphacypermethrin, at a dosage of 50 mg/m(2) was instituted in 2004 in the Democratic Republic of S?o Tomé and Príncipe. Rates of IRS acceptance were high, varying from 82% to 95% for dwellings and outhouses. Epidemiologic surveys of the children < 9 years of age before and after the first IRS cycle revealed a rapid reduction in malaria. Overall prevalence of malaria parasitemia for all districts was lowered from 20.1% to 2.8% at 12 months after the first IRS and reached 0.7% at 8 months after the second IRS. Longer insecticidal persistence was found on wood than on cement with alphacypermethrin.     

Mediation of β-endorphin in andrographolide-induced plasma glucose-lowering action in type I diabetes-like animals

In the present study, we investigated the mechanism(s) for glucose-lowering action of andrographolide in streptozotocin-induced diabetic rats (STZ-diabetic rats). Andrographolide lowered plasma glucose concentrations in a dose-dependent manner and increased plasma beta-endorphin-like immunoreactivity (BER) dose-dependently in diabetic rats. Both of these responses to andrographolide were abolished by the pretreatment of animals with prazosin or N-(2 -(2-cyclopropylmethoxy) ethyl) 5-choro-alpha-dimethyl-1H-indole-3-thylamine (RS17053) at doses sufficient to block alpha(1)-adrenoceptors (ARs). Also, andrographolide enhanced BER release from isolated rat adrenal medulla in a concentration-related manner that could be abolished by alpha(1)-ARs antagonists. Bilateral adrenalectomy in STZ-diabetic rats eliminated the activities of andrographolide, including the plasma glucose-lowering effect and the plasma BER-elevating effect. Andrographolide failed to lower plasma glucose in the presence of opioid mu-receptor antagonists and in the opioid mu-receptor knockout diabetic mice. Treatment of STZ-diabetic rats with andrographolide resulted in the reduced expression of phosphoenolpyruvate carboxykinase (PEPCK) in liver and an increased expression of the glucose transporter subtype 4 (GLUT 4) in soleus muscle. These effects were also blocked by opioid mu-receptor antagonists. In conclusion, our results suggest that andrographolide may activate alpha(1)-ARs to enhance the secretion of beta-endorphin which can stimulate the opioid mu-receptors to reduce hepatic gluconeogenesis and to enhance the glucose uptake in soleus muscle, resulting in a decrease of plasma glucose in STZ-diabetic rats. However, the roles of other endogenous opioid peptides or the mixture of several opioid peptides in the activation of opioid mu-receptors associated with the plasma glucose-lowering action of andrographolide, should be considered and need more investigation in the future.     

Genetic polymorphisms in hMTH1, hOGG1 and hMYH and risk of chronic benzene poisoning in a Chinese occupational population

Oxidative damage to DNA induced by benzene is an important mechanism of its genotoxicity, which leads to chronic benzene poisoning (CBP). Therefore, genetic variation in DNA repair genes may contribute to susceptibility to CBP in the exposed population. We hypothesized that single nucleotide polymorphisms (SNPs) in hMTH1, hOGG1 and hMYH genes are associated with risk of CBP. We genotyped SNPs at codon 83 of hMTH1, codon 326 of hOGG1, and codon 324 of hMYH in 152 CBP patients and 152 healthy workers occupationally exposed to benzene without poisoning manifestations. The genotypes were determined by polymerase chain reaction-restrained fragment length polymorphism (PCR-RFLP) technique. There were 2.51-fold [adjusted odds ratio (OR_adj), 2.51; 95% CI, 1.14-5.49; P = 0.02] and 2.49-fold (OR_adj, 2.49; 95% CI: 1.52-4.07; P < 0.01) increased risk of CBP for individuals carrying genotypes of hMTH1 83Val/Met + Met/Met and hOGG1 326Cys/Cys, respectively. Compared with individuals carrying genotypes of hOGG1 326Cys/Cys and hMYH 324His/His at the same time, there was a 0.33-fold (OR_adj, 0.33; 95% CI: 0.15-0.72; P < 0.05) decreased risk of CBP for those with genotypes of hOGG1 326Ser/Cys + Ser/Ser and hMYH 324His/Gln + Gln/Gln. In the smoking group, there was a 0.15-fold (OR_adj, 0.15; 95% CI, 0.03-0.68; P = 0.01) decreased risk of CBP for subjects carrying genotypes of hMYH 324His/Gln + Gln/Gln compared with those of genotype of hMYH 324His/His. Therefore, our results suggested that polymorphisms at codons 83 of hMTH1 and codon 326 of hOGG1 might contribute to CBP in a Chinese occupational population.