从《伤寒论》热厥论治脓毒症休克

《伤寒论》中热厥的本质应为现代医学中脓毒症休克,二者皆由外界致病因素引起,均为急性感染性疾病引起的急危重症.“厥应下之”论述了热厥的治疗应以清热或攻下为主.脓毒症休克病因病机复杂,临证应四诊合参,辨证施治.若伴见阳明腑实证,治宜攻下,方以小承气汤内泄肠腑热结、外解厥阴气滞;若腑实未见,而是无形邪热内郁,阳气郁遏不能通达...     

κ-硒化角叉菜胶对大鼠红细胞膜流动性与封闭度的影响(英文)

通过测定大鼠红细胞膜荧光偏振度P和N A DH-细胞色素c氧化还原酶的变化,研究kappa-硒化卡拉胶对红细胞膜流动性和封闭度的影响。结果表明,kappa-硒化卡拉胶140mg·kg~(-1)·d~(-1)×30 d可显著降低大鼠红细胞膜荧光偏振度,即可显著提高细胞膜流动性(P<0.05),ig 140及70 mg·kg~(-1)·g~(-1)×30d可显著提高大鼠红细胞膜封闭度(P<0.05)。     

氯沙坦对大鼠心肌缺血再灌注诱导心肌细胞凋亡及对bcl-2,bax 和p53基因表达的影响

目的:研究氯沙坦对大鼠在体心肌缺血再灌注后细胞凋亡影响以及与bcl-2,bax和p53基因表达变化之间的关系.方法:用原位末端标记、原位杂交、免疫组化分别检测细胞凋亡、基因表达产物的mRNA和蛋白质,经图象分析系统测量阳性染色区域的平均光密度值,从而对原位杂交和免疫组化检测物质进行量化分析.大鼠分成对照组、治疗组和假手术组.结果:细胞凋亡数各组间差异非常显著(P<0.001);原位杂交和免疫组化bcl-2对照组、治疗组的升高值与假手术组之间差异显著(P<0.05),治疗组和对照组之间无显著差异(P>0.1);免疫组化bax治疗组、假手术组的降低值与对照组间差异非常显著(P<0.001),治疗组和假手术组之间无差异(P>0.9);bcl-2/bax比值由高到低分别为治疗组、对照组和假手术组.原位杂交p53各组间差异非常显著(P<0.001),假手术组>治疗组>对照组;免疫组化p53假手术组显著高于对照组和治疗组(P＜0.001 ),治疗组和对照组间差异无显著性(P>0.1).结论:氯沙坦可抑制缺血再灌注后心肌细胞凋亡,机制可能是通过抑制bax基因表达使bcl-2/bax比值升高,并抑制p53基因表达的降低.     

原发性和转移性脑肿瘤患者抗凝治疗相关问题探讨

原发性和转移性脑肿瘤患者发生静脉血栓栓塞症和颅内出血的风险均会增加,因此,必须对这类患者抗凝治疗的潜在益处与颅内出血风险加以权衡。本文探讨了原发性和转移性脑肿瘤患者颅内出血的风险以及抗凝治疗的现有证据和近期研究。对于大多数原发性和转移性脑肿瘤患者,使用低分子肝素及新型口服抗凝药谨慎抗凝治疗不会进一步增加颅内出血的风险,应结合患者的具体情况选择合适的抗凝治疗方案,同时还需关注药物相互作用对出血风险的影响。     

麝香酮对谷氨酸所致PC12细胞损伤的保护及作用机制研究

目的:考察麝香酮对谷氨酸引起PC12细胞损伤的保护作用及作用机制.方法:将大鼠嗜铬细胞瘤细胞株(pheochromocytoma,cells,PC12)分为正常组、模型组、麝香酮10.0,1.0,0.1 μmol·L~(-1)高、中、低剂量组和1μmol·L~(-1)尼莫地平组,用500μmol·L~(-1)谷氨酸造成PC12细胞损伤,采用药物预处理给药方法,MTT法测定细胞存活率,流式细胞仪测定细胞凋亡率,采用Fura3/AM为荧光指示剂,用Vector~2 1420多标记免疫分析仪研究麝香酮对谷氨酸所致损伤PC12细胞内Ca~(2+)的作用,流式细胞仪检测线粒体跨膜电位,考察不同浓度麝香酮对PC12细胞的保护作用.结果:麝香酮可明显提高谷氨酸诱导的PC12细胞还原能力,抑制该细胞LDH的释放,提高细胞存活率;抑制兴奋性氨基酸所引起的细胞内Ca~(2+)含量的升高;降低PC12细胞的凋亡百分率,并呈剂量相关性.结论:麝香酮可抑制谷氨酸诱导的PC12细胞凋亡,其作用机制可能与抑制细胞内钙超载,稳定细胞线粒体跨膜电位有关.     

Functional Fiber Reduces Mice Obesity by Regulating Intestinal Microbiota

Obesity may cause metabolic syndrome and has become a global public health problem, and dietary fibers (DF) could alleviate obesity and metabolic syndrome by regulating intestinal microbiota. We developed a functional fiber (FF) with a synthetic mixture of polysaccharides, high viscosity, water-binding capacity, swelling capacity, and fermentability. This study aimed to investigate the effect of FF on obesity and to determine its prevention of obesity by modulating the gut microbiota. Physiological, histological, and biochemical parameters, and gut microbiota composition were investigated in the following six groups: control group (Con), high-fat diet group (HFD), low-fat diet group (LFD, conversion of HFD to LFD), high-fat +8% FF group (8% FF), high-fat +12% FF group (12% FF), and high-fat +12% FF + antibiotic group (12% FF + AB). The results demonstrated that 12% FF could promote a reduction in body weight and epididymal adipocyte area, augment insulin sensitivity, and stimulate heat production from brown adipose tissue (BAT) (p < 0.05). Compared with the HFD, 12% FF could also significantly improve the intestinal morphological integrity, attenuate systemic inflammation, promote intestinal microbiota homeostasis, and stabilize the production of short-chain fatty acids (SCFAs) (p < 0.05). Consistent with the results of 12% FF, the LFD could significantly reduce the body weight and epididymal adipocyte area relative to the HFD (p < 0.05), but the LFD and HFD showed no significant difference (p > 0.05) in the level of inflammation and SCFAs. Meanwhile, 12% FF supplementation showed an increase (p < 0.05) in the abundance of the Bifidobacterium, Lactococcus, and Coprococcus genus in the intestine, which had a negative correlation with obesity and insulin resistance. Additionally, the treatment with antibiotics (12% FF + AB) could inhibit the effect of FF in the HFD. The Kyoto Encyclopedia of Genes and Genomes (KEGG) function prediction revealed that 12% FF could significantly inhibit the cyanogenic amino acid metabolic pathway and decrease the serum succinate concentration relative to the HFD group. The overall results indicate that 12% FF has the potential to reduce obesity through the beneficial regulation of the gut microbiota and metabolites.     

探讨血清lncRNA联合检测CEA、CA724、CA199在胃癌诊断中的临床意义

目的 探讨血清长链非编码RNA(lncRNA)FOXD2-AS1、含铜胺氧化酶4的假基因(AOC4P)的相对表达水平,以及与肿瘤标志物癌胚抗原(CEA)、糖类抗原(CA)199、CA724的联合检测在胃癌(GC)诊断中的临床应用价值。方法 收集该院80例GC患者和85例年龄相仿的体检健康者的血清以及16组GC组织与癌旁组织。利用TCGA数组库分析FOXD2-AS1在GC及癌旁组织中的表达;应用实时荧光定量聚合酶链反应(qRT-PCR)方法检测组织AOC4P,以及血清FOXD2-AS1、AOC4P的相对表达量;化学发光法检测血清CEA、CA199、CA724的水平。应用受试者工作特征(ROC)曲线评价FOXD2-AS1、AOC4P单独诊断以及其与CEA、CA199、CA724联合检测对GC的诊断效能。结果 初诊GC患者血清FOXD2-AS1、AOC4P相对表达量升高,且显著高于健康对照者,差异有统计学意义(P<0.01)。ROC曲线分析结果显示,FOXD2-AS1、AOC4P、CEA、CA199和CA724的曲线下面积(AUC)分别为0.879、0.856、0.699、0.654和...     

Comparison of the safety and prognosis of sequential regorafenib after sorafenib and lenvatinib treatment failure in patients with unresectable hepatocellular carcinoma: a retrospective cohort study

BackgroundThere is lack of studies on sequential regorafenib after sorafenib and lenvatinib treatment failure in patients with unresectable hepatocellular carcinoma (HCC). This study was to explore the safety and prognosis of sequential regorafenib after sorafenib and lenvatinib failure in HCC patients.MethodsThis study was a retrospective, real-world study that included 50 HCC patients who received sequential regrafinib after sorafenib and lenvatinib failure. The safety and prognosis of two groups were compared.ResultsThe incidence of all grade and III/IV adverse events were 68% and 24%. According to Response Evaluation Criteria in Solid Tumours (RECIST) 1.1 and modified (m) RECIST standards, the objective response rates (ORRs) after receiving regorafenib were 14.0% and 22.0%, respectively. The disease control rates (DCRs) were 62.0% and 60.0%, respectively. Based on different first-line targeted drugs, 50 patients were divided into sorafenib (n=22) and lenvatinib group (n=28). There was no differences between two groups except age and bilirubin. And there was no differences in other treatments before or after regorafenib. The baseline between two groups was basically same and had good comparability. There was no difference in incidence of all grade and III/IV adverse events, ORR and DCR between two groups (P>0.05). On long-term prognosis, total overall survival (TOS) in sorafenib and lenvatinib group were 23.0 (95% CI: 15.1–30.9) vs. 29.7 (95% CI: 21.4–38.1) months. The difference was statistically significant (P=0.041). Besides, regorafenib overall survival (ROS) in sorafenib and lenvatinib group were 11.7 (95% CI: 7.1–16.3) vs. 15.9 (95% CI: 8.3–23.5) months. The difference was statistically significant ( P=0.045). The regorafenib progression-free survival (RPFS) was 5.6 (95% CI: 1.9–9.2) vs. 8.0 (95% CI: 5.1–10.9) months in sorafenib and lenvatinib group, respectively, and difference was not statistically significant (P=0.380).ConclusionsRegorafenib is an effective drug for second-line treatment of HCC, with fewer severe adverse events, ORR and DCR was 14–22% and 62–60%, respectively. Both TOS and ROS in lenvatinib group were better than those in sorafenib group. For HCC patients whose first-line targeted drug is lenvatinib, it is safe and effective to accept regorafenib after disease progresses.     

鼻高流量氧疗治疗慢阻肺合并Ⅱ型呼吸衰竭的临床效果

目的 探讨经鼻高流量氧疗治疗老年慢阻肺合并Ⅱ型呼吸衰竭的临床效果。方法 方便选取2019年5月—2020年3月该院诊治的慢阻肺合并Ⅱ型呼吸衰竭老年患者96例,随机平均分为两组。对照组（n=48）患者给予无创正压通气治疗,观察组（n=48）患者给予经鼻高流量氧疗治疗。比较对照组和观察组患者治疗前后的呼吸频率、心率、动脉血气分析指标及FEV1%与慢阻肺症状（CAT）评分。结果 两组患者经治疗后,观察组呼吸频率（20.92±3.77）次/min、心率（85.67±8.82）次/min、MAP(85.22±6.16)mmHg、PaCO2(48.12±4.36)mmHg低于对照组（23.82±4.81）次/min、（91.36±8.93）次/min、（91.18±4.83）mmHg、（51.43±4.94）mmHg,PaO2(85.37±8.51)mmHg高于对照组（76.91±8.47）mmHg,差异有统计学意义（t=3.288、3.141、5.275、3.480、4.882,P<0.05）。观察组患者的FEV1%(84.51±7.65)%高于对照组（73.18±8.57）%,CAT评分...