老年人代谢综合征与心脑血管事件

代谢综合征(MS)是一组以肥胖、高血糖、血脂异常以及高血压等聚集发病、严重影响人类健康的临床症候群.代谢综合征在老年人群中具有较高的患病率,其所引发的多种代谢异常都是老年人心脑血管事件的重要危险因子,严重影响老年人的身心健康.     

丙种球蛋白对重症病毒性脑炎疗效的Meta分析

目的:分析评价静脉注射大剂量丙种球蛋白(IVIG)对儿童重症病毒性脑炎(SVE)疗效的随机对照研究(RCT)。方法:根据纳入和排除标准,从医学电子数据库中筛选相关RCT文献,应用Cochrane Handbook for Systematic Reviews of Intervention质量评价标准进行质量评价,用Review Manager 5.0软件进行Meta分析。疗效判断指标为观察期内退热时间、惊厥停止时间、意识恢复时间、脑膜刺激征消失时间、平均住院时间。结果用均差(MD)及其可信区间(CI)表示,以P<0.05为差异有统计学意义。结果:共有6个RCT入选,Meta分析结果显示:治疗组和对照组在退热时间上差异有统计学意义[MD=-2.49,95%CI(-3.75-1.24),P<0.01],惊厥停止时间上差异有统计学意义[MD=-42.86,95%CI(-51.43-34.29),P<0.01],意识恢复时间上差异有统计学意义[MD=-1.73,95%CI(-2.21--1.24)],脑膜刺激征消失时间上差异有统计学意义[MD=-3.25,95%CI(-5.66--0.84),P<0.01],平均住院时间上差异也有统计学意义[MD=-3.25,95%CI(-5.66--0.84),P<0.01]。结论:在儿童重症病毒性脑炎治疗中,大剂量IVIG能有效缩短退热时间、惊厥停止时间、意识恢复时间、脑膜刺激征消失时间、平均住院时间,临床值得推荐使用。开展多中心、大样本、严格试验设计的临床试验有助于进一步明确大剂量IVIG在儿童SVE治疗中的有效性和安全性。     

Daxx与雄激素受体结合的功能片段筛选

目的体外筛选出能与雄激素受体具有相互作用的Daxx结构域。方法应用聚合酶链反应扩增Daxx四个不同功能结构域,分别连接到带有GST标记的原核表达质粒pGEX-6p-1中,构建Daxx四个功能结构域的原核表达载体。经测序鉴定转化E Coli.BL21DE3菌株,经氨苄青霉素筛选并扩增阳性克隆,用IPTG诱导蛋白表达后纯化蛋白,采用GST pu ll-down体外筛选出与雄激素受体具有相互作用的Daxx功能结构域。结果 Daxx不同功能结构域的四个原核表达载体pGEX-6p-1/Daxx/DM1-240、pGEX-6p-1/Daxx/DM241-501、pGEX-6p-1/Daxx/DM502-625和pGEX-6p-1/Daxx/DM626-740经琼脂糖凝胶电泳和DNA测序分析,证实插入质粒的片段大小正确,无读码框移位和突变。IPTG诱导后蛋白表达具有明显差异性,表达蛋白与预期表达蛋白质分子量大小相当。纯化蛋白进行GST pu ll-down实验结果显示Daxx与雄激素受体具有相互作用。结论 Daxx通过第626-740位氨基酸序列与雄激素受体相互结合。     

导向逆转剂Ab-IL2体外偶联以及协同抑瘤作用的研究

探讨利用乳腺癌单克隆抗体作为导向载体,将逆转剂IL2特异性地导向肿瘤细胞,使其发挥逆转作用的临床应用价值,为将此方法用于肿瘤的临床治疗提供医学依据。方法:分别制备人基因重组白细胞介素2（IL-2）以及人乳腺癌单克隆抗体（记为Ab）,将其经过体外的偶联与纯化,并对偶联产物进行严格的质量检测,最终得到导向多药耐药（MDR）逆转剂Ab-IL2,并通过体外MDR逆转作用检测其活性保留。将对阿霉素（ADM）耐药的人乳腺癌细胞系MCF-7/ADM,种植于BALB/c裸鼠皮下,每只小鼠注射量为106个细胞,将得到的荷瘤小鼠分为三组,并于接种后的第14,19天分别进行如下处理:1）对照组:腹腔注射生理盐水;2）ADM组:腹腔注射阿霉素（1 mg/kg体重）;3）协同用药组:同时注射阿霉素（1 mg/kg体重）和前述实验获得的多药耐药逆转剂Ab-IL2（1 mg/kg体重）。分别于14、16、18、20天测量肿瘤大小,并于第20天处死小鼠,取出瘤块并称重,据此计算肿瘤抑瘤率。结果:Ab-IL2的质量合格,活性保留为90.7%。多药耐药逆转剂Ab-IL2与阿霉素联合应用显示出体内协同抑瘤作用,至第20天处死小鼠时,协同用药组的抑瘤率为60.48%,是ADM组（抑瘤率19.44%）的3.11倍。结论:将单克隆抗体介导技术应用于肿瘤MDR导向逆转,可以促进逆转剂有效地发挥其应有的作用,本研究为实现临床上MDR逆转剂的成功应用提供了有力保证。      

刘国安主任医师应用炙甘草汤治疗心悸经验

刘国安主任医师认为心悸主要是由于心阳不足、心阴心阳两虚、中阳不足、心脾两虚、肾阳亏虚、胃虚饮停,上逆犯心所致,临床以中老年人多见,证型以心阴心阳两虚多见,治疗应以炙甘草汤为主方,随证加减。     

低温等离子射频消融治疗慢性肥厚性鼻炎36例效果观察

目的：总结低温等离子射频消融术治疗慢性肥厚性鼻炎疗效。方法：选择下鼻甲肥大并对药物治疗无效的慢性鼻炎病人36例,鼻窥镜直视下应用射频电极在每侧下鼻甲打孔消融,术后1、2周,1,3,6个月分别复查。结果：显效31例,有效4例,无效1例。总有效率97.2%。结论：鼻窥镜下射频消融治疗慢性肥厚性鼻炎,视野清晰,该术式是耳鼻喉科一种安全、有效的微创技术,远期疗效有待观察。     

Depth of sedation using Cerebral State Index in infants undergoing spinal anesthesia

Background: Infants are noted to frequently sleep during spinal anesthesia, with a concomitant fall in Bispectral Index. However, there are suggestions that EEG derived anesthesia depth monitors have inferior performance in infants. The aim of this study was to quantify the degree of sedation during spinal anesthesia in infants using another EEG derived measure of anesthesia effect – the Cerebral State Index (CSI). Methods: Twelve infants, <52 weeks postconceptual menstrual age, scheduled for bilateral inguinal hernia repair under spinal anesthesia were enrolled. Patients received a standard anesthetic protocol with a subarachnoid dose of 1 mg·kg^?1 of levobupivacaine 0.5%. No premedication, sedatives, opioids or anticholinergics were administrated during the perioperative period and patients were left undisturbed during the surgical time, without tactile stimulation or loud auditory stimuli. CSI score (0–100) and bust suppression (BS) (0–100%) were continuously recorded during the surgical time and then statistically re‐evaluated. Results: In all patients the CSI fell during the procedure and there were significant levels of BS recorded by the CSI monitor. The BS occurred between 12 and 34 min after spinal anesthesia with the peak being at 30 min and mean onset time being 15 (2.6) min after spinal block. A statistical significant difference was found between the lowest mean CSI as well as the highest BS if compared with their baseline values. A negative correlation was found between CSI and BS. Conclusions: The degree of burst suppression detected by the CSI in our study supports the hypothesis that infants may have discontinuous patterns of EEG during spinal anesthesia similar to those seen during emergence from general anesthesia. Moreover, the limitations in the application of the adult algorithms to infant EEG may lead to an overestimation of the degree of sedation.     

人原发性胃恶性淋巴瘤裸鼠原位移植高转移模型的建立

Objective To construct a mouse model of highly metastatic gastric lymphoma with orthotopic transplantation of human primary gastric lymphoma specimen. Methods A fresh surgical specimen of primary gastric lymphoma was obtained intraoperatively and implanted into the submucosa of stomach in nude mice. Tumor formation, invasion, metastasis, morphological characteristics under light microscopy and electron microscopy, immunohistochemistry,and the karyotype of orthotopically transplanted tumor cells were studied. Results An orthotopic highly metastatic model of human primary gastric lymphoma in nude mice (HGBL-0305) was successfully established. Histopathology of transplanted tumors showed primary gastric diffuse large B cell lymphoma. CD19, CD20, CD22 and CD79α were positive, while CD3 and CD7 were negative. The number of chromosome ranged from 56 to 69. DNA index(DI) was 1.47±0.12(i.e. heteroploid). Until now, HGBL-0305 model has been maintained for 45 generations by orthotopic passage for almost 4 years in nude mice. A total of 156 nude mice were used for transplantation. The growth rate and resuscitation rate of liquid nitrogen cryopreservation of transplanted tumor cells were both 100%. The autonomic growth of the transplanted tumor cells invaded and destructed all the layers of the nude mice stomach. The metastasis rates of liver, spleen, lymph node, and peritoneal seeding were 69.5%, 55.6%, 45.7%, and 30.5%, respectively. Conclusions An orthotopic highly metastatic model of human primary gastric lymphoma in nude mice is successfully established. HGBL-0305 model may simulate the natural course of primary gastric lymphoma in human and provides an ideal animal model for studies on pathogenesis, metastasis biology and anti-metastatic therapies of primary gastric lymphoma.     

尼曼-匹克C1型类似蛋白1介导依泽替米贝对RAW264.7细胞脂质蓄积的抑制作用

目的观察肠道胆固醇吸收抑制剂依泽替米贝(ezetimibe)对RAW264.7细胞源性荷脂细胞脂质蓄积的影响并对其机制进行初步探讨。方法采用油红O染色、高效液相色谱法检测细胞内脂滴数量和细胞内脂质含量,Western blot对NPC1L1(Niemann-Pick type C1Like-1)进行定性和半定量检测。结果RAW264.7细胞中有NPC1L1蛋白表达。不同浓度(0、0.003、0.01和0.03mol.L-1)依泽替米贝预先孵育RAW264.7细胞24h或最佳浓度(0.03mol.L-1)预先孵育不同时间(0、6、12和24h)后,换50mg.L-1oxLDL继续孵育24h,结果显示不同浓度ezetimibe预先孵育后,细胞内脂滴数量与面积随着浓度的增加而逐渐减少;Ezetimibe预先孵育可减少细胞内脂质蓄积,并呈浓度和时间依赖性。其中0.03mol.L-1ezetimibe预先孵育24h组作用最明显,CE百分比较oxLDL单独孵育组减少了约47%±0.1%。结论小鼠源性巨噬细胞RAW264.7中存在NPC1L1蛋白表达;依泽替米贝能够减少RAW264.7细胞中NPC1L1蛋白表达;依泽替米贝抑制RAW264.7细胞中脂质蓄积。