5-氟-2,3-二氢苯并呋喃的合成

对氟苯酚经溴化制得的邻溴对氟苯酚,与1,2-二氯乙烷反应制得2-(2-溴-4-氟苯氧基)氯乙烷,再经格氏反应制得5-氟-2,3-二氢苯并呋喃,总收率79%.     

单眼一退一缩术式矫正集合不足型间歇性外斜视短期效果分析

目的：观察一退一缩术式对集合不足型间歇性外斜视的效果和术后回退程度。

方法：对45例集合不足型间歇性外斜视患者由同一术者进行单眼一退一缩术式后,检查术后1d,2wk的斜视度,并进行统计分析。

结果：集合不足型间歇性外斜视患者45例进行单眼一退一缩术式后,术后1d,视远平均过矫8.27±7.17PD,视近平均过矫2.40±8.86PD,术后2wk视远平均欠矫1.18±6.98PD,视近平均欠矫4.36±7.83PD。术后2wk内,视远平均回退9.45±6.40PD,视近平均回退6.77±7.92PD。视远及视近回退呈正相关。术后2wk视远视近斜视度差异(3.18±5.60PD)较术前(7.65±6.55PD)明显减小,两者呈正相关。

结论：集合不足型间歇性外斜视患者适合一退一缩术式,适当加大内直肌手术量可减少术后远近斜视度的差异,且不改变患者内外直肌的张力状态。术后视远视近回退呈同步状态,视远约回退10PD,术后近期过矫10PD可有利于远期正位。     

High infiltration of mast cells is associated with improved response to adjuvant chemotherapy in gallbladder cancer

Recent studies have reported that tumor‐infiltrating mast cells (TIM) play an important role in tumor regression, but the effect of TIM in gallbladder cancer (GBC) remains unclear. The present study aims to investigate the prognostic value of TIM in GBC patients and its responsiveness to gemcitabine‐based adjuvant chemotherapy (ACT). A total of 298 GBC patients from Zhongshan Hospital were recruited for this study. TIM infiltration was measured by immunohistochemical staining. Accumulation of TIM is significantly associated with prolonged overall survival in GBC patients. The benefit from gemcitabine‐based ACT was superior among patients with high infiltration of TIM with GBC. Multivariate analysis identified TIM infiltration as an independent prognostic factor for overall survival. A heatmap showed that TIM‐activated gene signatures were positively correlated with CD8+ T cells' gene signatures. Gene set enrichment analysis (GSEA) suggested that TIM was related to multiple T cell‐related processes and signaling pathways, including the interferon gamma signaling pathway and the leukocyte migration signaling pathway. It was confirmed that CD8+ T cell infiltration was positively correlated with high TIM infiltration in tissue microarray (TMA), suggesting that TIM infiltration was linked to the immune surveillance in GBC. TIM can be used as an independent prognostic factor and a predictor of therapeutic response of gemcitabine‐based ACT in GBC patients, which may mediate immune surveillance by recruiting and activating CD8+ T cells in GBC.     

A novel technique to insert nasogastric tube for the anesthetized patients during cervical esophageal reconstruction

We are describing a novel technique to insert nasogastric tube （NGT） in the anesthetized patients dur- ing cervical esophageal reconstruction. Methods： Forty patients with mid and upper esophageal tumor enrolled into this study were randomly allocated into two groups （the control group, group C and the novel method group, group N）. All the patients were applied mechanical anastomosis to finish the cervical esophageal reconstruction. The procedure of NGT insertion for group C use the conventional method; well, the group N use the novel technique. Results： All the patients in group N had been finished the NGT insertion in the first attempt, and the total time for insertion was （5.05 ＋ 1.15） mins; on the contrary, for the group C, duration of insertion （min） was （24.45 ± 5.23） mins, and the successful rate of NGT insertion in the first attempt was 40% （P〈 0.05）; no one in group N had coiling/kinking, and 6/20 （30%） in group C had it （P= 0.020）. The complication rate of bleeding between the two group had no significant difference. Conclusion： For the patient with mid and upper esophageal tumor who need cervical esophageal reconstruction, this novel method can save the NGT insertion time, and make it easier with higher successful rate.     

冒癌表达胃泌素受体的特征

目的 研究胃癌表达胃泌素受体(gastrin receptor,GR)的特征及意义。 方法 应用受体的放射配基结合分析法测定34例胃癌标本GR含量及其亲和力,并比较胃癌表达的GR与其部位、分期、分级、胃癌细胞DNA含量、邻近正常胃粘膜的GR及患者生存期的关系。 结果 34例胃癌组织中,16例(47.1％)胃癌GR阳性,其中14例(41.2％)表达高亲和力GR,2例表达低亲和力GR;在高亲和力GR中,9例表达高含量GR(平均含量39.5±14.4 fmol/mg蛋白),5例表达低含量GR(平均含量6.0±2.8 fmol/mg蛋白)。胃体癌(77.8％)和贲门癌(50％)较胃窦癌(20.1％)更易于表达高亲和力GR。相同部位的胃癌及邻近正常粘膜表达GR是一致的,但胃癌表达的胃泌素受体含量(39.5±14.4 fmol/mg蛋白)高于粘膜(26.1±16.6 fmol/mg蛋白)。Ⅲ、Ⅳ期胃癌表达高亲和力GR的比例(13/24)明显高于Ⅰ、Ⅱ期胃癌(1/10)。胃癌表达的GR与癌细胞的分级无关。随访23～61月发现,对于Ⅲ、Ⅳ期胃癌患者,13例表达高亲和力GR的胃癌,有11例死亡;而11例低亲和力GR或GR阴性的胃癌,仅有4例死亡。 结论 GR在胃癌自分泌生长过程中也是一个重要的因素;GR有利于预测患者的预后及指导GR拮抗剂的应用。     

Regulation of PPAR-γ activity in lipid-laden hepatocytes affects macrophage polarization and inflammation in nonalcoholic fatty liver disease

BACKGROUNDLipid metabolism disorder and inflammatory-immune activation are vital triggers in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). Various studies have shown that PPAR-γ exerts potent anti-inflammatory and immunomodulatory properties. However, little is known about the regulation of PPAR-γ activity in modulating cell crosstalk in NAFLD.AIMTo investigate whether the regulation of PPAR-γ activity in lipid-laden hepatocytes affects macrophage polarization and inflammation.METHODSPrimary hepatocytes were isolated from wild-type C57BL6/J mice or hepatocyte-specific PPAR-γ knockout mice and incubated with free fatty acids (FFAs). Macrophages were incubated with conditioned medium (CM) from lipid-laden hepatocytes with or without a PPAR-γ agonist. Wild-type C57BL/6J mice were fed a high-fat (HF) diet and administered rosiglitazone.RESULTSPrimary hepatocytes exhibited significant lipid deposition and increased ROS production after incubation with FFAs. CM from lipid-laden hepatocytes promoted macrophage polarization to the M1 type and activation of the TLR4/NF-κB pathway. A PPAR-γ agonist ameliorated oxidative stress and NLRP3 inflammasome activation in lipid-laden hepatocytes and subsequently prevented M1 macrophage polarization. Hepatocyte-specific PPAR-γ deficiency aggravated oxidative stress and NLRP3 inflammasome activation in lipid-laden hepatocytes, which further promoted M1 macrophage polarization. Rosiglitazone administration improved oxidative stress and NLRP3 inflammasome activation in HF diet-induced NAFLD mice in vivo.CONCLUSIONUpregulation of PPAR-γ activity in hepatocytes alleviated NAFLD by modulating the crosstalk between hepatocytes and macrophages via the reactive oxygen species-NLRP3-IL-1β pathway.     

浮针配合电针治疗中风偏瘫痉挛状态疗效观察

目的：观察浮针配合电针治疗中风偏瘫痉挛状态的临床疗效。方法：将 120 例中风偏瘫肢体痉挛患者随机分为治疗组和对照组,每组 60 例。治疗组采用浮针配合电针治疗,对照组采用单纯电针治疗。分别于治疗前、治疗 30 d 后采用 Ashworth 量表评定肢体痉挛状态,采用简化 Fugl-Meyer 运动功能评分法评定肢体运动功能,采用改良 Barthel 指数（Barthel Index, BI）评定日常生活能力（Activity of Daily Living,ADL）。结果：治疗后,治疗组 Ashworth 评分、Fugl-Meyer 运动功能评分、BI 评分均明显高于对照组（P〈0.05）。浮针配合电针可明显缓解偏瘫肢体的痉挛并且优于对照组。结论：浮针配合电针可有效地缓解脑卒中偏瘫的痉挛状态。     

中药含药血清的研究进展及其在中医学中的应用

主要论述了药物血清制备方法、应用领域、存在问题和未来发展趋势.对当前药物血清的制备,从给药量、给药时间、采血时间及采血后的处理等主要问题进行了总结.同时指出含药血清在中医药研究中应用的范围之泛,能够较好地反映中药的药效,推动中药药代学的发展,建立国际认可的中药及复方质量标准,促进新药开发,阐明中药复方配伍机制.针对含药血清存在的不足,提出药物血清制备要运用现代科学技术,包括中药药代学、中药药效学、中药血清药物化学共同发展,做更深入的研究.     

多途径综合治疗原发性巨块型肝癌48例疗效分析

作者对４８例不能一期切除的原发性巨块型肝癌进行多途径的综合治疗。在一期探查术中应用肝动脉结扎、碘化油化疗药物（ＭＤＦ）混合液灌注化疗和液态硅胶（ＴＨ）栓塞术；术后行肝动脉、门静脉分期灌注化疗；化疗间期经皮向癌灶内分点注射无水酒精。综合治疗半年复查结果：ＰＲ６６．７％、ＭＲ２２．９％、ＳＤ１０．４％。复查后依据病情施行Ⅱ期手术切除２３例，占本组病例的４７．９％（２３／４８）。本组病例随访结果：６、８、１０个月、１、３、５年生存率分别为９３．８％、８７．５％、７９．２％、７５．０％、５６．１％、２５．９％。结果显示，多途径综合治疗疗效显著。     

Effectiveness of novel,lower cost molecular human papillomavirus‐based tests for cervical cancer screening in rural china

This study examined the efficacy of the OncoE6? Cervical Test, careHPV? and visual inspection with acetic acid (VIA) in identifying women at risk for cervical cancer and their capability to detect incident cervical precancer and cancer at 1‐year follow‐up. In a population of 7,543 women living in rural China, women provided a self‐collected and two clinician‐collected specimens and underwent VIA. All screen positive women for any of the tests, a ～10% random sample of test‐negative women that underwent colposcopy at baseline, and an additional ～10% random sample of test‐negative women who did not undergo colposcopy at baseline (n = 3,290) were recruited. 2,904 women were rescreened 1 year later using the same tests, colposcopic referral criteria, and procedures. Sensitivities of baseline tests to detect 1‐year cumulative cervical intraepithelial neoplasia Grade 3 or cancer (CIN3+) were 96.5% and 81.6% for careHPV? on clinician‐collected and self‐collected specimens, respectively, and 54.4% for OncoE6? test. The OncoE6? test was very specific (99.1%) and had the greatest positive predictive value (PPV; 47.7%) for CIN3+. Baseline and 1‐year follow‐up cervical specimens testing HPV DNA positive was sensitive (88.0%) but poorly predictive (5.5–6.0%) of incident CIN2+, whereas testing repeat HPV16, 18 and 45 E6 positive identified only 24.0% of incident CIN2+ but had a predictive value of 33.3%. This study highlights the different utility of HPV DNA and E6 tests, the former as a screening and the latter as a diagnostic test, for detection of cervical precancer and cancer.