IL-17在小鼠肾脏缺血再灌注损伤表达的变化及意义

目的:观察小鼠肾脏缺血再灌注损伤(IR)后不同时间点的血清及肾组织中白细胞介素-17(IL-17)的变化情况。方法:将C57BL/6雄性小鼠随机分为两组。假手术组(n=20)小鼠仅暴露腹腔游离肾蒂,30分钟后关闭腹腔;IR组(n=20)采用100g压力无创血管夹夹闭双侧肾蒂,30分钟后去除,恢复血流。于肾脏IR手术再灌注后3、6、12、24小时收集小鼠血浆及肾脏标本,用全自动生化仪分析血清中肌酐(SCr)与尿素氮(BUN)含量;用HE染色法观察小鼠肾脏组织病理变化;应用酶联免疫吸附法(ELISA)检测不同时间点小鼠血清及肾脏组织中IL-17的含量。结果:肾脏IR诱导小鼠血清BUN、SCr水平显著增高,肾小管坏死率也显著增加,均于IR后24小时达高峰,与假手术组小鼠3、6、12及24小时同时间点相比较,差异有统计学意义(P0.01);小鼠血清及肾组织中IL-17含量也随病情进展表现出升高趋势,IR后24小时达顶峰,与假手术组同时间点相比,差异均具有统计学意义(P0.01)。结论:小鼠肾IR后血清及肾组织中IL-17表达明显增加,大量IL-17表达与肾IR后炎症反应的发生密切相关。IL-17的大量表达可能对小鼠肾脏功能损伤及病理改变有诱导或促进作用。     

一种基于R-R间期的改进型模板匹配法在心电图自动诊断中的应用

目的探讨R-R间期的改进型模板匹配法在心电图(ECG)自动诊断中的应用。方法选择26例受试者ECG数据作为研究对象,分为3组。10例心律失常患者数据作为实验组,其中男性7例,女性3例,年龄24~75岁,平均年龄58.4岁。再选取10例正常人数据作为对照组,其中男性3例,女性7例,年龄26~45岁,平均年龄32.2岁。另选取6例ECG时间大于6 h的长时间病例数据用以证实算法的稳定性,其中男性3例,女性3例,年龄42~63岁,平均年龄56.6岁。使用改进型的信号模板匹配算法检测R波并进而利用计算机程序计算出诊断心率变异性(HRV)的多个因素,借用美国麻省理工学院生理数据库(MIT/BIH)中数据进行测试,对测试结果分组进行统计学检验。结果所选数据组间R-R间期标准差(SDNN)、相邻R-R间期差值的均方根值(RNSSD)、正常窦性心搏间期的平均值(NNVGR)、相邻R-R间期差值大于50 ms的个数占所有R-R间期个数的百分比(PNN50)的计算结果在实验组与对照组之间差异存在统计学意义(P<0.05)。根据改进型模板匹配法得到的6例长时间病例心律失常患者均值都高于对照组。结论该方法可以用来初步筛选ECG心律失常患者,可作为心电预警自动诊断的一种检测参考方法。     

早产儿胃肠道舒适护理管理的临床应用与效果

目的探讨早产儿胃肠道舒适护理管理的临床应用效果。方法加强早产儿舒适体位管理、早期喂养技术管理、舒适洗胃法管理、舒适排便管理,以促进早产儿胃肠道动力,改善肠道微生态。结果喂养不耐受发生率降低,摄入奶量增多,达到足量喂养的日龄和恢复出生体质量的日龄减少,每日体质量增长更快(P0.01或P0.05)。结论加强胃肠道舒适护理管理,能促进早产儿胃肠功能及动力更快发育成熟,改善喂养耐受性,促进其生长发育。     

T4N (+)Ⅲ期食管胸中下段癌3DRT长期生存分析

目的 观察T₄N (+)Ⅲ期食管胸中下段癌IMRT长期生存情况及不良反应。方法 2004-2010年间300例T₄N (+)Ⅲ期食管中下段癌患者采用3DCRT 202例、IMRT 98例,常规分割照射剂量60 Gy。比较两种不同治疗方式的长期生存情况及不良反应。Kaplan Meier法计算生存率并Logrank法检验。结果 5、7年样本量分别为239、120例。3DCRT和IMRT组1、3、5、7年LC率分别为64.4%、40.6%、38.3%、34.2%和68.3%、55.3%、51.9%、51.9%(P=0.048),OS率分别为54.5%、19.8%、14.7%、10.9%和63.3%、34.7%、24.4%、20.3%(P=0.013)。分层分析显示年龄>65岁、放疗前食管造影长度>8.0 cm、CT最大横径>4.6 cm、GTV>60 cm³、邻近组织或器官受累、非手术 N₂期、未行化疗者,IMRT组OS率高于3DCRT组(P=0.022、0.003、0.022、0.034、0.016、0.044、0.047)。IMRT组GTVD_min、GTVD₁₀₀高于3DCRT组(P=0.000、0.000),脊髓D_max低于3DCRT组(P=0.000)。IMRT组急性放射性食管炎发生率明显高于3DCRT组,以轻度(1-2级)食管炎为著(P=0.000)。3DCRT组死于肿瘤局部因素的比率明显高于IMRT组(P=0.039)。结论 局部晚期食管胸中下段癌IMRT安全有效,LC率明显提高,正常组织保护良好,长期生存获益显著。基于回顾分析结果还有待前瞻性随机对照研究的证实。     

Association of the insulin-like growth factor binding protein 3 (IGFBP-3) polymorphism with longevity in Chinese nonagenarians and centenarians

Human lifespan is determined greatly by genetic factors and some investigations have identified putative genes implicated in human longevity. Although some genetic loci have been associated with longevity, most of them are difficult to replicate due to ethnic differences. In this study, we analyzed the association of 18 reported gene single nucleotide polymorphisms (SNPs) with longevity in 1075 samples consisting of 567 nonagenarians/centenarians and 508 younger controls using the GenomeLab SNPstream Genotyping System. Our results confirm the association of the forkhead box O3 (FOXO3) variant (rs13217795) and the ATM serine/threonine kinase (ATM) variant (rs189037) genotypes with longevity (p=0.0075 and p=0.026, using the codominant model and recessive model, respectively). Of note is that we first revealed the association of insulin-like growth factor binding protein 3 (IGFBP-3) gene polymorphism rs11977526 with longevity in Chinese nonagenarians/centenarians (p=0.033 using the dominant model and p=0.035 using the overdominant model). The FOXO3 and IGFBP-3 form important parts of the insulin/insulin-like growth factor-1 signaling pathway (IGF-1) implicated in human longevity, and the ATM gene is involved in sensing DNA damage and reducing oxidative stress, therefore our results highlight the important roles of insulin pathway and oxidative stress in the longevity in the Chinese population.     

Antibiotic resistance rates for Pseudomonas aeruginosa clinical respiratory and bloodstream isolates among the Veterans Affairs Healthcare System from 2009 to 2013

Pseudomonas aeruginosa is a major cause of healthcare-associated infections and resistance among isolates is an increasing burden. The study purpose was to describe national resistance rates for clinical P. aeruginosa respiratory and bloodstream cultures and the prevalence of multidrug-resistant (MDR) P. aeruginosa within the Veterans Affairs (VA). MDR was defined as non-susceptibility to at least one drug in at least 3 of the following 5 categories: carbapenems, extended-spectrum cephalosporins, aminoglycosides, and piperacillin/tazobactam. We reviewed 24,562 P. aeruginosa respiratory and bloodstream isolates across 126 VA facilities between 2009 and 2013. Most isolates were collected from inpatient settings (82%). Resistance was highest in fluoroquinolones (33%) and exceeded 20% for all classes assessed (carbapenems, extended-spectrum cephalosporins, aminoglycosides, and piperacillin/tazobactam). Resistance was higher in inpatient settings and in respiratory isolates. Prevalence of MDR was 20% overall (22% for inpatient isolates, 11% outpatient, 21% respiratory, 17% bloodstream). Our findings are consistent with previous surveillance reports.