水通道蛋白-9与脑部疾病

水通道蛋白-9(AQP9)是水通道蛋白家族中特殊的一员,对水和多种中性溶质均具有转运活性.AQP9在脑内主要分布于神经胶质细胞、内皮细胞和儿茶酚胺能神经元.目前AQP9在脑内的功能还不完全清楚,初步认为除维持脑内水代谢平衡外,还可能在能量代谢方面发挥重要作用.AQP9与脑部涉及水或能量代谢的疾病如脑血管病、帕金森病和脑肿瘤等密切相关.     

继续教育对基层医务人员有关慢性阻塞性肺疾病相关认知的影响研究

目的了解基层医务人员对慢性阻塞性肺疾病的认知、过去一年继续教育情况及继续教育对慢性阻塞性肺疾病相关认知的影响。方法选取2019年10月1—31日2372名来自社区卫生服务中心(站)、乡镇卫生院和村卫生室的医务人员自愿在线填写了调查问卷,内容包括个人基本特征,对慢性阻塞性肺疾病危险因素和诊断的认知及继续教育情况。结果基层医务人员熟知吸烟、二手烟、长期呼吸道疾病史、室外空气污染和职业性粉尘等危险因素,但是对室内空气污染和遗传因素认知不足,并且仍有12.1%的基层医务人员知晓吸烟是危险因素,但正在吸烟或戒烟6个月以内。80%的调查对象知道肺功能是诊断慢性阻塞性肺疾病的金标准,但仅60.7%的调查对象能正确判读肺功能结果。过去一年中仅44.3%的基层医务人员接受了相关继续教育。继续教育对提升基层医务人员慢性阻塞性肺疾病危险因素和诊断相关认知的影响差异有显著性(OR=1.524,95%CI 1.289～1.802;OR=1.528,95%CI 1.289～1.812)。结论加大继续教育的惠及范围,有针对性地加强基层医务人员对室内空气污染和遗传因素的认知,同时在基层配备肺功能仪的前提下,开展以实操...     

全视网膜光凝治疗糖尿病视网膜病变对视野影响的研究进展

糖尿病视网膜病变(DR)早期视野改变往往比视力更能及时反映病情进展。而全视网膜光凝(PRP)治疗DR在延缓病情进展的同时也造成了患眼视力下降和视野缩小等副作用。有研究表明,PRP治疗后的DR患者可因中心20°范围内的视野缺损而导致驾驶测试失败。为保证PRP疗效同时达到降低并发症的目的,激光技术不断改进与发展,通过调整激光参数、使用新型激光系统、与抗血管内皮生长因子(VEGF)药物联合、中西医结合治疗等方式可一定程度改善患眼视野,实现更佳疗效。未来可考虑在缺血指数(ISI)量化分析下,对视网膜缺血程度进行分级,依据ISI指标和视网膜无灌注区分布探索PRP治疗建议的最佳阈值及光凝范围,从而为DR患者提供更及时、更合理的个性化治疗方案。文章就PRP治疗DR对视野的影响进行简要综述。     

肺开放通气治疗重症急性胰腺炎并发急性呼吸窘迫综合征研究

目的探讨肺开放通气治疗重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)疗效及其对血流动力学的影响。方法将20例重症胰腺炎并发急性呼吸窘迫综合证(ARDS)随机分为Ⅰ组:肺开放通气组(肺保护通气联合肺复张术)和Ⅱ组:常规肺保护通气组,比较两组通气前,通气后12 h,24 h,48 h,72 h血气指标,Ⅰ组与Ⅱ组同时间血气指标和Ⅰ组肺开放通气前后心率,平均动脉压。结果两组通气后较通气前PaO2,SaO2,氧合指数(PaO2/FiO2)显著改善,Ⅰ组较Ⅱ组通气后PaO2,SaO2,氧合指数(PaO2/FiO2)增加更显著,Ⅰ组通气前后心率和平均动脉压无显著变化。结论肺开放通气较常规肺保护通气更能提高氧合且对血流动力学无影响。     

The altering in sensory sensitivity: a current issue of female breast surgery

Breast surgery is an important treatment for women with malignant breast diseases. In addition to breast appearance, the integrity of breast function is increasing in patients with breast diseases. As the basis of breast physiological function, breast skin sensitivity is important to the quality of life of patients after surgery. Breast skin sensitivity gives the patient a “real” breast feeling. The sensory recovery after breast surgery has also become one of the important goals of breast surgery. In this review, we aim to discuss the research progress on recovery of breast skin sensitivity after different treatment modalities for breast disease.     

Intraoperative choroidal detachment during small-gauge vitrectomy: analysis of causes,anatomic, and visual outcomes

IntroductionTo investigate the incidence and causes of intraoperative choroidal detachment (CD) during small-gauge vitrectomy, as well as the anatomic and visual outcomes.MethodsWe retrospectively reviewed the medical records of 1026 consecutive patients who underwent small-gauge vitrectomy from June 2017 to December 2018 at Zhongshan Ophthalmic Centre, Guangzhou, China. Data on the presence, location, and extent of intraoperative CD and its relationship to the infusion cannula were collected. Patient demographic characteristics and postoperative anatomic and visual outcomes were also assessed.ResultsA total of six cases were found to have intraoperative CD, including two with serous CD, three with limited haemorrhagic CD, and one with CD caused by inadvertent perfusion of gas during air/fluid exchange. Retraction of the infusion cannula and acute ocular hypotony were found to be the main causes of intraoperative CD in five out of the six cases. The best-corrected visual acuity of all cases significantly improved after the surgery.ConclusionThe incidence of intraoperative CD during small-gauge vitrectomy is low; the predominant causes are retraction of the infusion cannula and acute ocular hypotony. Immediate awareness and timely closure of the incision may contribute to a better surgical prognosis.Subject terms: Uveal diseases, Diseases     

中美婴儿运动表现测试常模差异分析

目的比较中美婴儿运动表现测试(TIMP)常模,明确本地化研究和修正的重要性,为指导TIMP在国内的推广提供依据。方法经TIMP手册正反译,评估人员培训、信度考核后,分别在华东、华北、华南、华中、西南、西北、东北区域11家医疗机构采样,建立中国TIMP常模,并就样本情况、得分情况及亚组分类与美国常模进行对比。结果中国TIMP常模共13个周龄组,样本总数为1 035例,其中男性占56%,女性占44%,汉族占比95%,少数民族5%,早产儿和足月儿分别占比31%、69%;美国常模共12个周龄组,样本总数为990例,其中男性占52%,女性48%,白种人占58%,黑种人25%,高危、中危、低危婴儿分别占比35%、30%、35%。中国TIMP常模各周龄组得分均值低于同周龄组的美国常模(P<0.01);中国常模第10、50、90百分位数曲线低于美国常模。中国常模足月儿与早产儿亚组对比,大多数周龄组得分无显著差异;美国常模中高危儿亚组得分显著低于低危组(P<0.001)。结论基于两国人口特征和儿童保健发展现状的不同,中美TIMP常模取样人群存在差异。中国常模各周龄组的得分均值低于美国常模同周...     

水凝胶的生物力学研究进展

水凝胶是生物医用领域的重要生物材料,也是近年来的研究热点。但人体内的细胞与组织的微环境和调控机制非常复杂,水凝胶应用于再生修复领域仍存在一些待解决的科学问题。随着生物力学的发展,越来越多的研究者发现除了关注水凝胶的材料学及生物学特性以外,其生物力学特性也是调控细胞功能、影响组织再生修复的关键因素之一。因此,本文总结了水凝胶材料的生物力学研究进展,并对未来的研究工作进行了展望。     

Ruthenium-catalyzed asymmetric hydrogenation of aromatic and heteroaromatic ketones using cinchona alkaloid-derived NNP ligands

A series of cinchona alkaloid-based NNP ligands, including a new one, have been employed for the asymmetric hydrogenation of ketones. By combining ruthenium complexes, various aromatic and heteroaromatic ketones were smoothly reacted, yielding valuable chiral alcohols with extremely high 99.9% ee. Moreover, a proposed reaction mechanism was discussed and verified by NMR.

A series of cinchona alkaloid-based NNP ligands including a new one has been employed for the asymmetric hydrogenation of ketones. By combining ruthenium complexes, various ketones were smoothly reacted with up to 99.9% ee.

Since the well-known failure of using racemic thalidomide, attention has been paid to the manufacture of optically pure compounds as effective components in pharmaceuticals and agrochemicals. Asymmetric hydrogenation of ketones, especially heteroaromatic ketones, has emerged as a popular facile route to approach enantiopure secondary alcohols as essential intermediates for the construction of biologically active molecules.^1–4 Knowles et al.⁵ pioneered the production of enantioenriched chiral compounds in 1968, and Noyori and co-workers^6–8 laid the cornerstone of asymmetric hydrogenation in 1990s. Subsequently, numerous catalytic systems have been developed. Ru-BICP-chiral diamine-KOH was developed and proved to be effective for asymmetric hydrogenation of aromatic ketones by Xumu Zhang.⁹ Cheng-yi Chen reported asymmetric hydrogenation of ketone using trans-RuCl₂[(R)-xylbinap][(R)-daipen] and afforded secondary alcohol in 92–99% ee.¹⁰ Mark J. Burk and Antonio Zanotti-Gerosa disclosed Phanephos-ruthenium-diamine complexes catalyzing the asymmetric hydrogenation of aromatic and heteroaromatic ketones with high activity and excellent enantioselectivity.¹¹ Qi-Lin Zhou et al. designed and synthesized chiral spiro diphosphines as a new chiral scaffold applied in the asymmetric hydrogenation of simple ketones with extremely high activity and up to 99.5% ee.^12–15 Similarly, Kitamura and co-workers have developed a set of tridentate binan-Py-PPh₂ ligands for the asymmetric hydrogenation of ketones affording excellent results.¹⁶ Recently, chiral diphosphines and tridentate ligands based on ferrocene have been developed for the asymmetric hydrogenation of carbonyl compound with a remarkable degree of success.^17–21 Despite many ligands for asymmetric hydrogenation of ketones have been reported, expensive reagent and multistep complicated reactions were employed to synthesize most of them.^22–24 In light of increasing industrial demand, easily obtained, cheap and practical chiral ligands are still highly desirable. In addition to chiral ligands, the selection of metals was essential for asymmetric hydrogenation.^25–27 Although Mn,^28–30 Fe,^31–34 Co,^35–37 Ni^38,39 and Cu^40,41 metals were proved to be effective for asymmetric hydrogenation in recent years, Rh,^42–44 Ir^45,46 and especially Ru remained the most preferred metals. Ruthenium^47–51 was chosen owing to its superior performances in terms of low price, selectivity and activity. Takeshi Ohkuma,⁵² Hanmin Huang^53,54 and Johannes G. de Vries⁵⁵ all successfully used ruthenium catalysts for asymmetric hydrogenation of ketones. Admittedly, there is a continuing interest in the development of cheaper, simpler and more efficient catalysts for the asymmetric hydrogenation of ketones under mild conditions to access corresponding secondary alcohols. Recently, we developed new NNP chiral ligands derived from cinchona alkaloid for the asymmetric hydrogenation of various ketones in extremely excellent results using a iridium catalytic system.⁵⁶ Prompted by these encouraging results, we were interested in exploring a ruthenium-catalyzed asymmetric hydrogenation of ketones with NNP chiral ligands derived from cinchona alkaloid. Here, we showed that changing from iridium to ruthenium, with the same simple synthetic ligands, delivered a catalyst catalyzed asymmetric hydrogenation of ketones to give the industrially important chiral alcohols with up to 99.9% ee. Although the catalytic activity of ruthenium catalyst was not as high as that of the iridium catalyst, the enantioselectivity could be maintained, and even showed higher enantioselectivity in the hydrogenation of some substrates.Chiral tridentate ligand NNP (L1–L10) were synthesized and characterized as reported in our previous publication. With tridentate ligands in hand, we began to evaluate the catalytic performance in benzylidene-bis(tricyclohexylphosphine) dichlororuthenium-catalyzed asymmetric hydrogenation of acetophenone employed as a standard substrate (Fig. 2). MeOH was found to be a better one as the conversion and enantioselectivity were 99.9% and 98.2%, respectively. Bases screening showed that Ba(OH)₂ was superior to the others, giving >99.9% conversion and 98.8% ee in the present catalytic system (Fig. 1). Ligand screening revealed that the configuration of chiral centers of cinchona alkaloids of the ligand markedly affected the catalytic performance. NNP ligands derived from cinchonine and quinidine appeared to benefit both the reaction rate and enantioselectivity, while those derived from cinchonidine and quinine had the opposite effect. Further, different NNP ligands that bearing different substituents on the phenyl rings were evaluated. Similar to our previous research, ligands with electron-withdonating substituents showed better catalytic performance than those with electron-withdrawing substituents. However, it was noted that the more electron-withdonating substituents furnished lower activity but same enantioselectivity. The optimal ligand L5 derived from quinidine with one methoxy group on benzene ring provided the corresponding chiral alcohol with 99.9% conversion and 98.8% ee. Considering that L3 derived from cinchonine had similar catalytic performance to L4 derived from quinidine, new ligand L10 similar to L5 with one methoxy group on benzene ring was synthesized and applied to the asymmetric hydrogenation of template substrate. 99.6% conversion and 97.6% ee was obtained. Hence, L5 was employed as better ligand in subsequent experiments.Open in a separate windowFig. 1The effect of different bases for the asymmetric hydrogenation of acetophenone (substrate/Ru/L5 = 500/1/2, ketones: 0.429 mol L⁻¹, base: 0.15 mol L⁻¹, MeOH: 2 mL, 30 °C, 6 MPa, 2 h.).Open in a separate windowFig. 2The effect of different solvents for the asymmetric hydrogenation of acetophenone. (substrate/Ru/L5 = 1000/1/2, ketones: 0.858 mol L⁻¹, Ba(OH)₂: 0.15 mol L⁻¹, solvent: 2 mL, 30 °C, 6 MPa, 2 h.).The effect of different ligand for the asymmetric hydrogenation of acetophenone^a

静息态功能磁共振局部一致性在抑郁障碍伴失眠症状患者中的研究进展

在抑郁障碍患者中,失眠是常见的伴发症状。早期有效评估抑郁障碍患者的失眠症状是预防患者睡眠问题与抑郁障碍进一步恶化的关键。目前关于睡眠评估工具的综述仅说明了主客观评估工具的效用,极少综述指出与抑郁障碍伴失眠症状相关的评估指标,也很少围绕静息态功能磁共振成像(rs-fMRI)技术作为睡眠状况的客观评估工具进行阐述。因此,本文就用于抑郁障碍伴发失眠症状患者的rs-fMRI局部一致性进行阐述,并指出目前研究单相抑郁障碍(UDD)和双相抑郁障碍(BDD)患者之间在rs-fMRI局部一致性的区别,以期为临床上UDD与BDD患者的诊断、鉴别、治疗及相关研究提供理论基础和实用性参考。