苏拉明对体外培养视网膜色素上皮细胞增殖的影响

目的　研究苏拉明 (suramin)对培养人视网膜色素上皮细胞 (retinal pigm ent epithelium,RPE)增殖的影响 .方法　将不同质量浓度的苏拉明 (1.5 ,15和 15 0 mg· L- 1 )加入RPE细胞培养液 ,采用四甲基偶氮唑盐 (tetrazolium,MTT)比色法 ,细胞分裂指数计数和核仁组成区嗜银染色(Ag NORs)检测苏拉明对 RPE增殖活力的影响 .结果　含有10 0 m L· L- 1小牛血清的培养液可以显著刺激 RPE的增殖(P<0 .0 1) ,无血清组 A值为 0 .19± 0 .0 1、含血清组 A值为0 .30± 0 .0 1;苏拉明抑制了 10 0 m L· L- 1血清条件下 RPE的增殖 ,呈剂量依赖性 ,最大抑制率达 5 1% ,3种浓度组 A值分别为 0 .2 9± 0 .0 1,0 .2 4± 0 .0 1和 0 .14± 0 .0 1,对细胞的形态无明显影响 .结论　苏拉明对血清刺激 RPE增殖有显著非毒性抑制作用     

Pilon骨折的手术治疗体会

目的回顾性分析治疗P ilon骨折的适宜手术方法、最佳手术时机及其手术疗效。方法对2001年至2004年接受手术治疗的52例单侧P ilon骨折患者进行随访,平均年龄36.5岁,伤后至手术时间平均6.8 d。骨折类型:Ⅰ型4例、Ⅱ型36例、Ⅲ型12例。40例行切开复位三叶型(或T型)钢板内固定;12例行有限切开内固定并辅以外固定,其中应用外固定支架者2例,辅以石膏托者10例。术后平均随访16个月。结果采用Mazur评分系统评估手术疗效,52例患者中,优43例,良6例,可3例。术后并发症包括创面不愈合4例,感染2例,延迟愈合1例和关节退行性变7例。结论正确选择手术时机,根据骨折类型和条件灵活选择固定方式是取得良好手术效果的关键。     

Using machine learning to aid treatment decision and risk assessment for severe three-vessel coronary artery disease

BACKGROUNDThree-vessel disease (TVD) with a SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score of ≥ 23 is one of the most severe types of coronary artery disease. We aimed to take advantage of machine learning to help in decision-making and prognostic evaluation in such patients.METHODSWe analyzed 3786 patients who had TVD with a SYNTAX score of ≥ 23, had no history of previous revascularization, and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) after enrollment. The patients were randomly assigned to a training group and testing group. The C4.5 decision tree algorithm was applied in the training group, and all-cause death after a median follow-up of 6.6 years was regarded as the class label.RESULTSThe decision tree algorithm selected age and left ventricular end-diastolic diameter (LVEDD) as splitting features and divided the patients into three subgroups: subgroup 1 (age of ≤ 67 years and LVEDD of ≤ 53 mm), subgroup 2 (age of ≤ 67 years and LVEDD of > 53 mm), and subgroup 3 (age of > 67 years). PCI conferred a patient survival benefit over CABG in subgroup 2. There was no significant difference in the risk of all-cause death between PCI and CABG in subgroup 1 and subgroup 3 in both the training data and testing data. Among the total study population, the multivariable analysis revealed significant differences in the risk of all-cause death among patients in three subgroups.CONCLUSIONSThe combination of age and LVEDD identified by machine learning can contribute to decision-making and risk assessment of death in patients with severe TVD. The present results suggest that PCI is a better choice for young patients with severe TVD characterized by left ventricular dilation.

Coronary artery disease (CAD) is the leading cause of death and disability worldwide.^[1] Three-vessel disease (TVD) is the most severe form of CAD and is characterized by significant stenosis in all three major coronary arteries. The application of myocardial revascularization techniques, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), has significantly improved the clinical outcomes of patients with severe CAD. CABG has traditionally been the standard therapy for complex coronary lesions, including TVD.^[2] In recent years, with the advancements in PCI technology and the accumulation of operators’ experience, the incidence of periprocedural and long-term adverse events of PCI has substantially decreased, and PCI has been gradually applied in the treatment of TVD.^[3,4] Current guidelines recommend use of the SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score and diabetes status to guide the revascularization strategy for patients with TVD.^[5,6] Current practice guidelines do not recommend PCI for patients with TVD with a SYNTAX score of ≥ 23. However, using the SYNTAX score to guide clinical decision-making between PCI and CABG remains controversial, and its reasonability has been questioned since a newly published meta-analysis showed no significant association between the SYNTAX score and the comparative effectiveness of PCI and CABG.^[7] Moreover, the SYNTAX score is a quantitative indicator of the anatomical complexity of TVD and does not include clinical variables that may have significant effects on the patient’s prognosis. Whether some patients with specific clinical characteristics can obtain a comparable or even greater survival benefit from PCI than from CABG is unclear. Moreover, risk assessment for patients with TVD after revascularization therapy remain challenging.^[8–10]Machine learning has recently emerged as an important research method and has been successfully applied in many scientific fields, including clinical medicine.^[11–13] The decision tree algorithm, a common approach in machine learning, can handle non-linearity, heterogeneous effects, and high-dimensional features and partition a trial population into subgroups characterized by multiple simultaneous characteristics.^[14] In the present study involving a large cohort of patients with TVD with a SYNTAX score of ≥ 23, we employed a decision tree algorithm to generate specific subgroups, compared the long-term prognosis between patients who underwent PCI or CABG in each subgroup, and conducted a comparative analysis of the long-term prognosis between subgroups generated by machine learning. We evaluated whether machine learning can help in selecting the optimal revascularization method and assessing risk in patients with severe TVD.     

碳酸氢钠溶液对人牙釉质的抗酸性作用

目的研究碳酸氢钠溶液对人牙釉质抗酸性的影响。方法取制备好的釉质标本40块,随机分成4组,每组10块,设置实验组3组与对照组进行矿化及抗酸实验,分别测定矿化实验及抗酸实验前后各组釉质表面显微硬度值,比较实验前后各组标本显微硬度值的变化。结果矿化实验后,3组实验组釉质标本表面显微硬度值均较实验前显著升高（P〈0.01）,对照组硬度值较实验前略有下降,无统计学意义（P〉0.05）。抗酸实验后,实验组和对照组显微硬度值均下降,混合矿化液组下降程度显著高于其他各组（P〈0.01）;氟化钠矿化液组与碳酸氢钠矿化液组的下降程度差异无统计学意义（P〉0.05）。结论碳酸氢钠溶液可增加釉质抗酸性,且能协同氟化物增强其抗酸能力。     

One‐Year Clinical Outcome of a Randomized Trial of Polymer‐Free Paclitaxel‐Eluting Stents Versus Biodegradable Polymer‐Based Rapamycin‐Eluting Stents in Patients with Coronary Heart Disease

Background: More widespread use of drug‐eluting stents (DES) to treat coronary heart disease (CHD) has recently generated more attention to thrombosis, which was relative to the polymer. Polymer‐free and biodegradable polymer‐based stents are more frequently studied, but their efficacy on preventing detrimental clinical events is unclear. Methods and Results: To assess whether polymer‐free paclitaxel‐eluting stent (YINYI stent) was noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents (EXCEL stent) in preventing detrimental clinical cardiovascular events, a total of 167 consecutive CHD patients requiring DES implantation were randomly divided into the YINYI group (n = 82) and the EXCEL group (n = 85). The primary end‐point was major adverse cardiac events (MACE). The secondary end‐points included stent thrombosis events, all‐cause mortality, and rehospitalization. The study was designed to test the noninferiority or equivalence of the YINYI stent compared with the EXCEL stent with respect to one‐year MACE according to a noninferiority or equivalence margin of 0.1. One‐year MACE was 6.10% in the YINYI group versus 5.88% in the EXCEL group. The lower limit of the one‐sided 95% confidence interval was ?0.0582 (P = 0.002 from the test for noninferiority). The 95% confidence interval for the equivalence test was [?0.0698, 0.0742] (P₁=0.004 and P₂=0.007 from 2 times the 1‐sided test for equivalence). There was no statistically significant difference in thrombosis events, all‐cause death, and rehospitalization (all P > 0.05). Conclusions: In this small randomized trial, polymer‐free paclitaxel‐eluting stents appear to be noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents. (J Interven Cardiol 2012;25:604–610)     

腺病毒介导的HSV-tk基因治疗人脑胶质瘤SHG44的研究

目的　探讨带有ＨＳＶｔｋ 基因的重组腺病毒（Ａｄ．ｔｋ） 结合ＧＣＶ 对国人脑胶质瘤ＳＨＧ４４ 的治疗作用。方法　Ｘｇａｌ 染色比较带有报告基因ＬａｃＺ的重组腺病毒（Ａｄ．ＬａｃＺ） 转染ＳＨＧ４４ 细胞和大鼠脑胶质瘤Ｃ６ 细胞的效率,ＭＴＴ法比较Ａｄ．ｔｋ／ＧＣＶ 系统对ＳＨＧ４４ 和Ｃ６ 细胞的敏感性,ＤＮＡ片段分析细胞杀伤机制;在活体用Ａｄ．ｔｋ／ＧＣＶ 治疗ＳＨＧ４４ 移植瘤。结果　ＭＯＩ为５０ 时,Ａｄ．ＬａｃＺ感染ＳＨＧ４４ 细胞的效率近１００％ ,较Ｃ６ 细胞高;ＭＯＩ为１００ 时,Ａｄ．ｔｋ 感染的ＳＨＧ４４ 细胞对ＧＣＶ 的敏感性较Ｃ６ 细胞高,其半致死剂量（ＩＣ５０） 分别为０ ．１２ μｍｏｌ／Ｌ 和０ ．２６ μｍｏｌ／Ｌ,有凋亡机制参与其细胞杀伤;５ ×１０８ＰＦＵ 的Ａｄ．ｔｋ 肿瘤原位注射结合ＧＣＶ治疗,有效抑制ＳＨＧ４４ 移植瘤生长,肿瘤组织坏死,出血伴有纤维组织增生;与Ａｄ ．ｔｋ／ＰＢＳ组、Ａｄ．ＬａｃＺ／ＧＣＶ 组、ＰＢＳ组相比,肿瘤抑制效率分别为９２．５ ％ 、９２．６％ 、８９ ．５％ （ Ｐ＜０ ．０１） 。结论　Ａｄ．ｔｋ／ＧＣＶ系统对人脑胶质瘤细胞的感染效率和敏感性较高,治疗国人脑胶质瘤效果显著。     

肛管直肠膀胱后尿道贯通伤的诊治

目的 探讨肛管直肠膀胱后尿道贯通伤的诊断与治疗。方法 回顾性总结1995年－2000年肛管直肠膀胱后尿道贯通伤12例，行肛管直肠膀胱伤口清创缝合，粪便尿液有效转流、充分骶前引流。结果 本组12例均治愈，其中2例术后并发骶前间隙感染，经充分引流而愈；1例肛门括约肌修补失败，行Ⅱ期修补治愈；1例发生直肠膀胱瘘，保守治疗而愈。无肛门狭窄、排尿困难、阳瘘等并发症。结论 掌握肛管直肠膀胱后尿道贯通伤的临床特点，及时作出准确诊断，选择合理的手术方案，加强围手术期治疗，是提高疗效的关键。     

硫化氢复合浅低温可选择性激活突触内NMDARs及其下游PI3K/Akt信号通路

目的观察硫化氢（H₂S）复合浅低温对大鼠全脑缺血-再灌注后海马N-甲基-D-天冬氨酸受体（NMDARs）的亚单位NR2A、NR2B、磷酸化蛋白激酶B（p-Akt）及磷酸化糖原合成酶激酶3β（p-GSK 3β）的影响,旨在探讨其发挥脑复苏作用的潜在机制。方法雄性SD大鼠100只,随机均分为五组:假手术组（Ⅰ组）、模型组（Ⅱ组）、浅低温组（Ⅲ组）、硫氢化钠（NaHS）组（Ⅳ组）、浅低温+NaHS组（Ⅴ组）。采用Pulsinelli-Brierley四血管阻塞法建立大鼠全脑缺血再灌注损伤模型,缺血15 min再灌注即刻Ⅳ组和Ⅴ组腹腔注射14μmol/kg NaHS,Ⅲ组和Ⅴ组行体表降温至肛温32～33℃。6 h后断头取海马,分别采用分光光度计法测H₂S的含量,western blot法测NR2A、NR2B、p-Akt及p-GSK 3β的表达,每组分别取4只于再灌注24 h取脑行Tunel染色观察CA1区锥体细胞凋亡情况。结果与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ、Ⅴ组海马组织H₂S含量均升高（P<0.05）;与Ⅱ组相比,Ⅳ和Ⅴ组H₂S含量显著升高（P<0.05）;与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ、Ⅴ组NR2A、NR2B的表达、凋亡指数（AI）均增高（P<0.05）,且Ⅱ和Ⅲ组NR2A/NR2B<1,Ⅰ、Ⅳ和Ⅴ组NR2A/NR2B>1;与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ、Ⅴ组海马p-Akt及p-GSK 3β的表达均上调（P<0.05）;与Ⅱ组相比,Ⅲ、Ⅳ、Ⅴ组海马p-Akt及p-GSK 3β的表达均上调,AI降低（P<0.05）;与Ⅲ和Ⅳ组相比,Ⅴ组海马p-GSK 3β的表达上调（P<0.05）。与Ⅱ组相比,Ⅲ、Ⅳ、Ⅴ组CA1区锥体细胞凋亡程度均明显减轻,尤以Ⅴ组效果最明显。结论 H₂S复合浅低温可能通过选择性作用于突触内的NMDARs,进而激活其下游促存活磷脂酰肌醇-3-激酶/蛋白激酶B（PI3K/Akt）信号通路,抑制锥体细胞凋亡,从而发挥脑复苏的作用。     

中心静脉压联合全心舒张末容积指数指导感染性休克患者容量治疗的效果

目的 评价中心静脉压(CVP)联合全心舒张末容积指数(GEDVI)指导感染性休克患者容量治疗的效果.方法 感染性休克患者23例,性别不煨,年龄18～64岁,休克时间＜6h,急性生理和慢性健康状况评分13～31分,采用随机数字表法,将其随机分为2组:CVP指导容量治疗组(Ⅰ组,n=12)和CVP联合GEDVI指导容量治疗组(Ⅱ组,n=11).2组均静脉输注生理盐水和6％羟乙基淀粉200/0.5,晶体液和胶体液的比例为1∶(0.5 ～ 1.0),输注速率800～ 1600 ml/h,容量治疗过程中Ⅰ组维持CVP8～ 12mmHg;Ⅱ组维持CVP＞8 mm Hg和GEDVI 600 ～ 750 ml/m2.分别于容量治疗前及容量治疗开始后6h时采集动脉及中心静脉的血样,测定血乳酸浓度和中心静脉血氧饱和度(ScvO2),计算乳酸和ScvO2的变化率.结果 与Ⅰ组比较,Ⅱ组乳酸变化率升高(P＜0.05),ScvO2变化率差异无统计学意义(P＞0.05).结论 与CVP指导容量治疗比较,CVP联合GEDVI指导感染性休克患者容量治疗时可增加组织灌注,其效果较好.     

急性出血坏死性胰腺炎大鼠肾上腺病理及功能的变化

目的 建立急性出血坏死性胰腺炎(AHNP)大鼠肾上腺损伤的病理评分标准,观察肾上腺病理损伤和血清皮质酮的变化.方法 将106只大鼠分为假手术组(SO组)和胰腺炎组(AHNP组),设立0、1、3、6、12、24h时间点,其中AHNP12h组11只,24h组15只,其他各时间点均为8只.用5％牛磺胆酸钠溶液(0.1 ml/100 g)逆行胰胆管注射法造模,测定血清淀粉酶、皮质酮水平,观察胰腺和肾上腺病理表现,并进行评分.结果 AHNP组大鼠血清淀粉酶和胰腺病理评分进行性升高,血清皮质酮在1h达高峰,为1252.7μg/L,维持至3h,为1214.1 μg/L,然后迅速下降,至12、24h低于SO组同期皮质酮水平(P＞0.05).肾上腺病理评分逐渐升高,在1～3h之间病理改变最快,由2.08分升至5.26分,3h后病理损伤减慢,12h(7.14分)与24h(7.53分)病理评分差异无统计学意义(P＞0.05).结论 在皮质酮水平处于高峰时,肾上腺皮质病理改变加重最快,此时对肾上腺进行保护治疗,可能是防治胰腺炎相关肾上腺功能不全的关键期.