敏咳清颗粒对人胚肺成纤维细胞增殖、凋亡的影响

目的:通过观察敏咳清颗粒对体外培养的肺成纤维细胞(lung fibroblast,LFB)增殖、凋亡的影响,探讨敏咳清颗粒治疗咳嗽变异性哮喘的作用机制.方法:将常规培养LFB分为空白组、模型组、对照组、敏咳清高浓度组、敏咳清低浓度组、养阴清肺糖浆高浓度组、养阴清肺糖浆低浓组、地塞米松组,加入肝素刺激后分别加入对应的含药血清,采用MTT法检测LFB增殖,TUNEL法检测LFB凋亡.结果:①各组含药血清均可以不同程度地抑制肝素刺激下LIB的增殖,以敏咳清颗粒高剂量组抑制LFB增殖的作用最强,48 h的抑制作用强于24 h,呈剂量依赖性;②各组均出现不同程度细胞凋亡的形态改变,以敏咳清高剂量组诱导LFB凋亡细胞最多.结论:敏咳清颗粒能显著抑制LFB增殖,诱导LFB凋亡.     

严肃游戏在《中国医学史》学习中的应用

传统中医知识学习通常采用“机械记忆”的方式,学生在学习中感到十分抽象,学习效果不尽人意。《岐黄之途》游戏采用Unity 3D为开发平台,融合中国医学史知识要点,将中医理论知识学习与严肃游戏相结合,采用寓教于乐的方式,激发学生学习热情,并提高其学习效率。     

大鼠肝纤维化模型中基质金属蛋白酶-2及其抑制物的表达

目的了解基质金属蛋白酶－２（ＭＭＰ－２）及其组织型抑制剂（ＴＩＭＰ－２）在纤维化过程中的变化,分析它们在始动阶段的作用。方法用免疫组化和酶图法,在异种血清诱导的大鼠肝纤维化模型不同阶段,作肝细胞内ＭＭＰ－２、ＴＩＭＰ－２、酶降解底物Ⅳ型胶原（ＣｏｌⅣ）以及结蛋白（Ｄｍ）定位和半定量研究。结果实验鼠于４周末形成细胞间隔,８周末发展为肝纤维化,含细胞－纤维间隔或纤维间隔,１２、１６周仍为纤维间隔。酶图法表明４周末ＭＭＰ－２活性升高２．５倍左右,８周末仍高于对照鼠。免疫组化显示４周末ＭＭＰ－２阳性细胞数最多,连续切片观察ＭＭＰ－２与Ｄｍ阳性细胞（活化的肝星状细胞）几乎重叠。８周末阳性细胞数有所减少,１２周末明显减少。半定量变化趋势与酶图法一致。ＴＩＭＰ－２于８周末表达开始升高,１２周末达最高。２周末ＣｏｌⅣ表达开始上升,４周末达高峰,以后缓慢下降。结论肝纤维化早期ＭＭＰ－２活性增高,继而ＴＩＭＰ－２分泌过多,ＭＭＰ－２活性受抑,ＥＣＭ降解受阻,纤维化进一步发展。     

Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials

Background

The best reconstruction method for the pancreatic remnant after pancreaticoduodenectomy remains debatable. We aimed to investigate the perioperative outcomes of 2 popular reconstruction methods: pancreaticogastrostomy and pancreaticojejunostomy.

Data Sources

Randomized controlled trials comparing pancreaticogastrostomy versus pancreaticojejunostomy were identified from literature databases (MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Library).The meta-analysis included 8 studies: 607 patients who underwent pancreaticogastrostomy and 604 who underwent pancreaticojejunostomy. Postoperative pancreatic fistula and intra-abdominal fluid collection rates were significantly lower after pancreaticogastrostomy compared with pancreaticojejunostomy. No statistically significant differences were found in the incidence of delayed gastric emptying, biliary fistula, hemorrhage, reoperation, wound infection, overall morbidity, mortality, and length of hospital stay.

Conclusions

Our meta-analysis suggests that pancreaticogastrostomy not only reduces the rate of postoperative pancreatic fistula but also decreases its severity. Pancreaticogastrostomy is associated with a lower rate of intra-abdominal fluid collection. Our results suggest that pancreaticogastrostomy should be the preferred reconstruction method.     

子宫体、乳腺双原发癌的临床病理特征

目的 探讨子宫体、乳腺双原发癌的临床病理特征。方法 回顾性分析首都医科大学附属北京朝阳医院2004年1月至2015年1月收治子宫体、乳腺双原发癌患者（双癌组）29例和子宫体恶性肿瘤患者（单癌组）319例的临床病理资料。结果 双癌组合并糖尿病（χ²=8.02,P=0.007）、肿瘤家族史（χ²=31.76,P<0.001）及其他部位恶性肿瘤（χ²=31.76,P<0.001）的比例显著高于单癌组,双癌组Ⅱ型子宫体恶性肿瘤（χ²=5.52,P=0.030）及低分化癌（χ²=8.39,P=0.020）的构成比明显高于单癌组。单癌组的总生存率（overall survival,OS）明显优于双癌组（Log-rank=6.75,P=0.011）。分层分析显示,在双癌组中,首发子宫体癌的双癌患者Ⅱ型子宫内膜癌的构成比明显高于首发乳腺癌组（58.33%vs 11.76%,χ²=6.882,P=0.014）。首发子宫体癌与首发乳腺癌的两癌发病间隔时间显著不同,前者的间隔时间明显缩短（t=2.23,P=0.028）。两组双原发癌间隔时间的分布差异有统计学意义（χ²=9.60,P=0.010）。结论 合并乳腺癌的子宫体恶性肿瘤与子宫体恶性肿瘤的临床、病理特征不同。乳腺癌后子宫体恶性肿瘤与子宫体恶性肿瘤术后发生乳腺癌的临床、病理特征不同。     

医院信息系统安全架构及实施策略

随着医院信息化建设的拓展,如何建立有效的医院信息系统安全架构,保障信息系统安全、平稳、高效,成为医院信息化建设的重要研究课题.本文从制度、管理和技术三个关键的方面对医院信息系统建设进行综合分析,简要介绍了医院信息系统安全体系的建设实践,结合医院实际,对信息系统的安全架构的实施进行了介绍.     

Multimodal investigation of dopamine D2/D3 receptors,default mode network suppression,and cognitive control in cocaine-use disorder

Stimulant-use disorders have been associated with lower availability of dopamine type-2 receptors (D2R) and greater availability of type-3 receptors (D3R). Links between D2R levels, cognitive performance, and suppression of the default mode network (DMN) during executive functioning have been observed in healthy and addicted populations; however, there is limited evidence regarding a potential role of elevated D3R in influencing cognitive control processes in groups with and without addictions. Sixteen individuals with cocaine-use disorder (CUD) and 16 healthy comparison (HC) participants completed [¹¹C]-(+)-PHNO PET imaging of D2R and D3R availability and fMRI during a Stroop task of cognitive control. Independent component analysis was performed on fMRI data to assess DMN suppression during Stroop performance. In HC individuals, lower D2R-related binding in the dorsal putamen was associated with improved task performance and greater DMN suppression. By comparison, in individuals with CUD, greater D3R-related binding in the substantia nigra was associated with improved performance and greater DMN suppression. Exploratory moderated-mediation analyses indicated that DMN suppression was associated with Stroop performance indirectly through D2R in HC and D3R in CUD participants, and these indirect effects were different between groups. To our knowledge, this is the first evidence of a dissociative and potentially beneficial role of elevated D3R availability in executive functioning in cocaine-use disorder.Subject terms: Addiction, Cognitive control     

HIV-1-specific cytotoxic T lymphocyte (CTL) responses against immunodominant optimal epitopes slow the progression of AIDS in China

To assess the immunodominance patterns of HIV-1-specific cytotoxic T lymphocyte (CTL) responses and the contribution of these responses against the peptides scanning optimal epitopes in chronic infection, we test the HIV-1-specific CTL responses against a panel of 413 overlapping peptides spanning HIV-1 Asian B sequence, including 147 peptides corresponding to optimal clade B epitopes in 49 chronically HIV-1 infected individuals by interferon-gamma Elispot assay. A large variation in the recognition of peptides restricted by the same HLA class I allele is presented. Some epitopes are targeted frequently by individuals while other epitopes restricted by the same allele are rarely recognized in our research. HLA-B35 and HLA-A03 rather than other HLA alleles contribute greatly to total virus-specific CTL responses. Furthermore, there is a significant inverse correlation between the total contribution of HIV-1-specific CTL responses restricted by different HLA alleles to virus-specific immune responses and viral load in the individuals during advanced infection (P=0.002, r=-0.549). The peptides targeted by individuals have significantly lower entropy compared with those not targeted but restricted by the same HLA class I alleles (P<0.05) in 49 individuals infected by HIV-1, especially the advanced infection subgroup (P=0.044). These data demonstrate that the consistent immunodominance patterns of HIV-1-specific CTL responses of Chinese HIV-1 infected individuals and an inverse correlation between the relative contribution of responses restricted by HLA alleles and viral load, which indicates the important protective effect of optimal epitopes against slow disease progression even in advanced infection.     

万古霉素首剂给予负荷剂量对临床结局影响的系统评价

摘 要 目的:系统评价万古霉素首剂给予负荷剂量对患者临床结局的影响。方法：系统检索英文数据库PubMed,Embase,Cochrane Library,中文数据库CNKI,WanFang,CBM,纳入所有关于万古霉素首剂给予负荷剂量的研究。结局指标为感染治疗的有效率、目标浓度的达标率和肾毒性的发生率。结果：纳入1篇随机对照试验,2篇队列研究,共199名患者,其中1篇研究报道负荷剂量可以提高感染治疗的有效率[RR=1.27,95%CI(0.97,1.67),P＞0.05],2篇研究报道负荷剂量可以提高目标浓度的达标率[RR=1.54,95%CI (0.72,3.30),P＞0.05],1篇研究报道负荷剂量组与对照组的肾毒性发生率[RR=3.87,95%CI(0.46,32.57),P＞0.05]。结论：万古霉素首剂给予负荷剂量可以提高感染治疗的有效率和目标浓度的达标率,但未显示出临床优势。