二尖瓣关闭不全患者心脏瓣膜置换术后发生低心排综合征的相关因素及预测模型构建

目的:分析二尖瓣关闭不全(MR)患者心脏瓣膜置换术(CVR)后发生低心排综合征(LCOS)的相关因素,并构建预测模型.方法:选取我院2018年1月至2020年12月收治的163例MR患者作为研究对象,记录患者基线资料,均行CVR治疗,记录手术相关资料,统计LCOS发生情况,患者分为发生LCOS组和未发生LCOS组,比较两组基线资料及手术相关资料,经Logistic回归分析检验MR患者CVR后发生LCOS的风险因子,构建LCOS预测模型,采用Hosmer-Lemeshow拟合优度检验,并绘制ROC曲线,评价LCOS预测模型的预测效能.结果:163例MR患者完成CVR治疗后,28例发生LCOS,发生率为17.18％;发生LCOS组美国纽约心脏病学会(NYHA)分级、术前B型脑钠肽(BNP)、术前心肌肌钙蛋白T(cTnT)、水电解质紊乱占比高于未发生LCOS组,体外循环(CPB)时间、主动脉阻断(ACC)时间长于未发生LCOS组,术后出血量大于未发生LCOS组,术前LVEF低于未发生LCOS组(P<0.05);经Logistic回归分析结果显示,NHYA分级高、术前LVEF低、术前BNP高、术前cTnT高、水电解质紊乱、CPB时间长、ACC时间长、术后出血量大是MR患者CVR后LCOS发生的风险因子(OR>1,P<0.05);建立预测模型LCOS=0.951?NHYA分级(Ⅱ级=0,Ⅲ级=1)-0.179?术前LVEF+0.015?术前BNP+3.869?术前cTnT+1.014?水电解质紊乱(否=0,是=1)+0.084?CPB时间+0.129?ACC时间+0.298?术后出血量,预测风险值P=e(-17.813+LCOS)/[e(-17.813+LCOS)+1]?100％.绘制受试者工作曲线(ROC)曲线发现,LCOS预测模型用于预测MR患者CVR后LCOS发生风险的AUC为0.895,>0.80,有一定预测价值;LCOS预测模型经Hosmer-Lemeshow拟合优度检验χ2=3.324,P=0.912,P>0.05,模型矫正能力良好,拟合满意.结论:MR患者CVR后LCOS发生受多个风险因子影响,结合多个风险因子建立LCOS预测模型,对预测MR患者CVR后LCOS有一定效能.     

Management of acute intra-abdominal hemorrhage in ruptured hepatoblastoma with transarterial embolization using calibrated gelfoam particles

This brief report aims to evaluate the treatment outcome of transarterial embolization in ruptured hepatoblastoma complicated with acute intra-abdominal hemorrhage. Three children (mean age 6 years) with high-risk hepatoblastoma presented with rupture and acute intra-abdominal hemorrhage. In addition to aggressive fluid resuscitation and blood product support, super-selective embolization of the arteries with active bleeding or pseudoaneurysm was performed using calibrated gelfoam particles, with a technical success rate of 100%. Hemodynamic status and hemoglobin level were normalized in all patients within 2 days postembolization. The 30-day survival rate was 100%. No major complication was detected apart from mild elevation of alanine transaminase.     

Comparative evaluation of simple indices using a single fasting blood sample to estimate beta cell function after islet transplantation

Six single fasting blood sample–based indices—Secretory Unit of Islet Transplant Objects (SUITO), Transplant Estimated Function (TEF), Homeostasis Model Assessment (HOMA)2‐B%, C‐peptide/glucose ratio (CP/G), C‐peptide/glucose creatinine ratio (CP/GCr), and BETA‐2 score—were compared against commonly used 90‐minute mixed meal tolerance test (MMTT) serum glucose and beta score to assess which of them best recognizes the state of acceptable blood glucose control without insulin supplementation after islet allotransplantation (ITx). We also tested whether the indices could identify the success of ITx based on the Igls classification of beta cell graft function. We analyzed values from 47 MMTT tests in 4 patients with up to 140 months follow‐up and from 54 MMTT tests in 13 patients with up to 42 months follow‐up. SUITO, CP/G, HOMA2‐B%, and BETA‐2 correlated well with the 90‐minute glucose of the MMTT and beta‐score (r 0.54‐0.76), whereas CP/GCr showed a modest performance (r 0.41‐0.52) while TEF showed little correlation. BETA‐2 and SUITO were the best identifiers and predictors of the need for insulin support, glucose intolerance, and ITx success (P < .001), while HOMA2‐B% and TEF were unreliable. Single fasting blood sample SUITO and BETA‐2 scores are very practical alternative tools that allow for frequent assessments of graft function.

     

人转化生长因子β3的构建

目的:获取人转化生长因子β₃的编码基因,开发抗衰老的皮肤药物。 方法：采用重叠PCR的方法,设计4对引物,进行4次PCR合成人转化生长因子β₃的编码基 因。 结果：4次PCR后,经2％的琼脂糖凝胶电泳可见一357 bp的条带,将电泳产物回收,连接入pMD-18T载体,经测序分析证实,所获得DNA片段为人转化生长因子β₃的编码基因。 结论：利用重叠PCR方法能够成功构建人转化生长因子β₃的编码基因。     

A Three‐wave Study of Antecedents of Work–Family Enrichment: The Roles of Social Resources and Affect

On the basis of conservation of resources theory (Hobfoll, 1989 ) and the resource‐gain‐development perspective (Wayne, Grzywacz, Carlson, & Kacmar, 2007 ), this paper examines the differential impact of specific social resources (supervisory support and family support) on specific types of affect (job satisfaction and family satisfaction, respectively), which, in turn, influence work‐to‐family enrichment and family‐to‐work enrichment, respectively. A sample of 276 Chinese workers completed questionnaires in a three‐wave survey. The model was tested with structural equation modelling. Job satisfaction at time 2 partially mediated the relationship between time 1 supervisory support and time 3 work‐to‐family enrichment (capital), and the effect of supervisory support on work‐to‐family enrichment (affect) was fully mediated by job satisfaction. Family satisfaction at time 2 fully mediated the relationship between time 1 family support and time 3 family‐to‐work enrichment (affect, efficiency). Implications for theory, practice and future research are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Lentiviral Vectors and Adeno‐Associated Virus Vectors: Useful Tools for Gene Transfer in Pain Research

Pain, especially chronic pain, has always been a heated point in both basic and clinical researches since it puts heavy burdens on both individuals and the whole society. A better understanding of the role of biological molecules and various ionic channels involved in pain can shed light on the mechanism under pain and advocate the development of pain management. Using viral vectors to transfer specific genes at targeted sites is a promising method for both research and clinical applications. Lentiviral vectors and adeno‐associated virus (AAV) vectors which allow stable and long‐term expression of transgene in non‐dividing cells are widely applied in pain research. In this review, we thoroughly outline the structure, category, advantages and disadvantages and the delivery methods of lentiviral and AAV vectors. The methods through which lentiviral and AAV vectors are delivered to targeted sites are closely related with the sites, level and period of transgene expression. Focus is placed on the various delivery methods applied to deliver vectors to spinal cord and dorsal root ganglion both of which play important roles in primary nociception. Our goal is to provide insight into the features of these two viral vectors and which administration approach can be chosen for different pain researches. Anat Rec, 301:825–836, 2018. © 2017 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.