Use of sirolimus in patients with primary steroid-resistant nephrotic syndrome

Persistent nephrotic syndrome that does not respond to treatment may cause progression to kidney failure. We designed a therapeutic protocol with sirolimus for this group of patients. We conducted a prospective, interventional, time series, cohort study lasting 20 months. Thirteen patients were enrolled, with a mean age of 10 years (range: 8-18 years old) with steroid-resistant primary nephrotic syndrome and a histological diagnosis of focal and segmental glomerulosclerosis. We administered sirolimus 3.6mg/m2/day. The duration of this regimen was 12 months in responsive patients. The protocol's efficacy was assessed according to reduction of proteinuria (3 response levels: total, partial, or no response). Severity of histological renal damage and mean time from clinical diagnosis to protocol initiation were also assessed. Nine of 13 patients responded to the treatment with sirolimus, and mean progression time and the severity of histological renal damage influenced response to therapy. We believe that sirolimus is a valid treatment option in patients with steroid-resistant nephrotic syndrome, even though this regimen probably requires an earlier treatment.     

糖尿病学组在非内分泌科糖尿病护理中的应用

目的探讨糖尿病学组在非内分泌科糖尿病护理中的运用效果。方法在院内成立糖尿病学组。对非内分泌科护理人员开展系统的糖尿病知识及糖尿病专科技能培训．组织糖尿病专项护理质量检查,制订糖尿病相关护理流程,开展糖尿病护理会诊,开设糖尿病教育门诊,组建糖尿病护理微信及QQ群。最后对组内成员理论知识及操作技能进行评测,并与成立前作比较分析;总分为100分,评价非内分泌科病区糖尿病专项护理质量检测的得分情况,做比较分析。结果培训前学组成员理论知识、胰岛素笔注射操作、血糖仪操作及胰岛素泵操作达标率分别为23．68％、21．05％、39．47％和6．58％,而培训后,除了理论知识达标率为94．74％外,其他均为100．00％．差异有高度统计学意义（P＜0．01）;培训前非内分泌科病区糖尿病专项护理质量检测得分为（65．00±10．23）分,培训后为（95．00±6．18）分,培训前后比较差异显著,差异有高度统计学意义（P＜0．01）;完成院内疑难糖尿病护理会诊28次、糖尿病教育门诊接诊788人次,规范了5项糖尿病护理流程,微信及QQ群共有成员321人。学组成员共同完善了糖尿病的会诊流程。结论糖尿病学组对非内分泌专科护理人员实施的糖尿病知识与护理技能培训可以有效提高对糖尿病患者的护理质量。     

儿童不同病理亚型非霍奇金淋巴瘤的临床特征及预后因素

目的:研究儿童不同病理亚型非霍奇金淋巴瘤(NHL)的临床特征及预后影响因素。方法:收集2011年3月到2017年9月期间福建医科大学附属协和医院收治的初发儿童NHL 93例,按照WHO-2008淋巴系恶性肿瘤分类标准诊断,根据不同免疫标记、病理类型及肿瘤分期选择化疗方案;采用Kaplan-Meier方法计算5年无事件生存率(EFS),用Cox比例风险模型对预后影响因素进行分析。结果:93例NHL患儿中,男女比例为2.88:1,中位年龄6(0.9-13)岁,病理亚型伯基特淋巴瘤(BL)、ALK+间变大细胞淋巴瘤(ALCL)、淋巴母细胞淋巴瘤(LBL)、弥漫大B细胞淋巴瘤(DLBCL)和结外NK/T细胞淋巴瘤(ENKTL)分别为35、17、17、11和7例。在临床上,浅表淋巴结肿大为最常见的首诊表现,而腹腔瘤块(尤其是回盲部)伴LDH明显升高最常见于成熟B-NHL(B-NHL),纵膈肿物最常见于LBL,噬血细胞综合征(HPS)最常见于成熟T/NK细胞型NHL。79例完成2个疗程诱导化疗并评估,总体完全缓解(CR)率为81.01%;中位随访时间为32.5(1.0-88.5)个月,10例复发,复发率为11.90%,中位复发时间为5.9(3.4-15.7)个月;总体5年EFS为(77.1±4.9)%,T-LBL、B-LBL、成熟B淋巴细胞淋巴瘤、ALK+ALCL及ENKTL的5年EFS分别为(53.5±16.1)%、100%、(86.2±5.2)%、(87.5±8.3)%和(28.6±17.1)%。单因素分析显示,B症状、LDH水平、继发HLH、免疫分型、病理亚型、临床分期、诱导化疗是否CR等因素影响患儿的预后。多因素分析显示,诱导化疗2个疗程能否CR为独立的预后危险因素(HR0.001,95%CI:0.000-0.122)。结论:不同病理亚型的儿童NHL临床特征及预后不同,诱导化疗后能否达CR是儿童NHL独立的预后因素。     

新生儿肺泡表面活性物质专用注射管的设计及应用

目的 应用新生儿肺泡表面活性物质专用注射管,探讨最佳的新生儿肺泡表面活性物质给药方式。方法 设计新生儿肺泡表面活性物质专用注射管。选取2019年4月—9月武汉市某三级甲等医院新生儿ICU收治的126例新生儿呼吸窘迫综合征的患儿为研究对象,按入院顺序分为试验组和对照组。试验组66例使用新生儿肺泡表面活性物质专用注射管进行气管内给药;对照组60例使用传统的头皮针与普通气管插管的方法进行气管内给药。观察两组用药过程中SpO₂波动差值、心率波动差值、药物反流发生率并计算给药时间。结果 试验组用药过程中SpO₂的波动差值以及心率波动差值均小于对照组（P<0.05）,试验组药物反流发生率低于对照组,给药时间短于对照组,差异具有统计学意义（均P<0.05）。结论 新生儿肺泡表面活性物质专用注射管操作简便,能减轻给药过程中新生儿SpO₂以及心率的波动,保证新生儿生命体征的稳定,且可以降低药物反流的发生率,减少药物浪费及缩短给药时间。     

Oculus角膜地形图观察泪膜首发破裂点位置的临床研究

目的用Oculus角膜地形图观察正常人及干眼症患者泪膜破裂的首发破裂点位置。方法本研究采用横断面观察性研究。选择26例干眼症患者为研究对象,选取21名正常志愿者作为对照组。检查指标包括干眼主观症状评分、泪膜破裂时间、角膜荧光染色、泪液分泌试验及Oculus角膜地形图检测泪膜破裂的首发破裂点位置,并比较组间差异。结果按照鼻上象限、鼻下象限、颞下象限及颞上象限的顺序,干眼症组泪膜首发破裂点发生于各象限的比例分别为8眼(15.4%)、19眼(36.5%)、10眼(19.2%)、15眼(28.8%)。正常对照组各象限比例依次为8眼(19%)、15眼(35.7%)、14眼(33.3%)、5眼(11.9%)。两组泪膜首发破裂点均最多见于鼻下象限,两组间首发破裂点位置差异无统计学意义(χ2=5.13,P=0.16)。结论利用Oculus角膜地形图可以观察泪膜破裂点的时间和位置,泪膜首发破裂点位置最易出现在鼻下象限。     

Modelling the impact of extended vaccination strategies on the epidemiology of pertussis

The aim of this study was to investigate the optimal pertussis booster vaccination strategy for The Netherlands. A realistic age-structured deterministic model was designed. Assuming a steady-state situation and correcting for underreporting, the model was calibrated using notification data from the period 1996-2000. Several sensitivity analyses were performed to explore the impact of different assumptions for parameters surrounded by uncertainty (e.g. duration of protection after natural infection, underreporting factors, and transmission probabilities). The optimal age of an additional booster dose is in the range of 10-15 years, and implementation of this booster dose will reduce both symptomatic and asymptomatic infections, although the incidence of symptomatic infections in older age groups will increase. The impact of the different assumptions used in the model was in general limited. We conclude that over a wide range of assumptions, an additional booster dose can reduce the incidence of pertussis in the population.     

FASN expression,angiogenesis and lymphangiogenesis in central and peripheral giant cell lesions

Central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL) are non-neoplastic proliferative processes of the jaws. PGCL is a reactive process induced by irritant local factors and CGCL is an intra-osseous lesion of unknown etiology. Both lesions exhibit similar histologic features showing abundant mononuclear cells, admixed with a large number of multinucleated giant cells and a rich vascularized stroma with extravasated erythrocytes, hemosiderin deposition, and blood-filled pools. Recent studies have linked fatty acid synthase (FASN) with angiogenesis.

Objective

To evaluate angiogenesis and lymphangiogenesis and their relationship with FASN expression in CGCL and PGCL.

Material and Methods

Thirteen CGCL and 14 PGCL of the jaws were selected for immunoexpression of FASN; CD34 and CD105 (to assess blood microvessel density [MVD] and microvessel area [MVA]); and D2-40 (to assess lymphatic MVD and MVA).

Results

Within PGCL and CGCL, MVD-CD34 was signifcantly higher than MVD-CD10S, followed by MVD-D2-40. Moreover, a signifcantly higher number of FASN-positive multinucleated giant cells than mononuclear cells were observed. Between PGCL and CGCL, only MVD-CD34 and all MVA were signifcantly higher in PGCL. Positive correlation between MVA-CD10S with FASNpositive mononuclear cells in both lesions was observed.

Conclusions

Our results show both lesions exhibiting similar levels of FASN expression and neoangiogenesis, suggesting constitutive processes that regulate tissue maintenance.     

2008—2018年国内性教育相关研究的文献计量学分析

[目的] 了解近10年以来性教育相关领域的研究热点及研究方向。[方法] 选用中国知网、维普、万方三大中文数据库对2008—2018年国内性教育相关文献进行检索,借助文献管理软件NoteExpress对检索到的文章进行收集与整理。[结果] 共检索到文献2 058篇,出现的关键词有3 221个,其中排名前10的关键词分别为性教育、大学生、青春期性教育、青少年、青春期、中学生、幼儿性教育、性知识、家长、家庭性教育;核心作者共有117位,核心作者群总发文量为463篇,占总文献量的21.5%;成果共发表于674种期刊上,载文量排名前15位的期刊累计载文量406篇;研究单位共有1 031个,其中发文量最大的单位为北京师范大学,共发文31篇。[结论] 近10年国内性教育发文量较大,研究的范围很宽泛,热点集中在大学生以及青春期青少年的性知识、性观念、性心理、性道德等内容,以及针对性教育现状提出相应对策;但未形成较明显的核心作者群,且研究机构相对较分散。