2型糖尿病患者垂体-肾上腺轴的变化与胰岛素抵抗

目的探讨2型糖尿病患者早期垂体-肾上腺轴的改变与胰岛素抵抗(IR)的关系。方法采用化学发光等方法测定67例新诊断的2型糖尿病患者和33名志愿者(对照组)的血皮质醇(F)和促肾上腺皮质激素(ACTH)(8Am、4Pm和地米抑制后次8Am)以及血清胰岛素(INS)、C肽(C-P)和血糖水平;按HOMA模型计算胰岛素抵抗指数HOM-IR=FINS×FBG/22.5,以此反映2型糖尿病患者IR的情况。结果①2型糖尿病患者8Am血浆F和ACTH、4Pm和地米抑制后次8Am血浆F、血糖、INS、C-P水平以及HOMA-IR均明显高于对照组(P<0.01);②4Pm和地米抑制后次8Am血浆ACTH水平显著低于对照组;③直线相关统计分析显示,皮质醇浓度的升高与空腹血糖升高呈正相关(r=0.48,P<0.01)。与HOMA-IR的升高无直线相关性。结论2型糖尿病患者早期呈现ACTH、皮质醇过度分泌和慢性垂体-肾上腺轴功能紊乱,诱发并加重了糖代谢紊乱和胰岛素抵抗。     

血管内皮损伤标志物在肾移植患者中的应用价值

目的 :通过对肾移植患者血浆可溶性血栓调节蛋白 (solublethrombomdulin ,sTM)、可溶性血管内皮细胞蛋白C受体 (endothelialproteinCreceptor ,sEPCR)、血管性血友病因子 (vonWillebrandfactor,vWF)含量水平的动态检测分析 ,探讨其在肾移植及移植排斥反应中的应用价值。方法 :采用双抗体夹心ELISA法检测 4 2例肾移植患者手术前后、排斥反应治疗过程中的sTM、sEPCR、vWF含量。结果 :肾移植术后sTM、sEPCR、vWF含量水平较术前明显增高 (P <0 0 5 )、与正常对照组比较有显著性差异 (P <0 0 1) ;发生移植排斥反应者较无排斥者有明显差异 (P <0 0 5 ) ;肾移植术前、排斥反应有效治疗后与正常对照组比较无显著差异 (P >0 0 5 ) ;肾移植患者sTM、sEPCR、vWF各指标间呈正相关 (r =0 5 95 ,P <0 0 1,r =0 5 81,P <0 0 1,r =0 6 0 6 ,P <0 0 1)。结论 :sTM、sEPCR、vWF均可作为肾移植患者血管内皮的免疫损伤标志物 ,联合动态监测sTM、sEPCR、vWF的含量在观察肾移植手术创伤程度、排斥反应的早期诊断和治疗效果的监测等方面均有重要的临床应用价值。     

骨组织工程用聚磷酸钙的结构和性能的研究

多孔聚磷酸钙（Calcium polyphosphate，CPP）生物陶瓷是一种新型的骨组织工程支架材料，国外有研究表明聚磷酸钙作为骨组织工程支架材料具有良好的生物相容性及可降解性。通过对原料煅烧过程的研究，探索了聚合度的计算方法，制备出不同聚合度的材料。通过对材料烧结温度的试验，制得了不同晶型的聚磷酸钙多孔材料。在Tris—HCl缓冲液中进行的体外降解实验表明，CPP多孔支架材料是可控降解的，不同聚合度和晶型的支架材料力学强度和降解性能不同。随着聚合度的增加，材料的力学强度增大，降解速率变小；非晶态的CPP17d就可以完全降解，7晶型的CPP25d可完全降解，β和α晶型的CPP降解缓慢，30d分别降解了大约12％和5％。因此聚磷酸钙是一种很有前途的骨组织工程支架材料，凭借其独特的无机聚合物结构及降解性能，有望实现可控速率的降解。     

Population survey of CCR5 delta32, CCR5 m303, CCR2b 64I,and SDF1 3'A allele frequencies in indigenous Chinese healthy individuals,and in HIV-1-infected and HIV-1-uninfected individuals in HIV-1 risk groups

The aim of this study is to determine in indigenous Chinese ethnic groups the frequencies of the chemokine (SDF1 3'A) and chemokine receptors (CCR5 delta32, CCR5 m303, and CCR2b 64I) HIV-1/AIDS restriction alleles. The study includes two cohorts; the first comprised 3165 indigenous healthy subjects representing eight ethnic groups: Han (n = 1406), Uygur (n = 316), Mongolia (n = 134), Hui (n = 386), Tibetan (n = 330), Zhuang (n = 378), Dai (n = 101), and Jingbo (n =114). The second cohort consisted of 330 HIV-1-infected (86 subjects infected by sexual transmission and 198 subjects infected by HIV-1-contaminated blood or by sharing injection equipment; the remaining 46 subjects said nothing about HIV-1 transmission) and 474 HIV-1-uninfected Han Chinese belonging to one of two HIV-1 high-risk groups: intravenous drug users (n = 215) and individuals with sexually transmitted diseases (n = 259). Genotypes for the four genes were obtained using PCR (CCR5 delta32) or PCR-restriction fragment length polymorphism. Randomly selected amplified PCR products were further confirmed by direct DNA sequencing. The variant allele frequencies were determined to be 0% to 3.48% for CCR5 delta32, 0% for CCR5 m303, 16.23% to 28.79% for CCR2b 64I, and 17.70% to 27.76% for SDF1 3'A in Chinese healthy individuals from eight ethnic groups. These findings show that allele frequencies differ among the eight Chinese ethnic groups for CCR5 delta32, CCR2b 64I, and SDF1 3'A and that the CCR5 m303 and CCR5 delta32 mutant alleles were absent or infrequent in Chinese, which may be helpful for studies of specific anti-HIV-1 vaccine trials and coreceptor inhibitor drug targets in Chinese populations. Furthermore, we observed no significant differences in allele or genotypic frequencies between HIV-1-infected and HIV-1-uninfected groups from the Han ethnic group. Our finding is the first reporting that there is likely no effect of the examined polymorphisms in our study on HIV-1 transmission in the Chinese Han population, However, the genetic effects of these and other AIDS-modifying polymorphisms on the pathogenesis and clinical outcome of HIV-1/AIDS diseases is under investigation in Chinese populations.     

Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways

We previously identified the major pathological changes in the respiratory and immune systems of patients who died of severe acute respiratory syndrome (SARS) but gained little information on the organ distribution of SARS-associated coronavirus (SARS-CoV). In the present study, we used a murine monoclonal antibody specific for SARS-CoV nucleoprotein, and probes specific for a SARS-CoV RNA polymerase gene fragment, for immunohistochemistry and in situ hybridization, respectively, to detect SARS-CoV systematically in tissues from patients who died of SARS. SARS-CoV was found in lung, trachea/bronchus, stomach, small intestine, distal convoluted renal tubule, sweat gland, parathyroid, pituitary, pancreas, adrenal gland, liver and cerebrum, but was not detected in oesophagus, spleen, lymph node, bone marrow, heart, aorta, cerebellum, thyroid, testis, ovary, uterus or muscle. These results suggest that, in addition to the respiratory system, the gastrointestinal tract and other organs with detectable SARS-CoV may also be targets of SARS-CoV infection. The pathological changes in these organs may be caused directly by the cytopathic effect mediated by local replication of the SARS-CoV; or indirectly as a result of systemic responses to respiratory failure or the harmful immune response induced by viral infection. In addition to viral spread through a respiratory route, SARS-CoV in the intestinal tract, kidney and sweat glands may be excreted via faeces, urine and sweat, thereby leading to virus transmission. This study provides important information for understanding the pathogenesis of SARS-CoV infection and sheds light on possible virus transmission pathways. This data will be useful for designing new strategies for prevention and treatment of SARS.     

Inhibitory effect of intrathecal meptazinol on carrageenan-induced thermal hyperalgesia in rats

The effect of meptazinol in the spinal cord on carrageenan-induced hyperalgesia was investigated. The latency of paw withdrawal (PWL) to a thermal stimulus was used as an index of inflammatory hyperalgesia in awake rats. Intrathecal (i.t.) injection of 10 and 100 microg meptazinol markedly increased the PWL of the carrageenan-injected paw (P<0.01). The PWL of the non-injected paw was not detectably affected by the administration of meptazinol at the doses tested. I.t. injection of naloxone (5 microg) or atropine (1 microg) alone exhibited no effect on the PWLs of either the carrageenan-injected or non-injected paw. Pretreatment with naloxone, but not atropine, completely blocked the meptazinol-induced anti-hyperalgesia. These observations suggested that mu opioid receptor rather than muscarinic acetylcholine receptor may be involved in the anti-hyperalgesia of meptazinol in the spinal cord.     

引导管芯在更换经口气管导管的应用

目的 观察应用引导管芯做引导，更换经口气管内导管的临床效果。方法 随机选择26例已完成气管内插管的病人，将引导管芯插入气管导管内至隆突水平，并拔出气管导管；将欲更换的气管导管套在引导管芯外，在管芯引导下将气管导管插入气管内，完成换置；结果 全部病例均顺利完成更换导管，换管过程中病人氧合良好，术后未发生与更换导管相关并发症；结论 应用引导管芯更换气管内导管，方法安全，简便易行，可替代传统换管方法。     

Narrowly Distributed Surfactant‐Free Polystyrene Latex with a Water‐Soluble Comonomer

Summary: The surfactant‐free synthesis of latex polymers of styrene and sodium styrenesulfonate (NaSS) was investigated. The development of size and size distribution of the particles was studied by photo‐correlation spectroscopy (PCS) and transmission electronic microscopy (TEM). The effects of NaSS concentration and the order of addition of reactants were examined in detail. The results showed that the particle size decreases with an increase in the styrene sulfonate concentration. The polydispersity index can be reduced by mixing NaSS with styrene homogeneously before adding initiator, but this leads to a slightly larger mean particle size.

TEM image of surfactant‐free polystyrene latex made by the modified method.     

医院感染防控长效工作机制的应用效果研究△

目的：研究在疫情常态化防控下,某三级医院实行感染防控长效工作机制后,医院感染管理质量持续改进的效果。方法：在实行长效机制过程中建立全员参与感控组织和效果评价追踪体系、开展分层级全员培训、利用信息化技术进行质量控制。以长效机制前（2021年1月-2021年7月）感控质量结果为对照组,长效机制后（2021年8月-2022年1月）的感控质量结果为实验组,比较长效机制的应用效果。结果：实行长效机制后感控问题整改不合格率下降,全员的感控意识增强。发热门诊职业防护合格率、多重耐药菌隔离消毒合格率、环境卫生学监测合格率、医院感染率和多重耐药菌医院感染发生率等质量考核指标均有显著改善。结论：实行医院感染防控长效工作机制,能够显著改进医院感染管理质量。