巨核细胞程序性死亡在系统性红斑狼疮合并血小板减少机制中的研究进展

系统性红斑狼疮（systemic lupus erythmatosus,SLE）是一种以免疫炎症为特点的自身免疫性疾病,血小板减少是SLE常见的血液系统表现之一。SLE合并血小板减少的发病机制一直是研究的难点与热点。随着细胞的程序性死亡与SLE及自身免疫性疾病关系的研究,巨核细胞程序性死亡在SLE合并血小板减少的作用显得尤为重要。本文就巨核细胞程序性死亡在SLE合并血小板减少中发病中的研究进展作一综述。     

重组人胰岛素样生长因子-I对心肌梗死大鼠心肌基质金属蛋白酶表达及心肌间质降解的影响

目的：探讨重组人胰岛素样生长因子-I（rhIGF-I）对心肌梗死（MI）大鼠心肌基质金属蛋白酶（MMPs）的表达及心肌间质降解的影响。方法：48只SD大鼠腹腔注射异丙基肾上腺素建立MI模型后随机分成3组,每组16只,术后分别给予rhIGF-I50μg·kg^-1·d^-1（IGF-I组）、奥曲肽50μg·kg^-1d·^-1d（Oct组）和生理盐水5mL·kg^-1d·d^-1d（MI组）,每组按照用药时间（2、14d）再分成2个亚组（分别是IGF-I2d、IGF-I14d,Oct2d、Oct14d,和MI2d、MI14d组,N=8）,另取8只正常SD大鼠作为阴性对照组。超声测定大鼠左室前壁（LVAW）、后壁（LVPW）厚度、左室收缩末期内径（LVESD）、左室舒张末内径（LVEDD）以及短轴缩短率（FS）;大鼠处死后消化法测定心肌组织匀浆羟脯氨酸浓度;免疫组织化学法检测基质金属蛋白酶-2（MMP-2）、基质金属蛋白酶-9（MMP-9）及基质金属蛋白酶组织抑制因子-1（TIMP-1）在心肌中的表达。结果：与MI组相比,IGF-I组大鼠梗死区心肌MMP-2、MMP-9活性降低,TIMP-1表达增加,心肌胶原降解减少,LVEDD、LVESD减小,FS增加;Oct组MMP-2、MMP-9表达增加,胶原蛋白降解显著,LVAW降低,LVEDD、LVESD增加,FS下降。结论：rhIGF-I治疗使MI大鼠心肌MMPs活性减弱,TIMP-1表达上调,心肌间质胶原降解减少,心室重构减轻。     

卡培他滨维持治疗晚期胃癌的疗效和安全性研究

目的：观察卡培他滨维持治疗晚期胃癌的疗效和安全性.方法：收集48例一线化疗方案以氟尿嘧啶类药物为基础治疗后获益的晚期胃癌患者,设卡培他滨维持治疗组（n=25）和观察组（n=23）,维持组予以卡培他滨1.0 g/m^2 bid第1～14天,休息7d,21d为1个周期,至疾病进展或不能耐受不良反应停药.观察组仅随诊,定期复查.观察维持治疗组的近期疗效和安全性,比较两组无进展生存期的差异.结果：25例卡培他滨维持治疗患者,共完成148个周期化疗,其中5例患者因不良反应停药,余均口服至病情进展,中位治疗周期为6周期.维持治疗疗效分析：5例患者达到PR,16例SD,4例PD.维持治疗有效率为20％,疾病控制率为84％.维持治疗组的中位无进展生存期为8.2个月,观察组的中位无进展生存期为6.1个月（P＜0.05）.维持治疗组的主要不良反应为手足综合症和血液学毒性,但程度较轻,主要为Ⅰ～Ⅱ级,Ⅲ级发生率为28％,无Ⅳ级不良反应发生,耐受性好.结论：一线化疗方案以氟尿嘧啶类药物为基础治疗后获益的晚期胃癌患者,予以卡培他滨维持治疗可延长无进展生存期,不良反应可耐受.     

乳腺疾病超声与钼靶 X线诊断回顾性分析

目的：探讨超声、钼靶X线在乳腺疾病中的诊断价值。方法回顾性分析102例患者超声及钼靶影像资料,并且以临床病理结果作为对照标准。结果乳腺疾病超声诊断符合率87．3％,X线钼靶诊断符合率84．3％,两者联合应用诊断符合率92．2％。结论超声与钼靶对乳腺疾病诊断均有较大价值,乳腺超声可作为乳腺疾病普查首选方法,两者联合应用可提高乳腺疾病诊断符合率。     

甲泼尼松龙琥珀酸钠致血糖升高1例

1例慢性支气管炎急性发作合并阻塞性肺气肿80岁男性患者,给予注射用甲泼尼松龙琥珀酸钠抗炎对症处理,连续使用5天,空腹血糖由2.62 mmol/L升至5.0 mmol/L,考虑为注射用甲泼尼松龙琥珀酸钠引起,给予停药处理。第7天,因气喘加重给予甲泼尼松龙琥珀酸钠。第11天,患者血糖6.2 mmol/L,遂给予阿卡波糖降糖处理。第12天,患者空腹血糖上升至6.8 mmol/L,将注射用甲泼尼松龙琥珀酸钠更换为波尼松口服。继续治疗3天,复查血糖3.2 mmol/L。     

Acute kidney injury after radical gastrectomy: a single center study

Objectives

To investigate the incidence of acute kidney injury (AKI) and identify risk factors for AKI in patients who undergo radical gastrectomy.

Methods

This study included 536 patients underwent radical gastrectomy. Primary outcome was AKI, defined as a ≥50 % increase in serum creatinine relative to baseline during the first three postoperative days. Secondary outcomes were duration of hospitalization and all-cause hospital mortality within 30 days after radical gastrectomy.

Results

A total of 37 (6.9 %) patients developed postoperative AKI. Age, body mass index (BMI), presence of hypertension, hyperlipidemia, poor blood glucose control, and preoperative higher cystatin C were associated with increased frequency of AKI. By multivariable analyses, the independent risk factors for AKI were age, BMI, hypertension, hyperlipidemia, and preoperative cystatin C.

Conclusions

Postoperative AKI is not infrequent after radical gastrectomy. Age, BMI, hypertension, hyperlipidemia, and preoperative cystatin C are independently associated with increased risk of postoperative AKI.     

The analysis of cell-free DNA concentrations and integrity in serum of initial and treated of lymphoma patients

ObjectiveTo evaluate cell-free DNA (cfDNA) in plasma as a promising biomarker for lymphoma, altered levels of cfDNA and its association with clinical parameters are investigated in patients suffered from lymphomas.MethodsPeripheral blood specimens were collected from 60 patients with lymphoma during initial diagnosis and those of another 107 patients with lymphoma during treated stage were also collected, 93 healthy volunteers were selected as control group. Quantitative PCR was used to detect cfDNA level in each group, cfDNA level in different groups was analyzed to understand its relationship with lymphoma patients' clinical features. After correlation analysis between cfDNA and clinical characteristics, Receiver operator characteristic curve was performed to analyze sensitivity and specificity of cfDNA and LDH.ResultscfDNA concentration and integrity in initial stage of lymphoma patients were significantly higher than those in treated stage, and cfDNA concentration in treated phase was significantly higher than cfDNA concentration in control group. There was no significant difference in cfDNA integrity at treated stage compared with control group. There was no significant correlation between patient's age, gender, extranodal invasion and lymphoma pathological type and cfDNA concentration and integrity; In contrast, there was a significant correlation between ECOG score, LDH content, Ann Arbor stage, IPI, B-symptoms, Ki-67 expression and radiotherapy and cfDNA concentration and integrity, both at the time of initial diagnosis and treated stage. cfDNA concentration detection is an optimal diagnostic indicator, followed by cfDNA integrity detection, the sensitivity and specificity of both are superior to the traditional LDH detection.ConclusioncfDNA level is significantly increased in lymphomas patient plasma and may help lymphoma screening. cfDNA level may serve as a potential indicator of lymphomas treatment efficacy.     

猪囊尾蚴跨膜蛋白T24基因的克隆及序列分析

目的 寻找猪囊尾蚴病新的免疫学候选诊断分子.方法 设计合成引物,用PCR法从猪囊尾蚴cDNA文库中扩增出猪囊尾蚴跨膜蛋白T24基因编码序列,将其与线性克隆载体PMD-18T连接,分别进行酶切和PCR鉴定及DNA测序证实.结果 PCR法扩增出一条长度约678 bp的特异性片段,将重组质粒PMD-18T-T24作BamHⅠ和XhoⅠ双酶切,均能得到一个大小与PCR扩增产物一致的插入片段,对插入片段的测序结果表明,T24具有一个长度为678 bp的完整开放阅读框,编码225个氨基酸,理论分子量为23.91 kDa,与GenBank收录的猪囊尾蚴T24基因(编号为AY211879)具有高度的同源性(99.85%).结论 猪囊尾蚴跨膜蛋白T24编码基因克隆成功,为进一步的表达、鉴定及免疫诊断研究奠定了基础.     

日本血吸虫(大陆株)14-3-3 epsilon同型信号转导蛋白诱导小鼠保护性免疫的研究

目的：探索日本血吸虫新的疫苗候选分子对小鼠的保护性免疫效果。方法：利用已构建的真核表达质粒pBK-Sj14-3-3在大肠杆菌ＢＬ２１内表达的日本血吸虫（大陆株）14－3－3epsilon同型融合蛋白质，免疫6周龄BALB／c雌性小鼠，免疫3次，每次间隔2周，第3次免疫后2周感染尾蚴。42d后剖杀小鼠，计算其减虫率和肝减卵率。结果：各免疫组与对照组相比，均获得了部分抗血吸虫保护性免疫力，第1、2、3各免疫组的减虫率分别为32．7％（P＜0．05）、30．7％（P＜0．05）、27．5％（P＜0．05）；其肝减卵率分别是48．5％（P＜0．05）、43．1％（P＜0．05）、28．2％（P＜0．05）。结论：首次证明日本血吸虫14－3－3epsilon同型重组融合蛋白可诱导小鼠抗血吸虫感染的部分保护性免疫力。     

一种新的商环内环内置手术路径在成人包皮环切中的临床应用研究

目的:观察商环内环内置手术路径行成人包皮环切的手术特点及术后并发症。方法:因包皮过长或包茎就诊的528例成年患者采用商环内置手术路径实施商环包皮环切手术,其中包皮过长465例(88.1%),包茎63例(11.9%)。对手术时间、术中出血;术后感染、水肿、伤口裂开、出血进行观察。结果:528例患者手术时间为(3.8±0.3)min;术中出血量为(0.6±0.1)ml;术后2 h疼痛评分为(7.3±0.3)分。67例(12.7%)患者选择不拆环,让环切器自行脱落,脱落时间为(21.6±2.1)d,461例(87.3%)患者术后第7天复诊时选择拆环,给予拆外环处理,拆环时没有出现疼痛。术后感染3例(0.56%),轻度水肿9例(1.70%)。未发生术后出血及切口裂开,患者对外观满意度为98.1%。结论:商环内置式手术方式安全,不需要拆内环,操作更简便,需要的手术器械少,与标准的商环技术相比,缩短了手术时间,术后并发症发生率低,满意度高。不过,仍需要进行随机对照研究来证实这些优势。