留置导尿患者膀胱冲洗频率的研究

目的探讨长期留置导尿患者的膀胱冲洗问题。方法选择120例长期留置导尿患者分为四组,分别给予2次／d、1次／d、1次／周或特殊情况下冲洗及不冲洗4种冲洗方法。于留置导尿当天、5d．7d、10d、14d、21d及拔尿管前采集尿液标本进行病原学检查,比较各组泌尿系感染情况。结果不冲洗组泌尿系感染率（13．33％）与1次／周或特殊情况下冲洗组（13．33％）相近,但较2次／d组（56．67％）、1次／d组（36．67％）低,差异具有统计学意义（x^2=18．73,P〈0．01）。但是尿培养阳性率比较中不冲洗组（20．00％）均低于1次／周或特殊情况下冲洗组（30．00％）、1次／d组（53．33％）、2次／d组（76．67％）,差异具有统计学意义（X^2=23．30,P〈0．01）。泌尿系感染的危险因素分析冲洗频率、尿管留置天数是泌尿系感染的重要危险因素。结论频繁的膀胱冲洗不能预防泌尿系感染的发生,应根据患者情况采取个性化膀胱冲洗方案。     

A polysaccharide from the fruiting bodies of Agaricus blazei Murill induces caspase-dependent apoptosis in human leukemia HL-60 cells

Polysaccharides are the major active ingredients of fungus Agaricus blazei for treating and preventing cancer. However, there are no reports showing anti-tumor activity of A. blazei polysaccharides (ABP) on human leukemia (HL)-60 cells in vitro and in vivo. In this study, we demonstrated that ABP efficiently inhibited proliferation of cultured HL-60 cells, which was associated with the induction of apoptosis. The increase in ABP-induced apoptosis was accompanied by loss of mitochondria membrane potential (?Ψm), cytochrome c release from the mitochondria, activation of caspase-3, degradation of poly(ADP-ribose) polymerase (PARP), and the elevated ratio of Bcl-2-associated X (Bax)/B-cell lymphoma 2 (Bcl-2). Moreover, z-DEVD-fmk, a caspase-3 inhibitor, reversed the cytotoxic effects and apoptotic characteristics induced by ABP in HL-60 cells. Furthermore, we confirmed that ABP could obviously inhibit the solid cancer growth of leukemia HL-60 in tumor xenograft model. These data demonstrated that ABP effectively induced the apoptosis of HL-60 cells via a signaling cascade of mitochondrial caspase-3-dependent pathway.     

新型冠状病毒肺炎疫情期间骨科急症处理原则的专家共识

自2019年12月以来,湖北省武汉市部分医院相继收治多个有华南海鲜市场暴露史的不明原因肺炎病例[1]。患者症状多为发热、乏力、干咳并逐渐出现呼吸困难,部分重症患者出现了急性呼吸窘迫综合征或脓毒症休克、甚至病死。2020年1月7日,我国研究人员首次从患者标本中检测出一种新型冠状病毒[2]。2020年1月20日,中华人民共和国国家卫生健康委员会发布2020年1号公告,将新型冠状病毒感染的肺炎纳入乙类传染病,并按照甲类传染病进行防疫、控制[3]。世界卫生组织将新型冠状病毒肺炎命名为"COVID-19"[4]。     

First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advancedEGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label,randomized study

BackgroundIcotinib has been previously shown to be non-inferior to gefitinib in non-selected advanced non-small-cell lung cancer patients when given as second- or further-line treatment. In this open-label, randomized, phase 3 CONVINCE trial, we assessed the efficacy and safety of first-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance in lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutation.Patients and methodsEligible participants were adults with stage IIIB/IV lung adenocarcinoma and exon 19/21EGFR mutations. Participants were randomly allocated (1 : 1) to receive oral icotinib or 3-week cycle of cisplatin plus pemetrexed for up to four cycles; non-progressive patients after four cycles were maintained with pemetrexed until disease progression or intolerable toxicity. The primary end point was progression-free survival (PFS) assessed by independent response evaluation committee. Other end points included overall survival (OS) and safety.ResultsBetween January 2013 and August 2014, 296 patients were randomized, and 285 patients were treated (148 to icotinib, 137 to chemotherapy). Independent response evaluation committee-assessed PFS was significantly longer in the icotinib group (11.2 versus 7.9 months; hazard ratio, 0.61, 95% confidence interval 0.43–0.87;P = 0.006). No significant difference for OS was observed between treatments in the overall population or inEGFR-mutated subgroups (exon 19 Del/21 L858R). The most common grade 3 or 4 adverse events (AEs) in the icotinib group were rash (14.8%) and diarrhea (7.4%), compared with nausea (45.9%), vomiting (29.2%), and neutropenia (10.9%) in the chemotherapy group. AEs (79.1% versus 94.2%;P < 0.001) and treatment-related AEs (54.1% versus 90.5%;P < 0.001) were significantly fewer in the icotinib group than in the chemotherapy group.ConclusionsFirst-line icotinib significantly improves PFS of advanced lung adenocarcinoma patients withEGFR mutation with a tolerable and manageable safety profile. Icotinib should be considered as a first-line treatment for this patient population.     

Effect of lentivirus-mediated gene silencing,targeting toll-like receptor 2, on corneal allograft transplantation in rats

AimThe present work aims to assess the effectiveness of lentiviral vector (LV) mediated Toll-like receptor 2 (TLR2) gene silencing in the survival of transplanted corneal allografts, against immune rejection, in rats.MethodsLV mediated TLR2 small interference RNA (SiRNA) with enhanced green fluorescent protein (eGFP) [LV-TLR2-siRNA-eGFP] was realised and transfected to both rat corneal epithelial (EC) and stromal cells (SC). Multiplicity of infection (MOI) was optimized for transfection efficiency using flow cytometric (FCM) analysis. Viability of transfected cells and the success rate of TLR2 gene silencing were respectively determined by CCK-8 assay and western blot assay. The in-vivo experiments were subjected to a penetrating keratoplasty (PK) performed between host Sprague Dawley (SD) and donor Wistar/SD rats, randomly dividing them into 4 groups including the allograft, isograft, allograft treated with LV-eGFP (LV blank control) and allograft treated with LV-TLR2-siRNA-eGFP (LV treated group). The rejection index (RI) was then recorded under a slit lamp, every day following surgery. Expression of the TLR2 and Myeloid differentiation primary response gene 88 (MyD88) were detected by using immunohistochemistry on day 9 post-surgery, whereas grafts’s TLR2 and MyD88 mRNA were determined on day 5, 9, and 14 post-surgery performing RT-PCR and, normal rat corneas were included as additional controls.ResultsTransfected cells showed the strongest eGFP expression when MOI was 200 with an efficiency of 77.5% for EC and 76.3% for SC. CCK-8 assay, as measured at 72 and 96 h post transfection, showed no significant changes in the cell viability (both EC and SC) between the transfected and the control group (p > 0.05, p > 0.05). Western blot results demonstrated a successful down regulation of TLR2 expression by LV-TLR2-SiRNA-eGFP, in both EC and SC. In vivo, compared to allograft group, LV treated group demonstrated less edema, opacity and neovascularization. Immunohistochemical analysis revealed a lower expression of TLR2 and MyD88 in isograft and LV treated group as compared to allograft group. TLR2 and MyD88 mRNA were detected in all grafts, and increased over time. With its highest expression in allograft group (peak on day 9), the mRNA expression for TLR2 and MyD88 showed a significant difference amongst the groups, on both day 9 and 14 (p < 0.001).ConclusionsLV mediated TLR2 siRNA could effectively down regulate the TLR2 expression via RNA interference and prolong the survival of corneal grafts, although not necessarily able to prevent the rejection.     

疏血通对急性脑梗塞患者脑血流动力学、血清sICAM-1、IL-6、TNF-α的影响

［摘要］目的　探讨疏血通对急性脑梗塞患者血流动力学和血清可溶性细胞间粘附分子-1 （soluble intercellular adhersion molecule-1, sICAM-1）、白介素-6（Interleukin-6, IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）的影响．方法　将2011年1月至2015年1月清涧县人民医院收治的100例急性脑梗塞患者随机分为观察组和对照组,其中对照组患者50例,给予常规药物进行治疗,观察组50例,在给予常规药物治疗的同时静脉滴注疏血通注射液进行治疗．观察2组患者治疗前后脑血流动力学指标变化,并采用酶联免疫吸附实验（enzyme linked immunosorbent assay,ELISA）检测血清sICAM-1、IL-6、TNF-α的表达水平．结果　脑血流动力学指标比较,治疗后对照组脑血流动力学指标改变不显著,差异无统计学意义（P＞0.05）,而观察组患者治疗后各血流动力学指标较同组治疗前以及对照组治疗后均有明显改善,差异具有统计学意义（P＜0.05）．血清sICAM-1、IL-6、TNF-α水平比较,2组患者治疗后血清sICAM-1、IL-6、TNF-α水平较治疗前均有明显降低（P＜0.01）;且治疗后观察组血清sICAM-1、IL-6、TNF-α水平又显著低于同期对照组,差异均具有统计学意义（P＜0.01）．结论　疏血通注射液可有效改善急性脑梗塞患者血流动力学指标,降低患者血清sICAM-1、IL-6、TNF-α的表达,对脑梗塞的治疗有积极作用．     

针药结合治疗老年期痴呆语言障碍疗效观察

目的:观察针药结合对老年期痴呆语言障碍的疗效。方法:将30例老年期痴呆患者采用自身前后对照的方法 ,观察"三焦针法"配合盐酸美金刚在治疗前、治疗1个月、治疗3个月后《严重障碍量表-语言量表》(SIB-L)评分、自发性言语、听理解评分的变化并判断其临床疗效。结果:治疗3个月后,听理解改善总有效率为86.6%,自发性言语改善总有效率为83.3%,SIB-L评分总有效率为86.7%。结论:针药结合治疗老年期痴呆语言障碍具有较好的疗效,值得临床推广应用。     

The human lens: An antioxidant-dependent tissue revealed by the role of caffeine

Cataract is the leading cause of blindness worldwide and surgery is the only option to treat the disease. Although the surgery is considered to be relatively safe, complications may occur in a subset of patients and access to ophthalmic care may be limited. Due to a growing and ageing population, an increase in cataract prevalence is expected and its management will become a socioeconomic challenge. Hence, there is a need for an alternative to cataract surgery. It is well known that oxidative stress is one of the main pathological processes leading to the generation of the disease. Antioxidant supplementation may, therefore, be a strategy to delay or to prevent the progression of cataract. Caffeine is a widely consumed high-potency antioxidant and may be of interest for the prevention of the disease. This review aims to give an overview of the anatomy and function of the lens, its antioxidant and reactive oxygen species (ROS) composition, and the role of oxidative stress in cataractogenesis. Also, the pharmacokinetics and -dynamics of caffeine will be described and the literature will be reviewed to give an overview of its anti-cataract potential and its possible role in the prevention of the disease.     

The faith of non-surveilled pancreatic cysts: a bicentric retrospective study

BackgroundIncidental discovery of pancreatic cystic neoplasms (PCLs) is a common and steadily increasing occurrence. The aim of this study was to investigate a cohort of patients presenting with incidentally detected PCLs which were not included in a surveillance protocol, and to compare their risk of malignant evolution with that of systematically surveilled lesions.Materials and methodsA population of PCLs which did not receive surveillance over a period >10 years (population A) was selected at the Medical University of Vienna. A group of “low risk” branch duct intraductal papillary mucinous neoplasm ≤15 mm in size upon diagnosis undergoing a regular follow-up of at least 5 years at the University of Verona was selected as control (population B). The incidence of pancreatic cancer (PC), cumulative risk of PC and disease-specific survival were compared.ResultsOverall, 376 patients with non-surveilled PCLs were included in study group A and compared to 299 patients in group B. This comparison resulted in similar incidence rates of PC (1.6% vs 1.7%, p = 0.938), a strong similarity in terms of disease-specific mortality rates (1.3% vs 0.3%, p = 0.171) and the 5- and 10-year cumulative risk of PC (? 1% and 2%, p = 0.589) and DSS (? 100% and 98%, p = 0.050).ConclusionThe “price to pay” for a negligence-based policy in the population of non-surveilled PCLs was reasonable, and the incidence of PC was comparable to that reported for a population of low-risk cysts enrolled to a standardized surveillance protocol.