三种营养评价方法对老年住院患者营养状况的评价

目的 用三种营养评价方法评价住院老年患者营养不良风险的发生率,探讨最适合住院老年患者的营养评价方法。方法 采用微型营养评价精法(MNA-ALL)、简易的微型营养评价法(MNA-SF)、欧洲营养不良风险调查方法(NRS-2002)对108例住院老年患者营养状况进行调查,并比较不同评价方法的优劣。结果 MNA-ALL和MNA-SF对营养良好、潜在营养不良、营养不良的检出率差异无统计学意义(P>0.05)。MNA-ALL、MNA-SF、NRS2002对营养良好和潜在营养不良(包括营养不良)的检出率差异有统计学意义(P<0.01)。三种方法对男性、低龄组(60~79岁)住院老年患者潜在营养不良(包括营养不良)的检出率差异无统计学意义,女性、高龄组(>80岁)差异有统计学意义(P<0.01,P<0.05)。结论 住院老年患者的营养不良风险的发生率较高,MNA-ALL较其他方法检出营养不良的发生率更高,可作为老年患者入院营养状况筛查的方法。     

益气活血化痰汤、无创双水平气道正压通气联合纳美芬治疗老年慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭疗效研究

目的:探究益气活血化痰汤、无创双水平正压通气联合纳美芬治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭疗效及对患者肺功能、肺部活化调节趋化因子(PARC/CCL18)水平的影响。方法:选取152例老年COPD合并Ⅱ型呼吸衰竭患者,随机分为观察组和对照组,每组76例。两组患者均采用常规解痉、祛痰、抗感染、水电解质平衡等对症治疗和无创双水平气道正压通气,对照组给予纳洛酮治疗,观察组患者另给予益气活血化痰汤、纳美芬治疗,对比两组血气指标、肺功能指标、血清肺表面活性相关蛋白D(SP-D)、PARC/CCL18水平及临床疗效。结果:治疗前两组患者动脉血氧分压(PaO₂)、二氧化碳分压(PaCO₂)、血氧饱和度(SaO₂)、心率及呼吸频率、肺功能、SP-D、PARC/CCL18比较差异无统计学意义(P>0.05)。治疗后观察组患者血气指标水平均优于对照组(P<0.05);治疗后观察组患者心率、呼吸频率、收缩压(SBP)、舒张压(DBP)优于对照组(P<0.05);治疗后观察组患者肺活量为50%时的呼气流速(PEF5...     

NOTCH2 基因突变致Hajdu-Cheney 综合征临床特征及随访并文献复习

目的探讨NOTCH2基因变异致Hajdu-Cheney综合征(HCS)的临床表现和致病基因特点。方法回顾分析1例HCS患儿的临床及随访资料,并复习相关文献。结果患儿,男,11岁8月龄。手指末端发育异常,特殊面容,身材偏矮,摔跤后胸椎压缩性骨折;影像学发现肢端骨溶解、颅底凹陷。高通量测序结果显示,患儿NOTCH2基因存在c.6449_6450delCT,p.Pro2150Argfs*2杂合变异,其父母该位点的基因型均无异常,为新生突变。结论基因检测有助于明确诊断HCS。     

Fracture morphology and biomechanical characteristics of Pauwels III femoral neck fractures in young adults

BackgroundPauwels classification, which categorizes types of femoral neck fractures, cannot fully reflect the three-dimensional characteristics of this injury. The purpose of our study was to determine the morphological characteristics of Pauwels III fractures through computed tomography image analysis and summarize the relevant biomechanical characteristics of different morphological fractures.MethodsWe retrospectively reviewed a total of 209 patients diagnosed with Pauwels type III femoral neck fractures. Fracture reduction was simulated based on mirror symmetry of the bilateral femur by Mimics. The fracture angle was measured and subtypes were defined. Biomechanical characteristics were compared by finite element analysis and validated using a biomechanical experiment, which was performed on a cadaveric sample.ResultsPauwels III femoral neck fractures can be divided into three subtypes: anterior, posterior, and classical. The proportion of three subtypes was 28.71%, 67.46%, and 3.82%, respectively. The anterior subtype showed the lowest axial stiffness but highest implant and bone stress. High stress distributions was concentrated on the screw-bone interface and screw-plate connections.ConclusionsBiomechanical differences across the three subtypes of Pauwels III femoral neck fractures could increase our understanding of the biomechanical characteristics that underlie the Pauwels type III femoral neck fractures (such as, three-dimensional morphology and the stress distribution of bone and implant) that have been associated with high failure rates.     

Modulation of Atg5 expression by globular adiponectin contributes to autophagy flux and suppression of ethanol-induced cell death in liver cells

Globular adiponectin (gAcrp) protects liver cells from ethanol-induced apoptosis via induction of autophagy. However, the underlying mechanisms are unknown. The present study aims to investigate the potential role of autophagy-related protein 5 (Atg5), an essential Atg for the elongation of autophagosomes, in suppression of ethanol-induced cytotoxicity by gAcrp. Here, we demonstrated that suppression of Atg5 expression by ethanol was restored by pretreatment with gAcrp both in primary rat hepatocytes and human hepatoma cell line (HepG2). Moreover, ethanol-induced accumulation of p62 (sequestosome1), a marker of autophagic flux, was restored by gAcrp treatment, implying that gAcrp modulates autophagic flux in liver cells. Further, Atg5 silencing prevented p62 degradation by gAcrp, suggesting that Atg5 plays a critical role in induction of autophagic flux by gAcrp. Interestingly, gene silencing of Atg5 by siRNA abrogated restoration of autophagosome formation by gAcrp in ethanol-treated cells. Finally, protection of liver cells by gAcrp from ethanol-induced apoptosis was also significantly attenuated by knocking-down of Atg5 expression, suggesting an important role of Atg5 in autophagy induction and cellular apoptosis modulated by gAcrp. Taken together, our data demonstrated that Atg5 expression, at least in part, is implicated in gAcrp-induced autophagy and subsequent anti-apoptotic effects in ethanol-treated liver cells.     

新型人工肛门括约肌系统及初步动物实验研究

目的研究可用于治疗肛门失禁的植入式人工肛门括约肌系统（artificial anal sphincter system,AASS）。方法系统由体内执行、体外控制和经皮能量传输3个模块构成,体内外通过无线模式通信。当体内直肠壁上压力超出阈值后,向体外发送排便报警信号,患者通过体外控制模块控制体内执行模块打开或关闭直肠,采用经皮能量传输模块为体内电池充电。通过1例猪的动物实验,评估在活体环境下系统各模块的可靠性和稳定性。15d后将动物解剖,观察组织变化并进行体内的腹泻实验和血供实验。结果植入体内后,体外控制模块可实时控制体内执行模块的各项操作,通过经皮能量传输充电3h,在体内可持续工作24h。拟腹泻状态下,对肠壁施加7．16kPa的压力（正常肛肠静息压为6．26～9．47kPa）,能有效抑制肠道内容物渗漏。结论AASS可以模拟正常人体肛门括约肌功能,为严重肛门失禁的患者提供了一种新的治疗方法。     

腹和腹腔镜下治疗异位妊娠的临床效果及再次妊娠结局

目的：探究腹腔镜手术治疗与开腹手术治疗异位妊娠的临床效果差异及再次妊娠结局。方法：选择我院妇产科2014年11月至2016年12月收治的93例异位妊娠患者作为研究对象,依据治疗方法分为开腹手术治疗（开腹组）45例,腹腔镜手术治疗（腹腔镜组）47例。对比两组患者手术时间、切口长度、术中出血量、排气时间、人绒毛膜促性腺激素（HCG）恢复时间、住院时间、术后受孕情况、疼痛及并发症发生率等指标。结果：腹腔镜组患者手术时间稍多于开腹组,但差异无统计学意义（P＞0.05）;腹腔镜组患者切口长度、术中出血量、排气时间、HCG恢复时间、住院时间均低于开腹组,差异均有统计学意义（P＜0.05）;开腹组术后6、24、48 h VAS评分均高于腹腔镜组,差异均有统计学意义（P＜0.05）;腹腔镜组并发症发生率（2.13%）低于开腹组（13.33%）,差异有统计学意义（P＜0.05）;两组术后输卵管通畅情况、宫内妊娠率对比,腹腔镜组稍高于开腹组,但差异均无统计学意义（P＞0.05）;两组1年内再次异位妊娠发生率对比,腹腔镜组低于开腹组,差异有统计学意义（P＜0.05）,未孕率比较,两组差异无统计学意义（P＞0.05）。结论：异位妊娠治疗中采用腹腔镜手术具有较好的临床效果,切口小,术后疼痛程度更低,术中出血量与排气时间更短,术后1年内再次妊娠率更高。     

疏肝健脾汤联合阿德福韦酯治疗拉米夫定耐药的肝郁脾虚型慢性乙型肝炎疗效观察

目的：观察疏肝健脾汤联合阿德福韦酯治疗拉米夫定耐药的肝郁脾虚型慢性乙型肝炎（CHB）患者的疗效。方法：将80例拉米夫定耐药的CHB肝郁脾虚型患者随机分为疏肝健脾汤组和对照组各40例,对照组采用拉米夫定联合阿德福韦酯片治疗,疏肝健脾汤纽在对照组治疗基础上加服疏肝健脾汤,观察两纽的临床疗效。结果：疏肝健脾汤组患者治疗后在肝功能复常率、症候改善率、HBVDNA阴转率、细胞免疫功能增强等方面均优于对照组,两组比较差异有统计学意义（P〈0．05）。结论：疏肝健脾汤联合阿德福韦酯治疗拉米夫定耐药的肝郁脾虚型CHB患者,具有改善肝功能及临床症候,增强细胞免疫功能从而抑制乙肝病毒复制的临床疗效。     

磁共振波谱成像评价绝经前双侧卵巢切除术对骨髓脂肪的影响

目的探讨磁共振波谱成像(MRS)评估绝经前双侧卵巢切除术对腰椎骨髓脂肪的影响。方法收集32例接受子宫切除术和双侧卵巢切除术的患者(年龄47.4±2.8岁),分别在术前、术后第6个月、12个月行腰3椎体MRS扫描,测定骨髓脂肪分数(fat fraction,FF)。同时,定量CT测量L 3椎体松质骨容积骨密度(vBMD)。结果卵巢切除术后,腰椎vBMD呈现时序性降低而骨髓FF呈现急剧时序性增高。术后6个月骨髓FF及腰椎vBMD分别为(49.7±6.9)%、(134±22)mg/cc,FF急剧增加22.7%,而vBMD下降9.5%。术后12个月时骨髓FF及腰椎vBMD分别为(53.1±6.3)%、(128±24)mg/cc,分别较6个月时增高6.8%、降低4.5%。相关性分析示△vBMD6M-0M与△FF6M-0M(r=-0.801,P<0.001)、△vBMD12M-0M与△FF12M-0M(r=-0.769,P<0.001)以及△vBMD12M-6M与△FF12M-6M(r=-0.680,P<0.001)均存在负相关性。结论双侧卵巢切除术导致骨髓脂肪含量急剧增加,骨小梁密度减少。MRS测定卵巢切除术后骨髓脂肪或许可早于BMD探及骨髓分子生化成分变化。     

玉屏风多糖组分对皮肤角质形成细胞的作用研究

目的 研究中药方剂玉屏风的多糖组分在体外对角质形成细胞的免疫调节作用。方法 利用Real-time PCR法检测玉屏风多糖组分对激活的皮肤角质形成细胞中各炎症因子表达的调控作用;分别用Real-time PCR法和Elisa法对聚角蛋白微丝蛋白（Filaggrin）在mRNA和蛋白水平的表达进行检测;用Western bolt法检测多糖组分对NF-κB信号通路的调节作用。结果 玉屏风多糖组分明显抑制激活的皮肤角质形成细胞分泌炎症因子,促进Filaggrin的表达,并对NF-κB信号通路有明显的抑制作用,该信号通路对炎症和免疫细胞的活化有重要作用。结论 玉屏风多糖组分在体外对皮肤角质形成细胞有免疫调节作用,能够减缓皮肤局部炎症的发展,为玉屏风方剂的进一步开发应用奠定理论基础。