镁离子在治疗心律失常中的研究进展

Mg^2＋是人体内重要的电解质离子，是人体细胞内含量第二丰富的阳离子，具有复杂的调节机制，对维持机体新陈代谢及其他生理功能具有极其重要的作用。目前已发现人体内超过300种酶的作用离不开其参与，其中包括Mg^2＋-K^＋-ATP酶、Ca^2＋-ATP酶等。临床上利用Mg^2＋调节这些酶的活性等特点，将Mg^2＋作为一种预防和治疗心律失常的药物在很多方面运用，但其规范化运用仍有待进一步明确。现将Mg^2＋在心律失常中的运用综述如下。     

稠环磺酰胺衍生物的合成与抗菌活性研究

为了寻找抗菌候选化合物,在前期研究基础上,18个稠环磺酰胺衍生物被设计合成,经1H NMR、13C NMR和MS确认结构。采用两倍稀释法对目标物进行体外抗菌活性测试,结果表明:该类衍生物对所测细菌有不同程度的抑制活性,尤以化合物Ⅱi、Ⅱr的抗菌活性最为突出,其中前者对金葡菌(S.aureus)、大肠埃希菌(E.coli)和耐甲氧西林金葡菌(MRSA)的最小抑菌浓度(MIC)分别为8、32和16μg·mL^-1,后者对S.aureus、E.coli及MRSA的MIC分别为8、64和32μg·mL^-1,两者的抗MRSA活性较显著,值得进一步结构优化和深入研究。     

A 16-plex Y-SNP typing system based on allele-specific PCR for the genotyping of Chinese Y-chromosomal haplogroups

Y-chromosomal SNP (Y-SNP), with its stable inheritance and low mutation, can provide Supplementary information in forensic investigation. While commonly used Y-chromosomal STR haplotypes show their limitations, typing of Y-SNP would become a powerful complement. In this study, a 16-plex Y-SNP typing system based on allele-specific PCR (AS-PCR) was developed to discriminate four dominant Y-chromosomal haplogroups (C-M130, D-CTS3946, N-M231, and O-M175) and 12 predominant sub-haplogroups of O-M175 (O1a-M119, O1a1a1a-CTS3265, O1b-M268, O1b1a2-Page59, O2-M122, O2a1-L127.1, O2a1b-F240, O2a1b1a1-CTS5820, O2a2-P201, O2a2b1a1-M177, O2a2b1a1a1a-Y17728, O2a2b1a2-F114). A series of experimental validation studies including sensitivity, species specificity, male-female mixture and inhibition were performed. The discrimination of the typing system was preliminarily proved with a haplogroup diversity of 0.9239. Altogether, the Y-SNP typing system based on AS-PCR should be capable of distinguishing China’s dominant Y-chromosomal haplogroups in a rapid and reliable manner, thus can be employed as a useful complement in forensic casework.     

Genetic Testing in Inherited Arrhythmias: Approach,Limitations, and Challenges

Genetic testing is playing an ever-expanding role in cardiovascular care and is becoming part of the “toolkit” for the cardiovascular clinician. In patients with inherited arrhythmias, genetic testing can confirm a suspected diagnosis, establish a diagnosis in unexplained cases, and help facilitate cascade family screening. Many inherited arrhythmia syndromes are monogenic diseases arising from a single pathogenic variant involved in the structure and function of cardiac ion channels or structural proteins. As such, “arrhythmia gene panels” will often cast a wide net for such heritable diseases. However, challenges may arise when genetic testing results are ambiguous, or when genetic testing results (genotype) and clinical phenotypes do not match. In cases of “genotype-phenotype matching,” genetic results complement the clinical phenotype and genetic testing can be used in diagnosis, family screening, and occasionally prognostication. It becomes more challenging when genetic results are negative or noncontributory and “contradict” the clinical phenotype. “Genotype mismatches” can also occur when genotype-positive patients have no clinical phenotype, or when genetic testing results point towards a completely different disease than the clinical phenotype. We discuss an approach to genetic testing and review the challenges that may arise when interpreting genetic testing results. Genetic testing has opened a wealth of opportunities in the diagnosis, management, and cascade screening of inherited arrhythmia syndromes, but has also opened a “Pandora’s box” of challenges. Genetic results should be interpreted with caution and in a multidisciplinary clinic, with support from genetic counsellors and an expert with a focused interest in cardiovascular genetics.     

ROS act as an upstream signal to mediate cadmium-induced mitophagy in mouse brain

As a well known generator of reactive oxygen species (ROS), cadmium (Cd) is found to be an effective inducer of mitophagy in mouse kidney and liver cells. Here, we aim to elucidate whether Cd can also initiate mitophagy in mouse brain and what role ROS play in this process. Our results showed that Cd caused overproduction of ROS. Meanwhile, Cd induced mitophagy, as indicated by the collapse of mitochondrial membrane potential (MMP), formation of mitophagosomes, increases of PINK1 level and LC3-II/LC3-I ratio and decrease of mitochondrial mass. Scavenging of ROS by N-acetyl-l-cysteine (NAC) or acetyl-l-carnitine (ALC) rescued MMP and mitochondrial mass, and squelched PINK1 level, mitochondrial accumulation of Parkin and LC3-II/LC3-I ratio, suggesting that ROS were associated with Cd-induced mitophagy. Cyclosporine A (CsA), an inhibitor of mitophagy, blocked Cd-induced mitophagy and PINK1/Parkin pathway but failed to suppress ROS increase, revealing that ROS are the causes rather than the results of Cd-induced mitophagy. In conclusion, this study suggested that ROS functioned on the upstream of PINK1/Parkin pathway to mediate Cd-induced mitophagy.     

面动脉穿支螺旋桨皮瓣修复上唇皮肤恶性肿瘤切除后创面

目的探讨面动脉穿支螺旋桨皮瓣修复上唇皮肤恶性肿瘤切除后创面的疗效。方法2012 年 7 月—2017 年 1 月，收治上唇皮肤恶性肿瘤 17 例。男 3 例，女 14 例；年龄 35～82 岁，平均 57 岁。其中鳞状细胞癌 5 例，基底细胞癌 12 例。病程 4 个月～11 年，平均 20 个月。肿瘤范围 1.4 cm×0.3 cm～3.1 cm×1.4 cm。术中扩大切除肿瘤后，根据创面位置、大小、形状及超声多普勒探查血管情况设计面动脉穿支螺旋桨皮瓣，以穿支动脉所在位置为旋转点切取皮瓣修复创面及部分供区，皮瓣切取面积为 5 cm×2 cm～7 cm×3 cm；穿支血管蒂长度为 0.5～1.0 cm，平均 0.8 cm。供区直接拉拢缝合。结果术后 3 例皮瓣远端出现青紫，经对症处理后愈合；其余皮瓣均顺利成活，创面 Ⅰ 期愈合。供区切口均 Ⅰ 期愈合。患者均获随访，随访时间 6～36 个月，平均 18 个月。患者上唇形态良好，供区无明显瘢痕，无口角畸形、嘴唇歪斜、鼻翼偏移，张、闭口口裂基本对称，面部无紧绷感，鼻腔通气无影响。随访期间肿瘤无复发。末次随访，患者自评满意度达非常满意 13 例、满意 4 例。结论面动脉穿支螺旋桨皮瓣具有血供好、旋转幅度大、色泽与受区相似、供区损伤小等优点，用于修复上唇皮肤恶性肿瘤切除后创面不仅能恢复良好功能，还能实现理想的美学修复。     

Comparison of efficiency and safety of conservative versus interventional management for primary spontaneous pneumothorax: A meta-analysis

BackgroundThere is growing opinion that primary spontaneous pneumothorax (PSP) patients without hemodynamic compromise could be safely and successfully managed with observation alone. The aims of this meta-analysis were to estimate the safety and effectiveness of conservative treatment compared with that of interventional management as the initial treatment option for patients with PSP.MethodsThe PubMed, Embase and Cochrane library databases were systematically searched for randomized controlled trials (RCTs) and cohort studies (prospective or retrospective) until April 25, 2020, that compared conservative treatment and interventional treatment as the initial treatment for patients with PSP. The primary outcomes were success rates and recurrence rates. The secondary outcome was complication rates. Data extraction and quality assessment from eligible studies were independently conducted by two reviewers.Results8 trials with a total of 1342 patients were identified. The success rates of conservative management were similar with interventional treatment, with a risk ratio 1.05 (95% confidence interval 0.94 to 1.17, I2 = 69.1%). There was no significant difference of recurrence rates between these two type managements. (RR, 1.43, 95% confidence interval 0.45 to 4.55, I2 = 86.7%). Complication rates were lower in conservative treatment group (13 of 215 [6.05%]) than in interventional treatment group (57 of 212, [26.89%]), although the difference did not reach statistical significance (RR, 0.15, 95% CI, 0.02 to 1.13, I2 = 56.7%).ConclusionsResults of the meta-analysis suggest that conservative treatment offers a safe and effective alternative as compared with interventional management as the initial treatment approach for patients with PSP. However, more randomized clinical trials are need to provide more strong evidence to confirm our results.     

痰热清注射液联合中频脉冲药物导入治疗小儿肺炎疗效观察

[目的]观察痰热清注射液联合中频脉冲药物导入治疗小儿肺炎的临床疗效。[方法]将确诊为普通型小儿肺炎的96例患儿随机分为治疗组和对照组,每组48例,两组均给予头孢硫咪(对头孢过敏者选用阿奇霉素)和利巴韦林抗感染,并于止咳、化痰、退热及糜蛋白酶雾化吸入等对症支持治疗;治疗组在常规治疗基础上加用痰热清注射液0.3～0.5mL/kg,加入5%葡萄糖注射液或0.9%氯化钠注射100～200mL中静脉滴注,10～20滴/min,1次/d,疗程5～7d;电脑中频脉冲药物导入治疗,每次20min,1次/d,连用3～5d。观察发热、咳嗽、气促、呼吸困难及肺部罗音消退情况。[结果]治疗组总有显率91.66%;对照组总显效率70.83%。差异有统计学意义(P<0.05)。[结论]痰热清注射液联合中频脉冲药物导入治疗小儿肺炎可有效改善肺炎症状,缩短疗程,且安全有效,值得推广。