痰培养阳性患者基础疾病与细菌种类的研究

目的观察全科医学科肺部感染患者呼吸道病原菌的分布,分析病原菌种类与患者基础疾病-脑血管疾病及慢性呼吸系统疾病之间的关系。方法收集2007年6月至2008年3月间以我院全科医学科病房为主的肺部感染患者的痰培养阳性结果,按患者基础疾病分组,对两组细菌不同革兰染色结果进行卡方检验。结果慢性呼吸系统疾病组革兰染色阴性菌较多,而脑血管疾病组革兰染色阳性菌较多（P〈0．005）。结论积极开展健康教育,加强呼吸功能训练,防止误吸,规范抗生素的使用等环节可减少耐药菌株的产生,改善疾病的预后。     

Effect of phosphorus-32 glass microspheres on human hepatocellular carcinoma in nude mice

AIM: To study the effects of phosphorus-32 glass microspheres ((32)P-GMS) on human hepatocellular carcinoma in nude mice. METHODS: Human liver cancer cell line was implanted into the dorsal subcutaneous tissue of 40 BALB/c nude mice. Then the 40 tumor-bearing BALB/ c nude mice were allocated into treatment group (n=32) and control group (n=8). In the former group different doses of (32)P-GMS were injected into the tumor mass, while in the latter nonradioactive (31)P-GMS was injected into the tumor mass. The experimental animals were sacrificed on the 14th day. The ultrastructural changes of tumor in both treatment group and control group were studied with transmission electron microscopy (TEM) and stereology. RESULTS: In treatment group, a lot of tumor cells were killed and the death rate of tumor cells was much higher (35-70%). Ultrastructurally, severe nuclear damage was observed in the death cells. The characteristics of apoptosis such as margination of heterochromatin was also found in some tumor cells. Besides, well differentiated tumor cells, degenerative tumor cells and some lymphocytes were seen. The skin and muscle adjacent to the tumor were normal. In control group, the tumor consisted of poorly differentiated tumor cells, in which there were only a few of dead cells(5%). Stereological analysis of ultrastructural morphology showed that Vv of nuclei (53.31+/-3.46) and Vv of nucleoli(20.40+/-1.84) in the control group were larger than those(30.21+/-3.52 and 10.96+/-2.52) in the treatment group respectively (P<0.01), and Vv of RER (3.21+/-0.54) and Vv of mitochondria (4.53+/-0.89) in the control group were smaller than those (8.67+/-1.25 and 7.12+/-0.95) in the treatment group respectively (P<0.01, 0.05). Sv of the membrane of microvilli and canaliculi (27.12 um(2)/100 um(3)+/-11.84 um(2)/100 um(3)) in the control group was smaller than that (78.81 um(2)/100 um(3)+/- 19.69 um(2)/100 um(3)) in the treatment group (P<0.01). But Vv of lipid particles (3.71+/-1.97) and Vv of vacuoles (5.72+/-1.58) were much larger than those (0.30+/-0.16 and 0.35+/-0.15) in the treatment group respectively (P<0.05, P<0.01). CONCLUSION: The experimental results indicate that local administration of (32)P-GMS can produce obvious effect on liver cancer cells and the anticancer effect of (32)P-GMS is directly proportional to the dose administrated. Ultrastructural stereology can also show the effect of (32)P-GMS on the normalization of tumor cells, which is beneficial to the prognosis and treatment of patients. Moreover, local administration of (32)P-GMS is also safe.     

急性呼吸窘迫综合征绵羊早期血管外肺水变化及影响因素的研究

目的 探讨急性呼吸窘迫综合征(ARDS)绵羊早期血管外肺水(EVLW)变化及呼气末正压(PEEP)和心排出量(CO)对EVLW的影响。方法 以内毒素持续静脉注射复制绵羊ARDS模型,分成ARDS模型组(12只)、多巴酚丁胺组(13只)和PEEP组(21只),其中PEEP组又分为5、10、15 cm H2O等3个亚组(分别7、8、6只绵羊)。观察ARDS绵羊模型复制成功后6 h、不同水平PEEP机械通气2 h以及多巴酚丁胺静脉注射引起CO增加(≥50％基础值)1 h、2 h后EVLW、血流动力学和呼吸力学改变。单指示剂热稀释法测定EVLW。结果 (1)ARDS模型组:与内毒素注射前比较,模型复制成功后ARDS动物EVLW为(18.1±7.1)ml/kg,显著高于内毒素注射前[(12.8±4.7)ml/kg,P<0.01],但6 h内EVLW无明显变化(P>0.05)。ARDS模型组氧合指数(PaO2/FiO2)为(136.8±34.9)mm Hg,与模型前比较显著降低[(444.3±127.7)mm Hg,P<0.01]。EVLW与PaO2/FiO2无明显相关(P>0.05),而ARDS模型复制成功前、后EVLW变化(AEVLW)和PaO2/FiO2变化(△PaO2/FiO2)显著相关(r=-0.501,P<0.001)。模型复制成功前、后Cst变化(△Cst)和AEVLW显著相关(r=-0.503,P<0.001)。(2)PEEP组:应用PEEP 2 h后,10 cm H2O组和15 cm H2O组EVLW分别为(14.7±4.5)ml/kg和(15.3±3.7)ml/kg,较应用PEEP前[(16.5±4.7)ml/kg和(18.4±6     

Assay of DNA-binding proteins with a dsDNA-coupled plate

OBJECTIVES: This paper fabricated a cost-effective dsDNA-coupled plate (dcPlate) and applied it to measure the abundance and DNA-binding activity of a DNA-binding protein (DBP). DESIGN AND METHODS: The dcPlate was manufactured by covalently immobilizing an amino-modified oligonucleotide in wells of the plate coated with N-oxysuccinimide esters. The dcPlate was applied to measure the abundance of DNA-binding activity of a DBP in the same four steps, including protein incubation, primary antibody binding, enzyme-linked secondary antibody binding, and colorimetric development. RESULTS: The detections of three purified DBPs including NF-kappaB, AP1 and SP1, and HeLa cell nuclear extract and assays of DNA-binding activity of NF-kappaB p50 to five various DNA sequences demonstrated that dcPlate can be used to measure the abundance of DBPs quantitatively and assay DNA-binding activity of DBPs in high throughputs format. CONCLUSIONS: The homemade cost-effective dcPlate provides a simple and versatile platform for studying DBPs.     

Different efficacy of EGFR tyrosine kinase inhibitors and prognosis in patients with subtypes of EGFR-mutated advanced non-small cell lung cancer: a meta-analysis

Background

Nearly 85 % of lung-cancer-specific epidermal growth factor receptor (EGFR) sensitive mutations comprise a substitution at position 858 (21L858R) and deletion mutants in exon 19 (19del). The aim of this study was to assess the role of EGFR mutation subtypes in predicting the efficacy of EGFR tyrosine kinase inhibitors (EGFR TKIs) and the prognosis of patients with advanced non-small cell lung cancer (NSCLC).

Method

We systematically searched for eligible articles investigating the association between EGFR mutation subtypes and the efficacy of EGFR TKIs and the prognosis of patients with NSCLC. The summary risk ratio (RR) and mean difference (MD) were calculated using meta-analysis. In addition, we used variance analysis for the progression-free survival data (PFS) and used the rank sum test for the overall survival data.

Results

We identified 22 eligible trials involving 1,082 patients. The objective response rate of the 19del mutation group was significantly higher than the 21L858R mutation group (RR 1.23; 95 % CI 1.12–1.36; P < 0.0001). The PFS (MD 3.55; 95 % CI 0.90–6.20; P = 0.009; MD 2.57; 95 % CI 0.51–4.62; P = 0.01) and overall survival (OS) (MD 10.52; 95 % CI 5.10–15.93; P = 0.0001) of the 19del mutation group were significantly longer than the 21L858R mutation group; the same results were observed in the variance analysis and rank sum test.

Conclusion

The 19del mutation may be a more efficient clinical marker for predicting the response of patients with NSCLC to EGFR TKIs. Furthermore, patients with the 19del mutation have both a longer PFS and OS. The 19del mutation is also the prognostic factor for patients with NSCLC.     

不同抗凝强度华法林对阵发性心房颤动患者预后的影响

目的探讨不同抗凝强度的华法林对阵发性非瓣膜病性房颤（PAF）患者的预防血栓作用及出血等副作用。方法采用多中心随机单盲设计,选取中高危PAF患者,随机分入4组,使用不同剂量的华法林进行抗凝治疗,将其凝血酶原时间国际标准化比值（INR）分别控制在1．3～1．6（第1组）、1．7～2．0（第2组）、2．0～2．5（第3组）和2．6～3．0（第4组）,随访心脑血管事件发生情况,比较其主要终点事件、次要终点事件,主要出血事件、次要出血事件,主要事件（主要终点事件＋主要出血事件）、次要事件（次要终点事件＋次要出血事件）以及总事件（主要事件＋次要事件）发生率,分析血栓栓塞和出血事件与INR的相关性。结果共纳入868例中高危PAF患者,最终826例进入分析,其中第1组167例、第2组220例、第3组215例、第4组224例。随访结果显示,随着INR的增大,终点事件减少（其中第1组与第2、3、4组相比,差异有统计学意义,P均〈0．05）,但出血事件有增加的趋势。在主要事件、次要事件、总事件发生率方面,第1组除主要事件发生率与第4组差异无统计学意义（P〉0．05）外,其余均高于第2、3、4组且差异有统计学意义（P均〈O．05）。结论对国人PAF患者,华法林抗凝强度INR在1．7～2．5能降低主要终点事件及次要终点事件发生率,不增加出血事件发生率,该抗凝强度对国人安全有效,而INR在2．6～3．0时,总获益并不增加。     

经皮旋转扩张气管切开术在危重病中的应用

目的探讨经皮旋转扩张气管切开术在危重病中的应用价值。方法回顾性分析重症监护病房（ICU）中气管切开的危重病患者共88例,其中经皮扩张气管切开术组（PDT组）52例,常规外科气管切开术组（ST组）36例。比较两组手术操作时间、术中出血量、并发症发生率。结果PDT组手术操作时间为4—20min,平均（8．6±2.8）min,ST组为13—28min,平均（18．2±3．6）min,PDT组手术操作时间较ST组显著缩短（P〈0．01）;PDT组术中出血量〈5ml的48例,〉5ml的4例,ST组〈5ml的4例,〉5ml的32例,PDT组术中出血量较ST组显著减少（P〈0．01）;PDT组并发症发生率为3．8％,ST组为11．1％,PDT组并发症发生率较ST组明显减少（P〈0．05）。结论经皮旋转扩张气管切开术是一种快速、术中出血量少、并发症少的微创气管切开术。除未成年人外,PDT可以广泛应用于ICU中的危重病患者。     

供者淋巴细胞骨髓腔内输注对移植物抗宿主病和外周血IL-4与IFN-γ水平的影响

本研究观察骨髓腔内供者淋巴细胞输注对异基因小鼠外用造血干细胞移植（allo—PBSCT）后移植物抗宿主病（GVHD）和外周血IL-4和球N-γ水平的影响。以雌性C57BL／6小鼠为受鼠,接受全身照射（TBD预处理后,先骨髓腔移植雄性BABL／c小鼠来源的经rbG—CSF动员后的外周造血千细胞,然后分别经尾静脉和骨髓腔内进行供者淋巴细胞输注（DLI）,建立异基因GVHD模型,观察移植后小鼠的生存状态和GVHD发生情况;以酶联免疫吸附实验（ELISA）检测白介素4（IL-4）和γ干扰素（IFN-γ）水平。结果显示：骨髓腔内-DLI组的受鼠GVHD发生比例和严重程度较尾静脉一DLI组明显减低（P〈0．01）;与尾静脉-DLI组比较,骨髓腔内-DLI组IL4分泌增多,IFN-γ分泌减少（P〈0．01）。结论：与尾静脉-DLI相比,IBM—DLI有利于减少GVHD的发生。