高血压及抗高血压药物对勃起功能的影响与研究进展

高血压与抗高血压药物均与血管性勃起功能障碍的发病有密切关系,现就其相互影响及机制作一综述,并对高血压合并勃起功能障碍的防治对策作一简单介绍。     

某妇幼保健院药品不良反应监测改进工作分析

目的通过某院改进前后对比,总结成效、发现问题,保障该院药品不良反应监测工作高质高效运行。方法应用PDCA循环模式,分析原因,实施对策,通过改进前后对比进行效果检查,运用雷达图分析法查找改进后的不足并持续优化。结果该院药品不良反应上报率明显提高,各科室医护能够主动监测更多系统和各类药品的不良反应。运用雷达图分析法可以发现不足之处,利于对下一步的改进标准进行修订。结论该院药品不良反应监测质量改进工作行之有效,持续开展不断优化,充分保障患者用药安全。     

MR集合序列定量参数评价中轴型脊柱关节炎骶髂关节病变

目的 观察MR集合序列（MAGiC）定量参数对于中轴型脊柱关节炎（axSpA）骶髂关节病变的应用价值。方法 对临床诊断axSpA患者分别采用常规序列和MAGiC序列行骶髂关节MR扫描,对比常规T1WI及短时翻转恢复（STIR）序列图像所示病理性脂肪沉积及骨髓水肿（BME）,比较MAGiC T1-mapping、T2-mapping和质子密度（PD）-mapping定量图所示骶髂关节病理性脂肪沉积及BME与S_2-3骶孔间正常骨髓（正常对照）的T1、T2及PD值差异。结果 共纳入28例axSpA患者。常规T1WI及STIR图像显示24例存在48处骶髂关节病理性脂肪沉积,23例存在57处BME。病理性脂肪沉积的T1值[（477.37±5.60）ms]低于正常骨髓[（614.65±17.83）ms,t=-6.952,P<0.05],T2值及PD值[（103.26±2.42）ms、（113.93±4.27）pu]均高于正常骨髓[（83.30±2.28）ms,78.30（62.50,84.00）pu,t=5.858,Z=-3.440,P均<0.05）]。BME的T1、T2、PD值分别为（2 617.92±176.85）ms、[101（94.00,96.90）]ms和（89.70±3.78）pu,均高于正常骨髓[（614.65±17.83）ms、（83.30±2.28）ms和78.30（62.50,84.00）pu,t=11.219、Z=-4.031、-2.266,P均<0.05]。结论 MAGiC定量参数有助于评价axSpA骶髂关节病变。     

FXR信号通路介导何首乌导致脂质沉积的作用及机理研究

目的 探索何首乌对肝细胞脂质沉积的影响及其机制。方法 利用永生化肝细胞系LO2,采用1 mmol/L游离脂肪酸（FFA）处理,建立脂肪肝沉积细胞模型。同时加入不同浓度的何首乌提取物处理（0、2.5、5、10 μg/mL）,采用油红O染色以观察何首乌对LO2细胞脂肪沉积的作用;采用实时荧光定量PCR进行实验组LO2细胞内法尼酯X受体（FXR）基因及其下游通路胆盐输出泵（BSEP）、小分子异源二聚体伴侣（SHP）、胆固醇7α-羟化酶1（CYP7A1）关键基因的检测;并采用蛋白免疫印迹法检测FXR及其下游通路关键蛋白的表达水平。结果 何首乌处理后的LO2细胞中,油红O的染色量会随着药物浓度增加而增加;FXR的mRNA表达下降,而FXR蛋白诱导促进的下游基因BSEP、SHP的表达相应下降,而其下游抑制基因CYP7A1的表达则上升（P均<0.05）。何首乌处理的LO2肝细胞中,FXR的蛋白水平明显降低,蛋白激酶C （PKC）蛋白磷酸化水平明显降低,而PKC总蛋白表达水平无明显改变,SHP的蛋白水平也明显下降。结论 何首乌可通过抑制FXR-PKC/SHP信号转导通路,从而促进LO2肝细胞内的脂质沉积。为何首乌导致胆汁淤积所引起的肝损伤的治疗提供新的理论依据。     

结直肠癌根治术后患者复发恐惧现状及其影响因素分析

目的 调查结直肠癌根治术后患者复发恐惧现状及其影响因素,为针对性干预措施的制定提供参考。方法 采用一般资料调查表、疾病进展恐惧简化量表、心理弹性简化量表和领悟社会支持量表对胃肠外科就诊的146例结直肠癌根治术后患者进行调查。结果 结直肠癌根治术后患者的复发恐惧得分为(31.05±7.74)分,得分≥34分者占患者总数46.57%;心理弹性与领悟社会支持得分分别为(32.53±6.83)、(58.44±9.41)分。多元线性回归分析显示,性别、年龄、心理弹性和领悟社会支持是结直肠癌根治术后患者复发恐惧的独立影响因素(F=30.482,P<0.001),共解释43.5%的变异量。结论 结直肠癌根治术后患者复发恐惧状况不容乐观,医护人员除需多关注女性、年龄低的患者外,还需注重多角度挖掘结直肠癌根治术后患者的正向积极心理,充分调动患者社会支持系统,以有效改善患者的复发恐惧。     

上颌前磨牙牙根及根管形态的锥形束CT研究

目的研究上颌前磨牙牙根形态、三根管的发生率和根管解剖形态,为临床诊疗提供参考。方法选取珠海市口腔医院412名患者,共779颗上颌第一前磨牙,728颗上颌第二前磨牙的锥形束CT(cone-beam computed tomography,CBCT)扫描数据,分析上颌前磨牙的牙根及根管形态,三根管的发生率、双侧对称性、根管分叉位置等。结果上颌第一前磨牙三根管发生率为1.8%,上颌第二前磨牙三根管发生率为0.3%,上颌第一前磨牙三根管发生率显著高于上颌第二前磨牙(X^2=8.304,P=0.004)。上颌第一前磨牙三根管对称率为27.3%,上颌第二前磨牙无对称三根管结构出现。上颌前磨牙解剖形态可为单根、双牙根或三牙根,其内部根管形态复杂,存在七种Vertucci根管类型,上颌第一前磨牙以VertucciⅣ型为主,上颌第二前磨牙则以VertucciⅠ型常见。三根管上颌前磨牙的根管分叉位置多见于根中或根上1/3,16颗三根管上颌前磨牙都具有三个独立的根尖孔。结论上颌前磨牙根管形态复杂多变,CBCT对发现变异和额外根管具有重要辅助作用。     

Unifying neural learning and symbolic reasoning for spinal medical report generation

Automated medical report generation in spine radiology, i.e., given spinal medical images and directly create radiologist-level diagnosis reports to support clinical decision making, is a novel yet fundamental study in the domain of artificial intelligence in healthcare. However, it is incredibly challenging because it is an extremely complicated task that involves visual perception and high-level reasoning processes. In this paper, we propose the neural-symbolic learning (NSL) framework that performs human-like learning by unifying deep neural learning and symbolic logical reasoning for the spinal medical report generation. Generally speaking, the NSL framework firstly employs deep neural learning to imitate human visual perception for detecting abnormalities of target spinal structures. Concretely, we design an adversarial graph network that interpolates a symbolic graph reasoning module into a generative adversarial network through embedding prior domain knowledge, achieving semantic segmentation of spinal structures with high complexity and variability. NSL secondly conducts human-like symbolic logical reasoning that realizes unsupervised causal effect analysis of detected entities of abnormalities through meta-interpretive learning. NSL finally fills these discoveries of target diseases into a unified template, successfully achieving a comprehensive medical report generation. When employed in a real-world clinical dataset, a series of empirical studies demonstrate its capacity on spinal medical report generation and show that our algorithm remarkably exceeds existing methods in the detection of spinal structures. These indicate its potential as a clinical tool that contributes to computer-aided diagnosis.     

224例氯氮平药物不良反应/事件的临床特点及超说明书用药分析

目的探讨氯氮平所致药物不良反应/事件(ADR/ADE)的发生特点、规律及其超说明书用药情况,为临床合理用药提供参考。方法收集2012-2018年期间上报的怀疑药品为氯氮平的ADR/ADE报告表,并对患者年龄、用药剂量等临床资料进行分析。结果纳入ADR/ADE报告表共224份,其中一般ADR/ADE 207份,严重ADR/ADE 17份。男性145例(64.73%),女性79例(35.27%),男女比例为1.84∶1,年龄16~79岁。累及器官或系统多见于神经系统(32.70%)和消化系统(24.34%),主要临床表现为便秘、锥体外系反应和流涎等。不存在超适应证使用情况,但有22份(9.82%)每日用量超过600 mg。共94份(41.96%)进行治疗药物监测,其中8份为严重ADR/ADE,血药浓度>600μg·L^-1的严重ADR/ADE构成比最高(25.00%)。结论氯氮平因超说明书使用引起的ADR/ADE比例虽然较低,但仍能引起累及不同器官或系统的ADR/ADE。药师需重视氯氮平超说明书用药情况,对有需要的患者进行治疗药物监测,以减少ADR/ADE的发生。     

The RND protein is involved in the vulnibactin export system in Vibrio vulnificus M2799

Vibrio vulnificus, an opportunistic marine bacterium that causes a serious, often fatal, infection in humans, requires iron for its pathogenesis. This bacterium exports vulnibactin for iron acquisition from the environment. The mechanisms of vulnibactin biosynthesis and ferric-vulnibactin uptake systems have recently been reported, while the vulnibactin export system has not been reported. Mutant growth under low-iron concentration conditions and a bioassay of the culture supernatant indicate that the VV1_0612 protein plays a crucial role in the vulnibactin secretion as a component of the resistance-nodulation-division (RND)-type efflux system in V. vulnificus M2799. To identify which RND protein(s) together with VV1_0612 TolC constituted the RND efflux system for vulnibactin secretion, deletion mutants of 11 RND protein-encoding genes were constructed. The growth inhibition of a multiple mutant (Δ11) of the RND protein-encoding genes was observed 6 h after the beginning of the culture. Furthermore, ΔVV1_1681 exhibited a growth curve that was similar to that of Δ11, while the multiple mutant except ΔVV1_1681 showed the same growth as the wild-type strain. These results indicate that the VV1_1681 protein is involved in the vulnibactin export system of V. vulnificus M2799. This is the first genetic evidence that vulnibactin is secreted through the RND-type efflux systems in V. vulnificus.     

人胰腺癌PANC-1细胞裸鼠移植瘤模型建立及其用于观察载siRNA纳米微粒体内效应的研究

 目的：探讨建立人胰腺癌PANC-1裸鼠移植瘤模型的最佳实验方法,并应用该模型进行载基因纳米微粒体内效应的研究。方法：将不同数量PANC-1细胞悬液接种于BALB/c (nu/nu)小鼠右侧背部皮下,当肿瘤体积达100 mm3时尾静脉注射siRNACY5.5纳米复合物进行活体荧光成像。此外,于尾静脉注射负载siRNAKras纳米复合物,蛋白印迹及免疫组织化学染色法观察肿瘤组织Kras蛋白表达水平。结果：1×107 cells/300 μL 接种成瘤率达100%,成瘤时间＜2周。荧光呈像及组织学检查显示载siRNA纳米微粒可靶向聚集在肿瘤组织发挥体内基因沉默效应。结论:本研究报道的人胰腺癌裸鼠移植瘤模型建立方法成瘤率达100%,成瘤时间短,是研究药物示踪和观察疗效的理想模型。