替诺福韦酯和恩替卡韦治疗老年慢性乙型肝炎患者的抗病毒疗效及对致炎细胞因子的调节作用

目的：比较替诺福韦酯（TDF）和恩替卡韦（ETV）治疗老年慢性乙型肝炎（CHB）患者的临床疗效及其对致炎细胞因子的调节作用,为其临床应用提供依据。方法：选取老年CHB患者93例,随机分为TDF组48例和ETV组45例,分别服用TDF （300mg/次,每天1次）和ETV （0.5mg/次,每天1次）,连续观察48周。检测治疗前及治疗后4、12、24、36和48周时患者血清中HBV-DNA、丙氨酸氨基转移酶（ALT）、肿瘤坏死因子α（TNF-α）和白细胞介素10（IL-10）水平,检验ALT复常率、HBV-DNA阴转率和HBeAg阴转率。结果：与治疗前比较,治疗后2组患者血清中HBV-DNA和ALT水平均明显降低（P<0.05）,治疗4和12周时TDF组患者血清中HBV-DNA和ALT水平明显低于ETV组（P<0.05）。与治疗前比较,治疗后2组患者血清中TNF-α和IL-10水平均明显下降,治疗12周时开始2组患者血清TNF-α和IL-10水平差异均有统计学意义（P<0.05）。治疗后,2组患者ALT复常率逐渐升高,治疗4和12周时TDF组患者ALT复常率明显高于ETV组（P<0.05）。治疗4周时2组患者均出现完全病毒学应答,HBV-DNA阴转率逐渐升高,治疗4、12和24周时,TDF组患者HBV-DNA阴转率明显高于ETV组（P<0.05）。TDF组患者于12周开始出现HBeAg阴转,早于ETV组;ETV组患者于24周出现HBeAg阴转,2组患者HBeAg阴转率比较差异无统计学意义（P>0.05）。结论：TDF和ETV均可用于治疗老年CHB,TDF抗病毒作用起效早,肝功能恢复快,炎症反应轻,是临床治疗的理想抗病毒药物。     

Rh(iii)-catalyzed synthesis of dibenzo[b,d]pyran-6-ones from aryl ketone O-acetyl oximes and quinones via C–H activation and C–C bond cleavage

A redox-neutral synthesis of dibenzo[b,d]pyran-6-ones from aryl ketone O-acetyl oximes and quinones has been realized via Rh(iii)-catalyzed cascade C–H activation annulation. A possible Rh(iii)–Rh(v)–Rh(iii) mechanism involving an unprecedented β-C elimination step was proposed.

A novel procedure for the synthesis of dibenzo[b,d]pyran-6-ones via Rh(iii)-catalyzed C–H activation and C–C bond cleavage is described.

The dibenzo[b,d]pyran-6-one is one of the most important structural motifs widely present in natural products with pharmacological relevance,¹ such as gut microbiota metabolites urolithins (1–4) that show anti-inflammatory, antiglycative and neuroprotective effects,^2–4 and the extracts of an endophytic fungus Cephalosporium acremonium IFB-E007 (5–7) that have pronounced anticancer activities.⁵ In addition, the related heterocyclic structure benzo[d]naphtho[1,2-b]pyran-6-one is found in some bactericidal and antitumor natural products including gilvocarcins^6,7 (8–10) chrysomycins^8,9 (11–13), etc. (Fig. 1). Therefore, a number of approaches to access dibenzo[b,d]pyran-6-ones have been developed via the intra- or inter-molecular biaryl formation as the key step.¹⁰ However, many of these methodologies require multi-step reactions, and the development of new efficient synthetic methods, especially those easy one-step reactions that are still of great interest.Open in a separate windowFig. 1Selected representative natural products.In the past decade, transition-metal-catalyzed C–H bond activation has proven to be a powerful tool in organic syntheses¹¹ and several methods for the synthesis of dibenzo[b,d]pyran-6-ones via C–H activation have been reported.¹² Actually, in 2015, our group reported Rh(iii)-catalyzed synthesis of dibenzo[b,d]pyran-6-ones from N-methoxybenzamides and quinones through C–H activation annulation.¹³ Interestingly, we obtained the same products using aryl ketone O-acetyl oximes as substrates to react with quinones under Rh(iii)-catalyzed conditions in this work. Rh(iii)-catalyzed C–H activation using ketoximes as substrates has been developed for synthesis of various substituted heterocycles.¹⁴ Compared to the previous reports, this reaction undergoes a novel mechanism involving an unexpected C–C bond cleavage, which is attractive. Moreover, our study demonstrated that solvent is vital to these reactions. In 2018, we reported Rh(iii)-catalyzed annulation of aryl ketone O-acetyl oximes with quinones to synthesize 6H-benzo[c]chromenes with acetone as a co-solvent.¹⁵ Herein, we described Rh(iii)-catalyzed synthesis of dibenzo[b,d]pyran-6-ones using the same substrates without acetone (Scheme 1).Open in a separate windowScheme 1Rh(iii)-catalyzed divergent C–H activation annulation with quinones.Initially, the reaction of acetophenone O-acetyl oxime 1a with benzoquinone 2a was employed to optimize the reaction conditions (

高校女大学生性与生殖健康管理模式的探讨

当前,中国高校女大学生性与生殖健康问题是急需被关注并亟待解决的现实问题,已成为高校健康教育的共识。依据近年来高校女大学生性与生殖健康现状及其对未来生活和社会健康发展的影响,基于《“健康中国2030”规划纲要》及《中国妇女发展纲要（2021—2030）》视阈下阐述高校女大学生的性与生殖健康管理模式,主要包括：规划、规范与实施、监测与管理、评估与考核。以期全面提高高校女大学生性与生殖健康教育水平,为高校的健康教育提供借鉴。     

留置气囊导尿管嵌顿的护理干预

目的：探讨留置气囊导尿管嵌顿后的正确处理方法。方法：将临床上5例留置尿管嵌顿的患者,根据病情及嵌顿的位置进行分析、分类及有效的处理。结果：对发生尿管嵌顿的患者进行正确的处理,减轻患者的痛苦。结论：护理人员应熟练掌握气囊导尿管的结构、性能、特点及使用的注意事项,正确掌握气囊导尿管拔管的方法。     

中西医结合治疗复发性口腔溃疡48例临床分析

复发性口腔溃疡是长期反复发作的疑难之症。可单发或多发于口腔粘膜的任何部分 ,有剧烈自发性灼痛 ,致使患者饮食及睡眠困难 ,严重危害健康。其发病一般以青壮年为多 ,男性少于女性 ,约为 1∶ 2 4,目前尚无特效疗法。本文通过对 48例复发性口腔溃疡中西医结合治疗的临床观察 ,认为疗效显著 ,无副作用 ,患者易接受 ,有效率达到 86% ,可用于临床 ,值得推广。     

中西医结合医院医院感染控制与管理

医院感染预防与控制是医院管理工作中非常重要的组成部分，关系到医疗质量和患者的安全。医院感染管理人员应针对诊疗活动中存在的医院感染、医源性感染及相关的危险因素，运用相关的理论与方法，总结医院感染的发生规律。并为降低医院感染而进行有组织、有计划的预防、诊断和控制活动。本文笔者就上述问题进行了总结探讨。     

甘草苷体内暴露特征及体外跨膜转运机制研究

目的总甘草素是甘草苷在体内的主要暴露形式,对两者在大鼠体内暴露特征及体外跨膜转运机制进行研究,为以甘草苷单体为新药的进一步开发提供依据。方法采用LC-MS/MS分析方法测定大鼠给药后不同时间点血浆样品中的总甘草素浓度,并应用WinNonlin.6.3软件采用非房室模型的统计矩法计算药代动力学参数;同时测定大鼠ig给药后组织匀浆中的浓度,考察不同类型甘草素在各组织中的暴露特征;应用体外MDCK-MDR1细胞模型,研究甘草苷、甘草素的跨膜转运能力及其机制。结果 ig给药后在大鼠体内,甘草苷不呈线性动力学特征;血浆和大部分组织中主要以甘草素的II相结合产物存在,肝、子宫、卵巢、胃和肠组织中主要为游离甘草素;总甘草素暴露量排序为肠血浆肝肾肺胃子宫卵巢脂肪心脾肌肉睾丸,且不易产生组织蓄积现象;甘草素跨膜转运能力较甘草苷良好,且均不是P-gp转运体的底物。结论甘草苷不呈线性动力学吸收特征;甘草素在组织中暴露特征表现为不同组织中甘草素的存在形式和分布程度差异较大,总甘草素不易产生组织蓄积现象;两者均为被动扩散跨膜转运方式。     

Study of driving skill level discrimination based on human physiological signal characteristics

The primary purpose of the study is to distinguish the differences in driving skill between novice and experienced drivers from the viewpoint of human cognitive behavior. Firstly, EEG (electroencephalogram) signals were collected using EEG acquisition equipment called Neuroscan. The δ sub-band and EOG (electrooculogram) signals were extracted from the EEG. Furthermore, the eye movement rate and the sample entropy (SampEn) values of δ sub-bands were calculated. Finally, the heart rate variability (HRV) characteristics, calculated using the SampEn algorithm, were used to analyze driving skill. The final result showed that human physiological signals (EEG, EOG and ECG (electrocardiogram)) could effectively distinguish different driving skills.

The study of driving skill level discrimination based on EEG, EOG and ECG characteristics, which uses the driver''s license examination “subject two”, is carried out in our current research work.     

组合核支持向量机在放电模式识别中的优化策略

传统的单一核函数SVM无法实现局部放电中的多特征空间向量的映射分类,且目前SVM大都采用不同尺度的径向基函数作为核函数,核的调整空间较为有限,无法针对不同特征空间的放电参数达到普适的效果。针对上述问题,本文提出一种基于多分组特征的组合核多分类SVM的局部放电识别方法。该方法首先完成多类特征空间在不同类型SVM核函数中的映射分类,再采用骨干粒子群(BBPSO)优化方法选取最佳核参数,并求解核函数权值系数,最终形成最优核函数组合分类模型。实验结果表明,该方法对多个特征空间数据具有普适性,且融合效果理想,分类精度高于误差反向传播神经网络(BPNN)和SVM识别方法。     

配合中药灌肠治疗溃疡性结肠炎的临床观察

目的探讨西医内科基础治疗辅以活血化淤中药灌肠治疗溃疡性结肠炎(UC)的临床疗效。方法选择2005年5月至2007年12月我院门诊和住院溃疡性结肠炎患者39例,随机分为治疗组20例、对照组19例,两组在西医内科基础治疗的情况下,治疗组加用中药灌肠,2个疗程(60d),观察两组患者的临床疗效。结果治疗组:临床痊愈18例(90%),有效2例(10%),无效0例,总有效率100%,显效时间为1～8d,平均(4.5±3.5)d。对照组:临床痊愈13例(68%),有效4例(21%),无效2例(11%),总有效率89%,显效时间为1～21d,平均(11±10)d,两组疗效比较有统计学意义(P<0.05),治疗组疗效好于对照组。结论在对溃疡性结肠炎治疗中加用中药灌肠是可以推荐的。