稳心颗粒联合尼可地尔治疗缺血性心肌病合并房性心律失常患者的效果

目的:观察稳心颗粒联合尼可地尔治疗缺血性心肌病合并房性心律失常患者的效果。方法:选取103例缺血性心肌病合并房性心律失常患者作为研究对象,以电脑随机数字表法将其分为研究组51例和对照组52例。两组均开展常规基础治疗,在此基础上,对照组采用尼可地尔治疗,研究组在对照组基础上联合稳心颗粒治疗,比较两组治疗前后心功能指标[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)]水平、P波最大时限、P波离散度、6 min步行试验(6MWT)距离和不良反应发生率。结果:治疗后,研究组LVEDD和LVESD水平均低于对照组,LVEF水平高于对照组,6MWT距离长于对照组,差异有统计学意义(P<0.05);治疗后,研究组P波最大时限和P波离散度均小于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:稳心颗粒联合尼可地尔治疗缺血性心肌病合并房性心律失常患者可改善心功能指标水平,延长6MWT距离,减小P波最大时限和P波离散度,效果优于单纯尼可地尔治疗。     

MYD88 L265P mutation in intraocular lymphoma: A potential diagnostic marker

Purpose:Vitreoretinal lymphoma (VRL) is the most common intraocular lymphoma (IOL). This can be either primary or secondary to the central nervous system lymphoma. The diagnosis of primary intraocular lymphoma (PIOL) currently relies on clinical diagnosis and cytological analysis of the vitreous or subretinal biopsy. Although most cases are diagnosed without much issue, the limited amount of vitreous fluid, subjectivity in cytological reporting, and special expertise in ocular pathology make the diagnosis challenging. MYD88 L265P mutation has been implicated to have diagnostic utility in PIOL. In this study, we screened consecutive vitreous biopsies for the presence of MYD88 L265P mutation to understand its diagnostic utility compared to conventional cytological analysis.Methods:Cytological analysis and MYD88 L265P mutation by PCR-based sequencing and restriction fragment length polymorphism (RFLP) were carried out on consecutive vitreous and subretinal biopsies collected from 21 patients. The diagnostic utility of the cytology and MYD88 L265P mutation analysis were compared.Results:Out of the 21 patients, 15 had clinical suspicion of having PIOL. Out of these suspected cases of PIOL, nine were confirmed on follow-up, while six were diagnosed as other intraocular pathologies. Diagnostic utility of MYD88 L265P mutation analysis revealed a sensitivity of 88.9%, specificity of 91.6%, positive and negative predictive value of 88.9% and 91.7%, respectively. Diagnostic accuracy of 90.5% was achieved with the mutation analysis that shows the superiority of MYD88 in both ruling in and ruling out PIOL. The diagnostic utility of MYD88 L265P mutation was superior to conventional cytological analysis.Conclusion:The analysis of MYD88 L265P mutation is reliable and efficient in the diagnosis of PIOL.     

提壶揭盖法治疗糖尿病合并便秘的临床疗效及对患者血清SP、NO 水平的影响

目的:观察提壶揭盖法治疗糖尿病合并便秘的临床疗效及对患者血清P物质(SP)、一氧化氮(NO)水平的影响。方法:选取70例糖尿病合并便秘患者,按随机数字表法分为治疗组和对照组,每组35例,治疗期间2组共脱落3例,最终纳入治疗组34例,对照组33例。治疗组在常规降血糖基础上基于提壶揭盖法组方治疗,对照组在常规降血糖基础上给予乳果糖联合枸橼酸莫沙必利治疗,2组均连续治疗8周。比较2组临床疗效、症状积分、排便情况、心理状态及血清SP、NO水平。结果:治疗组愈显率为91.18%,高于对照组的72.73%(P<0.05)。治疗后,2组大便干结、排便不畅、腹胀、里急后重及腹痛积分均较治疗前降低(P<0.05),治疗组大便干结、排便不畅、腹胀、里急后重及腹痛积分均低于对照组(P<0.05)。与治疗前比较,治疗后2组排便时间均缩短,排便频率均降低,大便性状均有改善(P<0.05);治疗组排便时间短于对照组,排便频率低于对照组,大便性状改善情况优于对照组(P<0.05)。治疗后,2组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均较治疗前降低(P<0.05),治疗组SAS、SDS评分均低于对照组(P<0.05)。治疗后,2组血清SP水平均较治疗前升高,血清NO水平均较治疗前降低(P<0.05);治疗组血清SP水平高于对照组,血清NO水平低于对照组(P<0.05)。结论:基于提壶揭盖法治疗糖尿病合并便秘,可以较好地改善患者的临床症状,改善其肠道动力及心理状态,促进排便。     

刺五加P450基因的筛选及其表达对皂苷含量的影响

目的筛选和鉴定刺五加Eleutherococcus sentsicosu中的细胞色素P450基因(EsP450),分析其进化特征,探究其与刺五加总皂苷含量的相关性。方法根据转录组测序结果,筛选得到EsP450基因,并对其进行生物信息学分析与适应性进化分析,采用qRT-PCR法检测EsP450基因的表达量,采用分光光度计测定刺五加的总皂苷含量。结果筛选得到了 18条EsP450基因。刺五加P450蛋白不存在跨膜区域,二级结构以α-螺旋和无规则卷曲结构为主。EsP450基因不存在正选择位点。各EsP450间的表达量差异显著,部分基因表达量差值在10倍以上,7条EsP450基因的表达与皂苷含量呈正相关关系(P0.05)。结论鉴定出与刺五加总皂苷含量存在正相关关系的EsP450基因,EsP450基因在进化中受到纯净选择。     

针刺四神聪四关穴对脑卒中后抑郁患者P300的影响

目的观察脑卒中后抑郁患者针刺治疗前后P300电位的变化。方法将94例脑卒中患者根据汉密尔顿抑郁量表(HRS-D)评分分为抑郁组(63例)和非抑郁组(31例),抑郁组患者应用双四穴组针刺治疗;于HRS-D测评分组后,以及抑郁组患者针刺治疗1个疗程后,对两组患者进行P300电位测定。结果治疗前,与非抑郁组患者比较,抑郁组患者P300电位中的P3波潜伏期延长,波幅降低;经针刺治疗后,抑郁组患者的P3波潜伏期明显缩短(P<0.01),波幅增高(P<0.05)。结论P300电位测定有助于早期发现脑卒中后抑郁患者的认知障碍,及时进行针刺治疗可减轻或消除患者的抑郁情绪。     

云南汉族非综合征性唇腭裂与p53基因多态性的相关性研究

目的:分析p53基因单核苷酸多态性(SNPs)位点的多态性,探究云南汉族非综合征性唇腭裂与p53基因的相关性。方法:选取2016年1月-2018年12月于笔者医院就诊的非综合征性唇腭裂患儿100例为试验组,选取医院同期无先天性畸形正常患儿100例为对照组。采用Taqman探针荧光定量PCR法对p53基因的SNPs位点rs12947788和rs1042522进行基因分型,并用χ^2检验和Logistic回归分析多态位点与非综合征性唇腭裂的相关性。结果:p53的基因SNPs位点rs12947788的等位基因变体A携带者(AA+GA vs GG)发生非综合征性唇腭裂的风险增加(OR=1.393,95%CI 1.030~1.884,P=0.032)。rs1042522(CC vs CG+GG)增加吸烟者母亲生下NSCL/P患儿的风险(OR=2.561,95%CI=1.146~5.721,P=0.022)。rs12947788(AA+GA vs GG)可明显增加有饮酒史母亲(OR=3.235,95%CI=1.158~9.040,P=0.025)生下NSCL/P患儿的风险。结论:云南汉族人群非综合征性唇腭裂与p53基因rs1042522、rs12947788多态具有一定的相关性。     

蓝萼乙素对三阴性乳腺癌 MDA-MB-231细胞增殖、迁移及侵袭的影响

目的:探讨蓝萼乙素对三阴性乳腺癌MDA-MB-231细胞增殖、迁移及侵袭的影响及其作用机制。方法:体外培养人乳腺癌细胞MDA-MB-231,加入不同浓度(0、2、4、8μmol/L)蓝萼乙素干预处理,采用MTT法检测细胞增殖能力;划痕实验考察细胞迁移能力;Transwell小室法考察细胞侵袭能力;Western blotting法检测细胞内p38MAPK、p-p38MAPK、FOXO3a及上皮-间质转化(EMT)相关标志物(E-cadherin、Vimentin及N-cadherin)的表达水平。结果:蓝萼乙素浓度为2、4、8μmol/L时,细胞增殖率分别为(83.2±6.90)%、(70.72±6.53)%、(45.43±7.51)%,较空白对照组[(100.00±7.84)%]降低;细胞侵袭数量分别为(300.54±24.91)、(255.44±23.59)、(208.66±36.18),较空白对照组(368.44±28.32)降低;细胞迁移距离分别为(487.11±53.00)μm、(394.93±61.91)μm、(312.88±35.42)μm,较空白对照组[(559.37±75.77)μm]降低;p-p38MAPK表达量分别为(1.38±0.11)、(1.69±0.13)、(2.23±0.19),较空白对照组(1.00±0.09)增加;FOXO3α表达量分别为(1.40±0.16)、(1.97±0.31)、(2.44±0.26),较空白对照组(1.00±0.18)增加;E-cadherin表达量分别为(1.15±0.11)、(1.77±0.22)、(1.86±0.15),较空白对照组(1.00±0.11)增加;Vimentin表达量分别为(0.86±0.04)、(0.49±0.05)、(0.54±0.04),较空白对照组(1.00±0.04)减少;N-cadherin表达量分别为(0.66±0.07)、(0.58±0.08)、(0.42±0.04),较空白对照组(1.00±0.12)减少,差异均有统计学意义(P 0.05)。结论:蓝萼乙素可通过介导p38MAPK/FOXO3a信号传导有效干扰肿瘤细胞EMT进程,发挥其抑制三阴性乳腺癌细胞增殖、迁移及侵袭的作用。     

Resistance to antiplatelet drugs: molecular mechanisms and laboratory detection

Summary.  The definition 'resistance to antiplatelet drugs' should be limited to situations in which failure of the drug to hit its pharmacological target has been documented by specific laboratory tests. Aspirin resistance, as determined by specific tests (e.g. serum thromboxane B₂), appears to be rare (1–2%) and, in most instances, is caused by poor compliance. In contrast to aspirin, studies that used specific tests to measure the pharmacological effect of thienopyridines [e.g. vasodilator-stimulated phosphoprotein (VASP)] showed a wide variability of responses to these drugs, with significant proportions of subjects (15–30%) who are very poor responders. Inter-individual differences in the extent of metabolism of thienopyridines to their active metabolites is the most plausible mechanism for the observed inter-individual variability in platelet inhibition. The demonstration that some patients may be 'resistant' or 'poor responders' to the pharmacological effect of antiplatelet drugs, has prompted the need of laboratory monitoring of antiplatelet therapy. However, many published studies have been performed using unspecific tests of platelet function, which identify patients on antiplatelet treatment with high residual platelet reactivity, which is not necessarily because of resistance to antiplatelet drugs. Despite this drawback, identification of patients with high residual platelet reactivity may be useful to predict their risk of atherothrombotic events. However, many studies still need to be carried out to identify the ideal laboratory test and to answer basic questions on its clinical utility and cost-effectiveness, before monitoring antiplatelet therapy can be recommended in the clinical practise. Until then, monitoring of antiplatelet therapy should be considered for investigational purposes only.     

细胞色素P4502D6＊10多态性对术后患者体内曲马多药动学特征的影响

目的研究细胞色素P450（CYP）2D6＊10多态性对患者手术后应用曲马多止痛后体内曲马多药动学特征的影响。方法45例患者于手术后首次静脉注射曲马多100mg,随后采用LC—Ms法测定曲马多及其代谢物O-去甲基曲马多（M1）的血浆浓度,采用非房室模型法计算曲马多和M1的主要药动学参数（AUC、CL、t1／2、MRT、ρmax和tmax）。采用聚合酶链反应一限制性片段长度多态性（PCR．RFLP）技术检测患者的CYP2D6＊10基因型,即野生型、杂合子和突变型。结果45例患者中CYP2D6＊10等位基因的发生频率为51％。与野生型比较,突变型患者体内曲马多的t1／2、MRT延长,AUC增大,CL减少（P均〈0．05）。结论CYP2D6＊10基因多态性对术后患者体内曲马多的药动学特征有显著影响。