白芍总苷对维持性血液透析患者自身炎症因子及血清NGAL、TLR4、MYD88表达的影响

目的探究白芍总苷(total glucosides of paeony,TGP)对维持性血液透析患者(maintenance hemodialysis,MHD)炎症因子和血清中性粒细胞明胶酶相关载脂蛋白(NGAL)、Toll受体4(TLR4)、髓样分化因子88(MYD88)表达的影响。方法回顾性分析2017年6月至2019年6月期间成都市青白江区人民医院收治的75例MHD患者,按照治疗方法不同分为白芍总苷组(n=38)和常规治疗组(n=37),比较治疗后两组肾功能指标、炎性因子水平(IL-6,CRP,TNF-α,NGAL)、氧化应激水平(GSH-PX,SOD,MDA)、TLR4、MYD88表达和不良事件发生情况。结果治疗后白芍总苷组血肌肝、周均脱水量低于常规治疗组,日均尿量、GSH-PX、SOD高于常规治疗组,NGAL、IL-6、CRP、TNF-α、MDA水平均低于常规治疗组,差异具有统计学意义(P<0.05);治疗后白芍总苷组TLR4、MYD88 mRNA均低于对照组,差异具有统计学意义(P<0.05);两组不良事件发生概率无明显差异(P>0.05)。结论白芍总苷能降低MHD患者NGAL水平,改善微炎症状态,这可能是通过影响氧化应激反应或TLR4/MYD88通路蛋白表达而发挥作用的。     

The role of disengagement in the psychology of competence drift

Background

The framing of competence as a binary “either-or” process may be shaped by the measurement tools and assessment methods used to define it. Blunt measures such as passing or failing a licensure examination, or revoking/suspending a license after a single dispensing error fosters anxiety amongst professionals and potentially leads to behaviours where learning needs are actually hidden from educators, employers or regulators. Such framing may not accurately capture the lived experience of those labelled “incompetent” and in fact may be counterproductive to remediation and skills enhancement.

Hypomethylating agents as maintenance therapy following allogeneic hematopoietic cell transplantation for myeloid malignancies

With improved safety of the procedure, disease recurrence is now the leading cause of treatment failure when allogeneic hematopoietic cell transplantation is used to treat acute myeloid leukemia (AML). Recent studies suggest that maintenance therapy with hypomethylating agents after standard induction and consolidation chemotherapy prolongs disease-free and possibly overall survival in older patients with AML. While these results argue that hypomethylating agents should likewise prolong remission duration if used as maintenance after allogeneic transplantation for AML, trials to date have failed to show a benefit. This failure may be due, in part, to difficulties in administering the drugs in this setting, and in part, because of an inability to identify those patients most likely to benefit. Realizing the full potential of hypomethylating agents in the management of patients with AML will likely require both improved drug formulations as well as an increased understanding of their mechanism of action in the complex post-allogeneic transplant environment.     

祛风活血方对终末期肾病维持性血液透析患者凝血功能及炎症状态的影响

目的 探讨祛风活血方对终末期肾病维持性血液透析(Maintenance hemodialysis,MHD)患者凝血功能及炎症状态的影响。方法 将本院2018年5月～2019年4月收治的76例终末期肾病MHD患者按照随机数字表法划分成对照组和治疗组,每组各38例。对照组接受维持电解质平衡、纠正酸中毒、控制血压、抗感染、纠正贫血等常规西医治疗,治疗组在对照组基础上应用祛风活血方治疗。对比两组治疗前后凝血功能、炎症因子水平、血电解质指标变化及不良反应。结果 治疗后,两组超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)与治疗前相比均下降(P0.05),且治疗组均低于对照组(P0.05);两组凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)与治疗前相比均下调(P0.05),且治疗组均低于对照组(P0.05);治疗组血清钾(K+)、碳酸氢根(HCO_3~-)、钙(Ca~(2+))等血电解质与治疗前比较差异无统计学意义(P0.05),对照组K~+含量与治疗前相比降低(P0.05),HCO_3~-、Ca~(2+)含量与治疗前相比增高(P0.05),且治疗后K+、HCO_3~-、Ca~(2+)含量均较治疗前优(P0.05);两组均发生皮肤黏膜受损等不良反应,不良反应较轻,且组间不良反应发生率比较差异无统计学意义(P0.05)。结论 终末期肾病MHD患者采用祛风活血方进行灌肠治疗,可显著改善凝血功能,明显减轻炎症状态,有效维持血电解质稳定,且用药安全性高。     

系统性红斑狼疮的目标治疗

系统性红斑狼疮（SLE）属于慢性、不可治愈性疾病。治疗高度异质性的SLE需要引入目标治疗的理念,朝着完全缓解的目标进行诱导治疗。根据病人的治疗反应,评估和调整治疗方案,确保疾病朝着缓解或低度活动的目标逐渐改善,直至完全缓解。     

失眠对大学生认知功能影响的研究

目的探讨失眠对大学生认知功能的影响。方法应用CCMD-3对认为存在失眠的大学生进行诊断,对确诊的310位失眠大学生进行统计学调查,另选取同一院校310名大学生为对照组,采用匹兹堡睡眠质量指数(PSQI)对大学生的睡眠质量进行初步调查评估,结合事件相关电位(P300)和认知能力筛查量表(CASI)对结果进行综合评定。结果实验组大学生的PSQI总分及各成分均高于对照组大学生,且在主观睡眠质量、入睡时间、睡眠障碍及日间障碍4个成分上的得分差异有统计学意义(P<0.01);2组大学生均未发现使用药物帮助睡眠的情况。实验组大学生P300中的N2、P3的潜伏期(PL)有所延长,P3有所波幅下降,潜伏期与认知障碍程度呈正相关,差异有统计学意义(P<0.05或P<0.01);失眠的大学生认知能力筛查量表(CASI)测验4项评分较差,与对照组比较,差异有统计学意义(P<0.01)。结论有失眠现象的大学生存在一定的认知障碍,我们应该重视大学生的睡眠问题,有针对性的加强他们的健康教育。     

Evidence-based appraisal of the upfront treatment for unresectable metastatic colorectal cancer patients

Colorectal cancer(CRC)is a significant health problem,with around 1 million new cases and 500000 deaths every year worldwide.Over the last two decades,the use of novel therapies and more complex treatment strategies have contributed to progressively increase the median survival of patients with unresectable advanced CRC up to approximately 30 mo.The availability of additional therapeutic options,however,has created new challenges and generated more complicated treatment algorithms.Moreover,several clinically important points are still in debate in first-line,such as the optimal treatment intensity,the most appropriate maintenance strategy,the preferred biologic to be used upfront in patients with KRAS wild-type CRC,and the need for more detailed information on tumor biology.In this moving landscape,this review analyses why the firstline treatment decision is crucial and how the choicemay impact on further treatment lines.In addition,it focuses on results of major phaseⅢrandomized trials.