Genetic insight into cytochrome P450 in Chinese from the Chinese Millionome Database

Genetic variations of cytochrome P450 (CYP) influence the inter‐individual differences in drug response. Here, we collected 8682 variants of 57 CYP genes and cytochrome P450 oxidoreductase (POR) from a large‐scale sequencing project in Chinese, Chinese Millionome Database (CMDB). In addition, 52 294 variants from the Genome Aggregation Database (gnomAD) had been simultaneously identified and analysed. Rare variants with a variant allele frequency (VAF) < 0.01 comprised 41.4% (3594/8682) of identified variations in the CMDB, while 98.1% (51 320/52 294) in the gnomAD were rare. Out of 8682 variants in the CMDB, 66.9% (5808/8682) were in introns and only 4.3% (377/8682) were missense variants. In contrast, 36.2% (18 929/52 294) variants in the gnomAD were missense. The common alleles with a VAF over 0.1 were found in CYP1A2*1C, CYP1A2*1F, CYP2C19*2, CYP2D6*2, CYP2D6*10, CYP3A5*3 and CYP4F2*3, with a VAF of 0.161, 0.6, 0.27, 0.274, 0.678, 0.92 and 0.233, respectively. The growing number of genetic variations in CYP genes as more genomes are sequenced would increase the power to predict drug metabolism and response based on the genotype of the particular individual.     

注射用丹参多酚酸对神经系统疾病药理作用的研究进展

注射用丹参多酚酸（SAFI）作为脑梗死的辅助治疗药,能有效改善神经功能缺损症状,有效性和安全性已经得到认可。近年研究发现SAFI在神经系统疾病中具有抗炎、抑制氧化应激、抑制神经细胞凋亡、拮抗缺血再灌注损伤、稳定斑块、改善认知功能等作用。就近年来国内外对SAFI在中枢神经系统疾病中的药理作用的研究进展进行综述,为进一步深度研发和临床合理应用提供依据。     

CKLF1/CCR5 axis is involved in neutrophils migration of rats with transient cerebral ischemia

BackgroundChemokine-like factor 1 (CKLF1) is a chemokine increased significantly in ischemic brain poststroke. It shows chemotaxis effects on various immune cells, but the mechanisms of CKLF1 migrating neutrophils are poorly understood. Recent studies have provided evidence that CC chemokine receptor 5 (CCR5), a receptor of CKLF1, is involved in ischemic stroke.PurposesTo investigate the effects of HIF-1α guided AAV in ischemic brain, investigating the outcome of stroke, and examining the involvement of CKLF1/CCR5 axis in recruitment of neutrophils.ResultsHIF-1α guided AAV knocked down CKLF1 in ischemic area and alleviated brain damage of rats. CKLF1 migrated neutrophils through CCR5, worsening inflammatory responses. Akt/GSK-3β pathway may involve in CKLF1/CCR5 axis guided neutrophils chemotaxis.ConclusionsCKLF1/CCR5 axis is involved in neutrophils migration of rats with transient cerebral ischemia. CKLF1/CCR5 axis may be a useful target for stroke therapy.     

七步理疗法在哺乳期乳腺炎治疗中的应用分析

目的探讨七步理疗法对哺乳期乳腺炎疼痛及泌乳量的影响。方法选取120例哺乳期乳腺炎患者作为研究对象,随机分为对照组和观察组,每组60例。对照组患者均接受常规治疗,观察组患者在对照组基础上接受七步理疗法治疗。比较两组患者临床症状及体征、实验室指标、临床疗效、泌乳情况、并发症发生情况及视觉模拟评分法(VAS)评分。结果治疗前,两组患者肿块大小分级情况比较差异无统计学意义(P>0.05);治疗后,观察组患者者肿块大小分级情况显著优于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者的白细胞计数、中性粒细胞百分比、C反应蛋白水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的白细胞计数、中性粒细胞百分比、C反应蛋白水平均低于治疗前,且观察组患者的白细胞计数、中性粒细胞百分比、C反应蛋白水平均低于对照组,差异均具有统计学意义(P<0.05)。治疗后,观察组患者的临床总有效率为95.00%,显著高于对照组的80.00%,差异具有统计学意义(P<0.05)。治疗前,两组患者的乳汁充足率比较差异无统计学意义(P>0.05);治疗后,观察组患者的乳汁充足率65.00%高于对照组的40.00%,差异具有统计学意义(P<0.05)。观察组患者的并发症发生率为1.67%,低于对照组的15.00%,差异具有统计学意义(P<0.05)。治疗前,两组患者的VAS评分比较差异无统计学意义(P>0.05);治疗后,观察组患者的VAS评分(21.47±2.28)分,显著低于对照组的(36.58±2.14)分,差异具有统计学意义(P<0.05)。结论七步理疗法治疗哺乳期乳腺炎能显著改善患者疼痛,增加泌乳量,减少炎症及并发症,提高临床疗效。     

基于关联规则对缺血性脑卒中住院患者联合用药分析*

目的：了解缺血性脑卒中患者的一般基础情况、合并疾病及临床药物联合使用特征。方法：运用回顾性分析法,对医院信息系统数据库中部分缺血性脑卒中住院患者病历进行分析。采用频数分析法对患者的基本信息进行描述性统计,运用关联规则分析方法统计常用药物二联、三联等使用情况。结果：缺血性脑卒中患者多为老年人,男性较多,常合并高血压、冠心病和糖尿病等疾病。该类患者临床用药中,硫酸氢氯吡格雷联合阿托伐他汀钙使用最多;使用阿托伐他汀钙和前列地尔的患者中,同时使用硫酸氢氯吡格雷最多。在使用抗心绞痛药的患者中,使用抗血小板药的概率最高;在同时使用抗心绞痛药和调血脂药的患者中,使用抗血小板药的概率最高。结论：在缺血性脑卒中患者临床治疗中,抗血小板药、降血压药、调血脂药、活血化瘀药和血管扩张药常一起联合使用,如阿司匹林、瑞舒伐他汀钙、硫酸氢氯吡格雷、前列地尔和美托洛尔最可能合并使用。     

我院新生儿肠外营养处方的合理性分析

目的：评价我院新生儿肠外营养三种固定组套处方临床实际应用的合理性。方法：收集2018年1-7月我院NICU的新生儿肠外营养处方共320份,患儿共52例,其中早产儿38例,足月儿14例。对新生儿肠外营养三种固定组套处方的成分进行分析,统计患儿的住院时间、使用TPN的时间、患儿摄入的液体量、热卡量、血糖、肝功能等,并结合患儿的生长发育情况,来评价三种固定组套处方的合理性。结果：三种固定组套处方在临床应用中的稳定性能够得到保证,糖速、热氮比、电解质浓度均在合理范围内,但52例患儿中存在3例前期液体量摄入过多,320份处方中存在114份热卡摄入不足,早产儿组套处方中缺少电解质钠和镁,足月儿组套中缺少电解质镁等。结论：我院新生儿肠外营养三种固定组套处方在临床的实际应用中,能够基本满足大多数新生儿的生长发育需求,但肠外营养处方存在热卡和蛋白质摄入不足,需要进一步完善。     

硫酸氢氯吡格雷片、阿托伐他汀钙片联合丁苯酞治疗急性进展性缺血性脑卒中效果观察

目的观察硫酸氢氯吡格雷片(波立维)、阿托伐他汀钙片(立普妥)联合丁苯酞治疗急性进展性缺血性脑卒中(PIS)的临床效果。方法选取2018年8-12月上饶市立医院收治的PIS患者60例,采取随机数字表法分为观察组和对照组,每组30例。对照组给予波立维、立普妥治疗,观察组在对照组的基础上联合丁苯酞治疗。比较2组临床疗效、治疗前后神经功能缺损情况以及不良反应。结果观察组治疗总有效率为96.67%,高于对照组的80.00%(P<0.05);治疗后,2组神经功能缺损评分均低于治疗前,且观察组优于对照组(P均<0.01);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论波立维、立普妥联合丁苯酞治疗PIS的临床效果显著,能有效改善患者神经功能,且安全性较高,值得临床推广应用。     

悬吊训练治疗脑卒中患者平衡功能障碍的临床研究

目的: 观察悬吊训练（SET）对脑卒中患者平衡功能恢复的影响。方法: 脑卒中平衡功能障碍患者40例,随机分为对照组和观察组各20例,2组均接受常规康复训练,在此基础上,观察组加以悬吊训练。治疗前和治疗4周后采用Berg平衡量表（BBS）、Barthel指数（BI）以及采集竖脊肌表面肌电平均肌电值（AEMG）和中位频率值（MF）对2组患者进行评定。结果: 治疗4周后,2组BBS、BI评分均明显高于治疗前（均P<0.01）,且观察组以上评分均明显高于对照组（均P<0.05）。治疗前,2组患者AEMG、MF值组内比较健侧均明显高于患侧（均P<0.05）;治疗４周后,2组患者健患侧竖脊肌AEMG、MF值均较治疗前明显提高（均P<0.05）,观察组健患侧AEMG、MF值均较对照组明显提高（均P<0.05）,但观察组健患侧AEMG、MF值之间无统计学差异。结论: SET能够改善脑卒中患者的竖脊肌AEMG、MF值及BBS和BI评分,提高脑卒中患者躯干肌肉运动功能,从而提高平衡功能以及日常生活活动能力,值得在临床推广应用。     

Biomarkers in the prognostic evaluation of ischemic stroke: Is there benefit in the measurements of TREM-1 and TREM-2 in the acute phase?

Background and purposeTriggering receptors expressed on myeloid cells 1 and 2 (TREM-1 and TREM-2) are cell surface receptors important for modulation of microglia immune response. In this study, we evaluate serum levels of TREM-1 and TREM-2 as potential biomarkers in acute ischemic stroke (AIS).Material and methodsProspective cohort study of 50 patients with AIS admitted at our hospital. Serum TREM-1 and TREM-2 was evaluated within 24 h of the acute event and on the third and fifth days after the stroke. Neurological stroke severity and global disability were determined with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at the same three times and at the time of hospital discharge.ResultsTREM-1 and TREM-2 levels were elevated in stroke. TREM-1, but not TREM-2, exhibited correlations with NIHSS and mRS within 24 h (NIHSS and TREM-1: r_S = 0.31, p = 0.029; mRS and TREM-1: r_S = 0.32, p = 0.023). The serum level of TREM-1 within 24 h correlated with the neurological outcomes at hospital discharge (NIHSS and TREM-1: p = 0.021; mRS and TREM-1: p = 0.049). The serum concentrations of TREM-1 protein within 24 h after stroke was significantly higher in patients with poor outcome (mRS > 2) at hospital discharge (p = 0.021). After Exact Logistic Regression, large segmental stroke (O.R. = 4.14; 95CI = 1.07–16.09; p = 0.040) and initial sTREM levels (O.R. = 1.02; 95CI 1.00–1.04; p = 0.045) remained independent prognostic factors for AIS poor outcome (mRS > 2).ConclusionIn our study, TREM-1 and TREM-2 were significantly increased in AIS. Early elevation of TREM-1 correlated with stroke severity and it was an independent prognostic factor for stroke outcome.