ER "capture" of the skid-row alcoholic

In response to the spiraling anger and frustration voiced by the emergency room (ER) medical staff and the observed negative interactions between the alcohol-dependent patient and the ER staff, the author completed a 6-month retrospective review of all patients evaluated by the ER service with a complaint of alcohol abuse, chronic alcoholism, or requesting detoxification. As a result of that study, an ER-based comprehensive approach to the management of this population was proposed. Utilizing an existing Connecticut state statute, a specific approach to manage the skid-row alcoholic arriving repeatedly in the ER was developed. I report on this ER-based model and an approach to "capturing" the skid-row alcoholic.     

Sodium regulation of agonist and antagonist binding to β-adrenoceptors in intact and Ns-deficient membranes

Summary Agonist binding to various hormone receptors mediating adenylate cyclase inhibition is decreased by sodium ions. We studied the influence of Na⁺ on agonist and antagonist binding to -adrenoceptors in membrane preparations of guinea pig lung, S49 lymphoma wild-type cells (WT) and their N_s-deficient cyc^– variants by measuring binding of the antagonist, [¹²⁵I]iodocyanopindolol ([¹²⁵I]CYP). At 37° C, sodium decreased the receptor affinity for the agonist, isoproterenol, in all three membrane preparations. In lung and WT membranes, Na⁺ steepened the shallow agonist competition curves in a manner similar to and synergistic with guanine nucleotides. When binding was performend at 4° C, sodium regulation but not guanine nucleotide regulation of agonist binding was preserved. At the low temperature, [¹²⁵I]CYP affinity was reduced, and sodium increased [¹²⁵I]CYP binding in both N_s-containing and N_s-deficient membranes by increasing the antagonist affinity without significant change in total receptor number. Compared to Na⁺, Li⁺ and K⁺ were much less potent and efficient in decreasing agonist and increasing antagonist binding. Na⁺ and Mg²⁺ had opposite effects on agonist binding in the N_s-containing lung and WT membranes but not in the N_s-deficient cyc^– membranes. The data indicate that sodium not only regulates binding of inhibitory hormone receptors but also agonist and antagonist binding to the adenylate cyclase stimulatory -adrenoceptor. The finding that sodium regulation of -adrenoceptor binding is also observed in the N_{s 2} cyc^– membranes, furthermore, indicates that the target of sodium is not the -subunit of N_s but possibly a component common to both types of receptor systems regulating adenylate cyclase activity.     

Spinal facilitation in cholinergic-sympathetic efferents by desipramine

Summary Electrodermal potentials (EDPs) evoked by electrical stimulation of the cholinergic-sympathetic system at different levels were recorded in the forepaws of anaesthetized cats and used as a measure of sudomotor activity. After pretreatment with yohimbine (0.25 mg/kg i.v.) to block ₂-adrenoceptors, unilateral electrical stimulation of the hypothalamus (square wave pulses 1 ms duration, 16 Hz, 2 s train length at intervals of 1 min) induced EDPs in both forepaws. Injection of the inhibitor of neuronal catecholamine reuptake, desipramine (1 mg/kg i.v.), facilitated the EDPs in both forepaws, even though access of the drug to the sweat glands was prevented by application of a tourniquet to one paw. The facilitation was abolished by injection of the specific ₁-adrenoceptor antagonist, prazosin (0.5 mg/kg i.v.). An equal enhancement of this effect by desipramine (1 mg/kg i.v.) and its abolition by prazosin (0.5 mg/kg i.v.) was obtained in cats with the brain stem transected at the level of the medulla oblongata and electrical stimulation of the spinal cord at C1. EDPs evoked in the right forepaw by preganglionic electrical stimulation of the right stellate ganglion were inhibited by desipramine (1 mg/kg i.v.).From these and previous results it is concluded that inhibition of neuronal reuptake of catecholamines results in facilitation of activity in sudomotor efferents. This effect is mediated by spinal ₁-adrenoceptors and provides an explanation of the occasional occurrence of excessive sweating in psychiatric patients treated with tricyclic antidepressants.     

Potential Role of Probiotics in Ameliorating Psoriasis by Modulating Gut Microbiota in Imiquimod-Induced Psoriasis-Like Mice

Psoriasis is an immune-mediated systemic disease that may be treated with probiotics. In this study, probiotic strains that could or could not decrease interleukin (IL)-17 levels were applied to imiquimod (IMQ)-induced psoriasis-like mice via oral administration. Bifidobacterium adolescentis CCFM667, B. breve CCFM1078, Lacticaseibacillus paracasei CCFM1074, and Limosilactobacillus reuteri CCFM1132 ameliorated psoriasis-like pathological characteristics and suppressed the release of IL-23/T helper cell 17 (Th17) axis-related inflammatory cytokines, whereas B. animalis CCFM1148, L. paracasei CCFM1147, and L. reuteri CCFM1040 neither alleviated the pathological characteristics nor reduced the levels of inflammatory cytokines. All effective strains increased the contents of short-chain fatty acids, which were negatively correlated with the levels of inflammatory cytokines. By performing 16S rRNA gene sequencing, the diversity of gut microbiota in psoriasis-like mice was found to decrease, but all effective strains made some specific changes to the composition of gut microbiota compared to the ineffective strains. Furthermore, except for B. breve CCFM1078, all other effective strains decreased the abundance of the family Rikenellaceae, which was positively correlated with psoriasis-like pathological characteristics and was negatively correlated with propionate levels. These findings demonstrated effects of strain-specificity, and how probiotics ameliorated psoriasis and provide new possibilities for the treatment of psoriasis.     

腹主动脉瘤腔内修复术后感染病原菌及Hippo信号通路基因改变

目的探讨腹主动脉瘤腔内修复术(EVAR)后医院感染病原特点及Hippo信号通路基因、白细胞介素-17(Interleukin-17,IL-17)、IL-23改变。方法选择天津医院血管外科2017年5月-2020年3月收治腹主动脉瘤EVAR术后医院感染患者49例作为感染组,选择同期医院进行EVAR术后未发生医院感染患者60例作为非感染组。采用实时荧光定量逆转录聚合酶链反应(RT-PCR)法检测Hippo通路基因yap、taz、mst1相对表达水平,采用酶联免疫吸附法检测其辅助型T细胞17(Th17)促炎细胞因子白细胞介素-17(IL-17)、IL-23水平。结果49例患者共发生肺部感染33例(67.35%),尿路感染10例(20.41%),手术切口感染4例(8.16%),移植物感染2例(4.08%);感染病原以革兰阳性菌为主,共25株,占51.02%,革兰阴性菌共22株,占44.90%,真菌2株,占4.08%;感染组yap、taz、mst1基因相对表达水平和IL-17、IL-23水平高于非感染组(P<0.05)。结论腹主动脉瘤EVAR术后医院感染以肺部感染、尿路感染为主,应及时予以针对性预防;Hippo通路参与了感染发生过程,通过Th17促炎途径诱导炎症反应,其机制仍有待研究。     

肝包虫病合并HBV感染患者Th17、CD4+细胞表面PD-1/PD-L1的表达水平及意义

目的探讨肝包虫合并乙型肝炎病毒(HBV)感染患者辅助性T细胞17(Th17)、CD4⁺细胞表面程序性死亡分子-1/程序性死亡分子1配体(PD-1/PD-L1)的表达水平及其临床意义。方法选取2014年9月一2019年9月新疆医科大学第一附属医院收治的肝包虫病患者作为研究对象﹐其中100例肝包虫病合并HBV感染患者为合并HBV感染组,肝包虫病无HBV感染患者88例为非HBV感染组﹐采用流式细胞仪检测外周血Th17,CD4⁺细胞表面PD-1,PD-L1表达水平。结果合并HBV感染组患者乙型肝炎家族史,B~C Child分级占比均高于非HBV感染组(P<0.05);肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST),γ-谷氨酰转肽酶(γ-GT)]水平以及Th17 PD-1、Th17 PD-L1,CD,PD-1,CD4⁺PD-L1表达水平均高于非HBV感染组(P<0.05);Child分级A级肝包虫病患者的Th17 PD-1,Th17 PD-L1,CD4⁺PD-1,CD4⁺PD-L1表达水平均低于Child分级B~C级患者(P<0.05)。结论HBV感染会影响肝包虫病患者的肝功能及外周血Th17,CD4⁺细胞表面PD-1,PD-L1表达水平,肝功能严重程度可能与外周血Th17,CD4⁺细胞PD-1,PD-L1表达存在关系。     

孕早期外周血中lnc-C17orf64-1:1对子痫前期的预测价值

目的 探究孕早期孕妇外周血中lnc-C17orf64-1∶1的表达及其在子痫前期发病中的预测价值。方法 选择2018年9月至2019年9月于上海交通大学医学院附属国际和平妇幼保健院就诊分娩的孕妇,留取其孕早期(11~13周)外周血样本。根据妊娠结局是否为子痫前期分组:正常孕妇29例为对照组,子痫前期孕妇20例为子痫前期组。收集孕产妇相关临床资料,采用实时荧光定量PCR(qRT-PCR)检测孕早期外周血中lnc-C17orf64-1∶1的表达水平(ΔCT值),分析其与病情相关临床指标的相关性,并通过受试者工作特征(receiver operating characteristi, ROC)曲线分析其预测价值。结果 子痫前期组孕妇孕早期外周血中lnc-C17orf64-1∶1表达升高(ΔCT值降低);ROC曲线分析发现孕早期外周血lnc-C17orf64-1∶1预测子痫前期发病的曲线下面积(area under the curve, AUC)为0.9172(95%置信区间:0.8445-0.9899),敏感度80.00%,特异度86.21%,最大约登指数0.6621,最佳截断点13.71(ΔCT值),阳性预测值80.00%,阴性预测值86.21%;Spearman相关性分析发现孕早期外周血lnc-C17orf64-1∶1的ΔCT值与收缩压及舒张压均呈负相关。结论 孕早期外周血lnc-C17orf64-1∶1高表达与子痫前期密切相关,且对子痫前期早期诊断有一定预测价值。     

慢性乙型肝炎患者外周血SOCS3 mRNA的表达及其与Th17的关系

 目的 研究慢性乙型肝炎(CHB)患者外周血辅助性T细胞17(Th17)以及细胞因子信号转导抑制因子3(SOCS3) mRNA的表达状况,探索CHB患者SOCS3 mRNA表达与Th17的关系。方法 选取2021年2—8月于某院门诊就诊的30例CHB患者为研究对象,并选取同期正常体检者15例为对照组。采用流式细胞术(FCM)检测外周血Th17细胞频数,酶联免疫吸附试验(ELISA)检测血清细胞因子IL-17A和IL-23表达水平,实时荧光定量逆转录聚合酶链反应(qRT-PCR)法测定外周血SOCS3、维甲酸相关孤儿核受体γt (RORγt) mRNA表达水平,并比较两组患者的检测结果。结果 CHB患者外周血Th17细胞频数及其效应分子IL-17A、IL-23表达水平高于对照组(均P＜0.05),Th17细胞频数、IL-17A与HBV DNA水平之间存在正相关(r值分别为0.570、0.563,均P＜0.005)。CHB患者外周血SOCS3、RORγt mRNA表达水平高于对照组(均P＜0.05),两者与HBV DNA水平正相关(r值分别为0.662、0.561,均P＜0.05)。CHB患者SOCS3 mRNA与RORγt mRNA、Th17细胞频数、IL-17A之间存在正相关(r值分别为0.552、0.626、0.826,均P＜0.05)。结论 CHB患者外周血SOCS3 mRNA的异常高表达,可能通过调节RORγt mRNA的表达来影响Th17的分化及其效应分子的分泌。     

APP17肽对卵巢去势大鼠海马神经元凋亡相关因子表达的影响

为研究卵巢去势大鼠海马神经元内凋亡相关因子Fas、Fas L、NFκB、c fos、c Jun的表达及APP1 7肽对这些因子表达的影响 ,将健康雌性Wistar大鼠行双侧卵巢切除手术造模 ,并用APP1 7肽治疗 ,分别用免疫组化方法观察Fas、Fas L、NFκB、c fos、c Jun的表达 ,用TUNEL方法检测神经元的凋亡。结果发现 :卵巢去势大鼠海马神经元Fas、Fas L、c fos、c Jun的表达增高 ,而NFκB的表达则减少 ;使用APP1 7肽治疗后 ,上述蛋白质的表达恢复到正常水平 ,TUNEL检测未发现凋亡神经元。提示卵巢去势大鼠发生了海马神经元的凋亡相关蛋白的改变 ,可能是神经元处于凋亡前状态 ;APP1 7肽可改善卵巢去势大鼠海马神经元内凋亡相关蛋白的表达 ,维持神经元的正常功能     

毛细管区带电泳测定尿17-羟皮质类固醇

目的 :应用高效毛细管区带电泳 (CZE)技术分离和检测人尿内 1 7-羟类皮质类固醇 (1 7-OHCS) ,以解决微色谱柱 -分光光度测定尿 1 7-OHCS时 ,多酚类化合物对测定的干扰。方法 :标本用活性高岭土吸附尿内色素 ,以茶碱作内标 ,中性苯乙烯 -二乙烯苯树脂微色谱柱吸附尿中 1 7-OHCS。乙醇解吸附 ,采用毛细管区带电泳进一步分离并测定。结果 :运用CZE法分离了人尿 1 7-OHCS ,皮质醇浓度在 2～ 5 0mg .L- 1 范围内具有良好的线性关系 (r=0 .994) ,方法平均回收率 96 .1 7% ,日内及日间CV均小于 5 % ,最低检测限度为 0 .3mg .L- 1 。结论 :与微色谱柱 -分光光度法相比 ,CZE法检测尿内 1 7-OHCS无干扰 ,方法简便、快速、可靠。