吸入布地奈德对AECOPD患者气道促炎/抗炎介质水平的影响

目的测定AECOPD患者雾化吸入布地奈德前后诱导痰中TNF-α和sTNF-R55、sTNF-R75水平,阐明吸入布地奈德是否影响TNF-α系统。方法检测57例AECOPD患者(吸入组28例,常规组29例)入院时和治疗第7天诱导痰中TNF-α和sTNF-R55、sTNF-R75水平及肺功能的变化。结果吸入组治疗后FEV1、FEV1%、FEV1/FVC、PaO2的改善优于常规组,其中FEV1、FEV1%的改善有显著性。吸入组诱导痰中TNF-α、sTNF-R55和sTNF-R75水平显著低于治疗前。常规组诱导痰中TNF-α、sTNF-R55和sTNF-R75水平低于治疗前,其中TNF-α和sTNF-R75的差异有显著性。治疗后吸入组诱导痰中TNF-α、sTNF-R55和sTNF-R75的水平较常规组显著降低。结论吸入布地奈德利于TNF-α、sTNFR水平降低,有助于TNF-α/sTNF-R恢复平衡,减轻气道炎症反应,改善肺功能。     

大面积脑梗死患者血管内低温技术的可操作性分析

目的探讨大面积脑梗死患者血管内低温技术的可操作性。方法前瞻性纳入大面积脑梗死接受血管内低温治疗的患者22例。按发病6个月生存与否或改良Rankin评分（mRS）,分为生存组（14例）和死亡组（8例）,预后良好组（mRS0～4分,11例）和预后不良组（mRS5～6分,11例）。分析血管内低温技术的可操作性及其与预后的关系。结果①22例患者诱导低温时间为（7．4±3．1）h,降温速度（0．66±0．40）℃/h;维持低温中位数时间24．0（20．5～72．0）h,最大温度偏差中位数0．2（0．1～2．0）℃,最大温度偏差≤0．3℃时长占维持低温时长的比率平均〉90％,15例患者低温过程中最大温度偏差≤0．3℃;恢复常温时间（36．0±13．9）h,复温速度（0．09±0．05）℃/h。生存组与死亡组比较以及预后良好组与预后不良组比较,各项温度相关变量的差异无统计学意义（P〉0．05）。②1例发生低温操作技术实施意外（盐水腔破裂）;4例患者发生低温仪器运转意外（6例次）,其中3次电源松动和1次机器停止运转的持续时间长,并引起体温波动,幅度为0．4～0．7℃。生存组与死亡组比较以及预后良好组与预后不良组比较,低温操作意外事件差异无统计学意义（P=1．000）。结论血管内低温技术的可操作性较好,但仍需提前做好低温治疗方案和各种意外事件处理预案,以保证低温治疗顺利实施。     

Induced pluripotent stem cells: progress towards a biomedical application

Evaluation of: Burridge PW, Thompson S, Millrod MA et al. A universal system for highly efficient cardiac differentiation of human induced pluripotent stem cells that eliminates interline variability. PLoS One 6(4), e18293 (2011).

Some 5 years ago, Takahashi and Yamanaka first obtained induced pluripotent stem cells (iPSCs) by genetically ‘reprogramming’ adult somatic cells (fibroblasts). This breakthrough opened a new frontier in regenerative medicine, in which iPSCs might effectively replace embryonic stem cells (ESCs), with the additional advantage of permitting autologous transplant. Unfortunately, the risk of aberrant reprogramming and of the complications related to the use of transgenes in the process still hinders iPSC clinical application. Nevertheless, differentiation of iPSCs derived from patients may already provide a formidable platform for the in vitro analysis of human disease mechanisms and their modulation by drugs. Such an approach has already been validated by the finding that iPSCs obtained from patients with a specific genetic syndrome can be differentiated into cardiomyocytes retaining the gene abnormality and recapitulating, at the cell level, the syndrome functional phenotype. Unlike the use of iPSCs in regenerative therapy, their development as disease models is unencumbered by safety constraints. Whatever the intended use, the availability of reliable and reproducible methods for somatic cell reprogramming, iPSC expansion and differentiation is pivotal and remains a major challenge to date. The article by Burridge and coworkers describes a process encompassing all the phases in the preparation of precursor-derived cardiomyocytes, characterized by unprecedented efficiency and, most notably, applicable to different human precursors, including ESCs and iPSCs derived from multiple somatic cell types. Provided that the process will prove reproducible when applied by different laboratories, the contribution of Burridge and coworkers may represent a genuine leap in the development of precursor-derived technologies.     

肝硬化失代偿合并妊娠瘢痕子宫患者中期引产一例的护理

目的探讨肝硬化失代偿期合并妊娠瘢痕子宫患者中期引产的护理方法。方法回顾性分析2010年北京佑安医院收治的1例肝硬化失代偿期合并妊娠瘢痕子宫患者的临床资料。患者入院后,即对其进行心理护理,制定有针对性的预防并发症发生的护理措施,指导患者饮食。结果经过积极有效的治疗和护理,该患者未发生严重并发症,引产过程顺利,预后良好,病情平稳后转入内科继续治疗。结论肝炎肝硬化失代偿合并妊娠瘢痕子宫的患者在实施中期引产时,风险大,并发症多。密切观察患者病情变化,采取有效的治疗措施,制定以"病人为中心"的个性化护理,是预防并发症发生和救治成功的关键。     

地西他滨联合自体CIK细胞治疗2例高龄急性髓系白血病的疗效观察

本研究旨在观察低甲基化药物地西他滨联合自体细胞因子诱导的杀伤细胞(CIK)治疗老年急性髓系白血病(AML)的安全性及有效性。本科于2006-2012年收治2例80岁以上老年AML患者(M4型和M6型),均继发于骨髓增生异常综合征。对这2例患者先后采取单用自体CIK细胞输注、地西他滨或(和)自体CIK细胞方案治疗,系统观察了2例CIK治疗前后淋巴细胞亚群、临床相关指标(血液学反应、输血频率、白血病相关基因表达、缓解情况、生活质量)及生存期的变化。结果表明,与单用自体CIK细胞输注和单用地西他滨治疗相比,地西他滨联合自体CIK细胞治疗方案可减轻骨髓抑制程度,降低输血频率及输血量,延长部分缓解持续时间,同时表达的白血病相关基因减少,生存期显著延长,患者生活质量得到明显改善。结论:地西他滨联合自体CIK细胞治疗老年AML患者安全有效。     

Over‐expression of inducible heat shock protein 70 in the gastric mucosa of partially sleep‐deprived rats

Background: Previous findings have demonstrated increased expression of inducible heat shock protein 70 (iHSP70) in the gastric mucosa of rats exposed to partial sleep deprived (PSD). The purpose of this study was to investigate the functional role of iHSP70 and its relationship with acid secretion in the stomachs of PSD animals. Methods: A slowly rotating drum was used to induce PSD in male Sprague‐Dawley rats with or without omeprazole treatment. Gastric mucosal samples were harvested for iHSP70 mRNA and protein analysis with RT‐PCR and Western blotting, respectively. Enzyme immunoassay was used to determine plasma gastrin level and gastric acidity was measured by titration. The modulating effect of PSD on 0.6?M hydrochloric acid (HCl)‐induced gastric damage was also evaluated. Results: PSD increased plasma gastrin, gastric acidity and expression of iHSP70, while significantly reducing HCl‐induced gastric damage. Omeprazole administration decreased gastric acidity and reversed iHSP70 over‐expression in PSD rats. Conclusions: PSD increases gastric acidity which enhances expression of mucosal iHSP70. Over‐expression of iHSP70 may be a protective homeostatic response of the stomach to stress induced by PSD and acid secretion.