系统性毛细血管渗漏综合征的临床研究进展

系统性毛细血管渗漏综合征为一组反复发作的低容量性低血压、血液浓缩、非蛋白尿性低蛋白血症 ,全身水肿、多数情况下伴有异型球蛋白血症的临床综合征。其原因由于毛细血管通透性增加 ,目前具体发病机理尚不明确。近年发现特布他林和茶碱对预防发作有效。临床医生应对该病提高警惕性。     

Serotoninergic activation and inhibition: effects on carbohydrate tolerance and plasma insulin and glucagon.

Glucose and arginine infusion tests were performed on 12 healthy volunteers (8 males, 4 females) before and after serotoninergic activation [oral administration of L-5-hydroxytryptophan (5-HTP-) for 6 days] and serotoninergic inhibition (oral treatment with D,L-p-chloropenylalanine for 6 days). 5-HTP treatment markedly increased urinary 5-hydroxyindoleacetic acid excretion, increased the mild hyperglycemic effect of arginine infusion, and lowered the glucose disposal rate constant. The adverse effect of serotoninergic activation on glucose tolerance is not sufficiently explained by the observed changes in insulin and glucagon secretion during the fasting state and after intravenous glucose and arginine infusions. Serotoninergic inhibition did not affect the carbohydrate tolerance of normal individuals. The results of this work supports the idea that excessive indoleamine production is probably the main cause for carbohydrate intolerance in carcinoid tumors.     

Films based on the biopolymer poly(3-hydroxybutyrate) as platforms for the controlled release of dexamethasone

Controlled drug delivery aims to achieve an effective drug concentration in the action site for a desired period of time, while minimizing side effects. In this contribution, biodegradable poly(3-hydroxybutyrate) films were evaluated as a reservoir platform for dexamethasone controlled release. These systems were morphological and physicochemically characterized. In vitro release assays were performed for five different percentages of drug in the films and data were fitted by a mathematical model developed and validated by our research group. When the profiles were normalized, a single curve properly fitted all the experimental data. Using this unique curve, the dissolution efficiency (DE), the time to release a given amount of drug (t_X%), and the mean dissolution time were calculated. Furthermore, the dissolution rate, the initial dissolution rate (a%) and the intrinsic dissolution rate were determined. The a% mean value was 1.968 × 10^?2% released/min, t_80% was about 14 days, and the DE was 59.6% at 14 days and 66.5% at 20 days. After 2 days, when approximately 40% of the drug was released, the dissolution rate decreased about 60% respect to the initial value. The poly(3-hydroxybutyrate) platforms behaved as an appropriate system to release and control the dexamethasone delivery, suggesting that they could be an alternative to improve drug therapy.     

Rehabilitación respiratoria

Pulmonary rehabilitation (PR) has been shown to improve dyspnea, exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). PR has also shown benefits in diseases other than COPD but the level of evidence is lower. The fundamental components of PR programs are muscle training, education and chest physiotherapy. Occupational therapy, psychosocial support and nutritional intervention should also be considered. Home programs have been shown to be as effective as hospital therapy. The duration of rehabilitation programs should not be less than 8 weeks or 20 sessions. Early initiation of PR, even during exacerbations, has proven safe and effective. The use of oxygen or noninvasive ventilation during training is controversial and dependent on the patient's situation. At present, the best strategy for maintaining the benefits of PR in the long term is unknown. Longer PR programs or telemedicine could play a key role in extending the results obtained.     

完全腹膜外腹腔镜疝修补术的护理配合

目的：总结经腹腔镜完全腹膜外疝修补术的配合方法。方法回顾性分析20例腹股沟疝患者经腹腔镜完全腹膜外疝修补的临床资料,术前准备充分,术中护士与医生密切配合。结果20例患者均顺利完成手术,无1例发生并发症。结论加强经腹腔镜完全腹膜外疝修补术的手术配合是手术成功的关键,术前充分准备、术中严格遵守操作规程、熟练的配合技术是手术成功的重要保证。     

Lower Extremity and Trunk Electromyographic Muscle Activity During Performance of the Y-Balance Test on Stable and Unstable Surfaces

BackgroundThe Star Excursion Balance Test (SEBT) has been used as a rehabilitation exercise. To improve its efficacy, efficiency, and method variations, the Y-Balance Test (YBT) with anterior (A), posterolateral (PL), and posteromedial (PM) directions of the SEBT has been recommended. Electromyographic activity has been reported to change when the same task is performed on various surfaces.Hypothesis/PurposeTo compare the EMG activity of trunk and LE muscles during the performance of the YBT on stable and unstable surfaces.Study DesignCross-Sectional study.MethodsHealthy adults with no history of chronic ankle instability were recruited for the study. Surface electromyography was collected for bilateral (ipsilateral [i] and contralateral [c]) rectus abdominis (RA), external oblique (EOB), erector spinae (ES). While, gluteus maximus (GMAX), gluteus medius (GMED), medial hamstrings (MH), biceps femoris (BF), vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL), anterior tibialis (AT), and medial gastrocnemius (MG) on the stance leg (ipsilateral side), during the performance of the YBT. The unstable surface was introduced using a Thera-Band stability trainer. Differences in electromyography were examined for each reach direction and muscle between the stable and unstable surfaces (p≤ 0.05).ResultsTwenty (10 male, 10 female) subjects participated (age: 27.5 ± 4.0 years, height:167 ± 1.0 cm, weight: 66.5 ± 13.0 kg, body fat: 14.1 ± 6.2%). Significantly higher muscle activity for the unstable surface (p<0.05) with moderate to large effect sizes were observed for the following muscles in the A direction: GMED, GMAX, VM, RF, and MG; PL direction: iEOB, iES, cES, GMED, BF, VM, RF, and MG; and PM direction iEOB, iES, GMED, BF, VM, and RF. Significantly higher muscle activity for the stable surface (p = 0.007) was observed in MH muscle in the A direction. No significant differences (p>0.05) between the stable and unstable surfaces were observed in iRA, cRA, cEOB, VL, and AT for any of the directions of the YBT.ConclusionAn increase in muscle activity was observed during YBT on unstable versus stable surfaces for some muscles.Level of Evidence2B     

冠状动脉旁路手术中动脉材料的选择与应用

目的 在冠状动脉旁路手术(CABG)中寻求动脉材料作旁路移植，减少因大隐静脉桥(SVG)阻塞对远期通畅率的影响。方法 34例冠心病患者以乳内动脉(IMA)和桡动脉(RA)作为血管桥行CABG，采用不接触血管技术制备动脉桥，应用药物防止动脉痉挛。结果 取乳内动脉35根，桡动脉20根，大隐静脉11根，平均移植血管1．94支，死亡1例，手术死亡率2．9％。结论 使用动脉材料行旁路移植术安全有效，预计能保持移植血管长期通畅。     

Cambios en la selección e impacto potencial de los inhibidores de neprilisina y del receptor de la angiotensina en los pacientes sometidos a reparación mitral percutánea borde a borde

Introduction and objectivesTranscatheter edge-to-edge repair (TEER) should be considered in patients with heart failure and secondary mitral regurgitation (MR). Angiotensin receptor-neprilysin inhibitors (ARNIs) have been demonstrated to improve prognosis in heart failure. We aimed to evaluate the impact ARNIs on patient selection and outcomes.MethodsThe population of the Spanish TEER prospective registry (March 2012 to January 2021) was divided into 2 groups: a) TEER before the ARNI era (n = 450) and b) TEER after the recommendation of ARNIs by European Guidelines (n = 639), with further analysis according to intake (n = 52) or not (n = 587) of ARNIs.ResultsA total of 1089 consecutive patients underwent TEER for secondary MR. In the ARNI era, there was a reduction in left ventricle dilation (82 mL vs 100 mL, P = .025), and better function (35% vs 38%, P = .011). At 2 years of follow-up, mortality (10.6% vs 17.3%, P < .001) and heart failure readmissions (16.6% vs 27.8%, P < .001) were lower in the ARNI era, but not recurrent MR. In the ARNI era, 1- and 2-year mortality were similar irrespective of ARNI intake but patients on ARNIs had a lower risk of readmission + mortality at 2 years (OR, 0.369; 95%CI, 0.137-0.992; P = .048), better NYHA class, and lower recurrence of MR III-IV (1.9% vs 14.3%, P = .011).ConclusionsBetter patient selection for TEER has been achieved in the last few years with a parallel improvement in outcomes. The use of ARNIs was associated with a significant reduction in overall events, better NYHA class, and lower MR recurrence.     

抗人结肠癌单抗MC5的功能性ScFv在大肠杆菌中的可溶性表达

目的：制备抗人结肠癌单抗MC5的具功能活性的可溶性单链可变区片段（ScFv）。方法：从分泌MC5的杂交瘤细胞分离mRNA，RT-PCR分别扩增抗体质量、轻链可变区基因（VH和VLDNA），经linkerDNA连接形成ScFvDNA。将ScFvDNA与噬粒载体pCANTAB5E的连接产物转化于大肠杆菌TG1，转化菌经辅助噬菌体M13KO7感染后，获得重组噬菌体。以高表达MC5结合抗原的人结肠癌细胞系SW480对重组噬菌体进行2轮筛选后，经ELISA筛选呈现抗体ScFv片段的噬菌体单克隆。取2个强阳性克隆的噬菌体感染大肠杆菌HB2151，用于表达可溶性ScFv。经点印迹和Western印迹对可溶性ScFv进行鉴定，经ELISA检测可溶性ScFv的抗原结合活性。结果：所获得的VH、VL和ScFvDNA分别约为340、320和750bp。对重组哓菌体经2轮亲和筛选后，经ELISA从25个克隆中筛检出10个抗原阳性克隆。源于2个强阳性克隆的可溶性ScFv的分子质量为32000u，且浓集于细菌周质腔中，可溶性ScFv具有抗原结合活性，其结合位点与亲本单抗MC5相同。结论：针对MC5的具功能活性的可溶性ScFv的成功制备，为人结肠癌的体外（乃至体内）研究提供了新的靶向载体分子。     

酸枣仁化学成分研究

目的 研究酸枣仁的化学成分.方法 利用正、反相硅胶柱色谱分离纯化,通过化学及波谱分析方法鉴定化合物的结构.结果 从酸枣仁中分离并鉴定了1个新的酮基达玛烷型四环三萜皂苷H(jujuboside H,Ⅰ)及3个已知化合物原酸枣仁皂苷A(protojujuboside A,Ⅱ)、酸枣素(斯皮诺素,Ⅲ)、白桦脂酸(Ⅳ).结论 化合物Ⅰ为新化合物,命名为酸枣仁皂苷H.