不同胎龄早产儿凝血功能及出血性疾病的临床研究

目的 分析早产儿凝血功能与胎龄间的相关性,并探讨凝血功能检测对出血性疾病的可能预测价值。方法 收集2016年9月至2017年8月住院的早产儿的相关临床资料以及生后2 h内凝血功能检测结果。依据胎龄分为晚期早产儿组（n=322）、早期早产儿组（n=241）和超/极早产儿组（n=128）,比较不同胎龄各组早产儿的凝血功能;并比较生后3 d内有无并发出血性疾病早产儿的凝血功能检测指标。结果 不同胎龄的3组间凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原降解产物（FDP）、D-二聚体（DD）的比较差异有统计学意义（P < 0.05）,其中APTT、PT、FDP、DD与胎龄呈负相关,而TT与胎龄呈正相关（P < 0.05）。与未患出血性疾病的早产儿相比,罹患出血性疾病早产儿的APTT延长（P < 0.05）,DD值升高（P < 0.05）。结论 早产儿随着胎龄的增长,生后凝血功能逐渐成熟。APTT及DD检测结果异常,预示早产儿可能会具有更高的风险罹患出血性疾病。     

Alteration of fecal tryptophan metabolism correlates with shifted microbiota and may be involved in pathogenesis of colorectal cancer

BACKGROUNDGut tryptophan (Trp) metabolites are produced by microbiota and/or host metabolism. Some of them have been proven to promote or inhibit colorectal cancer (CRC) in vitro and animal models. We hypothesized that there is an alteration of gut Trp metabolism mediated by microbiota and that it might be involved in the pathogenesis of cancer in patients with CRC.AIMTo investigate the features of Trp metabolism in CRC and the correlation between fecal Trp metabolites and gut microbiota.METHODSSeventy-nine patients with colorectal neoplastic lesions (33 with colon adenoma and 46 with sporadic CRC) and 38 healthy controls (HCs) meeting the inclusion and exclusion criteria were included in the study. Their demographic and clinical features were collected. Fecal Trp, kynurenine (KYN), and indoles (metabolites of Trp metabolized by gut microbiota) were examined by ultraperformance liquid chromatography coupled to tandem mass spectrometry. Gut barrier marker and indoleamine 2,3-dioxygenase 1 (IDO1) mRNA were analyzed by quantitative real-time polymerase chain reaction. Zonula occludens-1 (ZO-1) protein expression was analyzed by immunohistochemistry. The gut microbiota was detected by 16S ribosomal RNA gene sequencing. Correlations between fecal metabolites and other parameters were examined in all patients.RESULTSThe absolute concentration of KYN [1.51 (0.70, 3.46) nmol/g vs 0.81 (0.64, 1.57) nmol/g, P = 0.036] and the ratio of KYN to Trp [7.39 (4.12, 11.72) × 10^-3 vs 5.23 (1.86, 7.99) × 10^-3, P = 0.032] were increased in the feces of patients with CRC compared to HCs, while the indoles to Trp ratio was decreased [1.34 (0.70, 2.63) vs 2.46 (1.25, 4.10), P = 0.029]. The relative ZO-1 mRNA levels in patients with CRC (0.27 ± 0.24) were significantly lower than those in HCs (1.00 ± 0.31) (P < 0.001), and the relative IDO1 mRNA levels in patients with CRC [1.65 (0.47-2.46)] were increased (P = 0.035). IDO1 mRNA levels were positively associated with the KYN/Trp ratio (r = 0.327, P = 0.003). ZO-1 mRNA and protein levels were positively correlated with the indoles/Trp ratio (P = 0.035 and P = 0.009, respectively). In addition, the genera Asaccharobacter (Actinobacteria) and Parabacteroides (Bacteroidetes), and members of the phylum Firmicutes (Clostridium XlVb, Fusicatenibacter, Anaerofilum, and Anaerostipes) decreased in CRC and exhibited a positive correlation with indoles in all subjects.CONCLUSIONAlteration of fecal Trp metabolism mediated by microbiota is associated with intestinal barrier function and tissue Trp metabolism, and may be involved in the pathogenesis of CRC.     

老年患者发生迟发性脑缺血前多种影响因素的探究

目的  探究老年患者发生迟发性脑缺血（DCI）的危险因素,防止迟发性脑缺血的发生。方法  回顾性分析120例动脉瘤性蛛网膜下腔出血患者。年龄60～79岁,Fisher分级>1。将患者分为DCI组和非DCI组。分析患者的相关指标（性别、吸烟史、局部脑氧饱和度等）,找出迟发性脑缺血的独立危险因素,并用受试者工作曲线评估其预测性能。结果  所有入组患者中,69例患者伴有DCI。单因素分析结果表明,DCI组患者中,有吸烟史、低钠、局部脑氧饱和度<50的患者比例明显大于非DCI组,差异有统计学意义（P <0.05）。多因素Logistic回归分析发现,钠离子浓度（■=3.011,95%CI：1.123,8.070）与局部脑氧饱和度（■=3.324,95%CI：1.734,6.372）是迟发性脑缺血的独立危险因素,且局部脑氧饱和度预测性能更佳。结论  局部脑氧饱和度是老年患者动脉瘤性蛛网膜下腔出血后迟发性脑缺血较好的预测指标。

     

江苏省13家医院新生儿严重高胆红素血症现状调查

目的 了解江苏省新生儿严重高胆红素血症的发生情况及诊治、随访等管理情况,为新生儿严重高胆红素血症的预防及规范化管理提供依据。方法 以2018年1~12月江苏省13家医院收治的严重高胆红素血症新生儿为研究对象,回顾性分析患儿的临床资料及随访资料。结果 江苏省13家医院2018年严重高胆红素血症新生儿病例共上报740例,占新生儿科收治病例总数的2.70%（740/27 386）,其中重度高胆红素血症620例（83.8%）,极重度高胆红素血症106例（14.3%）,危险性高胆红血症14例（1.9%）;诊断为急性胆红素脑病共4例（0.5%）。484例（65.4%）新生儿于分娩机构出院后因严重高胆红素血症返回医院住院治疗,中位入院日龄为7 d,其中214例（44.2%）再入院前进行过门诊黄疸随访,第1次门诊中位随访日龄为6 d。住院期间行头颅MRI检查211例（28.5%）,其中85例（40.3%）提示双侧基底节、苍白球T1WI信号偏高;行脑干听觉诱发电位检查238例（32.2%）,其中14例（5.9%）仅一侧通过,7例（2.9%）双侧均未通过。急性胆红素脑病或危险性高胆红素血症患儿（共17例）进行了随访,除1例失访外,均无异常神经系统症状。结论 新生儿严重高胆红素血症在新生儿科住院病人中的占比较高;新生儿从分娩机构出院后黄疸监测及管理需要加强;对并发了严重高胆红素血症的患儿,住院期间相关检查需更完善,出院后均需全面系统地随访。     

Muscone Protects Vertebral End-plate Degeneration by Antiinflammatory Property

Most chronic neck pain is the result of degeneration of the cervical spine. IL-1β may play an important role in intervertebral disc degeneration. This being the case, inhibiting IL-1β could provide a therapeutic approach for reducing or preventing disc degeneration. Muscone reportedly relieves pain and suppresses inflammation. Therefore, we asked whether muscone, a potent antiinflammatory agent, could reduce proinflammatory cytokines in vitro (end-plate cartilage cultures) and end-plate degeneration in vivo (a rat model that induces intervertebral disc degeneration). In vitro, muscone reversed IL-1β-induced upregulation of IL-1β, tumor necrosis factor α, cyclooxygenase 2, inducible nitric oxide synthase, matrix metalloproteinase 13, aggrecanase 2, and nitric oxide and downregulation of Col2α1 and aggrecan. Pretreatment with muscone (6.25, 12.5, 25 μmol/L) inhibited the IL-1β-induced phosphorylation of extracellular signal-regulated kinases 1/2 and c-Jun N-terminal kinase in a dose-dependent manner. In vivo, muscone inhibited the expression of prostaglandin E2, 6-keto-prostaglandin F1α, IL-1β, and tumor necrosis factor α and recovered the structural distortion of the degenerative disc. Our findings suggest muscone is a promising agent for treating intervertebral disc degeneration through its antiinflammatory effects.     

郑州市某区9621名高三学生视力不良检出率和近视患病率调查分析

目的　了解郑州市某区9621名高三学生视力不良检出率和近视患病率情况。方法　采取整体抽样法对9621名高三学生体检视力和近视度数结果进行分析,通过卡方检验分析不同性别、不同眼别间视力不良检出率、近视患病率的差异。结果　本研究受检者共9621人19 242眼,其中女生4720人9440眼、男生4901人9802眼;处于病理状态3眼（具体表现为角膜斑翳、人工晶状体眼和弱视）。正常视力4445眼,占受检眼的23.10%;视力不良14 797眼,占76.90%。右眼视力不良检出率高于左眼（χ²=30.024,P<0.001）,女生视力不良检出率高于男生（χ²=27.490,P<0.001）。本调查19 242受检眼中共发现12 339眼近视眼,占64.13%（其中高度近视563眼,占2.93%;中度近视6049眼,占31.44%;轻度近视5727眼,占29.76%）。右眼近视患病率高于左眼（χ²=38.533,P<0.001）,女生近视患病率高于男生（χ²=17.107,P<0.001）。结论　郑州市某区高三学生有较高的视力不良检出率和近视患病率,视力不良检出率和近视患病率中女生高于男生、右眼高于左眼。     

新型原位植入式人工肛门括约肌样机及离体肠道实验研究

设计一款基于生物信号反馈机制的智能化可遥控式人工肛门括约肌系统。所设计的蠕动式微型医用泵在3.3 V 驱动电压下,最大流量为8.5 mL/min,最大封闭压可达170 kPa。新型括约肌假体在较小注水量（9～10.5 mL）的情况下,可实现对肠壁作用压的均匀分布（3.34～7.26 kPa）,符合人体肠道生理结构和安全压力阈值的要求,避免由于局部高压导致的缺血性坏死。人工括约肌系统采用体内充电电池、体外无线经皮能量充电的供电方式,实现系统的完全植入式移植。离体实验结果表明,该系统可以有效地抑制肠道内容物渗漏,成功建立排便感知信号,从而为严重肛门失禁、结肠造口等肛门功能严重缺失的患者提供一种人性化的治疗方案。