特发性肺纤维化急性加重期证候与血清生物标志物的相关性研究＊

目的 通过分析特发性肺纤维化急性加重期（AE-IPF）患者证候与血清生物标志物的关系，为中医辨证治疗提供参考。方法 采用观察性研究设计，收集2019年3月至2019年11月三个中心的AE-IPF患者76例，其中痰热壅肺证26例、痰浊阻肺证50例，并纳入健康志愿者10例作为对照。采用ELISA测定患者血清CCL18、HMGB1、KL-6、MMP-7、SP-A和SP-D水平，分析与中医证候的相关性。结果 AE-IPF患者血清CCL18、HMGB1、KL-6、MMP-7、SP-A和SP-D水平均显著高于健康对照组。血清CCL18、HMGB1、KL-6、MMP-7和SP-D水平在痰热壅肺证和痰浊阻肺证患者间无显著性差异（P＞0.05），而血清SP-A水平存在显著性差异（P＜0.05）。结论 血清SP-A与AE-IPF证候存在一定的相关性，血清SP-A的浓度升高，与痰热壅肺证关系越密切，反之，血清SP-A浓度降低，则与痰浊阻肺证关系越密切。AE-IPF痰热壅肺证患者的预后可能较痰浊阻肺证患者更差。     

经典名方中杜仲的本草考证

通过查阅历代本草、医籍、方书并结合近现代文献资料,笔者对杜仲药材的名称、基原、产地、品质评价、采收加工、炮制历史沿革及产地变迁情况进行了系统梳理及考证,以期为含杜仲的经典名方开发提供参考依据。经考证可知,历代本草均以杜仲为正名,基原为杜仲科植物杜仲Eucommia ulmoides的干燥树皮,古今一致;杜仲最早的产地为河南、山西、陕西、四川一带,自明代以来产地扩展至全国大部分地区,且推崇四川、陕西、重庆、贵州、湖北等地为杜仲的道地产区;近代以来总结其品质以皮厚、块大、粗皮刮净、断面多丝、内表面色暗紫为佳;杜仲的古代炮制加工方法主要有去粗皮切制生用和加酥蜜、姜汁、盐水、酒等辅料炮制,近现代以来炮制方法日趋简化,沿用的炮制方法主要为净制后切制生用、盐炙,建议挖掘不同杜仲炮制品的现代科学内涵,通过标准恢复传统主流炮制方法。基于宋代陈自明的三痹汤中杜仲“去皮,切,姜汁炒”的要求,根据考证结果,建议使用姜杜仲,即参考2020年版《中华人民共和国药典》炒法,以姜汁为辅料进行炮制后入药。     

Increasing organ donation via changes in the default choice or allocation rule

This research utilizes a laboratory experiment to evaluate the effectiveness of alternative public policies targeted at increasing the rate of deceased donor organ donation. The experiment includes treatments across different default choices and organ allocation rules inspired by the donor registration systems applied in different countries. Our results indicate that the opt-out with priority rule system generates the largest increase in organ donation relative to an opt-in only program. However, sizeable gains are achievable using either a priority rule or opt-out program separately, with the opt-out rule generating approximately 80% of the benefits achieved under a priority rule program.     

Clinical significance and pathological features of ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis

Objective To investigate the clinical significance and pathological features of lymphocytes and plasma cells infiltration and related ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis (IgG4-TIN). Methods Complete data was collected from 24 patients with IgG4-TIN confirmed by pathology in the Peking University First Hospital. The renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy examination. In addition, immunohistochemistry was used to detect the distribution of CD20+ B lymphocytes, CD3+ T lymphocytes and CD138+ plasma cells. Results A total of 24 patients were enrolled in the study, including 21 males (87.5%), 3 females (12.5%). The age was (58.0±10.8) years (38-75 years). Pathology analysis showed ectopic lymphoid-like structures were located in 16 (66.7%) cases and Russell bodies were detected in infiltrative plasma cells of 19(79.2%) cases with IgG4-TIN. Compared with cases without Russell body formation, cases with Russell body formation in renal interstitial plasma cells were more prone to show ectopic germinal center-like structure formation (P=0.001), tubular basement membrane (TBM) electron dense deposits (P=0.040) and reduced blood C3 levels (P=0.028). Conclusions Abnormal tubulointerstitial infiltration of ectopic lymphoid-like structures and plasma cells with prominent Russell body exist in IgG4-TIN patients, which suggests the persistent activation of lymphocytes and plasma cells in renal interstitium may contribute to the pathogenesis of IgG4-TIN.     

Prognostic factors for postoperative survival in melanoma patients with bone metastasis

Melanoma can spread to the bone by metastasis and is relevant to a poor outcome. However, because of the rarity of melanoma patients with bone metastasis, the prognostic postoperative survival factors of them have not been elucidated. The aim of this special population-based cohort was to elucidate the prognostic factors associated with postoperative survival. The Surveillance, Epidemiology, and End Results database was used to extract postoperative survival data relating to patients with melanoma and bone metastasis at diagnosis between 2010 and 2016, along with data on a range of potential postoperative prognostic factors. We then investigated the potential postoperative prognostic roles of these factors using a Cox regression model and the Kaplan-Meier analysis. In all, the Surveillance, Epidemiology, and End Results database included 186 cases. Regarding overall survival, the 1-, 3-, and 5-year overall survival rates for the entire cohort were 36.2%, 15.4%, and 9.5%, respectively. Regarding cancer-specific survival, the 1-, 3-, and 5-year cancer-specific survival rates were 42.0%, 23.2%, and 16.6%, respectively. Within a cohort of melanoma patients with bone metastasis after surgery, our analysis showed that a smaller tumor size and the lack of metastases at other sites were predictors of survival.     

Silymarin attenuates paraquat‐induced lung injury via Nrf2‐mediated pathway in vivo and in vitro

The present study aims to investigate the impacts and mechanisms of silymarin on paraquat (PQ)‐induced lung injury in vivo and in vitro. In in vivo experiments, a total of 32 male Sprague‐Dawley (SD) rats were randomly divided into four groups. The rats were killed on day 3. Histopathological changes in lung tissue were examined using HE and Masson's trichrome staining. Biomarkers of neutrophil activation, pulmonary oedema, pulmonary fibrosis, lung permeability and oxidative stress were detected. Several proinflammatory mediators and antioxidant related proteins were measured. In in vitro experiments, A549 cells were transfected with Nrf2 special siRNA to investigate the roles of Nrf2. The results show that silymarin administration abated PQ‐induced lung histopathologic changes, decreased inflammatory cell infiltration and lung wet weight/dry weight (W/D) ratio, suppressed myeloperoxidase (MPO) activity and nitric oxide (NO)/inducible nitric oxide synthases (iNOS) expression, downregulated hydroxyproline (HYP) levels, reduced total protein concentration and proinflammatory mediator release, and improved oxidative stress (malondialdehyde, MDA; superoxide dismutase, SOD; catalase, CAT; and glutathione peroxidase, GSH‐Px) in lung tissue and serum. Meanwhile, treatment with silymarin upregulated the levels of nuclear factor‐erythroid‐2‐related factor 2 (Nrf2), heme oxygenase‐1 (HO‐1) and NAD(P)H:quinone oxidoreductase‐1(NQO1). However, the addition of Nrf2 siRNA reduced the expression of Nrf2‐mediated antioxidant protein HO‐1 and thus reversed the protective effects of silymarin against oxidative stress and inflammatory response. These results suggest that silymarin may exert protective effects against PQ‐induced lung injury. Its mechanisms were associated with the Nrf2‐mediated pathway. Therefore, silymarin may be a potential therapeutic drug for lung injury.     

Use of Intracolonic Bypass Secured by a Biodegradable Anastomotic Ring to Protect the Low Rectal Anastomosis

Purpose Because of the relatively high morbidity and mortality of anastomotic leakage in patients with low rectal cancer who receive an anterior resection, many fecal diverting methods have been introduced. This study was designed to assess the efficacy and safety of the Valtrac™-secured intracolonic bypass in protecting low rectal anastomosis and to compare the efficacy and complications of Valtrac™-secured intracolonic bypass with those of loop ileostomy. Methods From January 2002 to April 2006, 83 patients with rectal cancer who underwent elective low anterior resection received intracolonic bypass or ileostomy. Demographics, clinical features, and operative data were recorded. Results Forty-four patients (53 percent) received a Valtrac™-secured intracolonic bypass and 39 patients (47 percent) a loop ileostomy. The demographics and clinical features of the groups were similar. None of the patients developed clinical anastomotic leakage. Longer overall postoperative hospital stay (21.3 ± 5.8 days) and higher costs incurred (3.1 ± 0.9 × $1,000 U.S. dollars) were observed in the ileostomy group than in the intracolonic bypass group (12.5 ± 6.3 days, 4.4 ± 1.2 × $1,000 U.S. dollars; P < 0.05). Stoma-related complications in the ileostomy group included dermatitis (12.8 percent), bleeding (2.6 percent), and intestinal obstruction after stoma closure (5.1 percent). No complications were observed in the intracolonic bypass group except for the Valtrac™ ring discharging en bloc, which compromised fecal evacuation in two cases (4.5 percent). Conclusions The Valtrac™-secured intracolonic bypass procedure is a safe, effective, but time-limited, diverting technique to protect an elective low colorectal anastomosis. Valtrac™-secured intracolonic bypass, in contrast to loop ileostomy, avoids stoma-related complications or readmission for closure and is associated with decreased hospital time and cost. Presented at the First National Conference on Colorectal Surgery, Zhu Hai, Guang Dong, China, November 2 to 5, 2006. Reprints are not available.     

醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿的疗效观察

摘 要 目的：探讨醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿的疗效。方法: 40例中枢性性早熟患儿随机分为观察组和对照组,每组20例。对照组给予肌注醋酸曲普瑞林,每28 d 1次;观察组在对照组治疗基础上,增加每28 d 1次的心理干预。观察比较两组患儿治疗1年前后的情绪稳定性、抑郁心理、治疗依从性,以及身高、体质量、生长速度、骨龄（BA）、预测成年身高（PAH）等各项生长指标变化。结果:治疗1年后,观察组患儿的情绪稳定性评分及抑郁心理HAMD评分均显著低于对照组(P＜0.05),用药依从性明显高于对照组(P＜0.05)。观察组患儿的生长速度、PAH均显著高于对照组(P<0.05)。结论:醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿,可以缓解患儿的抑郁心理、稳定情绪、提高用药依从性,且有效地提高生长速度,显著改善患儿的PAH。     

微针在美容整形外科应用中的进展

微针技术近几年发展迅速,在美容整形外科应用广泛且相关种类繁多.基于这种情况,通过检索近几年国内外微针在美容整形外科应用的文献,分析了微针在皮瓣及皮片存活、瘢痕、面部年轻化、局部麻醉、脱发、皮肤松弛、痤疮、色素沉着等方面的应用现状,归纳出微针在该领域的应用的机制主要基于:微针能刺激表皮细胞和胶原的增生及微针能进行物质导入两方面.总结了微针使用过程中优点突出而不良反应较少的特点,展望了微针在美容整形外科中应用的美好前景.