端粒酶突变体对肝癌细胞端粒酶活性的作用

目的　观察端粒酶突变体对肝癌细胞端粒酶活性和生长抑制的作用。方法　利用质脂体转染法在培养的肝癌细胞中导入端粒酶突变体，并与维甲酸和人参皂甙对照，利用TRAP－银染方法对不同时期肝癌细胞进行了端粒酶活性的测定，并观察各期细胞生长情况。结果　在加入端粒酶突变体后肝癌细胞端粒酶活性明显降低，细胞出现明显凋亡现象，其作用效果与维甲酸基本相同。结论　端粒酶突变体对肝癌细胞的抑制作用可能是通过抑制端粒酶活性途径实现的。     

不同阶段ICU患者家属需求的调查分析

目的 了解不同阶段重症监护病房（ICU）患者家属的需求状况。方法 选取符合入选标准的25名患者家属。分别在患者入CU24h内和72h后采用急危重患者家属需求量表（CCFN1）进行调查。结果 ICU患者家属72h后在接近患者需求、信息需求、情感及物质支持需求、舒适需求方面得分低于24h内的评分，且差异有显著性意义（P〈0．05，P〈0．01）；而在保证患者安全方面的需求有升高趋势，但两者差异无显著性意义。结论患者入院初期，其家属处于极度应激状态，对各项需求都较高。72h后，随着应激水平的下降，其需求也相应有所降低，但保证患者安全的需求没有下降。提示医护人员要在患者八院初期，高度重视、满足家属的各种需求，以帮助其渡过急性应激期；同时要在整个治疗过程中时刻注意满足家属对患者安全和治疗的需求。     

56例极重型乙脑患者应用人工呼吸器治疗的并发症和死亡原因分析

对 5 6例使用机械通气的极重型乙脑患者的并发症和死亡原因进行分析。 5 6例患者呼吸衰竭的原因为 :脑水肿、脑疝 1 0例 ,呼吸道分泌物阻塞 8例 ,呼吸肌瘫痪 8例 ,混合因素 3 0例。应用机械通气后 5 6例患者中出现并发症的有 5 0例 (89.3 % )。机械通气 1 0d内仅 4例 (7.1 4% )发生感染 ,机械通气大于 2 0d有 48例 (85 .7% )发生感染(P <0 .0 1 ) ;同时机械通气大于 2 0d患者绿脓杆菌感染高达 2 7例 (4 8.2 % ) ,而机械通气小于 2 0d者仅 2例 (3 .6% )绿脓杆菌感染 (P <0 .0 1 )。结果提示 :极重型乙脑患者使用机械通气极易发生感染等并发症 ,通气天数减少 ,则并发症减少 ,病人存活机会增加。     

Optimal management of postpartum hemorrhage

目的　讨论产后出血干预治疗的合理方案。方法　回顾性分析 15例行干预性治疗的严重产后出血的病人的临床特点及方法。结果　 15例患者中子宫切除者 9例 ,行动脉栓塞治疗 7例 (2例切除子宫后又行栓塞治疗 ) ,行病灶挖除术 1例。需行干预性治疗的产后出血的原因依次为 :DIC ,子宫动 -静脉瘘及血管畸形 ,胎盘异常 ,子宫肌瘤及子宫裂伤。结论　应针对产后出血的不同原因、部位及性质选择合理有效的干预治疗。合理的治疗方案是抢救病人生命 ,保留生育功能 ,尽可能减少创伤的关键。     

避免鼻内窥镜手术并发症的临床解剖

目的：为避免鼻内窥镜手术并发症提供解剖学基础。方法：在３０侧成人头部正中矢状剖面标本上,观察了泪囊的毗邻、在鼻腔外侧壁上的投影及筛窦的毗邻。结果：泪囊与中鼻道前房相邻,其在鼻腔外侧壁上投影的前界为“骨梭”,后界为钩突基部,上界为中鼻甲附着处前部的下缘,下界为下鼻甲附着处前部的上缘。筛顶壁为一前窄后宽的骨板,筛前、后动脉在筛窦内均靠筛顶下方并与筛板同水平走行。结论：鼻内窥镜手术者若熟悉手术区的解剖可减少或避免并发症。     

基于常见遗传变异和传统风险因素的中国南方汉族人群结直肠癌风险预测模型研究

目的 基于结直肠癌全基因组关联研究(GWAS)发现的易感位点,联合传统风险因素建立中国南方汉族人群结直肠癌风险预测模型。方法 对1 066例结直肠癌患者和3 880例健康对照的21个GWAS候选位点进行基因分型,分析其与结直肠癌易感性之间的关联。通过遗传风险评分(GRS)和加权遗传风险评分(wGRS)计算显著候选位点的联合效应。以不同方式组合遗传风险评分和传统风险因素,构建结直肠癌风险预测模型,并绘制受试者工作特征曲线评价模型优劣性。结果 7个候选位点与结直肠癌易感性显著相关。随着风险评分的升高,人群患结直肠癌的风险也随之升高(GRS:P=0.002 6,wGRS:P<0.000 1),相比于四分位分组中最低一组,GRS和wGRS最高的一组OR值分别为1.33(95%CI:1.12~1.58,P=0.001 0)和1.76(95%CI:1.45~2.14,P<0.000 1)。联合传统风险因素和wGRS的模型为最优模型,其曲线下面积为0.593(95%CI:0.573~0.613)。结论 结直肠癌易感位点间存在显著的联合作用。相比于传统风险因素模型,传统风险因素结合加权遗传风险评分模型能更好预测结直肠癌的患病风险。     

氨甲环酸在非体外循环冠脉移植手术中应用效果与安全性的系统评价

目的：系统评价氨甲环酸（T A ）在非体外循环冠状动脉移植手术中使用的有效性与安全性。方法计算机检索MEDLINE、Embase等数据库,收集TA用于非体外循环冠状动脉移植术的随机对照临床试验（RCT）,使用Cochrane协作网的RevMan 5．2软件对纳入文献进行系统评价。结果共纳入10个RCT ,共851例患者。TA可显著减少术后总出血量（24 h：SD＝－208．41,95％ CI：－311．48～－105．35,P＜0．0001）,降低围术期同种异体输血风险（RR＝0．47,95％ CI：0．33～0．66,P＜0．0001）,可显著降低输入袋装红细胞的人数（RR＝0．60,95％ CI：0．49～0．74,P＜0．001）。该研究尚无足够证据证明 TA与血栓栓塞事件有关。结论 TA可减少OPCAB手术患者的出血量和输血风险。由于样本量小、剂量小、随访时间短的问题,其不良反应仍存争议,仍需更多高质量的临床试验进行确证。     

Diagnostic Accuracy of Bronchodilator Response for Asthma in a Population of South China

Introduction

A significant bronchodilator response is commonly defined as a 12% or greater and 200 ml or greater change in FEV₁ from baseline according to the 2005 American Thoracic Society (ATS)/European Respiratory Society (ERS) criterion. A number of studies have shown that the ATS/ERS criterion has limitations in asthma diagnosis, and some experts have argued for correcting the criteria. The aim of this study is to investigate the diagnostic value of acute bronchodilator response for asthma in a Southern Chinese population.

Methods

We prospectively evaluated 805 patients with obstructive lung disease (309 for asthma, 496 for non-asthma). Spirometry was performed according to the ATS/ERS guidelines. Data were analyzed by SPSS 18.0. The receiver-operating characteristic (ROC) curve was drawn to assess the diagnostic accuracy of the ATS/ERS criterion based on FEV₁. Linear regression was used to analyze the factors of FEV₁ change.

Results

The sensitivity and specificity of the acute bronchodilator test when judged by the ATS/ERS criteria (200 ml or higher and 12% improvement) were 68.6% and 78.2%, respectively. For the ATS/ERS criteria, the Youden Index, which comprehensively reflects the authenticity of a diagnostic test, was 46.8%. The absolute change of FEV₁ positively correlated with baseline FEV₁ and weight and negatively with age, while the percentage change of FEV₁ was negatively correlated with baseline FEV₁, age and height and positively with weight. Compared with the different diagnostic values, when ?FEV₁ was 195 ml and ?FEV_1i% was 14%, the Youden Index was the largest (48.2%) and the diagnostic capability of the test the biggest.

Conclusions

The ATS/ERS criterion for acute bronchodilator response might not be completely suitable for asthma in the Chinese population.

Trial Registration

Chinese Clinical Trial Registry (Registry ID: ChiCTR-DDT-14004976).

Funding

This work was supported by the National Natural Science Foundation of China (grant nos. 81670027, 81270080).

     

Heart Failure with Preserved Ejection Fraction Trials Have Heterogeneous Control Groups: a Comparison of Kaplan-Meier Curves

Purpose

Previous studies have evaluated intra-study heterogeneities of heart failure with preserved ejection fraction (HFpEF), but inter-study heterogeneities remain poorly understood. We investigate the heterogeneities of outcomes among control groups of HFpEF trials.

Methods

We included randomized controlled trials recruiting HFpEF patients with ejection fraction ≥?40% and reporting Kaplan-Meier curves for at least 36 months. The Kaplan-Meier curves of control groups were extracted and calculated for hazard ratios and 95% confidence intervals. Two virtual trials were developed to validate the reliability and accuracy of our method.

Results

Of 4161 studies, we included six trials containing 7682 HFpEF patients in control groups. The DIG trial had the highest all-cause mortality, cardiovascular mortality, heart failure mortality, and composite endpoints of cardiovascular mortality and heart failure hospitalization (all p?<?0.001). The TOPCAT trial had the lowest all-cause mortality, cardiovascular mortality, heart failure hospitalization, and composite of cardiovascular mortality and heart failure hospitalization (all p?<?0.001). Adoption of different ejection fraction cut-off values for HFpEF diagnosis did not significantly change the outcomes of control groups in the DIG trial (45% vs. 50%: hazard ratio, 1.05, 95% confidence interval, 0.97–1.13, p?=?0.271), or in the CHARM-Preserved trial (40% vs. 50%: hazard ratio, 1.01, 95% confidence interval, 0.93–1.09, p?=?0.864) during 36-month follow-up.

Conclusions

The control groups of HFpEF trials have heterogeneous outcomes. Future trials should consider these heterogeneities when designing protocols.