基于Nrf2/HO-1通路的中医药干预溃疡性结肠炎研究进展

溃疡性结肠炎（UC）是临床常见的一种慢性消化系统疾病,其病情反复且治疗难度大,发病机制复杂,与氧化应激反应相关。核转录因子E₂相关因子2（Nrf2）是抗氧化反应中的重要因子,可调控其下游血红素加氧-1（HO-1）的表达,发挥维持机体氧化还原稳态的作用。UC的病程中Nrf2与HO-1的生物活性及含量水平均下降,组织抗氧化和抗炎能力减弱,肠上皮细胞损伤,肠黏膜屏障破坏。目前西医临床上主要以控制炎症和缓解症状治疗为主,虽有一定疗效,但存在停药后易复发、长期用药不良反应多等问题。研究表明,中医药治疗手段丰富,治疗方法灵活,在UC的防治上有广阔的应用前景。近年来,以Nrf2/HO-1通路为切入点,中医药领域开展了大量关于UC中该信号的基础和临床实验,结果表明Nrf2/HO-1通路是中医药治疗UC的重要潜在靶点。基于虚实夹杂的病因病机,中医药以清热解毒燥湿、活血化瘀止痛、益气补中温里和标本兼治等法调控Nrf2/HO-1通路,提高组织抗氧化应激能力,维持促炎因子与抗炎因子平衡,缓解炎症反应,发挥对UC的治疗作用。该文总结和分析了中医药靶向Nrf2/HO-1信号通路干预UC的机制和作用,以期为科研人员更为全面认识中医药对UC中Nrf2/HO-1通路的作用机制提供帮助,旨在推动今后中医药合理运用于临床UC的防治。     

Outcomes and factors associated with early mortality in pediatric postcardiotomy veno‐arterial extracorporeal membrane oxygenation

Mortality and morbidity of children received veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) support after cardiac surgery remain high despite remarkable advances in medical management and devices. The purpose of this study was to describe outcomes and risk factors of applying VA‐ECMO in the surgical pediatric population. We retrospectively analyzed 85 consecutive pediatric patients (aged <18 years) who received postcardiotomy VA‐ECMO from January 2010 to December 2018. Median (IQR) age at ECMO implantation in this cohort was 12.7 (6.4, 43.2) months, median weight was 8.5 (6.0, 12.8) kg, mean ECMO duration was 143.2 ± 81.6 hours and mean hospital length of stay was 48.4 ± 32.4 days. Seventy‐five patients (88.2%) were indicated for postcardiotomy cardiogenic shock. The successful ECMO weaning rate was 70.6% and in‐hospital mortality was 52.9%. The most common diagnosis was transposition of great arteries (n = 18, 21.2%), while acute kidney injury occurred most often (n = 64, 75.3%). Multivariate logistic regression analysis showed that thrombocytopenia, hemolysis, and nosocomial infection were positively correlated with in‐hospital mortality. Multivariate Cox proportional hazard regression analysis presented that thrombocytopenia significantly increased the 180‐day mortality in patients with successful weaning. Therefore, multiple factors had adverse effects on prognosis. Patient selection and procedures from ECMO implantation to weaning need to be closely monitored and performed in a timely manner to improve outcome.     

脊椎血管瘤手术后复发放射治疗疗效观察(附6例报告)

目的 探讨脊椎血管瘤手术后复发放射治疗疗效和适宜剂量。方法 1968—1992年间共收治手术后复发的有症状的脊椎血管瘤6例，中位年龄28岁。病灶在胸椎5例，腰椎1例。4例有病灶局部疼痛合并不完全性截瘫，2例为局部疼痛合并下肢麻木无力。采用^60Co和8MV—X线照射治疗，总剂量范围30-60Gy，平均40Gy。结果 所有接受放疗的患均获得良好的远期效果，4例不完全截瘫患中3例基本恢复，1例完全恢复，另外2例原有的下肢麻木症状消失，但影像学检查均无明显改变。结论 放射治疗对手术后复发的脊椎血管瘤是安全有效的，剂量以36—40Gy为宜。但放射治疗起效比较慢，且影像学改变不明显，所以应以远期症状改善率作为评价放射治疗效果的标准。     

中专内科学教学艺术

中专生年龄小，自我约束力差，文化基础薄弱，理解能力有限，以自我为中心。这些特点决定知识点繁杂。且相对枯燥的内科学教学要讲究艺术，才能激发学生学习兴趣，提高教学质量。     

Constructing novel molecular subtypes and an 11-gene signature based on pyroptosis signaling for lung adenocarcinoma

Pyroptosis plays important roles in various cancers. In this study, we focused on lung adenocarcinoma (LUAD) and aimed to develop new molecular subtypes based on pyroptosis signaling. Pyroptosis-related genes were used as a basis to classify molecular subtypes through unsupervised consensus clustering. Gene set enrichment analysis was performed to characterize tumor microenvironment (TME) and functional pathways. Univariate Cox regression and least absolute shrinkage and selection operator (LASSO) analysis were conducted to identify prognostic genes for establishing a prognostic model. Three molecular subtypes were established with distinct overall survival, TME and enriched pathways. C3 subtype had the longest survival and the highest immune infiltration. 11 prognostic genes were screened to build a prognostic signature for predicting LUAD prognosis. This study emphasized the important role of pyroptosis in LUAD development. Pyroptosis was considered to play critical roles in regulating TME. Moreover, the 11-gene signature could serve as an indicator for predicting LUAD prognosis, and was potential targets for developing targeted drugs.     

色谱指纹谱技术在甘肃道地药材大黄鉴定中的应用

目的：建立甘肃道地药材大黄的数字化色谱指纹谱以用于药材鉴定。方法：采用RP—HPLC洗脱技术进行HPLC分离分析，建立甘肃道地药材大黄的数字化色谱指纹谱。色谱柱：C18柱；流动相：甲醇0．5％乙酸水溶液作为洗脱液；流速：1ml／min；检测波长：280nm。结果：在选定的色谱条件下，建立了药材的数字化色谱-指纹谱HPLC-DFPS(HPLC-Digitized Finger Print Spectrum)，提供了稳定可控的药材指纹谱图，以及通过与标准药材比较探求了道地药材中用以鉴定的特征峰群。结论：利用数字化色谱指纹谱技术分析鉴定甘肃道地药材大黄是切实可行的。     

葡萄籽提取物对破骨细胞分化的影响

目的检测葡萄籽提取物对破骨细胞分化、形成、功能的影响。方法利用实时定量基因扩增荧光检测系统(qPCR)检测破骨细胞分化标志分子的表达,利用抗酒石酸酸性磷酸酶(TRAP)染色及 TRAP活性定量实验检测破骨细胞的形成情况,利用c?TX定量实验检测破骨细胞的骨吸收活性。结果细胞克隆经诱导分化后,与对照组相比, GSE组细胞的破骨标志分子 Itgb3 mRNA相对表达量由(216.59±34.61)下降至(104.55±9.54)(n＝3,P＝0.0355); Acp5由(103.37±14.77)下降至(78.96±13.15)(n＝3,P＝0.0351); Dcst由(304.85±14.77)下降至(65.03±11.75)(n＝3,P＝0.0003); Ctsk由(290.23±41.65)下降(132.23±14.06)(n＝3,P＝0.0229)。经葡萄籽提取物处理后,破骨标志分子 Itgb3、Acp5、Dcst、Ctsk mRNA水平均显著降低, TRAP阳性细胞数目减少, TRAP活性由(2.52±0.39)下降至(0.91±0.10)(n＝3,P＝0.0165),TRAP活性显著降低;与对照组细胞相比, GSE组细胞分泌的 c?TX量由(1.01±0.11)nmol/L下降至(0.49±0.06)nmol/L(n＝3,P＝0.0028),c?TX分泌显著减少。结论葡萄籽提取物有效抑制破骨细胞分化、形成及活性,葡萄籽提取物是潜在的预防治疗骨质疏松的营养补充剂。     

腹腔镜胰十二指肠切除术在老年胰腺导管腺癌患者中的肿瘤学疗效研究

目的 研究腹腔镜胰十二指肠切除术在老年胰腺导管腺癌患者中的肿瘤学疗效.方法 回顾性分析自2015年1月-2017年12月在复旦大学附属华东医院普外科完成胰十二指肠切除术治疗的胰腺导管腺癌、年龄≥60岁患者的临床资料.根据其手术方式分为腹腔镜(LPD)组与开放(OPD)组,并对2组的手术及肿瘤学资料进行比较.结果 共入组...