不可切除胃癌转化治疗的研究进展

胃癌在全国范围内是发病率最高的恶性肿瘤之一，在癌症相关死亡原因中排名第三。目前外科手术仍然是胃癌获得根治性治疗的主要手段，但是其中有30%~40%的进展期胃癌患者在初诊时就失去了根治手术的机会，因此不可切除胃癌转化为可切除胃癌是患者获得"治愈"的最佳选择。随着近些年来新型药物的出现、治疗手段的多样化及多学科诊治模式的发展，"转化治疗"的理念应运而生，从而延长患者生存时间并提高其生活质量。本文就不可切除胃癌的治疗现状与进展、"转化治疗"的应用等进行综述。     

肝内胆管癌转化治疗

肝内胆管癌（ICC）可切除率低，进展期ICC的治疗有效率不高，预后很差。转化治疗在多种晚期肿瘤中有一定的疗效，是目前晚期肿瘤治疗的研究热点。随着对ICC基因组的深入了解和新的治疗药物的开发及组合，基于系统化疗的联合治疗策略，精准靶向治疗，免疫检查点抑制剂等显示出较好的疗效，使得部分进展期ICC病人能降期转化手术，获得长期生存。     

耐碳青霉烯肺炎克雷伯菌对替加环素不同体外药敏试验方法学评估

目的 比较不同药敏试验方法检测替加环素对耐碳青霉烯肺炎克雷伯菌(CRKP)的敏感性。初步了解辽宁地区CRKP对替加环素的耐药情况，为临床合理用药提供依据。方法 回顾性收集辽宁省内多家大型三甲医院2011年1月-2016年12月分离的CRKP共269株，采用微量肉汤稀释法、KB纸片扩散法、Vitek-2仪器法及E试验法检测替加环素对CRKP的敏感性。结果 微量肉汤稀释法、E试验法、Vitek-2仪器法测定替加环素MIC50和MIC90分别为(0.5/1)、(0.25/0.5)和(0.5/4)μg/mL。按美国食品与药品监督管理局(FDA)和欧洲药敏试验委员会(EUCAST)判读标准，微量肉汤稀释法测得CRKP对替加环素的敏感率为97.4%/93.3%，中介率为2.2%/4.1%，耐药率为0.4%/2.6%。E试验法敏感率最高，为100%/98.9%，Vitek-2法耐药率最高，为8.6%/13.4%，纸片扩散法的中介率最高，为11.9%/46.5%。与微量肉汤稀释法比较，E试验法的基本一致率(EA)和分类一致率(CA)均≥90%，但存在重大误差(VME)，分别为0.4%/1.9%；Vitek-2法EA仅为61.7%，CA为87.4%/72.1%，且大误差(ME)为6.3%/7.4%，无VME；纸片扩散法CA仅为85.9%/46.5%，小误差(mE)为1.9%/2.6%，ME为0.7%/5.6%。结论 辽宁地区绝大多数CRKP对替加环素仍保持较高的敏感性。对于CRKP、E-试验法、Vitek-2仪器法和纸片扩散法均不适合单独检测替加环素敏感性，可考虑联合检测，若结果不一致，均应参考微量肉汤稀释法。     

Heteroepitaxy of Cerium Oxide Thin Films on Cu(111)

An important part of fundamental research in catalysis is based on theoretical and modeling foundations which are closely connected with studies of single-crystalline catalyst surfaces. These so-called model catalysts are often prepared in the form of epitaxial thin films, and characterized using advanced material characterization techniques. This concept provides the fundamental understanding and the knowledge base needed to tailor the design of new heterogeneous catalysts with improved catalytic properties. The present contribution is devoted to development of a model catalyst system of CeO₂ (ceria) on the Cu(111) substrate. We propose ways to experimentally characterize and control important parameters of the model catalyst—the coverage of the ceria layer, the influence of the Cu substrate, and the density of surface defects on ceria, particularly the density of step edges and the density and the ordering of the oxygen vacancies. The large spectrum of controlled parameters makes ceria on Cu(111) an interesting alternative to a more common model system ceria on Ru(0001) that has served numerous catalysis studies, mainly as a support for metal clusters.     

2003-2005年新生儿感染常见致病菌及耐药性的变迁

目的了解本地区新生儿2003至2005年感染常见致病菌的种类及耐药的现状，以指导临床合理应用抗生素。方法收集我院新生儿科2003年1月至2005年12月收治的613份体液培养阳性（痰液、血液、分泌物、胃液等标本）的患儿资料，对常见检出菌及其耐药性的变迁情况进行分析。结果共检出40种613株病原菌，以革兰阴性杆菌为主约占57．6％，而肺炎克雷伯菌和大肠埃希菌分别位于前二位，其产ESBLs菌株检出率分别为78．1％和82．6％。药敏结果显示，常见致病菌对青霉素、第一、二代头胞类抗生素、红霉素类耐药性显著增加，但对第三代头胞类抗生素如头孢曲松、头孢噻肟（凯福隆）、头孢他啶（复达欣）及B内酰胺酶抑制剂复方制剂、碳青霉烯类、万古霉素等较敏感。产ESBLs菌仅对亚胺培南及B内酰胺酶抑制剂复方制剂敏感。结论革兰阴性杆菌特别是肺炎克雷伯菌和大肠埃希菌是新生儿感染主要病原菌，产ESBLs菌比例增加应引起高度重视。碳青霉烯类、哌拉西林／三唑巴坦和头孢哌酮／舒巴坦，可作为新生儿严重医院感染经验用药，应尽量根据药敏试验调整抗生素。     

Light exposure required for optimum conversion of light activated resin systems

OBJECTIVE: The aim of this study was to evaluate the relationship between the degree of conversion (DC) of composites and the light intensity using LED-curing units and also to determine the amount of exposure required to achieve optimal curing. METHOD: The light outputs of light-curing units and the depths of cure of composites exposed to these units were determined using the methods outlined in modified ISO standards, ISO/TS10650 and ISO 4049, respectively. The distributions of DC in composites were investigated by IR spectra of microareas obtained at various depths from the irradiated surface of thin specimens cut out from the cured composites. IR spectra were measured using a Fourier transform infrared spectrometer equipped with a microscopic unit. DC was calculated from the changes in the amount of C=C double bonds in the IR spectra. RESULTS: The light intensity at various depths through the cured composite was calculated from the attenuation coefficient of each material, obtained from the linear relationship between the depth of cure and the logarithm of the amount of exposure, which is defined as the product of the irradiance and irradiation time. There was a third or fourth order regression relationship between DC and the logarithm of total light energy at a particular depth. SIGNIFICANCE: The minimum light energy required to produce a saturated DC was about 1000 s mW/cm2.     

败血症98例临床分析

目的：探讨近年来败血症病原菌变迁和对常用抗菌药物的敏感状况以及影响败血症预后的因素。方法：回顾性分析1998～2004年的98例经血培养和临床资料证实的败血症。结果：98例败血症患者血培养共分离出致病菌102株，属社区获得性败血症81例（82．7％），医院获得性17例（17．3％）。革兰阳性菌、革兰阴性菌和真菌感染分别占34．3％、60．8％、4．9％。社区获得性败血症以大肠埃希菌为主，其次是金黄色葡萄球菌和肺炎克雷伯菌。医院获得性败血症以大肠埃希菌、真菌和不动杆菌为主。23抹金葡菌中苯唑西林耐药率39．1％，未发现对万古霉素耐药的菌株；31株大肠埃希菌对氨苄西林、阿米卡星和左氧氟沙星耐药率分别占90．3％、61．3％和45．2％，但对头孢三代、四代及酶抑制剂耐药率较低（12．9％～19．1％），未发现对亚胺培南-西司他丁耐药菌株。院内感染、血小板下降、血糖升高及休克增加了败血症患者病死率。结论：院内感染败血症病原菌中真菌和不动杆菌呈上升趋势，大肠埃希菌和金葡菌感染首选亚胺培南-西司他丁和万古霉素，大肠埃希菌院外败血症可首选头孢三代或亚胺培南-西司他丁。     

人体β-胡萝卜素的肠转化和吸收后转化的研究

目的 :为了解部分中国人体内 β 胡萝卜素 ( β carotene ,以下简称 β C)转化维生素A (vitaminA ,以下简称VA)的效率 ,开展了本研究。方法 :使用稳定同位素稀释法对 15名 5 0 60岁健康农村志愿者 (男 9,女6)进行β C人体代谢实验。 2周适应期和 5 6天实验期内 ,志愿者接受常规膳食 ,避免大量VA和 β C摄入以及烟、酒和营养补充剂。实验第 1天 ,给受试者含 6mg氘标记 β C( 2 H8β C)玉米油胶丸 ,随半流质早餐 (脂肪热能比 2 5 % )一起摄入。实验第 4天 ,受试者以同样方法摄入含 3mg氘标记醋酸视黄醇 ( 2 H8RAC)油剂胶丸。实验第 1天和第 4天摄入标记物后 0 ,3 ,5 ,7,9,11,13h时 ,实验第 2 ,3 ,5 ,6,7,8,9,10 ,14,2 1,2 8,3 5 ,42 ,49,5 6天晨空腹时 ,采静脉血。用高效液相色谱仪 (HPLC)分离血清 β C和VA组分 ,再分别使用气相质谱仪(GC MS)和液相质谱仪 (LC MS)测定VA和 β C组分的同位素丰度。根据VA和 β C的浓度和同位素丰度 ,描述标记VA和β C在体内应答的血液动力学曲线。 结果 :所有 15名受试者对2 H8RAC应答明显 ;但是在对2 H8β C的应答方面 ,只有 11名受试者2 H4视黄醇应答曲线明显 ,有 4名受试者血清2 H4视黄醇应答曲线非常微弱。经过对备份血清样品进行的多次重复GC MS测定 ,我们目前初步?     

Quantitative evidence of peripheral conversion of angiotensin within the human leg: effects of local angiotensin-I administration and angiotensin-converting enzyme inhibition on regional blood flow and angiotensin-II balance across the leg

Summary The renin-angiotensin system relevantly contributes to the maintenance of systemic vascular tone and there is experimental evidence that large amounts of angiotensin-converting enzyme (ACE) are present in peripheral vascular tissues, including resistance vessels. To determine and quantify peripheral vascular conversion of angiotensin-I (ANG-I) to angiotensin-II (ANG-II) across the human leg, the response of regional blood flow to local regional intra-arterial infusion of ANG-I and changes in associated ANG-I1 balance were evaluated during ANG-I infusion and following additional ACE inhibition. Ten sodium-loaded healthy men were enrolled in the study. Following cannulation of both femoral arteries and the right femoral vein, leg blood flow was determined (indocyanine-green dye-dilution method) at baseline conditions and during constant intra-arterial infusion of haemodynamically ineffective doses of ANG-I as well as following concomitant intra-arterial administration of low doses of the non-sulfhydril ACE inhibitor cilazapril. From the transfemoral arterio-venous differences in ANG-II plasma concentrations and the corresponding regional blood (plasma) flow, the ANG-II balance across the leg was calculated. Systemic blood pressure did not change throughout the trial, indicating that no major systemic effects were present during ANG-I infusion or concomitant ACE inhibition. Moreover, arterial ANG-II plasma concentrations were not significantly changed by ANG-I infusion. Leg blood flow decreased to below baseline values following ANG-I infusion, increasing again then in a dose-dependent manner during concomitant cilazapril administration. The calculated baseline ANG-II balance across the leg revealed a net extraction in 6 out of 10 subjects and a net ANG-II formation in 4. Following ANG-I, a shift towards net ANG-II formation or decrease in extraction was seen in 8 subjects, while 2 had no change in ANG-II balance.During concomitant ACE inhibition, ANG-II balance was again shifted towards net extraction or reduced formation. Our results confirm that, in man, considerable regional arterio-venous differences in ANG-II plasma concentrations are present, resulting in either net transfemoral extraction or net formation of the peptide. It is suggested that systemic vascular conversion of circulating ANG-I might contribute to the maintenance of peripheral vasuclar tone in man. Send offprint requests to S. Gasic at the above address     

苯并恶唑类化合物的研究——Ⅰ.化合物的合成及光物理性能

合成了四种结构类型的苯并恶唑化合物共15个:测试了它们的红外吸收光谱,以及它们在DMF中的紫外吸收、荧光发射和激光发射光谱。苯基取代物的荧光量子产率在0.64～0.66,无激光性能。其余的化合物荧光量子产率都大于0.70,在最大吸收波长下的激光转换效率为2.5～5.9%。