不同剂量乌司他丁联合微量推注泵美罗培南对重症肺炎患者的疗效及血管生成素2的影响

摘要 目的：探讨与分析不同剂量乌司他丁联合微量推注泵美罗培南对重症肺炎患者的疗效及血管生成素-2的影响。方法：2019年1月到2022年2月选择在本院诊治的重症肺炎患者78例作为研究对象,将其分为研究组与对照组各39例,两组都给予美罗培南微量推注治疗,研究组与对照组分别给予高剂量与低剂量的乌司他丁治疗,连续应用7 d,观察患者的疗效及血清血管生成素2表达变化情况。结果：研究组的ICU住院时间、退热时间、炎症吸收时间与痰液颜色改变时间较对照组少（P<0.05）。研究组的治疗总有效率较对照组高（P<0.05）。两组治疗后的血清白细胞介素-6（IL-6）、白细胞介素-17（IL-17）含量明显低于治疗前(P<0.05),研究组治疗后的血清IL-6、IL-17含量也明显低于对照组（P<0.05）。两组治疗后的血清血管生成素-2含量低于治疗前,治疗后研究组血清血管生成素-2含量低于对照组（P<0.05）。结论：高剂量乌司他丁联合微量推注泵美罗培南在重症肺炎患者的应用能抑制血清血管生成素-2的表达,也可抑制血清IL-6、IL-17的表达,从而能提高治疗效果,促进改善患者的临床症状,有利于患者康复。     

头孢哌酮舒巴坦联合美罗培南对重症肺炎患者动脉血气指标及血清TNF-α、PCT、CRP水平的影响

摘要 目的：探讨头孢哌酮舒巴坦联合美罗培南对重症肺炎（SP）患者动脉血气指标及血清肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）、C反应蛋白（CRP）水平的影响。方法：选取2018年8月~2020年8月期间我院收治的SP患者78例,根据入院奇偶顺序分为对照组（头孢哌酮舒巴坦治疗）和观察组（头孢哌酮舒巴坦联合美罗培南治疗）,各39例,疗程为7 d,观察两组治疗7 d后的疗效,对比两组治疗前、治疗7 d后的动脉血气指标及血清TNF-α、PCT、CRP水平,观察两组临床症状缓解时间和不良反应发生情况。结果：观察组的临床总有效率高于对照组（P<0.05）。观察组肺部啰音消失时间、退热时间、脓性痰消失时间短于对照组,组间对比有差异（P<0.05）。治疗7 d后,观察组氧分压（pO₂）、氧合指数（OI）高于对照组,二氧化碳分压（pCO₂）低于对照组（P<0.05）。治疗7 d后,观察组TNF-α、PCT、CRP低于对照组（P<0.05）。两组不良反应发生率组间对比无差异（P>0.05）。结论：头孢哌酮舒巴坦联合美罗培南治疗SP患者,可促进患者症状改善,且改善患者动脉血气指标,降低机体炎症反应,无严重不良反应发生,安全有效。     

美罗培南联合常规治疗对脓毒症休克合并急性肾功能不全患者炎性因子、肾功能及免疫球蛋白的影响

摘要 目的：探讨脓毒症休克合并急性肾功能不全患者在常规治疗的基础上联合美罗培南治疗后对其肾功能、炎性因子及免疫球蛋白的影响。方法：选取我院80例脓毒症休克合并急性肾功能不全患者,根据随机数字表法分为对照组（n=40）和研究组（n=40）,对照组予以常规治疗,研究组在对照组的基础上联合美罗培南治疗,比较两组患者疗效、炎性因子[降钙素原（PCT）、C反应蛋白（CRP）、白介素-6（IL-6）]、肾功能[尿素氮（BUN）和血肌酐（Scr）]、免疫球蛋白[免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、免疫球蛋白A（IgA）]及不良反应。结果：研究组治疗1个疗程后的临床总有效率为90.00%（36/40）,高于对照组的72.50%（29/40）（P<0.05）。两组不良反应发生率比较无差异（P>0.05）。两组患者治疗1个疗程后BUN、Scr和PCT、CRP、IL-6均下降,且研究组低于对照组（P<0.05）。两组患者治疗1个疗程后IgG、IgM均升高,且研究组高于对照组（P<0.05）;两组患者治疗1个疗程后IgA组间及组内比较无差异（P>0.05）。结论：脓毒症休克合并急性肾功能不全患者在常规治疗的基础上联合美罗培南治疗,疗效显著,可有效改善肾功能及免疫功能,减轻炎性反应,且安全性较好。     

糖皮质激素辅助治疗对肺炎支原体肺炎患儿肺功能、血清炎症因子及体液免疫功能的影响

摘要 目的：探讨糖皮质激素辅助治疗对肺炎支原体肺炎（MPP）患儿肺功能、血清炎症因子及体液免疫功能的影响。方法：选取2016年3月~2019年3月间在我院接受住院治疗的100例MPP患儿,根据随机数字表法将患儿分为研究组、对照组,各50例,其中对照组予以常规治疗,研究组则予以糖皮质激素辅助常规治疗,比较两组患儿临床疗效、肺功能[呼气峰流速值（PEF）、第1s用力呼气容积（FEV1）、潮气量（V-T）]、血清炎症因子[白介素-6（IL-6）、白介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）]及体液免疫功能[免疫球蛋白A（IgA）、免疫球蛋白M（IgM）、免疫球蛋白G（IgG）]等指标变化情况,记录两组治疗期间不良反应情况。结果：研究组治疗后的临床总有效率为92.00%（46/50）,高于对照组的70.00%（35/50）（P<0.05）。治疗后两组患儿IgG、IgA、IgM均较治疗前升高,且研究组高于对照组（P<0.05）。治疗后两组患儿IL-6、IL-10、TNF-α均较治疗前降低,且研究组低于对照组（P<0.05）。治疗后两组患儿PEF、FEV1、V-T均较治疗前升高,且研究组高于对照组（P<0.05）。两组不良反应发生率相比无差异（P>0.05）。结论：糖皮质激素辅助治疗MPP患儿,可减轻机体炎症因子水平,改善患儿肺功能的同时还可缓解体液免疫紊乱,且联合用药安全性较好。     

免疫性不孕患者全血Cu、Zn、Se水平及与炎性因子相关性研究

摘要 目的：考察免疫性不孕患者全血微量元素铜（Cu）、锌（Zn）、硒（Se）水平和血清炎性因子白细胞介素（Interleukin,IL）-6、IL-8、肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)水平,明确微量元素、炎性因子与免疫性不孕的关系。方法：回顾性选择40例免疫性不孕患者作为研究组,另以同期40名健康者作为对照。对两组全血微量元素Cu、Zn、Se进行检测,以酶联免疫法试剂盒检测血清IL-6、IL-8以及TNF-α,并对Cu、Zn、Se水平和IL-6、IL-8、TNF-α与免疫性不孕的相关性进行分析。结果：研究组的全血Cu水平显著高于对照组,而Zn、Se水平显著低于对照组(P＜0.05),即免疫性不孕患者全血微量元素Cu、Zn和Se水平异常,其中Cu异常增高,而Zn和Se异常降低;研究组患者的IL-6、IL-8和TNF-α均显著高于对照组健康女性(P＜0.05),即免疫性不孕患者血清存在炎性因子的异常增高;全血微量元素Cu、Zn、Se和血清炎性因子IL-6、IL-8、TNF-α均与免疫性不孕密切相关（P＜0.05)。结论：免疫性不孕患者全血微量元素Cu和Zn水平异常,血清炎性因子水平异常,微量元素和炎性因均与免疫性不孕密切相关。     

连续性血液净化及肠内营养治疗重症胰腺炎疗效及对炎症因子影响

摘要 目的：探究连续血液净化及肠内营养治疗重症胰腺炎患者的疗效及对患者炎症因子水平的影响。方法：选择2018年1月至2019年12月于我院接受治疗的82例重症胰腺炎患者为研究对象,按照治疗方式不同将其分为研究组(49例)与对照组(33例)。对照组患者仅接受连续血液净化,研究组患者在对照组患者基础上加用肠内营养支持,对比两组患者腹痛缓解时间、感染发生率、住院时间、治疗前后血尿素氮(Blood urea nitrogen,BUN)、血肌酐(creatinine,SCr)、C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF-α)、急性生理与慢性健康评分表评分(acute physiology and chronic health evaluationⅡ,APACHE II)评分的变化。结果：研究组患者腹痛缓解时间、感染发生率、住院时间均短于对照组患者(P<0.05)。治疗后,研究组患者APACHE II评分、血清CRP、IL-6、TNF-α、BUN及SCr水平均低于对照组(P<0.05)。结论：连续血液净化联合肠内营养支持对重症胰腺炎患者具有较好的治疗效果,能够显著加快重症胰腺炎患者转归,改善患者肾损伤及机体炎症状态。     

化脓性牙髓炎患者血清CRP、IL-6、TNF-α及CD14水平的变化及其临床意义

摘要 目的：探讨化脓性牙髓炎患者血清C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及白细胞分化抗原-14 (CD14)水平的变化及其临床意义。方法：选取2016年1月~2017年12月期间本院收治的110例化脓性牙髓炎患者为研究组,其中急性化脓性牙髓炎患者59例（急性组）,慢性化脓性牙髓炎患者51例（慢性组）,另选同期在我院进行健康检查的健康受试者50例为对照组。放射免疫分析法检测对照组体检时、研究组患者治疗前后血清CRP、IL-6、TNF-α及CD14水平。Pearson相关性分析化脓性牙髓炎患者治疗前血清CRP、IL-6、TNF-α与CD14水平的相关性。结果：研究组患者治疗前血清CRP、IL-6、TNF-α、CD14水平均高于对照组体检时各项指标水平,组间对比差异有统计学意义(P<0.05)。急性组患者治疗前后血清CRP、IL-6、TNF-α、CD14水平均高于慢性组患者(P<0.05);急性组、慢性组患者治疗后血清CRP、IL-6、TNF-α、CD14水平均低于治疗前(P<0.05)。Pearson相关性分析结果显示,化脓性牙髓炎患者治疗前血清CRP、IL-6、TNF-α与CD14水平均呈正相关(P<0.05)。结论：化脓性牙髓炎患者血清CRP、IL-6、TNF-α及CD14均呈现高表达,可能参与了化脓性牙髓炎的发生、发展过程,经牙髓根管治疗后上述指标水平均降低,且CD14与血清CRP、IL-6、TNF-?琢呈正相关,可能作为评估化脓性牙髓炎病情的重要指标。     

体外循环预充还原型谷胱甘肽对心脏瓣膜置换术患者的临床研究

摘要 目的：观察体外循环（CPB）预充还原型谷胱甘肽（GSH）对心脏瓣膜置换术患者心肌损伤指标和炎症因子指标的影响。方法：选择2020年10月到2021年10月期间于我院行心脏瓣膜置换术治疗的180例患者。以随机数字表法分为对照组和研究组,均为90例。研究组患者CPB预充GSH 1200 mg,对照组患者预充等量氯化钠注射液。观察两组患者围术期指标、心肌损伤指标[肌酸激酶（CK）、乳酸脱氢酶（LDH）、肌钙蛋白Ⅰ（cTnⅠ）、肌红蛋白（Mb）]、炎症因子指标[肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）]变化,并记录两组并发症发生情况。结果：研究组术中转流时间、呼吸机使用时间、ICU留置时间、术后多巴胺使用天数短于对照组,术后多巴胺使用总量少于对照组（P<0.05）。主动脉开放后2 h、12 h、24 h,两组CK、LDH、cTnⅠ、Mb水平均升高后下降（P<0.05）,且研究组CK、LDH、cTnⅠ、Mb水平低于对照组（P<0.05）。主动脉开放后2 h、12 h、24 h,两组IL-6、TNF-α水平均升高后下降（P<0.05）,且研究组IL-6、TNF-α水平低于对照组（P<0.05）。研究组的并发症发生率低于对照组（P<0.05）。结论：CPB预充GSH可减轻心脏瓣膜置换术患者心肌损伤,有效控制炎症反应,同时还可降低并发症发生率,缩短呼吸机使用时间、术中转流时间、ICU留置时间、术后多巴胺使用天数,减少术后多巴胺使用总量,效果显著。     

氟康唑胶囊联合知柏地黄丸治疗滴虫性阴道炎的疗效及对患者血清IL-10和TNF-?琢水平的影响

摘要 目的：探讨氟康唑胶囊联合知柏地黄丸对滴虫性阴道炎患者血清白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)的影响及临床疗效。方法：收集我院就诊的78例滴虫性阴道炎患者,随机分为实验组和对照组,各39例。对照组患者给予氟康唑胶囊治疗,实验组在对照组基础上给予知柏地黄丸治疗。观察并比较两组患者治疗前后IL-10、TNF-α、阴道健康评分及临床疗效。结果：与治疗前相比,两组患者治疗后血清IL-10、TNF-α水平均显著下降,阴道健康评分均明显升高,差异具均有统计学意义(P<0.05);与对照组相比,实验组患者治疗后血清IL-10、TNF-α水平较低,阴道健康评分和临床治疗总有效率均较高,差异均具有统计学意义(P<0.05)。结论：氟康唑胶囊联合知柏地黄丸能够有效提高滴虫性阴道炎患者的临床疗效,可能与其显著降低血清IL-10、TNF-α水平有关。     

补肾通络汤联合甲氨蝶呤对类风湿关节炎患者炎症细胞因子、骨代谢标志物及血管新生相关因子的影响

摘要 目的：探究补肾通络汤联合甲氨蝶呤治疗类风湿关节炎患者的临床效果。方法：选取2017年9月到2018年6月我院收治并确诊的79例类风湿关节炎患者,按照随机数字表法将其分为对照组39例和研究组40例,对照组仅接受甲氨蝶呤治疗,研究组在对照组基础上联合补肾通络汤治疗,治疗3个月后比较临床疗效、炎症细胞因子、骨代谢标志物、血管新生相关因子水平、28个关节疾病活动度积分(DAS28)及不良反应。结果：研究组治疗总有效率为90.00%,明显高于对照组的71.79%（P＜0.05）;研究组治疗3个月后白细胞介素-1(IL-1)、白细胞介素-6(IL-6) 、肿瘤坏死因子-α(TNF-α)、骨碱性磷酸酶 (B-ALP)、碱性成纤维细胞生长因子（bFGF）、血管内皮生长因子（VEGF）水平以及DAS28积分均低于对照组（P＜0.05）;研究组治疗3个月后25羟维生素D［25( OH) D］、Ⅰ型前胶原羧基端前肽 (PICP)、甲状旁腺激素(PTH)、转化生长因子-β1（TGF-β1）水平高于对照组;研究组不良反应发生率为17.50%,与对照组的25.64%比较无差异（P＞0.05）。结论：补肾通络汤联合甲氨蝶呤治疗类风湿关节炎患者能够有效控制炎性反应,实现对骨代谢的调节,且能够对新生血管增生形成有效抑制,同时不会增加不良反应,值得推广应用。     

Anthropology and genetics of the caucasus peoples and the problem of the origin of the caucasoids

The electrophoretical polymorphisms of some blood proteins were studied in the Talysh population of Pirasora situated in South-East Azerbaidjan. We calculated the gene frequencies of these polymorphisms and determined the genetic distances between the Talyshes and some Iranian populations of North, Central and South Iran, Afghans, and three populations of Azerbaijan. The Talyshes are very close to Iranians of Shiraz, whereas they are distant from the Azerbaijanians. Anthropological investigations showed that the Caucasoids and Mongoloids lived in the Aragvi Basin since the Eneolithic period. This was stated by Alexeev (1974), who emphasized the mixture of the Caucasus populations from ancient times on. We calculated the genetic distances between the Caucasus populations and numerous populations of other geographic regions, considering 28 alleles of 12 loci of blood group, serum protein and red cell enzyme polymorphisms and constructed the dendrogram of these populations. The position of the Caucasus populations in the dendrogram corresponds on principle to the earlier anthropological observations. The clustering of the Caucasoid populations corresponds completely with anthropological and historical data, and supports our earlier hypothesis (Nazarova 1999) concerning the differentiation of Caucasoids, Northern Mongoloids and Amerinds from the populations, which inhabitated Asia in palaeolithic times.     

人类基因组及后基因组研究进展及其应用与开发研究现状

人类对自身基因组的研究,随着人类基因组工作草图的绘制完成和对基因功能研究的深入已加快进入了实质性、关键性的开发利用阶段。本文概述了人类基因组及后基因组的研究进展及依此开展基因治疗及基因（组）药物研制等应用开发研究的现状。     

Serology and systematics of the Ebenales and the Theales

The systematic position ofthe Ebenaceae, Sapotaceae, Styracaceae, Ochnaceae, Stachyuraceae, Dipterocarpaceae, Clusiaceae and Hypericaceae has been investigated using serological comparisons of sets of antigenic determinants. The results show that the Sytracaceae and Sapotaceae are undoubtedly more closely associated with the Actinidiaeceae and Theaceae, respectively, than with each other. We found no corresponding determinants betnween antigen systems from the Ebenaceae and systems from any other family whose relations to this family have been proposed. As discovered previously, investigations of antigen systems from the Ochnaceae, Dipterocarpaceae, Stachyuraceae, Clusiaceae and Hypericaceae are against the idea of a natural order “Theales” in which these families, or at least some of them, are combined with the Theaceae and Actinidiaceae. This paper completes our previous investigations which largely support a superorder Ericanae sensu Ehrendorfer and Takhtajan. We propose to include the Actinidiaceae and Theaceae in this superorder, assigning them a central position laong with the Sapotaceae and Sytracaeae on one side and the Primulales and Ericales on the other. Another most interesting finding is that there are corresponding determinants between antigen systems from the members of the Ericanae and representatives of the Polemoniaceae and Loasaceae.     

Kinematics and dynamics of the temporomandibular joint and of the movements of the mandible

In order to analyze the complicated movements of the mandible as the open-closing movement and the protrusio are, it is useful to evaluate the basic kinematic principles and reduce them to simple technical constructions. Both the open-closing movement and the protrusio could be reduced to 4-bar links, which were used to simulate the movements with help of a computer. Besides, the polodes and the curves of points in the muscular attachments could be constructed. The 2 entirely different 4-bar links have 3 things in common: The resting system - cranium, the moving system - mandibula, and 1 of the 2 arms connecting these 2 systems - the ligamentum laterale. As this ligament is taut during movements it can be considered a "guiding ligament" representing 1 of the 3 determining components of the mandibular movements. The other of the 2 arms has no anatomical equivalent; this arm, however, is "replaced" by the 2 other determining components of the mandibular movements: the joint and the muscles. The curves, which the Caput mandibulae describes, are practically identical for the open-closing movement and the protrusio despite of the different 4-bar links and these curves exactly correspond to the Discus articularis, taut by the upper part of the M. pterygoideus lateralis. The muscles do not only just move the mandibula, but they are also the component, which can choose between the different mandibular movements. By means of the curves, which points in the muscular attachments describe, the function of the masticatory muscles could be analyzed exactly.     

On the structure and dynamics of the complex of the nucleosome and the linker histone

Several different models of the linker histone (LH)–nucleosome complex have been proposed, but none of them has unambiguously revealed the position and binding sites of the LH on the nucleosome. Using Brownian dynamics-based docking together with normal mode analysis of the nucleosome to account for the flexibility of two flanking 10 bp long linker DNAs (L-DNA), we identified binding modes of the H5-LH globular domain (GH5) to the nucleosome. For a wide range of nucleosomal conformations with the L-DNA ends less than 65 Å apart, one dominant binding mode was identified for GH5 and found to be consistent with fluorescence recovery after photobleaching (FRAP) experiments. GH5 binds asymmetrically with respect to the nucleosomal dyad axis, fitting between the nucleosomal DNA and one of the L-DNAs. For greater distances between L-DNA ends, docking of GH5 to the L-DNA that is more restrained and less open becomes favored. These results suggest a selection mechanism by which GH5 preferentially binds one of the L-DNAs and thereby affects DNA dynamics and accessibility and contributes to formation of a particular chromatin fiber structure. The two binding modes identified would, respectively, favor a tight zigzag chromatin structure or a loose solenoid chromatin fiber.     

Biophysics and Structure of the Patch and the Gigaseal

Interpreting channel behavior in patches requires an understanding of patch structure and dynamics, especially in studies of mechanosensitive channels. High resolution optical studies show that patch formation occurs via blebbing that disrupts normal membrane structure and redistributes in situ components including ion channels. There is a 1-2 μm region of the seal below the patch where proteins are excluded and this may consist of extracted lipids that form the gigaseal. Patch domes often have complex geometries with inhomogeneous stresses due to the membrane-glass adhesion energy (E_a), cytoskeletal forces, and possible lipid subdomains. The resting tension in the patch dome ranges from 1-4 mN/m, a significant fraction of the lytic tension of a bilayer (∼10 mN/m). Thus, all patch experiments are conducted under substantial, and uneven, resting tension that may alter the kinetics of many channels. E_a seems dominated by van der Waals attraction overlaid with a normally repulsive Coulombic force. High ionic strength pipette saline increased E_a and, surprisingly, increased cytoskeletal rigidity in cell-attached patches. Low pH pipette saline also increased E_a and reduced the seal selectivity for cations, presumably by neutralizing the membrane surface charge. The seal is a negatively charged, cation selective, space with a resistance of ∼7 gigohm/μm in 100 mM KCl, and the high resistivity of the space may result from the presence of high viscosity glycoproteins. Patches creep up the pipette over time with voltage independent and voltage dependent components. Voltage-independent creep is expected from the capillary attraction of E_a and the flow of fresh lipids from the cell. Voltage-dependent creep seems to arise from electroosmosis in the seal. Neutralization of negative charges on the seal membrane with low pH decreased the creep rate and reversed the direction of creep at positive pipette potentials.     

The efficacy of ropivacaine and bupivacaine in the caesarean section and the effect on the vital signs and the hemodynamics of the lying-in women

ObjectiveTo investigate the efficacy of ropivacaine and bupivacaine in caesarean section and vital signs and the hemodynamics of the lying-in women.MethodsA total of 480 lying-in women who were admitted to this hospital for treatment between December 2017 and June 2018 were enrolled into this study as the subjects, which were divided into the experiment group and the control group, with 240 subjects in each group. In the experiment group, subjects received the local anesthesia by infusion of 1.5 mL ropivacaine (0.75%), while those in the control group also took the local anesthesia by infusion of 1.5 mL bupivacaine (0.75%). Thereafter, we observed the differences in the anesthetic efficiency, vital signs and hemodynamics of the lying-in women between two groups.ResultsThe excellent and good rates of the anesthesia in two groups were 92.1% and 87.9%, showing no obvious difference; in the experiment group, the average arterial pressures and systolic pressures at 5 min and 10 min after combined spinal and epidural analgesia (CSEA) were all elevated when comparing to the control group (all P < 0.05); in the experiment group, the onset time was obviously extended, while duration of sensory and motor block and the duration of motor block were all shorter than those in the control group (all P < 0.05). During anesthesia, the incidence rate of the adverse reactions in the control group was 2.50%, significantly higher than 0.83% in the experiment group (P < 0.05).ConclusionDespite that ropivacaine and bupivacaine are efficient in anesthesia in the CSEA in the caesarean section, ropivacaine is more recommended for little influence on the hemodynamics, shorter duration of sensory block and motor block and low incidence rate of adverse reactions, which are conducive to the recovery and also safe to the patients.