加速康复外科在肾移植术后静脉补液中的应用

目的探讨加速康复外科(ERAS)在肾移植术后静脉补液中的应用。 方法回顾性分析陆军军医大学第一附属医院124例肾移植受者临床资料。根据肾移植术后多尿期每24小时静脉补液量分为3组，A组每24小时静脉补液量2 500～<4 000 mL，术后6 h进食流质；B组每24小时补液量4 000～6 000 mL，肛门排气后进食；C组每24小时补液量>6 000 mL，肛门排气后进食。采用单因素方差分析比较3组受者术后1周中心静脉压(CVP)、心率、血压、尿量和血糖以及平均特护时间、平均住院日和术后1个月血清肌酐。采用χ²检验比较3组受者性别、供肾类型以及术后高血糖、伤口延迟愈合和移植肾功能延迟恢复(DGF)发生率。P<0.05为差异有统计学意义。 结果A、B和C组受者术后1个月血清肌酐分别为(110±23)、(114±22)和(118±22)μmol/L，差异无统计学意义(F＝1.19，P>0.05)。A组受者术后1周CVP、收缩压、尿量和血糖均低于B、C组(P均<0.05)，平均特护时间和平均住院日均短于B、C组(P均<0.05)。3组受者术后高血糖和DGF发生率差异均无统计学意义(χ²＝4.581和0.404，P均>0.05)，A组受者伤口愈合延迟发生率低于C组(χ²＝7.303，P<0.017)。仅C组1例受者因心力衰竭和肺水肿死亡。 结论ERAS适用于肾移植受者术后静脉补液策略，鼓励受者尽早饮水进食，在保证血压正常或偏高的情况下，适当减少静脉补液量，有利于减少并发症，促进受者恢复。     

Metabolism and pharmacokinetics studies of allyl methyl disulfide in rats

1. Allyl methyl disulfide (AMDS) is one of the main compounds in garlic, whereas its metabolism has not been studied yet.

2. In this work, we first identified the metabolites of AMDS in rat erythrocytes and rats using GC–MS. The transformation mechanism study among different metabolites was then conducted. The apparent kinetics of AMDS in rat erythrocytes and pharmacokinetics of AMDS by oral administration in rats were also studied.

3. The metabolic pathway study showed that AMDS was mainly metabolized in rats to allyl methyl sulfoxide (AMSO) and allyl methyl sulfone (AMSO₂) through mechanisms of reduction, methylation and oxidation. The transformation mechanism study indicated that AMDS was firstly reduced to allyl mercaptan (AM) in rat erythrocytes, and then methylated to allyl methyl sulfide (AMS) by S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH), and finally oxidized to AMSO and AMSO₂ by liver microsomes. The half-life of AMDS in rat erythrocytes was 6.285?±?0.014?min while the half-lives of its active metabolites AMSO and AMSO₂ in vivo were 18.17 and 17.50?h, respectively. Also, the large AUCs of the two active metabolites were observed, indicating potential applications of AMDS for certain pharmacological effects.     

培养检验医师队伍的对策探讨

随着现代检验医学的发展,传统医学检验正在向现代化检验医学的转变,急需加强检验与临床的沟通,医师型检验人才应运而生。目前,由于相关的管理体制,人文教育,工作职责不清晰等原因,检验医师队伍发展缓慢,仍存在很多值得改善和探索的地方。因此,我们应督促检验医师队伍,要具备较高的人文精神,掌握扎实的专业知识,参与完善的培训体制,明确工作职责,提高检验医师学习临床知识,掌握和运用医学检验知识,同时加强对临床与检验医学综合运用的能力,向临床医师提供医学检验知识,更好的与临床医生沟通解决临床问题,加强对检验医师的宣传与认识,共同促进检验医师队伍的规范化发展。     

输尿管镜下Vela激光联合球囊扩张治疗继发性输尿管狭窄的疗效

目的探讨输尿管镜下Vela激光联合球囊扩张治疗继发性输尿管狭窄的安全性及可靠性。方法回顾性分析2014年1月至2016年6月收治的36例继发性输尿管狭窄患者的临床资料。输尿管镜下联合应用Vela激光及球囊扩张治疗狭窄段输尿管。其中经尿道输尿管镜下治疗31例,经皮肾微穿刺后输尿管镜下治疗5例,术后5~7 d拔除导尿管,常规留置"D-J"管12周。结果所有手术均顺利完成,无并发症发生。手术时间36~94 min,平均45 min。36例患者获得随访,随访时间12~23个月,平均18个月。29例治愈,4例好转,3例无效。其中1例再次治疗后无效定期更换输尿管支架管。2例行腹腔镜下输尿管端端吻合术。有效率91.7%。结论输尿管镜下Vela激光联合球囊扩张治疗继发性输尿管狭窄安全可靠,损伤小,恢复快,有效率高,是继发性输尿管狭窄的有效治疗手段。     

Chronic hepatitis B virus infection and preterm labor(birth) in pregnant women—an updated systematic review and meta‐analysis

We aimed to explore whether maternal chronic hepatitis B virus (HBV) infection certainly affects preterm labor (birth) in pregnant women. Four databases were systematically searched up to May 31, 2017, without language restriction. Any study was included if it clearly defined exposure to chronic HBV infection, reported risk of preterm labor or birth in pregnant women, and reported relative risks (RRs) or odds ratios (ORs) or provided data for estimation. RRs (or ORs) with 95% confidence intervals were pooled using random‐effects models. Statistical heterogeneity was assessed with Cochran's Q statistic and I² statistic. Twenty‐two observational studies involving 6 141 146 pregnant women (three prospective cohort studies, n = 1 116 799; 15 retrospective cohort studies, n = 5 022 513 and four case‐control studies, n = 1834) were included. The risk of preterm labor was significantly intensified with chronic HBV infection compared with uninfected women, with substantial heterogeneity. Chronic HBV infection was also significantly associated with a 16% increase in the risk of preterm birth, with substantial heterogeneity. The risk of preterm birth significantly increased by 21% in HBsAg+/HBeAg+ pregnant women compared with uninfected pregnant women. Chronic HBV infection intensifies the risk of preterm labor and birth in pregnant women, but this conclusion should be interpreted with caution given the possibility of residual confounding and be confirmed by well‐designed studies in the future.     

多通道微流控芯片的设计、仿真及细胞迁移应用研究

细胞迁移是指细胞朝着特定的化学浓度梯度发生定向迁移运动,其在胚胎发育、伤口愈合、肿瘤转移中发挥着至关重要的作用。当前研究手段大多通量低,难以综合考虑不同浓度梯度条件对细胞迁移行为的影响。针对上述问题,本文首先设计了一款四通道微流控芯片,其特征如下:借助层流和扩散机制在细胞迁移主通道中建立和维持浓度梯度;可在单一显微镜视野下同时观测四组细胞迁移现象;集成了宽度为20μm的细胞隔离带,可校准细胞初始位置,保证实验结果的准确性。随后,借助Comsol Multiphysics有限元分析软件完成了微流控芯片的仿真分析,证明了芯片上设计S型微通道和水平压力平衡通道有助于在细胞迁移主通道中形成稳定的浓度梯度。最后,采用不同浓度(0、0.2、0.5、1.0μmol·L^-1)与糖尿病及其并发症密切相关的晚期糖基化终末产物(AGEs)孵育中性粒细胞,研究了其在100 nmol·L^-1趋化因子fMLP浓度梯度环境中的迁移行为。结果表明,AGEs抑制了中性粒细胞的迁移能力,证明了四通道微流控芯片的可靠性和实用性。     

Let-7 microRNAs Regenerate Peripheral Nerve Regeneration by Targeting Nerve Growth Factor

Peripheral nerve injury is a common clinical problem. Nerve growth factor (NGF) promotes peripheral nerve regeneration, but its clinical applications are limited by several constraints. In this study, we found that the time-dependent expression profiles of eight let-7 family members in the injured nerve after sciatic nerve injury were roughly similar to each other. Let-7 microRNAs (miRNAs) significantly reduced cell proliferation and migration of primary Schwann cells (SCs) by directly targeting NGF and suppressing its protein translation. Following sciatic nerve injury, the temporal change in let-7 miRNA expression was negatively correlated with that in NGF expression. Inhibition of let-7 miRNAs increased NGF secretion by primary cultured SCs and enhanced axonal outgrowth from a coculture of primary SCs and dorsal root gangalion neurons. In vivo tests indicated that let-7 inhibition promoted SCs migration and axon outgrowth within a regenerative microenvironment. In addition, the inhibitory effect of let-7 miRNAs on SCs apoptosis might serve as an early stress response to nerve injury, but this effect seemed to be not mediated through a NGF-dependent pathway. Collectively, our results provide a new insight into let-7 miRNA regulation of peripheral nerve regeneration and suggest a potential therapy for repair of peripheral nerve injury.     

肿瘤干细胞标志物在鼻咽癌细胞株中的表达

目的探索肿瘤干细胞(CSC)标志物ABCG2、CD44、CD34在鼻咽癌细胞株CNE2、5-8F和6-10B中的表达情况,为选择CSC标志物进行鼻咽癌CSC样研究奠定基础。方法常规培养CNE2、5-8F和6-10B这3种鼻咽癌细胞株,用流式细胞仪检测3种鼻咽癌细胞株中ABCG2、CD44、CD34细胞比例及其交互情况。结果 ABCG2在CNE2、5-8F和6-10B这3种鼻咽癌细胞株中表达率分别为0.1%、18.6%、19.9%;CD44在CNE2、5-8F和6-10B中表达率分别为99.5%、93.2%、99.1%;CD34在CNE2、5-8F和6-10B中表达率分别为0、3.0%、0.1%。在5-8F中,ABCG2+CD44+细胞交互比例为11.6%,ABCG2+CD34+细胞交互比例为0。结论 5-8F和6-10B中CD34+细胞比例与CSC理论中CSC的比例相符。CD34可以作为鼻咽癌CSC的候选标志物。     

MiR-340经组织型纤溶酶原激活剂调控施万细胞的纤溶能力

目的:探讨microRNA-340(miR-340)对施万细胞纤溶能力的调控作用及作用的靶基因。方法:采用溶圈实验来检测miR-340对施万细胞纤溶能力的影响,用荧光素酶双报告基因系统确定miR-340与组织型纤溶酶原激活剂的靶向关系,用实时定量聚合酶链反应检测坐骨神经夹伤后组织型纤溶酶原激活剂mRNA和miR-340的表达变化。结果:miR-340能够抑制施万细胞的纤溶能力,并直接靶向作用于组织型纤溶酶原激活剂的3’UTR,坐骨神经夹伤后组织型纤溶酶原激活剂mRNA与miR-340的表达呈负相关性。结论:miR-340通过直接靶向组织型纤溶酶原激活剂的3’UTR,从而下调靶基因组织型纤溶酶原激活剂的表达抑制施万细胞的纤溶能力。