药护协同管理在急性心肌梗死患者溶栓治疗中的实践

目的 探讨药护协同管理在急性心肌梗死患者溶栓治疗中的实践效果.方法 将100例急性心肌梗死溶栓治疗的患者按数字随机法分为常规组(n=50)和协同管理组(n=50),常规组按照常规护理,协同管理组在此基础上实施药护协同管理,干预6个月后比较治疗效果.结果 两组入院后明确诊断至开始溶栓时间、冠脉有效灌注率和住院天数比较,协同干预组显著优于常规组,48h内恶性心律失常发生例数协同组显著少于常规组,差异有统计学意义(均P＜0.05).两组患者溶栓治疗后12h、24 h、48 h、7d的LVEF值比较,差异有统计学意义(均P＜0.05);出院后6个月心脏不良事件发生比例比较,差异无统计学意义(P＞0.05).结论 药护协同管理能够有效缩短急性心肌梗死患者入院后至溶栓的时间,提高冠脉有效灌注,减少48 h内恶性心律失常发生和缩短住院天数,促进心功能恢复.     

Inducible proteins binding to the murine thymidine kinase promoter in late G1/S phase.

By performing DNase I footprint and band-shift analyses of a 170-base-pair region of the murine thymidine kinase promoter, we identified an inducible DNA binding activity that we named Yi. Yi binding activity was not detected in G0 and G1 extracts, but it was observed as cells crossed the G1/S boundary. Yi proteins bind specifically to a consensus sequence (CCCNCNNNCT) found at three distinct sites in this promoter region. We also observed a murine Sp1 binding activity that was constitutive throughout the cell cycle. We propose that the G1/S-specific Yi binding is important for murine thymidine kinase gene regulation and perhaps also for initiation of DNA synthesis.     

Molecular Analysis of Codon 548 in the rpoB Gene Involved in Mycobacterium tuberculosis Resistance to Rifampin

Most Mycobacterium tuberculosis rifampin-resistant strains have been associated with mutations in an 81-bp rifampin resistance-determining region (RRDR) in the gene rpoB. However, if this region alone were targeted, rifampin-resistant strains with mutations outside the RRDR would not be detected. In this study, among 51 rifampin-resistant clinical isolates analyzed by sequencing 1,681-bp-long DNA fragments containing the RRDR, 47 isolates contained mutations within the RRDR, three isolates contained mutations both within and outside the RRDR, and only one isolate had a single missense mutation (Arg548His) located outside the RRDR. A drug susceptibility test of recombinant Mycobacterium smegmatis and M. tuberculosis isolates carrying mutated rpoB (Arg548His) showed an increased MIC for rifampin compared to that of the control strains. Modeling of the Arg548His mutant RpoB-DNA complex revealed that the His548 side chain formed a more stable hydrogen bond structure than did Arg548, reducing the flexibility of the rifampin-resistant cluster II region of RpoB, suggesting that the RpoB Arg548His mutant does not effectively interact with rifampin and results in bacterial resistance to the drug. This is the first report on the relationship between the mutation in codon 548 of RpoB and rifampin resistance in tuberculosis. The novel mutational profile of the rpoB gene described here will contribute to the comprehensive understanding of rifampin resistance patterns and to the development of a useful tool for simple and rapid drug susceptibility tests.     

Analysis of the factors affecting lymph node metastasis and the prognosis of rectal neuroendocrine tumors

Objective: To analyze the factors affecting lymph node metastasis and the prognosis of rectal neuroendocrine tumors after surgical treatment. Methods: A retrospective analysis was conducted using the clinical data from 156 cases of rectal neuroendocrine tumors during the period of January 1999 to December 2013. The Kaplan-Meier method was used to calculate the survival time, Cox regression analysis was performed for statistical analysis of clinicopathological factors that may be associated with lymph node metastasis and prognosis, and correlation analysis was carried out using binary logistic regression. Results: The overall 5-year survival rate of the entire group was 95.7%. Multivariate analysis showed that the depth of invasion was an independent prognostic factor (P < 0.001). The incidence of lymph node metastasis was 7.7% (12/156), and logistic regression analysis showed that lymph node metastasis was related to the depth of invasion (P = 0.003) and tumor diameter (P = 0.006). Conclusion: The surgical approach of rectal neuroendocrine tumors should be selected based on a comprehensive consideration of factors such as tumor size, depth of invasion and lymph node metastasis.     

Myelin ultrastructure of sciatic nerve in rat experimental autoimmune neuritis model and its correlation with associated protein expression

To explore the relationship of peripheral nerve ultrastructure and its associated protein expression in experimental autoimmune neuritis (EAN). EAN was established in Lewis rats using an emulsified mixture of P0 peptide 180-199, Mycobacterium tuberculosis, and incomplete Freund’s adjuvant. Rats immunized with saline solution were used as a control group. Sciatic nerve ultrastructure and immunofluorescence histopathology were measured at the neuromuscular severity peak on day 18 post-induction. Cell-specific protein markers were used for immunofluorescence histopathology staining to characterize sciatic nerve cells: CD3 (T cell), Iba-1 (microglia), S100 (myelin), and neurofilament 200 (axon). The results showed that swelling of the myelin lamellae, vesicular disorganization, separation of the myelin lamellae, and an attenuation or disappearance of the axon were observed by transmission electron microscopy in the EAN group. CD3 and Iba-1 increased significantly in the structures characterized by separation or swelling of the myelin lamellae, and increased slightly in the structures characterized by vesicular of the myelin lamellae, S100 decreased in the structures characterized by vesicular disorganization or separation of the myelin lamellae. And neurofilament 200 decreased in the structures characterized by separation of the myelin lamellae. Furthermore, we found that Iba1 were positive in the myelin sheath, and overlapped with S100, which significantly indicated that Schwann cells played as macrophage-like cells during the disease progression of ENA. Our findings may be a significant supplement for the knowledge of EAN model, and may offer a novel sight on the treatment of Guillain-Barré syndrome.     

Diagnostic accuracy of fecal lactoferrin for inflammatory bowel disease: a meta-analysis

Objective: To do a systematic review using meta-analysis to assess the diagnostic accuracy of fecal lactoferrin (FL) in patients with inflammatory bowel disease (IBD). Methods: We performed a literature review and systematically searched the Medline and EMBASE databases for eligible studies. The quality of the included studies was assessed using the QUADAS tool. The sensitivity, specificity, and other diagnostic indexes of FL were pooled using a random-effects model. Results: Seven studies, involving 1816 patients, met the inclusion criteria. In all studies, the pooled FL sensitivity and pooled specificity were 0.82 (95% confidence interval [CI]: 0.72, 0.89) and 0.95 (95% CI: 0.88, 0.98), respectively. The positive and negative likelihood ratios were 16.63 and 0.18, respectively. The area under the summary receiver-operating characteristic curve (SROC) was 0.95 (95% CI: 0.93, 0.97), and the diagnostic odds ratio was 90.04 (95% CI: 37.01, 219.02). The pooled FL sensitivity and specificity for Crohn’s disease (CD) diagnosis (sensitivity =75%, specificity =100%) was not as good as it was for ulcerative colitis (UC) diagnosis (sensitivity =82%, specificity =100%). Conclusion: FL, as a noninvasive and screening marker, has a high specificity and a modest specificity during the diagnosis of suspected IBD.     

NAFLD合并T2DM患者糖化血红蛋白和甲状腺激素水平的变化及其临床意义*

目的 探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者糖化血红蛋白(HbA1C)和甲状腺激素水平的变化及其临床意义。方法 2017年4月～2019年3月我院内分泌科就诊的T2DM患者50例和NAFLD合并T2DM患者55例,检测人体学指标,采用电化学发光法检测空腹胰岛素(FINS)水平,采用胶体金法检测血糖化血红蛋白(HbA1C)水平,采用化学发光免疫分析法测定血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)和促甲状腺激素(TSH)水平。结果 NAFLD合并T2DM患者体质指数(BMI)为(28.4±2.7)kg/m²,显著大于T2DM患者【(24.0±2.4)kg/m²,P<0.05】,NAFLD合并T2DM患者腰围为(94.5±8.5)cm,显著大于T2DM患者【(84.0±7.6)cm,P<0.05】,NAFLD合并T2DM患者臀围为(97.1±8.0)cm,显著大于T2DM患者【(89.7±7.2)cm,P<0.05】;NAFLD合并T2DM患者血清谷丙转氨酶(ALT)水平为(79.5±7.6)U/L,显著高于T2DM患者【(42.3±4.3)U/L,P<0.05】,NAFLD合并T2DM患者血清谷草转氨酶(AST)水平为(59.7±6.1)U/L,显著高于T2DM患者【(41.2±3.9)U/L,P<0.05】,NAFLD合并T2DM患者血清谷氨酰转肽酶(GGT)水平为(105.8±9.4)U/L,显著高于T2DM患者【(60.9±6.5)U/L,P<0.05】;NAFLD合并T2DM患者血甘油三酯(TG)水平为(4.2±1.7) mmol/L,显著高于T2DM患者【(2.4±0.9)mmol/L,P<0.05】,NAFLD合并T2DM患者空腹血胰岛素(FINS)水平为(12.0±2.5)mU/L,显著大于T2DM患者【(9.1±1.8)mU/L,P<0.05】;NAFLD合并T2DM患者血清TSH水平为(3.4±1.2)mU/L,显著大于T2DM患者【(1.9±0.8)mU/L,P<0.05】,而两组FT3和FT4水平无显著性差异(P>0.05)。结论 NAFLD合并T2DM患者BMI、肝功能指标、TG、FINS和TSH水平均显著增大或升高,与T2DM患者有明显的不同,在临床诊治过程中应当有所甄别,深入研究NAFLD患者发病机制对诊治将大有裨益。     

非小细胞肺癌中Pokemon蛋白与P14ARF-MDM2-p53通路蛋白的相关性研究

目的探讨Pokemon蛋白与P14ARF-MDM2-p53通路蛋白在非小细胞肺癌(NSCLC)发病中的作用。方法纳入2015年10月至2016年10月河北医科大学第一医院行手术治疗的35例NSCLC患者为NSCLC组。同时,将癌旁正常支气管断端组织29例及肺炎组织25例分别作为支气管对照组和肺泡对照组。采用免疫组织化学法检测3组中Pokemon、P14ARF、MDM2和p53蛋白的表达情况,分析其与临床病理资料的关系及各蛋白间的相关性。结果Pokemon、MDM2、p53蛋白在NSCLC组中的表达均显著高于支气管对照组和肺泡对照组(P值均<0.01),P14ARF蛋白在NSCLC组中的表达显著低于支气管对照组和肺泡对照组(χ^2=25.39,P<0.01)。p53和MDM2蛋白的表达与NSCLC的分化程度相关(P=0.02、0.03)。在NSCLC组中,Pokemon与P14ARF蛋白表达呈负相关性(r=-0.58,P<0.05),P14ARF与MDM2蛋白表达呈负相关性(r=-0.51,P<0.05),MDM2与p53蛋白的表达呈正相关性(r=0.86,P<0.05)。结论Pokemon通过P14ARF-MDM2-p53通路在NSCLC发病过程中发挥癌基因作用。