腹腔镜下肝切除与开腹肝切除术对原发性大肝癌患者远期疗效、胃肠功能及氧化应激反应的影响

目的对比腹腔镜下肝切除与开腹肝切除术对原发性大肝癌患者远期疗效、胃肠功能及氧化应激反应的影响。方法回顾性分析2013年2月-2016年7月97例在该院接受手术治疗并随访至2019年10月的原发性大肝癌患者的病例资料。根据治疗方式分为对照组(n=50)和观察组(n=47),对照组行开腹肝切除术,观察组行腹腔镜下肝切除术。对比两组患者手术一般情况、远期疗效、胃肠功能、氧化应激反应及并发症发生情况。结果两组患者手术时间与术中出血量比较,差异均无统计学意义(P>0.05),观察组患者术后引流时间及术后住院时间均明显较对照组短(P<0.05)。无复发生存期分析结果显示:对照组中位无复发生存时间为17个月(95%CI:14.532~19.468),观察组中位无复发生存时间为23个月(95%CI:20.845~25.155),两组比较,差异无统计学意义(P>0.05)。总生存期分析结果显示:对照组中位总生存时间为31个月(95%CI:27.931~36.092),观察组总生存时间为34个月(95%CI:29.743~37.068),两组比较,差异无统计学意义(P>0.05)。两组患者术后胃泌素(GAS)及胃动素(MTL)水平均明显下降,但对照组下降幅度更大,两组患者术后胆囊收缩素(CCK)水平明显升高,对照组较观察组升高更明显(P<0.05)。两组患者术后超氧化物歧化酶(SOD)水平明显下降,对照组下降幅度较观察组更大,两组患者术后丙二醛(MDA)与晚期氧化蛋白产物(AOPP)水平明显升高,对照组较观察组升高更明显(P<0.05)。两组患者术后均未出现胆漏、出血和肝功能衰竭等严重并发症,对照组出现7例(14.00%)Clavien-Dindo分级在Ⅰ至Ⅱ级的轻度并发症,观察组出现6例(12.77%),两组比较,差异无统计学意义(P>0.05)。结论采用腹腔镜下肝切除与开腹肝切除术治疗原发性大肝癌,两者远期疗效及并发症发生情况比较,差异均无统计学意义,但腹腔镜手术对患者胃肠功能和氧化应激反应的影响较开腹手术小。     

Three-dimensionally ordered macro–mesoporous CoMo bulk catalysts with superior performance in hydrodesulfurization of thiophene

The introduction of surfactants during the fabrication of hydrodesulfurization catalysts could not only tune the microstructure but also promote the dispersion of active components. In this work, CoMo bulk catalysts with the hierarchical structure of three-dimensionally ordered macro–mesopores were successfully fabricated by using a colloidal crystal template with the addition of PEG 400 and/or F127 surfactants. The obtained samples were characterized by various techniques, and the possible mechanism of the structure formation was also discussed. The characterization and evaluation results reveal that the addition of surfactants can promote the formation of the mesopores (3–4 nm) inside the macroporous walls of these bulk catalysts, which is essential for the increase of catalyst surface area, and the active sites for reaction. The CoMo–PF-1 catalyst displayed superior catalytic performance for thiophene hydrodesulfurization with the thiophene conversion of 99.4% under 1 MPa at 360 °C, which is much higher than that (77.8%) at 0.1 MPa. This result is even comparable to our previous report with the thiophene conversion of 99.2% over the 3DOM CoMo catalyst under 3 MPa.

The addition of surfactants can promote the formation of mesopores and improve the dispersion of MoS₂ slabs.     

Amino group dependent sensing properties of metal–organic frameworks: selective turn-on fluorescence detection of lysine and arginine

Recently, metal–organic frameworks (MOFs) have been extensively investigated as fluorescence chemsensors due to their tunable porosity, framework structure and photoluminescence properties. In this paper, a well-known Zr(iv)-based MOF, UiO-66-NH₂ was demonstrated to have capability for detection of l-lysine (Lys) and l-arginine (Arg) selectively from common essential amino acids in aqueous media via a fluorescence turn-on mechanism. Further investigation reveals its high sensitivity and strong anti-interference properties. Moreover, the possible mechanism for sensing Lys and Arg was explored by FT-IR and ¹H-NMR, and the results indicate that the enhancement of the fluorescence could be ascribed to the adsorption of Lys/Arg and the hydrogen bonding interactions between Lys/Arg and the amino group of UiO-66-NH₂. The difference of the sensing capacity and sensitivity between UiO-66 and UiO-66-NH₂ revealed that the amino group plays an essential role in the sensing performance. This work presents a unique example of the functional group dependent sensing properties of MOFs.

The amino group of UiO-66-NH₂ was demonstrated to play an important role in selective fluorescence turn-on sensing of lysine and arginine.     

64排128层螺旋CT冠状动脉CTA在冠心病筛查中的临床应用

目的:探讨64排128层螺旋CT冠状动脉血管造影术(CTA)在冠心病筛查中的临床应用。方法:回顾性分析2018年6月~2019年10月某院收治的70例冠心病患者临床资料,均采用64排128层螺旋CT冠状动脉CTA检查,1周内进行选择性冠脉造影(CAG)检查。以CAG诊断为金标准,记录CT影像表现,统计冠状动脉狭窄情况;以CAG检查为金标准,分析64排128层螺旋CT冠状动脉CTA对冠脉狭窄诊断的敏感性、特异性。结果:70例患者经64排128层螺旋CT冠状动脉CTA检查,以CAG检查为金标准,螺旋CTA图像表现为冠状动脉轻度狭窄44支,中度54支,重度40支,正常105支;CAG检查冠状动脉轻度狭窄39支,中度62支,重度46支,正常106支。螺旋CTA图像显示轻度冠状动脉狭窄数量多于CAG检查数量,中度、重度狭窄少于CAG检查;64排128层螺旋CT冠状动脉CTA检查敏感性为87.18%,特异性为97.06%。结论:冠心病采用64排128层螺旋CT冠状动脉CTA筛查,具有较高的敏感性、特异性,为冠心病临床筛查、诊断提供参考依据,值得临床推广应用。     

某综合性教学医院连续三年病原菌分布特点与耐药性分析

目的对某院2016—2018年连续三年病原菌的分布及耐药性情况进行统计分析,以了解感染特点,探索下一阶段医院感染防控重点。方法采用迪尔细菌鉴定系统对标本进行耐药情况分析,利用WHONET 5.5软件统计分析细菌耐药数据。结果感染部位主要是呼吸系统和泌尿系统。病原菌的标本来源以痰液为主,其次是为尿液和血液。主要检出病原菌为鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和白色念珠菌。与2016和2017年相比,2018年病原菌耐药率均有不同程度的降低。我院的铜绿假单胞菌耐药率稍低在14%~24%左右,对大多数抗菌药物耐药率逐年下降;大肠埃希菌耐药率基本一致,常用药物复方磺胺甲噁唑耐药率稍下降但仍较高为61.6%~76.1%;肺炎克雷伯菌耐药率整体平稳,维持在20.4%~40.2%,除呋喃妥因耐药率从35.6%升到58.8%;鲍曼不动杆菌的整体耐药率较高,除头孢哌酮/舒巴坦耐药率稍低为32.5%~45.4%,对大部分药物的耐药率都在65.0%~85.8%,连续三年对亚胺培南耐药率85.8%降到61.2%,其余药物耐药率均有不同程度的升高;金黄色葡萄球菌耐药率相对较低,对左氧氟沙星、苯唑西林、红霉素、利福平、庆大霉素耐药率略有不同程度的下降。2016年—2018年我院分离的多重耐药菌感染率分别是0.80%、0.88%和0.83%。多重耐药菌中以多重/泛耐药鲍曼不动杆菌、大肠埃希菌(产-ESBLs)和肺炎克雷伯菌(耐碳青霉烯类)居多。结论我院主要病原菌为革兰阴性杆菌,多数细菌已产生多重耐药性,致病菌耐药性较高,应加强临床患者的综合管理以降低多重耐药菌的产生。     

Intranasal delivery of rapid-onset antidepressants: a new trend of treating major depressive disorder

Existing antidepressants seem to have an onset time of several weeks. However, newly found depression-related receptors and pathways may enlighten us to find more rapid-onset antidepressants, in which ketamine is one of the most potential antidepressants. By intranasal administration, drugs can be directly delivered to the brain via olfactory nerve route, which is proved to be suitable for some antidepressants. Well-designed rapid-onset antidepressants are the urgent requirements of the patients with depression. Intranasal administration, as a potential strategy to deliver antidepressants to brain, can improve drug efficacy and largely shorten the onset time. In this article, we sorted out some new formulation approaches in treating depression with different mechanisms and pathways compared with traditional treating strategies, along with new findings in clinical studies, proving that the combination of rapid-onset antidepressants with intranasal delivery will lead a new trend in treating depression.     

儿童闭塞性细支气管炎的核素肺灌注/通气显像研究

目的 了解闭塞性细支气管炎(BO)患儿的核素肺V/Q显像表现及该项检查在BO患儿临床诊断、病情评估、预后判断方面的价值.方法 前瞻性分析2005年2月至2011年4月在首都医科大学附属北京儿童医院呼吸感染中心确诊的30例BO患儿(男18例,女12例,年龄7个月～ 14岁)的核素肺V/Q显像资料,对不同病情和不同预后的BO患儿分别加以分析,比较其各自累及的肺段数.结果 30例BO患儿肺灌注显像异常25例(83.3％),肺通气显像异常27例(90.0％).异常肺V/Q匹配者13例(48.1％),不匹配者1例(3.7％),反向不匹配者13例(48.1％).3例轻度病情患儿中,1例肺V/Q显像正常,另2例仅1个肺段受累.10例中度病情患儿肺灌注显像异常平均累及3.7个肺段,肺通气显像异常平均累及5.6个肺段.17例严重病情患儿平均6.0个肺段肺灌注显像异常,平均8.2个肺段肺通气显像异常.30例患儿出院后随访到24例,其中8例病情加重患儿肺灌注显像异常累及肺段数量及受损程度明显高于16例复查好转患儿.结论 BO患儿的肺V/Q显像呈现肺段性、多发性肺灌注和(或)通气稀疏或缺损.该显像方法对BO患儿的临床诊断、病情评估及预后判断有重要意义.     

宫颈癌后装放疗时膀胱直肠小肠受照剂量探讨

目的 探讨宫颈癌腔内放疗时不同体积的膀胱、直肠与危及器官受照剂量的关系。方法 选取宫颈癌患者共47例,给予剂量点处方剂量600 cGy的高剂量率腔内后装治疗,用剂量体积直方图(DVH)评价标准计划下不同体积的膀胱、直肠和小肠对相应受照剂量的影响。将膀胱按体积大小分成<80 cm³组、80~120 cm³组和>120 cm³组,直肠按体积大小分成>60 cm³ 组和≤60 cm³组,分析其体积与剂量分布的关系。采用方差分析和t检验方法分析D_{1 cm³}、D_{2 cm³}、D_30%和D_50%。结果 与膀胱体积<80 cm³组相比,80~120 cm³组和>120 cm³组的膀胱D_30%、D_50%受照剂量增高(F=5.074、5.088,P<0.05),小肠D_{1 cm³}和D_{2 cm³}值差异无统计学意义(P>0.05);与直肠体积>60 cm³ 组相比,≤60 cm³组的直肠D_{1 cm³}受照剂量减小(t=-2.045,P<0.05)。结论 宫颈癌近距离放疗时,保持膀胱的适当充盈,直肠体积的减少,可使直肠、膀胱和小肠的受照射剂量均相对降低,从而减少放疗的不良反应。