六味能消胶囊联合复方消化酶对功能性消化不良患者临床症状及脑-肠轴相关因子水平的影响

摘要 目的：探讨六味能消胶囊联合复方消化酶对功能性消化不良（FD）患者临床症状及脑-肠轴相关因子水平的影响。方法：选取2018年7月~2019年12月期间攀枝花市中心医院收治的80例FD患者,以随机数字表法分为研究组（n=40）和对照组（n=40）。对照组给予复方消化酶治疗,研究组给予复方消化酶联合六味能消胶囊治疗,对比两组的脑-肠轴相关因子水平,疗效,症状改善时间及不良反应。结果：治疗4周后研究组的临床总有效率为92.50%（37/40）,高于对照组的72.50%（29/40）（P<0.05）。研究组食量恢复时间（4.62±0.74）d、食欲恢复时间（3.61±0.57）d、恶心呕吐消失时间（1.59±0.36）d分别较对照组的（7.68±1.71）d、（5.71±0.86）d、（3.87±0.52）d缩短（P<0.05）。研究组治疗4周后胃泌素（149.77±13.89）ng/L、胃动素（159.18±12.86）ng/L、神经肽S 受体 1（NPSR1）（164.10±15.88）pg/mL均高于对照组的（93.34±8.92）ng/L、（123.23±10.97）ng/L、（130.23±12.64）pg/mL（P<0.05）,研究组治疗4周后降钙素基因相关肽（CGRP）（49.52±6.49）pg/mL、血管活性肠钛（VIP）（22.69±3.61）ng/L、生长抑素（SS）（32.13±3.36）pg/mL低于对照组的（63.19±8.38）pg/mL、（27.83±3.73）ng/L、（41.85±4.38）pg/mL（P<0.05）。两组不良反应发生率对比无明显差异（P>0.05）。结论：复方消化酶联合六味能消胶囊治疗FD患者疗效显著,可有效缓解临床症状,改善脑-肠轴相关因子水平,且不增加不良反应发生率。     

长期肾移植受者外周血B淋巴细胞亚群分布特征

摘要 目的：观察移植肾功能稳定的长期受者（>10年）外周血B细胞亚群分布特征及其相关因素。方法：54名肾移植受者接受流式细胞仪检查,测算外周血总B细胞、未转化记忆B细胞、转化记忆B细胞、双阴性B细胞（CD19⁺CD27^-IgD^-）比例及数量（个/微升）。患者均服用包括环孢霉素的免疫抑制治疗。术后时间16.33±5.98年,GFR：91.63±11.28 mL/min/1.73 m²。结果：1长期肾移植患者外周血B细胞中幼稚B细胞最多（37.92% ± 22.06%）,未转化记忆B细胞最少(16.23% ± 11.10%)。B细胞亚群数量与白细胞总数、中性粒细胞比例等相关。2 以上述条件为控制因素行相关分析,转化记忆B细胞比例和GFR相关（r=-0.279,P=0.045）,双阴性B细胞数量和环孢霉素浓度相关（r=-0.300,P=0.029）。线性回归显示双阴性B细胞数目与环孢霉素浓度相关（R²=0.123,P=0.049）。3按GFR将患者分为肾功能减退组（GFR<90 mL/min/1.73 m²,n=19）和肾功能正常组（GFR≥90 mL/min/1.73 m²,n=35）。前者转化记忆B细胞比例显著升高（23.61% ± 10.96% vs.17.48%±8.91%,P=0.030）。按环孢霉素谷浓度将患者分为低浓度组（<64 mmol/L,n=28）和高浓度组（≥64 mmol/L,n=26）,前者双阴性B细胞数量显著升高（13.74±10.70 vs. 8.14±6.72/μL,P=0.027）。转化记忆B细胞比例与GFR分组相关（r=-0.326,P=0.018）,双阴性B细胞数量和环孢霉素浓度分组相关（r=-0.350,P=0.01）。结论：移植肾功能稳定的长期存活受者（>10年）外周血幼稚B细胞较多。转化记忆B细胞增多与移植肾功能减退相关,增多的双阴性B细胞和低孢霉素浓度治疗相关。     

静注人免疫球蛋白联合万古霉素治疗小儿败血症的疗效及外周血NLR、PCT变化观察

摘要 目的：观察静注人免疫球蛋白联合万古霉素治疗小儿败血症的疗效及外周血中性粒细胞/淋巴细胞比值（NLR）、降钙素原(PCT)变化。方法：选取2011年1月~2020年1月我院收治的败血症患儿80例为研究对象,按数字随机表法分为对照组和观察组各40例,对照组给予万古霉素治疗,观察组在对照组基础上给予静注人免疫球蛋白治疗,比较两组临床疗效、症状改善时间和住院时间、NLR、PCT、超敏C反应蛋白(hs-CRP)、白细胞计数（WBC）、免疫功能及不良反应发生率。结果：观察组治疗有效率高于对照组（87.50%vs65.00%）（P<0.05）。观察组神经系统症状改善时间、体温改善时间、拒奶改善时间和住院时间为（6.22±1.05）d、（3.88±0.25）d、（5.10±0.86）d、（8.71±2.05）d,均短于对照组的（8.76±1.53）d、（6.22±0.64）d、（7.53±1.46）d和（11.24±3.36）d,比较差异有统计学意义（P<0.05）。治疗后观察组外周血NLR、PCT、hs-CRP、WBC水平为（1.35±0.20）、（0.80±0.34）mg/mL、（3.56±0.62）g/L、（9.12±1.80）×10⁹/L,均显著低于对照组的（1.83±0.32）、（2.19±0.73）mg/mL、（9.78±2.64）g/L和（12.26±2.59）×10⁹/L,比较差异有统计学意义（P<0.05）。治疗后观察组CD4⁺、CD3⁺、CD4/CD8为（42.77±11.36）％、（41.27±11.26）％、（1.70±0.33）,均显著高于对照组的（35.80±9.32）％、（35.66±9.40）％和（1.29±0.25）,比较差异有统计学意义（P<0.05）。两组不良反应发生率比较无差异（10.00%vs7.50%）（P>0.05）。结论：静注人免疫球蛋白联合万古霉素治疗小儿败血症的疗效显著,可降低炎症因子,提高免疫功能,且安全性较高。     

白细胞介素33通过促进上皮细胞黏附分子表达参与干燥综合征发病

摘要 目的：探讨白细胞介素（Interleukin-33,IL-33）可能通过调控上皮细胞黏附分子（Epithelial cell adhesion molecule, EpCAM）表达参与干燥综合征（Sj?gren''s syndrome, SS）发病的作用机制。方法：收集因SS诊断需要行唇腺活检术的患者血清和唇腺组织标本及相关临床资料,根据2016年ACR-EULAR SS分类诊断标准将患者分为SS组和非SS组,选取性别、年龄匹配的21例SS患者和21例非SS患者,利用多重检测流式试剂盒（人炎症因子组合1）检测血清中IL-33水平并用t检验比较SS患者组与非SS患者组、抗SSA抗体阳性与阴性组以及唇腺病理阳性与阴性组之间IL-33水平的差异。对唇腺组织石蜡切片进行IL-33免疫组织化学染色,用流式细胞术检测新鲜唇腺组织中上皮细胞EpCAM表达水平并与血清IL-33水平进行相关性分析。结果：SS患者组IL-33水平为（1736±590.1,n=21, pg/mL）,显著高于非SS患者组（306.8±120.3, n=21, pg/mL）（t=2.373,P=0.027）;唇腺病理阳性组即灶性血清IL-33水平（489.8±170, n=27, pg/mL）高于病理阴性组（1978±793.1, n=15, pg/mL）,2组之间有统计学差异（t=2.368,P=0.023）;而抗SSA抗体阳性组与阴性组之间无明显差异（P＞0.05）。免疫组化染色结果提示SS患者唇腺组织上皮细胞IL-33表达相较于非SS患者上升,且血清IL-33水平与唇腺上皮细胞EpCAM的表达呈中等强度正相关（r=0.4915,P=0.0009,95%CI 0.2205-0.692）。结论：IL-33是与SS密切相关的炎症因子,IL-33可能通过促进唾液腺上皮细胞EpCAM的表达参与SS发病。     

白细胞、C反应蛋白与凝血指标在哮喘发作期患儿的临床意义

摘要 目的：探讨白细胞（WBC）、C反应蛋白（CRP）与常见凝血指标凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、凝血酶时间（TT）、抗凝血酶Ⅲ（ATⅢ）、D二聚体（D-D）在哮喘发作期儿童的临床意义。方法：选取发作期哮喘儿童,根据发作严重程度分为轻度、中度、重度3组。比较指标的组间差异,Pearson相关计算WBC、CRP与凝血指标的相关性,Logistic评估中度或重度哮喘发作期的影响因素。结果：全血WBC在中度组（12.02 ×10⁹ /L ± 4.61 ×10⁹ /L）显著高于轻度组（9.56 ×10⁹ /L ± 3.21 ×10⁹ /L,P < 0.05）,重度组（12.91×10⁹ /L ± 3.14 ×10⁹ /L）显著高于轻度组（9.56 ×10⁹ /L ± 3.21 ×10⁹ /L,P < 0.05）;重度组抗凝血酶ATⅢ（109% ± 13%）高于轻度组（99% ± 13%,P < 0.05）。WBC与FIB正相关（r = 0.297, P = 0.018）,CRP与TT（r = -0.330, P = 0.008）、ATⅢ（r = -0.375, P = 0.002）负相关,与FIB（r = 0.496, P = 0.001）、D-D（r = 0.326, P = 0.009）正相关。Logistic回归显示校正性别年龄的WBC影响重度组的比值比（OR）为1.602。结论：WBC和儿童哮喘发作严重程度有关,哮喘发作期儿童体内炎症状态与凝血指标存在一定关联。     

补肾益气活血方及其单味药对人牙周膜干细胞增殖分化的影响

摘要 目的：探讨自拟补肾益气活血方及其单味药当归、补骨脂对体外培养的人牙周膜干细胞（hPDLSCs）增殖和相关成骨基因表达的影响。方法：分离培养得到hPDLSCs,选取第3代hPDLSCs,细胞增殖试剂盒（CCK-8）检测不同浓度（0 g/mL、1×10^-7 g/mL、1×10^-5 g/mL、1×10^-3 g/mL）补肾益气活血方和当归、补骨脂对hPDLSCs增殖的影响,并确定最佳作用浓度和最佳作用时间;通过定量聚合酶链式反应（qPCR）检测Runt相关转录因子2（Runx2）、碱性磷酸酶（ALP）、骨桥蛋白（OPN）、骨钙蛋白（OCN）相关成骨基因的表达水平,通过茜素红染色观察细胞成骨分化情况。结果：与0 g/mL相比,补肾益气活血方各浓度在第一天和第三天时均能显著促进细胞增殖（P<0.05）,且浓度为1×10^-5 g/mL在第三天、第五天时效果均最为显著（P<0.05）;当归同样在浓度为1×10^-5 g/mL、第三天及第五天时效果均最为显著（P<0.05）;补骨脂则仅在第一天时能显著促进细胞增殖（P<0.05）。与空白对照组比较,1×10^-5 g/mL的补肾益气活血方、当归、补骨脂均能显著提升成骨相关Runx2、OCN、OPN、ALP的表达（P<0.05）,且补肾益气活血方的上调效果最为显著。茜素红染色检测显示,补肾益气活血方可增加矿化结节,促进作用最为显著。结论：补肾益气活血方可促进hPDLSCs的增殖和骨向分化,在治疗慢性牙周炎中有望发挥更大作用。     

针灸、推拿及中药外敷对腰椎间盘突出的临床疗效及血清TXB2、IL-1β、IL-10水平对比

摘要 目的：研究针灸、推拿及中药外敷对腰椎间盘突出的临床疗效及血清血栓素（thromboxane,TXA2）、白细胞介素-1β （Interleukin-1β）、白细胞介素-10 （Interleukin-10 IL-10）水平对比。方法：选取2019年1月至2020年12月的80例腰椎间盘突出患者。按照随机数表法分为观察组（n=41）和对照组（n=39）,对照组采用中药外敷治疗,观察组采用针灸、推拿及中药外敷联合治疗。对比两组治疗效果,治疗前后日本骨科协会评估治疗分数（Japanese Orthopaedic Association Scores JOA）、视觉模拟评分法（visual analogue scale VAS）评分情况变化,血清TXB2、IL-1β、IL-10水平变化,腰椎功能及腰部关节活动度,不良反应发生率。结果：治疗后,观察组总有效率显著高于对照组[95.12%（39/41）vs71.79％（28/39）]（P＜0.05）;JOA显著高于对照组[（23.19±3.21）分vs（17.62±2.65）分]（P<0.05）,VAS评分显著低于对照组[（2.07±0.38）分vs（3.58±0.61）分]（P<0.05）;血清TXB2、IL-1β水平均显著低于对照组[（24.37±3.26）μg/L vs（34.08±4.72）μg/L,（0.12±0.03）ng/L vs（0.27±0.05）ng/L]（P<0.05）;血清IL-10水平显著低于对照组[（85.82±7.03）pg/mL vs（57.28±6.31）pg/mL]（P<0.05）;功能障碍指数（Oswestry disability index）显著低于对照组[（37.81±6.23）％ vs（68.02±8.91）％]（P<0.05）;腰部关节活动度显著高于对照组[（80.36±0.82）° vs（71.27±0.6）°]（P<0.05）;两组不良反应对比无显著差异（P>0.05）。结论：针灸、推拿及中药外敷对腰椎间盘突出的临床疗效显著,可有效改善患者的临床症状,缓解疼痛,抑制炎症因子TXB2、IL-1β表达,促进抗炎因子IL-10水平升高,安全有效。     

酶标仪法测定氨茶碱血药浓度的研究

摘要 目的：通过酶标仪法,建立一种研究氨茶碱在新西兰兔体内的药代动力学参数及房室模型的分析方法。方法：新西兰兔以剂量15 mg/kg静脉注射氨茶碱后,应用酶标仪法,测定在274 nm 波长处吸光度值,采用直线相关与回归分析进行数据统计分析氨茶碱在体内的药代动力学参数、回收率实验及房室模型分析。结果：血清茶碱在浓度5～30 μg/mL范围内线性关系良好,回归方程为：A= 0.0013C+0.0074,r²=0.991。各浓度氨茶碱回收率均大于90%,平均回收率为95.83±3.83,RSD均小于15%,回收效果良好。通过氨茶碱体内房室模型拟合得：二室模型拟合显示：由消除相,得外推线浓度线性回归方程：lgC=-0.1271t+1.0562;由分布相,得残数浓度线性回归方程为：lgCr =-0.5829t+1.030,综合得其二室模型的药动学方程为：C=22.000e^-1.342t +11.381e^-0.292t 、T_1/2（α）= 0.516 h、T_1/2（β）= 2.369 h。一室模型拟合显示：一室模型药动学方程为：lgC= -0.2131t + 1.315,其药时方程为：C= 20.649e^-0.491t 、T_1/2= 1.412 h;结论：可以用酶标仪法测定氨茶碱体内药代动力学相关参数,其回收率良好,体内代谢符合二室模型,消除半衰期较长。     

3.0 T磁共振扩散加权成像在乳腺良恶性病变鉴别中的价值及较优b值下ADC值与预后因子相关性研究

摘要 目的：研究3.0 T磁共振扩散加权成像在乳腺良恶性病变鉴别中的价值及较优b值下ADC值与预后因子的相关性。方法：选取2017年11月～2019年11月于我院接受诊治的乳腺病变患者50例进行研究,将其按照良恶性差异分成恶性组40例与良性组10例,另取同期于我院体检的健康志愿者50例作为对照组。对所有人员均进行3.0 T磁共振扩散加权成像,比较不同b值下ADC值在不同乳腺组织中的差异,比较不同b值下诊断乳腺良恶性病变的效能,分析较优b值下ADC值和乳腺癌患者各项预后因子的相关性。结果：对照组、良性组、恶性组在不同b值下的ADC值均呈逐渐降低趋势（P＜0.05）;对照组、良性组、恶性组b值为1000 s/mm²下的ADC值均低于b值为600 s/mm²（P＜0.05）。b值为1000 s/mm²时诊断乳腺恶性病变的敏感度、特异度、准确度分别为92.50%、100.00%、94.00%,高于b值为600 s/mm²的70.00%、60.00%、68.00%（P＜0.05）。b值为1000 s/mm²下雌激素受体、孕激素受阳性患者的ADC值低于阴性患者,而人类表皮生长因子受体2阳性患者的ADC值高于阴性患者（P＜0.05）。经Spearman相关性分析可得,b值为1000 s/mm²下ADC值与雌激素受体、孕激素受体阳性表达均呈负相关关系,而与人类表皮生长因子受体2阳性表达呈正相关关系（P＜0.05）。结论：3.0 T磁共振扩散加权成像在乳腺良恶性病变鉴别中的价值较高,且以b值为1000 s/mm²的诊断能效较优。此外,b值下ADC值和乳腺癌部分预后因子表达状态密切相关。     

不同体质量指数对腹腔镜结直肠癌切除术患者临床疗效和远期预后的影响

摘要 目的：研究不同体质量指数（BMI）对腹腔镜结直肠癌切除术患者临床疗效和远期预后的影响。方法：将从2014年1月～2016年1月于我院接受腹腔镜结直肠癌切除术治疗的110例患者纳入研究。将所有受试者根据BMI的差异分作正常组（18.6 kg/m²≦BMI<23.0 kg/m²）35例、超重组（23.0 kg/m²≦BMI<25.0 kg/m²）53例、肥胖组（BMI≧25.0 kg/m²）22例。分析三组患者各项基线资料,临床疗效,术后并发症发生情况,远期预后等方面的差异。结果：三组患者各项基线资料比较差异均不明显（均P＞0.05）。肥胖组手术时长为（268.01±36.14）min,均明显高于正常组、超重组的（211.73±30.56）min、（224.12±34.87）min（均P＜0.05）;三组术中失血量、肛门排气时间以及住院康复时间对比均不明显（均P＞0.05）。三组患者术后肺部感染、下肢静脉血栓、切口感染以及吻合口出血发生率对比均不明显（均P＞0.05）。正常组5年生存率为45.71%（16/35）,超重组5年生存率为47.17%（25/53）,肥胖组5年生存率为45.45%（10/22）,三组比较差异无统计学意义（均P＞0.05）。结论：不同BMI对腹腔镜结直肠癌切除术患者的手术时长具有一定影响,但和远期预后无关,值得临床重点关注。     

关节镜下前交叉韧带重建中保留残端对膝关节功能及本体感觉恢复的影响研究

目的:探讨关节镜下前交叉韧带(ACL)重建术中保留韧带残端对ACL损伤患者膝关节功能及本体感觉恢复的影响。方法:回顾性分析2010年1月~2016年3月解放军第174医院收治的ACL损伤患者266例,所有患者均行关节镜下ACL重建,其中保留韧带残端的163例为保留残端组,术中完全清理韧带残端的103例为非保留残端组,所有患者术后随访12个月以上,评价两组患者的膝关节功能及本体感觉恢复情况。结果:术前、术后9个月、术后12个月两组膝关节患侧Lysholm评分、国际膝关节文献委员会膝关节评估表(IKDC)评分、被动活动察觉阀值、被动角度再生试验结果比较差异无统计学意义(P0.05);两组术后各检测时间点的Lysholm评分、IKDC评分较术前均显著提高,被动活动察觉阀值、被动角度再生试验结果较术前明显降低(P0.05);保留残端组术后3个月、6个月的Lysholm评分、IKDC评分高于非保留残端组,被动活动察觉阀值、被动角度再生试验结果低于非保留残端组,差异有统计学意义(P0.05)。结论:关节镜下ACL重建中保留残端可加快膝关节功能及本体感觉恢复速度,获得满意的临床疗效,值得推广应用。     

本体感觉训练对膝关节周围骨折术后所致关节僵硬患者康复的影响

目的:分析本体感觉训练对膝关节周围骨折术后所致关节僵硬患者康复的影响。方法:选取我院收治的膝关节周围骨折术后所致关节僵硬患者62例,随机分成两组,对照组(n=31)采取常规康复训练,观察组(n=31)强化常规康复训练,采取本体感觉训练,比较两组康复训练方式对患者和的影响。结果:两组患者治疗前AROM水平比较(P0.05)。两组患者治疗后AROM水平均优于治疗前,且观察组高于对照组(P0.05)。两组患者治疗前LKSS评分比较(P0.05)。两组患者治疗后LKSS评分均优于治疗前,且观察组高于对照组(P0.05)。两组患者治疗前BBS评分比较(P0.05)。两组患者治疗后BBS评分均优于治疗前,且观察组高于对照组(P0.05)。结论:本体感觉训练对膝关节周围骨折术后所致关节僵硬患者康复有利,具有较高的临床价值。     

TRPV4 plays an important role in rat prefrontal cortex changes induced by acute hypoxic exercise

ObjectiveThis study aims to investigate the effects of TRPV4 on acute hypoxic exercise-induced central fatigue, in order to explore the mechanism in central for exercise capacity decline of athletes in the early stage of altitude training.Methods120 male Wistar rats were randomly divided into 12 groups: 4 normoxia groups (quiet group, 5-level group, 8-level group, exhausted group), 4 groups at simulated 2500 m altitude (grouping as before), 4 groups at simulated 4500 m altitude (grouping as before), 10 in each group. With incremental load movement, materials were drawn corresponding to the load. Intracellular calcium ion concentration was measured by HE staining, enzyme-linked immunosorbent assay, immunohistochemistry, RT-qPCR, Fluo-4/AM and Fura-2/AM fluorescence staining.Results(1) Hypoxic 2–5 groups showed obvious venous congestion, with symptoms similar to normoxia-8 group; Hypoxic 2–8 groups showed meningeal loosening edema, infra-meningeal venous congestion, with symptoms similar to normoxia-exhausted group and hypoxic 1-exhaused group. (2) For 5,6-EET, regardless of normoxic or hypoxic environment, significant or very significant differences existed between each exercise load group (normoxic ? 5 level 20.58 ± 0.66 pg/mL, normoxic ? 8 level 23.15 ± 0.46 pg/mL, normoxic - exhausted 26.66 ± 0.71 pg/mL; hypoxic1-5 level 21.72 ± 0.43 pg/mL, hypoxic1-8 level 24.73 ± 0.69 pg/mL, hypoxic 1-exhausted 28.68 ± 0.48 pg/mL; hypoxic2-5 level 22.75 ± 0.20 pg/mL, hypoxic2-8 level 25.62 ± 0.39 pg/mL, hypoxic 2-exhausted 31.03 ± 0.41 pg/mL) and quiet group in the same environment(normoxic-quiet 18.12 ± 0.65 pg/mL, hypoxic 1-quiet 19.94 ± 0.43 pg/mL, hypoxic 2-quiet 21.72 ± 0.50 pg/mL). The 5,6-EET level was significantly or extremely significantly increased in hypoxic 1 environment and hypoxic 2 environment compared with normoxic environment under the same load. (3) With the increase of exercise load, expression of TRPV4 in the rat prefrontal cortex was significantly increased; hypoxic exercise groups showed significantly higher TRPV4 expression than the normoxic group. (4) Calcium ion concentration results showed that in the three environments, 8 level group (normoxic-8 190.93 ± 6.11 nmol/L, hypoxic1-8 208.92 ± 6.20 nmol/L, hypoxic2-8 219.13 ± 4.57 nmol/L) showed very significant higher concentration compared to quiet state in the same environment (normoxic-quiet 107.11 ± 0.49 nmol/L, hypoxic 1-quiet 128.48 ± 1.51 nmol/L, hypoxic 2-quiet 171.71 ± 0.84 nmol/L), and the exhausted group in the same environment (normoxic-exhausted 172.51 ± 3.30 nmol/L, hypoxic 1-exhausted 164.54 ± 6.01 nmol/L, hypoxic 2-exhausted 154.52 ± 1.80 nmol/L) had significant lower concentration than 8-level group; hypoxic2-8 had significant higher concentration than normoxic-8.ConclusionAcute hypoxic exercise increases the expression of TRPV4 channel in the prefrontal cortex of the brain. For a lower ambient oxygen concentration, expression of TRPV4 channel is higher, suggesting that TRPV4 channel may be one important mechanism involved in calcium overload in acute hypoxic exercise.     

前交叉韧带保留残端重建对患者术后膝关节本体感觉功能恢复的影响

目的:研究前交叉韧带保留残端重建对患者术后膝关节本体感觉功能恢复的影响。方法:选取2014年3月-2016年3月于我院行膝关节镜下前交叉韧带重建手术患者108例,采用随机数字表法将所有患者分为对照组(n=54)和研究组(n=54)。对照组给予非保留残端重建治疗,研究组给予保留残端重建治疗,两组患者均进行为期12个月的随访观察。分别比较两组患者术前、术后3个月、术后6个月、术后12个月膝关节功能以及本体感觉功能恢复情况。结果:术前、术后12个月两组患者膝关节Lysholm评分对比均无统计学差异(P0.05),术后3个月、术后6个月研究组膝关节Lysholm评分明显高于对照组,差异有统计学意义(P0.05)。术后各个时间两组患者膝关节Lysholm评分均高于术前,且随着时间的推移呈上升的趋势,差异有统计学意义(P0.05)。术前、术后12个月两组膝关节被动活动察觉阈值、被动角度再生试验结果对比无统计学差异(P0.05),术后3个月、术后6个月研究组的膝关节被动活动察觉阈值、被动角度再生试验结果明显低于对照组,差异有统计学意义(P0.05),术后各个时间两组患者膝关节被动活动察觉阈值、被动角度再生试验结果均低于术前,且随着时间的推移呈下降的趋势,差异有统计学意义(P0.05)。两组患者不良反应发生率均为1.85%,无统计学差异(P0.05)。结论:前交叉韧带保留残端重建有利于患者术后膝关节功能以及本体感觉功能早期恢复,安全性好,值得临床推广。     

Calcium Challenge to Confirm Secondary Hyperparathyroidism Caused by Decreased Calcium Intake

ObjectiveSecondary hyperparathyroidism commonly occurs in the setting of mid-to low-normal serum calcium levels, often in the setting of chronic kidney disease, phosphate loading, vitamin D deficiency, or insufficient calcium intake or absorption. In this article, we report 9 patients who had adequate kidney function (estimated glomerular filtration rate >60 mL/min/1.73 m²) and normal 25-hydroxy vitamin D level (≥30 ng/dL) and whose secondary hyperparathyroidism resolved after starting adequate oral calcium intake.MethodsOur retrospective case series included 8 women and 1 man; the mean age was 69.0 ± 12.2 years (mean ± standard deviation). The initial intact parathyroid hormone (iPTH) level was 80.6 ± 13.4 pg/mL (reference range [ref], 10-65 pg/mL), corrected serum calcium level was 9.2 ± 0.2 mg/dL (ref, 8.5-10.5 mg/dL), serum phosphate level was 3.6 ± 0.4 mg/dL (ref, 2.5-4.9 mg/dL), 25-hydroxy vitamin D level was 42.2 ± 10.5 mg/dL (ref, 20-50 ng/mL), and estimated glomerular filtration rate was 72.6 ± 14.4 mL/min/1.73 m². Patients were treated clinically with oral calcium 600 mg twice a day.ResultsiPTH was retested after a mean duration of 17.6 ± 12.7 days of calcium supplementation; the iPTH level decreased to 51.0 ± 10.6 pg/mL, with all patients achieving iPTH in the normal range with normocalcemia, consistent with hyperparathyroidism being because of insufficient calcium intake or absorption. All patients were normocalcemic after supplementation.ConclusionSecondary hyperparathyroidism can result from insufficient oral calcium intake. Calcium challenge is an efficacious and cost-effective tool for confirming and treating secondary hyperparathyroidism in the setting of normal vitamin D levels and kidney function.     

Correlation of viral load of Hepatitis B with the gestation period and the development of diabetes mellitus

ObjectiveTo elaborate how the viral load of HBV affects the gestational diabetes mellitus (GDM).MethodsWe enrolled 196 chronic HBV-infected pregnant patients in this hospital between January 2012 and December 2017 for delivery in this study. According to the viral load of HBV-DNA, these patients were divided into the HBV-DNA negative group (n = 107, <1 × 10³ copies/mL) and HBV-DNA positive group (n = 89, ≥1 × 10³ copies/mL). Simultaneously, 100 HBV-free pregnant women who were admitted to the hospital for delivery were included in the control group. Before delivery, fasting venous blood was drawn from the pregnant women to perform the HBV-DNA quantification through qRT-PCR; from the 24th to 28th gestation week, all pregnant women underwent OGTT, with the third-trimester-of-pregnancy as the endpoint. Besides, we also measured the FBG, 2hPG and hemoglobin A1c (HbAIc).ResultsAmong 168 pregnant patients carrying chronic HBV, viral load of 107 patients was less than 1 × 10³ copies/mL (54.6%), and 89 not less than 1 × 10³ copies/mL (45.4%). The incidence rates of GDM in the HBV-DNA negative group and HBV-DNA positive group were 18.7% and 19.1%, respectively, significantly higher than that in the control group (p < 0.05), while the difference of the incidence rates of GDM between two HBV-DNA groups were not significant (p > 0.05). In HBV-DNA negative group and HBV-DNA positive group, FBGs, 2hPGs and HbAIcs were respectively (6.96 ± 0.36) mmol/L and (7.04 ± 0.37) mmol/L, (10.26 ± 1.29) mmol/L and (10.16 ± 1.12) mmol/L, and (8.66 ± 0.97) % and (8.91 ± 0.90) %, significantly higher than (4.57 ± 0.34) mmol/L, (6.16 ± 0.86) mmol/L and (5.13 ± 0.57) % (p < 0.05); however, between two HBV-DNA groups, comparisons of the FBG, 2hPG and HbAIc suggested no significant differences (p > 0.05). In 196 patients carrying chronic HBV, positive correlations were identified between the viral load of HBV-DNA, and FBG, 2hPG and HbAIc (p < 0.01).ConclusionHBV infection can increase the incidence rate of GDM, and the viral load of HBV-DNA is correlated with the glucose level of pregnant patients.     

腹主动脉下段球囊临时阻断术时钙蛋白T水平的变化及临床意义

目的:探讨腹主动脉下段球囊临时阻断术时钙蛋白T(TnT)水平的变化及临床意义。方法:回顾性分析2015年5月至2016年12月我院收治的58例难治性盆腔类手术患者的临床资料,包括骨盆骨折11例、凶险性前置胎盘并发胎盘植入22例、骶骨肿瘤切除术12例、盆腔肿瘤切除术13例。以上全部操作均给予腹主动脉下段球囊临时阻断术。分别于术前、球囊阻断时、术后的血液样本对钙蛋白T(TnT)进行检测。手术时间2~5 h,平均3.6 h。结果:术前,所有患者血清TnT水平为(90±5)pg/m L。阻断时,血清TnT升高至(109±3)pg/m L,与术前比较差异有统计学意义(p0.05)。解除阻断后1小时,TnT升高至(113±2)pg/m L;解除阻断后2小时TnT较阻断时升高至(115±3)pg/m L,较阻断前明显升高,差异有统计学意义(p0.05)。解除阻断后6小时,TnT较阻断时下降(95±5)pg/ml,较阻断后2 h明显下降并恢复至正常值,差异有统计学意义(p0.05)。结论:腹主动脉下段球囊临时阻断术不可避免引起心肌细胞不同程度的缺血再灌注损伤,但是此类损伤不大,为一过性、可代偿的损害。     

Twenty-four-hour ghrelin is elevated after calorie restriction and exercise training in non-obese women

Objective: The purpose of this study was to determine whether chronic energy deficiency achieved with caloric restriction combined with exercise is associated with changes in the 24‐hour profile of ghrelin in non‐obese, pre‐menopausal women. Research Methods and Procedures: Twelve non‐obese (BMI = 18 to 25 kg/m²), non‐exercising women (age, 18 to 24 years) were randomly assigned to a non‐exercising control group or a diet and exercise group. The 3‐month diet and exercise intervention yielded a daily energy deficit of ?45.7 ± 12.4%. Serial measurements were made of body composition, energy balance, and feelings of fullness. Repeated blood sampling over 24 hours to measure ghrelin occurred before and after the study. Results: Significant decreases in body weight, body fat, and feelings of fullness were observed in only the energy‐deficit group (p < 0.05); significant changes in the following ghrelin features were found in only the deficit group (p < 0.05): elevations in baseline (+353 ± 118 pg/mL), lunch peak (+370 ± 102 pg/mL), dinner peak (+438 ± 149 pg/mL), nocturnal rise (+269 ± 77 pg/mL), and nocturnal peak (+510 ± 143 pg/mL). In addition, we found a larger dinner decline (?197 ± 52 pg/mL) and negative correlations between changes in the ghrelin dinner profile and changes in body weight (R = 0.784), 24‐hour intake (R = 0.67), energy deficiency (R = 0.762), and feelings of fullness (R = 0.648; p < 0.05). Discussion: Changes in ghrelin concentrations across the day after weight loss are closely associated with other physiological adaptations to energy deficiency, further supporting the role of ghrelin as a countermeasure to restore energy balance.     

Measurement of thromboxane B2 in human plasma or serum by radioimmunoassay

A radioimmunoassay for thromboxane B₂ (TxB₂), a stable metabolite of thromboxane A₂, is described. The method consists of extraction of TxB₂ into ethyl acetate from acidified plasma or serum samples and saturation analysis using specific antibodies produced in rabbits against TxB₂-BSA conjugate. The 50 % displacement level of the standard curve was 19.1 ± 2.9 pg/tube (mean ± S.D., n = 19). The method blank was 3.4 ± 3.1 pg/ml (n = 15) and the assay sensitivity thus 9.6 pg/ml (mean blank + 2 S.D.). When 100 to 200 pg of TxB₂ were added to plasma, 96.2–103.6 % were recovered. The intra-assay coefficient of variation varied from 6.7 to 9.7 %, and the inter-assay coefficient of variation was 18.6 % (n = 10). The TxB₂ concentration in the plasma of 14 healthy subjects varied from 29.3 to 120.8 pg/ml with a mean ± S.D. of 70.1 ± 26.1 pg/ml, when the blood was collected into tubes containing acetylsalicylic acid (ASA), whereas significantly higher (p < 0.001) TxB₂ concentrations of 68.3 – 285.3 pg/ml with a mean ± S.D. of 151.8 ± 66.6 pg/ml were obtained from the same subjects in the plasma of blood which was collected into tubes containing no ASA. When blood samples from 10 subjects were allowed to clot at 0, +24 or +37°C for 60 min., the TxB₂ concentrations in the sera were 2053 ± 870 pg/ml, 4001 ± 1370 pg/ml and 178557 ± 54000 pg/ml, respectively. The TxB₂ levels in sera which were separated from blood samples incubated at +37°C, correlated significantly (p < 0.001) with the TxB₂ productions in platelet-rich-plasma (PRP) after an induced aggregation. Our results indicate 1) when TxB₂ is measured in plasma, the use of prostaglandin synthesis inhibitor in the collection tubes is necessary and 2) the measurement of TxB₂ in serum of blood which has been kept at +37°C for a strictly standardized period of time could replace the use of PRP in TxB₂ studies.