不同血糖水平对体外循环心脏手术围术期患者血乳酸以及康复进程的影响

目的:探讨体外循环(CPB)心脏手术围术期患者不同血糖水平对血乳酸值及术后康复进程的影响。方法:选择2016年3月至2018年5月在我院行CPB心脏手术的患者78例为研究对象,根据术前血糖水平分为糖尿病组(术前空腹血糖≥7.0 mmol/L)33例和非糖尿病组(术前空腹血糖7.0 mmol/L)45例,于术前2h(T_1)、麻醉后(T_2)、CPB转机后5 min(T_3)、主动脉阻断后5 min(T_4)、停止CPB时(T_5)、手术结束时(T_6)、术后2h(T_7)、4h(T_8)、6h(T_9)、8h(T_(10))、12h(T_(11))、24h(T_(12))及48h(T_(13))监测两组血糖及血液乳酸水平,比较两组康复进程指标及并发症发生情况。结果:糖尿病组患者围手术期各时间点血糖及血乳酸水平均高于非糖尿病组,且两组血糖与血乳酸水平呈正相关(P0.05);两组各时间点血糖及血乳酸水平均高于T_1时刻(P0.05)。非糖尿病组患者呼吸机辅助通气时间、ICU停留时间、术后住院时间均短于糖尿病组(P0.05)。非糖尿病组并发症发生率为4.44%(2/45),与糖尿病组的15.15%(5/33)比较无统计学差异(P0.05)。结论:CPB心脏手术患者围术期血糖及血乳酸水平明显升高,二者呈正相关关系,但术前糖尿病患者围手术期血糖及血乳酸水平波动更明显,控制围手术期血糖水平有助于加快康复进程。     

过敏原检测在幼儿喘息性疾病中的临床意义

目的:探讨过敏原检测在幼儿喘息性疾病中的临床应用价值。方法:选择我院儿科收治的的1～5岁下呼吸道感染的特应性体质患儿217例,按照有无喘息症状分为喘息组与非喘息组。采集并比较两组患儿年龄、性别、过敏史(食物过敏,药物过敏,鼻炎,湿疹)、体外过敏原检测结果:TIgE(总IIgE)及sIgE(特异性IgE),(视sIgE≥2级为阳性)、一二级亲属过敏性疾病史。结果:(1)喘息组反复呼吸道感染及鼻炎人数均高于非喘息组(P0.05)。两组在湿疹、喜揉眼、食物过敏、药物过敏、一级亲属过敏史、二级亲属过敏史方面比较差异不具有统计学意义(P0.05)。(2)两组体外过敏原检测结果比较:喘息组户尘螨阳性人数多于非喘息组;(3)喘息患儿组根据是否伴有鼻炎及湿疹分为:A组,喘息,不伴有鼻炎及湿疹;B组,喘息伴有鼻炎或者湿疹;C组,喘息,伴有鼻炎及湿疹。ABC三组TIgE、年龄、吸入过敏原个数、吸入过敏原阳性人数、户尘螨阳性率逐渐增多,差异具有统计学意义(P0.05),其他吸入过敏原及食入过敏原比较差异无统计学意义。结论:反复呼吸道感染、鼻炎和喘息密切相关。尘螨是幼儿喘息、变应性鼻炎和特应性皮炎主要过敏原之一,是特应性体质患儿是否发生喘息的关键过敏原。     

高压氧对肾脏缺血再灌注损伤的保护作用及其机制研究

目的:观察高压氧(hyperbaric oxygen,HBO)对肾脏缺血再灌注损伤的保护作用并探讨其作用机制.方法:56只SD大鼠被随机分为三组,假手术组(n=8);I/R组(n=24),夹闭双肾动脉45分钟后恢复血流灌注;I/R+HBO组(n=24),夹闭双肾动脉45分钟并在恢复血流后1h、24 h、48 h行HBO治疗,每次HBO后采血并取双肾,比色法测定血浆尿素氮(BUN)、肌酐(Cr)值,原位末端标记(TUNEL)法检测肾小管上皮细胞凋亡情况,实时定量PCR法检测促凋亡基因Bax的mRNA含量.结果:与sham组(BUN值为9.563± 1.384 mmol/L;Cr值为45.912±2.685 mmo1/L,TUNEL值为2.088％)比较,I/R组大鼠再灌注1小时尿素氮(12.5±1.487 mmol/L)和血肌酐水平(51.388±3.092 mmol/L)升高,但差异无统计学意义,而TUNEL阳性细胞数(9.775％)和Bax的mR-NA(3.219± 0.427)表达水平均显著升高(P＜0.05),再灌注24小时及48小时后尿素氮(28.087± 2.012 mmol/L、41.225± 1.397mmol/L)和血肌酐(241.75± 11.853 mmol/L、278.75± 12.578 mmol/L)水平、TUNEL阳性细胞数(12.512％、14.413％)和Bax的mRNA(5.541±0.227、6.407± 0.291)表达水平均显著升高(P＜0.05);而HBO治疗可显著降低再灌注24小时及48小时的大鼠尿素氮(14.15±1.397 mmol/L、25.962± 2.497 mmol/L)和血肌酐(146.375± 8.782 mmolL、210.125± 11.519 mmol/L)水平(P＜0.05),但仍显著高于假手术组(P＜0.05).结论:HBO治疗可以改善I/R后肾功能,其作用机制可能与在早期明显降低Bax的mRNA表达,减轻肾小管上皮细胞凋亡有关.     

婴幼儿急性轮状病毒肠炎42例临床检验分析

目的:探讨婴幼儿急性轮状病毒肠炎临床检验方法及原因。方法:选取我院2014年1月至2015年1月间收治的患者42例,按脱水程度分为两组,观察组21例为轻度脱水,对照组21例为中度脱水,并对患者的新鲜粪便进行轮状病毒检测,同时对其各项血清指标进行分析。结果:观察组:血钾指标为(3.89±0.32)mmol/L、血氯指标(113.9±3.41)mmol/L、血钠指标为(143.1±2.69)mmol/L、二氧化碳结合力为(16.90±5.98)mmol/L,对照组的对应数据为:(3.67±0.22)mmol/L、(92.9±3.41)mmol/L、(112.1±2.41)mmol/L、(8.90±5.98)mmol/L,观察组各项血清指标高于对照组,差异显著,具有统计学意义(P0.05)。结论:恢复患儿体液平衡,有助于解决婴幼儿急性轮状病毒肠炎引发的腹泻等症状。     

高反气道应性与慢性持续期哮喘儿童呼出一氧化氮水平的相关性研究

目的:探讨慢性持续期哮喘患儿呼出一氧化氮水平(FeNO)与气道高反应性(AHR)的相关性。方法:选取我院收治的慢性持续期哮喘患儿72例,依据是否应用吸入性糖皮质激素药物分为激素治疗组和非激素治疗组。非激素治疗组患儿36例给予常规哮喘药物(复方妥英麻黄茶碱片)治疗,激素治疗组患儿36例在非激素治疗的基础上加用糖皮质激素药物(丙酸氟替卡松吸入气雾剂)治疗,另选取同期到我院进行相关检查的40例健康儿童作为对照组。疗程结束后检测3组患儿呼出FeNO水平及其AHR指标,并进行相关的统计学分析。结果:(1)非激素治疗组呼出的FeNO水平显著高于激素治疗组和对照组(P0.05),激素治疗组呼出的FeNO水平明显高于对照组(P0.05);(2)激素治疗组患儿与非激素治疗组50%肺活量最大呼气流量变异率(△MEF50值)比较无显著差异(P0.05);非激素治疗组患儿第一秒用力呼气容积变异率(△FEV1值)显著高于激素治疗组(P0.01);(3)激素治疗组患儿呼出的FeNO水平与△MEF50值和△FEV1值具有显著正相关性(P0.05),相关系数分别为0.526、0.485;非激素治疗组以及对照组患儿FeNO水平与△MEF50值和△FEV1值无相关性(P0.05)。结论:应用糖皮质激素对慢性持续期哮喘患儿进行规范化治疗能够有效控制其临床AHR,患儿呼出的FeNO水平与AFEV1值和AMEF50值均具有显著相关性,可能作为评价哮喘患儿气道反应性的临床指标。     

乳酸堆积和二氯乙酸钠对肝癌细胞凋亡及bax、bcl-2 表达 和caspase-3 活性的影响

目的：探讨乳酸堆积和二氯乙酸钠(DCA)对肝癌细胞(HepG2)凋亡和bax、bcl-2 表达及caspase-3 活性的影响。方法：通过体 外培养HepG2,建立稳定的体外培养模型,配制成终浓度分别为0 mmol/L、1.0 mmol/L、2.0 mmol/L、4.0 mmol/L、8.0 mmol/L的乳 酸培养液以及在不同浓度乳酸组中加入终浓度为10-3mmol/L DCA 培养液与HepG2共同培养,其中以0 mmol/L 乳酸组为对照 组。采用MTT法检测乳酸对HepG2 的抑制率,流式细胞仪检测乳酸和DCA 对HepG2的凋亡百分率,用Real-time PCR法测定 bax 及bcl-2 mRNA的表达,用免疫荧光法检测caspase-3 的活性。结果：乳酸对HepG2 的IC50值为13.6 mol/L,与对照组比较,随 着乳酸浓度的增加,HepG2 凋亡率增加,bax mRNA 表达升高,bcl-2 mRNA 的表达降低,caspase-3活性增加,其中1.0 mmol/L 乳 酸组与对照组比较(P>0.05),2.0 mmol/L,4.0 mmol/L 和8.0 mmol/L乳酸组与对照组比较差异有统计学意义(P<0.05)。加入DCA 后,HepG2 凋亡减少,2.0 mmol/L 乳酸+DCA 组、4.0 mmol/L乳酸+DCA 组、8.0 mmol/L乳酸+DCA 组与同浓度的乳酸组比较, bax mRNA 表达减少（P<0.05）,bcl-2 mRNA 表达增加（P<0.05）,caspase-3 活性减低（P<0.05）。结论：乳酸可诱导HepG2凋亡,且随 着乳酸浓度的增高,HepG2 的凋亡率增加,其机制可能是通过对bcl-2 及bax mRNA 表达的改变以及激活caspase-3 活性而实现, DCA可以降低HepG2 凋亡,对乳酸堆积造成的HepG2凋亡有抑制作用。     

小儿脓毒性休克早期血乳酸浓度与病情严重程度的相关性分析

目的:探讨早期动态监测血乳酸浓度对评价小儿脓毒性休克病情严重程度与预后的价值。方法:入选90例小儿脓毒性休克患儿,以诊断休克为研究起点,动态监测研究0 h、6 h的血乳酸,计算6 h乳酸清除率。按PCIS评分分为≥70分组(n=41)、60~70分组(n=40)、60分组(n=9);按预后分为存活组(n=62)与死亡组(n=28);按乳酸清除率分为高乳酸清除率组(n=57)与低乳酸清除率组(n=33),对各组PCIS评分、0 h血乳酸及乳酸清除率等指标进行比较。结果:≥70分组、60~70分组、60分组0 h血乳酸及乳酸清除率比较差异有计学意义(P0.05),≥70分组明显低于60~70分组及60分组,60~70分组明显低于60分组(P均0.05);存活组PCIS评分及乳酸清除率显著高于死亡组,0 h血乳酸水平明显低于死亡组(P0.05);高乳酸清除率组PCIS评分显著高于低乳酸清除率组。PCIS评分与0 h血乳酸浓度呈显著负相关(r=-0.619,P0.05),与乳酸清除率呈显著正相关(r=-0.702,P0.05)。结论:在评价小儿脓毒性休克的病情严重程度及预后方面,早期血乳酸清除率比单次血乳酸浓度更有意义。     

化痰脉通片对高脂血症大鼠血脂、肝功能、脂肪肝的影响

目的:探讨国医大师沈宝藩临床运用三十余年的化痰脉通片对高脂血症大鼠脂肪肝、肝功能的干预效果,了解其改善肝功能,治疗脂肪肝作用疗效。方法:选取SD大鼠75只,随机分为正常组、模型组、氟伐他汀组、化痰脉通中剂量组、化痰脉通高剂量组,每组15只,观察对比各组治疗后血脂水平、肝功能的变化,并通过病理切片,对比各组脂肪肝疗效。结果:正常组、氟伐他汀组、化痰脉通中剂量组、化痰脉通高剂量组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均显著低于模型组(P0.05),而高密度脂蛋白胆固醇(HDL-C)显著高于模型组(P0.05);正常组及化痰脉通高剂量组TC、TG、LDL-C均显著低于化痰脉通中剂量组及氟伐他汀组(P0.05),而HDL-C显著高于化痰脉通中剂量组及氟伐他汀组(P0.05),且化痰脉通中剂量组及氟伐他汀组血脂水平无显著性差异(P0.05);正常组TC、TG、LDL-C[(1.28±0.38)mmol/L,(0.40±0.16)mmol/L,(0.39±0.07)mmol/L]显著低于化痰脉通高剂量组[(5.18±1.42)mmol/L,(0.51±0.24)mmol/L,(2.07±0.46)mmol/L](P 0.05),而HDL-C[(3.78±0.34)mmol/L]显著高于化痰脉通高剂量组[(2.89±0.78)mmol/L](P0.05)。正常组、氟伐他汀组、化痰脉通中剂量组、化痰脉通高剂量组丙氨酸转氨酶(ALT)、谷草转氨酶(AST)均显著低于模型组(P0.05);正常组[(10.38±1.46)mmol/L,(10.85±1.24)mmol/L]、化痰脉通中剂量组[(15.97±3.64)mmol/L,(16.52±1.18)mmol/L]、化痰脉通高剂量组[(10.54±1.01)mmol/L,(10.62±1.67)mmol/L]AST、ALT均显著低于较氟伐他汀组[(25.47±2.38)mmol/L,(21.34±2.39)mmol/L](P0.05),而组间AST、ALT比较无显著性差异,不具有统计学意义(P0.05)。在肝脏病理切片的对比中,随着化痰脉通片剂量的增加,脂肪肝的程度减轻。结论:化痰脉通片具有良好的降脂效果,且与剂量有关,其对肝功能具有良好的保护作用并对脂肪肝具良好的治疗作用,其治疗机制可能与调脂作用有关。     

Ⅱ型糖尿病患者血糖对肝功能和血脂的影响及其意义

目的:探讨II型糖尿病患者血糖浓度对患者肝功能及血脂指标的影响及其意义。方法:选取某三级甲等医院内分泌科已确诊为II型糖尿病患者408例,根据空腹血糖浓度(FPG)分为三组:(A组,FPG8.0 mmol/L;B组,8.0≤FPG11.0 mmol/L;C组,FPG≥11 mmol/L),检测三组患者的肝功能指标及血脂指标,进而对其肝功能损害及血脂的异常情况进行分析,其数据结果应用统计学软件SPSS 17.0处理。结果:与A组及B组相比较,C组患者肝功能损伤更为严重,表现为:肝酶显著升高(P0.05);胆红素显著升高(P0.05);球蛋白显著升高(P0.05);总胆固醇、甘油三酯水平异常(P0.05)。其结果均有统计学意义。结论:II型糖尿病患者随着其血糖浓度升高可造成肝功能损伤及血脂异常,血糖监测及控制对糖尿病患者的身体健康状况具有重要意义。     

两种肺表面活性物质治疗新生儿呼吸窘迫综合症的临床疗效比较

目的:比较珂立苏与固尔苏两种肺表面活性物质(PS)治疗新生儿呼吸窘迫综合症(NRDS)的临床疗效.方法:选择2011年2月～2012年12月在我院确诊并接受治疗的NRDS患儿58例,在患儿家长知情同意的情况下,随机分为A组(n=26例)和B组(n=32例).在给予相同基础治疗措施的情况下,A组患儿采用珂立苏治疗,B组患儿采用固尔苏治疗,比较两组患儿治疗24h后的机械通气参数与血气指标的变化,并比较两组患儿症状缓解时间、机械通气时间、吸氧治疗时间及住院时间.结果:治疗24h后,两组患儿的呼气末正压(PEEP)、吸氧峰压(PIP)、平均气道压力(MAP)和氧浓度(FiO2)比较,均较治疗前显著降低,且B组以上指标均显著低于A组,差异均具有统计学意义(P＜0.05);两组患儿的血PaO2和pH值均较治疗前显著升高,而血PaCO2、氧合指数(OI)均较治疗前显著降低,且B组血PaO2、pH值和OI均显著高于A组,而血PaCO2显著低于A组,差异具有统计学意义(P＜0.05).此外,B组患儿经治疗后的症状缓解时间、机械通气时间、吸氧治疗时间及住院时间均较A组患儿显著缩短,差异均具有统计学意义(P＜0.05).结论:积极给予固尔苏治疗NRDS,可促进患儿机械通气参数与血气指标的改善,并缩短临床治疗时间,其效果优于珂立苏.     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

Synthesis and antimicrobial studies of hydrazone derivatives of 4-[3-(2,4-difluorophenyl)-4-formyl-1H-pyrazol-1-yl]benzoic acid and 4-[3-(3,4-difluorophenyl)-4-formyl-1H-pyrazol-1-yl]benzoic acid

Microbial resistance to antibiotics is an unresolved global concern, which needs urgent and coordinated action. One of the guidelines of the Centers for Disease Control and Preventions (CDC) to combat antibiotic resistance is the development of new antibiotics to treat drug-resistant bacteria. In our effort to find new antibiotics, we report the synthesis and antimicrobial studies of 30 new pyrazole derivatives. These novel molecules have been synthesized by using readily available starting materials and benign reaction conditions. Some of these molecules have shown activity with MIC values as low as 0.78?µg/mL against four bacterial strains; Staphylococcus aureus, methicillin-resistant S. aureus, Bacillus subtilis, and Acinetobacter baumannii. Furthermore, active molecules are non-toxic to mammalian cell line.

     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.     

Novel compounds with potent CDK9 inhibitory activity for the treatment of myeloma

Cyclin-dependent kinases (CDKs) and Polo-like kinases (PLKs) play key role in the regulation of the cell cycle. The aim of our study was originally the further development of our recently discovered polo-like kinase 1 (PLK1) inhibitors. A series of new 2,4-disubstituted pyrimidine derivatives were synthesized around the original hit, but their PLK1 inhibitory activity was very poor. However the novel compounds showed nanomolar CDK9 inhibitory activity and very good antiproliferative effect on multiple myeloma cell lines (RPMI-8226).