基于7所三甲医院数据的血液透析成本测算与分析

目的 通过对7所三级甲等医院血液透析医疗成本的测算和成本构成分析,找出成本构成的主要因素。方法 回顾性调查,分别采用传统成本法和作业成本法对血液透析的直接医疗成本和间接医疗成本进行测算。结果 成本构成中直接医疗成本占总医疗成本的比重最大,为36.68%,其中6所医院的血液透析收费标准低于成本,是血液透析成本的89.35%（均值）。结论 透析液和一次性材料应成为成本控制的重点,调整血液透析收费标准和调整支付方式已经成为可能。     

Pre-culturing islets with mesenchymal stromal cells using a direct contact configuration is beneficial for transplantation outcome in diabetic mice

Background aimsWe recently showed that co-transplantation of mesenchymal stromal cells (MSCs) improves islet function and revascularization in vivo. Pre-transplant islet culture is associated with the loss of islet cells. MSCs may enhance islet cell survival or function by direct cell contact mechanisms and soluble mediators. We investigated the capacity of MSCs to improve islet cell survival or β-cell function in vitro using direct and indirect contact islet-MSC configurations. We also investigated whether pre-culturing islets with MSCs improves islet transplantation outcome.MethodsThe effect of pre-culturing islets with MSCs on islet function in vitro was investigated by measuring glucose-stimulated insulin secretion. The endothelial cell density of fresh islets and islets cultured with or without MSCs was determined by immunohistochemistry. The efficacy of transplanted islets was tested in vivo using a syngeneic streptozotocin-diabetic minimal islet mass model. Graft function was investigated by monitoring blood glucose concentrations.ResultsIndirect islet-MSC co-culture configurations did not improve islet function in vitro. Pre-culturing islets using a direct contact MSC monolayer configuration improved glucose-stimulated insulin secretion in vitro, which correlated with superior islet graft function in vivo. MSC pre-culture had no effect on islet endothelial cell number in vitro or in vivo.ConclusionsPre-culturing islets with MSCs using a direct contact configuration maintains functional β-cell mass in vitro and the capacity of cultured islets to reverse hyperglycemia in diabetic mice.     

Concise synthesis and antitumor activities of trisaccharide steroidal saponins

The naturally derived trisaccharide steroidal saponin 1 and structurally modified derivatives 2 and 3 bearing the same sarsasapogenin aglycon were synthesized concisely via a direct transglycosylation strategy. The antitumor activities of the synthetic trisaccharide saponins 1–3 and their corresponding α-isomers 1a–3a were preliminarily evaluated against human gastric adenocarcinoma cell (MKN-45) and human epithelial cervical cancer cell (HeLa) by CCK-8 assay.     

Samarium-153 EDTMP for metastatic bone pain palliation: The impact of europium impurities

PurposeTo evaluate the impact on the radiation protection policies of the radiocontaminants in Samarium-153 ethylenediamine tetramethylene phosphonate (¹⁵³Sm-EDTMP).MethodsThe internal contamination of patients treated with ¹⁵³Sm-EDMTP for palliation of painful disseminated multiple bone metastases due to long-lived impurities was assessed by direct measurements. These measurements were coupled with dose-rate measurements close to their bodies and spectroscopic analysis of the residual activity in post-treatment radiopharmaceutical vials.ResultsWhole-body counting carried out in six patients showed a 30–81-kBq europium −152 plus europium-154 contamination. The 0.85 mean ¹⁵²Eu- to -¹⁵⁴Eu activity ratio obtained by direct counting was similar to that assessed by analysis of post-treatment residual activities in twelve radiopharmaceutical vials following radiopharmaceutical injection.ConclusionsThe long-lived radiocontaminants in the patient's bodies and the treatment wastes require modifications of the applicable radiation protection policies.     

Validation of High Resolution Melting Analysis (HRM) of the Amplified ITS2 Region for the Detection and Identification of Yeasts from Clinical Samples: Comparison with Culture and MALDI-TOF Based Identification

AimCandida species are known as opportunistic pathogens, and a possible cause of invasive infections. Because of their species-specific antimycotic resistance patterns, reliable techniques for their detection, quantification and identification are needed. We validated a DNA amplification method for direct detection of Candida spp. from clinical samples, namely the ITS2-High Resolution Melting Analysis (direct method), by comparing it with a culture and MALDI-TOF Mass Spectrometry based method (indirect method) to establish the presence of Candida species in three different types of clinical samples.ResultsFor 83.9% of the samples there was complete concordance between both techniques, i.e. the same Candida species were detected in 31.1% of the samples or no Candida species were detected in 52.8% of the samples. In 16.1% of the clinical samples, discrepant results were obtained, of which only 6.01% were considered as major discrepancies. Discrepancies occurred mostly when overall numbers of Candida cells in the samples were low and/or when multiple species were present in the sample.DiscussionMost of the discrepancies could be decided in the advantage of the direct method. This is due to samples in which no yeast could be cultured whereas low amounts could be detected by the direct method and to samples in which high quantities of Candida robusta according to ITS2-HRM were missed by culture on Candida ID agar. It remains to be decided whether the diagnostic advantages of the direct method compensate for its disadvantages.     

Expansion and CD2/CD3/CD28 stimulation enhance Th2 cytokine secretion of human invariant NKT cells with retained anti-tumor cytotoxicity

Background aimsKey obstacles in human iNKT cell translational research and immunotherapy include the lack of robust protocols for dependable expansion of human iNKT cells and the paucity of data on phenotypes in post-expanded cells.MethodsWe delineate expansion methods using interleukin (IL)-2, IL-7 and allogeneic feeder cells and anti-CD2/CD3/CD28 stimulation by which to dependably augment Th2 polarization and direct cytotoxicity of human peripheral blood CD3⁺Vα24⁺Vβ11⁺ iNKT cells.ResultsGene and protein expression profiling demonstrated augmented Th2 cytokine secretion (IL-4, IL-5, IL-13) in expanded iNKT cells stimulated with anti-CD2/CD3/CD28 antibodies. Cytotoxic effector molecules including granzyme B were increased in expanded iNKT cells after CD2/CD3/CD28 stimulation. Direct cytotoxicity assays using unstimulated expanded iNKT cell effectors revealed α-galactosyl ceramide (α-GalCer)-dependent killing of the T-ALL cell line Jurkat. Moreover, CD2/CD3/CD28 stimulation of expanded iNKT cells augmented their (α-GalCer-independent) killing of Jurkat cells. Co-culture of expanded iNKT cells with stimulated responder cells confirmed contact-dependent inhibition of activated CD4⁺ and CD8⁺ responder T cells.DiscussionThese data establish a robust protocol to expand and novel pathways to enhance Th2 cytokine secretion and direct cytotoxicity in human iNKT cells, findings with direct implications for autoimmunity, vaccine augmentation and anti-infective immunity, cancer immunotherapy and transplantation.     

通用PCR法在痰标本真菌检测中的临床应用价值分析

目的:探讨通用PCR法在痰标本真菌检测中的临床应用价值。方法:选择2015年9月至2017年9月本院收治的免疫力低下患者178例作为研究资料,各收集痰标本2份,其中一份用于PCR扩增,另一份经培养后若观察到真菌或可疑菌落,则提取后在此进行PCR扩增测序。比较3种方法对真菌的检出情况、真菌阳性率,与组织病理学结果进行比较,分析3种方法的诊断效能。结果:178份痰标本经平板培养可观察到107份真菌生长,其余71份未见真菌生长。挑取真菌及可疑菌落行PCR结果显示阳性、阴性分别115、63份。对痰标本直接PCR结果显示,阳性、阴性分别124、54份。PCR扩增产物测序结果显示大多是白色念珠菌感染,仅3份是曲霉菌感染。内对照扩增验证结果显示有1份阴性标本存在扩增抑制现象。3种方法的真菌阳性率:直接PCR法痰培养后PCR法痰培养,但组间无显著差异(P0.05)。3种方法诊断效能总体趋势:直接PCR法痰培养后PCR法痰培养,其中直接PCR法与痰培养后PCR法的特异度、准确度均显著高于痰培养法(P0.05),直接PCR法的敏感度显著高于痰培养法(P0.05)。结论:通用PCR法在痰标本真菌检测中的临床应用价值较高,直接PCR具有操作简单、快速等优势。     

Ceramide-1-phosphate sugars: new types of glycophospholipids

Ceramide-1-phosphate sugars were synthesized by direct glycosyl phosphite/phosphate andO-glycosyl trichloroacetimidate/phosphate exchange reactions, respectively. Thus, ceramide-1-O-phosphoric acid 5 gave with sialyl phosphite1 as sialyl donor directly -linked sialyl phosphate6; deprotection afforded the corresponding glycophospholipid ceramide-1-phosphateN-acetylneuraminate7. Similarly, fromO-glucosyl- andO-galactosyltrichloroacetimidate10 and13 with phosphoric acid derivative5 glycosyl ceramide-1-phosphate sugars12 and15, respectively, were obtained.     

Postprandial Dysmetabolism: the Missing Link Between Diabetes and Cardiovascular Events?

ObjectiveTo investigate the association of postprandial dysmetabolism, ie, hyperglycemia, and hyperlipidemia with myocardial disease in diabetic, glucose-intolerant, and glucose-tolerant patients.MethodsWe performed a MEDLINE search of the English-language literature published between January 1979 and April 2007 for studies regarding postprandial dysmetabolism and heart disease.ResultsPostprandial dysmetabolism is associated with increased inflammation, endothelial dysfunction, decreased fibrinolysis, plaque instability, and cardiac events.ConclusionThere is a direct and proportional association between postprandial dysmetabolism and both coronary artery disease and cardiac events. (Endocr Pract. 2008;14:112-124)     

SYNTHESIS OF 2-THIOHYDANTOINS AND THEIR S-GLUCOSYLATED DERIVATIVES AS POTENTIAL ANTIVIRAL AND ANTITUMOR AGENTS

A series of 3-alkyl-5-((Z))-arylidene-2-thiohydantoins 4a-l were synthesized from the direct condensation of the aromatic aldehydes with 3-alkyl-2-thiohydantoins 3a-c, which in turn were prepared from the reaction of glycine (1) and alkyl isothiocyanates 2a-c. The alkylation of 4a-l with methylthioethyl chloride gave 5-((Z))-arylidene-3-alkyl-S-(2-methylthioethyl)-2-thiohydantoins 5a-e. S-Glucosylation took place on the reaction of 4a-l with 2,3,4,6-tetra-O-acetyl-α-D-glucopyranosyl bromide under anhydrous alkaline conditions. These structures have been confirmed from a model study of the coupling of 4a with methylthioethyl chloride and α-D-glucose pentaacetate, respectively under Lewis acid conditions.     

Distinguishing the effects of vegetation restoration on runoff and sediment generation on simulated rainfall on the hillslopes of the loess plateau of China

Aims

Since the 1970s, extensive croplands were converted to forest and pasture lands to control severe soil erosion on the Loess Plateau of China. We quantify the direct and indirect effects of vegetation restoration on runoff and sediment yield on hillslopes in the field to improve environmental governance.

Methods

An artificial rainfall experiment at a rainfall intensity of 120 mm h⁻¹ and a slope gradient of 22° were used to distinguish the effects of vegetation restoration on runoff and sediment yield.

Results

Compared to the farmland slopes, vegetation restoration directly prolonged the time-to-runoff by 140%, reduced the runoff rate by 20%, and increased the soil infiltration capacity by 15%. Vegetation restoration indirectly delayed the time-to-runoff by 120%, reduced the runoff rate and sediment yield rate by 50% and 94%, respectively, and increased the soil infiltration capacity by 58% on the hillslopes with vegetation restoration.

Conclusions

The direct effects of vegetation restoration on runoff and sediment yield were lower than its indirect impacts. Vegetation cover, decreases in soil bulk density, and increases in belowground root biomasses and > 0.25 mm aggregate stability were the primary causes of runoff and sediment yield reduction on the slopes with vegetation restoration.

     

Egyptian Mongoose,Herpestes ichneumon,in southern Turkey

Abstract

Foot-prints and direct observations showed that the Egyptian Mongoose is relatively common in the Çukurova region of southern Turkey. Droppings contained approx. 65% birds.     

Nucleoside Transport in Neurons. Regulation by Secretagogues and Effectors of Protein Kinases A and C

Abstract

In chromaffin cells, secretagogues and direct activators of protein kinase C and protein kinase A inhibited the nucleoside transport with a parallel decrease in the high affinity binding sites.     

Direct and indirect facilitation affect community productivity through changes in functional diversity in an alpine system

Background and AimsFacilitation is an important ecological process for plant community structure and functional composition. Although direct facilitation has accrued most of the evidence so far, indirect facilitation is ubiquitous in nature and it has an enormous potential to explain community structuring. In this study, we assess the effect of direct and indirect facilitation on community productivity via taxonomic and functional diversity.MethodsIn an alpine community on the Tibetan Plateau, we manipulated the presence of the shrub Dasiphora fruticosa and graminoids in a fenced meadow and a grazed meadow to quantify the effects of direct and indirect facilitation. We measured four plant traits: height, lateral spread, specific leaf area (SLA) and leaf dry matter content (LDMC) of forbs; calculated two metrics of functional diversity [range of trait and community-weighted mean (CWM) of trait]; and assessed the responses of functional diversity to shrub facilitation. We used structural equation modelling to explore how shrubs directly and indirectly drove community productivity via taxonomic diversity and functional diversity.Key ResultsWe found stronger effects from herbivore-mediated indirect facilitation than direct facilitation on productivity and taxonomic diversity, regardless of the presence of graminoids. For functional diversity, the range and CWM of height and SLA, rather than lateral spread and LDMC, generally increased due to direct and indirect facilitation. Moreover, we found that the range of traits played a primary role over taxonomic diversity and CWM of traits in terms of shrub effects on community productivity.ConclusionsOur study reveals that the mechanism of shrub direct and indirect facilitation of community productivity in this alpine community is expanding the realized niche (i.e. expanding range of traits). Our findings indicate that facilitators might increase trait dispersion in the local community, which could alleviate the effect of environmental filters on trait values in harsh environments, thereby contributing to ecosystem functioning.     

Is the subarachnoid administration of mesenchymal stromal cells a useful strategy to treat chronic brain damage?

Background aimsTraumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. Developing effective protocols for the administration of mesenchymal stromal cells (MSCs) is a promising therapeutic strategy to treat TBI. It is important to develop alternatives to direct parenchymal injection at the injury site because direct injection is an expensive and invasive technique. Subarachnoid transplantation, a minimally invasive and low-risk procedure, may be an important and clinically applicable strategy. The aim of this study was to test the therapeutic effect of subarachnoid administration of MSCs on functional outcome 2 months after an experimental TBI in rats.MethodsTwo months after TBI, 30 female Wistar rats were divided into 3 groups (n = 10 in each group): sham, MSC (received 2 × 10⁶ MSCs) and saline (received only saline) groups. Neurological function, brain and spinal cords samples and cerebrospinal fluid were studied.ResultsNo significant differences were found in neurological evaluation and after histological analysis; differences in the expression of neurotrophins were present but were not statistically significant. MSCs survived in the host tissue, and some expressed neural markers.ConclusionsSimilar to direct parenchymal injections, transplanted MSCs survive, migrate to the injury cavity and differentiate into mature neural cell types for at least 6 months after engraftment. These results open the possibility that MSC administration through subarachnoid administration may be a treatment for the consequences of TBI. The transplantation technique and cell number should be adjusted to obtain functional outcome and neurotrophin production differences.     

Metabolites of 2,4-Dichloro-l-nitrobenzene by Mucor javanicus

Metabolism of 2,4-dichloro-l -nitrobenzene (1) by Mucor javnicus AHU 6010 was investigated. In addition to the corresponding benzenamine derivative (2), two novel metabolites detected gas-chromatographically were extracted from the culture medium and isolated. The structures were unequivocally elucidated to be 4-chloro-2-methylthio-l-nitrobenzene (3) and 4-chloro-2-methyl-thiobenzenamine (4), respectively, by direct comparisons with authentic compounds. It was suggested that two biological reactions, namely, reduction of the nitro group and/or substitution of the ortho-chlorine atom by a methylthio group, were responsible for the formation of these metabolites.     

Vocalizations and courtship displays of the Bittern Botaurus stellaris

Capsule We report on the courtship behaviour of the Eurasian Bittern from direct observation in rice fields.     

Response of Forest Trees to Increased Atmospheric CO 2

The CO ₂ fertilization hypothesis stipulates that rising atmospheric CO ₂ has a positive effect on tree growth due to increasing availability of carbon. The objective of this paper is to compare the recent literature related to both field CO ₂ -enriched experiments with trees and empirical dendrochronological studies detecting CO ₂ fertilization effects in tree-rings. This will allow evaluation of tree growth responses to atmospheric CO ₂ enrichment by combining evidence from both ecophysiology and tree-ring research. Based on considerable experimental evidence of direct CO ₂ fertilization effect (increased photosynthesis, water use efficiency, and above- and belowground biomass), and predications from the interactions of enriched CO ₂ with temperature, nitrogen and drought, we propose that warm, moderately drought-stressed ecosystems with an ample nitrogen supply might be the most CO ₂ responsive ecosystems. Empirical tree-ring studies took the following three viewpoints on detecting CO ₂ fertilization effect in tree-rings: 1) finding evidence of CO ₂ fertilization effect in tree-rings, 2) attributing growth enhancement to favorable climate rather than atmospheric CO ₂ enrichment, and 3) considering that tree growth enhancement might be caused by synergistic effects of several factors such as favorable climate change, CO ₂ fertilization, and anthropogenic atmospheric deposition (e.g., nitrogen). At temperature-limiting sites such as high elevations, nonfindings of CO ₂ fertilization evidence could be ascribed to the following possibilities: 1) cold temperatures, a short season of cambial division, and nitrogen deficiency that preclude a direct CO ₂ response, 2) old trees past half of their maximum life expectancy and consequently only a small increase in biomass increment due to CO ₂ fertilization effect might be diminished, 3) the elimination of age/size-related trends by statistical detrending of tree-ring series that might remove some long-term CO ₂ -related trends in tree-rings, and 4) carbon partitioning and growth within a plant that is species-specific. Our review supports the atmospheric CO ₂ fertilization effect hypothesis, at least in trees growing in semi-arid or arid conditions because the drought-stressed trees could benefit from increased water use efficiency to enhance growth.     

Design,synthesis, and in vitro anti-hepatocellular carcinoma of novel thymine thioglycoside analogs as new antimetabolic agents

A first reported direct method for preparation of thymine thioglycoside analogs utilizing novel pyrimidine-2(1H)-thiones and α-bromoglucose or α-bromogalactose tetraacetate as starting components is described. The synthetic potential of the method is demonstrated. The evaluation of antiproliferative activity against HepG-2 cell lines (Liver carcinoma cell lines) shows that most of the compounds have high antitumor activities especially 6b, 6e, 11b, and 12b. Moreover, molecular modelings of these compounds reveal that they have high binding affinity through hydrogen bond interaction with the binding pocket of thymidylate synthase dihydrofolate reductase (TS-DHFR).