连续性血液净化在肾衰危重病人抢救中的应用及效果评价

目的:探讨连续性血液净化在危重病人抢救中的应用及效果评价.方法:选取2010年1月～2012年11月我院收治的危重病人共26例,均采用连续性静脉-静脉血液滤过方法治疗,比较治疗前后的心脏血流动力学参数、肾功能与电解质的变化,观察全部患者治疗前后的临床症状改善情况及临床转归.结果:治疗前后的心率、中心静脉压、平均动脉压、心指数及心排出量差异均存在统计学意义(P＜0.05);治疗后患者的血尿素氮、肌酐及钾水平均明显低于治疗前(P＜0.05);治疗后患者的低血压、低血氧、昏迷改善率分别为66.67％、71.43％及62.50％;26例患者中死亡14例(53.85％),存活12例(46.15％).结论:连续性血液净化可以积极有效地治疗危重病患者,选择治疗的时候需要针对患者的情况进行综合判断和全面评估.     

Sizeable acquired subglottic cyst in a baby with Williams–Beuren syndrome: Association or coincidence?

We describe a case of an acquired subglottic cyst presented with persistent stridor and voice hoarsening in a baby diagnosed with Williams–Beuren syndrome that was born premature and required intubation during neonatal period. We also comment on whether this is a coincidence or there can be an association between impaired elastogenesis, a feature of patients with the syndrome and the formation of a subglottic cyst.     

Two continuous coupled assays for ornithine-δ-aminotransferase

We have developed two new continuous coupled assays for ornithine-δ-aminotransferase (OAT) that are more sensitive than previous methods, measure activity in real time, and can be carried out in multiwell plates for convenience and high throughput. The first assay is based on the reduction of Δ¹-pyrroline-5-carboxylate (P5C), generated from ornithine by OAT, using human pyrroline 5-carboxylate reductase 1 (PYCR1), which results in the concomitant oxidation of NADH (nicotinamide adenine dinucleotide, reduced form) to NAD⁺ (nicotinamide adenine dinucleotide, oxidized form). This procedure was found to be three times more sensitive than previous methods and is suitable for the study of small molecules as inhibitors or inactivators of OAT or as a method to determine OAT activity in unknown samples. The second method involves the detection of l-glutamate, produced during the regeneration of the cofactor pyridoxal 5’-phosphate (PLP) of OAT by an unamplified modification of the commercially available Amplex Red l-glutamate detection kit (Life Technologies). This assay is recommended for the determination of the substrate activity of small molecules against OAT; measuring the transformation of l-ornithine at high concentrations by this assay is complicated by the fact that it also acts as a substrate for the l-glutamate oxidase (GluOx) reporter enzyme.     

化疗联合冷循环射频消融术治疗原发性肝癌的效果分析

目的：探讨化疗联合冷循环射频消融术治疗原发性肝癌的疗效及安全性。方法：108例原发性肝癌患者随机分为两组,均给予灌注化疗,每4周进行一次灌注化疗,对照组（n=54）进行3次,治疗组（n=54）只进行一次。治疗组给予冷循环射频消融术。评价生活质量Kamofsky评分,治疗前后检查患者的血、尿、便常规,肝肾功能（包括天冬氨酸转氨酶、丙氨酸转氨酶（AVr）、白蛋白（ALB）、总胆红素、肌酐及尿素氮等指标）,甲胎蛋白（AFP）,T细胞亚群和加强肝脏CT扫描。随访1年,经CT确定肝癌复发。结果：治疗组Kamofsky评分有效率为59．26％,对照组Kamofsky评分有效率为37．03％,两组Kamofsky评分有效率相比较,差异有统计学意义（P〈0．05）。两组治疗后症状变化相比较,除腹胀外其余各项指标差异均有统计学意义（P〈O．05）。治疗后两组相比较,ALT和AFP差异有统计学意义（P〈0．05）。治疗后两组T细胞亚群变化相比较,治疗组各项指标均变化显著（P〈0．05）。治疗后随访一年,治疗组复发率为22．22％;对照组复发率为53．70％。两组治疗一年后复发率相比较,差异有统计学意义（P〈0．05）。结论：化疗结合冷循环射频消融术治疗原发性肝癌疗效肯定,并发症及副作用小,复发率低。     

Continuous purification of antibodies from cell culture supernatant with aqueous two-phase systems: From concept to process

An aqueous two-phase extraction (ATPE) process based on a PEG/phosphate system was developed for the capture of human immunoglobulin G and successfully applied to a Chinese hamster ovary and a PER.C6® cell supernatant. A continuous ATPE process incorporating three different steps (extraction, back-extraction, and washing) was set up and validated in a pump mixer-settler battery. Most of the higher molecular weight cell supernatant impurities were removed during the extraction step, while most of the lower molecular weight impurities were removed during the subsequent steps. A global recovery yield of 80% and a final protein purity of more than 99% were obtained for the IgG purification from a CHO cell supernatant, representing a 155-fold reduction in the protein/IgG ratio. For the purification of IgG from a PER.C6® cell supernatant, a global recovery yield of 100%, and a host cell protein purity were attained, representing a 22-fold reduction in the host cell protein/IgG ratio. These results, thus, open promising perspectives for the application of the developed ATPE process as a platform for the capture of antibodies. In fact, this new process has shown the ability to successfully recover and purify different antibodies from distinct cell culture supernatants. This technology can also overcome some of the limitations encountered using the typical chromatographic processes, besides inherent advantages of scalability, process integration, capability of continuous operation, and economic feasibility.     

A preliminary phylogenetic study of late Palaeozoic spiriferoid brachiopods using cladistic and Bayesian approaches

The brachiopod Superfamily Spiriferoidea diversified greatly and was widely distributed in the late Palaeozoic (Carboniferous–Permian), and yet its phylogeny has been seldom investigated with analytical methods. This is reflected in the current flux of very different classification schemes for this superfamily. This paper provides the first attempt to investigate the phylogenetic relationships of spiriferoid brachiopods through both cladistic and Bayesian analyses involving 24 discrete and continuous characters. The continuous characters, from morphometric data, have been separately discretized using the gap weighting method, and the ‘as such’ option in TNT. Our results highlight the potential significance of continuous characters in reconstructing and elucidating phylogenies, as much as qualitative characters. Building on the outcomes of the analyses, we also briefly evaluate existing classification schemes of Spiriferoidea. We found that none of the existing classifications fully reflect the phylogeny properly; major families within the superfamily, such as Spiriferidae, Choristitidae, and Trigonotretidae, turned out to be polyphyletic. Although this study is considered preliminary, due to the selection of and restriction to certain taxa, combined with the use of a relatively small number of characters, it nevertheless demonstrates that potentially the true phylogenetic relationships of spiriferoid taxa sharply contrast with any of the existing classification schemes. This highlights the need to develop an alternative scheme that takes into account a more comprehensive range of phylogenetic variables.     

An integrated practical implementation of continuous aqueous two‐phase systems for the recovery of human IgG: From the microdevice to a multistage bench‐scale mixer‐settler device

Aqueous two‐phase systems (ATPS) are a liquid‐liquid extraction technology with clear process benefits; however, its lack of industrial embracement is still a challenge to overcome. Antibodies are a potential product to be recovered by ATPS in a commercial context. The objective of this work is to present a more integral approach of the different isolated strategies that have arisen in order to enable a practical, generic implementation of ATPS, using human immunoglobulin G (IgG) as experimental model. A microfluidic device is used for ATPS parameters preselection for product recovery. ATPS were continuously operated in a mixer‐settler device in one stage, multistage and multistage with recirculation configuration. Single‐stage pure IgG extraction with a polyethylene glycol (PEG) 3350‐phophates ATPS within continuous operation allowed a 65% recovery. Further implementation of a multistage platform promoted a higher particle partitioning reaching a 90% recovery. The processing of IgG from a cell supernatant culture harvest in a multistage system with top phase recirculation resulted in 78% IgG recovery in bottom phase. This work conjugates three not widely spread methodologies for ATPS: microfluidics, continuous and multistage operation.     

持续性血液滤过联合高流量吸氧治疗重症急性呼吸综合征的疗效及对血清炎症因子水平的影响

目的:探讨持续性血液滤过联合高流量吸氧治疗重症急性呼吸综合征的疗效及对血清炎症因子水平的影响。方法:选择2013年2月至2016年2月我院接诊的60例重症急性呼吸综合征患者,通过随机数表法将其分为观察组(n=30)和对照组(n=30)。观察组采用持续性血液滤过联合高流量吸氧进行治疗,对照组采用持续性血液滤过进行治疗。比较两组临床疗效、治疗前后动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、氧合指数、氢离子浓度指数(pH)值、呼吸频率(RR)、心率(HR)、血清C反应蛋白(CRP)、白介素6(IL-6)、白介素8(IL-8)、肿瘤坏死因子α(TNF-α)水平的变化及不良反应的发生情况。结果:治疗后,观察组有效率为76.67%,显著高于对照组(50.00%,P0.05)。两组治疗后PaO_2、PaCO_2、氧合指数、pH值、RR、HR均较治疗前明显改善,观察组患者PaO_2、氧合指数明显高于对照组,PaCO_2、pH值、RR、HR、血清CRP、IL-6、IL-8及TNF-α水平均显著低于对照组(P0.05)。治疗期间,观察组患者不良反应总发生率(10.00%)显著低于对照组(36.67%,P0.05);观察组死亡1例(3.33%),对照组死亡6例(20.00%),观察组病死率显著低于对照组(P0.05)。结论:持续性血液滤过联合高流量吸氧治疗重症急性呼吸综合征患者的临床疗效及安全性明显优于单用持续性血液滤过治疗,可能与其更有效减轻炎症反应有关。     

脓毒症急性肾损伤患者血液净化时机选择对治疗期间微循环系统的影响研究

目的:探究脓毒症急性肾损伤患者血液净化时机选择对治疗期间微循环系统的影响。方法:选取2016年2月～2017年2月期间来我院治疗的脓毒症急性肾损伤患者200例作为研究对象,依据急性肾损伤的诊断和分级(RIFLE)标准将脓毒症急性肾损伤患者分为1期(A组,n=56)、2期(B组,n=70)、3期(C组,n=74),所有患者皆采取连续性肾脏替代疗法。观察不同时期治疗前后微循环的变化。结果:三组脓毒症急性肾损伤患者在性别、年龄、空腹血糖浓度、急性生理功能和慢性健康状况(APACHE)评分、体温、心率指标上差异无统计学意义(P0.05);治疗后,A组患者微血管流动指数低于B组和C组,而灌注血管比例、灌注血管密度及总血管密度显著高于B组和C组(P0.05);A组患者血液流态积分、襻周状态积分、管襻形态积分及总积分显著低于B组和C组(P0.05),而襻顶血管直径显著大于B组和C组(P0.05)。结论:在RLFLE诊断标准1期对脓毒症急性肾损伤患者实施血液净化,可以明显地改善治疗效果,促进微循环系统的恢复。