北京一起副溶血性弧菌和非O1/O139霍乱弧菌共感染导致急性胃肠炎暴发事件病原检测分析

目的 对一起副溶血性弧菌和非O1/O139霍乱弧菌共感染导致急性胃肠炎暴发事件进行实验室病原学分析。方法 采用实时荧光PCR方法对4个病例肛拭子、12件可疑污染食品和8件环境涂抹的增菌液进行多种腹泻病原检测,将副溶血性弧菌和霍乱弧菌分离培养,并对分离株进行全基因组测序,获取菌株毒力基因和耐药基因,基于核心基因组单核苷酸多态性构建聚类树。结果 4件病例肛拭子增菌液荧光PCR检测副溶血性弧菌结果均为toxRVP+/tdh+/trh-,其中2件肛拭子荧光PCR检测霍乱弧菌结果为阳性。病例肛拭子副溶血性弧菌培养法检出率为100%(4/4),分离株均为toxRVP+/tdh+/trh-,血清型均为O4:KUT;病例肛拭子霍乱弧菌培养法检出率为50%(2/4),均为非O1/O139血清型,其中1分离株为toxR_VC+/ctx-/t3ss+。可疑污染食品副溶血性弧菌培养法检出率为66.67%(8/12),环境涂抹副溶血性弧菌检出率为12.50%(1/8),可疑污染食品和环境副溶血性弧菌分离株均为toxRVP+/tdh-/trh-;可疑污染食品霍乱弧菌检出率为25.00%(3/1...     

Fluid overload and acute kidney injury

Acute kidney injury is commonly encountered in critically ill patients, and is associated with worse outcomes. Fluid therapy is a key component in the management of these patients, often leading to fluid overload, especially in the setting of septic acute kidney injury. Emerging data overwhelmingly suggest that fluid overload in these patients may be associated with adverse outcomes. Management of such patients should include a strategy of early guided resuscitation, followed by careful assessment of fluid status, and early initiation of renal replacement therapy as soon as it is deemed safe, aiming for a neutral or negative fluid balance. This review will focus on the pathophysiological link between fluid overload and acute kidney injury, mechanisms of organ dysfunction in fluid overload, and strategies for management.     

γ射线致小鼠血液β-肌动蛋白、凝血和炎性因子改变的观察

通过观察γ射线诱导的小鼠血液β-肌动蛋白(β-actin)、凝血因子和IL-8表达改变的时相关联性,了解β-actin在急性放射损伤中的作用。BALB/C小鼠经60Coγ射线6Gy剂量照射(剂量率0.81Gy/min),收集照后立即及照后第1、2、3、4、7和14d小鼠外周血及脾脏。磁珠分离酶联免疫法检测外周血β-actin含量;STAGO血液凝集仪检测凝血酶原时间(PT)、活化部分凝血酶时间(APTT)和血浆纤维蛋白原(FIB)三项凝血指标;Realtime-PCR检测白细胞介素8(IL-8)DNA表达。结果发现,小鼠经6Gy辐照后血浆β-actin立即升高,并于照后1d达峰值,随后直至照后第4d快速下降,照后4―14d下降速度趋缓,但血浆β-actin量仍显著高于对照。照后不同时间PT、APTT、FIB和IL-8的变化趋势与β-actin类似。其中,FIB上升达到峰值及下降的时相过程与β-actin基本一致。从照后第4d起FIB下降直至低于正常对照水平,而PT、APTT和IL-8DNA表达约在照后2―3d升至峰值,然后下降,但PT和APTT值仍高于未照射对照,而IL-8DNA表达则可下降至未照射对照水平。受照小鼠血中凝血指标PT、APTT、FIB,炎性指标IL-8和β-actin均发生相似时相变化。结果提示,辐照后血中β-actin的量和量变的时间动力学过程研究,对于了解电离辐射诱导机体损伤的新病理因素有积极意义。     

针药结合对慢性脑缺血大鼠大脑皮质BDNF、TrkB及VEGF表达的影响

目的: 观察电针联合复方丹参对慢性脑缺血大鼠大脑皮质脑源性神经营养因子(BDNF)、酪氨酸激酶B(TrkB)及血管内皮生长因子(VEGF)表达的影响,探讨针药结合治疗脑缺血的可能机制。方法: 将SD雄性大鼠采用永久性双侧颈总动脉结扎术制备慢性脑缺血模型,将造模成功的32只大鼠随机分为模型组、复方丹参组、电针组、针药结合组,每组8只。复方丹参组给予复方丹参片 0.75 g/kg 灌胃,电针组选取百会、大椎穴给予电针刺激,持续 30 min,针药结合组联合采用复方丹参片灌胃和电针刺激,各组治疗均每天1次,连续5周。另用8只SD雄性大鼠作为正常对照组。采用免疫组织化学方法检测各组大鼠大脑皮质BDNF、TrkB及VEGF的表达。结果: 与正常组比较,模型组大鼠大脑皮质BDNF、TrkB 及VEGF表达明显减弱(P<0.01 或P<0.05);与模型组比较,复方丹参组、电针组、针药结合组大脑皮质BDNF、TrkB 及VEGF表达均明显增强(P<0.01 或P<0.05),并且针药结合组的表达高于复方丹参组和电针组(P<0.01 或P<0.05)。结论: 电针与复方丹参联合疗法对大鼠慢性缺血性脑损伤有保护作用,其机制可能与上调BDNF、TrkB及VEGF的表达有关。     

联合应用间苯三酚与硫酸镁治疗急性胆绞痛的临床研究

目的: 观察联合应用间苯三酚与硫酸镁在治疗急性胆绞痛中的临床疗效以及不良反应情况。方法: 将本院肝胆外科2010年1月至2012年6月收治的300例胆绞痛患者随机分成间苯三酚组(A组)、间苯三酚+硫酸镁组(B组)、山莨菪碱组(C组),每组100例。结果: B组的有效率高于A组和C组(χ²=21.5000,P<0.01);A组有效率高于C组(χ²=6.6528, P<0.01)。B组的平均腹痛缓解时间少于C组(t=4.1067, P<0.01),B组的平均缓解时间与A组相似(t=0.7190,P=0.4730)。B组平均VAS分值低于A组和C组(F=285.6,P<0.01)。C组不良反应发生率高于A、B两组(χ²=115.6116,P<0.01)。A、B组之间不良反应发生率相似(χ²=0.0962,P=0.7564)。结论: 对于急性胆绞痛的治疗,联合使用间苯三酚与硫酸镁在症状改善、起效时间以及药物不良反应等方面明显优于单独使用间苯三酚或山莨菪碱,值得临床推广。     

抗血小板膜P2Y12受体拮抗剂的研究进展

抗血小板药物是治疗急性冠脉综合征的必备用药,其中抗血小板膜P₂Y₁₂受体拮抗剂已成为急性冠脉综合征药物治疗研究中最活跃的一个领域,从基础到临床研究,不断地开发出系列新药。本文就对P₂Y₁₂受体拮抗剂作用机制、药代动力学、急性冠脉综合征临床研究、临床指南等进行分析,为临床合理用药提供参考。     

急性冠脉综合征患者血清高敏C反应蛋白和组织蛋白酶S水平变化与临床意义

目的: 探讨血清高敏C反应蛋白(hs-CRP)、组织蛋白酶S(CatS)与急性冠脉综合征的相关关系。方法: 选择53例急性冠脉综合征患者(ACS组),对照组36例,检测两组血清CatS、hs-CRP水平并进行比较。同时检测ACS组治疗后血清hs-CRP、CatS水平的变化。结果: ACS组在性别、年龄、吸烟、糖尿病、脑梗死、高血压患病率方面与对照组相比,差异无统计学意义(P>0.05);ACS组治疗前血清CatS水平为(0.51±0.03) nmol/L,hs-CRP为(10.21±5.03) mg/L,分别高于对照组的(0.43±0.04) nmol/L 和(3.64±1.87) mg/L,差异具有统计学意义(P<0.05); ACS组治疗后血清CatS、hs-CRP水平分别为(0.45±0.06) nmol/L 和(6.05±3.25) mg/L,较治疗前的(0.51±0.03) nmol/L 和(10.21±5.03) mg/L 明显降低,差异有统计学意义(P<0.05)。结论: ACS患者血清CatS及hs-CRP的水平的变化提示 CatS及hs-CRP可能在ACS发生发展过程中具有重要作用,推测 CatS可能作为ACS的一种新的生物标志物。     

羧胺三唑对角叉菜胶诱导急性炎症的抗炎作用

目的: 探讨羧胺三唑(CAI)对角叉菜胶诱导的大鼠足爪急性炎症的预防作用及部分机制。方法: 采用角叉菜胶诱导大鼠足爪急性炎症模型,测量足爪肿胀度以及足爪组织中髓过氧化物酶(MPO)、NO、前列腺素2(PGE₂)、TNF-α、IL-1β、中性粒细胞趋化因子-1(CNCI-1)和诱导一氧化氮合酶(iNOS)。结果: CAI能明显减轻大鼠足爪炎性肿胀,显著降低炎症足爪中MPO、NO、PGE₂、TNF-α、IL-1β和CNCI-1含量及iNOS蛋白表达。结论: CAI可能通过减少炎症介质和中性粒细胞浸润来发挥对角叉菜胶诱导急性炎症的抗炎作用。     

Genetic selection for hoof health traits and cow mobility scores can accelerate the rate of genetic gain in producer-scored lameness in dairy cows

Cattle breeding programs that strive to reduce the animal-level incidence of lameness are often hindered by the availability of informative phenotypes. As a result, indicator traits of lameness (i.e., hoof health and morphological conformation scores) can be used to improve the accuracy of selection and subsequent genetic gain. Therefore, the objectives of the present study were to estimate the variance components for hoof health traits using various phenotypes collected from a representative sample of Irish dairy cows. Also of interest to the present study was the genetic relationship between both hoof health traits and conformation traits with producer-scored lameness. Producer-recorded lameness events and linear conformation scores from 307,657 and 117,859 Irish dairy cows, respectively, were used. Data on hoof health (i.e., overgrown sole, white line disease, and sole hemorrhage), mobility scores, and body condition scores were also available from a research study on up to 11,282 Irish commercial dairy cows. Linear mixed models were used to quantify variance components for each trait and to estimate genetic correlations among traits. The estimated genetic parameters for hoof health traits in the present study were greater (i.e., heritability range: 0.005 to 0.27) than previously reported in dairy cows. With the exception of analyses that considered hoof health traits in repeatability models, little difference in estimated variance components existed among the various hoof-health phenotypes. Results also suggest that producer-recorded lameness is correlated with both hoof health (i.e., genetic correlation up to 0.48) and cow mobility (i.e., genetic correlation = 0.64). Moreover, cows that genetically tend to have rear feet that appear more parallel when viewed from the rear are also genetically more predisposed to lameness (genetic correlation = 0.39); genetic correlations between lameness and other feet and leg type traits, as well as between lameness and frame type traits, were not different from zero. Results suggest that if the population breeding goal was to reduce lameness incidence, improve hoof health, or improve cow mobility, genetic selection for either of these traits should indirectly benefit the other traits. Results were used to quantify the genetic gains achievable for lameness when alternative phenotypes are available.     

rhG-CSF用于外照射急性放射病治疗的研究现状

重组人粒细胞刺激因子是一种有效的促进造血系统恢复的细胞因子,可用于外照射急性放射病的临床救治。本文介绍重组人粒细胞刺激因子的作用机理、临床应用指征,以及该因子与其他细胞因子联合应用的研究现状;介绍了其用于治疗辐射事故病人的应用情况。