目的 分析ITP患者血清中IgG型抗体糖基化的特异性,初步探讨其特异性与临床症状的相关性。方法 选取健康献血员30例、ITP患者13例及健康怀孕妇女23例,纯化血清中的IgG型抗体,应用nano-LC-MS法分析糖基化种类及水平,对比分析ITP患者血清中IgG型抗体的糖基化特异性。结果 ① ITP 患者血清中IgG型抗体的半乳糖糖基化水平为47.08±2.69,低于健康怀孕妇女(50.93±2.21),高于健康献血员(42.88±2.00)(P<0.05);② ITP 患者岩藻糖基化水平为81.16±2.49低于健康献血员(82.60±2.56)(P>0.05),同时低于健康怀孕妇女(86.17±2.23)(P<0.05);③ITP 患者唾液酸化水平为3.93±1.20,高于健康献血员(3.69±1.19),低于健康怀孕妇女(4.28±0.88)(P>0.05)。④ITP 患者乙酰葡糖氨基化水平为10.53±1.41,低于健康献血员(11.54±1.76),高于健康怀孕妇女(10.13±1.45)(P>0.05)。结论 ITP患者血清中的IgG型抗体的岩藻糖基化、半乳糖糖基化水平的特异性可能是其产生有别于健康怀孕妇女的临床症状的的分子基础。

Objective To investigate the glycosylation specificity of the IgG antibody in ITP. Methods Choose 30 healthy donors, 23 healthy pregnants and 13 ITP patients, purified the IgG antibody from serum, analysied the level of all kinds of glycosylation. Compared with healthy donor and healthy pregnants to find the specificity of the IgG antibody in ITP patients. Results ① The galacosylation of IgG antibody in ITP patients was 47.08±7.24,lower than healthy pregnants (50.93±4.91), higher than healthy donor (42.88±4.01), and the healthy pregnants were higher than healthy donor (P<0.05). ② The fucosylation in ITP patients was 81.16±6.2, lower than healthy donors (82.60±2.56) (P>0.05), higher than healthy pregnants(86.17±2.23)(P<0.05); ③The sialylation in ITP patients was 3.93±1.20, higher than healthy donors (3.69±1.19), lower than healthy pregnants (4.28±0.88)(P>0.05); ④The GlcNAc in ITP patients was 10.53±1.41, lower than healthy donors (11.54±1.76), higher than healthy pregnants (10.13±1.45)(P>0.05). Conclusion The specificity of IgG antibody in ITP patients in galacosylation and fucosylation may be the molecule base of ITP's clinic symptom.

目的 观察养血祛瘀方联合血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)类药物对糖尿病肾病不同分期的疗效。方法 134例糖尿病肾病患者采用随机区组设计方案,以初诊时间(月份)作为配伍因素,随机分为治疗组67例和对照组67例,两组均采用常规西医综合基础治疗,对照组给予ACEI或ARB类药物治疗,治疗组在对照组治疗的基础上联用养血祛瘀方治疗,观察60 d,分析两组治疗前后24h尿微量白蛋白、24 h尿蛋白定量、血清C反应蛋白(hs-CRP)的变化。结果 对于糖尿病肾病Ⅲ期患者,治疗组较对照组尿蛋白减少,但差异无统计学意义(P＞0.05),治疗组较对照组hs-CRP水平明显下降(P＜0.05);对于糖尿病肾病Ⅳ期患者,治疗组较对照组尿蛋白减少(P＜0.05),治疗组较对照组hs-CRP水平下降(P＜0.05)。结论 养血祛瘀方联合ACEI或ARB类药物可有效减少糖尿病肾病Ⅳ期患者蛋白尿,降低糖尿病肾病患者hs-CRP水平。

Objective To investigate the efficacy of Yang Xue Qu Yu Fang combined with ARB/ACEI on different stages of diabetic nephropathy. Mehtods 134 patients who suffered from diabetic nephropathy were randomly divided into observation group and control group, each of them had 67 cases. The experiment use randomized block design and choose the time (months) of initial diagnosis as the compatibility factors. Both groups were treated by conventional therapy. The control group was given medicine of ARB/ACEI while the observation group was added Yang Xue Qu Yu Fang on the basis of control group. We observed all the patients for 60 days, to compare the microalbuminuria in urine of 24h, the urinary protein of 24h and the serum high sensitive C-reaction protein (Hs-CRP) between two groups before and after treatment. Results For patients of the 3rd stage of diabetic nephropathy, the albuminuria in observation group decreased obviously, but there was no significant difference between two groups (P>0.05), the serum Hs-CRP in observation group decreased obviously (P<0.05). For patients of the 4rd stage of diabetic nephropathy, the albuminuria in observation group decreased obviously (P<0.05), the serum Hs-CRP in observation group decreased obviously (P<0.05). Conclusion The Yang Xue Qu Yu Fang combined with ARB/ACEI can effectively reduce the albuminuria and can obviously lower the Hs-CRP level in the patients of the 4rd stage of diabetic nephropathy.

目的 探讨不同年份CLSI文件中头孢吡肟折点变化对肠杆菌科细菌药敏结果的影响,辅助临床合理调整用药。方法 应用2013年(S23)与2014年(S24)CLSI文件中的头孢吡肟折点回顾性分析我院2014年肠杆菌科细菌的药敏变化情况。结果 与S23折点相比,肠杆菌科细菌中大肠埃希菌、肺炎克雷伯菌对头孢吡肟的耐药率分别上升了2.6%、2.8%,耐药率差异有统计学意义(P<0.05);产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌以及非产ESBLs肺炎克雷伯菌对头孢吡肟的耐药率分别上升了3.8%、2.4%、2.0%,耐药率差异有统计学意义(P<0.05); 对于其它肠杆菌科细菌如非产ESBLs大肠埃希菌、阴沟肠杆菌等对头孢吡肟的耐药率变化无差异(P>0.05)。与S23相比,在S24中头孢吡肟MIC值分布在4 μg/mL、8 μg/mL、16 μg/mL时对细菌的药敏变化最为显著。结论 依照S24折点,肠杆菌科细菌对头孢吡肟的耐药率有不同程度的升高;尤其对产ESBLs菌株耐药率影响更大;临床应结合实验室报告合理调整用药。

Objective To investigate the change of the break point of the CLSI in different years on the drug sensitivity of Enterobacteriaceae bacteria. This is valuable for rational use of antibiotics. Methods To retrospective analyze 2014 Enterobacteriaceae bacteria susceptibility variation by CLSI file cefepime breakpoint of 2013(S23) and 2014(S24). Results Compared with breakpoint of S23, E. coli and Klebsiella pneumonia, cefepime resistant rate rose by 2.6% and 2.8% respectively, and the resistance difference was statistically significant (P<0.05); ESBLs-producing E. coli, ESBLs-producing Klebsiella pneumoniae and ESBLs non-producing Klebsiella pneumoniae toword cefepime resistant rate rose by 3.8%, 2.4% and 2.0% respectively, and the resistance difference was statistically significant (P<0.05); For other Enterobacteriaceae bacteria, such as ESBLs non-producing E. coli and Enterobacter cloacae with cefepime in drug resistance rate had no significant difference (P>0.05). Compared with S23, variety in drug susceptibility of bacteria was most significant in S24, during cefepime MIC of 4 μg/mL, 8 μg/mL, 16 μg/mL. Conclusion According to the S24 breakpoint, the drug resistance rates of the bacteria in the intestines of the bacteria is increasing, especially in ESBLs strain; antibiotics use should be following laboratory results.

目的 统计分析2011—2014年我院分离的肠杆菌科细菌数据,探讨耐碳青霉烯肠杆菌科细菌(CRE)的流行特征。方法 收集肠杆菌科细菌,根据药敏结果筛选出CRE菌株,并对相关临床资料进行统计分析。结果 共分离得到CRE菌株187株,标本来源依次为尿液(32.6%)、痰液(28.9%)和血液(10.7%)。从科室分布来看,39.0%的菌株来自重症监护室病区,23.0%的菌株来自泌尿外科病区,在其它病区呈散发分布。菌株的种属分布方面,肺炎克雷伯菌的比例为39.6%, 大肠埃希菌的比例为20.9%;从病人年龄构成来看,50岁以上高龄患者的分离比例达74.4%。CRE的分离数目随年份的递增而不断升高。结论 耐碳青霉烯肠杆菌科细菌的流行率呈现逐年递增的趋势,临床应合理使用相关抗生素,预防和控制CRE在医院环境中的流行。

Objective To investigate the epidemiological features of carbapenem resistant Enterobacteriaceae in a collection of clinical Enterobacteriaceae strains isolated during 2011-2014 from our hospital. Methods The Enterobacteriaceae strains were collected and CRE strains were screened by their resistance to carbapenems. Clinical information was analyzed to characterize the epidemiological traits of CRE strains. Results The total number of CRE isolates was 187. These CRE strains were isolated from various clinical specimens, including urine(32.6%), sputum (28.9%), blood (10.7%), and so on. These strains were frequently isolated from intensive care units (ICU) (39.0%) and department of Urology (23.0%). The most frequently isolated species were Klebsiella pneumoniae (39.6%), Escherichia coli (20.9%). The isolation rate is much higher in elderly patients more than 50 years old (74.4%). The percentage of CRE isolates were kept on increasing by years. Conclusion The prevalence carbapenem resistant Enterobacteriaceae in our hospital is increasing every year and it is important to prevent and control the transmission and outbreaks of CRE in the hospital by proper use of related antibiotics in clinical treatment.

目的 探讨小脑延髓池注射纳洛酮对心肺复苏大鼠脑神经保护的作用机制。方法 将30只雄性SD大鼠随机分为假手术组、常规复苏组和纳洛酮复苏组。采用窒息法建立大鼠心脏骤停模型,复苏的同时给予药物治疗。恢复自主循环(ROSC)后24 h取脑组织,荧光定量PCR法检测脑组织c-Fos mRNA表达水平,免疫组化法检测脑组织c-Fos蛋白的表达。结果 与常规复苏组比较,纳洛酮可显著降低大鼠脑组织c-Fos mRNA及蛋白表达量(P<0.01)。结论 小脑延髓池注射纳洛酮可及时有效的作用于c-Fos基因,发挥脑神经保护作用。

Objective To investigate the neuroprotective mechanism of naloxone injected into cisterna magna on cerebral ischemia-reperfusion. Methods Thirty adult male SD rats were randomly divided into sham group, conventional cardiopulmonary resuscitation (CPR) group and naloxone CPR group. Asphyxiation was used to set up rat cardiac arrest model, and corresponding drugs were given when the resuscitation was carried out. The Brain tissues were taken at 24 h after restoration of spontaneous circulation(ROSC). Fluorescence quantitative polymerase chain reaction (PCR) and immunohistochemical was used to detect the expression of c-Fos proteins was used to detect the expression of c-Fos mRNA level. Results Compared with the conventional CPR group, Naloxone could significantly decrease the expression of c-Fos protein and c-Fos mRNA in rat brain. Conclusion Naloxone injected into cisterna magna can promptly and effectively act on c-Fos gene, playing a neuroprotective role.

大数据时代的到来,给各行各业及整个社会文化带来了深刻变革。医学图书馆经受这一领域洗礼时,其数据处理方法和用户服务模式会发生显著变化,也对馆员素质提出了新的要求。文章就大数据时代医学图书馆馆员素质教育提出了几点建议。

目的 了解2014年广州地区儿童专科医院的病原菌分布及耐药情况与全国细菌耐药监测网(CARSS)公布数据的异同点,并提出相关用药建议,为儿童临床合理应用抗生素提供科学依据。方法 将2014年本中心儿童院区检测的儿童细菌耐药数据与同期国家卫生计生委合理用药专家委员颁布的CARSS数据进行比较。结果 儿童医院与CARSS数据比较,革兰阳性菌比例较高(49.8% vs 28.5%),革兰阴性菌比例较低(50.2% vs 71.5%);肺炎链球菌、化脓性链球菌及流感嗜血杆菌检出率较高;耐药率明显升高的是肺炎链球菌对青霉素耐药率(33.2% vs 4.3％),耐药率明显降低的是鲍曼不动杆菌对碳青霉烯类耐药率(10.3% vs 57.0％),大肠埃希菌对喹诺酮类耐药率(27.6% vs 54.3％)。结论 广州地区儿童病原菌分布及耐药情况与CARSS数据比较有一定差异,特别是儿童主要致病菌肺炎链球菌对青霉素耐药的形势严峻,经验性抗感染治疗时需考虑本地及儿童的病原菌特殊性。

目的 探究自我管理干预对慢性阻塞性肺疾病(COPD) 稳定期患者的临床疗效影响。方法 选取2013年6月—2014年6月我院诊断的COPD稳定期患者90例,随机分为对照组(45例)和观察组(45例)。对照组只给予常规治疗,观察组在常规治疗基础上给予自我管理干预,包括健康教育和康复训练,之后通过比较两组患者肺功能、6MWD、生活质量问卷(SGRQ)评分、急性发病频率、依从性等方面的变化来探讨自我管理干预对COPD治疗的临床意义。结果 观察组患者肺功能和6MWD较对照组有改善,观察组的SGRQ得分、急性加重频率显著低于对照组,而其依从性比例明显高于对照组,两组间差异在统计学上均有意义(P<0.05)。结论 加强COPD稳定期自我管理干预能够改善COPD的预后,值得在临床上进行应用。

目的 分析个体化营养指导对双胎妊娠的结局影响。方法 将2014年2月—2015年12月在新疆喀什疏附县人民医院分娩的80例双胎妊娠,接受过个体化营养指导的42例为治疗组;未能或不自愿接受个体化营养指导的38例为对照组,观察比较对照组和治疗组的妊娠结局。结果 治疗组妊娠期糖尿病(GDM)、贫血、妊娠期高血压疾病、产后出血、新生儿窒息、低出生体重儿发生率小于对照组差异有统计学意义(P<0.05)。结论 利用个体化营养指导双胎妊娠孕妇饮食,可以减少并发症,取得理想的妊娠结局。

目的 观察并分析小儿肝门静脉海绵样变性者核因子-κB(NF-κB)活性在手术前后的变化。方法 以2005年2月—2013年7月我院收治的43例小儿肝门静脉海绵变性者为研究对象,以40例正常儿童为对照组,检测对照组以及观察组儿童在手术前后血清单个核细胞(PBMC)中的NF-κB p65/Lamin B1的相对含量和NF-κB活性。结果 观察组术前、术后PBMC中NF-κB p65的相对含量分别为(1269.3±349.8)ng/mg、(884.5±154.8)ng/mg,均高于正常对照组(106.1±12.7)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05);观察组术前、术后PBMC中NF-κB的活性分别为(2194.5±471.3)ng/mg、(1376.9±203.7)ng/mg,均高于正常对照组(221.1±33.6)ng/mg(P＜0.05);与术前相比,术后相对含量降低(P＜0.05)。结论 经手术治疗后,小儿肝门静脉海绵样变性者PBMC中NF-κB p65的相对含量、NF-κB的活性均显著降低,表明手术在一定程度上有效缓解了肝门静脉高压的病症。