目的 分析重症流感相关性脑病患儿的临床特点及诊治要点。方法 回顾性分析2017年5月—2020年4月收入我院PICU的17例重症流感相关性脑病患儿的临床资料进行回顾性分析。结果 17例患儿中男性10例、女性7例,起病年龄3(2～5)岁。所有患儿均出现发热,1(0～3.5)天后出现神经系统症状,包括惊厥发作(88%)和昏迷(88%)。头颅影像学检查病变主要分布在丘脑、脑干、髓质脑室周围白质,呈对称性和多灶性改变。经颅多普勒检查出现脑血流速度减慢呈震荡波、钉子波的5例患儿均死亡。16例患儿予机械通气,2例予连续性肾替代治疗,死亡8例,存活者出院前均遗留不同程度神经系统损害。结论 儿童重症流感相关性脑病以发热、惊厥和昏迷为主要表现,头颅影像学及脑电图、经颅多普勒等检查有助于早期诊断和预后判断,早期联合应用甲强龙冲击及IVIG的有效性仍需进一步研究。

Objective To analyze the characteristics, diagnosis and treatment of severe influenza-associated encephalopathy in children. Methods The clinical data of 17 children with severe influenza-associated encephalopathy admitted to PICU from May 2017 to April 2020 were retrospectively analyzed. Results Among the 17 cases, 10 were male and 7 were female, and the onset age was 3 (2-5) years old. All children developed fever, and neurological symptoms 1 (0-3.5) days later, including seizures (88%) and coma (88%). The lesions were mainly distributed in the thalamus, brainstem and medullary ventricular white matter, showing symmetry and multifocal changes. All the 5 cases with slowed cerebral blood flow velocity and presented shock wave or nail wave died. 16 children were on mechanical ventilation, 2 with continuous renal replacement therapy, and 8 died. All the survivors had varying degrees of neurological damage before discharge. Conclusion Severe influenza-associated encephalopathy of childhood is mainly characterized by fever, convulsions and coma. Cranial imaging, EEG, TCD and other examinations are helpful for early diagnosis and prognosis judgment. The effectiveness of early combined application of methylprednisolone and IVIG still needs further study.

目的 探讨不同年龄儿童性早熟的影响因素及预防措施。方法 本文将2020年1月—2021年1月的性早熟儿童45例(观察组)与正常健康儿童45例(对照组)作为研究对象,通过问卷调查的形式了解所选儿童的家庭因素、饮食、生活方式与社会因素等方面的情况,通过单因素分析与多因素分析探讨相关影响因素。结果 观察组不同年龄段儿童在骨龄、身高、体质量、BMI方面存在统计学差异,P＜0.05;观察组性激素水平明显高于对照组,P＜0.05。结论 儿童性早熟的发生与生活习惯、家庭关系、饮食习惯、母亲初潮年龄等因素有关,帮助其养成科学合理的生活习惯与饮食习惯,改善家庭关系可很好的降低并预防儿童性早熟的发生。对于已经出现性早熟现象的儿童来说,学校与家庭要及时给予其合理的健康教育,包括心理方面与生殖健康方面,及时有效的疏导可有效避免性早熟对儿童心理方面造成不良影响。

Objective To explore the influencing factors and preventive measures of precocious puberty in children of different ages. Methods 45 cases of precocious puberty children (observation group) and 45 cases of normal healthy children (control group) from January 2020 to January 2021 were selected as the research objects. The family factors, diets, lifestyles and social factors of the selected children were investigated by questionnaire survey, and the related influencing factors were discussed by single factor analysis and multi factor analysis. Results There were statistical differences in bone age, height, weight and BMI among children of different ages in the observation group, P<0.05. The levels of sex hormones in the observation group were higher than those in the control group, P<0.05. Conclusion The occurrence of children's precocious puberty is related to living habits, family relations, eating habits, mother's menarche ages and other factors. To help them develop scientific and reasonable living habits and dietary habits and improve family relations can reduce and prevent the occurrence of children's precocious puberty. For children with precocious puberty, schools and families should give them proper health education in time, including psychological and reproductive health. Timely and effective counseling can effectively avoid the adverse effects of precocious puberty on children's psychology.

目的 观察紧密连接蛋白在高尿酸血症致大鼠肾损害模型中的表达变化以及非布司他的干预疗效。方法 将SD大鼠分为正常组,高尿酸血症组(模型组),非布司他组(干预组);氧嗪酸联合尿酸诱导制作高尿酸血症大鼠模型,给予非布司他进行干预,分别于6周后检测各组大鼠血中尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)水平,免疫组化及RT-PCR方法检测紧密连接蛋白包括膜周蛋白-1(ZO-1)、跨膜蛋白(occludin) 的表达变化,采用Masson染色检测大鼠肾间质病理改变。结果 6周时,模型组、干预组ZO-1、occludin表达较正常组降低(均P<0.05);干预组ZO-1、occludin表达较模型组增加,差异有统计学意义(均P<0.05),与正常组相比,模型组、干预组RIF指数均增高(均P<0.05),干预组RIF指数低于模型组,高于正常组(均P<0.05)。结论 紧密连接蛋白表达的降低在高尿酸血症肾间质纤维化发展过程中起着举足轻重的作用,并与血尿酸水平及肾功能损害密切相关。非布司他通过降低血尿酸水平,能改善紧密连接蛋白的表达,延缓肾功能损害,起到肾保护作用。

Objective To observe the expression of tight junction protein in hyperuricemia induced renal damage model in rats and the intervention effect of febuxostat. Methods SD rats were randomly divided into three groups: normal control group, model control group, febuxostat treatment group. Hyperuricemia was induced in rats with oxonic acid per time for three times per day, by gavage and combined with uric acid added in drinking water, while febuxostat were administered by gavage in febuxostat treatment group.The blood of rats were collected to analyse the differences of control, model and treatment group on changes of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA). Immunohistochemistry was used to assay ZO-1 and occludin protein expression and quantitive real time PCR to detect the expression of ZO-1 and occludin in renal tissue of renal interstitial fibrosis model rats induced by hyperuricemia. Paraffin section of kidney was maked and then performed Masson staining to make sure the model is successful. Results At 6 weeks, the expressions of ZO-1 and occludin in the model group and treatment group were lower than those in the normal group (all P<0.05). The expressions of ZO-1 and occludin in the treatment group were higher than those in the model group (all P<0.05). Compared with the normal group, the RIF index in the model group and treatment group were higher (all P<0.05), and the RIF index in the treatment group was lower than that in the model group and higher than that in the normal group (all P<0.05). Conclusion The downregulated expression of ZO-1 and occludin plays a crucial role during the development of hyperuricemia in renal interstitial fibrosis, and are closely related to UA level and renal function impairment. Febuxostat may improve the expression of tight junction by downregurating UA, reduce renal fuction impairment and play a role in renal protection.

目的 探讨miR-148a对大鼠急性胰腺炎细胞模型中细胞自噬的影响。方法 选取培养AR42J细胞,细胞分为4组,即正常对照组、模型组、miR-148a mimics组及miR-148a阴性对照组。利用Lipofectamine 2000转染miR-148a mimics及阴性对照miR-148a至AR42J细胞,继续培养48 h后,利用浓度为200 μmol的牛磺胆酸钠盐(TLCs)刺激以上两组及模型组AR42J细胞20 min,正常对照组不做处理,然后提取各组细胞蛋白及RNA。利用RT-qPCR检测各组细胞中miR-148a的表达;利用CCK8实验检测各组细胞的活性;利用ELISA法检测各组细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量;利用Western blot检测自噬相关的基因Beclin1、LC3Ⅰ、 LC3Ⅱ的表达。结果 RT-qPCR结果显示,与正常对照组相比较,模型组心肌细胞中miR-148a mRNA的表达降低,而miR-148a mimics组细胞中miR-148a mRNA的表达显著升高;CCK-8实验结果显示,转染miR-148a mimics至细胞后,可提高模型细胞的活性;ELISA实验结果显示,与模型组相比较,转染miR-148a mimics至细胞后,细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量显著降低;Western blot结果显示,与模型组相比较,转染miR-148a mimics至细胞后,可降低细胞中Beclin1的表达,降低LC3Ⅱ/LC3Ⅰ的比率。结论 利用miR-148a mimics提高TLCs刺激的细胞模型中的miR-148a表达后,细胞中Beclin1的表达降低,LC3Ⅱ/LC3Ⅰ的比率降低,抑制了细胞自噬,降低了炎性因子IL-6、IL-1β、TNF-α的释放,从而提高了细胞的活性,miR-148a可通过调节模型细胞的自噬而发挥细胞保护作用。

Objective To investigate the effect of miR-148a on autophagy in rat acute pancreatitis cell model. Methods AR42J cells were cultured and divided into 4 groups: normal control group, model group, miR-148a mimics group and miR-148a negative control group. miR-148a mimics and miR-148a negative control were transfected to AR42J cells with Lipofectamine 2 000, then cells were cultured for 48 h. The AR42J cells were stimulated with sodium taurocholate (TLCs) at a concentration of 200 μmol for 20 min, the normal control group was not treated, then the protein and RNA were extracted in each group. The expression of miR-148a was detected by RT-qPCR in each group. The activity of cells was detected by CCK8 assay in each group. The contents of IL-6, IL-1β and TNF-α in the cell culture medium were detected by ELISA. Western blot was used to detect the expression of autophagy related genes Beclin1, LC3Ⅰ and LC3Ⅱ. Results RT-qPCR results showed that the expression of miR-148a mRNA in model group was significantly lower than that in normal control group, while the expression of miR-148a mRNA in miR-148a mimics group was significantly higher than that in normal control group. The results of CCK-8 assay showed that miR-148a could significantly increase the activity of model cells stimulated by TLCs. The results of ELISA showed that the contents of IL-6, IL-1β and TNF-α in cell culture medium were significantly decreased after miR-148a mimics transfection, compared with the model group. Western blot showed that miR-148a mimics could significantly decrease the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ, compared with the model group. Conclusion miR-148a mimics was used to enhance the expression of miR-148a in cells model stimulated by TLCs, the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ were decreased, and the autophagy was inhibited. The release of IL-6, IL-1β and TNF-α was decreased and the activity of cells was increased. miR-148a plays a cellular protective role by regulating autophagy in model cells.

前列腺癌作为最常见的男性泌尿系统恶性肿瘤之一,目前常规治疗手段主要为手术、放化疗、内分泌治疗等,但后期并发症、治疗副作用等问题突出,且多转化为去势抵抗性前列腺癌,预后极差。既往研究已然证实,中医药在前列腺癌的治疗中可有效减少复发、减轻症状,提高患者生活质量。本文旨在总结近几年中医药对前列腺癌的研究,为往后的研究与临床治疗提供一些新的思路。

Prostate cancer(PCa) is one of the most common male urinary system malignancies.At present,conventional treatment methods are mainly surgery, radiotherapy and chemotherapy, endocrine therapy,etc.However, late complications, treatment side effects and other problems are prominent, and prostate cancer tends to develop as castration-resistant prostate cancer (CRPC), and the prognosis is very poor. Previous studies have confirmed that Chinese medicine can effectively reduce recurrence incidence, relieve symptoms and improve the quality of life of patients in the treatment of prostate cancer. This article summarizes the research of traditional Chinese medicine on prostate cancer in recent years, and provides some new ideas for future research and clinical treatment.

目的 探讨妊娠中晚期服用奥司他韦对罹患甲流孕妇症状及母婴结局的影响。方法 选择2018年1月—2019年12月在某三甲医院进行就诊且罹患甲型H1N1的20名孕妇作为研究组对象;同时随机选择同一孕期在该医院产检和分娩,妊娠期间未患甲流H1N1的80名正常孕妇作为对照组对象。在给予口服奥司他韦后,记录研究对组对象流感症状的缓解时间。在妊娠结束后,记录两组研究对象的母婴结局,并进行比较。结果 两组孕妇的年龄≥30岁(65.0% vs 56.3%)、孕周≥32周(60.0% vs 52.5%)、汉族(100.0% vs 95.0%)、中学及以下(40.0% vs 45.0%)、月收入≥3500元(70.0% vs 65.0%)比较,差异均无统计学意义(P＞0.05)。服药时间＜48 h和服药时间≥48h研究对象的发热缓解时间[(2.9±0.3)d vs(3.4±0.4)d]、肌肉和关节酸痛的缓解时间[(3.3±0.4)d vs(3.8±0.5)d]、流涕的缓解时间[(5.6±0.5)d vs(6.8±0.7)d]、咽痛的缓解时间[(2.7±0.3)d vs(3.4±0.5)d]、咳嗽的缓解时间[(8.1±0.6)d vs(9.6±0.8)d]、体力恢复时间[(7.8±0.9)d vs(9.2±0.7)d]比较,服药时间＜48 h者低于服药时间≥48 h者,差异均有统计学意义(P＜0.05)。两组孕妇的自然流产(5.0% vs 2.5%)、死胎(0.0 vs 1.3%)、胎膜早破(10.5% vs 13.8%)、顺产(79.0%vs 81.8%)、低出生体重(15.8%vs 19.5%)比较,差异均无统计学意义(P＞0.05)。结论 奥司他韦对于缓解善中晚期孕妇的甲型H1N1流感症状和预防甲型H1N1带来的不良母婴结局具有良好作用,具有良好的临床推广意义。

目的 研究鼻内镜下应用低温等离子高选择性翼管神经分支切断治疗变应性鼻炎患者的临床疗效。方法 选取我院2019年1月—2020年12月收治的60例变应性鼻炎患者,随机数字表法分为对照组(30例)和观察组(30例)。对照组行保守治疗,观察组行鼻内镜下低温等离子高选择性翼管神经分支切断术治疗。比较两组治疗前后Lund—Kennedy内镜黏膜形态评分、视觉模拟量表(VAS)评分,分析两组治疗前后炎症细胞因子[血清肿瘤坏死因子-α(TNF-α)、白介素-4(IL-4)、白介素-6(IL-6)]及鼻黏膜功能指标[血管活性常态肠肽(VIP)、鼻腔阻力(NR)、鼻黏膜纤毛传输时间(MTT)、鼻黏膜纤毛输送率(MTR)]变化情况。结果 两组治疗后VAS评分、Lund—Kennedy评分较治疗前降低(P＜0.05);观察组治疗后VAS评分、Lund—Kennedy评分低于对照组(P＜0.05)。两组治疗后TNF-α、IL-4、IL-6水平较治疗前降低(P＜0.05);观察组治疗后TNF-α、IL-4、IL-6水平低于对照组(P＜0.05)。两组治疗后VIP、NR、MTT水平较治疗前降低(P＜0.05),MTR水平较治疗前升高(P＜0.05);观察组治疗后VIP、NR、MTT水平低于对照组(P＜0.05),MTR水平高于对照组(P＜0.05)。结论 鼻内镜下应用低温等离子高选择性翼管神经分支切断术治疗变应性鼻炎疗效显著,可改善鼻腔黏膜功能,减轻炎症反应,值得推广。

目的 观察牙周基础治疗联合口腔正畸对牙周炎患者炎症细胞因子的疗效分析。方法 以2017年4月—2018年5月于我院医院进行治疗的82例牙周炎患者为研究对象,按随机数字表法分为研究组(41例,给予牙周基础治疗联合口腔正畸)和对照组(41例,口腔正畸)。观察两组患者治疗后临床疗效,对比治疗前后两组患者牙周指数情况、血清炎症因子及咀嚼功能。结果 治疗1周后,研究组有效率高于对照组(97.56% vs 82.93%),组间比较(P<0.05)。治疗前,两组SBI、PLI、GI比较(P＞0.05);治疗1周后,两组SBI、PLI、GI均低于治疗前,与对照组SBI、PLI、GI比较,研究组降低,组间比较(P<0.05)。治疗前,两组AL、PD比较(P＞0.05);治疗1周后,两组AL、PD均低于治疗前,与对照组AL、PD比较,研究组降低,组间比较(P<0.05)。治疗前,两组TNF-α、IL-8及IL-6水平比较(P＞0.05);治疗1周后,两组TNF-α、IL-8及IL-6水平均低于治疗前,与对照组TNF-α、IL-8及IL-6水平比较,研究组下降明显,组间比较(P<0.05)。治疗前,研究组及对照组的咀嚼功能分别为(51±2)分、(52±2)分,两组比较(P＞0.05);治疗后1周,研究组及对照组的咀嚼功能分别为(85±4)分、(73±3)分,研究组咀嚼功能明显高于对照组,组间比较(P<0.05)。结论 牙周基础治疗联合口腔正畸治疗牙周炎患者效果确切,可降低炎症反应,值得临床推广应用。

目的 研究探讨体质指数和体脂百分比与老年类风湿关节炎患者发生肌少症的相关性。方法 纳入2018 年1月— 2020 年 6 月我院治疗的230例RA患者以及110例正常体检人员,分别设为研究组与对照组。采用双能X线骨密度仪测定骨骼肌肉量,四肢骨骼肌总量,体脂百分比(PBF),计算骨骼肌质量指数(SMI),体质指数(BMI);根据SMI水平将RA患者分为有、无肌少症组,比较两间组指标差异,采用Logistics回归分析探讨RA患者合并肌少症的独立影响因素。结果 ①RA组患者肌少症发生率高于对照组(49.1％ vs 18.2％,χ²=29.927,P＜0.001)。RA组患者消瘦百分比高于对照组(20.9％ vs 8％,χ²=5.375,P=0.020), RA组与正常对照组间BMI分组构成比比较差异有统计学意义(χ²=8.157,P=0.043)。②RA组BMI、骨骼肌量及四肢骨骼肌量均低于对照组,差异有统计学意义(P＜0.05),体脂百分比高于对照组,差异有统计学意义(P＜0.05)。③RA消瘦组肌少症发生率高于正常组(χ²=10.716,P＜0.001)、超重组(χ²=28.073,P＜0.001)和肥胖组(χ²=11.601,P＜0.001);RA消瘦组、正常组、超重组、肥胖组间肌少症发生率差异有统计学意义(χ²=32.522,P＜0.001)。PBF分组肌少症发生率正常组高于超重组,差异无统计学意义(χ²=2.609,P=0.016)。④RA肌少症组BMI消瘦百分比高于无肌少症组(22.1％ vs 3.4％,χ²=40.593,P＜0.001),BMI正常百分比高于无肌少症组(60.1％vs 51.3％,χ²=1.843,P=0.175);BMI超重百分比低于无肌少症组(15.0％ vs 39.3％,χ²=33.895,P＜0.001), BMI肥胖百分比低于无肌少症组(2.6％ vs 6.0％,χ²=1.531,P=0.216)。两组间PBF构成比比较差异无统计学意义(χ²=2.609,P=0.106)。⑤RA消瘦组患者肌少症的发生风险高于正常组(OR=7.197,95％CI:3.103～23.614,P＜0.001),超重RA患者肌少症的发生风险低于正常组(OR=0.095,95％CI:0.036～0.268,P=0.026),年龄为RA患者发生肌少症的危险因素(OR=1.096,95％CI:1.015～1.390,P＜0.001)。结论 肌少症在老年RA患者中发病率高,与体质指数具有一定相关性。

目的 利用高精确的外照射治疗技术,即图像引导放射治疗/容积旋转调强放疗(IGRT/VMAT) 时,使用千伏锥形束CT (kV-CBCT)定位来获得最佳的宫颈癌治疗获益。方法 205例接受IGRT/VMAT治疗的宫颈癌患者纳入实验组。每周做一次kV-CBCT定位后,将这些图像与计划CT扫描图像匹配后记录摆位误差。总共研究了1 025个kV-CBCT图像。采取同时期常规X片定位的90例宫颈癌患者作为对照组。根据定位中的摆位误差计算计划靶区(PTV)的边界。结果 实验组前后、上下和左右方向的摆位误差分别为(1.8±1.1)mm、(2.8±2.2)mm和(1.7±1.4)mm,对照组分别为(2.8±2.1)mm、(3.9±2.2)mm和(2.7±2.4)mm,两组差异具有统计学意义(P<0.05)。实验组前后、上下和左右方向的CTV-PTV边界分别为5.27 mm、8.54 mm和5.23 mm,对照组分别为8.47 mm、11.29 mm和8.43 mm。结论 在采用高精度技术治疗宫颈癌时,每周kV-CBCT是一种令人满意的精确定位方法,有助于减少CTV-PTV边界。

Objective To obtain the best cervical cancer treatment benefit through kilovoltage cone-beam CT (kV-CBCT) positioning, by using high-precision external beam therapy technology, that is, image-guided radiation therapy/volumetric modulated arc therapy (IGRT/VMAT). Methods Two hundred and five patients with cervical cancer treated with IGRT/VMAT were included in the experimental group. After kV-CBCT positioning once a week, these images were matched with the planned CT scan images and the setup errors were recorded. A total of 1 025 kV-CBCT images were studied. Ninety patients with cervical cancer positioned by conventional X-ray during the same period were selected as the control group. The boundary of the planned target volume (PTV) was calculated based on the setup errors. Results In the experimental group, the setup errors in the anteroposterior, superoinferior and mediolateral direction were (1.8±1.1) mm, (2.8±2.2) mm, and (1.7±1.4) mm, respectively. And in the control group, the setup errors were (2.8±2.1) mm, (3.9±2.2) mm, and (2.7±2.4) mm, respectively. The differences between the two groups were statistically significant (P<0.05). In the experimental group, the CTV-PTV boundaries in the anteroposterior, superoinferior and mediolateral direction were 5.27 mm, 8.54 mm, and 5.23 mm, respectively. And in the control group, the CTV-PTV boundaries were 8.47 mm, 11.29 mm, and 8.43 mm, respectively. Conclusion When using high-precision technology to treat cervical cancer, weekly kV-CBCT is a satisfactory and accurate positioning method, which helps to reduce the CTV-PTV boundary.