β-CTX、t-P1NP及N-MID-OT在绝经后女性骨质疏松性骨折风险评估中的应用

目的探讨β胶原特殊序列(β-crosslaps,β-CTX)、总1型胶原氨基端延长肽(t-P1NP)及N端中段骨钙素(N-MID-OT)在绝经后女性骨质疏松性骨折风险评估中的应用价值。方法回顾性分析2020年2月至2022年12月解放军总医院第六医学中心收治的102例绝经后骨质疏松(postmenopausal osteoporosis,PMOP)患者的临床资料,将其作为研究组,并根据是否发生骨折将其分为PMOP骨折组(39例)与PMOP未骨折组(63例),另选100名健康体检者作为对照组。记录所有研究对象的β-CTX、t-P1NP及N-MID-OT水平并进行比较,用ROC曲线评价β-CTX、t-P1NP及N-MID-OT在绝经后女性骨质疏松性骨折风险评估中的应用价值。结果研究组的平均体重、体质量指数、股骨颈骨密度(bone mineral density,BMD)、左髋总和BMD及L 1~4总和BMD均明显低于对照组(P<0.05);而两组研究对象的平均年龄、平均身高及绝经年龄等比较差异均无统计学意义(P>0.05)。研究组的β-CTX、t-P1NP及N-MID-OT均明显高于对照组(t值依次为12.688、37.430、26.599,P<0.05)。β-CTX+t-P1NP+N-MID-OT联合检测用于预测PMOP的AUC值为0.978,敏感度为98.04%,特异度为97.00%,表明β-CTX+t-P1NP+N-MID-OT三指标联合检测用于预测PMOP的效能更高。PMOP骨折组的β-CTX、t-P1NP及N-MID-OT均明显高于PMOP未骨折组(t值依次为6.078、16.363、12.227,P<0.05)。β-CTX+t-P1NP+N-MID-OT联合检测用于评估PMOP骨折风险的AUC值为0.939,敏感度为94.87%,特异度为95.24%,表明β-CTX+t-P1NP+N-MID-OT联合检测用于评估PMOP骨折风险的效能更高。结论PMOP患者β-CTX、t-P1NP及N-MID-OT水平均明显升高,而PMOP骨折患者β-CTX、t-P1NP及N-MID-OT水平升高更为明显,且β-CTX+t-P1NP+N-MID-OT联合检测可显著提高对PMOP预测及骨折风险评估效能,值得借鉴。

Current Status and Perspectives of Dual-Atom Catalysts Towards Sustainable Energy Utilization

The exploration of sustainable energy utilization requires the imple-mentation of advanced electrochemical devices for efficient energy conversion and storage,which are enabled by the usage of cost-effective,high-performance electro-catalysts.Currently,heterogeneous atomically dispersed catalysts are considered as potential candidates for a wide range of applications.Compared to conventional cata-lysts,atomically dispersed metal atoms in carbon-based catalysts have more unsatu-rated coordination sites,quantum size effect,and strong metal-support interactions,resulting in exceptional catalytic activity.Of these,dual-atomic catalysts(DACs)have attracted extensive attention due to the additional synergistic effect between two adja-cent metal atoms.DACs have the advantages of full active site exposure,high selectiv-ity,theoretical 100%atom utilization,and the ability to break the scaling relationship of adsorption free energy on active sites.In this review,we summarize recent research advancement of DACs,which includes(1)the comprehensive understanding of the synergy between atomic pairs;(2)the synthesis of DACs;(3)characterization meth-ods,especially aberration-corrected scanning transmission electron microscopy and synchrotron spectroscopy;and(4)electrochemical energy-related applications.The last part focuses on great potential for the electrochemical catalysis of energy-related small molecules,such as oxygen reduction reaction,CO_(2) reduction reaction,hydrogen evolution reaction,and N_(2) reduction reaction.The future research challenges and opportunities are also raised in prospective section.

多普勒彩色超声在甲状腺乳头状癌术前T分期和N分期评估中的应用

目的探讨多普勒彩色超声对甲状腺乳头状癌术前T分期和N分期的评估价值,并分析影响分期的主要因素。方法选择经彩超检查确诊的甲状腺乳头状癌150例,以病理证实T分期、N分期为参照,分析彩超检查评价T分期与N分期的准确率。根据T分期不同,分为T_(1)~T_(2)期组、T_(3)~T 4期组;根据N分期不同,分为N_(0)期组、N_(1)期组(N_(1)a、N_(1)b期),收集患者的一般资料,采取单因素与多因素分析T、N分期的影响因素。结果术后病理证实T_(1)期56例,T_(2)期4例,T_(3)期86例,T 4期4例,病理证实N_(0)期70例,N_(1)a期49例,N_(1)b期31例,术前彩超证实T分期同分期一致性高(Kappa值=0.832),术前彩超证实N分期同术后病理分期一致性高(Kappa值=0.897)。经单因素与多因素Logistic回顾分析,年龄、肿瘤直径、病灶类型均是影响甲状腺乳头状癌T、N分期的影响因素。结论多普勒彩色超声用于术前评价甲状腺乳头状癌术前T分期、N分期的准确率高,可为疾病早期治疗提供参考;年龄、肿瘤直径、病灶类型是影响甲状腺乳头状癌T、N分期的主要因素。

Scr、hs-cTnT、NT-proBNP与烧伤患者院内主要心血管不良事件的相关性分析

目的探讨血清肌酐(Scr)、高敏心肌肌钙蛋白T(hs-cTnT)、N末端B型利钠肽原(NT-proBNP)与烧伤患者院内主要心血管不良事件(MACE)的相关性及其预测价值。方法回顾性收集254例烧伤患者作为研究对象。根据住院期间是否发生MACE,分为MACE组(85例)和非MACE组(169例),比较2组临床基线资料和实验室指标水平,采用受试者操作特征(ROC)曲线评价Scr、hs-cTnT、NT-proBNP对烧伤患者院内并发MACE的预测价值。结果与非MACE组相比,MACE组患者年龄、烧伤总面积、Scr、hs-cTnT、NT-proBNP、胱抑素C水平更高(P均<0.05),同时2组性别、高血压病史、脓毒血症、吸烟史比较差异均有统计学意义(P均<0.05)。多因素分析显示,Scr、hs-cTnT、NT-proBNP是烧伤患者院内MACE的独立危险因素(P均<0.05)。ROC曲线分析显示,Scr、hs-cTnT、NT-proBNP及三者联合预测MACE的曲线下面积(AUC)值分别为0.743、0.802、0.733、0.801。DeLong检验显示,三者联合预测MACE的AUC值高于Scr单独预测(Z=2.897,P=0.003);Scr、hs-cTnT、NT-proBNP三者单独预测MACE两两比较差异均无统计学意义(Z值分别为1.398、0.202、1.900,P值分别为0.162、0.840、0.057)。亚组分析显示,hs-cTnT≥0.0145μg/L组烧伤患者MACE发生率高于hs-cTnT<0.0145μg/L组(P<0.05)。Spearman秩相关分析显示,hs-cTnT水平与烧伤严重程度呈正相关(P<0.05)。结论Scr、hs-cTnT、NT-proBNP是烧伤患者院内MACE的独立危险因素且具有良好的预测价值,hs-cTnT水平与烧伤患者严重程度相关。

驱梅汤联合多西环素对梅毒患者免疫炎症反应及外周血单核细胞TLR2、Foxp3 mRNA的影响

目的探讨驱梅汤联合多西环素对梅毒患者免疫炎症反应及外周血单核细胞(PBMCs)Toll样受体2(TLR2)、叉头框蛋白3(Foxp3)mRNA水平的影响。方法选取2016年12月至2020年12月邢台市第二医院收治的107例梅毒患者作为研究对象。采用随机信封法分为常规组(n=53)和实验组(n=54)。常规组采用多西环素治疗,实验组采用多西环素联合驱梅汤治疗。比较两组梅毒滴度快速血浆反应素试验(RPR)转阴率、临床疗效、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、PBMCs TLR2、Foxp3 mRNA相对表达量及不良反应发生情况。结果实验组治疗后3、6个月RPR转阴率高于常规组(P<0.05);实验组总有效率高于常规组(P<0.05);治疗30 d后实验组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于常规组(P<0.05);治疗30 d后实验组PBMCs TLR2、Foxp3 mRNA相对表达量低于常规组(P<0.05);实验组不良反应发生率低于常规组(P<0.05)。结论驱梅汤联合多西环素治疗梅毒患者能提高转阴率,疗效确切,且安全性较高,这可能与抑制PBMCs TLR2、Foxp3 mRNA表达有关。

CT与MRI诊断直肠癌T分期和N分期的价值

目的比较CT与MRI诊断直肠癌T分期和N分期的价值。方法回顾性分析2016年1月至2022年12月医院收治的80例直肠癌患者的临床资料。患者术前均进行CT与MRI检查,分析CT与MRI诊断直肠癌T分期和N分期与手术病理结果的符合率。结果手术病理结果显示,80例患者中,T1、T2、T3、T4期分别为16、36、19、9例,NO、N1、N2期分别为41、28、11例。MRI诊断直肠癌T分期和N分期与手术病理结果的符合率均高于CT,差异均有统计学意义(P<0.05)。结论CT与MRI对直肠癌T分期和N分期均有一定的诊断价值,MRI的诊断结果与手术病理结果的符合率更高。

Clinical outcome and prognostic factors of T4N0M0 colon cancer after R0 resection:A retrospective study

BACKGROUND Paradoxically,patients with T4N0M0(stage II,no lymph node metastasis)colon cancer have a worse prognosis than those with T2N1-2M0(stage III).However,no previous report has addressed this issue.AIM To screen prognostic risk factors for T4N0M0 colon cancer and construct a prognostic nomogram model for these patients.METHODS Two hundred patients with T4N0M0 colon cancer were treated at Tianjin Medical University General Hospital between January 2017 and December 2021,of which 112 patients were assigned to the training cohort,and the remaining 88 patients were assigned to the validation cohort.Differences between the training and validation groups were analyzed.The training cohort was subjected to multi-variate analysis to select prognostic risk factors for T4N0M0 colon cancer,followed by the construction of a nomogram model.RESULTS The 3-year overall survival(OS)rates were 86.2%and 74.4%for the training and validation cohorts,respectively.Enterostomy(P=0.000),T stage(P=0.001),right hemicolon(P=0.025),irregular review(P=0.040),and carbohydrate antigen 199(CA199)(P=0.011)were independent risk factors of OS in patients with T4N0M0 colon cancer.A nomogram model with good concordance and accuracy was constructed.CONCLUSION Enterostomy,T stage,right hemicolon,irregular review,and CA199 were independent risk factors for OS in patients with T4N0M0 colon cancer.The nomogram model exhibited good agreement and accuracy.

Measurement of^(134)Xe(n,2n)^(133m),gXe reaction cross sections in 14‑MeV region with detailed uncertainty quantification

A lead-shielded HPGe detector and offlineγ-ray spectra of the residual product were used to measure the cross section(CS)and ratios of isomeric CS(σm/σg)in^(134)Xe(n,2n)^(133m),gXe reactions at different energies(13.5 MeV,13.8 MeV,14.1 MeV,14.4 MeV,14.8 MeV)relative to the^(93)Nb(n,2n)^(92)mNb reaction CS.The target was high-purity natural Xe gas under high pressure.The T(d,n)4He reaction produces neutrons.TALYS code(version 1.95)for nuclear reactions was used for calculations,with default parameters and nuclear level density models.The uncertainties in the measured CS data were thoroughly analyzed using the covariance analysis method.The results were compared with theoretical values,evaluation data,and previous experimental findings.CS data of the 134Xe(n,2n)133mXe and 134Xe(n,2n)133gXe reactions and the corresponding isomeric CS ratios at 13.5 MeV,13.8 MeV,and 14.1 MeV neutron energies are reported for the first time.This research advances our knowledge of pre-equilibrium emission in the(n,2n)reaction channel by resolving inconsistencies in the Xe data.

接受根治性手术治疗的直肠癌患者临床病理特征对T/N分期的影响分析

目的研究接受根治性手术治疗的直肠癌患者临床病理特征对T/N分期的影响。方法选择2018年1月-2022年8月我院收住的70例直肠癌患者,均接受根治性手术治疗,统计并整理所有患者的临床资料,观察其临床病理特征对T/N分期的影响。结果70例直肠癌患者中,T1期14例,T2期23例,T3期20例,T4期13例;而N0期30例,N1期22例,N2期18例。T1-2期患者的癌结节、分化程度、神经侵犯、淋巴脉管癌栓和T3-4期患者相比差异均有统计学意义(P<0.05)。N0期患者的癌结节、分化程度、神经侵犯、淋巴脉管癌栓、T分期和N1-2期患者相比差异均有统计学意义(P<0.05)。通过Logistic方程分析,发现癌结节、分化程度、神经侵犯、淋巴脉管癌栓均是影响T/N分期的因素。结论影响接受根治性手术的直肠癌患者T/N分期的因素较多,需引起临床重点关注。

Activation of Transition Metal(Fe,Co and Ni)-Oxide Nanoclusters by Nitrogen Defects in Carbon Nanotube for Selective CO_(2) Reduction Reaction

The electrochemical carbon dioxide reduction reaction(CO_(2)RR),which can produce value-added chemical feedstocks,is a proton-coupled-electron process with sluggish kinetics.Thus,highly efficient,cheap catalysts are urgently required.Transition metal oxides such as CoO_(x),FeO_(x),and NiO_(x)are low-cost,low toxicity,and abundant materials for a wide range of electrochemical reactions,but are almost inert for CO_(2)RR.Here,we report for the first time that nitrogen doped carbon nanotubes(N-CNT)have a surprising activation effect on the activity and selectivity of transition metal-oxide(MO_(x)where M=Fe,Ni,and Co)nanoclusters for CO_(2)RR.MO_(x)supported on N-CNT,MO_(x)/N-CNT,achieves a CO yield of 2.6–2.8 mmol cm−2 min−1 at an overpotential of−0.55 V,which is two orders of magnitude higher than MO_(x)supported on acid treated CNTs(MO_(x)/O-CNT)and four times higher than pristine N-CNT.The faraday efficiency for electrochemical CO_(2)-to-CO conversion is as high as 90.3%at overpotential of 0.44 V.Both in-situ XAS measurements and DFT calculations disclose that MO_(x)nanoclusters can be hydrated in CO_(2)saturated KHCO_(3),and the N defects of N-CNT effectively stabilize these metal hydroxyl species under carbon dioxide reduction reaction conditions,which can split the water molecules and provide local protons to inhibit the poisoning of active sites under carbon dioxide reduction reaction conditions.

超声结合血清Tg、TSH水平对分化型甲状腺癌术前T分期和N分期的鉴别

目的探讨超声结合血清甲状腺球蛋白(Tg)、促甲状腺激素(TSH)水平对分化型甲状腺癌(DTC)术前T分期和N分期的鉴别价值。方法回顾性分析商丘市第四人民医院2020年6月至2022年12月收治的经病理学检查确诊的124例DTC患者的临床资料,术前均行超声检查,并检测血清Tg、TSH水平。以术后病理分期为“金标准”,评估超声检查鉴别T、N分期的准确性,比较不同T分期和N分期患者血清Tg、TSH水平;绘制受试者工作特征(ROC)曲线分析超声及血清Tg、TSH单独与联合对DTC患者术前T分期和N分期的鉴别价值。结果以术后病理为依据,超声检查T_(1)期的准确率为85.11%,T_(2)期为77.14%,T_(3)期为60.00%,T_(4)期为58.82%,N_(0)期为86.57%,N_(1)期为68.42%。T_(2)、T_(3)、T_(4)期患者的血清Tg、TSH水平均高于T_(1)期(P<0.05),T_(3)、T_(4)期患者均高于T_(2)期(P<0.05),T_(4)期患者均高于T_(3)期(P<0.05);N_(1)期患者血清Tg、TSH水平高于N_(0)期(P<0.05)。超声联合血清Tg、TSH鉴别DTC患者术前T_(1~2)与T_(3~4)分期的灵敏度、特异度、曲线下面积(AUC)分别为84.15%、97.62%、0.939,鉴别N_(0)与N_(1)分期的灵敏度、特异度、AUC分别为80.60%、96.49%、0.947,且联合鉴别T_(1~2)和T_(3~4)、N_(0)和N_(1)分期的特异度和AUC均高于单独鉴别(P<0.05)。结论超声及血清Tg、TSH均可鉴别DTC患者术前T分期和N分期,但三者联合鉴别价值更佳。

Operationally Simple Enantioselective Silane Reduction of Ketones by the [Ir(OMe)(cod)]2/Azolium Catalytic System

An operationally simple protocol was designed for the enantioselective silane reduction (ESR) of ketones using air- and moisture-stable [Ir(OMe)(cod)]2 (cod = 1,5-cyclooctadiene) (3) as a metal catalyst precursor. This reaction was driven by chiral hydroxyamide-functionalized azolium salt 2. The catalytic ESR reaction could be performed under benchtop conditions at room temperature. Treatment of 2 with 3 in THF yielded the monodentate IrCl(NHC)(cod) (NHC = N-heterocyclic carbene) complex 4 in 93% yield, herein the anionic methoxy ligand of 3 serves as an internal base that deprotonates the azolium ring of 2. The well-defined Ir complex 4 catalyzed the ESR reaction of propiophenone (6) with (EtO)2MeSiH using the pre-mixing reaction procedure. Based on this success, the catalytic ESR reaction was designed and implemented using an in situ-generated NHC/Ir catalyst derived from 2 and 3. Thus, a wide variety of aryl ketones could be reduced to the corresponding optically active alcohols in moderate to excellent stereoselectivities at room temperature without temperature control. Since the high catalytic activity of 3 was observed, we next evaluated several other transition metal catalyst precursors for the catalytic ESR reaction under the influence of 2. This evaluation revealed that Ir(acac)(cod) (acac = acetylacetonate) (28) and [IrCl(cod)]2 (5) can be successfully used as metal catalyst precursors in the ESR reaction.

Microbial synthesis of N, P co-doped carbon supported PtCu catalysts for oxygen reduction reaction

Developing highly efficient and stable platinum-based electrocatalyst for oxygen reduction reaction(ORR) is critical to expediting commercialization of fuel cells.Herein,several PtCu alloy nanocatalysts supported on N,P co-doped carbon(PtCu/NPC) were prepared by microbial-sorption and carbonization-reduction.Among them,PtCu/NPC-700 ℃ exhibits excellent catalytic performance for ORR with a mass activity of 0.895 A mg_(pt)^(-1)(@0.9 V) which is 8.29 folds of commercial Pt/C.Additionally,the ECSA and MA of PtCu/NPC-700℃ only decrease by 14.2% and 18.7% respectively,while Pt/C decreases by 35.2% and 52.8% after 10,000 cycles of ADT test.Moreover,the PtCu/NPC-700℃ catalyst emanates a maximum power density of 715 mW cm^(-2) and only 11.1% loss of maximum power density after 10,000 ADTs in single-cell test,indicating PtCu/NPC-700℃ also manifests higher activity and durability in actual single-cell operation than Pt/C.This research provides an easy and novel strategy for developing highly active and durable Pt-based alloy catalyst.

Pd nanoparticles embedded in N-Enriched MOF-Derived architectures for efficient oxygen reduction reaction in alkaline media

Developing high efficient Pd-based electrocatalysts for oxygen reduction reaction(ORR) is still challenging for alkaline membrane fuel cell,since the strong oxygen adsorption energy and easy agglomerative intrinsic properties. In order to simultaneously solve these problems, Pd/Co_(3)O_(4)–N–C multidimensional materials with porous structures is designed as the ORR catalysts. In details, the ZIF-67 with polyhedral structure was firstly synthesized and then annealed at high-temperature to prepare the N-doped Co_(3)O_(4)carbon-based material, which was used to homogeneously confine Pd nanoparticles and obtained the Pd/Co_(3)O_(4)–N–C series catalysts. The formation of Co–N and C–N bond could provide efficient active sites for ORR. Simultaneously, the strong electronic interaction in the interface between the Pd and N-doped Co_(3)O_(4)could disperse and avoid the agglomeration of Pd nanoparticles and ensure the exposure of active sites, which is crucial to lower the energy barrier toward ORR and substantially enhance the ORR kinetics. Hence, the Pd/Co_(3)O_(4)–N–C nanocompounds exhibited excellent ORR catalytic performance, ideal Pd mass activity, and durability in 0.1 mol L-1KOH solution compared with Co_(3)O_(4)–N–C and Pd/C. The scalable synthesis method, relatively low cost, and excellent electrochemical ORR performance indicated that the obtained Pd/Co_(3)O_(4)–N–C electrocatalyst had the potential for application on fuel cells.

H.I.N.T.S检查法联合ABCD2评分对急性中枢性头晕、眩晕的诊断价值

探讨H.I.N.T.S检查法联合ABCD2评分对急性中枢性头晕/眩晕的诊断价值。方法 选取2022年6月至2023年8月就诊于我院急诊的急性头晕/眩晕患者127例作为研究对象,分别并对其进行H.I.N.T.S检查、ABCD2评分及颅脑影像学检查,对比分析H.I.N.T.S检查法、ABCD2评分以及H.I.N.T.S检查法联合ABCD2评分对急性中枢性头晕/眩晕的诊断效能。结果 H.I.N.T.S检查法联合ABCD2评分的准确率为96.06%,敏感度为91.18%,特异度为97.85%,阳性拟然比为42.39,阴性拟然比为0.09。结论 H.I.N.T.S检查法联合ABCD2评分能有效预测急性中枢性头晕/眩晕,诊断价值较高。

One‑Step Gas-Solid‑Phase Diffusion‑Induced Elemental Reaction for Bandgap‑Tunable Cu_(a)Agm_(1)Bim_(2)I_(n)/CuI Thin Film Solar Cells

Lead-free inorganic copper-silver-bismuth-halide materials have attracted more and more attention due to their environmental friendliness,high element abundance,and low cost.Here,we developed a strategy of one-step gas-solid-phase diffusioninduced reaction to fabricate a series of bandgap-tunable Cu_(a)Agm_(1)Bim_(2)I_(n)/CuI bilayer films due to the atomic diffusion effect for the first time.By designing and regulating the sputtered Cu/Ag/Bi metal film thickness,the bandgap of Cu_(a)Agm_(1)Bim_(2)I_(n)/CuI could be reduced from 2.06 to 1.78 eV.Solar cells with the structure of FTO/TiO_(2)/Cu_(a)Agm_(1)Bim_(2)I_(n)/CuI/carbon were constructed,yielding a champion power conversion efficiency of 2.76%,which is the highest reported for this class of materials owing to the bandgap reduction and the peculiar bilayer structure.The current work provides a practical path for developing the next generation of efficient,stable,and environmentally friendly photovoltaic materials.

Geophysical Reactions to Remote 2022 Tonga Eruption and to Türkiye Earthquakes in Georgia (Caucasus): Hydrogeology, Geomagnetics and Seismicity

The paper is devoted to analysis of hydrogeological, geomagnetic and seismic response to the two great remote geophysical events, 2022 Tonga volcano eruption and 2020-2023 Türkiye earthquakes in Georgia (Caucasus). The geophysical observation system in Georgia, namely, water level stations in the network of deep wells, atmospheric pressure and the geomagnetic sensors of the Dusheti Geophysical Observatory (DGO) as well as seismic data in Garni Observatory (Armenia) respond to the Tonga event by anomalies in the time series. These data show that there are two types of respond: infrasound disturbances in atmospheric pressure and seismic waves in the Earth generated by the eruption. After Tonga eruption January 15 at 04:21 UTC three groups of N-shaped waveforms were registered in the water level corresponding to the global propagation characteristics of the N-shaped waveform of infrasound signals on the barograms generated by eruption at the distance ~15,700 km: they were identified as the Lamb wave, a surface wave package running in the atmosphere with a velocity around ~314 m/s. The paper also presents the WL reactions to three strong EQs that occur in Türkiye 2020-2023, namely Elazığ, Van and Türkiye-Syria EQs. WL in Georgian well network reacts to these events by anomalies of different intensity, which points to the high sensitivity of hydrosphere to remote (several hundred km) strong EQs. The intensity and character of WL reactions depend strongly on the local hydrogeological properties of rocks, surrounding the well.

老年慢性心力衰竭稳定期病人心肺功能、运动耐力特征及NT-proBNP和TNT分析

目的 观察并分析老年慢性心力衰竭(CHF)稳定期病人的心肺功能、运动耐力特征及外周血N末端脑钠肽前体(NT-proBNP)、肌钙蛋白T(TNT)水平。方法 收集2020年10月至2022年10月期间于本院就诊的稳定期CHF病人102例(CHF组),另选同期健康体检人群50例为对照组。检测并比较2组心功能指标、肺功能指标、NT-proBNP水平、TNT水平及6 min步行距离(6MWD)。结果 CHF组中61例(59.80%)发生肺功能损伤,且NYHAⅢ级组肺功能损伤发生率显著高于Ⅰ/Ⅱ级组(69.23%比53.97%,P<0.05)。CHF组的LVEF、FVC、FEV1、FEV1/FVC、肺总量(TLC)、肺一氧化碳弥散量(DLCO)和6MWD显著低于对照组,且NYHAⅢ级组上述指标亦显著低于Ⅰ/Ⅱ级组;CHF组的左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心房内径(LAD)及血NT-proBNP、TNT水平均显著高于对照组,且NYHAⅢ级组上述指标亦显著高于Ⅰ/Ⅱ级组(P<0.01)。Pearson相关分析显示,CHF病人的LVEF、6MWD与FVC、FEV1、FEV1/FVC、TLC、DLCO均呈显著正相关,而LVEDD、LVESD、LAD、NT-proBNP、TNT与FVC、FEV1、FEV1/FVC、TLC及DLCO均呈显著负相关(P<0.05)。结论 老年稳定性CHF病人具有不同程度的心肺功能及运动耐力下降,且随着心功能不全加重,肺功能损伤及运动耐力下降明显加重。

T细胞亚群与应用免疫检查点抑制剂的肿瘤患者产生不良反应的相关性分析

目的观察临床不同癌种患者在接受肿瘤细胞免疫检查点抑制剂治疗前后外周血中T淋巴细胞亚群的变化,探索其与不良反应发生相关性。方法回顾性收集2021年8月~2022年12月于辽宁中医药大学附属医院住院接受ICIs治疗的60例肿瘤患者的临床资料,对比接受ICI治疗前后的CD3^(+)、CD4^(+)、CD8^(+)计数及CD4^(+)/CD8^(+)的变化,分析T细胞亚群变化的影响因素。结果接受ICI治疗后CD3^(+)、CD4^(+)计数较前升高、CD4^(+)/CD8^(+)较前升高,差异具有统计学意义(P<0.05);虽CD8^(+)较前降低,但差异无统计学意义(P>0.05)。结果显示使用中药时间越长,CD4^(+)/CD8^(+)更趋近于正常范围0.7~2.78,同时不良反应出现的几率越低,irAEs分级越低。结论细胞病理免疫分析的T淋巴细胞结果或可作为临床指导预防免疫相关不良反应的指标之一,治疗过程中联合应用中药可显著降低临床不良反应。

金匮肾气丸联用cART对HIV-1感染者的疗效及不良反应分析

获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)的主要治疗方法为联合抗逆转录病毒治疗(combined antiretroviral therapy,cART),但部分患者由于免疫功能重建不全和不良反应,可能出现药物性肝损伤、消化功能下降、神经系统毒性和代谢紊乱等,严重影响了抗病毒疗效和患者生存质量,已成为AIDS治疗领域的瓶颈[1]。部分国家资助的中医药防治AIDS科研课题提出正虚(主要为肾虚)是AIDS发生发展的内在病理基础,以肾气与肾阴肾阳的功能下降为主要特征[2-3]。补肾制剂可能是缓解人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染患者病情和不良反应的可靠方式。金匮肾气丸是由地黄、山药、茯苓、牡丹皮、山茱萸、牛膝、泽泻等多味中药制成的综合制剂[4],具有温补肾阳、化气行水的作用。本研究首次采用金匮肾气丸与cART联用治疗HIV-1感染者,比较了金匮肾气丸与cART联用、单用cART对HIV-1感染者抗病毒疗效和不良反应的差异,试图为探索HIV-1感染者治疗的新途径提供参考。