成功的老年──近期老年学领域一个新的研究主题

“成功的老年”是近３０年来老年学领域提出的一个新的科学概念和模型．“成功的老年”是相对于“普通的老年”而言的，它不仅仅是寿命的延长，更重要的是通过生理因素和心理社会因素的积极作用，提高年老过程的生命质量。“成功的老年”可通过身心健康、认知功能、社会能力、生活满意度等多项指标来衡量。“成功的老年”在成为老年学领域一个重要的研究方向．

EBV阳性淋巴瘤组织中EBNA1基因多态性研究

EBV与多种人类肿瘤的发生有关，如伯基特淋巴瘤（Burkitt＇s lymphoma，BL）、霍奇金病（Hodgkin＇s disease， HD）、鼻咽癌（nasopharyngeal carcinoma，NPC）以及胃癌等［1］。EBV潜伏感染和细胞转化能力被广泛认为是其致癌的基础，目前已知EBV多种潜伏期基因编码产物可引起细胞转化，其中核抗原家族基因（EBNAs）编码产物中的EBNA1是唯一在所有EBV相关肿瘤中均表达的蛋白，当病毒潜伏感染时，其在基因组的维持、复制和转录过程中发挥重要作用［2］。EBNA1重复序列可通过顺式作用方式抑制抗原递呈细胞对自身的加工处理，使CTL不能识别自身免疫表位从而逃避机体免疫应答［3］。EBNA1由N端（AA 1-89）、甘氨酸和丙氨酸重复序列（AA 90-327）以及C端（AA 328-641）组成，对EBNA1基因变异的分析多集中在C端。Bhatia等［4］和Gutiérrez等［5］根据突变热点AA487的变化及AA466-527之间的变异，将EBNA1基因分为P-ala、P-thr、V-val、V-leu和V-pro 5种亚型。本研究对EBV阳性淋巴瘤组织中EBNA1编码基因多态性进行了检测和分析，旨在探讨EBNA1多态性在EBV阳性淋巴瘤发生中的意义。

网络干预在生命限制性疾病患儿居家姑息照护中应用的范围综述

目的对网络干预在生命限制性疾病患儿居家姑息照护中的应用研究进行范围综述。方法以Arksey和O'Malley的范围综述方法为框架,检索Web of Science、PubMed、CINAHL、Embase、中国知网、万方数据库、维普网、中国生物医学文献数据库中相关研究。检索时限为建库至2022年10月21日,对纳入文献进行分析汇总。结果纳入9篇文献。网络干预的要素包括提供信息和照护技能指导、病情评估与监测、症状管理与决策支持、与专业人员沟通、心理支持。结局指标类型主要为干预可行性、有效性及成本效益。结论网络干预在生命限制性疾病患儿居家姑息照护中的应用具备成本效益和可行性,其有效性需要进一步证实;需要充分结合患儿及其照顾者的需求,制订符合我国国情的本土化网络干预模式,以提供精准、高效、高质量的居家姑息照护服务。

Analysis of TLR4 and TLR2 polymorphisms in inflammatory bowel disease in a Guangxi Zhuang population

AIM: To study the polymorphisms of toll-like receptor 4 (TLR4) gene Asp299Gly, Thr399Ile and TLR2 gene Arg753Gln, Arg677Trp and susceptibility to inflammatory bowel disease (IBD) in the Zhuang population from Guangxi, China. METHODS: A case-control study was performed from February 2007 to October 2011 which included 146 Zhuang patients with IBD in the experimental group and 164 healthy Zhuang subjects who acted as the control group. All patients and healthy subjects were from the Guangxi Zhuang Autonomous Region of China. Genomic DNA was extracted from intestinal tissue by the phenol chloroform method. TLR4 gene Asp299Gly, Thr399Ile and TLR2 gene Arg753Gln, Arg677Trp were amplified by polymerase chain reaction (PCR), and then detected by PCR-restriction fragment length polymorphism (RFLP). RESULTS: The TLR4 gene Asp299Gly was digested using Nco Ⅰ restriction enzyme, and a single band of 249 bp was observed which showed that it was a wild type (AA). The TLR4 gene Thr399Ile was digested using Hinf Ⅰrestriction enzyme and only the wild type (CC) was detected. In addition, the TLR2 gene Arg-677Trp was digested using Aci Ⅰ restriction enzyme and only the wild type (CC) was detected. The TLR2 gene Arg753Gln was digested using Pst Ⅰ restriction enzyme. Only the wild type (GG) as a single band of 254 bp was observed during RFLP. Overall, no heterozygous or homozygous single nucleotide polymorphism mutations were found in patients with Crohn's disease and ulcerative colitis both in the TLR4 gene Asp299Gly, Thr399Ile and the TLR2 gene Arg677Trp, Arg753Gln in the Zhuang population from the Guangxi Zhuang Autonomous Region of China. CONCLUSION: The TLR4 gene Asp299Gly, Thr399Ile and TLR2 gene Arg753Gln, Arg677Trp polymorphisms may not be associated with IBD in the Zhuang population from the Guangxi Zhuang Autonomous Region of China.

紧急肺移植的临床应用进展

肺移植是终末期肺病唯一有效的治疗手段,然而世界范围内供肺紧缺的问题日益突出,许多患者在等待移植的过程中死亡。紧急肺移植是一种根据患者疾病紧急程度进行优先移植的肺源分配策略,其目的是为了减少肺源等待时间和降低肺移植等待者的病死率。然而,目前各国关于紧急肺移植这一术语的定义、标准和应用并不统一,且基于该分配制度的肺移植受者术后生存和净获益也存在较多争议。本文基于既往紧急肺移植的临床研究,对其定义标准、危险因素、生存结果、局限性和优化措施进行详细综述,为综合评估紧急肺移植的可行性并进一步优化肺源分配制度提供理论参考。

肺移植受者术后肺功能的变化特点

目的分析肺移植受者术后肺功能的变化特点。方法收集81例行双肺移植及心肺联合移植受者的临床资料,分析受者术后一般情况。分析肺移植受者术后1个月、3个月、每3个月(术后3~18个月)以及每6个月(术后18~36个月)肺通气及弥散功能指标。分析受者术后的最佳肺功能特点。结果受者术后机械通气时间为4(2,9)d,术后重症监护室入住时间为10(7,20)d。81例受者中,27例术后发生原发性移植物功能障碍(PGD),发生率为33%。受者术后用力肺活量(FVC)占预计值百分比(FVC%pred)、第1秒用力呼气容积(FEV_(1))占预计值百分比(FEV_(1)%pred)、FEV_(1)/FVC占预计值百分比(FEV_(1)/FVC%pred)、校正后肺一氧化碳弥散功能占预计值百分比(DLCOc%pred)随时间发生变化(均为P<0.001)。FVC%pred、FEV_(1)%pred在术后9个月内逐渐上升,DLCOc%pred在术后3个月内逐渐上升(均为P<0.05)。FVC%pred≥80%者36例,FEV_(1)%pred≥80%者41例,FEV_(1)/FVC%pred≥92%者76例;FVC%pred≤40%者1例,FEV_(1)%pred≤40%者1例。DLCOc%pred≥80%者16例,校正后肺一氧化碳弥散功能/肺泡容量占预计值百分比(DLCOc/VA%pred)≥80%者63例;DLCOc%pred≤40%者4例,DLCOc/VA%pred≤40%者1例。原发病为阻塞性肺疾病的受者术后FVC%pred、FEV_(1)/FVC%pred、DLCOc%pred均高于原发病为限制性肺疾病的受者(均为P<0.05)。发生PGD的受者术后DLCOc%pred低于未发生PGD的受者(P<0.05)。结论肺移植受者肺通气功能在术后9个月达到最佳状态且达到稳态,肺弥散功能在术后3个月达到稳态,原发病以及是否发生PGD可能对术后肺功能存在影响。

Technical Evaluation of Eye Drops Instillation： A Systematic Review

Objective： Assess the profile of eye drops in patients with eye diseases. Methods： Studies available in the scientific literature were identified without any time limits using the databases Embase-Medline, Scielo, Scopus and Web of Knowledge. The selected studies were compared with the following inclusion criteria： （i） if the study evaluated the eye drop instillation, （ii） if the study involved participation of patients with eye diseases. Results： Twelve studies met the inclusion criteria. Of them, 83.33% evaluated the technique of eye drop instillation in patients with glaucoma, 8.33% in patients with eye diseases and 8.33% in patients with cataract after undergoing surgery to correct. 41.66% of studies have chosen to record a video of patients to analyze the technique of instilling eye drops and 41.66% did not describe the/esearch location. Regarding the type of study, 75% had the design as prospective cross-sectional, 8.33% prospective open label study, 8.33% intervention study and 8.33% study called masked trial. Although studies evaluate the technique of eye drop instillation, only 8.33% describe in the article the reference in the literature used to evaluate patients. 50% of articles acknowledged some sort of bias or limitation. Conclusion： The limitations inherent in these types of studies should guide future research.