生命伦理学研究的最近进展

本文对近年来新兴生物医学技术伦理学研究进行了综述,报告了干细胞研究、人一动物混合胚胎研究、干细胞研究的临床转化、生物信息库、神经科学、合成生物学和汇聚技术中的伦理问题研究的最近进展。这些新兴生物医学技术伦理学研究,包括“我们应该做什么”的实质伦理学研究,以及“我们应该怎样做”的程序伦理学研究。本文也报告了人们在探讨这些伦理问题的基础上,对这些新兴生物医学技术的政策和管理提出的种种建议。     

End Stage Renal Disease,Differential Diagnosis,A Rare Genetic Disorder: Bardet–Biedl Syndrome: Case Report and Review

End stage renal disease (ESRD) represents a clinical condition in which there is an irreversible loss of endogenous renal function. Both structural and functional abnormalities of the kidney are associated with increased morbidity, mortality. Bardet–Biedel syndrome (BBS) is one of the rare genetic disorders with prevalence of 1 in 1, 40,000–1 in 1,60,000 worldwide. ESRD in BBS patients is the final stage of the disease, increasing mortality in youth.     

Role of Cytokines in the Pathogenesis of Non-Alcoholic Fatty Liver Disease

A number of factors are linked with non-alcoholic fatty liver diseases (NAFLD), a condition that ranges from clinically benign fatty liver to its more severe form, non alcoholic steatohepatitis (NASH). In this study, we evaluated the role of cytokines secreted from adipose tissue in the pathogenesis and progression of NAFLD. We also compared anthropometric profile, lipid profile and insulin resistance data in 105 NAFLD patients with 77 normal subjects. These subjects showed a normal serum albumin level, prothrombin time and renal function but elevated aminotransferases. Predisposing factors were diabetes mellitus (35%), overweight (56%) and hyperlipidemia (44%). Insulin resistance (IR), determined by homeostasis model assessment (HOMA) was confirmed in 70% patients with NAFLD and 42% patients fulfilled the minimum criteria for insulin resistance syndrome (IRS). NAFLD patients showed elevated levels of pro-inflammatory cytokines tumor necrosis factor (TNF)-α, and interleukin (IL)-6, while anti-inflammatory cytokines IL-4 level decreased and IL-10 level remain unchanged; however, TGF-β1 level elevated significantly compared to normal subjects. While insulin level and HOMA-IR both were significantly positively correlated with BMI, waist-to-hip ratio, total cholesterol, VLDL-cholesterol, triglyceride and TGF-β1; glucose, IL-6 and TNF-α levels were significantly positively correlated with HOMA-IR only. In conclusion, pro-inflammatory cytokines play an important link between metabolic and liver disorders in the fat accumulation, and thereby cause IR, inflammation and liver fibrosis.     

A Study on the Level of T<Subscript>3</Subscript>, T<Subscript>4</Subscript>, TSH and the Association of A/G Polymorphism with CTLA-4 Gene in Graves’ Hyperthyroidism among South Indian Population

Graves’ disease (GD) is an organ-specific heterogenous autoimmune disorder associated with T-lymphocyte abnormality affecting the thyroid, eyes and skin. GD is a multifactorial disease that develops as a result of complex interaction between genetic susceptibility genes and environmental factors. It has been suggested that the Cytotoxic T lymphocytes associated molecule-4 (CTLA-4) is a genetic susceptibility candidate for GD. The present study was focused on A/G polymorphism at position 49 in exon-1 of the CTLA-4 gene in 80 GD patients (GP) and 80 sex and age matched healthy individuals among South Indian (Madurai) population. Serum concentrations of thyroid hormone (T₄, T₃ and TSH) were determined by using automated analyzer. The genomic DNA was isolated from the patient and control groups and genotyping was performed using the polymerase chain reaction followed by restriction enzyme analysis using Bbv1. Significant difference (P < 0.001) was observed in the level of T₃, T₄ and TSH in GD patients and healthy individuals. The results revealed the CTLA-4 gene G/G genotype to be 32 (40%) in patients and 26 (32.50%) in healthy individuals, A/G genotype to be 37 (46.25%) in patients and 25 (31.25%) in healthy individuals and A/A genotype to be 11 (13.75%) in patients and 29 (36.25%) in healthy individuals. The calculated odds ratio (OR) in individuals with mutant genotype (GG/AG) reveal 3.6 fold risk for GD (95% confidence interval = 1.6–7.8). The mutant “G” allele frequency was observed to be 0.63 in GD patients and 0.48 in healthy individuals. Thus the present study demonstrates an association between the CTLA-4 gene polymorphism and Graves’ disease.     

体育运动对大学生心理疾病的调节与治疗

从某种程度上来说，心理疾病是一种比生理疾病对人更具危害的疾病，它严重 地困扰着大学生的健康成长。目前，对心理疾病的治疗已引起人们的重视，且手段不 少，但有意识地利用体育手段进行系统调节治疗的却为数不多。本文不仅分析了用体 育手段来调节治疗大学生心理疾病的种种优点，而且还对它的可行性、普及性在理论 上进行了探讨，提出了一套调节治疗心理疾病的具体方法。该方法能有效地消耗患者 积聚的大量心理能量，打乱患者已形成的病态心理秩序，最终使患者达到身心平衡。 此外，笔者还提出了一套对体育手段调节治疗效果评估的标准，并大胆设想用现 代医学、生理学、生物化学的测试数据来更科学地评估与评价体育调节治疗的效果， 以期起到抛砖引玉的作用。     

网球运动对高校中老年教职工心血管病及肝肾功能危险因素的影响

探讨了长期适宜网球运动对高校中老年教师的心血管疾病危险因素的影响。结果显示：网球组教职工的静息心率、收缩压、舒张压、平均压和心率乘积均低于对照组;网球组教职工的总胆固醇、甘油三酯和低密度脂蛋白、体重指数、血糖均明显低于对照组,而高密度脂蛋白显著高于对照组;网球组教职工的C反应蛋白（CRP）显著低于对照组;网球组教职工的高血压、糖尿病、脂肪肝的患病率均低于对照组（P〈0.05）。     

Exercise training and antioxidant supplementation independently improve cognitive function in adult male and female GFAP-APOE mice

PurposeThe purpose of this study was to determine if antioxidant supplementation, moderate exercise, and the combination of both treatments could ameliorate cognitive performance in adult mice and whether the apolipoprotein E (APOE) genotype as well as sex could influence the functional outcomes of the treatments.MethodsFor a period of 16 weeks, separate groups of male and female mice expressing either the human APOE3 or APOE4 isoforms were fed either a control diet (NIH-31) or the control diet supplemented with vitamins E and C (1.12 IU/g diet α-tocopheryl acetate and 1.65 mg/g ascorbic acid). The mice were further separated into a sedentary group or a group that followed a daily exercise regimen. After 8 weeks on the treatments, the mice were administered a battery of functional tests including tests to measure cognitive and affective function.ResultsThere was no effect of genotype or treatment on the learning performance in the Morris water maze. In the discriminated avoidance task, APOE4 mice performed better in learning the discrimination component of the task. Overall, exercise improved performance of APOE4 and APOE3 mice on various aspects of the active avoidance task. Antioxidant supplementation improved performance only in the APOE4 mice. On the test for anxiety, APOE4 mice spent more time in the open arms and supplementation with antioxidant reversed that effect.ConclusionExercise was the most effective treatment at improving cognitive function in both genotypes and sex, while antioxidants seemed to be effective only in the APOE4. In young adult mice only non-spatial learning and memory were improved. The combination of the two treatments did not yield further improvement in cognition, and there was no antagonistic action of the antioxidant supplementation on the beneficial effects of exercise.     

Criss-cross heart three-dimensional printed models in medical education: A multicenter study on their value as a supporting tool to conventional imaging

The utility of three-dimensional (3D) printed models for medical education in complex congenital heart disease (CHD) is sparse and limited. The purpose of this study was to evaluate the utility of 3D printed models for medical education in criss-cross hearts covering a wide range of participants with different levels of knowledge and experience, from medical students, clinical fellows up to senior medical personnel. Study participants were enrolled from four dedicated imaging workshops developed between 2016 and 2019. The study design was a non-randomized cross-over study to evaluate 127 participants' level of understanding of the criss-cross heart anatomy. This was evaluated using the scores obtained following teaching with conventional images (echocardiography and magnetic resonance imaging) versus a 3D printed model learning approach. A significant improvement in anatomical knowledge of criss-cross heart anatomy was observed when comparing conventional imaging test scores to 3D printed model tests [76.9% (61.5%–87.8%) vs. 84.6% (76.9%–96.2%), P < 0.001]. The increase in the questionnaire marks was statistically significant across all academic groups (consultants in pediatric cardiology, fellows in pediatric cardiology, and medical students). Ninety-four percent (120) and 95.2% (121) of the participants agreed or strongly agreed, respectively, that 3D models helped them to better understand the medical images. Participants scored their overall satisfaction with the 3D printed models as 9.1 out of 10 points. In complex CHD such as criss-cross hearts, 3D printed replicas improve the understanding of cardiovascular anatomy. They enhanced the teaching experience especially when approaching medical students.     

循证护理在心血管病介入治疗术后并发症中的应用

目的:探讨应用循证护理在心血管病介入治疗术后常见并发症的护理对策。方法:将循证护理应用于心血管疾病介入治疗术后并发症中,解决术后冠状动脉闭塞、血管迷走反射(VVR)、出血或血肿及假性动脉瘤等问题的实践过程。结果:A组164例,发生各种并发症共12例(8.5%),B组160例,发生各种并发症共5例(3.1%),主要并发症为冠状动脉闭塞、VVR、穿刺局部出血或血肿、假性动脉瘤、血压异常、心律失常等。结论:循证护理应用于对心血管病介入治疗术后常见并发症具有一定的实用价值,通过提高护理质量,进一步提高心内科护理的专科性。     

浅谈静脉输液疗法在犬病诊治中的应用

根据多年从事宠物诊疗的临床经验,通过对犬静脉输液的适应症、静脉输液的部位和方法、静脉输液的原则及剂型选择、静脉输液的量及速度的确定的具体分析,总结出较为科学的静脉输液在犬病诊治中的应用方法及注意事项和其在临床诊疗中的重要意义。