RTKN2 is a new effector protein of Rho GTPase, and has been indicated to be a tumor inhibitor in colon cancer. In this article, we explored the function of RTKN2 in BC cell development. RTKN2 expression in BC tissues and BC cell lines was evaluated by RT-qPCR and Western blot assay. CCK-8, Wound-healing and Transwell assays were carried out to examine the role of RTKN2 knockdown on proliferation, the migratory ability and the invasive ability of BC cells. FCM and Western blot assay were performed to measure the function of RTKN2 silencing on BC cell apoptosis. In addition, the regulatory effect of RTKN2 on Wnt/β-catenin pathway was studied via Western blot assay. RTKN2 expression was elevated in BC tissues and BC cells. Down-regulation of RTKN2 restrained BC cell progression by suppressing cell proliferation, migratory ability, invasive ability, and inducing apoptosis. In addition, reduced of RTKN2 sharply reduced the expressing levels of Wnt3A, β-catenin, C-Myc, and Cyclin D1, suggesting that RTKN2 silencing blocked the motivation of Wnt/β-catenin pathway in BC development. The in vivo experiment also confirmed the inhibitory effect of RTKN2 on BC tumors. Our study confirmed that RTKN2 was highly expressed in BC. Moreover, RTKN2 knockdown suppressed the development of BC through affecting the Wnt/β-catenin pathway. Hence, we deduced that RTKN2 was a possible treatment target for BC.

目的 探索胃食管反流病(GERD)患者服药依从性现状及影响因素.方法 对2020年10月至2021年6月就诊于广州市南方医科大学南方医院消化内科的200例GERD患者进行问卷调查,包括一般资料问卷、药物依从性评估与鉴别量表、社会支持量表.比较GERD患者药物依从性评估与鉴别量表评分在不同人口学特征、病程、保险、社会支持等方面的差异;采用多元线性回归分析GERD患者药物依从性评估与鉴别量表总分的独立影响因素.结果 200例GERD患者的药物依从性评估与鉴别量表平均分为(27.78±9.21)分.年龄、文化程度、病程、保险、居住地、社会支持等是GERD患者药物依从性评估与鉴别量表总分的影响因素(P均<0.05).多元线性回归显示,社会支持是GERD患者药物依从性评估与鉴别量表总分的独立保护因素;文化程度初中及以下、居住在农村、自费、病程12～24月和≥36月、年龄≤60岁是独立危险因素.结论 社会支持度低、文化程度初中及以下、居住在农村、自费、病程12～24月和≥36月、年龄≤60岁是GERD患者服药依从性差的危险因素.医务人员应对存在以上特征的GERD患者加强服药依从性的教育,并鼓励家属参与到患者的治疗中.

目的 评估数字减影血管造影术(DSA)后经椎动脉灌冲常温生理盐水(IVNI)的可行性和安全性,为IVNI用于后循环脑梗死患者提供研究基础.方法 对接受脑动脉DSA的14例非脑卒中受试者进行IVNI(流速30～50 mL/min,持续6～10 min),期间监测受试者各项生理指标并记录患者主观症状.使用DSA或经颅多普勒超声(TCD)检测脑动脉血流速度,评估血管痉挛情况.结果 14例受试者均成功完成IVNI,其中7例(50％)受试者在IVNI期间出现短暂的头晕、头面肢体麻木无力或高血压,1例患者在IVNI后即刻的DSA中发现脑血管痉挛.IVNI后平均动脉压、心率和呼吸节律与基线相比均出现显著变化,但均在正常范围.IVNI后TCD检查发现基底动脉血流速度减慢,但未发现神经功能缺损和意识程度改变.结论 经椎动脉灌冲常温生理盐水安全可行,有望成为后循环缺血性脑卒中患者超早期神经保护的新方法.

目的 评价间歇经口至食管或胃管管饲(间歇管饲)在脑卒中吞咽障碍患者的吞咽功能、营养状况、吸入性肺炎、生活质量、日常生活活动能力(ADL)中的应用效果.方法 计算机检索PubMed、Web of Science、Cochrane Library、CINAHL、MEDLINE、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(CBM)、百度学术等数据库中关于间歇管饲在脑卒中吞咽障碍患者中应用的随机对照试验,检索时限为建库至 2021 年 12 月 31 日.由 2 名研究员独立进行文献的检索、筛选、质量评价和数据提取,采用Revman 5.4 软件对纳入的文献进行Meta分析.结果 最终纳入文献 22 篇,其中中文 21 篇,英文 1 篇,总样本量为 1765 例.Meta分析结果显示,间歇管饲组在改善吞咽功能(MD=-1.15,95％CI:-1.33～-0.96,P<0.01)、吞咽障碍疗效(RR=1.31,95％CI:1.22～1.40,P<0.01);提高血红蛋白含量(MD=4.70,95％CI:3.05～6.34,P<0.01)、血清白蛋白含量(MD=2.16,95％CI:1.35～2.96,P<0.01)、血清前白蛋白含量(MD=21.36,95％CI:14.16～28.56,P<0.01)、血清总蛋白含量(MD=3.07,95％CI:1.82～4.31,P<0.01)、体质指数(MD=2.30,95％CI:1.79～2.81,P<0.01)、肱三头肌皮褶厚度(MD=1.53,95％CI:0.83～2.23,P<0.01);降低吸入性肺炎发生率(RR=0.33,95％CI:0.24～0.45,P<0.01);提高患者的生活质量(MD=21.67,95％CI:18.76～24.59,P<0.01)和日常生活活动能力能力(MD=7.78,95％CI:4.96～10.60,P<0.01)方面均优于留置胃管组,差异具有统计学意义.结论 间歇管饲可以改善脑卒中吞咽障碍患者的吞咽功能和营养状况、提高患者的生活质量和日常生活活动能力、降低肺炎的发生率,具有良好的临床效果.

Objective To evaluate and summarize the relevant evidence of the prevention of tracheostomy-related pressure injury（TRPI） in adults,and to provide references for clinical practice. Methods We searched for clinical decisions,guidelines,recommended practices,evidence summaries,expert consensuses and other evidence on the prevention of TRPI in the Up To Date,BMJ Best Practice,Joanna Briggs Institute Library,Guidelines International Network,National Guideline Clearinghouse,Registered Nurses’ Association of Ontario,Society of Critical Care Medicine,European Pressure Ulcer Advisory Panel,National Pressure Injury Advisory Panel,Cochrane Library,Pub Med,CNKI,Wanfang Data etc. Results A total of 15 articles were incorporated,including 2 clinical decisions,8 guidelines,2 evidence summaries,1 recommended practice,2 expert consensuses. Thirty-two pieces of the best evidence were summarized in 7 aspects,namely risk assessment,skin assessment,selection and application of tracheal cannula and tapes,selection and application of preventive dressings,skin care,nutrition assessment and support,organization management and education training. Conclusion Clinical institutions and medical staffs should evaluate factors such as the medical environment,cost of consumables,and patients’ willingness,and combine with the best evidence to implement preventive strategies in a standardized manner,and ultimately reduce the occurrence of TRPI.

糖代谢紊乱是危重患者常见的临床表现,血糖升高是患者病死率增加的独立危险因素.因此,安全有效的血糖管理是提高危重患者救治质量的重要环节.近年来,随着技术的进步和研究的深入,危重患者血糖管理的效果越来越好,血糖目标由既往的单一化逐步向多样化过渡,血糖监测和胰岛素给药模式也越来越符合患者的个性化需求.本文将从目标血糖、血糖监测方法、胰岛素调节方案3个方面对危重患者血糖管理的研究进展进行综述,以期为临床危重患者血糖管理提供理论依据,并开拓关于血糖管理研究的新思路.

The endothelial-mesenchymal transition (EndMT) participates in the progression of diabetic retinopathy (DR), but cell-intrinsic factors modulating this process remain elusive. In this study, we explored the role of lysophosphatidic acid (LPA) - producing enzyme, acylglycerol kinase (AGK), in the EndMT of human retinal microvascular endothelial cells (HRECs) under high-glucose (HG) conditions. We found that AGK was significantly elevated in HG-treated cells. In addition, AGK knockdown reversed the HG-induced EndMT in HRECs, which was evidenced by the increased endothelial markers (CD31 and VE-cadherin) and decreased mesenchymal markers (FSP1 and α-SMA). Furthermore, downregulation of AGK inhibited the HG-induced activation of transforming growth factor β (TGF-β)/Notch pathways, whereas exogenous TGF-β1 (10 ng/mL) impeded the inhibitory effects of AGK knockdown on HG-induced EndMT in HRECs. Additionally, the silencing of AGK abolished the HG-induced upregulation of LPA and its receptor, LPA receptor 1 (LPAR1), and overexpression of LPAR1 further rescued the AGK knockdown-mediated inhibition of the EndMT process. In conclusion, we demonstrate that downregulation of AGK suppresses HG-induced EndMT in HRECs through regulating the LPAR1/TGF-β/Notch signaling pathway, indicating that AGK might be a potential therapeutic target for the treatment of DR.

目的 探讨吸痰时咳嗽强度对气囊压力不达标的预测价值,旨在为个性化校正气囊压力提供参考.方法 2020年6月至2021年2月,便利选取某院50例建立人工气道的患者,采用半定量咳嗽强度评分法(semi-quantitative cough strength score,SC-SS)评估吸痰时咳嗽强度,分析咳嗽强度与气囊压力不达标的相关性,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算预测气囊压力不达标的咳嗽强度临界值.结果 SCSS 5分组吸痰时(最大值)的气囊压力为(88.67±8.04)cmH2O(1 cm H2 O=0.098 kPa).SCSS 4～5分组吸痰后20 min时气囊压力均低于正常范围,5分组平均损失8.50 cm H2 O,不达标率为92.68％.吸痰时咳嗽强度对气囊压力的影响存在组别、时间和交互效应(P<0.001).吸痰时咳嗽强度与气囊压力不达标呈中度正相关(r=0.563,P<0.001),ROC曲线下面积为0.820(P<0.001),最佳界值3.5,灵敏度0.716,特异度0.847.结论 吸痰时咳嗽强度对气囊压力不达标具有良好的预测价值,当SCSS评分≥4分时,建议吸痰后10 min重新校正气囊压力.

腹膜后神经鞘瘤是一种少见的起源于周围神经鞘雪旺细胞的肿瘤,本文报道了1例腹膜后良性神经鞘瘤,术前超声内镜引导下细针穿刺活检有助于准确诊断,最后的诊断是基于术后的组织学和免疫组织化学结果,主要的治疗方案是手术切除,术后第2、4、5、7、9个月的随访中,患者情况良好,无复发疾病.

当前干眼患者日渐增加,其病因繁多,病理过程复杂,如性激素水平降低、基于免疫的炎症反应、糖尿病、电子产品、隐形眼镜、睡眠质量及飞秒手术等.虽然各因素之间的联系和因果关系尚未完全明确,但了解病因从而针对病因进行治疗,有利于更好地缓解患者的症状.该文综述目前发现的与干眼症相关的病因.

目的 观察远方视力训练法治疗远视性弱视儿童的临床疗效.方法 选取2016年1月～2018年12月哈尔滨医科大学附属第一医院大桥分院眼科门诊收治的远视性弱视儿童120例.将患儿随机分为1、2、3、4组,每组30例.1组采取单纯配镜治疗,2组采取遮盖治疗,3组采取近方视力训练法治疗,4组采取远方视力训练法治疗.经3个月治疗后,比较4组患儿治疗前后远方视力的变化,观察远方视力训练法治疗远视性弱视儿童的临床疗效.结果 1组、2组、3组、4组治疗后远方视力与本组治疗前比较均有提高,差异具有明显统计学意义(P ＜0.001);4组与其它3组远方视力疗效进行两两比较,差异具有统计学意义(P＜0.001).结论 在儿童远视性弱视治疗中,远方视力训练法治疗效果优于单纯配镜、遮盖疗法、近方视力训练法.

随着人们生活方式及环境等因素的改变,眼干燥症的发病率逐年升高,并呈低龄化发展趋势,已成为全球流行性疾病,严重影响人们的工作生活质量.目前眼干燥症的常规治疗仍以人工泪液替代治疗及抗炎治疗为主,但是临床上常用的人工泪液成分并不包含生长因子等,其疗效短暂且局限,仅能暂时缓解患者症状,对于中重度眼干燥症,眼表上皮受到严重损伤,有明显的疼痛甚至出现视力波动或下降的患者常规治疗难以获得有效持久的治疗效果.因此,眼干燥症尤其是中重度眼干燥症的有效治疗成为当前研究的热点与难点.

The endothelial-mesenchymal transition (EndMT) participates in the progression of diabetic retinopathy (DR), but cell-intrinsic factors modulating this process remain elusive. In this study, we explored the role of lysophosphatidic acid (LPA)-producing enzyme, acylglycerol kinase (AGK) in the EndMT of human retinal microvascular endothelial cells (HRECs) under high glucose (HG) conditions. We found that AGK was significantly elevated in HG-treated cells. In addition, AGK knockdown reversed the HG-induced EndMT in HRECs, which was evidenced by the increased epithelial markers (CD31 and VE-cadherin) and decreased mesenchymal markers (FSP1 and α-SMA). Furthermore, downregulation of AGK inhibited the HG-induced activation of TGF-β/Notch pathways, whereas exogenous TGF-β1 (10 ng/ml) impeded the inhibitory effects of AGK knockdown on HG-induced EndMT in HRECs. Additionally, the silence of AGK abolished the HG-induced upregulation of LPA and its receptor LPAR1, and overexpression of LPAR1 further rescued the AGK knockdown-mediated inhibition of the EndMT process. In conclusion, we demonstrate that downregulation of acylglycerol kinase suppresses high glucose-induced endothelial-mesenchymal transition in HRECs through regulating the LPAR1/TGF-β/Notch signaling pathway, indicating that AGK might be a potential therapeutic target for the treatment of DR.

目的探讨急性缺血性脑卒中后吞咽障碍发病率、危险因素及预后,为采取干预措施提供参考.方法对急性缺血性脑卒中患者在入院48 h内,采用洼田饮水试验结合容积一黏度吞咽测试完成吞咽功能评估,收集年龄、性别、既往史、卒中部位、肌力、Barthel指数、美国国立卫生研究院脑卒中量表(NIHSS)评分等资料,并随访患者出院后1、3个月的预后情况.结果共纳入542例患者,吞咽障碍发病率为37.3％;Logistic回归分析显示,NIHSS评分、年龄、肌力及Barthel指数是吞咽障碍的影响因素(P<0.05,P<0.01);吞咽障碍患者与吞咽正常患者出院后死亡率、肺部感染率及改良Rankin评分比较,差异有统计学意义(均P<0.01).结论急性缺血性脑卒中后吞咽障碍发病率较高,日常生活自理能力、神经功能、年龄及肌力是影响因素,吞咽障碍的发生显著影响患者预后;需系统和针对性开展吞咽障碍筛查,早期进行护理干预,以改善预后.

目的 探讨SpyGlass在在胆胰疾病中的应用.方法 回顾性分析2017年3月至2019年12月南方医院消化内镜中心行SpyGlass胆道镜检查的10例患者.结果 10例患者均顺利完成SpyGlass诊治.其中,SpyGlass下胆总管结石激光碎石1例;胆管活检2例,胰管活检2例;单纯观察5例.10例患者术后均未发生并发症.结论 SpyGlass能实现胆管、胰管的直视化,并可完成镜下活检,提高了胆胰疾病的诊断准确率及治愈率.

目的 探讨肢体肌力的变化对急性缺血性脑卒中患者吞咽障碍的预测价值,旨在快速识别急性缺血性脑卒中后吞咽障碍的发生和变化.方法 便利抽样法连续选择2018年1月至2019年3月某医院收治的急性缺血性脑卒中患者235例,分析肢体肌力与吞咽障碍的相关性,并绘制受试者工作特征曲线(ROC曲线),计算肢体肌力预测吞咽障碍的临界值.结果 急性缺血性脑卒中后吞咽障碍的发生率为37.87％(89/235),不同肢体肌力患者吞咽障碍的发生率差异有统计学意义(P<0.05);肢体肌力与吞咽障碍呈负相关(r=-0.654,P<0.05),肢体肌力预测吞咽障碍的ROC曲线下面积为0.848,灵敏度为0.893,特异度为0.742,最佳界值为3.5,P<0.05.结论 肢体肌力的变化对急性缺血性脑卒中患者吞咽障碍有一定的预测价值,当一侧肢体肌力小于4级时,应当警惕吞咽障碍的发生,及时优化此类患者的护理.

Conjunctival filtering bleb scar formation is the main reason for the failure of glaucoma filtration surgery. Cytoglobin (Cygb) has been reported to play an important role in extracellular matrix (ECM) remodeling, fibrosis and tissue damage repairing. This study aimed to investigate the role of Cygb in anti-scarring during excessive conjunctival wound healing after glaucoma filtration surgery. Cygb was overexpressed in human tenon fibroblasts (hTFs) by transfecting hTFs with lentiviral particles encoding pLenti6.2-FLAG-Cygb. Changes in the mRNA and protein levels of fibronectin, collagen I, collagen III, TGF-β1, and HIF1α were determined by RT-PCR and western blotting respectively. After Cygb overexpression, hTFs displayed no significant changes in visual appearance and cell counts compared to controls. Whereas, Cygb overexpression significantly decreased the mRNA and protein expression levels of collagen I, collagen III and fibronectin compared with control (p < 0.01). There was also a statistically significant decrease in the mRNA and protein levels of TGF-β1 and HIF-1α in hTFs with overexpressed Cygb compared with control group (p < 0.05). Our study provided evidence that overexpression of Cygb decreased the expression levels of fibronectin, collagen I, collagen III, TGF-β1 and HIF-1α in hTFs. Therefore, therapies targeting Cygb expression in hTFs may pave a new way for clinicians to solve the problem of post-glaucoma surgery scarring.

目的:采用光学相干断层扫描血管成像技术(OCTA)检测不同屈光人群的黄斑区视网膜密度及厚度并分析其相关性.方法:选取2016年2月～2018年2月我院收治的近视患者200例为研究对象,根据等效球镜度数的差异将其分为轻度近视组(-0.50～-2.75D)52例、中度近视组(-3.00～-5.75D)46例、高度近视组(-6.00～-8.75D)48例、超高度近视组(≤-0.90D)54例.所有患者均进行OCTA检测,比较各组患者黄斑区不同区域视网膜血管密度以及厚度的差异.结果:轻度近视组、中度近视组、高度近视组、超高度近视组等效球镜均呈逐渐降低趋势,而眼轴长度均呈逐渐升高趋势,各组间对比差异有统计学意义(P＜0.05).超高度近视组患者中心凹、中心凹旁、颞侧、上方、鼻侧、下方视网膜血管密度和中心凹、中心凹旁、颞侧、上方、鼻侧、下方视网膜厚度相比轻度近视组、中度近视组、高度近视组均显著降低(P＜0.05).经Pearson相关性结果显示:近视屈光人群的黄斑中心凹以及上方视网膜血管密度以及视网膜厚度呈正相关关系(P＜0.05).结论:采用OCTA检测不同屈光人群的黄斑区视网膜密度及厚度,结果表明近视屈光度患者的黄斑区视网膜密度增加以及黄斑区视网膜厚度的增厚呈正相关关系.

目的 探讨"微课"在眼科住院医师规范化培训专科操作教学中建设与应用.方法 选取本院2017年7月—2018年7月参加规范化培训的60名眼科住院医师分成对照组(传统教学方式)和观察组("微课"教学方式)进行对比分析,比较两组眼科住院医师的考核成绩和对规范化培训教学的评价度.结果 观察组实行"微课"教学方式后,考核总成绩为(88.12±4.69)分、临床医学知识和临床技能操作均高于对照组;住院医师对规范化培训教学的评价度总分为(50.27±4.48)分,也高于对照组,差异有统计学意义(P<0.05).结论 "微课"在眼科住院医师规范化培训专科操作教学中的应用,提高了眼科住院医师的综合能力和学习能力,在对教学的满意度、学习兴趣和积极性等个方面均比传统教学的方式有了很大改善,有利于眼科住院医师规范化培训的建设和应用.