医院与社区联合对慢性心力衰竭患者的院外干预研究

目的探索医院与社区联合,对慢性心力衰竭患者进行院外规范化管理干预的有效途径和方式。方法选择出院的心力衰竭患者1894例,随机分为3组：医院社区联合组630例,其中男352例,女278例,平均年龄（69.39±12.46）岁;医院对社区全科医师进行心力衰竭诊疗技能及规范化管理知识的培训,医院与社区共同制定心力衰竭患者的干预方案,社区全科医师对心力衰竭患者进行防治管理。医院组631例,其中男359例,女272例,平均年龄（68.51±12.15）岁;由专科医师对心力衰竭患者进行院外随访干预。社区组633例,其中男356例,女277例,平均年龄（68.50±12.51）岁;不开展对社区全科医师的培训,由社区医师对心力衰竭患者进行随访。所有病例平均随访（12.0±1.6）个月。结果医院社区联合组、医院组患者的一级终点事件总病死率、心血管病死率、心力衰竭再住院率、心力衰竭急诊率较社区组分别下降17.53﹪、15.71﹪、19.11﹪、18.15﹪,差异均有统计学意义（均P＜0.05）;二级终点事件患者的心功能级别、左心室射血分数（LVEF）、依从性、生活质量均明显高于社区组,心力衰竭恶化率较社区组下降15.59﹪（均P＜0.05）;平均住院日较社区组减少4.56d（P＜0.05）;社区全科医师的心力衰竭诊治及管理水平明显提高。结论通过医院与社区联合对院外心力衰竭患者进行规范化管理干预,提高社区全科医师的心力衰竭诊治及管理水平,可显著降低心力衰竭患者的病死率、再次住院率、心力衰竭急诊率,改善患者的心功能、依从性、生活质量及预后,降低医疗费用。     

Simultaneous determination of citrulline and arginine in human blood plasma by capillary electrophoresis with ultraviolet absorption detection

A new capillary electrophoresis method to measure human blood plasma arginine and citrulline levels in a single run without derivatization was established. After adding homoarginine as internal standard, plasma proteins were removed by a 90:10 v/v acetonitrile/ammonia mixture. Arginine and citrulline were detected by an ultraviolet detector at 190 nm and separated in 11.65 and 20.43 min, respectively, by using a 75 mmol/L Tris phosphate solution at pH 1.2 as a background electrolyte. Limits of detection were 0.8 and 5 μmol/L for arginine and citrulline, respectively. Precision tests indicated a good repeatability of migration times and of peak area both for citrulline (CV% = 0.82 and 3.19) and arginine (CV% = 0.65 and 2.79). The CV% for intra‐ and interassay tests were, respectively, 1.84 and 3.23 for citrulline and 1.25 and 1.50 for arginine. Mean recovery was 101.5 and 98.5% for citrulline and arginine, respectively. The performance of the developed method was assessed by measuring plasma arginine levels in 52 subjects and the data were compared with those obtained by our previous assay. The new method was then applied to assess plasma citrulline and arginine in ten chronic kidney disease patients under hypolipidemic therapy with statin.     

Zinc in gastrointestinal and liver disease

Zinc is an essential trace element with important biological functions, depending on the structural and/or catalytic role played by zinc ions in a large variety of enzymes. Zinc plays a critical role in cellular integrity, protein synthesis, nucleic acid metabolism, contributing to cell growth, proliferation, differentiation and death. The present review reports data on zinc homeostasis and metabolism, zinc absorption, intercellular trafficking, intracellular transport inside enterocytes and hepatocytes. Particular emphasis is given to data regarding the role of zinc carriers ZnTs and Zips, and to their expression in liver and gut in experimental and in human studies. The role of zinc in the gastrointestinal tract and in the liver as a powerful antioxidant and its relationship with apoptosis is discussed. Possible implications of zinc status in different disorders of the gastrointestinal tract are presented, focusing on its possible introduction in the therapy of inflammatory bowel diseases. Data on the role of zinc and zinc carriers in the evolution of liver fibrosis towards cirrhosis are also discussed. Finally, data on the ability of zinc therapy to obtain regression of liver cirrhosis in patients affected by Wilson's disease are reported, and the hypothesis that zinc could protect against liver fibrosis in chronic liver disease of different origin is presented.     

Nanoparticle-based therapeutic approaches for wound healing: a review of the state-of-the-art

Wound healing is a complex physiological procedure that includes diverse stages, comprising hemostasis, inflammation, proliferation, and remodeling to reconstruct the skin and subcutaneous tissue's integrity. As reported, various coexisting diseases (diabetes, vascular diseases, etc.) substantially impact wound healing. Factors like recurring injury, age, or hypertrophic scarring also affect wound healing. The management of wound care depends primarily on the advancement of novel and efficient wound dressing substances, and it persists to be a vivid research area in chronic wound healing. Over the past years, the investigation and advancement of wound dressing biomaterials have registered a new standard level, and superior knowledge based on chronic wound pathogenesis has been achieved. Recently, nanotechnology has presented an excellent method to accelerate acute and chronic wound healing via stimulating appropriate movement through the diverse healing stages. Among various nanomaterials, nanoparticles (NPs) have been spotlighted as an efficient treatment strategy for wound healing due to their ability to act as both a therapeutic and carrier system. Their small size and high surface area to volume ratio enhance the probability of bio-interaction and penetration at the wound area aiding cell–cell interactions, the proliferation of cells, cell signaling, and vascularization. This review endeavored to throw light on different aspects of wounds and the latest advances in nanoparticle-based biomaterials for effective wound healing. Further, challenges and future potentialities have been addressed.     

COPD急性加重合并活动性肺结核患者的危险因素及临床特征分析

目的分析慢性阻塞性肺疾病（COPD）急性加重合并活动性肺结核患者的危险因素及临床特征,以指导临床治疗。方法选取COPD急性发作合并活动性肺结核患者42例（合并组）及同期单纯COPD急性发作的患者72例（对照组）,比较两组患者的临床特征,并采用单因素分析及logistic回归分析其危险因素。结果两组患者的部分临床特征有统计学差异（均P＜0.05）。单因素分析表明,吸烟史、营养不良、长期吸入糖皮质激素史及既往有肺结核史是COPD急性发作合并活动性肺结核的主要危险因素（均P＜0.05）。多因素分析发现,营养不良（OR=4.100,95%CI：1.471～11.431）、长期吸入糖皮质激素史（OR=2.695,95%CI：1.078～6.739）及既往肺结核史（OR=11.102,95%CI：3.076～40.065）为独立危险因素（均P＜0.05）。结论根据危险因素早期识别合并活动性肺结核的高危COPD患者,可尽早明确诊断,给予积极治疗。     

Extensive fractionation and identification of proteins within nasal lavage fluids from allergic rhinitis and asthmatic chronic rhinosinusitis patients

Allergic rhinitis (AR), chronic rhinosinusitis (CRS), and asthma are prevalent airway diseases that can have a substantial impact on a patient's quality of life. MS analyses of biological fluids can effectively screen for proteins associated with disease processes, however, initial detection of diagnostic proteins is difficult due to protein complexity and dynamic range. To enhance the detection of lower abundance proteins, intact nasal lavage fluid (NLF) proteins from nonpolypoid AR and from asthmatic CRS patients were extensively fractionated prior to LC/MS/MS analysis. Pooled NLF samples were processed to remove low molecular weight molecules and high abundance plasma proteins. Anion exchange (AX) chromatography followed by RP‐LC further separated the remaining intact NLF proteins. The resulting fractions were digested with trypsin and the peptides analyzed by LC/MS/MS. Spectra were searched with MASCOT, SEQUEST, and X!Tandem to obtain peptide identifications and subsequently analyzed by Scaffold software to identify parent proteins with at least 99% confidence. The 197 identified proteins are compared to those previously cited in the literature and the workflow evaluated to determine the usefulness for the detection of lower abundance proteins. This is the first extensive list of NLF proteins generated from CRS patients with coexisting asthma.     

A Substituted-Rhodamine-Based Reversible Fluorescent Probe for In Vivo Quantification of Glutathione

Quantifying glutathione (GSH) in cells and organisms is of great significance for understanding the mechanism of oxidative stress in various physiological and pathological processes. However, the quantification by fluorescence bioimaging in living tissues has much stricter requirements than the “Petri dish”-cultured cells in flat plates. Based on the evaluation of the electronic structure and steric hindrance-tuned reactivity of phospha-substituted rhodamine with GSH, a reversible Förster resonance energy transfer (FRET) probe ZpSiP with a distinct performance (K_d=4.9 mM, t_1/2=0.57 s, k=81 M⁻¹ s⁻¹) is developed for real time quantifying GSH in living cells. Furthermore, the near-infrared (NIR) probe succeeded in sensitively tracking the dynamics of GSH in the real organisms bearing tumors, chronic renal failure, and liver fibrosis for unveiling the related pathological processes. We believe that the advance in chemistry with quantitative analysis methods will initiate more promising progress and broad applications.