章亚成教授辨证治疗恶性淋巴增殖性疾病顽固性盗汗

章亚成教授认为,恶性淋巴增殖性疾病(MLPD)的治疗在于使原本失衡的阴阳气血重新恢复动态平衡,患者表现出的顽固性盗汗也可理解为相同病因病机所生,应同样以“和法”为基本治疗原则.对于MLPD且顽固性盗汗的用药,强调在辨证的基础上使用较平和的药物以纠其偏,如对于营卫不和之证,选用桂枝配白芍,一散一收,调和营卫;对于血瘀之证切不可盲目选用攻利破瘀之品免伤正气,而以和血为上;对于邪热之证,不可过用寒凉之品伤及阳气,而应透热固表,佐以清热,选药以药性平和为先.     

Evening ambient light exposure can reduce circadian phase advances to morning light independent of sleep deprivation

Short sleep/dark durations are common in modern society. We investigated if exposure to additional evening ambient light, often associated with later bedtimes and short sleep, reduces circadian phase advances to morning bright light. Twelve healthy subjects participated in two conditions that differed in the distribution of sleep before exposure to morning bright light. Subjects had a consolidated 9‐h night time sleep opportunity, or a 3‐h daytime nap followed by a 6‐h night time sleep opportunity, each before morning bright light. Eight of the 12 subjects obtained similar amounts of sleep in both conditions, and yet still showed significant reductions in phase advances with 6‐h nights (1.7 versus 0.7 h, P < 0.05). These results suggest that the exposure to additional evening ambient light often associated with short sleep episodes can significantly reduce phase advances to morning light, and may therefore increase the risk for circadian misalignment.     

Emotional Eating Moderates the Relationship of Night Eating with Binge Eating and Body Mass

Night eating syndrome is marked by substantial evening or nocturnal food intake, insomnia, morning anorexia, and depressed mood. Night eating severity has been positively associated with body mass index (BMI), binge eating frequency, and emotional eating tendencies. We conducted an online questionnaire study among students (N = 729) and explored possible interactive effects between those variables. Night eating severity, binge eating frequency, BMI and emotional eating were all positively correlated with each other. Regression analyses showed that night eating severity was particularly related to more frequent binge episodes and higher BMI at high levels of emotional eating but unrelated to those variables at low levels of emotional eating. Thus, eating as a means of emotion regulation appears to be an important moderator of the relationship between night eating and both binge eating and BMI. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Biogeography of time partitioning in mammals

Many animals regulate their activity over a 24-h sleep–wake cycle, concentrating their peak periods of activity to coincide with the hours of daylight, darkness, or twilight, or using different periods of light and darkness in more complex ways. These behavioral differences, which are in themselves functional traits, are associated with suites of physiological and morphological adaptations with implications for the ecological roles of species. The biogeography of diel time partitioning is, however, poorly understood. Here, we document basic biogeographic patterns of time partitioning by mammals and ecologically relevant large-scale patterns of natural variation in “illuminated activity time” constrained by temperature, and we determine how well the first of these are predicted by the second. Although the majority of mammals are nocturnal, the distributions of diurnal and crepuscular species richness are strongly associated with the availability of biologically useful daylight and twilight, respectively. Cathemerality is associated with relatively long hours of daylight and twilight in the northern Holarctic region, whereas the proportion of nocturnal species is highest in arid regions and lowest at extreme high altitudes. Although thermal constraints on activity have been identified as key to the distributions of organisms, constraints due to functional adaptation to the light environment are less well studied. Global patterns in diversity are constrained by the availability of the temporal niche; disruption of these constraints by the spread of artificial lighting and anthropogenic climate change, and the potential effects on time partitioning, are likely to be critical influences on species’ future distributions.Natural cycles of light and darkness structure the environment of the majority of eukaryotic organisms. The rotation of the Earth partitions time into regular cycles of day and night, and although all points on the Earth’s surface receive roughly equal durations of light and darkness over the course of a year, at mid to high latitudes seasonal variation in day length imposes an uneven distribution throughout the annual cycle. During the hours when the sun is below the horizon, there is seasonal and latitudinal variation in the duration of “biologically useful semidarkness” in the form of twilight and moonlight (1), modified by both the lunar cycle and variable cloud cover, providing changing opportunities for animals able to use visual cues for key behaviors including foraging, predator avoidance, and reproduction (2–6). Activity during both daylight and semidarkness may be further constrained by covariance between the natural cycles of light and temperature; the metabolic costs of thermoregulation place constraints on the time available for activity (7). Thermal constraints may limit nocturnal activity when nighttime temperatures are low, and diurnal activity when temperatures are high. Furthermore, energetic constraints may force some species to be active throughout hours of both light and darkness (8). Where energetic and thermal costs are not prohibitive, temporal niche partitioning may occur as species specialize and avoid competition by concentrating their activity within a particular section along the light gradient (9, 10). Behavioral traits are associated with a range of specialized adaptations, particularly in visual systems and eye morphology (11) and energetics and resource use (6, 12). Thus, some species are apparently obligately diurnal in their peak activity patterns, some obligately nocturnal, obligately crepuscular (active primarily during twilight), or obligately cathemeral (significant activity both during daylight and night), and others make facultative use of both daylight and night (13), or show seasonal and/or geographical variation in their strategy. Strict nocturnality and diurnality are hence two ends of a continuum of possible strategies for partitioning time over the 24-h cycle. As properties of organisms that strongly influence performance within a particular environment, these strategies can be considered functional traits in themselves (14), but are also associated with suites of adaptations, with implications for the ecological roles of species and individuals. Crepuscular and cathemeral species may have intermediate adaptations (15), and behavior may be flexible to vary within species and among individuals according to factors such as time of year, habitat structure, food availability, age, temperature, and the presence or absence of predators (16–18).The ecology of diel time partitioning by organisms remains rather poorly understood (19, 20). Studies have considered the adaptive mechanisms behind strategies within a single ecosystem, including predator avoidance, energetic constraints, diet quality, and interspecific competition (9, 21). Meanwhile, although mapping functional traits has become a core technique in functional biogeography (22, 23), surprisingly little is known about the biogeography of diel activity patterns, and the extent to which they are determined by geographic gradients in light and climate. Addressing such issues has become more pressing with growth in the evidence for a wide range of ecological impacts of both anthropogenic climatic change and nighttime light pollution (24–28). Natural cycles of light have remained consistent for extremely long geological periods, providing a rather invariant context, and a very reliable set of potential environmental cues. The continued spread of electric lighting has caused substantial disruption to how these cycles are experienced by many organisms, exerting a novel environmental pressure (29). Direct illumination of the environment has quite localized effects, but sky glow—the amplified night sky brightness that is produced by upwardly emitted and reflected electric light being scattered by water, dust, and gas molecules in the atmosphere—can alter light regimes over extensive areas. Indeed, under cloudy conditions in urban areas, sky glow has been shown to be of an equivalent or greater magnitude than high-elevation summer moonlight (30). Understanding the biogeography of time partitioning by organisms provides a first step toward determining where such changes are likely to have the greatest impact.In this paper, we (i) document basic biogeographic patterns of time partitioning by organisms, using terrestrial mammals as a case study; (ii) document ecologically relevant large-scale patterns of natural variation in “biologically useful” natural light, constrained by temperature; and (iii) determine how well the first of these are predicted by the second. Mammals provide an interesting study group, being globally distributed, occupying a broad range of environments, and exhibiting a wide diversity of time-partitioning behavior. Much concern has also been expressed as to the potential impacts of nighttime light pollution on the group, and there are many studies documenting significant influences (31, 32). Due to the global nature of this study, and the paucity of detailed information on time partitioning reported for many species, our focus is on a high-level categorization, allocating species to one of four temporal niches: nocturnal, diurnal, cathemeral, and crepuscular (Fig. 1), albeit with the acknowledgment that in many species behavior occurs along a continuum of possible strategies that may be more flexible and complex.Open in a separate windowFig. 1.Examples of recorded diel activity patterns illustrating the four main time-partitioning strategies used to classify terrestrial mammals in this study (64–67).     

老年高血压患者血压节律变化与靶器官损害的关系

目的 探讨老年高血压患者血压节律变化与靶器官损害的关系. 方法 70例老年高血压患者均行24h动态血压检测、颈动脉超声和超声心动图检查,根据24 h动态血压检测结果分为2组:勺形组40例及非勺形组30例,并对2组颈动脉粥样硬化(CAS)、左室肥厚(LVH)及动态血压各参数进行比较. 结果 CAS及LVH检出率非勺形组均高于勺形组(P＜0.01);2组间24 h平均收缩压(24hSBP)及舒张压(24hDBP)、24 h收缩压和舒张压负荷值(24hSBPL、24hDBPL),差异无统计学意义(P＞0.05).勺形组白天平均收缩压(dSBP)及舒张压(dDBP)、白天收缩压和舒张压负荷值(dSBPL、dDBPL)高于非勺形组(P＜0.05).勺形组夜间平均收缩压(nSBP)及舒张压(nDBP)、夜间收缩压和舒张压负荷值(nSBPL、nDBPL)明显低于非勺形组(P＜0.01). 结论 老年高血压患者血压节律变化的消失与靶器官损害关系密切,高血压患者降压治疗的同时还需纠正紊乱的血压昼夜节律.     

Functional analysis of congenital stationary night blindness type-2 CACNA1F mutations F742C, G1007R, and R1049W

Congenital stationary night blindess-2 (incomplete congenital stationary night blindness (iCSNB) or CSNB-2) is a nonprogressive, X-linked retinal disease which can lead to clinical symptoms such as myopia, hyperopia, nystagmus, strabismus, decreased visual acuity, and impaired scotopic vision. These clinical manifestations are linked to mutations found in the CACNA1F gene which encodes for the Ca(v)1.4 voltage-gated calcium channel. To better understand the physiological effects of these mutations, three missense mutants, F742C, G1007R and R1049W, previously shown to be mutated in patients with CSNB-2, were transiently expressed in human embryonic kidney (HEK) tsA-201 cells and characterized using whole-cell patch clamp. The G1007R mutation is located in transmembrane segment 5 (S5) of domain III and R1049W is located in the extracellular linker between S5 and the P-loop of domain III. Both mutants produced full length proteins that targeted to the membrane but did not support ionic currents. In 20 mM Ba(2+), F742C (S6 domain II) produced a approximately 21 mV hyperpolarizing shift in half activation potential (V(a[1/2])) and a approximately 23 mV hyperpolarizing shift in half inactivation potential (V(h[1/2])). Additionally, F742C displayed slower inactivation kinetics and a smaller whole cell conductance (G(max)). In physiological 2 mM Ca(2+), F742C produced a approximately 19 mV hyperpolarizing shift in V(a[1/2]). These findings suggest that the pathology of CSNB-2 in patients with these missense mutations in the Ca(v)1.4 calcium channel is the result in either a gain of function (F742C) or a loss of function (G1007R, R1049W).     

产科夜间护理风险管理思路与方法

目的探讨产科夜间护理存在的风险隐患,为提高护理安全提供有效的防范管理措施。方法对2004-2006年我院产科夜间医疗护理存在的高风险因素进行了统计分析。结果夜间阴道分娩率明显高于白天(P<0.01),夜间剖宫产率占夜间分娩率的45.0%。夜间新收孕产妇中高危孕产妇占42.3%,夜间新收高危孕产妇中胎膜早破占62.0%。产科病区低年资合同护士占夜班人数56%。结论针对夜间不安全因素或高风险问题,提出相应护理管理措施和方法,以确保母婴安全、减少医疗纠纷事故发生。     

骨伤科术后盗汗的辨证论治

目的对骨伤科术后盗汗进行辨证分型、治疗。方法根据骨科术后盗汗患者的症状及体征,总结规律,进行分型,行辩证论治。结果术后盗汗分为气血亏虚证、阴虚火旺证、肝气郁结证、气滞血瘀及气阴两虚证五型。结论中医辨证治疗骨伤科术后盗汗疗效显著。