全氟类化合物在人体与动物体内的生殖毒性

全氟类化合物（polyfluorinated chemicals，PFCs）是一类来自工业生产，存在于人们日常生活环境中内分泌干扰物（endocrine disruptors，EDCs）。研究表明，PFCs可以聚集在生物体内，并通过影响甾体激素合成、诱导生殖系统细胞凋亡、拮抗激素受体等机制，在生殖系统表现出毒性作用。在男性中，这类物质被证明与精子的质量与数量的下降及异常精子比率的上调有关，干扰男性性激素水平（如睾酮）；而在女性中也发现血液或卵泡液中PFCs水平的升高，往往伴随着性激素及促性腺激素（如雌孕激素，卵泡刺激素等）水平的异常以及生育力的下降，这类物质在孕期的暴露甚至有影响至下一代的可能。此外，已有动物实验从分子层面对这类物质的毒性机制进行了证实，因此PFCs的生殖毒性值得关注。     

Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy

ObjectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered “low-value”, and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.MethodsWe analyzed 2002–2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.ResultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: ?3.1%; 95%CI ?4.7, ?1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: ?2.2%; 95%CI ?3.0, ?1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: ?0.6%; 95%CI ?2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI ?1.9, 2.0]; ?0.9% [95%CI ?3.1, 1.3]; and ?1.2% [95%CI ?5.3, 2.9], respectively).ConclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.     

Berberine Induces Cell Apoptosis through Cytochrome C/Apoptotic Protease-Activating Factor 1/Caspase-3 and Apoptosis Inducing Factor Pathway in Mouse Insulinoma Cells

Objective: To investigate apoptotic effects of berberine, a significant alkaloids component existing in Rhizoma coptidis, and its possible acting mechanism in insulinoma cells. Methods: Different concentrations of berberine were used to treat mouse insulinoma(MIN6) cells for various period of time. The viability and apoptosis of the cells were analyzed using methylthiazolyldiphenvl-tetrazolium bromide assay, flow cytometry and enzyme-linked immuno sorbent assay. Changes in the relating pro-and anti-apoptosis proteins were detected by western-blotting. Results: The half-maximal inhibitory concentration(IC50) of berberine was 5.7 μmol/L on MIN6 cells viability for 16 h. Berberine caused a 20% reduction(P0.05) in cell number after only 4-h incubation; which reached 50% after 24 h(P0.01). Berberine treatment for 16 h significantly increased the level of DNA fragmentation. The flow cytometry showed the apoptotic rate increased 2.9-and 4.6-fold after treating with berberine(5 μmol/L) for 8 and 16 h, while 3-and 8.7-fold after 10 μmol/L treatment for 8 and 16 h(P0.01). Berberine treatment dramatically elevated the expression ratio of Bax to Bcl-2. Meanwhile, berberine notably increased the apoptosis-inducing factors and cytochrome C transforming from the mitochondria to the cytoplasm. Apoptotic protease-activating factor 1(Apaf-1) was subsequently activated after cytochrome C release. Furthermore, caspase-3 and poly adenosine diphosphate-ribose polymerase were also activated to trigger apoptosis cascade. Conclusion: High concentration(5 and 10 μmol/L) of berberine could induce the apoptosis of MIN6 cells through cytochrome C/Apaf-1/caspase-3 and apoptosis inducing factor(AIF) pathway.     

基于调控肠道菌群探讨中药防治脑卒中

肠道菌群是一个独特的生态系统,被称为人体"被遗忘的器官",被誉为人类的"第二基因组"。肠道菌群失调与许多中枢神经系统疾病相关,例如帕金森病、阿尔茨海默症、精神分裂症及多发性硬化等。脑卒中具有高的发病率、复发率、死亡率和致残率的特点。肠道菌群在脑卒中的发生、发展中起着关键的作用,可通过影响机体的吸收、代谢、血压、血糖、血脂及动脉粥样斑块等因素,进一步影响脑卒中的发病。中医认为脾胃气血流注失度、阴阳盛衰失衡,机体生理功能失调,化生"风、火、痰、虚、瘀"等病理产物,可致中风的发生。脾胃主腐熟运化水谷,肠道菌群影响饮食的消化吸收,现代研究的肠道菌群功能与中医之脾胃功能失调相关。因此,调整肠道菌群的稳态,可作为一个潜在的干预靶点预防和治疗缺血性脑卒中。中药干预脑卒中已经取得了很好的疗效,是否与调节肠道菌群有关,值得未来做进一步的研究。同时对中药有效成分(小檗碱、黄芩苷、白藜芦醇等),中药单方(丹参、红景天等)和中药组方(补阳还五汤、脑心通胶囊、补中益气汤等)防治脑缺血的研究进展进行综述,为缺血性脑卒中的预防和开发提供新的途径和思路。     

《中医基础理论》多元化教学评价方式的构建与实践

《中医基础理论》是中医学课程体系中的主干课程,其教学质量对于中医学人才的总体培养质量具有举足轻重的作用。构建科学合理的教学评价方式是切实推进教学改革,提升教学质量的重要一环。文章论述了《中医基础理论》课程多元化教学评价方式的构建和具体实施方案,在整个《中基》教学过程的不同阶段合理地运用三种评价方式,进行全面客观和准确的判断评价,从而为师生"教"与"学"的切实改进和提升提供真实的依据。实践表明:多元化教学评价方式增强了学生学习的兴趣,提高了学生自主学习的积极性和能力,提高了学生运用知识分析和解决问题的能力,培育了学生的团队协作精神和创新思维;同时,激发了教师教学的热情,促进了教师教学理念、教学方法、教学手段以及专业知识的更新,提高了教师综合素质。本文对实践中存在的问题也进行了总结。     

中药配方颗粒品种统一标准的有关问题探讨

通过参考《中国药典》2015年版和相关文献,结合国家药典委员会2016年发布的《中药配方颗粒质量控制与标准制定技术要求(征求意见稿)》,综合考虑中药配方颗粒的实际生产情况,对《关于中药配方颗粒品种试点统一标准的公示》中质量标准特异性、定量检测指标的选择和指标性成分转移率等方面进行讨论,根据讨论结果为中药配方颗粒质量标准的完善和提高提出了相关建议,为推进配方颗粒产业健康发展提供参考。     

中西医不同角度对儿童新型冠状病毒肺炎(COVID-19)的认识

2019年12月以来,以湖北省武汉市为中心陆续发现了多例新型冠状病毒肺炎(COVID-19)患者。人群普遍易感,儿童亦有感染病例出现,感染波及新生儿、婴幼儿,并且已出现儿童重症病例。儿童感染病例引起了社会高度重视。目前COVID-19病理机制尚不清楚,治疗亦缺乏特效药,这些问题都给疫情防控和临床救治带来极大困难。尝试从中西医不同角度认识儿童COVID-19,分析儿童COVID-19病因、流行特点、病情发展特点及治疗措施,同时从中医角度探讨儿童COVID-19病因病机、辨证及治疗方法,能更好地通过中西医结合对此次儿童COVID-19进行深入了解,理解其病理之基础,分析目前疫情发展之趋势,并在此基础上寻找安全有效的防治措施,以期对临床更好地防治儿童COVID-19提供参考。