从痰瘀论治动脉粥样硬化的研究进展

动脉粥样硬化(Atherosclerosis,AS)一种常见的、慢性、进行性、全身性疾病,往往同时累及多处血管,导致严重后果。近年来随着中医治疗动脉粥样硬化的实验和临床研究逐步深入,从痰瘀论治动脉粥样硬化性疾病取得了显著的进展,值得我们深入研究。本文对动脉粥样硬化性疾病的病因病机、证候要素分布,以及从痰瘀角度防治本病进行了归纳总结。     

上海市徐汇区45~55岁居民动脉粥样硬化性心血管疾病风险的影响因素分析

背景　动脉粥样硬化性心血管疾病（ASCVD）是我国居民健康的首要威胁，也是我国居民的首要死亡原因，占城市居民的41.8%，占农村居民的44.8%。家庭医生及其团队对社区中年人群相关风险因素的调研评估、干预及综合管理，可尽早预防ASCVD的发生发展。目的　调查上海市徐汇区45~55岁居民ASCVD风险因素，为日后对相关人群开展针对性的健康干预提供参考意见和建议。方法　采集2019年1-5月在上海市徐汇区枫林街道社区卫生服务中心门诊就诊、信息平台留存准确个人资料（性别、年龄、联系电话）及在本单位体检留存生理、生化数据〔身高、体质量、BMI、血压和血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）及空腹血糖（FPG）〕的530例居民的信息。采用电话回访或现场面对面调查，参照《中国成人血脂异常防治指南（2016年修订版）》中“总体心血管危险评估”相关章节内容定义ASCVD 风险，同时基于社区实际情况，将评估低危和中危人群归为ASCVD低风险组，高危和极高危人群归为ASCVD高风险组。采用多元Logistic逐步回归分析探究居民ASCVD风险的影响因素。结果　发放问卷530份，回收有效问卷502份，有效回收率为94.7%。ASCVD低风险组38例，ASCVD高风险组464例。ASCVD高风险组年龄、TG、FPG、男性比例、心脑血管病史比例、糖尿病史比例、高血压史比例、服用降压药史比例、服用调脂药史比例高于ASCVD低风险组（P<0.05）。多元Logistic逐步回归分析结果显示，≥50岁、TG≥1.5 mmol/L、FBG≥6.1 mmol/L、男性是居民ASCVD风险的危险因素（P<0.05）；服用调脂药史是居民ASCVD风险的保护因素（P<0.05）。结论　上海市徐汇区45~55岁居民ASCVD风险的主要可控危险因素是血脂（TG）及血糖的异常；不可控危险因素是年龄、性别。对于增龄、男性、合并脂代谢异常的居民更应关注ASCVD的风险并予以生活方式干预和调脂药规范使用指导。社区开展多重风险因素评估及管理对ASCVD的早期筛查、早期干预及治疗均非常重要，对家庭医生及其团队开展相关一、二级预防工作有指导借鉴意义。     

Functional nano-vector boost anti-atherosclerosis efficacy of berberine in Apoe(−/−) mice

Atherosclerosis (AS) is the leading cause of heart attacks, stroke, and peripheral vascular disease. Berberine (BBR), a botanical medicine, has diversified anti-atherosclerotic effects but with poor absorption. The aim of this study was to develop an effective BBR-entrapped nano-system for treating AS in high-fat diet (HFD)-fed Apoe^(−/−) mice, and also explore the possible underlying mechanisms involved. Three d-α-tocopherol polyethylene glycol (PEG) succinate (TPGS) analogues with different PEG chain lengths were synthesized to formulate BBR-entrapped micelles. HFD-fed Apoe^(−/−) mice were administered with optimized formula (BBR, 100 mg/kg/day) orally for 5 months. The artery plaque onset and related metabolic disorders were evaluated, and the underlying mechanisms were studied. Our data showed that, BT₁₅₀₀M increased BBR deposition in liver and adipose by 107.6% and 172.3%, respectively. In the Apoe^(−/−) mice, BT₁₅₀₀M ameliorated HFD-induced hyperlipidemia and lipid accumulation in liver and adipose. BT₁₅₀₀M also suppressed HFD-induced chronic inflammation as evidenced by the reduced liver and adipose levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β); and decreased plasma level of TNF-α, IL-6, IL-1β, interferon-γ (IFN-γ), monocyte chemotactic protein (MCP), and macrophage inflammatory factor (MIP). The mechanism study showed that BT₁₅₀₀M changed Ampk and Nf-κb gene expression, and interrupted a crosstalk process between adipocytes and macrophages. Further investigation proved that BT₁₅₀₀M decreased endothelial lesion and subsequent macrophage activation, cytokines release, as well as cholesteryl ester gathering in the aortic arch, resulting in ameliorated artery plaque build-up. Our results provide a practical strategy for treating AS using a BBR-entrapped nano-system.     

DVH预测模型在VMAT计划培训中的应用

目的:以宫颈癌为例，探索使用剂量体积直方图（DVH）预测模型培训放疗物理师容积旋转调强（VMAT）计划设计的可行性及其效果。方法:随机选取20例宫颈癌测试病例对3名见习物理师进行两个阶段培训（第一阶段15例，第二阶段5例）。每位物理师分别采用两种方法设计VMAT计划:传统人工计划（MP）和基于DVH预测模型引导的自动计划（KBP）。对比不同阶段两种计划靶区和危及器官的各种剂量学参数，并做相应统计分析。结果:与人工计划相比，自动计划在明显提高PGTV靶区V60覆盖（P<0.001），改善高剂量控制（V66）（P=0.027）的情况下，显著降低膀胱（P<0.001）、直肠（P<0.001）、左右肾（P=0.001和P<0.001）以及左右侧股骨头（P<0.001和P<0.001）等绝大部分正常组织器官的受照剂量。在提高计划合格率的同时，亦减小了计划者间的质量差异。结论:DVH预测模型有助于深化物理师对VMAT初始优化参数设置的理解，加快培训进度，提升VMAT计划设计水平。     

基于Bark域的电子耳蜗频带划分分析和拟合研究

目前电子耳蜗主流的言语处理策略是基于滤波器组的言语处理算法，该算法通过分频带进行信号处理并把参数传递到对应的电极上。电子耳蜗滤波器组的频带划分不是等分的，而是按一定规律进行并且符合人耳听觉特性的，其中，Bark域的频带划分是重要的参考。本研究基于Bark域的电子耳蜗频带划分方法，探讨Bark域频带划分的特性并结合目前的电子耳蜗滤波器组的频带划分进行分析，进而探讨频带划分中的曲线拟合方法，为电子耳蜗滤波器组中的频带划分提供重要的方法和参数。     

Anti-atherosclerotic action of GW9508 – Free fatty acid receptors activator – In apoE-knockout mice

BackgroundIn the past two decades, enhanced understanding of the biology of G-protein-coupled receptors (GPRs) has led to the identification of several such receptors as novel targets for free fatty acids (FFAs). Two GPRs, FFAR1 and FFAR4, have received special attention in the context of chronic inflammatory diseases, thanks to their anti-inflammatory activities.MethodsThe present study investigates the influence of prolonged treatment with GW9508 – agonist of FFAR1 and FFAR4 – on the development of atherosclerosis plaque in apoE-knockout mice, using morphometric and molecular methods.ResultsGW9508 administration has led to the reduction of atheroscletoric plaque size in an apoE-knockout mice model. Moreover, a FFAR1/FFAR4 agonist reduced the content of macrophages by almost 20%, attributed by immunohistochemical phenotyping to the pro-inflammatory M1-like activation state macrophages.ConclusionsProlonged administration of GW9508 resulted in significant amelioration of atherogenesis, providing evidence that the strategy based on macrophage phenotype switching toward an M2-like activation state via stimulation of FFAR1/FFAR4 receptors holds promise for a new approach to the prevention or treatment of atherosclerosis.     

复杂后循环颅内段动脉粥样硬化性病变的诊疗进展

中国是颅内动脉粥样硬化疾病的高发地区，多种危险因素与之有关。前后循环颅内动脉 狭窄/闭塞在危险因素分布上存在一定的差异性，同时后循环动脉的解剖结构具有自身独特的特点且 具有较多的解剖变异性。本综述回顾了基于颅内动脉粥样硬化的Mori分型、LMA分型，并对复杂后循 环颅内段动脉粥样硬化性病变进行了临床定义。由于复杂后循环颅内段动脉粥样硬化性病变药物治 疗效果往往不佳，卒中复发率高，同时血管内治疗又较困难，因此，本文从解剖结构、危险因素、卒中 病理生理特点、侧支循环、影像学评估及临床治疗进展多个方面对复杂后循环病变进行了综述。     

Adolescent cardiometabolic risk scores: A scoping review

AimsClustering of cardiometabolic risk factors (CMRFs) indicates cardiometabolic risk (CMR), a key driver of cardiovascular disease. Early detection and treatment of CMR are important to decrease this risk. To facilitate the identification of individuals at risk, CMRFs are commonly combined into a CMR Score. This scoping review aims to identify CMRFs and methods used to calculate adolescent CMR Scores.Data synthesisSystematic searches were executed in Child Development and Adolescent Studies, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCO CINAHL, Scopus Elsevier, Cochrane CENTRAL, and Nursing and Allied Health. No limits were placed on publication date or geographic location. Studies were included if participants were 10–19 years and the study reported CMRFs in a composite score. Key extracted information included participant characteristics, CMRFs comprising the scores, and methods of score calculation. CMRFs were categorized and data were reported as frequencies. This study identified 170 studies representing 189 CMR Scores. The most common CMRF categories were related to lipids, blood pressure, and adiposity. The most frequent CMRFs were triglyceride z-score, systolic blood pressure z-score, and inverse high-density lipoproteins z-score. Scores were mostly calculated by summing CMRF z-scores without weighting.ConclusionsThe range of CMRFs and Scores identified in adolescent CMR literature limits their use and interpretation. Published CMR Scores commonly contain two main limitations: (a) use of an internal cohort as the z-score reference population, and (b) Scores relying on adiposity measures. We highlight the need for a standard set of CMRFs and a consensus for a CMR Score for adolescents.