基于网络药理学探讨搜风愈喘方拆方“祛宿痰方”调控儿童哮喘的作用机制＊

目的 基于“伏风暗瘀宿痰”小儿哮喘病机新说，采用网络药理学及实验验证的方法，探索搜风愈喘方拆方“祛宿痰方”治疗儿童哮喘的作用机制，验证中医“宿痰”病机与西医细胞外基质改变病理之间的交通性。方法 通过TCMSP数据库建立“祛宿痰方”的有效成分和靶点数据集，利用OMIM、GeneCards、DrugBank、TTD疾病数据库建立哮喘疾病靶点数据集，利用Cytoscape软件取交集并构建“祛宿痰方”与哮喘的蛋白质互作网络，筛选关键靶点蛋白。利用Metascape数据库进行基因本体（Gene ontology，GO）分析以及京都基因和基因组百科全书（Kyoto encyclopedia of genes and genomes，KEGG）富集分析。复制卵蛋白（OVA）诱导的哮喘大鼠模型，对核心通路及关键靶点进行实验验证。结果 共得到“祛宿痰方”治疗哮喘的靶点98个，包括IL-13、TP53、TGF-β1、VEGF-A、MMP9等，KEGG得到与哮喘相关的通路287条（P＜0.05），包括NF-κB信号通路、PI3K-AKT信号通路、IL-17信号通路等。GO结果显示与哮喘相关生物进程包括炎症反应、细胞外基质调控、氧化应激、血管生成等。动物实验证实“祛宿痰方”可下调大鼠肺组织中p-NF-κB-P65磷酸化水平，抑制NF-κB信号通路的激活，降低IL-13、TGF-β1 mRNA表达量（P<0.05），减少哮喘大鼠肺组织中炎症细胞浸润、黏液产生，从而延缓哮喘的进程。结论 “祛宿痰方”可抑制NF-κB信号通路的激活，降低肺组织中IL-13、TGF-β1 mRNA表达量，可能通过抑制炎症反应、调控细胞外基质等途径作用于哮喘，中医“宿痰”病机与西医细胞外基质改变病理之间存在一定的的交通性。     

基于数据挖掘和网络药理学的血脂异常用药规律和作用机制研究＊

目的 从文献研究的角度出发，运用数据挖掘和网络药理学研究方法，探讨中医药在血脂异常治疗中的组成规律和作用机制研究，为该病的防治提供参考。方法 以1979-2019年“中国知网（CNKI）”、“万方数据”、“维普中文期刊”等数据库中检索到的中药复方治疗血脂异常文献为数据来源，采用中医传承辅助平台对其进行频次分析、关联规则分析和熵聚类方法分析，研究防治血脂异常方药组成规律，并在此基础上采用网络药理学方法，通过KEGG通路和基因本体富集分析，研究高频核心药物的生物信号通路，阐明其作用机制。结果 共计786篇文献符合检索条件，包含314味中药，发现48味高频中药，按照药物使用频次从高到低排序为：活血化瘀药、补虚药（健脾补肾为主）、利水渗湿药、消食化积药；药物性味以温、苦为主，归肝经和脾经最多；进一步关联分析得到高频药对（药组）17个；经过熵聚类分析发现潜在药物组合22个和新方组合11个。应用网络药理学研究方法，对核心药组“山楂、泽泻和决明子”的作用机制进行探索，发现其主要通过作用于包括雌激素受体1（ESR1）、大麻素受体1型（CNR1）、糖皮质激素受体基因（NR3C1）、环氧合酶2（PTGS2/COX2）等潜在靶点，干预三羧酸（TCA）循环、脂质代谢、脂肪酸降解等调节血脂相关的关键信号通路而发挥调节血脂作用。结论 中药治疗血脂异常以健脾补肾治其本，活血化瘀、消痰化积治其标的方法为主，核心药组的作用机制可能是通过干预脂质代谢和基础代谢相关通路发挥治疗作用。     

基于代谢组学技术的宁神灵抗抑郁作用机制研究＊

目的 采用代谢组学技术研究宁神灵抗抑郁的作用机制，确定抑郁症的生物标记物及宁神灵药效作用的关键通路。方法 参考Banasr的CUMS模型建立方法制备抑郁症大鼠模型。采用超高效液相-高分辨串联质谱（AB TripleTOF 5600⁺LC/MS/MS）系统分析抑郁症大鼠尿液代谢物含量及组成的变化，聚焦抑郁症核心生物标记物及关键代谢酶，并评价宁神灵抗抑郁的作用机制。结果 通过模式识别分析发现，抑郁症大鼠代谢发生显著差异代谢，其代谢轮廓在健康状态区域发生显著偏移。对影响代谢分布的生物标记物分析发现，主要涉及苯丙氨酸、酪氨酸、赖氨酸、甘氨酸、谷氨酰胺、组氨酸脯氨酸、泛酸、二羟基丙酮磷酸盐、3-羟基丁酸、肌酐、腺苷。其主要涉及氨基酰基-tRNA生物合成、氮代谢、硫胺素代谢、苯丙氨酸、酪氨酸和色氨酸生物合成等，给予宁神灵后其含量呈回调趋势。结论 宁神灵对抑郁症有很好的治疗作用，宁神灵可能通过氨基酸代谢、糖酵解、TCA循环和ATP生物合成过程中调节发挥抗抑郁的治疗作用。     

运用全面质量管理构建血管神经病学高级人才管理平台

目的 运用信息化建设对血管神经病学高级人才进行系统化管理，在培养人才的基础上，提高人 才管理质量和效益。 方法 以首都医科大学附属北京天坛医院血管神经病学科为例，运用全面质量管理对高级人才进 行规范化管理，同时建立医院人才网络管理平台，实现数据共享，为信息积累和分析提供依据。 结果 在质量管理的基础上，理顺了业务流程，建立了多元化的人才培养机制，搭建了医院高级人 才网络管理平台，实现动态业务管理。 结论 医院在对血管神经病学高级人才进行质量管理中，体现了全面性和合理性，实现医院关于高 级人才的现代化、科学化、可持续化管理。     

Major trauma associated with mobility scooters: An analysis of the trauma audit research network

AimsTo establish the incidence and nature of injuries seen in patients following mobility scooter incidents.MethodsThe Trauma Audit and Research Network (TARN) database was used to collect data concerning injuries associated with mobility scooters. The data was taken from incidents that occurred between February 2014 and November 2020. The data analysed included: patient demographics, injury mechanism and patterns and associated mortality rates.Results1,504 patients were identified of which 61.4% were male. The median age was 76.2 years (IQR 63.5–84.9). The median injury severity score (ISS) was 9 (IQR 9–17), with major trauma (ISS ≥16) being observed in 29.4% of patients. Injuries to the limb were most common, although injuries to the head were most severe. Vehicle collisions accounted for 65.4% of injuries and were most closely associated with the most severe incidents. The median length of stay in hospital was 12 days, excluding the patients who died. Overall, mortality following injury was 10.6%, but the mortality rate was 15.4% in those aged 75 years and over, and 24.2% in those sustaining severe trauma.ConclusionAs the population ages, injury characteristics of those with both major and non-major trauma changes. Mobility scooter use is prevalent amongst older people, and we provided a detailed analysis of injuries sustained with their use across a national database. The length of stay and the inherent resource use, because of admission following mobility scooter trauma, is considerable. These injuries particularly affect the ‘most elderly’ and carry a considerable mortality burden.     

Building immunization decision-making capacity within the World Health Organization European Region

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of national experts that provides evidence-based recommendations to policy-makers, assisting them in making sound immunization policy and programme decisions. The World Health Organization (WHO) Regional Office for Europe is working to strengthen the capacity of newly-established NITAGs and has targeted efforts on low- and middle-income countries. The Regional Office, in collaboration with WHO Headquarters and USA Centers for Disease Control and Prevention (CDC), developed a new training strategy and held training workshops to improve NITAGs’ functioning and ability to make evidence-based recommendations. Feedback from countries that participated in trainings indicated that the updated training materials and interactive approach with follow-up technical support enabled them to align their NITAG charters and processes with WHO recommendations. To ensure continued progress, global and regional partners such as WHO and CDC should continue providing technical support to recently established NITAGs.     

The 12th International Food Data Conference (IFDC): From food composition to better policies and programmes in nutrition and agriculture

The 12th International Food Data Conference (IFDC) was held in Buenos Aires, Argentina, from 11 to 13 October 2017. It was organized by Instituto Nacional de Investigaciones Biológica and International Network of Data System/FAO (INSIBIO and INFOODS/FAO) as a pre-conference of the 21th International Congress of Nutrition (ICN2017). The theme was “From Food Composition to Better Policies and Programmes in Nutrition and Agriculture”. A total of 152 delegates from 37 countries participated in the Conference. The programme included one keynote address, 46 oral presentations and 82 poster displays. The conference programme along with the Power Point files of the oral presentations are available on the conference website (http://www.ifdc2017.com/). The Conference was very successful, with high-quality scientific oral presentations and posters, and very satisfactory participation. The participants were able to exchange knowledge and personal experiences, and develop new ideas while discussing current research and other matters.     

Avoidable hospitalisation for diabetes mellitus among immigrants and natives: Results from the Italian Network for Longitudinal Metropolitan Studies

Background and aimsItaly has experienced a relevant increase in migration inflow over the last 20 years. Although the Italian Health Service is widely accessible, immigrants can face many barriers that limit their use of health services. Diabetes mellitus (DM) has a different prevalence across ethnic groups, but studies focusing on DM care among immigrants in Europe are scarce. This study aimed to compare the rates of avoidable hospitalisation (AH) between native and immigrant adults in Italy.Methods and resultsA multi-centre open cohort study including all 18- to 64-year-old residents in Turin, Venice, Reggio-Emilia, Modena, Bologna and Rome between 01/01/2001 and 31/12/2013–14 was conducted. Italian citizens were compared with immigrants from high migratory pressure countries who were further divided by their area of origin. We calculated age-, sex- and calendar year-adjusted rate ratios (RRs) and 95% confidence intervals (95% CIs) of AH for DM by citizenship using negative binomial regression models. The RRs were summarized using a random effects meta-analysis. The results showed higher AH rates among immigrant males (RR: 1.63, 95% CI: 1.16–2.23), whereas no significant difference was found for females (RR: 1.14, 95% CI: 0.65–1.99). Immigrants from Asia and Africa showed a higher risk than Italians, whereas those from Central-Eastern Europe and Central-Southern America did not show any increased risk.ConclusionAdult male immigrants were at higher risk of experiencing AH for DM than Italians, with differences by area of origin, suggesting that they may experience lower access to and lower quality of primary care for DM. These services should be improved to reduce disparities.     

Relation between PTSD symptom clusters and positive memory characteristics: A network perspective

Positive memory characteristics relate to posttraumatic stress disorder (PTSD) severity. We utilized a network approach to examine relations between PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive memory characteristics (count, accessibility, valence, vividness, coherence, time perspective, sensory details). We identified differential relations between PTSD clusters and positive memory characteristics, and central/bridging symptoms. Participants were an Amazon Mechanical Turk-recruited sample of 206 individuals (M_age = 35.36; 61.20% females). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD clusters and six nodes representing positive memory characteristics. Regarding cross-community relations, AAR (highest node strength) was negatively associated with positive memory count, valence, coherence, and accessibility; avoidance was positively and negatively associated with positive memory vividness and count respectively. The NACM-AAR and intrusion-avoidance edges were significantly stronger than most edges. From the PTSD community, AAR and avoidance had the highest bridge strength and bridge expected influence respectively; from the positive memory community, coherence and vividness had the highest bridge strength and bridge expected influence respectively. Results indicate the potential pivotal role of AAR, avoidance, coherence, and vividness in the PTSD-positive memory relation, which renders them assessment/treatment targets pending further investigation.     

Variation in Brain Subcortical Network Topology Between Men With and Without PE: A Diffusion Tensor Imaging Study

IntroductionPremature ejaculation (PE) is a highly prevalent male sexual dysfunction. Previous studies have found abnormal activity in the sympathetic nervous system and penile sensory pathway of PE. Few studies have investigated the neural mechanisms underlying PE.AimThe aim of this study was to examine whether the altered cortico-subcortical network topological properties of the brain white matter structural network could be used to differentiate patients with PE from healthy control (HC) subjects.MethodsDiffusion tensor images data were collected from 32 patients with PE and 35 HC participants. Then, brain white matter structural networks were reconstructed from image acquisition.Main Outcome MeasureFurthermore, nodal measures were calculated and hub regions were identified using the graph-theoretical methods.ResultsFor cortical brain regions, increased strength, global efficiency, and decreased shortest path length were found in the right superior frontal gyrus (medial), and superior frontal gyrus (medial orbital) were found in patients with PE. In addition, patients with PE also showed decreased strength in the right rolandic operculum and decreased shortest path length, and increased global efficiency in the right inferior frontal gyrus (triangular part). For subcortical brain structures, patients with PE were associated with decreased shortest path length and increased global efficiency in the left insula and right caudate nucleus. Finally, the results showed that 9 PE-specific hub regions were identified in patients compared with HCs, including 7 cortical regions and 2 subcortical regions.Clinical ImplicationsOur results provide new understanding about the pathology of PE and enhances the understanding of PE pathology.Strength & LimitationsOur results offer biological markers for understanding the physiopathology of PE. However, our study is a cross-sectional design, longitudinal design studies need to explore the causal relationships between aberrant topological characteristics and PE.ConclusionOur results provide new insights into the neural mechanism of PE involving cortico-subcortical network changes, which could serve as a potential biomarker to differentiate individuals with PE from HCs.Chen J, Yang J, Huang X, et al. Variation in Brain Subcortical Network Topology Between Men With and Without PE: A Diffusion Tensor Imaging Study. J Sex Med 2020;17:48–59.