Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.     

独活寄生汤治疗骨质疏松性椎体压缩骨折的临床效果

目的：探讨独活寄生汤对骨质疏松性椎体压缩骨折（OVCF）患者高迁移率族蛋白-1（HMGB-1）、C反应蛋白（CRP）、降钙素原（PCT）的影响。方法：选取2015年4月至2016年9月广州中医药大学第二附属医院收治的OVCF患者92例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组46例。2组均行经皮椎体后凸成形术治疗，对照组给予常规处理，观察组在此基础上加用独活寄生汤，2组均治疗2周。比较2组术后2周的骨折愈合情况、股骨颈骨密度及日本骨科协会腰痛评价表（JOA）评分，术前、术后3 d的炎性反应递质水平，术后1、3、7 d的疼痛视觉模拟评分（VAS）。结果：与术前比较，术后2周，2组伤椎前缘高度、股骨颈骨密度及JOA评分均升高，且观察组高于对照组，差异有统计学意义（P<0.05）；2组伤椎楔变角及后凸Cobb角均降低，且观察组低于对照组，差异有统计学意义（P<0.05）；术后3 d，2组血清TNF-α、CRP、PCT及HMGB-1水平均升高，且观察组低于对照组，差异有统计学意义（P<0.05）。与术后1 d比较，术后3、7 d，2组VAS评分均降低，且观察组低于对照组，差异有统计学意义（P<0.05）。结论：采用独活寄生汤治疗OVCF，可降低患者炎性反应递质水平，减轻疼痛，并可改善患者骨质疏松症状，促进骨折愈合，疗效显著。     

基于UPLC-LTQ-Orbitrap-MS分析刺果番荔枝叶的化学成分

目的利用UPLC-LTQ-Orbitrap-MS技术对刺果番荔枝叶的化学成分进行定性分析。方法采用Waters Acquity UPLC HSS T 3色谱柱(2.1 mm×100 mm,1.8μm),流动相为0.1%甲酸水(A)和乙腈(B)梯度洗脱,流速为0.3 mL/min,进样量2μL,在电喷雾正负离子模式下采集数据。经Reaxys数据库检索番荔枝属类化合物信息,通过质谱信息比对各化合物的m/z值、保留时间、质谱特征碎片等,并结合文献数据对鉴定的化合物进行验证。结果根据各化合物的特征裂解规律,从刺果番荔枝叶中共鉴定出45个化合物,包括16个生物碱类,14个番荔枝内酯类,7个黄酮类和8个其他类化合物,其中以番荔枝内酯类和生物碱类成分居多,与文献报道番荔枝内酯与生物碱类化合物是发挥抗癌的主要活性成分一致。结论利用UPLC-LTQ-Orbitrap-MS技术对刺果番荔枝叶中的化学成分进行了快速、准确的定性分析,为刺果番荔枝叶的提取分离与药效物质基础的研究提供依据。     

经典名方泽泻汤的HPLC指纹图谱及多指标含量测定研究

目的建立经典名方泽泻汤的HPLC指纹图谱,结合化学模式识别技术对其进行分析,并测定泽泻汤中3种成分23-乙酰泽泻醇B、23-乙酰泽泻醇C和白术内酯Ⅲ的含量,为泽泻汤质量控制提供科学依据。方法采用Waters WAT054275C18色谱柱(250 mm×4.6 mm,5μm),以乙腈-水为流动相进行梯度洗脱,建立15批泽泻汤的HPLC指纹图谱,并采用"中药色谱指纹图谱相似度评价系统"、SPSS22.0及SIMCA14.1软件对15批泽泻汤的HPLC指纹图谱进行相似度评价及聚类分析(CA)、偏最小二乘判别分析(PLS-DA)等化学模式识别。同时测定23-乙酰泽泻醇B、23-乙酰泽泻醇C和白术内酯Ⅲ的含量。结果建立了15批泽泻汤的HPLC指纹图谱,相似度均0.94,标定了18个共有峰,指认出3个色谱峰,分别为11号峰白术内酯Ⅲ、15号峰23-乙酰泽泻醇C、16号峰23-乙酰泽泻醇B,CA和PLS-DA将15批泽泻汤样品分为2类,同时15批泽泻汤中23-乙酰泽泻醇B、23-乙酰泽泻醇C和白术内酯Ⅲ的质量分数分别为0.321～0.569、0.075～0.139、0.106～0.142 mg/g。结论 HPLC指纹图谱结合多成分同时测定的方法,快速、简便、重复性好,为泽泻汤及其制剂的质量评价提供参考。     

李延应用泽泻汤合温胆汤治疗舒张压高的临床经验

随着社会的发展,人类生活方式的改变,高血压病越来越高发,具有低龄化趋势,代谢综合征常伴随发生,此种情况下的高血压往往是以舒张压升高为主,临床表现常与“亚健康”状态混淆,未能引起患者甚至部分医生的重视,然而事实上越来越多的科学研究证实舒张压高之危害十分明显,不容忽视。尽管现代医学对舒张压高的病因及病理机制有明确的阐述,但是暂时没有特效的药物。李延教授在治疗高血压病方面有着丰富的临床经验,临床中运用泽泻汤合温胆汤加减治疗舒张压高之眩晕,切中病机,加减灵活,屡有良效。文中从中医角度阐述舒张压高的病因病机,介绍李师辨病辨证思路,组方用药特点,附三则典型验案,另加个人心得体会,以期为舒张压高的有效治疗提供思路。     

厚朴超临界CO_2提取工艺优化及提取物抗氧化活性研究

目的优选超临界CO_2提取厚朴有效成分的工艺并探讨厚朴超临界CO_2提取物的抗氧化活性。方法采用HPLC法测定厚朴超临界CO_2提取物中厚朴酚与和厚朴酚的含量,正交试验优选厚朴超临界CO_2提取工艺,MTT法检测提取物抗氧化活性。结果厚朴酚优化工艺为萃取压力25 MPa,萃取温度55℃,CO_2用量30 kg;和厚朴酚最佳提取工艺压力15 MPa、萃取温度50℃、CO_2用量25 kg。厚朴超临界CO_2提取物具有抗氧化活性,且分离参数不同,抗氧化活性有显著差异。结论在所优选的提取工艺条件下,厚朴酚、和厚朴酚的提取效率较高,重复性较好,工艺稳定可行,提取物具有良好的抗氧化活性。     

HPLC法同时测定健儿膏中8种成分

目的建立HPLC法同时测定健儿膏(党参、山药、甘草等)中白术内酯Ⅲ、白术内酯Ⅰ、党参炔苷、紫丁香苷、去氢土莫酸、土莫酸、去氢茯苓酸、茯苓酸的含有量。方法该药物甲醇提取液的分析采用Diamonsil Plus C18色谱柱(4.6 mm×250 mm,5μm);流动相乙腈-0.05%磷酸,梯度洗脱;体积流量1.0 mL/min;柱温30℃;检测波长210、220、266 nm。结果 8种成分在各组范围内线性关系良好(r≥0.999 1),平均加样回收率96.99%~100.01%,RSD 0.83%~1.47%。结论该方法准确可靠,重复性好,可用于健儿膏的质量控制。     

16个产地地乌药材的系统鉴定及质量评价

目的:构建地乌药材基原物种系统鉴定体系,并对全国16个产地的地乌药材进行综合品质评价,为地乌药材产地选择及临床用药安全奠定基础。方法:使用传统鉴别方法结合DNA条形码核糖体DNA第二内部转录间隔区(ITS2)序列分子鉴定技术快速鉴别地乌药材真伪,并基于HPLC-UV对地乌药材中5个有效成分进行含量测定,采用Welch Ultimate XB-C18色谱柱(4.6 mm×250 mm,5μm),流动相乙腈-0.01%三氟乙酸溶液(30∶70),检测波长210 nm,柱温30℃,流速1.0 mL·min-1。结果:传统鉴别及DNA条形码快速鉴别技术均能准确鉴别地乌药材真伪。BLAST比对分析发现,16个产地地乌药材均与林荫银莲花Anemone flaccida具有最大相似度;基于多指标成分含量测定表明湖北恩施板桥镇的地乌药材中5个三萜皂苷类成分含量之和最高(10.59%),其次为贵州毕节赫章(6.28%)和湖北长阳都镇湾(5.64%)。结论:DNA条形码技术可作为地乌药材传统鉴定技术的有效补充,该鉴别体系可保障地乌药材基原准确及临床用药安全。HPLC多指标成分综合评价及聚类分析结果表明在本研究所涉及的产地中,湖北恩施、长阳、五峰,贵州毕节和重庆金佛山的地乌药材质量较优,可作为地乌药材的重要产地。     

Circulating microRNA‐590‐5p functions as a liquid biopsy marker in non‐small cell lung cancer

Despite the availability of various diagnostic procedures, a tissue biopsy is still indispensable for the routine diagnosis of lung cancer. However, inaccurate diagnoses can occur, leading to inefficient cancer management. In this context, use of circulating microRNAs (miRNAs) may serve as diagnostic tools as liquid biopsies, and as biomarkers to better understand the molecular mechanisms involved in the progression of cancer. We identified miR‐590‐5p as a potential prognostic marker in the progression of non‐small cell lung cancer (NSCLC). We were able to detect this miRNA in blood plasma samples of NSCLC patients through quantitative real‐time PCR. Our data showed an ~7.5‐fold downregulation of miR‐590‐5p in NSCLC patients compared to healthy controls, which correlated with several clinicopathological features. Further, overexpression of miR‐590‐5p led to decreased cell viability, proliferation, colony formation, migration, and invasion potential of lung cancer cells, whereas its knockdown showed the opposite effect. In addition, the levels of several proteins involved in the epithelial‐to‐mesenchymal transition negatively correlated with miR‐590‐5p levels in lung adenocarcinoma cells and tumors of NSCLC patients. Further, dual‐luciferase reporter assays identified STAT3 as a direct target of miR‐590‐5p, which negatively regulated STAT3 activation and its downstream signaling molecules (eg, Cyclin D1, c‐Myc, Vimentin, and β‐catenin) involved in tumorigenesis. Taken together, our study suggests that miR‐590‐5p functions as a tumor suppressor in NSCLC through regulating the STAT3 pathway, and may serve as a useful biomarker for the diagnosis/prognosis of NSCLC, and as a potential therapeutic target for the treatment of NSCLC.