从湿热论治新诊断2型糖尿病

全球2型糖尿病(T2DM)的患病率不断增加,给医疗保健系统带来了越来越大的负担。由于其发病率及并发症,糖尿病越来越引起重视。传统中医认为消渴病的基本病机为阴虚内热,然而这是仅表现为消渴病“已病、病久”状态,根据临床观察发现,初诊断的糖尿病患者多以湿、热为主要病理因素,“中满内热”为其核心病机。在治疗上以清热祛湿为主要,配以健脾化湿、运脾升清、芳香化浊等法。     

Size and morphology of toxic oligomers of amyloidogenic proteins: a case study of human stefin B

Amyloid-induced toxicity is a well-known phenomenon but the molecular background remains unclear. One hypothesis relates toxicity to amyloid–membrane interactions, predicting that amyloid oligomers make pores into membranes. Therefore, the toxicity and membrane interaction of prefibrillar aggregates and individual oligomers of a non-pathological yet highly amyloidogenic protein human stefin B (cystatin B) was examined. By monitoring caspase-3 activity and by testing cell viability, we showed that the lag phase aggregates obtained at pH 5 and 3 were toxic to neuroblastoma cells. Of equal toxicity were the higher-order oligomers prepared at pH 7 by freeze–thaw cycles. The higher-order oligomers eluted on size-exclusion chromatography (SEC) as a broad peak comprising hexamers, octamers, 12- and 16-mers, well separated from monomers, dimers and tetramers. Only oligomers higher than the tetramers (Rh >3.5 nm) proved toxic, in contrast to dimers and tetramers. In accordance with data from SEC, dynamic light scattering and atomic force microscopy data indicate that the toxic oligomers have diameters larger than 4 nm. Critical pressure measurements showed that the toxic higher-order oligomers inserted more effectively into model lipid monolayers than dimers and tetramers. They also bound, similarly to prefibrillar aggregates, to the plasma membrane and became internalized. Taken together, our results confirm the importance of membrane interaction and perforation in the phenomenon of cytotoxicity.     

Guideline for the Out‐of‐Hospital Management of Human Exposures to Minimally Toxic Substances

Guideline Summary

All substances are capable of producing toxicity, so nothing is completely non‐toxic. Minimally toxic substances are those which produce little toxicity, minor self‐limited toxicity, or clinically insignificant effects at most doses. Examples include silica gel, A&D ointment, chalk, lipstick, and non‐camphor lip balms, watercolors, hand dishwashing detergents, non‐salicylate antacids (excluding magnesium or sodium bicarbonate containing products), calamine lotion, clay, crayons, diaper rash creams and ointments, fabric softeners/sheets, glow products, glue (white, arts, and crafts type), household plant food, oral contraceptives, pen ink, pencils, starch/sizing, throat lozenges without local anesthetics, topical antibiotics, topical antifungals, topical steroids, topical steroids with antibiotics, and water‐based paints. Minimally toxic exposures have the following characteristics: (1) The information specialist has confidence in the accuracy of the history obtained and the ability to communicate effectively with the caller. (2) The information specialist has confidence in the identity of the product(s) or substance(s) and a reasonable estimation of the maximum amount involved in the exposure. (3) The risks of adverse reactions or expected effects are acceptable to both the information specialist and the caller based on available medical literature and clinical experience. (4) The exposure does not require a healthcare referral since the potential effects are benign and self‐limited. However, decisions regarding patient disposition should take into account the patient's intent, symptoms, and social environment. In addition, individual patient circumstances (e.g., pregnancy, pre‐existing medical conditions, therapeutic interventions) need to be considered. Minimally toxic exposures may vary in route (dermal, inhalation, ingestion, ocular), chronicity (acute, chronic), and substance composition (single or multi‐ingredient, single or multiple product). Future categorization of substances as “minimally toxic” should be based on a process involving review of current knowledge, a thorough analysis of poisoning experience, and prospective validation.     

Influence of salbutamol on the anticonvulsant potency of the antiepileptic drugs in the maximal electroshock-induced seizures in mice

Backgroundβ₂-Adrenergic receptor agonists are widely used agents in the treatment of asthma or preterm labor. Since prevalence of asthma was shown to be higher in patients with epilepsy and modulation of noradrenergic system activity may modify epilepsy course, the aim of the present study was to examine the effect of salbutamol (SALB), one of the most commonly used β₂-adrenergic receptor agonist on the anticonvulsant potency of four classical antiepileptic drugs (AEDs): valproate (VPA), carbamazepine (CBZ), phenytoin (DPH) and phenobarbital (PB) in mice subjected to the maximal electroshock (MES)-induced seizures.MethodsSeizures were caused by a current delivered through ear-clip electrodes. The influence of AEDs and SALB on animals’ motor coordination and memory processes was also evaluated.ResultsSingle SALB injection did not change, whereas 7 days SALB administration decreased seizure threshold in the MES-induced seizures in mice. Moreover, SALB injected ip for 1 day and for 7 days lowered the antiepileptic activity of PB in the MES-induced seizures in mice, but did not change the effect of other analyzed AEDs: VPA, CBZ or DPH. Butoxamine, a selective β₂-adrenergic receptor antagonist, reversed SALB influence on the activity of PB. SALB given alone or in combination with the tested AEDs did not affect animals’ motor performance and memory after both single and 7 days administration.ConclusionsPresented results show that SALB may decrease the antiepileptic efficacy of PB. A special caution is advised to patients with epilepsy receiving β₂-adrenergic receptors agonists in the pharmacotherapy of pulmonary and obstetrical disorders.     

浅谈新型冠状病毒肺炎

新型冠状病毒肺炎是一种由新型冠状病毒引发的炎症,患者感染后出现发烧、咳嗽、乏力、舌胖大、苔厚腻等症状。中医认为新型冠状病毒肺炎属于瘟疫范畴,病性为湿毒,病位在肺脾,病机为"湿、热、瘀、毒、虚"。发病后传染速度极快,根据疾病传变规律,可分急性期、中期、极期、恢复期4个时期,治则治法以清热解毒、祛湿化瘀、扶正固本为主,早期中药介入治疗对疾病的转归发展起到关键作用。     

从肾-脾轴论治强直性脊柱炎

强直性脊柱炎（AS）是一种慢性进展性自身免疫性疾病,传统中医临床一般多从肾论治,根据现代医学的最新研究及中医生克制化理论提出肾虚督亏是AS的致病之本,脾病湿盛是发病关键,提出从肾-脾轴论治AS的治疗思路,并以温肾强督、健脾祛湿为其治疗大法,自拟基础方温肾健脾定脊汤。      

从湿毒疫论治新型冠状病毒肺炎医案探析

新型冠状病毒肺炎属于中医疫病范畴。通过对两则临床医案的辨析,认为其主要病机为湿毒为患,有寒湿和湿热之分,早期以寒湿为主,日久向湿热发展;亦有平素湿热体质者,疾病初期即表现为湿热证。病位主要在肺与脾,以化湿解毒为主要治疗大法,除了散寒除湿、清热化湿之外,还需要注意条畅气机、活血化瘀、健脾益气等法,忌过用辛温、柔腻、寒凉之品。初期恶寒者还需与伤寒表证相鉴别。      

基于糖脂代谢研究筋疽（糖尿病足非缺血性坏疽）湿热毒盛证

[目的] 通过现代检验技术研究筋疽（糖尿病足非缺血性坏疽）湿热毒盛证的糖脂代谢指标。[方法] 收集136例筋疽（糖尿病足非缺血性坏疽）患者进行不同证型间指标的比较。[结果] 湿热毒盛证患者空腹血糖（FBG）、糖化血红蛋白（HbA1c）、餐后2 h血糖（2 hPBG）、晚期糖基化终末产物（AGEs）、白蛋白（ALB）、总胆固醇（TC）、高密度脂蛋白（HDL-C）与其他证型比较存在统计学差异（P<0.05）。湿热毒盛证患者C-反应蛋白（CRP）、人可溶性血管细胞黏附分子1（sVCAM-1）与其他证型组间比较存在统计学差异（P<0.01）。[结论] 筋疽（糖尿病足非缺血性坏疽）湿热毒盛证形成的原因与低营养状态下糖脂代谢紊乱引起的高血糖及持续炎症反应相关。     

刘完素治湿别论

湿之为病,总以体内水液代谢异常为根本,故与脾胃的生理、病理均具有十分紧密的联系,对此历代医家均颇为重视,并常以脾胃为基础论治湿病。金元医家刘完素亦颇有心得,但不同于一般医家常采用温脾燥湿等法,刘完素则遵其寒凉思想,主张中土脾胃尤需湿润,不可妄用温燥,迫土干无以润物,并指出湿盛常自热生,应解阳热怫郁为要,方药宜选凉润之品。然而刘完素治湿绝非不予温热,更多的是警醒寒凉之用,务要使润燥相宜土得其平。     

白术茯苓汤中用生白术或熟白术对湿困脾阻模型大鼠的影响

目的:研究白术茯苓汤中用生白术或熟白术对湿困脾阻模型大鼠的影响。方法:复制大鼠湿困脾阻模型。50只SD大鼠分为正常对照(等容生理盐水)组、模型(等容生理盐水)组、白术茯苓汤(生,8 g/kg)组、白术茯苓汤(熟,8 g/kg)组、平胃散(8 g/kg)组。测量大鼠体质量、腹围、腿围、平均进食量、饮水量,检测大鼠血清Na+-K+-ATP酶活性,神经降压素(NT)、P物质(SP)、血管活性肠肽(VIP)含量。结果:与正常对照组比较,模型组大鼠体质量减少,腹围、腿围增加,平均进食量、平均饮水量减少,差异有统计学意义(P<0.05);大鼠血清Na+-K+-ATP酶活性减弱,SP含量减少,NT、VIP含量增加,差异有统计学意义(P<0.05)。与模型组比较,白术茯苓汤(生)组大鼠体质量增加、腹围减少,平均进食量、平均饮水量增加,差异有统计学意义(P<0.05);大鼠血清Na+-K+-ATP酶活性增强,NT、VIP含量减少,差异有统计学意义(P<0.05)。结论:生白术之白术茯苓汤对湿困脾阻模型大鼠的保护作用较熟白术之白术茯苓汤为好,其作用机制可能是通过同时调节Na+-K+-ATP酶、NT及胃肠激素(SP、VIP)的分泌而达到治疗湿困脾阻的目的,白术茯苓汤中的生白术不可用熟白术替代。