Intracellular sensing of microbes and danger signals by the inflammasomes

The cells of the innate immune system mobilize a coordinated immune response towards invading microbes and after disturbances in tissue homeostasis. These immune responses typically lead to infection control and tissue repair. Exaggerated or uncontrolled immune responses, however, can also induce acute of chronic inflammatory pathologies that are characteristic for many common diseases such as sepsis, arthritis, atherosclerosis, or Alzheimer's disease. In recent years, the concerted efforts of many scientists have uncovered numerous mechanisms by which immune cells detect foreign or changed self-substances that appear in infections or during tissue damage. These substances stimulate signaling receptors, which leads to cellular activation and the induction of effector mechanisms. Here, we review the role of inflammasomes, a family of signaling molecules that form multi-molecular signaling platforms and activate inflammatory caspases and interleukin-1β cytokines.     

DNA polymorphism among isolates from multiple sites of a patient with chronic herpes simplex virus, type 1 infection

DNA polymorphisms among independent isolates of herpes simplex virus (HSV) type 1 were studied from a 7-year-old male patient with recurrent infections of the skin and internal organs. In the patient's serum, HSV antibodies could not be detected by complement fixation, enzyme-linked immunosorbent assay (ELISA), or neutralization tests. ELISA tests for the presence of antibodies to human immunodeficiency virus were also negative. One HSV isolate was obtained from mesenteric nodes biopsied in 1983; one from skin in 1984; and three (postmortem) from brain, lungs, and liver in 1985. Restriction enzymes Eco RI, Bgl II, Hind III, Kpn I, and Bam H1 digestion patterns of the five isolates were similar. However, Sal I digests of isolates from skin, mesenteric nodes, lungs, and liver showed variations that were distinct from that of the brain isolate. Although Sal I digests of skin, mesenteric nodes, lungs, and liver isolates share a common variation in lacking F and G, the liver isolate can be further differentiated because of the gain of a restriction site on the H fragment. Thus, the three distinct variants observed were the isolates from brain (variant 1); from skin, mesenteric nodes, and lungs (variant 2); and from liver (variant 3). The fragments involved in variations among these isolates (presence or absence of Sal, G and H) are from the unique short and long regions (invariable regions) of the genome and therefore do not show heterogeneity in size. The extent of variation among these isolates is less than that seen among epidemiologically unrelated strains, suggesting that they originated from a single infecting strain, probably the brain isolate.     

柴芍六君子汤加减治疗肝郁脾虚型慢性萎缩性胃炎的临床疗效

目的分析柴芍六君子汤加减治疗肝郁脾虚型慢性萎缩性胃炎的应用效果。方法80例肝郁脾虚型慢性萎缩性胃炎患者,随机分为对照组和观察组,各40例。对照组给予常规西医治疗,观察组在对照组基础上加柴芍六君子汤加减治疗。比较两组临床疗效、胃肠道生活质量指数量表(GIQLI)评分、中医症候积分、不良反应发生情况、幽门螺杆菌(Hp)转阴率。结果治疗后,观察组的GIQLI评分(102.32±9.35)分高于对照组的(91.35±9.65)分,中医证候积分(9.10±2.00)分低于对照组的(16.15±2.28)分,差异有统计学意义(P<0.05)。观察组治疗总有效率97.50%高于对照组的82.50%,差异有统计学意义(P<0.05)。观察组不良反应发生率5.00%(2/40)低于对照组的20.00%(8/40),差异有统计学意义(χ^2=4.114,P=0.043<0.05)。观察组Hp转阴率92.50%为(37/40),高于对照组的67.50%(27/40),差异有统计学意义(χ^2=7.813,P=0.005<0.05)。结论给予肝郁脾虚型慢性萎缩性胃炎患者柴芍六君子汤加减治疗临床疗效显著,安全性高,具有推广价值。     

杜仲补天素丸的HPLC指纹图谱建立、化学模式识别分析及含量测定

目的:建立杜仲补天素丸的指纹图谱并进行化学模式识别分析,测定杜仲补天素丸中7个成分的含量,为该制剂的质量控制提供参考。方法:采用高效液相色谱法(HPLC),以Pntulips BP-C18 Plus为色谱柱,以0.2%磷酸水溶液-乙腈为流动相进行梯度洗脱,流速为1.0 mL/min,检测波长为330 nm,柱温为35℃,进样量为20μL。以丹皮酚为参照,使用《中药色谱指纹图谱相似度评价系统软件(2012版)》建立12批杜仲补天素丸(S1~S12)的指纹图谱,确定共有峰并进行相似度评价,通过与对照品比对进行色谱峰指认。采用SPSS 21.0软件和SIMCA 13.0软件进行聚类分析和主成分分析,对22个共有峰进行评价。采用上述HPLC法测定12批样品中指认成分的含量。结果:从12批杜仲补天素丸的HPLC指纹图谱中标定共有峰22个,相似度均不低于0.960;共指认化学成分7个,分别为没食子酸(峰1)、绿原酸(峰3)、甘草苷(峰6)、金丝桃苷(峰7)、毛蕊花糖苷(峰8)、淫羊藿苷(峰14)和丹皮酚(峰15)。12批样品中,S1、S3~S5、S7、S9、S11聚为一类,S2、S10、S12聚为一类,S6聚为一类,S8聚为一类;22个共有峰被分为3个主成分,主成分1的特征值(15.130)和方差贡献率(68.775%)最大,其中峰3(0.305)和峰4(0.298)对应成分的得分系数最高。12批样品中,上述7个成分的含量分别为18.1962~31.9513、0.0006~0.0494、0.2348~0.4159、0.0395~0.0791、0.0535~0.2493、0.0005~0.0008、0.6464~1.1469 mg/g。结论:成功建立了杜仲补天素丸的HPLC指纹图谱。12批样品被聚类分成4类,峰3(绿原酸)和峰4(未知)可能是造成样品差异的重要因素。7个成分中没食子酸的含量最高。     

老年反杓型节律高血压患者的药物选择对血压控制及心脏重构的影响

目的观察老年反杓型血压节律者中,日间血压控制是否达标的影响因素、用药选择以及对心脏重构的影响。方法连续入选2016年1月至2019年1月在我院老年内科住院的年龄≥65岁的高血压患者,通过24小时动态血压监测(24 h ABPM)筛选出反杓型血压节律患者共300例,根据日间手测血压结果是否达标分为达标组148例和未达标组152例。比较2组患者的特征及药物使用的差异,通过超声心动图方法比较血压控制是否达标对心脏结构和功能的影响。结果2组日间手测血压比较,未达标组收缩压更高,而舒张压差异无统计学意义;ABPM结果显示,2组间除舒张压外,不同时段的平均收缩压和平均脉压之间差异均有统计学意义(均P<0.05)。2组患者中,年龄、性别、冠心病、外周血管疾病、肾功能不全共患病率、血脂水平之间差异均无统计学意义(均P>0.05);糖尿病共患病率、体重指数(BMI)、氮末端脑钠肽(NT-pro-BNP)水平在血压未达标组中明显高于达标组,差异均有统计学意义(均P<0.05)。药物治疗方面,绝大多数患者(272例,90.67%)为联合用药,钙离子拮抗剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)以及α受体拮抗剂的应用比例差异均无统计学意义,而噻嗪类利尿剂和β受体阻滞剂的应用,在日间血压达标组较未达标组明显增多。应用超声心动图评估心脏结构功能,2组患者的左心室射血分数(LVEF)之间差异无统计学意义;室间隔厚度、左心室重量指数(left ventricular mass index,LVMI)、左心房内径、E/e’值在血压未达标组均高于达标组(均P<0.05)。结论在老年反杓型节律高血压患者中,噻嗪类利尿剂及β受体阻滞剂的应用更有利于血压降至目标值。血压控制未达标患者的NT-pro-BNP水平升高,且室间隔厚度、LVMI、左心房内径和E/e’值均明显升高,显示即使同为反杓型血压节律患者中,血压控制未达目标值对心脏重构的影响更加显著。     

提高结核病病人用药依从性临床药学工作模式探索

目的 探索提高结核病患者用药依从性的临床药学工作模式,提高药物治疗效果,减少耐药.方法 结合问卷调查与文献分析明确结核科医护人员对临床药学服务的需求,制定基于结核科需求的临床药学工作模式.结果 明确结核科对临床药学服务的需求集中在提高患者用药依从性,建立提高结核科患者用药依从性临床药学服务模式.结论 临床药师通过提高结核病患者用药依从性确保抗结核药物规范化治疗.     

Lenke 5C型青少年特发性脊柱侧凸病人弯型特征及矫形疗效的性别差异

目的 探讨不同性别间Lenke 5C型青少年特发性脊柱侧凸（AIS）病人弯型特征及矫形疗效的差异。方法 回顾性分析2014年1月至2019年12月接受后路选择性胸腰椎融合术且有2年以上完整随访资料的Lenke 5C型AIS病人70例,男性组20例,女性组50例。对两组病人术前、术后即刻及末次随访时的胸腰弯/腰弯Cobb角、胸弯Cobb角等冠状面参数,胸椎后凸角（TK）、腰椎前凸角（LL）、近端交界性后凸角（PJA）等矢状面参数及脊柱侧凸研究学会-22简明量表调查问卷（SRS-22）评分进行比较分析。结果 男性组不典型弯型的比例高于女性组（20% vs. 12%）,但组间差异无统计学意义（P＞0.05）。女性组和男性组的胸腰弯/腰弯Cobb角、胸弯Cobb角均较术前显著改善,且两组病人术后即刻和末次随访时的胸弯Cobb角比较,差异有统计学意义（P＜0.05）。两组术后胸腰弯/腰弯矫正率分别为70.6%±12.9%和72.6%±17.9%,末次随访时两组的矫正丢失率分别为5.3%±15.8%和7.6%±15.7%。女性组术前的TK明显低于男性组（19.2°±7.0° vs. 24.5°±14.5°）,术前和术后即刻的矢状面平衡（SVA）均大于男性组,差异有统计学意义（P＜0.05）。末次随访时,男性组的近端交界性后凸（PJK）发生率高于女性组（30% vs. 16%）,但差异无统计学意义（P＞0.05）。男性组在SRS-22量表疼痛维度上的得分显著高于女性组［（4.8±0.2）分 vs. （3.9±0.5）分］,差异有统计学意义（P＜0.05）。结论 男性Lenke 5C型AIS病人中表现为左胸弯右腰弯的不典型弯型的比例稍高于女性,女性病人的术前和术后即刻的SVA大于男性,但均可获得良好的长期矫形疗效。     

多种缺失机制共存的定量纵向缺失数据处理方法的模拟比较研究

目的 比较在处理多种缺失机制共存的定量纵向缺失数据时,基于对照的模式混合模型（PMM）、重复测量的混合效应模型（MMRM）以及多重填补法(MI)的统计性能。方法 采用Monte Carlo技术模拟产生包含完全随机缺失、随机缺失和非随机缺失中两种或三种缺失机制的定量纵向缺失数据集,评价三类处理方法的统计性能。结果 基于对照的PMM控制Ⅰ类错误率在较低水平,检验效能最低。MMRM和MI的Ⅰ类错误率可控,检验效能高于基于对照的PMM。两组疗效无差异的情况下,所有方法的估计误差相当,基于对照的PMM方法的95%置信区间覆盖率最高;有差异的情况下,各方法受符合其缺失机制假设的缺失比例大小影响。含有非随机缺失数据时,基于对照的PMM基本不高估疗效差异,95%置信区间覆盖率最高,MMRM和MI高估疗效差异,95%置信区间覆盖率较低。所有方法的95%置信区间宽度相当。结论 分析多种缺失机制共存,特别是含有非随机缺失的纵向缺失数据时,MMRM和MI的统计性能有所降低,可采用基于对照的PMM进行敏感性分析,但需要注意其具体假设,防止估计过于保守。     

Dietary Pattern and Dietary Energy from Fat Associated with Sarcopenia in Community-Dwelling Older Chinese People: A Cross-Sectional Study in Three Regions of China

Associations between dietary patterns (DPs) and sarcopenia remain controversial, and fewer studies have mentioned the relationship between dietary energy composition and sarcopenia. The present cross-sectional study was conducted in three regions of China, to detect the associations between DPs and sarcopenia, and to identify the influencing nutrients. Exploratory factor analysis was conducted for DP identification. Logistic regressions were performed to explore the associations between DPs and sarcopenia. Dietary nutrients and dietary energy composition were calculated and compared among different DPs. Three DPs were identified from 861 community-dwelling older people. The “mushrooms–fruits–milk” pattern was negatively associated with sarcopenia (OR = 0.33, 95% CI = 0.14~0.77, p-trend = 0.009). Subjects in the highest quartile of the “mushrooms–fruits–milk” pattern showed more abundant intake (1.7 g/kg/d) of dietary protein, and lower percentage (31%) of energy from fat (PEF) than the other two DPs. Further analyses indicated that lower PEF (<30%) was negatively associated with sarcopenia. In conclusion, the “mushrooms–fruits–milk” pattern was negatively associated with sarcopenia in community-dwelling older Chinese people. This pattern showed abundant protein intake and low PEF, which may partially contribute to its protective effect on sarcopenia. Therefore, besides protein, dietary fat and PEF may also be considered in the prevention and management of sarcopenia.