期刊视角的近代上海名医文化效应研究

以中国近代中医药期刊为主视角,以近代中医名家为研究主体,探讨近代上海名医文化区域特征。近代上海名医多家学渊源,国学功底深厚,以文会友,在期刊阵营中思想活跃;上海为近代中医药期刊创刊的主阵地,名医办刊办学,刊学相辅,使中医教育呈现出师承、家学、院校、函授等多种模式相结合的发展趋势。生逢乱世的近代上海名医,将中医的命运与民族命运紧密相连,注重扶持民族企业,研发自主品牌,这标志着近代中医民族品牌意识开始觉醒。近代上海名医具有传统中医的特色,深受江南地域文化影响,又注重吸收和借鉴西方医学,形成了异彩纷呈的海派特色。     

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。     

The Diversity of Gut Microbiome is Associated With Favorable Responses to Anti–Programmed Death 1 Immunotherapy in Chinese Patients With NSCLC

IntroductionGut microbiome affecting the responses to immune checkpoint inhibitors against advanced NSCLC has been investigated in the Western population. However, considering pre-existing genetic and gut microbiota variation, the relevance remains unknown in the East-Asian NSCLC population. This study is designed to explore the relationship between gut microbiome and clinical outcomes in Chinese patients with NSCLC who have received treatment using an anti–programmed death 1 (PD-1) blockade.MethodsThirty-seven patients with advanced NSCLC receiving treatment with nivolumab were enrolled in CheckMate 078 (NCT02613507) and CheckMate 870 (NCT03195491). Fecal samples were collected at the starting point, when patients received nivolumab, at clinical evaluation, and when disease progression was noted. 16S ribosome RNA gene sequencing was applied to assess gut microbiota profiles. Peripheral immune signatures were determined by multicolor flow cytometry in parallel.ResultsWhen subgrouping patients into responder (R) and nonresponder according to the clinical response assessed using Response Evaluation Criteria in Solid Tumor version 1.1, R patients harbored higher diversity of gut microbiome at the starting point with stable composition during the treatment. Patients with high microbiome diversity had significantly prolonged progression-free survival when compared to those with low diversity. Compositional difference was observed between the two groups as well with the enrichment of Alistipes putredinis, Bifidobacterium longum, and Prevotella copri in R whereas Ruminococcus_unclassified enriched in nonresponding patients. Analysis of systemic immune responses using multicolor flow cytometry revealed that patients with a high abundance of microbiome diversity in the gut had a greater frequency of unique memory CD8⁺ T cell and natural killer cell subsets in the periphery in response to anti–PD-1 therapy.ConclusionsOur results reveal strong correlation between gut microbiome diversity and the responses to anti–PD-1 immunotherapy in Chinese patients with advanced NSCLC. Patients with favorable gut microbiome (such as those with high diversity) exhibit enhanced memory T cell and natural killer cell signatures in the periphery. These findings provide important implications for the prediction and the evaluation of anti–PD-1 immunotherapy against NSCLC in the Chinese population.     

Interleukin-34 drives macrophage polarization to the M2 phenotype in autoimmune hepatitis

BackgroundAutoimmune hepatitis is a chronic inflammatory disease, the abnormal immunological function is the main pathogenesis. Interleukin-34 is a newly identified cytokine that shares the same receptor as colony stimulating factor-1.MethodsWe used interleukin-34 knockout and wild-type mice in a Con A-induced hepatitis model and cocultured RAW264.7 macrophage cells with interleukin-34. We then detected associated inflammatory cytokine and chemokine levels to elucidate the role of interleukin-34.ResultsIn this study, we found that the loss of interleukin-34 resulted in higher sensitivity to Con A-induced hepatitis. RAW264.7 macrophage cells were able to differentiate to the M2 phenotype upon interleukin-34 stimulation.ConclusionsWe conclude that interleukin-34 may protect the liver from Con A-mediated hepatitis by driving M2 macrophage polarization and suppressing inflammation.