基于知识图谱的名医经验传承模式探究＊

名医经验传承是中医药文化传承和发展的重要内容。本文结合当前名医经验传承研究的基本现状以及名医学术经验整理与深度传承发展的核心需求，提出基于知识图谱的名医经验传承模式研究构想。利用知识图谱在多维度知识及海量信息网络整合方面的优势，从名医学术源流整理，学术思想挖掘及临床经验整理等多个角度出发，探讨知识图谱构建和挖掘分析的研究思路。通过多主题、结构化的知识图谱构建，探索名医经验传承系统化、规范化建设的新思路。     

川芎-天麻配伍对川芎中2种成分在大鼠脑内药动学的影响

目的探讨川芎⁃天麻配伍对川芎中川芎嗪、阿魏酸在大鼠脑内药动学的影响。方法18只大鼠随机分成川芎组、川芎⁃天麻(1∶0.25)组、川芎⁃天麻(1∶1)组,每组6只,建立血瘀型偏头痛模型。灌胃给药后,于大鼠脑内插入微透析探针,收集不同时间点脑透析液,UPLC⁃MS/MS法检测川芎嗪、阿魏酸含有量,绘制血药浓度⁃时间曲线,计算药动学参数。结果与单味药组比较,配伍组2种成分T1/2[川芎⁃天麻(1∶1)组阿魏酸除外]、MRT0~∞、Cmax、AUC0~∞升高(P<0.05,P<0.01);川芎⁃天麻(1∶0.25)组两者T1/2、MRT0~∞、AUC0~∞高于川芎⁃天麻(1∶1)组(P<0.05,P<0.01),川芎嗪Cmax降低(P<0.05)。结论天麻可提高川芎中川芎嗪、阿魏酸脑组织吸收程度,延长作用时间,减缓消除速率,增加蓄积,其作用强度与天麻剂量有关。     

Medical masks’ and respirators’ pattern of use,adverse effects and errors among Portuguese health care professionals during the COVID-19 pandemic: A cross-sectional study

BackgroundDuring COVID-19 pandemic, a shortage of surgical masks (Mask) and respirators (Resp) was experienced worldwide. We aimed to assess its pattern of use, adverse effects and user errors by Portuguese health care professionals (HCP).MethodsA cross-sectional study was conducted through snowball convenience sample, collected by email/ social media to health care organizations. Participants answered an online anonymous survey in March 2021.ResultsMean age of 3052 respondents was 42.1 years old, 83.6% were female and 77.8% provided direct health care to COVID-19 patients. Mean time of use per shift was 6-8 hours in 40.8% of the participants. 28.0% reported never changing it during their shift. Resp use (vs Mask) was more associated with discomfort (58.2% vs 26.8%), affecting task performance (41.5 vs 18.9%) and communication (55.0 vs 40.9%), dyspnea (36.0 vs 14.4%), skin rash (37.5 vs 19.4%) and headache (37.5 vs 19.4%). Frequent user errors included touching the front while in use (70.1% Mask vs 66.3% Resp) and omitting hand hygiene before (61.8% Mask vs 55.0% Resp) or after use (61.3% Mask vs 57.0% Resp). Average number of errors was higher for Mask (4.3), than for Resp (3.2) (all: P < .001).ConclusionsMost HCP admitted an extended use of Mask/ Resp. Resp were more prone to adverse effects and Mask more prone to errors. Strategies to reinforce good practices should be considered.     

黄芪建中汤对脾胃虚寒证胃溃疡大鼠的影响

目的探讨黄芪建中汤对脾胃虚寒证胃溃疡大鼠的影响。方法将SD大鼠随机分为正常组、模型组、埃索美拉唑组(4.17 mg/kg)及黄芪建中汤低、高剂量组(9.27、18.54 g/kg)。采用番泻叶(10 m L/kg)联合游泳力竭法建立脾胃虚寒证候模型,无水乙醇(10 m L/kg)联合阿司匹林肠溶片(200 mg/kg)建立胃溃疡模型。观察并记录大鼠的整体状态、体质量、进食量、饮水量和肛温,肉眼及HE染色观察胃黏膜组织形态学损伤,测量胃液总酸度和胃蛋白酶活性,ELISA法检测大鼠血清IL-4、IL-10、NO和TNF-α水平,qRT-PCR和免疫组化法分别检测TLR-2、MyD88 mRNA及蛋白表达。结果与模型组比较,黄芪建中汤组大鼠体质量、进食量、饮水量和肛温均上升(P<0.05,P<0.01),溃疡指数下降(P<0.01),胃酸总酸度和胃蛋白酶活性均降低(P<0.01),血清TNF-α水平下降(P<0.05、P<0.01),IL-4、IL-10和NO水平上升(P<0.05、P<0.01),胃组织中TLR-2、MyD88 mRNA及蛋白表达下调(P<0.01)。结论黄芪建中汤对脾胃虚寒型胃溃疡大鼠有显著的疗效,其作用机制可能通过调节TLR-2/MyD88信号通路,影响炎性因子表达,下调黏膜攻击因子水平,从而加速胃黏膜溃疡修复。     

石学敏院士运用“调神醒脑止颤”针法治疗特发性震颤浅析

石学敏院士从"百病始生,皆源于神,凡刺之法,必先治神"的整体观念论治特发性震颤,治疗以神为本,注重对"神"的调节,提出治疗特发性震颤的新方案。石院士认为本病病位在"脑",脑为髓之海,病机为窍闭神妄,阳缓阴急,致使经筋拘挛弛纵,诱发颤证。治疗应醒神开窍,安神定志,调和阴阳,并强调"醒神、调神、安神"的重要性,形成以脑统神、以神统针、以针调神的学术思想。石学敏院士重视手法的运用和针刺手法量效关系,在其从医数十载的临床治疗中发现,神机异常是百病始生的关键。通过"醒神、调神、安神",在改善特发性震颤患者不自主运动方面均显现其独特优势。     

Poly-ICLC,a multi-functional immune modulator for treating cancer

Immunotherapies have become the first line of treatment for many cancer types. Unfortunately, only a small fraction of patients benefits from these therapies. This low rate of success can be attributed to 3 main barriers: 1) low frequency of anti-tumor specific T cells; 2) lack of infiltration of the anti-tumor specific T cells into the tumor parenchyma and 3) accumulation of highly suppressive cells in the tumor mass that inhibit the effector function of the anti-tumor specific T cells. Thus, the identification of immunomodulators that can increase the frequency and/or the infiltration of antitumor specific T cells while reducing the suppressive capacity of the tumor microenvironment is necessary to ensure the effectiveness of T cell immunotherapies.In this review, we discuss the potential of poly-ICLC as a multi-functional immune modulator for treating cancer and its impact on the 3 above mentioned barriers. We describe the unique capacity of poly-ICLC in stimulating 2 separate pattern recognition receptors, TLR3 and cytosolic MDA5 and the consequences of these activations on cytokines and chemokines production. We emphasize the role of poly-ICLC as an adjuvant in the setting of peptide-based cancer vaccines and in situ tumor vaccination by mimicking natural immune responses to infections. Finally, we summarize the impact of poly-ICLC in enhancing T infiltration into the tumor parenchyma and address the implication of this finding in the clinic.     

Calnexin functions in antibacterial immunity of Marsupenaeus japonicus

Calnexin (Cnx) is an endoplasmic reticulum membrane–bound lectin chaperone that comprises a dedicated maturation system with another lectin chaperone calreticulin (Crt). This maturation system is known as the Cnx/Crt cycle. The main functions of Cnx are Ca²⁺ storage, glycoprotein folding, and quality control of synthesis. Recent studies have shown that Cnx is important in phagocytosis and in optimizing dendritic cell immunity. However, the functions of Cnx in invertebrate innate immunity remain unclear. In this research, we characterized Cnx in the kuruma shrimp Marsupenaeus japonicus (designated as MjCnx) and detected its function in shrimp immunity. The expression of MjCnx was upregulated in several tissues challenged with Vibrio anguillarum. Recombinant MjCnx could bind to bacteria by binding polysaccharides. MjCnx protein existed in the cytoplasm and on the membrane of hemocytes and was upregulated by bacterial challenge. The recombinant MjCnx enhanced the clearance of V. anguillarum in vivo, and the clearance effects were impaired after silencing MjCnx with RNA interference assay. Recombinant MjCnx promoted phagocytosis efficiency of hemocytes. These results suggest that MjCnx functions as one of the pattern recognition receptors and has crucial functions in shrimp antibacterial immunity.     

IL-1β induces expression of costimulatory molecules and cytokines but not immune feedback regulators in dendritic cells

Dendritic cells play an important role in the initiation of immune reactions. Due to their high capacity to prime T-cell responses, the activation of dendritic cells must be tightly controlled. Because Interleukin-1β (IL-1β) is a key player in autoinflammatory diseases, we compared the ability of IL-1β to activate human dendritic cells and induce immune-regulatory molecules versus the effects induced by pathogen-derived stimuli.Upon activation with either IL-1β or microbial stimuli, monocyte-derived dendritic cells showed enhanced expression of costimulatory molecules, increased secretion of chemokines and cytokines, and the ability to activate T cells. In contrast, immune-feedback molecules, including PD-L1, IL-1RA, IL-10 and SOCS1, were exclusively upregulated in response to microbial stimuli, whereas IL-1β treatment had no inducing effect on them. Thus, the limited capacity of IL-1β to induce potential feedback inhibitors may support its key etiologic role in chronic inflammation and autoinflammatory responses.     

模式识别受体PRRs在急性肺损伤/急性呼吸窘迫综合征发病机制中的作用研究进展

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是继发于肺内或全身的炎症反应过程,它由肺泡损伤导致并形成炎症性非心源性的肺水肿。模式识别受体(PRRs)参与先天免疫系统的激活,PRRs可以启动炎症信号级联反应,并释放促炎细胞因子。本综述对PRRs所包括的跨膜受体TLRs、胞质受体RLRs和NLRs以及下游炎症通路NF-κB、IRF、MAPK、NETs、RAGE和Nrf2信号通路及自噬进行总结,以阐述模式识别受体PRRs在ALI/ARDS发病机制中的作用。     

泌尿外科实施医护联合查房的效果评价

目的：探讨医护联合查房新型服务模式在泌尿外科的实施效果。方法选择2014年1—12月在泌尿外科住院的650例手术患者作为实验组,在患者入院当天、手术前第1天、手术当天、术后第1天、出院当天实施医护联合查房模式,选择同期在泌尿外科住院的500例手术患者作为对照组,实施传统的医护分开查房模式,对两组病人进行出院满意度及护士工作满意度问卷调查,对照两种工作模式的患者满意度、护士对专业提升效果及满意度、护理成效。结果实验组护理工作质量高,调查护士工作满意度95．45％,出院患者满意度98．46％,差异有统计学意义P＜0．05。结论实施医护联合查房,能提高整体护理水平,建立和谐的医护关系,更重要的是为患者提供了优质、安全、高效的医疗护理服务,大大提高了病人满意度,赢得了社会效益。