抗结核药物研究进展

结核病病例一般集中在发展中国家。抗结核领域一直以来未受到学术界和制药企业的关注,随着多药耐药结核病和广泛耐药结核病不断出现,以及艾滋病患者感染结核杆菌的病例逐渐增加,抗结核药物的研究已成为药物研发领域中的一个热点。本文系统地总结了已上市抗结核药物及正处在研发阶段的新型化学实体,根据其作用机制划分为4个大类,同时结合近期文献报道对其作用机制进行了简要阐述。在过去40年中,只有两种全新作用机制的新药：贝达喹啉与德拉马尼上市,以ATP合成酶抑制剂为代表的具有新型作用机制的药物将有望成为抗结核药物研发的重点。     

离子通道调整与新药研制——胃肠离子通道病研究最新进展

本文概述近年来尤其是最近5年,胃肠平滑肌和肠神经细胞离子通道及其与消化道疾病关系研究的最新进展,总结了可能用于新疗法、新药研制的新靶点,提出离子通道调整及修饰,应是今后与离子通道特性改变密切相关的功能性胃肠道疾病的诊治的方向。     

医院科室建设与目标管理

阐述了医院学科建设在医院发展中的重要意义,分析了目前医院科室管理的现状,介绍了科室目标管理的基本内涵和特点、组织实施的程序和方法,论述了科室实施目标管理的注意事项。     

Right on target?

Targets have become an integral part of health care, whether we agree with them or not. Many accept the progress made with the use of targets, but our duty as health professionals is to ensure that their use and interpretation is undertaken with the same care and understanding of their limitations that we apply to our clinical practice, and that they are not mis-interpreted or used to justify the latest political idioms. Currently the healthcare profession is failing to understand the consequences of setting targets, or the wider implications of hitting them. This article aims to summarise how we can learn from past experiences to become more aware of the benefits and draw-backs of targets in healthcare, and how we can utilise them more efficiently in health care.     

乳腺常见疾病的钼靶X线诊断

目的通过分析337例乳腺病变的钼靶X线征象,总结出各种病变的特征性表现,以提高乳腺疾病的钼靶X线诊断水平。方法337例均进行钼靶照片。乳腺导管内乳头状瘤患者除照乳腺平片外,尚进行溢乳导管造影。所有病例均经手术或穿刺病理证实。结果良性病变中以乳腺增生症、纤维腺瘤、乳腺囊肿、乳腺导管内乳头状瘤和炎症多见,良性肿块边缘光滑、锐利、密度均匀,钙化较粗大,肿块直径X线测量值等于临床测量值。乳腺癌主要表现为肿块,边缘不光整,有分叶和毛刺,钙化细小、成簇、泥沙样,肿块直径X线测量值<临床测量值。结论乳腺钼靶X线照片对乳腺病变的发现及良、恶性病变的鉴别诊断有很大价值。     

基于网络药理学对参麦注射液缓解CIPN作用机制分析

目的 探讨参麦注射液缓解化疗所致周围神经毒性(CIPN)的作用机制。方法 借助ETCM及TCMSP检索红参及麦冬的化学成分和作用靶点,通过OMIM、Disgenet、GeneCards等多个数据库查询与CIPN相关的基因。运用Cytoscape软件构建化合物-靶点网络,并利用String工具获得PPI网络筛选出核心靶点,最后通过Metascape对PPICN的靶蛋白进行基因富集分析。结果 参麦-靶点网络包含38个化合物和相应靶点105个;PPI核心网络包含23个蛋白;GO分析得到条目34个,KEGG通路富集筛选得到9条信号通路（P＜0.01）。结论 参麦注射液中对CIPN关键活性成分源自麦冬的组分占比60%;GO富集分析与KEGG通路分析结果显示参麦注射液通过多靶点与多通路的协同作用缓解CIPN。     

基于生信分析筛选胆囊癌关键基因#br# 及相关通路的研究#br#

目的通过生信分析筛选胆囊癌治疗的关键基因及癌症相关通路,挖掘胆囊癌患者的差异基因,预测胆囊癌的潜在治疗靶点。方法对GEO数据库中获得的芯片数据进行差异基因（DEGs）分析。选取NCBI 基因表达综合数据库(GEO)中的基因表达芯片 “GSE76633 ”和 “GSE74048”,利用GEO2R在线分析工具对胆囊癌样本和正常胆囊样本中的差异基因进行筛选。在DAVID和KOBAS上对差异基因进行生物过程（GO）分析和通路富集（KEGG）分析。使用蛋白质 蛋白质相互作用（PPI）分析数据库STRING构建靶点互作（PPI）网络模型。结果该研究共筛选了197个差异基因（P<005,|Log2FC|>2）,其中有33个上调基因,164个下调基因。这些基因主要参与了代谢过程的调节,脂肪酸β 氧化、氧化 还原过程等GO生物过程。主要调控代谢途径,甘氨酸、丝氨酸和苏氨酸代谢,缬氨酸亮氨酸和异亮氨酸降解,抗生素的生物合成等。结论该研究利用生物信息学筛选出胆囊癌中的差异基因及相关通路,帮助理解其分子机制及在胆囊癌发病机制和发生、发展过程中的作用,为寻找胆囊癌新的治疗靶点提供思路。     

颈前入路不同靶点射频热凝术治疗颈椎间盘突出症的疗效比较

目的 比较颈前入路不同靶点射频热凝术治疗颈椎间盘突出症的疗效.方法 将颈椎间盘突出症患者30例随机分为两组,每组各15例.A组射频靶点为病变椎间盘患侧中后1/3部,B组射频靶点为突出物基底部.采用视觉模拟评分法（VAS）评定术前与术后1、7d时疼痛程度;术后3、12个月时随访,采用日本骨科学会（JOA）评分标准行疗效评定.结果 与术前比较,两组术后1、7d时VAS评分减低,术后3、12个月时JOA评分提高,差异有统计学意义（P＜0.05）;与术后1d时比较,两组术后7d时VAS评分差异无统计学意义（P＞0.05）;与术后3个月时比较,两组术后12个月时JOA评分差异无统计学意义（P＞0.05）;两组术后同时点比较,术后1、7d时VAS评分和术后3、12月时JOA评分差异均无统计学意义（P＞0.05）.各例术中及术后均未见严重并发症.结论 病变椎间盘患侧中后1/3部和突出物基底部均是射频热凝术治疗颈椎间盘突出症的安全有效靶点,两者临床近中期疗效无明显差别.     

A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Filling the Gaps

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for ASCVD risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis. The guideline has been received with mixed reviews and significant controversy. Because of the evidence-based nature of the guideline, there is room for several questions and uncertainties on when and how to use lipid-lowering therapy in clinical practice. The goal of the Mayo Clinic Task Force in the assessment, interpretation, and expansion of the ACC/AHA cholesterol treatment guideline is to address gaps in information and some of the controversial aspects of the newly released cholesterol management guideline using additional sources of evidence and expert opinion as needed to guide clinicians on key aspects of ASCVD risk reduction.