熊磊教授基于“脾为痰源”辨治儿童癫痫临证思路探赜

熊磊教授以理脾为本，将治痰贯穿始终。根据小儿脾常不足、肾常虚、肝常有余的生理特点，癫痫发作期治疗主以涤痰开窍，辅以理气健脾，同时配合活血化瘀通窍与平肝息风潜阳。主要选方为柴芍温胆汤、天麻钩藤饮、桃红四物汤加减；缓解期则以补肾养肝为主，兼以健脾化痰，主要选方为杞菊地黄丸合定痫丸加减，取得较好临床疗效。     

Study on the Value of Ultrasound Elastography Combined with Plasma miRNA Expression in the Early Detection of Breast Cancer

Background: Breast cancer (BC) is the most common malignant tumor in women, and its morbidity and mortality are increasing each year, due to the lack of specific clinical symptoms in the early stage of BC, and the lack of diagnostic methods for early breast cancer. Therefore, identifying an effective diagnostic method for early BC has become urgent. Materials and Methods: Breast lesions with a histological diagnosis that were examined by ultrasonic elastography (UE) in our department from June 2020 to December 2021 were reviewed. qRT-PCR was performed to measure the expression levels of miR-144-5p and miR-26b-5p in the plasma of patients with BC. The receiver operating characteristics (ROC) curve and area under the curve (AUC) were used to investigate the potential diagnostic value of miR- 144-5p, miR-26b-5p and the elastographic score in BC. Results: The ultrasonic elastography score(UES) was found to be significantly upregulated in BC compared with that in benign breast lesions, and the AUC, sensitivity and specificity were 0.809, 0.717 and 0.806 for distinguishing BC from benign breast lesions, respectively. miR-144-5p and miR-26b- 5p were found to be upregulated in the plasma of BC patients, and miR-144-5p+miR-26b-5p had 0.781 sensitivity and 0.780 specificity for the diagnosis of BC. Furthermore, we found that the diagnostic performance of miR-144-5p and miR-26b-5p combined with UES for BC had 0.913 sensitivity and 0.890 specificity. Conclusions: The combination of plasma miR-144-5p, miR-26b-5p and UES has a very high clinical application value for the early detection of BC.     

Genomic variants within chromosome 14q32.32 regulate bone mass through MARK3 signaling in osteoblasts

Bone mineral density (BMD) is a highly heritable predictor of osteoporotic fracture. GWAS have identified hundreds of loci influencing BMD, but few have been functionally analyzed. In this study, we show that SNPs within a BMD locus on chromosome 14q32.32 alter splicing and expression of PAR-1a/microtubule affinity regulating kinase 3 (MARK3), a conserved serine/threonine kinase known to regulate bioenergetics, cell division, and polarity. Mice lacking Mark3 either globally or selectively in osteoblasts have increased bone mass at maturity. RNA profiling from Mark3-deficient osteoblasts suggested changes in the expression of components of the Notch signaling pathway. Mark3-deficient osteoblasts exhibited greater matrix mineralization compared with controls that was accompanied by reduced Jag1/Hes1 expression and diminished downstream JNK signaling. Overexpression of Jag1 in Mark3-deficient osteoblasts both in vitro and in vivo normalized mineralization capacity and bone mass, respectively. Together, these findings reveal a mechanism whereby genetically regulated alterations in Mark3 expression perturb cell signaling in osteoblasts to influence bone mass.     

滋肾育胎丸加减方预防ACA阳性者不良妊娠结局的效果及机制研究＊

目的 探讨滋肾育胎丸加减方预防抗磷脂抗体（ACA）阳性者不良妊娠结局的效果及机制研究。方法 选取2016年2月至2019年2月我院收治的89例ACA阳性，先兆性流产或有习惯性流产（RSA）史患者，将采用西医治疗的40例作为对照组，将采用西医联合滋肾育胎丸加减方治疗的49例作为观察组，比较两组中医证候疗效、中医证候积分、ACA-IgA、ACA-IgM、ACA-IgG、凝血指标［血小板聚集功能（PAF）、活化蛋白C（PC）、抗凝血酶（AT）、纤溶酶原激活抑制物-1（PAI-1）］、Th1/Th2细胞因子［干扰素γ（IFN-γ）、白介素-2（IL-2）、白介素-4（IL-4）、白介素-10（IL-10）］、妊娠结局、安全性。结果 治疗2周后检测ACA，观察组2例未降低，对照组11例未降低，观察组未降低患者占比低于对照组（P<0.05）；观察组总有效率100.00%高于对照组85.00%（P<0.05）；观察组治疗4周、7周后中医证候积分低于对照组（P<0.05）；观察组治疗4周、7周后ACA-IgA、ACA-IgM、ACA-IgG低于对照组（P<0.05）；观察组治疗4周、7周后PAF、PAI-1低于对照组，PC、AT高于对照组（P<0.05）；观察组治疗4周、7周后IFN-γ、IL-2低于对照组，IL-4、IL-10高于对照组（P<0.05）；观察组活产率95.92%高于对照组80.00%（P<0.05）；组间不良反应总发生率比较，差异无统计学意义（P>0.05）。结论 动态监测ACA对滋肾育胎丸加减方精准应用具有指导意义，指导滋肾育胎丸加减方通过调理脏腑、气血、经络功能，改善先兆性流产或有RSA史患者临床症状及凝血因子指标，降低ACA水平，并可改善患者免疫耐受功能，提高胎儿活产率，且安全性高。     

脑卒中患者急性应激障碍及影响因素研究

目的探讨脑卒中患者急性应激障碍发生现状及影响因素。方法采用斯坦福急性应激反应问卷对349例脑卒中住院患者进行调查。结果共163例(46.70%)患者发生急性应激障碍;Logistic回归分析结果显示,患者性格、是否存在偏瘫及是否吞咽功能障碍是脑卒中患者发生急性应激障碍的主要影响因素(P0.05,P0.01)。结论脑卒中患者急性应激障碍发生率较高,内向性格及存在偏瘫和吞咽功能障碍的患者更容易发生急性应激障碍。医护人员应及时为高危患者提供个体化治疗及预见性护理,防止脑卒中患者发生急性应激障碍。