基于生物钟节律探讨前列腺癌的 发病机理及择时治疗策略

生物钟节律观与中医“天人一体”观相契合，生物钟节律紊乱可影响人体的生理病理状态，通过调节生物钟节律可达到提高治疗效果的目的。生物钟节律系统包括中枢生物钟节律系统与外周生物节律系统两大系统，分别在疾病发生发展中发挥不同的作用。与之相应，择时疗法是根据人体气血阴阳节律变化而选择相应药物治疗以达到最佳的疗效的一种时间医学治疗方法。临床上许多前列腺癌患者的发病与生物钟节律紊乱密切相关，通过调整生物钟节律具有预防和改善前列腺癌预后的积极作用。因此，本文将以现代生物钟节律的生理及病理机理为切入点，探讨不同生物钟节律系统紊乱在促前列腺癌中医主证形成过程中的发生机理，进而探讨择时治疗策略在不同类型前列腺癌治疗中运用的可行性，以期对前列腺癌的防治及预后产生一定的影响。     

生大黄、芒硝湿敷联合集束化护理对骨折患者使用甘露醇期间发生静脉炎的预防效果观察

目的:观察生大黄、芒硝湿敷联合集束化护理对骨折患者甘露醇使用期间静脉炎的预防效果。方法:选取使用20%甘露醇静脉滴注治疗的300例骨折患者,按随机数字表法分为对照组和观察组各150例。2组均实施集束化护理,观察组在甘露醇静脉滴注后使用生大黄、芒硝湿敷。比较2组患者静脉炎发生率、留置针留置时间和针口处疼痛、红肿情况。结果:观察组静脉炎严重程度轻于对照组,差异有统计学意义(P0.05)。观察组和对照组静脉炎发生率分别为12.67%、37.33%,2组比较,差异有统计学意义(P0.05)。观察组留置针留置时间2 d的比率为24.67%,低于对照组的39.33%(P0.05);观察组留置针时间5 d的比率为30.00%,高于对照组的18.67%(P0.05)。干预后,2组针口处疼痛评分、红肿直径均较干预前改善(P0.05);观察组针口处疼痛评分、红肿直径改善情况均优于对照组(P0.05)。结论:生大黄、芒硝湿敷联合集束化护理能减少骨折患者甘露醇使用期间静脉炎发生,延长留置针留置时间,减轻针口处疼痛、肿胀。     

血瘀体质调体主药主方的筛选

中医体质学认为，不同的个体体质对某些疾病具有易罹性、倾向性。现代研究表明，血瘀体质的易患疾病涉及冠心病、黄褐斑、子宫肌瘤、肝癌等诸多疾病，改善和调节血瘀体质可起到防治相关疾病的作用。文章提出活血化瘀、调畅血脉为主，益气行血、理气行血、清热凉血、滋阴养血为辅的血瘀体质调体法则，并根据血瘀体质的稳定性和调体的长期性，阐述活血调体主药的适中性与调体辅药的前瞻性筛选原则。进而结合血府逐瘀汤的原方主治，并深入分析其组方结构和加减运用，将血府逐瘀汤移植作为血瘀体质的调理主方，以期对临床血瘀体质的调理起到一定的指导作用。     

不稳定股骨转子间骨折不同内固定方法的疗效比较

目的 浅析不同内固定方法对不稳定股骨转子间骨折的疗效差异。方法 2009年1月至2013年5月行内固定手术的不稳定股骨转子间骨折患者36例,采用Gamma钉固定10例为A组,动力髋螺钉(DHS)固定11例为B组,股骨近端抗旋髓内钉(PFNA)固定15例为C组。对不同的内固定方式的术中出血量、手术时间、术后并发症、骨折愈合时间及髋关节功能评分等相关数据进行统计学分析。结果 各组患者术后均获随访,平均随访时间1年半,住院及随访期间无死亡病例。C组手术时间较A、B两组短,且有统计学意义(P<0.05)。B组术中出血量最多,愈合时间长,C组出血最少,但与A组比较差异无统计学意义(P>0.05)。术中A组发生股骨颈干角变小1例,髋内翻1例;B组发生髋内翻2例,头钉穿出1例,内固定松动1例;C组无相关并发症发生。骨折愈合时间A、B、C三组间比较差异无统计学意义(P>0.05)。A、C两组髋关节功能评分均较B组高,差异有统计学意义(P<0.05),但A、C两组间差异无统计学意义(P>0.05)。结论 PFNA是治疗不稳定股骨转子间骨折一个很好的选择,手术操作简便,损伤较小,出血少,固定牢靠,术后髋关节功能恢复较好,值得临床推广。     

Altered inter‐ and intrahemispheric functional connectivity dynamics in autistic children

Emerging evidence has associated autism spectrum disorder (ASD) with static functional connectivity abnormalities between multiple brain regions. However, the temporal dynamics of intra‐ and interhemispheric functional connectivity patterns remain unknown in ASD. Resting‐state functional magnetic resonance imaging data were analyzed for 105 ASD and 102 demographically matched typically developing control (TC) children (age range: 7–12 years) available from the Autism Brain Imaging Data Exchange database. Whole‐brain functional connectivity was decomposed into ipsilateral and contralateral functional connectivity, and sliding‐window analysis was utilized to capture the intra‐ and interhemispheric dynamic functional connectivity density (dFCD) patterns. The temporal variability of the functional connectivity dynamics was further quantified using the standard deviation (SD) of intra‐ and interhemispheric dFCD across time. Finally, a support vector regression model was constructed to assess the relationship between abnormal dFCD variance and autism symptom severity. Both intra‐ and interhemispheric comparisons showed increased dFCD variability in the anterior cingulate cortex/medial prefrontal cortex and decreased variability in the fusiform gyrus/inferior temporal gyrus in autistic children compared with TC children. Autistic children additionally showed lower intrahemispheric dFCD variability in sensorimotor regions including the precentral/postcentral gyrus. Moreover, aberrant temporal variability of the contralateral dFCD predicted the severity of social communication impairments in autistic children. These findings demonstrate altered temporal dynamics of the intra‐ and interhemispheric functional connectivity in brain regions incorporating social brain network of ASD, and highlight the potential role of abnormal interhemispheric communication dynamics in neural substrates underlying impaired social processing in ASD.     

Zileuton,a 5-lipoxygenase inhibitor,increases production of thromboxane A2 and platelet aggregation in patients with asthma

Leukotrienes, generated from arachidonic acid via the lipoxygenase pathway, play an important role in the pathophysiology of asthma. Therefore, leukotriene inhibitors, such as Zileuton, are used in the treatment of asthma. However, thromboxanes, generated from arachidonic acid via the cyclooxygenase pathway, play an important role in platelet aggregation and thrombosis. Therefore, we studied whether Zileuton, by shifting arachidonic acid to the cyclooxygenase pathway, enhances thromboxane production and, hence, platelet aggregation. Blood samples were collected from 10 asthmatic patients before and 2 weeks after standard Zileuton treatment. Spontaneous platelet aggregation was measured in platelet-rich plasma. Platelet-rich plasma was also used to determine thromboxane B(2), a stable metabolite of thromboxane A(2), as the indirect measure of thromboxane A(2) because thromboxane A(2) is too unstable for assay. Baseline thromboxane B(2) and platelet aggregation values in the 10 asthmatic patients were normal. Treatment with Zileuton for 2 weeks significantly increased thromboxane B(2) levels from baseline levels of 267 +/- 54 microg/l to 389 +/- 62 microg/l after 2 weeks of treatment (P < 0.0002). Spontaneous platelet aggregation also increased significantly from baseline values of 4.2 +/- 2.4% to 6.8 +/- 2.8% after 2 weeks of treatment (P < 0.0001). These results establish that Zileuton, an effective drug for asthma, adversely affects in vitro platelet function. The findings suggest that this drug, and perhaps related agents also, may pose a thrombotic risk; clinical attention will be needed to address this possibility.     

MicroRNA与胃癌的关系

微小RNA(microRNA)是一类内源性、长度约为16～29 nt非编码小RNA,在细胞发育、增殖、分化、凋亡等方面都起了重要作用.通过与靶mRNA完全或不完全互补配对,引起mRNA的降解或翻译抑制,从而对基因转录后水平进行调控.microRNA既可作为促癌基因参与恶性肿瘤的发生和发育过程,又可作为抑瘤基因控制恶性肿...     

An alternative surgical approach for aortic infective endocarditis: vegetectomy

We describe a case of successful vegetectomy of the aortic valves for early infective endocarditis. An aortic vegetectomy was performed as an alternative to valve replacement for a 54-year-old man with three vegetations and mild regurgitation in aortic valve due to infective endocarditis. Postoperative clinical course was without signs of recurrent infection after follow-up of 19 months, and transesophageal echocardiography demonstrated aortic valve competence. We would suggest that vegetectomy with valve sparing may be a viable option in the context of early infective endocarditis involved aortic valve in selected patients.     

基于睾丸支持细胞结构功能探讨中药改善生精功能的动物实验系统评价

目的 系统评价中药对生精功能损害动物模型睾丸支持细胞结构功能的干预作用。方法 检索中国知网、维普、万方、EMbase、Pubmed数据库，筛选中药对生精功能损害动物模型睾丸支持细胞结构功能的实验研究。对文献偏倚风险进行评估，RevMan及Stata软件被用于结局指标分析。结果 共纳入30项研究，包含37篇随机对照实验文献。Meta分析结果显示，与模型组比较，中药可增加精子密度标准化均数差（SMD）=2.42，95%置信区间（CI）［1.47，3.37］，P<0.000 01，增加精子活力SMD=2.35，95%CI［1.70，2.99］，P<0.000 01。增加支持细胞骨架相关睾丸组织Vimentin及其mRNA水平。增加血睾屏障紧密连接相关睾丸组织Occludin、Claudin-11水平；增加血睾屏障黏附连接相关睾丸组织β-连环蛋白（β-catenin）、N-钙黏蛋白（N-cadherin）水平；增加血睾屏障缝隙连接相关睾丸组织间隙连接蛋白43（Cx43）水平。改善支持细胞功能，增加血清抑制素B（INHB）含量，增加睾丸组织卵泡刺激素受体（FSHR）、INHB mRNA、雄激素结合蛋白（ABP） mRNA、运铁蛋白（TF）、干细胞因子（SCF）、SCF mRNA、胶质细胞源性神经营养因子（GDNF）、GDNF mRNA、骨形态发生蛋白（BMP4）、BMP4 mRNA，差异均有统计学意义（P<0.05）。结论 中药能够有效提高生精功能损害动物模型的精子密度及活力，改善睾丸支持细胞结构及功能。然而受纳入文献质量因素的影响，以上论断有待相关高质量研究予以进一步验证。