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。     

Abnormal glucose tolerance in a pediatric cystic fibrosis cohort: Trends in clinical outcomes and associated factors in the preceding years

Background and aimsDeterioration of anthropometric and lung function parameters was shown to precede the onset of cystic fibrosis-related diabetes (CFRD) in adults. In children, studies have been conducted in small cohorts with relatively short observation period. Study objectives were to document the longitudinal trends of anthropometric, pulmonary, nutritional and metabolic parameters from cystic fibrosis (CF) diagnosis to the ascertainment of abnormal glucose tolerance and identify parameters associated with the incidence of such abnormalities in a pediatric CF cohort.Methods and resultsRetrospective cohort study of 281 children with CF. Longitudinal trends of anthropometric, lung function, nutritional and metabolic data were generated from CF diagnosis to the ascertainment of abnormal glucose tolerance defined as the presence of either impaired glucose tolerance (IGT), unconfirmed CFRD or CFRD. Cox models and Kaplan–Meier curves were used to identify factors associated with developing abnormal glucose tolerance.Forty-five percent of cohort had normal glucose tolerance (NGT), 27% IGT, 10% unconfirmed CFRD and 18% CFRD. Children who developed CFRD displayed lower height z-scores from a very early age. Conversely, HbA1c levels began to rise closer to CFRD ascertainment. Height z-scores (HR: 0.45; CI 95% [0.29–0.69]) and HbA1c (HR: 2.43; CI 95% [1.86–3.18]) in years preceding ascertainment were associated with the risk of developing CFRD.ConclusionChildren who developed CFRD display distinctive trends for height z-scores from a very early age, whereas HbA1c appears as a marker of established glucose metabolism derangements.     

人工智能在中医药领域的应用进展及现状思考

人工智能（Artificial Intelligence，AI）的蓬勃兴起为现代社会带来了前所未有的机遇，中医药是中华民族传承千年的文化瑰宝。随着人工智能技术不断在中医药领域的科技创新中崭露头角，二者的融合不断加深，人工智能在中医药领域的发展前景、争议挑战也引发了诸多思考。本文将从人工智能在中医药领域的应用入手，对人工智能辅助中医诊断、智能决策与数据挖掘、健康管理及中草药现代化研究等方面，就近年来国内外研究进展进行总结与分析，以期为AI视域下实现中医药现代化、智能化赋能。     

A Perioperative Care Display for Understanding High Acuity Patients

Background  The data visualization literature asserts that the details of the optimal data display must be tailored to the specific task, the background of the user, and the characteristics of the data. The general organizing principle of a concept-oriented display is known to be useful for many tasks and data types. Objectives  In this project, we used general principles of data visualization and a co-design process to produce a clinical display tailored to a specific cognitive task, chosen from the anesthesia domain, but with clear generalizability to other clinical tasks. To support the work of the anesthesia-in-charge (AIC) our task was, for a given day, to depict the acuity level and complexity of each patient in the collection of those that will be operated on the following day. The AIC uses this information to optimally allocate anesthesia staff and providers across operating rooms. Methods  We used a co-design process to collaborate with participants who work in the AIC role. We conducted two in-depth interviews with AICs and engaged them in subsequent input on iterative design solutions. Results  Through a co-design process, we found (1) the need to carefully match the level of detail in the display to the level required by the clinical task, (2) the impedance caused by irrelevant information on the screen such as icons relevant only to other tasks, and (3) the desire for a specific but optional trajectory of increasingly detailed textual summaries. Conclusion  This study reports a real-world clinical informatics development project that engaged users as co-designers. Our process led to the user-preferred design of a single binary flag to identify the subset of patients needing further investigation, and then a trajectory of increasingly detailed, text-based abstractions for each patient that can be displayed when more information is needed.     

Comparison of the protective effects of curcumin and caffeic acid phenethyl ester against doxorubicin-induced testicular toxicity

Whether testicular toxicity is mediated by matrix metalloproteinases (MMPs) is an important question that has not been examined. This study investigated the suppressive effect of curcumin and caffeic acid phenethyl ester (CAPE) on oxidative stress, apoptosis, and whether MMPs mediate doxorubicin (DOX)-induced testicular injury. Male rats were randomly divided into eight groups (n = 8 per group). The groups were as follows: sham, dimethyl sulphoxide (100 µL), DOX (3 mg/kg), CAPE (2.68 mg/kg), curcumin (30 mg/kg), DOX+CAPE (3 mg/kg DOX and 2.68 mg/kg CAPE), DOX+curcumin (3 mg/kg DOX and 30 mg/kg curcumin) and DOX+CAPE+curcumin (3 mg/kg DOX, 2.68 mg/kg CAPE and 30 mg/kg curcumin). Injections were administered daily for 21 days. The oxidative stress, MMPs, proinflammatory cytokines and apoptotic markers in the DOX group were higher than the sham group (p < .05); these measures were lower in the groups treated with CAPE and curcumin together with DOX compared with the DOX group (p < .05). The results showed that MMPs mediated DOX-induced testicular injury, but CAPE and especially curcumin suppressed testis injury and cell apoptosis by suppressing DOX-induced increases in MMPs, oxidative stress and proinflammatory cytokines. However, curcumin exhibited more pronounced effects than CAPE in terms of all studied parameters.     

Responsabilidad social corporativa en los centros de la red hospitalaria de utilización pública de Cataluña

The adoption of a management approach that integrates corporate social responsibility in organizations is an increasing trend that responds to the demands of society related to sustainability, ethics and transparency. Health organizations are adopting corporate social responsibility asymmetrically, which raises the analysis of the implementation models and the developed initiatives. Through qualitative research, with four in-depth case studies of the Catalan health sector, this article analyzes the need to address this new approach and to identify good practices and the challenges for its implementation.