荔枝草治疗急性咽炎有效部位筛选＊

目的 筛选荔枝草治疗急性咽炎的有效部位，研究治疗急性咽炎的作用机制，为荔枝草资源的药食两用开发提供理论依据。方法 通过二甲苯致小鼠耳肿胀试验筛选荔枝草抗炎有效部位，采用氨水刺激喉部法建立大鼠急性咽炎模型，通过行为学观察、ELISA双抗夹心检测、病理形态学观察和咽部组织蛋白表达研究乙酸乙酯部位对大鼠急性咽炎的治疗效果。结果 荔枝草乙酸乙酯提取物对二甲苯致小鼠耳肿胀有明显的抑制作用，氨水刺激建立的急性咽炎模型符合急性咽炎动物模型特征，乙酸乙酯部位提取物可显著改善急性咽炎大鼠的咽部病理形态学表现。不同剂量治疗组大鼠血清及咽部组织中IL-1β、IL-6及TNF-α炎性因子数量均下降，高剂量组下降最为明显。荔枝草乙酸乙酯提取物可明显增加大鼠咽部组织IκBα蛋白表达，降低NF-κBp65蛋白表达。结论 荔枝草乙酸乙酯部位提取物对急性咽炎具有治疗作用，可能与抑制咽部炎症病理改变的发生，能调节血液中炎症因子、抑制NF-κB表达和IκBα解离有关。     

Active learning in head and neck trauma: outcomes after an innovative educational course

Excellence in teaching and learning is fundamental to the provision of quality training for doctors and for this a sound knowledge of the principles of adult learning theory is important. We present an educational course in head and neck trauma skills for emergency medicine (EM) registrars, using the pedagogical principle of active learning. Our aim was to provide trainees with skills in the evaluation and management of hard and soft tissue injuries to the head, neck, and mouth. Active learning has been shown to provide a superior experience in classrooms, creating a ‘deep’ understanding of the material. To maximise learning, we used these principles to develop small group seminars led by a diverse range of teachers that allowed trainees to acquire hands-on skills. Questionnaires that were completed before and after the course showed an appreciable educational impact. We conclude that innovative teaching methods facilitate the sharing of knowledge that will benefit patient care.     

活态中医药传统知识数据库的构建与应用意义＊

目的 国家印发《关于促进中医药传承创新发展的意见》指出要依托现有资源建设国家和省级中医药数据中心，以信息化支撑中医药服务体系建设。本文提出活态中医药传统知识数据库的构建思路和具体实施，为推动中医药知识信息化和推广中医药保护提供参考。方法 主要采用文献分析法了解国外数据库进展，梳理国内中医药数据库运行经验，剖析活态中医药传统知识数据库的建设和运行的实际问题，明确数据库建设思路与意义。结果 国家利用资源建立中医药传统知识保护数据库，信息化在知识的保护和传承创新方面发挥一定的作用，但世界上许多传统知识较为丰富的国家和地区，如印度、韩国等已经走在在传统知识数据保护的前列，我国数据库建设和应用仍需要研究、探索和改善，中医药传统知识的保护和分类建设亟需加强，数据信息挖掘与共享合作等规范需要确立。结论 国家高度重视中医药的传承与发展，要以信息化支撑中医药传统知识体系建设，活态中医药传统知识数据库系统帮助数据信息收集整理的同时，也对中医药传统知识的专家人才队伍和技术标准化体系建设有积极作用，以及将来中医药行业规范化建设形成坚实的数据基础。     

Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

Pentobarbital overdose: A case of contract killing

Suicides by pentobarbital overdose have increased since about 2012, which appear to be influenced by technical information on active euthanasia that has spread over the Internet. We encountered a pentobarbital poisoning case of a patient with amyotrophic lateral sclerosis. A caregiver found the patient unconscious immediately after two visitors left the room. The patient was immediately transferred to the emergency hospital but eventually declared dead. A fatal concentration of pentobarbital was detected in peripheral blood samples collected in the emergency hospital and during autopsy (53.8 μg/mL and 29.4 μg/mL, respectively). Because the ratios of pentobarbital concentrations between the gastric contents and peripheral blood were 35 and 29 in the hospital and autopsy samples, respectively, it is likely that pentobarbital was administered via the gastrostomy tube. The patient had contacted the visitors through social media. Although the patient had requested the doctor perform active euthanasia and expressed a desire to end their life on social media, nobody had noticed the plan to commit suicide.     

Visualizing changes in physical activity behavioral patterns after redesigning urban infrastructure

The aim of this study was to explore effects of a major urban reconstruction on physical activity (PA) behavior by comparing PA intensity hotspots before and after the tunneling of a highway with a new infrastructure prioritized for walking and cycling. In total, 126 individuals participated before and after the tunneling. GPS loggers and accelerometers were used to assess location and PA levels. A geographic information system (GIS) was used to perform optimized hotspot analyses on PA data, both on transport and stationary data points. The results showed several changes in PA hotspots on trip data, even if total PA levels did not change. At follow-up, PA intensity hotspots were more connected, with the new infrastructure as a central connection. This was true for higher and lower educated individuals. Therefore, if changes in the built environment do not result in changes on population-level outcomes, this does not imply that they have no impact on behavior.     

基于网络药理学研究黄连解毒汤抗幽门螺杆菌感染作用机制

目的运用网络药理学方法预测黄连解毒汤抗Hp感染的主要有效成分、靶点及信号通路,挖掘其潜在作用机制,为后续实验研究提供依据。方法应用TCMSP筛选黄连解毒汤中黄连、黄芩、黄柏、栀子4味中药的主要有效成分及其潜在作用靶点。通过GeneCards数据库和人类孟德尔遗传数据库(OMIM)筛选Hp感染相关靶点,并取药物和疾病的交集靶点。将交集靶点导入Cytoscape 3.7.2构建有效成分和Hp感染相关靶点网络,并进行拓扑学分析。应用STRING在线分析平台构建靶蛋白相互作用(PPI)网络并进行分析。运用R语言在线检索Bioconductor平台对靶点进行GO功能富集;通过DAVID数据库对靶点进行KEGG通路富集分析。结果黄连解毒汤中共筛选出85个有效成分,主要包括槲皮素、小檗碱、山柰酚、汉黄芩素、黄芩素等。对应靶点112个,疾病相关靶点1960个,药物疾病共同靶点71个。网络中度值最高的有效成分为槲皮素,度值最高的靶点为环加氧酶1(PTGS1)。PPI网络中69个节点中度值较高的靶蛋白包括半胱氨酸蛋白酶3(CASP3)、IL6、MAPK8、原癌基因(MYC)、VEGFA、表皮生长因子受体(EGFR)等。GO功能富集分析共获得89个条目,KEGG通路富集分析共筛选12条存在显著差异的信号通路,其中发挥主要作用的有癌症通路、ErbB信号通路、p53信号通路、凋亡、黏附斑等。结论黄连解毒汤可通过多成分、多靶点、多通路发挥对Hp的治疗作用,可通过抗肿瘤机制调控胃癌进程,本研究可为其有效成分研究和抗Hp机制研究提供依据。     

Utility of Multiparametric Magnetic Resonance Imaging With PI-RADS,Version 2, in Patients With Prostate Cancer Eligible for Active Surveillance: Which Radiologic Characteristics Can Predict Unfavorable Disease?

BackgroundWe investigated the utility of multiparametric magnetic resonance imaging (mpMRI) using Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), scoring in patients with prostate cancer eligible for active surveillance (AS).Materials and MethodsThe medical records of the patients who had undergone mpMRI before radical prostatectomy from 2014 to 2018 were reviewed. All the patients had met the Prostate Cancer Research International AS criteria. PI-RADSv2 scores were assigned to 12 prostate regions. Unfavorable disease was stratified using the American Joint Committee on Cancer (AJCC) prognostic scale as stage IIB (Gleason score [GS], 3+4 and pathologic stage T2) and IIC-III (GS, ≥ 4+3 or pathologic stage T3).ResultsOf 376 eligible patients, 184 (48.9%), 129 (34.3%), and 63 (16.8%) had AJCC stage I, IIB, and IIC-III disease, respectively. The patients with IIC-III disease were older and had a higher prostate-specific antigen density than those with stage I or IIB disease. PI-RADS 5 lesions were more frequent in patients with stage IIC-III than in patients with stage I or IIB disease. Multivariable analysis revealed that ≥ 2 lesions with a PI-RADS 5 score was an independent predictor for unfavorable disease (hazard ratio [HR], 3.612; P < .001 for IIB; HR, 6.562; P < .001 for IIC-III), and PI-RADS score of ≥ 4 was limited for predicting AJCC stage IIB disease (HR, 2.387; P = .01).ConclusionmpMRI with PI-RADSv2 showed high negative predictive value for patients with prostate cancer eligible for AS. Multiple PI-RADS 4-5 lesions were associated with unfavorable disease compared with solitary lesions. Multiple PI-RADS 5 lesions were strongly associated with GS ≥ 4+3 or pathologic T3 disease. Targeted biopsy or radical treatment should be considered for these patients.     

Increasing Rate of Noninterventional Treatment Management in Localized Prostate Cancer Candidates for Active Surveillance: A North American Population-Based Study

Background

The rate of noninterventional treatment (NIT) in prostate cancer (PCa) active surveillance (AS) candidates is on the rise. However, contemporary data are unavailable. We described community-based NIT rates within 16 Surveillance Epidemiology and End Results (SEER) registries between 2010 and 2014.

基于药动学与药效学相关联的养阴通脑颗粒主要有效部位正交配伍研究

目的探讨养阴通脑颗粒主要有效部位(总生物碱、总黄酮、总皂苷、总酚酸)配伍后在脑缺血再灌注模型大鼠体内药物浓度及其药动学与药效学变化。方法采用正交试验法组成上述主要有效部位用量配比不同的9个组方,供脑缺血再灌注模型大鼠ig给药,高效液相色谱-二极管阵列检测器(HPLC-DAD)测定不同时间点血浆中的葛根素、阿魏酸和川芎嗪血浆药物浓度。DAS 3.2.6软件以非房室模型拟合药动学参数,并运用总量统计矩法和综合评分法对整体药动学特征进行评价。同时采用酶联免疫吸附测定(ELISA)法测定大鼠血浆中超氧化物歧化酶(SOD)和过氧化氢酶(CAT)的含量。最后进行药动学-药效学(PK-PD)模型研究,获得各药物浓度与药效之间的定量方程。结果葛根素、阿魏酸和川芎嗪在模型大鼠体内的药动学特征有所差异。总量统计矩和综合评分研究表明不同配伍对总量零阶矩、总量平均滞留时间、综合评分等参数影响不一。主要有效部位正交配伍给药后,一定程度上会抑制脑缺血再灌注大鼠血浆中SOD和CAT的降低。各PK-PD模型均采用Sigmoid-Emax模型,拟合结果与实测数据之间相关性良好,R值均大于0.85。结论养阴通脑颗粒主要有效部位配伍对模型大鼠体内的药动学行为和抗氧化指标具有一定影响;中药复方多成分药物代谢动力学可采用总量统计矩和综合评分法进行研究;PK-PD结合模型可用于中药复方多成分药动学与药效学之间相关性的评价与预测。