新指南、新观点、新认识

时隔3年,美国心脏协会（American Heart Association,AHA）/美国卒中协会（American Stroke Association,ASA）颁布了新版的《卒中和短暂性脑缺血发作（transient ischemic attack,TIA）二级预防指南》（以下称“新指南”）[1].新指南由美国耶鲁大学Walter Kernan博士领导的多学科写作小组执笔完成,对2011年版指南进行了大篇幅的更新,《国际脑血管病杂志》已刊出了其中文翻译版[2].新版指南有哪些更新？如何认识与对待,如何在临床实践中有效利用,在此做一浅谈.     

新指南、新观点、新认识

@@     

Hygiene: new hopes, new horizons

Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.     

Proteomics: new perspectives, new biomedical opportunities

Proteomics-based approaches, which examine the expressed proteins of a tissue or cell type, complement the genome initiatives and are increasingly being used to address biomedical questions. Proteins are the main functional output, and the genetic code cannot always indicate which proteins are expressed, in what quantity, and in what form. For example, post-translational modifications of proteins, such as phosphorylation or glycosylation, are very important in determining protein function. Similarly, the effects of environmental factors or multigenic processes such as ageing or disease cannot be assessed simply by examination of the genome alone. This review describes the underlying technology and illustrates several areas of biomedical research, ranging from pathogenesis of neurological disorders to drug and vaccine design, in which potential clinical applications are being explored.     

Vaccines,new opportunities for a new society

Vaccination is the most effective medical intervention ever introduced and, together with clean water and sanitation, it has eliminated a large part of the infectious diseases that once killed millions of people. A recent study concluded that since 1924 in the United States alone, vaccines have prevented 40 million cases of diphtheria, 35 million cases of measles, and a total of 103 million cases of childhood diseases. A report from the World Health Organization states that today vaccines prevent 2.5 million deaths per year: Every minute five lives are saved by vaccines worldwide. Overall, vaccines have done and continue to do an excellent job in eliminating or reducing the impact of childhood diseases. Furthermore, thanks to new technologies, vaccines now have the potential to make an enormous contribution to the health of modern society by preventing and treating not only communicable diseases in all ages, but also noncommunicable diseases such as cancer and neurodegenerative disorders. The achievement of these results requires the development of novel technologies and health economic models able to capture not only the mere cost–benefit of vaccination, but also the value of health per se.     

Phosphate handling: new genes, new molecules

BACKGROUND: Inappropriate renal phosphate transport may alter serum phosphate concentration and bone mineralization, and it may also increase the risk of renal lithiasis or soft-tissue calcifications. Molecular identification of renal phosphate transporters and regulatory proteins has improved our knowledge of the mechanisms that control phosphate balance. This summary reviews recent findings regarding the consequences of mutations affecting several human genes encoding for phosphate transporters or regulatory proteins. Further, it describes the role played by the fibroblast growth factor 23-Klotho axis in phosphate homeostasis and its involvement in the pathophysiology of phosphate disturbances in chronic kidney diseases. CONCLUSIONS: This progress may allow development of new drugs that interfere with phosphate transporters, hormonal receptors or associated proteins to improve treatment and to help prevent secondary hyperparathyroidism.     

Prostatitis revisited: new definitions,new approaches

Prostatitis syndromes represent an important health care problem resulting in considerable morbidity and expenditure of health care resources. Comparison of the traditional and consensus classification schemes demonstrates no changes in the traditional categories of acute bacterial prostatitis and chronic bacterial prostatitis. Examining only the EPS, however, results in diagnosis of half of the patients with inflammatory CP/CPPS. An optimal diagnostic strategy required evaluation of the VB3 and SFA in addition to the traditional EPS examination. Such precision is necessary for research studies, but whether such precision is important clinically remains unproved. The new interest in optimal evaluation and characterization of patients with chronic prostatitis and related conditions has resulted in important research initiatives examining the etiology and optimal treatment for this large group of patients.     

Redox balance in the aging microcirculation: new friends, new foes, and new clinical directions

Cardiovascular aging is associated with a decline in the function of the vascular endothelium. Considerable evidence indicates that age-induced impairment of endothelium-dependent vasodilation results from a reduction in the availability of nitric oxide (NO(?) ). NO(?) can be scavenged by reactive oxygen species (ROS), in particular by superoxide radical (O(2) (?-) ), and age-related increases in ROS have been demonstrated to contribute to reduced endothelium-dependent vasodilation in numerous large artery preparations. In contrast, emerging data suggest that ROS may play a compensatory role in endothelial function of the aging microvasculature. The primary goal of this review is to discuss reports in the literature which indicate that ROS function as important signaling molecules in the aging microvasculature. Emphasis is placed upon discussion of the emerging roles of hydrogen peroxide (H(2) O(2) ) and peroxynitrite (ONOO(?-) ) in the aging microcirculation. Overall, existing data in animal models suggest that maintenance in the balance of ROS is critical to successful microvascular aging. The limited work that has been performed to investigate the role of ROS in human microvascular aging is also discussed, and the need for future investigations of ROS signaling in older humans is considered.