烟雾病病因与发病机制研究进展

烟雾病是一种进行性脑血管病,其病因及发病机制目前尚未阐明。根据近年来国内外这方面的研究进展,本文作一简要综述,认为烟雾病可能属于多基因遗传性疾病,并且与感染、免疫、放射线、内分泌和转化生长因子-β1,碱性成纤维细胞生长因子等均具有密切关系。     

Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions. Chronic kidney disease (CKD) is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China. Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis, leading to proteinuria, hematuria and elevated serum creatinine. Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor, some doctors question its ability to increase the risk and severity of developing COVID-19. Neither clinical data nor basic scientific evidence supports this assumption. Therefore, patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy. Patients with CKD are generally the elderly population suffering from multiple comorbidities. Moreover, some patients with CKD might need to take glucocorticoids and immunosuppressants. Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week. Considering all the above reasons, patients with CKD are more vulnerable to COVID-19 than the general population. The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death. Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD. In this review, we provide some practical management recommendations for health care providers, patients with CKD, dialysis patients and dialysis facilities.     

肾康注射液对腺嘌呤致肾间质纤维化的预防机制

目的探讨肾康注射液对腺嘌呤致肾间质纤维化的预防机制。方法将SD大鼠24只随机分为3组,正常对照组,腺嘌呤模型组,肾康注射液干预组,28天后采集血液、尿液标本观察大鼠血尿素氮(BUN)、血肌酐(Scr)和24小时尿量、尿蛋白定量(UTP)水平的变化,留取肾组织,用于HE染色观察肾组织病理改变及免疫组化方法检测肾小管-间质中转化生长因子-β1(TGF-β1)和结缔组织生长因子(CTGF)的表达。结果同模型组相比,干预组可明显降低大鼠Scr、BUN、UTP,降低TGF-β1、CTGF在肾组织中的表达。结论肾康注射液可降低血BUN、Scr、UTP,肾组织CTGF和TGF-β1表达量,延缓肾间质纤维化。     

Clinical analysis of retroperitoneoscopic nephroureterectomy for renal tuberculosis

ObjectivesTo explore the feasibility and safety of retroperitoneoscopic nephroureterectomy for kidney tuberculosis.MethodsForty-eight retroperitoneoscopic nephroureterectomies and thirty-five nephroureterectomies for kidney tuberculosis procedures were performed from June 2008 to December 2014. The patients consisted of 53 males and 30 females with a mean age of 36 years (range: 26–51 years). The patients'' data were reviewed and analyzed.ResultsThe retroperitoneoscopic nephroureterectomy procedures were completed successfully in 48 cases with no conversions to open surgery. The mean operating time was 170 minutes (range: 121–258 minutes), the mean blood loss was 110 ml (range: 70–250 ml), and the mean hospital stay was 5.70 days (range: 5–14 days); these were all much less than nephroureterectomy procedures (P < 0.05). A total of five minor complications (10.4%) occurred, injury to the peritoneum was observed in three patients, and infection at the incision site was observed in two patients, there were no obvious difference between the two surgical methods (P > 0.05). Seventy-five patients were followed up, and the average follow-up time was 12.5 months (range: 6–20 months). All the patients recovered without any lesions remaining.ConclusionsThe results of this study indicate that retroperitoneoscopic nephroureterectomy is a feasible, safe, effective, and less invasive treatment modality for treating renal tuberculosis.     

Screening of long non-coding RNAs markers in plasma of children with chronic gastritis

ObjectiveThe study aimed to detect and analyze long non-coding RNAs (lncRNAs) in plasma of children diagnosed with chronic gastritis, and to explore its biological functions and involved signaling pathways.MethodsThe plasma samples were collected from six children that were diagnosed with chronic gastritis by physical examination, gastroscopy, and pathological examination and six healthy children. The plasma samples were assayed for determining the expression profiles of lncRNA based upon the gen chip detection. The specific expression of lcnRNA in plasma of children with chronic gastritis was analyzed and its biological functions were speculated.ResultsFive lncRNAs (RP11-697M17.1, RP11-388M20.9, AFAP1-AS1, BC062758, and XLOC001406) were significantly up-regulated, and five lncRNAs (UNQ697, BX571672.5, CYP4F35P, ANKRD20A5P, and AL832737) were observed to be significantly down-regulated. The lncRNAs RP11-697M17.1, and UNQ697 were detected with the highest up-regulation and down-regulation, respectively. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis showed that the up-regulated lncRNAs were significantly enriched in 20 signaling pathways such as phosphoinositide-3-kinase–protein kinase B (PI3K-Akt) pathway, and the down-regulated lncRNAs target genes were significantly enriched in 20 signaling pathways such as the metabolic pathway.ConclusionThe analysis of the lncRNA expression profiles in plasma of children with chronic gastritis revealed that the lncRNA RP11-697M17.1, and lncRNA UNQ697 may act as plasma markers for predicting chronic gastritis in children.     

Cardiovascular effects and mechanisms of sodium-glucose cotransporter-2 inhibitors

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a new type of drug for the treatment of diabetes, and they have been proven to have a good hypoglycemic effect. Several lines of clinical evidence have shown that SGLT2 inhibitors can significantly reduce the risks of atherosclerosis, hospitalization for heart failure, cardiovascular death, and all-cause mortality and delay the progression of chronic kidney disease. Because of the protective effects of SGLT2 inhibitors on the heart and kidney, they are being studied for the treatment of heart failure and chronic kidney disease in patients without diabetes. Therefore, it is necessary for cardiologists, patients with diabetes, and nephrologists to fully understand this type of drug. In this review, we summarize the following three aspects of SGLT2 inhibitors: the recent clinical evidence of their cardiovascular benefits, their mechanisms of action, and their safety.     

New insights into the pathogenesis of Peyronie’s disease: A narrative review

Peyronie’s disease (PD) is a benign, progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea (TA) of the penis. This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines, cell signaling pathways, biochemical mechanisms, genetic factors responsible for fibrogenesis. A growing body of literature has shown that PD is a chronically impaired, localized, wound healing process within the TA and the Smith space. It is caused by the influence of different pathological stimuli, most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features, imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase (MMP/TIMP), and suppressed antioxidant systems during chronic inflammation. Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling. The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.     

Early chronic obstructive pulmonary disease: A new perspective

Chronic obstructive pulmonary disease (COPD) is a respiratory disease with a high incidence, mortality, and disability rate. Because there are few symptoms in the early stages of COPD, diagnosis and treatment are seriously insufficient. It is necessary to find effective clues for early COPD diagnosis and provide appropriate interventions. Several studies suggest that small airway disease is the earliest stage of COPD because it is correlated with subsequent development of airflow obstruction. However, there are currently no globally accepted criteria for defining early COPD. This study mainly introduced risk factors, definition, diagnosis, and treatment of early COPD from a new perspective.     

择期经皮冠状动脉介入治疗术前负荷剂量他汀治疗对经皮冠状动脉介入治疗相关炎症及心肌损害的影响

目的探讨经皮冠状动脉介入治疗(PCI)术前阿托伐他汀预治疗对PCI相关炎症及心肌损害的影响。方法 86例拟行择期PCI的冠心病病例随机分为A组(n=30)、B组(n=26)和C组(n=30)。A组与B组术前48小时开始分别口服20mg、80mg阿托伐他汀,C组术前不服用阿托伐他汀。术后A组及C组均口服阿托伐他20mg/d,B组口服阿托伐他汀40mg/d。测定术前、术后中性粒细胞计数、超敏C反应蛋白(hs-CRP)、心肌酶、肌钙蛋白T(cTnT)、肝功能、肾功能、血脂,计算围手术期急性心肌梗死(MI)的发生率。结果 PCI术后hs-CRP、中性粒细胞计数显著升高(P<0.05);与A组和C组比较,B组△hs-CRP值显著降低,术后血清肌酸激酶同工酶(CK-MB)、cTnT降低,围手术期MI的发生率降低,术后血脂达标率最高(P<0.05)。3组PCI术前术后肝功能、肾功能、肌酸激酶等指标差异无统计学差异(P>0.05)。结论 PCI术前48小时阿托伐他汀80mg治疗可以通过抑制PCI相关炎症,对心肌具有一定的保护作用,减少围手术期MI的发生率,且与A组和C组比较,在药物安全性上没有差别。     

Environmental heavy metals and cardiovascular diseases: Status and future direction

Cardiovascular disease (CVD) and environmental degradation are leading global health problems of our time. Recent studies have linked exposure to heavy metals to the risks of CVD and diabetes, particularly in populations from low- and middle-income countries, where concomitant rapid development occurs. In this review, we 1) assessed the totality, quantity, and consistency of the available epidemiological studies, linking heavy metal exposures to the risk of CVD (including stroke and coronary heart disease); 2) discussed the potential biological mechanisms underlying some tantalizing observations in humans; and 3) identified gaps in our knowledge base that must be investigated in future work. An accumulating body of evidence from both experimental and observational studies implicates exposure to heavy metals, in a dose-response manner, in the increased risk of CVD. The limitations of most existing studies include insufficient statistical power, lack of comprehensive assessment of exposure, and cross-sectional design. Given the widespread exposure to heavy metals, an urgent need has emerged to investigate these putative associations of environmental exposures, either independently or jointly, with incident CVD outcomes prospectively in well-characterized cohorts of diverse populations, and to determine potential strategies to prevent and control the impacts of heavy metal exposure on the cardiometabolic health outcomes of individuals and populations.     

急性缺血性脑卒中侧支循环的影像学研究进展

急性缺血性脑卒中(acute ischemic stroke,AIS)发病率的逐年攀升,已是威胁人类健康,阻碍社会经济发展的重大疾病之一。高复发率、致残率及致死率无疑对人类生活质量及社会功能造成严重影响。多项研究表明,急性缺血性脑卒中后侧支循环的建立与临床的预后有明显相关性。因此,不少国内外学者正致力于研究多种成像技术对侧支循环的评估作用,并根据不同影像学侧支循环评分判断疾病的可能预后状况。目前针对侧支循环的形成机制、影像评估与临床预后的相关性学者们提出的观点仍存在差异性,本文将针对脑侧支循环的概念、形成原因、分级以及不同影像学技术进行综述。     

Research Progress on Postoperative Minimal/Molecular Residual Disease Detection in Lung Cancer

Lung cancer is the leading cause of cancer‐related deaths worldwide. Approximately 10%–50% of patients experience relapse after radical surgery, which may be attributed to the persistence of minimal/molecular residual disease (MRD). Circulating tumor DNA (ctDNA), a common liquid biopsy approach, has been demonstrated to have significant clinical merit. In this study, we review the evidence supporting the use of ctDNA for MRD detection and discuss the potential clinical applications of postoperative MRD detection, including monitoring recurrence, guiding adjuvant treatment, and driving clinical trials in lung cancer. We will also discuss the problems that prevent the routine application of ctDNA MRD detection. Multi‐analyte methods and identification of specific genetic and molecular alterations, especially methylation, are effective detection strategies and show considerable prospects for future development. Interventional prospective studies based on ctDNA detection are needed to determine whether the application of postoperative MRD detection can improve the clinical outcomes of lung cancer patients, and the accuracy, sensitivity, specificity, and robustness of different detection methods still require optimization and refinement.     

Cross-talk between Myc and p53 in B-cell lymphomas

Myc and p53 proteins are closely associated with many physiological cellular functions, including immune response and lymphocyte survival, and are expressed in the lymphoid organs, which are sites for the development and activation of B-cell malignancies. Genetic alterations and other mechanisms resulting in constitutive activation, rearrangement, or mutation of MYC and TP53 contribute to the development of lymphomas, progression and therapy resistance by gene dysregulation, activation of downstream anti-apoptotic pathways, and unfavorable microenvironment interactions. The cross-talk between the Myc and p53 proteins contributes to the inferior prognosis in many types of B-cell lymphomas. In this review, we present the physiological roles of Myc and p53 proteins, and recent advances in understanding the pathological roles of Myc, p53, and their cross-talk in lymphoid neoplasms. In addition, we highlight clinical trials of novel agents that directly or indirectly inhibit Myc and/or p53 protein functions and their signaling pathways. Although, to date, these trials have failed to overcome drug resistance, the new results have highlighted the clinical efficiency of targeting diverse mechanisms of action with the goal of optimizing novel therapeutic opportunities to eradicate lymphoma cells.     

高血压肾损害诊疗进展

高血压肾损害是一种临床常见疾病,已经成为导致终末期肾病的主要原因之一。高血压肾损害不同于其他慢性肾脏疾病,其具有独特的发病机制、临床病理特点,临床诊断及治疗也有所不同。高血压肾损害患者一旦出现蛋白尿,病情进展迅速,患者很快进入终末期肾病。但是高血压肾损害临床诊断与治疗普遍滞后,治疗干预手段有限,很难控制疾病的进展。因此深入研究高血压肾损害的发病机制、临床病理特点、诊断及治疗对于其临床防治具有重要的意义。本文从高血压肾损害病理机制、检测指标、临床病理特点及治疗四个方面对本病进行综述,旨在预防及延缓高血压肾损害的发生进展。     

哮喘—慢性阻塞性肺疾病重叠综合征患者76例临床特征

目的观察分析76例哮喘—慢性阻塞性肺疾病重叠综合征患者的临床特征。方法选取本院在2018年3月—2019年1月收治的76例哮喘—慢性阻塞性肺疾病重叠综合征患者(作为E组),再选取同期我院收治的76例哮喘患者(作为F组)和76例慢性阻塞性肺疾病患者(作为G组)。结果E组外周血嗜酸性粒细胞百分比、FEV 1% pred、FEV 1/FVC、Dm、FeNO低于F组(P<0.05),E组患者、G组患者血清总免疫球蛋白E升高所占比比较差异无统计学意义(P>0.05),E组患者血清总免疫球蛋白E升高所占比高于F组患者(P<0.05);E组RV/TLC高于F组患者(P<0.05),E组RV/TLC、Dm、FeNO高于G组(P<0.05)。结论哮喘—慢性阻塞性肺疾病重叠综合征患者与慢性阻塞性肺疾病患者相比而言具有较好的肺弥散功能,哮喘—慢性阻塞性肺疾病重叠综合征患者与哮喘患者相比而言肺弥散功能较差且肺通气功能降低。     

着力中医药文化认同 坚实中医药文化自信基础

中医药事业发展在迎来天时地利人和大好机遇的同时，也面临着中医药文化自觉、认同和自信不足的挑战。从其中医药整体观、中医药治未病观、中医药优势特色、中医药理论体系、中医药技术、中医药效果、中医药发展的生态环境等基本要素，大学职能缺失、人才培养模式滞后、部分教师使命感缺乏、中医药发展局限、中医药西化现象比较严重、社会认知偏差等主要影响因素，加强顶层设计、增强中医药文化自觉、提升教师专业化水平、改革人才培养模式、加强中医药创新、加强大学文化建设、加强交流互鉴等培养路径，探讨了大学生中医药文化认同的培养，力求为树立和坚定大学生中医药文化自信提供实践指导和参考。     

医学院校智库建设的发展与思考

我国医学院校智库建设已经启动,正在稳步有序推进中。通过认清医学院校具有人才、学科、研究力量和学术交流的优势,找出智库建设存在机构功能、人才标准、研究模式和智库作用的不足,明确医学智库以卫生健康发展和临床疾病解决为研究核心,开展战略谋划和综合研判,为决策层提供信得过、用得上、行得通的政策建议。     

批判性思维相关影响因素的思考

批判性思维对人才培养具有非常重要的意义,本文从个人因素、教育因素和环境因素三个方面针对国内外对批判性思维影响因素的相关研究进行了初步分析。     

人源神经干细胞移植治疗脑功能损害疾病

脑功能损害性疾病包括神经退行性疾病和外伤性疾病,均能导致不同程度的神经功能障碍。神经退行性疾病的传统治疗不能阻止病情进展,远期疗效往往欠佳,因此,人们提出了干细胞治疗。随着神经干细胞研究的深入,神经干细胞的特性和功能逐渐被认识。很多文献报道神经干细胞移植能够改善这些疾病的神经功能障碍。所以,神经干细胞移植可能成为治疗此类神经系统疾病的新方法。     

Unmet needs as indicator of improving chronic care delivery system in China

In 2009, China strengthened its public health service system. Since then, the country has made remarkable achievements in community-based chronic disease prevention and control;however, certain groups still have unmet needs. During 2019 to 2029, China will consolidate the top-level design of its medical health system. During this period, the coordination of department policies, improvement of service delivery mechanisms, building an integrated health service system, and other issues will be highlighted. This study will provide a basis for designing China’s chronic disease prevention and control system during the next stage of development. We will consider the unmet needs of patients with chronic diseases as an indicator for remodeling the prediction system in combination with the elements and structural theories of complex health systems. In this article, we first introduce the definition and measurement methods of unmet needs. Second, we identify the existing unmet needs found among patients with chronic diseases with reference to the chronic disease prevention and control policies of China as well as current service items. Finally, we propose the design of community chronic disease service package for the next development stage based on unmet needs of patients with chronic diseases. We also provide suggestions for how to improve China’s chronic care delivery system.