三黄口服液治疗代谢综合征的疗效观察

目的:探讨三黄口服液对代谢综合征肥胖人群的临床疗效。方法:以20名健康志愿者为参照,将100名代谢综合征患者随机分为治疗组(60名)和安慰剂组(40名),分别予三黄口服液和安慰剂治疗12周,观察治疗前后患者心血管危险因素的变化。结果:与安慰剂组相比,治疗组(起效剂量为10 ml/人,黄连素浓度为0.16～0.22 mg/ml)除空腹血糖,甘油三酯在治疗前后无显著差异外,腰围、体质量指数、腰臀围比值、胰岛素抵抗指数,血清C反应蛋白水平、游离脂肪酸明显改善,差异有显著性(P<0.05);随着腰围的增大,男性的糖代谢异常、高血压病、血脂紊乱及代谢综合征的发生率均呈现增高趋势(P<0.01)。结论:三黄口服液可明显降低代谢综合征人群肥胖和胰岛素抵抗程度,并能改善炎症状态,减轻致心血管病的危险性。     

我国2005—2012年发表文献中药源性肝损伤诊断标准使用分析

目的:通过系统综述总结我国2005-2012年发表文献使用的药源性肝损伤(DILI)的诊断标准,了解我国DILI诊断标准的使用情况及其特点.方法:中国期刊全文专题数据库(CNKI)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、万方数据以关键词“药物性/药源性+肝损害/肝损伤/肝病/肝炎”对2005-2012年文献进行检索,使用Noteexpress软件对检索到的文献进行管理,排除不同数据库间重复的文献,按照纳入和排除标准,对文献进行筛选.用Excel2007建立文献摘录表,进行数据提取和分析.结果:有273篇文献纳入研究,包括199篇病例系列和74篇病例报告.199篇病例系列采用的DILI诊断标准不一,有15个不同的标准,采用最多的是我国通用标准、1997年Maria评分、以及以“病史、临床表现和相关检查等”作为诊断标准.199篇病例系列对这3种标准的使用并没有明显随时间变化的趋势.不同类别杂志的文献对DILI诊断标准的使用也没有明显的趋势.74篇病例报告均是根据病史、临床表现和相关检查等做出诊断.结论:药源性肝损伤(DILI)目前没有统一的标准,在DILI诊断标准的选择上应根据患者年龄、原患疾病、临床症状、各项相关检查等选择合适的诊断标准,尽量避免漏诊和误诊的发生.     

Normalizing GDNF expression in the spinal cord alleviates cutaneous hyperalgesia but not ongoing pain in a rat model of bone cancer pain

Bone cancer pain (BCP) is the most common complication in patients with bone cancer. Glial cell line‐derived neurotrophic factor (GDNF) is believed to be involved in chronic pain conditions. In this article, the expression and roles of GDNF were studied in a rat model of BCP induced by tibia injection of Walker 256 rat mammary gland carcinoma cells. Significant mechanical and thermal hyperalgesia and ongoing pain were observed beginning as early as day 5 post injection. The expression level of GDNF protein examined on day 16 after tibia injection was decreased in the L3 dorsal root ganglion (DRG) and lumbar spinal cord, but not in other spinal levels or the anterior cingulate cortex. Phosphorylation of Ret, the receptor for GDNF family ligands, was also decreased. Furthermore, normalizing GDNF expression with lentiviral vector constructs in the spinal cord significantly reduced mechanical and thermal hyperalgesia, spinal glial activation, and pERK induction induced by tibia injection, but did not affect ongoing pain. Together these findings provide new evidence for the use of GDNF as a therapeutic treatment for bone cancer pain states.     

Levels of circulating cell-free nuclear and mitochondrial DNA in benign and malignant ovarian tumors

OBJECTIVE: To analyze the levels of circulating cell-free nuclear DNA and circulating cell-free mitochondrial DNA in patients with benign and malignant ovarian tumors using a gold-standard assay and to investigate whether quantitative alterations of the circulating cell-free species have values in the management of the patients. METHODS: One hundred four patients were recruited for this study. We developed a quantitative, multiplex polymerase chain reaction to measure the levels of circulating cell-free nuclear DNA and circulating cell-free mitochondrial DNA in serum and plasma of patients with epithelial ovarian cancer, benign epithelial ovarian tumors, or endometriosis. The levels of the circulating cell-free DNA were compared with those of a healthy, age-matched control group. RESULTS: The patients with epithelial ovarian cancer had significantly higher amounts of circulating cell-free nuclear DNA and circulating cell-free mitochondrial DNA in plasma compared with the healthy control group (mean of nuclear DNA 10,723/2,591 and mean of mitochondrial DNA 4,918,978/2,294,264, P=.009 and 0.022, respectively) and with the other group with benign ovarian diseases (mean of nuclear DNA 10,723/2,965 and mean of mitochondrial DNA 4,918,978/1,597,551, P=.027 and 0.002, respectively). However, no relationship between levels of the circulating cell-free DNA and the pathological parameters as well as CA 125 measurement in patients with epithelial ovarian cancer was found. A significant difference between the epithelial ovarian cancer and endometriosis group was found in circulating cell-free mitochondrial DNA but not in circulating cell-free nuclear DNA (mean of mitochondrial DNA 4,918,978/2,273,988 and mean of nuclear DNA 10,723/3,291, P=.013 and 0.105, respectively). CONCLUSION: Elevated levels of circulating cell-free nuclear DNA and circulating cell-free mitochondrial DNA in epithelial ovarian cancer may have diagnostic value. Our finding suggests that the circulating molecules might be potential biomarkers in the disease.     

The effect of labour and placental separation on the shedding of syncytiotrophoblast microparticles, cell-free DNA and mRNA in normal pregnancy and pre-eclampsia

The clinical features of the maternal syndrome of pre-eclampsia can be explained by generalised maternal endothelial cell dysfunction, which is a part of a more global maternal systemic inflammatory response. There is growing evidence that these effects are associated with the shedding of cellular debris, including syncytiotrophoblast microparticles (STBM), cell-free DNA and mRNA, from the surface of the placenta (syncytiotrophoblast) into the maternal circulation. The increased shedding of this debris seen in pre-eclampsia is believed to be caused by placental ischaemia, reperfusion and oxidative stress. This study was carried out to determine whether uterine contractions during labour and subsequent placental separation lead to an acute increase in the release of placental debris into the maternal circulation. To assess the effects of labour, samples were taken from 10 normal pregnant (NP) and 10 pre-eclamptic (PE) women at varied time points. Similarly to assess the effects of placental delivery, plasma samples were taken from 10 NP and 10 PE women undergoing elective caesarean section. There was a significant increase in the shedding of STBM in pre-eclampsia which was not seen in normal pregnancy and there was a small rise in STBM levels at placental separation in both normal pregnant and pre-eclamptic women undergoing caesarean section, but the differences were not significant. However, levels of placental cell-free corticotrophin releasing hormone mRNA were significantly increased in labour in both normal pregnancy and pre-eclampsia and were still high 24 h after delivery in the pre-eclamptic women. There was no significant increase in fetal or total DNA in labour, but the overall levels of total DNA (maternal and fetal) was increased in labour in pre-eclampsia compared to normal labour. The enhanced shedding of STBM and CRH mRNA in pre-eclampsia labour may have a role in cases of postpartum worsening of pre-eclampsia.     

全国胎儿医学与产前诊断学术研讨会纪要

由中华医学会<中华妇产科杂志>编委会主办、南方医科大学南方医院协办的全国胎儿医学与产前诊断学术研讨会于2007年9月14-17日在花城广州召开.<中华妇产科杂志>总编辑郎景和教授、副总编辑黄醒华教授和林其德教授,以及来自全国各地近300名产科、新生儿科等专家和代表参加了会议.会议系统介绍了从早孕到分娩期多种现代产科胎儿疾病诊断、治疗和胎儿监测技术,围绕胎儿医学、遗传咨询、宫内诊断等临床热点进行了热烈讨论.会议特邀澳大利亚南澳洲大学副校长McMillen教授、中国香港中文大学刘子建教授、首都医科大学附属北京妇产医院黄醒华教授等17位国内外著名专家作了专题讲座,并先后有13位代表进行了大会论文报告.现将会议内容纪要如下.     

社区精神分裂症患者精神康复状况及相关因素调查

目的：了解社区精神分裂症患者的精神康复状况并分析相关影响因素。方法：应用自编问卷收集178例社区精神分裂症患者的精神康复相关资料，由精神科医生对患者评定社会功能缺陷筛选量表（SDSS）、临床大体印象量表（CGI）、简明精神病量表（BPRS）。结果：轻度精神残疾者为60．7％，中度及以上者为39．3％。患者的年龄、婚姻状况、首次发病年龄、病程、住院次数、治疗依从性、病情严重程度、精神症状及自知力与患者的社会功能恢复情况显著相关。结论：社区精神分裂症患者多数社会功能恢复较好，患者的社会人口学特征、治疗依从性和病情严重程度影响康复状况。