三叶因子家族在胃癌发生中的作用机制

三叶因子家族（trefoil factor family，TFF）是一群主要由胃肠道黏液细胞分泌的小分子多肽，在黏膜修复和重建以及肿瘤的发生、发展过程中发挥重要作用，对其结构功能、遗传学改变等分子机制的研究一直是近20余年的研究热点。TFF在肠型胃癌中表达降低甚至缺失，在弥漫型胃癌中高表达。其在胃癌发生、发展过程中的机制涉及肿瘤抑制、促进肿瘤侵袭浸润以及促癌与抑癌的双重机制。通过对TFF在胃癌发生、发展中机制的深入研究，有望在胃癌防治方面开辟新途径。     

Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries

Background

Deintensification of diabetic therapy is often clinically appropriate for older adults, because the benefit of aggressive diabetes treatment declines with age, while the risks increase.

Objective

We examined rates of overtreatment and deintensification of therapy for older adults with diabetes, and whether these rates differed by medical, demographic, and socioeconomic characteristics.

Design, Subjects, and Main Measures

We analyzed Medicare claims data from 10 states, linked to outpatient laboratory values to identify patients potentially overtreated for diabetes (HbA1c < 6.5% with fills for any diabetes medications beyond metformin, 1/1/2011–6/30/2011). We examined characteristics associated with deintensification for potentially overtreated diabetic patients. We used multinomial logistic regression to examine whether patient characteristics associated with overtreatment of diabetes differed from those associated with undertreatment (i.e. HbA1c > 9.0%).

Key Results

Of 78,792 Medicare recipients with diabetes, 8560 (10.9%) were potentially overtreated. Overtreatment of diabetes was more common among those who were over 75 years of age and enrolled in Medicaid (p < 0.001), and was less common among Hispanics (p = 0.009). Therapy was deintensified for 14% of overtreated diabetics. Appropriate deintensification of diabetic therapy was more common for patients with six or more chronic conditions, more outpatient visits, or living in urban areas; deintensification was less common for those over age 75. Only 6.9% of Medicare recipients with diabetes were potentially undertreated. Variables associated with overtreatment of diabetes differed from those associated with undertreatment.

Conclusions

Medicare recipients are more frequently overtreated than undertreated for diabetes. Medicare recipients who are overtreated for diabetes rarely have their regimens deintensified.

     

Collimating micro-lens fiber array for noncontact near-infrared diffuse correlation tomography

Near-infrared diffuse correlation spectroscopy/tomography (DCS/DCT) has recently emerged as a noninvasive measurement/imaging technology for tissue blood flow. In DCT studies, the high-dense collection of light temporal autocorrelation curves (g₂(τ)) via fiber array are critical for image reconstruction of blood flow. Previously, the camera-based fiber array limits the field of view (FOV), precluding its applications on large-size human tissues. The line-shape fiber probe based on lens combination, which is predominantly used in current DCT studies, requires rotated-scanning over the surface of target tissue, substantially prolonging the measurement time and increasing the system instability. In this study, we design a noncontact optical probe for DCT based on collimating micro-lens fiber array, termed as FA-nc-DCT system. For each source/detector fiber, a single optical path was collimated by coupling with one micro-lens in the fiber array that is integrated in a square-shape base. Additionally, an 8×8 optical switch is used to share the hardware laser and detectors without spatial scanning. The FA-nc approach for the precise collection of g₂(τ) curves was validated through a speed-varied phantom experiment and the human experiments of cuff occlusion, from which the expected value of the blood flow index (BFI) was obtained. Furthermore, the flow anomaly in the phantom and the ischemic muscle in human were accurately reconstructed from the FA-nc-DCT system, which is combined with the imaging framework based on the Nth-order linear algorithm that we recently created. Those outcomes demonstrated the great potential of FA-nc-DCT technology for fast and robust imaging of various diseases such as human breast cancers.     

健康信息素养在2型糖尿病患者知识储备水平与自我管理行为间的调节作用

目的探讨2型糖尿病(T2DM)患者健康信息素养在糖尿病知识储备水平与自我管理行为关系中的调节作用及促进患者自我管理行为建立的有效措施。方法采用糖尿病知识问卷、健康信息素养自评量表和糖尿病自我管理活动量表对352例T2DM患者进行调查。记录T2DM患者健康信息素养、知识及自我管理行为评分,并对患者健康信息素养、糖尿病知识及自我管理行为进行相关性分析。结果 T2DM患者糖尿病知识、健康信息素养和糖尿病自我管理行为评分分别为(6.40±2.40)、(14.41±2.91)、(3.53±1.24)分。分层回归分析显示,糖尿病知识对自我管理行为有正向影响(β=0.276);健康信息素养对自我管理行为有正向影响(β=0.321);健康信息素养在T2DM患者知识储备水平及自我管理行为之间起调节作用(β=-0.180)。结论医护人员应尽早采取措施以提高患者糖尿病知识及健康信息素养水平,同时根据健康信息素养差异采取个性化干预方式,以改善糖尿病自我管理行为。     

银翘散对呼吸道合胞病毒感染小鼠呼吸系统的作用研究

目的:探讨银翘散对呼吸道合胞病毒感染小鼠呼吸系统的治疗效果以及作用机制。方法:小鼠随机分为6组,每组9只,分别是正常组、模型组、银翘散高剂量组、银翘散中剂量组、银翘散低剂量组、利巴韦林组。除正常组外,其他各组小鼠用乙醚浅麻后,以浓度TCID50呼吸道合胞病毒(RSV)液50μL滴鼻感染小鼠。银翘散高、中、低剂量组分别给予600、300、150mg/(kg·d)银翘散灌胃,利巴韦林组给予150 mg/(kg·d)利巴韦林灌胃。银翘散高、中、低剂量组、利巴韦林组于感染前1天开始灌胃给药,连续5天,正常组、模型组给予等容积蒸馏水灌胃。通过称量小鼠体质量和肺重量计算肺指数。HE染色检测小鼠鼻黏膜和肺组织炎性细胞浸润等病理形态学的改变。酶联免疫吸附法测定检测小鼠肺泡灌洗液中白细胞介素-1β(IL-1β)、肿瘤坏死因子α(TNF-α)以及白细胞介素-6(IL-6)的表达水平。实时荧光定量PCR和Western blot检测肺组织核苷酸结合寡聚化结构域样受体3(NALP3)炎性体、凋亡相关微粒蛋白(ASC)和半胱天冬酶-1(caspase-1)的表达。结果:与正常组比较,模型组小鼠肺指数显著升高,肺泡灌洗液中TNF-α、IL-1β和IL-6表达显著升高,肺组织NALP3、ASC、caspase-1 mRNA和蛋白表达显著升高,差异均有统计学意义(P0.05)。与模型组比较,银翘散高、中、低剂量组、利巴韦林组小鼠肺指数显著降低,肺泡灌洗液中TNF-α、IL-1β、IL-6表达显著降低,肺组织NALP3、ASC、caspase-1 mRNA和蛋白表达显著降低,差异均有统计学意义(P0.05)。与利巴韦林组比较,银翘散中剂量组小鼠肺泡灌洗液中TNF-α、IL-1β表达较高,肺组织NALP3和caspase-1 mRNA表达较高;银翘散低剂量组小鼠肺指数较高,肺泡灌洗液中TNF-α、IL-1β、IL-6表达较高,肺组织NALP3、ASC、caspase-1 mRNA和蛋白表达较高;差异均有统计学意义(P0.05)。结论:银翘散能够改善呼吸道合胞病毒感染所致的呼吸道系统炎症,其作用机制与抑制NALP3炎性体的激活和炎症因子的分泌相关。     

温阳解郁颗粒调节BDNF/TrkB/ERK信号通路保护皮质酮诱导损伤型海马神经细胞的作用机制研究＊

目的 观察温阳解郁颗粒（Wenyang Jieyu granule，WYJY）对皮质酮（Corticosterone，CORT）诱导损伤型小鼠海马神经细胞（TH22 cell）的保护作用，基于脑源性神经营养因子（Brain derived neurotrophic factor， BDNF）/酪氨酸激酶B（Tyrosine kinase B， TrkB）/细胞外信号调节蛋白激酶（Extra cellular regulated protein kinases， ERK）信号通路探讨WYJY保护海马神经细胞的作用机制。方法 体外构建小鼠海马神经细胞皮质酮诱导损伤模型，以不同浓度的WYJY和氟西汀（Fluoxetine，FXT）含药血清作用于模型细胞，细胞增殖-毒性检测（Cell Counting Kit-8， CCK-8）法分析细胞活性，倒置显微镜下观察给药前后细胞形态结构的改变，采用蛋白免疫印迹法（Western Blot）、实时荧光定量PCR（Quantitative real-time PCR， qPCR）法检测神经细胞内凋亡因子（BCL2-Associated X， Bax）、抗凋亡因子（B-cell lymphoma-2， Bcl-2）、BDNF、Trkb、ERK以及丝氨酸/苏氨酸激酶（Phospho-p90RSK， RSK）、环磷腺苷效应元件结合蛋白（cAMP-response element binding protein， CREB）蛋白表达水平以及相关基因的表达水平。结果 在浓度为459.5 μmol·L^-1的CORT作用24 h后，HT22细胞的活性抑制率达到50%，在此条件作用下细胞形态结构损伤明显，凋亡程度严重，细胞上清中BDNF的含量显著减少（P<0.05），细胞内凋亡相关因子Bax/Bcl-2的比值明显升高（P<0.01），BDNF、Trkb、ERK、RSK、CREB磷酸化蛋白表达水平和mRNA表达水平明显降低（P<0.01）；以5%的浓度为2.85 g·kg^-1的WYJY和10%的FXT含药血清作用于受损的HT22细胞后，HT22细胞存活率明显提升（P<0.01），细胞结构的损伤明显改善，细胞凋亡程度减轻，细胞外BDNF的含量显著升高（P<0.05），细胞内Bax/Bcl-2比值显著下调（P<0.01），BDNF、Trkb、ERK、RSK、CREB磷酸化蛋白表达水平和mRNA表达水平显著提升（P<0.05，P<0.01）。结论 温阳解郁颗粒可有效保护高浓度CORT造成的小鼠海马神经细胞损伤。调控BDNF/Trkb/ERK通路，放大CREB信号传导，影响Bcl-2、BDNF水平，可能是其保护海马神经元，发挥抗抑郁疗效的重要机制。     

中医临床证据分级和推荐体系发展现状

证据分级和推荐体系在中医药循证医学发展中不可或缺。中医药理论及临床独具特色,照搬西方医学分级体系不合实际,国内众多学者对中医药领域证据分级和推荐体系进行了多年的探索。本文回顾国际临床证据和推荐体系的发展,总结分析目前国内较有代表性的中医药证据分级体系,阐述中医证据特点及发展趋势,为中医临床证据分级体系的成熟与完善提供参考,进而推动中医证据评价的研究。     

肾维宁冲剂对慢性肾功能衰竭患者尿微量蛋白及脂质代谢疗效观察

应用肾维宁冲剂及清通肠液保留灌肠观察对慢性肾功能衰竭（ＣＲＦ）患者２７例２４小时尿蛋白（２４ｈ－ＵＰ）、尿β２微球蛋白（β２－ＭＧ）、白蛋白（Ａｌｂ）、血脂代谢及肾功能的影响。并与西药洛丁新治疗２５例作对照。结果：治疗组与对照组治疗前后比较,２４ｈ＝－ＵＰ、β２－ＭＧ、Ａｌｂ均明显下降,但治疗组β２－ＭＧ和Ａｌｂ下降的幅度均明显高于对照组（Ｐ〈０．０１）。治疗组还能使血浆总胆固醇（ＴＣｈ）和载脂蛋     

米索前列醇预防产后出血的临床观察

产后出血是分娩常见并发症，严重者危及产妇生命，预防产后出血是减少产妇病死率的重要内容之一。为探寻一种安全、简单、高效的预防方法，在产后立即给产妇一次性口服米索前列醇600μg，通过增强子宫收缩，预防产后出血，临床效果显著。现报告如下。