Asiatic acid ameliorates dextran sulfate sodium-induced murine experimental colitis via suppressing mitochondria-mediated NLRP3 inflammasome activation

In the present study, the effect of asiatic acid, a natural triterpenoid compound, on murine experimental colitis induced by dextran sulfate sodium (DSS) and its possible mechanism were examined in vivo and vitro. Oral administration of asiatic acid dose-dependently attenuated the loss of body weight and shortening of colon length induced by DSS. The disease activity index, histopathologic scores of musco and myeloperoxidase activity were also significantly reduced by asiatic acid treatment. Protein and mRNA levels of DSS-induced pro-inflammatory cytokines in colon, including TNF-α, IL-1β, IL-6 and IFN-γ, were markedly suppressed by asiatic acid. At the same time, decreased activation of caspase-1 in peritoneal macrophages was detected in asiatic acid-treated mice, which suggested that the NLRP3 inflammasome activation was suppressed. In addition, we also found that asiatic acid dose-dependently inhibited IL-1β secretion, caspase-1 activation as well as inflammasome assembling in vitro. Furthermore, the mechanism of asiatic acid was related to the inhibition of mitochondrial reactive oxygen species generation and prevention of mitochondrial membrane potential collapse. Taken together, our results demonstrate the ability of asiatic acid to inhibit NLRP3 inflammasome activation and its potential usage in the treatment of inflammatory bowel diseases.     

现状与未来：论我国综合性大学医学教育

在不同历史阶段,我国综合性大学医学教育经历了不同的发展模式。文章简要回顾了我国综合性大学医学教育的基本办学现状;结合我国高等教育事业的总体改革与发展思路,厘清综合性大学医学教育的办学定位和人才培养模式;重点分析和论述了综合性大学医学教育的人才培养目标以及基于此目标的预期教学效果。     

Assessment of fluid and nutritional status using bioelectrical impedance methods in acute kidney injury patients requiring continuous renal replacement therapy

Objective To investigate the predictive value of nutritional and fluid status measured by bioelectrical impedance methods for the prognosis of acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT). Methods Patients with severe AKI received CRRT in the First Affiliated Hospital of Nanjing Medical University from September 2016 to September 2018 were enrolled, and divided into death group and survival group according to 28-day survival. Cox regression was used to analyze the association between 28-day survival and lean tissue index (LTI), fat tissue index (FTI), the ratio of extracellular water (ECW) and body cell mass (BCM) (ECW/BCM), and overhydration (OH), respectively. Results A total of 156 patients were included, including 101 males and 55 females. The age was (62.7±15.4) years, with sequential organ failure assessment (SOFA) score of 9.9±3.9. The 28-day mortality rate was 46.2%. The pre-CRRT OH values in the 28-day survival group and death group were 2.95(1.80, 5.50) L and 4.20(2.95, 5.70) L(P=0.016), and ECW/BCM values were 1.00(0.76, 1.18) and 1.07(0.88, 1.25) (P=0.033), respectively. Univariate Cox regression analysis showed that pre-CRRT high OH values (HR=1.08, 95%CI 1.00-1.17, P=0.040) and high ECW/BCM values (HR=3.02, 95%CI 1.46-6.22, P=0.003) were associated with 28-day death. The changes of OH values (HR=0.83, 95%CI 0.72-0.95, P=0.008) and ECW/BCM values (HR=6.79, 95%CI 1.72-26.82, P=0.006) between pre-CRRT and the 7th day after CRRT initiation were significantly associated with 28-day mortality in patients who survived 7 days after CRRT initiation. After adjusting for age, gender, and SOFA scores, multivariate Cox regression analysis showed that the high OH value (HR=1.16, 95%CI 1.06-1.27, P=0.002) and the high ECW/BCM value (HR=2.80, 95%CI 1.30-6.06, P=0.003) before CRRT, the change of OH value (HR=0.82, 95%CI 0.72-0.95, P=0.008) and ECW/BCM value (HR=2.79, 95%CI 1.30-5.98, P=0.009) between the 7th day after CRRT initiation and pre-CRRT, were independently associated with 28-day death, while LTI (HR=0.93, 95%CI 0.86-1.02, P=0.113) and FTI (HR=0.98, 95%CI 0.92-1.04, P=0.475) before CRRT were uncorrelated with 28-day death. Conclusions In bioelectrical impedance analysis, the high OH value and high ECW/BCM value before CRRT are associated with 28-day mortality in patients with AKI, while the nutritional indicators LTI and FTI before CRRT are not significantly related. The correction of fluid overload by CRRT within 7 days may reduce the risk of 28-day mortality.     

南京市学龄前儿童视觉运动整合发育测验评估及相关因素分析

目的 对南京市学龄前儿童视觉运动整合能力发育情况进行调查,分析相关影响因素,为学龄前儿童的视觉运动整合临床工作提供参考。方法 2017年3—5月采用分层随机抽样的方法抽取南京市主城区6所幼儿园483名学龄前儿童,调查基本情况并进行视觉-运动整合发育测验评估。结果 1)随着儿童年龄增长,视觉运动整合能力原始得分呈上升趋势;2)各年龄组标准分性别间差异无统计学意义(P>0.05);3)除6岁8月~6岁9月组除外,各年龄组标准分均高于美国常模,差异有统计学意义(P<0.01);4)儿童学习舞蹈、乐器、父母文化水平因素与儿童视觉运动整合能力之间相关系数均在0.11~0.13之间,差异有统计学意义(P<0.05)。结论 视觉运动整合能力随年龄增长而提高,无性别差异,且与儿童学习舞蹈、乐器、父母文化水平因素存在一定的相关性。     

恶性黑素瘤免疫检查点抑制疗法研究进展

【摘要】 免疫检查点抑制剂在过去几年中已成为许多恶性黑素瘤患者的重要治疗选择，其旨在恢复并促进效应T细胞特异性识别和杀伤肿瘤细胞的功能，系统性增强全身的抗肿瘤免疫反应，对于手术切除后具有高复发风险或处于疾病晚期（不可切除或存在转移）的患者都是较好的治疗选择。目前免疫检查点抑制的主要目标是程序性死亡受体 1与细胞毒性T淋巴细胞相关抗原4，它们分别是中枢和外周免疫耐受的两个关键受体。本文主要讨论不同免疫检查点抑制剂的临床效应、可能存在的药物反应性预测标志物与相关不良反应。     

交感神经型颈椎病的中医认识及治疗研究概况

交感神经型颈椎病症状繁杂,在临床诊治过程中误诊误治率较高,对其病因病机、诊断及治疗方法的研究,越来越受到临床医生和科研工作者的重视。该文综合近年来部分学术论文,对交感神经型颈椎病的中医病名、中医病机、辨证分型、中医治疗现状的认识和存在的问题进行了总结与分析,以期为交感神经型颈椎病的诊治提供新的思路。     

中药诱导胃癌及癌前病变细胞凋亡研究进展

目的:探讨中药诱导胃癌及癌前病变细胞凋亡的研究进展。方法:对近年来胃癌及癌前病变细胞凋亡相关文献进行分析、总结,并提出研究中的不足及展望。结果:中药及复方可诱导胃癌及癌前病变细胞凋亡。结论:中药及其复方可通过诱导细胞凋亡,从而治疗胃癌及癌前病变。     

窄谱中波紫外线在皮肤科临床应用及治疗病人安全护理

对500多例(20564人次)多种疾病的患者应用窄谱中波紫外线(简称NB-UVB)进行治疗并获得成功。NB-UVB由最初治疗银屑病,逐渐发展到治疗白癜风、异位性皮炎、瘙痒症、多形性日光症以及早期的皮肤T细胞淋巴瘤等皮肤病中,具有较好的前景。通过大量的临床观察,发现波长为311nm窄谱中波紫外线(narrowbandultraviolet B,NB-UVB)是最具有治疗作用的成分。经加强安全护理均顺利完成治疗。NB-UVB临床有效率均在70%~80%,未发生NB-UVB治疗严重并发症及差错事故,提示强化治疗前、中、后安全护理的重要性。