肺癌患者条件致病性真菌感染的特征

目的：调查唐山市人民医院2005年至2009年住院肺癌患者感染条件致病性真菌的临床特点及种类,探讨条件致病性真菌感染的危险因素。方法：采用回顾性调查研究的方法,对2005年至2009年在唐山市人民医院住院并发生条件致病性真菌感染的肺癌患者进行研究。结果：住院肺癌患者送检标本的送检率和条件致病性真菌检出率均逐年增高,以念珠菌属为主,白色念珠菌是最常见的感染真菌,年龄≥60岁、住院时间长、吸烟、肿瘤恶性程度高、接受化疗及放疗、广谱抗生素和激素的大量使用、各种侵入性诊疗操作的应用等因素与肺癌患者发生条件致病性真菌感染有关。结论：控制危险因素,提高患者免疫力是预防肺癌患者条件致病性真菌感染的主要措施。     

Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches

Obstructive sleep apnea syndrome (OSAS), a chronic condition characterized by collapse of the pharynx during sleep, has been increasingly recognized as a health issue of growing importance over the last decade. Recently emerging evidence suggests that there is a causal link between OSAS and hypertension, and hypertension represents an independent risk factor in OSAS patients. However, the pathophysiological basis for patients with OSAS having an increased risk for hypertension remains to be elucidated. The main acute physiological outcomes of OSAS are intermittent hypoxia, intrapleural pressure changes, and arousal from sleep, which might induce endothelial dysfunction, sympathetic activation, renin–angiotensin–aldosterone system activation, lipid metabolism dysfunction, and increased oxidative stress. This brief review focuses on the current understanding of the complex association between OSAS and hypertension.     

论张仲景“客气”之意

张仲景书中的"客气"一词,一般被误解作"邪气"。笔者通过比较多条经文发现,"客气"并非张仲景理解的"邪气",而是指一种特殊的致病因素,是由于胃虚而浊气上逆所生的阳热之邪。由于这种情况并非"外来邪气",又非生理的"正气",因而张仲景创造"客气"一词,以解释这种特殊的病因。     

从胰岛微循环探索“脾气散精”环节对血糖稳态的调节机制

减少血糖波动是目前干预糖尿病和预防并发症的重点,也是中医药在糖尿病治疗中的优势所在。越来越多的研究表明,胰岛微循环障碍是胰岛功能下降进而引发血糖波动的关键病理环节,而胰岛微循环局部肾素-血管紧张素系统(renin-angiotensin system,RAS)的过度激活作为胰岛功能失代偿的使动环节,与胰岛内分泌细胞功能密切相关,是研究胰岛功能的关键靶点。中医学认为糖尿病血糖波动与"脾气散精"障碍密切相关,脾不散"精"(血糖),精滞为浊,浊邪壅塞,是血糖稳态失衡的使动环节,亦为糖尿病全病程的关键病机。通过补益"脾"气以促进"胰"中精微物质的布散能够恢复糖调节激素间的平衡,从而减少血糖波动。目前,"脾气散精"对血糖波动的调节机制尚不明确。作者基于以往的临床和科研工作基础,提出"脾气散精"环节通过促进机体胰岛微循环从而发挥其改善胰岛功能、调节血糖稳态的作用,其机制可能与抑制胰岛微循环局部RAS的激活状态相关。RAS系统在胰岛微循环中各信号通路的相互拮抗关系,与中医理论中脾气散精与固精作用的对立制约关系相类似。因此"脾气散精"环节对血糖波动的调节机制有必要从胰岛微循环RAS整体调控的角度进行深入探索,以此揭示中医药调节机体内环境稳态,减少糖尿病患者血糖波动的科学内涵。     

Thrombin stimulates insulin secretion via protease-activated receptor-3

The disease mechanisms underlying type 2 diabetes (T2D) remain poorly defined. Here we aimed to explore the pathophysiology of T2D by analyzing gene co-expression networks in human islets. Using partial correlation networks we identified a group of co-expressed genes (‘module’) including F2RL2 that was associated with glycated hemoglobin. F2Rl2 is a G-protein-coupled receptor (GPCR) that encodes protease-activated receptor-3 (PAR3). PAR3 is cleaved by thrombin, which exposes a 6-amino acid sequence that acts as a ‘tethered ligand’ to regulate cellular signaling. We have characterized the effect of PAR3 activation on insulin secretion by static insulin secretion measurements, capacitance measurements, studies of diabetic animal models and patient samples. We demonstrate that thrombin stimulates insulin secretion, an effect that was prevented by an antibody that blocks the thrombin cleavage site of PAR3. Treatment with a peptide corresponding to the PAR3 tethered ligand stimulated islet insulin secretion and single β-cell exocytosis by a mechanism that involves activation of phospholipase C and Ca²⁺ release from intracellular stores. Moreover, we observed that the expression of tissue factor, which regulates thrombin generation, was increased in human islets from T2D donors and associated with enhanced β-cell exocytosis. Finally, we demonstrate that thrombin generation potential in patients with T2D was associated with increased fasting insulin and insulinogenic index. The findings provide a previously unrecognized link between hypercoagulability and hyperinsulinemia and suggest that reducing thrombin activity or blocking PAR3 cleavage could potentially counteract the exaggerated insulin secretion that drives insulin resistance and β-cell exhaustion in T2D.     

益气散结法联合 mFOLFOX6术后辅助化疗治疗Ⅲ期结肠癌的临床研究

目的：观察益气散结法联合 mFOLFOX6术后辅助化疗对Ⅲ期结肠癌的治疗作用。方法将80例病理分期为Ⅲ期的结肠癌术后患者随机分为对照组与治疗组,每组40例。对照组单纯行 mFOLFOX6术后辅助化疗,治疗组口服散结益气法中药联合化疗治疗。观察两组病例的1年后生活质量评分、3年无病生存率（DFS）、5年生存时间及化疗毒副作用的发生率。结果1年后两组生存质量评分治疗组高于对照组（P ﹤0.05）。两组3年 DFS 与5年平均生存时间比较,治疗组均较对照组延长,但差异无统计学意义（P ﹥0.05）。治疗过程中治疗组的白细胞减少、胃肠道反应和周围神经毒性反应发生率明显低于对照组（P ﹤0.05）。结论益气散结法联合化疗治疗结肠癌能部分减低化疗药物的不良反应,对提高患者生存质量和生存时间具有一定意义。     

不同参数督脉走罐对亚健康人体背部局部皮肤血流量影响的初步观察

[目的]通过观察不同参数督脉走罐对亚健康人体背部局部皮肤血流量影响及规律的变化,探讨走罐对机体阳气的影响。[方法]对20名亚健康成年人分别进行静息空白观察,以及罐压为-0.01~-0.02 MPa,走罐时间为5 min,罐压为-0.02~-0.03 MPa,走罐时间为5 min,罐压为-0.02~-0.03 MPa,走罐时间为3 min的督脉走罐,应用激光散斑血流监测视频系统监测上述不同干预方法对亚健康人体大椎穴、身柱穴及大椎与身柱连线的中点,在走罐后即刻、5、10、15、20、25、30 min穴区局部皮肤血流量的变化。[结果]走罐后皮肤局部血流量升高(P<0.05),随时间延长血流量逐渐降低。不同参数督脉走罐对局部血流量的影响差异无统计学意义(P>0.05),但压力较大或刺激时间较长时,血流量的变化反而较小。3个观察点在静息状态下血流量随时间变化差异无统计学意义(P>0.05),但相同压力刺激时大椎穴与身柱穴从走罐后15 min起,血流量存在区别,且走罐后大椎穴变化幅度大,身柱穴维持高峰时间长。[结论]1)不同的走罐方法对督脉阳气的调节是不同的。2)走罐后皮肤局部血流量增加,机体阳气功能增强。3)穴位具有特异性。     

郭霞珍教授活血化瘀法治疗青春期崩漏经验

郭霞珍教授认为肝脾肾三脏的功能失调与青春期崩漏的发生关系密切,如肝郁血热、脾虚失摄、肾精不足等。无论何种原因导致的崩漏,血出日久,或过用固涩药物止血,最终均可发展为血瘀。故临床治疗应以活血化瘀以澄其源,同时针对"瘀"形成的不同原因,佐以疏肝清热、健脾益气或补肾填精,方能取得预期疗效。     

Pigs immunized with Chinese highly pathogenic PRRS virus modified live vaccine are protected from challenge with North American PRRSV strain NADC-20

Modified live virus (MLV) vaccines developed to protect against PRRSV circulating in North America (NA) offer limited protection to highly pathogenic (HP) PRRSV strains that are emerging in Asia. MLV vaccines specific to HP-PRRSV strains commercially available in China provide protection to HP-PRRSV; however, the efficacy of these HP-PRRSV vaccines to current circulating NA PRRS viruses has not been reported. The aim of this study is to investigate whether pigs vaccinated with attenuated Chinese HP-PRRSV vaccine (JXA1-R) are protected from infection by NA PRRSV strain NADC-20. We found that pigs vaccinated with JXA1-R were protected from challenges with HV-PRRSV or NADC-20 as shown by fewer days of clinical fever, reduced lung pathology scores, and lower PRRS virus load in the blood. PRRSV-specific antibodies, as measured by IDEXX ELISA, appeared one week after vaccination and virus neutralizing antibodies were detected four weeks post vaccination. Pigs vaccinated with JXA1-R developed broadly neutralizing antibodies with high titers to NADC-20, JXA1-R, and HV-PRRSV. In addition, we also found that IFN-α and IFN-β occurred at higher levels in the lungs of pigs vaccinated with JXA1-R. Taken together, our studies provide the first evidence that JXA1-R can confer protection in pigs against the heterologous NA PRRSV strain NADC-20.