基于中医古籍文献的升降散应用溯源及探析

通过对中医古籍中有关升降散论述的文献梳理,全面探讨其内涵。本方是在大黄、僵蚕为雏形的基础上增加蝉蜕、姜黄而成方,几经易名,终在杨璿《伤寒瘟疫条辨》中为后人所熟知。本方广泛用于治疗瘟疫,以丸剂、散剂为主,方便携带,便于服用;重用大黄旨在祛邪、逐秽;应用时视人之体质强弱和量其毒之轻重而判断用药多寡,并辅以米酒、生蜜等以顾护正气。杨璿将其由治疗“热疫”的专方扩展为治疗“表里三焦大热”的通用方剂,扩大了本方治疗疾病范围。     

Pediatric cardiac computed tomography angiography: Expert consensus from the Filiale de Cardiologie Pédiatrique et Congénitale (FCPC) and the Société Française d’Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV)

This article was designed to provide a pediatric cardiac computed tomography angiography (CCTA) expert panel consensus based on opinions of experts of the Société Française d’Imagerie Cardiaque et Vasculaire diagnostique et interventionnelle (SFICV) and of the Filiale de Cardiologie Pédiatrique Congénitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, CTA radiation dose reduction techniques, and post-processing techniques. The consensus was based on data from available literature (original papers, reviews and guidelines) and on opinions of a group of specialists with extensive experience in the use of CT imaging in congenital heart disease. In order to reach high potential and avoid pitfalls, CCTA in children with congenital heart disease requires training and experience. Moreover, pediatric cardiac CCTA protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible to prevent unnecessary radiation exposure. We also provided a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.     

不同b值下弥散加权成像及表观弥散系数在老年肺部肿瘤的临床研究

目的分析不同b值下弥散加权成像(DWI)与表观弥散系数(ADC)用于老年肺部肿瘤良恶性鉴别诊断的价值。方法采用分层整群抽样回顾性分析的方法,抽取我院2015年7月至2018年12月接诊的肺部肿瘤患者100例为研究对象,全部患者均接受磁共振技术弥散加权成像,分析不同病变性质肿瘤的弥散加权成像表现,对比不同良恶性肿瘤在不同b值下弥散加权成像信号强度分布情况及其对应的ADC值,经受试者操作特征曲线(ROC曲线)计算不同b值下ADC值对应曲线面积。结果100例老年肺部肿瘤患者中,检出良性肿瘤、恶性肿瘤例数分别为51例、49例。不同b值恶性肿瘤低信号占比均低于良性肿瘤,高信号占比均高于良性肿瘤,差异有统计学意义(P<0.05);不同b值下,恶性肿瘤ADC值均低于良性肿瘤,差异有统计学意义(P<0.05);且随着b值的升高,全部肺部肿瘤患者ADC值均呈下降趋势,差异有统计学意义(P<0.05);不同b值下ADC值ROC曲线下对应面积分别为0.884、0.834、0.754,AUC>0.5可作为鉴别诊断肺部肿瘤良恶性的有效指标,且以b值为500s/mm2时所得到的ADC指曲线下面积最大,在ADC值取1.470时,可获得最高诊断效能。结论b值为500s/mm2下的弥散加权成像技术信号强度与表观弥散系数用于老年肺部肿瘤良恶性鉴别诊断有着较高价值,患者整体表观弥散系数值随b值的升高而减小。     

不同时期颅骨修补术对颅脑损伤患者术后神经功能的影响研究

目的探讨不同时期颅骨修补术对颅脑损伤患者术后神经功能的影响。方法 选取我院在2013 年1 月～2020 年1 月收治的60 例颅脑损伤患者为研究对象,随机分为早期组（n=30）与晚期组（n=30）,分别予以早期、晚期颅骨修补术;比较两组患者的治疗效果、神经功能、日常生活活动能力及并发症发生情况。结果 （1）早期组优良率为86.67%,明显高于晚期组的60.00%（P＜0.05）。（2）早期组与晚期组术前NIHSS 评分比较,差异无统计学意义（P＞0.05）,两组术后NIHSS 评分均明显低于术前,且早期组明显低于晚期组（P＜0.05）。（3）早期组与晚期组术前Barthel 指数比较,差异无统计学意义（P＞0.05）,两组术后Barthel 指数均明显高于术前,且早期组明显高于晚期组（P＜0.05）。（4）早期组并发症总发生率为10.00%,明显低于晚期组的23.33%（P＜0.05）。结论 对颅脑损伤患者早期予以颅骨修补术治疗可获得更好的治疗效果,能够明显改善患者神经功能,提高日常生活活动能力,减少并发症的发生。     

Celtic Origin of the C282Y Mutation of Hemochromatosis

ABSTRACT: The C282Y mutation in theHFEgene is the main mutation causing hemochromatosis, and C282Y frequencies have been reported for various European populations. The aim of this review is to compile the Y allele frequencies of the C282Y mutation for twenty European populations. The most elevated value (6.88%) is observed in residual Celtic populations in UK and France, in accordance to the hypothesis of Simon et al. concerning a Celtic origin of the hereditary hemochromatosis mutation.     

Parental origin of mutation and the risk of breast cancer in a prospective study of women with a BRCA1 or BRCA2 mutation

The objective is to estimate the risk of breast cancer in women who carry a deleterious BRCA1 or BRCA2 mutation, according to parental origin of mutation. We conducted a cohort study of women with a BRCA1 mutation (n = 1523) or BRCA2 mutation (n = 369) who had not been diagnosed with breast or ovarian cancer. For each woman, the pedigree was reviewed and the origin of the mutation was assigned as probable paternal or maternal. The hazard ratio (HR) for developing breast cancer in the follow‐up period was estimated for women with a paternal mutation compared to a maternal mutation. The risk of breast cancer was modestly higher in women with a paternal BRCA1 mutation compared to women with a maternal BRCA1 mutation (HR = 1.46; 95% CI = 0.99–2.16) but the difference was not significant (p = 0.06). The parental mutation origin did not affect the risk in women with a BRCA2 mutation. Our results are consistent with the hypothesis that there is an increased risk of breast cancer among women with a paternally inherited BRCA1 mutation compared to a maternally inherited mutation. However, the data are not sufficiently compelling to justify different screening recommendations for the two subgroups.     

Translational cell biology of highly malignant osteosarcoma

Highly malignant osteosarcoma (HMO) is the most frequent malignant bone tumor preferentially occurring in adolescents and children with a second more flat peak in patients over the age of 60. The younger patients benefit from combined neoadjuvant chemotherapy with 65–70% 5-year survival rate. In patients with metastatic HMO the 5-year survival rate is consistently poor with approximately 30%. In the last several years strategies for target therapies have been developed by using next generation sequencing (NGS) for defining targetable molecular factors. However, it has so far been challenging to establish an effective target therapy for so-called ‘orphan tumors’ without recognizable driver mutations, including HMO. The molecular genetic studies using NGS have shown that HMOs are genomically unstable tumors with highly complex chaotic karyotypes. Before the background of this genetic complexity more investigations should be performed in the future for defining targetable biological factors. As the prognosis could not be improved for 40 years one may expect improvements for patients only by gaining a deeper understanding of the cell and molecular biology of HMO. The cell of origin of HMO is being clarified now. The majority of studies indicate that an osteoblastic progenitor cell is probably the cell of origin of HMO and not an undifferentiated mesenchymal stem cell. This means that the established histopathological definition of HMO through verification of osteoid production by the osteoblastic cells is well justified and will probably be the cornerstone for a precise differential diagnosis of HMO also in the years to come.     

From the Cover: Early Holocene chicken domestication in northern China

Chickens represent by far the most important poultry species, yet the number, locations, and timings of their domestication have remained controversial for more than a century. Here we report ancient mitochondrial DNA sequences from the earliest archaeological chicken bones from China, dating back to ∼10,000 B.P. The results clearly show that all investigated bones, including the oldest from the Nanzhuangtou site, are derived from the genus Gallus, rather than any other related genus, such as Phasianus. Our analyses also suggest that northern China represents one region of the earliest chicken domestication, possibly dating as early as 10,000 y B.P. Similar to the evidence from pig domestication, our results suggest that these early domesticated chickens contributed to the gene pool of modern chicken populations. Moreover, our results support the idea that multiple members of the genus Gallus, specifically Gallus gallus and Gallus sonneratii contributed to the gene pool of the modern domestic chicken. Our results provide further support for the growing evidence of an early mixed agricultural complex in northern China.In his epochal work on domestication, Darwin suggested that domestic chicken (Gallus gallus domesticus) originated from red jungle fowl (Gallus gallus gallus) ∼4,000 y B.P. in the Indus Valley (1). However, more recent evidence, based on both mitochondrial (mt) and nuclear DNA (2–4), refutes a monophyletic origin of G. g. domesticus. Analyses of large-scale mtDNA datasets (5) strongly suggest that chickens were domesticated multiple times in different parts of Asia, including regions in South Asia, Southwest China, and Southeast Asia. Although some of the earliest chicken bones have been discovered in northern China, dating to over 10,000 B.P. at the Nanzhuangtou site and to over 7,000 B.P. at several other sites (e.g., Cishan and Peiligang), northern China has not yet been suggested as a center of chicken domestication for two main reasons. First, it is unclear if the discovered bones really represent domesticated rather than wild members of the genus Gallus (6), and second, northern China is currently a semiarid steppe, and therefore does not provide suitable habitat for jungle fowl, the wild ancestor of domestic chicken. However, abundant remains of tropical animal and plant species excavated at the Cishan and Nanzhuangtou sites show that northern China was much warmer and more humid, with much more extensive forest coverage during the early Holocene (7, 8), providing a potentially suitable habitat for jungle fowl at this time. Moreover, previous studies have revealed northern China as a center for both early pig domestication (9) and the earliest millet domestication (10, 11) already by 10,000 B.P., showing that agriculture existed in this region at the time to which the earliest chicken bones date.Previous studies (9, 12, 13) have shown that ancient DNA analyses can be informative with regard to determining the places of domestication for a species. The time, region, and pattern of chicken domestication in particular regions over the world have also been worked out using ancient DNA analysis (14–17). However, the oldest chicken sequences analyzed to date are only around 4,000 y old, substantially postdating the beginning of chicken domestication.Therefore, we chose 39 ancient chicken bones from three archaeological sites in the area of the Yellow River (Cishan, Nanzhuangtou, and Wangyin), representing the earliest sites for chicken bones both in northern China and worldwide, and one younger archaeological site in the middle area of the Yangtze River (Jiuliandun Chu Tombs) for ancient DNA analyses (Fig. 1 and Table S1.Open in a separate windowFig. 1.Examples of ancient chicken bones and localities of all investigated samples. (A) Map of China showing the location of the four archaeological sites (red dots). (B) Typical ancient chicken bones unearthed in northern China. (C) Close-up of the Yellow River area from which the samples originate. The sites are marked with yellow dots with white asterisks.

Table 1.

Summary of ancient samples analyzed