大洋彼岸的涛声——美国新版初级卫生保健质量评估策略对中国全科医疗服务质量评估体系的启示

美国的公共卫生服务正处于改革阶段,发展基层保健已成为其近年改革的关键环节。2018年12月美国家庭医生学会(AAFP)发布了《基层保健质量评估策略的愿景和原则》(《原则》),包括区分质量评估与绩效评估、定义质量评估和绩效评估、强调全科医学学科特性、对信息数据系统进行规范等6项核心原则,从而为未来全新的美国基层保健质量评估标准的出台奠定了坚实的理论基础。本文结合传统绩效支付模型的局限性、质量改进方法学、全科医学学科理论等相关背景知识,对该《原则》的核心思想进行了深度解析,并将其与英国、欧盟、澳大利亚的质量评估体系进行横向对比,指出了其对传统绩效支付模型的理论突破。在此基础上,本文进一步剖析了《原则》对目前中国全科医疗服务质量评估体系的影响,提出了制订中国全科医疗服务核心绩效指标、相关学会及机构应对中国全科医生的自主质量改进提供支持两项建议。     

Nanocrystalline TiO2 doped by small amount of pre-synthesized colloidal CdS nanoparticles for photocatalytic degradation of 1,2,4-trichlorobenzene

The chemical stability and hydrophobic nature of chloroarenes make them a persistent environmental hazard. Modeling of 1,2,4-trichlorobenzene (1,2,4-TCB) degradation in alcohol-water solution under UV irradiation was carried out with the aim of probing how the 1,2,4-TCB might behave in the environment. The photocatalytic activity of both bare TiO₂ and TiO₂ doped by colloidal CdS nanoparticles synthesized by the sol-gel method has been investigated in the processes of 1,2,4-TCB photodegradation in the aqueous protic solvent. Non-sensitized TiO₂ cannot be regarded as catalyst for the 1,2,4-TCB photodecomposition. On the contrary, the CdS/TiO₂ composite accelerated the 1,2,4-TCB photodegradation process. The concentration of CdS/TiO₂ was shown to effect on the 1,2,4-TCB photolysis mechanisms, which resulted in the quantitative ratios of the 1,2,4-TCB photolysis products.     

Periodontal diseases and adverse pregnancy outcomes: Mechanisms

Adverse pregnancy outcomes (APOs) have been defined as (a) pre-term birth, when there is a delivery before 37 completed weeks (<259 days); (b) pre-eclampsia, which is a multisystem disorder of pregnancy characterized by maternal hypertension and proteinuria after the 20th gestational week; (c) low and very low birthweight, depending on whether the weight of the baby is less of 2500 g or <1500 g and (d) the spontaneous death of the fetus with <20 weeks (miscarriage) or between 20 and 36 weeks (stillbirth). In 2012, during the Consensus Report from the Joint EFP/AAP workshop on periodontitis and systematic diseases the role of periodontal diseases on APOs was reviewed. Some years later, this evidence has grown, and an update on the literature regarding the mechanisms related to this potential association (APOs and periodontal diseases) needs to be presented. The two major pathways (direct and indirect) already accepted in 2012 are still valid nowadays. Most evidence published in the last 5 years deals with a strong and solid evidence coming from the direct pathway while there is as scarce new evidence regarding indirect pathway. In this direct pathway, the haematological dissemination of oral microorganisms and their products, would later induce an inflammatory/Immune response in the foetal-placental unit. The most plausible route for this direct pathway is the hematogenous transmission through dental bacteremia, although not many new studies dealing with bacteremia has been performed lately.     

Molecular mechanisms in palatal rugae development

BackgroundPeriodic patterning of iterative structures is diverse across the animal kingdom. Clarifying the molecular mechanisms involved in the formation of these structures helps to elucidate the genetic commonality of developmental processes, as organs with these structures are believed to share the same molecular mechanisms and fundamental processes. Palatal rugae are periodic corrugated structures on the hard palate and are conserved in all mammals. Although the numbers and patterns of the palatal rugae are species specific, they are consistent in each mammalian species, except humans.HighlightPalatal rugae development is thus under strict genetic control in most mammals and is an excellent model to investigate the genetic commonality of developmental processes to form periodic patterning.ConclusionThis review highlights the current understanding of the molecular mechanisms of palatal rugae development.     

天然生物抗菌剂研究概况

目的：综述天然生物抗菌剂的研究进展。方法：结合国内外相关文献进行综合分析。结果：研究表明,天然抗菌剂主要有植物源、动物源、微生物源等抗菌剂,通过多种机制达到抑菌作用。结论：天然抗菌剂具有来源种类多,作用机制广等特点,具有良好的开发应用前景。     

麻杏调肺汤通过抑制炎症反应治疗慢性阻塞性肺病的探讨

目的:探讨麻杏调肺汤对慢性阻塞性肺病(COPD)的治疗效果,为后期的研究提供实验依据。方法:SD大鼠采用香烟烟雾暴露联合气管注射脂多糖(0.1 m L)法制造COPD大鼠模型,随机分为5组,分别为模型组,醋酸泼尼松组(3.3mg·kg~(-1)·d~(-1)),麻杏调肺汤低、中、高剂量组(1.7,3.4,6.8 g·kg~(-1)·d~(-1)),另设正常组,每组10只。待伤口愈合7 d后开始给药,连续5周;采用酶联免疫吸附测定(ELISA)法检测血清中肿瘤坏死因子-α(TNF-α),核转录因子-κB(NF-κB),白细胞介素-1β(IL~(-1)β),IL-8,IL~(-1)0;观察肺功能情况及肺病理组织学变化。结果:与正常组比较,模型组大鼠细胞因子TNF-α,NF-κB,IL~(-1)β,IL-8含量明显升高,IL~(-1)0含量明显降低(P0.01),肺部组织的病变明显,肺功能明显降低;与模型组比较,麻杏调肺汤高剂量组能明显降低大鼠细胞因子TNF-α,NF-κB,IL~(-1)β,IL-8,升高IL~(-1)0含量(P0.05,P0.01);减轻肺部组织的病变程度,改善肺功能。结论:麻杏调肺汤通过调节炎症反应中相关细胞因子TNF-α,NF-κB,IL~(-1)β,IL-8,IL~(-1)0治疗COPD模型大鼠,并对肺脏具有的保护作用。     

Mechanisms of virus-induced asthma exacerbations: state-of-the-art. A GA2LEN and InterAirways document

Viral infections of the respiratory tract are the most common precipitants of acute asthma exacerbations. Exacerbations are only poorly responsive to current asthma therapies and new approaches to therapy are needed. Viruses, most frequently human rhinoviruses (RV), infect the airway epithelium, generate local and systemic immune responses, as well as neural responses, inducing inflammation and airway hyperresponsiveness. Using in vitro and in vivo experimental models the role of various proinflammatory or anti-inflammatory mediators, antiviral responses and molecular pathways that lead from infection to symptoms has been partly unravelled. In particular, mechanisms of susceptibility to viral infection have been identified and the bronchial epithelium appeared to be a key player. Nevertheless, additional understanding of the integration between the diverse elements of the antiviral response, especially in the context of allergic airway inflammation, as well as the interactions between viral infections and other stimuli that affect airway inflammation and responsiveness may lead to novel strategies in treating and/or preventing asthma exacerbations. This review presents the current knowledge and highlights areas in need of further research.     

骨髓基质干细胞向神经细胞诱导分化及其机制的研究进展

骨髓基质干细胞是一种存在于骨髓间质中具备多向分化潜能的成体干细胞,其不仅能分化为中胚层起源的骨、软骨和脂肪细胞,还可以在特定条件下诱导分化为神经外胚层起源的神经细胞。主要对骨髓基质干细胞向神经细胞诱导分化及其机制的研究进展作一综述。     

Slow isomerization step in the interaction between mouse dopamine transporter and dopamine re-uptake inhibitor N-(3-iodoprop-2E-enyl)-2beta-carbo-[3H]methoxy-3beta-(4'-methylphenyl)nortropane

The kinetics of the association and dissociation of the tritium-labeled selective and potent dopamine transporter inhibitor N-(3-iodoprop-2E-enyl)-2β-carbo-[³H]methoxy-3β-(4′-methylphenyl)nortropane ([³H]PE2I) with the transporter of mouse striatal membranes was studied. The analysis revealed that the specific binding of [³H]PE2I occurs within a homogeneous population of binding sites in these membranes. The relatively slow binding process was characterized by the pseudo-first-order rate constant k_obs. The plot of these rate constants versus free radioligand concentration was hyperbolic, demonstrating that at least two kinetically distinguishable steps can be identified in the interaction of dopamine transporter with this inhibitor. The fast and reversible binding step, characterized by dissociation constant K_A = 51 ± 23 nM, is followed by a slow but also reversible isomerization step of the complex, characterized by the isomerization rate constant k_i = (7 ± 2)10⁻² s⁻¹ and by the rate constant k_−i = (3.9 ± 0.5)10⁻³ s⁻¹ for the reverse process. This isomerization step increases the apparent affinity of the ligand and probably consists of a conformational transition of the transporter protein, induced by the inhibitor molecule.