Overview of Dystrophies Associated with Calcium

合集下载

寄生虫笔记整理

免疫损害：超敏反应Ⅰ、Ⅱ、Ⅲ、Ⅳ。如蛔虫幼虫到肺部后其排泄物、蜕皮液作为抗原引起Ⅰ型超敏反应，导致蛔蚴性肺炎。
（二）宿主对寄生虫的抵抗——见寄生虫感染的免疫
（三）
1
即全部清除寄生虫，并具有抵御再感染能力。
2
感染者（带虫者，
3、不能有效控制寄生虫，寄生虫发育并大量繁殖→
寄生虫病（
二、寄生虫感染的特点：
Ｂ、切断传播途径：包括杀灭媒介节肢动物和动物中间宿主，加强粪管和水源管理，搞好环境卫生和个人卫生，改变不良的饮食习惯，切断传播途径。
Ｃ、保护易感者：加强集体与个人的防护，如预防服药、使用蚊帐、涂驱避剂（防护剂）、提高机体抵抗力。
福建医科大学教案
（首页）
课程名称：临床寄生虫学与检验
章节题目
医学原虫概述、溶组织内阿米巴、蓝氏贾第鞭毛虫（贾第虫）、隐孢子虫、结肠小袋纤毛虫
<3>与群众生活习惯有关：猪、牛带绦虫多流行于吃生或未熟的猪、牛肉地区；肝吸虫病流行于吃生鱼或未熟鱼的广东。
<4>与生产方式有关：钩虫病常流行于南方，用人粪施肥的旱地作物区。
２、季节性：寄生虫病的传播和感染常有季节性。与以下因素有关：
<1>媒介节肢动物或中间宿主的消长有季节性。如蚊、蝇、钉螺生长高峰在夏或秋季节。
c、影响寄生虫在中间宿主及媒介节肢动物体内发育。
低于15℃疟原虫不能在蚊体内发育,超过37.5℃疟原虫在蚊体内数小时死亡。
2、生物因素：生物因素也是自然因素。
3、社会因素：政治制度（五大寄生虫病的消灭与控制）、经济条件（日本预防日本血吸虫采用水泥沟）、生活条件、文化水平、医疗卫生、防疫机构健全情况、卫生状况、生产方式、习俗等。
3、经呼吸道感染：如疟原虫、丝虫。

中国痴呆与认知障碍诊治指南写作组英文

中国痴呆与认知障碍诊治指南写作组英文全文共10篇示例，供读者参考篇1Hey guys, do you know what dementia and cognitive impairment are? Today, I'm going to talk to you about it and how we can help those who have these conditions.Dementia is a condition that affects our brain and how we think, remember, and make decisions. It can make it hard for us to do everyday things like cooking, getting dressed, or even talking to our friends. Cognitive impairment is when our brain doesn't work as well as it should, and it can make it hard for us to learn new things or remember things we already know.But don't worry, there are ways to help people with dementia and cognitive impairment. One way is to encourage them to exercise their brains by doing puzzles, reading books, or even just talking to them and asking them questions. Another way is to make sure they eat well and get enough sleep, because a healthy body can help keep our brains healthy too.It's also important to be patient and understanding with people who have dementia or cognitive impairment. They mayforget things or get confused, but that's okay. Just be there for them and try to help them in any way you can.So let's all work together to support those who have dementia and cognitive impairment. We can make a difference in their lives and show them that they are not alone. Thanks for listening, and remember to be kind and compassionate to everyone you meet.篇2Title: A Guide to Understanding and Treating Dementia and Cognitive Impairment in ChinaHey guys, have you ever heard of something called dementia and cognitive impairment? It's a big word, but basically it means having trouble with your memory and thinking skills. It's something that can happen to older people, but it can also affect younger people too.In China, there are a lot of people who suffer from dementia and cognitive impairment. That's why it's important for us to learn about it and understand how we can help. There are many ways to diagnose and treat these conditions, so let's dive into some helpful tips and information!First of all, it's important to know the signs of dementia and cognitive impairment. Some common symptoms include forgetfulness, confusion, difficulty with everyday tasks, and changes in mood or behavior. If you or someone you know is experiencing these symptoms, it's important to see a doctor for a proper diagnosis.Once a diagnosis is made, there are different treatment options available. These can include medication, therapy, and lifestyle changes. It's important to work closely with healthcare professionals to find the best treatment plan for each individual.In addition to treatment, there are also ways to support people with dementia and cognitive impairment in their daily lives. This can include creating a safe and supportive environment, providing regular mental and physical stimulation, and maintaining a healthy diet and exercise routine.It's also important for families and caregivers to educate themselves about dementia and cognitive impairment. By understanding the condition and how to best support their loved ones, they can provide better care and improve quality of life.In conclusion, dementia and cognitive impairment are serious conditions that can impact people of all ages in China. By educating ourselves, seeking early diagnosis, and exploringtreatment options, we can help improve the lives of those affected by these conditions. Let's work together to create a more supportive and understanding community for all!篇3Hello everyone,Today, I want to talk to you about dementia and cognitive impairment. These are big words, but they are important to understand because they affect a lot of people, especially older people.Dementia is a condition where people have trouble remembering things, thinking clearly, and communicating. It can be really scary for someone to forget things or not be able to do things they used to do easily. Cognitive impairment is when people have trouble with their memory, attention, language, and reasoning skills. It's like their brain isn't working as well as it used to.But don't worry, there are ways to help people with dementia and cognitive impairment. They can go to the doctor to get a diagnosis and then they can get treatment to help them with their symptoms. There are also things that we can do tohelp them feel better, like spending time with them, talking to them, and helping them with everyday tasks.It's important to be patient and understanding with people who have dementia or cognitive impairment. They might get frustrated or confused, but we can help them by being kind and supportive. Let's all work together to make sure that everyone gets the help and support they need.Remember, we can all make a difference by being caring and understanding towards those who are facing these challenges. Let's show compassion and empathy to those who need it most.Thank you for listening and let's all do our part to support those with dementia and cognitive impairment. Together, we can make a positive impact on their lives.Take care and stay safe, everyone!Sincerely,[Your Name]篇4Title: Guide to Diagnosis and Treatment of Dementia and Cognitive Impairment in ChinaHey everyone! Today, let's talk about something super important - dementia and cognitive impairment. These are conditions that can affect our brains and make it hard for us to remember things or think clearly. But don't worry, we've got a guide to help you understand more about them and how to deal with them!First off, what is dementia? Dementia is a term used to describe a group of symptoms that affect our memory, thinking, and social abilities. It can be caused by different things like Alzheimer's disease or stroke. Cognitive impairment is similar, but it's a milder form of memory loss or trouble with thinking.So, how do we know if someone has dementia or cognitive impairment? Well, some signs to look out for include forgetting things often, having trouble with words or numbers, or getting lost in familiar places. If you notice any of these things in yourself or a loved one, it's important to see a doctor for a proper diagnosis.Once diagnosed, there are different treatments and therapies available to help manage dementia and cognitive impairment. These can include medications, cognitive therapy, and lifestyle changes like eating a healthy diet and staying active.In China, there are also resources available to help support those with dementia and cognitive impairment. There are specialized clinics and programs that provide care and assistance, as well as organizations that offer education and advocacy for those affected by these conditions.Remember, it's important to seek help and support if you or someone you know is experiencing symptoms of dementia or cognitive impairment. By working together and staying informed, we can better understand these conditions and help those affected live their best lives possible.That's all for today, folks! Stay sharp and take care of your brains!篇5Hi guys! Today I want to talk about China's dementia and cognitive impairment diagnosis and treatment guidelines writing group.So, first of all, let's talk about what dementia and cognitive impairment are. Dementia is when you have trouble remembering things, thinking clearly, or making decisions. It's like your brain is all mixed up and you can't do the things you used to do. Cognitive impairment is when your brain doesn'twork as well as it should. You might have trouble thinking, remembering, or learning new things.The China dementia and cognitive impairment diagnosis and treatment guidelines writing group is a group of smart people who study how to help people with dementia and cognitive impairment. They write down all the things that doctors should do to help people with these problems.One important thing they do is to make sure doctors can figure out if someone has dementia or cognitive impairment. They do tests and ask questions to see how well your brain is working. Then, they can give you the right medicine or therapy to help you feel better.It's really important to take care of our brains, guys! So if you or someone you know is having trouble remembering things or thinking clearly, make sure to go see a doctor. They can help you get better and feel like yourself again.Remember, it's okay to ask for help when you need it. The China dementia and cognitive impairment diagnosis and treatment guidelines writing group is here to help you!篇6Hello everyone! Today I'm going to talk about dementia and cognitive impairment in China. Do you know what that means? It's when people have trouble remembering things or thinking clearly. It can be really hard for them and their families.But don't worry, there are ways to help people with dementia and cognitive impairment. Doctors can give them medicine or therapy to make them feel better. They can also do things like puzzles or games to exercise their brains.It's important for us to be kind and patient with people who have dementia. They might get confused or frustrated, but we should always try to understand and help them as best as we can.If you know someone who has dementia or cognitive impairment, make sure to show them love and support. Spend time with them, listen to them, and try to make them feel happy.Let's all work together to make life better for people with dementia and cognitive impairment. We can make a difference by being compassionate and caring towards them. Thank you for listening!篇7Hello everyone! Today I want to talk to you about Chinese guidelines for the diagnosis and treatment of dementia and cognitive impairment. It's a big topic, but I'll try to break it down for you in simple terms.First of all, what is dementia? Dementia is a syndrome that affects memory, thinking, behavior and the ability to perform everyday activities. It is not a normal part of aging, and can be caused by various diseases or conditions.In China, the diagnosis of dementia is based on a comprehensive assessment that includes medical history, physical examination, cognitive tests, blood tests and brain imaging. Treatment usually involves a combination of medication, therapy and lifestyle changes.There are also guidelines for the management of specific types of dementia, such as Alzheimer's disease and vascular dementia. These guidelines provide recommendations on medication, therapy, and support for patients and their families.It's important to remember that early diagnosis and treatment of dementia can help improve quality of life and slow down progression of the disease. So if you or a loved one are experiencing memory problems or other symptoms of dementia, don't hesitate to seek help from a healthcare professional.That's all for today! Remember, knowledge is power, so stay informed and take care of your brain. Thanks for listening!篇8Hi everyone, today I'm going to talk about the Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines Writing Group. It's a big word, I know, but it's important to understand how to take care of our brains!First of all, what is dementia and cognitive impairment? Well, it's when our brains start to have trouble with things like memory, thinking, and reasoning. It's like when you forget where you put your toys or what you had for breakfast. It can be really scary for people who have it, so it's important to know how to help them.The guidelines from the writing group give doctors and nurses information on how to diagnose and treat dementia and cognitive impairment. They can do things like memory tests and brain scans to see what's going on in the brain. They can also give medicines and therapy to help improve symptoms.It's also really important for us to take care of our brains every day. Things like eating healthy foods, exercising, and staying social can help keep our brains healthy. And if you noticesomeone having trouble with their memory or thinking, be kind and patient with them. They might need a little extra help.So let's all work together to learn more about dementia and cognitive impairment, and how we can help people who have it. Our brains are super important, so let's take care of them!篇9Hello everyone! Today, I'm going to talk about something super important - Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines. Yeah, that's a mouthful, but don't worry, I'm here to break it down for you!So, what exactly is dementia and cognitive impairment? Well, it's basically when your brain doesn't work as well as it used to. It can make it hard to remember things, think clearly, or even do everyday tasks. But don't worry, there are ways to help!First off, it's important to see a doctor if you or someone you know is having trouble with their memory or thinking. They can do some tests to figure out what's going on and come up with a plan to help.One way to help with dementia and cognitive impairment is through lifestyle changes. Eating healthy, exercising, and stayingsocial can all help keep your brain in tip-top shape. Plus, it's important to keep your brain active by doing puzzles, reading, or learning new things.There are also medications that can help with symptoms of dementia and cognitive impairment. These can help improve memory, thinking, and even mood. Just make sure to talk to your doctor about any medications you're taking.And finally, it's important to have a good support system. Whether it's friends, family, or a support group, having people who care about you can make a big difference.So, remember, if you're worried about your memory or thinking, don't be afraid to talk to a doctor. There are ways to help improve your brain function and make life easier. Stay healthy, keep learning, and don't forget to take care of your brain!篇10Hello everyone! Today I want to tell you about the Chinese dementia and cognitive impairment diagnosis and treatment guidelines writing group. It's a group of smart people who are working hard to help patients with dementia and cognitive impairment in China.First of all, let's talk about what dementia and cognitive impairment are. Dementia is a condition that affects a person's memory, thinking, and behavior. It can make it difficult for someone to do everyday tasks and even recognize their loved ones. Cognitive impairment is when a person has trouble with their memory, attention, or problem-solving skills.The writing group is making guidelines to help doctors in China diagnose and treat people with dementia and cognitive impairment. They are working to improve the quality of care for these patients and make sure they get the help they need.The guidelines will provide doctors with important information on how to diagnose dementia and cognitive impairment. They will also give recommendations on the best ways to treat these conditions, such as medication, therapy, and lifestyle changes.Overall, the Chinese dementia and cognitive impairment diagnosis and treatment guidelines writing group is doing important work to help people in China who are struggling with these conditions. Let's give them a big round of applause for all their hard work!Remember, if you or someone you know is experiencing memory problems or other symptoms of dementia, it's important to see a doctor for help. Don't wait, take action now!。

川芎消肿止痛膏联合活血止痛汤加减治疗骨伤肿痛（气滞血瘀证）效果分析

DOI：10.19368/ki.2096-1782.2023.22.020川芎消肿止痛膏联合活血止痛汤加减治疗骨伤肿痛（气滞血瘀证）效果分析杨杨，吴兴球，张鹏沭阳县中医院骨伤科，江苏宿迁223600[摘要]目的评估骨伤肿痛（气滞血瘀证）患者接受川芎消肿止痛膏联合活血止痛汤加减治疗的效果。

方法选取2021年6月—2023年6月沭阳县中医院收治的78例骨伤肿痛（气滞血瘀证）患者为研究对象，通过简单随机化掷骰子法将其分为对照组和联合组，各39例。

对照组给予川芎消肿止痛膏治疗；联合组加用活血止痛汤加减治疗。

比较两组的疼痛测评值变化情况，记录患者的效果优良率。

结果两组治疗前的疼痛测评值比较，差异无统计学意义（P>0.05），治疗后两组疼痛测评值均降低，且联合组低于对照组，差异有统计学意义（P<0.05）；联合组患者的效果优良率（97.43%）显著高于对照组（79.48%），差异有统计学意义（χ2=6.155，P< 0.05）。

结论给药骨伤肿痛（气滞血瘀证）患者川芎消肿止痛膏联合活血止痛汤加减治疗，可以更快速地降低患者疼痛不适情况，从而提升患者治疗配合度，更好地调节气滞血瘀，帮助骨伤处肿胀的缓解，更利于消肿止痛，药物安全有效。

[关键词]川芎消肿止痛膏；活血止痛汤；加减治疗；骨伤肿痛；气滞血瘀证[中图分类号]R274 [文献标识码]A [文章编号]2096-1782（2023）11(b)-0020-04Effect Analysis of Chuanxiong Xiaozhong Zhitong Ointment Combined with Huoxuetong Zhitong Decoction in the Treatment of Bone Injury and Swollen Pain (Syndrome of Qi Stagnation and Blood Stasis)YANG Yang, WU Xingqiu, ZHANG PengDepartment of Orthopedics and Traumatology, Shuyang County Hospital of Traditional Chinese Medicine, Suqian, Ji⁃angsu Province, 223600 China[Abstract] Objective To evaluate the effect of Chuanxiong Xiaozhong Zhitong ointment combined with Huoxue Zhi⁃tong decoction on patients with bone injury and swelling pain (syndrome of Qi stagnation and blood stasis). Methods A total of 78 patients with bone injury, swelling and pain (syndrome of Qi stagnation and blood stasis) admitted to Shuy⁃ang County Hospital of Traditional Chinese Medicine from June 2021 to June 2023 were included, and they were di⁃vided into control group and combination group by simple randomization dice method, with 39 cases in each group. The control group was treated with Chuanxiong Xiaozhong Zhitong ointment. Patients in the combined group were also treated with Huoxue Zhitong decoction. The changes of pain assessment values were compared between the two groups, and the rate of good and good effect was recorded. Results There was no statistically significant difference in pain as⁃sessment between the two groups before treatment (P>0.05). After treatment, the pain assessment values were de⁃creased in both groups, and the combined group were significantly lower than the control group, and the difference was statistically significant (P<0.05). The rate of excellent and good effect in combined group (97.43%) was significantly higher than that in control group (79.48%), and the difference was statistically significant (χ2=6.155, P<0.05). Conclu⁃sion Chuanxiong Xiaozhong Zhitong ointment combined with Huoxue Zhitong decoction can reduce the pain and dis⁃comfort of patients with bone injury and swelling pain (syndrome of Qi stagnation and blood stasis) more quickly, thereby improving the patient's cooperation in treatment, better regulating Qi stagnation and blood stasis, helping to re⁃lieve swelling at bone injury, and more conducive to reducing swelling and pain relief. The drug is safe and effective.[作者简介] 杨杨（1989-），男，本科，主治中医师，研究方向为中医骨伤方面。

一种先天性颅神经支配异常疾病译文

一种先天性颅神经支配异常疾病：Möbius综合症Picture 1. 会聚性斜视以及右边面瘫，异常面部外观Picture 2. 单侧性舌麻痹Picture 3. a-c.右手正常外观（a），左手手指呈现笔尖样外观（b），左手前后位图影响显示远端趾骨发育不全（c）摘要：Möbius综合征，又称Möbius序列征，是一种以先天性面神经和展神经麻痹为特征的非进行性颅神经分布异常疾病。

我们在此报道了一个经体外受精后孕育而生的有着吸吮困难和面瘫症状的五天大的女婴。

患儿表现出双眼上睑下垂及侧视受限、舌左偏、面部畸形、左手手指及指甲发育不全，该患儿被诊断患有Möbius综合征。

该综合征可伴随其他颅神经如第3、4、5、9、10、12对颅神经的累及和四肢畸形。

为了追究病因，已有几项要素被提出，然而目前只报道了一些很稀少的与人工生殖技术相关的案例。

喂养困难及误吸是婴儿期所要面对的主要问题。

对于先天性面瘫的新生儿，应对其他颅神经做进一步的检查，同时应考虑其他神经分布异常疾病以进行鉴别诊断。

关键词：人工生殖技术、先天性面瘫、Möbius综合征简介：Moebius综合征（MS），又称Moebius序列征，是一种以先天性面神经和展神经麻痹为特征的非进展性疾病，可归组于先天性颅神经分布异常疾病（CCDD）。

先天性颅神经分布异常疾病为原发或继发地起自于先天性发育异常或是一条或多条颅神经的完全缺如的肌肉异常支配性疾病。

这类疾病是非进展性的，发作可为散发或遗传。

眼球的异常后退，眼外肌的先天性纤维化，水平方向的视觉麻痹，先天性上睑下垂，先天性面神经麻痹也属于CCDD。

第7和第6对神经是MS中最常受影响的颅神经，在一些病人中同时也观察到第3、4、5、9、10和12对颅神经的累及。

吞咽困难，颅脑形态异常，肢端异常，胸小肌发育不全（波兰异常）及精神障碍也同时被观察到。

（1）在这些患者中，喂养困难及误吸是婴儿期要面对的主要问题。

中药复方治疗急性胰腺炎作用机制的研究进展

中药复方治疗急性胰腺炎作用机制的研究进展牛小龙1，2，姚广涛1，31 上海中医药大学研究生院，上海201203；2 上海中医健康服务协同创新中心；3 上海中医药大学创新中药研究院摘要：急性胰腺炎（AP）是临床常见的一种急腹症。

大多数AP患者为轻症，病程具有自限性，通常1～2周即可恢复。

但约20% AP患者会发展为重症急性胰腺炎（SAP），病死率为20%～40%。

西医治疗AP易引起继发性感染、腹膜炎、休克等并发症，整体治疗效果并不理想。

中医认为，AP起因于诸多病邪，包括热、湿、水、气、瘀等壅阻于胰、肝、胆、胃、脾、肠等脏腑，在治疗上应以“攻下通腑”“疏肝退热”“清热解毒”为突破点。

常用的中药复方包括大承气汤、大柴胡汤、大黄牡丹汤、柴芩承气汤、清胰汤等，其作用机制包括改善胃肠功能，修复肠黏膜屏障；抑制炎症反应，提高免疫功能；促进胰腺微循环；诱导胰腺腺泡细胞凋亡等。

这些中药复方以其多组分、多途径、多靶点相互作用，协同发挥治疗作用。

关键词：急性胰腺炎；中药复方；作用机制doi：10.3969/j.issn.1002-266X.2024.01.023中图分类号：R657.5+1 文献标志码：A 文章编号：1002-266X（2024）01-0093-05急性胰腺炎（AP）是临床常见的消化系统急症之一。

大多数AP患者为轻症，病程具有自限性，通常1～2周即可恢复。

但仍有约20% AP患者会发展为重症急性胰腺炎（SAP），病死率为20%～40%［1］。

西医治疗AP的主要方法包括立即禁食水、持续胃肠减压、静脉输液支持、抑制胃酸和胰液分泌等［2］。

但西医治疗易引起继发性感染、腹膜炎、休克等并发症，整体治疗效果并不理想。

中医药以其多组分、多途径、多靶点相互作用，协同发挥治疗作用，在治疗AP方面具有独特优势。

经典中药复方大承气汤、清胰汤能够减轻胰腺炎症，抑制病情加重［3］。

此外，大柴胡汤、大黄牡丹汤、柴芩承气汤等中药复方亦能通过改善胃肠功能、修复肠黏膜屏障、诱导细胞凋亡等基金项目：上海市科技计划项目资助（22S21901300）。

坦普·葛兰汀—聂思师

坦普· 葛兰汀
制作人：聂思师
坦普职业
• 动物学家，畜产学学者，畅销作家，禽畜动物行为顾问。
坦普荣誉
天宝· 葛兰汀，身为知名的亚斯伯格综合症患者，葛兰汀致力于宣导自闭症、并发明了Hug machine给过度敏感的人。时代周刊2010年100位“全球最具影响力人物” 评选，英雄榜第5位。她是当今少数的牲畜处理设备设计、建造专家之一。她在此专业领域中，发表过上百篇学术论文，并经常性地巡回各地发表演说。
坦普学历
• 坦普· 葛兰汀虽然自幼患有自闭症，却拥有亚利桑那州立大学畜牧科学硕士，并于一九八八年获得伊利诺大学的畜牧科学博士学位。她是当今少数的牲畜处理设备设计、建造专家之一。她在此专业领域中，发表过上百篇学术论文，并经常性地巡回各地发表演说。
《自闭历程》
பைடு நூலகம்
是一部基于著名自闭症患者天宝· 葛兰汀的自传进行改编，由克莱尔· 丹尼斯出演传记主人公，讲述她与众不同的成长经历。 2010年2月6日，电影《自闭历程》在美国上映，此片获得了2010年艾美奖最佳女主角奖，以及2011年金球奖最佳女主角奖。

外周血应激性血糖升高比值联合前白蛋白对AMI并发急性左心衰竭病人预后不良的预测价值

[9]ZHOU D,YAN M Q,CHENG Q,et al.Prevalence and prognosis ofleft ventricular diastolic dysfunction in community hypertensionpatients[J].BMC Cardiovascular Disorders,2022,22(1):265. [10]JENAB Y,HEDAYAT B,KARIMI A,et al.Effects of opium use onone-year major adverse cardiovascular events(MACE)in thepatients with ST-segment elevation MI undergoing primary PCI:apropensity score matched-machine learning based study[J].BMC Complementary Medicine and Therapies,2023,23(1):16. [11]MASOUDKABIR F,YAVARI N,PASHANG,et al.Effect ofpersistent opium consumption after surgery on the long-term outcomes of surgical revascularisation[J].European Journal ofPreventive Cardiology,2020,27(18):1996-2003.[12]何远利,安祯祥,杨蕊琳,等.心衰宁合剂对慢性心力衰竭大鼠心肌AMPK和PPARα的影响[J].中药新药与临床药理,2020,31(3):287-293.[13]丁应勇.中西医结合心竭宁方治疗冠心病慢性心衰临床价值研究[J].饮食保健,2020,7(11):110-111.[14]陈可斌,史超,寻增艳,等.心电图ST段压低㊁QTc㊁QTd及投影间夹角有助于判断慢性心力衰竭患者心脏同步化治疗的预后[J].内科急危重症杂志,2022,28(4):301-304.[15]范梦丽,孟红社.2型糖尿病合并慢性心力衰竭患者发生主要心血管不良事件的影响因素[J].河南医学研究,2021,30(4):628-630.[16]哈斯,莎其尔,于立鹏,等.老年心力衰竭患者BNP㊁LVEDD㊁LVEF水平与心脏功能的关系[J].现代生物医学进展,2021,21(21):4113-4117.[17]杨东,骆昌云,刘川,等.急性心力衰竭合并房颤患者sST2㊁BNP㊁AngⅡ的表达及意义[J].解放军医药杂志,2022,34(2):79-82. [18]BACKHAUS S J,KOWALLICK J T,STIERMAIER T,et al.Culpritvessel-related myocardial mechanics and prognostic implicationsfollowing acute myocardial infarction[J].Clinical Research inCardiology,2020,109(3):339-349.[19]TOVAR FORERO M N,ZANCHIN T,MASDJEDI K,et al.Incidenceand predictors of outcomes after a first definite coronary stentthrombosis[J].EuroIntervention,2020,16(4):e344-e350. [20]韦荣文,王惠香,黄慧琨.心脏超声对高血压左室肥厚伴左心力衰竭的临床诊断价值[J].影像研究与医学应用,2021,5(20):62-63.(收稿日期:2023-03-12)(本文编辑郭怀印)外周血应激性血糖升高比值联合前白蛋白对AMI并发急性左心衰竭病人预后不良的预测价值米黑热古丽㊃艾尼瓦尔,李超摘要目的:探讨外周血应激性血糖升高比值(SHR)㊁前白蛋白(PA)对急性心肌梗死(AMI)并发急性左心衰竭(ALHF)病人预后不良的预测价值㊂方法:选取2019年5月 2021年4月北京儿童医院新疆医院收治的317例AMI病人作为研究对象,根据有无并发急性左心衰竭将其分为急性左心衰竭组(113例)和非急性左心衰竭组(204例)㊂采集病人外周血样,检测入院即刻血糖水平㊁空腹糖化血红蛋白水平和PA水平,计算SHR㊂跟踪随访急性左心衰竭组病人治疗后12个月内的生存情况,根据病人有无发生心源性死亡将其分为预后不良组和预后良好组,分析AMI并发急性左心衰竭病人预后不良的影响因素,另绘制受试者工作特征(ROC)曲线分析外周血SHR和PA对AMI并发急性左心衰竭病人预后不良的预测价值㊂结果:急性左心衰竭组外周血SHR高于非急性左心衰竭组(P<0.05),外周血PA水平低于非急性左心衰竭组(P<0.05);急性左心衰竭组病人随访12个月内预后不良发生率为35.40%,预后不良组年龄㊁SHR高于预后良好组(P<0.05),外周血PA水平㊁左室射血分数及再灌注㊁β受体阻断剂㊁他汀类药物治疗占比均低于预后良好组(P<0.05)㊂Logistic回归分析结果显示,年龄㊁外周血SHR高及左室射血分数㊁外周血PA水平低均是AMI并发急性左心衰竭病人预后不良的危险因素(P<0.05),再灌注㊁β受体阻断剂㊁他汀类药物治疗是AMI并发急性左心衰竭病人预后不良的保护因素(P<0.05);外周血SHR㊁PA水平单项及二者联合预测AMI并发急性左心衰竭病人预后不良的敏感度分别为75.00%㊁67.50%㊁92.50%,特异度分别为89.04%㊁93.15%㊁86.30%,曲线下面积(AUC)分别为0.752,0.798,0.913,二者联合预测的敏感度和AUC均高于单项预测(P<0.05)㊂结论:AMI并发急性左心衰竭病人外周血SHR明显升高,PA水平明显降低,二者均与病人预后不良有关,对预后具有预测价值,但联合预测更有助于临床评估病人预后情况㊂关键词急性心肌梗死;急性左心衰竭;应激性血糖升高比值;前白蛋白;预后d o i:10.12102/j.i s s n.1672-1349.2024.06.025作者单位北京儿童医院新疆医院/新疆维吾尔自治区儿童医院(乌鲁木齐830054),E-mail:****************引用信息米黑热古丽㊃艾尼瓦尔,李超.外周血应激性血糖升高比值联合前白蛋白对AMI并发急性左心衰竭病人预后不良的预测价值[J].中西医结合心脑血管病杂志,2024,22(6):1094-1098.急性心力衰竭是急性心肌梗死(AMI)的严重并发症,其中以急性左心衰竭(ALHF)最为常见,不仅增加AMI病人治疗难度和费用,也明显增加了病人的病死率[1]㊂调查显示,AMI合并急性左心衰竭病人1年㊁5年病死率分别高达37%㊁62%[2]㊂因此,探讨早期预测AMI合并急性左心衰竭病人预后的指标以指导临床干预,对改善病人预后具有重要意义㊂既往研究报道,在机体遭受AMI㊁急性左心衰竭等严重疾病时会出现应激性高血糖,血糖适度升高可维持梗死心肌能量供给,减轻损伤,但过度升高会激活氧化应激和免疫应答,加重微循环障碍和心肌损伤,单一检测血糖或糖化血红蛋白容易忽略基础血糖水平对应激性血糖改变的影响[3]㊂应激性血糖升高比值(SHR)是近年来提出的评估应激性血糖水平相对变化的新参数,且国内外研究均发现SHR与AMI病人并发严重心力衰竭㊁心源性休克和死亡率相关[4-5]㊂前白蛋白(PA)是肝脏在机体严重感染㊁创伤㊁AMI等急性期合成的蛋白,可反映机体损伤程度和营养状况,Wang等[6]研究表明,较低的PA与冠心病严重程度和心脏不良事件发生有关㊂本研究观察AMI合并急性左心衰竭病人SHR和PA 变化,探讨SHR和PA对AMI并发急性左心衰竭病人预后不良的预测价值㊂1资料与方法1.1一般资料选取2019年5月 2021年4月我院收治的317例AMI病人作为研究对象㊂纳入标准:符合AMI诊断标准[7],发病到入院治疗不超过24h;年龄18~80岁;签署知情同意书者㊂排除标准:严重肝㊁肾㊁肺等功能不全者;近1个月有严重创伤㊁感染或手术史;既往有急性左心衰竭史;合并心肌炎㊁肥厚型心肌病㊁瓣膜病㊁主动脉夹层等;先天性心脏病病人;恶性肿瘤病人;合并白血病㊁血友病等血液系统疾病;妊娠期或哺乳期女性病人;神经器质性病变及精神疾病病人㊂急性左心衰竭诊断标准:1)既往有心脏病史或心力衰竭史;2)突发呼吸困难㊁端坐呼吸㊁发绀㊁咳粉红泡沫痰;3)听诊两肺湿啰音(或伴哮鸣音)㊁心率快㊁闻及奔马律,胸部X 线示肺淤血㊁肺水肿;4)心脏生物学标志物血浆B型钠尿肽㊁N末端脑钠肽前体㊁肌钙蛋白等明显升高[8]㊂根据AMI病人有无并发急性左心衰竭将其分为两组,急性左心衰竭组113例,其中,男60例,女53例;年龄53~77(66.93ʃ6.27)岁;体质指数(BMI)20~29(24.89ʃ2.56)kg/m2㊂非急性左心衰竭组204例,其中,男106例,女98例;年龄51~76(66.47ʃ6.59)岁;BMI20~ 29(25.02ʃ2.74)kg/m2㊂两组性别㊁年龄㊁BMI比较差异均无统计学意义(P>0.05)㊂本研究经医院伦理委员会批准(伦理批号:201903-002)㊂1.2方法1.2.1SHR检测于病人入院后即刻采集肘静脉血,应用全自动生化分析仪测定入院即刻血糖水平,另于入院后次日清晨采集病人空腹静脉血样,应用全自动糖化血红蛋白分析仪检测糖化血红蛋白(HbA1c)水平,应用全自动生化分析仪检测血清PA水平㊂计算SHR,SHR=入院即刻血糖水平/(1.59ˑHbA1c-2.59)㊂1.2.2资料收集及随访收集病人的性别㊁年龄㊁BMI㊁心率㊁血压㊁既往病史(心肌梗死㊁慢性心力衰竭)㊁合并疾病(糖尿病㊁高血压㊁高脂血症)㊁实验室检查情况(外周血SHR㊁外周血PA㊁血红蛋白㊁血肌酐㊁血钠㊁血钾㊁N末端脑钠肽前体㊁肌酸激酶同工酶)㊁心肌梗死类型㊁左室射血分数㊁Killip心功能分级㊁治疗情况[再灌注治疗(溶栓或PCI)㊁血管紧张素转化酶抑制剂(ACEI)/血管紧张素Ⅱ拮抗剂(ARB)㊁β受体阻断剂㊁他汀类药物㊁利尿剂㊁抗血小板药物]等㊂对急性左心衰竭组病人进行跟踪随访,病人出院后1㊁3㊁6㊁12个月来院复诊,同时每月电话随访病人预后情况㊂根据随访12个月内病人有无发生心源性死亡将其分为预后不良组和预后良好组㊂1.3观察指标比较急性左心衰竭组和非急性左心衰竭组外周血SHR及PA水平;统计急性左心衰竭组预后情况,比较预后良好组和预后不良组临床资料;分析AMI并发急性左心衰竭病人预后不良的影响因素,并分析外周血SHR及PA水平对AMI并发急性左心衰竭病人预后不良的预测价值㊂1.4统计学处理采用SPSS26.0软件进行统计分析㊂对定量资料均行正态性检验,符合正态分布以均数ʃ标准差(xʃs)表示,两组间比较采用独立样本t检验;偏态分布以中位数及四分位数[M(P25,P75)]表示,采用Mann-Whitney U检验㊂定性资料以例数或百分率表示,采用χ2检验,若任一理论频数>1且<5时需对检验进行校正;采用Logistic回归分析探讨AMI并发急性左心衰竭病人预后不良的影响因素,记录比值比(OR)和95%置信区间(95%CI);采用受试者工作特征曲线(ROC)分析外周血SHR及PA水平对AMI并发急性左心衰竭病人预后不良的预测价值,记录截断值㊁敏感度㊁特异度㊁曲线下面积(AUC)和95%CI㊂以P<0.05为差异有统计学意义㊂2结果2.1急性左心衰竭组和非急性左心衰竭组外周血SHR及PA水平比较急性左心衰竭组外周血SHR高于非急性左心衰竭组(P<0.05),外周血PA水平低于非急性左心衰竭组(P<0.05)㊂详见表1㊂表1急性左心衰竭组和非急性左心衰竭组外周血SHR及PA水平比较[M(P25,P75)]组别例数SHR PA(g/L)急性左心衰竭组113 1.19(0.87,1.43)0.19(0.15,0.21)非急性左心衰竭组204 1.03(0.75,1.33)0.23(0.18,0.30) U值907.500618.000P0.001<0.0012.2预后良好组和预后不良组临床资料比较113例急性左心衰竭病人随访12个月内有40例发生心源性死亡,预后不良发生率为35.40%(40/113)㊂预后不良组年龄㊁SHR高于预后良好组(P<0.05),外周血PA水平㊁左室射血分数及再灌注㊁β受体阻断剂㊁他汀类药物治疗占比均低于预后良好组(P<0.05)㊂详见表2㊂表2预后良好组和预后不良组临床资料比较项目预后不良组(n=40)预后良好组(n=73)统计值P 男性[例(%)]19(47.50)41(56.16)χ2=0.7790.377年龄(岁)70.06ʃ5.2865.21ʃ6.44t=4.070<0.001 BMI(kg/m2)24.77ʃ2.4624.96ʃ2.28t=-0.4120.681心率(次/min)91.84ʃ20.6786.57ʃ18.29t=1.3980.165收缩压(mmHg)135.36ʃ28.13128.44ʃ27.52t=1.2680.207舒张压(mmHg)76.54ʃ15.3875.94ʃ16.22t=0.1910.849既往病史[例(%)]心肌梗死13(32.50)20(27.40)χ2=0.3250.568慢性心力衰竭17(42.50)24(32.88)χ2=1.0350.309合并疾病[例(%)]糖尿病16(40.00)31(42.47)χ2=0.0650.799高血压29(72.50)48(65.75)χ2=0.5420.462高脂血症[例(%)]5(12.50)10(13.70)χ2=0.0120.912 SHR 1.45(1.28,1.66) 1.08(0.84,1.27)U=723.000<0.001 PA(g/L)0.14(0.12,0.18)0.20(0.18,0.22)U=590.000<0.001血红蛋白(g/L)118.94ʃ11.53123.61ʃ13.89t=-1.8110.073血肌酐(μmol/L)103.15(70.28,128.74)95.88(64.57,120.13)U=1304.5000.344血钠(mmol/L)137.11ʃ5.48137.79ʃ5.86t=-0.6030.548血钾(mmol/L) 4.13ʃ0.75 4.05ʃ0.66t=0.5870.558 N末端脑钠肽前体(ng/L)6071(2935,16829)4512(2406,10764)U=1127.5000.219肌酸激酶同工酶(U/L)236.57ʃ38.62224.13ʃ35.39t=1.7300.086 ST段抬高型心肌梗死[例(%)]14(35.00)28(38.36)χ2=0.1250.724左室射血分数(%)44.21ʃ12.8948.76ʃ10.24t=-2.0570.042 Killip心功能分级[例(%)] Ⅱ级13(32.50)38(52.05)Ⅲ级17(42.50)22(30.14)U=3.9900.134Ⅳ级10(25.00)13(17.81)治疗情况[例(%)]再灌注14(35.00)49(67.12)χ2=10.8090.001 ACEI/ARB10(25.00)28(38.36)χ2=2.0650.151β受体阻断剂26(65.00)61(83.56)χ2=5.0260.025他汀类药物28(70.00)69(94.52)χ2=12.783<0.001利尿剂32(80.00)60(82.19)χ2=0.0820.775抗血小板药物37(92.50)70(95.89)χ2=0.5910.4422.3AMI并发急性左心衰竭病人预后不良影响因素分析将AMI并发急性左心衰竭病人预后情况作为因变量(预后良好=0,预后不良=1),将上述预后良好组和预后不良组临床资料比较P<0.10的项目作为自变量[年龄(实测值)㊁外周血SHR(实测值)㊁PA水平(实测值)㊁血红蛋白水平(实测值)㊁肌酸激酶同工酶(实测值)㊁左室射血分数(实测值)㊁再灌注(有=0,无=1)㊁β受体阻断剂(有=0,无=1)㊁他汀类药物治疗(有=0,无=1)],进行Logistic回归分析,结果显示,年龄大㊁外周血SHR高及左室射血分数㊁外周血PA水平降低均是AMI并发急性左心衰竭病人预后不良的危险因素(P <0.05),再灌注㊁β受体阻断剂㊁他汀类药物治疗是AMI 并发急性左心衰竭病人预后不良的保护因素(P <0.05)㊂详见表3㊂表3 AMI 并发急性左心衰竭病人预后不良的影响因素分析变量回归系数标准误Wald χ2值P OR 值95%CI 年龄0.6530.2089.8560.002 1.921[1.278,2.888]左室射血分数0.8950.3168.0220.005 2.447[1.317,4.546]外周血SHR 1.0770.29113.698<0.001 2.936[1.660,5.194]外周血PA 水平 1.1640.32412.907<0.001 3.203[1.697,6.044]再灌注-0.6290.2178.4020.0040.533[0.348,0.816]β受体阻断剂治疗-0.3720.158 5.5430.0180.689[0.506,0.939]他汀类药物治疗-0.5260.1947.3510.0060.591[0.404,0.864]常数项-7.0241.44723.555<0.0012.4 外周血SHR 及PA 水平对AMI 并发急性左心衰竭病人预后不良的预测价值外周血SHR ㊁PA 水平联合预测AMI 并发急性左心衰竭病人预后不良的敏感度均高于单项指标预测(χ2=4.501,P =0.034;χ2=7.813,P =0.005);AUC 均高于单项指标预测(Z =2.727,P =0.006;Z =2.050,P =0.040);特异度与单项指标预测对比差异均无统计学意义(P >0.05)㊂详见表4㊁图1㊂表4 外周血SHR 及PA 水平对AMI 并发急性左心衰竭病人预后不良的预测价值项目截断值敏感度(%)特异度(%)AUC 95%CI SHR 1.34 75.0089.040.752[0.662,0.829]PA 0.16g/L67.5093.150.798[0.712,0.868]二者联合92.5086.300.913[0.845,0.958]图1 外周血SHR 、PA 单项及联合预测AMI并发急性左心衰竭病人预后不良的ROC 曲线3 讨论急性左心衰竭是AMI 的并发症之一,具有较高的致残率㊁致死率㊂随着医疗水平的发展,临床在治疗AMI 并发急性左心衰竭病人效果方面也取得了很大进步,但仍有较高的再住院率和病死率[9]㊂本研究通过对AMI 并发急性左心衰竭病人进行随访,发现治疗后12个月预后不良发生率高达35.40%,由此可见预测AMI 并发急性左心衰竭病人预后不良风险对指导临床早期个体化㊁循证治疗具有重要意义㊂SHR 反映应激状态下血糖变化情况,机体在应激状态下会产生儿茶酚胺㊁肾上腺素㊁胰高血糖素等,导致胰岛素抵抗和糖异生,进而使血糖迅速升高[10]㊂有研究报道,血糖升高能够反映疾病严重程度和应激程度,血糖升高越显著,提示疾病越严重,应激反应越剧烈[11]㊂本研究发现,急性左心衰竭组外周血SHR 高于非急性左心衰竭组,说明AMI 并发急性左心衰竭病人SHR 高于未并发急性左心衰竭病人,可能由于AMI 病人在并发急性左心衰竭后应激反应进一步加剧,导致血糖显著升高,SHR 较高㊂应激状态下血糖升高虽对机体具有一定的保护作用,但血糖过度升高会上调富含线粒体相关内质网膜蛋白表达,破坏钙离子平衡,激活心肌细胞内质网应激㊁线粒体氧化应激,促进心肌细胞死亡[12];Thakur 等[13]研究发现,在高血糖状态下,心肌细胞暴露24h 后心肌标志物肌钙蛋白及CXC 趋化因子㊁热休克蛋白㊁Toll 样受体等炎症相关介质上调,心肌细胞受损,心脏收缩功能也发生障碍㊂以上研究均提示应激状态下高血糖可能会对AMI 并发急性左心衰竭病人预后造成影响㊂故本研究进一步比较AMI 并发急性左心衰竭病人中不同预后病人SHR ,发现预后不良组SHR 高于预后良好组,且经Logistic 回归分析证实SHR 较高是病人预后不良的危险因素㊂吴伏鹏等[14]研究也发现,急性心力衰竭病人中SHR高水平组死亡率高于低水平组,SHR水平升高是此类病人死亡的独立危险因素㊂PA是一种急性期负性蛋白,半衰期短,相比清蛋白更能准确评估机体营养状态和炎症状态,且能在一定程度上反映损伤程度㊂既往研究发现,在AMI病人中PA水平随心功能分级升高而降低,且并发心力衰竭病人PA水平低于未并发病人[15]㊂本研究也发现急性左心衰竭组外周血PA水平低于非急性左心衰竭组,与上述研究报道一致,提示PA水平降低可能与AMI病人病情程度有关㊂本研究还发现AMI并发急性左心衰竭病人中预后不良组PA水平低于预后良好组,且经Logistic回归分析证实PA水平较低是病人预后不良的危险因素㊂炎症反应在AMI和急性左心衰竭发病机制中起重要作用,急性期病情加重,炎症反应剧烈,使PA合成受抑制,水平降低,同时AMI并发急性左心衰竭处于应激状态,能量代谢增加,且病情严重㊁病程长,机体消耗巨大,常导致营养不良,PA水平降低,而营养不良又会使机体免疫力下降,加重感染,恶化心功能,导致预后不良[16]㊂Akashi等[17]研究也发现,急性心力衰竭病人入院时PA水平较低与较高的死亡率相关,能够有效预测病人全因性死亡㊂本研究进一步绘制ROC曲线分析外周血SHR㊁PA水平单项及联合预测AMI并发急性左心衰竭病人预后不良的价值,发现联合预测的敏感度和AUC均高于单项预测,特异度与单项预测相近,提示外周血SHR㊁PA水平联合检测更有助于临床评估AMI并发急性左心衰竭病人预后不良的风险,以便早期对此类病人进行危险分层,给予个体化干预以改善预后㊂此外,本研究还发现年龄大㊁左室射血分数低均也是AMI并发急性左心衰竭病人预后不良的危险因素,再灌注㊁β受体阻断剂㊁他汀类药物治疗是预后不良的保护因素,与既往研究报道[18-19]一致㊂综上所述,AMI并发急性左心衰竭病人SHR升高,PA水平降低,均是AMI并发急性左心衰竭病人预后不良的危险因素,且对预后不良具有预测价值,二者联合预测应用价值更高㊂但本研究尚有不足:如单中心研究样本选取相对较为局限㊁样本量较小;对病人发生应激性血糖改变机制尚未完全清楚,需进一步深入探讨;未具体分析SHR对伴或不伴糖尿病病人预后的影响㊂参考文献:[1]KAMON D,SUGAWARA Y,SOEDA T,et al.Predominant subtypeof heart failure after acute myocardial infarction is heart failurewith non-reduced ejection fraction[J].ESC Heart Failure,2021,8(1):317-325.[2]李杨,孙筱璐,秦俭,等.急诊科急性心肌梗死后并发急性心力衰竭患者远期预后及其影响因素研究[J].中国临床医生杂志,2021,49(4):408-414.[3]STALIKAS N,PAPAZOGLOU A S,KARAGIANNIDIS E,et al.Association of stress induced hyperglycemia with angiographicfindings and clinical outcomes in patients with ST-elevationmyocardial infarction[J].Cardiovascular Diabetology,2022,21(1):140.[4]汤莉莹,白玉芝,王晶,等.应激性高血糖及氧化应激产物水平对急性心肌梗死患者预后的评估价值[J].中国急救医学,2019,39(1):57-60.[5]RAJPUROHIT A,SEJOO B,BHATI R,et al.Association of stresshyperglycemia and adverse cardiac events in acute myocardialinfarction--a cohort study[J].Cardiovasc Hematol Disord DrugTargets,2021,21(4):260-265.[6]WANG W,WANG C S,REN D,et al.Low serum prealbumin levelson admission can independently predict in-hospital adversecardiac events in patients with acute coronary 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[12]WU L D,LIU Y,LI F,et al.Glucose fluctuation promotescardiomyocyte apoptosis by triggering endoplasmic reticulum(ER)stress signaling pathway in vivo and in vitro[J].Bioengineered,2022,13(5):13739-13751.[13]THAKUR V,ALCOREZA N,CAZARES J,et al.Changes in stress-mediated markers in a human cardiomyocyte cell line underhyperglycemia[J].International Journal of Molecular Sciences,2021,22(19):10802.[14]吴伏鹏,朱晓光,李梅芳,等.应激性血糖升高比值对急性心力衰竭患者预后的评估价值[J].中华急诊医学杂志,2021,30(3):318-322.[15]凌杰兵,马斌.血清超敏C-反应蛋白与前白蛋白比值对急性心肌梗死患者并发心力衰竭的预测价值研究[J].临床误诊误治,2018,31(1):82-85.[16]宋仁杏,高倩萍.血浆前白蛋白水平对心力衰竭严重程度及预后的影响[J].心血管病学进展,2018,39(3):392-394.[17]AKASHI M,MINAMI Y,HARUKI S,et al.Prognostic implications ofprealbumin level on admission in patients with acute heart failurereferred to a cardiac intensive care unit[J].Journal ofCardiology,2019,73(2):114-119.[18]苗博,李延鑫,吴静,等.静息心率与行PCI治疗的急性心肌梗死合并心力衰竭患者远期预后的关系[J].现代医学,2021,49(5):494-500.[19]DESTA L,KHEDRI M,JERNBERG T,et al.Adherence to beta-blockers and long-term risk of heart failure and mortality after amyocardial infarction[J].ESC Heart Fail,2021,8(1):344-355.(收稿日期:2022-09-28)(本文编辑郭怀印)。

慢性炎性痛模型小鼠腹外侧眶额叶皮质的转录组分析

慢性炎性痛模型小鼠腹外侧眶额叶皮质的转录组分析张思博;尹美娴;李婧;柳垂亮【期刊名称】《神经解剖学杂志》【年(卷),期】2024(40)2【摘要】目的:筛选小鼠腹外侧眶额皮质(vlOFC)参与疼痛调节的生物学标记物。

方法:雄性C57BL/6J小鼠于左后足底注射完全弗氏佐剂(CFA)诱导慢性炎性痛。

通过测定缩足阈值(PWT)和缩足潜伏期(PWL)检测痛敏变化。

行为学测试之后取小鼠vlOFC新鲜组织进行转录组测序。

运用生物信息学方法筛选差异表达基因(DEGs),并进行生物学功能和通路富集分析。

结果:与PBS组小鼠相比,CFA组小鼠左后足机械痛阈值和热痛导致的缩爪潜伏期均显著降低(P<0.001)。

两组小鼠vlOFC的DEGs为497个,其中上调143个,下调354个。

基因本体(GO)和京都基因与基因组百科全书(KEGGs)分析显示:慢性炎性痛模型小鼠,vlOFC的DEGs主要表现在有机阳离子转运、神经递质转运、胞质钙离子浓度的调节等生物过程;与G蛋白偶联受体(GPCRs)、神经肽相关以及铵转运等分子功能相关;DEGs主要集中于神经活性配体-受体相互作用、细胞因子-细胞因子受体相互作用、cAMP信号通路。

Reactome功能富集分析显示,参与富集的DEGs数量最多且校正后P值最低的通路为GPCRs配体结合。

结论:vlOFC中的离子转运、神经递质转运与结合、GPCRs相关活动参与了慢性炎性痛的调节。

【总页数】9页(P187-195)【作者】张思博;尹美娴;李婧;柳垂亮【作者单位】广州中医药大学佛山临床医学院;中山大学中山医学院人体解剖学与生理系【正文语种】中文【中图分类】R28【相关文献】1.腹外侧眶皮质在痛觉下行调制中的神经递质与受体机制2.刺激额叶皮层对丘脑腹后外侧核痛放电的影响及其与电针的关系3.大鼠丘脑中央下核GABA纤维终末与腹外侧眶皮质投射神经元的突触联系4.电离辐射激活前额叶皮质NLRP3炎性小体诱导小鼠认知功能障碍5.GluN3A基因缺失影响小鼠抑郁样行为及内侧前额叶皮质与海马mRNA转录组的实验研究因版权原因，仅展示原文概要，查看原文内容请购买。

2例疑似克雅氏病患者的护理

2023 年第 9 卷第 12 期Vol.9， No.12， 2023中西医结合护理Chinese Journal of Integrative Nursinghttp ：/ / OPEN ACCESS 2例疑似克雅氏病患者的护理耿钥潇，史曼玉，马靖沂，李沙（北京中医药大学东直门医院脾胃病科，北京， 100700）摘要：本文总结2例疑似克雅氏病患者护理的经验。

克雅氏病临床表现复杂，病程进展快速，临床护士需要了解克雅氏病的本质，管理患者的症状和体征，并通过整合护理的心理、情感、精神和社会组成部分来创造治疗经验。

在院期间，应严密观察病情变化，保持患者呼吸道通畅；严格执行消毒隔离制度，做好相应消毒隔离的防护护理。

2例患者住院期间未发生护理相关并发症，未出现交叉感染。

关键词：克雅氏病；临床护理；感染；消毒；隔离中图分类号： R 47 文献标志码： A 文章编号： 2709-1961（2023）12-0207-05Nursing of two patients with suspectedCreutzfeldt -Jakob diseaseGENG Yuexiao ，SHI Manyu ，MA Jingyi ，LI Sha（Department of Spleen and Stomach Diseases ， Dongzhimen Hospital Beijing University ofChinese Medicine ， Beijing ， 100700）ABSTRACT ： To summarize the nursing experiences of two patients with suspected Creutzfeldt -Jakob disease （CJD ）.Because of the complex clinical manifestation and rapid course of CD ， nurs⁃es caring for patients and families are challenged to understand the nature of CJD ， manage the pa⁃tients ’ signs and symptoms ， and create a therapeutic experience by integrating the psychological ， emotional ， spiritual ， and social components of nursing care. During the hospitalization ， nurses had closely observed the changes of patients ’ conditions ， maintained the patients ’ airway unob⁃structed ， strictly executed the disinfection and isolation rules ， and carried out the corresponding protection and nursing. Neither patient had any nursing related complications or cross infection during hospitalization.KEY WORDS ： Creutzfeldt -Jakob disease ； clinical nursing ； infection ； disinfection ； isolation 克雅氏病（CJD ）又称为皮质-纹状体-脊髓变性或者亚急性海绵状脑病，是一种快速进展和可传播的致命性神经退行性疾病，与中枢神经系统中错误折叠的朊病毒蛋白的积累有关［1］。

自我接纳在勃起功能障碍患者病耻感与抑郁症状间的中介作用

自我接纳在勃起功能障碍患者病耻感与抑郁症状间的中介作用*廖晓红①　吴金华①　曾秋萍①　何燕妃①　汪林芳① 【摘要】　目的：探讨自我接纳在勃起功能障碍（ED）患者病耻感与抑郁症状间的中介作用。

方法：采用便利抽样法选取2022年1—12月于赣州市人民医院就诊的76例ED患者为研究对象，选取80例健康者作为健康组。

使用一般资料调查表、自我接纳问卷（SAQ）、社会影响量表（SIS）和患者健康问卷（PHQ-9）调查评估研究对象自我接纳程度、病耻感程度、抑郁症状程度。

并用采用分层回归法分析、检验患者自我接纳、病耻感与抑郁症状程度之间的关系和中介效应。

结果：本次调查的ED患者SAQ总分（37.04±6.50）分，SIS总分（56.04±6.56）分，PHQ-9总分（8.53±2.98）分；ED组SAQ总分显著低于健康组，SIS总分和PHQ-9总分均显著高于健康组，差异均有统计学意义（P<0.05）。

Pearson检验显示，ED患者自我接纳程度与病耻感程度、抑郁症状严重程度均为负相关（P<0.05），病耻感程度与抑郁症状严重程度为正相关（P<0.05）；中介效应检验显示，ED患者的自我接纳在患者病耻感与抑郁症状严重程度间起部分中介作用，占总效应的14.95%。

结论：ED患者病耻感通过自我接纳的中介作用影响抑郁症状严重程度。

【关键词】　勃起功能障碍　自我接纳　病耻感　抑郁　中介作用 The Mediating Effect of Self Acceptance between Stigma and Depressive Symptoms in Patients withErectile Dysfunction/LIAO Xiaohong, WU Jinhua, ZENG Qiuping, HE Yanfei, WANG Linfang. //MedicalInnovation of China, 2024, 21(08): 147-151 [Abstract]　Objective: To explore the mediating effect of self acceptance between stigma and depressivesymptoms in patients with erectile dysfunction (ED). Method: A total of 76 patients with ED treated in GanzhouPeople's Hospital from January to December 2022 were selected as the study objects according to conveniencesampling method, 80 healthy subjects were selected as the healthy group. The general information questionnaire,self acceptance questionnaire (SAQ), social impact scale (SIS) and patient health questionnaire-9 (PHQ-9) wereused to investigate and evaluate the degree of self acceptance, stigma and depressive symptoms of the subjects.Hierarchical regression method was used to analyze and examine the relationship and mediating effect between selfacceptance, stigma and the degree of depressive symptoms. Result: The total score of SAQ, SIS and PHQ-9 in EDpatients respectively was (37.04±6.50) scores, (56.04±6.56) scores and (8.53±2.98) scores. The total score of SAQin ED group was significantly lower than those in healthy group, and the total score of SIS and PHQ-9 in ED groupwere significantly higher than those in healthy group, the differences were statistically significant (P<0.05). Pearsontest showed that the degree of self acceptance was negatively correlated with the degree of stigma and the severity ofdepressive symptoms in ED patients (P<0.05), and the degree of stigma was positively correlated with the severityof depressive symptoms (P<0.05). The mediating effect test showed that the self acceptance of ED patients played apartial mediating effect in the relationship between stigma and the severity of depressive symptoms, accounting for14.95% of the total effect. Conclusion: The stigma of ED patients influences the severity of depressive symptomsthrough the mediating effect of self acceptance. [Key words]　Erectile dysfunction　Self acceptance　Stigma　Depression　Mediating effect First-author's address: Department of Male Medicine, Ganzhou People's Hospital, Ganzhou 341000,China doi：10.3969/j.issn.1674-4985.2024.08.033*基金项目：江西省中医药管理局科技计划项目（2022B620）①赣州市人民医院男性医学科　江西　赣州　341000通信作者：廖晓红- 147 - 勃起功能障碍（erectile dysfunction，ED）是男科常见的性功能障碍，是指男性长期无法实现持续或维持阴茎勃起，导致无法获得满意的性生活[1]。

不同脑小血管病负荷评分与伴无症状腔隙的脑小血管病患者认知功能的关系

不同脑小血管病负荷评分与伴无症状腔隙的脑小血管病患者认知功能的关系杜晓光，魏荣，刘琦慧，于力群，周丽摘要：目的　探讨不同脑小血管病（CSVD）负荷评分与伴无症状腔隙的CSVD患者认知功能的关系。

方法　纳入2021年7月—2023年10月就诊于潍坊市人民医院神经内科的128例伴无症状腔隙的CSVD患者，运用蒙特利尔量表（MoCA）、CSVD总负荷评分和改良负荷评分统计受试者的认知功能和CSVD负荷，分为认知障碍组（MoCA<26分）和无认知障碍组（MoCA≥26分），比较两组患者的人口社会学信息、血管病危险因素及CSVD负荷评分的差异。

采用线性回归分析MoCA评分与两种CSVD负荷评分的关系，采用趋势检验分析伴无症状腔隙的CSVD 患者认知障碍的发病趋势。

结果　研究共纳入伴无症状性腔隙的CSVD患者128例，其中认知障碍组68例（53.1%），无认知障碍组60例（46.9%），两组患者人口社会学信息及血管病危险因素差异无统计学意义（P>0.05）。

两组患者的CSVD总负荷评分和改良负荷评分比较均存在统计学差异（P<0.05）。

Spearman秩相关分析显示，CSVD 总负荷评分和改良负荷评分均与MoCA评分呈负相关（P<0.001）。

线性趋势χ2检验分析显示，伴无症状腔隙的CSVD患者认知障碍发病风险随CSVD改良负荷评分增加而增加（P trend<0.05），该发病风险与CSVD总负荷评分间趋势分析无统计学意义（P trend=0.069）。

结论　CSVD总负荷评分和改良负荷评分均可用于筛检伴无症状腔隙的CSVD认知障碍患者。

改良负荷评分可能在识别认知障碍高风险患者方面更具优势。

关键词：脑小血管病；认知；腔隙中图分类号：R743 文献标识码：ARelationship between cerebral small vessel disease burden scores and cognitive function in patients with cerebral small vessel disease with asymptomatic lacunes　DU Xiaoguang，WEI Rong，LIU Qihui， et al.（Department of Neurol⁃ogy， Weifang People′s Hospital， Weifang 261000， China）Abstract：Objective To investigate the relationship between cerebral small vessel disease （CSVD） burden scores and cognitive function in patients with CSVD with asymptomatic lacunes.Methods A total of 128 patients with CSVD with asymptomatic lacunes who visited the Department of Neurology of Weifang People′s Hospital from July 2021 to October 2023 were included. All the patients were scored using the Montreal Cognitive Assessment （MoCA） for cognitive function and using the total CSVD score and the modified CSVD score for CSVD burden. They were divided into cognitive impairment group （MoCA score<26）and non-cognitive impairment group （MoCA score≥26）.The demographic information，vascular disease risk factors， and the CSVD scores of the two groups were compared. A linear regression analysis was performed to as⁃sess the relationship between the MoCA score and the two CSVD scores. A trend analysis was conducted to analyze the trend of incidence of cognitive impairment in patients with CSVD with asymptomatic lacunes.Results Among the 128 patients with CSVD with asymptomatic lacunes， 68 （53.1%） were in the cognitive impairment group and 60 （46.9%） were in the non-cognitive impairment group. There were no significant differences in the demographic information and vascular disease risk factors between the two groups （P>0.05）. The total CSVD score and the modified CSVD score differed significantly be⁃tween the two groups （P<0.05）. The Spearman correlation analysis showed that the total and modified CSVD scores were sig⁃nificantly negatively correlated with the MoCA score （P<0.001）. The chi-square test for linear trend revealed that the cogni⁃tive impairment risk increased significantly with the modified CSVD score in patients with CSVD with asymptomatic lacunes （P trend<0.05）， but with no significance for the total CSVD score （P trend=0.069）.Conclusion Both the total and modified CSVD scores are useful tools to detect cognitive impairment in patients with CSVD with asymptomatic lacunes， and the modi⁃fied CSVD score may be superior in identifying patients at high risk of cognitive impairment.Key words：Cerebral small vessel disease；Cognition；Lacune脑小血管病（cerebral small vessel disease，CSVD）是血管性认知障碍的主要原因［1］。

布地奈德雾化联合孟鲁司特钠对小儿咳嗽变异性哮喘疗效及复发的影响观察

布地奈德雾化联合孟鲁司特钠对小儿咳嗽变异性哮喘疗效及复发的影响观察江敏梁彬（成都市双流区妇幼保健院，四川成都610200）作者简介：江敏，女，本科，主治医师。

咳嗽变异性哮喘（cough variant asthma ，CAV ）比较常见，儿童是主要发病人群，临床主要表现为顽固性的慢性咳嗽，因此也叫咳嗽型哮喘。

糖皮质激素吸入是治疗CAV 的常用措施，但是治疗周期较长，复发率也较高。

本研究探讨了布地奈德联合孟鲁司特钠对CAV 临床疗效以及复发的影响，现报告如下。

1资料与方法1.1一般资料以2014年5月—2016年5月我院收治的62例CAV 患儿作为研究对象，纳入标准：①患儿症状体征等符合CAV 有关诊断标准。

主要表现为持续或反复咳嗽，一般不伴有发热、喘息或肺部啰音，肺部X 线片异常多为纹理增粗，其他异常较少，通常有抗生素治疗史，但基本无效。

②年龄2岁~12岁。

③近2周内未使用糖皮质激素或抗白三烯制剂。

排除标准：①合并其他可导致咳嗽的疾病，如肺结核、慢性扁桃体炎、慢性咽炎等。

②治疗依从性不好，不能遵医嘱治疗并接受随访者。

剔除标准：中途退出研究或治疗后失访者。

所有家长对本研究知情同意。

根据就诊先后将62例患儿分为2组，观察组32例，男19例，女13例，平均年龄（4.2±1.8）岁，平均病程（8.3±3.3）个月；对照组30例，男20例，女10例，平均年龄（3.9±1.7）岁，平均病程（8.0±3.4）个月。

2组年龄、性别、病程等一般资料比较差异无统计学意义（P >0.05）。

1.2治疗方法对照组：根据患儿病情给予常规治疗，主要包括止咳、平喘、解痉、消炎等，在此基础上给予布地奈德雾化吸入，0.5~1mg/次，2次/d ，雾化时间15min~20min/次，症状消失后停用。

观察组：在对照组的基础上给予孟鲁司特钠咀嚼片口服，6岁以下4mg/次，6岁以上5mg/次，每晚睡前1次，连续服用3个月。

口服助壮素中毒后呼吸心跳骤停心肺复苏抢救成功1例的体会

甘肃医药2019年38卷第5期Gansu Medical Journal ,2019,Vol.38,No.5［15］Fujisaki T ，Ikari T ，Kamei A ，et al.Transcatheter arterial chemoem-bolization （TACE ）using degradable starch microspheres （DSM ）（DSM-TACE ）for primary and metastatic liver neuroendocrine tumors from gastrointestinal neuroendocrine tumors ［J ］.The Japanese Journalof Gastro-Enterology ，2008，105（2）：206-213.［16］郭晓光，王虎明.替吉奥联合TACE 序贯肝动脉灌注奥沙利铂治疗转移性肝癌的临床研究［J ］.中国临床研究，2015，28（5）：559-562.（本文编辑：时海英）患者，女，50岁，2019年2月17日家人争执后口服助壮素4支，感觉头晕、心慌、胸闷、恶心、呕吐、四肢乏力、呼吸困难等，家人急呼120入院，转运途中监测患者BP100/70mmHg ，P90次/分，R30次/分，SAT85%，双侧瞳孔D 大约3mm ，对光反射迟钝，听诊双下肺满布湿性啰音，手指血糖BS 6.7mmol/L 。

立即给予吸氧、吸痰，甘露醇125ml 加压静滴，速尿20mg 缓慢静推，导尿。

入院后向患者家属告病危，给予清水洗胃。

洗胃过程中患者血氧饱和度和血压急剧下降至零，立即静推盐酸肾上腺素1mg 并实施心肺复苏，吸痰，给氧。

给予气管插管，五分钟后给予盐酸肾上腺素1mg 静推重复一次，九分钟后，心电监护出现细室颤波，立即给予电除颤一次，继续心肺复苏，十三分钟，心电监护提示患者恢复窦性心律，心律98次/分，患者恢复自主呼吸，紫绀减退，血氧饱和度88%，血压80/60mmHg ，立即给予180mg 多巴胺+50ml 生理盐水用微量泵5ml/h 泵入，血压逐渐上升，血氧饱和度94%，患者转至ICU 观察，18小时后完全苏醒，三天后出院。

腰间盘突出译文

Many patients with back pain, leg pain, or weakness of the lower extremity muscles arediagnosed with a herniated disc.许多患腰腿疼痛，下肢肌端乏力的病患均为椎间盘突出症。

When a disc herniation occurs, the cushion that sits between the spinal vertebra is pushedoutside its normal position.椎间盘突出发生时，脊柱间的缓冲带将发生侧突。

A hrniated disc would not be a problem if it werent for the spinal nerves that are very close tothe edge of these spinal discs.如果脊神经不是离椎间盘特别近的话，椎间盘突出就不是什么大问题了。

HOW ARE THE SPINE AND ITS DISCS *****D脊柱与椎间盘The vertebras are the bony building blocks of the spine.脊椎是建造脊柱的构件。

Between each of the largest parts (bodies) of the vertebrae are the discs.各椎骨之间为椎间盘。

Ligaments are situated around the spine and discs.脊椎和椎间盘周围散布着韧带。

The spine has seven vertebrae in the neck (cervical vertebrae), 12 vertebrae in the mid-back(thoracic vertebrae) , and five vertebrae in the low back (lumbar vertebrae).颈部有7条椎骨，胸部为12条，腰部有5条。

口腔癌术后吞咽困难的相关因素、评估方法及术后护理

口腔癌术后吞咽困难的相关因素、评估方法及术后护理周钰伟，黄子贤，黄志权(中山大学孙逸仙纪念医院口腔颌面外科，广东广州510120)[摘要]口腔癌是一种常见的恶性肿瘤，手术及相关治疗都易导致术后发生吞咽困难，极大地影响患者生活质量及。

此，准确诊断和及时治非常重要。

本文针对目前口腔癌手术致的相关因素及临床上常见的、护理手段作一综述，为口腔癌术的功能恢复提供重要参考。

[关键词]口腔癌；吞咽困难；$术后护理[中图分类号]A782;A739.8[文献标志码]A D O I：10.3969/j.issn.1005-4979.2021.01.012Review of Related Factors, Assessment Method and PostoperativeCare of Dysphagia following Surgical Treatment for Oral CancerZHOU Yuwei，HUANG Zixian，HUANG Zhiquan(Department o f Oral and Maxillofacial Surgery* Sun Yat-sen Memorial Hospital* Sun Yat-sen University*Guangzhou 510120* Guangdong Province* China)[Abstract] O ral can cer is a com m on m a lig n a n t tum or. S urgery and re la te d treatm ents can ea sily lead to dysphagia after s u rg e ry，w h ic h greatly affects the q u a lity o f life and prognosis o f patients. Therefore, accurate diagnosis and tim e ly tre a tm ent o f dysphagia are very necessary. In this paper, re le va n t factors, com m on c lin ic a l eva lu a tio n and nu rsin g m ethods o f dysphagia caused b y oral can cer surgery are sum m arized, w h ic h provides im p o rta n t reference fo r fu n c tio n a l recovery o f patients.[Keywords] ora l cancer; dysphagia; sw allow ing assessment; postoperative care吞咽是指食团通过口腔、咽和食管进入胃的过程，是一种杂的。

DYSLEXIA AND THE UNIVERSITY

FOREWORDThis booklet is written in simple English, to make it easier to read for students with dyslexia as well as busy university lecturers, student services personnel, administrators and others who work with people who have dyslexia. It provides a starting point for people wishing to understand this syndrome that is often referred to as a ‘hidden’ disability. As such, it is neither prescriptive nor exhaustive. An extensive bibliography is included to satisfy the inquisitive mind.This book is not only based on research on the neuro-physiological basis of dyslexia, but all examples are based on true-life experiences.It provides an overview of what we know about dyslexia, the difficulties experienced by university students with dyslexia and appropriate accommodations and modifications to assist them to achieve success.There are examples of courses of study and examinations papers that were found to be effective with dyslexic students. There are also examples that are considered unsuitable for dyslexic students.Much research has been conducted in the past on learning disabilities. However, in recent years, the National Institutes of Mental Health have undertaken extensive research on dyslexia.Dyslexia is the most common learning disability. It accounts for 85% of all learning disabilities. It is not surprising therefore, that dyslexia will be the learning disability that is more apparent at the university level. Most other learning disabilities on the other hand, do not affect reading after the student reaches the grade 5 level.Copyright 2001 by Louise Brazeau-WardRevision: 2005All rights reserved.No part of this book may be reproduced, taped or broadcasted,in part or as a whole by any means includingelectronic, mechanical, photographic or any other form,without written permission from the publisher.Published and Distributed by: Canadian Dyslexia Centre (CDC) Inc.495 Richmond Road, suite 201, Ottawa, Ontario, Canada K2A 4B2Telephone : (613) 722-4777 Fax : (613) 722-4799ISBN 1-894964-71-3ACKNOWLEDGEMENTThis book would not be possible without the support of my family, friends and colleagues.My very special thanks to my ghostwriter who has harnessed my dyslexic thoughts, coped with my sudden bursts of inspiration, and helped me to present this information in a format that can be shared with others.Louise Brazeau-WardTABLE OF CONTENTSDefinitions Page1 Causes of Dyslexia Page 4Characteristics of Dyslexia Page 6The Dyslexic Way of Learning Page 14Course Accommodations Page 18Test Accommodations Page 20Ask the Experts Page 24In Good Company Page 2730 References Page Appendix 1: Request for Accommodations Page 31Appendix 2: Form to be attached to student’s work Page 32DEFINITIONSMany definitions exist to describe dyslexia. Some may even appear to be contradictory. This can be best explained by the fact that some people look at it from a medical point of view and others from an educational point a view.From the educational point of view, there are also different manifestations of the difficulties depending on the age, the grade level or the work environment of dyslexic persons. It is not surprising that the lay public is often confused by all the definitions. However, all the definitions really reveal different aspects of dyslexia. While dyslexia results from a biological difference in the brain, its outward manifestations, or symptoms, can be different depending on the type of dyslexia and/or tasks at hand.The following are the most common definitions:From The International Dyslexia Association (IDA).Dyslexia is one of several distinct learning disabilities. It is a specific language-based disorder of constitutional origin characterized by difficulties in single word decoding, usually reflecting insufficient phonological processing. These difficulties in single word decoding are often unexpected in relation to age and other cognitive and academic abilities; they are not the result of generalized developmental disability or sensory impairment. Dyslexia is manifested by variable difficulty with different forms of language, often including, in addition to problems reading, a conspicuous problem with acquiring proficiency in writing and spelling.From The British Dyslexia AssociationDyslexia is best described as a combination of abilities and difficulties which affect the learning process in one or more of reading, spelling, writing and sometimes numeracy/language. Accompanying weaknesses may be identified in areas of speed of processing, short-term memory, sequencing, auditory and/or visual perception, spoken language and motor skills. Some dyslexics have outstanding creative skills. Others have strong oral skills. Whilst others have no outstanding talents, they all have strengths. Dyslexia occurs despite normal intellectual ability and conventional teaching. It is independent of socio-economic or language background.The Canadian Dyslexia Association definition:Dyslexia results from a different brain organization, which may cause a problem with reading, writing, spelling and/or speaking, despite average or superior intelligence, traditional reading instruction and socio-cultural opportunity. It is genetically inherited and its cause is biological.Often, a person with dyslexia will also have special abilities and talents associated with superior visual-spatial skills. These abilities, contrasted with deficits in basic skills, make dyslexia very confusing for teachers and parents. There are also many famous people who have or had dyslexia – for example: Albert Einstein, John Lennon, Walt Disney, Alexander Graham Bell and Steven Spielberg are just a few of these.There are three main types of dyslexia:Dysnemkinesia/dysgraphia (motor)Dysphonesia (auditory)Dyseidesia (visual)Dyslexia can vary in its severity. A person may also have a combination of these three types of dyslexia. Some dyslexic students may also have a sensitivity to light (scotopic sensitivity, Irlen syndrome, magnocellular defect.)Dyslexia can cause a lifelong disability in reading, writing, spelling and/or speaking. Some of these basic skills will always be more difficult for people with dyslexia than for others. However, with appropriate and timely intervention people with dyslexia do make progress.Dyslexia is genetically inherited, and its cause is biological. According to Albert M. Galaburda, Associate Professor of Neurology at the Harvard Medical School, sufficient scientific evidence accumulated in the last decade confirms that dyslexia stems from neurological causes. Proof has been obtained from both anatomical observations of autopsy specimens and imaging studies in living subjects.”As Galaburda notes, “Anatomical evidence suggests there are differences in the symmetry of brains of dyslexics, in the specific areas dealing with language. This form of symmetry indicates that the language areas of dyslexics are organized differently and that they probably process linguistic information differently as well.”For most people the left side of the brain is usually larger than the right side. In the brain of persons with dyslexia, the right side is as large as the left side. It is not that there are fewer connections but rather, more. Neurons are found in places where they do not usually belong. Due to this different brain organization, persons with dyslexia will process language in a different way.Dr. Sally Shaywitz, from Yale University, has found that persons with dyslexia learn language by using parts of the brain not usually used to process language.Dr. John Stein, from Oxford University has done extensive research in the visual processing systems of persons with dyslexia. He believes that unstable eye-movement can cause “letters and words appear to move around, jump over each other, blur and reverse themselves”.“My overall conclusion will be that reading difficulties are neitherspecific to reading nor exclusively linguistically based, but a consequenceof mildly impaired development of a particular kind of neuron in the brain,magnocellular neurons, so that dyslexia has widespread manifestationswhich are not at all confined to reading. However they are best thought ofas individual differences between people rather that a consequence ofneurological ‘disease”. J. Stein (2000): The neurobiology of readingdifficulties. Prostaglandins, Leukotrienes and Essential Fatty Acids Vol.63, No. 1/2m July/August. Pp. 109-116CHARACTERISTICS OF DYSLEXIAPeople with dyslexia do not all have the same symptoms but the following ones are the most likely to affect the learning abilities of students at the university level.Reading difficulties:• extremely slow rate of reading• blurring and distortion of wordsc o n c l ud i n g p a r a g r a p h.E s se n t i a lf o r s t r u c t u r i ng a n d w r i t i n g a n e s s a y i s,o fc o u r s e,de c i d i n g w h a t t o s a y,h o w t o g o a b o u t a s s e s s i n g a p a r t i c u l a r a r g u m e n tf o r t h e p u r p o s e o f c o n s t r u c t i ng a n i n t e r p r e t a t i o n o f i t.Th is co urse wil lst riv etoeq pst ud ent swi th bas iccrit ical t hin kingan d es sa ywri ting sk il ls.• missreading of words which are visually similarwas-saw, speak-break• misreading multisyllabic wordsphilosophical, inheritance, interference• omitting connecting wordsat, is, where, who, over, under etc.• understanding complex sentences, (especially in testing situation)I will meet you for lunch unless you call to cancel.It would be easier to say:I will meet you for lunch. Call if you need to cancel.• understanding negative sentencesWhich one was not there?What aspect cannot be inherited?• understanding long sentencesStudents will be introduced to a common essay-writingtemplate which includes the introductory paragraph with thesisstatement, three supporting paragraphs with topic sentences,and a concluding paragraph. Essential for structuring andwriting an essay is, of course, deciding what to say, how to goabout assessing a particular argument for the purpose ofconstructing an interpretation of it.The same information can be presented in the following way:• reading small print below 12 to 13 point font• reading poor quality photocopies• reading on white paper• confusion with math symbols• reading a professor’s writing if not written very clearly.½ may look like y2,“A t” may look like A+Spelling difficulties:• misspelling visually similar words that are not picked up by a spellcheckerimportance-impotence, brown-drown,cursing-cruising, cake-bake• writes the same words differently in the same passageletergy, leiturgy, leatergy, letourgy, leitorgy• numerous erasures and/or cross-outs which make written work very messy• may take up to 2000X more to remember how to spell a word, compared to the maximum of 14 times needed by a non-dyslexic. Many famous writers never mastered spelling.• mixes up and/or omits letters or words Note-taking difficulties:• inability to read own writing• taking notes while listening• writing legible notes• writing fast enough to copy from the board Writing difficulties:• expressing ideas clearly in writing• immature writing• poor sentence structure• inadequate or missing punctuation• mixing up sounds in multisyllabic words • reversal of letters and/or numbersSpeaking:While most persons with dyslexia are articulate, some may have speech difficulties.• expressing ideas clearly orally• fast and sometimes cluttered speech• speaking clearly during interviews or oral examinations“But Jean-Marie did not understand the words. In his nervousness it was as if all the Latin Monsieur Balley had pounded into his head had simply poured out of it.”(Lomask, Milton: The Curé of Ars, P.102)• speaking on a specific subject within a time limit or interviewIn his mind’s eye he could see the white sheets of paper on which he had written his sermon. Then suddenly the thing happened--the terrible thing he had feared.The words disappeared! In panic he searched his mind only to find it blank - the rest of the sermon – the words he had tried so hard to memorize - was gone, gone!(Lomask, Milton: The Curé of Ars, P.102)• omitting words (believed to have been said)• repeating sentences (believed not to have been said)• difficulties with the pronunciation of multisyllabic words (aluminum, visualisation etc.) • finding the right word when speaking• substituting wordsListening difficulties:• while lecturer has his/her back to students• in a noisy room• when lecturer uses unfamiliar words without visual support• misunderstanding instructions• misunderstanding long complex sentences• screening out important informationMath difficulties:• memorizing multiplication tables• reversing numbers• losing place in long divisionOrganization skills:• forgetting assignments and/or appointments• forgetting books at home or at school• losing papers• miscalculating time needed for tasks• getting lost in an unfamiliar building (sometimes in a familiar building as well)• getting mixed up between left-right, west-east, up-down• telling the time (clock with hands)Common physical problems often seen in dyslexic persons and affecting school/work environment:• migraine headache caused by fluorescent lighting or weather• allergies affecting listening and ability to concentrate• inability to concentrate under particular weather conditions• extreme stress during testing situations• unexplained days of total fatigue• a feeling of being overwhelmed when a large amount of writing is required• motion sickness affecting the ability to use elevators, escalators, driving etc.• motion sickness caused by vertical/horizontal blinds in a room• visual disturbance caused by strong contrast (a lecturer in a checkered/striped shirt) • sensitivity to perfumes, strong deodorant or chemicals• physical pain in wrist and hands in producing written work• auditory problems in the presence of background noise (someone tapping a pencil on the desk, or a noise from an adjacent room etc.)• sensitivity to some sounds, such as: speaker’s phone, hand clapping in a theater etc) Performance of dyslexic students during examinationsStudents with dyslexia are greatly disadvantaged in the examination process and may show the following symptoms:• discrepancy between knowledge of subject matter and performance on tests• slow reading rate increased by blurring of words (words may jump all over the page or totally disappear)• stress affecting memory for simple known words (e.g.: forgetting what the word ‘division’ or ‘multiply’ means)• inability to produce written work on the spot• writing in the right column of the multiple choice questions (the columns can switch back and forth and then the student writes the wrong answer)• inability to write in a room with fluorescent lighting (causes words on the page to move)• slow reading makes understanding ‘trick’ questions next to impossible.• does not “see” non-image words such as: at, after, last, etc.Dyslexics aren’t slow learners. They simply learn differently. Their I.Q. ranges from the average to the gifted range.For people without dyslexia, the two brain hemispheres are usually asymmetrical: the left side is larger than the right. For people with dyslexia, the two hemispheres are symmetrical. Because the left side of the brain is the seat of sequential, linear thinking prevalent in reading and writing, dyslexics tend to have problems in these areas. However, because the right side of the brain is the seat of intuitive, creative, and visual thinking, dyslexics tend to be favored in this domain.This visual ability also translates not only into quantity but also quality. Dyslexics can see in 3-D. When looking at an object, they can view it simultaneously from different perspectives. This is good for creativity, but bad for reading. If you look at a pencil upside-down, it is still a pencil. If you look at the letter “p”, it becomes a “b” or a “d”. This shifting of visual vantage points can give the impression that the letters are literally jumping. Some people will actually place their hands flat open against the printed page in an attempt to keep the letters in place long enough for them to be able to read.Besides affecting the visual system, dyslexia affects the auditory system and more specifically, phoneme awareness. This is the capacity to segment into phonemes or to hear the smallest units of sounds contained in any given word. For instance, the word “cat” consists of three phonemes: “kuh”, “aah”, and “tuh”. If you can’t hear the sounds of spoken language that is learned naturally and unconsciously, how do you go about consciously learning to match these sounds with the corresponding letters, particularly when different letters or groups of letters make the same sound?Dyslexia also affects laterality and directionality. Some persons with dyslexia tend to be more awkward in gross motor movement than those without dyslexia. This in turn can translate into the loss of memory relative to the movement required to write a letter. For example: on which side of the straight line does one make a ball for a “p”?People with dyslexia do not use the same areas of their brain when reading as other readers do. This means that they will learn to read, write, and spell in a different way than most people. This is why our conventional methods do not work for persons with dyslexia.It is important to open our minds to this difference to better understand dyslexia, especially since, as remarks Norman Gerschwind, “It has become increasingly evident in recent years that dyslexics are prodigiously talented in a variety of areas.This brain difference often results in significant strengths in the areas controlled by the right side of the brain, such as visual-spatial skills, problem solving skills, creative skills and mechanical abilities. The major strength of most persons with dyslexia is their intuition. They often “hear” what the other is “thinking”.Owing to their brain difference, dyslexic persons rely more on right hemisphere functioning. Of course, they will experience weaknesses on left hemisphere functioning.The dyslexic uses “a form of thought in which images are generated or recalled in the mind and are manipulated, overlaid, translated, associated with other similar forms. They can be rotated, increased or reduced in size, distorted, or otherwise transformed gradually from one familiar image into another.” (Thomas G. West) It is often said that dyslexic people succeed not in spite but because of dyslexia. Albert Galaburda observed that this difference in the brain, while suppressing the development of some areas, did increase the development of other areas of the brain.THE DYSLEXIC WAY OF LEARNING“It has become increasingly clear in recent years that dyslexics themselves are frequently endowed with high talents in many areas.” (Geschwind, Norman)Geschwind also shocked the audience with his opening remark at an address to the Orton Dyslexia Society in 1982 when he described dyslexia as: “the pathology of superiority”.Over 50% of NASA employees are dyslexic. They are deliberately sought after because they have superb problem-solving skills and excellent 3D and spatial awareness.File: //A:Cases_gif.htm“…the conventional education system may be focusing on the wrong kind of skills and on rewarding some of the wrong kinds of learning. Conventional education practices may be substantially weeding out many of those who might have the most to give.’’Thomas G. West: In the Mind’s EyeDepending on the form of dyslexia, it may be necessary to waive all or part of a course requirement, or allow a course substitution. For example, if a program requires English essay writing, it may be reasonable to waive that course requirement for a student with dyslexia/dysgraphia. After all, to ask a physically handicapped person to fulfill physical education requirements in order to graduate would be discriminatory.To allow the dyslexic person to successfully complete the requirements of a course, the teacher/professor should allow the following accommodations might be necessary:permit tape recoding or make your notes availabledo not penalize the student for failure to speak publicly in classgive visual support to your lectures as much as possibleunderline key words such as: at, after, not, etc. on textsavoid asking questions which contain double negatives, if negative questions need to be asked, underline the key word eg; ‘not’give short, precise instructions in writing as well as oral instructionsavoid complex languageuse coloured paper and/or larger print if neededuse a type face which is easier to read (the teacher could ask the student) allow note-takers and/or proof readerswrite legibly on the board or on the student’s paperavoid fluorescent lightingavoid vertical and/or horizontal blinds in the viewing range of the student teachers should avoid clothing with black/white stripes or checksavoid cluttered textThe Canadian Human Rights requires that “reasonable accommodations” must be provided for dyslexic students. The difficulties for dyslexic students will become even more noticeable in situations such as interviews, tests or exams where the dyslexic person has to demonstrate his/her knowledge or capability within a time limit. Dyslexic students may then become so stressed that they temporarily forget everything they know.Remember: A test is meant to measure knowledge in the subject area, not linguistic ability.Not all accommodations are necessary for all dyslexic students but the following are the most reasonable:allow the student to present a draft copy of a written assignment at least 2 weeks prior to the due date to ensure that he/she is on the ‘topic’ and remember that dyslexics look at issues in a different wayavoid trick questions in multiple choice questionsavoid essay tests as much as possible. (it could take a dyslexic person significantly longer than a regular student)do not hesitate to clarify a particular exam questiongive an explanation of your meaning of words such as: define, clarify, identify, explaingive extra time to complete the examinationunderline important prepositions ‘little words’ such as after, before, etc. (the person with dyslexia usually does not see those words)use fill-in-the-blank, match up type tests instead of long essaysgive an oral examination while the student has a written copy of the test questions accept tape recorded or dictated answers to questionsallow a reader with good pronunciation skillsallow a scribe/amanuensis knowledgeable on the subject matter, to read, write and/or type the examination paperprovide a private exam room without fluorescent lightsallow a short ‘health break’accept poor grammar and spelling mistakesthe teacher could have an interview with the student if needed to ensure that the student understands what is required on the examination paper.The following information was reprinted with permission from the Dyslexic Students Information Pack, University of Oxford Disability ServicesThis information should be attached to all scripts of Student Number ……………………………………This student is dyslexic. Problems with writing become acute when writing under time pressure. The most common indicators, in addition to poor general organization of essays, are poor sentence structure and syntax, inappropriate use of tense, of singular and plural, and of punctuation and capital letters. The student may use inappropriate word or, in the case of unstressed words such as prepositions and conjunctions, may miss them out altogether. All of these factors, and spelling errors may increase with each page of writing as fatigues sets in and can make the student’s work appear disjointed, immature or careless.The dyslexic student is not aware of these errors.Form Code No. --------------------1. Some school personnel say that they don’t like to use the word“dyslexic” they prefer the word ‘learning disabilities’. What is the difference?Dyslexia falls under the category of LD. The term ‘LD’’ should be used to establish policies and to advocate for the millions of persons with LD. However, to make proper accommodations, one must know “what to accommodate”. After all, when a person is sick because of diabetes, the doctor will not write ‘sick’ on that patient’s chart, but will indicate ‘diabetes’ and will prescribe the right kind of medicine. Imagine what would happen if in fact he prescribed a ‘migraine headache’ medicine instead. This may sound absurd but this is exactly what happens when we treat all “LD” the same way.The LD category is actually composed of seven different types ofdisabilities, each of which is significantly different from the others. As anumber of scientists have recently pointed out, it simply makes little senseto conduct investigations of some broadly defined entity called ‘’learningdisabilities’’ given what we already know about the differences betweenthe various types of learning disabilities.NICHD Research Program in Learning Disabilities by G. Reid Lyon, Ph. D.and Duane Alexander, M.D. Their world 1996/1997“70-80 percent of all children identified as learning disabled by public school are impaired in reading.” (Lerner 1989)2. What are the different types of Learning Disabilities (LD)?The following are the different sub-types of LD.a. Dyslexia, (listening, speaking, reading, writing, spelling)b. Dysphasia (oral comprehension)c. Dyscalculia (math reasoning)d. Non-verbal learning disabilities (writing, oral comprehension, mathreasoning, impaired social skills)3. Are there more males than females who are dyslexic?Despite the widely held belief that males are more likely to have reading disabilities than females, research has shown that as many females as males have difficulties learning to read. More males have usually been identified by teachers in school because of their tendency to be more rowdy and active than females.Dr. G. Reid Lyon, ibid4. Are dyslexia and ADD the same thing?No. Dyslexia and ADD are different. However, they may co-exist.5. I heard that some people with dyslexia have been good writers, howcan that be?Depending on the type of dyslexia, yes, it is possible to become a good writer.However, the spelling will always be ‘atrocious’. Most people with dyslexia will use a ghostwriter or have someone to assist them with revising and editing their work.Many famous writers were dyslexics. Read what was said about one such person.Yeats, the greatest lyric poet Ireland has ever produced, is one of the majorliterary figures of the 20th-century and the acknowledged leader of the IrishLiterary Renaissance. He has been acclaimed the greatest poet sinceWilliam Wordsworth. He won the Nobel Prize for Poetry in 1923. He wasdyslexic and his dyslexia prevented him from spelling the titles of his own playscorrectly. He often gave multiple renderings of the same word within a singleparagraph. He dictated his letters because of his painful and relentless eyeproblems.R. A. Oldaker。

基因治疗

基因治疗
基于以上研究以及其它学者的研究，遗传性疾病的治疗出现了一种新的治疗方法，这就是基因治疗，其中最激动人心的是牛津大学分子医学研究所凯•戴维斯教授关于遗传性疾病进行性肌无力肌营养不良的研究工作，该病由基因缺陷所致，正常情况下，这种基因能够产生一种重要的蛋白质，被称为dystrophin蛋白。

戴威斯教授的研究表明，当dystrophin基因缺陷时，另外一种蛋白质utrophin能够替代它而在肌营养不良中发挥作用。

她和其他人研究出一种新的基因治疗方法，即将utrophin产物转换进去从而取代丢失的或有缺陷的dystrophin蛋白。

如今英国基因治疗学家正在重点研究囊性纤维化病，简称CF。

这是另外一种常见的遗传性疾病，CF能够影响水和盐进入细胞的通道的正常转运，从而对肺、胰腺、内脏和汗腺造成损害。

目前英国有两组科学家正在进行这项研究，一组是来自利兹、曼彻斯特、剑桥和牛津的联合小组，一组是来自伦敦圣•玛利医院和皇家布朗普顿医院的学者。

他们正在进行基因治疗的实验研究，利用称为脂质体的微小脂肪滴把正确的基因送到有基因缺陷的肺部。

目前这项实验技术已进入相当深入的阶段。

在另外一个主要的医学研究中心――伦敦哈默史密斯（Hammersmith）医院临床科学中心，卡罗•史克罗教授正在从事对乳腺癌基因治疗的进一步研究。

在这些实验当中，其中有一项是应用细胞杀伤药物治疗病人，而这些药物只针对癌细胞，不会损害正常的细胞。

目前尽管实验尚处于初期阶段，但结果令人满意。