FORMANT RE-SYNTHESIS OF DYSARTHRIC SPEECH
NLRP3炎症小体组分NLRP3及CARD8基因的遗传变异与缺血性脑卒中

[14]Tayman C, Öztekin O, Serkant U, et al. Ischemia-modified albumin may be a novel marker for predicting neonatal neurologic injury in small-for-gestational-gge infants in addition to neuron-specific enolase [J]. Am J Perinatol, 2017, 34(4): 349-358. [15]Jena I, Nayak SR, Behera S, et al. Evaluation of ischemia-modified albumin, oxidative stress, and antioxidant status in acute ischemic stroke patients [J]. J Nat Sci Biol Med, 2017, 8(1): 110-113. [16]Topuzova MP, Alekseeva TM, Panina EB, et al. The possibility of using neuron-specific enolase as a biomarker in the acute period of stroke [J]. Zh Nevrol Psikhiatr Im S S Korsakova, 2019, 119(8. Vyp. 2): 53-62. [17]Wang Y, Xu S, Pan S, et al. Association of serum neuron-specificenolase and bilirubin levels with cerebral dysfunction and prognosis in large-artery atherosclerotic strokes [J]. J Cell Biochem, 2018, 119(12): 9685-9693.[18]Liu Q, Zhang Y. PRDX1 enhances cerebral ischemia-reperfusion injury through activation of TLR4-regulated inflammation and apoptosis [J]. Biochem Biophys Res Commun, 2019, 519(3): 453-461.[19] Ingram S, Mengozzi M, Heikal L, et al. Inflammation-induced reactive nitrogen species cause proteasomal degradation of dimeric peroxiredoxin-1 in a mouse macrophage cell line [J]. Free Radic Res, 2019, 53(8): 875-881.(收稿日期:2020-03-20)NLRP3炎症小体组分NLRP3及CARD8基因的遗传变异与缺血性脑卒中吕 洁 蒋晓山 张 晶 彭湘晖 林红梅中图分类号:R743.32 文献标识码:A 文章编号:1006-351X(2020)10-0645-05作为重要的先天免疫模式识别受体,Nod 样受体蛋白3(nucleotide-binding domain (NOD)-like receptor protein 3,NLRP3)炎症小体在参与动脉粥样硬化(atherosclerosis,AS)的病理生理学机制以及介导缺血性脑卒中(ischemic stroke,IS)的炎性损伤中发挥着关键的作用,而编码NLRP3炎症小体组分的基因变异会影响其介导的炎症反应。
Diamond-Blackfan贫血诊断及治疗的研究新进展

目前,D B A 发 病 机 制 尚 不 清 楚 ,普 遍 认 为 其 为 一 种 核 糖 体 病 L3]。D B A 与 核 糖 体 蛋 白 (ribosomal proteins,R P )的 关 系 是 D B A 相 关 研 究 的 热 点 ,大多 数 (6 0 % ) D B A 患 者 均 伴 编 码 R P 的 基 因 异 常 。迄 今 为 止 已 发 现 1 9 个 尺P 基 因 异 常 ,包 括 R P 小亚基 (RP small subunit, i?PS ) 7 , R P S 10 , R P S 15A , R P S 17 , R P S 19 , R P S 24 ,R P S 26 ,R P S 27 , R P S 28 , R P S Z S ,/?/3 大 亚 基 (R P large subunit,/?/^) 5, R P L 11 , R P L 15 , R P L 18 , R P L 26 , R P L 27 , R P L 31 , K P L 3 5 及尺P L 35A 基 因 异 常 w 。一 方 面 基 因 突 变 导 致 R P 单 倍 剂 量 不 足 ,核 糖 体 无 效 组 装 ,发生 核 糖 体 应 激 或 者 核 仁 应 激 (nucleolar stress) ,引起 p53 激 活 ,并 且 游 离 的 R P (R P L 5 、R P L 11、R P S 19) 可 抑 制 鼠 双 微 蛋 白 (murine double minute,M D M )2 介 导 的 p5 3 泛 素 化 和 降 解 ,使 P5 3 稳 定 性 增 加 ,并且 进 一 步 活 化 ,从 而 引 起 红 系 祖 细 胞 p5 3 依 赖性 的细 胞 凋 亡 增 加 ,最 终 导 致 红 系 发 育 不 全 [5]。另 一 方 面 , R P 单 倍 剂 量 不 足 导 致 部 分 红 系 基 因 (G A 77U 基因 等 )的 翻 译 效 率 低 下 [67],影 响 红 细 胞 生 成 。此 外 , G A 77U 基 因 突 变 可 导 致 其 编 码 产 物 G A T A 1 蛋白 变短[8],而 G A T A 1 蛋 白 是 一 种 关 键 的 红 系 造 血 转 录 因 子 ,因 而 造 血 转 录 因 子 的 合 成 受 到 影 响 . 致 使 红 细 胞 发 育 成 熟 障 碍 。 同 时 ,热 休 克 蛋 白 (heat shock protein,H S P )70 表 达 水 平 下 降 ,使 G A T A 1 蛋 白 易 在 半 胱 氨 酸 天 冬 氨 酸 蛋 白 酶 (cysteineaspartic protease ,caspase) 介 导 下 发 生 裂 解 〜 。有 研 究 发 现 .H S P 7 0 表 达 水 平 的 下 降 与 球 蛋 白 和 血 红 素 合 成 失 衡 有 关 [1°]。 由 此 可 见 ,D B A 的 发 病 并 非
复旦大学生物医学研究院科学家首次发现人体生理状态下存在大量非细胞核蛋白的乙酰化修饰

癌细胞 的增殖为方 向。
法 、 意科学家揭示细菌低温存活之谜 德、 据 中国军 网 2 1 0 0年 1月 1 日援 引新 华社 巴黎 1 1 7 月 6
日电 , 国国家科研 中心 、 法 意大利 卡梅里 诺大 学和 德国杜塞 尔多夫大学 的研究人员通 过合作研究 发现 , 一种名 为“ 冷休
皮层区域。“ 这说明人们在听到别人正 面评价的时候非常关 注 自我。也就 是说 , 如果 家长 和教师 多夸 奖和表扬 孩子 , 将 会十分有利于孩子 形成积 极的 自我概 念。如果 领导也这 样 对待下属 , 将会十分有利于激发下属 的的积极性 。 ” 潘晓红也对实验对 象进 行了绩效反馈实验 。结果显示 ,
饰特性与各种疾病 的关 系 , 指导相关药物 的有效开发 。
中科 院上海生 命科学研 究院科学家
揭 秘 D A 甲 基化 发 生 机 制 N
克蛋 白” 的信使 核糖核酸具有 感知冷 暖的特殊 能力 , 使其 只
有在低温时才会表现稳定 , 就是说 , 低温 下这 种信使核 也 在 糖核酸反而能 更有效 地复 制细 菌 的遗 传信 息 , 助细 菌繁 帮 衍。长期 以来 , 冷休克 蛋 白” “ 帮助 细菌 在低 温 下生存 的机
癫痫是一种较常见的神 经疾病 , 发病 者 占人 口的 I %左 右, 通常认为癫痫 由神经 细胞异 常兴奋 所致 , 具体病 因 尚 但 未完全清楚 , 也未有根本 的治疗方法 。 日美科 学家的研究结 果有望为癫痫 的治疗研 究打开新 的思 路。该项 研究 的相关 论文发表于美 国《 国家科学院学报》 网络版 上。
D A甲基化具有不 可或 缺 的作 用 , 且辅 助 因子能 与组蛋 N 而 白 H 发生相互作用并引 发起始性 的 D A甲基化 。这一研 ] N 究首次从功能上揭示 了组蛋 白 H 3与 D A甲基化 之间的联 N 系, 加深了对 D A甲基化发生机制 的认识 。 N
脉冲电磁场联合双膦酸盐对绝经后骨质疏松症患者心理健康和生活质量的影响

- 20 -spondyloarthritis patients[J].Mod Rheumatol,2022,32(5):974-979.[27] BAATEN C,SCHROER J R,FLOEGE J,et al.Plateletabnormalities in CKD and their implications for antiplatelet therapy[J].Clin J Am Soc Nephrol,2022,17(1):155-170.[28] HE Z,WANG H,WANG S,et al.Predictive value of platelet-to-albumin ratio (PAR) for the cardiac-associated acute kidney injury and prognosis of patients in the intensive care unit[J].Int J Gen Med,2022,15:8315-8326.[29] COLOTTA F,ALLAVENA P,SICA A,et al.Cancer-relatedinflammation, the seventh hallmark of cancer:links to genetic instability[J].Carcinogenesis,2009,30(7):1073-1081.[30] KAWAI Y,MASUTANI K,TORISU K,et al.Associationbetween serum albumin level and incidence of end-stage renal disease in patients with Immunoglobulin a nephropathy:a possible role of albumin as an antioxidant agent[J/OL].PLoS One, 2018,13(5):e0196655.https:///29795559/.[31]管娜,丁洁,杨霁云,等.基于病例对照研究的儿童肾病综合征低白蛋白血症诊断标准探讨[J].中国循证儿科杂志,2017,12(2):131-134.[32] AKBOGA M K,CANPOLAT U,YUKSEL M,et al.Platelet tolymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: a single center large-scale study[J].Platelets,2016,27(2):178-183.(收稿日期:2023-11-17) (本文编辑:何玉勤)*基金项目:江西省卫生健康委科技计划项目(202311306)①南昌市洪都中医院骨质疏松科 江西 南昌 330000②南昌市洪都中医院针灸科 江西 南昌 330000通信作者:刘利群脉冲电磁场联合双膦酸盐对绝经后骨质疏松症患者心理健康和生活质量的影响*刘利群① 胡俊① 张莉莉② 袁忠① 张楚焌① 谈荣珍① 杨盼盼①【摘要】 目的:观察脉冲电磁场联合双膦酸盐对绝经后骨质疏松症患者心理健康和生活质量的影响。
诱导型多能干细胞在体外三维环境中诱导分化出肠道类器官

诱导型多能干细胞在体外三维环境中诱导分化出肠道类器官李向阳;赵鑫;相小松;郑鹏;惠璜;嵇武【摘要】BACKGROUND: Induced pluripotent stem cells (iPSCs) are a special type of cells with self-renewal and multi-differentiation potential, which can differentiate into intestinal organoids under certain conditions. OBJECTIVE: To explore whether iPSCs can differentiate into intestinal organoids under specific conditions in vitro.METHODS: iPSCs from B6J mice were recovered and cultured for 3 days until clone units covered about 80% of the culture dish, and then the cells were cultured in the medium containing Activin A for 3 days until the deterministic endoderm formed. Further, the culture medium was replaced by the medium with fibroblast growth factor 4 and Wnt3A for 4 days to differentiate into the spheroids with CDX2+. After that, spheroids were collected and mixed with Matrigel,and then the mixture was dropped into the 4-well plate and cultured with Rspondin1, Noggin, epidermal growth factor, B27 and other growth factors to differentiate into intestinal organoids. Cell morphology was observed, FoxA2 and Sox17 expresson in the deterministic endoderm was detected, and CDX2, Sox9, CGA, MMP7 were measured.RESULTS AND CONCLUSION: iPSCs were cultured with Activin A for 3 days with higher cell fusion, initial differentiation and FoxA2/Sox17 expression (P < 0.05) than those of non-induced iPSCs. Spheroids began to appear at the 3rd day after culture with fibroblast growth factor 4 and WNT3A, and formed a lot at the 4th day. And CDX2 expression in spheroids was significantlyincreased compared with that in the deterministic endoderm (P < 0.05). Organoids gradually formed after 3 days culture, which contained all cell types of intestinal organoids, and expressions of specific markers, Sox9, CGA, MMP7, were significantly higher than those in spheroids (P < 0.05).To conclude, iPSCs can be induced to differentiate into intestinal organoids in three-dimensional niche in vitro.%背景:诱导型多能干细胞是一类特殊的细胞,具有自我更新及多向分化潜力,在一定诱导条件下能够分化为肠道类器官.目的:探究诱导型多能干细胞在体外特定条件下是否可分化出肠道类器官.方法:复苏B6J小鼠18代诱导型多能干细胞,培养3 d克隆单位覆盖培养皿80%左右后,加入含有激活素A的培养基培养3 d,得到确定性内胚层,加入含成纤维细胞生长因子4和Wnt3A的培养基培养4 d,得到中后肠细胞球,将其与Matrigel培养基混合后滴入四孔板形成滴株样生长,在HEPES、Rspondin1、头蛋白、表皮细胞生长因子、B27添加剂等生长因子等共同作用下向肠道类器官分化,期间观察细胞形态变化,检测确定性内胚层FoxA2、Sox17表达,中后肠细胞球特异性标记物CDX2表达,肠道类器官特异性标记物Sox9、CGA、MMP7表达.结果与结论:①诱导型多能干细胞在含有激活素A的培养基培养3 d,细胞初步分化,相互融合,确定性内胚层标记物FoxA2、Sox17表达较诱导型多能干细胞明显升高(P<0.05);②确定性内胚层在含成纤维细胞生长因子4和WNT3A环境下培养第3天开始就有少量中后肠细胞球形成,第4天大量中后肠细胞球形成,中后肠细胞球标记物CDX2较确定性内胚层明显升高(P<0.05);③中后肠细胞球培养3 d后逐渐形成肠道类器官,其特异性标记物Sox9、CGA、MMP7表达明显高于中后肠细胞球(P<0.05);④结果表明,诱导型多能干细胞可在体外三维环境中诱导分化出类肠道器官.【期刊名称】《中国组织工程研究》【年(卷),期】2017(021)025【总页数】5页(P4057-4061)【关键词】干细胞;分化;诱导型多能干细胞;定向分化;体外培养;确定性内胚层;肠道类器官【作者】李向阳;赵鑫;相小松;郑鹏;惠璜;嵇武【作者单位】南京大学医学院附属金陵医院,解放军南京军区南京总医院解放军普通外科研究所,江苏省南京市 210002;南京大学医学院附属金陵医院,解放军南京军区南京总医院解放军普通外科研究所,江苏省南京市 210002;南京大学医学院附属金陵医院,解放军南京军区南京总医院解放军普通外科研究所,江苏省南京市210002;南京大学医学院附属金陵医院,解放军南京军区南京总医院解放军普通外科研究所,江苏省南京市 210002;解放军第二军医大学,上海市 200433;南京大学医学院附属金陵医院,解放军南京军区南京总医院解放军普通外科研究所,江苏省南京市210002【正文语种】中文【中图分类】R394.20 引言 Introduction类器官衍生于多能干细胞或器官前体祖细胞,在细胞成分、特定功能和组织结构等方面与相应的器官高度相似[1]。
果胶与多酚相互作用机制及其对食品加工特性影响的研究进展

张璇,赵文,高哲,等. 果胶与多酚相互作用机制及其对食品加工特性影响的研究进展[J]. 食品工业科技,2024,45(1):378−386.doi: 10.13386/j.issn1002-0306.2023030201ZHANG Xuan, ZHAO Wen, GAO Zhe, et al. Research Progress on the Interaction Mechanism of Pectin and Polyphenol and Their Effect on Food Processing Characteristics[J]. Science and Technology of Food Industry, 2024, 45(1): 378−386. (in Chinese with English abstract). doi: 10.13386/j.issn1002-0306.2023030201· 专题综述 ·果胶与多酚相互作用机制及其对食品加工特性影响的研究进展张 璇1,赵 文1,2,高 哲1,李美娇1,吴梦颖1,周 茜1,*(1.河北农业大学食品科技学院,河北保定 071000;2.河北省农产品加工工程技术研究中心,河北保定 071000)摘 要:果胶和多酚共存于植物性食品体系中。
除天然存在的果胶-多酚复合物外,在受到加热、高压、干燥等外力作用的食品加工过程中,两者会快速且自发地进行相互作用。
果胶与多酚之间的相互作用会影响食品的理化性质和功能特性。
本文总结了果胶与多酚相互作用的机制、内部和外部多重影响因素、主要的研究方法并结合 Langmuir 和Freundlich 常见的等温吸附模型对果胶与多酚之间的吸附行为进行描述和定量表征。
此外还探讨了两者相互作用对食品加工特性及多酚生物可利用性的影响,分析了该领域的研究方向和发展趋势。
关键词:果胶,多酚,相互作用,等温吸附模型,生物可利用性本文网刊:中图分类号:TS255.1 文献标识码:A 文章编号:1002−0306(2024)01−0378−09DOI: 10.13386/j.issn1002-0306.2023030201Research Progress on the Interaction Mechanism of Pectin and Polyphenol and Their Effect on Food Processing CharacteristicsZHANG Xuan 1,ZHAO Wen 1,2,GAO Zhe 1,LI Meijiao 1,WU Mengying 1,ZHOU Qian 1, *(1.College of Food Science and Technology, Hebei Agricultural University, Baoding 071000, China ;2.Engineering Technology Research Center for Agricultural Product Processing of Hebei, Baoding 071000, China )Abstract :The pectin and polyphenols that co-exist in plant-based food systems form complexes in natural conditions and interact quickly and spontaneously during food processing due to external forces, such as heating, high pressure, and drying.The interaction can affect the physicochemical properties and functional properties of foods. This review summarizes the mechanisms, multiple internal and external influencing factors, and main research methods involved in pectin and polyphenol interaction, while their adsorption behavior is described and quantitatively characterized using the isothermal adsorption model commonly used by Langmuir and Freundlich. In addition, the impact of pectin and polyphenol interaction on food processing characteristics and polyphenol bioavailability is also discussed, and the future research prospects and development trends in this field are analyzed.Key words :pectin ;polyphenol ;interactions ;isothermal adsorption models ;bioavailability果胶是一种酸性杂多糖,广泛存在于蔬菜、水果和谷物等植物细胞壁中,在人类健康中发挥着重要的作用[1]。
线粒体和过氧化物酶体教案

线粒体中有可能包含正常mtDNA和突变DNA的混合物,这种情形被称做异质体。研究表明,只有在特定的组织中大多数线粒体携带有缺陷的遗传信息时,代谢紊乱的症状才会表现出来。由于这种可变性,携带相同DNA突变的家庭成员之间可能存在明显不同的症状。 携带突变DNA百分比高的个体忍受更多的病痛。
过氧化物酶体
词汇
Mitochondria 线粒体 exhibit 呈现 elevated 高的 metabolic rate 代谢率 respiratory 呼吸的 oxidize 氧化 initial 最初的 abnormality 异常,反常 impacted 压紧的,结实的 severity 严重 infancy 婴儿期
过氧化物酶体是由一层单位膜包裹的囊泡,通常比线粒体小,直径约为:0.1~1.0微米 过氧化物酶体普遍存在于真核生物的各类细胞中,但在肝和肾的细胞中数量特别多.
过氧化物酶体含有丰富的酶类,目前已知有40余种,主要是氧化酶、过氧化氢酶和过氧化物酶. 氧化酶:是过氧化物酶体中的主要酶类,各种氧化酶作用于不同的底物其共同特征是氧化底物的同时,将氧还原成过氧化氢: RH2+O2 → R+H2O2
ADAMTSL5与银屑病

ADAMTSL5与银屑病发表时间:2018-04-19T13:10:31.387Z 来源:《医药前沿》2018年4月第12期作者:袁育林杨霞芳[导读] 可以成为银屑病中产生IL-17的CD8+ T细胞的活化抗原。
对ADAMTSL5的深入研究为阐明银屑病发病机制及靶向治疗带来了新希望。
(南宁市广西壮族自治区人民医院检验科广西南宁 530021)【中图分类号】R758.63 【文献标识码】A 【文章编号】2095-1752(2018)12-0014-03银屑病是一种常见的慢性复发性炎症性皮肤病。
其发病机制非常复杂,包括遗传、环境、免疫等多种因素参与其中。
虽然基于广泛的遗传,免疫和药理学证据,T细胞在银屑病发病机制中的作用已被广泛接受,但免疫系统在银屑病中被触发的机制仍然是一个迷。
银屑病易感基因座PSORS1上的HLA-C*06:02(6p21.33)是银屑病主要风险等位基因。
最近的研究显示ADAMTS样蛋白5(ADAMTSL5)作为Vα3S1/Vβ13S1TCR的HLA-C*06:02呈递的黑素细胞自身抗原,可导致产生IL-17的T细胞的活化,从而引起银屑病发病。
本文将对这一新鉴定的银屑病的自身抗原作简要综述。
1.ADAMTSL5 的结构与功能1.1 ADAMTSL5结构含凝血酶敏感蛋白-1(TSP-1)基序的解聚蛋白样金属蛋白酶(a disintegrin-like and metalloproteinase with thrombospondin motifs,ADAMTS)超家族是一类整合于细胞外基质或游离于血浆中的基质金属蛋白酶亚家族,包括19种不同的ADAMTS蛋白[1]和至少7种ADAMTS-like(ADAMTSL)蛋白(ADAMTSL1-6和papilin)[2-3]。
ADAMTSL5是具有独特结构域的分泌型蛋白质,其包含N-末端TSR,富含半胱氨酸的模块,间隔基模块和C末端NTR模块,其通过富含脯氨酸的片段连接到间隔区(见图1)。
复方苁蓉益智胶囊治疗血管性痴呆的研究进展

血管性痴呆(vascular dementia,VD)是一种由脑血管病变导致的疾病,其临床症状包括引起记忆和执行功能障碍等。
它被认为是继阿尔茨海默病之后的第二大常见痴呆类型[1]。
目前,在亚洲和发展中国家的痴呆病例中,VD 约占30%,高于北美和欧洲(15%~20%)[2-3]。
据研究资料显示,我国60岁及以上人群的血管性痴呆发病率为每年每千人中有2.42例[4-5]。
研究表明,我国约有1507万人60岁以上的痴呆患者,其中约有392万人为VD 患者[6]。
VD 会造成日常生活质量不断下降,而且不能扭转,给家庭和社会带来极大的冲击和负担。
复方苁蓉益智胶囊是由王永炎院士多年临床实践研制的具有益智养肝,化浊活血和增智健脑等功效的中成药[7],主料何首乌、肉苁蓉、荷叶、地龙、漏芦等。
Progress of compound ciYizhi capsule in the treatment of vascular dementia Di Shuai, Zhang Jiapeng, Liu Yixuan, LiYanan, Zhang Jiang, Zhou Fuling. The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, China【Abstract 】Compound ciYizhi capsule has the effect of nourishing liver,promoting turbidity and activating blood, and increasing wisdom and brain. It is suitable for mild to moderate vascular dementia with liver and kidney deficiency and phlegm stasis blocking collateral syndrome. Recently, it has been widely used in the long-term and synergistic treatment of vascular dementia with remarkable efficacy.To summarizes the clinical and experimental studies of compound ciYizhi capsule. It is found that compound ciYizhi capsule can treat vascular dementia by reducing the expression of MARKS mRNA in hippocampus, inhibiting oxidative stress in brain tissue, protecting mitochondria, reducing the range of cerebral infarction, protecting cerebral ischemic injury and pound ciYizhi capsule combined with other anti-dementia drugs can significantly improve the clinical symptoms of patients with vascular dementia and improve the self-care ability and quality of life.In order to provide some reference for the subsequent study of compound cistanche qianyi capsule.【Key words 】Vascular dementia; Compound ciYizhi capsule; Dementia; Clinical application 复方苁蓉益智胶囊治疗血管性痴呆的研究进展邸帅 张佳朋 刘乙璇 李亚楠 张江* 周福玲作者单位:063000 河北省唐山市,华北理工大学附属医院神内二、四病区*通讯作者【摘要】 复方苁蓉益智胶囊具有益智养肝,化浊活血和增智健脑的功效,适用于肝肾亏虚兼痰瘀阻络证的轻中度血管性痴呆。
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. 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[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 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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]。
1,4,5-三磷酸肌醇受体与神经变性疾病

1,4,5-三磷酸肌醇受体与神经变性疾病赵吉利1,岳雅蓉1,张鑫1,杜文倩1,王云霞1综述,薛慧2,项文平2,孟天予2审校摘要:1,4,5-三磷酸肌醇受体(inositol 1,4,5-trisphosphate receptors,IP3Rs)是细胞内质网上的钙离子(cal‑cium ion,Ca2+)通道,通过调控Ca2+参与细胞生物学功能,是维持中枢神经系统正常功能的关键分子。
近年来,越来越多的研究发现,IP3Rs结构和功能异常与神经变性疾病如阿尔茨海默病、帕金森病、亨廷顿病、脊髓小脑共济失调等的发病机制密切相关,这些结构和功能异常如何影响IP3Rs功能,及相关钙信号,并且如何在这些疾病的发病和严重程度中发挥作用,仍尚不清楚。
IP3Rs如何在神经变性疾病中发挥作用将于本文中进行综述。
关键词:1,4,5-三磷酸肌醇受体;钙离子;神经变性疾病;认知障碍中图分类号:R741 文献标识码:AInositol 1,4,5-trisphosphate receptors and neurodegenerative diseases ZHAO Jili,YUE Yarong,ZHANG Xin,et al.(Central School of Clinical Medicine,Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014040,China)Abstract:Inositol 1,4,5-trisphosphate receptor (IP3R),which is a calcium ion (Ca2+) channel in the endoplasmic re‑ticulum,participates in cellular biological functions through regulating the Ca2+ signal,and it is a key molecule in maintaining the normal function of the central nervous system. In recent years,more and more studies have found that the structural and functional abnormalities of IP3Rs are closely related to the pathogenesis of neurodegenerative diseases such as Alzheimer's disease,Parkinson disease,Huntington disease,and spinocerebellar ataxia. However,it remains unclear how these structural and functional abnormalities affect the function of IP3Rs and the related calcium signal as well as the pathogenesis and sever‑ity of neurodegenerative diseases. This paper reviews the role of IP3Rs in neurodegenerative diseases.Key words:Inositol 1,4,5-trisphosphate receptor;Calcium ion;Neurodegenerative disease;Cognitive disorder1,4,5-三磷酸肌醇受体(inositol 1,4,5-trisphos‑phate receptors,IP3Rs)是一种位于内质网上的配体门控的Ca2+通道,1998年Supattapone等人[1]首次在大鼠小脑中发现IP3Rs,其广泛表达于单细胞原生动物在内的动物细胞中,通过调节内质网中Ca2+的释放,产生钙信号。
不饱和脂肪酸与炎症性肠病因果关系的孟德尔随机化分析

不饱和脂肪酸与炎症性肠病因果关系的孟德尔随机化分析*李 健1 高建淑1,2 赵可可1,2 高鸿亮1,2#新疆医科大学第一附属医院消化病二科1(830054) 新疆医科大学研究生学院2背景:炎症性肠病(IBD )是一种慢性复发性胃肠道炎症性疾病,包括溃疡性结肠炎(UC )和克罗恩病(CD )。
目前尚不清楚不饱和脂肪酸与IBD 之间是否存在因果关系。
目的:采用两样本孟德尔随机化分析探究不饱和脂肪酸与IBD 之间的因果关系。
方法:不饱和脂肪酸和IBD 的全基因组关联研究(GWAS )数据均来源于网络公开数据库。
采用逆方差加权分析法进行两样本孟德尔随机化分析,使用加权中位数法和MR⁃Egger 回归分析验证因果效应,以OR 及其95% CI 评价不饱和脂肪酸与IBD 风险的因果关系。
结果:ω⁃6脂肪酸与CD 无直接因果关系,与UC 有直接因果关系,逆方差加权分析结果显示ω⁃6脂肪酸基因水平每增加一个标准差,UC 风险增加16%(OR =1.16,95% CI : 1.00~1.36,P =0.04)。
而ω⁃3脂肪酸、单不饱和脂肪酸与IBD 之间均未发现因果关系。
结论:ω⁃6脂肪酸可能仅与UC 存在因果关系,ω⁃3脂肪酸、单不饱和脂肪酸与IBD 之间均未发现因果关系。
关键词 脂肪酸类,不饱和; 脂肪酸类,ω⁃6; 炎症性肠病; 结肠炎, 溃疡性; Crohn 病; 孟德尔随机化分析Causal Association Between Unsaturated Fatty Acids and Inflammatory Bowel Disease: A Mendelian Random ⁃ization Analysis LI Jian 1, GAO Jianshu 1,2, ZHAO Keke 1,2, GAO Hongliang 1,2. 1The Second Department of Gastroenterology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi (830054); 2Graduate School of Xinjiang Medical University, UrumqiCorrespondence to:GAOHongliang,Email:*************************.cnBackground: Inflammatory bowel disease (IBD) is a chronic recurrent inflammatory disease of gastrointestinal tract including ulcerative colitis (UC) and Crohn's disease (CD). It is unclear whether there is a causal association between unsaturated fatty acids and IBD. Aims: A two ⁃sample Mendelian randomization analysis was used to explore the causal association between unsaturated fatty acids and IBD. Methods: The data of the genome⁃wide association study (GWAS) of unsaturated fatty acids and IBD were obtained from web ⁃based public databases. Two ⁃sample Mendelian randomization analysis was performed by using inverse⁃variance weighted analysis, and weight median estimator and MR⁃Egger regression were conducted to validate the association of the causal effect. The causality of unsaturated fatty acids on the risk of IBDwas evaluated by OR and 95% CI . Results: No direct causal association was found between ω⁃6 fatty acids and CD, and a direct causal association was found with UC. Inverse⁃variance weighted analysis showed a 16% increase in the risk of UC for each standard deviation increase in ω⁃6 fatty acid gene levels (OR =1.16, 95% CI : 1.00⁃1.36, P =0.04). However, no causal association was found between ω⁃3 fatty acids, monounsaturated fatty acids and IBD. Conclusions: ω⁃6 fatty acids may be onlycausally associated with UC, and no causal association is found between ω⁃3 fatty acids, monounsaturated fatty acids and IBD.Key words Fatty Acids, Unsaturated; Fatty Acids, Omega⁃6; Inflammatory Bowel Disease; Colitis, Ulcerative; Crohn Disease; Mendelian Randomization AnalysisDOI : 10.3969/j.issn.1008⁃7125.2023.01.003*基金项目:新疆维吾尔自治区自然科学基金杰出青年科学基金项目(2022D01E25)炎症性肠病(inflammatory bowel disease, IBD )是一种免疫介导的胃肠道慢性炎症性疾病,包括溃疡性结肠炎(ulcerative colitis, UC )和克罗恩病(Crohn's disease, CD ),临床特征以腹痛和腹泻为主。
博士复试英文PPT

3. PTBP1 enhances exon11a skipping of Mena premRNA in lung cancer cells
Results
1. PTBP1 is highly expressed in lung adenocarcinoma (LUAD) tissues and 95-D cells and upregulation of PTBP1 is associated with EMT progress
2. PTBP1 promotes migration and invasion of lung cancer cells
Master Research
PTBP1 enhances exon11a skipping in Mena premRNA to promote migration and invasion in lung
carcinoma cells
Background Objectives Technology Methods Results Conclusions
5. PTBP1-mediated migration and invasion of 95-D cells are partially dependent on MenaINV
Results
2.1. Overexpressed PTBP1 promotes levels of EMT-related proteins in lung cancer cells
Technology Methods
Results
1. PTBP1 is highly expressed in lung adenocarcinoma (LUAD) tissues and 95-D cells and upregulation of PTBP1 is associated with EMT progress
谷红注射液联合奥拉西坦治疗缺血性脑血管病的疗效分析

基金项目:江西省卫生计生委科技计划(20204093)作者简介:肖建林,男,本科,主治医师。
【摘要】目的对谷红注射液联合奥拉西坦治疗缺血性脑血管病的临床疗效进行分析。
方法以随机数字表法将2018年1月—2019年1月收治200例缺血性脑血管病患者分为2组,每组100例。
对照组应用奥拉西坦治疗,联合用药组应用谷红注射液联合奥拉西坦治疗,比较2组治疗效果的差异。
结果治疗后联合用药组患者MMP-9、Hs-CRP 、Hcy 、血小板黏附、纤维蛋白维、凝血酶原时间等指标改善情况优于对照组。
对照组患者治疗优良率为84.0%,联合用药组患者治疗优良率为95.0%,差异有显著性意义(P <0.05)。
结论谷红注射液联合奥拉西坦联合用药在治疗缺血性脑血管病方面疗效优于单独应用奥拉西坦。
【关键词】缺血性脑血管病谷红注射液奥拉西坦联合用药Curative effect analysis of Guhong injection combined with Oxiracetam in the treatment of ischemic cerebrovascular disease Xiao Jianlin ,Cao Xianhong ,Fu Yanqing.The 334Hospital of Nanchang City ,Nanchang ,Jiangxi 330024【Abstract 】Objective To analyze the clinical efficacy of Guhong injection combined with oxiracetam in the treatment of is chemic cerebrovascular disease.Methods 200patients with ischemic cerebrovascular disease from January 2018to January 2019were randomly divided into two groups ,100cases in each group.The control group was treated with oxiracetam ,and the combination group was treated with Guhong injection combined with oxiracetam.ResultsAfter treatment ,the improvement of MMP-9,hs CRP ,Hcy ,plateletadhesion ,fibrin dimension and prothrombin time in combination group was better than that in control group.The excellent and good rate was 84.0%in the control group and 95.0%in the combination group (P <0.05).Conclusion The curative effect of Guhong injection combined with oxiracetam is better than that of oxiracetam alone in the treatment of ischemic cerebrovascular disease.【Key Words 】Ischemic cerebrovascular disease Guhong injection Oxiracetam Drug combination中图分类号:R4文献标识码:A文章编号:1672-1721(2021)10-1350-03DOI :10.19435/j.1672-1721.2021.10.007谷红注射液联合奥拉西坦治疗缺血性脑血管病的疗效分析肖建林操先红符艳清(南昌三三四医院,江西南昌330024)表达率仅为6.7%(P <0.01)。
抑郁症的神经炎症假说以及中医药相关研究进展

抑郁症的神经炎症假说以及中医药相关研究进展刘忠1,孙忠文21.泰安市中医医院急诊科,山东泰安271000;2.山东省泰山医院药学部,山东泰安271000[摘要]抑郁症神经炎症假说以小胶质细胞激活和炎性因子水平异常为主要特征,NLRP3炎性小体作为中枢神经免疫的重要组成,对于抑郁症发病机制研究有重要意义。
论述神经炎症和抑郁症的相关性以及涉及小胶质细胞激活和炎性因子水平异常的抑郁症的发病机制;基于NLRP3炎性小体在小胶质细胞激活和炎性因子分泌中的重要作用,进一步探讨了NLRP3炎性小体的激活诱发神经炎症的相关通路和机制;最后,介绍了中医药基于神经炎症假说的抗抑郁作用研究,为抑郁症治疗提供新的方向和靶点。
[关键词]神经炎症;抑郁症;小胶质细胞;炎性因子;NLRP3炎性小体;中医药[中图分类号]R4 [文献标识码]A [文章编号]1674-0742(2023)08(b)-0194-05The Neuroinflammatory Hypothesis of Depression and The Related Re⁃search Progress of TCMLIU Zhong1, SUN Zhongwen21.Department of Emergency, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong Province 271000;2.Department of Pharmacy, Taishan Hospital of Shandong Province, Tai'an, Shandong Province, 271000 China[Abstract] The neuroinflammatory hypothesis of depression is characterized by abnormal levels of microglia activation and inflammatory factors, NLRP3 inflammasome is of significance for the study of neuroinflammation and pathogenesis of depression. Reviewing the correlation between neuroinflammation and depression, the pathogenesis of depression in‐volving microglial activation and abnormal levels of inflammatory cytokines. Based on the important role of NLRP3 in‐flammasome in microglial activation and the secretion of cytokines, we further review the relevant pathway and mecha‐nism of NLRP3 inflammasome activation. In the end, presenting the study on the antidepressant effect of Traditional Chinese Medicine (TCM) based on the neuroinflammation hypothesis, which provides a new direction and target for the treatment of depression.[Key words] Neuroinflammation; Depression; Microglia; Cytokine; Nlrp3 Inflammasome; Traditional chinese medicine抑郁症给社会造成严重疾病负担。
谷氨酸能神经传递在抑郁症发病机制中作用的研究进展_李婧

· 20 ·李 婧1,2 孙建栋1 苑玉和1 陈乃宏11. 天然药物活性物质与功能国家重点实验室,新药作用机制研究与药效评价北京市重点实验室,中国医学科学院药物研究所,北京,100050,中国2. 天津中医药大学,天津,300193,中国【摘要】 对抑郁症发病机制的解释主要以中枢神经系统单胺类递质的功能失调为主,然而新的研究表明除单胺类神经递质外,谷氨酸等神经递质也扮演了非常重要的角色。
该文就谷氨酸循环的生理特点及其在抑郁症中可能的病理生理作用及各类针对谷氨酸异常抗抑郁药物的治疗进展进行综述。
【关键词】 抑郁症;谷氨酸;抗抑郁药物【中图分类号】 R-05,R964 【文献标识码】 A 文章编号:2095-1396(2012)06-0020-005Progress in Studies of Glutamatergic Neurotransmission in the Pathogenesis of DepressionLI Jing 1,2, SUN Jian-dong 1, YUAN Yu-he 1, CHEN Nai-hong 11. State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Department of Pharmacology, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, China2. Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China【ABSTRACT 】 The “monoamine hypothesis ” of depression ,which posits that depression is caused by decreased monoamine function in the brain ,originated several decades ago. Although these monoamine-based agents are potent antidepressants ,the cause of depression is far from being a simple deficiency of central monoamines. The glutamatergic system also plays important roles in the pathophysiology of major depressive disorder. This paper summarized the physiological characteristics of glutamate in the brain ,glutamatergic abnormalities in depression and antidepressants acting on the glutamatergic system.【KEY WORDS 】 depressive disorder ;glutamate ;antidepressant 谷氨酸能神经传递在抑郁症发病机制中作用的研究进展基金项目: 国家863计划基金项目(No.2012AA020303),长江学者和创新团队发展计划项目(No.PCSIRTIRT1007),国家自然科学基金项目(No.81274122、No.81102831、No.81173578),国家国际科技合作项目(No.2010DFB32900),创新药物研究开发技术平台建设项目(No.2012ZX09301002-004、No.2012ZX09103101-006),教育部博士点基金重点项目(No.20121106130001),北京市自然基金重点项目(No.7131013),北京市重点实验室基金项目(No.BZ0150)作者简介: 李婧,女,硕士研究生;研究方向:神经药理学;E -mail:693170945@通讯作者: 陈乃宏,男,研究员,博士生导师;Tel.:+86-010-********,Fax:+86-010-********,E -mail:chennh@抑郁症是一种常见的情感性精神障碍,近年来患病人数呈现出逐年上升的趋势。
上皮间质转化与哮喘气道重塑的研究进展

上皮间质转化与哮喘气道重塑的研究进展魏盼;李恋曲;吴鹏;贾志荣;王晓钰;洪敏;江国荣【摘要】Bronchial asthma is a respiratory system disease char-acterized by airway remodeling as a pathological basis. Repeated inflammatory infiltration and tissue damage repair can lead to airway remodeling. At present,the mechanism of airway remod-eling is not comprehensive. Studies have shown that epithelial-mesenchymal transition (EMT) plays an important role in the genesis and development of airway remodeling. Airway epithelial cells can be induced to mesenchymal transition through a variety of secretion factors and signaling pathways,leading to airway re-modeling in asthma. This review summarizes the study of EMT and airway remodeling in asthma,providing a reference for clini-cal follow-up treatment and research.%支气管哮喘是一类以气道重塑为病理基础的呼吸道疾病,反复的炎性浸润与组织损伤修复可导致气道重塑,目前有关气道重塑形成的机制尚不全面.研究表明,上皮间质转化在气道重塑的发生和发展过程中发挥重要作用.气道上皮可通过分泌多种因子及信号通路诱发间质转化,进而导致哮喘气道重塑.该文对上皮间质转化与哮喘气道重塑之间的研究进行综述,为临床后续哮喘治疗和研究提供参考.【期刊名称】《中国药理学通报》【年(卷),期】2018(034)005【总页数】4页(P600-603)【关键词】气道重塑;上皮间质转化;哮喘;结构蛋白;表型转化;气道炎症【作者】魏盼;李恋曲;吴鹏;贾志荣;王晓钰;洪敏;江国荣【作者单位】南京中医药大学药学院,科技部国家规范化中药药理实验室,江苏省中药药效与安全性评价重点实验室,江苏南京 210023;南京中医药大学药学院,科技部国家规范化中药药理实验室,江苏省中药药效与安全性评价重点实验室,江苏南京210023;南京中医药大学药学院,科技部国家规范化中药药理实验室,江苏省中药药效与安全性评价重点实验室,江苏南京 210023;南京中医药大学药学院,科技部国家规范化中药药理实验室,江苏省中药药效与安全性评价重点实验室,江苏南京210023;南京中医药大学药学院,科技部国家规范化中药药理实验室,江苏省中药药效与安全性评价重点实验室,江苏南京 210023;南京中医药大学药学院,科技部国家规范化中药药理实验室,江苏省中药药效与安全性评价重点实验室,江苏南京210023;南京中医药大学附属苏州市中医医院苏州市吴门医派研究院,江苏苏州215003【正文语种】中文【中图分类】R-05;R322.33;R329.24;R318.02;R562.25据Global Burden of Disease Study资料显示,全世界约有2.4亿哮喘患者,且有增加趋势,预计到2025年将达到3亿。
子宫螺旋动脉重铸与病理妊娠

子宫螺旋动脉重铸与病理妊娠董胜雯;郭洁【摘要】子宫螺旋动脉重铸是妊娠正常进行的关键环节,绒毛外滋养细胞的增殖和侵袭是血管重铸过程的必要条件.滋养细胞生物学功能的完整和调控机制的协调起着至关重要的作用.滋养细胞浸润不足,栓塞螺旋动脉不彻底,母-胎循环的发生提前,使绒毛受到直接的机械损伤,氧化应激作用间接地造成细胞机能障碍和损伤,出现胎盘退化变性;人肿瘤蛋白p53(TP53)介导细胞通路对细胞周期蛋白依赖性激酶抑制剂1A(CDKN1A)和Bax基因的异常表达,微小RNA-520(miR-520)过度调控滋养细胞的凋亡导致母体出现复发性流产.由滋养细胞分泌产生的基质金属蛋白酶9(MMP-9)的异常表达和大量炎性因子的释放造成了胎盘缺血缺氧,表现出子痫前期的相关症状.胎盘绒毛的血管密度、绒毛间隙体积的降低、滋养细胞分化程度下降、微环境缺氧以及突触缺陷因子1 (SYDE1)呈低水平表达,可能是造成胎儿生长受限的重要原因.因此研究螺旋动脉重铸过程对病理妊娠的早期诊治有着重要意义.%Uterine spiral artery remodeling is the key procedure in normal pregnancy.The proliferation and invasion of trophoblast cells is necessary for vascular remodeling process.When the trophoblast invasion is not fully enough,the spiral artery embolism is uncomplete,maternal-fetal circulation occurs earlier,the villi are damaged mechanically and directly.Oxidative stress cause cellular dysfunction and injury indirectly,followed by placental degeneration;cyclin-dependent kinase inhibitor 1A (CDKN1A) and Bax gene expressing abnormally caused by the pathway mediated TP53 protein,the apoptosis of trophoblast over regulated by miR-520 may lead to the emergence of the recurrent spontaneous abortion.The abnormalexpression of MMP-9 produced by trophoblast cells and the release of a large number of inflammatory factors cause placental ischemia and hypoxia.The decrease of the vascular density,the volume of villus space,the degree of differentiation of trophoblast cells,hypoxia in microenvironment and the low level expression of synapse defective 1 (SDYE1) in placental villi may be an important cause of fetal growth restriction.So the study of spiral artery remodeling process has important significance for early diagnosis and treatment of pathological pregnancy.【期刊名称】《国际妇产科学杂志》【年(卷),期】2017(044)002【总页数】4页(P176-179)【关键词】流产,习惯性;先兆子痫;胎儿生长迟缓;子宫螺旋动脉;重铸【作者】董胜雯;郭洁【作者单位】300193 天津中医药大学;天津医科大学;天津中医药大学第二附属医院【正文语种】中文(J Int Obstet Gynecol,2017,44:176-179)子宫螺旋动脉是母体向胎儿输送营养物质的管道。
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FORMANT RE-SYNTHESIS OF DYSARTHRIC SPEECH Alexander Kain,Xiaochuan Niu,John-Paul Hosom,Qi Miao,Jan van Santen Center for Spoken Language UnderstandingOGI School of Science&EngineeringOregon Health&Science University,Portland,Oregon,USA{kain,xiaochua,hosom,miaoqi,vansanten}@ABSTRACTDysarthria is a motor speech disorder that is often associated with irregular phonation(e.g.vocal fry)and amplitude,incoordination of articulators,and restricted movement of articulators,among other problems.The present study is part of a project on voice transformation systems for dysarthria,with the goal of producing intelligibility-enhanced speech.We report on a procedure in which formants and energies are estimated from dysarthric speech;next, these trajectories are modified to more closely approximate desired targets;finally,transformed speech is generated using formant syn-thesis.Results indicate that the transformation step enhances intel-ligibility,and that removal of vocal fry enhances perceived qual-ity.However,the initial step of stylizing the formant trajectories results in a decrement in intelligibility,thereby reducing the net impact of the process.1.INTRODUCTIONDysarthria is a motor speech disorder due to weakness or poor co-ordination of the speech muscles.Affected muscles include the lungs,larynx,oro-and nasopharynx,soft palate,and articulators (lips,tongue,teeth,and jaw).The degree to which these mus-cle groups are compromised determines the particular pattern of speech impairment.For example,poor lung function affects the overall volume or loudness,while problems with specific articu-lators may cause mispronunciations of certain phonemes.There is a great variety of diseases that can cause dysarthria,including Parkinson’s,Multiple Sclerosis,and strokes.We are currently investigating algorithms that,when imple-mented on a wearable device,can enable people with dysarthria to be understood by the general population.Although there are al-ready devices on the market[1]that address certain forms of dys-arthria,these devices,not substantially different fromfine-tuned filters and amplifiers,do not take advantage of recent advances in speech technology and are therefore limited in the assistance they provide.While there is no doubt that such devices can help certain types of dysarthria,many dysarthric persons suffer from speech problems that require forms of speech modification that are much more complex.Among these problems are:•Irregular sub-glottal pressure,resulting in distracting loud-ness variation•Absence or poor control of voicing•Systematic or variable mispronunciations of certain pho-neme groups,resulting in certain sounds becoming indis-tinguishable or unrecognizableThis research was conducted with support from NSF Grant0117911“Making Dysarthric Speech Intelligible”.•Prosodic problems,due to problems in pitch controlFor these difficult problems,new approaches are needed that an-alyze the speech signal at the acoustic,articulatory,phonetic,and linguistic levels.As afirst step toward such an approach,we pro-pose a transformation system whose core idea is to extract acoustic parameters from the input speech signal that are especially rel-evant to speech intelligibility,modify those parameters,and then synthesize a new speech signal from them.It is likely that any spe-cific form of the proposed system will only work for a subgroup of dysarthrias,due to the widely different forms of the disorder.2.METHOD2.1.OverviewOur overall strategy is to improve intelligibility by the manipula-tion of a small set of highly relevant speech features.We are moti-vated by the observation that formant synthesizers,which control only a very small set of speech features,may not sound very nat-ural but are highly intelligible.Therefore,our selection of speech features is very similar to those used in formant synthesizers.Figure1shows aflowchart of the system used in our approach. The dysarthric input speech waveform is subjected to several anal-yses that extract energy,F0and formant information.For voiced regions,these features are subsequently modified or,as is the case for F0,completely re-generated.The modified features are then used as input to a formant synthesizer.Finally,the original un-voiced regions and the modified voiced regions are assembled into an output speech waveform.Note that the system does not make any changes to phoneme durations.Also,no attempts are made to use additional,more conventional modifications such as compression/expansion of the speech dynamics or amplifications of certain frequency regions.2.2.Speech DataIn order to deal with the formidable difficulty of the task,we lim-ited ourselves to studying consonant-vowel-consonant(CVC)con-texts from a special-purpose database.The speech data used for training,transformation and evaluation were utterances of one dys-arthric speaker and one non-dysarthric(normal)speaker.Each speaker read278isolated,monosyllabic,nonsense CVC“words”. The speech signal was recorded and stored in16k Hz,16-bit PCM format.The vowels in the CVC words consisted of4front vowels(/i:/, /I/,/E/,and/@/;see[2]for pronunciation)and4back vowels (/A/,/^/,/U/,and/u/).These vowels are representative of typical vocal-tract configurations in American English.The consonants consisted of6stops(/p/,/b/,/t/,/d/,/k/,and/g/),4fricatives(/v/, /s/,/z/,and/S/),and3approximants(/l/,/j/,and/w/),coveringFig.1.Flowchart of the modification system.most places of articulation and voicing distinctions among Amer-ican English consonants.We manually segmented each utterance into a sequence of phoneme labels with time alignments.The complete set of recordings was divided into two groups, A and B.Utterances from Group A were used for training and evaluating intelligibility,and utterances from Group B were used for evaluating speech quality.Group A was divided into two non-overlapping partitions,one of228utterances used for training the formant mapping function,and one of50utterances used for the intelligibility evaluation.The number of occurrences of each vowel in the intelligibility evaluation was6or7.Group B consisted of 50utterances from Group A’s training partition,and was used for the evaluation of speech quality.2.3.Analysis2.3.1.Feature extractionWe used the ESPS waves+software package[3]to extract voicing, F0and formant information.Additionally,we converted the pho-netic labeling into consonant-vowel boundary information;while a production system would need to estimate these boundaries from the speech signal,we use the manual segmentation information directly.V oiced regions of speech are divided into a low band (0–4kHz)and a high band(4–8kHz).We calculate the energy of the lower band using root mean squared values multiplied by an asymmetric trapezoidal window(this window matches thefinal synthesis window).2.3.2.Formant targetsIt is well known that the formant pattern of a vowel is an impor-tant acoustical correlate of vowel identity.Thefirst formant(F1)is inversely related to the perception of vowel height,and the differ-ence between thefirst(F1)and the second(F2)formant is related to the perception of vowel backness.Formant analysis may help us to understand the acoustical and articulatory reasons that impair the intelligibility of vowel sounds in dysarthric speech.By com-paring the formant pattern of vowels in dysarthric speech with that in normal speech,we also expect tofind a way to improve the in-telligibility of dysarthric speech.In the present study,F1and F2 modifications were considered.This is partly because F1and F2 are perceptually more important than other formants,and partly because the formant tracker we used could provide more reliable F1and F2trajectories than other formant trajectories.It has been assumed that there exists a target vocal-tract con-figuration during the production of each monophthong,and that this configuration corresponds to a certain formant pattern,which can be measured from the acoustic data at a stable point or sec-tion of the vowel that is least influenced by context.There have been different ways of choosing the sampling point or section in the studies of the formant characteristics of vowels.Stevens and House[4]studied formant values at temporal midpoints of vowels. Lindblom[5]represented Swedish vowels with the values of the first three formants at the time at which thefirst derivative of the corresponding trajectory was zero.In the study by Di Benedetto [6],the sampling points of formants were chosen at the time at which F1reached its maximum.The motivation for this choice was the concave upward shape of the F1trajectory of a vowel be-tween two consonants,which is consistent with the prediction of the acoustic theory.In fact,under the shape assumption,the maxi-mum F1point is equivalent to the point at which thefirst derivative is zero.However,the numeric calculation of the derivative ampli-fies the noise of trajectory measurements,which makes it difficult to determine the zero point automatically from data.This diffi-culty is more severe for dysarthric speech due to more irregulari-ties.Therefore,in the present study,we chose the maximum point on the F1trajectory of each vowel to approximate its stable point.As for the F2trajectory of a vowel,we assumed that it could only be in one of the following four shapes:concave upward or downward,or monotonically increasing or decreasing.When it was in the concave upward or downward shape,we chose the max-imum or minimum point as the stable point of the F2trajectory. We have observed that the maximum or minimum does not nec-essarily occur at the same instant of time as the maximum of the F1trajectory.This observation could be a consequence of the fact that different articulators can move relatively independently dur-ing speech production.When the F2trajectory was monotonically increasing or decreasing,we chose the stable point corresponding to the median F2value of the trajectory.In summary,the procedure to measure F1and F2values at stable points is described as follows.The formant trajectories are extracted by the formant tracker at10-millisecond intervals.Then a3-order medianfilter is used to suppress impulsive noise in the trajectory data.A forward-reverse low-passfilter,whose impulse response is a5-tap Hanning window,is used to smooth the F1 and F2trajectories.Within the vowel section,the maximum of the F1trajectory is then obtained.In order to automatically de-termine the shape of the F2trajectory of the vowel,F2data are tested by four types of shape-constrained regressions,including an increasing isotonic regression,a decreasing isotonic regression,a unimodal regression,and a reverse unimodal regression[7].The shape is determined by the least regression error among the tests. According to the shape of the F2trajectory,the stable point andF1 [Hz]F 2 [H z ](a)Dysarthric speakerF1 [Hz]F 2 [H z ](b)Normal speakerFig.2.F 1and F 2formant frequency targets for the 8vowel classes of the training set,modeled as Gaussians (blue and red,dashed),and projections of corresponding joint density Gaussian mixture model components (green,solid).Each vowel class is modeled by two components for a total of 16components.Ellipses are centered at component means and radii are set to equal standard deviations.F 2value are determined.The F 1and F 2values measured at the stable points are used as the estimates of formant targets during the training and modification process.2.4.TrainingIn order to transform formant targets x of the dysarthric speaker to formant targets y of the normal speaker,we must train a transfor-mation function F .As in previous work [8],we choose a piece-wise linear,probabilistic function,derived from parameters of a Gaussian mixture model (GMM)that models the joint density of x and y .The predicted normal formant targets are given byˆy=F (x )=QXq =1(W q x +b q )·p (c q |x )(1)where W q and b q represent the q th linear transformation,and theterm p (c q |x )denotes the GMM posterior probability that the input vector “belongs”to class q .There are several ways in which the parameters of the GMM can be estimated.For example,the GMM can be trained in unsu-pervised mode using a standard EM algorithm,or it can be trained in supervised mode by using the vowel class information directly (in this case Q =8).Initial informal perceptual tests showed that a semi-supervised method worked best.In this scheme,we performed a K -means clustering separately on the joint density of each vowel class.After estimating two codewords per class,a two-component sub-GMM is constructed by letting the Gaussian means equal the codewords,and adjusting the priors and the co-variances appropriately.We preferred a K -means method over an EM method because the former produces density models that have less “overlap”as compared to the latter,which produces densities that may model the data more accurately but less distinctly (this is also known as the information-modeling trade-off [9]).Finally,the eight sub-GMMs are assembled into a single16-F1 [Hz]F 2 [H z ]Fig.3.The transformed vowel space.Shown are Gaussian approx-imations of formant targets of the normal speaker for the 8vowel classes (red,dashed)and Gaussian approximations of transformed dysarthric data grouped by their known classes (magenta,solid).component GMM,as shown in Figure 2.The advantage of using the semi-supervised approach lies in the fact that component allo-cation is partially guided,but components can still model any non-Gaussian behavior of the data within each class.Figure 3shows the transformed vowel space.2.5.Modification2.5.1.Energy ModificationOne of the problems of using energy values of the dysarthric speak-er directly is that they result in modified speech with significantflutter(variations in energy).The variations in energy measure-ment are probably due to the high levels of“vocal fold fry”[10]. We therefore smooth the energy trajectory with a combination of zero-phasefiltering using a normalized Hanning window and me-dianfiltering.2.5.2.F0GenerationGenerally,F0of the dysarthric speaker was characterized by ex-cessive amounts of jitter(variations in F0),and was perceived as rough.We decided to discard the original F0and generate syn-thetic F0values.We have tried three different variations in im-plementation:1)let F0be directly proportional to the energy;2)find one or more peaks in the energy trajectory,and consider them as peak locations for accent curves;3)for CVC contexts,consider 33%of the vowel duration as the center of the peak location of a single accent curve[11].Thefirst variation is the most simple and produced somewhat natural,albeit meaningless,pitch changes.The second variation attempts to identify regions of emphasis based on energy and uses the superpositional F0model to create accent and phrase curves. For the purposes of this paper,we used the third variation,which assumes that the emphasis occurs during the production of the vowel.2.5.3.Formant ModificationBecause the output of the formant tracker was more erratic on dysarthric speech than on the normal speech,we used zero-phase filtering to smooth the formant trajectories prior to any other pro-cessing.Thefirst step consisted of obtaining modified formant target values for the center of the vowel portion(which is a simplifi-cation,since these targets may occur in locations other than the center).There were three types of modifications performed,each corresponding to a different condition during the perceptual test described in Section3:clean The modified formant frequency targets were set to the dys-arthric speaker’s formant frequency targets,as obtained fromthe process described in Section2.3.2map We predicted the normal speaker’s formant frequency tar-gets from the dysarthric formant frequency targets using thetransformation function introduced in Section2.4oracle The modified formant frequency targets were set to the normal speaker’s formant frequency targetsSince the targets only included F1and F2,we estimated F3and F4from the average values of the center third of the vowel.The bandwidths B1–B4were set to appropriate constant values.The clean and oracle conditions can be regarded as the baseline and best possible system performance,respectively;the performance of the map condition can be expected to be within this range.Once the modified target values were available,the modified formant trajectories needed to be calculated.In the absence of a sophisticated method that can properly account for coarticula-tory effects[12],we employed a strategy of adding a synthetic target trajectory to the originally observed trajectories(for both frequencies and bandwidths),weighted by a crossfade function. The existence of the crossfade function avoided discontinuities by slowly changing from the observed formant values on the left side of the vowel to the synthetic values,and then back again;this is important since,in contrast to energy and F0features which are modified and generated in voiced regions(which includes all sono-rants),formants were modified in the vowel region only.We chose the n th root of a Hanning window as crossfade function,where n can adjust the fade-in and fade-out“speed”(we set n=3).The synthetic trajectory was set to constant values for the entire modifi-cation region.Crossfading the observed formant frequencies with constants resulted in trajectories that gave reasonable approxima-tions for concave and convex formant movements.2.6.SynthesisThe implementation of our synthesizer is very similar to a Klatt formant synthesizer[13].We use manually adjusted,global values for the source parameters TL(spectral tilt,implemented as afirst-orderfilter)and OQ(open quotient).For each synthetic speech frame,we produced two periods of excitation using the synthetic F0values.Based on thefirst four formant frequency and band-width values we constructed the all-pole formantfilter.We also constructed a global spectral adjustmentfilter,implemented as a low-order,linear phase FIRfilter,which was tuned so that the nor-mal speaker’s spectral balance was reproduced correctly on aver-age.Finally,the excitation waveform wasfiltered with the com-bined formant and adjustmentfilter to render the output frame. The frame’s energy was adjusted to the modified energy specifica-tions,and the original high band speech waveform was added to it. To produce thefinal speech waveform,every frame,unvoiced and voiced,was overlap-added using an asymmetric trapezoidal win-dow to give good transitions between voiced/unvoiced regions as well as between neighboring voiced frames.3.EV ALUATIONTwo perceptual experiments were conducted.Thefirst experiment evaluated the intelligibility of the original dysarthric speech,mod-ified dysarthric speech,and original normal speech.The second experiment measured the quality of the original dysarthric speech as compared to the clean dysarthric speech.3.1.Stimulus TypesThefive types of stimuli used in these experiments included the clean,map,and oracle modifications to dysarthric speech de-scribed in Section2.5.3,as well as the original waveform of dys-arthric speech(referred to as origDys)and the original waveform of the normal speaker(referred to as origNor).The clean stimuli were used to evaluate the intelligibility and quality of dysarthric speech that has had its energy,F0,and for-mant structure drastically simplified,but without efforts to modify the speech for improved intelligibility.The map stimuli were used to evaluate the intelligibility of dysarthric speech in which the formant values have been modified in an effort to improve intelligibility.This modification of for-mants relies on the formant-transformation procedure described in Section2.4and,as such,could be implemented in a working sys-tem.The oracle stimuli were used to evaluate the intelligibility of dysarthric speech in which the formant values have been modified so that they reach values that are thought to be correct for the pur-poses of intelligibility.This modification of formants represents the best output of a hypothetical formant-transformation procedure that has been perfectly trained.As such,results from oracle stim-uli can not yet be implemented in a working system,but illustrate best-possible performance using the current system architecture.3.2.Perceptual ExperimentsThe perceptual experiments were conducted with6males and4fe-males,all of whom were native speakers of American English andH za m p l i t u d e10002000300040005000600070008000H z(a)Dysarthricspeech H za m p l i t u d e10002000300040005000600070008000H z(b)Transformed speechFig.4.Analysis of dysarthric speech and synthesis of transformed speech.The top panel displays F 0values in voiced (red,solid)and unvoiced (blue,dashed)regions.The middle panel displays the speech waveform (red/blue)and scaled energy values (green).The bottom panel shows the spectrogram superimposed with formant frequencies F 1–F 4.had no known hearing problems.These subjects were unfamil-iar with dysarthric speech.Subjects took these tests using graphi-cal user interfaces that presented the stimuli and possible response choices,and then recorded the responses.Replaying the stimuli was not possible.The stimuli were played over loudspeakers in a quiet room.Two stimuli were presented at the beginning of each test to familiarize the subjects with the procedure;responses from these stimuli were not recorded.The waveforms were normalized for energy levels and the signal was trimmed to have no more than 100milliseconds of silence at either end.3.2.1.Intelligibility TestingThe evaluation of intelligibility had a structure similar to that pro-posed by Kent et al.[14]for measuring the intelligibility of speech.The 50CVC utterances with five stimulus types (origDys ,clean ,map ,oracle ,and origNor )yielded 250stimuli in total.Each sub-ject evaluated 100of these stimuli.Each subject listened to the same (random)ordering of the CVCs but a different stimulus type within that ordering,so that the order of presentation had no effect on the relative intelligibility results.In conducting this test,each CVC was aurally presented.Sub-jects chose the vowel that they heard from the list of all 8possible vowels.V owels were represented using both phonetic symbols (for subjects who were familiar with phonetics)and complete words that contain those vowels (for subjects who were unfamiliar with phonetics).The total time to complete this test was about 15min-utes.3.2.2.Quality TestingThe goal of the test of speech quality was to evaluate whether or not the analysis of dysarthric speech and subsequent synthesis us-ing smooth F 0,formant,and energy contours would improve the perceived quality of the dysarthric speech.It was hypothesized that such processing would improve perceived quality because of the preponderance of vocal fry in the dysarthric speaker’s voice.The evaluation of speech quality used a standard Comparison Category Rating (CCR)test.In conducting this test,CVC pairs were aurally presented in sequence,using the origDys and clean stimulus types.The ordering of the presentation of these stimulus types was randomized.Subjects were asked to indicate the change in speech quality of the two speech samples using a response scale,resulting in a comparison mean opinion score (CMOS).The scale included the following rankings (with assigned scores in parenthe-ses):"much worse"(-2),"slightly worse"(-1),"about the same"(0),"slightly better"(+1),and "much better"(+2).In order to evaluate the change in quality as a function of the presence of vocal fry,the evaluation consisted of 40utterances containing vocal fry and 10utterances without vocal fry.The pres-ence of vocal fry was determined using a glottalization detector [15]in the vowel regions of the dysarthric speech.The total time to complete this test was about 15minutes.3.3.ResultsFor the intelligibility test,the average correct response rate for the five stimulus types were:origDys =43.4%,clean =38.5%,map =45.5%,oracle =63.5%,and origNor =99.0%.Results of a planned-comparison one-tailed t -test [16]are displayed in Table 1.The improvements from clean to map and from map to oracle are significant at the 5%level.An analysis of the results per target vowel indicates that vowels that should have a high value of F1had improved intelligibility and vowels that should have a low value of F1had reduced intelligibility.This is shown in Table 2.For the test of speech quality,we computed the mean opinion score of the clean utterances relative to the corresponding origDys utterances.For all utterances,the mean opinion score of the clean utterances was 0.19.For those origDys utterances considered to have vocal fry,the mean opinion score of the clean utterances was 0.26.For utterances without vocal fry,the mean opinion score was -0.08.Results of t -tests between the origDys and clean utterances are shown in Table 3.Comparison Diff.t-test p value(%)origDys vs.clean-4.9-0.760N.S.origDys vs.map 2.10.293N.S.clean vs.map7.0 1.9820.039map vs.oracle18.0 3.7560.002Table1.Results of planned-comparison one-tailed significance testing of intelligibility.Vowel(Word)OrigDys clean map oracle origNor(%)(%)(%)(%)(%) i:(beet)82717583100 I(bit)73715482100 E(bet)28332538100 @(bat)2945471100 u(boot)5650454100 U(book)4450424293 ^(but)3183333100 A(Bob)131******** Table2.Results of intelligibility test on a per-vowel basis4.CONCLUSIONIn conclusion,these preliminary results show that a method that modifies formants without knowledge of vowel identities may be capable of enhancing intelligibility.The major issue that needs to be addressed is why the clean condition results in a decrement in intelligibility and an increment in quality.Results indicate that the increment in quality is due to the removal of vocal fry.This fol-lows not only from the overall result,but also from the difference in results for stimuli with versus without vocal fry.The decrement in intelligibility may have multiple causes,and include the fol-lowing.First,the consonants were re-synthesized fairly crudely; this will be addressed by using a mixed formant/sinusoidal re-synthesis process.Second,the formant trajectories were drawn using a scheme that leaves the formant values at the vowel bound-aries intact.One problem that this generates is unusually strong formant movement.New schemes will be considered that mod-ify the formant trajectories well into the consonants.Addition-ally,further control experiments need to be conducted in which we compare the cleaned version with a similar version in which the original formants are used.Although the mapping operation was clearly successful,performance on the/E/,/u/,and/I/vow-els was problematic.It is important to point out that the mapping operation does not reduce overlap in the productions of different vowels.Instead,it moves the vowel space such that more vowels are in the appropriate regions of the vowel space.Because of the relatively high degree of overlap,formant mapping unavoidably creates errors.Two avenues of research need to be explored here. One is to obtain a more accurate perceptual picture of the formant space,and use this picture instead of the normal speaker’s produc-tions as targets.The other is to reduce overlap by attempting to "de-coarticulate"the vowels.Work is underway on precisely this issue[12].Finally,we want to remind ourselves of the fact that this speaker represents one of many patterns of dysarthria,and that we should be prepared for deeply different methods being required for different syndromes.Utterance Type Diff.Score(-2to+2)t-test p value All Utterances0.190 2.5710.015V ocal Fry Only0.259 2.7590.011 Non-Fry Only-0.079-1.299N.S. 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