Journal of Heredity 200394(2)181–183 ó 2003 The American Genetic Association DOI 10.1093j
《猪、鸡重要经济性状遗传的分子机制》
遗 付 HEREDITAS(Beijing) 2013
第 35卷
· 综 合 信 息·
《猪 、鸡 重 要 经 济 性 状 遗 传 的 分 子 机 制 》
作者 :李 宁 ISBN:9787030381897 定价:150 开本:16装帧:圆脊精装 页码:424 初版时间:9/1/2013
内容 介 绍 《猪 、鸡 重要经 济性状 遗传 的分子 机制 》介绍 了 973计 划项 目 “猪 、鸡重要 经济性 状遗 传的分 子机制 ” 的研 究成
果 。内容包 括 :猪 、鸡 生长发 育 的功能基 因组,猪 、鸡 品质性 状形成 的分 子机制 ,繁殖性 状形成 的遗 传机制 ,抗病 和抗 逆基 因 的克隆分 析,重要复 杂性状 的 比较 基 因组 ,表 观遗传 和 miRNA 影 响性状 形成 的机制,以及猪 、鸡重要 经济 性状 的分 子改 良。这些 重大科 学 问题 的 阐释和相关 功 能基 因组 学等 技术 的建立,将为 我国农业 动物 的高产 、优 质 、高效 发展 提供 遗传理 论和 高新技术 。 购 书 指 南 :
学 士 书 店 :http://www.xueshi.tom.c 科学 出版社 科学销 售 中心 联 系人 :周 文字 E·mail:zhouwenyu@mail.sciencep.corn
儿科病例--黑斑息肉病
诊断
PJS的诊 断主 要 依 据 患 者病 史 、皮 肤 黏膜 色 素沉 着 等 临床 表现及 内镜下 或影 像学 发现 胃肠 道息 肉等证 据 。 • 对 于 胃与 大肠 的息 肉可 通过 胃十 二指肠 镜 及结肠 镜 进行 诊 断 ,并 可 在 内镜
下 取 活 检 行 病 理检 查 。 • 对 于 小 肠息 肉的诊 断 目前 主要 有 胶 囊 内镜 (CE)、CT小 肠 造 影 (CTE)、磁 共 振
临床表现
• 临床表 现 PJS患 者 的 临 床 表 现 主 要 包 括 皮 肤 黏 膜 色 素 沉 着 、消化道 多 发性息 肉及 肿瘤 易 感性 。
• 约 95% 的 PJS患 者 出现 皮肤 黏 膜 色素 沉 着 ,出生 时少 见 ,而多 于幼 年期 出现 ,典 型 的色 素 沉着 直 径 1~ 5mm,颜 色为 深 褐 色 ,多 分 布 于 眼 、耳 、口周 、肛 周 、颊 黏 膜及 四肢末 端 ,部 分色 素 沉 着 可 随 患 者年 龄 增 长 而 褪 色 。 目前 尚无研 究证 实 PJS患 者 的皮 肤黏 膜 色 素沉 着具 有恶 变倾 向 。
• PJS 患者 胃肠 道 息 肉的病 理类 型主要 为错 构 瘤性 息 肉。 胃 肠道 息 肉可 导致反 复发 作 的 肠 梗 阻 与肠 套 叠 ,使 得 患 者需 要 经历 多次 开腹 手术 与肠 段 切 除 。另外 ,胃肠 道 息 肉也 可 引起消 化 道 出血 ,长 此 以往导 致 缺 铁 性 贫 血 。
为 85.7% ,在 所 有 PJS患 者 中为 63.2% ,且 LKB1基 因启 动 序 列 的 甲基 化 可 能 与 胃肠 道 息 肉癌变 的发 生有 关 。 • WANG等 研 究 发 现 , LKB1是一 种 DNA损 伤 应 答 蛋 白 ,缺 乏 LKB1的肿 瘤 细胞 将对 基 于 DNA损伤 的放 疗及 阻碍 DNA修 复 的化 疗 (如 PARP抑制 剂 )更 为 敏感 ,这 可 能 为 PJS的治 疗 提 供 了新 方 向。 • KIM 等 认 为 ,STK11的突变与在不同部位出现的幽门腺黏液上皮异常增殖有着密切关联 。 总之 ,基 于上 述发 现 ,认 为 STK11/LKB1的突变与大部分遗传性PJS的发生有关,但除此以外是否有 其他基因参与PJS的发生,目前仍有待研究 。
单核苷酸多态性_环境因素与肝细胞肝癌遗传易感性的关系_纪龙
文章编号:100028020(2009)022*******・综述・单核苷酸多态性、环境因素与肝细胞肝癌遗传易感性的关系纪龙综述 余红平审校广西医科大学公共卫生学院,南宁 530021摘要:肝细胞肝癌(HCC )的发生和演进是一个多基因、多因素的复杂过程,是遗传与环境因素相互作用的结果。
单核苷酸多态性(S NP )作为第三代遗传标记,充分反映了个体间的遗传差异,决定了个体对疾病的易感性,正成为肝癌遗传易感性研究的重要工具。
关键词:单核苷酸多态性 环境因素 肝细胞肝癌 遗传易感性 肝肿瘤中图分类号:R73517R73011 文献标识码:AR elationship of single nucleotide polymorphism ,environmental factors and the hereditary susceptibility of hepatocellular carcinomaJI Long ,YU H ongpingSchool of Public Health ,G uangxi Medical University ,Nanning 530021,ChinaAbstract :Resulting by the interaction between the hereditary factor and the environmental factor ,the occurrence anddevelopment of hepatocellular carcinoma (HCC )is a com plicated course with multi 2genes and multi 2factors.As the third genetic marker ,the single nucleotide polym orphism reflects the hereditary difference am ong individuals ,decides the susceptibility to disease and becomes an im portant tool to study the hereditary susceptibility of HCC.K ey w ords :single nucleotide polym orphism ,environmental factor ,hereditary susceptibility ,hepatocellular carcinoma基金项目:国家自然科学基金资助项目(N o.30660162);广西自然科学基金资助项目(N o.桂科攻0592007221);广西研究生教育创新计划资助项目(N o.2008105981004M189);广西大型仪器协作网测试补助(N o.529220072108)作者简介:纪龙,男,硕士研究生,助教,研究方向:慢性病流行病学,E 2mail :tsmcjl @ 肝细胞肝癌(HCC )是我国最常见的恶性肿瘤之一,死亡率为2014Π10万,严重威胁人们的生命健康。
巴氯芬临床应用研究进展
巴氯芬临床应用研究进展世?界?临?床?药?物WRLDCLINICALDRUGS巴氯芬临床应用酮究进展复旦大学附属中山医院老年科,神经内科'.__????一.谢瑞满中枢性肌松剂巴氯芬在降低肌张力的神经康复治疗和减轻疼痛的治疗方面有独特效果,特别是在脑卒中后偏瘫,脊髓损伤后截瘫和多发性硬化等疾病引起的中枢性痉挛性瘫痪等的临床治疗中取得了明显疗效,且安全可靠.巴氯芬;脑卒中;疼痛10年来,中枢性肌松剂巴氯芬的临床应用得到很大进展,特别是在降低肌张力的神经康复治疗和减轻疼痛的治疗方面获得很多经验,例如在脑卒中后偏瘫,脊髓损伤后截瘫和多发性硬化等疾病引起的中枢性痉挛性瘫痪等的临床治疗中取得了明显疗效.近来有研究还发现,巴氯芬能够明显减少胃食管反流并改善其症状,有效缓解儿童肌张力障碍的症状,治疗中枢性顽固性呃逆和脊髓损伤后的排尿功能障碍.另外,巴氯芬鞘内注射疗法的临床应用,能够进一步提高临床疗效和随时调整药物用量,稳定治疗效果.本文对中枢性肌松剂巴氯芬在临床上的各种应用研究作一回顾3_.概述巴氯芬(baclofen,氯苯氨丁酸)为解痉药,是y-氨基丁酸(GABA)的衍生物,为作用于中枢神经系统脑和脊髓的骨骼肌松弛剂,镇静剂.本品通过激动GABA~B受体而使兴奋性氨基酸如谷氨酸,门冬氨酸的释放受到抑制,从而抑制单突触和多突触反射在中枢神经系统脑和脊髓的传递,从而起作者简介谢瑞满:神经科博士,教授,1999年作为NIH课题成员在哈佛医学院神经科任客座教授,博士后导师.从事神经眼耳科,行为神经科及人脑功能损伤研究.参加国家七五一十五脑卒中防治和康复攻关等课题.2001年获上海市老年学科带头人和优秀人才基金.世?界?临-床?药?物WIRLDCLINICALDRUGS到解痉作用.巴氯芬在胃肠道中吸收迅速而完全,脑脊液中活性物质浓度约为血浆中的1/8,血浆消除半衰期(f1,)平均为3~4小时,大部分巴氯芬以原型排出,在72小时内,摄入量中约75%经肾脏排出.与三环类抗抑郁药联用.巴氯芬作用增加,有可能引起肌张力过低.巴氯芬和降压药联用,可使降压作用加强,因此降压药的剂量应根据情况适当调整.帕金森病患者,同时接受较大剂量巴氯芬和左旋多巴/卡比多巴治疗,有个别报告引起精神错乱,幻想和激动不安. 作用机制巴氯芬的作用机制目前尚不清楚,一般认为,GABA在人体中枢神经系统脑和脊髓中含量很高,比脑内单胺类如儿茶酚胺,去甲肾上腺素,多巴胺等高出1000多倍,其中以中脑黑质和苍白球中含量最高, 脑内约有20%一40%的突触以GABA 为递质.GABA是中枢神经系统脑和脊髓中主要的抑制性递质,但它不能透过血脑屏障.GABA通过B碳原子接上对位氯苯基(B-chloropheny1) 即变为巴氯芬,从亲水性物质变为亲脂性,从而能透过血脑屏障.巴氯芬的主要作用是激动GABA的B受体,通过突触抑制兴奋性氨基酸如天门冬氨酸,谷氨酸的释放,并使神经元内K,Ca离子外流,产生超极化作用,降低单突触性与多突触性反射的传递,促使中间神经元活动的正常,减少oc运动神经元的活动,从而缓解锥体束受损引起的骨骼肌痉挛状态.降低肌张力,促进运动功能恢复【".脑卒中患者早期产生的兴奋性神经递质是有害的.因此应用巴氯芬治疗不仅能够降低脑卒中后的肌张力异常增高,并且可以减少兴奋性神经递质对神经元细胞的毒性.脊髓损伤患者经巴氯芬治疗后,肌电图检查显示F波振幅,时程,F/M显着减小,提示巴氯芬治疗能够降低oc 运动神经元活性,改变中间神经元的活性,对y运动神经元,Renshaw细胞活性影响不大.临床应用巴氯芬主要用于脑卒中后偏瘫,脊髓损伤后截瘫和多发性硬化等疾病引起的中枢性痉挛性瘫痪等的临床治疗.也能明显改善胃食管反流性疾病的症状,有效缓解儿童肌张力障碍,治疗中枢性顽固性呃逆和脊髓损伤后的排尿功能障碍.>))脑卒中后偏瘫脑卒中后肌张力增高是中枢神经系统受损引起的上运动神经元损害的特征,脑卒中后一般过程是:发病初出现肌张力丧失,无随意运动,而后联合反应运动,肌张力,反射及随意共同运动出现,之后随意共同运动为主,肌张力增加并至高峰,接着是共同运动减少,随意分离运动出现,肌张力开始下降,随后随意分离运动为主,肌张力下降至正常,最后随意分离运动充分,肌张力正常.肌张力过高不能及时降低,随意分离运动不能恢复,使精细技巧运动不能完成,引起挛缩,关节脱位及畸形,脑卒中后这种现象在我国极为常见,临床上一般要等到脑卒中后肌张力很高,如达到Ashworth评价的…,lV级时才给予降低肌张力的药物,并且剂量偏大.往往使正常药物作用难以发挥且不良反应明显.因此,正确合理应用降低肌张力的药物,防止肌张力异常增高.促使肌张力由低一高一正常顺序进行恢复.是临床治疗中实用和有效的方法.作者报道的脑卒中急性期巴氯芬治疗的前瞻性随机双盲对照临床研究,选择急性单侧半球脑卒中患者160例,随机分为2组,按双盲法给药,用药前,用药2周,4周观察肌力,肌张力,运动机能障碍及日常生活能力,统计分析后揭盲.结果显示,巴氯芬治疗组在肌张力,运动机能障碍评定方面较对照组有显着差异,表明巴氯芬有利于脑卒中患者的神经康复.有助于提高临床疗效,改善预后;而肌力和日常生活能力评定结果,未见差异.可能与巴氯芬药理作用机制以及对日常生活能力的影响等因素有关.研究提示,巴氯芬治疗确能防止脑卒中患者肌张力异常增高,提高临床疗效,改善预后.揭盲后显示,巴氯芬的世?界?临?床?药?物WRLDCLINICALDRUGS2006V01.27No.3用药剂量为每次2.5mg,一日2次起始,逐步增加剂量.至每次5~10mg.一日3次较为合适[.许多文献报道和我们的临床研究还发现.有些脑卒中患者应用巴氯芬后还有助于腱反射亢进的缓解和病理征的消失.临床上3~6个月的随访研究发现,应用巴氯芬治疗有助于脑卒中患者的长期神经康复,提高治疗效果,最终改善预后,防止肌肉挛缩,关节脱位及畸形发生[2I. )))脊髓损伤,多发性硬化症后的中枢痉挛性瘫痪Hattab[】对欧洲发表的关于巴氯芬治疗脊髓损伤,多发性硬化症后肌痉挛的280篇文献作了综述,并针对其中1531例患者进行了分析,发现患者用药后显着进步的为66%,中等进步的为12%,两者合计总有效率为78%.一项针对多发性硬化症患者的前瞻性随机双盲对照临床研究[5】发现,与地西泮比较,巴氯芬疗效更好,并且镇静作用较少见.国内相关研究结果显示,巴氯芬组的有效率为77.39%,显效率为29.57%,和国外文献报道的结果基本一致[.,.)))胃食管反流性疾病研究表明,巴氯芬能够减少胃食管反流性疾病患者餐后第一个3/J\ 时内的反流发生.短期研究选择28例伴或不伴轻度内镜下食管炎的胃食管反流性疾病患者为治疗组,以15例健康志愿者为对照组,进行食管胃48小时pH值监测,期间采用双盲的方式给予巴氯芬或安慰剂1天,结果发现,短期给予巴氯芬后,胃食管反流性疾病患者(尸之O.003)反流发生次数和pH值小于4的时间明显减少,给予巴氯芬后胃食管反流性疾病患者(P<O.001)胃pH值明显升高. 长期研究选择16例胄食管反流性疾病患者给予巴氯芬每次10mg,一日4次或安慰剂共4周,在治疗前,后进行24小时食道pH值监测和反流症状积分计算.研究发现,巴氯芬给药4周,所有胃食管反流性疾病患者的反流发生次数(P<O.OO3)和pH值小于4的时问(P<O.02)明显减少.巴氯芬治疗后症状积分明显改善(P<O.0007).提示巴氯芬治疗胃食管反流性疾病可能有效[.)))中枢性顽固性呃逆和神经性疼痛由于巴氯芬为神经传导抑制性递质的相似物,能同时抑制中枢神经系统单突触和多突触反射,可能使传人端高度极化,具有中枢神经系统抑制作用,因此可用于解除上运动神经元受损所致的痉挛状态.特别是屈肌痉挛及并发的疼痛,肌阵挛和肌肉震颤.有多组报道采用巴氯芬治疗各种中枢性疾病引起的顽固性呃逆,效果显着,其可能因上述抑制机制而达到止呃逆效果,具有起效快,不易复发,不良反应少的特点[引.自1980年巴氯芬首先用于治疗三叉神经痛以来,有许多研究表明巴氯芬能够治疗各种神经性疼痛,包括偏头痛的预防和治疗,反复发作的丛集性头痛的治疗,安全且耐受性好[们.)))脊髓损伤后的排尿功能障碍临床上.发生脊髓损伤患者,其膀胱尿道功能经常受到损害,所出现的排尿功能障碍主要类型是逼尿肌反射亢进,急迫性尿失禁,或逼尿肌无反射及低顺应性,溢出性尿失禁,给患者带来极大痛苦.有研究采用巴氯芬等治疗脊髓损伤后患者排尿功能障碍,选择主诉尿失禁,排尿困难或遗尿的脊髓损伤患者,以美国Life-TechJanusV型尿动力学检查仪检查其排尿功能障碍,对尿道横纹肌括约肌功能亢进者予以巴氯芬每次1Omg,一日3 次.表现为尿道横纹肌括约肌协同失调或痉挛,伴逼尿肌反射亢进属上运动神经元病变者,辅以托特罗定;伴逼尿肌无反射属下运动神经元病变者,辅以坦洛新及吡啶斯的明.多数患者症状均有明显改善,表现为恢复排尿,尿失禁及遗尿消失,尿线增粗和排尿次数减少等.巴氯芬是GABA的B受体激动剂,该受体兴奋在骶髓水平导致阴部神经核抑制,尿道横纹肌括约肌松弛,对尿道横纹肌括约肌功能亢进者有治疗作用.在桥脑,排尿中枢和贮尿中枢是分离而无神经联系的,而逼尿肌括约肌的协调在骶髓水平,对脊髓损伤患者无论是上或下运动神经元病变,保证逼尿肌压力处于安全水2006V o1.27No.3世?界?临?床-药?物WRLDCLINICALDRUGS平如小于40cmH.O,减少剩余尿极为重要.应适当采用辅助药物,减少出口阻力.巴氯芬的适应证包括失调性排尿,逼尿肌无力,导尿管依赖状态,神经性膀胱中有神经性梗阻存在和膀胱过动症合并出口过紧者【131.)))腰椎间盘突出症急性发作期腰椎问盘突出症以男性青壮年为最多,这与劳动强度大及外伤有关.由于腰骶部活动度大,故L4/5及L5/$1椎间盘突出发病率最高,一般发病时间短,急性期时症状,体征较严重,通常有腰肌痉挛,可发生一例甚至两侧腰肌痉挛,大部分伴脊柱侧弯畸形,脊柱侧弯的方向一般取决于髓核突出位置与神经根的关系.腰肌痉挛和脊柱畸形均属继发性,适应性改变,属痛性反应.在椎问盘突出治愈后,这些畸形会随之消失.传统治疗对本病有良好的效果,但对伴随的肌张力增高未予足够的重视.腰椎的稳定性依靠脊柱本身结构和与之相关联的肌肉系统维持,如果肌肉痉挛始终存在,必然引起肌力下降,致使腰椎间盘突出症迁延难愈和反复发作.研究发现,巴氯芬对痛性痉挛有明显缓解作用,患者应用后2,4,6周肌张力分别下降57.39%,71.30%和77.39%,大部分病例经2周治疗后可取得显着效果.巴氯芬是目前国内外首选的抗肌痉挛药物, 能缓解肌肉痉挛及因痉挛引起的疼痛.本品口服吸收良好,服药1周左右疗效最佳.有研究显示,100例腰椎间盘突出症急性发作期伴明显肌肉痉挛且行动障碍的患者,在进行传统康复治疗的同时,给予巴氯芬治疗,不但改善了肌痉挛,还促进了肌力平衡的恢复,显着提高了康复疗效.有患者服用较大剂量巴氯芬后出现嗜睡不良反应.但这恰恰对因疼痛而造成的夜不能寐有帮助.至今尚无本品引起严重不良反应的报道I.>))可卡因成瘾性加州大学洛杉矶分校Shoptaw博士进行的一项纳入70例吸毒者的研究显示,巴氯芬能够降低长期,大量吸毒者的毒瘾.研究中有半数吸毒者连续使用巴氯芬16周,并接受行为咨询;其余半数则服用安慰剂,也接受行为咨询.研究结束时的尿液毒品检测结果显示.使用巴氯芬的患者,其毒品使用量比安慰剂组要低.且长期,大量吸毒者功效尤为明显【].)))酒精成瘾性酒精能够促进大脑释放GABA,引起愉悦感,但过量的GABA会损害对肌肉的控制并降低反应速度,所以大脑会释放谷氨酸盐对其进行抑制.当谷氨酸盐水平很高却没有酒精存在的时候,人会出现易怒或其他不适症状.为了减轻这些感觉,大脑就会产生饮酒的冲动.随着更多的GABA和谷氨酸盐的释放,为了与之相适应,大脑细胞就会发生结构和功能的变化.当人戒酒时就会出现心理和身体上的各种痛苦. GABA也许是人想喝酒的原因.而谷氨酸盐则是人无法戒酒的原因. 这种物质在人脑学习中心扮演着重要的角色,其过量会对饮酒过程造成深刻的记忆,使人即使戒酒多年以后也会因为遇到某人,回到某地或者闻到酒精味而再次产生饮酒的欲望.这种诱导是戒酒者复饮的主要原因.有许多报道表明,巴氯芬有助于戒酒成功.巴黎的奥利维尔?阿梅森医生也是一个酗酒者,在1997—2004 年问.阿梅森因酗酒和心脏病发作多次被送进医院抢救.巴氯芬可以通过干预大脑中的神经回路来抑制对饮酒的欲望,阿梅森接受了9个月的巴氯芬治疗后,第一次没有了对酒精的渴望,即使与朋友在餐馆里,也不受别人饮酒的影1~[16,17].鞘内注射治疗鞘内巴氯芬注射法(1TBT)的优点是可使巴氯芬在脑脊液中的浓度高于口服给药的30倍,其药效相对明显,例如能够长期减低脑卒中后的痉挛性肌张力增高,显着改善闭锁综合征患者的运动功能,对成人脑外伤性或缺氧性痉挛患者有明显疗效,也可明显缓解中枢性疼痛.ITBT可以根据患者需求,通过电脑向植入腹部皮下的泵输入信息而随时调整每日用药量,必要时还可终止用药以避免或减少药物不良反应,也可使巴氯芬随脑脊液流至脊髓和脑.因此能使全身紧张状态松弛,包括颈,上肢,躯干和腿,从而减少患者痛苦,更好地改善功能[18,伯】. ITBT的缺点是患者有嗜睡,恶心,呕吐,头痛,肌肉无力等不良反应,也可出现视物模糊,语言不清等表现,绝大多数症状是暂时的或能通过改变用药剂量而改善,但剂量过大可致昏迷甚至死亡.Penn对7年中接受ITBT的62例患者进行了回顾分析,ITBT的手术过程并不复杂,术后泵植入部位感染或泵固定不好是可能造成手术失败或不得不将泵取出的主要原因.另外泵的电池使用年限,也是造成再次手术的原因.且泵的体积偏大[2o】. 随着技术的改进,ITBT将在临床逐步推广.总之,随着中枢性肌松剂巴氧芬的临床应用越来越广泛,其在降低脑和脊髓疾病引起的肌张力增高的神经康复治疗,以及减轻各种原因尤其是神经性病变所致的疼痛治疗方面获得了很多宝贵经验.另外,巴氯芬对有些临床治疗比较困难的疾病或症状,也显示出很好的效果.随着ITBT的逐步推广应用,以及医患对其药物特性的不断认识,我们相信中枢性肌松剂巴氯芬将会使更多的患者受益.参考文献1MilanovIG.Mechanismsofbaclofenactionon spasticity.ActaNeuroScand,1992,85(5):305-3102.谢瑞满,姚景莉.方定华,等.中风急性期巴氯芬治疗的双盲随机对照研究.国际中华神经精神医学杂志,2001,2(1):9-113.MeythalerJM.Guin?RenfroeS,BrunnerRC,eta1.Intrathecalbaolofenforspastichypertonia fromstroke.Stroke,2001,32(9):2099?21094.HattabJR.ReviewofEuropeanclinicaltrials withbaclofenIn:FeldmanRG,YoungRR,Kiella WP,eds.Spasticity:DisorderedMotorContro1. 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单克隆抗体药物治疗视神经脊髓炎谱系疾病的临床试验研究进展
单克隆抗体药物治疗视神经脊髓炎谱系疾病的临床试验研究进展刘晔1,孟德旺2△,杨贵莉1,孙莉1摘要:视神经脊髓炎谱系疾病(NMOSD)是一种体液免疫介导的中枢神经系统自身免疫性疾病,以脊髓和视神经的炎性脱髓鞘病变为特征,可导致瘫痪和失明。
其治疗除传统的免疫抑制剂外,还有B细胞靶向的利妥昔单抗及伊比利珠单抗,抑制白细胞介素-6受体的托珠单抗和沙妥珠单抗,阻断补体介导的细胞毒性和继发性炎症的依库珠单抗等新型靶向药物。
就治疗NMOSD的单克隆抗体靶向药物的作用机制、疗效、不良反应及其研究进展予以综述。
关键词:视神经脊髓炎;水通道蛋白质4;抗体,单克隆;利妥昔单抗;临床试验;分子靶向治疗中图分类号:R744.52文献标志码:A DOI:10.11958/20211261Progress in clinical trials of monoclonal antibody therapy for neuromyelitisoptica pedigree diseasesLIU Ye1,MENG De-wang2△,YANG Gui-li1,SUN Li11Department of Neurology,Tianjin Medical University General Hospital,Tianjin Neurological Institute,Key Laboratory ofPost-trauma Neuro-repair and Regeneration in Central Nervous System,Ministry of Education;Tianjin Key Laboratory ofInjuries,Variations and Regeneration of Nervous System,Tianjin300052,China;2Department of Medical Record QualityControl,Tianjin Chest Hospital△Reviser E-mail:*********************Abstract:Neuromyelitis optica spectrum disorder(NMOSD)is an autoimmune disease of the central nervous system mediated by humoral immunity.It is characterized by inflammatory demyelination of the spinal cord and optic nerve,which may lead to paralysis and blindness.In addition to traditional immunosuppressants,more and more new drugs are used in the treatment of NMOSD,such as rituximab and inebilizumab targeting B cells,tocilizumab and satralizumab inhibiting interleukin-6receptor and eculizumab blocking complement mediated cytotoxicity and secondary inflammation.In recent years,the results of several randomized clinical trials of these monoclonal antibody drugs have been published.This paper will review the research progress of these targeted drugs in the treatment of NMOSD from the aspects of the mechanism of基金项目:国家自然科学基金青年项目(81601039);国家自然科学基金面上项目(82071389);天津市自然科学基金(20JCQNJC00460)作者单位:1天津医科大学总医院神经内科,天津市神经病学研究所,教育部“中枢神经系统创伤修复与再生”重点实验室,天津市“神经损伤变异与再生”重点实验室(邮编300052);2天津市胸科医院病案质检科作者简介:刘晔(1984),女,博士,助理研究员,主要从事视神经脊髓炎谱系疾病的研究和治疗。
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性别决定和伴性遗传(英文版)
X-linked dominant diseases are usually inherited through the paternal line. Males with the disease gene will usually be affected by the disease, and their daughters will inherit the disease gene and may also be affected. Sons of affected males will also inherit the disease gene but usually show no symptoms.
Gender Determination and Sexually Associated Inher
目录
contents
sex determination Sexually inherited Sex chromosome abnormalities Gender and prevention and treatment of hereditary diseases
The impact of genetics and environment on gender
02
Sehromosome recessive genetic disease
X-linked Recessive Genetic Diseases: These diseases are caused by mutations in genes located on the X chromosome. Since males have only one X chromosome, they are more likely to be affected by these diseases than females, who have two X chromosomes copies. Some examples of X-linked recessive genetic diseases include Duchenne muscular dystrophy, hemophilia A, and red-green color blindness.
盐酸托莫西汀胶囊联合哌甲酯应用于注意缺陷多动障碍中的效果及安全性
①南通瑞慈医院(扬州大学第四临床医学院) 江苏 南通 226001通信作者:徐孝华盐酸托莫西汀胶囊联合哌甲酯应用于注意缺陷多动障碍中的效果及安全性唐美玲① 赵银梅① 徐孝华①【摘要】 目的:探讨盐酸托莫西汀胶囊联合哌甲酯应用于注意缺陷多动障碍中的效果及安全性。
方法:选取2019年1月—2022年10月南通瑞慈医院收治的102例注意缺陷多动障碍患儿,依照随机数字表法分为常规组(n =51)和观察组(n =51),常规组采用盐酸托莫西汀胶囊治疗,观察组采用盐酸托莫西汀胶囊联合哌甲酯治疗,比较两组反应时间、漏报数,斯诺佩评估量表第四版(SNAP-Ⅳ)评分,临床疗效及不良反应发生率。
结果:治疗后,两组反应时间均缩短(P <0.05),且观察组短于常规组(P <0.05)。
治疗后,两组漏报数均减少(P <0.05),且观察组少于常规组(P <0.05)。
治疗后,两组患儿SNAP-Ⅳ评分均降低(P <0.05),且观察组低于常规组(P <0.05)。
观察组总有效率(92.16%)高于常规组(76.47%)(P <0.05)。
两组不良反应发生率比较,差异无统计学意义(P >0.05)。
结论:盐酸托莫西汀胶囊联合哌甲酯用于治疗注意缺陷多动障碍,能够改善临床症状,疗效显著,且安全可靠。
【关键词】 盐酸托莫西汀胶囊 哌甲酯 注意缺陷多动障碍 Efficacy and Safety of Tomoxetine Hydrochloride Capsules Combined with Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder/TANG Meiling, ZHAO Yinmei, XU Xiaohua. //Medical Innovation of China, 2023, 20(23): 010-013 [Abstract] Objective: To investigate the efficacy and safety of Tomoxetine Hydrochloride Capsules combined with Methylphenidate in the treatment of attention deficit hyperactivity disorder. Method: A total of 102 children with attention deficit hyperactivity disorder admitted to Nantong Rich Hospital from January 2019 to October 2022 were selected and divided into the conventional group (n =51) and the observation group (n =51) according to random number table method. The conventional group was treated with Tomoxetine Hydrochloride Capsules, while the observation group was treated with Tomoxetine Hydrochloride Capsules combined with Methylphenidate. The reaction time and number of omissions, Swanson Nolan and Pelham version Ⅳ scale (SNAP-Ⅳ) scores, clinical efficacy and incidence of adverse effects of the two groups were compared. Result: After treatment, the reaction time of both groups were shortened (P <0.05), and that of the observation group was shorter than that of the conventional group (P <0.05). After treatment, the number of omissions were decreased in both groups (P <0.05), and that of the observation group was lower than that of the conventional group (P <0.05). After treatment, the SNAP-Ⅳ scores were reduced in both groups (P <0.05), and that of the observation group was lower than that of the conventional group (P <0.05). The total effective rate in the observation group (92.16%) was higher than that in the conventional group (76.47%) (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion: Tomoxetine Hydrochloride Capsules combined with Methylphenidate can improve clinical symptoms in the treatment of attention deficit hyperactivity disorder, and the efficacy is significant, safe and reliable. [Key words] Tomoxetine Hydrochloride Capsules Methylphenidate Attention deficit hyperactivity disorder First-author's address: Nantong Rich Hospital, Nantong 226001, China doi:10.3969/j.issn.1674-4985.2023.23.003 注意缺陷多动障碍是由多种原因(主要是额叶及皮质下的功能发育问题)所致的一种儿童时期常见的,并以注意力缺陷和活动过度为主要特征的一组综合征。
各学科顶级杂志期刊
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2005 Impact Factors for Wiley Journals
65% of Wiley journals increased their Impact Factors
Journal of Pathology (Pathological Society) - #1 in Pathology Arthritis & Rheumatism (American College of Rheumatology) increased its IF and remains #1 in Rheumatology Reviews in Medical Virology now ranks second in Virology Angewandte Chemie International Edition (German Chemical Society) increased its Impact Factor to 9.596 and remains the leading chemistry journal Mass Spectrometry Reviews ranks #1 in Spectroscopy for the 7th running year Medicinal Research Reviews leads the Medicinal Chemistry category Advanced Synthesis & Catalysis retains its #1 position in Applied Chemistry
Online ISSN:1098-1128 Print ISSN:0198-6325. 1981年创刊,全年6期,SCI收录期刊. 2005 Impact Factor: 7.964 刊载医药研究以及治疗用药剂开发方面的评论。 Ranking the 1st in 34 medicinal chemistry jnls.
肾小球滤过率估算公式在糖尿病患者中的应用
肾小球滤过率估算公式在糖尿病患者中的应用吴楠【摘要】Diabetic kidney disease (DKD) is the most common microvascular complications of diabetes and the main cause of chronic kidney disease and end-stage renal disease (ESRD). Because of its incidence of occult, poor prognosis and high cost, it is essential to raising awareness of DKD, making a reasonable assessment of golmerular filtration rate (GFR) and taking effective intervention to prevent disease progression as early as possible, which is also important for preventing serious complications of the kidney. Many clinicians have recognized the importance of stratifying chronic kidney disease (CKD)in diabetic subjests. This article reviews recent literature of application of equations to estimate GFR in patients with diabetes to wake a general review.%糖尿病肾脏疾病(diabetic kidney disease,DKD)是糖尿病最常见的微血管并发症,是慢性肾脏疾病及终末期肾病(end-stage renal disease,ESRD)的首因,其发病隐匿且预后不佳,治疗费用极为昂贵.提高对DKD的早期认识,对GFR进行合理性评估,早期采取有力干预手段能预防疾病恶化.目前越来越多的临床医师认识到进行慢性肾脏疾病(chronic kidney disease,CKD)分期的重要性,但目前尚未确立适合于糖尿病患者的肾小球滤过率(glomerular filtration rate,GFR)评估公式.本文回顾近年来的文献资料,就GFR估算公式在糖尿病患者中的应用做一系统综述.【期刊名称】《复旦学报(医学版)》【年(卷),期】2011(038)003【总页数】6页(P275-280)【关键词】糖尿病;糖尿病肾脏疾病;肾小球滤过率;评估公式【作者】吴楠【作者单位】复旦大学附属华山医院内分泌科,上海,200040【正文语种】中文【中图分类】R587.1糖尿病是慢性肾脏疾病(chronic kidney disease,CKD)的主要病因之一,也是终末期肾脏疾病(end-stage renal disease,ESRD)接受肾脏替代治疗的首因[1]。
精子常规参数与IVF-ET结局相关性的临床研究
精子常规参数与IVF-ET结局相关性的临床研究刘海娟,胡海翔,徐少强,罗少波[摘要]目的探讨精子常规参数与体外受精-胚胎移植结局的相关性。
方法回顾性分析2018年1—12月在空军特色医学中心接受体外受精-胚胎移植(in vitro ferfizafion-embryo transfer,IVF-ET)治疗的49例不育患者,分为精液质量异常组和正常组,比较2组患者的临床结局。
结果2组年龄、不育年限、其性伴侣年龄、胚胎移植日子宫内膜的厚度、胚胎移植日雌二醇水平比较,差异均无统计学意义(P>0.05)。
精子密度、活动率、活动力(a+b级)、正常形态百分率组间比较,差异均有统计学意义(P<0.05)。
精液质量异常组和正常组临床妊娠率分别为16.7%和44%,差异有统计学意义(*=4.307, P=0.038)。
结论精子常规参数对IVF-ET临床结局有一定影响作用,进一步证实将精子常规参数的检査作为男性不育症基础检测项目的必要性。
[关键词]精子常规参数,精子形态,体外受精-胚胎移植,临床结局[中图分类号]R828.1[文献标识码]A[文章编号]2095-3402(2020)06-506-03DOI:10.3969/j.issn.2095-3402.2020.06.014Correlations between routine parameters of sperms and IVF-ET outcomeLIU H aijuan*HU H aixiang,XU S haoqiang,LUO Shaobo.*Department of E ndocrinology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing100700,ChinaCorresponding author:HUHaixiang,E-mail:*******************[Abstract]Objective To explore the correlation between routine parameters of sperms and IVF-ET outcome. Methods Retrospective analysis was conducted of49patients with infertility who had receivedlVF-ET treatment at the Air Force Specialty Medical Center between January and December in2018.These patients weredivided into the abnormal semen quality group and normal group.The difference in clinical outcomes was compared between these two groups. Results There was no statistically significant difference between the two groups in age,years of infertility,age of their sexual partners,thickness of the endometrium or levels of E2on the day of ET(P>0.05).However,there was statistically significant significance in sperm density,activity rate,activity(a+b)and percentage of normal morphology between the two groups(P<0.05).The rate of clinical pregnancy in the abnormal group was16.7%,compared with44%in the normal group.There was statistically significant significance between the two groups(才=4.307,P=0.038).Conclusion The routine parameters of sperms have some effect on the clinical outcomes of IVF-ET.There is the need to consider the examination of routine parameters of sperms a basic testing item for male infertility.[Key words]routine parameters of sperm;sperm morphology;IVF-ET;clinical outcome随着人们生活习惯、饮食偏好、工作环境等潜移默化的演变,不孕不育发病率呈逐年上升趋势叫不育症是生殖医学领域重要的研究课题之一。
朱章志运用扶正祛邪法论治糖尿病经验
ʌ临证验案ɔ朱章志运用扶正祛邪法论治糖尿病经验❋曾绘域1,朱章志2ә,周㊀海3,陈㊀珺3,张文婧3(1.深圳市中西医结合医院,广东深圳㊀518104;2.广州中医药大学第一附属医院,广州㊀510405;3.广州中医药大学,广州㊀510405)㊀㊀摘要:糖尿病属于中医学 消渴病 范畴,以往医家多认为其病机为阴虚燥热,治疗以滋阴清热为法㊂朱章志教授通过长期的临床观察与实践,立足于张仲景 保胃气,扶阳气 的理论,认为糖尿病的病机为正虚邪滞,即太阴虚损㊁阳气不足㊁收敛不及,寒㊁水㊁湿之邪阻滞阳气运行通道㊂治疗上不囿陈法,以扶正祛邪为大法,通过固护太阴㊁扶助阳气㊁收敛阳气,祛除寒水湿之邪,恢复阳气运行之通畅,使阳气功能复常㊁运行有序,为糖尿病的治疗提供临床新思路㊂㊀㊀关键词:扶正祛邪;糖尿病;朱章志㊀㊀中图分类号:R587.1㊀㊀文献标识码:A㊀㊀文章编号:1006-3250(2021)01-0149-03Discussion on ZHU Zhang-zhi's Experience in Treating Diabetes Mellitus by Using The Method of Reinforcing The Healthy Qi and Eliminating The Pathogenic FactorsZENG Hui-yu 1,ZHU Zhang-zhi 2ә,ZHOU Hai 3,CHEN Jun 3,ZHANG Wen-jing 3(1.Shenzhen Hospital of Integrated traditional Chinese and Western Medicine,Guangdong,Shenzhen 518104,China;2.The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;3.Guangzhou University of Chinese Medicine,Guangzhou 510405,China)㊀㊀Abstract :Diabetes mellitus belongs to the category of "xiao ke"in traditional Chinese medicine.Doctors used to think that its pathogenesis was Yin deficiency and dryness heat ,and the treatment was nourishing Yin and clearing heat.Through long-term clinical observation and practice ,and based on ZHANG Zhong-jing's theory of protecting stomach Qi and supporting Yng Q ,professor ZHU Zhang-zhi believes that the pathogenesis of diabetes is deficiency of healthy Qi and stagnation of pathogen.Because of the deficiency of greater Yin and Yang Qi ,and the lack of convergence ,the cold ,water and dampness block the operational channel of Yang Qi.The treatment of diabetes mellitus should be based on reinforcing the healthy Qi and eliminating the pathogenic factors.By strengthening Taiyin ,supporting Yang Qi ,astringent Yang Qi ,dispelling the evil of cold ,water and dampness ,we can restore the smooth operation of Yang Qi ,restore the function of Yang Qi to normal and operate orderly ,which provides a new clinical method for the treatment of diabetes mellitus.㊀㊀Key words :Reinforcing the healthy Qi and eliminating the pathogenic factors ;Diabetes mellitus ;ZHU Zhang-zhi❋基金项目:国家自然科学基金资助项目(81873190)-降糖三黄片在糖脂毒性所致胰岛β细胞损伤的自噬调控作用作者简介:曾绘域(1990-),女,广东云浮人,住院医师,硕士研究生,从事六经辨治内分泌疾病的临床与研究㊂ә通讯作者:朱章志(1963-),男,湖南衡阳人,主任医师,博士研究生导师,从事六经辨治内分泌疾病的临床与研究,Tel :************,E-mail :zhuangi@ ㊂㊀㊀随着人口老龄化和生活方式的改变,我国糖尿病的患病率呈上升趋势,2013年我国18岁以上人群糖尿病患病率为10.4%[1]㊂中医药在延缓糖尿病的进展及防治其并发症方面具有一定优势[2-4]㊂糖尿病属于中医学 消渴病 范畴,以往医家多认为其病机为阴虚燥热,治疗以滋阴清热为法,但疗效尚不能令人满意㊂朱章志教授通过长期的临床观察与实践,认为正虚邪滞乃糖尿病病机之核心,采用扶正祛邪法治之屡获奇效㊂1㊀正虚邪滞之糖尿病病机‘素问㊃经脉别论篇“曰: 饮入于胃,游溢精气,上输于脾,脾气散精 水精四布,五经并行㊂食物入胃,经脾胃运化化生精气,然后输布全身㊂糖尿病患者常嗜食肥甘,起居无常,烦劳紧张,致太阴虚损,正气内虚,阳气戕伐,津液代谢异常,而生寒水湿之邪㊂寒㊁水㊁湿之邪气作为阴邪,又可阻滞阳气运行之通道㊂阳气运行通道不畅,不能敷布温煦四肢,可见手足逆冷;阳气运行受阻,又可出现郁而化热之象㊂因此朱章志认为,疗糖尿病的关键在于恢复阳气运行之通畅,根据糖尿病正虚邪滞的病机,治疗以扶正祛邪为法,顾护太阴㊁扶助阳气㊁收敛阳气,祛除寒水湿之邪,使阳气功能复常则行有序㊂2㊀运用扶正祛邪法治疗糖尿病2.1㊀扶正2.1.1㊀固护中气,扶助阳气㊀张仲景遣方用药常体现 保胃气 之思想[5],如桂枝汤中配伍生姜㊁大枣㊁炙甘草,发汗祛邪不忘顾护中气;又如白虎汤中加梗米㊁炙甘草以和中益胃,又可防止石膏㊁知母大寒伤中㊂ 有胃气则生,无胃气则死 ,故扶正之要以保胃气为先㊂朱章志认为,阳气在人体的生命活动中占主导9412021年1月第27卷第1期January 2021Vol.27.No.1㊀㊀㊀㊀㊀㊀中国中医基础医学杂志Journal of Basic Chinese Medicine地位㊂‘素问㊃生气通天论篇“曰: 阳气者若天与日,失其所则折寿而不彰 是故阳因而上,卫外者也㊂ ‘黄帝内经“把阳气比作太阳,阳气运行失常可致短寿㊂阳气具有抵御外邪㊁护卫生命㊁维持机体生命活动的作用,津液的气化㊁血液的运行均需阳气的温煦与推动㊂因此,在人体的阴阳平衡中阳气起着主导作用㊂朱章志认为,正气虚衰㊁太阴虚损㊁阳气不足是糖尿病发生发展之根本原因,因此扶正首当 固护中气,扶助阳气 ,故常以附子理中汤为底方,固护中宫㊂太阴脾土居中央,犹如足球比赛之中场,能联系前锋与后卫进可攻退可守,进可充养肺卫之气抵御外邪,退可顾护少阴以防寒邪内陷㊂‘四圣心源㊃卷二太阴湿土“提到: 湿者,太阴土气之所化也故胃家之燥,不敌脾家之湿,病则土燥者少而土湿者多也㊂[6] 阴脾土易挟寒湿,附子理中汤功善固护中气㊁温补脾阳而散寒湿,为治疗太阴阳虚寒湿之要方㊂方中附子辛温大热,补坎中真阳,又能散寒湿,荡去群阴;干姜去脏腑沉寒痼冷,温暖脾土,复兴火种;人参被誉为 百草之王 能大补元气,为扶正固本之极品;白术味苦性温,功善健脾燥湿,乃扶植太阴之要药;炙甘草善益气补中,调和药性,诸药合用以收培补中阳㊁散寒除湿之效㊂若其人神疲懒言,气虚较甚,在附子理中汤的基础上可重用红参㊁北芪以大补元气,健脾益气;若其人四肢不温㊁肢体困重㊁寒湿较重者,可加重附子㊁干姜之量,并加细辛㊁吴茱萸以散久寒;若其人口干口苦㊁舌苔黄腻㊁大便黏滞不爽兼夹湿热之象,可仿当归拈痛汤之意,加茵陈㊁当归㊁黄芩以利湿清热㊂2.1.2㊀收敛阳气,阳密乃固㊀朱章志认为, 阴 可理解为 阳气 的收敛㊁收藏状态,糖尿病 阴虚燥热 之象乃阳气不足㊁收敛不及㊁升发太过所致[7]㊂‘素问㊃生气通天论篇“提到: 阳气者,烦劳则张 ㊂现代人起居无节,以妄为常,阳气因而不能潜藏,常常浮越于外容易出现假热之象,医者不察,妄投清热泻火之品,实乃雪上加霜㊂ 凡阴阳之要,阳密乃固 ,收敛阳气即是扶正,犹如太极之能收能放,收敛是为了聚集能量,阳气固密,正气才能强盛,方能更好的制敌㊂朱章志常用砂仁㊁肉桂㊁白芍㊁山萸肉㊁泽泻等药物收敛阳气㊂砂仁辛温,既能宣太阴之寒湿,又能纳气归肾,使阳气收敛于少阴,少火生气㊂‘本草经疏“提到: 缩砂蜜,辛能散,又能润 辛以润肾,故使气下行 气下则气得归元㊂[8] 肉桂引火归原,导浮越之阳气归于命门,益火消阴㊂若患者出现咽痛㊁牙龈肿痛㊁痤疮等阳气不敛㊁虚火上冲之象,常用砂仁㊁肉桂以收敛阳气,纳气归肾,引火归原㊂白芍味酸能敛,敛降甲木胆火,使相火归位㊂‘本草求真“曰: 气之盛者,必赖酸为之收,故白芍号为敛肝之液,收肝之气,而令气不妄行也㊂[9] 朱章志常使用白芍以补肝之体㊁助肝之用,收敛肝气,肝平则郁气自除,火热自消㊂山萸肉秘精气㊁敛阳气,使龙雷之火归于水中㊂朱章志常用山萸肉收敛正气,遇汗出多者,常重用以固涩敛汗㊂泽泻能泻能降,能入肾泻浊,开气化之源,泻浊以利扶正,又能降气而引火下行㊂朱章志常用泽泻打通西方潜藏之要塞[10],在温阳之品中加入泽泻,利于阳气潜藏,使孤阳有归㊂2.1.3㊀填补阴精,以滋化源㊀‘素问㊃金匮真言论篇“提到: 夫精者,身之本也㊂ 精 是人体生命活动的物质基础,能化气生髓,濡养脏腑㊂人体之精禀受于父母,又由后天水谷之精不断充养,归藏于肾中㊂ 孤阴不生,独阳不长 ,无阳则阴无以生,无阴则阳无以化㊂肾乃水火之脏,阴精充足才能涵养坎中真火,使真阳固密于内,化生正气㊂朱章志常在秋冬之季嘱糖尿病患者进补阿胶等血肉有情之品填补肾精㊂肾主封藏,秋冬进补使肾精充养,以滋阳气化生之源㊂阿胶用黄酒烊化,既能祛除阿胶之腥,又能借黄酒通行之性解阿胶滋腻碍胃之弊,每日少量服用,以有形之精难以速生,填补肾精以缓补为要㊂除此之外,遣方用药时亦会注意顾护阴精,在使用温阳药的同时常常配伍山萸肉㊁白芍等养阴药,以防温燥伤阴之弊㊂2.2㊀祛邪2.2.1㊀外散寒水以运太阳㊀ 太阳为开 ,太阳乃三阳之表,巨阳也,其性开泄以应天,为祛邪之重要通道㊂在运气里,太阳在天为寒,在地为水,合而为太阳寒水㊂张仲景太阳病篇研究的是水循环过程,治太阳就是治水[11]㊂寒㊁水之邪闭郁在表,气血运行不畅,可见肌肤麻木不仁㊂邪气滞留太阳,阻碍阳气运行,当因势利导㊁开太阳之表以发汗,外散寒㊁水之邪㊂糖尿病患者正气亏虚为本,祛邪不能伤正,朱章志临床常用桂枝麻黄各半汤小发其汗,使玄府开张,邪有出路㊂桂枝麻黄各半汤乃发汗轻剂,为桂枝汤与麻黄汤相合而得,其中麻黄㊁桂枝㊁生姜㊁北杏发散宣肺以开皮毛,芍药㊁大枣㊁炙甘草酸甘化阴以益营,诸药相合,刚柔相济,祛邪而不伤正㊂邪去正安,阳气运行通畅,水液代谢复常则阳气自充,而无寒水之扰㊂若寒邪较重可用三拗汤,此为麻黄汤去桂枝而成,功善开宣肺气,疏散风寒,因去辛温之桂枝发汗力不及麻黄汤,祛邪而不伤正㊂2.2.2㊀下利水湿以健少阴㊀少阴乃水火交会之脏,元气之根,人身立命之本㊂‘医理真传“提到: 坎中真阳,一名龙雷火,发而为病,一名元阳外越,一名孤阳上浮,一名虚火上冲㊂此际之龙,乃初生之龙,不能飞腾而兴云布雨,惟潜于渊中,以水为家,以水为性,遂安其在下之位㊂水盛一分龙亦盛一分,水高一尺龙亦高一尺,是龙之因水盛而游 [12]㊂阴盛051中国中医基础医学杂志Journal of Basic Chinese Medicine㊀㊀㊀㊀㊀㊀2021年1月第27卷第1期January2021Vol.27.No.1则阳衰,水湿之邪泛滥,则龙雷之火因而飞越在外㊂叶天士深谙张仲景之理,提到 通阳不在温,而在利小便 [10,13],通过利小便的方法,使水湿之邪从下而解,阳气运行通道无水湿之邪阻碍,则阳气无需温养而自通,水盛得除则真龙亦安其位㊂朱章志常用五苓散㊁真武汤下利水湿,以复阳气之通达,少阴之健运㊂五苓散具有通阳化气利水之效,治疗膀胱气化不利形成的蓄水证㊂方中猪苓㊁茯苓㊁泽泻导水湿之邪下行;白术健脾燥湿,杜绝生湿之源;桂枝助膀胱气化,通阳化气行水又通气于表,使全身在表之湿邪皆得解,五药合用,膀胱气化复常,水道通调使小便得利,水湿得出㊂真武汤为治疗少阴阳虚㊁水气泛滥之主方,方中附子振奋少阴阳气,使水有所主;白术㊁茯苓健脾制水;生姜助附子敷布阳气,宣散水气;芍药利小便,制附㊁姜之燥,五味相合共奏温阳利水之功㊂2.2.3㊀开郁逐寒以畅厥阴㊀肝为将军之官,肝气主动主升发,能统帅兵马,捍卫君主㊂厥阴肝经,体阴用阳,内寄相火,相火敷布阳气,祛阴除寒,是祛邪的先锋主力军㊂朱章志常用吴茱萸汤祛除厥阴肝经之寒邪,恢复肝经阳气之运行㊂方中吴茱萸辛苦而温,芳香而燥,‘本草汇言“曰: 开郁化滞,逐冷降气之药 [14],能温胃暖肝,降浊阴止呕逆,为治疗肝寒之要药㊂配以生姜温胃散寒,佐以人参㊁大枣健脾益气补虚,全方散寒与降逆并施,共奏暖肝温胃㊁降逆止呕之效㊂‘素问㊃至真要大论篇“说: 帝曰:厥阴何也?岐伯曰:两阴交尽也㊂ 物极必反,重阴必阳㊂厥阴为阴尽阳生之脏,足厥阴肝经与足少阳胆经互为表里,若出现肝气不疏㊁枢机不利㊁气郁化火,朱章志常用小柴胡汤和畅枢机,开郁以复气机调达㊂方中柴胡疏泄肝胆之气;黄芩清泄胆火,一疏一清,气郁通达,火郁得发;生姜㊁半夏和胃降逆;人参㊁大枣㊁炙甘草固护中宫,全方寒温并用㊁补泻兼施,以复厥阴疏泄之职,使气机和畅㊁阳气运行有序㊂3㊀典型病案患者杨某,女,65岁,2017年3月10日初诊:2型糖尿病病史6年余,症见疲乏,双下肢轻度浮肿,下肢冰凉,背部易汗出,口苦口干,偶有腰膝酸软,纳眠可,二便调,舌淡暗,苔黄腻,脉沉细㊂辅助检查示糖化血红蛋白10.8%,空腹血糖14.59mmol/L,总胆固醇6.38mmol/L,甘油三酯3.66mmol/L,低密度脂蛋白胆固醇4.34mmol/L㊂西医诊断2型糖尿病㊁高脂血症,治疗给予门冬胰岛素30(早餐前22u晚餐前20u)控制血糖,阿托伐他汀钙片(20mg, qn)调脂㊂中医诊断消渴病,少阴阳虚寒湿证㊂患者少阴阳气衰微不足以养神,固见疲乏;腰为肾之府,少阴阳虚则见腰膝酸软,阳虚寒盛则见下肢冰凉;背部正中乃督脉运行之所,阳气虚衰无以固摄则见背部汗出;少阴阳虚不能主水,寒水泛滥则见双下肢浮肿;水湿内停有郁而化热之象,则见口苦口干㊁舌苔黄腻㊁舌淡暗,脉沉细为少阴阳虚寒湿之征,治以温阳散寒㊁利水除湿为法㊂方以扶正祛邪方合当归拈痛汤加减:炮附片10g(先煎1h),红参10g (另炖),干姜15g,白术30g,炙甘草15g,桂枝12 g,麻黄8g,生姜30g,猪苓10g,泽泻30g,茯苓30 g,白芍30g,酒萸肉45g,当归15g,茵陈10g,5剂水煎服,2d1剂,水煎至250ml,饭后分2次服用,次日复煎㊂方中以附子理中汤为底方温补中焦,散寒除湿;加桂枝㊁麻黄使寒湿之邪从皮毛而解;加五苓散通阳化气,使湿邪从下而出;生姜散寒除湿;白芍㊁酒萸肉收敛阳气,以助正气祛邪;当归活血利水;茵陈清热利湿㊂2017年3月24日二诊:患者双下肢浮肿减轻,疲乏较前好转,无口干口苦,无腰膝酸软,仍觉下肢冰凉,背部仍有汗出,动则尤甚,大便每日二行,质偏烂,舌淡暗,苔白腻,脉细㊂患者大便质烂,乃邪有出路,导水湿之邪从大便而解㊂患者无口干口苦,舌苔由黄腻转为白腻,知湿郁化热之象已除,遂去茵陈㊂仍觉下肢冰凉乃内有久寒,加制吴茱萸12g以散沉寒痼冷;上方加酒萸肉至60g以加强收敛阳气㊁固摄敛汗之效,加黄芪60g以健脾益气敛汗;加砂仁6g(后下)㊁肉桂3g(焗服)以加强收敛阳气㊁扶助正气之效,7剂水煎服,服法同前㊂2017年4月7日三诊:患者背部汗出减少,下肢转温,余症皆除,大便每日二行质软,舌淡红,苔薄白,脉细较前有力,继续服二诊方药5剂㊂后给予附子理中丸(每次8粒,每日3次)服用1个月巩固疗效㊂2017年11月17日复诊:患者上述症状皆除,纳眠可,二便调㊂复查糖化血红蛋白6.8%,空腹血糖6.5mmol/L,总胆固醇5.14mmol/L,甘油三酯1.65 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高钾血症的疾病负担及预后
高钾血症的疾病负扌且及预后李沭*,张倩,张相林#(中曰友好医院药学部,北京100029)*药师。
研究方向:治疗药物监测。
E-mail :****************#通信作者:主任药师。
研究方向:治疗药物监测。
E-maii zryhyyzxl@126. com中图分类号 R977.7 文献标志码 A 文章编号 1672-2124( 2020) 12-1527-05DOI 10. 14009/j. issn. 1672-2124. 2020. 12. 030摘 要 高钾血症是危及慢性肾脏病(chronic kidney disease ,CKD )患者生命的常见电解质紊乱类型之一。
近年来的研究结果表明,高钾血症在CKD 患者特别是CKD G4、G5期患者中易反复发作,增加了患者严重心血管不良事件的发生风险和死亡风险。
为此,本文针对高钾血症的发病、复发及其预后的相关研究进展进行综述。
关键词 高钾血症'慢性肾脏病'反复发作'临床结局Disease Burden and Prognosis of HyperkalemiaLI Shu, ZHANG Qian, ZHANG Xianglin ( Dept. of Phaonacy, China-Japan Friendship Hospital #Beijing 100029, China)ABSTRACTHyperkalemia is one of the most ccmmon electrolyte disordero thatendangeo the lives of patients withchronic kidney diseese( CKD) . Recnt rtudies have shown that hyperkalemia is prone ta recurrent attacks in CKD,especially in patients with CKD ot stages G4 and G5, which ccn the incidence and mortality ot patients with seriousccrdiovesculao adverss events. This paper reviews the related reseerch pogoss on the onset, recurrencc and pognosisof hyperkalemia.KEYWORDS Hyperkalemia;Chronic kidney disese ; Recurrent attacks ; Clinicyl outcome1高钾血症概述1.1高钾血症的定义、临床表现及病因高钾血症主要是人体血浆中的钾离子浓度高,患者可以表现为乏力、肢体麻木,最严重的表现为肌无力或肌麻痹、心脏传导异常及心律失常。
ZWINT和CDK2在乳腺癌中的表达及与临床病理特征的关系和诊断价值
ZWINT和CDK2在乳腺癌中的表达及与临床病理特征的关系和诊断价值作者:张芳芳韩一菲王靖楠邹炎应莉李娜来源:《新医学》2024年第01期【摘要】目的探討ZW10结合因子(ZWINT)和细胞周期蛋白依赖激酶2(CDK2)的相关性及其在乳腺癌病理诊断中的价值。
方法通过GEPIA数据库分析ZWINT 在乳腺癌和正常乳腺组织之间的表达差异,以及在乳腺癌中ZWINT和CDK2表达的相关性。
通过Kaplan-Meier Plotter数据库预测ZWINT的表达与乳腺癌患者预后的关系。
收集84例乳腺癌及其配对癌旁组织石蜡包埋病理标本和20例乳腺癌及其配对的癌旁组织新鲜标本,通过实时荧光定量PCR(RT-qPCR)和免疫组织化学检测乳腺癌和癌旁正常乳腺组织中ZWINT和CDK2 的mRNA及蛋白的表达,分析ZWINT和CDK2与乳腺癌临床病理特征的关系,并采用关联分析分析ZWINT和CDK2的相关性;采用受试者操作特征(ROC)曲线评估ZWINT和CDK2在乳腺癌病理诊断中的价值。
结果数据库分析结果显示, ZWINT在乳腺癌组织中高表达,在乳腺癌中ZWINT和CDK2的表达呈正相关(rs = 0.600,P < 0.001),ZWINT的表达与乳腺癌患者的预后相关(P均< 0.05)。
84例病例检测结果显示,在乳腺癌组织中ZWINT和CDK2 的mRNA及蛋白的表达均高于癌旁组织(P均< 0.05),并且其高表达均与肿瘤大小、分期和淋巴结转移相关(P均< 0.05)。
关联分析结果显示,对称测量下的Φ、Cramer V系数检验的关联程度相同,为0.322(P = 0.003),而列联系数为0.306(P = 0.003),ZWINT蛋白和CDK2蛋白表达密切相关。
ZWINT和CDK2的ROC曲线的曲线下面积分别为0.886和0.818,对乳腺癌均具有较高的诊断价值。
结论 ZWINT和CDK2与乳腺癌的发生发展及预后相关,检测ZWINT和CDK2有助于乳腺癌的病理诊断。
顶端钠依赖性胆汁酸转运蛋白(ASBT)在肝胆疾病中的作用
顶端钠依赖性胆汁酸转运蛋白(ASBT)在肝胆疾病中的作用谢晓暄,杜丽娜,郭紫云,杨燕国家儿童医学中心,首都医科大学附属北京儿童医院中医科,北京 100045通信作者:杨燕,***************(ORCID: 0000-0003-1070-9614)摘要:顶端钠依赖性胆汁酸转运蛋白(ASBT)是负责胆汁酸肠道重吸收的关键转运体,对维持胆汁酸和胆固醇稳态起重要作用,其表达受到转录因子、核受体和肠道微生物等多种因素的调控。
ASBT的表达和功能异常会导致胆汁酸及胆固醇代谢紊乱,引起多种肝胆相关疾病。
目前,ASBT作为一种治疗靶点已受到广泛关注。
本文阐述了ASBT的生物学特征及表达调控机制,并对ASBT在肝胆疾病中的作用进行了综述,为相关疾病的治疗提供新方向。
关键词:顶端钠依赖性胆汁酸转运蛋白;胆汁酸类;胆汁淤积基金项目:国家自然科学基金(82205184);北京市属医院科研培育计划(PZ2022027)Role of apical sodium-dependent bile acid transporter in hepatobiliary diseasesXIE Xiaoxuan, DU Lina, GUO Ziyun, YANG Yan.(Department of Traditional Chinese Medicine, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China)Corresponding author: YANG yan,***************(ORCID: 0000-0003-1070-9614)Abstract:Apical sodium-dependent bile acid transporter (ASBT) is a key transporter responsible for intestinal reabsorption of bile acid and plays an important role in maintaining bile acid and cholesterol homeostasis, and its expression is regulated by various factors including transcription factors, nuclear receptors, and intestinal microflora. The abnormal expression and function of ASBT can lead to disorders in the metabolism of bile acid and cholesterol, causing a variety of hepatobiliary diseases. At present, ASBT has attracted wide attention as a therapeutic target. This article elaborates on the biological characteristics and expression regulation mechanism of ASBT and reviews the role of ASBT in hepatobiliary diseases, in order to provide a new direction for the treatment of related diseases.Key words:Apical Sodium Dependent Bile Acid Transporter; Bile Acid; CholestasisResearch funding:National Natural Science Foundation of China (82205184);Bejing Municipal Administration of Hospital Incubating Program (PZ2022027)胆汁酸(bile acid,BA)肝肠循环是维持胆酸池稳态的重要调控环节,位于回肠末端的顶端钠依赖性胆汁酸转运蛋白(apical sodium-dependent bile acid transporter,ASBT)是负责BA肠道重吸收的关键转运体。
丁酸盐在炎症性肠病中的免疫调节机制研究进展
doi :10.3969/j.issn.1002-7386.2024.09.026·综述与讲座·丁酸盐在炎症性肠病中的免疫调节机制研究进展崔馨月 石璠 郑丽红 王海强项目来源:国家中医药管理局第五批全国中医临床优秀人才研修项目(国中医药人教函[2022]1号);黑龙江中医药大学“优秀青年骨干教师”计划(编号:150********)作者单位:150040 哈尔滨市,黑龙江中医药大学(崔馨月、石璠);黑龙江中医药大学附属第四医院消化内科(郑丽红);黑龙江中医药大学附属第一医院消化二科(王海强)通信作者:王海强 E⁃mail:haiqiang915@ 【摘要】 炎症性肠病(IBD )是一组与肠道慢性炎症相关的异质性疾病,丁酸盐是肠道微生物群产生的关键代谢产物,能够调节免疫细胞的发育和功能,调节免疫功能并防止过度免疫反应,从而延缓IBD 的临床进展。
本文就丁酸盐在调节免疫功能方面改善IBD 作用机制的研究进展进行综述,旨在为IBD 的临床治疗提供新的选择。
【关键词】 炎症性肠病;丁酸盐;G 蛋白耦联受体;Th17细胞;Treg 细胞【中图分类号】 R 321.54 【文献标识码】 A 【文章编号】 1002-7386(2024)09-1397-06Research progress on the immunomodulatory mechanism of butyrate in inflammatory bowel diseases CUI Xinyue ∗,SHI Fan ∗,ZHENG Lihong ,et al.∗Heilongjiang University of Chinese Medicine ,Heilongjiang ,Harbin 150040,China【Abstract 】 Inflammatory bowel diseases (IBDs )are a group of heterogeneous diseases associated with chronic inflammation of the gut.Butyrate is a key metabolite produced by the gut microbiota that regulates the development and function of immune cells ,modulates immune function and prevents excessive immune responses ,thereby delaying the clinical progression of IBDs.This paper reviews the progress of research on the mechanism of butyrate in modulating immune function to improve IBD ,aiming to provide new options for the clinical treatment of IBD.【Key words 】 inflammatory bowel disease ;butyrate ;G⁃protein coupled receptor ;Th17cell ;Treg cell 炎症性肠病(inflammatory bowel disease,IBD)是一组与肠道慢性炎症相关的异质性疾病[1],常表现为腹痛、腹泻、血便、体重减轻等,在过去的10年里在全球范围内变得越来越普遍[2]。
淫羊藿苷抗自发性高血压大鼠肾小管上皮细胞凋亡的作用
淫羊藿苷抗自发性高血压大鼠肾小管上皮细胞凋亡的作用朱玲;王颖婉;李叶丽;钱志强;杨华;杨丹莉【摘要】目的:观察淫羊藿苷( icariin,Ica)对自发性高血压大鼠(spontaneously hypertensive rats,SHR)肾小管上皮细胞凋亡的影响,探讨其可能的机制。
方法将21只14周龄♂SHR随机分为模型组, Ica低、高剂量组(20、40 mg · kg-1,ig,bid,至26周龄),14周龄♂同源京都大鼠( WKY)为对照组,各组动物数均为7只。
WKY组、模型组同期灌胃等体积双蒸水。
采用HE染色观察肾脏病理学变化;原位缺口末端标记法检测肾小管上皮细胞凋亡;real time RT-PCR法检测肾Bok、Bcl-2、Bax mRNA水平;Western blot法检测肾Bcl-2、Bax、Active caspase-3蛋白表达。
结果与WKY组相比,模型组肾小球囊腔狭窄且不规则,肾小球系膜基质增多,细胞排列紊乱,毛细血管扩张充血,个别肾小球出现皱缩,肾小管上皮细胞水肿、管腔狭窄;肾小管上皮细胞凋亡明显,Bok 和Bax mRNA水平、Bax和Active caspase-3蛋白表达均明显上调,Bcl-2 mRNA 和蛋白的水平明显下调( P <0.05或 P <0.01)。
与模型组比较,Ica-L组、Ica-H组肾小球囊腔增宽,肾小球系膜基质增生减少,细胞排列紊乱有所改善,毛细血管扩张充血、肾小管管腔狭窄均减轻;肾小管上皮细胞凋亡以及 Bok、Bax mRNA水平和Bax蛋白表达均明显下调,Ica-H组肾 Bcl-2 mRNA 水平和蛋白表达明显上调, Active caspase-3蛋白表达明显下调( P<0.05或P<0.01)。
结论淫羊藿苷可抑制SHR肾小管上皮细胞凋亡,其机制可能与下调Bax、Active caspase-3、Bok,上调Bcl-2表达有关。
WHO Definition of Elderly老年人的定义
Morbidity profile of elderly attended / admitted in Jeddahhealth facilities, Saudi ArabiaIbrahim NK, Ghabrah TM, Qadi MDepartment of Family and Community Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi ArabiaAbstract: A cross-sectional study was conducted to determine morbidity profile and predictors of increased number of morbidities among 2264 elderly attended / admitted in Jeddah healthfacilities. Results: About one-fourth of elderly reported poor self-perceived health, 37.3 %were dependent on others in their activities and 32.1 % utilized > 3 drugs/ day. Diminishedvision was the commonest complaint while the most prevalent diseases were diabetesmellitus, arthritis and hypertension. The number of morbidities ranged from 1-6 with a meanof 2.11 ± 1.16. In multivariate analysis, the predictors of increased morbidities were obesity(OR= 1.83; 95 % CI= 1.37-2.44), feeling depressed (OR= 1.64; 95 % CI= 1.26-2.13),advanced age, stop working and female gender. It is recommended that there is a great needfor increasing elderly medical and social care.INTRODUCTIONIn recent years, there has been a sharp increase in the number of older persons worldwide (1) and more old people are alive nowadays than at any time in history. (2) The proportion of the population aged 60 and over, is also growing each year. By the year 2025, the world will host 1.2 billion people aged 60 and over and rising to 1.9 billion in 2050. (3)The same trend is also predicted in the EMR; while the proportion of the elderly population to total population was 5.8 % in 2000 it expected to reach 8.7 % by year 2025 and 15.0 % by 2050.(4)The demographic transition with ageing of the population is a global phenomenon which demands international, national, regional and local action. (4,5) In recent years there has been an increasing international awareness of health issues relating to aging populations.(6) . Traditional perceptions of old age have been challenged during the past few years and it is important that elderly people are not taken as a burden on society, but rather as an asset.(5,6)The health problems of the elderly are complicated by social, economic and psychological interactions to a greater degree than younger people. Moreover, these problems are usually multiple and are often masked by sensory and cognitive impairments so that special skills are required to detect them. These factors contribute to a worsening of morbidity and mortality. (7) Morbidity among elderly people has an important influence on their physical functioning and psychological well-being. Many elderly have several disorders at the same time. The incidence of diseases increases with age. (8) The importance of early surveillance of the health needs of elderly people has been emphasized, Knowledge of the situation and circumstances of the elderly population is essential to the provision of cost- effective services and the planning of strategies for intervention and care. (7)Little is known about the health needs of elderly population.(9) Assessment of the morbidity profile will help in the application of interventions,to improve the health status and the quality of life of the elderly.The objective of this study was to evaluate the morbidity profile and predictors of increased number of morbidities among the elderly patients attended / admitted in Jeddah health facilities.MATERIAL & M ETHODSA cross sectional study was conducted among all elderly (aged 60 years and above) attended / admitted in health facilities which deliver health care for elderly in Jeddah governorate, during the study period of the year 2005. All hospitals either governmental (7 hospitals) or private (25 hospitals) in addition to 17 randomly selected primary health care facilities from the total of 38 primary facilities were included in the study. The data were collected through interviewing questionnaire, reviewing of records, and taking some measurements.Interviewing questionnaire: All elderly attended / admitted in the selected health facilities on the day of interview were recruited. A pre-designed questionnaire was used to collect information about personal and socio-demographic data, presence of a caregiver, personal habits and perceived health. Functional capacity of elderly was inquired by asking about the ability of elderly to conduct the basic activities as walking, bathing, using the toilet, dressing, eating, and getting in and out of home without need of help.The main physical & psychological complaints were inquired.In addition, diagnosed chronic diseases were inquired by asking about the presence of chronic diseases diagnosed by physicians & / diseases written in the patients' record.Reviewing of records: A cross-checking of medical records of interviewed patients was done. The clinical diagnosis was taking according to physician based report. The main diagnosis, associated diagnosis were reviewed. All investigations were also reviewed. The total numbers of morbidities were calculated according to the main and associated diagnoses. Measurements: The weight & height were taken. The body mass index (BMI) was calculated. (BMI = Weight in kg/ height in meter square).Statistical analysis: The statistical analysis was conducted using two statistical packages; SPSS version 13 and Epi-Info version 6.04. Chi-square, independent sample t- test and ANOVA tests were performed. Multivariate regression analysis using stepwise regression model was done for controlling and adjusting of all confounding factors.RESULTSThe total number of elderly in the study amounted to 2246 persons. Two- thirds of elderly were recruited from governmental health facilities (hospitals and primary care facilities) while one third of the sample was recruited from private hospitals. About one- fifth of the elderly (21.6 %) were inpatients while the rest were recruited from outpatient clinics.Table (1) portrays personal and socioeconomic characteristics of elderly. Males represented 62.7 % of the sample. The age of elderly ranged from 60 - 104 years with a mean of 67.9 ± 7.71 years, about two fifths of the sample aged 70 years & above. About three- fourths were Saudi. Widowed elderly represented about one- fifth (21.8 %) of the sample. The majority of elderly (78.4 %) had less than secondary education. Almost all geriatric subjects in the present study lived with their families and were cared for by family members (93.6%), while only 6.4% lived aloneTable (2) shows that 39 .0 % of elderly perceived their health as good, while about one fourth (23.5 %) of the sample rated their health as poor. The percentage of females who perceived their health as poor was higher (31.2 %) than males (19.0 %). The differences between both sexes has a highly statistical significant difference (X2= 66.8, p=0.0000).The table also shows that about two-fifths (37.3 %) of elderly were dependent on others in their usual daily activities; 23.5 % were dependent in 1-3 of daily activities and 13.8 % for more than 3 of their activities. The number of utilized drugs by elderly patients ranged from 0- 10 drugs with a mean of 2.98 ±2.27. About one third (32.1 %) of elderly were on more than three medications. Females utilized excessive number of drugs compared to males with a high statistical significant difference (X2= 21.39, p=0.000).The number of elderly morbid conditions ranged from 1- 6 diseases with a mean of 2.11 ± 1.16. About two- fifths (39.4 %) of the elderly had one disease while 60.6 % had two or more morbid conditions.Table (3) demonstrates physical and psychological complaints of elderly. Diminished vision was the most frequent physical complaint (61.5 %) while diminished hearing was encountered among 30.6 % and 25.6 % of elderly complained from dementia. Regarding psychological complaints; rapidly angry was the commonest one (61.4 %). The table alsoportrays that females showed higher percentages of all physical and psychological symptoms than males. Regarding physical complaints, they were more susceptible to repeated falling (OR= 2.10; 95% CI: 1.66-2.64), urinary incontinence (OR= 1.74; 95% CI: 1.34 -2.26). Regarding psychological complaints females were more than two times more prone to feeling of depression (OR= 2.31; 95% CI: 1.93-2.77) and insomnia (OR= 2.00; 95% CI: 1.67 -2.77).Table (4) shows the morbidity profile of the elderly, it is apparent from the table that diabetes mellitus was the commonest elderly disease (53.6 %), followed by arthritis (52.12%) and hypertension (50.4%). Females were at higher risks of having many types elderly diseases compared to males. The highest risk was for osteoporosis (OR= 4.82; 95 % CI= 3.93- 5.93), followed by arthritis (OR= 2.16; 95 % CI= 1.81- 2.59) and psychological problems (OR= 2.14;95 % CI= 1.58- 2.90). In addition, females were also at higher risks of having bronchial asthma, cancer, COPD and eye diseases. On the other hand, they were slightly less susceptible to diabetes mellitus and renal diseases.Table (5) illustrates the relationship between the numbers morbidities and the studied variable. Higher number of morbidities was observed among females compared to males with a highly statistical significant difference (t= 5.41, p= 0.000). Age-wise, higher mean morbidities was noticed with advancing age and a highly statistical significant difference was present (F= 12.53, p= 0.000). Lower morbid conditions were observed among married elderly compared to others. Based on BMI, lower morbidity was found among non obese elderly. Non practicing exercise was associated with higher numbers of morbidities compared to those who practicing exercise. Based on psychological condition of elderly, those who were still working, those having no family or social problems and who d idn’t feel loneliness or depression encountered less number of morbid conditions compared to others. (p<0.0000)Multivariate regression analysis (Table 6) shows that the first predictor of increase number of morbidity was obesity; obese elderly were at 1.83 times increased risk of multiple morbidities compared to non-obese. The second predictor was feeling depressed; participants who felt depressed were 1.64 times more liable to increased morbidities. The following predictor is advanced age, elderly aged 70 years and above were 1.61 times more prone to multiplemorbidities compared to those aged 60- 65. (OR=1.61; 95 % CI: 1.26- 2.13). On the other hand males, elderly who were still working were favorable of decrease morbidity number compared to females and those who stop working.DISCUSSIONHealth status is an important factor that has a significant impact on the quality of life of an elderly population. The major elements of health status are perceived health, especially psychological well-being, chronic illnesses, and functional status. (8) Almost all geriatric subjects in the present study lived with their families (93.6%) this result agrees with result of a study from Abha city. (7)Results of the present study revealed that poor perceived health was reported by 23.5 % of elderly; 19.0 % by males and 31.2 % by females. These rates are much better than those reported by Yadava et al, India, their corresponding figures were 37% and 70% among both sexes respectively. (10) These differences may be attributed to differences in socioeconomic level and health care delivered to elderly patients in both Saudi Arabia and India.On the other hand, 39.0 % of elderly in the present study rated their health as good which is lower than rates reported from a Spanish study (49.5 %) (11) and a Singaporean study (82 %). (12) Present results showed that 37.3 % of elderly were dependent on others on conduction of their activities. Results obtained from a study conducted in Alexandria, 2003, revealed that about one fourth of elderly cancer patients were dependent on others on more than one of daily functions.(13)PHCone % of 100 elderly attended 19hat reported t )4(1Doghether et al , 2004, –AL in Riyadh governorate, Saudi Arabia, were on more than three drugs, while the corresponding figure from the current study was 32.1 %. These differences may be because elderly in the present study were recruited from both hospitals and PHC facilities, and hospitalized elderly (especially inpatients) usually utilize more number and have more severe form of diseases and accordingly they consumed excessive amount of drugs than PHC attendance, or the difference may be due to difference in sample size in both studies.High rates of co-morbidity present a challenge in providing care to elderly. AL –Doghether et al, (14) reported that 56 % of elderly had two or more diseases. A slightly higher finding (60.4 %) was obtained from the present study.Regarding elderly complaints, more than two- thirds of elderly in the present study complained from diminish vision which agrees with result of Iecovich et al , 2003, (15) who found that the majority of elderly in their study reported visual problems.Present results show that 25.6 % of elderly complained from dementia which coincides with the percentage reported among elderly in Hong Kong (27.0%). (16)Results of the present study revealed that female subjects encountered more physical complaints compared to males. Urinary incontinence was 1.74 more prevalent among females and this coincideswith results a study reported from Alexandria, 2000. (17)Psychological symptoms were also more encountered among females; feeling of depression among females was 2.31 times higher than males. This goes on line with results from Abha city; female geriatric subjects were 2.6 times more likely to suffer from depression than males. (7) The Saudi Arabia is a rapidly developing country with changes that influence life-style of people towards urbanization with more progression towards epidemiological transition. Diabetes is present in epidemic proportions throughout Saudi Arabia with exceedingly high rates concentrated in urban areas. (18) Results of the present study revealed that diabetes mellitus was the most common chronic disease (53.6 %) diagnosed among elderly patients. Al- Nozha et al, 2004, (18) in a National Community Based Survey in the Saudi Arabia found that the prevalence of diabetes among elderly population aged 60-70 years was 36.5 % and other 14.9 % showed impaired glucose tolerance. The higher figures obtained from the present study may be because the age of elderly in present study ranged from 60-104 years and not just elderly 60-70 and as it is known there is an increase in the rates of diabetes with advanced age, or the difference may be because the present study conducted among elderly patients not among the general elderly population. The striking high figures of elderly diabetes obtained from these two studies werehigher than may parts of the world (19 -21) may indicate that there is dramatic increase in rate of diabetes especially with advanced aging and indicates that the risk factors of increased diabetes in increasing in Saudi Arabia. (18)A study from the USA reported that arthritis was the most prevalent (48.9 %) chronic condition among elderly ≥ 65 years, followed by hypertension (40.3 %).(22) In the present study, Arthritis was the second most common disease (52.12 %) among elderly patients followed by hypertension (50.4 %). The lower figures reported from the USA are probably the reflection of their community based study. In Singapore study, 46 % of elderly in a population based study had hypertension. (12)In the present study, psychological problems were more encountered among females and this agrees with results of Hafez et al, 2003.(23)Results of the current study showed that IHD was more encountered among males compared to females and 22.7 % of elderly had these diseases. Results from the National Community Based Survey in the Saudi Arabia revealed that male gender was a risk factor of IHD and the prevalence among elderly aged 60-70 years was lower (9.3 %). (24) This difference may be due to differences in the age group or the type of the target population.The mean number of morbidities among elderly in the present study was 2.11 ±1.16, and it was significantly higher among females (2.28 ± 1.20) compared to males (2.00 ± 1.12). These results approach those of Fuchs et al(25)who found that the mean morbidity number among females was 2.4 ±1.6 and 1.9 ±1.4 among males. On the other hand, the reported mean morbidities from the Indian study was much higher in both males and females.(8) It was noted from the present study that the number of morbid conditions increased among those with poor self rated health. A study conducted in 2002 among 100 elderly in El-Minia governorate (Egypt) showed that there were positive relationship between functional health status and perceived health status. (26) It is clear from the present study that morbidity number increased among elderly experiencing family or social problems which agrees with results of Yadava et al. (10)In the elderly, obesity contributes to the early onset of chronic morbidity and functionalimpairment and is related to premature mortality. (27) Obesity significantly increases the chance of developing diabetes, coronary artery disease, and stroke. (28) In the present study, obesity was the first predictor of increased morbidities among elderly.There is an implicit assumption that disease and deterioration of ill-health are inevitably associated with chronological ageing. (7) The results of the present study showed that increase number of morbidities was associated with advanced aging which agrees with results of Sunder et al (29) who observed that multiple morbidities were more common with advanced age. Johsi et al (8) reported that the age was among factors which predict increased morbidity.CONCLUSION AND RECOMMENDATIONSAbout one-fourth of elderly in the present study reported poor self-perceived health and the number of morbidities among elderly ranged from 1- 6 with mean of 2.11 ±1.16 diseases. There is an alarming high rate of diabetes mellitus and hypertension among elderly. Obesity was the most important modifiable risk factor for increase number of morbidity, females and those felt depression were more susceptible. We recommend that there is a need for promotion of healthy lifestyles and behavioral changes through conduction of community-based health education program. The program should insist on modifying risk factors especially those causing obesity. This in tern leads to tackling the chronic health problems among ageing population by decrease the prevalence of many morbidities and also decreasing co- morbidities. Screening programs for chronic diseases, especially for diabetes and hypertension, is highly recommended among elderly population. There is also a need for satisfactory living condition for elderly; satisfy psychosocial needs, increase recreational activities for elderly involvement of elderly in doing useful activities.Acknowledgment: The authors would like to thank all persons who participated and help in accomplishing this work and also would like to thank all the elderly. Special thanks to fourth year medical students in Family and Community medicine department , King Abdul-Aziz University, Jeddah.REFERENCE1.Hafez G, Bagchi K, Mahaini R. Caring for the elderly: a report on the status of care for theelderly in the Eastern Mediterranean Region. EMHJ July 2000; 6 (4):636-643.2.McMurdo ME. A healthy old age: realistic or futile goal? BMJ 2000; 321(7269): 1149–1151.3.World Population Prospects: The 2002 Revision, Highlights. New York: United NationsPopulation Division; 2003. (ESA/P/WP. 180).4.WHO/EMR. Technical paper: Health care of the elderly in the Eastern Mediterranean Region:Challenges and Perspectives, 2003.5.WHO/ Regional Office for Europe. Health and nutritional status of the elderly in the FormerYugoslav Republic of Macedonia: Results of a national household survey, WHO,2001.( Document EUR/00/50 15388)6.Szucs TD. Future disease burden in the elderly: Rationale for economic planning. CardiovascDrugs Ther 2001;15:359–361.7.Abolfotouh MA,Daffallah AA, Khan MY, Khattab MS, Abdulmoneim I. Psychosocialassessment of geriatric subjects in Abha City, Saudi Arabia. EMHJ 2001; 3: 481- 491.8.Joshi K, Kumar R, Avasthi A. Morbidity profile and its relationship with disability andpsychological distress among elderly people in Northern India. International Journal ofEpidemiology 2003; 32:978-987.9.Allain TJ, Wilson AO, Gomo ZA, Mushangi E, Senzanje B,Adamchak DJ,Matenga JA.Morbidity and disability in elderly Zimbabweans. Age Ageing 1997 Mar; 26(2):115-21.10.Yadava KN, Yadava SS, Vajpeyi DK. A study of aged population and associated health risks inrural India. Int J Aging Hum Dev 1997; 44(4):293-315.11.Damian J, Ruigomez A, Pastor V, Martin-Moreno JM. Determinants of self assessed healthamong Spanish older people living at home. Journal of Epidemiology and Community Health 1999; Vol 53, 412-416.12.Ng TP, Niti M, Chiam PC, Kua EH. Prevalence and correlates of functional disability inmultiethnic elderly Singaporeans. JAGS 2006; 54: 21-29.13.El-Qadhi HM. Quality of life of a group of elderly with common chronic morbidities inAlexandria Main University Hospital. M.Sc Thesis, Geriatric Health Dept , High Institute of Public Health, Alexandria: Alexandria University; 2003.14.AL – Doghether MH, AL – Megbil TI. Determinants of prescribing for the elderly in primaryhealth care. Middle East Journal of Family Medicine 2004; 2 (1):1-5.15.Iecovich E, Isralowitz RE. Elderly Bedouins and Jews in Israel: the effects of visual impairmenton perceived functional and health status. J Health Soc Policy 2003;18(2):55-69.16.Chu LW, Pei CKW. Morbidity patterns of persons waiting for infirmary care in Hong Kong.HKMJ 1997; 3: 362-8.17.Fouaad RA, El- Gueneidy M, Abdel Moniem S. Urinary incontinence among institutionalizedelderly in Alexandria. Bulletin of High Institute of Public Health 2000; 30 (4): 607-630.18.Al-Nozha MM, Al-Maatouq MA, Al-Mazrou YY, et al. Diabetes mellitus in Saudi Arabia. SaudiMed J 2004; 25(11):1603-10.19.Hiltunen L, Luukinen H, Koski K, Kivela SL. Prevalence of diabetes mellitus in an elderlyFinnish population. Diabet Med 1994 Apr;11(3):241-9.20.Barceló et al. The Prevalence of Diagnosed Diabetes Among the Elderly of Seven Cities in LatinAmerica and the Caribbean. J Aging Health.2006; 18: 224-23921.Kutty VR, Soman CR, Joseph A, Pisharody R, Vijayakumar K. Type 2 diabetes in southernKerala: variation in prevalence among geographic divisions within a region. Natl Med J India 2000 Nov-Dec;13(6):287-92.22.Desai MM, Zhang P, Hennessy CH. Surveillance for morbidity and mortality among older adults- United States, 1995-1996. MMWR, December 17, 1999; 48(SS08);7-25.23.Hafezh A S, Esmaeil EA. Epidemiology of psychiatric symptomatology among householdgeriatric population in a rural community at Kalubia Governorate, Egypt. The Scientific Journal of Al-Azhar Medical Faculty 2003; 24 (2): 235-264.24.Al-Nozha MM, Arafah MR, Al-Mazrou YY, et al. Coronary artery disease in Saudi Arabia.Saudi Med J 2004; 25(9):1165-71.25. Fuchs Z, Blumstein T, Novikov I, et al. Morbidity, co morbidity, and their association withdisability among community dwelling oldest-old in Israel. J Gerontol: Med Sci, 1998; 53A:447–55.26.Mussttafa JR. Assessment of the quality of health status of Egyptian elderly. M.Sc Thesis,Faculty of Nursing , Assiut : Assiut Univ., 2002.27.Donini LM, Cameron Chumlea Wm, Vellas B , Balzo V del, Cannella C. Obesity in the elderly:the evidence. International Symposium "Obesity in the Elderly" Rome, 26-28 th January 2006.28.Firdaus M, Mathew MK, Wright J. Health promotion in older adults: the role of lifestyle in themetabolic syndrome. Geriatrics 2006; 61(2):18-22, 24-5.29.Sunder L, Chadha SL, Bhatia PC. A study on senior citizens in rural areas. Health for theMillions 1999; 25:18–20.。
癌组织中的遗传不稳定性的RAPD分析(简报)
癌组织中的遗传不稳定性的RAPD分析(简报)
王建勋;王倩文;何志巍;叶锋
【期刊名称】《分子细胞生物学报(英文版)》
【年(卷),期】2001(034)002
【摘要】@@ 肿瘤仍然是导致人类死亡的重要原因,由于缺乏深刻了解癌症的发生机制,尽管在过去25年中肿瘤的诊断和治疗都取得很大的进展,但肿瘤病人的存活
率并没有显著的提高[1,2].目前有很多癌基因和抑癌基因如P16、P53、P73、ras、DCC和RB等[3,4]已经被克隆和分析,但仍有必要去发现更多的癌基因和抑癌基因.【总页数】6页(P151-156)
【作者】王建勋;王倩文;何志巍;叶锋
【作者单位】广东医学院附属医院中心实验室,;广东医学院附属医院中心实验室,;广东医学院病原生物学教研室;广东医学院肿瘤研究所
【正文语种】中文
【中图分类】R73
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丁咯地尔治疗周围血管慢性阻塞性疾病32例分析
丁咯地尔治疗周围血管慢性阻塞性疾病32例分析
谭霞
【期刊名称】《中国中西医结合外科杂志》
【年(卷),期】2003(009)004
【摘要】@@ 我院自2000年9月- 2001年6月应用盐酸丁咯地尔(buflomedil hydrochloride)治疗外周慢性阻塞性疾病32例疗效满意,报告如下.
【总页数】2页(P322-323)
【作者】谭霞
【作者单位】沈阳医学院附属第二医院血管外科,沈阳,110002
【正文语种】中文
【中图分类】R654.4
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Programmed Cell Death and Hybrid IncompatibilityS.A.F RANK AND C.M.B ARRFrom the Department of Ecology and Evolutionary Biology,University of California,Irvine,CA92697-2525,USA.This research was supported by National Institutes of Health grant AI24424and National Science Foundation grant DEB-0089741. Address correspondence to S.A.Frank at the address above,or e-mail:safrank@.We propose a new theory to explain developmental aberrations in plant hybrids.In our theory,hybrid in-compatibilities arise from imbalances in the mechanisms that cause male sterility in hermaphroditic plants.Mitochondria often cause male sterility by killing the tapetal tissue that nurtures pollen mother cells.Recent evidence suggests that mitochondria destroy the tapetum by triggering standard pathways of programmed cell death.Some nuclear geno-types repress mitochondrial male sterility and restore pollen fertility.Normal regulation of tapetal development therefore arises from a delicate balance between the disruptive effects of mitochondria and the defensive countermeasures of the nuclear genes.In hybrids,incompatibilities between male-sterile mitochondria and nuclear restorers may frequently upset the regulatory control of programmed cell death, causing tapetal abnormalities and male sterility.We propose that hybrid misregulation of programmed cell death may also spill over into other tissues,explaining various developmental aberrations observed in hybrids.Natural populations with mitochondrial male sterility usually have two or more mitochondrial genotypes(Frank2000). Each mitochondrial genotype can be repressed by its own specific set of matching nuclear restorer genes,suggesting that each mitochondrial type causes male sterility in a biochemically different way.Distinct polymorphic sets of mitochondrial and nuclear genes coexist,each set with mitochondrial destruction of pollen production and match-ing nuclear repression of mitochondrial action.The matching mitochondrial and nuclear polymorphisms arise from the conflicting patterns of transmission between mitochondrial and nuclear genes(Frank2000).Mitochondria typically transmit only through seeds and not through pollen. Matrilineally transmitted mitochondria increase theirfitness by pollen abortion and enhanced seed production,whereas biparentally inherited nuclear genes favor a balance of pollen and seeds.The polymorphisms from this reproductive conflict are much like the matching polymorphisms of attack and defense that often occur in host-parasite systems.Morphological signs of tapetal deterioration have been observed in several male-sterile species.The maize mito-chondrial gene T-urf13expresses a protein that results in early tapetal degeneration soon after microspore meiosis (Schnable and Wise1998).In sunflower,the mitochondrial PET1gene causes tapetal degeneration soon after meiosis II (Schnable and Wise1998).Similar tapetal abnormalities arise in male-sterile petunia,wheat,sorghum,and other species (Laser and Lersten1972).Mitochondrial genes may cause tapetal degeneration through pathways of programmed cell death(PCD).Balk and Leaver(2001)provide the clearest study relating tapetal deterioration to PCD.In their study,they analyzed morphological and biochemical aspects of male sterility caused by the PET1-CMS cytoplasm in sunflower.They observed classical signs of PCD in tapetal tissues,including cell condensation,oligonucleosomal cleavage of nuclear DNA,separation of chromatin into delineated masses,and partial release of cytochrome c into the cytosol of tapetal cells before the major changes associated with PCD.These characteristics of PCD in tapetal tissue are similar to apoptosis in mammals.However,tapetal deterioration lacks two attributes of apoptosis:condensation of nuclei and deterioration of cells into structures called apoptotic bodies. Thus,following Balk and Leaver,we use PCD as a general term for the triggered and orderly killing of cells;we reserve apoptosis for the subset of PCD with characteristics that have so far only been observed in animals.Other studies have also suggested that PCD causes tapetal deterioration in mitochondrial male sterility.Induced pollen abortion in barley causes the tapetum and nearby tissue to digest its DNA intofixed size classes(Wang et al. 1999).Such DNA laddering is a hallmark of PCD(Danon et al.2000).Some authors have suggested that maize mitochondria carrying the T-urf13gene cause male sterility by inducing PCD in the tapetum,but this has not yet been demonstrated directly(Wu and Cheung2000).It has beenJournal of Heredity2003:94(2):181–183Ó2003The American Genetic Association DOI:10.1093/jhered/esg020181shown that,in the presence of a fungal toxin,maize mitochondria carrying the T-urf13gene experienced small ion leakage and a loss of membrane potential(Holden and Sze1987).These symptoms of mitochondrial deterioration appear to be caused by the formation of pores in the mitochondrial membrane(Wu and Cheung2000),a common feature of apoptosis in animals(Green and Reed1998).Different mitochondrial genotypes may trigger cell death in different ways by altering the complex regulatory cascade leading to PCD.Each male-sterile mitochondrial genotype has its own matching nuclear restorer genes.Thus,it appears that each mitochondrial pathway for interfering with the regulation of PCD can be blocked by a matching nuclear pathway that restores normal regulation.Normal regulation therefore arises from a delicate balance between the disrup-tive effects of mitochondria and the defensive counter-measures of the nuclear genes.Hybrid crosses often produce male-sterile progeny(Laser and Lersten1972;Schnable and Wise1998),suggesting that hybrid incompatibilities readily disrupt the delicate mito-chondrial–nuclear balance over the regulation of tapetal cell death.Such mitochondrial–nuclear imbalances may some-times disturb the regulation of cell death in other tissues, causing diverse hybrid aberrations associated with the mis-regulation of PCD.Many tissues,such as xylem and leaves, use PCD as part of their normal development(Pennell and Lamb1997).In addition,plant cells use PCD as a mechanism to limit pathogen growth at the site of infection(Pennell and Lamb1997).Therefore,misregulation of the PCD pathway could cause defects in tissues throughout the plant.Hybrids often have reducedfitness and developmental abnormalities(Burke and Arnold2001;Waldmann1999). However,we found surprisingly little detail in the literature about morphological and biochemical aberrations in plant hybrids.In our own work,we have observed aberrations of Nemophila menzesii when crossed between distant locations (Barr CM,unpublished data).The resulting progeny are stunted,have thickened and curled leaves,have aberrant petals and anthers,and make little or no pollen.Interestingly, N.menzesii has CMS,making it a good candidate species to analyze associations between CMS and PCD-induced aberrations in crosses between diverged populations.We have found one case that associates hybrid aberrations with PCD.Hybrids from crosses between Nicotiana suavolens and Nicotiana tabacum had developmental abnormalities of cellular death withtheclassicalmorphological and biochemical signatures of PCD(Yamada et al.2001).Nicotiana species have widespread male sterility(Nikova et al.1999).It is these sorts of hybrid abnormalities in Nicotiana and Nemophila that deserve closer attention.Perhaps there is a link between mitochondrial-nuclear imbalances arising from male sterility and hybrid aberrations in the regulation of PCD.Why should the normally tapetal-specific effects of PCD in male sterility occur in other tissues in hybrids?One explanation for tapetal problems in CMS plants is that tapetal tissue experiences exceptional demand for respiration and mitochondrial performance(Hanson1991).Thus,tapetal tissue is particularly sensitive to mitochondrial aberrations and is usually the only tissue that exceeds the threshold for showing signs of mitochondria-induced failure.If this quantitative explanation is correct,and hybrids have a lower threshold for expressing mitochondrial aberrations,then hybrids may express aberrant PCD in tissues other than the tapetum.Lower hybrid thresholds could arise from poorer physiological performance of hybrid tissues,rendering those tissues more susceptible to expressing aberrations normally masked in intraspecific crosses.Alternatively,Balk and Leaver(2001)present evidence in favor of tapetal PCD in male sterility arising from tightly regulated,tissue-specific expression of genes.In this case, misregulation of PCD in hybrids may arise from failure of the mechanisms that confine the CMS-induced expression of PCD to the tapetum.Such failure may occur because the genes involved in causing or suppressing CMS are likely to evolve exceptionally rapidly.We expect rapid evolution because CMS arises from a conflict between cytoplasmic and nuclear genes,and antagonistic coevolution often leads to rapid evolutionary change in other systems such as host-parasite interactions(Frank2002).Our idea about misregulation of PCD in hybrids calls for closer attention to the nature of hybrid aberrations in plants.ReferencesBalk J and Leaver CJ,2001.The PET1-CMS mitochondrial mutation in sunflower is associated with premature programmed cell death and cyto-chrome c release.Plant Cell13:1803–1818.Burke JM and Arnold ML,2001.Genetics and thefitness of hybrids.Annu Rev Genet35:31–52.Danon A,Delorme V,Mailhac N,and Gallois P,2000.Plant programmed cell death:a common way to die.Plant Physiol Biochem38:647–655. 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