Ab-initio investigation of the covalent bond energies in the metallic covalent superconduct

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A_2B_型腺苷受体拮抗剂的研究进展

A_2B_型腺苷受体拮抗剂的研究进展

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W E I J ing1 , YU W en2quan1 , GAO Q ing2zhi23
( 1. S chool of Pha rm aceu tica l S cience and Technology, T ian jin U n iversity, T ian jin 300072, Ch ina; 2. Chem istry D epa rtm en t, X enoPort, Inc. , 3410 Cen tra l Expressw ay, S an ta C la ra, CA 95051, USA )
图 2 天然腺苷受体拮抗剂结构
3. 2 82取代黄嘌呤衍生物类选择性拮抗剂 20世 纪末腺苷受体拮抗剂的研究取得了突破性的进展 。 研究中发现黄嘌呤类化合物的 8位上取代基的变化 能大大提高其腺苷受体亲和力 ,并达到纳摩尔 级 [6]。
魏 静等 : A2B型腺苷受体拮抗剂的研究进展
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82环戊烷 21, 32二丙基黄嘌呤 (DPCPX, 3) ,不仅 表现出对 A1 受体较强的亲和力 ( Ki = 019 nmol· L - 1 ) ,而且相对于 A2A受体和 A3 受体具有较好的选 择性 ( Ki 2A / Ki A1 = 522, Ki A3 / Ki A1 = 883 ) ,对 A2B受体 也有较好的亲和力 ( Ki = 51 nmol·L - 1 ) 。因此 ,同 位素 [3 H ]DPCPX被广泛用于 A1 和 A2B受体放射性 标定实验的标记物 ,并为 A2B受体拮抗剂的研究提 供了良好的测定活性条件 。

金属掺杂锐钛矿相TiO2的第一性原理计算

金属掺杂锐钛矿相TiO2的第一性原理计算

金属掺杂锐钛矿相TiO2的第一性原理计算金属掺杂锐钛矿相TiO2的第一性原理计算/王海东等?129?金属掺杂锐钛矿相TiO2的第一性原理计算王海东,万巍(中南大学无机材料研究所,长沙410083)摘要采用基于密度泛函理论的从头算平面波超软赝势方法,计算了纯锐钛矿相TiU2及5种不同金属掺杂Ti()2的晶格常数,能带结构,态密度与光吸收系数.结果表明,掺杂后能级的变化主要是过渡金属Co3d,Fe3d,Zr4d,Zr4p,V3p,V3d,W5d及W5p轨道的贡献.随着co,Fe,V掺杂浓度的增加,禁带宽度呈减小趋势;Zr掺杂对能带结构几乎不产生影响;W掺杂能级远离禁带,只对价带构成产生了影响.金属掺杂使禁带宽度变化或出现新杂质能级,导致了Ti()2吸收边沿红移或在可见光区域出现新的吸收峰;其中Co,Fe掺杂的吸收边沿明显红移,而w掺杂时在可见光区域出现较强的吸收峰.'关键词第一性原理锐钛矿相TiOz金属掺杂中图分类号:TN302;O411文献标识码:A StudyontheMetalDopedAnataseTiO2byFirstPrinciplesW ANGHaidong,WANWei(InstituteofInorganicMaterials,CentralSouthUniversity,Changsha410083) AbstractThelatticeconstant,bandstructure,densityofstatesandopticalpropertiesofpurean dCo,Fe,Zr,V,WdopingTi02werecalculatedusingthefirst-principleplane-waveultrasoftpseudopotent ialmethodsbasedonthe densityfunctionaltheorNTheresultsindicatethattheformationofimpuritylevelismainlyco ntributedbymixingwithCO3d,Fe3d,Zr4p,Zr4d,V3p,V3d,W5p,W5dorbita1ofthetransitionmeta1.Thebandg apdecreaseswithincreasingCo,ice,Vconcentration.ThereisnoimpuritylevelpresentinthebandstructureofZ rdopingTi02.Impu—ritylevelofWdopingTi02leavesawayfromthebandgap,onlycausestheconstitutionofvalen ceban&Thedoping withmetalliciconsisresponsibleforthechangesofbandgapornewappearanceofimpurityle vel,whichbringstheredshiftofTi02absorptionwavelengthortheappearanceofnewabsorptionpeakinthevisible 1ightregion.Thedo—pingofCo,FebringstheredshiftofTi02absorptionwavelengthobviouslyandW-dopingcaus esastrongabsorptionpeakinthevisiblelightregion.KeywordsFirst-principlecalculation,anatasetitaniumdioxide,metaldoped0引言作为光催化环境净化材料,Ti0因具有无毒,成本低,稳定性好等诸多优点而成为最具研发潜力的光催化剂.但由于TiO是宽禁带半导体氧化物,使其对太阳能的利用受到了限制.因此,如何通过改性手段提高其光谱响应范围是TiO光催化性能推广应用的关键.对TiOz的改性研究表明,金属离子掺杂改性是有效的方法之一理想的掺杂离子应在材料内形成合适的施主或受主能级,且这些能级位于距离导带或价带较理想的位置,既可以俘获载流子促进光生载流子的分离,又能快速释放载流子以避免成为载流子失活中心[1].在已开展的金属离子掺杂TiO光催化活性的实验研究中,Choi等采用Sol—gel法将与Ti半径接近的21种金属离子掺入到TiO中,结果表明,掺杂Fe",Mo",Ru什,Os抖,Re汁,V",Rh3均可明显提高TiO的氧化还原能力,而Li,M,Al",Ga什等S区及P区离子掺杂则降低了Ti0.的光催化活性.相对于实验研究,模拟计算技术具有可以克服实验中人为因素的影响,更易于深入分析离子掺杂改性机理的特点.从2O世纪9O年代开始应用第一性原理对Ti02纳米材料进行计算模拟的研究工作已逐渐展开r3].曹红红等_4]使用全电势线性缀加平面波法,对锐钛矿相TiO做了较系统的计算,优化后所得结果与实验值符合得很好.Umebayashi等]利用基于密度泛函理论的全电势线性缀加平面波法计算了3d过渡金属掺杂锐钛矿相TiO.的电子结构,结果表明掺杂物的t.态在禁带或价带中产生了一个杂质能级,并且随着掺杂原子序数的增大,杂质能级向低能级方向移动.为进一步系统地研究金属掺杂对锐钛矿相TiO光催化性能的影响机理,采用基于密度泛函理论的从头算平面波超软赝势方法,计算了纯锐钛矿相Ti()2及5种不同金属(Co,*教育部博士点基金(20100162110062)王海东:1963年生,博士,教授Tel:0731—8836963E-mail:***************】30?材料导报B:研究篇2O11年7月(下)第25卷第7期Fe,Zr,V,w)在多浓度掺杂下TiO.的晶格常数,能带结构,电子态密度及光吸收性质,研究了相应掺杂情况下各种掺杂对锐钛矿相()电子结构及光学性能的影响.1计算方法与结构优化通过在锐钛矿型Ti().超晶胞中掺杂一个原子替代,¨原子对掺杂效应进行模拟.建立的3个模型是:2×1xl,2x2×1,3×2×1的超晶胞,这些超晶胞分别包含24,48,72个原子,对的理论掺杂浓度(原子分数,下同)为4.17,2.08,1.3【{,标记为模型(b),((t),(d);作为参照也刈'未掺杂的Ti():单胞进行了讣算,标记为模型(a),如图1所示.相应的(a),(b),(c),(d)模型k—point取样Monkhorst—pack的格点分别选取为5×5×2,5×3×2,3×3x2,3×2×2.埘品体结构优化后,找到晶体结构的最稳定点,再完成能带结构, 态密度和光学性质的计算.图1替位掺杂锐钛矿型Ti02计算模型Fig.1ThecalculationmodelsforsubstitutionalanataseTi()2通过Accelrys公司开发的Materialsstudio中的CASTEP模块,采用基于密度泛函理论(Densityfunction theory,DFT)的平面波超软赝势方法进行计算.在掺杂前后的结构优化环节中交换关联函数均采用广义梯度近似(GGA,Generalizedgradientapproximation),赝势函数采用PBE(Perdew,BurkeandErnzerhof)梯度修正函数,并在此近似下进行了结构及性质计算.其它计算参数设置为:平面波截断~(Cutoff)340eV,自洽场收敛性标准(SCFtolerance)5×10eV/atom,两次迭代体系能量收敛精度5×10eV/ atom,原子最大受力收敛精度1×lOeV/A,最大应变收敛精度2×10GPa,原子最大位移收敛精度5×10A,计算的价态电子有Ti3s.3p3d4s.,O2s2p,Co3d4s,Fe3d.4s,Zr4s4p.4d5s,V3s.3p3d.4s,WSs.5p5d6s,所有计算均在倒易空间中进行.作为后续计算基础的未掺杂rri模型,表1为经优化后锐钛矿相Ti()晶胞结构参数的计算结果n,c,"(dap/c, dap是轴向Ti一()键长)与实验值及文献值的比较.从表1中可以看出,理论计算结果l7与实验数值_8接近, 表明计算精确度高,模型可靠.表l锐钛矿相TiO2结构参数比较Table1StructureparameterofanataseTiO22结果与讨论2.1能带结构分析根据掺杂模型计算所得能带结构,各模型的禁带宽度值9Ti●O●M(掺杂原子)如表2所示.从表2中可以看出,随着Co,Fe,V掺杂浓度的增加,禁带宽度呈现出明显减小的趋势;而掺杂时不同掺杂浓度下禁带宽度几乎一致;但w掺杂下禁带宽度反而增大,甚至比未掺杂TiO的禁带宽度更大.表2计算模型的带隙宽度值Table2Bandgapofcalculationmodels考查掺杂前后禁带宽度变化最大的模型,选取费米能级为零点,纯锐钛矿相TiO:及各金属元素4.17掺杂浓度下在沿布里渊区对称点上的能带结构如图2所示.据图2(a)可以看出锐钛矿型TiO.的导带最低点及价带最高点均在G点,据此判定其为直接能隙半导体,禁带宽度为2.23eV,小于实验值3.23eV,与Asahi等的计算结果相近.由于在广义梯度近似(GGA)计算下,交换关联函数不能完全反映真实的多电子相互作用,导致得到的禁带宽度要比真实的禁带宽度小.这种由于计算方法本身造成低估带隙的情况,文献[9,10]已进行过讨论.但作为一种有效的近似方法,其结果的相对值还是准确的,不影响对能带结构的分析.由图2(b)一(f)可知,Co,Fe,Zr,V和w掺杂TiO.的导带最低点分别在G,Z,G,G,G点,而价带最高点分别位于G, F,F,F,F点.这表明Co掺杂的电子为直接跃迁,禁带宽度为0.47eV;而Fe,Zr,V和w掺杂的电子为间接跃迁,禁带宽度分别为1.70eV,2.18eV,1.78eV,2.74eV.与TiO2的金属掺杂锐钛矿相TiOz的第一性原理计算/王海东等?131? 禁带宽度2.23eV相比,w掺杂后禁带宽度变宽,而co,Fe,Zr,V均有不同程度的减小,其中C()掺杂后TiO禁带宽度最小.根据半导体掺杂理论,杂质浓度较高时杂质原子相互间较接近,因此杂质原子之间的电子波函数发生重叠,使孤立的杂质扩展成为能带,即杂质能带[1.图2(b),(c)中,Co,Fe掺杂分别在禁带中上部产生了2条和3条新杂质能级,可在电子跃迁时起中问过渡作用,能有效减小所需的激发能量,从而拓宽了Co和Fe掺杂TiO.的光响应波长范围. 42净O器一2一4-6在图2(e)中,V掺杂能级位于接近导带底的位置,与Ti3d轨道形成复合导带底.由图2(d)可知,Zr掺杂在低浓度下产生的能级不明显,新能级与O2p轨道复合形成价带顶,但Zr 掺杂与V掺杂一样也没有引人中间能级,不会形成新的空穴俘获中心,因而亦可较有效地提高T[O的光催化活性.如图2(f)所示,w掺杂后只在靠近价带下方出现了新的能级, 使价带宽度增加,对禁带影响不明显,不会使光吸收边沿发生红移.42;≈一2一4—6GFqzGGFQZGGFQzG图2能带结构Fig.2Energybandstructure2.2电子态密度分析与能带结构分析相对应,选取4.17掺杂浓度,对不同金属元素Co,Fe,Zr,V和W掺杂Ti()2在沿布里渊区对称点上的总态密度(DOS)与纯Ti02总态密度进行了比较,如图3 所示.图3总态密度图Fig.3Totaldensityofstates从图3可知,与纯TiO.相比掺杂后体系的导带和价带的位置出现了负移,且掺杂后导带的宽度均有不同程度的减小,理论上将使掺杂后的TiO.具有更强的氧化还原能力.Zr掺杂TiOz后的态密度与未掺杂TiOz的态密度基本相似, 2O一2三醣≈一4口[一6-8GFQ没有明显的变化;Co,Fe掺杂后分别在禁带中间靠近导带和靠近价带方向出现了新的态密度.在V掺杂TiO靠近导带下方出现了一个"小肩峰",使导带向低能量方向偏移,有利于禁带宽度的减小;在W掺杂靠近TiOz价带下方也出现了新的态密度"肩峰",使得价带加宽;V和W掺杂TiO.的总态密度整体向能量最低的方向偏移.掺杂前后电子结构的变化可根据费米能级附近价带和导带的偏态密度(PDOS)作进一步分析,如图4所示.由图4(a)可以看出,锐钛矿型TiO在费米能级附近的价带和导带分别主要由.原子的2p轨道和rri原子的3d轨道组成,价带范围一5.26~0.77eV,宽度为6.03eV;导带范围1.61~5.49eV,宽度为3.88eV.如图4(b)所示,Co掺杂Ti02价带(一6.40~O.36eV)主要由02p轨道组成,昆合了Ti3d和Co3d轨道,宽度为6.76 eV,比未掺杂Ti02的价带宽度明显增加;导带(2.O9~3.94 eV)主要由Ti3d轨道组成,同时也混合了Co3d和02p轨道,宽度为1.85eV,比未掺杂TiO:的导带宽度明显减小.相对未掺杂的TiO.,Co掺杂后价带向下移动0.41eV,导带向上移动0.48eV.但在导带和价带之间形成了由Co3d和O2p轨道杂化的中间能带,从而有利于价电子从价带到导带的跃迁,表现出良好的光学性能.6420>∞\∞金属掺杂锐钛矿相Ti()2的第一性原理计算/王海东等?133? 荷和更小的半径,取代后可能导致Ti什与O.卜距离变小,有利于光生电子的跃迁,而且具有更大的电荷半径比,以至于w对()一有较强的极化效应.另外一个原因是w的掺杂是高价掺杂.Kiriakidou等口认为掺杂离子的化合价高时会使费米能级和能带向上漂移,表面势垒变高,空间电荷区变窄,使光生电子和空穴在强场的作用能够得到有效的分离.图5掺杂TiO2的紫外一可见吸收光谱Fig.5UV-visabsorptionspectraofaopedTi023结论采用基于密度泛函理论的从头算平面波超软赝势方法研究了纯锐钛矿相TiO及5种不同金属掺杂TiO.的晶格常数,能带结构,电子态密度与光吸收系数.模拟计算表明:掺杂计算基础的未掺杂TiO模型,经优化后晶胞结构参数的计算结果与实验值偏差较小,参数设置合理,模型可靠. (1)掺杂后能级的变化主要是过渡金属Co3d,Fe3d,Zr4d,Zr4p,V3p,V3d,W5p,W5d轨道的贡献.随着3d过渡金属Co,Fe,V掺杂浓度的增加,禁带宽度呈减小趋势,且均在禁带中产生了明显的杂质能级;Zr掺杂前后所得结构几乎一致,与掺杂浓度无关;但w掺杂由于导带价带相对位置的变化使禁带宽度增大,并在原有价带以下产生了新的杂质能级.(2)掺杂导致禁带宽度变窄或出现新的杂质能级,在紫外一可见吸收光谱中表现为TiO吸收边沿的红移或出现新的吸收峰.其中Co,Fe掺杂的吸收边沿明显红移,而w掺杂在可见光区域出现了很强的新的吸收峰.致谢感谢q-南大学高性能计算q-心在模拟计算方面提供的技术支持与帮助.参考文献I张金龙,陈锋,何斌.光催化EM].上海:华东理工大学出版社,2004:712ChoiW,TerrainA.HoffmanMRTheroleofmetaliondopantsinquantum-sizedTiO2:Correlationbetweenphoto—reactivityandchargecarrierrecombinationdynamics[J].j PhysChem,1994,98(51):136693SegallMD,LindanJDP,ProbertMJ,eta1.First-princi—plessimulation:Ideas,illustrationsandtheCASTEPcodeLJ一].JPhys:CondensedMatter,2002,14(11):27174CaoHonghong(曹红红),HuangHaibo(黄海波),ChenQiang(陈强).AbinitiocalculationsofanataseTi()2(对锐钛矿相TiO2的第一原理计算KJ].JBeijingUniversityAero—nauticsAstronautics(北京航空航天大学),2005,31(2):2515AsalhiR,TagaY,MannstadtW,eta1.Electronicandop—ticalpropertiesofanataseTiO2口].PhysRevB,2000,61 (11):74596UmebayashiT,Y amakiT,ItohH,eta1.Analysisofelec—tronicstructuresof3dtransitionmetal—dopedTiO2basedon bandcalculations[J].JPhysChemSolids,2002,63(10):'19097TianFenghui(田风惠).Theorystudy0nnon-metallicele—mentdopedTiO2一basedphotocata1yst(非金属元素掺杂改性的Ti02基光催化剂的理论研究)[D].Shangdong(山东): ShangdongUniversity(山东大学),20068BurdettJK,HughbandksT,MillerGJ,eta1.Structural electronicrelationshipsininorganicsolids:Powderneutron diffractionstudiesoftherutileandanatasepolymorphsofti—taniumdioxideat15and295K[J].JAmChemSoc,1987,109(12):36399PerdewJP.PhysicalcontentoftheexactKohn-shamorbital energies:Bandgapsandderivativediscontinuities[J].Phys RevLett,1983,5l(20):188410V alentinCD,FinazziE,PaeehioniG,eta1.Densityfunc—tionaltheoryandelectronparamagneticresonancestudyon theeffectofN-FCo-dopingofTi()2[J].ChemMater,2008,20(11):3706l1谢希德,陆栋.固体能带理论EM].上海:复旦大学出版社, 1998:1012WengHongming,Y angXiaoping,DongJinming,eta1.E—lectronicstructureandopticalpropertiesoftheCo-doped anataseTi02studiedfromfirstprinciples[J].PhysRevB, 2004,69(12):12521913LiaoBin,ZhaoQinli,YingWuxian,eta1.Calculationofe—lectronicstructureofanataseTi02dopedwithtransition metalV,Cr,FeandCuatomsbythelinearizedaugmented planewavemethod[J].ChineseJStructuralChem,2009,28 (7):86914DuXiaosong,LiQunxiang,SuHaibin,eta1.Electronicand magneticpropertiesofV-dopedanataseTi02fromfirstprin—ciples[J].PhysRevB,2006,74(23):233201l5KiriakidouF,KondaridesDI,V erykiosXE.Theeffectof operationalparametersandTi02一dopingonthephotocataly- ticdegradationofazo-dyes[-J~.CatalToday,1999,54(1):119(责任编辑汪雁南)。

2021年6月大学英语六级仔细阅读练习题附答案及解析(3)

2021年6月大学英语六级仔细阅读练习题附答案及解析(3)

2021年6月大学英语六级仔细阅读练习题附答案及解析(3)Passage OneQuestions 56 to 60 are based on the following passage.Caught in a squeeze between the health needs of aging populations on one hand and the financial crisis on the other, governments everywhere are looking for ways to slow the growth in health-care spending. Increasingly, they are looking to the generic-drugs (普通药物) industry as a savior. In November Japan's finance ministry issued a report complaining that the country's use of generics was less than a third of that in America or Britain. In the same month Canada's competition watchdog criticized the country's pharmacies for failing to pass on the savings made possible by the use of generic drugs. That greed, it reckoned, costs taxpayers nearly C$1 billion a year.Then on November 28th the European Commission issued the preliminary results of its year-long probe into drug giants in the European Union. The report reached a damning~, though provisional, conclusion: the drugs firms use a variety of unfair strategies to protect their expensive drugs by delayingthe entry of cheaper generic opponents. Though this initial report does not carry the force of law (a final report is due early next year), it has caused much controversy. Neelie Kroes, the EU's competition commissioner, says she is ready to take legal action if the evidence allows.One strategy the investigators criticize is the use of the "patent duster( 专利群)". A firm keen to defend its drug due to go off-patent may file dozens or hundreds of new patents, often of dubious merit, to confuse and terrify potential copycats and maintain its monopoly. An unnamed drugs firm once took out 1,300 patents across the EU on a single drug. The report also suggests that out-of-court settlements between makers of patented drags and generics firms may be a strategy used by the former to delay market entry by the latter.According to EU officials, such misdeeds -have delayed the arrival of generic competition and the accompanying savings. On average, rite report estimates, generics arrived seven months after a patented drug lost its protection, though where the drug was a big seller the lag was four months. The report says taxpayers paid about q 3 billion more than they would have-had the generics gone on sale immediately.But hang on a minute, Though many of the charges of badbehavior leveled at the patented-drugs industry by EU investigators may well be true, the report seems to let the generics industry off the hook(钩子) too lightly. After all, if the drugs giants stand accused, in effect, of bribing opponents to delay the launch of cheap generics, shouldn't the companies that accepted those "bribes" also share the blame?56. Why are governments around the world seeking ways to reduce their health-care spending?A) They consider the generic-drugs industry as a savior.B) They are under the double pressure of aging group and financial crisis.C) Health-care spending has accounted too large proportion.D) Health-care spending has cost taxpayers too much income.57. What can we learn from the report issued by the European Commission?A) Drug firm will use just ways to protect their drags.B) Cheaper generic drugs are easy to enter market,C) The report has come to an ultimate conclusion.D) The final report may lead to commissioner's legal action.58. The investigators seriously condemned the drug firms for__________.A) they do not let their opponents to resort to the cometB) they use clusters of patents to protect their productsC) they bribe the cheaper generic opponentsD) trey do not pass on the savings made by use of generic drugs59. On average, the genetics will be delayed to enter the market by __________.A) seven monthsB) three monthsC) four monthsD) eleven months60. Which of the following accords with the author's view?A) Charges on patented-drug industry are anything but true.B) Generics industry is a sheer victim in the competition.C) Only drug giants are to blame.D) Exclusion of generics industry from taking responsibility is questionable.Passage TwoQuestions 61 to 65 are based on the following passage.Yet with economies in free fail, managers also need up-to-date information about what is happening to their businesses, so that they can change course rapidly if necessary. Cisco, an American network-equipment giant, hasinvested over many years in the technology needed to generate such data .Frank Caideroni, the firm's CFO, says that every day its senior executives can track exactly what orders are coming in from sales teams around the world, and identify emerging trends in each region and market segment. And at the end of each month, the firm can get reliable financial results within four hours of closing its books. Most firms have to wait days or even weeks for such certainty.Admittedly, Cisco's financial results have not made happy reading recently because, in common with many other large technology companies, it has seen demand for its products decline in the downturn. In early February it announced that its fiscal second-quarter revenues of $ 9.1 billion were 7.5% lower than the same period in 2021 and that its profit had fallen by 27%, to $1.5 billion.In response to hard times, Cisco plans to cut $1 billion of costs this year by, among other things, making use of its own video-conferencing and other communications technologies to reduce the amount its executives travel. It is also using these facilities to relay information from employees on the ground to its senior managers, and to get instructions from Cisco's leaders back out to its 67,000 staff. A rapid exchangeof information and instructions is especially valuable if the company wants to alter course in stormy times.If everybody in a company can rapidly grasp what they have to do and how it is changing, they are more likely to get the job done. But some firms are reluctant to share their goals with the wider world. Unilever, a big Anglo-Dutch consumer-goods group, has decided against issuing a 2021 financial forecast to investors, arguing that it is difficult to predict what is going to happen, given the dangerous state of the world economy. "We're not just going to provide numbers for the sake of it," explains James Allison, the company's head of investor relations. Other companies that have decided not to provide annual earnings estimates for 2021 include Costco, a big American retailer, and Union Pacific, an American railway company.Some firms, such as Intel, seem to have chosen to take things quarter by quarter. The giant chipmaker(芯片制造商) said in January that it would not issue an official forecast for the first quarter of 2021 after its fourth-quarter 2021 profit decreased by 90%. Several retail chains have also stopped providing monthly sales estimates because they cannot see what the future holds. Retailers, chipmakers and firms inmany other industries may have a long wait before the economic fog finally lifts.61. What can we learn about Cisco from the passage?A) It will keep a record of the orders from sales teams.B) It cuts $1 billion cost by solely relying on its own technologies.C) Unlike other technology companies, its financial reports are encouraging.D) Only employees can use the video-conferencing to pass information.62. According to the author, the staff can perform better by__________.A) getting instructions from their senior managersB) seizing what to do at hand and what to do nextC) having a financial forecast as a goalD) sharing their goals with others63. What is important in the unstable time ff a company wants to change strategies?A) To issue company's financial reports faster.B) To obtain the up-to-date information of company's business.C) To predict what is going to happen in the future.D) To wait until the economic fog finally lifts.64. The reason Unilever plans not to issue financial forecast in 2021 lies in__________.A) its reluctance to share its goal with othersB) its rapid grasp of changes in the marketsC) the unstable economic situationD) its reduction in the cost of prediction65. What can we know about the giant chipmaker, Intel in the passage?A) It did not issue first-quarter forecast for great decrease in January.B) Inters chain store used to report sales estimates by year.C) Only retailers and chipmakers are greatly influenced.D) Intel's profit was greatly decreased in 2021's last quarter.答案解析:56.B)。

医护英语考试题及答案

医护英语考试题及答案

医护英语考试题及答案一、选择题(每题2分,共20分)1. What is the most common symptom of the common cold?A. FeverB. CoughC. Sore throatD. All of the above答案:D2. Which of the following is NOT a vital sign?A. Blood pressureB. PulseC. Respiratory rateD. Body temperature答案:D3. What does the acronym "ICU" stand for?A. Intensive Care UnitB. International Clinical UnitC. Immediate Care UnitD. Inpatient Clinical Unit答案:A4. The term "diabetes" refers to a condition characterized by:A. High blood sugar levelsB. Low blood sugar levelsC. High blood pressureD. High cholesterol levels答案:A5. A patient is said to be "anemic" if they have:A. Too much red blood cellsB. Too few red blood cellsC. Too much white blood cellsD. Too few platelets答案:B6. What is the medical term for a surgical incision?A. IncisionB. AmputationC. BiopsyD. Excision答案:A7. Which of the following is a method of sterilization?A. Washing with soap and waterB. BoilingC. Using alcohol swabsD. All of the above答案:D8. The abbreviation "MRI" stands for:A. Magnetic Resonance ImagingB. Medical Radioactive ImagingC. Multiple Radioactive IndicatorsD. Medical Radio Imaging答案:A9. What is the primary function of the liver?A. To filter bloodB. To produce bileC. To regulate blood sugar levelsD. To produce red blood cells答案:B10. A "thermometer" is used to measure:A. Blood pressureB. Body temperatureC. Respiratory rateD. Pulse答案:B二、填空题(每题1分,共10分)11. The medical term for a broken bone is ____________.答案:fracture12. A person with a severe allergy to penicillin would be given a warning to avoid contact with this medication, known as a(n) ____________.答案:allergy alert13. The abbreviation "HIV" stands for Human Immunodeficiency ____________.答案:Virus14. A healthcare professional who specializes in the diagnosis and treatment of diseases of the heart is called a ____________.答案:cardiologist15. The process of removing waste products from the body is known as ____________.答案:excretion16. A patient's medical history is recorded in their____________.答案:medical record17. The practice of washing hands with soap and water to prevent the spread of disease is called ____________.答案:hand hygiene18. A(n) ____________ is a healthcare professional trained to provide emergency medical services.答案:paramedic19. The abbreviation "OT" stands for Occupational____________.答案:Therapy20. A patient's condition is assessed and monitored throughregular ____________.答案:check-ups三、简答题(每题5分,共30分)21. What are the four stages of the nursing process?答案:The four stages of the nursing process are assessment, planning, implementation, and evaluation.22. Explain the difference between a virus and a bacterium.答案:A virus is a microscopic infectious agent that can only replicate inside the living cells of an organism, while a bacterium is a single-celled microorganism that can exist independently and can be beneficial, neutral, or harmful to humans.23. What is the purpose of a stethoscope in medical practice?答案:A stethoscope is used by healthcare professionals to listen to the sounds produced by the body, such as the heartbeat and breathing, to diagnose or monitor various conditions.24. Describe the role of a registered nurse in a hospital setting.答案:A registered nurse in a hospital setting providesdirect patient care, administers medications, monitors patients' conditions, collaborates with physicians and other healthcare professionals, and educates patients about theirhealth conditions and treatments.四、翻译题(每题5分,共20分)25. 请将以下句子翻译成英文:医生建议他每天服用阿司匹林以预防心脏病。

蝙蝠葛碱对阿尔茨海默病小鼠海马组织Aβ水平的影响

蝙蝠葛碱对阿尔茨海默病小鼠海马组织Aβ水平的影响

蝙蝠葛碱对阿尔茨海默病小鼠海马组织Aβ水平的影响目的:研究中药提纯成分蝙蝠葛碱对阿尔茨海默病小鼠海马组织Aβ水平的影响。

方法:阿尔茨海默病小鼠随机分成对照组、模型组、治疗组、蝙蝠葛碱组。

给予蝙蝠葛碱灌胃,观察小鼠Aβ的变化。

结果:与模型组比较后,蝙蝠葛碱组Aβ水平明显降低。

结论:蝙蝠葛碱能降低Aβ水平,对阿尔茨海默病小鼠具有一定的海马组织保护作用。

标签:蝙蝠葛碱;阿尔茨海默病;小鼠蝙蝠葛碱(Dauricine,DAU)是祖国医药北豆根植物的提纯有效成分单体,具有广泛的药理作用,包括抗氧化作用[1]、脑缺血保护作用[2-3]等。

基于此实验开展DAU对脑部疾病阿尔茨海默病(Alzheimer’s disease,AD)海马组织密切相关的因子、淀粉样斑块核心成分、即β-淀粉样蛋白(Amyloid beda,Aβ)[4]的研究,研究DAU对AD小鼠Aβ的影响作用。

1 实验材料1.1 实验动物3月龄标准体重APP/PS1双转基因小鼠和同月龄、同背景C57小鼠,常温、常湿、自由摄取食物,饲养在黑龙江中医药大学实验动物中心。

1.2 药物西药阳性对照吡拉西坦购于湖南迪诺制药有限公司(批号130325);DAU 购于MUST公司,批号MUST-13010313,纯度为98.66%;Aβ酶联免疫试剂盒(批号20140401),南京建成生物工程研究所生产。

2 方法2.1 分组AD小鼠共18只,随机分为3组,其中模型组6只、治疗组6只、DAU组6只;另设定对照组6只。

2.2 给药实验动物对照组小鼠6只给予生理盐水灌胃;模型组6只给予生理盐水灌胃;治疗组6只给予吡拉西坦(0.62gokg-1·d-1)灌胃;DAU组6只给予DAU (20mgokg-1·d-1)灌胃,灌胃时间为2周。

2.3 Aβ检测小鼠断头、取海马组织、匀浆、静置、离心、分装、-20℃低温保存备用。

按Aβ酶联免疫试剂盒说明书操作进行,450nm波长处测定各孔OD值,记录并且分析数据。

非典型精神病药物超适应症用药

非典型精神病药物超适应症用药

Comparative Effectiveness ReviewNumber 6Efficacy and Comparative Effectiveness of Off-Label Use of Atypical AntipsychoticsThis report is based on research conducted by the Southern California/RAND Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0003). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.This report is intended as a reference and not as a substitute for clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information.This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.Comparative Effectiveness ReviewNumber 6Efficacy and Comparative Effectiveness ofOff-Label Use of Atypical AntipsychoticsPrepared for:Agency for Healthcare Research and QualityU.S. Department of Health and Human Services540 Gaither RoadRockville, MD 20850Contract No. 290-02-0003Prepared by:Southern California/RAND Evidence-based Practice CenterInvestigatorsPaul Shekelle, M.D., Ph.D. Lara Hilton, B.A.Director Programmer/Analyst Margaret Maglione, M.P.P. Annie Zhou, M.S.Project Manager/Policy Analyst StatisticianSteven Bagley, M.D., M.S. Susan Chen, B.A.Content Expert/Physician Reviewer Staff AssistantMarika Suttorp, M.S. Peter Glassman, M.B., B.S., M.Sc.Benefits ManagementStatistician PharmacyWalter A. Mojica, M.D., M.P.H. ExpertPhysician Reviewer Sydne Newberry, Ph.D.Jason Carter, B.A. Medical EditorCony Rolón, B.A.Literature Database ManagersAHRQ Publication No. 07-EHC003-EFJanuary 2007This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders.Suggested citation:Shekelle P, Maglione M, Bagley S, Suttorp M, Mojica WA, Carter J, Rolon C, Hilton L, Zhou A, Chen S, Glassman P. Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics. Comparative Effectiveness Review No. 6. (Prepared by the Southern California/RAND Evidence-based Practice Center under Contract No. 290-02-0003.)Rockville, MD: Agency for Healthcare Research and Quality. January 2007. Available at: /reports/final.cfm.PrefaceThe Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to organize knowledge and make it available to inform decisions about health care. As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress directed AHRQ to conduct and support research on the comparative outcomes, clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services to meet the needs of Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP).AHRQ has an established network of Evidence-based Practice Centers (EPCs) that produce Evidence Reports/Technology Assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care. The EPCs now lend their expertise to the Effective Health Care Program by conducting Comparative Effectiveness Reviews of medications, devices, and other relevant interventions, including strategies for how these items and services can best be organized, managed, and delivered.Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strengths and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews are useful because they define the strengths and limits of the evidence, clarifying whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about systematic reviews, see/reference/purpose.cfm.AHRQ expects that Comparative Effectiveness Reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. In addition, AHRQ is committed to presenting information in different formats so that consumers who make decisions about their own and their family’s health can benefit from the evidence. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site () to see draft research questions and reports or to join an e-mail list to learn about new program products and opportunities for input. Comparative Effectiveness Reviews will be updated regularly.AcknowledgmentsWe would like to thank the Effective Health Care Scientific Resource Center, located at Oregon Health & Science University, for assisting in communicating with stakeholders and ensuring consistency of methods and format.We would like to acknowledge Di Valentine, J.D., Catherine Cruz, B.A., and Rena Garland, B.A., for assistance in abstraction of adverse events data.Technical Expert PanelMark S. Bauer, M.D., Brown University, Providence Veterans Affairs Medical Center, Providence, RIBarbara Curtis, R.N., M.S.N., Washington State Department of Corrections, Olympia, WACarol Eisen, L.A. County Department of Mental Health, Los Angeles, CABruce Kagan, M.D., Ph.D., UCLA Psychiatry and Biobehavioral Science – Neuropsychiatric Institute, Los Angeles, CAJamie Mai, Pharm.D., Office of the Medical Director, Tumwater, WAAlexander L. Miller, M.D., University of Texas, Department of Psychiatry, Health Science Center at San Antonio, San Antonio, TXAdelaide S. Robb, M.D., Children’s National Medical Center, Department of Psychiatry, Washington, DCCharles Schulz, M.D., University of Minnesota, Department of Psychiatry, Minneapolis, MNSarah J. Spence, M.D., Ph.D., UCLA, Autism Evaluation Clinic, Los Angeles, CA David Sultzer, M.D., UCLA and VA Greater L.A. Healthcare System, Department. of Psychiatry and Biobehavioral Sciences, Los Angeles, CAAHRQ ContactsBeth A. Collins-Sharp, Ph.D., R.N. Margaret Coopey, M.P.S., M.G.A., R.N. Director Task Order OfficerEvidence-based Practice Center Program Evidence-based Practice Center Program Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Agency for Healthcare Research and Quality Quality Rockville, MDRockville,MDContentsExecutive Summary (1)Introduction (11)Background (11)Scope and Key Questions (15)Methods (17)Topic Development (17)Search Strategy (17)Technical Expert Panel (18)Study Selection (18)Data Abstraction (18)Adverse Events (20)Quality Assessment (20)Applicability (21)Rating the Body of Evidence (21)Data Synthesis (22)Peer Review (24)Results (25)Literature Flow (25)Key Question 1: What are the leading off-label uses of antipsychotics in the literature? (28)Key Question 2: What does the evidence show regarding the effectiveness of antipsychotics for off-label indications, such as depression? How doantipsychotic medications compare with other drugs for treating off-labelindications? (28)Dementia (28)Depression (32)Obsessive-Compulsive Disorder (37)Posttraumatic Stress Disorder (40)Personality Disorders (43)Tourette’s Syndrome (47)Autism (50)Sensitivity Analysis (51)Publication Bias (51)Key Question 3: What subset of the population would potentially benefit from off-label uses? (52)Key Question 4: What are the potential adverse effects and/or complicationsinvolved with off-label antipsychotic prescribing? (52)Key Question 5: What is the appropriate dose and time limit for off-label indications? (62)Summary and Discussion (63)Limitations (63)Conclusions (64)Future Research (69)References (71)TablesTable 1. Efficacy outcomes abstracted (19)Table 2. Pooled results of placebo-controlled trials of atypical antipsychotics for patients with dementia and behavioral disturbances or agitation (29)Table 3. Trials of atypical antipsychotics as augmentation therapy for major depression (33)Table 4. Placebo-controlled trials of atypical antipsychotics as augmentation for obsessive compulsive disorder (39)Table 5. Posttraumatic Stress Disorder (42)Table 6. Personality Disorders (46)Table 7. Tourette’s Syndrome (49)Table 8. Cardiovascular adverse events among dementia patients – Atypical Antipsychotics Compared to Placebo (55)Table 9. Neurological adverse events among dementia patients – Atypical Antipsychotics Compared to Placebo (55)Table 10. Urinary adverse events among dementia patients – Atypical Antipsychotics Compared to Placebo (56)Table 11. Summary of Evidence – Efficacy (65)Table 12. Summary of adverse event and safety findings for which there is moderate or strong evidence (67)FiguresFigure 1. Literature flow (26)Figure 2. Pooled analysis of the effect of atypical antipsychotic medications versus placebo on “response” in patients with obsessive compulsive disorder (40)AppendixesAppendix A. Exact Search StringsAppendix B. Data Collection FormsAppendix C. Evidence and Quality TablesAppendix D. Excluded ArticlesAppendix E. Adverse Event AnalysisEfficacy and Comparative Effectiveness of Off-Label Use of Atypical AntipsychoticsExecutive SummaryThe Effective Health Care Program was initiated in 2005 to provide valid evidence about the comparative effectiveness of different medical interventions. The object is to help consumers, health care providers, and others in making informed choices among treatment alternatives. Through its Comparative Effectiveness Reviews, the program supports systematic appraisals of existing scientific evidence regarding treatments for high-priority health conditions. It also promotes and generates new scientific evidence by identifying gaps in existing scientific evidence and supporting new research. The program puts special emphasis on translating findings into a variety of useful formats for different stakeholders, including consumers.The full report and this summary are available at/reports/final.cfmBackgroundolanzapine, quetiapine, risperidone, and ziprasidone are atypical antipsychotics Aripiprazole,approved by the U.S. Food and Drug Administration (FDA) for treatment of schizophrenia and bipolar disorder. These drugs have been studied for off-label use in the following conditions: dementia and severe geriatric agitation, depression, obsessive-compulsive disorder, posttraumatic stress disorder, and personality disorders. The atypicals have also been studied for the management of Tourette’s syndrome and autism in children. The purpose of this report is to review the scientific evidence on the safety and effectiveness of such off-label uses.The Key Questions were:Key Question 1. What are the leading off-label uses of atypical antipsychotics in theliterature?Key Question 2. What does the evidence show regarding the effectiveness of atypicalantipsychotics for off-label indications, such as depression? How do atypical antipsychotic medications compare with other drugs for treating off-label indications?Key Question 3. What subset of the population would potentially benefit from off-label uses?Key Question 4. What are the potential adverse effects and/or complications involved with off-label prescribing of atypical antipsychotics?Key Question 5. What are the appropriate dose and time limit for off-label indications?ConclusionsEvidence on the efficacy of off-label use of atypical antipsychotics is summarized in Table A. Table B summarizes findings on adverse events and safety.Leading off-label uses of atypical antipsychotics•The most common off-label uses of atypical antipsychotics found in the literature were treatment of depression, obsessive-compulsive disorder, posttraumatic stress disorder,personality disorders, Tourette's syndrome, autism, and agitation in dementia. In October 2006, the FDA approved risperidone for the treatment of autism.Effectiveness and comparison with other drugsDementia-agitation and behavioral disorders• A recent meta-analysis of 15 placebo-controlled trials found a small but statistically significant benefit for risperidone and aripiprazole on agitation and psychosis outcomes.The clinical benefits must be balanced against side effects and potential harms. See“Potential adverse effects and complications” section.•Evidence from this meta-analysis shows a trend toward effectiveness of olanzapine for psychosis; results did not reach statistical significance. The authors found three studies of quetiapine; they were too dissimilar in their design and the outcomes studied to pool.• A large head-to-head placebo controlled trial (Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer’s Disease; CATIE-AD) concluded there were nodifferences in time to discontinuation of medication between risperidone, olanzapine,quetiapine, and placebo. Efficacy outcomes favored risperidone and olanzapine, andtolerability outcomes favored quetiapine and placebo.•We found no studies of ziprasidone for treatment of agitation and behavioral disorders in patients with dementia.•Strength of evidence = moderate for risperidone, olanzapine, and quetiapine; low for aripiprazole.Depression•We identified seven trials where atypical antipsychotics were used to augment serotonin reuptake inhibitor (SRI) treatment in patients with initial poor response to therapy, twostudies in patients with depression with psychotic features, and four trials in patients with depression with bipolar disorder.•For SRI-resistant patients with major depressive disorder, combination therapy with an atypical antipsychotic plus an SRI antidepressant is not more effective than an SRI alone at 8 weeks.•In two trials enrolling patients with major depressive disorder with psychotic features, olanzapine and olanzapine plus fluoxetine were compared with placebo for 8 weeks.Neither trial indicated a benefit for olanzapine alone. In one trial, the combination group had significantly better outcomes than placebo or olanzapine alone, but the contribution of olanzapine cannot be determined, as the trial lacked a fluoxetine-only comparison arm.•For bipolar depression, olanzapine and quetiapine were superior to placebo in one study for each drug, but data are conflicting in two other studies that compared atypicalantipsychotics to conventional treatment.•We found no studies of aripiprazole for depression.•Strength of evidence = moderate strength of evidence that olanzapine, whether used as monotherapy or augmentation, does not improve outcomes at 8 weeks in SRI-resistantdepression; low strength of evidence for all atypical antipsychotics for other depression indications due to small studies, inconsistent findings, or lack of comparisons to usualtreatment.Obsessive-compulsive disorder (OCD)•We identified 12 trials of risperidone, olanzapine, and quetiapine used as augmentation therapy in patients with OCD who were resistant to standard treatment.•Nine trials were sufficiently similar clinically to pool. Atypical antipsychotics have a clinically important benefit (measured by the Yale-Brown Obsessive-Compulsive Scale) when used as augmentation therapy for patients who fail to adequately respond to SRItherapy. Overall, patients taking atypical antipsychotics were 2.66 times as likely to“respond” as placebo patients (95-percent confidence interval (CI): 1.75 to 4.03).Relative risk of “responding” was 2.74 (95-percent CI: 1.50 to 5.01) for augmentationwith quetiapine and 5.45 (95-percent CI: 1.73 to 17.20) for augmentation withrisperidone. There were too few studies of olanzapine augmentation to permit separatepooling of this drug.•We found no trials of ziprasidone or aripiprazole for obsessive-compulsive disorder.•Strength of evidence = moderate for risperidone and quetiapine; low for olanzapine due to sparse and inconsistent results.Posttraumatic stress disorder (PTSD)•We found four trials of risperidone and two trials of olanzapine of at least 6 weeks duration in patients with PTSD.•There were three trials enrolling men with combat-related PTSD; these showed a benefit in sleep quality, depression, anxiety, and overall symptoms when risperidone orolanzapine was used to augment therapy with antidepressants or other psychotropicmedication.•There were three trials of olanzapine or risperidone as monotherapy for women with PTSD; the evidence was inconclusive regarding efficacy.•We found no studies of quetiapine, ziprasidone, or aripiprazole for PTSD.•Strength of evidence = low for risperidone and olanzapine for combat-related PTSD due to sparse data; very low for risperidone or olanzapine for treating non-combat-relatedPTSD.Personality disorders•We identified five trials of atypical antipsychotic medications as treatment for borderline personality disorder and one trial as treatment for schizotypal personality disorder.•Three randomized controlled trials (RCTs), each with no more than 60 subjects, provide evidence that olanzapine is more effective than placebo and may be more effective than fluoxetine in treating borderline personality disorder.•The benefit of adding olanzapine to dialectical therapy for borderline personality disorder was small.•Olanzapine caused significant weight gain in all studies.•Risperidone was more effective than placebo for the treatment of schizotypal personality disorder in one small 9-week trial.•Aripiprazole was more effective than placebo for the treatment of borderline personality in one small 8-week trial.•We found no studies of quetiapine or ziprasidone for personality disorders.•Strength of evidence = very low due to small effects, small size of studies, and limitations of trial quality (e.g., high loss to followup).Tourette’s syndrome•We found four trials of risperidone and one of ziprasidone for treatment of Tourette’s syndrome.•Risperidone was more effective than placebo in one small trial, and it was at least as effective as pimozide or clonidine for 8 to 12 weeks of therapy in the three remainingtrials.•The one available study of ziprasidone showed variable effectiveness compared to placebo.•We found no studies of olanzapine, quetiapine, or aripiprazole for Tourette’s syndrome.•Strength of evidence = low for risperidone; very low for ziprasidone.Autism•Just before this report was published, the FDA approved risperidone for use in autism.•Two trials of 8 weeks duration support the superiority of risperidone over placebo in improving serious behavioral problems in children with autism. The first trial showed agreater effect for risperidone than placebo (57-percent decrease vs. 14-percent decrease in the irritability subscale of the Aberrant Behavior Checklist). In the second trial, morerisperidone-treated than placebo-treated children improved on that subscale (65 percentvs. 31 percent).•We found no trials of olanzapine, quetiapine, ziprasidone, or aripiprazole for this indication.•Strength of evidence = low.Population that would benefit most from atypical antipsychotics •There was insufficient information to answer this question. It is included as a topic for future research.Potential adverse effects and complications•There is high-quality evidence that olanzapine patients are more likely to report weight gain than those taking placebo, other atypical antipsychotics, or conventionalantipsychotics. In two pooled RCTs of dementia patients, olanzapine users were 6.12times more likely to report weight gain than placebo users. In a head-to-head trial ofdementia patients, olanzapine users were 2.98 times more likely to gain weight thanrisperidone patients. In the CATIE trial, elderly patients with dementia who were treatedwith olanzapine, quetiapine, or risperidone averaged a monthly weight gain of 1.0, 0.7, and 0.4 pounds while on treatment, compared to a weight loss among placebo-treated patients of 0.9 pounds per month. Even greater weight gain relative to placebo has been reported in trials of non-elderly adults.•In two pooled RCTs for depression with psychotic features, olanzapine patients were 2.59 times as likely as those taking conventional antipsychotics to report weight gain.•In a recently published meta-analysis of 15 dementia treatment trials, death occurred in3.5 percent of patients randomized to receive atypical antipsychotics vs. 2.3 percent ofpatients randomized to receive placebo. The odds ratio for death was 1.54, with a 95-percent CI of 1.06 to 2.23. The difference in risk for death was small but statistically significant. Sensitivity analyses did not show evidence for differential risks forindividual atypical antipsychotics. Recent data from the DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network suggest that conventionalantipsychotics are also associated with an increased risk of death in elderly patients with dementia, compared to placebo.•In another recently published meta-analysis of six trials of olanzapine in dementia patients, differences in mortality between olanzapine and risperidone were notstatistically significant, nor were differences between olanzapine and conventionalantipsychotics.•In our pooled analysis of three RCTs of elderly patients with dementia, risperidone was associated with increased odds of cerebrovascular accident compared to placebo (odds ratio (OR): 3.88; 95-percent CI: 1.49 to 11.91). This risk was equivalent to 1 additional stroke for every 31 patients treated in this patient population (i.e., number needed to harm of 31). The manufacturers of risperidone pooled four RCTs and found thatcerebrovascular adverse events were twice as common in dementia patients treated with risperidone as in the placebo patients.•In a separate industry-sponsored analysis of five RCTs of olanzapine in elderly dementia patients, the incidence of cerebrovascular adverse events was three times higher inolanzapine patients than in placebo patients.•We pooled three aripiprazole trials and four risperidone trials that reported extrapyramidal side effects (EPS) in elderly dementia patients. Both drugs wereassociated with an increase in EPS (OR: 2.53 and 2.82, respectively) compared toplacebo. The number needed to harm was 16 for aripiprazole and 13 for risperidone.•Ziprasidone was associated with an increase in EPS when compared to placebo in a pooled analysis of adults with depression, PTSD, or personality disorders (OR: 3.32; 95-percent CI: 1.12 to 13.41).•In the CATIE trial, risperidone, quetiapine, and olanzapine were each more likely to cause sedation than placebo (15-24 percent vs. 5 percent), while olanzapine andrisperidone were more likely to cause extrapyramidal signs than quetiapine or placebo(12 percent vs. 1-2 percent). Cognitive disturbance and psychotic symptoms were morecommon in olanzapine-treated patients than in the other groups (5 percent vs. 0-1percent).•There is insufficient evidence to compare atypical with conventional antipsychotics regarding EPS or tardive dyskinesia in patients with off-label indications.•Risperidone was associated with increased weight gain compared to placebo in our pooled analyses of three trials in children/adolescents. Mean weight gain in therisperidone groups ranged from 2.1 kg to 3.9 kg per study. Odds were also higher forgastrointestinal problems, increased salivation, fatigue, EPS, and sedation among theseyoung risperidone patients.•Compared to placebo, all atypicals were associated with sedation in multiple pooled analyses for all psychiatric conditions studied.Appropriate dose and time limit•There was insufficient information to answer this question. It is a topic for future research.Remaining IssuesMore research about how to safely treat agitation in dementia is urgently needed. The CATIE-AD study has substantially added to our knowledge, but more information is still necessary. We make this statement based on the prevalence of the condition and uncertainty about the balance between risks and benefits in these patients. While the increased risk of death in elderly dementia patients treated with atypical antipsychotics was small, the demonstrable benefits in the RCTs were also small. Information is needed on how the risk compares to risks for other treatments.An established framework for evaluating the relevance, generalizability, and applicability of research includes assessing the participation rate, intended target population, representativeness of the setting, and representativeness of the individuals, along with information about implementation and assessment of outcomes. As these data are reported rarely in the studies we reviewed, conclusions about applicability are necessarily weak. In many cases, enrollment criteria for these trials were highly selective (for example, requiring an open-label run-in period). Such highly selective criteria may increase the likelihood of benefit and decrease the likelihood of adverse events. At best, we judge these results to be only modestly applicable to the patients seen in typical office-based care.With few exceptions, there is insufficient high-grade evidence to reach conclusions about the efficacy of atypical antipsychotic medications for any of the off-label indications, either vs. placebo or vs. active therapy.More head-to-head trials comparing atypical antipsychotics are needed for off-label indications other than dementia.IntroductionBackgroundAntipsychotic medications, widely used for the treatment of schizophrenia and other psychotic disorders, are commonly divided into two classes, reflecting two waves of historical development. The conventional antipsychotics--also called typical antipsychotics, conventional neuroleptics, or dopamine antagonists--first appeared in the 1950s and continued to evolve over subsequent decades, starting with chlorpromazine (Thorazine), and were the first successful pharmacologic treatment for primary psychotic disorders, such as schizophrenia. While they provide treatment for psychotic symptoms - for example reducing the intensity and frequency of auditory hallucinations and delusional beliefs - they also commonly produce movement abnormalities, both acutely and during chronic treatment, arising from the drugs’ effects on the neurotransmitter dopamine. These side effects often require additional medications, and in some cases, necessitate antipsychotic dose reduction or discontinuation. Such motor system problems spurred the development of the second generation of antipsychotics, which have come to be known as the “atypical antipsychotics.”Currently, the U.S. Food and Drug Administration (FDA)-approved atypical antipsychotics are aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. Off-label use of the atypical antipsychotics has been reported for the following conditions: dementia and severe geriatric agitation, depression, obsessive-compulsive disorder, posttraumatic stress disorder, and personality disorders. The purpose of this Evidence Report is to review the evidence supporting such off-label uses of these agents. We were also asked to study the use of the atypical antipsychotics for the management of Tourette’s Syndrome and autism in children. The medications considered in this report are those listed above; however, we have excluded clozapine, which has been associated with a potentially fatal disorder of bone-marrow suppression and requires frequent blood tests for safety monitoring. Because of these restrictions, it is rarely used except for schizophrenia that has proven refractive to other treatment. Dementia and Severe Geriatric AgitationDementia is a disorder of acquired deficits in more than one domain of cognitive functioning. These domains are memory, language production and understanding, naming and recognition, skilled motor activity, and planning and executive functioning. The most common dementias – Alzheimer’s and vascular dementia - are distinguished by their cause. Alzheimer’s dementia occurs with an insidious onset and continues on a degenerative course to death after 8 to10 years; the intervening years are marked by significant disturbances of cognitive functioning and behavior, with severe debilitation in the ability to provide self-care. Vascular dementia refers to deficits of cognitive functioning that occur following either a cerebrovascular event – a stroke – leading to a macrovascular dementia, or, alternatively, more diffusely located changes in the smaller blood vessels, leading to a microvascular dementia. These (and other) dementia types commonly co-occur. Psychotic symptoms are frequent among dementia patients and include。

溴吡斯的明引起重症肌无力患者心肌梗死的1例报告并文献复习

溴吡斯的明引起重症肌无力患者心肌梗死的1例报告并文献复习

J Apoplexy and Nervous Diseases, Nov. 2023, Vol 40,No. 11溴吡斯的明引起重症肌无力患者心肌梗死的1例报告并文献复习周丽枝, 胡云, 周礼鑫, 童理, 杨剑文摘要: 重症肌无力是一种自身免疫性疾病,通常由针对神经肌肉接头处的乙酰胆碱受体的抗体介导,其常见的治疗有胆碱酯酶抑制剂,例如溴吡斯的明。

该药物在治疗过程中出现心血管事件较少见,但在临床中早期识别病情变化并警惕重症肌无力患者可能出现的心血管事件非常重要。

因此,我们报道重症肌无力老年女性患者继发于抗胆碱酯酶治疗导致急性心肌梗死并发心源性猝死的病例,并基于此病例对发生心血管不良事件的可能原因进行讨论。

关键词: 重症肌无力; 急性心肌梗死; 溴吡斯的明; 胆碱酯酶抑制剂中图分类号:R741 文献标识码:APyridostigmine bromide causes myocardial infarction in myasthenia gravis : a case report and literature reviewZHOU Lizhi ,HU Yun ,ZHOU Lixin , et al.(The First Affiliated Hospital of Hunan Normal University , Changsha 410005, China )Abstract : Myasthenia gravis is an autoimmune disease ,which is usually mediated by antibodies to acetylcholine re⁃ceptors at the neuromuscular junction. It is commonly treated with cholinesterase inhibitors such as pyridostigmine bro⁃mide. Although cardiovascular events with the drug are rare ,it is very important to early recognize disease changes and be alert to potential cardiovascular events in patients with myasthenia gravis. Therefore , we report a case of an elderly female patient with myasthenia gravis developing acute myocardial infarction and then sudden cardiac death following anticholines⁃terase therapy , and discuss the possible causes of adverse cardiovascular events based on this case.Key words : Myasthenia gravis ; Myocardial infarction ; Pyridostigmine bromide ; Cholinesterase inhibitor重症肌无力(myasthenia ,MG )是一种自身免疫性疾病,通常由针对神经肌肉接头处的乙酰胆碱受体的抗体介导,其特征临床表现为骨骼肌无力和易疲劳[1]。

最新理论试题及答案英语

最新理论试题及答案英语

最新理论试题及答案英语一、选择题(每题1分,共10分)1. The word "phenomenon" is most closely related to which of the following concepts?A. EventB. FactC. TheoryD. Hypothesis答案:C2. In the context of scientific research, what does the term "hypothesis" refer to?A. A proven factB. A testable statementC. A final conclusionD. An unverifiable assumption答案:B3. Which of the following is NOT a characteristic of scientific theories?A. They are based on empirical evidence.B. They are subject to change.C. They are always universally applicable.D. They are supported by a body of evidence.答案:C4. The scientific method typically involves which of the following steps?A. Observation, hypothesis, experimentation, conclusionB. Hypothesis, observation, conclusion, experimentationC. Experimentation, hypothesis, observation, conclusionD. Conclusion, hypothesis, observation, experimentation答案:A5. What is the role of experimentation in the scientific process?A. To confirm a hypothesisB. To disprove a hypothesisC. To provide evidence for or against a hypothesisD. To replace the need for a hypothesis答案:C6. The term "paradigm shift" in the philosophy of science refers to:A. A minor change in scientific theoryB. A significant change in the dominant scientific viewC. The process of scientific discoveryD. The end of scientific inquiry答案:B7. Which of the following is an example of inductive reasoning?A. Observing a pattern and making a general ruleB. Drawing a specific conclusion from a general ruleC. Making a prediction based on a hypothesisD. Testing a hypothesis through experimentation答案:A8. Deductive reasoning is characterized by:A. Starting with a specific observation and drawing a general conclusionB. Starting with a general rule and applying it to a specific caseC. Making assumptions without evidenceD. Relying on intuition rather than logic答案:B9. In scientific research, what is the purpose of a control group?A. To provide a baseline for comparisonB. To test an alternative hypothesisC. To increase the number of participantsD. To confirm the results of previous studies答案:A10. The principle of falsifiability, introduced by Karl Popper, suggests that:A. Scientific theories must be proven trueB. Scientific theories must be able to withstand attempts at being disprovenC. Scientific theories are never wrongD. Scientific theories are always based on personal beliefs答案:B二、填空题(每题1分,共5分)1. The scientific method is a systematic approach to__________ knowledge through observation, experimentation, and __________.答案:gaining; logical reasoning2. A scientific law is a statement that describes a__________ pattern observed in nature, while a scientific theory explains the __________ behind these patterns.答案:recurring; underlying principles3. The process of peer review in scientific publishing is important because it helps to ensure the __________ and__________ of research findings.答案:validity; reliability4. In the context of scientific inquiry, an __________ is a tentative explanation for an aspect of the natural world that is based on a limited range of __________.答案:hypothesis; observations5. The term "empirical" refers to knowledge that is based on __________ and observation, rather than on theory or__________.答案:experimentation; speculation三、简答题(每题5分,共10分)1. Explain the difference between a scientific theory and a scientific law.答案:A scientific theory is a well-substantiated explanation of some aspect of the natural world, based on a body of facts that have been repeatedly confirmed through observation and experimentation. It is a broad framework that can encompass multiple laws and observations. A scientific law, on the other hand, is a concise verbal or mathematical statement that describes a general pattern observed in nature. Laws summarize specific phenomena, while theories explain the broader principles behind those phenomena.2. What is the significance of the falsifiability criterionin the philosophy of science?答案:The falsifiability criterion, proposed byphilosopher of science Karl Popper, is significant because it provides a way to distinguish between scientific and non-scientific theories. For a theory to be considered scientific, it must be testable and potentially refutable by empirical evidence. This criterion ensures that scientific theories are open。

英文:坏的习惯会影响你的大脑

英文:坏的习惯会影响你的大脑

The New Theory On Weight Loss: Your Bad Diet Has Damaged Your BrainYou’ve tried and tried to lose weight, but it just doesn’t happen. Or you lose a bit, then gain it back with a vengeance. Sound familiar?Recently, while reporting a story on 3 new supplements studied for weight loss, I had the opportunity to speak with nationally known obesity expert Louis Aronne, M.D., Director of the Comprehensive Weight-Control Program at New York-Presbyterian HospitalAccording to Aronne, scientists are finally finding answers to the mystery that has stumped them for so long: Why do some people seem to find it impossible to lose weight, despite numerous serious attempts to get slim using diets and exercise?And what they’ve discovered might surprise you: Years of eating – and overeating – the typical American diet actually changes the brain. More specifically, it damages the signaling pathways in the hypothalamus, the part of the brain that regulates metabolism.“The evidence is quite convincing – eating fattening foods causes inflammatory cells to go into the hypothalamus, ” explains Aronne. “This overloads the neurons and causes neurological damage.”A groundbreaking study in the British Journal of Nutrition published in February, 2013 is one example of the kind of high-quality, on-target research that’s proving the theory of hypothalamic damage and thus paving the way to new weight loss strategies, Aronne says.A team of scientists at the University of Liverpool analyzed a body of research that included studies of different weight loss diets. What they found was that a diet high in saturated fat and simple carbohydrates sets in motion a chain reaction of “metabolic dysfunction” involving the appetite regu lating hormones leptin and ghrelin. (Leptin’s job is to suppress appetite, ghrelin’s to increases it.) In addition, a fatty high-carb diet resulted in “alterations in structural plasticity” – i.e. brain changes.Over time, consuming too many calories from fat and simple sugars damages the nerves that conduct signals through the hypothalamus, affecting thefunction of leptin and ghrelin, and thus the body’s ability to regulate weight and metabolism, says Aronne. “Because of this damage, the signals don’t get through about how much fat is stored.”In other words, your brain has gone haywire and you can no longer trust the messages it’s sending you about appetite, hunger, and fullness. “It’s like your gas gauge points to empty all the time, whether or not the t ank is full, ” says Aronne. “So you keep stopping for gas, and then eventually you start filling up gas cans and storing them in the back of your car because you’re so convinced you could run out of gas at any moment.”So What Does Work for Weight Loss?Ch ange your diet, and change it fast. “It’s about biology, ” Aronne is fond of saying. While some damage to the hypothalamus may be permanent, it’s possible to reverse much of it. “If less fatty food comes in, it reduces the rate of damage, ” he explains, noting that it doesn’t matter so much which specific diet you follow, as long as it’s one that cuts calories, reduces fat, and reduces simple carbohydrates.Of course, there are lots of trendy diets, such as the Fast Diet currently making headlines. And ther e’s no reason not to try a new approach and see if it works better for you than the ones you’ve tried in the past. But work with your body, not against it, Aronne says, and the weight will come off much faster.But wait, there’s more. Retooling your diet t o be rich in health-promoting foods can stop and even reverse the damage done by an unhealthy one. In the above-mentioned study at the University of Liverpool, the researchers also looked at the impact of omega-3 fatty acids, known to be beneficial to brain health. And sure enough, fish oil appears to modulate some of the negative effects of the saturated fats and carbs.What that means, in effect, is that switching to a healthy diet can heal the hypothalamic damage that’s playing havoc with your hunger and satiety cues. Not surprisingly, Aronne has authored his own diet book (with coauthor Alisa Bowman), The Skinny: The Ultimate Guide to Weight Loss Success (2010). It features lean meat, plenty of seafood, lots of vegetables and fruit, and unprocessed grain s. There’s also more information on Aronne and his views on brain signaling and weight loss available on the Weill Cornell Medical College website.But here’s secret number two: Permanent weight loss takes time. Aronne is quick to point out that many of th ose who’ve dropped massive amounts of weight on The Biggest Loser have gained most of it back again within a year ortwo. Once again, science suggests the problem is that it takes time for thebrain’s metabolic messaging system to heal.Weight Loss Medications May HelpIf you’re in the group of people who’ve tried (really tried) controlling yourweight with diet and exercise, Aronne says it’s worth considering taking aprescription weight loss medication. Doing so can reset your brain to begin healing the hypothalamic damage. The two new diet drugs that just entered the market, Qsymia (formerly Qnexa) and Belviq, have the potential to do this, Aronne says.“Qsymia supports neuropeptide Y, amplifying the signals that come from the hypothalamus, ” Aronne says, adding that Belviq (lorcaserin) and the migraine drug Topamax also have a beneficial effect on brain signaling. In other words, these drugs at least partially fix the broken gas gauge.Along with being overweight comes insulin and leptin resistance, Aronne says.“When inflammatory cells go into the hypothalamus, they prevents leptin –which signals to the brain that the stomach is full from getting in, ” Aronne says. Among other things, Belviq stimulates the effect of leptin, Aronne says.“We don’t know exactly how it works, but it’s possible the mechanisms are hypothalamic. Belviq appears to amplify signals that go to the critical area of injury.”Now I know I’ve reported in the past on concerns about side effects fromQsymia and Belviq. Qsymia has been looked at for potential heart valvedamage because phentermine, one of the two drugs in the combination, was part of the notorious Fen Phen diet drug combo that caused serious heartvalve damage in the 1980s and early 90s.But from Aronne’s perspective, the drugs have been studied very thoroughly and these concerns are unfounded. And more importantly, the seriousness of the health problems – and the increased risk of death – associated withobesity outweigh the risks of the drugs.n. 机制;原理,途径;进程;机械装置;技巧∙appetite['æpitait]videon. 食欲;嗜好∙reset[,ri:'set, 'ri:set]videovi. 重置;清零vt. 重置;重新设定;重新组合n. 重新设定;重新组合;重排版∙overeat[,əuvə'ri:t]videovt. 使吃过量vi. 吃得过多n. 药物;药物治疗;药物处理∙pathway['pɑ:θwei,'pæθ-]videon. 路,道;途径,路径∙insulin['insjulin, 'insə-]videon. [生化][药] 胰岛素∙stimulate['stimjuleit]videovt. 刺激;鼓舞,激励vi. 起刺激作用;起促进作用∙saturate['sætʃəreit, 'sætʃərit]videovt. 浸透,使湿透;使饱和,使充满adj. 浸透的,饱和的;深颜色的∙analyze['ænəlaiz]videovt. 对…进行分析,分解(等于analyse)。

证据分析英语作文带翻译

证据分析英语作文带翻译

证据分析英语作文带翻译标题,Evidence-based Analysis: A Key to Effective English Writing。

Evidence-based analysis is an essential skill in English writing, allowing writers to support their arguments with credible information and logical reasoning. In this essay, we will delve into the significance of evidence-based analysis in English writing, explore its benefits, and provide examples to illustrate its effectiveness.首先,证据分析在英语写作中的重要性不言而喻。

一个有力的论点需要有可靠的证据来支撑,而不仅仅是作者的主观看法。

通过引用权威来源、统计数据、案例分析等可靠证据,作者能够使自己的观点更具说服力,从而增强读者对其立场的认同感。

First and foremost, the importance of evidence-based analysis in English writing cannot be overstated. A compelling argument requires reliable evidence to supportit, rather than just the subjective opinions of the author. By citing authoritative sources, statistical data, case studies, and other credible evidence, writers can maketheir points more convincing, thereby enhancing readers' sense of agreement with their stance.其次,证据分析有助于提高写作的逻辑性和连贯性。

An Investigation of the Effects of the

An Investigation of the Effects of the

An Investigation of the Effects of the Core Protein Telomerase Reverse Transcriptase on Wnt Signaling in Breast Cancer CellsImke Listerman,Francesca S.Gazzaniga,Elizabeth H.BlackburnDepartment of Biochemistry and Biophysics,University of California at San Francisco,San Francisco,California,USATelomerase canonically maintains telomeres,but recent reports have suggested that the core protein mammalian telomerase reverse transcriptase(TERT)component,together with the chromatin remodeling factor BRG1and␤-catenin,may also bind to and promote expression of Wnt target genes.However,this proposed noncanonical role of TERT in Wnt signaling has been con-troversial.Here,we investigated the effects of human TERT(hTERT)on Wnt signaling in human breast cancer lines and HeLa cells.We failed tofind evidence for physical association of hTERT with BRG1or␤-catenin;instead,we present evidence that anti-FLAG antibody cross-reactivity properties may explain the previously reported interaction of hTERT with␤-catenin.Fur-thermore,altering hTERT levels in four different breast cancer cell lines caused minimal and discordant effects on Wnt target and Wnt pathway gene expression.Although hTERT’s role in Wnt signaling was addressed only indirectly,no significant repre-sentation of Wnt target genes was detected in chromatin immunoprecipitation-sequencing(ChIP-seq)and chromatin isolation by RNA purification and sequencing(ChIRP-seq)loci cooccupied in HeLa S3cells by both BRG1and hTR.In summary,our evi-dence fails to support the idea of a biologically consistent hTERT interaction with the Wnt pathway in human breast cancer cells, and any detectable influence of hTERT depended on cell type and experimental system.T he mammalian telomerase ribonucleoprotein complex adds TTAGGG repeats to telomeres,the ends of linear chromo-somes.The core human telomerase contains the catalytic reverse transcriptase protein component(hTERT)and the telomerase RNA(called hTR,hTER,or hTERC)that provides the template for telomeric DNA synthesis(1).In most human somatic cells, telomerase expression is very low.In contrast,telomerase expres-sion is upregulated in many human cancer cells and stem cells(2). In human cancer cells,the degree of telomerase expression seems higher than would appear necessary solely for maintaining telo-mere length.In fact,many studies suggest telomere-independent roles for telomerase.We and others have shown that overexpres-sion of TERT protects cells in culture from apoptosis indepen-dently of the telomere-lengthening properties of telomerase(3–5).Furthermore,overexpression of mouse and human TERT promotes cell proliferation in stem,normal,and cancer cell lines (6–11).Experiments employing overexpression or reduced ex-pression of hTERT in cells in culture have suggested roles for hTERT in controlling expression of growth factor response and other genes(9,12).Gene expression changes have been reported to occur as soon as1week after ectopic hTERT overexpression(9). Taken together,these results strongly suggest nontelomeric roles for telomerase;however,the mechanisms by which telomerase might protect against apoptosis and promote proliferation remain largely unknown.Some previous studies have linked TERT expression and Wnt/␤-catenin signaling,here referred to as Wnt signaling(13–15). The Wnt signaling pathway plays a central role in development, stem cell renewal,and cancer.In the absence of Wnt signaling, cytoplasmic␤-catenin is bound by destruction complex proteins, including AXIN,adenomatous polyposis coli(APC),and glyco-gen synthase kinase3beta(GSK3B).Consequently,␤-catenin is phosphorylated and degraded by the ubiquitin-proteasome path-way.When secreted Wnt proteins bind to Frizzled and low-den-sity lipoprotein receptor-related proteins(LRPs)at the plasma membrane,a signal is transduced to destabilize the␤-catenin de-struction complex.␤-Catenin can then translocate to the nucleus, where it complexes with T-cell factor/lymphoid enhancer factor (TCF/LEF)transcription factors to promote target gene transcrip-tion(16).The Wnt pathway has been previously shown to upregu-late telomerase in mouse mammary tumors and human cells(17, 18).Furthermore,␤-catenin may contribute to telomerase up-regulation in stem and cancer cells by directly regulating TERT expression via binding to the TERT promoter in complex with Klf4,as previously reported in a study of mouse adult stem cells and human carcinoma lines NTera2and SW480(15).Reciprocally,Park et al.previously suggested that TERT ex-pression promotes Wnt signaling(13).In that study,TERTϪ/Ϫknockout mice in thefirst generation were reported to have devel-opmental defects such as homeotic transformations of the vertebrae.Such defects,occurring before the onset of significant telomere shortening,resembled effects of aberrant Wnt signaling. Those authors additionally reported protein-protein interactions between hTERT and the chromatin remodeling factor BRG1and between hTERT and␤-catenin.It was also reported that TERT overexpression upregulated expression of a Wnt luciferase re-porter in TERTϪ/Ϫand TRϪ/Ϫmouse embryonicfibroblasts (MEFs)and humanfibroblast(BJ)cells and that,in SW-13and HeLa cancer cells,TERT overexpression hyperactivated a Wnt signaling reporter in a BRG1-dependent manner(13).Consistent with these results,Hrdlickováet al.reported increased prolifera-tion and a slight but significant increase in Wnt reporter activation Received28June2013Returned for modification6August2013Accepted4November2013Published ahead of print11November2013Address correspondence to Elizabeth H.Blackburn,Elizabeth.Blackburn@.I.L.and F.S.G.contributed equally to this article.Copyright©2014,American Society for Microbiology.All Rights Reserved.doi:10.1128/MCB.00844-13 Molecular and Cellular Biology p.280–289January2014Volume34Number2upon overexpression of either hTERT or a catalytically incompe-tent hTERT splice variant,in both U2OS(telomerase-deficient) and HeLa(telomerase-positive)cell lines(19).BRG1has been reported to bind to␤-catenin and to promote␤-catenin target gene expression(20,21).Because many growth-promoting genes are␤-catenin targets and because Wnt signaling plays an impor-tant role in self-renewal,proliferation,and survival,these reports suggested that TERT,in concert with BRG1,might promote cell proliferation via Wnt signaling.An influence of TERT on Wnt signaling has not been consis-tently reproduced in other experimental settings.Strong et al.did not detect homeotic transformations or diminished Wnt re-porter activity in TERTϪ/Ϫknockout mice or mouse embry-onicfibroblasts(MEFs)derived from these mice(22).The dis-crepancies between the two mouse TERTϪ/Ϫknockout studies could have been due to slightly different experimental condi-tions,such as different mouse backgrounds and/or Wnt signal-ing activators(13,22).Alternatively,the TERT overexpression system that identified a Wnt pathway interaction(13)may not produce a biologically relevant phenotype.While Strong et al. disputed a TERT/Wnt signaling interaction in mice and MEFs (22),they did not address a possible TERT/Wnt signaling in-teraction in human cancer cells.The primary aim of the present study was to determine whether hTERT promotes or otherwise affects Wnt signaling in cultured human breast cancer cells.Wnt signaling is often dys-regulated in breast cancer(23).Furthermore,either TERT over-expression or Wnt activation leads to mammary tumorigenesis in mice(23,24).We therefore focused on breast cancer cell lines to further study the potential for biologically relevant TERT/Wnt signaling interactions.MATERIALS AND METHODSCell lines.HeLa cells were purchased from the American Type Culture Collection(ATCC)and grown in Dulbecco’s modified Eagle’s medium (DMEM)with10%fetal bovine serum(FBS),1%penicillin-streptomy-cin,and1%GlutaMax(Invitrogen).HCC3153,HCC1806,SUM149PT, and MCF10A cells were obtained from the laboratory of Joe W.Gray, Oregon Health and Sciences University.HCC3153and HCC1806cells were grown in RPMI medium with10%FBS,1%penicillin-streptomycin, and1%GlutaMax(Invitrogen).SUM149PT cells were grown in Ham’s F-12medium with5%FBS,0.01mg/ml insulin,500ng/ml hydrocorti-sone,and1%penicillin-streptomycin.MCF10A cells were grown in DMEM–F-12with5%horse serum,20ng/ml epidermal growth factor, 100ng/ml cholera toxin,0.01mg/ml insulin,500ng/ml hydrocortisone, and1%penicillin-streptomycin.All cell lines were grown at37°C with5% CO2.Light microscopy.The HCC3153,HCC1806,SUM149PT,and MCF10A cell lines were grown on chamber slides(Lab-Tek II154526)and treated with25mM LiCl or200ng/ml Wnt3a(5036-WN-010/CF;R&D Systems)for4h.Cells werefixed in2%paraformaldehyde–phosphate-buffered saline(PBS)and permeabilized with0.5%NP-40–PBS.Immu-nostaining was performed with anti-␤-catenin antibody clone14(BD Biosciences)followed by secondary Alexa Fluor488(Molecular Probes). DNA was visualized with4=,6-diamidino-2-phenylindole(DAPI;Invitro-gen).Images were acquired in0.5-␮m increments using a Deltavision RT deconvolution microscope(Applied Precision)with a100ϫ/1.40N PlanApo objective(Olympus).Images were deconvolved,Z-projected in Softworx(Applied Precision),and then adjusted for brightness and con-trast in FIJI(25).cDNA generation and qPCR.Total RNA was extracted with a Qiagen RNeasy minikit from cells treated with25mM LiCl,200ng/ml Wnt3a,or PBS for4h.cDNA synthesis was performed using2␮g RNA,random hexamers,and SuperScript III(Invitrogen).cDNA was amplified in10-␮l reaction mixtures containing LightCycler480DNA SYBR green I Master (Roche Applied Science)and a0.5to1␮mol/literfinal concentration of each primer using a Light Cycler480instrument(Roche Applied Science). The cycling conditions were95°C for5min,50cycles of95°C for10s and 60°C for20s,and72°C for20s.A melting curve(65to98°C)was gener-ated at the end of each run.Relative expression levels were determined by the2Ϫ⌬⌬CT method(26)and were normalized to GAPDH(glyceralde-hyde-3-phosphate dehydrogenase).AXIN2forward(5=-CATGTTCGTC ATGGGTGTGAACCA-3=)and AXIN2reverse(5=-TGGCTGGTGCAAA GACATAG-3=)and GAPDH forward(5=-CATGTTCGTCATGGGTGTG AACCA-3=)and GAPDH reverse(5=-ATGGCATGGACTGTGGTCATG AGT-3=)primers were used.For Wnt target gene expression analysis,cell lines were transduced with control or wild-type hTERT lentivirus pHR=cytomegalovirus(CMV)-hTERT-internal ribosome entry site (IRES)-PURO and selected with1␮g(HCC1806and SUM149PT)or2␮g (HCC3153)puromycin for3days and allowed to recover for1to2days. Cells were treated with25mM LiCl for6h,following total RNA extraction using an RNeasy kit(Qiagen)and cDNA generation using an RT2First Strand kit(Qiagen)according to the manufacturer’s instructions.A total of84Wnt target genes were measured using quantitative PCR(qPCR) human Wnt signaling target arrays(PAHS-243G;SABiosciences)accord-ing to the manufacturer’s instructions.A minimum cutoff of a2.5-fold change compared to control results was used to determine significant gene changes.Wnt luciferase reporter assays.The M50Super TOPFLash and M51 Super FOPFlash luciferase reporter vectors were obtained from Addgene (27).pRL-TK Renilla luciferase was used as an internal control(Invitro-gen).The lentivirus plasmids pBARL(␤-catenin activated reporter lucif-erase)and pfuBARL(mutated pBARL)and pSL9/rLuc(Renilla luciferase) were obtained from the laboratory of Randall Moon,University of Wash-ington(28).Cells were seeded on96-well microplates(655083;Greiner Bio-One),and each well was transiently transfected with0.5pg pRL-TK control along with either50pg SUPER TOPFLash or50pg mutated FOPFLash and with either10pg empty vector or10pg pcDNA3-FLAG-hTERT using X-tremeGene HP(Roche)and treated or not treated with25 mM LiCL for24h,followed by cell lysis with passive lysis buffer(Pro-mega)for10min and analysis using a dual-luciferase reporter assay sys-tem(Promega).Firefly and Renilla luciferases were read with a Veritas Microplate Luminometer(Turner Biosystems).Lentivirus production and transduction were carried out as previously described(28).Stable cell lines expressing reporter Renilla luciferase,pBARL,or pfuBARL lentivirus were generated as reported previously(28),using the same titer of lenti-virus in all cell lines.Then,cell lines were transduced with either control or hTERT lentivirus(28),selected with puromycin,treated with25mM LiCl for24h,and analyzed as described above.Background luciferase readings were subtracted,andfirefly luciferase values were normalized to Renilla luciferase.RNA interference(RNAi).Lentivirus expressing short hairpin RNAs (shRNAs)against␤-catenin(5=-CCGGAGGTGCTATCTGTCTGCTCT ACTCGAGTAGAGCAGACAGATAGCACCTTTTTT-3=;29),hTERT (5=-GGAGACCACGTTTCAAAAGTCTCTTGAACTTTTGAAACGTGG TCTCC-3=),and scramble shRNA(5=-GTTCTACAACGTAACGAGGTT TCTCTTGAAAACCTCGTTACGTTGTAGAAC-3=;30)was generated as described previously(30).Cells were transduced with shRNA and control vector lentivirus and were selected with1␮g/ml puromycin for3days and then expanded.IP and Western blotting.HeLa cells were transfected with pcDNA3 constructs containing wild-type hTERT with one N-terminal FLAG tag using Lipofectamine2000(Invitrogen)for18h,followed by treatment with25mM LiCl for6h.The following antibodies were used:anti-FLAG (M2;Sigma F3165and F1804),anti-BRG1(H-88;Santa Cruz),anti-␤-catenin(clone14)(610153;Transduction Laboratories),and anti-GAPDH(MAB374;EMD Millipore).Cell lysis and immunoprecipitationhTERT Effects on Wnt Signaling in Breast Cancer281(IP)procedures and immunoblotting were done as described previously (13),using Western Lightning Plus ECL(PerkinElmer)for detection of horseradish peroxidase-conjugated secondary antibodies and Gamma-Bind G Sepharose(GE Healthcare Life Sciences)for preclearing and IP.Bioinformatics analysis.We determined the union of published BRG1-and hTR-enriched regions identified by chromatin immunopre-cipitation-sequencing(ChIP-seq)and chromatin isolation by RNA puri-fication and sequencing(ChIRP-seq),respectively,in HeLa S3cells(31, 32)and merged any united regions that were separated byՅ100bp using the ChIPPeakAnno R package(33).Enriched gene sets were obtained through use of the Genomic Regions Enrichment of Annotations Tool (GREAT)(34)on all145genomic regions.Gene ontology(GO)terms were identified using DAVID(35,36).RESULTSEndogenous Wnt signaling competency varies among the basal breast cancer cell lines SUM149PT,HCC1806,HCC3153,and MCF10A.One immortalized breast cell line with low telomerase activity and three basal breast cancer cell lines with midrange to high levels of telomerase activity(MCF10A[lower telomerase ac-tivity level],HCC3153[midrange telomerase activity level],and SUM149PT and HCC1806[higher telomerase activity levels]) were selected(4).First,to determine the extent of Wnt signaling in the breast cancer cell lines,we induced Wnt signaling with Wnt3a or LiCl.Wnt3a activates the pathway at the cell surface receptor level and specifically induces␤-catenin signaling by binding to Frizzled and LRP receptors(37).LiCl pharmacologically inhibits GSK3B kinase activity in the cytoplasm,thus leaving␤-catenin un-phosphorylated and stabilized(38).Under control conditions,both SUM149PT and HCC3153cells showed diffuse cytoplasmic and nuclear␤-catenin staining,suggesting that they may have had dysregulated Wnt signaling,which is found frequently in breast cancers(39).Upon Wnt3a orLiCl treatment,SUM149PT and HCC3153cells showed strongernuclear localization of␤-catenin(Fig.1A).In accordance with theincreased nuclear localization of␤-catenin in those cells,bothtreatments increased the expression of the endogenous AXIN2␤-catenin target gene(Fig.1B).In contrast,in HCC1806cells,␤-catenin was largely membrane bound and remained so even after LiCl or Wnt3a treatment(Fig.1A).Consistent with thesefindings,HCC1806cells did not significantly upregulate AXIN2after Wnt signaling induction(Fig.1B).In MCF10A cells,␤-catenin was also largely membrane bound but showed weak nuclear localization after LiCl or Wnt3A treatment(Fig.1A),and AXIN2was moderately upregulated(Fig.1B).These results sug-gest that HCC1806cells are not competent for Wnt signaling in-duction by LiCl or Wnt3A.We conclude that Wnt signaling can be activated in SUM149PT and HCC3153lines,and somewhat less in MCF10A cells,but at most minimally in HCC1806cells.hTERT overexpression has minimal and nonconcordant ef-fects on Wnt signaling reporters in breast cancer cell lines.Hav-ing established that HCC3153,SUM149PT,and MCF10A but notHCC1806cancer cells can strongly to moderately activate Wntsignaling,we tested whether hTERT overexpression modulatedWnt signaling reporter genes in these lines,as has been reportedfor MEFs,HeLa cells,and U2OS cells(13,19).For independentFIG1Endogenous Wnt/␤-catenin target gene induction varies in breast cancer cell lines.(A)Cell lines SUM149PT(high telomerase),HCC3153(medium telomerase),HCC1806(high telomerase),and MCF10A(low telomerase)were treated with PBS,25mM LiCl,or200ng/ml Wnt3a for4h prior to staining for ␤-catenin(green)and DAPI(blue).(B)The increase in Wnt/␤-catenin target gene AXIN2mRNA expression over that of PBS control-treated cells was measuredby qRT-PCR following activation with Wnt3a or LiCl for4h.Listerman et al. Molecular and Cellular Biologyverification,we employed two different Wnt signaling reporter construct systems with multimerized TCF/LEF binding sites driv-ing luciferase expression:the M50Super TOPFlash reporter and its corresponding control M51Super FOPFlash Wnt reporter(27) and the BARL(␤-catenin activated reporter luciferase)/fuBARL (control)system(28).While TOPFlash contains7TCF/LEF bind-ing sites and was transiently expressed via plasmid transfection, BARL contains12TCF/LEF binding sites and was stably inte-grated.Vector or hTERT plasmids were cotransfected together with TOPFlash/FOPFlash in SUM149PT,HCC5313,HCC1806, MCF10A,and HeLa cells,followed by LiCl treatment(Fig.2A).As expected,LiCl treatment strongly increased luciferase activity in the vector-transfected TOPFlash SUM149PT,HCC3153, MCF10A,and HeLa cells.LiCl treatment induced the luciferase activity in HCC1806cells only weakly,with maximum luciferase expression being5-to100-fold lower than in the other four cell lines,consistent with our observations(Fig.1),indicating that HCC1806cells are severely impaired in Wnt signaling.Further-more,only HCC3153cells exhibited a statistically significant but mild(ϳ1.4-fold)increase in relative luciferase activity over that of the vector control,while the relative luciferase activity did not change significantly compared to that of vector controls in SUM149PT,HCC1806,MCF10A,or HeLa cells.In the pBARL cells,overexpressing hTERT increased luciferase activity over that of the vector control cells only in HCC3153cells(byϳ2-fold) (Fig.2B).Overexpression of hTERT did not detectably change the luciferase activity in SUM149PT,HCC1806,or MCF10A cell lines expressing pBARL.In HeLa cells that stably expressed the TCF/ LEF mutant(control)binding site construct,fuBARL,with hTERT overexpression,we observed anϳ3-fold increase in lucif-erase activity over that of control cells.However,in HeLa cells stably expressing BARL,there was an onlyϳ2-fold increase in luciferase activity in hTERT-overexpressing cells over that of control cells(Fig.2B).Hence,hTERT overexpression activated luciferase expression regardless of the presence or absence of a functional TCF/LEF promoter in HeLa cells.Because hTERT overexpression led to mild hyperactivation of both Wnt signaling reporters only in HCC3153cells and not in the four other cell lines,we conclude that Wnt reporter hyperactivation through hTERT is dependent on the context.Hence,hTERT does not hy-peractivate Wnt reporters universally but instead does so in a cellline-and context-dependent manner.Lack of evidence for hTERT interaction with␤-catenin orBRG1in HeLa cells.Since Park et al.(13)reported that FLAG-hTERT in HeLa cells coimmunoprecipitated(co-IP)with BRG1,aprotein previously reported to interact with␤-catenin(13,20),wealso investigated hTERT/Wnt pathway interactions using HeLacells.To independently verify the previously published results(13),we transiently overexpressed FLAG-hTERT in LiCl-treatedHeLa cells and tested whether BRG1or␤-catenin interacted withFLAG-hTERT by coimmunoprecipitation(co-IP).Interestingly,using the same buffers as described by Park et al.(13)and thenon-affinity-isolated version of anti-FLAG antibody M2(F3165;Sigma)for IP,we observed a strong band migrating slightly slowerthan the␤-catenin band in Western blots(M2lanes in Fig.3A)when the FLAG-IP Western blot was stained with the␤-cateninantibody.Importantly,we also observed the same band in similarquantities independently of whether FLAG-hTERT was expressedin the HeLa cells(M2lanes in Fig.3A)and using a variety ofwashing procedures in the IP and Western blot experiments.Weextended these experiments using the affinity-isolated anti-FLAGM2antibody(F1804;Sigma),which,while it did not enrich forthis background band,instead detected another band of the ex-pected size for␤-catenin at low levels(1.7-fold over IgG control IPresults)that again were identical regardless of whether FLAG-hTERT was expressed(Fig.3B).We verified the identity of thiscross-reacting coimmunoprecipitated protein band as␤-cateninby RNAi:reducing␤-catenin expression produced correspondingreductions in the intensity of the band pulled down by the affinity-purified M2antibody co-IP experiments(Fig.3C).Thus,we didnot detect a significant or specific interaction between hTERT and ␤-catenin in HeLa cells above the background signals caused by anti-FLAG antibody ing the same antibodiesand IP buffers as Park et al.(13),we were also unable to detect aninteraction between overexpressed FLAG-hTERT and endoge-nous BRG1,despite obtaining high signals corresponding toFLAG-hTERT itself with the FLAG antibodies used(Fig.3B).In addition,we were able to detect only a weak interaction,atbest,between endogenous levels of BRG1and␤-catenin;suchan interaction has previously been reported only in a BRG1FIG2Effect of hTERT overexpression on two Wnt/␤-catenin reporters.(A)SUM149PT,HCC3153,HCC1806,MCF10A,and HeLa cells were transiently transfected with pRL-TK Renilla luciferase vector(internal control),hTERT or vector,and M50SuperTOPFlash or M51SuperFOPFlash reporter vectors and treated or not treated with25mM LiCl for24h prior to luciferase measurement.*,PϽ0.05.(B)Cell lines were transduced with pSL9/rLuc,pBARL,or pfuBARL and either hTERT or vector control lentivirus and selected for stable expression prior to LiCl treatment and luciferase measurement.hTERT Effects on Wnt Signaling in Breast Cancer 283overexpression context(20).We conclude,first,that the en-dogenous expression levels of BRG1in HeLa cells were too low to detect strong interactions with␤-catenin in our experi-ments,second,that M2anti-FLAG antibody cross-reacts with a protein with a gel mobility close to that of␤-catenin,and third, that the interaction of FLAG-hTERT with BRG1or with ␤-catenin was not significantly above background IP levels.BRG1and hTR do not colocalize at Wnt target genes.In hu-man cells,the hTERT protein and the telomerase RNA hTR,to-gether with additional proteins,assemble to form the telomerase ribonucleoprotein complex,although it has not been determined what fractions of the total levels of hTERT and hTR exist in these complexes.Previously,Chu et al.(31)used whole-genome chro-matin isolation by RNA purification(ChIRP)in HeLa S3cells to detect hTR associated with chromatin at2,198genomic locations in HeLa S3cells.Those authors additionally reported that the hTR-bound peaks they had identified were significantly enriched at loci of genes in the“Wnt receptor signaling pathway”gene ontology(GO)term and on this basis proposed that hTR in com-plex with hTERT cooccupies Wnt target genes(31).Given the evidence described above that a previously reported interaction between hTERT and␤-catenin protein can be explained by cross-reactivity of anti-FLAG antibody rather than a bonafide interac-tion,we used a bioinformatics approach to reexamine any poten-tial connection between the published genomic localizations of BRG1cross-linked sites,telomerase RNA cross-linked sites,and Wnt signaling genes.To identify loci on the HeLa S3genome enriched for localization sites of both BRG1and hTR(with hTR inferred to likely be in complex with hTERT,as was described previously[31]),we merged the published BRG1-enriched local-ization sites identified by ChIP-seq in HeLa S3cells(32)and the published hTR-enriched localization sites(31).We applied the criterion that they were separated byՅ100bp,as the same crite-rion was previously used to determine cooccupancy of BRG1with other members of the SWI/SNF complex at genomic loci(32). Using this criterion,217genes in the vicinity of the merged BRG1/ hTR-enriched loci were identified.However,while“Positive reg-ulation of apoptosis”was identified as a highly significant GO term among these217genes,Wnt signaling was not identified as a significant GO term(Table1).Of the217genes,only MYC is known to be a target gene of Wnt signaling.Thus,this analysis in HeLa S3cells(applying the criterion of peak separation no greater than100bp)failed to verify any significant cooccupancy by hTR and BRG1of Wnt target genes or their nearby controlling regionsFIG3hTERT does not interact with␤-catenin or BRG1.(A)Anti-␤-catenin antibody cross-reacts with anti-FLAG immunoprecipitate.HeLa cells were either transfected with pcDNA3-FLAG-hTERT for16h(left)or left untransfected(right),followed by treatment with25mM LiCl or no LiCl treatment.Precipitates from anti-␤-catenin(clone14)or anti-FLAG(M2antibody F3165,Sigma)IP were subjected to Western blotting(WB)with anti-␤-catenin(clone14)or anti-FLAG antibodies.The asterisk indicates a slower-migrating background band.(B)Top:Western blot of HeLa cells transfected with FLAG-hTERT(right hand side)or left untransfected(left hand side)following IP with specific antibodies.M indicates size marker lane.Bottom:Western blot of input samples from experiment.(C)Top:Western blot of HeLa cells treated with or without␤-catenin shRNA following IP with specific antibodies.Bottom:Western blot of input samples from the experiment.Listerman et al. Molecular and Cellular Biologyexcept for MYC.This analysis does not directly address hTERT and BRG1cooccupancy on chromatin genomic loci.However, because some fractions of hTERT and hTR exist as telomerase complexes in HeLa S3cells,colocalization of hTR with BRG1at Wnt signaling gene loci might be predicted if hTERT protein and BRG1protein interact,as suggested previously(31).Our negative finding for hTR and BRG1cooccupancy at Wnt signaling gene loci thus does not support,but by itself does not refute,the possibility of interaction between hTERT and BRG1.Effects of hTERT overexpression on Wnt signaling target gene expression in cell lines do not reflect cellular Wnt signaling competency.While our bioinformatics data analysis did not iden-tify a significant overlap of Wnt pathway genes with genomic loci cross-linkable to hTR and BRG1in HeLa cells,this analysis did not exclude the possibility that TERT,possibly not bound to hTR,still promotes Wnt signaling.To test directly whether hTERT modu-lates endogenous Wnt signaling target gene expression in breast cancer cells,we stably overexpressed hTERT in the high-Wnt-signaling SUM149PT and HCC3153cells and,as a control,in the Wnt-signaling-impaired HCC1806cells.We then measured the mRNA levels of84endogenous Wnt downstream target genes supplied as arrays for quantitative RT-PCR(qRT-PCR)(see Ma-terials and Methods).First,with hTERT overexpression(Fig.4C), the Wnt-signaling-competent SUM149PT cells showed a modest overall trend to greater expression of the Wnt target genes as a group compared with vector controls;however,this trend was no greater than that seen for the Wnt-signaling-impaired HCC1806TABLE1Significant GO terms for genes close to BRG1and hTR co-occupied loci in HeLa S3genomeGene GO term P valueGO:0043065Positive regulation of apoptosis0.005GO:0006928Cell motion0.025GO:0051693Actinfilament capping0.027GO:0007028Cytoplasm organization0.035GO:0006917Induction of apoptosis0.035GO:0048146Positive regulation offibroblast proliferation0.037GO:0030834Regulation of actinfilament depolymerization0.040GO:0033043Regulation of organelle organization0.043GO:0032272Negative regulation of protein polymerization0.045GO:0032271Regulation of protein polymerization0.046FIG4Effect of hTERT overexpression on Wnt target gene expression in breast cancer cell lines.SABiosciences qPCR arrays were used to measure the effect of hTERT overexpression on the mRNA expression of endogenous Wnt target genes after treatment with25mM LiCl for6h.(A)Scatter plots of log-transformed relative expression levels of each gene.Red lines indicate a2.5-fold change in gene expression.(B)Wnt target genes that changedϮ2.5-fold compared to the control results(indicated by dotted line)upon hTERT overexpression in SUM149PT,HCC1806,and HCC3153cells.(C)hTERT mRNA expression relative to GAPDH mRNA and vector control expression in SUM149PT,HCC1806,and HCC3153.Bars represent means of the results of3(SUM149PT and HCC1806)and 2(HCC3153)biological replicates.Error bars indicate standard deviations(SD).hTERT Effects on Wnt Signaling in Breast Cancer 285。

药学英语TEXT A

药学英语TEXT A

Unit1 text A急性缺血性中风的神经保护药物开发的艰辛安全有效的治疗急性缺血性中风的发展仍然是临床研究者和制药行业困难的挑战。

目前,只有急性脑卒中的试验,表明出明确的疗效,是重组组织型纤溶血酶激活剂(rt-PA)试验在美国进行的时间为3小时的病人登记。

在这项研究中的rt-PA组的改善结果导致该药物在美国的治疗急性缺血性中风发病3小时内批准。

利用rt-PA在急性缺血性中风3小时的窗口和其他严格的标准限制了其使用急性缺血性中风人口的比例很小。

出血的风险的担忧,以及如何最好地瞄准这一有效的,但潜在的风险治疗已征收的另一个障碍,它的广泛使用。

RT-PA治疗急性缺血性中风在这个时候,只使用在美国监管机构批准,但这种情况可能很快改变,可能有效的时间窗口,等待第二个欧洲合作急性脑卒中试验结果(ECAST-2)RT-PA。

RT-PA的可用性显然只是在寻求有效的急性中风治疗和溶栓治疗以外的其他介入战略的第一步,必须考虑,其他急性中风治疗的主要方法是,旨在干预后,众多的神经保护治疗细胞和代谢事件发生在缺血区作为一个阻碍脑血管血栓的后果。

神经保护策略之一是抑制和中性粒细胞的招聘活动,因为这是显而易见的,这些炎症的白血细胞被招募到局部缺血区域,并有可能导致组织损伤的进展。

在动物中风模型,干扰多形核白细胞粘附疗法可以减少在临时局部缺血再灌注后梗死面积。

永久阻塞中风模型,有一点如果有证据表明,这些干预措施是有效的。

施耐德等。

报告的剂量递增安全与恩莫单抗,抗小鼠单克隆抗体,在32例急性缺血性中风患者的研究结果。

随后,恩莫单抗接受一个更大的药效试验。

不幸的是,在这个药效试验恩莫单抗被证明是无效的和相关的死亡率增加的速度和功能比安慰剂治疗结果较差。

什么样的安全性试验的意见可能会影响药效试验的设计和实施所遇到的困难可能避免吗?此外,有什么教训,从这个可能了解到,以改善未来急性缺血性中风的神经保护药物开发的安全性试验?这一剂量递增安全性研究是在一个开放标签的方式进行,只有总额的32例,4剂量层之间没有平衡。

早期安定干预对匹罗卡品诱导颞叶癫痫小鼠学习记忆能力变化的影响

早期安定干预对匹罗卡品诱导颞叶癫痫小鼠学习记忆能力变化的影响
安定对照( C组) 正常对照( 组) D
潜伏 期() s
4 . 5 1. 3 67 ± 1 2 #
2.3 9 8 ±5 3 . 6* 1.9 2 3 ±2 5 .3 1.2 O 1 土2 4 .7
1 l 贾丽景 , 王维平 , 刘瑞 春, 美 金刚对 戊 四氮致痫 大 鼠空间 学习 等. 记忆能力 的影响 及其 机 制F ] J.广 东 医学 , 0 0 1 0 ) 7 — 2 1 ,3 ( 2 :10
卡品腹腔注射所致 的小鼠颞 叶癫痫 , 具有操作 简单 、 复性好 、 重 受外界干扰小等优点 [ 。由于 PL 3 ] IO颞叶癫痫小 鼠的海马和杏 仁核 受损 , 我们 推测其 学习记忆功 能可能受到 损害。但 早期 安 定抑 制其 点燃效应 是否影 响造 模程 度及学 习记 忆功能 目前未 见相关 文献报道 , 实验采用氯化锂——匹罗卡 品建 立 IR小 本 C 鼠颞 叶癫痫模型 , 此基础 之上 早期使 用安 定麻 醉干预 , 用 在 运 Mor 水迷 宫实验系统 , ri s 从行 为学角 度探讨 抑制 PL I O诱 导癫 痫的首次 点燃对学习记忆能力 的影 响效果 。
腔注射 ,0mg・ g 。 1 k_ 。
1 2 方 法 .
症 , 时短暂 , 多次 突 然发 作 , 患者 和家 庭 带来 极 大 的痛 历 可 给 苦 [ 。P L 1 I O诱导 的癫痫 动物模 型是一种 比较成 熟的颞 叶癫 痫 ] 模型, 国际上广 泛用于颞 叶癫 痫的研 究L。而氯化 锂—— 匹罗 2 ]
摘 要 目的: 研究早期使用安定麻醉对匹罗卡品( IO 诱导的颞叶癫痫小鼠的学习记忆能力的变化, PL ) 从行为学角度评价
抑制 点燃效应对颞叶癫痫造模程度 的影 响。方法 : 腔注射 P L 建立颞 叶癫痫 小鼠模型 , P L 腹 IO 分 I 0癫痫组 ( 组) 安 定麻 醉条 件 A 、 下 PL I 0癫痫组( B组) 安 定麻 醉对 照组 ( 、 C组) 正常 对照组 ( 组) 对 照组 腹腔 注射 与 P L , D , I O等 量的 生理 盐水 。各 组 小 鼠进 行 Mor 水迷 宫学 习记 忆 实验 , ri s 测其寻找到 隐藏平 台所需潜伏期 。结果 : ri 水迷 宫实验 中, Mors A组癫痫 小鼠逃避潜伏期 时 间明显 延 长( P<O 0 ) B组癫痫 小鼠第一 次癫痫发作程度 有大幅度的减 轻 , 避潜伏期 时间延长 , 延 长时间较正 常情 况下点燃 癫痫 小鼠 .5 , 逃 但

基因检测确诊肯尼迪病一例并文献复习

基因检测确诊肯尼迪病一例并文献复习

Advances in Clinical Medicine 临床医学进展, 2023, 13(8), 12221-12225 Published Online August 2023 in Hans. https:///journal/acm https:///10.12677/acm.2023.1381711基因检测确诊肯尼迪病一例并文献复习杨欣雨1,郝延磊2,王玉忠3,李若林3*1济宁医学院临床医学院,山东 济宁 2泰康宁波医院神经内科,浙江 宁波3济宁医学院附属医院神经内科,山东 济宁收稿日期:2023年7月1日;录用日期:2023年7月25日;发布日期:2023年8月1日摘要 肯尼迪病(Kennedy’s disease, KD)是一种罕见的X 连锁隐性遗传性下运动神经元疾病,以进行性双下肢无力为主要特征,可伴有雄激素不敏感症状和内分泌受累症状。

本文报道1例KD 病例,该患者进行性双下肢无力,肌肉萎缩、跳动,伴舌肌萎缩,肌酶增高,肌电图显示感觉、运动神经均受累。

经基因检测检出患者雄激素受体基因(androgen receptor, AR)中CAG 重复数为47,为致病型。

现将该患者的诊疗经过、家属基因分析进行总结。

关键词肯尼迪病,脊髓延髓肌萎缩症,基因检测,CAGA Case of Kennedy Disease Confirmed by Genetic Testing and Literature ReviewXinyu Yang 1, Yanlei Hao 2, Yuzhong Wang 3, Ruolin Li 3*1Clinical Medicine, Jining Medical University, Jining Shandong 2Department of Neurology, Taikang Ningbo Hospital, Ningbo Zhejiang 3Department of Neurology, Affiliated Hospital of Jining Medical University, Jining Shandong Received: Jul. 1st , 2023; accepted: Jul. 25th , 2023; published: Aug. 1st , 2023AbstractKennedy’s disease (KD) is a rare X-linked recessive lower motor neuron disease characterized by progressive lower limb weakness, and it may be accompanied by androgen insensitivity and en-*通讯作者。

最新欧盟反倾销规则

最新欧盟反倾销规则

COUNCIL REGULATION (EC) No 1225/2009of 30 November 2009on protection against dumped imports from countries not members of the European Community(codified version)THE COUNCIL OF THE EUROPEAN UNION,Having regard to the Treaty establishing the European Commu­nity, and in particular Article 133 thereof,Having regard to Council Regulation (EC) No 1234/2007 of 22 October 2007 establishing a common organisation of agricul­tural markets and on specific provisions for certain agricultural products (Single CMO Regulation)(1) OJ L 299, 16.11.2007, p. 1. (1),Having regard to the proposal from the Commission,Whereas:(1)Council Regulation (EC) No 384/96 of 22 December 1995 on protection against dumped imports from countries not members of the European Community (2) OJ L 56, 6.3.1996, p. 1. (2), has been sub­stantially amended several times (3) See Annex I.(3). In the interests of clar­ity and rationality the said Regulation should be codified.(2)The multilateral trade negotiations concluded in 1994 led to new Agreements on the implementation of Article VI of the General Agreement on Tariffs and Trade (hereinafter referred to as ‘GATT’). In the light of the different nature of the new rules for dumping and subsidies respectively, it is also appropriate to have a separate body of Community rules in each of those two areas. Consequently, the rules on protection against subsidies and countervailing duties are contained in a separate Regulation.(3)The agreement on dumping, namely, the Agreement on Implementation of Article VI of the General Agreement on Tariffs and Trade 1994 (hereinafter referred to as ‘the 1994 Anti-Dumping Agreement’), contains detailed rules, relat­ing in particular to the calculation of dumping, procedures for initiating and pursuing an investigation, including the establishment and treatment of the facts, the imposition of provisional measures, the imposition and collection of anti-dumping duties, the duration and review of anti-dumping measures and the public disclosure of informa­tion relating to anti-dumping investigations. In order to ensure a proper and transparent application of those rules, the language of the agreement should be brought into Community legislation as far as possible.(4)In applying the rules it is essential, in order to maintain the balance of rights and obligations which the GATT Agree­ment establishes, that the Community take account of how they are interpreted by the Community’s major trading partners.(5)It is desirable to lay down clear and detailed rules on the calculation of normal value. In particular such value should in all cases be based on representative sales in the ordinary course of trade in the exporting country. It is expedient to give guidance as to when parties may be considered as being associated for the purpose of determining dumping. It is expedient to define the circumstances in which domes­tic sales may be considered to be made at a loss and may be disregarded, and in which recourse may be had to remaining sales, or to constructed normal value, or to sales to a third country. It is also appropriate to provide for a proper allocation of costs, even in start-up situations, and to lay down guidance as to the definition of start-up and the extent and method of allocation. It is also necessary, when constructing normal value, to indicate the method­ology to be applied in determining the amounts for sell­ing, general and administrative costs and the profit margin that should be included in such value.(6)When determining normal value for non-market economy countries, it appears prudent to set out rules for choosing the appropriate market-economy third country to be used for such purpose and, where it is not possible to find a suit­able third country, to provide that normal value may be established on any other reasonable basis.(7)It is appropriate for the Community’s anti-dumping prac­tice to take account of the changed economic conditions in Kazakhstan. In particular, it is appropriate to specify that normal value may be determined in accordance with the rules applicable to market economy countries in cases where it can be shown that market conditions prevail for one or more producers, subject to investigation in relation to the manufacture and sale of the product concerned.(8)It is also appropriate to grant similar treatment to imports from such countries which are members of the World Trade Organisation (WTO) at the date of the initiation of the relevant anti-dumping investigation.(9) It is appropriate to specify that an examination of whethermarket conditions prevail will be carried out on the basisof properly substantiated claims by one or more produc­ers subject to investigation who wish to avail themselves ofthe possibility to have normal value determined on thebasis of rules applicable to market economy countries.(10) It is expedient to define the export price and to enumeratethe adjustments which are to be made in those cases wherea reconstruction of this price from the first open-marketprice is deemed necessary.(11) For the purpose of ensuring a fair comparison betweenexport price and normal value, it is advisable to list the fac­tors which may affect prices and price comparability andto lay down specific rules as to when and how the adjust­ments should be made, including the fact that any dupli­cation of adjustments should be avoided. It is also necessaryto provide that comparison may be made using averageprices although individual export prices may be comparedto an average normal value where the former vary by cus­tomer, region or time period.(12) It is necessary to lay down clear and detailed guidance asto the factors which may be relevant for the determinationof whether the dumped imports have caused materialinjury or are threatening to cause injury. In demonstratingthat the volume and price levels of the imports concernedare responsible for injury sustained by a Community indus­try, attention should be given to the effect of other factorsand in particular prevailing market conditions in theCommunity.(13) It is advisable to define the term ‘Community industry’ andto provide that parties related to exporters may be excludedfrom such industry, and to define the term ‘related’. It isalso necessary to provide for anti-dumping action to betaken on behalf of producers in a region of the Commu­nity and to lay down guidelines on the definition of suchregion.(14) It is necessary to lay down who may lodge an anti-dumpingcomplaint, including the extent to which it should be sup­ported by the Community industry, and the informationon dumping, injury and causation which such complaintshould contain. It is also expedient to specify the proce­dures for the rejection of complaints or the initiation ofproceedings.(15) It is necessary to lay down the manner in which interestedparties should be given notice of the information whichthe authorities require, and should have ample opportunityto present all relevant evidence and to defend their inter­ests. It is also desirable to set out clearly the rules and pro­cedures to be followed during the investigation, inparticular the rules whereby interested parties are to makethemselves known, present their views and submit infor­mation within specified time-limits, if such views andinformation are to be taken into account. It is also appro­priate to set out the conditions under which an interestedparty may have access to, and comment on, informationpresented by other interested parties. There should also becooperation between the Member States and the Commis­sion in the collection of information.(16) It is necessary to lay down the conditions under which pro­visional duties may be imposed, including the conditionthat they may be imposed no earlier than 60 days from ini­tiation and no later than nine months thereafter. Foradministrative reasons, it is also necessary to provide thatsuch duties may in all cases be imposed by the Commis­sion, either directly for a nine-month period or in twostages of six and three months.(17) It is necessary to specify procedures for accepting under­takings which eliminate dumping and injury instead ofimposing provisional or definitive duties. It is also appro­priate to lay down the consequences of breach or with­drawal of undertakings and that provisional duties may beimposed in cases of suspected violation or where furtherinvestigation is necessary to supplement the findings. Inaccepting undertakings, care should be taken that the pro­posed undertakings, and their enforcement, do not lead toanti-competitive behaviour.(18) It is necessary to provide that the termination of casesshould, irrespective of whether definitive measures areadopted or not, normally take place within 12 months,and in no case later than 15 months, from the initiation ofthe investigation. Investigations or proceedings should beterminated where the dumping is de minimis or the injuryis negligible, and it is appropriate to define those terms.Where measures are to be imposed, it is necessary to pro­vide for the termination of investigations and to lay downthat measures should be less than the margin of dumpingif such lesser amount would remove the injury, as well asto specify the method of calculating the level of measuresin cases of sampling.(19) It is necessary to provide for retroactive collection of pro­visional duties if that is deemed appropriate and to definethe circumstances which may trigger the retroactive appli­cation of duties to avoid the undermining of the definitivemeasures to be applied. It is also necessary to provide thatduties may be applied retroactively in cases of breach orwithdrawal of undertakings.(20) It is necessary to provide that measures are to lapse afterfive years unless a review indicates that they should bemaintained. It is also necessary to provide, in cases wheresufficient evidence is submitted of changed circumstances,for interim reviews or for investigations to determinewhether refunds of anti-dumping duties are warranted. Itis also appropriate to lay down that in any recalculation ofdumping which necessitates a reconstruction of exportprices, duties are not to be treated as a cost incurredbetween importation and resale where the said duty isbeing reflected in the prices of the products subject to mea­sures in the Community.(21) It is necessary to provide specifically for the reassessmentof export prices and dumping margins where the duty isbeing absorbed by the exporter through a form of com­pensatory arrangement and the measures are not beingreflected in the prices of the products subject to measuresin the Community.(22) The 1994 Anti-Dumping Agreement does not containprovisions regarding the circumvention of anti-dumpingmeasures, though a separate GATT Ministerial Decisionrecognises circumvention as a problem and has referred itto the GATT Anti-dumping Committee for resolution.Given the failure of the multilateral negotiations so far andpending the outcome of the referral to the WTO Anti-Dumping Committee, it is necessary that Community leg­islation should contain provisions to deal with practices,including mere assembly of goods in the Community or athird country, which have as their main aim the circum­vention of anti-dumping measures.(23) It is also desirable to clarify which practices constitute cir­cumvention of the measures in place. Circumvention prac­tices may take place either inside or outside theCommunity. It is consequently necessary to provide thatexemptions from the extended duties which may alreadybe granted to importers may also be granted to exporterswhen duties are being extended to address circumventiontaking place outside the Community.(24) It is expedient to permit suspension of anti-dumping mea­sures where there is a temporary change in market condi­tions which makes the continued imposition of suchmeasures temporarily inappropriate.(25) It is necessary to provide that imports under investigationmay be made subject to registration upon importation inorder to enable measures to be applied subsequentlyagainst such imports.(26) In order to ensure proper enforcement of measures, it isnecessary that Member States monitor, and report to theCommission, the import trade of products subject to inves­tigation or subject to measures, and also the amount ofduties collected under this Regulation.(27) It is necessary to provide for consultation of an AdvisoryCommittee at regular and specified stages of the investiga­tion. The Committee should consist of representatives ofMember States with a representative of the Commission aschairman.(28) Information provided to Member States in the AdvisoryCommittee is often of a highly technical nature andinvolves an elaborate economic and legal analysis. In orderto provide Member States with sufficient time to considerthis information, it should be sent at an appropriate timebefore the date of a meeting set by the Chairman of theAdvisory Committee.(29) It is expedient to provide for verification visits to checkinformation submitted on dumping and injury, such visitsbeing, however, conditional on proper replies to question­naires being received.(30) It is essential to provide for sampling in cases where thenumber of parties or transactions is large in order to per­mit completion of investigations within the appointedtime-limits.(31) It is necessary to provide that where parties do not coop­erate satisfactorily other information may be used to estab­lish findings and that such information may be lessfavourable to the parties than if they had cooperated.(32) Provision should be made for the treatment of confiden­tial information so that business secrets are not divulged.(33) It is essential that provision be made for proper disclosureof essential facts and considerations to parties whichqualify for such treatment and that such disclosure bemade, with due regard to the decision-making process inthe Community, within a time-limit which permits partiesto defend their interests.(34) It is prudent to provide for an administrative system underwhich arguments can be presented as to whether measuresare in the Community interest, including the consumers’interest, and to lay down the time-limits within which suchinformation has to be presented as well as the disclosurerights of the parties concerned,HAS ADOPTED THIS REGULATION:Article 1Principles1. An anti-dumping duty may be applied to any dumped prod­uct whose release for free circulation in the Community causes injury.2. A product is to be considered as being dumped if its export price to the Community is less than a comparable price for the like product, in the ordinary course of trade, as established for the exporting country.3. The exporting country shall normally be the country of ori­gin. However, it may be an intermediate country, except where, for example, the products are merely transhipped through that country, or the products concerned are not produced in that country, or there is no comparable price for them in that country.4. For the purpose of this Regulation, ‘like product’ means a product which is identical, that is to say, alike in all respects, to the product under consideration, or in the absence of such a prod­uct, another product which, although not alike in all respects, has characteristics closely resembling those of the product under consideration.Article 2Determination of dumpingA. N ORMAL VALUE1. The normal value shall normally be based on the prices paid or payable, in the ordinary course of trade, by independent cus­tomers in the exporting country.However, where the exporter in the exporting country does not produce or does not sell the like product, the normal value may be established on the basis of prices of other sellers or producers. Prices between parties which appear to be associated or to have a compensatory arrangement with each other may not be consid­ered to be in the ordinary course of trade and may not be used to establish normal value unless it is determined that they are unaf­fected by the relationship.In order to determine whether two parties are associated account may be taken of the definition of related parties set out in Article 143 of Commission Regulation (EEC) No 2454/93 of 2 July 1993 laying down provisions for the implementation of Council Regulation (EEC) No 2913/92 establishing the Commu­nity Customs Code (1) OJ L 253, 11.10.1993, p. 1.(1).2. Sales of the like product intended for domestic consump­tion shall normally be used to determine normal value if such sales volume constitutes 5 % or more of the sales volume of the product under consideration to the Community. However, a lower volume of sales may be used when, for example, the prices charged are considered representative for the market concerned.3. When there are no or insufficient sales of the like product in the ordinary course of trade, or where because of the particularmarket situation such sales do not permit a proper comparison, the normal value of the like product shall be calculated on the basis of the cost of production in the country of origin plus a rea­sonable amount for selling, general and administrative costs and for profits, or on the basis of the export prices, in the ordinary course of trade, to an appropriate third country, provided that those prices are representative.A particular market situation for the product concerned within the meaning of the first subparagraph may be deemed to exist, inter alia, when prices are artificially low, when there is signifi­cant barter trade, or when there are non-commercial processing arrangements.4. Sales of the like product in the domestic market of the exporting country, or export sales to a third country, at prices below unit production costs (fixed and variable) plus selling, gen­eral and administrative costs may be treated as not being in the ordinary course of trade by reason of price, and may be disre­garded in determining normal value, only if it is determined that such sales are made within an extended period in substantial quantities, and are at prices which do not provide for the recov­ery of all costs within a reasonable period of time.If prices which are below costs at the time of sale are above weighted average costs for the period of investigation, such prices shall be considered to provide for recovery of costs within a rea­sonable period of time.The extended period of time shall normally be one year but shall in no case be less than six months, and sales below unit cost shall be considered to be made in substantial quantities within such a period when it is established that the weighted average selling price is below the weighted average unit cost, or that the volume of sales below unit cost is not less than 20 % of sales being used to determine normal value.5. Costs shall normally be calculated on the basis of records kept by the party under investigation, provided that such records are in accordance with the generally accepted accounting prin­ciples of the country concerned and that it is shown that the records reasonably reflect the costs associated with the produc­tion and sale of the product under consideration.If costs associated with the production and sale of the product under investigation are not reasonably reflected in the records of the party concerned, they shall be adjusted or established on the basis of the costs of other producers or exporters in the same country or, where such information is not available or cannot be used, on any other reasonable basis, including information from other representative markets.Consideration shall be given to evidence submitted on the proper allocation of costs, provided that it is shown that such allocations have been historically utilised. In the absence of a more appropri­ate method, preference shall be given to the allocation of costs on the basis of turnover. Unless already reflected in the cost alloca­tions under this subparagraph, costs shall be adjusted appropri­ately for those non-recurring items of cost which benefit future and/or current production.Where the costs for part of the period for cost recovery are affected by the use of new production facilities requiring substan­tial additional investment and by low capacity utilisation rates, which are the result of start-up operations which take place within or during part of the investigation period, the average costs for the start-up phase shall be those applicable, under the abovemen­tioned allocation rules, at the end of such a phase, and shall be included at that level, for the period concerned, in the weighted average costs referred to in the second subparagraph of para­graph 4. The length of a start-up phase shall be determined in relation to the circumstances of the producer or exporter con­cerned, but shall not exceed an appropriate initial portion of the period for cost recovery. For this adjustment to costs applicable during the investigation period, information relating to a start-up phase which extends beyond that period shall be taken into account where it is submitted prior to verification visits and within three months of the initiation of the investigation. 6. The amounts for selling, for general and administrative costs and for profits shall be based on actual data pertaining to produc­tion and sales, in the ordinary course of trade, of the like product, by the exporter or producer under investigation. When such amounts cannot be determined on this basis, the amounts may be determined on the basis of:(a) the weighted average of the actual amounts determined forother exporters or producers subject to investigation in respect of production and sales of the like product in the domestic market of the country of origin;(b) the actual amounts applicable to production and sales, in theordinary course of trade, of the same general category of products for the exporter or producer in question in the domestic market of the country of origin;(c) any other reasonable method, provided that the amount forprofit so established shall not exceed the profit normally rea­lised by other exporters or producers on sales of products of the same general category in the domestic market of the country of origin.7. (a)In the case of imports from non-market economy coun­tries (1) Including Azerbaijan, Belarus, North Korea, Tajikistan, Turkmenistan and Uzbekistan.(1), normal value shall be determined on the basis of the price or constructed value in a market economy third country, or the price from such a third country to other countries, including the Community, or where those are not possible, on any other reasonable basis, including the price actually paid or payable in the Community for the like product, duly adjusted if necessary to include a reasonable profit margin.An appropriate market economy third country shall be selected in a not unreasonable manner, due account being taken of any reliable information made available at the time of selection. Account shall also be taken of time-limits; where appropriate, a market economy third country which is subject to the same investigation shall be used.The parties to the investigation shall be informed shortly after its initiation of the market economy third country envisaged and shall be given 10 days to comment.(b)In anti-dumping investigations concerning imports from Kazakhstan and any non-market-economy country which is a member of the WTO at the date of the initiation of the investigation, normal value shall be determined in accor­dance with paragraphs 1 to 6, if it is shown, on the basis of properly substantiated claims by one or more producers subject to the investigation and in accordance with the cri­teria and procedures set out in subparagraph (c), that mar­ket economy conditions prevail for this producer or producers in respect of the manufacture and sale of the like product concerned. When this is not the case, the rules set out under subparagraph (a) shall apply.(c)A claim under subparagraph (b) must be made in writing and contain sufficient evidence that the producer operates under market economy conditions, that is if:—decisions of firms regarding prices, costs and inputs,including for instance raw materials, cost of technology and labour, output, sales and investment, are made in response to market signals reflecting supply and demand, and without significant State interference in this regard, and costs of major inputs substantially reflect market values,—firms have one clear set of basic accounting recordswhich are independently audited in line with interna­tional accounting standards and are applied for all purposes,—the production costs and financial situation of firms arenot subject to significant distortions carried over from the former non-market economy system, in particular in relation to depreciation of assets, other write-offs, barter trade and payment via compensation of debts,—the firms concerned are subject to bankruptcy andproperty laws which guarantee legal certainty and sta­bility for the operation of firms, and—exchange rate conversions are carried out at the mar­ket rate.A determination whether the producer meets the above­mentioned criteria shall be made within three months of the initiation of the investigation, after specific consultation of the Advisory Committee and after the Community industry has been given an opportunity to comment. This determi­nation shall remain in force throughout the investigation.B. E XPORT PRICE8. The export price shall be the price actually paid or payable for the product when sold for export from the exporting country to the Community.9. In cases where there is no export price or where it appears that the export price is unreliable because of an association or a compensatory arrangement between the exporter and the importer or a third party, the export price may be constructed on the basis of the price at which the imported products are first resold to an independent buyer, or, if the products are not resold to an independent buyer, or are not resold in the condition in which they were imported, on any reasonable basis.In these cases, adjustment for all costs, including duties and taxes, incurred between importation and resale, and for profits accru­ing, shall be made so as to establish a reliable export price, at the Community frontier level.The items for which adjustment shall be made shall include those normally borne by an importer but paid by any party, either inside or outside the Community, which appears to be associated or to have a compensatory arrangement with the importer or exporter, including usual transport, insurance, handling, loading and ancil­lary costs; customs duties, any anti-dumping duties, and other taxes payable in the importing country by reason of the impor­tation or sale of the goods; and a reasonable margin for selling, general and administrative costs and profit.C. C OMPARISON10. A fair comparison shall be made between the export price and the normal value. This comparison shall be made at the same level of trade and in respect of sales made at, as closely as pos­sible, the same time and with due account taken of other differ­ences which affect price comparability. Where the normal value and the export price as established are not on such a comparable basis due allowance, in the form of adjustments, shall be made in each case, on its merits, for differences in factors which are claimed, and demonstrated, to affect prices and price comparabil­ity. Any duplication when making adjustments shall be avoided, in particular in relation to discounts, rebates, quantities and level of trade. When the specified conditions are met, the factors for which adjustment can be made are listed as follows:(a) Physical characteristicsAn adjustment shall be made for differences in the physical characteristics of the product concerned. The amount of the adjustment shall correspond to a reasonable estimate of the market value of the difference.(b) Import charges and indirect taxesAn adjustment shall be made to normal value for an amount corresponding to any import charges or indirect taxes borne by the like product and by materials physically incorporated therein, when intended for consumption in the exporting country and not collected or refunded in respect of the prod­uct exported to the Community.(c) Discounts, rebates and quantitiesAn adjustment shall be made for differences in discounts and rebates, including those given for differences in quantities, if these are properly quantified and are directly linked to the sales under consideration. An adjustment may also be made for deferred discounts and rebates if the claim is based on consistent practice in prior periods, including compliance with the conditions required to qualify for the discount or rebates.(d) Level of trade(i) An adjustment for differences in levels of trade, includ­ing any differences which may arise in OEM (OriginalEquipment Manufacturer) sales, shall be made where, inrelation to the distribution chain in both markets, it isshown that the export price, including a constructedexport price, is at a different level of trade from the nor­mal value and the difference has affected price compa­rability which is demonstrated by consistent and distinctdifferences in functions and prices of the seller for thedifferent levels of trade in the domestic market of theexporting country. The amount of the adjustment shallbe based on the market value of the difference.(ii) However, in circumstances not envisaged under point (i), when an existing difference in level of trade cannot bequantified because of the absence of the relevant levelson the domestic market of the exporting countries, orwhere certain functions are shown clearly to relate tolevels of trade other than the one which is to be used inthe comparison, a special adjustment may be granted.(e) Transport, insurance, handling, loading and ancillary costsAn adjustment shall be made for differences in the directly related costs incurred for conveying the product concerned from the premises of the exporter to an independent buyer, where such costs are included in the prices charged. Those costs shall include transport, insurance, handling, loading and ancillary costs.(f) PackingAn adjustment shall be made for differences in the directly related packing costs for the product concerned.。

职称英语理工AB级阅读理解精讲(3)

职称英语理工AB级阅读理解精讲(3)

"Hidden" Species May Be Surprisingly Common Cryptic species animals that appear identical but are genetically quite distant⼀may be much more widespread than previously thought. The findings could have major implications in areas ranging from biodiversity estimates and wildlife management,to our understanding of infectious diseases and evolution. Reports of cryptic species have increased dramatically over the past two decades with the advent of relatively inexpensive DNA sequencing technology. Mark Pfennninger and Klaus Schwenk, of the Goethe-Universitat in Frankfurt’s Germany, analyzed all known data on cryptic animal species aad discovered that they are found in equal proportions throughout all major branch, of the animal kingdom and occur in equal numbers in all biogeographical regions. Scientists had previously speculated that cryptic species were predominantly found in insects and reptiles,and were more likely to occur in tropical rather than temperate regions. "Species that are seemingly widespread and abundant could in reality he many different cryptic species that have low populations and are highly endangered," says Henninger. Until the genetic information of all species'. in at least one texon is thoroughly studied, no one will know just how many cryptic species exist. "It could be as high. as 30%,”Pfenninger says "I'm extremely surprised by their results." says Alex Smith of the University of Guelph`Intririo'. Canada. "It's a call to arms to keep doing the broad kind of genetic studies that we are doing. Sampling as many individuals as possible, scientists hope to complete work on all fish and birds in another 5 to 10 years. Once either of these taxonumic groups is completed. Pfenninger says researchers will be able to decide how many cryptic species exist throughout the animal kingdom. Examples of cryptic species include the African elephant. A 2001 study found the elephants were actually two genetically distinct.non-interbreeding species, the African bush elephant and the African elephant. The species are currently listed as vulnerable and threatened, respectively, by the World Conservation Union(WCU). The reclassifications are more than an academic exercise: They define populations that have evolved independently of each other and whom genetic differences that have evolved independently of each other and whose genetic differences can have significant consequences. In the early 1900s misidentification mosquito species based on morphology confused attempts to control malaria in Europe. Ultimately, what was thought to be a single species was actually made up of six sibling species, only three of which transmitted the disease. “The basic unit in biology is always the species, and you hav to know what you are dealing with,”Pfenninger said. Much previous research is now no longer used, he says, because it is not clear what species was studied. 1,Which of the following about the significance of the research on cryptic species is NOT true? A The results of the research can help the development of many other research areas: B The results of the research can help the development of biodiversity estimates. C The results of the research can help our understanding of infectious disease evolution. D. The results of the research can help our understanding of "survival of the fittest. 2. What was scientists' understanding of cryptic species? A They occurred in equal numbers in all biogeographical regions B They were mostly found in insects and reptiles. C They were likely to be in tropical rather than temperate regions D Both B and C 3, Do scientists know how many cryptic species exist? A Not yet. B Yes. they do. C They will know the answer in another one or two years. D They will never know the answer. 4. Which of the following about the African bush elephant and the African elephant is true? A The WCU are interbreeding those elephants B They are interbreeding species. C They are two genetically distant species. D They depend on each other for survival 5. People were confused in their attempts to control malaria in Europe in the early 1900s, because scientists A identified only one mosquito species instead of six species. B thought only three mosquito species transmitted disease. C thought there was only on, mosquito species. D did not know what species sees being studied. 答案与解析: 1. 分析⽂章标题: “Hidden”(隐藏的) species(物种) may be surprisingly(令⼈惊讶地) common(共同的,常见的,普通的) 分析:⽂章主题涉及到对⽣物物种的分析和介绍。

雅思写作主题词 — 科技类

雅思写作主题词 — 科技类

科技a big headache 一个令人头痛的难题a capacious database 一个容量巨大的数据库a controversial issue 一个富有争议性的话题a disastrous consequence 一个灾难性的后果a piece of cake 易如反掌的事a potential cause of certain illnesses 引起某些疾病的隐患a professional knowledge of computer operations and programs 对计算机操作和程序具有专业知识a reflection of human boredom 人们无聊的一种反映a two-edged sword 一把双刃剑account for the increasingly higher rates of various crimes 成为不断上升的各种犯罪率的原因acquire the habit of gambling on the Internet 染上网上赌博的恶习agronomist 农学家an authoritative medical survey 一份具有权威性的医学调查报告animal manure 动物的粪便bank account 银行帐号be afflicted with 受到…的侵害be applied as an ideal substitute for humans in some hazard jobs 在某些危险的工作中作为人类的一种理想的替代品be contingent on 取决于…be contrary to one’s expectations 与某人的期望恰好相反be convinced of 坚信…be dedicated to 献身于…be employed in an abusive way 被滥用be engrossed in …全神贯注于…, 痴迷于…be freed from the heavy workload required by industrial mass-production 被从工业大批量生产的沉重负担中解放出来be inflicted on 被施加于…之上be meaningless and tedious 无意义的和令人厌烦的be obsessed with …沉迷于…而无法自拔be of great benefit to …对…大有利处be on high alert 处于高度警惕状态be plagued with 为…所困扰be sufficient to 足够能…be turned into evil monsters in the hands of some wicked scientists 在某些邪恶的科学家手中变成恶魔be vulgar and suggestive 粗俗的和挑逗性的be widely used in many industrial and scientific fields 被广泛地运用于许多工业和科学领域become a health hazard for the local residents 成为一种对当地居民健康的危害break into the computer systems in governments and financial institutions闯入政府和金融机构的电脑系统bring about several outstanding advantages to mankind 给人类带来一些显著的好处by the same logic 根据同样的道理computer addicts 电脑迷constitute an integral part of the local food chain 构成当地食物链的重要一环criminal wrongdoings 犯罪活动degrade the soil 使土壤变质depict 描绘devote more time and energy to some creative and challenging work 将更多的时间和精力投入到一些具有创造性和挑战性的工作中去ecological disaster 生态的灾难eliminate the dreadful menace 消除可怕的威胁emit stinking gas 释放腐臭的气体enhance or impair people’s creativity 提高或削弱人们的创造力evolution 演变、演化、不断发展exert negative effects on our society and environment 对社会和环境产生负面的影响exploit coal mines 开采煤矿explore solutions 探索解决之道explore volcanoes 探索火山facilitate the development of people’s creativity 有利于人们创造力的发展figure out a feasible solution 想出一个可行的解决方法find effective solutions to …找到解决…的有效办法generate one of the most adverse effects on our natural environment 对自然环境产生一个极为不利的影响greatly enhance working efficiency and productivity 大大地提高了工作效率和生产能力groundless 毫无根据的hacker 电脑黑客have destructive powers 具有摧毁性的力量have easy access to the Internet 方便地利用因特网hinge on 取决于improve the production of crops dramatically 极大地提高了农作物的产量in favor of …青睐于…in the absence of 由于缺少…incredible power 超强大的能力infiltrate into the soil 渗入土壤之中information mine 信息宝库intelligent machines 智能机器intensify the effects of drought 加剧旱灾的影响intensive and specialized use of modern technology 广泛、专业地使用现代科技Internet banking 网上银行lack of visionary thinking 缺乏远见的思维方式lead to a dramatic increase in unemployment rates 导致失业率的急剧上升lead to the extinction of many species of native animals and plants 导致多种当地动植物的灭绝manual workers 体力劳动者massive use of fertilizers 大量地使用肥料minimize the effects of their disadvantages 尽量减少其弊端所带来的影响neglect the potential dangers 忽视其潜在的危害nuclear fuels 核燃料numerous search engines on the web 网上无数的搜索引擎pose threats to our society 对我们的社会造成威胁possess sophisticated intellect 拥有先进、尖端的智力put … to good application 合理地利用…put one’s mental capacity into full play 最大限度地发挥人的智力才能raise an unnerving question 提出一个令人不安的问题raze the planet for fifty times 摧毁地球五十次recuperate 恢复、复原、痊愈robots with artificial intelligence 具有人工智能的机器人rule humans like slaves 奴役人类run amok 失去控制save a lot of human labor 节省了许多人力savior 拯救者、救世主science fiction 科幻小说serve an increasingly vital part in …在…方面起到越来越重要的作用side effects 副作用steal confidential information and gigantic amounts of money 窃取机密信息和巨额钱款steal huge amounts of money 窃取大量钱财talented/gifted scientists 天才的科学家thanks to 由于、多亏、幸亏the daunting problems 令人畏惧的难题the depletion of the ozone layer 臭氧层的消失the ever-accelerated pace 不断加快的速度the increasing automation and efficiency 自动化程度和效率的提高the utilizations of fertilizers and machinery 对肥料和机械的使用tire out one’s physical strength 消耗人的体力ubiquitous 无所不在的ultraviolet radiation 紫外线辐射universal popularity 广泛的流行、普及with the advent of information technology 随着信息技术的到来。

anesthesiaaweightyissue麻醉有问题

anesthesiaaweightyissue麻醉有问题

Anesthesia:A Weighty IssueThe Case:A 77-year-old woman underwent a preoperative evalu-ation for an elective left hip arthroplasty.She reported a history of hypertension that was reasonably well controlled on nifedipine,atenolol,and lisinopril.The patient reported no history of bleeding disorders,tobacco use,anesthetic complications,or other significant comorbidities.Her calculated body mass index (BMI)was 34kg/m 2,which meets the definition of obesity (ie,BMI 30kg/m 2).A physician cleared her for surgery.The following week,the patient underwent an uneventful left hip arthroplasty with general anesthesia via a laryngeal mask airway.She had stable vital signs throughout.She was breathing spontaneously after the procedure,and she was safely extubated and transferred to the recovery unit.The patient continued to receive doses of morphine sulfate for procedure-related pain and became increasingly somno-lent.She also had oxygen desaturations,which persisted.An arterial blood gas test revealed acidosis with a mark-edly elevated partial pressure of carbon dioxide of 81mm Hg.Attempts at noninvasive ventilation failed,and the patient was reintubated for hypercarbic respiratory failure.The patient was extubated the following day after better pain control and airway management were achieved,and she had no further complications before discharge.Providers suggested in the discharge summary that the patient likely had obstructive sleep apnea (OSA).Because of the reintubation in the recovery unit,the hospital quality committee reviewed the case and raised the question of whether patients who are obese and undergoing anesthesia should receive formal preoperative screening for OSA.Discussion:Two-thirds of the population in the United States are overweight,and many patients who are obese and morbidly obese require anesthetic care.In addition to the comorbidities of obesity,such as hypertension,diabetes,dyslipidemia,and OSA,obesity itself puts patients at risk for slower wound healing,increased infection rates,longer hospital stays,deep vein thrombosis,and pulmo-nary embolism in surgical or anesthetic settings.In the perioperative setting,challenges in caring for patients who are obese can begin with routine IV access and continue through safe airway management.For the latter,difficult mask ventilation and intubation can make managing a patient’s cardiopulmonary status,intraoperative ventilation,and safe extubation more complex.Further-more,when comorbidities,for example,OSA,are not identified preoperatively,the stage is set for incidents such as the one in this case.Preoperative screening of patients who are obese should include cardiopulmonary status,including pulmonary hy-pertension and tricuspid regurgitation as well as airway challenges,such as OSA.Obstructive sleep apnea is a common sleep disorder:28%of women and 38%of men are at high risk.1In the general population,prevalence rates of moderate OSA are approximately 5%in women and 11%in men,1which increases 1.8%per decade of life.With patients who are morbidly obese (ie,BMI >40kg/m 2),the prevalence of OSA for men is between 42%and 55%,and for women is between 16%and 24%.1This content is adapted from AHRQ WebM&M (Morbidity &Mortality Rounds on the Web)with permission from the Agency for Healthcare Research and Quality.The original commentary was written by Ashish C.Sinha,MD,PhD,and was adapted for this article by Nancy J.Girard,PhD,RN,FAAN,consultant/owner,Nurse Collaborations,Boerne,TX.(Citation:Sinha AC.Anesthesia:a weighty issue.AHRQ WebM&M [serial online]./case.aspx?caseID ¼304.Accessed July 25,2014.)Dr Girard has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.(continued on page 682)/10.1016/j.aorn.2014.09.009714j AORN Journal December 2014Vol 100No 6ÓAORN,Inc,2014Screening for OSA should be part of every patient’s preoperative evaluation.The standard test for OSA is polysomnography,2which is expensive and requires an overnight stay.However,a commonly used and validated screening tool is“STOP BANG,”which stands for Snoring,daytime Tiredness,Observed apnea,high blood Pressure,high BMI,Advanced age,Neck circumference, and male Gender.3,4The presence of three or more of these symptoms indicates a positive screen,which should prompt the provider to manage the patient closely by minimizing the use of narcotics and by using nonnarcotic options(eg,nonsteroidal anti-inflammatory agents,local anesthetics,IV acetaminophen)for postoperative pain.If avoidance of narcotics is not possible,then patients at high risk should be observed in a monitored setting(eg,a postanesthesia care unit)for three hours after the last narcotic dose to evaluate for potential sedation,and they should be kept overnight in a monitored unit if necessary.In this case,the patient who was obese and with a positive STOP BANG screen d one point each for high blood pres-sure,high BMI,and advanced age d should have been managed differently,particularly with multiple risk factors for oversedation and respiratory depression:she likely had OSA,she was elderly,and she was opioid naive.Given the patient’s BMI and the lateral position required for the procedure,a laryngeal mask airway may not have been an optimal choice for airway management.A patient within the obese BMI range also may have been better managed by endotracheal tube placement and controlled mechanical ventilation.Patients who are obese are more prone to atel-ectasis,and frequent recruitment maneuvers are necessary to counteract atelectasis.Increasing inspired oxygen has min-imal effects on this atelectasis-related desaturation.In the absence of a local anesthetic component,the am-ount of narcotics that a spontaneously breathing patient can receive is limited and true preemptive narcotic analgesia is a challenge.When volatile agents were discontinued at the end of surgery,this patient’s pain was treated with morphine, which caused somnolence and hypercarbic respiratory fail-ure.For postoperative pain,a regional block would have been safer.If the patient could not receive a block due to technical reasons,patient preference,or contraindications,then mu-ltimodal analgesia with or without minimal narcotics would have been ideal.Even if a patient has a contraindication to nonsteroidal anti-inflammatory agents,IV acetaminophen can be effective.One gram of IV acetaminophen every six hours for24hours provides rapid and effective analgesia, especially when used as part of a multimodal analgesic pro-gram and results in good patient satisfaction and decreased patient-controlled analgesia narcotics use.5As this discussion suggests,managing anesthesia of pa-tients who are obese requires careful attention.Given the current prevalence of obesity,most anesthesia professionals have had ample opportunities to care for patients who are obese and to learn the requisite skills before entering prac-tice.Their training also should include how to communicate with patients who are obese in a sensitive and open manner. Patients who are obese can and should receive safe and high-quality care,but attention to obesity-related risks is impor-tant to help ensure desired outcomes.Perioperative Points:n Anesthesia professionals should consider multimodal analgesia and minimized use of narcotics for patients who are obese and those who are overweight.n The perioperative RN and other RNs should carefully monitor patients with known OSA before discharge. n Members of the surgical team should be aware that patients who are obese have a low functional resid-ual capacity and a high metabolic demand for oxy-gen and ensure that the patient’s blood oxygen level and respirations are monitored closely.n Perioperative nurses should be aware of the STOP BANG criteria when assessing patients preoperatively and communicate risks to the surgical team. References1.Chung SA,Yuan H,Chung F.A systemic review ofobstructive sleep apnea and its implications for anesthe-siologists.Anesth Analg.2008;107(5):1543-1563.2.Patil SP,Schneider H,Schwartz AR,Smith PL.Adultobstructive sleep apnea:pathophysiology and diagnosis.Chest.2007;132(1):325-327.3.Chung F,Yegneswaran B,Liao P,et al.STOP question-naire:a tool to screen patients for obstructive sleep apnea.Anesthesiology.2008;108(5):812-821.4.Chung F,Yegneswaran B,Liao P,et al.Validation of the Berlinquestionnaire and American Society of Anesthesiologistschecklist as screening tools for obstructive sleep apnea insurgical patients.Anesthesiology.2008;108(5):822-830.5.Sinatra RS,Jahr JS,Reynolds LW,Viscusi ER,Groudine SB,Payen-Champenois C.Efficacy and safety of single and repeated administration of1gram intravenous acetaminophen injection(paracetamol)for pain manage-ment after major orthopedic surgery.Anesthesiology.2005;102(4):822-831.(continued from page714)682j AORN JournalDecember2014Vol100No6PERIOPERATIVE GRAND ROUNDS。

肠道准备指南说明书

肠道准备指南说明书

You can help prevent infection by preparing your bowels before surgery. Your colon needs to be free of stool with fewer bacteria than usual. If your colon is not sufficiently clean, your surgeon may need to reschedule your procedure.If you get sick before surgery (fever of 101.5°F, cough, cold, etc.), please call the Prepare Clinic at 415-885-7670.Ask Your SurgeonWill I be able to complete my bowel prepwhile traveling to UCSF?No. You will need immediate access to a toiletfor your bowel prep, which you will complete theday before your surgery. Please plan your travelaccordingly.Sometimes I experience constipation. Willthe bowel prep still work?Most people complete the bowel prep the daybefore surgery but if you tend to be constipated,it’s a good idea to start your bowel prep sooner,up to 2-3 days before surgery. If you’re not sure,contact us.Why do I need to drink Boost Breeze/Gatorade?Boost Breeze is a clear carbohydrate drink thatdecreases the stress of surgery by providingyour body glucose during the operation. It isavailable for free at our clinic. You can purchasethese or a substitute at a drugstore or on. You will NOT take this if you arediabetic because it may increase your glucoselevels.I prefer the prep I did for mycolonoscopy, can I do that instead?Yes you can, but some bowel preps are noton our formulary. They are difficult for us toprescribe and some may not be covered byyour insurance.Why do I need to take antibiotics?Surgery preparation also involves decreasingthe bacterial load so antibiotics must beincluded during your bowel prep. They havebeen shown to decrease the risk of infectionsfollowing colon surgery.7amBegin a clear liquid diet. Do not eat any solid foods.If you are taking...Miralax®64 ozMix 1 bottle (238-gram) of polyethylene glycol (MiraLAX) into one 64-ounce bottle/pitcher of any clear liquid.8amIf you are taking...SUPREP®Fill linePour ONE 6-ounce bottle of SUPREP® liquid into the mixing container. Add cool water to the 16 oz. line on the container and mix. Drink ALL the liquid in the container over 1 hour. Drink two more 16-ounce glasses of water over the next hour (1hr).Moviprep ®Fill lineEmpty the contents of 1 pouch A and 1 pouch B into MoviPrep container. Add lukewarm water to the fill line. Mix to completely dissolve.Drink 8 oz every 15 minutes until done (1hr). Then drink 16 ounces of any clear liquid.This timing is important to allow the Moviprep to wash down the colon at a consistent rate.When you’re finished, drink at least 32 ounces of clear liquids. You should expect diarrhea within 1 hour.GoLytely®Powder medication should be given with a 4-liter bottle. Add water to fill line on the 4-liter container to dissolve powder.Drink 8 ounces every 15 minutes until completed (four hours).Miralax®Drink 8 ounces every 15 minutes until completed (2 hrs). Follow up with an additional 32 ounces of any clear liquid once completed.10am If you are taking...Moviprep® OR SUPREP®Repeat for the second dose.1pm Take your first dose of antibiotics by mouth:TWO neomycin (500mg) and TWO metronidazole(500mg). Follow with one glass of water.If you experience nausea, you can take one tablet (4mg) of Zofran by mouth every 8 hours, but only as needed. 3pm Take your second dose of antibiotics, following same instructions as your first dose.10pm Take your third dose of antibiotics,following same instructions as your first and second doses.You may continue to drink clear liquids until 2 hours before you arrive at the hospital.2hr Two hours before you arrive at the hospital, drink one container of Boost Breeze or Gatorade (if you are not diabetic)Do not eat or drink ANYTHING after this.What is a clear liquid diet?A clear liquid diet consists of liquids you can see through, consumed at room temperature. The purpose is to give your gastrointestinal (GI) tract a rest before surgery.It’s important to stay well hydrated during your bowel prep, so please drink many of the allowed liquids. Allowed:WaterClear broth (beef or chicken)Gatorade or other clear sportdrinks (regular, with sugar)Carbonated drinks, includingdark sodas like cola, root beerTea or coffee (without milk orcream)Gelatin (without fruit)Popsicles (without fruit orcream), Italian ices, hard candyClear fruit juices without pulp(apple, grape, cranberry)You may use salt, pepper, andsugarNot allowed:Milk, cream, milkshakes,smoothiesSoup, other than clear brothOatmeal, cream of wheat, gritsAll ice cream, gelatoOrange, grapefruit, or tomatojuice; fruit nectars。

Albumin replacement in severe sepsis or septic shock

Albumin replacement in severe sepsis or septic shock

correspondencen engl j med 371;1 july 3, 201483Since publication of their article, the authors report no fur-ther potential conflict of interest.1. López-Martín JM, Salviati L, Trevisson E, et al. Missense mu-tation of the COQ2 gene causes defects of bioenergetics and de novo pyrimidine synthesis. Hum Mol Genet 2007;16:1091-7.DOI: 10.1056/NEJMc1311763Albumin Replacement in Severe Sepsis or Septic ShockTo the Editor: The Albumin Italian Outcome Sepsis study conducted by Caironi et al. (April 10 issue)1 is the third large-scale, randomized trial to compare albumin with crystalloids in adult patients with severe sepsis. The first such trial was the Saline versus Albumin Fluid Evaluation study.2 In addition, the Early Albumin Resuscita-tion during Septic Shock study has been complet-ed and its mortality results published.3In all three trials, mortality was lower among patients receiving albumin, and the respective relative risks coincided closely, ranging from 0.87 to 0.94 (Fig. 1). Although the effect did not attain statistical significance in any of the indi-vidual trials, the pooled relative risk in all three trials is 0.92 (95% confidence interval [CI], 0.84 to 1.00; P = 0.046), indicating a significant re-duction in mortality associated with albumin use among adults with severe sepsis. This result supports the conclusion of a previous meta-analysis involving predominantly small trials with different control fluids and patient popula-tions.4 The result is also consistent with the observed reduction in mortality associated with albumin use among patients with spontaneous bacterial peritonitis, a disease that shares im-portant pathophysiological features with severe sepsis.5Christian J. Wiedermann, M.D.Central Hospital of BolzanoBolzano, Italychristian.wiedermann@asbz.itMichael Joannidis, M.D.Medical University of InnsbruckInnsbruck, AustriaDr. Wiedermann reports receiving lecture fees from CSL Behring, Baxter, and the Plasma Protein Therapeutics Association; and Dr. Joannidis, lecture fees from Baxter, Fresenius, Gambro, Orion Pharma, CLS Behring, and B. Braun Melsungen. No other potential conflict of interest relevant to this letter was reported.1. Caironi P, Tognoni G, Masson S, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 2014;370:1412-21.2. The SAFE Study Investigators. Impact of albumin comparedto saline on organ function and mortality of patients with severe sepsis. Intensive Care Med 2011;37:86-96.3. Charpentier J, Mira J-P. Efficacy and tolerance of hyperoncoticalbumin administration in septic shock patients: the EARSSstudy. Intensive Care Med 2011;37:Suppl 1:S115.4. Delaney AP, Dan A, McCaffrey J, Finfer S. The role of albu-min as a resuscitation fluid for patients with sepsis: a system-atic review and meta-analysis. Crit Care Med 2011;39:386-91.5. Salerno F, Navickis RJ, Wilkes MM. Albumin infusion im-proves outcomes of patients with spontaneous bacterial perito-nitis: a meta-analysis of randomized trials. Clin Gastroenterol Hepatol 2013;11:123-30.DOI: 10.1056/NEJMc1405675The New England Journal of MedicineDownloaded from on September 2, 2014. For personal use only. No other uses without permission.Copyright © 2014 Massachusetts Medical Society. All rights reserved.T h e ne w engl a nd jour na l o f medicinen engl j med 371;1 july 3, 201484The Authors Reply: Wiedermann and Joannidis suggest that there is a survival advantage associ-ated with albumin use in patients with severe sepsis. Formal meta-analyses will confirm or re-fute their findings. Our study was not limited to the resuscitation phase but included albumin supplementation for 28 days after enrollment. The improvement in survival associated with al-bumin use was concentrated among patients with septic shock (1121 patients; 90-day mortal-ity, 43.6% in the albumin group vs. 49.9% in the crystalloid group; relative risk, 0.87; 95% CI, 0.77 to 0.99; P = 0.03). These data, together with the lack of effects in patients enrolled with early sep-sis, suggest that there are beneficial effects as-sociated with albumin use in relation to its ancil-lary functions, rather than only to its primary oncotic properties.1 We may speculate that the benefits of albumin administration manifest mainly when endogenous albumin is function-ally exhausted owing to the severity of the injury, leading to insufficient pharmacologic activity, as nitric oxide modulation,2 antioxidant action,3 and anti-immunosuppressive action.4 Although this mechanism is speculative, the available data suggest that in patients with the most severe ex-pression of sepsis albumin supplementation may represent an option.Pietro Caironi, M.D.Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda–Ospedale Maggiore PoliclinicoMilan, Italy Gianni Tognoni, M.D.Fondazione Mario Negri Sud Santa Maria Imbaro, Italy Luciano Gattinoni, M.D.Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico Milan, Italygattinon@policlinico.mi.itSince publication of their article, the authors report no fur-ther potential conflict of interest.1. Quinlan GJ, Martin GS, Evans TW. Albumin: biochemicalproperties and therapeutic potential. Hepatology 2005;41:1211-9.2. Stamler JS, Jaraki O, Osborne J, et al. Nitric oxide circulates in mammalian plasma primarily as an S-nitroso adduct of se-rum albumin. Proc Natl Acad Sci U S A 1992;89:7674-7.3. Quinlan GJ, Margarson MP, Mumby S, Evans TW, Gutteridge JM. Administration of albumin to patients with sepsis syn-drome: a possible beneficial role in plasma thiol repletion. ClinSci (Lond) 1998;95:459-65.4. O’Brien AJ, Fullerton JN, Massey KA, et al. Immunosuppres-sion in acutely decompensated cirrhosis is mediated by prosta-glandin E2. Nat Med 2014;20:518-23.DOI: 10.1056/NEJMc1405675Thyroid Hormone Inactivation in Gastrointestinal Stromal Tumors To the Editor:(April 3 issue)1 report the overexpression of type 3 iodothyronine deiodinase (D3) in gastrointesti-nal stromal tumors (GISTs), resulting in con-sumptive hypothyroidism. D3 overexpression is suggested as an inherent property of these tu-mors, but the authors also acknowledge the pos-sibility of its secondary induction by kinase in-hibitors. Indeed, the index patient was treated with sorafenib before the diagnosis of consump-tive hypothyroidism, and it is not stated whether any of the additional four patients with hypothy-roidism had previously received kinase inhibitors.In a translational protocol of a randomized trial of sunitinib in breast cancer,2 supported by a grant from Pfizer to Karolinska University Hospital, we obtained sequential metastatic bi-opsy specimens for gene-expression profiling at baseline and 2 weeks after the start of treat-ment. Expression of messenger RNA (mRNA) encoded by the D3 gene (DIO3) was significantly up-regulated in patients treated with sunitinibThe New England Journal of MedicineDownloaded from on September 2, 2014. For personal use only. No other uses without permission.Copyright © 2014 Massachusetts Medical Society. All rights reserved.。

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a r X i v :c o n d -m a t /0105107v 2 [c o n d -m a t .m t r l -s c i ] 20 J u n 2001Ab-initio investigation of the covalent bond energies in the metallic covalentsuperconductor MgB 2and in AlB 2G.Bester and M.F¨a hnleMax-Planck-Institut f¨u r Metallforschung,Heisenbergstr.1,D-70569Stuttgart,Germany(February 1,2008)The contributions of the covalent bond energies of various atom pairs to the cohesive energy of MgB 2and AlB 2are analysed with a variant of our recently developed energy-partitioning scheme for the density-functional total energy.The covalent bond energies are strongest for the intralayer B-B pairs.In contrast to the general belief,there is also a considerable covalent bonding between the layers,mediated by the metal atom.The bond energies between the various atom pairs are analysed in terms of orbital-and energy-resolved contributions.71.15.Nc,71.20.Gj,74.25.Jb,74.72.YgI.INTRODUCTIONThe ceramic compound magnesium diboride,MgB 2,has the highest superconducting critical temperature T c =39K ever reported for a binary system.The structure is graphite-like,i.e.,it consists of honeycomb layers of B separated by triangular metal planes.Its discovery 1has triggered a tremendous activity to investigate the electronic 2–9and phononic 2,4,8–10properties as well as the electron–phonon coupling 2,4,8,10for MgB 2and for re-lated binary and ternary borides.The main electronic characteristics are:•The states at the Fermi level E F are dominantly de-rived from boron p orbitals.The B p x,y σ-bands are responsible for the strong covalent bonding in the B layers and have mainly 2D character,i.e.,only very little k z dispersion,whereas the B p z π-bands have 3D character.•Electrons are transferred from the Mg orbitals to the B orbitals.As a result,there is a partial ionic character,but these electrons are not well localized at the B sites,they are rather distributed over the whole crystal.•The Mg atoms are responsible for a downward shift of the B π-bands relative to the σ-bands,as com-pared to the corresponding C bands in graphite.As a result,there is a partial occupation of the π-bands and a hole doping of the σ-bands.Coupling of the σ-holes to the intralayer B bond-stretching phonon modes dominates the electron -phonon cou-pling and is responsible for the high T c 4,8.•The compound is hold together by dominant in-tralayer B-B covalent bonds,dominant interlayer metallic bonds and by a substantial ionic charac-ter.There are indications for an additional inter-layer B-Mg contribution to the bonding,e.g.,the slight increase in the k z dispersion of the B σ-bands as compared to a hypothetical structure where theMg atoms are removed.When going from MgB 2to AlB 2,the valence charge-difference plots show a stronger directional M-B bond 12(M=metal atom),and our own calculations show a slightly stronger k z dispersion of the σ-bands.It is the objective of the present paper to analyse and compare the covalent bonding properties of MgB 2and AlB 2quantitatively within a variant of our recently de-veloped energy-partitioning scheme 13,14.A first attempt in this direction was made by Ravindran et al.6by means of the crystal-orbital-Hamilton population 15(COHP).It will be shown below,however,that for the use of non-orthogonal basis functions the COHP do not have a well-defined physical meaning and cannot be used to compare quantitatively the covalent bonding properties between various structures.II.THE ENERGY-PARTITIONING SCHEMEStarting point of the discussion is the expression for the total energy E tot from the density functional theory in local density approximation,E tot =nf n εn − n (r )v eff(r )d 3r+E H +E xc +n (r )v ext (r )d 3r +E ii ,(1)with the occupation numbers f n and the eigenvalues εn of the Kohn-Sham single-particle wave functions Ψn ,the electron density n (r ),the effective potential v eff(r ),the Hartree energy E H ,the exchange-correlation energy E xc ,the potential v ext (r )of the nuclei (or of the ionic cores in the case of a pseudopotential calculation)and the in-teraction energy E ii between the nuclei (or between the ionic cores).The hope is that the trends for the to-tal energies are already well described by the first term (band-structure energy E band )when comparing varioussystems.This assumption is made implicitly in the com-mon practice to discuss the energetics via the electronic density of states.An energy-partitioning scheme is a tool to analyse E band further.For systems with covalent bonding the crystal wave-functionsΨn are best represented by a minimal set of well-localized orbitalsϕiα(with characterαdescribed by the angular and magnetic atom quantum numbers l and m)attached to the various atoms i(tight-binding representation),Ψn= iαc n iαϕiα.(2)The band-structure energy is calculated by inserting(2) inton f nεn= n f n Ψn|ˆH|Ψn (3)with the Kohn-Sham HamiltonianˆH.The remaining terms on the right-hand side of eq.(1)which we abbre-viated by D in Refs.13,14are calculated by approximat-ing n(r)by a superposition of atomic charge densities, yielding16D=E pair+E mb+E free atom− iαN free atom iαH free atom iαiα.(4)Here E pair is a pair potential term,E mb a many-body potential term which is small for nearly charge neutral systems,E free atom denotes the total energy of the free atoms before being condensed to the crystal,and theN free atom iαare the occupation numbers for the energy lev-els H free atomiαiα.We now add to and subtract from E tot thetermsn iα,jβ c n iα c n jβ ∗O jβiα−N free atom iαδjβ,iα H free atom iαiαandn iα,jβc n iα c n jβ ∗O jβiαH iαiα,(5) where O jβiαand H jβiαdenote the elements of the over-lap and Hamiltonian matrix.Rearranging the terms in an appropriate manner yields the cohesive energyE c=E tot−E free atom(6)=E prom+E cf+E polar+E cov+E pair+E mb. Thefirst term is the promotion energyE prom= iα q iα−N free atom iα H free atom iαiα(7) with Mulliken’s gross charge17q iα= jβ n f n c n iα c n jβ ∗O jβiα.(8)This term describes the cost in energy when start-ing the condensation process from free atoms and then redistributing the electrons among the various orbitalsfrom the occupation numbers N free atomiαto the occupa-tion number q iαfound in the crystal and characterized by q iα18.The second term is the crystal-field termE cf= iαq iα H iαiα−H free atom iαiα ,(9)which describes the change in energy due to a shift of the on-site energies when the atoms are condensed to form the crystal so that the potential acting on an electron at atom i is not just the atomic potential of this atom but the environment-dependent crystal potential.The polarization energyE polar= n,i,α,βf n c n iα c n iβ ∗ H iαiβ−δiβiαH iαiα (10)describes the change in energy due to the hybridization of orbitals localized at one atom when the atom is embed-ded in the crystal.Finally,the covalent bond energy E cov is the change in energy arising from the hybridization of orbitals localized at different atoms,E cov= iα,jβj=i E cov,iαjβ(11) withE cov,iαjβ= n f n c n iα c n jβ ∗[H jβiα−O jβiαεjβiα=1εjβiα].(14) E cov,iαjβ(E)is negative(positive)for bonding(antibond-ing)states.The respective quantity integrated up to a certain energy E will be referred to asIE cov,iαjβ(E)= E−∞E cov,iαjβ(E′)d E′.(15)The energy-partitioning scheme discussed above has the following very attractive property:In a band-structure calculation which deals with an infinitely ex-tended periodic system the average effective potential does not have a physical meaning,and it is thereforeset to an arbitrary value which is the same for different crystal structures.In order to be physically meaning-ful the total energy E tot and the considered terms of an energy-partitioning scheme for a band-structure calcula-tion therefore must be invariant against a constant shift of the effective potential of the band-structure calcula-tion.This is fulfilled for E tot(and hence also for E c) which becomes obvious from eq.(1):Shifting v effbyΦ0 yields opposite shifts for thefirst two terms which there-fore compensate each other(the remaining terms can be calculated without ambiguity,see for instance,Ref.19. Furthermore the terms E prom,E polar and E cov of eq.(6) as well as their atom-and orbital-resolved contributions (and in addition the respective energy-resolved contribu-tions to E cov)are all invariant.For instance,if the poten-tial is shifted by a constantΦ0,then the matrix elements H jβiαare transformed into H jβiα+Φ0O jβiαand H iαiα,εjβiα+Φ0because O iαiα=1,so thatΦ0drops out of the covalent bond energy.Because E c is also invariant,this must hold for the sum of the terms E pair+E mb+E cf,too.However,we cannot cal-culate separately,for instance,the crystal-field term E cf in a band-structure calculation,because the matrix ele-ment H iαiαis shifted by the shift of the effective potentialof the crystal whereas H freeatomiαiαis not(because for thecalculation of the latter quantity the effective potential is always normalized to zero for distances far from the atom).It is therefore physically meaningful only to dis-cuss the terms E prom,E polar,E cov and E pair+E mb+E cf. The covalent bond energy thereby is the only term which involves matrix elements for orbitals on different atoms, and therefore it clearly represents the contribution of the interatomic bonding to the band-structure energy.In the following we will confine ourselves to the discussion of this term.It should be noted that in our former version of the energy-partitioning scheme13,14the various terms have been arranged in a slightly different manner,arriving20 at the equivalent expressionE c= E prom+ E cf+ E cov+E pair+E mb,(16) withE prom= iα q iα−N free atom iα H iαiα,(17)i.e.,H free atomiαiαof E prom has been replaced by H iαiα, E cf= iαN free atom iα H iαiα−H free atom iαiα ,(18)i.e.,the q iαof E cf have been replaced by N free atomiα,andE cov= iα,jβE cov,iαjβ,(19)i.e.,the on-site contributions iαiβhave not been excluded from the covalent bond energy.When comparing the definitions E prom,E cf,with the definitions E prom, E cf, it becomes obvious that they correspond to a differentsuccession of processes in a gedanken experiment for the condensation of free atoms to the crystal.In thefirst case we promote the electrons by redistributing them among the various orbitals of the free atoms and then we bring the free atoms in the crystal positions(without allowing for a redistribution of the charge densities)and experi-ence a change in energy described by E cf due to a shift of the on-site energies in the crystal potential.In the secondcase we freeze the occupation numbers N free atomiαwhen bringing the free atoms to the crystal positions and cal-culate the crystal-field shift E cf for these circumstances, and then we allow for a redistribution of the electrons among the on-site energy levels in the crystal potential. We think that thefirst case is closer to the commonly used definitions of the promotion and the crystal-field energy,and we therefore prefer the new variant of the energy partitioning scheme.Finally,we think that it is reasonable to exclude the on-site hybridization contri-butions E cov,iαiβfrom the covalent bond energy because they do not describe interatomic interactions.In the new variant these terms enter the polarization energy which also has a well-defined physical meaning.It should be noted that E prom, E cov and E cf+E pair+ E mb are also invariant against a constant shift of the ef-fective potential of a band-structure calculation,as well as the atom-,orbital-and energy-resolved contributions of E cov.Again, E cf alone is not invariant and cannot be calculated separately in a band-structure calculation.In former papers the crystal-orbital-Hamilton population15,COHP iαjβ(E)= nδ(E−εn)f n c n iα c n jβ ∗H jβiα,(20)has been used to characterize the bonding properties. If orthonormal basis functions are used,this quantity is identical to E cov,iαjβ(E).However,in the chemical anal-ysis very often non-orthogonal basis sets are used.Then COHP iαjβ(E)is not invariant against a constant shift of the effective potential and therefore does not have a well-defined physical meaning in the context of a band-structure calculation.For systems with metallic bonding theΨn are better represented by a set of plane waves rather than by atom-localized functions.Alternatively,theΨn again can be represented by a set of atom-localized functions also in this case,but then often orbitals have to be included which are not occupied in the free atom in order to make the basis set more complete.Then formally a covalent bond energy E cov can be calculated even for a nearly-free-electron system.Whereas the term metallic conductivity is well defined,it is indeed a problem to discriminate between metallic and covalent bonding.As a working hypothesis we define a covalent bonding as a bonding which is dominated by the hybridization of those orbitalson various atoms which are already occupied in the re-spective free atoms.Note that this does not necessar-ily mean that the corresponding charge-density difference plot exhibits directionality,e.g.,it can be imagined that the p z-orbitals do not necessarily create a charge density with considerable directionality.Because our definitionof E cov is a generalization of the covalent bond energy in-troduced by Sutton et al.18to the case of non-orthogonal basis sets we keep this historical founded nomenclature “covalent bond energy”although this quantity may also contain metallic bonding contributions in the above de-fined sense.III.DETAILS OF THE CALCULATIONSThe calculations were performed with the ab-initio pseudopotential method21,22.Band structure and charge density difference plots were practically identical to thoseof previous calculations2–7.For the energy-partitioning analysis theΨn were projected23–26onto a set of overlap-ping atom-localized non-orthogonal orbitals.For these orbitals we choseϕiα(r)=f il(r)i l K lm( r),(21) f il(r)=C ilφPS il(λil r) 1−e−γil(r cut il−r)2 for r≤r cut il0for r≥r cutil,(22) where C il is a normalization constant,φPS il is the ra-dial pseudo-atomic wavefunction constructed accordingto Vanderbilt21,λil denotes a contraction factor and r cutil represents a cut-offlength.The parametersλil,γil andr cut il were selected in such a way that the spillage23–26was minimized,where the spillage characterizes the loss of the norm of the wavefunctions due to the incomplete-ness of the pseudo-atomic-orbital projection.We con-fined ourselves to a minimal set of s,p and d orbitals for Mg and B.The band-structure calculated with the pro-jected wavefunctions was nearly identical to the original band structure from the pseudopotential calculation for energies below and not too far above the Fermi level.IV.RESULTS AND DISCUSSIONTable I represents the covalent bond energies for vari-ous atom pairs in MgB2and AlB2.It should be recalled that the covalent bonding properties of the two materi-als may be compared only by the measure E cov and not by COHP because the latter quantity is not invariant against a constant shift of the potential when nonorthog-onal basis functions are used,which is the usual case for a chemical analysis in terms of atom-like functions.The total covalent bond energy is larger in absolute value for AlB2than for MgB2.As expected,the B-B intralayer covalent bond energy is largest.Interestingly enough,it is larger in absolute value for the Mg compound although the B-B distance is larger.Contrary to the general belief, there is also a considerable covalent bond energy between the layers(the B-M energy is only a factor of about2-2.5 smaller)and even in the M layers(the intralayer M-M energy is a factor of about two smaller than the B-M energy).The B-M covalent bond energy increases when going from M=Mg to M=Al,and this is consistent with the smaller c/a ratio of the Al compound.The B-M dis-tance is in fact smaller for M=Al than for M=Mg.The interlayer B-B(M-M)bonds are two orders of magnitude (one order of magnitude)smaller than the respective in-tralayer bonds,i.e.,their contributions to the cohesion between the layers is much smaller than the B-M con-tribution.Our calculations show that the covalent bond energies between all further-distant atoms are consider-ably smaller than the nearest-neighbor intralayer bonds and the nearest-neighbor B-M bonds.This means that a nearest-neighbor bond model suffices to describe the two materials.This is not at all trivial,because in in-termetallic compounds,e.g.,FeAl,CoAl and NiAl the further distant bonds are essential14.In Table II the covalent bond energies for the most important atom pairs are further analysed by consider-ing the dominant angular-resolved contributions.In all cases,the p-p contributions are strongest and the s-s con-tributions weakest.It becomes obvious from Table II that the d-orbitals make a non-negligible contribution to the bonding between the B and the M layer.Because the d-orbitals are not occupied in the respective free atoms we would denote this as a“metallic contribution”accord-ing to our working hypothesis of section II.This metallic contribution is stronger for AlB2than for MgB2.Never-theless,the“covalent contribution”is dominant also for the bonding between the layers,mediated by the metal atom.The energy-resolved covalent bond energies for the p-p and s-s contributions of the B-B intra,B-M and M-M in-tra atom pairs are shown in Fig.1,for MgB2and AlB2. The benefit of the energy-resolved representation is that we can clearly discriminate between bonding and anti-bonding states.The s-s bonds are weakened because both bonding and antibonding states are occupied.Without the energy-resolved analysis we could erroneously assume that the s-s covalent bond energy is low because the corre-sponding matrix elements are small.For the other orbital pairs of Table II dominantly bonding states are occupied, but there are slight differences between MgB2and AlB2. For instance,the stronger B-B intra bond energy of MgB2 (Table I)results mainly from a stronger p−p contribu-tion(Table II),and the reason for this is that for the trivalent Al part of the antibonding p-p states are occu-pied(Fig.1).Furthermore,the stronger B-M bond for M=Al(Table I)again results mainly from a stronger p−p contribution,and the reason for this is that the bonding p-p states are morefilled for Al than for Mg.V.CONCLUSIONWe have represented a new variant of an energy-partitioning scheme for the density-functional total en-ergy which allows to define a covalent bond energy whichis invariant against a constant potential shift.This prop-erty is a precondition for the comparison of the bondingproperties in different systems within the framework ofband-structure calculations.The atom-,orbital-and energy resolved contributionsto the covalent bond energy have been calculated forMgB2and AlB2.One central result of the calculationsis that a nearest-neighbor bond model is sufficient todescribe the bonding properties of these materials.Aworking hypothesis has been introduced to discriminatebetween a covalent and a metallic bonding character.Ithas been shown that both in MgB2and AlB2there is ametallic contribution to the bonding between the layerswhich is stronger for Al than for Mg.The benefits of theenergy-resolved representation are demonstrated by dis-cussing the differences between the trivalent Al and thedivalent Mg.ACKNOWLEDGMENTThe authors are indebted to R.Drautz for helpful dis-cussion.B-B M-M totalintra intraMgB2-193.5-37.6-73.73.710.2-3179TABLE I.Covalent bond energies(in mRy)for variousatom pairs.B-Mp-p p-s s-s p-p-84.9-42.8-14.4-10.0AlB2-30.8-17.6-14.1-1.7pairs in MgB2(upper panels)and AlB2(lower panels).。

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