中西医治疗代谢综合征的认识发展过程

代谢综合征是一系列代谢紊乱的状态和疾病。近年来代谢综合征在心脑血管疾病中的作用越来越引起学者们的重视。目前,腹型肥胖和胰岛素抵抗被认为是代谢综合征的核心因素,另外也有众多研究揭示了代谢综合征的其他致病机制。各个国家也在出台相应的诊断标准,这些标准都将指导临床的诊断及分型。在治疗方面,西药尚缺乏有效的综合治疗手段,已经有很多研究证实中药治疗疗效显著,复方治疗或单味药治疗均可以明显改善代谢综合征的症状。本文就中医及西医对于代谢综合征的各种认识的发展过程及其相应的治疗手段治疗做一综述。     

Perceptions and uses of Chinese medicine among the chinese in Hong Kong

The present paper was based on both qualitative observations and quantitative survey data. Major findings are as follows: (1) The sacred or magical-religious tradition of Chinese medicine is accepted by a relatively small portion (roughly one-fifth) of the ordinary Chinese people in urban Hong Kong, and is relatively more popular among women or less educated people. (2) Both the classical-professional and the local-empirical traditions of secular medicine are resorted to by many Chinese people (over one half) either for treating diseases or for strengthening their constitution. The acceptance of secular Chinese medicine does not vary significantly among different sex, age, education, or income groups. It should be noted that secular Chinese medicine is often used in addition to or in combination with modern Western medicine. (3) It appears that most people are more confident in the Chinese medical tradition than in Chinese-style practitioners in Hong Kong, and that people's confidence in secular Chinese medicine has been increasing in recent years. (4) There are reasons for the confidence in secular Chinese medicine. Chinese medicine is generally perceived to be better than or as good as Western, scientific medicine in some ways, such as for tonic care, for fewer side effects, for curing the cause (not symptoms) of diseases, and for treating certain diseases. Therefore, to ordinary Chinese people, Chinese and Western medicine may perform either equivalent or complementary functions. (5) As regards the process of seeking medical care, most people seem to follow the pattern of moving from self-medication, using Chinese and/or Western home remedies, to Western-style doctors, to Chinese-style practitioners, and finally to a Western medical hospital. Policy and theoretical implications of these findings are discussed.     

上海,无锡地区汉族人群HLADR4基因14种亚型分析

本文应用聚合酶链反应配合限制性内切酶片段长度多态性（ＰＣＲ－ＲＦＬＰ）分析方法,在１３０例上海、无锡地区汉族人群中发现２３例ＤＲ４基因检测呈阳性,对其ＤＲ４基因的亚型ＲＦＬＰ和分布频率特征进行了研究,结果显示,ＤＲ４基因携带者为１７．７％,存在７种ＤＲ４亚型,以ＤＲＢ１＊０４０５频率最高,构成ＤＲ４阳性人群的４７．８％,其次为ＤＲＢ１＊０４０６和ＤＲＢ１＊０４０３,分别为２１．７％和１７．４％,上     

微生物发酵法生产L-丝氨酸及L-半胱氨酸研究进展

L-丝氨酸及L-半胱氨酸在食品、医药和化妆品等行业有着广泛的应用,在植物和微生物中两者从头合成的前体物均为3-磷酸甘油酸。微生物发酵生产这两种氨基酸以其社会、经济及环境效益展现出良好的前景。针对近年来微生物发酵法生产L-丝氨酸及L-半胱氨酸的研究成果,本文综述了当前国内外学者在该领域研究的热点,即代谢途径及其调节、相关氨基酸的转运及运输、菌种及菌株改造、新菌种的开发等。最后结合当前生物技术的新发展,对今后的研究方向进行了展望。     

The French are different. French and American medicine in the context of AIDS.

Medicine has often been approached as a thing apart from culture, as a uniform Western science. Within the past 10 years, we have begun to recognize that medicine is a system of beliefs and practices intrinsically linked to its larger sociocultural context. Still, it is generally perceived as uniform across North America and Western Europe. My recent research on French and American medical perspectives on the acquired immunodeficiency syndrome (AIDS) challenges this view by exploring differences in the structure of health care, the physician-patient relationship, and the conceptualizations of disease, particularly AIDS. These differences are not specific to AIDS, but the disease serves to exemplify them and to act as a medium for expressing what makes French and American medicine distinct. Global epidemics such as AIDS require both international response and cross-cultural understanding.     

HLA-DR1 (DRB1*0101) and DR4 (DRB1*0401) use the same anchor residues for binding an immunodominant peptide derived from human type II collagen.

Rheumatoid arthritis is an autoimmune disease in which susceptibility is strongly associated with the expression of specific HLA-DR haplotypes, including DR1 (DRB1*0101) and DR4 (DRB1*0401). As transgenes, both of these class II molecules mediate susceptibility to an autoimmune arthritis induced by immunization with human type II collagen (hCII). The dominant T cell response of both the DR1 and DR4 transgenic mice to hCII is focused on the same determinant core, CII(263-270). Peptide binding studies revealed that the affinity of DR1 and DR4 for CII(263-270) was at least 10 times less than that of the model Ag HA(307-319), and that the affinity of DR4 for the CII peptide is 3-fold less than that of DR1. As predicted based on the crystal structures, the majority of the CII-peptide binding affinity for DR1 and DR4 is controlled by the Phe(263); however, unexpectedly the adjacent Lys(264) also contributed significantly to the binding affinity of the peptide. Only these two CII amino acids were found to provide binding anchors. Amino acid substitutions at the remaining positions had either no effect or significantly increased the affinity of the hCII peptide. Affinity-enhancing substitutions frequently involved replacement of a negative charge, or Gly or Pro, hallmark amino acids of CII structure. These data indicate that DR1 and DR4 bind this CII peptide in a nearly identical manner and that the primary structure of CII may dictate a different binding motif for DR1 and DR4 than has been described for other peptides that bind to these alleles.     

犬、猫肾功能衰竭的中西医结合疗法

本文介绍了中医的肾脏生理功能理论、阐述了目前西兽医及中兽医对犬猫急性肾功能衰竭、慢性肾功能衰竭发病原因的认识,分析了肾功能衰竭的中医辨证分型和急性肾功能衰竭、慢性肾功能衰竭的治疗原则。     

Microvesicles and exosomes in metabolic diseases and inflammation

Metabolic diseases are based on a dysregulated crosstalk between various cells such as adipocytes, hepatocytes and immune cells. Generally, hormones and metabolites mediate this crosstalk that becomes alterated in metabolic syndrome including obesity and diabetes. Recently, Extracellular Vesicles (EVs) are emerging as a novel way of cell-to-cell communication and represent an attractive strategy to transfer fundamental informations between the cells through the transport of proteins and nucleic acids. EVs, released in the extracellular space, circulate via the various body fluids and modulate the cellular responses following their interaction with the near and far target cells. Clinical and experimental data support their role as biomarkers and bioeffectors in several diseases includimg also the metabolic syndrome. Despite numerous studies on the role of macrophages in the development of metabolic diseases, to date, there are little informations about the influence of metabolic stress on the EVs produced by macrophages and about the role of the released vesicles in the organism. Here, we review current understanding about the role of EVs in metabolic diseases, mainly in inflammation status burst. This knowledge may play a relevant role in health monitoring, medical diagnosis and personalized medicine.     

A comparison of Chinese traditional and Western medical approaches for the treatment of mild hypertension

We compared the efficacy of Chinese traditional treatment for mild hypertension with that of a standard Western medical regimen in a group of 50 well-matched patients (24 allocated to Western medicine and 26 to Chinese traditional medicine) with mild hypertension (diastolic blood pressure 90-104 mmHg). Those receiving Western therapy were treated in a stepped-care fashion with dihydrochlorothiazide and atenolol. Those in the Chinese traditional therapy group received one of two mixtures of nine herbs and other ingredients, depending on symptoms at initial evaluation. Blood pressure dropped significantly in both groups after only a few days on therapy. After 19 days on treatment, the group receiving Western therapy had a fall in blood pressure from 168.2/96.3 mmHg to 137.3/76.7 mmHg (p less than 0.01), while those on Chinese traditional therapy fell from 168.2/95.9 mmHg to 146.4/80.5 mmHg (p less than 0.01). The fall in blood pressure was significantly greater, however, in those given Western therapy. The relief of existing symptoms or development of possible drug side effects was similar in both groups, except for nocturia, occurring more often in the group treated with Western therapy. We conclude that Western therapy is more effective in reducing blood pressure as compared with Chinese traditional therapy, but effective control of blood pressure in mild hypertensives is possible with either form of treatment.     

中西医结合治疗复发性口腔溃疡临床研究

目的:观察中西医结合治疗复发性口腔溃疡的疗效。方法:将80例患者随机分为治疗组(40例)和对照组(40例),对照组给予0.5%洗必泰含漱剂漱口,外敷复方冰硼散口腔溃疡膜,维生素C片,复合维生素B片口服,重型患者应用强的松,2周为1个疗程,治疗组在上述治疗基础加用自拟的中药消溃汤治疗。结果:治疗组总有效92.5%,对照组总有效72.5%,两组临床治疗有效率比较的差异有统计学意义,治疗组明显优于对照组,两组均未见局部及全身的不良反应。结论:中西医结合治疗复发性口腔溃疡,采取对因和对症治疗相结合,疗效确切,可显著提高疗效,无明显不良反应,使用方便,安全性强,值得临床推广使用。     

益坤宁对围绝经期大鼠下丘脑雌激素受体表达的影响

目的检测益坤宁对围绝经期大鼠下丘脑雌激素受体（estrogen receptor,ER）表达的影响,探讨益坤宁治疗围绝经期综合征的作用机制。方法采用自然衰老的围绝经期大鼠,随机分为围绝经期对照组、西药对照组和中药实验组;另取5月龄青年雌性大鼠做青年对照组。各组大鼠分别连续灌胃给予生理盐水、利维爱、中药益坤宁和生理盐水4周。通过免疫组化观察大鼠下丘脑ER蛋白的表达部位;Western blot定量检测大鼠下丘脑ERα和ERβ蛋白表达。结果ERα、ERβ蛋白主要表达于细胞胞质中。围绝经期对照组与青年组相比,ERa、E邓蛋白表达量明显下降（P〈0．05,P〈0．01）;中药实验组与围绝经期对照组比较,ERα、ERB蛋白表达量均明显增多（P〈0．05,P〈0．01）;西药对照组与围绝经期对照组相比,ERα、ERβ蛋白表达量增多（P〈0．05）。结论益坤宁通过提高围绝经期大鼠下丘脑组织中ERα、ERβ蛋白表达水平,使ER的合成增加,从而提高雌激素靶组织中ER的含量以增强雌激素的生物活性而发挥治疗作用。     

复方雷公藤逐痛颗粒辅助治疗痰瘀互结型类风湿关节炎的临床效果观察

目的:评价复方雷公藤逐痛颗粒治疗活动期类风湿关节炎痰瘀互结证的临床有效性和安全性。方法:选择2013年2月～2015年5月在上海光华中西医结合医院类风关内科门诊及住院的活动性痰瘀互结型类风湿关节炎患者63例,按治疗方式分为对照组33例和中西医结合治疗组30例,对照组采用西医治疗(甲氨蝶呤+青霉胺),治疗组采用中西医结合治疗(复方雷公藤逐痛颗粒+甲氨蝶呤+青霉胺)。治疗12周后,比较两组患者的临床疗效及各项观察指标的改善情况。结果:治疗后,两组患者晨僵持续时间、关节肿胀数、关节压痛数、中医症候积分、血沉(ESR)、血清CRP水平,疼痛VAS评分、患者总体状态自我VAS评分及DAS28评分均较治疗前显著下降(P0.05),且治疗组患者的上述各项指标均明显低于对照组(P0.05)。治疗期间,两组患者均未出现严重不良反应而中断治疗的情况,监测肝肾功能指标均未发现明显异常。结论:复方雷公藤逐痛颗粒辅助治疗痰瘀互结型类风湿关节炎的临床疗效确切,明显优于单用西医治疗,其有助于增强西医治疗对患者临床症状的缓解效果,提高患者的生活质量,且用药安全。     

四碳有机酸生物合成的代谢工程研究进展

四碳有机酸作为重要的平台化学品,广泛应用于食品、化工、农业、医药和生物材料等领域.与传统的石化法相比,利用微生物发酵生产四碳有机酸具有反应条件温和、过程绿色环保等优势,具有广泛的应用前景.文中总结了四碳有机酸的生物合成途径和代谢机制,着重讨论了天然菌株生产四碳有机酸以及基于菌种选育和代谢工程改造策略提高四碳有机酸合成能...     

肠道菌群与高血压病主要危险因素的相关性及 中药干预研究现状

近年来国内、外文献报道高血压病的发生可能与肠道菌群失调相关。肠道菌群与高血压病主要危险因素(肥胖、高血脂、糖尿病、代谢综合征、动脉粥样硬化)具有一定的相关性,某些益生菌或其发酵产品可能通过改善肠道菌群的方式为高血压病的治疗提供新的思路和途径。近年来研究显示中药具有较长的肠道停留时间,从而有利于其发挥调节肠道菌群的作用,提示某些中药具有调节肠道菌群的作用。但目前国内、外尚无关于中药直接通过肠道菌群作用而干预高血压病的文献报道,而近年来国内有研究显示肠道菌群可能是中药干预高血压病主要危险因素的作用机制之一。     

High Prevalence of Diabetic Retinopathy in Diabetic Patients Concomitant with Metabolic Syndrome

Objective

To evaluate the relationship between metabolic syndrome (MetS) and the prevalence of diabetic retinopathy (DR).

Research Design and Methods

We conducted a case-controlled study, with data obtained from 2,551 Chinese participants between 18–79 years of age (representing a population of 1,660,500 in a district of Beijing). 74 cases of DR were found following data assessment by two 45° digital retinal images. Subjects without DR (NDR group) selected from the remaining 2,477 subjects were matched 1:1 to the DR group by HbA1c. MetS was defined by incorporating diagnostic criteria of the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF).

Results

There were no statistical differences between the DR group and NDR group in a number of biological or laboratory tests. However, the percentage of patients with DR increased vs. patients without DR with the number of MetS components from 1 to 5 (14.3% vs. 85.7%, 38.9% vs. 61.1%, 49.1% vs. 50.9%, 61.4% vs. 38.6% and 83.3% vs. 16.7%, respectively) (Pearson χ² = 9.938, P = 0.037). The trend to develop DR with MetS was significantly higher than that without MetS (NMetS) (χ² = 5.540, P = 0.019). MetS was an independent statistical indicator of the presence of DR after adjusting for age and sex [odds ratio (95% CI): 2.701(1.248–5.849), P = 0.012], which is still the case with an additional adjustment for WC, SBP, TC, HbA1c and duration of diabetes [odds ratio (95% CI): 2.948(1.134–7.664), P = 0.027].

Conclusion

DR is one of the diabetic microvascular complications. Apart from poor glycemic control, the concomitance of other metabolic factors can also influence DR. MetS, defined as a cluster of metabolic risk factors, is a strong and independent indicator of DR, even to the same extent as glycemic control.     

Lipid metabolism and liver inflammation. I. Hepatic fatty acid uptake: possible role in steatosis

Hepatic steatosis is a growing public health concern. Nonalcoholic fatty liver is increasingly common in Western societies and may lead to steatohepatitis, fibrosis, and cirrhosis, possibly triggered by lipid peroxidation. The relation of fatty liver to obesity, type II diabetes, and/or metabolic syndrome is significant. One aspect these related disorders share is increased serum-free fatty acids, which may be taken up by hepatocytes. Uptake of fatty acids in excess of metabolic requirements will lead to storage as triglycerides, resulting in steatosis and providing substrate for lipid peroxidation. Fatty acid uptake may be crucial to understanding steatosis.     

Beneficial effects of dietary restriction on cerebral cortical synaptic terminals: preservation of glucose and glutamate transport and mitochondrial function after exposure to amyloid beta-peptide, iron, and 3-nitropropionic acid

Recent studies have shown that rats and mice maintained on a dietary restriction (DR) regimen exhibit increased resistance of neurons to excitotoxic, oxidative, and metabolic insults in experimental models of Alzheimer's, Parkinson's, and Huntington's diseases and stroke. Because synaptic terminals are sites where the neurodegenerative process may begin in such neurodegenerative disorders, we determined the effects of DR on synaptic homeostasis and vulnerability to oxidative and metabolic insults. Basal levels of glucose uptake were similar in cerebral cortical synaptosomes from rats maintained on DR for 3 months compared with synaptosomes from rats fed ad libitum. Exposure of synaptosomes to oxidative insults (amyloid beta-peptide and Fe(2+)) and a metabolic insult (the mitochondrial toxin 3-nitropropionic acid) resulted in decreased levels of glucose uptake. Impairment of glucose uptake following oxidative and metabolic insults was significantly attenuated in synaptosomes from rats maintained on DR. DR was also effective in protecting synaptosomes against oxidative and metabolic impairment of glutamate uptake. Loss of mitochondrial function caused by oxidative and metabolic insults, as indicated by increased levels of reactive oxygen species and decreased transmembrane potential, was significantly attenuated in synaptosomes from rats maintained on DR. Levels of the stress proteins HSP-70 and GRP-78 were increased in synaptosomes from DR rats, consistent with previous data suggesting that the neuroprotective mechanism of DR involves a "preconditioning" effect. Collectively, our data provide the first evidence that DR can alter synaptic homeostasis in a manner that enhances the ability of synapses to withstand adversity.     

Metabolic engineering of microorganisms for the production of multifunctional non-protein amino acids: γ-aminobutyric acid and δ-aminolevulinic acid

Gamma-aminobutyric acid (GABA) and delta-aminolevulinic acid (ALA), playing important roles in agriculture, medicine and other fields, are multifunctional non-protein amino acids with similar and comparable properties and biosynthesis pathways. Recently, microbial synthesis has become an inevitable trend to produce GABA and ALA due to its green and sustainable characteristics. In addition, the development of metabolic engineering and synthetic biology has continuously accelerated and increased the GABA and ALA yield in microorganisms. Here, focusing on the current trends in metabolic engineering strategies for microbial synthesis of GABA and ALA, we analysed and compared the efficiency of various metabolic strategies in detail. Moreover, we provide the insights to meet challenges of realizing industrially competitive strains and highlight the future perspectives of GABA and ALA production.     

Intercellular communication, NO and the biology of Chinese medicine

New multiple categories of health disciplines have become popular in the west and integration between the medicinal approaches has become essential. The hypothesis presented here suggests a novel integrative view that combines Western biochemistry with the Chinese medicinal concept of qi. The core for this hypothesis is that transmission of qi along the meridians is based on informational molecules that travel via an intercellular communication system. Acupuncture at specific points enhances the flow of the signaling molecules through this communication system. Nitric oxide is suggested as a prime candidate for such a signaling molecule in the meridian system. The biochemistry of nitric oxide can shed light on the biology underlying Chinese medicine while Chinese medicinal data can provide a clue to the sought after framework for nitric oxide.