中医药的抗炎机制在治疗肝纤维化中的作用

肝脏是人体腹腔内最大的实体器官,对维持机体的基本生理功能起着至关重要的作用。肝脏疾病是威胁人类健康的常见病多发病。全球约有10%人口受到不同程度的肝脏疾病的危害,其中,肝纤维化往往成为这些疾病的晚期病理特征。由于肝纤维化的发病机制复杂,尚无有效的合成类药物能够治疗肝纤维化。中药治疗肝纤维化具有多靶点和副作用小的优势。本文综述了肝纤维化的病理特征与诱发炎症的关系,讨论了中药治疗肝纤维化的单味中药、传统配方及其化学活性成分的抗炎症机制。     

呼吸道传染病治疗中抗体药物的研发进展

呼吸系统疾病影响着全世界数百万人,主要病变发生在气管、支气管、肺部及胸腔,病变轻者多咳嗽、胸痛,重者呼吸困难、缺氧甚至呼吸衰竭,可造成多种并发症,导致患者严重残疾甚至死亡。治疗性抗体的临床使用为肺癌、哮喘以及各类呼吸道传染病等的治疗开辟了新途径。目前已有数十种抗体（antibodies,Abs）获得市场批准,而且还有更多的抗体药物正在临床开发中。这些Abs中的大多数是针对哮喘、肺癌、慢性阻塞性肺病、特发性肺纤维化以及呼吸道传染病等疾病。其中,呼吸道传染病的爆发具有传播迅猛、传染性强的特点,常引发全球关注,如当下肆虐全球的新型冠状病毒肺炎。针对呼吸道传染病的多种Abs为其临床治疗提供了新策略。基于此,综述了已获准和正在临床开发的适用于治疗呼吸道传染病的Abs,通过综述抗体治疗的分子机制、优势和发展趋势,以期为呼吸道传染病治疗中抗体药物的研发提供参考。     

The N-terminus of Paenibacillus larvae C3larvinA modulates catalytic efficiency

C3larvinA was recently described as a mono-ADP-ribosyltransferase (mART) toxin from the enterobacterial repetitive intergenic consensus (ERIC) III genotype of the agricultural pathogen, Paenibacillus larvae. It was shown to be the full-length, functional version of the previously described C3larvin_trunc toxin, due to a 33-residue extension of the N-terminus of the protein. In the present study, a series of deletions and substitutions were made to the N-terminus of C3larvinA to assess the contribution of the α₁-helix to toxin structure and function. Catalytic characterization of these variants identified Asp²³ and Ala³¹ residues as supportive to enzymatic function. A third residue, Lys³⁶, was also found to contribute to the catalytic activity of the enzyme. Analysis of the C3larvinA homology model revealed that these three residues were participating in a series of interactions to properly orient both the Q-X-E and S-T-S motifs. Ala³¹ and Lys³⁶ were found to associate with a structural network of residues previously identified in silico, whereas Asp²³ forms novel interactions not previously described. At last, the membrane translocation activity into host target cells of each variant was assessed, highlighting a possible relationship between protein dipole and target cell entry.     

心肺运动试验（CPET）评价个体化精准运动整体方案强化管控心脑血管慢病疗效的临床研究*

目的: 探讨研究症状限制性极限运动心肺运动试验（CPET）评价个体化精准运动整体方案强化管控3月后（简称强化管控）的长期慢病患者整体功能的改善。方法: 选取2014年至2016年由我们团队强化管控的长期心脑血管代谢慢病为主的患者20例,签署知情同意书后完成CPET,根据CPET及连续功能学检测结果制定以个体化适度运动强度为核心的整体管理方案,强化管控3月后再行CPET,个体化分析每例患者强化管控前后CPET指标的变化、计算差值和百分差值。结果: 本研究心脑血管代谢性慢病为主的患者20例（18男2女）,年龄（55.75±10.80,26~73）岁,身高（172.20±8.63,153~190）cm,体重（76.35±15.63,53~105）kg,所有患者CPET和强化管控期间均无任何危险事件发生。①强化管控后患者静态肺功能指标及静息收缩压、心率收缩压乘积和空腹血糖等均显著改善（P<0.05）。②强化管控前峰值摄氧量为（55.60±15.69,34.37~77.45）%pred和无氧阈为（60.11±12.26,43.29~80.63）%pred;强化管控后峰值耗氧量为（71.85±21.04,42.40~102.00）%pred和无氧阈为（74.95±17.03,51.90~99.47）%pred;管控后较管控前峰值摄氧量和无氧阈显著提高分别达（29.09±7.38,17.78~41.80）%和（25.16±18.38,1.77~81.86）%（P均<0.01）;其他核心指标峰值氧脉搏、峰值负荷功率、摄氧通气效率平台和递增功率运动持续时间均显著升高（P均<0.01）,二氧化碳排出通气效率最低值及二氧化碳排出通气斜率也显著好转（P<0.01）。③个体化分析而言,强化管控后15例上述8项CPET核心指标全部改善,另5例7项指标改善;全部病例峰值摄氧量（%pred）提高>15%以上,16例>20%,13例>25%,10例>30%。结论: CPET能安全客观定量地评估人体整体功能状态和治疗效果、指导制定个体化精准运动强度。个体化精准运动整体方案强化管控三个月能安全有效逆转长期心脑血管代谢等慢病患者的整体功能状态和异常指标。     

盐城地区未成年过敏性疾病患者吸入性过敏原IgE检测结果分析

摘要 目的：通过研究分析盐城地区未成年过敏性疾病患者吸入性过敏原特异性IgE检测结果分布变化特点,为过敏性疾病预防和临床诊疗提供科学依据。方法：自2020年1月至2021年3月期间,选择430例未成年(<18岁)过敏性疾病患者,血清检测方法采用欧蒙公司生产的过敏原特异性IgE检测试剂盒。结果：430例患者中,血清过敏原IgE阳性166例(38.60%),其中尘螨和屋尘是主要的吸入性过敏原。血清IgE阳性率男性39%,女性36% (P>0.05),中学组女性阳性率（61.11 %）高于男性（45.83 %）（P<0.05）。不同年龄组间IgE阳性率有统计学差异（P<0.05）,蟑螂、尘螨、霉菌、豚草、屋尘和年龄组间有统计学差异（P<0.05）。不同临床症状与IgE阳性率有统计学差异(P<0.05),其中呼吸道过敏症状组IgE阳性率最高（48.30 %）,不同症状组间主要过敏原都是尘螨。屋尘阳性患者均合并尘螨阳性,其中70.93 %的患者表现出了呼吸道过敏症状。结论：尘螨、屋尘是盐城地区未成年过敏性疾病患者最主要的吸入性过敏原,研究血清过敏原分布,对未成年人过敏性疾病的预防、诊疗具有重要意义。     

Innate lymphoid cells and gastrointestinal disease

Innate lymphoid cells (ILCs) are a group of innate immune cells, which constitute the first line of defense in the immune system, together with skin and mucous membrane. ILCs also play an important role in maintaining the homeostasis of the body, particularly in the complex and diverse environment of the intestine. ILCs respond to different microenvironments, maintaining homeostasis directly or indirectly through cytokines. As a result, ILCs, with complex and pleiotropic characteristics, are associated with many gastrointestinal diseases. Their ability of transition among those subgroups makes them function as both promoting and inhibiting cells, thus affecting homeostasis and disease progressing to either alleviation or deterioration. With these special characteristics, ILCs theoretically can be used in the new generation of immunotherapy as an alternative and supplement to current tumor therapy. Our review summarizes the characteristics of ILCs with respect to category, function, and the relationship with intestinal homeostasis and gastrointestinal diseases. In addition, potential tumor immunotherapies involving ILCs are also discussed to shed light on the perspectives of immunotherapy.     

Knowledge and attitudes regarding genetic testing among Jordanians: An approach towards genomic medicine

BackgroundThe twenty first century can be called the genomic era referring to the rapid development of genetics, and the beginning of genomic medicine. An initial step towards genomic medicine is to evaluate the knowledge and attitude towards genetic testing among different populations. The aims of this study were to assess the genetic knowledge and attitude towards genetic testing among the Jordanian population and patients with immune diseases. In addition, we evaluated the association between knowledge, attitude and several demographic factors of the population.MethodsThis study was performed using an online questionnaire that was distributed to respondents from different regions of Jordan.ResultsA total of 1149 participants were recruited from the Jordanian population. Overall factual genetic knowledge of the participants was good (65.4%), with education level, working or studying in a health-related field and household average monthly income being significant predictors of factual knowledge scores (P = 0.03, P < 0.001 and P < 0.001, respectively). However, factual knowledge results revealed that scores of questions related to diseases were significantly higher than scores of gene-related scientific facts (P < 0.01). Participants of our study reported to have low perceived knowledge on medical uses (39.5%) and social consequences (23.9%) of genetic testing. Regarding the participants’ attitudes, favorable attitudes towards genetic testing were prevailing (91.5%). Favorable attitudes were more prominent among higher educated participants, and participants with higher scores of factual knowledge.ConclusionDespite the fact that our Jordanian-based study revealed a good level of genetic knowledge as well as a favorable attitude towards genetic testing, we realized an imbalance of knowledge between gene-related scientific facts and disease-related concepts as well as between factual and perceived genetic knowledge, which indicates the necessity of increasing the awareness about genetic testing in order to ensure that individuals can take informed decisions that help in the employment of personalized medicine.     

Noncommunicable disease outcomes and the effects of vertical and horizontal health aid

Foreign health aid forms a substantial portion of health spending in many low- and middle-income countries (LMICs). It can be either vertical (funds earmarked for specific diseases) or horizontal (funds used for broad health sector strengthening). Historically, most health aid has been disbursed vertically toward key infectious diseases, with minimal allocations to noncommunicable diseases (NCDs). High NCD burden in LMICs underscores a need for increased assistance toward NCD objectives, but evidence on the outcomes of health aid for NCDs is sparse. We obtained annual data on cause-specific deaths and disability-adjusted life years (DALYs) for four leading NCDs across 116 countries, 2000–2016, and evaluated the relationship between these indicators and vertical and horizontal health aid using country fixed-effects models with 1-to-5-year lagged effects. After adjusting for fixed and time-variant country heterogeneity, vertical assistance for NCDs was significantly associated with subsequent reductions in NCD morbidity and mortality, particularly for persons under age 70 and for cardiovascular and chronic respiratory diseases. An additional dollar in per-capita NCD vertical assistance corresponded to reductions in the average annual NCD burden of 7,459 DALYs/281 deaths after one year, 7,728 DALYs/319 deaths after two years, and 8,957 DALYs/346 deaths after three years. The findings suggest that vertical assistance for NCD programs may be an appropriate mechanism for addressing short-term NCD needs in LMICs, where it may help to fill health sector gaps in NCD care, but longer-term evaluation is needed for assessing the role of horizontal assistance.