脆弱拟杆菌BF839治疗寻常型银屑病：一项单臂、开放初步临床试验

银屑病被认为是一种T细胞主导的炎症性疾病,其发病与肠道菌群失调密切相关。脆弱拟杆菌 (Bacteroides fragilis,BF) 可通过调节T细胞的细胞因子表达起抗炎作用。目前尚无脆弱拟杆菌用于治疗银屑病的相关报道,文中率先探究脆弱拟杆菌BF839对银屑病的治疗效果。选择2019年4月至2019年10月广州医科大学附属第二医院就诊的27例银屑病患者,维持原治疗不变,口服脆弱拟杆菌BF839 12周,对比治疗前后银屑病皮损面积与严重程度指数 (Psoriasis area and severity index,PASI) 评分,统计治疗12周后药物减停率。结果表明,12周试验完成率为96.3% (26/27),12周PASI30 (PASIN定义为治疗后PASI评分下降≥N%的患者比例) 为65.4%,PASI50为42.3%,PASI75为19.2%;治疗前PASI评分为9.1±5.9,治疗12周后PASI评分为5.8±4.9,具有显著统计学差异 (P<0.01);治疗12周后皮肤瘙痒程度用视觉模拟量表 (Visual analog scale,VAS) 评分有效率为42.3%,治疗前VAS评分为2.9±2.2,治疗12周后VAS评分为2.3±2.1,无显著统计学差异 (P>0.05)。患者治疗12周内不良反应率为3.8% (1/26),其中便秘1例,药物减停率为60.0%。以上结果提示脆弱拟杆菌BF839可能对银屑病治疗有一定疗效,可降低PASI评分及药物使用率,不良反应少,值得进一步研究。     

乳酸菌作为药物分子粘膜投递载体的研究进展

乳酸菌是被公认为安全的食品级微生物,广泛地应用于食品生产、保存以及作为益生菌促进人类健康。鉴于发展有效的投递药物分子策略的需要,乳酸菌成为了极有吸引力的用于口服、鼻饲及阴道进行粘膜投递药物分子的活载体。用乳酸菌作为药物分子的投递载体,安全性好,且可直接合成并投递目标蛋白,显著降低药物生产成本。到目前为止,乳酸菌作为粘膜投递载体,已成功地向粘膜组织投递了一系列功能蛋白用以治疗多种疾病。文中综述了近20年的数据,重点聚焦乳酸菌作为药物分子投递载体的发展和应用,为今后乳酸菌作为活载体的临床研究提供一定参考。     

Exploiting nonsystematic covariate monitoring to broaden the scope of evidence about the causal effects of adaptive treatment strategies

In studies based on electronic health records (EHR), the frequency of covariate monitoring can vary by covariate type, across patients, and over time, which can limit the generalizability of inferences about the effects of adaptive treatment strategies. In addition, monitoring is a health intervention in itself with costs and benefits, and stakeholders may be interested in the effect of monitoring when adopting adaptive treatment strategies. This paper demonstrates how to exploit nonsystematic covariate monitoring in EHR‐based studies to both improve the generalizability of causal inferences and to evaluate the health impact of monitoring when evaluating adaptive treatment strategies. Using a real world, EHR‐based, comparative effectiveness research (CER) study of patients with type II diabetes mellitus, we illustrate how the evaluation of joint dynamic treatment and static monitoring interventions can improve CER evidence and describe two alternate estimation approaches based on inverse probability weighting (IPW). First, we demonstrate the poor performance of the standard estimator of the effects of joint treatment‐monitoring interventions, due to a large decrease in data support and concerns over finite‐sample bias from near‐violations of the positivity assumption (PA) for the monitoring process. Second, we detail an alternate IPW estimator using a no direct effect assumption. We demonstrate that this estimator can improve efficiency but at the potential cost of increase in bias from violations of the PA for the treatment process.     

Parental care in the Small Tree Finch Camarhynchus parvulus in relation to parasitism and environmental factors

The parental food compensation hypothesis suggests that parents may compensate for the negative effects of parasites on chicks by increased food provisioning. However, this ability differs widely among host species and may also depend on ecological factors such as adverse weather conditions and habitat quality. Although weed management can improve habitat quality, management measures can bring about a temporary decrease in food availability and thus may reduce parents’ ability to provide their nestlings with enough energy. In our study we investigated the interaction of parasitism and weed management, and the influence of climate on feeding rates in a Darwin’s tree finch species, which is negatively impacted by two invasive species. The larvae of the invasive parasitic fly Philornis downsi ingest the blood and body tissues of tree finch nestlings, and the invasive Blackberry Rubus niveus affects one of the main habitats of Darwin’s tree finches. We compared parental food provisioning of the Small Tree Finch Camarhynchus parvulus in parasitized and parasite‐free nests in three different areas, which differed in invasive weed management (no management, short‐term and long‐term management). In a parasite reduction experiment, we investigated whether the Small Tree Finch increases food provisioning rates to nestlings when parasitized and whether this ability depends on weed management conditions and precipitation. Our results provide no evidence that Small Tree Finches can compensate with additional food provisioning when parasitized with P. downsi. However, we found an increase in male effort in the short‐term management area, which might indicate that males compensate for lower food quality with increased provisioning effort. Furthermore, parental food provisioning was lower during rainfall, which provides an explanation for the negative influence of rain on breeding success found in earlier studies. Like other Darwin’s finches, the Small Tree Finch seems to lack the ability to compensate for the negative effects of P. downsi parasitism, which is one explanation for why this invasive parasite has such a devastating effect on this host species.     

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。     

遮光处理对草珊瑚光合特性及叶片解剖结构的影响

为探索遮光处理对草珊瑚光合特性及叶片解剖结构的影响,为草珊瑚的科学栽培提供理论依据。该研究以2年生草珊瑚为材料,设置全光照(L_0)及50%(L_(50))、70%(L_(70))和90%(L_(90))遮光处理,测定分析其光合特性和叶片解剖结构以及植株生长的变化。结果表明:(1)随着遮光率的增加,草珊瑚叶面光合有效辐射(PAR)、气孔导度(G_s)和蒸腾速率(T_r)逐渐减小,胞间二氧化碳浓度(C_i)先减少后增加,净光合速率(P_n)先增加后减少,并在L_(50)和L_(70)处理下具有较低的PAR、G_s、T_r和C_i,光合‘午休’现象得到有效缓解,表现出更高的P_n。(2)随着遮光率的增加,草珊瑚光补偿点(LCP)逐渐下降,光饱和点(LSP)、暗呼吸速率(R_d)先升高后下降,表观量子效率(AQE)逐渐上升,叶片最大净光合速率(P_(nmax))先升高后下降,并在L_(50)和L_(70)处理下具有较低的LCP,较高的LSP和AQE,以及更高的最大净光合速率。(3)随着遮光率的增加,草珊瑚叶片、表皮细胞、栅栏组织和海绵组织的厚度明显增加,角质层厚度逐渐变薄;在L_(50)和L_(70)处理下,草珊瑚叶片栅栏组织和海绵组织发达,栅栏组织细胞长度变短,海绵组织厚度显著增加,细胞排列疏松,叶绿体数量显著增加;叶肉细胞和叶绿体结构完整,基粒类囊体和基质类囊体片层结构发达,叶片捕获光能力增强。(4)随着遮光率的增加,草珊瑚株高、地径、总叶面积数及单株生物量先增加后减少,并在L_(70)处理下均达到峰值,分别为58.58 cm、5.09 mm、1 038.53 cm~2和15.50 g。研究认为,草珊瑚具有一定的弱光耐受力和光可塑性,50%～70%遮光处理有利于草珊瑚生长,在实际生产中可根据该光照范围选择合适的间套作林分或进行适当的遮光处理。     

Current Status of Human Papillomavirus-Related Head and Neck Cancer: From Viral Genome to Patient Care

Virologica Sinica - Human papillomavirus (HPV) infection identified as a definitive human carcinogen is increasingly being recognized for its role in carcinogenesis of human cancers. Up to...     

雪腐核盘菌菌核的萌发条件与致死温度

菌核是核盘菌Sclerotinia spp.在土壤中的主要存活形式和菌核病的主要初侵染源,在土壤中可存活8年以上,其数量和存活状况直接影响着菌核病的发生和危害程度。本研究以雪腐核盘菌Sclerotinia nivalis菌株SS-TB为材料,分析了菌核萌发的影响因素、致死温度以及土壤温度对菌核存活的影响。结果表明,未成熟菌核较成熟菌核更容易萌发;菌核萌发的最佳温度为20-25℃、pH为3.0-4.0、土壤含水量为20%-45%。菌核长时间浸泡水中对其存活不利,浸泡30d以后,存活率开始急剧下降,至47d时存活率为0。雪腐核盘菌菌核具有较强的耐高温特性,随着温度和处理时间的增加,菌核萌发率呈下降趋势。菌核在水浴中85℃ 5min、80℃ 10min、75℃ 10min、70℃ 30min、65℃ 120min、60℃ 180min时全部丧失活力。在土壤温度30℃和35℃处理5周、40℃和45℃处理4周时菌核全部失去活力。该研究结果为通过水旱轮作和土壤高温处理来防治西洋参菌核病提供了理论基础。     

癔球症患者食管测压结果、心理特征分析及小剂量阿米替林的干预效果研究

摘要 目的：分析患者的食管测压结果、心理特征及小剂量阿米替林的干预效果。方法：选取2017年5月~2019年5月期间上海市静安区市北医院收治的癔球症患者137例（癔球症组）,另选取同期到上海市静安区市北医院体检的健康志愿者50例（非癔球症组）,比较两组食管测压结果、癔球症症状评分量表（GETS）评分、汉密尔顿抑郁量表-17（HAMD-17）评分、汉密尔顿焦虑量表-14（HAMA-14）评分。按随机数字表法将癔球症患者分为对照组（n=68）和研究组（n=69）,对照组给予常规治疗,研究组则在对照组的基础上联合小剂量阿米替林干预。比较对照组、研究组的临床疗效、不良反应。结果：癔球症组、非癔球症组患者食管上括约肌（UES）长度、UES残余压、食管下括约肌（LES）静息压、收缩前沿速度（CFV）、远端潜伏时间（DL）组间比较差异无统计学意义（P>0.05）;癔球症组患者UES静息压高于非癔球症组（P<0.05）。癔球症组患者GETS、HAMA-14、HAMD-17评分高于非癔球症组（P<0.05）。研究组治疗后的临床总有效率为84.06%（58/69）,高于对照组的66.18%（45/68）（P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论：相对于非癔球症患者,癔球症患者具有较高的UES静息压,癔球症症状及较为严重的不良情绪,采用小剂量阿米替林对癔球症进行干预可提高治疗有效率,用药安全性较好。     

三氟苯嘧啶不同种子处理方式对稻飞虱的控制效应

为探明三氟苯嘧啶不同种子处理方式对稻飞虱的田间防治效果、防治时长以及对稻田蜘蛛和水稻的安全性,为该药剂种子处理防治稻飞虱提供科学依据,本研究设置10％三氟苯嘧啶悬浮剂按不同浓度(0.375、0.75、1.125和1.5 g a.i./kg种子)对水稻种子分别以干种子拌种(干拌)、清水浸种后拌种(湿拌)和药剂浸种3种方式,清水处理作为空白对照.结果表明,3种处理方式下的水稻发芽率和出苗率均与空白对照间无显著差异,播种后100 d,各浓度对稻飞虱的防治效果均在90％以上;当药剂浓度相同时,干拌与湿拌防治时长要优于药剂浸种;不同浓度三氟苯嘧啶药剂处理在3种方式下稻田蜘蛛种群数量均略低于空白对照田蜘蛛数量.因此,水稻生产中使用三氟苯嘧啶0.375～1.5 g a.i./kg种子干拌或湿拌处理,可有效降低田间稻飞虱种群数量,对天敌蜘蛛影响较小,对水稻种子发芽、出苗安全,可在水稻生产中推广使用.