The Ratio of 6β‐Hydroxycortisol to Cortisol in Urine as a Measure of Cytochrome P450 3A Activity in Postmortem Cases

Poisoning can occur with chronic accumulation of a drug due to reduced metabolic capacity; conversely, under‐treatment may occur due to an increased metabolic rate. Over half of all drugs are metabolized by the cytochrome P450 3A complex (CYP3A). The activity of CYP3A can be assessed by the urinary ratio of 6β‐hydroxycortisol to cortisol. The aim of this study was to determine the usefulness of this ratio as a postmortem marker for determining whether altered CYP3A enzyme activity occurred prior to death. In a series of 244 postmortem cases, this ratio ranged from 0.014 to 78.6 (median 3.50). The median was significantly higher (5.14) in a subgroup of 28 cases that exhibited the presence of CYP3A‐inducing drugs. In cirrhosis, the median ratio was 1.69. This pointed to a reduced metabolic capacity of CYP3A. Thus, the ratio may constitute a rough indicator of the CYP3A metabolic capacity, which could be of value in special cases.     

Death Due to Complications of Anhidrotic Ectodermal Dysplasia

Ectodermal dysplasia comprises a group of disorders affecting ectodermal tissues. Severity depends on the genetic aberration; hyperpyrexia secondary to absence of sweat glands is a common complication. Treatment is supportive. This case report describes a 1‐month, 27‐day‐old male infant with a diagnosis of X‐linked recessive anhidrotic ectodermal dysplasia. On the day of his death, his mother swaddled him in a blanket and placed him on the couch at 5:30 am. When she picked him up at 8:00 am, he was unresponsive. At the emergency department, his rectal temperature was 40°C. Postmortem blood culture was positive for group B streptococcus, a possible etiology for fever. It is vital to teach parents that close monitoring of children with ectodermal dysplasia is necessary, as an increase in body temperature can become life threatening.     

193例持续性姿势-知觉性头晕患者中医证候研究

目的 通过因子分析探索持续性姿势-知觉性头晕（persistent postural-perceptual dizziness，PPPD）的中医证候特点。方法 采集193例PPPD病例症状、舌象、脉象，将每一症状、舌象、脉象作为一个统计变量，“有”则赋值为“1”、“无”则赋值为“0”，计算四诊信息的频数和频率，运用因子分析对高频症状、舌象及脉象进行非线性降维并提取公因子，得出病性、病位证素及中医证型并加以总结分析。结果 频率排名前3位症状的依次为头晕（90.67%）、心烦（54.40%）、倦怠乏力（51.30%），舌象中舌质频率最高者为舌质暗红（22.28%），舌苔频率最高者为白苔（31.09%），脉象频率最高者为滑脉（41.97%）。利用因子分析共提取13个公因子，累计贡献率为64.798%。整合相同的证素，共得到5个病性证素，依次是气滞（71.50%）、阴虚（24.35%）、血虚（22.28%）、气虚（17.10%）、痰湿（15.03%）；5个病位证素，依次是肝（93.26%）、肾（24.35%）、脾（16.58%）、心（0.52%）；6个中医证型，依次是肝郁气滞证（56.48%）、肝肾阴虚证（21.76%）、肝郁脾虚证（15.03%）、肾阴虚证（2.59%）、脾肾阴虚证（1.55%）、气血两虚证（0.52%）。结论 PPPD的病性证素以气滞为主，病位证素以肝为主，中医证型以肝郁气滞证为主。     

中小城镇发展问题的反思与转变

分析我国城市发展“小城镇，大问题”、“小城镇，大发展”、“小城镇，大战略”转变历程，反思中小城镇发展问题的战略路径，在新型城镇化背景下，重新回归到研究增强中小城镇发展问题上。依据城镇规模等级体系理论，研究得出了中小城镇建设在城镇体系结构和城镇化建设中的战略地位作用，提出了加快中小城镇建设发展的思路，地方政府要优化公共服务，统筹城发乡展，更好引导发挥企业和居民“以足投票”的作用，为完善城市体系结构和城市可持续发展提供新动力。     

加减薯蓣丸治疗轻中度肾精亏虚证老年期痴呆的磁共振波谱研究

目的 采用氢质子磁共振波谱（1H magnetic resonance spectroscopy,1H MRS）检查结合神经心理学量表的方法,评价加减薯蓣丸对老年期痴呆患者的治疗效果。方法 收集2015年12月至2017年4月湖北省中医院脑病科及老年病科的血管性痴呆（vascular dementia,VD）及阿尔茨海默病（Alzheimers disease,AD）肾精亏虚证患者各20例,另选认知功能正常者20例作为对照组。入选老年期痴呆患者在内科治疗的基础上予以加减薯蓣丸治疗。对老年期痴呆患者治疗前后及对照组受试者进行简易精神状态评价量表（mini mental state examination,MMSE）、日常生活能力量表（activities of daily living,ADL）、痴呆证候分型量表（syndromes differentiation scale for dementia,SDSD）评估及1H MRS检查。结果 加减薯蓣丸显著升高VD及AD患者降低的MMSE评分（P＜0.05）,降低其升高的SDSD评分（P＜0.05）,但对ADL评分的改善作用无统计学意义（P＞0.05）。1H MRS检查表明,加减薯蓣丸显著升高VD和AD患者双侧额叶下降的N 乙酰天门冬氨酸（N aspart acetyl,NAA）/肌酸（creatine,Cr）水平（P＜0.05）,而降低双侧额叶升高的胆碱复合物（choline,Cho）/Cr作用无统计学意义（P＞0.05）。加减薯蓣丸对VD患者和AD患者MMSE、SDSD、ADL评分和双侧额叶NAA/Cr、Cho/Cr的作用差异无统计学意义（P＞0.05）。结论 加减薯蓣丸改善轻中度老年期痴呆患者认知功能的机制可能与促进损伤的神经细胞修复有关。     

Establishing a Social-Darwinist Mentality in Japan’s Paternalist State: The Potential of Resistance by a Counter-Public

ABSTRACT

From a historical perspective, the welfare net in Japan was established from above without democratic participation and expanded only slowly. This expansion in many cases was aimed at enhancing national cohesion, especially during war time. During the current neoliberal era, Japan’s paternalistic welfare state has been able to put into practice the dismantling of national pension and health-care systems without the need for any theoretical re-orientation. In response, counter-publics have engaged in protest and resistance. By doing so, the victims of modernization and those who are socially weak and disadvantaged in multiple ways are able to regain their self-esteem and personal integrity.     

Bacterial Cross‐contamination Potential Associated with Contaminated Currency

Previous studies have shown a significant amount of contaminants on paper currencies. It is important to study the transfer of microorganisms between paper currencies to determine whether it meets the level of a human health threat. This cross‐contamination potential was analyzed by seeding new US 1‐dollar bills with Bacillus thuringiensis, and pressing or rubbing them against clean currency to determine the amount of bacteria transfer to the unseeded currency. The transferred amount of bacteria was recovered, plated, incubated, and the colony‐forming units were quantified. Among the recovery methods tested, the most efficient method, vortexing for 10 min with a recovery efficiency of 40 ± 8.1%, was used in this analysis. The resulting transfer rates were 4.8%, 8.6%, and 14.3% when pressed for 24 h, 72 h, and rubbed together, respectively. These transferred amounts of bacteria are significant and have the potential to spread infectious diseases.     

Justifications for Non-Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. Yet it occasionally seems morally permissible to carry out non-consensual medical interventions on competent individuals for the purpose of infectious disease control (IDC). We describe two different moral frameworks that have been invoked in support of non-consensual IDC interventions and identify five desiderata that might be used to guide assessments of the moral permissibility of such interventions on either kind of fundamental justification. We then consider what these desiderata imply for the justifiability of carrying out non-consensual medical interventions that are designed to facilitate rehabilitation amongst serious criminal offenders. We argue that these desiderata suggest that a plausible case can be made in favor of such interventions.     

芪白平肺胶囊对慢性阻塞性肺疾病痰瘀阻肺证大鼠血清CAM-2和VEGF的影响

目的 观察芪白平肺胶囊对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)痰瘀阻肺证大鼠血清钙调节蛋白-2（calmodulin-2,CAM-2）和血管内皮生长因子(vascular endothelial growth factor, VEGF)的影响,探究其作用机制。方法 将280只SD大鼠随机分为正常组（60只）、模型组（60只）、芪白平肺胶囊预防组（芪预组,40只）、芪白平肺胶囊治疗组（芪治组,40只）、尼可地尔预防组（尼预组,40只）、尼可地尔治疗组（尼治组,40只）。采用连续4周的强迫游泳、烟熏和低氧应激的复合方法复制COPD痰瘀阻肺证大鼠模型。正常组和模型组分别在实验第4周、第8周、第12周各处死20只大鼠,检测血清CAM-2和VEGF水平;芪预组和尼预组均在模型复制同时预防性给药4周,分别在实验第4周、第8周各处死20只大鼠,检测血清CAM-2和VEGF水平;芪治组和尼治组均在模型复制结束后连续给药4周,分别在实验第8周、第12周各处死20只大鼠,检测血清CAM-2和VEGF水平。结果 两因素方差分析结果显示,模型因素和时间因素对大鼠血清CAM-2和VEGF水平的主效应及其交互作用均具有统计学意义（P<0.05）。在实验第4周、第8周、第12周,模型组大鼠血清CAM-2水平均显著低于正常组（P<0.05）,血清VEGF水平均显著高于正常组（P<0.05）。与同时间模型组比较,尼预组和芪预组大鼠血清CAM-2水平显著升高（P<0.05）,而血清VEGF水平显著降低（P<0.05）。与同时间尼预组比较,芪预组CAM-2水平显著升高（P<0.05）,VEGF水平显著降低（P<0.05）。与同一时间模型组比较,芪治组和尼治组大鼠血清CAM-2水平显著升高（P<0.05）,VEGF水平显著降低（P<0.05）;在实验第12周,芪治组大鼠血清VEGF水平显著低于尼治组（P<0.05）。结论 芪白平肺胶囊和尼可地尔预防性给药和治疗性给药均可调节COPD痰瘀阻肺证大鼠血清CAM-2和VEGF的异常,芪白平肺胶囊的远期效应优于尼可地尔。     

细菌素在动物疾病防治中的作用和机理研究进展

从细菌素的性质、生产与制备、在动物疾病防治中的作用、抑(杀)菌机理及安全性评价等方面概述了此类由细菌分泌的高效抗菌蛋白类物质的研究进展。认为,细菌素不仅在体外对各种致病菌具有较强的抑杀作用,而且经口服能显著抑制动物胃肠道内的有害菌,腹腔或静脉注射后可防治动物全身性细菌感染,无任何毒害作用,是一类可用于动物疾病防治的理想的抗生素替代品。