一氧化碳(CO)中毒通过与血红蛋白结合形成碳氧血红蛋白(CO-Hb)抑制氧气运输,导致组织缺氧,进而引发心脏、脑等器官的功能损伤。当前治疗方法包括常压氧和高压氧(HBO),尽管能够缩短CO半衰期,但治疗效果有限,且面临治疗时效性差、设备可...一氧化碳(CO)中毒通过与血红蛋白结合形成碳氧血红蛋白(CO-Hb)抑制氧气运输,导致组织缺氧,进而引发心脏、脑等器官的功能损伤。当前治疗方法包括常压氧和高压氧(HBO),尽管能够缩短CO半衰期,但治疗效果有限,且面临治疗时效性差、设备可得性等问题。近年来,血红蛋白一氧化碳清除剂作为新型治疗策略获得关注。这些清除剂通过优化血红蛋白与CO的结合特性,能够加速CO的清除,改善中毒症状。在小鼠模型中,工程化血红蛋白(如Ngb-H64Q-CCC)能够有效提高生存率并改善生理功能,显示出较好的治疗潜力。然而,血红蛋白清除剂的临床应用仍面临大规模生产、安全性等挑战,需进一步研究和优化。Carbon monoxide (CO) poisoning inhibits oxygen transport by binding to hemoglobin to form carboxyhemoglobin (CO-Hb), leading to tissue hypoxia, which in turn causes functional damage to the heart, brain, and other organs. Current treatments include normobaric oxygen and hyperbaric oxygen (HBO), which have limited therapeutic effects despite their ability to shorten the half-life of CO and face problems such as poor timeliness of treatment and availability of equipment. In recent years, hemoglobin CO scavengers have gained attention as a novel therapeutic strategy. These scavengers are able to accelerate CO clearance and improve poisoning symptoms by optimizing the binding properties of hemoglobin to CO. In mouse models, engineered hemoglobins (e.g., Ngb-H64Q-CCC) are effective in increasing survival and improving physiological functions, showing good therapeutic potential. However, the clinical application of hemoglobin scavengers still faces challenges such as large-scale production and safety, and requires further research and optimization.展开更多
背景:全球脓毒症休克的发病率和死亡率居高不下,尽管去甲肾上腺素可以增加危重病人的血压,但对额外治疗的需求未得到满足。方法:特利加压素与去甲肾上腺素治疗感染性休克的多中心随机对照试验来解决这个问题。结果:将617例患者随机分配...背景:全球脓毒症休克的发病率和死亡率居高不下,尽管去甲肾上腺素可以增加危重病人的血压,但对额外治疗的需求未得到满足。方法:特利加压素与去甲肾上腺素治疗感染性休克的多中心随机对照试验来解决这个问题。结果:将617例患者随机分配到特利加压素(n = 312)或去甲肾上腺素输注(n = 305)联合标准治疗组,其中包括开放标签血管加压药。对主要终点,即亚组28天死亡率(特利加压素n = 260;去甲肾上腺素n = 266)进行了先验改良的意向治疗初步分析。28天死亡率无差异(特利加压素 = 40%,去甲肾上腺素 = 38%,p NS)。选定的次要终点,如存活天数和无血管加压药天数以及脓毒症器官衰竭评估(SOFA)评分的变化,组间没有差异。然而,特利加压素组的不良事件比去甲肾上腺素组更严重(30% vs. 12%, P Background: The incidence and mortality of septic shock remain high globally, and although norepinephrine can increase blood pressure in critically ill patients, there is an unmet need for additional treatment. Methods: A multicenter randomized controlled trial of teripressin versus norepinephrine for septic shock was conducted to address this issue. Results: 617 patients were randomly assigned to teripressin (n = 312) or norepinephrine infusion (n = 305) in combination with standard care, which included open-label vasopressors. For the primary endpoint, the subgroup 28-day mortality (teripressin n = 260;Norepinephrine n = 266) performed a preliminary analysis of intention-to-treat with a priori modification. There was no difference in mortality at 28 days (teripressin = 40%, norepinephrine = 38%, pNS). Selected secondary endpoints, such as days of survival and vasopressor free days and changes in the Sepsis Organ Failure Assessment (SOFA) score, did not differ between groups. However, adverse events were more severe in the teripressin group than in the norepinephrine group (30% vs. 12%, P < 0.01). Conclusions: There was no difference in mortality between teripressin and norepinephrine, but teripressin had more serious adverse events. Therefore, norepinephrine remains the vasopressor of choice, but for patients with refractory septic shock who do not respond to norepinephrine, vasopressin or teripressin may be added.展开更多
偏头痛是一种引起原发性头痛的常见疾病,给个人和社会带来严重负担,其表现形式可能是一次又一次的剧烈的搏动性疼痛,这种疼痛会极大地降低患者的日常工作效率。本文对近年来关于偏头痛发病机制的研究进行综述,涵盖遗传因素、神经生物学...偏头痛是一种引起原发性头痛的常见疾病,给个人和社会带来严重负担,其表现形式可能是一次又一次的剧烈的搏动性疼痛,这种疼痛会极大地降低患者的日常工作效率。本文对近年来关于偏头痛发病机制的研究进行综述,涵盖遗传因素、神经生物学因素、血管因素、神经递质因素以及心理社会因素等方面,旨在为深入理解偏头痛的发病机制提供参考,并为其诊断和治疗提供新的思路。Migraine is a common disease that causes primary headache, which imposes a serious burden on individuals and society. It may be manifested in the form of intense throbbing pain again and again, which greatly reduces the efficiency of the patient’s daily work. This article reviews the recent studies on the pathogenesis of migraine, including genetic factors, neurobiological factors, vascular factors, neurotransmitter factors and psychosocial factors, in order to provide references for further understanding of the pathogenesis of migraine, and provide new ideas for its diagnosis and treatment.展开更多
缺血性脑卒中患者留有不同程度的运动功能障碍。运动功能障碍与皮质脊髓束受损相关,修复皮质脊髓束的完整性是治疗运动功能障碍的关键。重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)是目前广泛应用于运动功能...缺血性脑卒中患者留有不同程度的运动功能障碍。运动功能障碍与皮质脊髓束受损相关,修复皮质脊髓束的完整性是治疗运动功能障碍的关键。重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)是目前广泛应用于运动功能障碍的康复治疗手段,可修复受损皮质脊髓束的完整性。弥散张量成像(diffusion tensor imaging, DTI)可无创显示皮质脊髓束的形态和结构,是研究运动损伤的主要评估工具。本文就DTI在评估rTMS治疗缺血性脑卒中运动功能障碍疗效中的应用进行综述。Patients with ischemic stroke often suffer from varying degrees of motor dysfunction. Motor dysfunction is associated with damage to the corticospinal tract, and restoring the integrity of the corticospinal tract is crucial for the treatment of motor dysfunction. Transcranial magnetic stimulation (rTMS) is currently a widely used rehabilitative treatment for motor dysfunction, which can repair the integrity of the damaged corticospinal tract. Diffusion tensor imaging (DTI) can non-invasively visualize the morphology and structure of the corticospinal tract, serving as a primary assessment tool for studying motor impairment. This article reviews the application of DTI in evaluating the efficacy of rTMS in the treatment of motor dysfunction in ischemic stroke.展开更多
文摘一氧化碳(CO)中毒通过与血红蛋白结合形成碳氧血红蛋白(CO-Hb)抑制氧气运输,导致组织缺氧,进而引发心脏、脑等器官的功能损伤。当前治疗方法包括常压氧和高压氧(HBO),尽管能够缩短CO半衰期,但治疗效果有限,且面临治疗时效性差、设备可得性等问题。近年来,血红蛋白一氧化碳清除剂作为新型治疗策略获得关注。这些清除剂通过优化血红蛋白与CO的结合特性,能够加速CO的清除,改善中毒症状。在小鼠模型中,工程化血红蛋白(如Ngb-H64Q-CCC)能够有效提高生存率并改善生理功能,显示出较好的治疗潜力。然而,血红蛋白清除剂的临床应用仍面临大规模生产、安全性等挑战,需进一步研究和优化。Carbon monoxide (CO) poisoning inhibits oxygen transport by binding to hemoglobin to form carboxyhemoglobin (CO-Hb), leading to tissue hypoxia, which in turn causes functional damage to the heart, brain, and other organs. Current treatments include normobaric oxygen and hyperbaric oxygen (HBO), which have limited therapeutic effects despite their ability to shorten the half-life of CO and face problems such as poor timeliness of treatment and availability of equipment. In recent years, hemoglobin CO scavengers have gained attention as a novel therapeutic strategy. These scavengers are able to accelerate CO clearance and improve poisoning symptoms by optimizing the binding properties of hemoglobin to CO. In mouse models, engineered hemoglobins (e.g., Ngb-H64Q-CCC) are effective in increasing survival and improving physiological functions, showing good therapeutic potential. However, the clinical application of hemoglobin scavengers still faces challenges such as large-scale production and safety, and requires further research and optimization.
文摘背景:全球脓毒症休克的发病率和死亡率居高不下,尽管去甲肾上腺素可以增加危重病人的血压,但对额外治疗的需求未得到满足。方法:特利加压素与去甲肾上腺素治疗感染性休克的多中心随机对照试验来解决这个问题。结果:将617例患者随机分配到特利加压素(n = 312)或去甲肾上腺素输注(n = 305)联合标准治疗组,其中包括开放标签血管加压药。对主要终点,即亚组28天死亡率(特利加压素n = 260;去甲肾上腺素n = 266)进行了先验改良的意向治疗初步分析。28天死亡率无差异(特利加压素 = 40%,去甲肾上腺素 = 38%,p NS)。选定的次要终点,如存活天数和无血管加压药天数以及脓毒症器官衰竭评估(SOFA)评分的变化,组间没有差异。然而,特利加压素组的不良事件比去甲肾上腺素组更严重(30% vs. 12%, P Background: The incidence and mortality of septic shock remain high globally, and although norepinephrine can increase blood pressure in critically ill patients, there is an unmet need for additional treatment. Methods: A multicenter randomized controlled trial of teripressin versus norepinephrine for septic shock was conducted to address this issue. Results: 617 patients were randomly assigned to teripressin (n = 312) or norepinephrine infusion (n = 305) in combination with standard care, which included open-label vasopressors. For the primary endpoint, the subgroup 28-day mortality (teripressin n = 260;Norepinephrine n = 266) performed a preliminary analysis of intention-to-treat with a priori modification. There was no difference in mortality at 28 days (teripressin = 40%, norepinephrine = 38%, pNS). Selected secondary endpoints, such as days of survival and vasopressor free days and changes in the Sepsis Organ Failure Assessment (SOFA) score, did not differ between groups. However, adverse events were more severe in the teripressin group than in the norepinephrine group (30% vs. 12%, P < 0.01). Conclusions: There was no difference in mortality between teripressin and norepinephrine, but teripressin had more serious adverse events. Therefore, norepinephrine remains the vasopressor of choice, but for patients with refractory septic shock who do not respond to norepinephrine, vasopressin or teripressin may be added.
文摘偏头痛是一种引起原发性头痛的常见疾病,给个人和社会带来严重负担,其表现形式可能是一次又一次的剧烈的搏动性疼痛,这种疼痛会极大地降低患者的日常工作效率。本文对近年来关于偏头痛发病机制的研究进行综述,涵盖遗传因素、神经生物学因素、血管因素、神经递质因素以及心理社会因素等方面,旨在为深入理解偏头痛的发病机制提供参考,并为其诊断和治疗提供新的思路。Migraine is a common disease that causes primary headache, which imposes a serious burden on individuals and society. It may be manifested in the form of intense throbbing pain again and again, which greatly reduces the efficiency of the patient’s daily work. This article reviews the recent studies on the pathogenesis of migraine, including genetic factors, neurobiological factors, vascular factors, neurotransmitter factors and psychosocial factors, in order to provide references for further understanding of the pathogenesis of migraine, and provide new ideas for its diagnosis and treatment.
文摘缺血性脑卒中患者留有不同程度的运动功能障碍。运动功能障碍与皮质脊髓束受损相关,修复皮质脊髓束的完整性是治疗运动功能障碍的关键。重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)是目前广泛应用于运动功能障碍的康复治疗手段,可修复受损皮质脊髓束的完整性。弥散张量成像(diffusion tensor imaging, DTI)可无创显示皮质脊髓束的形态和结构,是研究运动损伤的主要评估工具。本文就DTI在评估rTMS治疗缺血性脑卒中运动功能障碍疗效中的应用进行综述。Patients with ischemic stroke often suffer from varying degrees of motor dysfunction. Motor dysfunction is associated with damage to the corticospinal tract, and restoring the integrity of the corticospinal tract is crucial for the treatment of motor dysfunction. Transcranial magnetic stimulation (rTMS) is currently a widely used rehabilitative treatment for motor dysfunction, which can repair the integrity of the damaged corticospinal tract. Diffusion tensor imaging (DTI) can non-invasively visualize the morphology and structure of the corticospinal tract, serving as a primary assessment tool for studying motor impairment. This article reviews the application of DTI in evaluating the efficacy of rTMS in the treatment of motor dysfunction in ischemic stroke.
