哮喘控制稳定后如何减停糖皮质激素

糖皮质激素是最有效的抗气道炎症药物,吸入糖皮质激素(ICS)是首选哮喘控制药物。由于治疗后达到哮喘临床控制(症状、肺功能)需要一定时间,ICS达到一定剂量后量效曲线较平坦,而全身不良反应却逐渐增加。因此,达到临床控制后在长期监测下至少维持哮喘控制3个月以上,开始减少50%ICS剂量,直至ICS减至最低维持剂量。如为ICS加另一种控制药(长效β2受体激动剂、白三烯调节剂、缓释茶碱)联合治疗达到控制者,在ICS减至最低剂量时再停用另一种控制药。应用最低剂量ICS维持控制达1年方可考虑停药。     

ESBLs大肠埃希菌Ⅰ类整合子与耐药性关系

整合子通过位点特异的基因重组在临床细菌耐药性传播中起重要作用。根据整合酶基因intⅠ的序列不同将整合子划分成4种类型,其中第一类整合子最常见,决定着细菌的多重耐药。产ESBLs菌株在整合予水平转移的介导下能增加捕获这些基因盒的可能性,更有利于耐药基因的传递和扩散。     

吸毒者回归社会的过程:归属与认同的剥夺

该研究通过回顾性研究与问卷测量的方法,对吸毒者的认同感、归属感与复吸风险进行了分析和探讨,并对他们的生存状况进行了初步调查,结果表明:不利的社会处境是高复吸风险的诱发因素,戒毒人员回归社会后的生存状况不容乐观;吸毒者的自我认同和社会认同程度都显著低于健康人群,社会缺乏对戒毒人员有效的社会支持;归属剥夺是导致复吸的危险性因素,戒毒人员回归社会之后缺乏亲密的人际交往和情感交流。     

道家去火毒法在《圣济总录》矿物类药炮制中的转变与利用

道家去火毒法源于道教炼丹术,是去除矿物类药火毒的特殊炮制方法。《圣济总录》部分继承和发展了道家去火毒方法,使矿物类药去火毒法成为《圣济总录》的一大特色。整理归纳《圣济总录》中的矿物类药去火毒法,对书中的方法深层次剖析,进一步阐释道家去火毒法在矿物类药炮制中发挥的具体作用;同时,深入挖掘生熟辅料、药衬、炮制装置以及特殊服法对矿物类药炮制去火毒的作用。《圣济总录》继承了道家去火毒法并进行改进,其去火毒法对现代矿物类药的炮制方法具有指导与启发意义。

     

为病患代购管制药品的情与法冲突及化解路径

为病患代购管制药品的案件在刑法上往往面临情与法的冲突。司法机关不愿意、却不得不定罪,只能在量刑时突破法律框架,尽量从轻。在刑法的实质解释下,为病患代购管制药品不成立贩卖毒品罪、非法经营罪或妨害药品管理罪,应处无罪。在刑事个案中,“情理”虽不能直接介入,但对刑法体系的适用具有批判功能。当“法理”分析的结论与公众的法直觉相违背时,应当检讨“法理”之适用过程是否出错,使刑事个案体现刑法正义,实现情与法的统一。

     

毒品原植物药用研究的“负责任创新”基本策略

毒品原植物具有药品和毒品双重属性,这种特殊性使其在科研创新活动中面临诸多伦理困境。立足解决国内毒品原植物医药研究面临的困境,参照负责任创新四维理论模型提出五个负责任行为框架,即政府主导为主、大众监督为辅,提倡多主体共同责任、资质认证与审查制度、全过程嵌入式伦理反思、建立负责任创新价值观和预后问责制,在提升创新动力方面提出部分性开放科学推进成果共享、创新监管机制以降低科研机构的风险。以中医药科研实践为基础,引入科学技术哲学思辨,为中医药毒品原植物科研创新规避风险,为提升创新动力提供有益思路。

     

药物成瘾者决策缺陷的特征、机制及干预

药物成瘾者存在决策缺陷, 并表现出冲动性、风险寻求、奖赏失调、躯体内感信号缺失等特征。神经影像学研究表明药物滥用导致成瘾者背外侧前额皮层、前扣带回、眶额叶皮层、腹内侧前额皮层、杏仁核、脑岛等脑区受损, 这些损伤是引发其决策缺陷的主要原因。认知训练有利于提高个体的决策能力, 如目标管理训练和正念冥想等可以增强个体工作记忆、促进自我觉察和以目标为导向的行为; 而非侵入性脑刺激则可以直接改变与成瘾者决策相关脑区的激活状态, 从而提升与决策相关的认知功能。总体而言, 未来认知训练和非侵入性脑刺激在成瘾干预方面仍有广阔的拓展空间。     

Resilience in Scientific Research: Understanding How Natural Product Research Rebounded in an Adverse Situation

The recent declining rate in the discovery of new drugs has made natural product (NP) research—the traditional method of using living organisms to acquire drug candidates—regain its importance, despite the fact that it was once regarded as an obsolete method in the face of the exalted expectations about emerging new approaches since the 1990s. The concept of ‘resilience’ in scientific research provides a clue for understanding the dynamism of this rebound in research. Four elements may be highlighted in the context of microbial NP research in Japan: first, ‘institutional precondition’ is essential in the sense that the research must be rooted in an institutional complex involving academia, drug companies, and national policies. Second, the dual nature of the ‘attack from rival innovations’ including semiotic labeling and technical advances is examined. Third, four approaches to NP research are observed as responses to such challenges: (1) reevaluating the naturalness of NPs; (2) adopting various technical elements from their rivals; (3) shifting the emphasis from the practical pursuit of drug candidates to biological research using bioprobes; and (4) examining the uneven degree of resilience between academia and industry. Fourth and finally, NPs are viewed as an icon of cultural practice. This view may eventually open the door to questions about the meaning of ‘tradition’ in the context of general contemporary scientific research.     

The Relation Between Compulsive Sexual Behaviors and Aggression in a Substance-Dependent Population

Research supports a high comorbidity between compulsive sexual behaviors (CSBs) and substance use disorders (SUDs), which are both classified by increased impulsivity. Literature has also indicated that increased impulsivity and substance use are associated with aggression. However, no known research has examined the relationship between CSBs and aggression among a substance-dependent population. The purpose of this study was to examine this relationship. Participants included 349 male patients in treatment for SUDs. Results indicated that after controlling for alcohol and drug use and problems and age, CSBs were significantly associated with total aggression, aggressive attitudes, physical aggression, and verbal aggression. This is the first known study to examine this relationship; thus continued research is needed to extend and replicate these findings.