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Chronic obstructive pulmonary disease: an overview of pathology and pathogenesis. 慢性阻塞性肺疾病:病理和发病机制概述。
Pub Date : 2008-10-07 DOI: 10.1002/0470868678.CH2
J. Hogg
A cigarette smoke-induced inflammatory process underlies the pathogenesis of the majority of pathologic lesions associated with chronic obstructive pulmonary disease (COPD). In chronic bronchitis, this process is located in the mucosa, gland ducts and glands of intermediate sized bronchi with an internal diameter of 2-4 mm. The mucus-containing exudate produced by the inflammatory response overpowers the normal clearance mechanisms, resulting in the cough and expectoration that characterize chronic bronchitis. In some cases of chronic bronchitis, the inflammatory process extends to smaller bronchi and bronchioles less than 2 mm in internal diameter. In this location, the inflammatory process thickens the wall, narrows the lumen and destroys the parenchymal support of the airways. These changes progressively increase peripheral airways resistance and eventually reduce the patient's ability to empty their lungs to a degree that can be measured by a reduction in FEV1 (forced expiratory volume in one second). The reduction in lung surface area produced by parenchymal inflammation contributes to the decline in FEV1 by reducing lung elastic recoil, which is the major force driving air out of the lung. It also contributes to the reduction in diffusing capacity by reducing the lung capillary bed. The purpose of this presentation is to review the quantitative aspects of these pathological changes and attempt to provide insight into factors which result in progression of these lesions.
香烟引起的炎症过程是与慢性阻塞性肺疾病(COPD)相关的大多数病理病变的发病机制的基础。在慢性支气管炎中,该过程位于内径2-4 mm的中等大小支气管的粘膜、腺体导管和腺体。炎症反应产生的含黏液渗出物压倒了正常的清除机制,导致慢性支气管炎特征的咳嗽和咳痰。在一些慢性支气管炎病例中,炎症过程扩展到内径小于2mm的较小的支气管和细支气管。在这个部位,炎症过程使管壁增厚,管腔变窄,破坏气道的实质支持。这些变化逐渐增加周围气道阻力,并最终降低患者排空肺部的能力,其程度可以通过FEV1(一秒钟用力呼气量)的降低来衡量。实质炎症引起的肺表面积减少,通过减少肺弹性后坐力,导致FEV1下降,而弹性后坐力是推动空气排出肺部的主要力量。它还通过减少肺毛细血管床而减少弥散能力。本报告的目的是回顾这些病理变化的定量方面,并试图提供深入了解导致这些病变进展的因素。
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引用次数: 43
Cooperation through moral commitment. 通过道德承诺进行合作。
Pub Date : 2008-10-07 DOI: 10.1002/9780470030585.CH14
R. Frank
Actions that promote fairness are sometimes consistent with the pursuit of individual self-interest, sometimes not. The diner who leaves a generous tip at a favourite local restaurant, for example, may do so partly out of a sense of obligation to the waiter. But we need not invoke fairness to explain the tip, which is, after all, a prudent investment in obtaining good service in the future. In contrast, narrow self-interest cannot explain why travellers might leave tips in restaurants located along interstate highways. Because it is unlikely that they will ever visit these restaurants again, their failure to tip cannot affect the quality of service they expect to receive in the future. So it is hard to escape the conclusion that concerns about fairness must be implicated when diners tip on the road. Of course, merely to assert the existence of a sense of fairness does not really explain why people often set aside concern for narrow self-interest. It simply raises the more fundamental question of why people have a sense of fairness in the first place. It is this question I will discuss.
促进公平的行为有时与追求个人利益相一致,有时则不然。例如,在当地一家最喜欢的餐馆,用餐者给了慷慨的小费,部分原因可能是出于对服务员的责任感。但我们不需要用公平来解释小费,毕竟,这是为了将来获得优质服务而进行的一项审慎投资。相比之下,狭隘的利己主义并不能解释旅行者为什么会在州际公路旁的餐馆留下小费。因为他们不太可能再光顾这些餐馆,他们不给小费不会影响他们期望将来得到的服务质量。因此,我们很难不得出这样的结论:当食客在路上给小费时,一定会涉及到对公平的担忧。当然,仅仅断言公平感的存在并不能真正解释为什么人们常常把狭隘的个人利益放在一边。它只是提出了一个更根本的问题:为什么人们首先会有公平感?我要讨论的就是这个问题。
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引用次数: 7
Food-induced anaphylaxis. 依然的过敏反应。
Pub Date : 2008-10-07 DOI: 10.1002/0470861193.CH13
H. Sampson
Food allergies affect approximately 2% of the population and are the single leading cause of anaphylaxis occurring outside of hospitals in westernized countries. Given the frequency of IgE-mediated food allergy, it is imperative that physicians appropriately diagnose food-allergic patients, educate them in the appropriate measures to prevent accidental ingestion of food allergens, teach them to recognize early signs of anaphylaxis, and arm them with medications and a treatment plan to utilize in case of the 'almost inevitable' accidental ingestion.
食物过敏影响约2%的人口,是西方化国家医院外发生过敏反应的单一主要原因。鉴于ige介导的食物过敏的频率,医生必须正确诊断食物过敏患者,教育他们采取适当措施防止意外摄入食物过敏原,教他们识别过敏反应的早期迹象,并为他们提供药物和治疗计划,以应对“几乎不可避免”的意外摄入。
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引用次数: 8
Defects in cardiac conduction system lineages and malignant arrhythmias: developmental pathways and disease. 心脏传导系统谱系缺陷与恶性心律失常:发育途径和疾病。
Pub Date : 2008-10-07 DOI: 10.1002/0470868066.CH16
T. S. St Amand, Jonathan T. Lu, K. Chien
To unravel the complex disease phenotype of heart failure, we are utilizing an integrative approach employing genomics, physiology, and mouse genetics to identify nodal pathways for specific physiological end points such as myocyte stretch activation responses, contractility and electrical conduction. A new class of genetic pathways for cardiac sudden death and associated arrhythmias has been based on transcription factors that control conduction system lineages, including HF1b/SP4 and NKX2.5. Previous studies have established that HF1b plays a critical role in conduction system lineage formation and the loss of HF1b leads to a confused electrophysiological identity in Purkinje and ventricular cell lineages, resulting in cardiac sudden death and marked tachy and brady arrhythmias. Utilizing Hf1b and Nkx2.5 floxed alleles, we now have identified the primary pathways which link these transcription factors with cardiac arrythmogenesis. Mice which harbour a neural crest restricted knockout of HF1b display marked arrhythmogenesis and conduction system defects, implicating neural crest cues in conduction system development and disease. Mice which harbour a ventricular-restricted knockout of Nkx2.5 display completely normal conduction at birth, but a hypoplastic atrioventricular (AV) node. During maturation, progressive complete heart block ensues, associated with a selective dropout of distal AV nodal cell lineages at the boundaries of the penetrating His bundle. Single cell analyses examining individual nodal cells within AV node of ventricular restricted Nkx2.5 knockout mice clearly document a cell autonomous requirement for NKX2.5 within AV nodal lineages per se. Micro-electrophysiological AV nodal mapping indicates a selective conduction defect at the boundary of the distal AV node and His bundle. HF1b and NKX2.5 reflect new cardiac cell non-autonomous and autonomous pathways for conduction system lineage defects and associated cardiac arrythmogenesis.
为了揭示心力衰竭的复杂疾病表型,我们利用基因组学、生理学和小鼠遗传学的综合方法来确定特定生理终点的节点通路,如肌细胞拉伸激活反应、收缩性和电传导。心源性猝死和相关心律失常的一类新的遗传途径基于控制传导系统谱系的转录因子,包括HF1b/SP4和NKX2.5。先前的研究已经证实HF1b在传导系统谱系形成中起着关键作用,HF1b的缺失导致浦肯野细胞谱系和心室细胞谱系的电生理身份混淆,导致心源性猝死和明显的心动过速和brady心律失常。利用Hf1b和Nkx2.5固定等位基因,我们现在已经确定了将这些转录因子与心律失常联系起来的主要途径。神经嵴限制性敲除HF1b的小鼠表现出明显的心律失常和传导系统缺陷,暗示神经嵴在传导系统发育和疾病中的线索。脑室限制性敲除Nkx2.5的小鼠在出生时显示完全正常的传导,但房室(AV)结发育不全。在成熟过程中,进行性完全性心脏传导阻滞随之而来,与穿透His束边界的远端房室结细胞系选择性脱落有关。检测室限制性Nkx2.5敲除小鼠房室结内单个结细胞的单细胞分析清楚地记录了房室结谱系本身对Nkx2.5的细胞自主需求。微电生理房室结测图显示在远端房室结和His束交界处有选择性传导缺陷。HF1b和NKX2.5反映了传导系统谱系缺陷和相关心律发生的新的心脏细胞非自主和自主途径。
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引用次数: 5
Pharmaceutical intervention of advanced glycation endproducts. 晚期糖基化终产物的药物干预。
Pub Date : 2008-10-07 DOI: 10.1002/0470868694.CH16
A. Cerami, P. Ulrich
Recent studies have revealed that reducing sugars, such as glucose, react with proteins through non-enzymatic glycosylation to form irreversible, covalently cross-linked proteins known as advanced glycation endproducts (AGEs). Furthermore, it has been demonstrated that this naturally occurring process, accelerated in diabetics due to hyperglycaemia, impairs biological functions leading to cardiovascular disorders, as well as diabetic and age-related complications. Pharmaceutical intervention to prevent or reverse these complications have focused on inhibiting the formation of AGEs by compounds such as dimethyl-3-phenacylthiazolium chloride or breaking the glucose derived cross-links by selective cleavage. Intervention targeted at AGE cross-links in vivo offers a way to interfere with age-related changes of tissues.
最近的研究表明,还原糖,如葡萄糖,通过非酶糖基化与蛋白质反应,形成不可逆的共价交联蛋白,称为晚期糖基化终产物(AGEs)。此外,已经证明这种自然发生的过程,在糖尿病患者中由于高血糖而加速,损害生物功能,导致心血管疾病,以及糖尿病和与年龄相关的并发症。预防或逆转这些并发症的药物干预主要集中在通过二甲基-3-phenacylthiazolium chloride等化合物抑制AGEs的形成或通过选择性切割破坏葡萄糖衍生的交联。针对AGE交联在体内的干预提供了一种干预与年龄相关的组织变化的方法。
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引用次数: 18
Regulation of gene expression in mast cells: micro-rNA expression and chromatin structural analysis of cytokine genes. 肥大细胞基因表达的调控:细胞因子基因的微rna表达和染色质结构分析。
Pub Date : 2008-10-07 DOI: 10.1002/9780470033449.CH14
S. Monticelli, K. Ansel, Dong U. Lee, A. Rao
Despite deriving from two different compartments of the immune system (myeloid and lymphoid respectively), Th2 cells and mast cells produce the same panel of cytokines, interleukin (IL)4, IL5 and IL13. We have compared the chromatin structure of the RAD50/IL13/IL4 locus in Th2 cells and mast cells. Th2 and mast cells display strong overlap in their patterns of DNase I hypersensitivity throughout this locus, except that the first intron of the IL13 gene (MCHS) is DNase I hypersensitive only in mast cells and the conserved non-coding sequence (CNS)-1 in the IL4/IL13 intergenic region is DNase I hypersensitive only in Th2 cells (explaining why cytokine expression is impaired in Th2 cells but not in mast cells of CNS-1-deleted mice). We have also examined the role of micro-RNAs (miRNAs) in the development and activation of mast cells and T cells. miRNAs are 21- to 25-nucleotide small RNAs that regulate gene expression posttranscriptionally by targeting protein-coding mRNAs. Using oligonucleotide arrays to analyse miRNA expression in murine T cells and mast cells, we have identified distinctive cell type-specific patterns of miRNA expression as well as changes related to differentiation and cell activation. We are studying the biological functions of selected miRNAs.
尽管来自免疫系统的两个不同的区室(分别是髓细胞和淋巴细胞),但Th2细胞和肥大细胞产生相同的细胞因子,白细胞介素(IL)4、IL5和IL13。我们比较了Th2细胞和肥大细胞中RAD50/IL13/IL4位点的染色质结构。除了IL13基因的第一个含子(MCHS)仅在肥大细胞中对DNase I过敏,IL4/IL13基因间区的保守非编码序列(CNS)-1仅在Th2细胞中对DNase I过敏外,Th2细胞和肥大细胞在该位点上显示出强烈的重叠,这解释了为什么细胞因子表达在Th2细胞中受损,而在CNS-1缺失小鼠的肥大细胞中没有受损。我们还研究了微rna (miRNAs)在肥大细胞和T细胞的发育和激活中的作用。mirna是21- 25个核苷酸的小rna,通过靶向蛋白质编码mrna转录后调节基因表达。利用寡核苷酸阵列分析小鼠T细胞和肥大细胞中的miRNA表达,我们已经确定了miRNA表达的独特细胞类型特异性模式以及与分化和细胞激活相关的变化。我们正在研究选定的mirna的生物学功能。
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引用次数: 14
Genetics of chronic obstructive pulmonary disease. 慢性阻塞性肺疾病的遗传学。
Pub Date : 2008-10-07 DOI: 10.1002/0470868678.CH4
E. Silverman
The marked variability in the development of chronic obstructive pulmonary disease (COPD) in response to cigarette smoking has been known for decades, but severe alpha 1-antitrypsin deficiency (PI Z) remains the only proven genetic risk factor for COPD. With cigarette smoking, PI Z subjects tend to develop more severe pulmonary impairment at an earlier age than non-smoking PI Z individuals. However, PI Z individuals exhibit wide variability in pulmonary function impairment, even among individuals with similar smoking histories. Therefore, other genes and environmental exposures are also likely involved. The role of heterozygosity for the Z allele as a risk factor for COPD remains controversial, but accumulating evidence suggests that at least some PI MZ individuals are at increased risk of developing airflow obstruction. In individuals without alpha 1-antitrypsin deficiency, familial aggregation of COPD has been reported in several studies. To study novel genetic determinants of COPD, our research group enrolled 44 severe, early-onset COPD probands (FEV1 < 40%, age < 53 yrs, non-PI Z) and 266 of their relatives. A marked female predominance was noted among the early-onset COPD probands. In addition, increased risk to current or ex-smoking first-degree relatives of early-onset COPD probands for reduced FEV1, chronic bronchitis and spirometric bronchodilator responsiveness has been demonstrated. These data strongly support the genetic basis for the development of COPD and the potential for gene-by-environment interaction. A variety of studies have examined candidate gene loci with association studies, comparing the distribution of variants in genes hypothesized to be involved in the development of COPD in COPD patients and control subjects. For most genetic loci which have been tested, there have been inconsistent results. Genetic heterogeneity could contribute to difficulty in replicating associations between studies. In addition, case-control association studies are susceptible to supporting associations based purely on population stratification, which can result from incomplete matching between cases and controls--including differences in ethnicity. No association studies in COPD have been reported which used family-based controls, a study design which is immune to such population stratification effects. More importantly, no linkage studies have been published in COPD to identify regions of the genome which are likely to contain COPD susceptibility genes--regions in which association studies are likely to be more productive.
吸烟对慢性阻塞性肺疾病(COPD)发展的显著变异性已经知道了几十年,但严重的α 1-抗胰蛋白酶缺乏症(PI Z)仍然是唯一被证实的COPD遗传风险因素。吸烟的PI Z受试者比不吸烟的PI Z受试者在更早的年龄出现更严重的肺损伤。然而,PI - Z个体在肺功能损害方面表现出广泛的差异,甚至在具有相似吸烟史的个体之间也是如此。因此,其他基因和环境暴露也可能参与其中。Z等位基因杂合性作为COPD危险因素的作用仍有争议,但越来越多的证据表明,至少一些PI - MZ患者发生气流阻塞的风险增加。在没有α - 1-抗胰蛋白酶缺乏症的个体中,有几项研究报道了COPD的家族聚集性。为了研究COPD新的遗传决定因素,我们的研究小组招募了44名严重早发性COPD先证患者(FEV1 < 40%,年龄< 53岁,非pi Z)及其266名亲属。在早发性COPD先证者中,女性明显占优势。此外,已经证明,目前或已戒烟的早发性COPD先发者的一级亲属因FEV1减少、慢性支气管炎和肺活量计支气管扩张剂反应性增加的风险。这些数据有力地支持了COPD发病的遗传基础以及基因-环境相互作用的可能性。多种研究通过关联研究检查了候选基因位点,比较了COPD患者和对照组中被假设参与COPD发展的基因变异的分布。对于大多数已经测试过的基因位点,结果并不一致。遗传异质性可能导致难以复制研究之间的关联。此外,病例-对照关联研究容易受到纯粹基于人口分层的支持关联的影响,这可能是由于病例和对照之间不完全匹配(包括种族差异)造成的。目前还没有使用基于家庭的对照的COPD相关性研究报告,这种研究设计不受这种人群分层效应的影响。更重要的是,目前还没有关于COPD的关联研究发表,以确定基因组中可能包含COPD易感基因的区域——在这些区域,关联研究可能更有成效。
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引用次数: 66
General intelligence and the definition of phenotypes. 一般智力和表型的定义。
Pub Date : 2008-10-07 DOI: 10.1002/0470870850.CH9
D. Detterman
From Spearman's famous 1904 paper to Carroll's recent book on factor analytic results from a multitude of studies, there has been one consistent conclusion: 'g', or general intelligence, is the factor that defines the phenotype for intellectual functioning. It is no overstatement to say that g is undoubtedly the most important psychological construct discovered in this century. It predicts more and is implicated in a wider range of behaviour than any other psychological construct. The empirical support for g is extensive and overwhelming. It would seem that g is the perfect phenotypic definition of intelligence. I argue that it is not the perfect phenotype. If we are to understand intelligence, we need to define a new, more elaborate definition of intelligence taking g as the starting place. It must be remembered that g is a statistical abstraction. Current formulations of g are largely silent about the composition of g. I argue that g is actually made of further separable basic cognitive processes and does not represent a single underlying entity. These basic cognitive processes are integrated into a complex system in the brain that makes them difficult to identify. None the less, until these basic processes are identified and related to brain function there are a number of findings that cannot be explained and this will inhibit scientific progress.
从斯皮尔曼1904年的著名论文到卡罗尔最近出版的关于大量研究的因素分析结果的书,有一个一致的结论:“g”,即一般智力,是定义智力功能表型的因素。毫不夸张地说,g无疑是本世纪发现的最重要的心理结构。与任何其他心理构造相比,它预测的更多,涉及的行为范围更广。对g的实证支持是广泛而压倒性的。g似乎是智力的完美表型定义。我认为这不是完美的表现型。如果我们要理解智力,我们需要以g为起点,定义一个新的、更详细的智力定义。必须记住,g是一个统计抽象。目前关于g的表述在很大程度上对g的构成保持沉默。我认为g实际上是由进一步可分离的基本认知过程组成的,并不代表一个单一的潜在实体。这些基本的认知过程被整合到大脑的一个复杂系统中,使它们难以识别。尽管如此,在这些基本过程被确定并与大脑功能联系起来之前,仍有许多发现无法解释,这将阻碍科学进步。
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引用次数: 18
Mesenchymal stem cell therapy in joint disease. 关节疾病的间充质干细胞治疗。
Pub Date : 2008-10-07 DOI: 10.1002/0470867973.CH7
F. Barry
Mesenchymal stem cells have the capacity to differentiate into a variety of connective tissue cells including bone, cartilage, tendon, muscle and adipose tissue. These multipotent cells have been isolated from bone marrow and from other adult tissues including skeletal muscle, fat and synovium. Because of their multipotentiality and capacity for self renewal adult stem cells may represent units of active regeneration of tissues damaged as a result of trauma or disease. In certain degenerative diseases such as osteoarthritis (OA) stem cells are depleted, and have reduced proliferative capacity and reduced ability to differentiate. The delivery of stem cells to these individuals may therefore enhance repair or inhibit the progressive destruction of the joint. We have developed methods for the delivery of mesenchymal stem cell preparations taken from bone marrow to the injured knee joint. This treatment has the potential to stimulate regeneration of cartilage and retard the progressive destruction of the joint that typically occurs following injury.
间充质干细胞具有分化为多种结缔组织细胞的能力,包括骨、软骨、肌腱、肌肉和脂肪组织。这些多能细胞已从骨髓和其他成人组织(包括骨骼肌、脂肪和滑膜)中分离出来。由于其多能性和自我更新能力,成体干细胞可以作为创伤或疾病损伤组织的主动再生单位。在某些退行性疾病中,如骨关节炎(OA),干细胞被耗尽,增殖能力和分化能力降低。因此,将干细胞输送到这些个体可能会增强修复或抑制关节的逐渐破坏。我们已经开发了从骨髓中提取间充质干细胞制剂到受伤膝关节的方法。这种治疗有可能刺激软骨再生,并延缓关节损伤后通常发生的进行性破坏。
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引用次数: 130
Social regulation of the brain: sex, size and status. 大脑的社会调节:性别、大小和地位。
Pub Date : 2008-10-07 DOI: 10.1002/0470868732.CH14
R. Fernald
Fish comprise the largest group of extant vertebrates with approximately 25,000 known species. Some of these species are exceptional among vertebrates because they can change sex as adults. This observation raises ultimate questions about what selective forces led to the evolution of sex-changing ability and raises proximate questions about what mechanisms could account for this process. Sex change can be either from female to male (protogyny) or the reverse (protandry). In either case, the actual process of sex reversal requires reorganization of many critically important physiological systems from transformation of the gonads to modification of the neural and hormonal control systems. All of these changes require an individual animal to initiate the process based on information gleaned from the social situation. This is all the more remarkable because the information could be as simple as size discrimination or as complex as detecting subtle behavioural signals. Although it is self-evident that the brain controls behaviour, clearly behaviour can also 'control' the brain. How does behaviour cause changes in the brain? The work described here links molecular events with organismal behaviour by using an African cichlid fish model system in which social behaviours regulate reproduction. These animals have a complex social system based on the behaviour of two distinct classes of males, those with territories and those without. Changes in social status produced by behavioural interactions cause changes in neurons and endocrine responses. Surprisingly, growth rate is also regulated by social status and prior social history. Discovering how relevant social information is transduced into physiological processes requiring cellular and molecular action presents a major challenge.
鱼类是现存脊椎动物中最大的一类,已知的种类约有25000种。其中一些物种在脊椎动物中是特殊的,因为它们成年后可以改变性别。这一观察结果提出了一些终极问题:是什么选择的力量导致了性别改变能力的进化,并提出了一些近似的问题:什么机制可以解释这一过程。性别变化可以从女性变为男性(原生生殖),也可以从女性变为男性(原生生殖)。无论哪种情况,性别逆转的实际过程都需要重组许多至关重要的生理系统,从性腺的转化到神经和激素控制系统的修改。所有这些变化都需要单个动物根据从社会环境中收集到的信息来启动这一过程。因为这些信息可能简单到大小辨别,也可能复杂到探测到细微的行为信号,所以这一点尤为引人注目。虽然大脑控制行为是不言而喻的,但显然行为也可以“控制”大脑。行为是如何引起大脑的变化的?这里描述的工作通过使用非洲慈鲷模型系统将分子事件与生物行为联系起来,其中社会行为调节繁殖。这些动物有一个复杂的社会系统,基于两种截然不同的雄性行为,有领地的和没有领地的。由行为相互作用产生的社会地位变化引起神经元和内分泌反应的变化。令人惊讶的是,增长率也受社会地位和先前的社会历史的影响。发现相关的社会信息如何转化为需要细胞和分子作用的生理过程是一个重大挑战。
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引用次数: 29
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