激光联合复方血栓通胶囊治疗糖尿病视网膜病变合并黄斑水肿的疗效观察

目的:分析糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效。方法:选取我院2017年1月—2019年1月收治的200例糖尿病视网膜病变合并黄斑水肿患者为研究对象,随机分为两组。对照组单独行激光治疗,观察组于对照组基础上联合复方血栓通胶囊治疗,对比两组临床疗效、治疗前后IL-6(白介素-6)、VEGF(血管内皮生长因子)、NOS(血清一氧化氮合成酶)水平变化情况。结果:对照组总有效率(68.00%,68/100)较观察组总有效率(98.00%,98/100)更高(P<0.05);与对照组对比,观察组治疗后NOS水平更高,IL-6、VEGF水平更低(P<0.05)。结论:糖尿病视网膜病变合并黄斑水肿联合采用激光与复方血栓通胶囊治疗的临床疗效显著,值得推广。     

Sequential Therapy Based on Evolvement of Patterns: A New Model for Treatment of Alzheimer’s Disease

In order to solve the problem of long-term (>9 months) efficacy in the treatment of Alzheimer''s disease (AD) by conventional therapy (CT), a staged and multiply-targeted sequential therapy based on the evolvement of patterns (STEP) was developed. Its main innovations include: (1) the time order of evolution of patterns defined by Chinese medicine (CM) in AD was found, that is, "the orderly pattern evolution starting from Shen (Kidney) deficiency, progressing to phlegm, stasis and fire, and worsening to severe toxin as well as functional collapse"; (2) the cascade hypothesis of Shen deficiency in AD and its sequential therapy based on Shen-reinforcing was proposed, that is, "reinforcing Shen in the early stage and throughout the whole process, resolving phlegm, activating blood and purging fire in the middle stage, detoxifying and replenishing vitality to stop the collapse in the advanced stage", and through meta-analysis, clinical drug use was optimized, thus the leap from "inferential selection" to "evidence-based selection" was realized; (3) the STEP regimen combined with CT maintained cognitive and behavioral stability in AD patients for at least 12 months, with cognitive enhancement and behavioral synergy after 9 months, and cognitive benefit was superior to CT at 9, 12, 15, 18, 21, and 24 months, respectively. The 2-year cognitive improvement rate was increased by 25.64% (P=0.020) and the cognitive deterioration rate was decreased by 48.71% (P=0.000). Among them, the cognitive and functional benefits of Shen-reinforcing therapy for very early AD (350 cases) for 1 year were better than the placebo (P<0.001), and the dementia conversion rate was reduced by 8.85% (P=0.002). The behavioral symptomatic relief of patients with vascular dementia received fire-purging therapy (540 cases) was superior to those received CT (P=0.016). These data suggested that the STEP regimen has synergistic effects on CTs at least in terms of cognitive benefit, and the earlier the use, the greater the benefit will have. Therefore, the STEP regimen should be considered as one of the clinical options, particularly for the dearth of effective pharmaceutical or immunological interventions that are currently available for AD.     

2014—2018年黄山市淋病疫情流行特征分析

目的分析2014-2018年黄山市淋病的流行特征,为全市的淋病防控工作提供科学依据。方法通过中国疾病预防控制信息系统收集黄山市2014—2018年的淋病数据、人口数据,进行统计分析。结果2014—2018年黄山市累计报告淋病病例761例,年均发病率为11.09/10万,年均增长率为29.14%,发病率呈逐年上升趋势(χ^2趋势=112.29,P<0.05)。淋病的人群分布中,男女报告病例数之比为13.63:1,男女发病率有统计学差异(χ^2=113.18,P<0.05);15~49岁年龄组病例数最多,占85.94%,职业以农民最多,占44.81%;以屯溪区、歙县报告病例数较多,分别占37.45%、23.26%。结论2014—2018年黄山市淋病发病率呈上升趋势,淋病防控形势严峻,需进一步完善各项防控措施。     

Implant wear induces inflammation, but not osteoclastic bone resorption, in RANK(-/-) mice.

Signaling of RANK (receptor activator of nuclear factor kappa B) through its ligand RANKL appears critical in osteolysis associated with aseptic loosening (AL). The purpose of this study was to investigate the role of RANK in a murine osteolysis model developed in RANK knockout (RANK(-/-)) mice. Ultra high molecular weight polyethylene (UHMWPE) debris was introduced into established air pouches on RANK(-/-) mice, followed by implantation of calvaria bone from syngeneic littermates. Wild type C57BL/6 (RANK(+/+)) mice injected with either UHMWPE or saline alone were included in this study. Pouch tissues were collected 14 days after UHMWPE inoculation for molecular and histology analysis. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in RANK(-/-) mice, as manifested by inflammatory cellular infiltration, pouch tissue proliferation, and increased gene expression of IL-1beta, TNFalpha, and RANKL. However, the UHMWPE-induced inflammation in RANK(-/-) mice was not associated with the osteoclastic bone resorption observed in RANK(+/+) mice. In RANK(+/+) mice subjected to UHMWPE stimulation, a large number of TRAP(+) cells were found on the implanted bone surface, where active osteoclastic bone resorption was observed. No TRAP(+) cells were found in UHMWPE-containing pouch tissues of RANK(-/-) mice. Consistent with the lack of osteoclastic activity shown by TRAP staining, no significant UHMWPE particle-induced bone resorption was found in RANK(-/-) mice. A well preserved bone collagen content (Van Gieson staining) and normal plateau surface contour [microcomputed tomography (microCT)] of implanted bone was observed in RANK(-/-) mice subjected to UHMWPE stimulation. In conclusion, this study provides the evidence that UHMWPE particles induce strong inflammatory responses, but not associated with osteoclastic bone resorption in RANK(-/-) mice. This indicates that RANK signaling is essential for UHMWPE particle-induced osteoclastic bone resorption, but does not participate in UHMWPE particle-induced inflammatory response.     

水通道：从原子结构到临床医学

阿格雷（Peter Agre）博士，美国杜克大学医学院细胞生物学系教授，约翰斯霍普金斯大学医学院生物化学系客座教授。阿格雷教授其研究成果在于分离出了长期以来所搜寻的特定输送水分子的通道。这一发现开启了针对细菌、植物和哺乳动物水通道的系列生化、生理和遗传研究之门，从而使得研究人员可以仔细跟踪水分子通过细胞膜的过程，并了解为何只有水分子而不是其他小分子能够通过细胞膜，阿格雷博士也因此获得了2003年诺贝尔化学奖。     

湘中地区50～59岁女性农民400人心血管功能测定

目的:观察体质监测身体功能指标——血压、肺活量/体质量、安静脉搏、台阶指数,了解经济不发达地区女性农民心血管功能现状。方法:于2004-07/08采用随机整群抽样的方法,在湘中地区4个县(市)中随机抽取50～54岁和55～59岁女性农民共400人作为研究对象,用体质测量仪对反映心血管功能的指标进行测定,包括血压、肺活量、安静脉搏、台阶指数。并将所获数据分别与全国同龄女性农民及湖南省城市体力、非体力劳动人群心血管功能指标进行差异性比较。测试同时对测试对象进行询问访谈,内容包括生活环境和经济收入、劳动生活方式、饮食营养习惯、体育锻炼现状、疾病情况等。要求测试者根据自己的实际情况如实回答。结果:400人均完成指标测试,全部进入结果分析。①湘中女性农民50～54岁高血压患病率为31.09%,55～59岁为40.13%,以1级、2级高血压为主。55～59岁年龄组,湘中女性农民收缩压和舒张压均高于全国农民及省内城市人群(P<0.05)。两年龄组比较,55～59岁年龄组高于50～54岁年龄组。②湘中55～59岁女性农民肺活量/体质量低于湖南省城市体力、非体力劳动人群(P<0.01,0.05)。③湘中50～54岁女性农民安静心率高于湖南省城市非体力人群(P<0.01)。④湘中55～59岁女性农民台阶指数低于湖南省城市体力劳动人群(P<0.05)。⑤湘中女性农民的心血管功能受体育锻炼、饮食习惯、经济等因素的影响。结论:湘中地区50～59岁女性农民心血管功能整体低于全国农民和湖南城市体力、非体力人群。影响湘中女性农民身体功能的主要因素有缺乏体育锻炼、饮食习惯、落后经济等因素。     

肾移植术后并发尿路上皮肿瘤的临床分析

目的 分析肾移植患者并发尿路上皮肿瘤的特点，探讨其诊治方法。方法 自1998～2003年肾移植患者1293例，术后发生尿路上皮恶性肿瘤21例（1．6％）。男4例，女17例。17例原发病为慢性问质性肾炎。发生尿路上皮肿瘤距肾移植6～62个月，平均26个月。其中膀胱癌6例，单侧肾盂或输尿管癌6例，单侧肾盂或输尿管、膀胱癌8例，双侧肾盂输尿管癌1例。10例上尿路肿瘤发生部位与移植肾同侧，4例发生于移植肾对侧。临床症状以无痛性肉服血尿和反复泌尿系感染为主。19例行手术治疗，术后所有患者免疫抑制剂用量减少1／3并辅以局部灌注化疗。结果 2例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5、8个月死亡。余19例现已随访2～5年。13例肿瘤复发，复发部位为膀胱或对侧原。肾、输尿管。所有患者在免疫抑制剂减量期间均未出现急性排斥。2例因切除移植肾恢复透析，17例肾功能正常。结论 慢性间质性。肾炎导致。肾功能衰竭的。肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤；移植肾同侧上尿路较对侧好发肿瘤；对移植肾对侧为首发的上尿路发生肿瘤者可预防性行双侧上尿路根治性切除。     

腺苷与异丙酚预处理对犬心肌缺血再灌注损伤的保护作用

目的探讨腺苷与异丙酚预处理对犬心肌缺血再灌注损伤的保护作用。方法 21只杂种犬,雌雄不拘,随机分为3组(n=7):缺血再灌注组(A组)、异丙酚预处理组(B组)、异丙酚与腺苷联合预处理组(C组)。A组冠状动脉的左前降支结扎60min后松开结扎,再灌注:120min;B组缺血前30min经静脉以5．6mg·kg-1·h-1速率持续泵注异丙酚30min;C组缺血前10min经主动脉根部一次性注入腺苷(10mmol·L-1,10ml),其余处理同B组。记录心脏血液动力学指标,并行节段性室壁运动评分(RWMS)。结果缺血即刻出现了缺血性心电图的变化。与基础值比较,A组缺血期及再灌注期 LVEDP升高,CO、SV、LVEF、CPP、RPP降低,再灌注期MAP降低,HR减慢,B、C组上述缺血再灌注诱导的血液动力学变化减弱,A组缺血期及再灌注期RWMS增加,但B、C组缺血期RWMS低于A组(P< 0．05或0．01)。结论异丙酚预处理对犬心肌缺血再灌注损伤有一定的保护作用,腺苷预处理并未增强其保护作用。     

Efficacy and safety of herbal medicines for idiopathic Parkinson's disease: a systematic review.

The objective of this study is to assess the efficacy and safety of herbal medicines (HMs), as a monotherapy or adjunct therapy, compared to placebo or conventional approaches in the treatment of idiopathic Parkinson's disease (PD). We conducted a systematic review of randomized controlled trials from both conventional and alternative medicine sources. Outcome measures were overall improvement, quality of life, reduction of levodopa dose, and adverse events. Nine studies were included, each testing a different HM. Six of the trials had limited internal validity due to major flaws in design, including the lack of proper randomization; insufficient blinding; unclear inclusive criteria in terms of diagnostic criteria, baseline staging, and duration of disease; lack of proper sample size calculation; and insufficient data analysis. Imbalances in gender and ethnicity among the patients in the included trials were observed. No major adverse events emerged, and no specific pattern was detected from the trials describing such data. In addition to major methodological defects, heterogeneity in (1) HM tested, (2) control treatment, and (3) outcome measure hindered in-depth data analysis and synthesis. Current evidence is insufficient to evaluate the efficacy and safety of various HMs. Further studies with improved trial design and reporting, with assessment on cost-effectiveness, quality of life, and qualitative data are warranted.