细胞外三磷酸腺苷对大鼠脊髓损伤后胶质纤维酸性蛋白表达的影响

目的 研究细胞外三磷酸腺苷(ATP)对大鼠脊髓损伤后胶质纤维酸性蛋白(GFAF)表达和运动功能恢复的影响.方法 健康成年Wistar大鼠66只按照随机数字表法取6只作为正常对照组,余60只制作成脊髓打击伤动物模型,并再按照随机数字表法分为两组:ATP组(A组,给予ATP注射)和对照组(B组,给予等量生理盐水注射),每组30只大鼠.伤后1、3、7、14和28 d取材,应用免疫组织化学方法观察GFAP的表达,采用计算机图像分析系统进行半定量分析;并用改良的Tarlov评分观察大鼠脊髓损伤后运动功能的恢复情况.结果 大鼠脊髓损伤后GFAP的表达呈进行性升高,损伤后14 d达高峰;在损伤后7、14和28 d,A组大鼠GFAP的表达明显强于B组;脊髓损伤后14 d和28 d,A组大鼠改良的Tarlov评分明显大于B组;以上差异均有统计学意义(P<0.05).结论 细胞外ATP能促进大鼠损伤脊髓表达GFAP,并有助于大鼠脊髓损伤后运动功能的恢复.     

一定剂量X线照射对大鼠脊髓损伤模型组织结构及功能恢复的影响

目的探讨一定剂量X线照射对大鼠压迫型脊髓损伤模型组织结构及功能恢复的影响。方法采用动脉瘤夹建立大鼠压迫型脊髓损伤模型,70只SpragueDawley大鼠均接受T2节段的脊髓损伤,然后被随机分为2组,照射组在损伤后14d接受X线照射,对照组则不接受任何治疗。所有大鼠分别在脊髓损伤后第3、7、14、21、28、35和42天接受后肢运动及斜板测定,43d将所有实验大鼠处死后取出脊髓损伤标本,进行组织学检查。结果70只实验鼠中符合设计要求的共62只,其中照射组32只,对照组30只。X线照射组大鼠的后肢运动恢复及斜板测定均明显优于对照组,两者之间的差异有统计学意义(P<0.01)。照射组大鼠脊髓损伤部位的水肿及坏死区域明显少于对照组,胶质原纤维酸性蛋白(glialfibrillaryacidicprotein,GFAP)阳性细胞数明显少于对照组,而神经元数目则明显多于对照组。结论一定剂量X线照射可以改善脊髓损伤区的组织结构并促进大鼠脊髓损伤后运动功能的恢复。     

体外转染绿色荧光蛋白基因的肌源性干细胞移植修复大鼠脊髓损伤

背景：肌源性干细胞易于提取、分离及扩增,在特定条件下可分化为骨、软骨、肌肉等中胚层组织细胞,还可以跨胚层分化为神经细胞等,是组织工程临床用于脊髓损伤修复的理想种子细胞。 目的：观察肌源性干细胞移植对脊髓半切损伤大鼠运动功能的修复作用。 方法：40只成年SD大鼠随机数字表法分为移植组和对照组,每组20只。均进行脊髓半切损伤,伤后9 d,移植组于伤处移植体外转染绿色荧光蛋白基因的大鼠肌源性干细胞,而对照组仅注射等量PBS,于移植后1,2,3,4周用斜板实验和BBB评分测大鼠的运动功能,同时进行损伤脊髓取材、快速冰冻切片进行荧光显微镜观察。 结果与结论：所有大鼠脊髓半切损伤手术均成功,术后无动物死亡。肌源性干细胞移植后1周,移植组与对照组均有所恢复,斜板实验和BBB评分差异无显著性意义(P > 0.05);2~4周移植组恢复明显较好,斜板实验和BBB评分显著高于对照组(P < 0.05),移植组后肢活动与前后肢活动的协调性明显优于对照组。荧光显微镜观察经诱导分化和基因标记的肌源性干细胞在损伤脊髓组织局部生长良好,并且有沿着脊髓神经束向头尾两侧迁移的趋势。提示脊髓半切损伤大鼠经肌源性干细胞移植后能在损伤脊髓组织局部长期存活并明显改善其运动功能,肌源性干细胞移植对脊髓半切损伤大鼠有修复作用。 关键词：肌源性干细胞;移植;脊髓损伤;绿色荧光蛋白;大鼠     

大鼠脊髓损伤后挫伤部位的X线照射治疗对运动功能恢复的作用研究

目的 探讨脊髓挫伤部位的X线照射治疗对脊髓损伤后运动功能恢复的作用.方法 将70只雌性Wistar大鼠按照纽约大学的重力冲击方法建立大鼠脊髓(T10)损伤动物模型,按照随机数字表法分为7组,每组10只,其中6组大鼠在损伤后不同时间(损伤后20 min、1 d、2 d、4 d、7 d、17 d)对挫伤部位进行X线(20 Gy)照射,第7组则不予照射(对照组).然后根据Basso、Beattie、Bresnahan(BBB)评分标准评测各组大鼠运动功能恢复情况,并进行统计学比较.采用快蓝染色对存活6周以上的大鼠进行挫伤脊髓的组织形态学观察.结果脊髓挫伤后20 min、1 d、2 d行X线照射组BBB评分明显高于对照组,差异均有统计学意义(P<0.05),且在脊髓损伤后的2～3周进展较快,后期恢复缓慢.组织形态学观察可见应用X线治疗组周边组织残存区面积大于对照组.结论 脊髓挫伤部位伤后早期行X线照射治疗可保护脊髓残存的神经组织,改善运动功能的恢复.     

减重平板训练联合甲基强的松龙对脊髓损伤大鼠运动功能的影响

目的研究减重平板训练联合应用大剂量甲基强的松龙(MP)对脊髓损伤大鼠运动功能恢复的影响。方法成年雄性SD大鼠48只,随机分为正常对照组(A组)、损伤对照组(B组)、单纯平板组(C组)、联合治疗组(D组)各12只。采用改良Allen's撞击法制作T10不完全性脊髓损伤模型。C组损伤后1周开始平板训练,30min/d,每周5d,共4周,D组于损伤后24h内给予大剂量甲基强的松龙琥珀酸钠冲击治疗,1周后平板训练,30min/d,每周5d,共4周。B组损伤后不作处理。分别在损伤前、损伤后1周、2周、3周、4周和5周时采用斜板试验、改良Tarlov评分、BBB评分进行运动功能评定。结果(1)损伤后第1周,联合治疗组运动功能评分高于损伤对照组和单纯平板组(但P0.05)。(2)训练2周后开始,联合治疗组运动功能评分明显高于单纯平板组和损伤对照组,且单纯平板组也显著高于损伤对照组(P0.05)。结论减重平板训练可促进SCI大鼠运动功能的恢复,且减重平板联合甲基强的松龙比较单纯平板训练更能促进SCI大鼠运动功能的恢复。     

甲基强的松龙对大鼠急性脊髓损伤截瘫后肠道细菌移位的抑制作用

背景：我们以往的研究显示急性脊髓损伤截瘫后,自主神经紊乱导致的肠道动力障碍促使细菌移位的发生。目前认为大剂量甲基强的松龙可促进脊髓损伤患者神经功能的恢复。但不清楚甲基强的松龙能否通过促进神经功能的恢复,从而抑制急性脊髓损伤后肠道细菌的移位？本实验的目的为明确上述问题。方法：建立大鼠脊髓损伤截瘫模型。实验组大鼠脊髓损伤截瘫后立即给予大剂量甲基强的松龙,对照组大鼠脊髓损伤截瘫后立即给予生理盐水作为对照,在急性脊髓损伤后24、72小时及1周评估BBB运动功能得分,采血行细菌培养和内毒素检测。同时采集肠系膜淋巴结、脾脏、肝脏标本行细菌培养。脊髓损伤后1周行肠系膜淋巴结、脾脏、肝脏、空肠和回肠组织学观察。结果：急性脊髓损伤后1周,实验组大鼠BBB运动得分显著高于对照组(10.36±0.86 vs 6.32±1.02, P <0.05)。两组动物在脊髓损伤后24小时均发现内毒素血症及细菌生长。然而,脊髓损伤后72小时及1周,实验组大鼠血浆内毒素水平显著低于对照组(损伤后72小时：216.15±12.90 vs 435.54±10.76 , P <0.05,损伤后1周：106.58±18.56 vs 368.85±17.35, P <0.05)。脊髓损伤截瘫后移位细菌主要为大肠杆菌、阴沟杆菌、大肠埃希氏菌、普通变形杆菌、肠粪球菌等。脊髓损伤后1周实验组大鼠肠系膜淋巴结、脾脏、肝脏、空肠和回肠组织学变化程度较对照组轻。结论：大剂量甲基强的松龙冲击疗法可抑制急性脊髓损伤后肠道细菌的移位。急性脊髓损伤患者立即给予甲基强的松龙和抗生素可能有助于抑制潜在的细菌移位。     

异体骨髓间充质干细胞移植治疗大鼠脊髓损伤

背景：脊髓损伤的修复目前尚无良好的治疗手段,细胞移植能促进神经轴突再生及脊髓功能恢复,为治疗脊髓损伤提供了可能,但因脊髓损伤模型及移植方式不同,其治疗效果并不相同。 目的：验证异体骨髓间充质干细胞移植对大鼠脊髓损伤的治疗作用。 方法：全骨髓贴壁法分离大鼠骨髓间充质干细胞。健康SD大鼠随机分为3组,细胞移植组、对照组和假手术组。细胞移植组和对照组采用改良Allen重物打击法制造大鼠脊髓损伤模型,假手术组仅暴露脊髓。术后4周,每周进行运动功能评分,ELISA检测脊髓损伤组织中脑源性神经营养因子、神经生长因子表达;免疫荧光染色检测脊髓组织中NF200和胶质纤维酸性蛋白表达。 结果与结论：与对照组比较,细胞移植组大鼠运动功能明显改善,脊髓组织中脑源性神经营养因子、神经生长因子蛋白含量明显增高(P < 0.05);移植组大鼠脊髓囊腔较小,NF200表达明显增加,胶质纤维酸性蛋白表达减少。提示异体骨髓间充质干细胞移植能增加损伤脊髓神经生长因子含量,抑制胶质瘢痕形成,促进神经轴突再生,改善大鼠脊髓损伤后运动功能恢复。     

蛛网膜下腔移植自体激活许旺细胞治疗大鼠脊髓损伤***

背景：许旺细胞能够分泌多种神经营养因子,促进脊髓损伤功能的恢复。但异体许旺细胞移植可引发自身免疫反应,且在移植方式上,局部移植无法避免二次损伤,静脉移植虽可以透过血脊髓屏障到达损伤局部,但不能达到有效的治疗浓度。 目的：探讨经蛛网膜下腔移植自体激活许旺细胞对脊髓损伤大鼠功能恢复的影响。 方法：66只大鼠均建立脊髓损伤模型,造模后随机分为3组,自体激活许旺细胞组通过结扎单侧隐神经从而激活许旺细胞,自体未激活许旺细胞组、模型对照组仅在相同部位手术但不结扎神经。切除各组手术远端1 cm神经,采用组织块法进行许旺细胞的体外分离培养及纯化。1周后,自体激活许旺细胞组、自体未激活许旺细胞组分别通过蛛网膜下腔注入经Hoechst33342标记的对应许旺细胞悬液,模型对照组仅注入等量DMEM。对脊髓损伤后肢体功能的恢复进行BBB运动功能评分及脚印分析,通过苏木精-伊红染色和GFAP染色从组织学角度评价脊髓损伤恢复情况。 结果与结论：从术后第4周开始,自体激活许旺细胞组BBB后肢功能评分明显优于另两组(P < 0.05)。移植后2周,可见迁移至大鼠脊髓损伤局部的许旺细胞。与自体未激活许旺细胞组比较,移植后5周自体激活许旺细胞组的前后足中心距离、后肢第3足趾外旋角度均显著减小(P < 0.05),移植后13周损伤区胶质瘢痕面积明显减小(P < 0.05),损伤区空洞面积明显减小(P < 0.05)。证实经蛛网膜下腔移植自体激活许旺细胞可以促进脊髓损伤的恢复。     

ChABC治疗大鼠脊髓损伤再生的组织形态学观察

目的：探讨ChABC对大鼠脊髓完全性横断伤后脊髓再生修复的组织形态改变及功能恢复的影响。方法：采用大鼠胸段（T7－8）脊髓完全横切损伤模型,将SD大鼠随机分为3组（n=12）： 假手术对照组只咬除T7-8椎板,不损伤硬脊膜;单纯横断组于椎板咬除部位将脊髓横断; ChABC治疗组在横断脊髓节段下方咬除T10的单侧椎板,蛛网膜下腔放置PE-10导管,以ChABC灌注治疗（6µl/次,隔日一次,共5次）。24W时取材,每组任选3只于取材前两周行BDA顺行示踪处理,所取脊髓标本作NF-200 免疫组化检查,并用图像分析系统进行定量分析。结果：NF-200表达在ChABC组与单纯横断组间有统计学差异p＜0.05）,ChABC组中NF-200表达明显较对照组高;BDA示踪示脊髓横断组伤区及远段未见蓝染的神经纤维; ChABC组损伤区近侧端及损伤区也可见蓝色的再生神经纤维。结论：ChABC能增加NF-200表达,可能改善脊髓损伤区及两端的神经细胞功能,具有促进轴突再生修复脊髓损伤的作用。     

高压氧联合神经干细胞移植治疗大鼠脊髓损伤

背景：单纯神经干细胞移植已应用于对受损脊髓组织的修复。 目的：以神经干细胞移植同时应用高压氧治疗大鼠脊髓损伤,观察联合作用对脊髓损伤大鼠运动功能恢复的影响。 方法：雌性SD大鼠60只,以半切法制成胸段脊髓半横断大鼠模型。随机分成单纯损伤组、神经干细胞移植组及高压氧治疗组,每组20只。伤后第4周取材行病理切片苏木精-伊红染色及BrdU免疫组织化学染色,第8周取材行辣根过氧化物酶示踪,透射电镜观察轴突的再生情况,通过体感诱发电位观察神经电生理恢复情况。造模后1,2,4,6,8周进行BBB评分和斜板实验等运动功能检测。 结果与结论：观察伤后4周病理切片,单纯损伤组未见神经轴索通过,神经干细胞移植组可见少量神经轴索样结构,高压氧治疗组可见较多神经轴索样结构。BrdU的阳性细胞数及辣根过氧化物酶阳性神经纤维数,高压氧治疗组最多,神经干细胞移植组次之,单纯损伤组最少,且各组之间差异有显著性意义(P < 0.05)。透射电镜下神经干细胞移植组、高压氧治疗组正中横断面可见新生的无髓及有髓神经纤维。高压氧治疗组大鼠体感诱发电位的潜伏期短于神经干细胞移植组,波幅高于神经干细胞移植组(P < 0.05),明显优于单纯损伤组(P < 0.01)。伤后4周神经干细胞移植组、高压氧治疗组大鼠后肢运动功能均有较明显恢复,高压氧治疗组较神经干细胞移植组恢复快(P < 0.05);单纯损伤组亦有所恢复,但程度较轻。提示神经干细胞移植对于脊髓损伤大鼠后肢功能的恢复有促进作用,联合应用高压氧有协同效果。     

Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials

OBJECTIVE: The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke.DATA SOURCES: The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, Wan Fang, Weipu Information Resources System, Chinese Biomedical Literature Database, Pub Med, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016. DATA SELECTION: We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy(traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis. OUTCOME MEASURES: Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index.RESULTS: A total of 16 prospective randomized controlled trials(379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm(weighted mean difference(WMD) = 10.822; 95% confidence intervals(95% CI): 7.419–14.226), the action research-arm test(WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement(WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index(WMD = 10.706; 95% CI: 4.417–16.966). CONCLUSION: Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.     

Biofeedback therapy improves motor function following stroke Meta-analysis of 14 articles from Chinese Medical Institutions

OBJECTIVE:To evaluate feasibility of biofeedback therapy in China Medical Institutions to improve dysfunction following stroke. DATA SOURCE:A computer-based online search of publications was conducted using the Vip and PubMed Databases to identify publications that addressed biofeedback. The search key words included "electromyogram", "biofeedback", and "stroke". In total, 81 articles were retrieved. DATA SELECTION:Studies closely related to biofeedback, or studies with contents recently published in the same study field or in authorized journals, were included. Duplicated articles were excluded. Following full-text retrieval of selected articles, a total of 14 articles were collected, which addressed randomized, controlled trials of biofeedback therapy for dysfunction after stroke. Methodological quality was assessed for randomized, controlled trials using criteria from Cochrane reviewers' handbook. Results were analyzed using Revman 4.2 software. MAIN OUTCOME MEASURES:Outcomes and evaluation indices were expressed by odds ratio (OR), weighted mean difference (WMD), and 95% confidence interval (95% CI). Potential publication bias was presented using the funnel plot. RESULTS:The study included 14 randomized, controlled trials of 1 147 patients. Following biofeedback therapy, meta-analysis results demonstrated that:(1) The total effective rate was significantly greater in the biofeedback therapy group compared with the control group [OR = 3.46, 95% CI (2.09, 5.73), P = 0.62]. (2) Electromyogram changes were better in biofeedback therapy patients compared to the control group [WMD = 22.31, 95% CI (17.19, 27.43), P < 0.001]. (3) Motor function was better in biofeedback therapy patients compared with the control group [WMD = 12.43, 95% CI (6.71, 18.16), P < 0.001]. (4) Daily living activities were better in biofeedback therapy patients compared with the control group [WMD = 18.11, 95% CI (15.77, 20.44), P = 0.36]. (5) Joint range of motion was better in biofeedback therapy patients compared with the control group [WMD = 6.43, 95% CI (4.44, 8.41), P = 0.77]. Sensitivity analysis also demonstrated similar results after eliminating articles that described unknown diagnostic criteria and statistical methods. CONCLUSION:Following stroke, biofeedback therapy for dysfunction was shown to result in significant and valid outcomes, increased motor function and electromyogram values, improved joint range of motion, and improved daily living activities.     

正念干预卒中后抑郁症状的meta分析

目的 评价正念训练干预改善卒中后抑郁的疗效。 方法 计算机检索Cochrane Library、PubMed、Embase、BMJ、中国知网、维普网、万方数据库从建库至 2021年1月20日公开发表的关于正念治疗卒中后抑郁疗效的随机对照试验（randomized controlled trial, RCT）。结局指标使用汉密尔顿抑郁量表（Hamilton depression scale,HAMD）或者抑郁自评量表（selfrating depression scale,SDS）对干预组和对照组进行评估。对符合纳排标准的文献用RevMan 5.3软件 进行数据分析。 结果 共纳入10项RCT研究,594例患者。meta分析结果显示,干预组患者干预后的HAMD评分[加 权均数差（weighted mean difference,WMD）－4.06,95%CI －4.70～－3.42,P＜0.000 01]及SDS评分 （WMD －6.32,95%CI －7.75～－4.90,P＜0.000 01）均较对照组降低。 结论 正念训练结合常规护理及治疗更有利于卒中后抑郁症状的缓解。     

Pharmacologic treatment of advanced Parkinson's disease: A meta-analysis of COMT inhibitors and MAO-B inhibitors

ObjectiveTo perform a meta-analysis of randomized placebo-controlled trials evaluating catechol-O-methyltransferase (COMT) inhibitors or monoamine oxidase type B (MAO-B) inhibitors in addition to levodopa versus levodopa alone for the treatment of advanced Parkinson's disease (PD).MethodsA systematic literature search was performed between 1990 and October 2007. The primary outcome measures assessed were the reduction in scores of Unified Parkinson's Disease Rating Scale (UPDRS) total, activities of daily living (ADL) and motor scores from baseline. Other efficacy and safety endpoints were also evaluated.ResultsA total of 13 trials (n = 3775 subjects) were included in the meta-analysis. As compared to placebo, COMT and MAO-B inhibitor use resulted in greater improvement in UPDRS total score (weighted mean difference [WMD] ?2.13, 95%CI ?0.46 to ?0.20; and WMD ?5.03, 95%CI ?7.38 to ?2.68) ADL scores (WMD ?0.99, 95%CI ?1.56 to ?0.43; and WMD ?1.48, 95%CI ?2.13 to ?0.83) and motor scores (WMD ?1.50, 95%CI ?2.70 to ?0.30; and WMD ?3.19, 95%CI ?4.57 to ?1.80) as well as increase in “on” time, reduction in “off” time and decreased need in levodopa dose compared to placebo. Incidences of dyskinesia were significantly higher with the COMT and MAO-B inhibitors compared to placebo.ConclusionThe use of COMT or MAO-B inhibitors plus levodopa is superior to levodopa alone at reducing PD symptoms in patients with advanced PD. While combination therapies with COMT or MAO-B inhibitor plus levodopa seem especially useful amongst PD patients with wearing-off phenomenon, they are associated with more adverse events.     

Systematic review of atorvastatin for the treatment of Alzheimer's disease

OBJECTIVE:To assess the clinical efficacy and safety of atorvastatin in the treatment of Alz-heimer’s disease.DATA SOURCES:Medline(1948/2011-04),Embase(1966/2011-04),Cochrane Library(Issue 3,2011),Chinese National Knowledge Infrastructure(1989/2011-04),and the Chinese Biomedical Literature Database(1979/2011-04) were searched for randomized clinical trials regardless of lan-guage.Abstracts of conference papers were manually searched.Furthermore,Current Controlled Trials(http://controlled-trials.com),Clinical Trials.gov(http://clinicaltrials.gov),and Chinese Clinical Trial Registry(http://www.chictr.org) were also searched.Key words included Alzheimer disease,dementia,cognition,affection,memory dysfunction,hydroxymethylglutaryl-CoA reductase inhibitors,atorvastatin and statins.DATA SELECTION:Randomized controlled trials of grade A or B according to quality evaluation criteria of the Cochrane Collaboration were selected,in which atorvastatin and placebo were used to evaluate the effects of atorvastatin in the treatment of Alzheimer’s disease.Study methodological quality was evaluated based on criteria described in Cochrane Reviewer’s Handbook 5.0.1.Revman 5.1 software was used for data analysis.MAIN OUTCOME MEASURES:Clinical efficacy,safety,withdrawal from the studies,and withdrawal due to adverse effects.RESULTS:Two randomized controlled trials were included,one was scale A,and the other was scale B.All patients(n = 710,age range 50-90 years) were diagnosed as probable or possible mild to moderate Alzheimer’s disease according to standard criteria and treated with atorvastatin 80 mg/d or placebo.There was no difference between the two groups in the final follow-up for Clinical Global Impression of Change scale(WMD = 0.13,95%CI:-0.15 to 0.40),the Alzheimer’s Disease Assessment Scale-cognitive subscale(WMD = 1.05,95%CI:-3.06 to 6.05),Mini-Mental State Examination Scale(WMD = 0.77,95%CI:-0.57 to 2.10),and the Neuropsychiatric Instrument(WMD = 2.07,95%CI:-1.59 to 5.73).The rates of abnormal liver function,withdrawal from treatment,and withdrawal due to adverse effects were higher in the treatment group(OR = 7.86,95%CI:2.50-24.69;OR = 4.70,95%CI:2.61-8.44;and OR = 5.47,95%CI:3.01-9.94;respectively) com-pared with the placebo group.CONCLUSION:There is insufficient evidence to recommend atorvastatin for the treatment of mild to moderate Alzheimer’s disease,because there was no benefit on general function,cognitive function or mental/behavior abnormality outcome measures.Efficacy and safety need to be confirmed by larger and higher quality randomized controlled trials,especially for moderate to severe Alzheimer’s disease,because results of this systematic review may be limited by selection bias,implementation bias,as well as measurement bias.     

普拉克索治疗帕金森病的系统评价

目的 系统评价普拉克索治疗帕金森病(Pakinson's disease,PD)的临床疗效.方法 通过检索Pubmed、Embase、Cochrane Database及中国生物医学文献数据库,检索国内外2007年4月前已发表的普拉克索对照安慰剂治疗PD的临床研究.对所纳入的研究进行质量评价及meta分析.结果 共纳入10项随机对照试验(RCT)研究(纳入患者1738例),meta分析结果 显示:普拉克索可以降低PD患者统一PD评分量表(UPDRS)总分[加权均数差值(WMD)=-10.01,95%CI(-12.76～-7.26)]、UPDRSⅡ分值[WMD=-2.44,95%CI(-2.93～-1.95)]以及UPDRSⅢ分值[WMD=-6.61,95%C/(-8.38～-4.84)];普拉克索还可以降低晚期PD患者UPDRS Ⅳ分值[WMD=-0.73,95%CI(一1.16～-0.30)],以上结果 皆有统计学意义(P＜0.05).3项研究比较了普拉克索与安慰剂治疗震颤的疗效,研究间存在异质性,其中2项研究显示疗效差异有统计学意义.结论 普拉克索可以缓解患者的运动症状,改善生活质量.普拉克索具有改善治疗震颤的趋势,还需要更多的RCT研究进一步证实.     

丁苯酞软胶囊治疗血管性认知功能障碍的系统综述

目的 综合评价丁苯酞软胶囊治疗血管性认知功能障碍(包括VaD、VCI-ND、VCI-AD)的有效性及安全性.方法 计算机检索万方数据库、MEDLINE、EMBAS、中国生物医学文献数据库、中国学术期刊全文数据库、PubMed、HairWire数据库,检索时间为该库最早时间至现在,收集丁苯酞软胶囊治疗血管性认知功能障碍相关性的文献.应用RevMan 4.2.10软件对各个纳入研究的结果进行一致性检验和数据合并,并评估发表偏倚.结果 共纳入5个研究,合计494例患者.Meta分析结果显示:丁苯酞软胶囊治疗组疗效好于对照组[OR=2.34,95％CI(1.16,4.71)];治疗末MMSE量表评分Meta分析[OR=3.71,WMD95％ CI (2.07,5.35)];治疗末ADL量表评分Meta分析[OR=-1.45,WMD95％CI(-6.36,3.47)];治疗末CDR量表评分Meta分析OR=-0.57,WMD95％ CI(-1.41,0.27)].结论 丁苯酞软胶囊治疗血管性认知功能障碍有效,MMSE量表评分提高丁苯酞治疗组较对照组明显,但其ADL量表、CDR量表评分改善情况不肯定,安全性有待于进一步研究.     

认知行为疗法联合抗抑郁药物治疗卒中后抑郁的系统评价

目的 系统评价认知疗法联合抗抑郁药物对卒中后抑郁（post-stroke depression,PSD）患者的疗效。 方法 计算机检索Pub Med 、Cochr ane图书馆、中国知网、中国生物医学文献数据库、中文科技期刊数 据库、万方数据库中所有关于认知疗法联合抗抑郁药物治疗PSD患者的随机对照试验（randomized controlled trial,RCT）。对符合纳入标准的文献用ReVMan 5.3软件对数据进行Meta分析,分析两组治疗 方法对汉密尔顿抑郁量表（Hamilton Depression Scale,HAMD）评分的改善情况,以及神经功能恢复情况 （Fugl-Meyer运动评分量表）。 结果 共纳入9个RCTs,共计584例患者,对认知行为联合抗抑郁药物治疗PSD的早期（4周、8周）及 长期（12周、21周、52周）疗效做亚组分析,结果显示,与对照组相比,认知行为合并抗抑郁药物治 疗组更能显著降低患者早期及长期的HAMD评分[4周WMD -1.42,95%可信区间（confidence interval, CI）（-2.02,-0.78）,P＜0.001;8周WMD -3.74,95%CI（-5.50,-1.99）,P＜0.001;12周WMD -1.86, 95%CI（-2.55,-1.17）,P＜0.001;21周WMD -2.20,95%CI（-3.09,-1.30）,P＜0.001;52周WMD -3.73,95%CI（-4.75,-2.70）,P＜0.001],同时也促进了治疗8周后患者Fugl -Meyer运动评分量表的改 善[WMD -0.32,95%CI（-0.60,-0.04）,P =0.03]。 结论 认知行为联合抗抑郁药物较单纯使用抗抑郁药物更能显著降低PSD患者的抑郁评分,促进 患者运动功能的康复。     

Huangqi Guizhi Wuwu Decoction for treating diabetic peripheral neuropathy:a meta-analysis of 16 randomized controlled trials

OBJECTIVE:This meta-analysis was performed to systematically assess the efficacy and safety of the Chinese herbal medicine Huangqi Guizhi Wuwu Decoction(HGWWD) for treating diabetic peripheral neuropathy.DATA SOURCES:Six electronic databases,including the Cochrane Library,MEDLINE database,Chinese Biomedical Database,Chinese National Knowledge Infrastructure Database,Chinese Science and Technique Journals Database,and the Wanfang Database,were search ed on the internet for randomized controlled trials published up until 1 December 2015.The search terms included "Chinese herbal medicine","diabetic peripheral neuropathy" and "randomized controlled trials" in Chinese and in English.DATA SELECTION:We included randomized controlled trials using HGWWD/modified HGWWD for the treatment group,without restriction for the control group.We assessed literature quality in accordance with the Cochrane Review Handbook.A random or a fixed effects model was used to analyze outcomes using Rev Man 5.2 software.OUTCOME MEASURES:The primary outcomes were changes in symptoms and nerve conduction velocities.The secondary outcomeswere fasting blood glucose and hemorheological indexes.RESULTS:Sixteen randomized controlled trials,with a total of 1,173 patients,were included.Meta-analysis revealed that the efficacy of HGWWD for diabetic peripheral neuropathy was significantly superior compared with the control treatment(i.e.,control group)(risk ratio = 0.36,95% confidence interval(CI):0.29–0.46,Z =8.33,P 0.00001) Compared with the control group,there was an increase in median motor nerve conduction velocity(mean difference(MD) = 3.46,95%CI:1.88–5.04,Z = 4.30,P 0.01) and median sensory nerve conduction velocity(MD = 3.30,95%CI:2.04–4.56,Z = 5.14,P 0.01).There was also an increase in peroneal motor nerve conduction velocity(MD = 3.22,95%CI:2.45–3.98,Z = 8.21,P 0.01) and peroneal sensory nerve conduction velocity(MD = 3.05,95%CI:2.01–4.09,Z = 5.75,P 0.01) in the treatment groups.No significant difference in fasting blood glucose was found between the treatment groups and the control groups(MD =-0.12,95%CI:-0.42–0.19,Z = 0.76,P = 0.45).Plasma viscosity was significantly decreased after treatment(MD =-0.11,95%CI:-0.21 to-0.02,Z = 2.30,P = 0.02).No significant difference in fibrinogen was detectable(MD =-0.53,95%CI:-1.28–0.22,Z = 1.38,P = 0.17).Four trials reported that treatment groups experienced no adverse reactions.Adverse events were not mentioned in the other 12 trials.No trial reported the incidence of complications,quality of life outcomes,or health economics.CONCLUSION:HGWWD treatment improves diabetic neurologic symptoms and ameliorates nerve conduction velocities.Our study suggests that HGWWD may have significant therapeutic efficacy for the treatment of diabetic peripheral neuropathy.However,the methodological quality of the randomized controlled trials was generally low.Larger and better-designed randomized controlled trials are required to more reliably assess the clinical effectiveness of HGWWD.     

移植分泌神经营养素3的人胚神经干细胞在脊髓损伤大鼠体内存活及对运动功能的影响

BACKGROUND： Many methods have been attempted to repair nerves following spinal cord injury, including peripheral nerve transplantation, Schwann cell transplantation, olfactory ensheathing cell transplantation, and embryonic neural tissue transplantation. However, there is a need for improved outcomes.
OBJECTIVE： To investigate the repair feasibility for rat spinal cord injury using human neural stem cells （hNSCs） genetically modified by lentivirus to express neurotrophin-3.
DESIGN, TIME AND SETTING： In vitro cell biological experiment and in vivo randomized, controlled genetic engineering experiment were performed at the Third Military Medical University of Chinese PLA and First People＇s Hospital of Yibin, China from March 2006 to December 2007.
MATERIALS： A total of 64 adult, female, Wistar rats were used for the in vivo study. Of them, 48 rats were used to establish models of spinal cord hemisection, and were subsequently equally and randomly assigned to model, genetically modified hNSC, and normal hNSC groups. The remaining 16 rats served as normal controls.
METHODS： hNSCs were in vitro genetically modified by lentivirus to secrete both green fluorescence protein and neurotrophin-3. Neurotrophin-3 expression was measured by Western blot. Genetically modified hNSC or normal hNSC suspension （5 × 10^5） was injected into the rat spinal cord following T10 spinal cord hemisection. A total of 5μL Dulbecco＇s-modified Eagle＇s medium was infused into the rat spinal cord in the model grop. Transgene expression and survival of transplanted hNSCs were determined by immunohistochemistry. Motor function was evaluated using the Basso, Beattie, and Bresnahan （BBB） scale.
MAIN OUTCOME MEASURES： The following parameters were measured： expression of neurotrophin-3 produced by genetically modified hNSCs, transgene expression and survival of hNSCs in rats, motor function in rats.
RESULTS： hNSCs were successfully genetically modified by lentivirus to stably express neurotrophin-3. The transplanted hNSCs primarily gathered at, or around, the injection site two weeks following transplantation, and gradually migrated towards the surrounding tissue. Transplanted hNSCs were observed 7.0-8.0 mm away from the injection site. In addition, hNSCs were observed 10 weeks after transplantation. At week 4, BBB locomotor scores were significantly greater in the genetically modified hNSC and normal hNSC groups, compared with the model group （P 〈 0.05）, and scores were significantly greater in the genetically modified hNSC group compared with the normal hNSC group （P 〈 0.05）.
CONCLUSION： hNSCs were genetically modified with lentivirus to stably secrete neurotrophin-3. hNSCs improved motor function recovery in rats following spinal cord injury.