中西医结合治疗单纯疱疹病毒性角膜炎研究进展

从辨证论治、中西医结合治疗、单方加减、中药制剂、外治法、其他疗法等6个方面阐述了单纯疱疹病毒性角膜炎临床研究的近况,提出了应加强中西医结合治疗本病的临床研究和实验研究的建议。     

中医药治疗小儿咳嗽变异型哮喘研究进展

通过对近年来中医药治疗小儿咳嗽变异型哮喘的文献进行整理,从本病的病名病因病机、辨证论治、自拟方治疗、中西医结合治疗、问题与展望等方面入手,对临床研究进行总结,为中医药治疗小儿咳嗽变异型哮喘提供系统的治疗思路和方法。     

天蚕壮阳散对肾阳虚雄性亚健康大鼠免疫功能的影响

目的:探讨天蚕壮阳散对肾阳虚雄性亚健康大鼠免疫功能的影响。方法:运用维生素B4(嘌呤法)建立肾阳虚雄性亚健康大鼠模型,造模成功后分为肾阳虚亚健康模型组、天蚕壮阳散组、金匮肾气丸组、古汉养生精组。分别运用药物干预大鼠,观察各组大鼠的体质量、活动情况、胸腺指数、脾脏指数,使用ELISA法检测大鼠血清IgG、IgA、IgM水平,进行统计分析后评价大鼠免疫功能状况。结果:天蚕壮阳散能改善模型组大鼠肾阳虚症状,提高模型组大鼠胸腺指数、脾指数,提高模型组大鼠血清IgA、IgG、IgM水平。结论:天蚕壮阳散可以提高肾阳虚雄性亚健康大鼠的免疫功能。     

Repeat hepatectomy for patients with early and late recurrence of hepatocellular carcinoma: A multicenter propensity score matching analysis

BackgroundRepeat hepatectomy is a feasible treatment modality for intrahepatic recurrence after hepatectomy of hepatocellular carcinoma, yet the survival benefit remains ill-defined. The objective of the current study was to define long-term, oncologic outcomes after repeat hepatectomy among patients with early and late recurrence.MethodsPatients undergoing curative-intent repeat hepatectomy for recurrent hepatocellular carcinoma were identified using a multi-intuitional database. Early and late recurrence was defined by setting 1 year after initial hepatectomy as the cutoff value. Patient clinical characteristics, overall survival, and disease-free survival were compared among patients with early and late recurrence before and after propensity score matching.ResultsAmong all the patients, 81 had early recurrence and 129 had late recurrence from which 74 matched pairs were included in the propensity score matching analytic cohort. Before propensity score matching, 5-year overall survival and disease-free survival after resection of an early recurrence were 41.7% and 17.9%, respectively, which were worse compared with patients who had resection of a late recurrence (57.0% and 39.4%, both P < .01). After propensity score matching, 5-year overall survival and disease-free survival among patients with early recurrence were worse compared with patients with late recurrence (41.0% and 19.2% vs 64.3% and 43.2%, both P < .01). After adjustment for other confounding factors on multivariable Cox-regression analysis, early recurrence remained independently associated with decreased overall survival and disease-free survival (hazard ratio 2.22, 95% confidence interval 1.35–3.34, P = .001; hazard ratio 1.86, 95% confidence 1.26–2.74, P = .002).ConclusionRepeat hepatectomy for early recurrence was associated with worse overall survival and disease-free survival compared with late recurrence. These data may help inform patients and selection of patients being considered for repeat hepatectomy of recurrent hepatocellular carcinoma.     

MicroRNA-30d/JAG1 axis modulates pulmonary fibrosis through Notch signaling pathway

Pulmonary fibrosis (PF) is a fibroproliferative disease which can finally end up fatal lung failure. PF is characterized by abnormal proliferation of fibroblast, dysregulated fibroblast differentiation to myofibroblast and disorganized collagen and extracellular matrix (ECM) production, deposition and degradation. JAG1/Notch signaling has been reported to play a key role in tissue fibrosis including PF. Herein, we confirmed the abnormal upregulation of JAG1 mRNA expression and protein levels in PF tissue specimens; JAG1 knockdown reduced TGF-β1-induced α-SMA and Collagen I protein levels. From the aspect of miRNA regulation, we searched for candidate miRNAs which might target JAG1 to inhibit its expression. Among the selected miRNAs, miR-30d expression was downregulated in PF tissues; miR-30d overexpression attenuated TGF-β1-induced primary normal human lung fibroblast (NHLF) proliferation, as well as α-SMA and Collagen I protein levels. Through directly binding to the 3′-UTR of JAG1, miR-30d significantly inhibited JAG1 mRNA expression and protein level. Furthermore, JAG1 overexpression partially reversed the effect of miR-30d on NHLF proliferation and α-SMA and Collagen I proteins upon TGF-β1 stimulation; miR-30d could suppress TGF-β1 function on NHLFs through blocking JAG1/Notch signaling. Rescuing miR-30d expression to suppress TGF-β1-induced activation of JAG1/Notch signaling may present a promising strategy for PF treatment.     

Segmental aneuploidies with 1 Mb resolution in human preimplantation blastocysts

PurposeThis study aimed to investigate the spectrum and characteristics of segmental aneuploidies (SAs) of <10 megabase (Mb) length in human preimplantation blastocysts.MethodsPreimplantation genetic testing for aneuploidy was performed in 15,411 blastocysts from 5171 patients using a validated 1 Mb resolution platform. The characteristics and spectrum of SAs, including the incidence, sizes, type, inheritance pattern, clinical significance, and embryo distribution, were studied.ResultsIn total, 6.4% of the 15,411 blastocysts carried SAs of >10 Mb, 4.9% of embryos had SAs ranging between 1 to 10 Mb, and 84.3% of 1 to 10 Mb SAs were <5 Mb in size. Inheritance pattern analysis indicated that approximately 63.8% of 1 to 10 Mb SAs were inherited and were predominantly 1 to 3 Mb in size. Furthermore, 18.4% of inherited SAs and 51.9% de novo 1 to 10 Mb SAs were pathogenic or likely pathogenic (P/LP). Different from whole-chromosome aneuploidies, reanalysis indicated that 50% of the de novo 1 to 10 Mb SAs and 70% of the >10 Mb SAs arose from mitotic errors.ConclusionBased on the established platform, 1 to 10 Mb SAs are common in blastocysts and include a subset of P/LP SAs. Inheritance pattern analysis and clinical interpretation based on the American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines contributed to determine the P/LP SAs.     

Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study

Background & aimsPostoperative morbidity following hepatectomy for hepatocellular carcinoma (HCC) is common and its impact on long-term oncological outcome remains unclear. This study aimed to investigate if postoperative morbidity impacts long-term survival and recurrence following hepatectomy for HCC.MethodsThe data from a multicenter Chinese database of curative-intent hepatectomy for HCC were analyzed, and independent risks of postoperative 30-day morbidity were identified. After excluding patients with postoperative early deaths (≤90 days), early (≤2 years) and late (>2 years) recurrence rates, overall survival (OS), and time-to-recurrence (TTR) were compared between patients with and without postoperative morbidity.ResultsAmong 2,161 patients eligible for the study, 758 (35.1%) had postoperative 30-day morbidity. Multivariable logistic regression analysis showed that diabetes mellitus, obesity, Child-Pugh grade B, cirrhosis, and intraoperative blood transfusion were independent risks of postoperative morbidity. The rates of early and late recurrence among patients with postoperative morbidity were higher than those without (50.7% vs. 38.8%, P < 0.001; and 41.7% vs. 34.1%, P = 0.017). Postoperative morbidity was associated with decreased OS (median: 48.1 vs. 91.6 months, P < 0.001) and TTR (median: 19.8 vs. 46.1 months; P < 0.001). After adjustment of confounding factors, multivariable Cox-regression analyses revealed that postoperative morbidity was associated with a 27.8% and 18.7% greater likelihood of mortality (hazard ratio 1.278; 95% confidence interval: 1.126–1.451; P < 0.001) and recurrence (1.187; 1.058–1.331; P = 0.004).ConclusionThis large multicenter study provides strong evidence that postoperative morbidity adversely impacts long-term oncologic prognosis after hepatectomy for HCC. The prevention and management of postoperative morbidity may be oncologically important.     

凉血消风汤联合阿维A胶囊治疗寻常型银屑病临床研究

目的评价凉血消风汤联合阿维A胶囊治疗寻常型银屑病的疗效。方法将符合入选标准的2015年3月-2019年6月本院80例寻常型银屑病患者按随机数字表法分为2组,每组40例。对照组在西医常规治疗基础上口服阿维A胶囊,研究组在对照组基础上服用凉血消风汤。2组均治疗2个月,随访6个月。分别于治疗前后进行皮损面积和严重程度指数(Psoriasis Area and Severity Index,PASI)评分;采用ELISA法检测IL-8、IL-6、TNF-α水平,采用Real time PCR法检测组蛋白乙酰化酶(histone acetyltransferase,HATs)、去乙酰化酶(histone deacetylase,HDACs)水平,记录治疗期间不良反应及随访期间的复发情况,评价临床疗效。结果研究组总有效率为82.5%(33/40)、对照组为62.5%(25/40),2组比较差异有统计学意义(χ²=4.012,P=0.045)。治疗后,研究组PASI评分低于对照组(t=7.921,P<0.01);血清IL-8、IL-6、TNF-α水平低于对照组(t值分别为12.749、13.933、10.856,P值均<0.01);HATs[(35.03±3.79)g/L比(29.26±2.41)g/L,t=8.125]活性高于对照组(P<0.01),HDACs[(31.00±2.71)g/L比(37.55±3.08)g/L,t=10.098]活性低于对照组(P<0.01)。结论阿维A胶囊联合凉血消风汤可降低寻常型银屑病患者的炎性细胞因子水平,有效阻止疾病进展,其机制可能与调节乙酰化内稳态平衡有关。     

生物型全髋关节置换术治疗成人髋关节发育不良29例回顾性分析

目的：分析生物型全髋关节置换术治疗成人髋关节发育不良伴骨性关节炎的临床治疗效果。方法：自2004年3月至2011年2月对29例32髋先天性髋关节发育不良伴骨性关节炎患者行生物型全髋关节置换术。其中男l】例,女18例;年龄37-73岁,平均52．6岁;单侧26例,双侧3例。主要症状为髋部疼痛及跛行。根据术前髋关节正位X线片分型,Crowe分型：I型17例18髋,Ⅱ型6例7髋,Ⅲ型3例4髋,Ⅳ型3例3髋。术前除3例双侧髋关节发育不良外,余患者下肢不等长1-6cm。结果：29例术后无感染、关节脱位、坐骨神经牵拉伤等并发症发生,1例股骨近端劈裂者,术中用钢丝捆扎,术后4年随访,骨折愈合,未发生假体松动迹象。所有植骨块及粗隆下截骨获得愈合,所有患者术后获随访,时间8个月-5．3年,平均3．7年。21例髋部疼痛消失、关节功能恢复良好;5例仍有轻度跛行,但较术前明显减轻。3例术后双下肢不等长〉1cm,其余均≤1cm,2例下肢延长4～5cm。Harris评分由术前的43．6±7．1提高至术后的86．7±5．3。结论：在真臼位置加深髋臼重建髋关节,根据Crowe分型不同特点,采用不同的手术方案,利用生物型全髋关节置换术治疗成人髋关节发育不良可获得良好效果。