益气养阴活血方对肾小球系膜细胞增殖及ERK通路的影响

目的 观察益气养阴活血方含药血清对高糖条件培养的大鼠肾小球系膜细胞增殖及胞外信号调节激酶(ERK)通路的影响.方法 制备益气养阴活血方和福辛普利含药血清.将大鼠肾小球系膜细胞分为正常对照组、高糖培养组、高糖培养+福辛普利含药血清组和高糖培养+三个不同浓度益气养阴活血方含药血清组.培养6 h、12 h、24 h、48 h、72 h后用Western-blot法对系膜细胞中磷酸化ERK1/2(pERK1/2)的表达进行半定量分析,用4-甲偶氮唑蓝(MTT)法检测细胞增殖.结果 与正常对照组相比,高糖组早期(24 h、48 h)能显著促进系膜细胞增殖,福辛普利和高浓度中药含药血清组均可抑制高糖引起的系膜细胞增殖(P<0.05),两组间无统计学差异(P>0.05).高糖刺激6 h后系膜细胞中pERK1/2蛋白的表达即明显增高,24 h达到高峰,后逐渐减弱,福辛普利和不同浓度中药含药血清干预后,pERK1/2蛋白水平显著下降(P<0.05),中药组和西药组间无统计学差异(P>0.05).结论 益气养阴活血方能抑制肾小球系膜细胞增殖和ERK通路的磷酸化,这可能是其临床肾脏保护作用机制所在.     

唑来膦酸联合椎体后凸成形治疗骨质疏松性压缩骨折：提高骨密度、预防椎体再骨折、远期疗效评价的Meta分析

文题释义：椎体后凸成形：采用椎体内置入气囊的方法通过扩张使椎体复位，在椎体内部形成空隙，减小骨水泥注入所需的推力，使骨水泥在椎体内不易流动，可有效解除或缓解疼痛、恢复病椎高度，但临床发现仍存在骨水泥渗漏等风险。 唑来膦酸：椎体后凸成形已被广泛应用于骨质疏松性压缩骨折的治疗，临床疗效显著，然而如何有效改善骨质疏松状况成为临床面临的重要问题。唑来膦酸是双膦酸盐类药物，可有效抑制骨吸收，降低再发骨折风险，改善骨折患者的功能评分。 背景：临床应用唑来膦酸治疗骨质疏松症缺乏系统的科学评价和循证学依据，因此目前对于唑来膦酸联合椎体后凸成形治疗骨质疏松性椎体压缩骨折的临床疗效尚无明确定论。 目的：系统评价唑来膦酸联合椎体后凸成形治疗骨质疏松性椎体压缩骨折的临床疗效。 方法：应用计算机检索公开发表在CNKI、万方、维普等中文数据库及CBM、PubMed、Cochrane等英文数据库中，有关唑来膦酸联合椎体后凸成形治疗骨质疏松性椎体压缩骨折的随机对照试验，试验组治疗方式为唑来膦酸联合椎体后凸成形，对照组治疗方式为椎体后凸成形，时间截止至2019年9月。由2位研究员独立进行文献筛选、数据提取，按Cochrane协作网标准对纳入随机对照试验逐个进行质量评价，采用RevMan 5.3软件对符合纳入标准的研究进行统计分析。 结果与结论：①最终纳入5篇文献，均为随机对照研究，试验组患者175例，对照组患者184例；②统计分析结果显示：试验组治疗后12个月的骨密度高于对照组[MD=0.12，95%CI(0.08，0.17)，P < 0.000 01]，治疗后6，12个月的目测类比评分低于对照组[MD=0.46，95%CI(0.18，0.75)，P=0.002；MD=0.85，95%CI(0.20，1.50)，P=0.01]，治疗后1年的Oswestry功能障碍指数评分低于对照组[MD=6.59，95%CI(4.77，8.41)，P < 0.000 01]，骨水泥渗漏率、椎体骨折再发率低于对照组[OR=0.22，95%CI(0.08，0.59)，P=0.003；OR=0.18，95%CI(0.07，0.50)，P=0.000 8]；两组椎体高度恢复、椎体后凸Cobb角比较差异无显著性意义[MD=0.65，95%CI(-0.27，1.56)，P=0.16；MD=-0.60，95%CI(-2.45，1.25)，P=0.53]；③结果表明与单独应用椎体后凸成形相比，唑来膦酸联合椎体后凸成形在提高骨密度值、减少椎体骨折再发率、改善患者远期临床症状、预防骨水泥骨水泥渗漏等并发症方面具有显著优势，但后期仍需大量高质量的多中心随机对照研究提供更充足的证据。 ORCID: 0000-0001-8871-3539(李凯明) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

基于数据挖掘技术分析全国名老中医安阿玥治疗肛瘘术后创面愈合缓慢的用药规律

[目的] 应用数据挖掘技术分析安阿玥教授治疗肛瘘术后创面愈合缓慢的用药规律。[方法] 收集2014年7月—2018年6月安阿玥教授收治的肛瘘术后创面愈合缓慢的病例，以“主症、兼症、舌象、脉象、辨证、治法、方药”为项目构建MySQL数据库，利用Python语言搭建分析系统，统计分析获得安阿玥教授治疗肛瘘术后创面愈合缓慢的辨证用药规律。[结果] 共纳入肛瘘术后创面愈合缓慢病例306例，证候多属阴虚内热、气血不足、脾胃不和、热毒内盛、气虚血瘀证，所用方剂多以增液汤、四物汤、青蒿鳖甲汤、半夏泻心汤等加减化裁，用药次数较多的依次为当归、生地、玄参、生黄芪、马齿苋等。[结论] 肛瘘术后创面愈合缓慢以虚证居多，包括阴虚、血虚、气虚等。临床治疗时重视“和血”的辨证思维。数据挖掘技术结果客观反映了安阿玥教授治疗肛瘘术后创面愈合缓慢的临床思路和经验。     

耳甲电针治疗功能性消化不良的临床效果

目的:观察耳甲电针治疗功能性消化不良的疗效。方法:选取2018年6月至2019年5月北京同仁医院收治的功能性消化不良患者90例作为研究对象,按照随机数字表法分为对照组和观察组,每组45例,对照组采用对照刺激,观察组采用耳甲电针刺激,所有患者治疗前后均使用功能性消化不良主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)评估患者症状的严重程度,并参照功能性消化不良中医诊疗专家共识意见和功能性消化不良中西医结合诊疗共识意见的疗效评估方法,对比分析观察组与对照组治疗功能性消化不良的疗效。结果:观察组和对照组治疗前主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)差异无统计学意义(P>0.05),治疗后观察组症状及量表评分与对照组差异有统计学意义(P<0.05)。观察组治疗有效率82.22%,对照组治疗有效率57.78%,差异有统计学意义(P<0.05)。结论:耳甲电针对于功能性消化不良的各项症状具有较好的疗效。     

基于网络药理学探讨清金化浊方治疗慢阻肺的作用机制＊

目的 利用网络药理学方法探讨清金化浊方治疗慢阻肺的作用机制。方法 在中药系统药理学数据库和分析平台（Traditional Chinese Medicine Systems Pharmacology，TCMSP）平台检索组方君臣药物的主要化学成分及作用靶点，通过TTD、CTD、DisGeNET、GeneCards数据库获得慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）相关靶点，筛选药物与疾病的交集靶点及有效活性成分。利用Cytoscape3.7.2构建药物-化合物-靶点-疾病网络，利用STRING数据库构建蛋白质-蛋白质相互作用关系（Protein-Protein Interaction，PPI）网络 拓扑分析图，并分析核心靶点。利用DAVID数据库进行基因功能（Gene Ontology，GO）和基于京都基因与基因组百科全书（Kyoto Encyclopedia of Genes and Genomes，KEGG）富集分析，并绘制通路-靶点网络图。基于网络分析结果，纳入2020年1月-2021年1月我科收治的AECOPD患者，采用区组随机法按1：1分为对照组（西医治疗组）、研究组（清金化浊方联合西医治疗组），比较两组患者的IL-6、TNF-α水平。结果 筛选得到164个中药成分靶点，3051个COPD靶点，映射得出药物-疾病交集靶点112个。分析得出清金化浊方治疗COPD主要有槲皮素、β-谷甾醇、山奈酚、豆甾醇、木犀草素等有效活性成分，涉及IL-6、TNF、MAPK3、VEGFA、TP53、PTGS2、MAPK1、PIK3CG等关键靶点。富集于药物反应、一氧化氮生物合成过程的正调控、缺氧反应等生物过程及83条信号通路，其中TNF、HIF-1和PI3K-Akt信号通路在COPD的治疗中最为重要。临床研究显示，两组治疗7天后IL-6、TNF-α均较治疗前下降；治疗后组间比较，研究组低于对照组（P<0.05）。结论 清金化浊方主要以抗炎为核心，兼有调节氧平衡、降低气道黏液高分泌、改善气道重塑、调节免疫功能及血液高凝状态等多方面的作用，为其临床应用提供一定指导价值，亦为进一步开展后续课题研究提供科学依据。     

Safety of a quadrivalent human papillomavirus vaccine in a Phase 3, randomized,double-blind,placebo-controlled clinical trial among Chinese women during 90 months of follow-up

Background

A quadrivalent human papillomavirus (qHPV) vaccine (HPV6/11/16/18) has demonstrated efficacy and acceptable safety in international studies. However, these studies did not include participants from mainland China, which has a substantial burden of HPV-related disease. This is the first safety report with a follow-up period of up to 90?months from a randomized, double-blind, placebo-controlled trial of qHPV vaccine in Chinese women 20–45?years of age.

经皮耳迷走神经刺激干预功能性消化不良模型大鼠的效应及机制研究

ObjectiveTo explore the effect and its possible mechanism of the intervention of transcutaneous auricular vagus nerve stimulation (taVNS) for the functional dyspepsia (FD) model rats.MethodsOf the 25 male SD rats, 6 rats were set as blank group, the other 19 rats were established to be the functional dyspepsia (FD) model by iodoacetamide intragastric administration, and 18 FD models were successfully established. The 18 model rats were randomly divided into a model group, a sham-taVNS group, and taVNS group, with 6 rats in each group. There was no intervention applied to the rats in the blank and model groups. Whereas, the rats in sham-taVNS group received stimulation to the rim of auricular concha of both sides, and those in taVNS group received stimulation to the cavity of auricular concha of both sides, for 30 min each time, once a day, 7 days in succession. After the intervention, the gastric sensitivity of the rats in each group under different pressure conditions in the stomach, the expressions of serum brain-gut peptide motilin (MTL), cholecystokinin (CCK), glucagon-likepeptide1 (GLP-1), and inflammatory factors IL-4, IL-10, and IL-1β were detected.Results(1) Gastric sensitivity: compared with the blank group, the gastric sensitivity of the model group was higher (P <0.05). Compared with the model group, the gastric sensitivity of the taVNS group was lower (P < 0.05). Compared with the sham-taVNS group, the gastric sensitivity of the taVNS group was lower (P <0.05).(2) Expression of brain-gut peptide: compared with the blank group, MTL was lower, CCK and GLP-1 were higher in the model group (all P <0.05). Compared with the model group, MTL was higher, CCK and GLP-1 were lower in the taVNS group (all P <0.05). Compared with the sham-taVNS group, CCK and GLP-1 were lower in the taVNS group (both P<0.05). (3)Expression of inflammatory factors: compared with the blank group, IL-4 and IL-10 were lower and IL-1β was higher in the model group (all P <0.05). Compared with the model group, IL-10 was higher and IL-1β was lower in the sham-taVNS group (all P <0.05), while IL-4 and IL-10 were higher and IL-1β was lower in the taVNS group (all P <0.05). Compared with the sham-taVNS group, IL-4 and IL-10 were higher and IL-1β was lower in the taVNS group (all P <0.05).ConclusionTaVNS can reduce the gastric sensitivity of FD model rats by peripheral anti-inflammatory action and regulating the abnormal secretion of brain-gut peptide.     

三棱火针加拔罐治疗腘窝囊肿30例

ObjectiveTo explore the therapeutic effect of the fire needling with the three-edged needle and the cupping on popliteal cyst.MethodsA total of 60 patients of popliteal cyst were divided into two groups, 30 cases in each one according to the random number table. In the fire needling group, the burnt-red three-edged needle was inserted to the deep layer of the cyst. After the fluid was squeezed out, the cupping was exerted. The treatment was given 1 to 2 times a week, for 4 weeks totally. In the western medication group, prednisolone acetate 25 mg was injected in the cyst capsule, once a week, for 4 weeks totally. The effective rate, recurrence rate and Rauschning–Lindgren grading were evaluated before and after treatment.ResultsThe total effective rate was 80.0% in the fire needling group and was 83.3% in the western medication group, without statistical significance in comparison (P > 0.05). The recurrence rate was 6.7% in the fire needling group and was 30% in the western medication group. The recurrence rate in the fire needling group was lower than that in the western medication group, indicating the statistical significance (P < 0.05). After treatment, Rauschning–Lindgren grade was different statistically as compared with that before treatment in either group (both P < 0.05). Rauschning–Lindgren grade was distributed in 0 to I in the fire needling group after treatment, which was different significantly as compared with the western medication group (P < 0.05).ConclusionThe combined treatment with the fire needling combined with cupping therapy achieves the satisfactory effect on popliteal cyst and the very low recurrence rate and it is easy in operation and deserves to be promoted in primary care.     

The Hepatorenal Toxicity and Tumor Response of Chemotherapy With or Without Aidi Injection in Advanced Lung Cancer: A Meta-Analysis of 80 Randomized Controlled Trials

PurposeChemotherapy-induced hepatorenal toxicity often decreases tolerance for further therapies and results in poor quality of life and prognosis for patients with lung cancer. In this meta-analysis, all related studies were systematically re-evaluated to determine whether Aidi injection relieves hepatorenal toxicity and improves tumor response, and to determine its threshold and the optimal treatment regimen for obtaining the desired responses.MethodsAll studies regarding Aidi injection with chemotherapy were gathered from Chinese and English databases (from inception until January 2019). Their bias risk was evaluated and the data were synthesized using meta-analysis; the quality of evidence of all outcomes was rated by using the Grades of Recommendation Assessment, Development, and Evaluation approach.FindingsEighty randomized controlled trials containing 6279 patients were included in the study. Most of the trials showed unclear risk of bias. Aidi injection with chemotherapy increased the objective response rate (risk ratio [RR], 1.32; 95% CI, 1.25–1.40) and the disease control rate (RR, 1.15; 95% CI, 1.12–1.17) and resulted in a lower incidence of hepatotoxicity (RR, 0.61; 95% CI, 0.55–0.69) and nephrotoxicity (RR, 0.62; 95% CI, 0.53–0.72) than that of chemotherapy alone. Subgroup analyses showed that treatment with 50 mL per time, 10 to 14 days per cycle, and 2 to 3 cycles of Aidi injection with chemotherapy resulted in a low incidence of hepatorenal toxicity. All of the results were robust, and their quality was moderate.ImplicationsThe moderate evidence indicates that Aidi injection with chemotherapy may improve tumor response and result in a low incidence of hepatorenal toxicity in patients with lung cancer. Aidi injection may relieve hepatorenal toxicity and exhibit an important protective effect against chemotherapy-induced hepatorenal toxicity. Based on the subgroup analysis results, Aidi injection seems to lower the threshold for chemotherapy. Treatment with 50 mL per time, 10 to 14 days per cycle, and 2 to 3 cycles may be the optimal usage for attaining a decrease in hepatorenal toxicity.