微创经皮肾镜取石术治疗肾结石的研究进展

肾结石是泌尿系统的常见病、多发病,如不能采取科学有效的治疗方式,会导致尿路感染,造成尿路阻塞,病情严重者甚至会引起肾实质萎缩,对肾功能产生严重损害。临床针对肾结石的主要治疗方案为实施手术,且选取合适的手术术式对改善患者预后至关重要。近年来,随着国内外科医疗技术的不断进步,微创经皮肾镜取石术(PCNL)取得了较大的进展,在我国的泌尿系统结石手术中发挥着举足轻重的作用。基于此,本文就微创PCNL治疗肾结石的研究进展进行综述。     

多组学联用在中药作用机制研究中的应用

组学技术的运用主要基于高通量分析检测技术,包括转录组学、蛋白质组学和代谢组学等。生物信息学的飞速发展,为探索中药治疗疾病的机制提供新的思路和方法。在过去的数十年间,组学技术广泛应用于中药作用机制的研究当中。中药具有多成分、多靶点的特点,单一通路研究难以诠释中药"整体观念"的治疗思想,而多组学联用研究与这一观点不谋而合。查阅近年文献,对转录组学、蛋白质组学、代谢组学及16S rRNA测序等联用在中药治疗疾病中发挥的作用进行综述。     

卵巢储备功能降低不孕症中西医结合治疗的理论与临床试验研究探讨

卵巢储备功能降低(DOR)导致的不孕症业已成为生殖健康领域的难题,引起了国内外学者的广泛关注,其根本病机为肾精亏虚。中医药治疗不孕症历史悠久、经验丰富,针对DOR不孕症,从肾论治。将中西医治疗思想相结合,辨病论治与辨证论治结合,采纳中医专病通治方的理念,确定补肾养血、疏肝健脾的治法治则,组方遣药,通过中药补肾方加减可多系统、多靶点、多环节调节生殖功能,充分发挥中医药优势。同时,提出"长(卵)排(卵)并调,数量质量并举"假说,临床上采用中西医结合的两阶段疗法,达到增加卵泡数量,改善卵泡质量,促进卵泡发育和排出的效果,有效规范治疗DOR不孕症。     

Learning from the research process: An advanced practitioner reporting radiographer reflective narrative

Research is one of the recognized four pillars of advanced practice. This reflective narrative outlines the radiographer author's critical thoughts throughout the completion of the research modules for an MSc in Clinical reporting. The journey is followed from formative stages through to completion. Skills are developed in determining a research subject, literature searching, navigating ethics, conducting research and dissemination. Throughout the process, as well as producing a published piece of research, the learning contributes to the remaining three pillars of advanced practice (Leadership, Clinical practice and Education), ultimately improving service to the patient.     

Aerobic exercise suppresses hepatocellular carcinoma by downregulating dynamin-related protein 1 through PI3K/AKT pathway

ObjectiveExercise, as a common non-drug intervention, is one of several lifestyle choices known to reduce the risk of cancer. Mitochondrial division has been reported to play a key role in the occurrence and transformation of hepatocellular carcinoma (HCC). This study investigated whether exercise could regulate the occurrence and development of HCC through mitosis.MethodsBioinformatics technology was used to analyze the expression level of dynamin-related protein 1 (DRP1), a key protein of mitochondrial division. The effects of DRP1 and DRP1 inhibitor (mdivi-1) on the proliferation and migration of liver cancer cells BEL-7402 were observed using cell counting kit-8, plate colony formation, transwell cell migration, and scratch experiments. Enzyme-linked immunosorbent assay, Western blot and real-time polymerase chain reaction were used to detect the expression of DRP1 and its downstream phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. A treadmill exercise intervention was tested in a nude mouse human liver cancer subcutaneous tumor model expressing different levels of DRP1. The size and weight of subcutaneous tumors in mice were detected before and after exercise.ResultsThe expression of DRP1 in liver cancer tissues was significantly upregulated compared with normal liver tissues (P < 0.001). The proliferation rate and the migration of BEL-7402 cells in the DRP1 over-expression group were higher than that in the control group. The mdivi-1 group showed an inhibitory effect on the proliferation and migration of BEL-7402 cells at 50 μmol/L. Aerobic exercise was able to inhibit the expression of DRP1 and decrease the size and weight of subcutaneous tumors. Moreover, the expression of phosphorylated PI3K (p-PI3K) and phosphorylated AKT (p-AKT) decreased in the exercise group. However, exercise could not change p-PI3K and p-AKT levels after knocking down DRP1 or using mdivi-1 on subcutaneous tumor.ConclusionAerobic exercise can suppress the development of tumors partially by regulating DRP1 through PI3K/AKT pathway.     

腰痹通胶囊治疗腰椎间盘突出症的Meta分析

目的系统评价腰痹通胶囊比较非甾体抗炎药(NSAIDs)治疗腰椎间盘突出症(LDH)的疗效和安全性,为临床提供循证参考。方法通过计算机检索Cochrane Library、PubMed、Web of Science、中文科技期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库(Wanfang Data),收集自建库以来至2019年6月腰痹通胶囊比较NSAIDs治疗LDH的随机对照试验(RCT),制定纳入标准和排除标准后,筛选出符合标准的文献,评价纳入文献的质量并提取数据,采用RevMan5.3软件对其进行Meta分析。结果共有10篇研究符合标准,合计1088例患者。Meta分析结果显示腰痹通胶囊治疗LDH与NSAIDs比较在提高临床总有效率[OR=4.74,95%CI(3.13,7.17),P<0.00001]、降低VAS评分[MD=-1.26,95%CI(-1.35,-1.17),P<0.00001]、改善白细胞介素-1β(IL-1β)[MD=-0.12,95%CI(-0.14,-0.10),P<0.00001]、白细胞介素-6(IL-6)[MD=-4.14,95%CI(-6.34,-1.93),P=0.0002]、白细胞介素-8(IL-8)[MD=-9.49,95%CI(-11.73,-7.24),P<0.00001]、肿瘤坏死因子-α(TNF-α)[MD=-0.27,95%CI(-0.36,-0.17),P<0.00001]水平方面均有优势,在安全性方面提示不良反应发生率低,临床使用相对安全。结论腰痹通胶囊与NSAIDs比较能明显提高LDH患者的临床疗效、改善相关指标,且不良反应较少。但由于本研究为二次研究,且纳入文献数量较少、质量较低,尚需大样本、高质量随机对照研究对其临床疗效及安全性进一步证实。     

中医诊断学形成性评价体系的建立与探索

形成性评价通过及时反馈,能够在教学过程中及时、动态、多次对学生进行评价,有效的形成性评价可通过对教与学的过程的改进,促进教学目标的达成,是改善学生学习、促进学生发展的重要手段。在“以学生为中心,体现临床思维路径,实现理论与实践相结合”的考核改革理念指导下,天津中医药大学中医诊断学教研室进行了形成性评价的改革,以期以考促学。     

基于“用推即是用药”理论的津沽健脾益气推拿法治疗婴儿脾虚便秘疗效观察

[目的] 观察基于“用推即是用药”理论的津沽健脾益气推拿法治疗婴儿脾虚便秘的临床疗效。[方法] 2017年1月—2018年6月天津中医药大学第一附属医院小儿推拿专病门诊86例便秘患儿，随机分为治疗组和对照组，每组各43例。两组患儿均予以纠正不良喂养习惯、加强排便训练、被动腹部运动等基础治疗。在此基础上治疗组给予津沽健脾益气推拿法治疗，对照组口服妈咪爱治疗，7 d为1个疗程，并于3个月后进行随访。分析两组患儿临床疗效、Wexner便秘评分、复发率及不良反应发生情况。[结果] 治疗组患者总有效率为97.67%，对照组为76.74%，两组差异有统计学意义（P<0.05）；治疗7 d后，两组患儿Wexner便秘评分均有所降低，治疗组明显低于对照组（P<0.01）。两组均未发生不良反应，随访3个月发现治疗组复发率明显低于对照组（P<0.05）。[结论] 津沽健脾益气推拿法治疗婴儿脾虚便秘的临床效果显著，可有效缓解婴儿脾虚便秘症状，缩短排便频率，从而改善肠动力障碍，且减少复发率，值得推广应用。     

新型冠状病毒肺炎的中西医防治研究进展

新型冠状病毒肺炎(简称新冠肺炎)归属中医"疫病",主要病位在肺,主要病机为"湿、毒",治疗上解毒化湿贯穿始终。新冠肺炎的主要诊断方法为核酸检测,《新型冠状病毒肺炎诊疗方案(试行第七版)》新增加了血清学检测。中医药在新冠肺炎的预防方面具有很大优势,如中医预防方、香囊、针灸、中国传统功法、食疗、足浴、熏蒸等。在新冠肺炎的治疗过程中,中西医结合疗法效果明显,在缓解患者早期临床症状,减少患者轻症向重症、重症向危重症转化的发生率方面具有重要价值。目前尚无治疗新冠肺炎的特效药,对新冠肺炎的认识尚不完整,因此,文章从新冠肺炎的诊断、预防和治疗3个角度出发,探讨了对新冠肺炎中西医方面的认识,为进一步明确新冠肺炎的诊疗提供参考。