轻度过度通气下施行CO2气腹对呼吸和动脉血气的影响

目的观察轻度过度通气下施行CO2气腹对呼吸和动脉血气的影响.方法行择期腹腔镜胆囊切除术(LC)病人术前快速诱导麻醉,气管内插管后行机械通气,吸入N2O、持续静脉输注异丙酚维持全麻,硬膜外间断给药.分别在诱导前5 min、气腹前1min和气膜后5、10、20、30、40、50、60min及放气后5 min记录各监测值,同时采桡动脉血作血气分析.结果气腹开始后20～60min,呼气末CO2分压(PETCO2)和Co2排出量(VCO2)较气腹前显著升高.气腹开始后,pH值逐渐降低,30 mm时较诱导前显著降低;PaCO2逐渐升高,60min时较诱导前显著升高,但PETCO2、VCO2、PaCo2及pH的变化均在正常范围.在气腹初期,气道压(PAW)较气腹前显著升高,而呼气分钟通气量(MVE)较气腹前明显降低.结论采用异丙酚静脉全麻复合硬膜外麻醉及气腹前适当过度通气的呼吸管理方式在LC中是切实可行的.     

Effect of Wuzi Yanzong Pills on Sertoli cells and blood–testis barrier in heat-stressed rats based on Akt signalling pathway

The blood–testis barrier (BTB) of Sertoli cells (SCs) is an important biological barrier that maintains spermatogenesis and provides a favourable microenvironment for spermatogenesis. However, heat stress can directly damage the BTB structural proteins of testicular SCs, leading to dyszoospermia. Wuzi Yanzong Pills (WYP) is a traditional Chinese medicine formula used to treat male reproductive diseases. However, whether WYP could ameliorate heat stress injury in primary SCs extracted from rat testes and BTB proteins remains unknown. Here, treatment with WYP (low, medium and high dose) increased the SC viability and the proliferation of cell antigen Ki67 significantly. Additionally, it promoted SC maturation, which presented in the form of increased androgen receptors (ARs) and decreased cytokeratin 18 (CK-18) in three WYP dose groups. WYP upregulated BTB proteins such as zonula occludens 1 (ZO-1) and occludin across all WYP groups and decreased phosphorylated Akt (p-Akt) in the middle and high-dose groups; however, ZO-1 and occludin recovery were reduced with the presence of Akt inhibitor in WYP groups. WYP improved SC viability and proliferation, and ameliorated dedifferentiation and BTB-proteins damaged by heat stress via Akt signalling. The findings present theoretical support for the effects of WYP in the management of dyszoospermia and male infertility.     

Observational study of pre-operative intravenous iron given to anaemic patients before elective cardiac surgery

Cardiac surgical patients with anaemia experience increased morbidity and mortality. Iron deficiency is the most common cause of pre-operative anaemia in this group. We designed and implemented the Cardiff Pathway, a pre-assessment and treatment pathway to identify cardiac surgical patients with anaemia and iron deficiency. Patients identified with anaemia and/or iron deficiency (Hb < 130 g.l^-1 and ferritin < 100 μg.l^-1) were offered intravenous iron infusion 20 mg.kg^-1 pre-operatively. Treatment success was defined as Hb ≥ 130g.l^-1 on the day of surgery. We analysed data from 447 patients: 300 (67%) were not anaemic; 75 (17%) were anaemic and treated with intravenous iron; and 72 (16%) were anaemic and not treated. Haemoglobin concentration increased in successfully treated anaemic patients by a mean (95%CI) of 17 (13–21) g.l^-1 and they received a median (IQR [range]) of 0 (0–2 [0–15]) units of blood peri-operatively. Transfusion was avoided in 54% of the successfully treated anaemic patients, which was significantly more than the unsuccessfully treated anaemic (22%, p = 0.005) and untreated anaemic (28%, p = 0.018) patients and similar to non-anaemic patients who received a median (IQR [range] of 0 (0–1 [0–16])) units of blood and, 63% avoided transfusion). Mean (95%CI) Hb fell between pre-assessment and surgery in the untreated anaemic (-2 (0 to -4) g.l^-1) and non-anaemic groups (-2 (-1 to -3) g.l^-1). Twenty-one (7%) of the non-anaemic group became newly anaemic waiting for surgery. The Cardiff Pathway reliably identified patients with anaemia and iron deficiency. Anaemic patients who had their Hb restored to normal after treatment required less blood peri-operatively and over half of them required no transfusion at all.     

基于“同病异治”原则治疗类风湿性关节炎中药的研究进展

类风湿性关节炎是一种常见的慢性自身免疫性复杂疾病, 病因尚不明确, 治疗困难, 国内常以传统中医药手段将其辨证分型, 遵循“同病异治”的原则对其进行治疗。中医药辨证治疗类风湿性关节炎历史悠久, 效果显著, 同时中药方剂多靶点、多成分的特点使其更有效的缓解各自适应证患者的炎症症状。近年来传统中医药与西医的关联日渐加深, 西医技术与手段在中药治疗 RA 上的广泛应用, 不仅使 RA 不同证型的差异更加清晰, 中医辨病更加准确, 更在针对类风湿性关节炎适应证的中药方剂在临床、药效、生物学与治疗机制方面的研究取得了较大进展。文章基于中医“同病异治” “辨证分型”的原则, 对治疗类风湿性关节炎代表方剂与其研究进展进行综述。     

基于数据挖掘的中医药治疗小儿湿疹组方用药规律研究

目的：通过应用中医传承辅助平台（V 2.5）挖掘中医药治疗小儿湿疹的组方用药规律,并对高频药物、用药模式及治疗思路进行探讨。方法：搜集国家知识基础设施数据库（CNKI）、中国学术期刊数据库（CSPD）及中文科技期刊数据库（CCD）中2000—2021年应用中医药治疗小儿湿疹的相关文献,经过筛选后建立方药数据库,运用中医传承辅助平台（V 2.5）集成的改进互信息法、关联规则Apriori算法、复杂系统熵聚类与无监督熵聚类等算法对药物频次、性味归经、用药模式、规则分析及新处方等结果进行输出,并进行网络可视化展示。结果：纳入处方200首,共涉及206味中药,高频药物包括甘草、白鲜皮、薏苡仁、茯苓、生地黄、金银花、蝉蜕、地肤子、防风、牡丹皮等,药性以寒性（52.76%）居多,药味以甘（38.89%）、苦（33.37%）、辛（21.96%）味为主,归经以胃经（1 138次）、脾经（1 088次）、肝经（1 061次）居多,并且得到药物之间的关联规则,以及新处方6个。结论：小儿湿疹用药以补虚药、利水渗湿药、清热药、清热解毒药、解表药为主,治疗以疏风清热,燥湿健脾,养血活血为主要大法,分析结果与本病诊疗指南较为吻合,可为小儿湿疹的临床治疗及新药开发提供参考。     

茯苓对阴虚水肿模型大鼠及其热象的影响

目的 观察茯苓对阴虚水肿模型大鼠的影响,研究茯苓利水作用特点及机制,并评价茯苓对阴虚水肿所表现出热象的影响。方法 尾iv阿霉素联合ig甲状腺片复制阴虚水肿模型大鼠,给予茯苓水煎液或六味地黄丸干预4周,观察大鼠水肿情况和一般生长状态,检测24 h尿量和尿蛋白,测量肛温,进行冷热板实验计算热板停留时间比;检测血清总蛋白（total cholesterol,TP）、白蛋白（albumin,Alb）、尿素氮（blood urea nitrogen,BUN）、肌酐（creatinine,Cr）、环磷酸腺苷（cyclic adenosine monophosphate,c AMP）、环磷酸鸟苷（cyclic guanosine monophosphate,c GMP）水平;测定肾组织超氧化物歧化酶（superoxide dismutase,SOD）活性及活性氧（reactive oxygen species,ROS）、丙二醛（malondialdehyde,MDA）水平;苏木素-伊红（HE）染色观察肾组织病理变化;Western blotting检测肾脏组织Klotho和棕色脂肪组织中解偶联蛋白1...     

清咳平喘颗粒治疗痰热郁肺型咳嗽的临床疗效观察

目的 观察清咳平喘颗粒治疗痰热郁肺型咳嗽的临床有效性。方法 选取2020年1月—2021年6月上海中医药大学附属龙华医院呼吸科门诊就诊的痰热郁肺型咳嗽患者100例,按随机数字表法分为对照组和治疗组各50例,对照组为西医常规治疗,治疗组在西医常规治疗基础上联合清咳平喘颗粒治疗。两组均连续治疗2周。观察两组患者治疗前后的中医证候、咳嗽症状、气道反应（血清免疫球蛋白E、外周血嗜酸性粒细胞）、肺功能［最大呼气流量、第1秒用力呼气容积（forced expiratory volume for 1 second,FEV1）与用力肺活量（forced vital capacity,FVC）的比值］、生活质量及不良反应情况。结果 治疗后,对照组和治疗组的总有效率分别是90%、94%,两组比较差异无统计学意义（P>0.05）。治疗后,两组患者中医证候评分、日间及夜间咳嗽积分较治疗前降低,且治疗组明显低于对照组（P<0.05）。治疗后,两组血清免疫球蛋白E、外周血嗜酸性粒细胞较治疗前明显下降,且治疗组气道反应指标改善好于对照组（P<0.05）。治疗后,两组最大呼气流量、FEV1/FVC较治疗前明显上升（P<0.05）,但两组比较差异无统计学意义（P>0.05）。随访时两组患者的生活质量评分较治疗前均显著升高,治疗组评分改善优于对照组,两组比较差异具有统计学意义（P<0.05）。治疗期间两组均未发生不良反应。结论 清咳平喘颗粒在治疗痰热郁肺型咳嗽安全性良好,有助于改善咳嗽症状,改善肺通气,提高患者生活质量。     

基于数据挖掘的益气活血类方防治脑缺血再灌注损伤用药规律及其作用机制研究

目的 探讨急性缺血性卒中溶栓治疗后使用益气活血类方剂干预的用药规律,预测核心药物防治脑缺血再灌注损伤的潜在作用机制。方法 检索中国知网、万方、维普和PubMed数据库中急性缺血性卒中溶栓治疗后使用益气活血类方有效干预的文献,对方中使用的药物进行频数、聚类及关联分析,依据关联规则选取置信度和支持度最高的核心药物,构建核心药物-活性成分-交集靶点网络图,并进行基因本体（gene ontology,GO）功能富集和京都基因与基因组百科全书（Kyoto encyclopedia of genes and genomes,KEGG）通路富集分析。结果 共筛选纳入232篇文献,涉及中药处方177首,包含中药119味,累计使用频次1903,以黄芪为首的高频药物28味,所有药物按功效可分为16种,药味总频次191,归经总频次292。高频药物聚类分析得到5个聚类,关联规则分析得到20组支持度较高的中药组合,其中支持度与置信度最高的二联药物组合为“黄芪-川芎”,三联药物组合为“黄芪-川芎-地龙”。网络药理学分析收集黄芪、川芎、地龙的活性成分30个;筛选“黄芪-川芎”防治脑缺血再灌注损伤的靶点91个,“黄芪...