霍山石斛多糖的结构分析、生物活性研究进展及与不同种间多糖成分差异性分析

霍山石斛Dendrobium huoshanense作为一种名贵的滋补类中药,收载于《中国药典》2020年版。多糖为其主要活性成分之一,具有免疫调节、保肝、抗肿瘤、抗氧化和抗炎等药理活性。通过查阅国内外文献,基于中国知网及PubMed等中英文文献数据库分析当前研究现状及研究热点;总结霍山石斛多糖（Dendrobium huoshanense polysaccharide,DHP）的提取分离、结构解析及其生物活性;分析其多糖成分与其他常用石斛品种的差异性。以期更好地开发利用DHP,为DHP产品的深入开发与研究及质量标准完善提供参考和思路。     

骨碎补内生菌Lecanicillium sp. GZWMJZ-847中3个新3-氢化萘特特拉姆酸衍生物

目的 研究骨碎补内生蜡蚧菌Lecanicillium sp. GZWMJZ-847的次级代谢产物和抑菌活性。方法 采用大米培养基对菌株Lecanicillium sp. GZWMJZ-847发酵;采用凝胶柱色谱、正反相硅胶色谱等方法对化合物进行分离纯化;采用核磁共振谱、质谱、NMR计算等方法确定化合物的化学结构;采用营养肉汤稀释法测试化合物对病原细菌及酵母菌的抑菌活性、平板法测试化合物对病原霉菌的抑菌活性。结果 从菌株的发酵产物中分离鉴定了3个新的和3个已知的3-氢化萘特特拉姆酸衍生物,包括蜡蚧特特拉姆酸A（1）、蜡蚧特特拉姆酸B（2）、蜡蚧特特拉姆酸C（3）、Sch 210971（4）、Sch 210972（5）、Sch 213766（6）。化合物1和4～6对4株人体革兰阳性病原菌和1株植物革兰阴性病原菌具有抑制作用,最小抑菌浓度（minimun inhibitory concentration,MIC）为7.8～125 mmol/L。化合物6对油菜菌核病菌和小麦赤霉病菌表现出一定的抑制作用,半数抑制浓度分别为（22.05±0.62）、（55.54±1.72）μg/mL。结论 蜡蚧特特拉姆酸A～C（1～3）为新的3-氢化萘特特拉姆酸衍生物,骨碎补内生菌Lecanicillium sp. GZWMJZ-847产生的3-氢化萘特特拉姆酸对人体病原菌和植物病原菌可表现出抑制作用。     

A randomized,double-blind placebo-controlled add-on trial to assess the efficacy,safety, and anti-atherogenic effect of spirulina platensis in patients with inadequately controlled type 2 diabetes mellitus

The efficacy of spirulina platensis (S. platensis) as an add-on therapy to metformin and its effect on atherogenic keys in patients with uncontrolled Type 2 Diabetes Mellitus (T2DM) was evaluated. Sixty patients were randomly assigned to S. platensis (2 g/day) or placebo group for three months while continuing metformin as their usual treatment. The efficacy of S. platensis was determined using the pre- and post-intervention HbA1c levels (primary outcome) as well as tracking FBS and lipid profiles levels (TC, LDL-C, TG, and HDL-C) as secondary outcomes at the different treatment time points (0,30,60,90 days). During the three–month intervention period, supplementation with S. platensis resulted in a significant lowering of HbA1c (↓1.43, p < 0.001) and FBS (↓ 24.94 mg/dL, p < 001) levels. Mean TG in the intervention group was found to be significantly lower in the intervention group than in controls (p < 0.001). Total cholesterol (TC) and its fraction, LDL-C, exhibited a fall (↓41.36 mg/dL and ↓38.4 mg/dL, respectively; p < 0.001) coupled with a marginal increase in the level of HDL-C (↑3 mg/dL; p < 0.001). Add-on therapy with S. platensis was superior to metformin regarding long-term glucose regulation and controlling blood glucose levels of subjects with T2DM. Also, as a functional supplement, S. platensis has a beneficial effect on atherogenic keys (TG and HDL-C) with no adverse events.     

加味薏苡附子败酱散对复杂性肛瘘患者术后的疗效观察

目的:探讨加味薏苡附子败酱散联合常规换药在复杂性肛瘘术后患者中的疗效观察及对视觉模拟疼痛(VAS)评分的影响。方法:选择复杂性肛瘘患者106例作为对象,电脑抽取随机数法分为两组,各53例。两组均采用手术治疗,对照组术后常规换药干预,观察组在对照组基础上联合加味薏苡附子败酱散干预,术后14 d对患者效果进行评估,并完成6个月随访,比较两组术后肛门功能、VAS评分、术后创面愈合评分及术后并发症、复发率。结果:观察组术后14 d排便干燥(0.68±0.14)分、不自主气体(0.70±0.16)分、需要衬垫(0.69±0.15)分、生活方式(0.72±0.18)分及稀便评分(0.63±0.12)分均低于对照组[排便干燥(1.69±0.45)分、不自主气体(2.10±0.46)分、需要衬垫(1.84±0.42)分、生活方式(1.67±0.36)分及稀便评分(2.16±0.39)分,差异有统计学意义(t=7.591、5.434、6.316、6.019、5.693,P0.001);观察组手术后14 d VAS评分(1.15±0.32)分、渗液(0.56±0.09)分及肉芽生长评分(1.72±0.16)分均低于对照组[VAS评分(3.24±0.41)分、渗液(1.69±0.11)分及肉芽生长评分(2.15±0.23)分],差异有统计学意义(t=7.493、5.671、6.434,P0.001);两组术后尿潴留、切口感染及肛门失禁发生率、术后1、3个月复发率差异均无统计意义(χ~2=0.343、1.101、1.039、1.101、0.343,P=0.558、0.315、0.308、0.315、0.558);观察组术后6个月复发率低于对照组(χ~2=4.970,P=0.026)。结论:加味薏苡附子败酱散联合常规换药用于复杂性肛瘘术后患者能提高患者肛门功能,减轻疼痛,能促进创面愈合,可降低术后复发率,且未增加手术并发症发生率。     

浮针治疗梨状肌综合征的疗效观察

目的:观察浮针在梨状肌综合征的临床应用效果。方法:本研究回顾性分析2017年7月1日—2018年6月30日宁波市中医院80例急性发病的梨状肌综合征患者,其中40例对照组患者采用常规药物及物理治疗,40例观察组患者在上述基础上以解剖列车理论为指导进行浮针治疗。两组患者均完成了随访。比较两组治疗后疼痛(VAS评分)、患髋关节Harris评分、患者满意度。结果:治疗前两组患者一般资料、疼痛VAS评分、患髋关节Harris评分差异无统计学意义(P0.05);治疗后两组患者疼痛VAS评分均较治疗前下降,观察组患者疼痛(VAS)评分治疗后24 h(6.5±0.5)分、7 d(3.4±0.5)分、14 d(2.1±0.3)分,较对照组术后24 h(7.9±0.6)分、7 d(5.2±0.5)分、14 d(3.6±0.5)明显下降(P0.05);治疗后两组患者髋关节Harris评分均较治疗前上升,观察组患者髋关节(Harris)评分治疗后24 h(55.6±1.1)分、7 d(68.5±1.8)、14 d(80.3±1.7)分,较对照组术后24 h(43.7±1.2)分、7 d(54.6±1.3)、14 d(63.0±1.4)分明显上升(P0.05);患者满意度观察组(92.5%)较对照组(72.5%)增加,差异有统计学意义(P0.05)。结论:合理运用浮针治疗,疼痛感触明显减轻、功能和患者的满意度显著提高。     

Treatment of spinal cord compression caused by C2 osteochondroma with reconstruction and fusion after total resection: Case report and literature review

Context: Osteochondroma is the most common benign tumor of the bone, but spinal osteochondroma is rare. We report a case of cervical osteochondroma in multiple exostoses arising from the lamina of the C2 vertebra, presenting with features of compressive myelopathy in a 22-year-old male. Total resection of the tumor and atlantoaxial fixation and fusion after reconstruction of the C1 posterior arch were performed.Findings: The patient recovered significantly. He was asymptomatic and no sign of recurrence was observed after one-year follow-up.Conclusions: Osteochondroma should be considered as a rare cause of spinal cord compression. Entire removal of the tumor will result in complete decompression and can reduce the risk of recurrence. We provide a new approach to reconstruct after resection.     

The Effect of Minimally Invasive Thoracoscopic Left Atrial Appendage Excision on Cardiac Dynamic and Endocrine Function

Purpose: Left atrial appendage (LAA) isolation is an effective surgical treatment for decreasing thromboembolic risk. We sought to evaluate the short-term effect of minimally invasive surgery with LAA excision on left atrial dynamic and endocrine function in atrial fibrillation (AF) patients.Methods: A total of 52 patients with paroxysmal AF undergoing minimally invasive surgery with LAA excision in Anzhen Hospital from October 2012 to June 2014 were enrolled in the study. The natriuretic peptide plasma level was determined by enzyme-linked immunosorbent assay (ELISA), and left atrial dynamic function was measured preprocedure by real-time three-dimensional echocardiography and postprocedure after 7 days and 3 months.Results: With the exception of six recurrences, 88.5% (46/52) of the patients were prospectively followed over 3 months in terms of their sinus rhythm postprocedure. No severe operative complications or embolism events occurred within those 3 months. Echocardiography showed a 3–6% decrease in left atrial volume postprocedure, and dynamic function was largely restored by 3 months. There was no significant change in natriuretic peptide levels, although a slight decrease was detected 7 days postprocedure, which gradually recovered by 3 months (P = 0.350).Conclusions: There are no significant differences in left atrial dynamics and natriuretic peptide secretion in AF patients after minimally invasive surgery with LAA excision.     

HbA1C is not directly associated with complications of bariatric surgery

IntroductionBariatric surgery is effective therapy for weight loss and diabetes control. While patients with poorly controlled type 2 diabetes (T2D) experience significant benefit from bariatric surgery, the impact of hyperglycemia on perioperative risks is unclear.ObjectiveThis study aims to investigate effect of elevated glycated hemoglobin (HbA1C) on perioperative risks for patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).Settings117,644 patients undergoing RYGB or SG between the years of 2017 and 2018 in the United Stated were analyzed. Data was obtained using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.MethodsThree commonly used cutoff levels of HbA1C were selected (6.5, 7.0, and 8.5). Complications were compared between groups of patients above and below each HbA1C level. Multivariable logistic regression models were used to account for confounders.ResultsWithout risk adjustment, HbA1C is indirectly associated with increased rates of surgical complications. However, after adjusting for underlying co-morbidities, HbA1C is not associated with overall complications, including 30 day readmissions, reoperations, reinterventions, or death at any HbA1C cutoff: 6.5 (odds ratio [OR] 1.041, P value = .219), 7.0 (OR 1.020, P value = .551), or 8.5 (OR 1.051, P value = .208).ConclusionThere is no direct relationship between HbA1C and early postoperative complications of SG and RYGB. Thus, optimizing preoperative HbA1C values alone, may not translate into decreased surgical complications of bariatric surgery. (Surg Obes Relat Dis 2020;17:271–275.) © 2020 American Society for Metabolic and Bariatric Surgery. All rights reserved.     

Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients

Outcomes following hepatitis C virus (HCV)-viremic heart transplantation into HCV-negative recipients with HCV treatment are good. We assessed cost-effectiveness between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts. Markov model simulated long-term outcomes among HCV-negative patients on the transplant waitlist. We compared costs (2018 USD) and health outcomes (quality-adjusted life-years, QALYs) between cohorts willing to accept any heart and those willing to accept only HCV-negative hearts. We assumed 4.9% HCV-viremic donor prevalence. Patients receiving HCV-viremic hearts were treated, assuming $39 600/treatment with 95% cure. Incremental cost-effectiveness ratios (ICERs) were compared to a $100 000/QALY gained willingness-to-pay threshold. Sensitivity analyses included stratification by blood type or region and potential negative consequences of receipt of HCV-viremic hearts. Compared to accepting only HCV-negative hearts, accepting any heart gained 0.14 life-years and 0.11 QALYs, while increasing costs by $9418/patient. Accepting any heart was cost effective (ICER $85 602/QALY gained). Results were robust to all transplant regions and blood types, except type AB. Accepting any heart remained cost effective provided posttransplant mortality and costs among those receiving HCV-viremic hearts were not >7% higher compared to HCV-negative hearts. Willingness to accept HCV-viremic hearts for transplantation into HCV-negative recipients is cost effective and improves clinical outcomes.