四妙勇安汤治疗冠心病临床和机制研究进展

近年来学术界日益关注到四妙勇安汤是治疗急性冠脉综合征的重要方剂。对其在治疗冠心病的临床研究以及作用机制等方面进行综述，发现：四妙勇安汤及其合方治疗冠心病已经有一定的循证医学证据支持。但目前高质量、得到广泛认可的临床研究仍有待继续加强。四妙勇安汤治疗冠心病的作用机制研究主要涉及调节血脂水平、保护血管、拮抗炎症反应、稳定易损斑块和抑制心肌细胞增殖等方面，但四妙勇安汤治疗冠心病的作用机制尚未完全阐释清楚，下一步需要借助组学分析等手段深入研究。     

A modality-specific somatosensory evoked potential test protocol for clinical evaluation: A feasibility study

ObjectiveWe aimed to establish an objective neurophysiological test protocol that can be used to assess the somatosensory nervous system.MethodsIn order to assess most fiber subtypes of the somatosensory nervous system, repetitive stimuli of seven different modalities (touch, vibration, pinprick, cold, contact heat, laser, and warmth) were synchronized with the electroencephalogram (EEG) and applied on the cheek and dorsum of the hand and dorsum of the foot in 21 healthy subjects and three polyneuropathy (PNP) patients. Latencies and amplitudes of the modalities were assessed and compared. Patients received quantitative sensory testing (QST) as reference.ResultsWe found reproducible evoked potentials recordings for touch, vibration, pinprick, contact-heat, and laser stimuli. The recording of warm-evoked potentials was challenging in young healthy subjects and not applicable in patients. Latencies were shortest within Aβ-fiber-mediated signals and longest within C-fibers. The test protocol detected function loss within the Aβ-fiber and Aδ-fiber-range in PNP patients. This function loss corresponded with QST findings.ConclusionIn this pilot study, we developed a neurophysiological test protocol that can specifically assess most of the somatosensory modalities. Despite technical challenges, initial patient data appear promising regarding a possible future clinical application.SignificanceEstablished and custom-made stimulators were combined to assess different fiber subtypes of the somatosensory nervous system using modality-specific evoked potentials.     

Analgesic effects and hemodynamic mechanisms of perpendicular and transverse needling at Sanyinjiao (SP 6) in patients with primary dysmenorrhea: A randomized controlled trial

ObjectiveTo explore the analgesic effects and uterine hemodynamics of perpendicular needling (PN) and transverse needling (TN) at SP 6 in patients with primary dysmenorrhea (PD).MethodsIn this randomized controlled trial, patients with PD diagnosed with cold-dampness congealing pattern were randomly assigned in a ratio of 1:1 to receive PN or TN at bilateral SP 6 for 10 min. Acupuncture was performed when the menstrual pain score was over 40 mm on the first day of menstruation, as measured using the visual analog scale for pain (VAS-P). The primary outcome was average menstrual pain (VAS-P). Secondary outcomes included the pulsatility index (PI), resistance index (RI), and systolic-diastolic peaks ratio (S/D) in uterine arteries as measured using color Doppler ultrasonography; anxiety as assessed using the Hamilton Anxiety Rating Scale (HAMA), blood pressure (BP), and heart rate (HR).ResultsForty-eight patients completed the study. The TN group exhibited a significant reduction in VAS-P scores (–5.71 mm, 95% confidence interval (CI): –8.78, –2.63, P = .001), RI values (–0.05, 95% CI: –0.09, –0.01, P = .015), and HAMA values (–2.50, 95% CI: –4.78, –0.22, P = .032) when compared with the PN group. No significant differences in PI, S/D, BP, or HR values were observed between the two groups (P > .05).ConclusionTN at SP 6 was superior to PN in alleviating menstrual pain and anxiety in patients with PD. This analgesic effect of TN may be due to its better ability to improve uterine arterial blood flow via decreases in RI values.     

Adaptive dynamic surface control using neural networks for hypersonic flight vehicle with input nonlinearities

This study proposes an effective adaptive dynamic surface control (DSC) method based on the radial basis function neural networks and the auxiliary system for hypersonic flight vehicle (HFV) systems in the presence of system uncertainties, external disturbances, and state variable and control input constraints. Firstly, to enhance the robustness of the system, the neural network is combined with the robust term to deal with the uncertainties and external disturbances of the system. Secondly, to prevent the deterioration of the dynamic performance of the system due to the over-adaptation of the neural networks and the robust terms caused by the state and control input constraints, the auxiliary system is added at each step in the DSC design to adjust the dynamic process of the reference signal and virtual control. Furthermore, the variable structure control is used to solve the problem of dead zone in the control input. Using the Lyapunov analysis method, all signals of the closed-loop system are semi-globally uniformly ultimate bounded. The simulation results illustrate the effectiveness of the proposed control scheme for the HFVs.     

艾灸治疗原发性痛经作用机制研究进展

艾灸治疗原发性痛经应用广泛,通过热效应、光效应、艾烟及药物作用4种起效机制发挥治疗作用,艾灸治疗原发性痛经的机制集中在调节内分泌激素、调节免疫功能、调节神经相关因素、改善子宫微循环等方面,艾灸治疗原发性痛经的机制研究仍存在问题和不足,应当加强艾灸起效机制研究,重视灸法光效应之中的光谱范围及波峰治疗痛经的机制探索,完善艾灸治疗原发性痛经的机制研究,为临床治疗提供实验依据和循证医学证据。     

基于氧化应激探究PCI损伤及中医药防治进展

我国心血管疾病的患病率及死亡率仍处于上升阶段,经皮冠状动脉介入治疗(PCI)是目前减少冠心病患者冠状动脉狭窄及闭塞和改善临床症状的最有效策略。临床上,存在很大一部分患者在大血管再通后,仍存在心痛症状。在PCI围术期常伴随着氧化应激、炎症、钙超载、内皮功能损害、血栓阻塞等不良事件,氧化应激在这个过程中扮演着重要角色。在PCI的再灌注时期,活性氧(ROS)的爆发可引发线粒体能量传递链异常和细胞离子稳态失衡,造成血管内皮细胞损伤,血管通透性增高,白蛋白漏出,白细胞和血小板黏附,血管狭窄。传统中医将PCI术后再狭窄纳入"胸痹"等范畴,气血的运行与五脏的功能密切相关,当气血运行不畅,心脏的生血、行血的功能受阻,造成气虚血瘀,从而造成机体虚损。目前,普罗布考和替格瑞洛等临床一线用药,具有一定的局限性,且忽略了"本虚邪实"的机体现状,无法协调机体气血阴阳五脏之间的关系。本研究从氧化应激在PCI损伤的现代医学分子研究出发,结合中医认识,总结中医药防治的研究进展,旨在为冠状动脉介入损伤的治疗提供候选药物及为相关实验研究提供参考。     

丹参治疗微循环障碍作用机制的“成分-靶点-通路”多层次互作网络模型研究

目的基于网络药理学分析丹参治疗微循环障碍的分子生物学机制。方法借助TCMSP、PubChem Search、Genecards数据库和Swiss target prediction在线工具得到丹参的活性成分治疗微循环障碍的作用靶标,利用Cytoscape 3.3.0软件构建丹参活性成分-微循环障碍作用靶标网络,通过STRING数据库构建靶蛋白相互作用(PPI)网络,通过生物学信息注释数据库(DAVID)进行基因本体(GO)生物学过程和京都基因与基因组百科全书(KEGG)通路富集分析。结果从丹参中共筛选出治疗微循环障碍的65个相关活性成分,并发现微循环障碍相关的9个关键靶点。GO和KEGG通路富集分析发现,丹参治疗微循环障碍可能与氧化还原、钙离子稳态等生物过程有关,能够调节血管内皮生长因子信号通路、神经突触信号传导、催产素信号通路、醛固酮-调节钠重吸收等信号通路。结论丹参治疗微循环障碍体现了多成分、多靶点、多途径的作用特点,为进一步开展丹参治疗微循环障碍作用机制研究提供了新的思路和方法。     

High tibial derotation osteotomy for distal extensor mechanism alignment in patients with squinting patella due to increased external tibial torsion

BackgroundThe patellofemoral joint is often affected by torsional disorders of the lower limb, causing pain, instability and knee degeneration. The aims of this study were to determine functional outcomes of patients who underwent a high tibial derotation osteotomy (HTDO) for symptomatic squinting patella due to increased external tibial torsion. Moreover, factors associated with inferior clinical outcomes were investigated.MethodsPatients with symptomatic squinting patella, increased external tibial torsion (>30°) treated with this technique, and with 2 years of follow up were included. Fulkerson and Kujala patellofemoral joint scores were assessed. Age, body mass index, history of prior surgery, increased femoral anteversion, association of lateral retinaculum release and patellar cartilage lesions were analysed.ResultsSixty HTDOs were included in this retrospective study with an average of 66 months of follow up. The mean Kujala score improved from 47.5 preoperatively to 93 postoperatively. The mean Fulkerson score improved from 40.6 to 91.6. Kujala subscores for pain improved from 8.6 to 30.4, for instability improved from 6.4 to 17.9, and their ability to climb stairs increased from 6.9 to 17.9 (all P < 0.0001). Multivariate logistic regression model identified that patient age (P < 0.005) and advanced chondral damage (P < 0.001) were the dominant factors predicting inferior clinical outcomes using Kujala’s score.ConclusionHTDO provided good results regarding the pain symptoms, instability and the ability to climb stairs. Advanced chondral damage and advanced age had negative effects on outcomes.     

Top‐down versus bottom‐up attention differentially modulate frontal–parietal connectivity

The moment‐to‐moment focus of our mind's eye results from a complex interplay of voluntary and involuntary influences on attention. Previous neuroimaging studies suggest that the brain networks of voluntary versus involuntary attention can be segregated into a frontal‐versus‐parietal or a dorsal‐versus‐ventral partition—although recent work suggests that the dorsal network may be involved in both bottom‐up and top‐down attention. Research with nonhuman primates has provided evidence that a key distinction between top‐down and bottom‐up attention may be the direction of connectivity between frontal and parietal areas. Whereas typical fMRI connectivity analyses cannot disambiguate the direction of connections, dynamic causal modeling (DCM) can model directionality. Using DCM, we provide new evidence that directed connections within the dorsal attention network are differentially modulated for voluntary versus involuntary attention. These results suggest that the intraparietal sulcus exerts a baseline inhibitory effect on the frontal eye fields that is strengthened during exogenous orienting and attenuated during endogenous orienting. Furthermore, the attenuation from endogenous attention occurs even with salient peripheral cues when those cues are known to be counter predictive. Thus, directed connectivity between frontal and parietal regions of the dorsal attention network is highly influenced by the type of attention that is engaged.     

Microwave Ablation versus Stereotactic Body Radiotherapy for Stage I Non–Small Cell Lung Cancer: A Cost-Effectiveness Analysis

PurposeTo assess the cost effectiveness of microwave ablation (MWA) and stereotactic body radiotherapy (SBRT) for patients with inoperable stage I non–small cell lung cancer (NSCLC).Materials and MethodsA literature search was performed in MEDLINE with broad search clusters. A decision-analytic model was constructed over a 5-year period. The model incorporated treatment-related complications and long-term recurrence. All clinical parameters were derived from the literature with preference to long-term prospective trials. A healthcare payers’ perspective was adopted. Outcomes were measured in quality-adjusted life years (QALYs) extracted from prior studies and U.S. dollars from Medicare reimbursements and prior studies. Base case calculations, probabilistic sensitivity analysis with 10,000 Monte Carlo simulations, and multiple 1- and 2-way sensitivity analyses were performed.ResultsMWA yielded a health benefit of 2.31 QALYs at a cost of $195,331, whereas SBRT yielded a health benefit of 2.33 QALYs at a cost of $225,271. The incremental cost-effectiveness ratio was $1,480,597/QALY, indicating that MWA is the more cost-effective strategy. The conclusion remains unchanged in probabilistic sensitivity analysis with MWA being the optimal cost strategy in 99.84% simulations. One-way sensitivity analyses revealed that MWA remains cost effective when its annual recurrence risk is <18.4% averaged over 5 years, when the SBRT annual recurrence risk is >1.44% averaged over 5 years, or when MWA is at least $7,500 cheaper than SBRT.ConclusionsMWA appears to be more cost effective than SBRT for patients with inoperable stage I NSCLC.