基于中药质量标志物和传统用法的中药饮片标准汤剂传承发展研究思路与建议

中药汤剂(也称煎剂)是中医师最常用的中药复方剂型,也是中药历史上应用最久和最广的制剂。药材是饮片的原料,饮片是制备提取物、构成中医处方和中药制剂的原料,更体现了传承发展中药的重要性。基于中药饮片标准汤剂,科学认识汤剂质量,提高药典饮片和中成药质量评价研究理论和方法是科学发展的重要策略。开展以中医药理论为指导、临床应用为基础的中药饮片标准汤剂研究,基于中药质量标志物理论和研究方法探讨饮片和煎煮工艺的影响,形成标准汤剂的质量评价体系,既有利于确保中医处方用药的安全和疗效,也有利于认识标准汤剂在"药材-饮片-中成药"的质量及其标准的差异和价值,提升国家对中药饮片监管水平,保障人民用药安全和有效;还有利于认识标准汤剂在中药饮片生产、中药配方颗粒及经典名方的传承研发中的重要意义。     

Relationship between EMG-detected and ultrasound-detected fasciculations in amyotrophic lateral sclerosis: A prospective cohort study

ObjectivesFasciculation potentials (FP) are an important consideration in the electrophysiological diagnosis of ALS. Muscle ultrasonography (MUS) has a higher sensitivity in detecting fasciculations than electromyography (EMG), while in some cases, it is unable to detect EMG-detected fasciculations. We aimed to investigate the differences of FP between the muscles with and without MUS-detected fasciculations (MUS-fas).MethodsThirty-one consecutive patients with sporadic ALS were prospectively recruited and in those, both needle EMG and MUS were performed. Analyses of the amplitude, duration, and number of phases of EMG-detected FPs were performed for seven muscles per patient, and results were compared between the muscles with and without MUS-fas in the total cohort.ResultsThe mean amplitude and phase number of FP were significantly lower in patients with EMG-detected FP alone (0.39 ± 0.25 mV and 3.21 ± 0.88, respectively) than in those with both FP and MUS-fas (1.22 ± 0.92 mV and 3.74 ± 1.39, respectively; p < 0.0001 and p = 0.017, Welch’s t-test).ConclusionSmall FP may be undetectable with MUS. MUS cannot replace EMG in the diagnostic approach for ALS.SignificanceClinicians should use a combination of EMG and MUS for the detection and quantitative analysis of fasciculation in ALS.     

Consistent age-dependent declines in human semen quality: A systematic review and meta-analysis

Reduced fertility typically occurs among women in their late 30s, but increasing evidence indicates that advanced paternal age is associated with changes in reproduction as well. Numerous studies have investigated age-based declines in semen traits, but the impact of paternal age on semen parameter values remains inconclusive. Using data from 90 studies (93,839 subjects), we conducted a systematic review and meta-analysis to quantify the effect of male age on seven ejaculate traits (semen volume, sperm concentration, total sperm count, morphology, total motility, progressive motility and DNA fragmentation). Age-associated declines in semen volume, percentage motility, progressive motility, normal morphology and unfragmented cells were statistically significant and results generally seemed to be robust against confounding factors. Unexpectedly, sperm concentration did not decline with increasing male age, even though we found that sperm concentration declined over time. Our findings indicate that male age needs more recognition as a potential contributor to the negative pregnancy outcomes and reduced offspring health associated with delayed first reproduction. We suggest that greater focus on collection of DNA fragmentation and progressive motility in a clinical setting may lead to better patient outcomes during fertility treatments of aging couples.     

Utility of quantitative EEG in early Lewy body disease

IntroductionThe reduction of background activity and the increase of low-frequency powers on electroencephalogram (EEG) correlate with cognitive impairment and have been suggested to be underpinned by cholinergic deficit. We aimed to investigate the ratio between α and θ band power (α/θ ratio), as a synoptic index of quantitative EEG (qEEG) slowing-down, in a peculiar group of patients with mild cognitive impairment (MCI) due to an early-stage Lewy body disease (MCI-LBD), as compared to de novo PD patients without cognitive impairment (PD-MOT), to patients with MCI due to Alzheimer's disease (MCI-AD), and to healthy controls (HC).MethodsTwelve patients with MCI-LBD (8 males; mean age 74.8 ± 3.6), 11 PD-MOT, 11 MCI-AD and 24 HC subjects undergoing qEEG were matched for gender, age, and education. Following logarithmic transformation, the α/θ ratio was compared among groups and brain regions by repeated measures ANOVA, also exploring group*regions interactions.ResultsA significant effect of group (p = 0.0003), regions (p = 0.0001), and group*regions interaction (p = 0.0001) on the α/θ ratio was observed. At post-hoc analysis, α/θ ratio was significantly lower in MCI-LBD (p = 0.001) and in PD-MOT (p = 0.02) compared to HC, and in MCI-LBD than MCI-AD (p = 0.05). No significant differences were found between MCI-AD and HC, as well as between MCI-LBD and PD-MOT.ConclusionThe α/θ power ratio as a synoptic index of EEG background slowing-down could be a simple and easy-to-use qEEG index which might indirectly mirror a cholinergic failure, useful to pick-up those MCI patients at higher risk of developing a Lewy-body disease.     

雅安市社区在管严重精神障碍患者现状研究

目的了解雅安市社区在管严重精神障碍患者的现况,为改进雅安市严重精神障碍管理治疗工作提出可行性建议。方法采用分层随机抽样的方法,抽取雅安市纳入社区管理的严重精神障碍患者1 002例,采用重性精神疾病管理随访表调查患者规范管理情况、服药情况、居家稳定情况以及肇事肇祸情况。结果完成有效问卷803份,雅安市社区在管严重精神障碍患者规范管理率为93. 03%(95%CI:91. 30%~94. 80%),服药率为65. 13%(95%CI:61. 80%~68. 40%),规律服药率为50. 44%(95%CI:47. 00%~53. 90%),居家稳定率为90. 78%(95%CI:88. 80%~92. 80%)。肇事肇祸发生率为4. 61%(95%CI:3. 20%~6. 10%)。结论雅安市严重精神障碍患者规范管理率、规律服药率达到国家标准,服药率尚未达到国家标准,居家稳定率较高,肇事肇祸率较低。