电针联合右美托咪定对骨科老年患者术中应激的影响研究

目的：探讨电针联合右美托咪定对老年骨科患者术中应激的影响。方法：选取拟行手术治疗的老年下肢骨折患者56例为研究对象，采用随机数字表法分为单纯全麻组、电针复合全麻组（简称复合电针组）、右美托咪定复合全麻组（简称复合右美组）及电针联合右美托咪定复合全麻组（简称针药复合组），各14例。记录各组各时间点血压、心率、血氧饱和度等各项监护指标，术前、术后神经心理学指标（简易智力检查评分和疼痛视觉模拟评分）及各时间点血糖水平，术中心血管活性药物使用情况及患者住院天数。结果：术后各时间点针药复合组简易智力检查评分高于单纯全麻组（P＜0.05）；术后72 h内，针药复合组疼痛评分低于其他三组（P＜0.05）；针药复合组术中循环系统指标及血糖水平更稳定；针药复合组术后意识恢复时间最短（P＜0.05）；四组术后呼吸恢复时间与住院天数比较，差异无统计学意义（P＞0.05）；四组心血管活性药物使用率比较，差异无统计学意义（P＞0.05）。结论：老年骨科患者手术中采用电针联合右美托咪定治疗，能够稳定围术期血糖、术中循环系统指标水平，减少术后认知功能障碍发生率，显著降低术中应激水平。     

医院-家庭过渡期有氧运动对轻中度稳定期COPD的作用

目的 探讨医院-家庭过渡期有氧运动在轻中度稳定期慢性阻塞性肺疾病(COPD)患者中的应用效果.方法 选取2017年7月至2019年7月该院就诊的轻中度稳定期COPD患者100例为研究对象,分为试验组和对照组,每组50例.在医院-家庭过渡期间,对照组给予常规药物处理及门诊呼吸功能训练、氧疗等,试验组在对照组的基础上给予有氧运动,治疗10周后比较2组肺功能、血气功能、6分钟步行试验(6 MWT)、日常活动能力(ADL)、呼吸困难评价(BS)评分、生活质量变化[采用圣乔治呼吸问卷(SGRQ)进行评估],并比较2组不良反应发生情况.结果 治疗10周后,试验组用力肺活量(FVC)、第一秒用力呼气容积(FEV1)及FEV1/FVC均显著高于对照组,差异有统计学意义(P<0.05);试验组动脉氧分压、6 MWT均显著高于对照组,二氧化碳分压显著低于对照组,差异有统计学意义(P<0.05).试验组ADL评分显著高于对照组,BS评分显著低于对照组,差异有统计学意义(P<0.05);试验组呼吸症状、活动能力、疾病影响及SGRQ总分均显著低于对照组,差异有统计学意义(P<0.05).2组均未出现心肌梗死、脑出血、心绞痛等严重不良事件.结论 医院-家庭过渡期有氧运动可显著提升轻中度稳定期COPD患者心、肺功能及日常生活能力,缓解呼吸困难症状,提高生活质量.     

Peripheral blood inflammatory markers in predicting prognosis in patients with COVID‐19. Some differences with influenza A

BackgroundTo evaluate the ability of peripheral blood inflammatory markers in predicating the typing of COVID‐19, prognosis, and some differences between COVID‐19 and influenza A patients.MethodsClinical data on 285 cases laboratory‐confirmed as SARS‐CoV‐2 infection were obtained from a Wuhan local hospital''s electronic medical records according to previously designed standardized data collection forms. Additional 446 Influenza A outpatients’ hematologic data were enrolled for comparison.ResultsNLR, SII, RLR, PLR, HsCRP, and IL‐6 were significant higher and LMR was lower in severe COVID‐19 patients than in mild COVID‐19 patients (p < .001). PLR and LMR were lower in the individuals with influenza A than those with COVID‐19 (p < .01). COVID‐19 patients with higher levels of NLR, SII, RLR, PLR, HsCRP, and IL‐6 and lower LMR were significantly associated with the severe type. AUC of NLR (0.76) was larger while the specificity of IL‐6 (86%) and sensitivity of HsCRP (89%) were higher than other inflammatory markers in predicating the typing of COVID‐19. PT had obvious correlation with all the inflammatory markers except RPR. NLR showed positive correlations with AST, TP, BUN, CREA, PT, and D‐dimer. Patients with high IL‐6 levels have a relatively worse prognosis (HR = 2.30).ConclusionPeripheral blood inflammatory markers reflected the intensity of inflammation and associated with severity of COVID‐19.NLR was more useful to predict severity as well as IL‐6 to predict prognosis of COVID‐19. PLR and LMR were initially found to be higher in SARS‐CoV‐2 virus‐infected group than in influenza A.     

The effects and acceptability of different exercise modes on glycemic control in type 2 diabetes mellitus: A protocol for systematic review and network meta-analysis

Introduction:Exercise has been believed to have positive effects on blood glucose control in patients with type 2 diabetes mellitus. However, few medical evidences have been found to ascertain which type of exercise has the best effect on blood glucose control in diabetes and which type of exercise is more acceptable. The purpose of this study is to compare the effects and acceptability of different exercise modes on glycemic control in type 2 diabetes patients by using systematic review and network meta-analysis.Methods and analysis:Relevant randomized controlled trial studies will be searched from PubMed, EMbase, CochraneCENTRAL, CNKI, VIP, and Chinese medical paper libraries. Primary outcome indicators: glycosylated hemoglobin and dropout rate of the research (number of dropouts/numbers of initially enrolled subjects). Secondary outcome measures: fasting blood glucose, body weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, triglycerides (TG), diastolic pressure, systolic pressure (SBP). Two reviewers are arranged to screen Title, Abstract, and then review full text to further extract data. Standard meta-analysis and network meta-analysis of the data are performed afterward. Methodological quality assessment is planned to be conducted using Cochrane risk of bias tool. The outcome will be analyzed statistically according to Bayesian analysis methods. After that, subgroup analysis is conducted on the duration of intervention, whether there is supervision of intervention, frequency of intervention per week, age, gender, and medication use.Trial registration number:PROSPERO CRD42020175181Discussion:The systematic review and network meta-analysis include evidence of the impact of different exercise modes on blood glucose control in type 2 diabetes mellitus. There are 2 innovative points in this study. One is to conduct a classified study on exercise in as much detail as possible, and the other is to study the acceptability of different exercise modes. The network meta-analysis will reduce the uncertainty of intervention and enable clinicians, sports practitioners, and patients to choose more effective and suitable exercise methods.Ethics and dissemination:The findings of the study will be disseminated through publications in peer-reviewed journals and scientific conferences and symposia. Further, no ethical approval is required in this study.     

Simultaneous Determination and Pharmacokinetics of Tetrandrine, Fangchinoline, and Cyclanoline in Rat Plasma by Ultra-High Performance Liquid Chromatography-Mass Spectrometry after Oral Administration of Stephaniae Tetrandrae Radix Extract

Objective: The objective of the study wasto develop a rapid and sensitive ultra?performance liquid chromatography?tandem massspectrometric method for the determination of tetrandrine, fangchinoline, and cyclanoline in rat plasma and to investigate their pharmacokinetics after oral administration of Stephaniae Tetrandrae Radix extracts. Methods: Sample pretreatment involved methanol pretreatment and liquid–liquid extraction of ethyl acetate from plasma with methanol. Tramadol was used as the internal standard. The analysis was performed using an high strength silica T3 column (100 mm × 2.1 mm, 1.8 μm) and a gradient elution method consisting of mobile phase solution A (0.1% formic acid in water) and B (acetonitrile) at a flow rate of 0.4 mL/min. The detection was performed using a triple quadrupole tandem mass spectrometer in the multiple reaction monitoring mode and using an electrospray ionization source in the positive ionization mode. Results: High efficiency was achieved with an analysis time of 4 min/sample. The calibration curve linear in the concentration range of 1250 ng/ml (R2 ≥ 0.9900) and the lower limit of quantification is 1 ng/ml. The intraday and interday precision (relative standard deviation) values were lower than 9.4. Accuracy (relative error) was within 10.3% at all three quality control levels. Conclusions: This method was successfully applied in pharmacokinetics of tetrandrine, fangchinoline, and cyclanoline in rats after oral administration of Stephaniae Tetrandrae Radix extracts. The maximum plasma concentration (Cmax) of tetrandrine, fangchinoline, and cyclanoline was 124.71 ± 16.08, 84.56 ± 3.28, and 57.61 ± 6.26 ng/ mL, respectively. The time to reach Cmax was 10.39 ± 3.04 for tetrandrine, 10.17 ± 3.04 for fangchinoline, and 6.40 ± 3.16 for cyclanoline. The pharmacokinetic results might help further guide the clinical application of Stephaniae Tetrandrae Radix.     

Genomic and Transcriptomic Landscape of Triple-Negative Breast Cancers: Subtypes and Treatment Strategies

1. Download high-res image (232KB)
2. Download full-size image

     

基于病因病机分析各省市新型冠状病毒肺炎的中医药防治

新型冠状病毒肺炎属于中医学“疫病”范畴。疫情爆发以来,全国各省市卫生行政管理部门坚持中西医结合原则,陆续制定了各省市的中医药防治方案,三因制宜,分期分型辨证并不断完善。笔者全面收集并整理相关信息,基于病因病机分析了各省市中医药防治方案,认为此次疫病是外感疫气,病位主要在肺卫,病邪主要表现为“毒、湿、热、虚、寒”。此“毒”即为疫气,武汉遇暖冬,非其时而有其气而发疫,一气一病,播散流行,治疫必先治毒;“湿”邪之地在南北方各占一半,东西部均有,在南方源于季节和地域,在北方可由寒挟杂,治疗均应祛湿;“热”主要见于南方,为南方常见的病邪,亦可因湿毒入里,湿郁化热,而在北方热与湿同现,主要是因湿毒入里,湿郁化热,治热均以清为主;“虚”则主要在北方,北方冬季多寒,易伤正致虚,或邪正交争激烈,伤阳伤阴致虚,宜祛邪为标,扶正为本;“寒”见于北方和南方山区,寒气过甚,易伤阳伤正,故尤其要注重预防,且以补正气为主。中医防疫治疫应三因制宜,重视预防,与时俱进。