加味黄连解毒汤灌肠辅助治疗重症肺炎合并胃肠功能障碍临床研究

目的:观察加味黄连解毒汤灌肠辅助治疗重症肺炎痰热壅肺证合并胃肠功能障碍的临床疗效。方法:选取64例重症肺炎痰热壅肺证合并胃肠功能障碍患者,依据不同的治疗方法分为治疗组和对照组,每组32例。对照组给予抗菌药、胃肠功能保护药、机械通气等对症治疗,治疗组在对照组基础上联合加味黄连解毒汤灌肠治疗。比较2组临床疗效、治疗前后中医证候积分及血清降钙素原(PCT)水平,记录不良反应发生情况。结果:治疗组总有效率93.75%,高于对照组的71.88%,差异有统计学意义(P<0.05)。治疗后,2组中医证候积分均较治疗前降低,治疗组中医证候积分比对照组下降更明显,差异均有统计学意义(P<0.05)。治疗3天与治疗7天,治疗组PCT水平均低于对照组,差异均有统计学意义(P<0.05)。治疗期间,治疗组发生不良反应5例,对照组发生不良反应4例,未经处理均自行缓解。结论:加味黄连解毒汤灌肠辅助治疗重症肺炎痰热壅肺证合并胃肠功能障碍,可以有效减轻患者的临床症状,改善胃肠功能,抑制炎症反应。     

Dynamic cyclic and torsional fatigue resistance of TruNatomy compared with different nickel–titanium rotary instruments

This study evaluated the dynamic cyclic and torsional fatigue resistance of recently introduced TruNatomy instruments (TRN) and compare with HyFlex CM (HFC), Vortex Blue (VB) and FlexMaster (FM) instruments. Size 20, 0.04 taper of TRN, HFC, VB and FM instruments was tested for dynamic cyclic and torsional fatigue resistance. Dynamic cyclic fatigue resistance was evaluated using an artificial canal with a radius of 5 mm and a 90° angle of curvature. The number of cycles to failure (NCF) was calculated. The dynamic torsional fatigue resistance was evaluated by holding a 5 mm of the tip of each instrument in a metal block with composite resin. Torsional fatigue resistance was recorded by counting the number of load applications before fracture for each instrument. The HFC instruments had greater fatigue resistance than VB, TRN and FM. FM had a higher resistance to torsional stress than TRN, HFC and VB instruments.     

热敏灸治疗原发性骨质疏松症的系统评价与Meta分析

摘要：目的 运用循证医学方法评价热敏灸治疗原发性骨质疏松症（primary osteoporosis，POP）疗效。方法 从CNKI、VIP、Wanfang、SinoMed和Pubmed数据库检索热敏灸治疗POP的随机对照试验，时间为建库至2021年8月。2名研究者依据纳入和排除标准独立筛选文献、提取资料。使用Cochrane系统评价手册5.1.0版评价文献偏倚风险并用RevMan5.3软件绘图，以Stata16软件进行合并分析并绘制森林图。结果 共纳入14项研究，受试者共921例。Meta分析结果显示，总有效率：OR=1.48，95 % CI (0.95，2.01)，P< 0.01；骨密度(BMD)：MD =0.05，95% CI (0.02，0.07)，P< 0.01；视觉模拟评分(VAS)：[MD = –1.13，95% CI (–1.49，–0.76)，P< 0.01；生活质量量表（SF-36）总评分：MD =–1.55，95% CI (–6.76，9.81)，P=0.71；骨保护素(OPG)：MD =49.73，95% CI (22.81，76.65)，P< 0.01；Ⅰ型胶原羧基末端肽（CTX）：MD =–0.18，95% CI (–0.22，–0.14)，P<0.01；Ⅰ型胶原氨基末端肽（NTX）：MD =–0.66，95% CI (–0.86，–0.47)，P<0.01。结论 热敏灸治疗POP能够使BMD有所增加，改善POP骨痛，改善OPG、CTX以及NTX等骨代谢指标。本研究纳入文献质量不高，治疗效果证据较为有限，尚需更多大样本、多中心、高质量临床随机对照研究予以佐证。     

Responsiveness of the urban primary health care delivery system in Bangladesh: A comparative analysis

This study analyses the responsiveness of outpatient care to assess the quality of urban primary health care among all 5 types of health care providers in Bangladesh, namely, the Urban Primary Health Care Services Delivery Project, the NGO Health Services Delivery Project (NHSDP), NGOs, private hospitals, and the Ministry of Health and Family Welfare (MOHFW). Other than some public‐private comparisons, there is an absolute knowledge gap regarding responsiveness in urban health systems, particularly in the context of Bangladesh, and this gap motivates this study. The study used primary data collected from 810 randomly selected outpatients. The survey used a structured questionnaire on all 7 domains of responsiveness of outpatient care suggested by the World Health Organization. The estimated mean responsiveness score reveals that overall, approximately 33% of the patients rated the responsiveness of the system as poor. In reported responsiveness, the NHSDP was ranked at the top and the MOHFW at the bottom. The latter is quite expected. Overall, prompt attention and autonomy were the worst‐performing domains, and choice of provider, dignity, and clear communication were the better‐performing ones. The results suggest the need to improve the degree of responsiveness of all domains, especially those that are more concerned with access to health care, namely, prompt attention, dignity, clear communication, and confidentiality. The Ministry of Health and Family Welfare facilities should give additional consideration to promote prompt attention, autonomy, and quality of basic amenities. Private facilities should also provide additional stress on improving prompt attention and autonomy. The nontherapeutic quality of health care needs to be emphasized in the medical education system. Further research based on household surveys could be worthwhile to measure responsiveness more comprehensively.     

羟基红花黄色素A通过抑制程序性坏死减轻小鼠重症中暑引起的急性肺损伤

目的 研究羟基红花黄色素A（HSYA）是否在重症中暑肺损伤中起保护作用及其可能的作用机制。方法 使用不同浓度（1.125、2.25、4.5 mg/kg）HSYA腹腔注射预处理小鼠，建立重症中暑（sHS）小鼠模型，分为低、中、高剂量HSYA中暑组、单纯中暑组及正常对照组，12只/组。初步观察及比较各组热耐受的情况，以确定HSYA最佳治疗剂量；后使用中剂量HSYA及RIP1活化抑制剂Nec-1预处理小鼠，分组为HSYA+HS组、Nec-1+HS组、HS组及正常对照组，8只/组，观察72 h恢复期核心体温变化特征，比较热耐受情况及生存情况。给予相同处理因素处理小鼠分组为正常对照组，HS组，HSYA+HS组及Nec-1+HS组，正常对照组6只，其余18只/组，分别于重症中暑恢复期不同阶段（0、2、6、12、24 h）处死小鼠，每个时间点处死3只小鼠，收集小鼠的肺组织、肺泡灌洗液及血液样本，取肺组织行HE染色，并进行病理评分，检测肺湿干重比，肺含水量，肺泡灌洗液中白细胞、中性粒细胞、蛋白含量；ELISA法检测肺泡灌洗液中HMGB1水平及血清中TNF-α、IL-6及HMGB1水平；Western blotting检测恢复期（2、6、12 h）肺组织中RIP1、RIP3、MLKL-s358、MLKL表达水平，及经HSYA预处理后MLKL-s358蛋白水平。结果 中剂量及高剂量HSYA预处理可明显改善小鼠热耐受能力，中剂量与高剂量无显著差异，后续药物预处理以中剂量（2.25 mg/kg）作为标准剂量；与HS组相比，HSYA+HS组和Nec-1+HS组小鼠热耐受程度均增加（P<0.05），HSYA+HS组和Nec-1+HS组无明显差异。HSYA及Nec-1预处理组小鼠生存率增加（P<0.05），肺组织病理评分、TNF-α、IL-6及HMGB1水平降低（P<0.05），肺湿干重比，肺含水量，肺泡灌洗液中白细胞、中性粒细胞、蛋白含量及HMGB1水平降低（P<0.05），HS小鼠恢复期肺组织RIP1水平及MLKL-s358磷酸化水平升高（P<0.05），与HS组相比，HSYA+HS组MLKL-s358磷酸化水平降低。结论 重症中暑小鼠肺组织可发生程序性坏死，HSYA可通过抑制程序性坏死发挥肺保护作用。     

Neighborhood: A Conceptual Analysis

Researchers interested in measuring neighborhood‐level effects should understand how “neighborhood” is defined within nursing sciences and other sciences, and the inherent strengths and weaknesses of current research methodologies. This concept analysis provides clarity around the concept of neighborhood within the context of health, analyzes the current state of development of the neighborhood concept, and proposes areas for future nursing research. Using the Rodger's Method of analysis, the concept of neighborhood within nursing and public health research is described based on existing literature. The concept's attributes, related concepts, antecedents, and consequences are given from the literature. Comparisons of the use of neighborhood are made between nursing, public health, sociology, and other sciences. The evolution of the concept of neighborhood throughout history is described, and important implications for future research are discussed.     

四妙清瘟败毒饮治疗儿童热毒炽盛型传染性单核细胞增多症临床研究

目的:观察四妙清瘟败毒饮治疗儿童热毒炽盛型传染性单核细胞增多症的临床疗效。方法:选取热毒炽盛型传染性单核细胞增多症儿童患者116例,随机分为治疗组和对照组,每组58例。治疗组患者给予四妙清瘟败毒饮联合更昔洛韦进行治疗,对照组患者给予更昔洛韦进行治疗,治疗期间每天观察患儿体温、咽部症状、肝脾及淋巴结情况;每3 d复查1次血常规(含白细胞计数、异常淋巴细胞比率);每5 d复查1次肝功能、肝脾彩色超声及CD_4~+、CD_8~+、CD_4~+/CD_8~+T细胞亚群。结果:1治疗后治疗组患儿的白细胞计数、异型淋巴细胞比率、肝功能中谷丙转氨酶、外周血CD_4~+、CD_8~+、CD_4~+/CD_8~+T细胞亚群及平均住院时间均较对照组明显缩短时间,差异有统计学意义(P0.05或P0.01);2治疗组患儿体温恢复正常时间、咽峡炎痊愈时间、淋巴结缩小时间、肝脾回缩至正常时间及症状和体征总积分均较对照组患儿恢复时间短,且症状和总积分较治疗前明显下降,差异有统计学意义(P0.05或P0.01);3经治疗组患儿整体有效率明显高于对照组,差异有统计学意义(P0.01)。结论:四妙清瘟败毒饮联合更昔洛韦治疗儿童热毒炽盛型传染性单核细胞增多症能够明显改善患儿的临床症状和体征,缩短白细胞、异常淋巴细胞比率、肝脾肿大、CD_4~+、CD_8~+、CD_4~+/CD_8~+T细胞亚群等实验室异常指标的恢复时间,缩短患儿住院时间,减轻患儿及家庭的负担。