《中医内科临床诊疗指南——头痛》制定中患者偏好与价值观的调查研究

目的:研究原发性头痛患者偏好与价值观,为形成推荐意见强度分级共识时提供参考。方法:采用横断面网络调查,通过半开放式电子问卷形式,使用视觉模拟评分(VAS)测量影响患者选择治疗措施的考虑因素重要性、总体治疗措施方向、头痛辨证汤剂治疗、原发性头痛的中成药及非药物治疗措施等方面的偏好与价值观。结果:调查共纳入研究对象217人。影响患者选择治疗措施的考虑因素重要性评分、总体治疗措施方向的偏好评分、偏头痛及紧张型头痛治疗措施的偏好评分差异具有统计学意义(P<0.01)。患者在选择治疗措施时最关注疗效,总体偏好于选择非药物疗法。在偏头痛治疗中,患者对针刺治疗偏好程度最高;在治疗紧张型头痛时,患者对推拿治疗的偏好程度最高;在治疗丛集性头痛时,患者对不同干预措施没有表现出明显偏好。结论:总体上,不良反应少的非药物疗法,如针灸、推拿等在原发性头痛治疗中更受患者欢迎,临床实践指南的制定应该考虑头痛患者的这一偏好与价值观结果。     

基于VAS评价右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床效果

目的:研究右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床应用效果。方法:将2015年7月至2018年7月在本院行宫颈癌根治术的86例患者随机分为对照组和观察组各43例。对照组术后镇痛采用舒芬太尼和格拉司琼，观察组术后镇痛加用右美托咪定。采用视觉模拟评分法（VAS）评价患者术后1 h、6 h、12 h、24 h、48 h疼痛情况，采用Ramesay评分法评价患者不同时间点镇静状况，记录并比较两组患者不同时间点收缩压、舒张压、心率及呼吸频率变化，比较两组患者不良反应发生情况。结果:观察组患者术后6 h、12 h、24 h、48 h VAS评分均明显低于对照组（P＜0.05），Ramesay评分均明显高于对照组（P＜0.05）；观察组和对照组患者术后不同时间点呼吸频率比较，差异无统计学意义，但术后6 h、12 h、24 h观察组患者收缩压、心率均明显低于对照组（P＜0.05），术后1 h、6 h观察组患者舒张压明显低于对照组（P＜0.05）；观察组患者恶心呕吐、高血压发生率较对照组明显减低。结论:右美托咪定用于宫颈癌根治术后镇痛，可以提高镇痛镇静效果，稳定患者血流动力学，有助于术后快速康复。     

Adeno-associated virus (AAV)-mediated neuroprotective effects on the degenerative retina: the therapeutic potential of erythropoietin

Retinal degeneration (RD) results in photoreceptor loss and irreversible visual impairments. This study sought to alleviate the photoreceptor degeneration via the adeno-associated virus (AAV)-mediated erythropoietin (EPO) therapy. AAV-2/2-mCMV-EPO vectors were constructed and delivered into the subretinal space of a RD model. The retinal morphology, optokinetic behaviour and electrophysiological function of the treated animals were analysed. The subretinal delivery of AAV-2/2 vectors induced robust EPO gene expressions in the retinas. AAV2/2-mediated EPO therapy ameliorated the photoreceptor degeneration and visual impairments of the RD animal model. Furthermore, the multi-electrodes array (MEA) was used to detect the firing activities of retinal ganglion cells. MEA recording showed that the EPO therapy could restrain the spontaneous firing response, enhance the light-induced firing response and preserve the basic configurations of visual signal pathway in RD model. Our MEA assay provided an example to evaluate the potency of pharmacological compounds on retinal plasticity. In conclusion, AAV2/2-mediated EPO therapy can ameliorate the photoreceptor degeneration and rectify the abnormities in visual signal transmission. These beneficial results suggest the AAV vector is a viable therapeutic option for retinopathies with rapidly degenerating kinetics and lay the groundwork for future development of EPO gene therapy.     

缓解视疲劳功能中药复方保健产品配方规律及特点分析

目的通过检索特殊食品信息查询平台公布的具有缓解视疲劳功能的保健食品信息资料,以及药智数据网的中成药处方数据库中眼科中成药中有保健功能的产品信息资料,为具有缓解视疲劳功能的保健产品的组方与产品开发提供依据与参考。方法运用Microsoft Excel2016软件及中医传承辅助平台对检得的产品信息进行统计,分析其配方特点。结果共收集到141个具有缓解视疲劳功能的保健食品,其中64个(45.4%)保健食品配方中含有中药类原料。使用频次≥5的中药原料有6味,累计使用145次(72%),由高到低分别是菊花、枸杞子、决明子、桑椹、熟地黄、茯苓。通过无监督的熵层次聚类得到3个新处方。非中药原料在缓解视疲劳功能的保健食品中应用较为普遍,含有外来天然植物资源的60个产品,含叶黄素及维生素类的17个。统计眼科中成药中有保健功能的产品可知,使用频次≥4的中药原料有7味,累计使用32次(29%),由高到低分别是枸杞子、决明子、菟丝子、熟地黄、菊花、五味子、车前子。通过无监督的熵层次聚类得到1个新处方。结论保健食品在中药原料的选择上与中医药理论治疗视疲劳的原则基本契合,即滋补肝肾、平肝明目。但二者在中药原料选择范围、原料配伍、剂型种类等方面有所不同。此外,还在辨证保健理论指导下,尝试探讨应用文献数据处理统计方法筛选新配方、开发新产品,为中药复方保健产品的研发开辟了新思路、新方法。     

Sensory evoked potentials in patients with Rett syndrome through the lens of animal studies: Systematic review

ObjectiveSystematically review the abnormalities in event related potential (ERP) recorded in Rett Syndrome (RTT) patients and animals in search of translational biomarkers of deficits related to the particular neurophysiological processes of known genetic origin (MECP2 mutations).MethodsPubmed, ISI Web of Knowledge and BIORXIV were searched for the relevant articles according to PRISMA standards.ResultsERP components are generally delayed across all sensory modalities both in RTT patients and its animal model, while findings on ERPs amplitude strongly depend on stimulus properties and presentation rate. Studies on RTT animal models uncovered the abnormalities in the excitatory and inhibitory transmission as critical mechanisms underlying the ERPs changes, but showed that even similar ERP alterations in auditory and visual domains have a diverse neural basis. A range of novel approaches has been developed in animal studies bringing along the meaningful neurophysiological interpretation of ERP measures in RTT patients.ConclusionsWhile there is a clear evidence for sensory ERPs abnormalities in RTT, to further advance the field there is a need in a large-scale ERP studies with the functionally-relevant experimental paradigms.SignificanceThe review provides insights into domain-specific neural basis of the ERP abnormalities and promotes clinical application of the ERP measures as the non-invasive functional biomarkers of RTT pathophysiology.     

温针灸阳陵泉穴治疗膝关节骨性关节炎临床疗效观察

目的:观察温针灸阳陵泉穴治疗膝关节骨性关节炎的临床疗效。方法:将2015年1月至2019年1月本院收治的膝关节骨性关节炎患者120例,根据随机数字表法分为对照组和观察组,每组60例。对照组给予等速肌力训练治疗,观察组在对照组的基础上加用温针灸阳陵泉穴治疗。观察两组患者膝关节屈曲度、伸直度,白细胞介素(interleukin,IL)-6及IL-18水平,VAS评分及膝关节症状和功能评分。结果:观察组治疗后屈曲度及伸直度均高于对照组,差异有统计学意义(P<0.05);观察组治疗后IL-6及IL-18水平均低于对照组,差异有统计学意义(P<0.05);观察组治疗后VAS评分低于对照组,差异有统计学意义(P<0.05);观察组治疗后症状和功能评分高于对照组,差异有统计学意义(P<0.05);观察组有效率95.0%,对照组有效率83.3%,观察组有效率高于对照组,差异有统计学意义(P<0.05)。结论:温针灸阳陵泉穴治疗膝关节骨性关节炎,可有效改善患者膝关节活动度,降低炎症因子,减轻疼痛,提高临床疗效。