中药复方灌肠治疗溃疡性结肠炎临床疗效Meta分析

[目的] 系统评价中药复方灌肠治疗溃疡性结肠炎（UC）随机对照试验（RCT）的临床疗效及安全性。[方法] 两位研究者独立系统检索中药复方灌肠治疗UC的全部临床RCT中英文文献。数据库包括：中国生物医学文献数据库（CBM）、中国知网知识发现网络平台（CNKI）、重庆维普科技数据库（VIP）和万方数据知识数据库（Wanfang Database）、Pubmed、Embase、Cochrane电子期刊全文数据库，检索时间均从建库至2019年2月9日。两位研究者独立提取资料，如遇分歧，请求第三方协助解决。同时使用Review Manager 5.3及Stata15.0软件进行本研究的数据处理。[结果] 最终共纳入17篇文献，共计1 597例UC患者。中药复方灌肠治疗UC的临床总有效率优于对照组[I²=0%，RR=1.31，95%CI（1.25，1.37），P<0.000 01]，亚组分析显示，中药复方灌肠较氨基水杨酸类溶液灌肠[I²=0%，RR=1.31，95%CI（1.24，1.38），P<0.000 01]或栓剂纳肛[I²=16%，RR=1.32，95%CI（1.16，1.51），P<0.000 1]或柳氮磺胺吡啶（SASP）灌肠[I²=0%，RR=1.29，95%CI（1.23，1.36），P<0.000 01]或美沙拉嗪灌肠[I²=4%，RR=1.37，95%CI（1.22，1.54），P<0.000 01]都有较好的疗效；中药复方灌肠改善中医症状积分优于对照组[I²=23%，MD=-1.42，95%CI（-2.38，-0.46），P=0.004]；中药复方灌肠改善肠黏膜积分优于对照组[I²=0%，MD=-0.29，95%CI（-0.50，-0.07），P=0.01]；中药复方灌肠改善Mayo积分优于对照组[I²=89%，MD=-2.50，95%CI（-4.25，-0.75），P=0.005]；中药复方灌肠的不良反应发生率较对照组无明显差异[I²=59%，RR=0.41，95%CI=（0.05，3.29），P=0.40]。亚组分析显示，中药复方灌肠不良反应发生率较美沙拉嗪栓纳肛[I²=0%，RR=0.14，95%CI（0.02，1.11），P=0.06]或SASP灌肠[I²=82%，RR=1.20，95%CI（0.02，77.88），P=0.93]皆无明显差异；中药复方灌肠治疗UC的复发率较对照组更低[I²=0%，RR=0.34，95%CI（0.16，0.72），P=0.005]。[结论] 中药复方灌肠治疗UC较氨基水杨酸类药物的临床疗效更佳且安全性更高。     

GC-MS分析水蒸气蒸馏法提取石菖蒲挥发油过程中油水分配规律

目的揭示石菖蒲Acori Tatarinowii Rhizoma挥发油提取过程中挥发性成分的提取、分布规律及影响因素,为挥发油去"乳化"技术提供理论参考。方法水蒸气蒸馏法提取石菖蒲挥发油,每30分钟收集提取液并分离芳香水和挥发油部分。结果实验共测得56个挥发性成分,其中β-细辛醚、甲基丁香酚、顺式-甲基异丁香酚、γ-细辛醚为主要特征成分,水中特有成分41个,油中特有成分4个,油水共有成分11个。相关性分析表明,水中特有成分与水中主要成分的溶出/扩散呈正相关,而与挥发油中主要成分呈负相关。水中特有成分在水中溶解度较高。雷达特征图谱及主成分(PCA)结果表明,水中特有成分的水溶解度和沸点极高,油水共有成分的蒸气压最高,油中特有成分的极性表面积和沸点较高。水溶性、沸点、极性表面积、蒸气压等是影响成分分布的主要理化性质。结论石菖蒲挥发性成分因理化性质不同,在芳香水部分和挥发油部分分布差异较大,水中特有成分可能是挥发油提取过程中产生"乳化"现象的重要原因。     

CDC42 promotes vascular calcification in chronic kidney disease

Vascular calcification is prevalent in patients with chronic kidney disease (CKD) and a major risk factor of cardiovascular disease. Vascular calcification is now recognised as a biological process similar to bone formation involving osteogenic differentiation of vascular smooth muscle cells (VSMCs). Cell division cycle 42 (CDC42), a Rac1 family member GTPase, is essential for cartilage development during endochondral bone formation. However, whether CDC42 affects osteogenic differentiation of VSMCs and vascular calcification remains unknown. In the present study, we observed a significant increase in the expression of CDC42 both in rat VSMCs and in calcified arteries during vascular calcification. Alizarin red staining and calcium content assay revealed that adenovirus-mediated CDC42 overexpression led to an apparent VSMC calcification in the presence of calcifying medium, accompanied with up-regulation of bone-related molecules including RUNX2 and BMP2. By contrast, inhibition of CDC42 by ML141 significantly blocked calcification of VSMCs in vitro and aortic rings ex vivo. Moreover, ML141 markedly attenuated vascular calcification in rats with CKD. Furthermore, pharmacological inhibition of AKT signal was shown to block CDC42-induced VSMC calcification. These findings demonstrate for the first time that CDC42 contributes to vascular calcification through a mechanism involving AKT signalling; this uncovered a new function of CDC42 in regulating vascular calcification. This may provide a potential therapeutic target for the treatment of vascular calcification in the context of CKD. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Liver Transplantation Following Life-threatening Abdominal Trauma: A Case Series of 5 Patients at a Single Institution

Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.     

Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

Background

The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown.