基于糖脂代谢研究筋疽（糖尿病足非缺血性坏疽）湿热毒盛证

[目的]通过现代检验技术研究筋疽(糖尿病足非缺血性坏疽)湿热毒盛证的糖脂代谢指标。[方法]收集136例筋疽(糖尿病足非缺血性坏疽)患者进行不同证型间指标的比较。[结果]湿热毒盛证患者空腹血糖(FBG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 hPBG)、晚期糖基化终末产物(AGEs)、白蛋白(ALB)、总胆固醇(TC)、高密度脂蛋白(HDL-C)与其他证型比较存在统计学差异(P<0.05)。湿热毒盛证患者C-反应蛋白(CRP)、人可溶性血管细胞黏附分子1(sVCAM-1)与其他证型组间比较存在统计学差异(P<0.01)。[结论]筋疽(糖尿病足非缺血性坏疽)湿热毒盛证形成的原因与低营养状态下糖脂代谢紊乱引起的高血糖及持续炎症反应相关。     

从免疫炎性损伤角度探讨5种清热解毒药物抗流感的机制及其临床意义

目的探讨黄芩、板蓝根、白头翁、虎杖、白花蛇舌草5种清热解毒代表药物抗流感病毒感染所致免疫炎性损伤的作用机制。方法在流感病毒亚洲甲型鼠肺适应株FM1感染小鼠后的不同时相(初期、极期、后期),采用ELISA法,动态观察清热解毒代表药物对小鼠血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、γ干扰素(IFN-γ)5种炎性细胞因子含量的影响。结果黄芩在感染后第3日可显著降低血清TNF-α、IL-1、IL-6含量,并于感染后各时相均可增加IFN-γ含量,感染后第1~5日增加IL-10含量。板蓝根在感染后第3日能显著降低血清TNF-α含量,第3~5日降低IL-6含量,并在感染后第1天升高IL-10含量,在感染后第3~5日能升高IFN-γ含量。白头翁在感染后第3日能明显降低血清TNF-α、IL-1、IL-6含量,同时显著升高IL-10含量。虎杖在感染后第1日可显著升高血清IL-10含量,在感染后第5日升高IFN-γ含量。白花蛇舌草在感染后第3日降低血清IL-6含量,在感染后第5日升高IFN-γ含量。结论黄芩的抗流感作用主要表现在流感病毒感染引起的急性外感热病的极期;板蓝根在流感病毒感染的各个时相均有一定的治疗作用;白头翁在流感病毒感染的极期可抑制炎性损伤;虎杖在感染流感病毒的初期与后期均可减少促炎性细胞因子的分泌;白花蛇舌草在流感病毒感染的极期及后期均可起到一定的抗免疫炎性损伤。各药物均具有抑制炎性损伤、防止多脏器功能衰竭、防止休克、退热和抑制促炎性细胞因子的分泌,调节机体免疫,从而减轻炎症反应的作用。     

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。     

温病学理论指导下的新型冠状病毒肺炎诊治刍议

基于温病学理论,探讨新型冠状病毒肺炎的中医病因病机与诊治思路。温病学说源于明清之前的历代中医理论积累,经过长期的温热病防治实践而形成,其对于外感热病(包括烈性传染病)的病因病机、证治方药有着较为系统的论述,近年来在我国的新发传染病防治中发挥出积极的作用。温瘟相通,瘟疫病因多为热毒疫邪,表现为热证阳证,可按温病学中的卫气营血或三焦辨证分期论治,或治以吴又可、庞安时等的经方验方,这些因、机、证、治理论可试用于新型冠状病毒肺炎的中医诊疗。且肺与大肠相表里,胃肠道也是新型冠状病毒侵袭或繁殖的部位,采用中医清热通下之法,使邪从肠道而出,可能是减轻体内病毒感染与肺脏炎症的一种途径。     

热疗对肿瘤免疫微环境中免疫细胞及免疫相关细胞因子的影响

随着对肿瘤热疗和肿瘤免疫微环境(TIME)的深入研究,近年来热疗对TIME的作用越来越受到学者们的重视。本文就目前国内外研究进展,对热疗与TIME中几类主要免疫细胞和免疫相关细胞因子的影响及作用机制作一综述。全面而透彻的了解热疗对TIME的调控作用,有助于为肿瘤治疗提供新的思路和方法。     

Challenging infections in pregnancy

Maternal sepsis is “a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or postpartum period.” (World Health Organisation, 2017). Serious infection during, or immediately after, pregnancy may go initially unrecognized in an otherwise young and healthy group, who nevertheless do have a compromized immune system. Secondly, whilst malaise, flushes, nausea, vomiting and abdominal pain are common in pregnancy, each can herald sepsis with rapid demise for mother and baby. The MBRRACE-UK report in 2017¹ found an overall sepsis-related maternal mortality rate of 0.56 per 100,000 maternities with a mortality rate from genital tract sepsis of 0.28 per 100,000 maternities. This review will focus on the major causes, recognition, differentiation and microbiological management of sepsis in pregnancy, using two detailed cases to illustrate.     

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。     

Molecular mechanism of miR-382 in the pathogenesis of renal tubulointerstitial fibrosis

Objective To investigate the roles of microRNA-382 (miR-382) in the pathogenesis of renal tubulointerstitial fibrosis (TIF). Methods Human kidney epithelial cells (HK2)transfected with miR-382 inhibitor (antagomiR-382) were used to examine the effect of miR-382 abundance on cell polarity, as well as to test the complementary relationship between miR-382 and its predicted target gene heat shock protein 60 (HSPD1), which was further verified by 3′-untranslated region luciferase assay and site-directed mutagenesis. The role of miR-382 played in the development of renal interstitial fibrosis and redox regulation was examined in a mouse unilateral ureteral obstruction (UUO) model. Locked nucleic acid (LAN)-modified anti-miR-382 was intravenous delivered via tail vein 30 min prior to UUO, and repeated the dosage 24 h after the surgery. For clinical verification, renal biopsy specimens from 12 IgA nephropathy (IgAN) patients were collected, 6 patients with moderate to severe TIF and 6 patients without TIF. The relative abundance of miR-382 and HSPD1 protein was analyzed by using in situ hybridization and immunohistochemistry. Results HSPD1 was confirmed to be a new, direct target gene of miR-382 by in vitro 3′-untranslated region luciferase assay and site-directed mutagenesis. The development of epithelial transition in HK2 cells was accompanied with up-regulation of miR-382 [(6.54±0.96) vs (1.12±0.26), P＜0.05]. Blocking the expression of miR-382 could reversed the progression of epithelial transition partially. In UUO mice the abundance of miR-382 was up-regulated [(6.89±2.47) vs (1.00±0.42), P＜0.01] while HSPD1 and Trx were down-regulated compared with the sham group. Down-regulation of miR-382 was associated with significant decrease in TIF, but increase in HSPD1 and thioredoxin protein compared with UUO group [HSPD1: (0.34±0.10) vs (0.14±0.05); Trx: (0.79±0.18) vs (0.36±0.16); all P＜0.05]. The expression of miR-382 was up-regulated and HSPD1 was significantly down-regulated in IgAN patients with TIF. Conclusions miR-382 play an important role in renal tubulointerstitial fibrosis in human and mice. HSPD1 is one of the target genes of miR-382. The down-regulation of HSPD1 and the decrease ability of anti-oxidative stress may be the important mechanism of miR-382 involved in renal tubulointerstitial fibrosis.     

Successful Use of Surgically Placed Impella 5.0 and Central Extracorporeal Membrane Oxygenation Circuit in a Patient with Postcardiotomy Shock

The Impella 5.0, a percutaneously inserted left ventricular assist device, has been used to support patients who have severe heart failure or who are undergoing high-risk percutaneous coronary intervention. We report our surgical placement of the Impella 5.0, through a graft sewn to the aorta, to unload the left ventricle of a 59-year-old man who was undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy shock. The patient underwent successful placement of a long-term left ventricular assist device before his discharge from the hospital. The versatility of the Impella 5.0 is exemplified in this patient who was successfully bridged to long-term support.