微创缝合联合术后早期加速康复治疗急性跟腱断裂的临床研究

目的 探讨利用自制缝线引导钳通过小切口微创缝合技术联合术后加速康复治疗急性跟腱断裂的方法和疗效.方法 前瞻性分析2015年10月—2017年4月中部战区总医院足踝与运动医学中心收治的跟腱断裂患者63例,男性55例,女性8例;年龄14～61岁,平均38.5岁;其中借助自制的缝线引导钳,通过小切口微创缝合技术治疗急性闭合性跟腱断裂患者38例,按照随机数字表法分为加速组(20例)和常规组(18例).两组采取不同的术后方案:加速组术后短腿支具固定踝关节于中立位(背屈0°),术后3d即开始膝关节屈曲90°进行主动踝关节屈伸练习(踝背屈限制在0°),术后2～4周去除短腿支具,主动踝关节全范围屈伸练习,可穿戴行走靴部分负重逐渐过渡到完全负重;常规组短腿支具固定踝关节于跖屈30°,术后3d开始练习屈伸膝关节;术后4周～3个月开始膝关节屈曲90°位主动踝关节屈伸练习,穿戴行走靴逐渐过渡到完全负重.采用美国足与踝外科协会(AOFAS)踝与后足功能评分标准进行评分,询问恢复到伤前体育活动水平的时间.结果 两组患者均未出现跟腱再断裂、切口深部感染、皮瓣坏死等.加速组切口浅表感染2例,腓肠神经损伤1例;常规组切口浅表感染1例,无腓肠神经损伤病例.术后1年AOFAS评分:加速组85～100分,平均94.3分;常规组83～95分,平均92.6分.重返运动情况:加速组15例(88.2％)恢复到伤前的运动水平,重返运动时间20～24周,平均21.0周;常规组11例(73.3％)恢复至伤前运动水平,重返运动时间22～27周,平均23.4周.结论 借助自制的缝线引导钳,通过小切口微创缝合技术修复急性跟腱断裂同时联合术后早期加速功能康复可获得满意的临床效果,且可缩短患者重返运动时间.     

AQP3-mediated H2O2 uptake inhibits LUAD autophagy by inactivating PTEN

It is widely accepted that redox reprogramming participates in malignant transformation of lung adenocarcinoma (LUAD). However, the source of excessive reactive oxygen species (ROS) and the downstream signaling regulatory mechanism are complicated and unintelligible. In the current study, we newly identified the aquaporin 3 (AQP3) as a LUAD oncogenic factor with capacity to transport exogenous hydrogen peroxide (H₂O₂) and increase intracellular ROS levels. Subsequently, we demonstrated that AQP3 was necessary for the facilitated diffusion of exogenous H₂O₂ in LUAD cells and that the AQP3-dependent transport of H₂O₂ accelerated cell growth and inhibited rapamycin-induced autophagy. Mechanistically, AQP3-mediated H₂O₂ uptake increased intracellular ROS levels to inactivate PTEN and activate the AKT/mTOR pathway to subsequently inhibit autophagy and promote proliferation in LUAD cells. Finally, we suggested that AQP3 depletion retarded subcutaneous tumorigenesis in vivo and simultaneously decreased ROS levels and promoted autophagy. These findings underscore the importance of AQP3-induced oxidative stress in malignant transformation and suggest a therapeutic target for LUAD.     

不明原因发热患者肺泡灌洗液病毒群落解析

目的: 分析不明原因发热患者肺泡灌洗液中的病毒谱。方法: 将58例肺泡灌洗液样本随机分为5组分别构建5个文库，利用病毒宏基因组学技术进行病毒群落分析，并对获得的细环病毒及鼻病毒进行阳性样本筛选。结果： 肺泡灌洗液病毒群落组成中，指环病毒科占主体地位（19.4%），其次为圆环病毒科（11.0%），藻去氧核糖核酸病毒科（11.0%），人类内源性递转录病毒科（10.2%），痘病毒科（4.9%），逆转录病毒科（3.2%），帚状病毒科（2.3%），小RNA病毒科（0.6%）；并发现了4株序列较长的细环病毒，根据细环病毒开放阅读框1进行系统进化分析，显示其与已知的细环病毒在核酸水平上有一定的差异。通过对细环病毒及鼻病毒阳性样本的筛选，发现细环病毒阳性率为11.3%，鼻病毒阳性率为10.0%。结论： 应用病毒宏基因组学技术成功解析出不明原因发热患者肺泡灌洗液中的病毒群落组成，病毒群落中指环病毒科占比最高，其中细环病毒因发热导致的炎性环境以及患者免疫力低下而大量增殖。     

灰色关联度法评价麸炒白术质量

目的:依据灰色关联度分析方法评价麸炒白术质量。方法:收集15份不同产地麸炒白术样品,测定其白术内酯Ⅰ、白术内酯Ⅱ、白术内酯Ⅲ、5-羟甲基糠醛、东莨菪内酯5种主要成分的含量,采用灰色关联度法,以定义的相对关联度为测度,构建麸炒白术质量评价模型。结果:应用该方法建立了麸炒白术的质量评价模型,收集白术代表产区的15批麸炒白术进行客观评价,得到各评价单元序列的相对关联度为0.320～0.706,其中第12、13、14批次样品质量排在前3,说明该样品产区的麸炒白术质量相对较好。结论:该研究为麸炒白术的综合质量评价提供了一种新方法。     

腰痹通胶囊治疗腰椎间盘突出症的Meta分析

目的系统评价腰痹通胶囊比较非甾体抗炎药(NSAIDs)治疗腰椎间盘突出症(LDH)的疗效和安全性,为临床提供循证参考。方法通过计算机检索Cochrane Library、PubMed、Web of Science、中文科技期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库(Wanfang Data),收集自建库以来至2019年6月腰痹通胶囊比较NSAIDs治疗LDH的随机对照试验(RCT),制定纳入标准和排除标准后,筛选出符合标准的文献,评价纳入文献的质量并提取数据,采用RevMan5.3软件对其进行Meta分析。结果共有10篇研究符合标准,合计1088例患者。Meta分析结果显示腰痹通胶囊治疗LDH与NSAIDs比较在提高临床总有效率[OR=4.74,95%CI(3.13,7.17),P<0.00001]、降低VAS评分[MD=-1.26,95%CI(-1.35,-1.17),P<0.00001]、改善白细胞介素-1β(IL-1β)[MD=-0.12,95%CI(-0.14,-0.10),P<0.00001]、白细胞介素-6(IL-6)[MD=-4.14,95%CI(-6.34,-1.93),P=0.0002]、白细胞介素-8(IL-8)[MD=-9.49,95%CI(-11.73,-7.24),P<0.00001]、肿瘤坏死因子-α(TNF-α)[MD=-0.27,95%CI(-0.36,-0.17),P<0.00001]水平方面均有优势,在安全性方面提示不良反应发生率低,临床使用相对安全。结论腰痹通胶囊与NSAIDs比较能明显提高LDH患者的临床疗效、改善相关指标,且不良反应较少。但由于本研究为二次研究,且纳入文献数量较少、质量较低,尚需大样本、高质量随机对照研究对其临床疗效及安全性进一步证实。     

淋巴瘤与转移淋巴结的超声弹性成像特征及其临床价值

目的:探讨淋巴瘤与转移淋巴结的超声弹性成像特征及其临床价值。方法:选取2017年7月至2019年2月我院收治的浅表淋巴结肿大的患者118例，其中淋巴瘤与转移淋巴结各59例，进行超声弹性成像，比较淋巴瘤组淋巴结和转移组淋巴结常规超声参数、弹性评分和弹性应变率比值。结果:淋巴瘤组长径、短径、长短径比值均大于转移组，淋巴瘤组淋巴门结构消失率低于转移组，淋巴瘤组淋巴结弹性评分及弹性应变率比值均低于转移组，差异具有统计学意义（P<0.05）；以SR 2.51为截断值，弹性成像诊断淋巴瘤的敏感性、特异性分别为74.58%、89.83%。结论:弹性成像能够提供组织硬度信息，通过弹性评分及弹性应变率比值，结合常规超声图像，能够为淋巴瘤及转移淋巴结的鉴别诊断提供可靠依据，具有一定的临床应用价值。     

Does acculturation affect the dietary intakes and body weight status of children of immigrants in the U.S. and other developed countries? A systematic review

Objective: This paper reviews available studies on the relationship between acculturation and obesity among children of immigrants who have at least one foreign-born parent.

Methods: A systematic review of relevant studies was undertaken using PubMed, Web of Science, and PsychInfo.

Results: The initial search identified 1317 potentially relevant publications, of which 21 were retained after three rounds of screening. Most studies were conducted in the U.S. The majority of studies used BMI or overweight/obesity prevalence as the outcome variable, while two studies used dietary intake. Three studies used standardized acculturation scales, while most of the studies used generation, duration of residency in host country, and language as proxy measures of acculturation. The relationship between acculturation and outcomes varied between the host countries and origin countries for children of immigrants.

Conclusion: This study suggests children of immigrants with different cultural backgrounds may interact with host countries to varying degrees, ultimately influencing their diet behaviours and body weight status. Researchers are encouraged to adopt standardized acculturation scales to compare the results across countries and populations.     

阴虚体质理论与科学实证

阴虚体质以虚热表现为特征,在偏颇体质中位列第4。从形成原因、生理及心理特征、在人群中的分布规律、发病倾向、调体方药等方面,结合近10年来在阴虚体质方面的研究成果作为实证依据,对阴虚体质的理论进行梳理。发现了阴虚体质研究中的优势与不足,为进一步开展阴虚体质相关研究提供参考。     

Birth weight,weight over the adult life course and risk of breast cancer

Breast cancer has been suggested to potentially have prenatal origins. We examined associations between birth weight, body mass index (BMI) at four-time points over 25 years of adulthood, and risk of postmenopausal breast cancer, with emphasis on whether the association between birth weight and risk of breast cancer was mediated by weight and height changes over the adult life course. Postmenopausal women (n = 70,397) aged 50–79 years without breast cancer at enrollment (1993–1998) were followed up to 25 years. Weight and height were measured at baseline. Birth weight, and weights at ages 18, 35 and 50 were self-reported. Breast cancer cases were centrally adjudicated. Compared to women with birth weight of 6–8 pounds, women with birth weight of <6 pounds had lower risk of breast cancer (HR = 0.88 95% CI: 0.79–0.99). 44% and 21% of the relationship between birth weight and breast cancer risk was mediated by adult height and weight at baseline, respectively. Birth weight of 8 pounds or more was not associated with risk of postmenopausal breast cancer. Weight gain in adulthood was associated with increased risk of breast cancer regardless of time periods. In conclusion, lower birthweight was associated with lower risk of postmenopausal breast cancer, and this reduction in risk was significantly mediated by childhood or adolescent growth, especially by adult height. Our data suggest that reaching and maintaining a healthy weight during adulthood is key in the prevention of breast cancer.