基于突触可塑性探讨电针改善大脑中动脉闭塞大鼠运动障碍的作用机制

目的：基于突触可塑性观察电针曲池、足三里对大脑中动脉闭塞（MCAO）大鼠运动障碍的改善。方法：将60只雄性SD大鼠随机分为假手术组、模型组、穴位组、非穴组，每组15只。采用Zea Longa线拴法制备MCAO大鼠模型，电针曲池、足三里，干预14 d。通过神经功能评分判断大鼠的神经功能缺损情况；CatWalk步态分析比较各组大鼠运动功能，TTC染色观察脑梗死体积，透射电镜观察突触超微结构和数量，免疫荧光检测缺血侧运动皮层突触相关因子突触后致密物-95（PSD-95)、突触蛋白的表达情况。结果：干预14 d后，与模型组比较，穴位组大鼠神经功能评分降低(P<0.05)；步行速度提高、双足支撑时间缩短(P<0.05)；脑梗死体积减少(P<0.05)；突触超微结构改善明显，突触数量增加(P<0.05)，突触相关因子突触蛋白、PSD-95表达上调(P<0.05)。Catwalk步态参数、脑梗死体积与突触超微结构改善有一致性。结论：电针曲池、足三里穴可改善MCAO大鼠运动障碍，其机制可能与上调突触相关因子的表达，改善突触可塑性有关。     

中医药对淋巴管新生与回流功能的作用研究进展＊

淋巴管作为循环系统的重要组成部分之一，具有调节机体体液稳态，协助免疫监视和肠道脂质吸收等重要作用。淋巴管新生是机体生理和病理过程中维持脉管系统结构和功能正常的重要手段，淋巴管新生调控对于防治肿瘤、心血管等诸多疾病有着潜在的临床转化意义；淋巴回流功能则与关节炎症等疾病发病机制关系密切。在循环系统中，相较于中医药调控血管相关疾病的发病机制已取得很大进展，近年来对于淋巴管的研究则明显相对滞后。本文从中医药作用于淋巴管新生及回流功能角度对这一领域的研究进展作一综述，以期为临床上中医药治疗相关疾病提供新的思路与方法。     

Gait parameters,functional performance and physical activity in active and inactive Juvenile Idiopathic Arthritis

BackgroundChildren with Juvenile Idiopathic Arthritis (JIA) may adopt different movement patterns and participate in physical activity during different states of disease.Research questionWhich specific features of gait and physical function performance differ among children with active or inactive JIA compared to healthy children?MethodsForty-three children participated (14.5 ± 4.2 yrs; 60 % female). 3D-motion analysis methods were coupled with force measures from an instrumented treadmill captured gait mechanical measures. The 30-second Chair Rise Test (repetitions) and stair ascent-descent tests were performed, and the 11-point Wong-Baker face scale assessed pain after each test.ResultsCompared to healthy controls children with active and inactive JIA had worse outcomes (12–21 % slower self-selected and fast walking speeds, 28–34 % slower stair navigation times, 28 % fewer chair rise repetitions in 30 s; all p < .05). Children with active JIA had 8–13 % slower gait speeds, 4 % fewer chair rise repetitions and 14–16 % slower stair navigation times. At faster walking speed, children with active JIA had less hip joint flexion/extension excursion in the sagittal plane during the gait cycle, produced higher leg stiffness, and demonstrated greater interlimb asymmetry in GRF vertical impulse during loading than healthy children (all p < .05). The Pedi-FABS subscore of “Duration: performing athletic activity for as long as you would like without stopping” was rated lower in children with active JIA compared to controls (p < .05).ConclusionGait speed, specific load-bearing functional tasks and leg stiffness features of gait may be informative ‘functional biomarkers’ for assessing JIA burden and tracking treatment efficacy. Additional prospective studies are needed to determine how these features change over time with pain change, and understand impact on quality of life and physical activity participation.     

Measurement errors in control risk regression: A comparison of correction techniques

Control risk regression is a diffuse approach for meta-analysis about the effectiveness of a treatment, relating the measure of risk with which the outcome occurs in the treated group to that in the control group. The severity of illness is a source of between-study heterogeneity that can be difficult to measure. It can be approximated by the rate of events in the control group. Since the estimate is a surrogate for the underlying risk, it is prone to measurement error. Correction methods are necessary to provide reliable inference. This article illustrates the extent of measurement error effects under different scenarios, including departures from the classical normality assumption for the control risk distribution. The performance of different measurement error corrections is examined. Attention will be paid to likelihood-based structural methods assuming a distribution for the control risk measure and to functional methods avoiding the assumption, namely, a simulation-based method and two score function methods. Advantages and limits of the approaches are evaluated through simulation. In case of large heterogeneity, structural approaches are preferable to score methods, while score methods perform better for small heterogeneity and small sample size. The simulation-based approach has a satisfactory behavior whichever the examined scenario, with no convergence issues. The methods are applied to a meta-analysis about the association between diabetes and risk of Parkinson disease. The study intends to make researchers aware of the measurement error problem occurring in control risk regression and lead them to the use of appropriate correction techniques to prevent fallacious conclusions.     

Does newborn screening improve early lung function in cystic fibrosis?

Despite evidence showing an improvement in nutritional outcomes following diagnosis by newborn screening (NBS) for cystic fibrosis (CF), the impact on pulmonary outcomes has been less clear. In this review the approaches to measurement of early lung function and knowledge gained from NBS CF cohorts will be described. Studies which have compared outcomes in those diagnosed by NBS to those diagnosed following symptomatic presentation will be presented. Compiling the evidence base used to evaluate the impact of NBS on pulmonary outcomes has been complicated by improvements in clinical management, infection control practices, as well as public health interventions (such as tobacco smoking bans in public places) that have evolved substantially over recent decades. Forced expiratory volumes have been used as the main outcome but it is important not to draw conclusions for ‘early lung function’ from tests such as spirometry alone, which lack sensitivity in early lung disease. There is, at present, insufficient evidence to draw firm conclusions about the effect of NBS on early lung function. In an era of highly effective treatments targeting the underlying molecular defect responsible for CF, future opportunities for early initiation of treatment may mean that the impact of NBS on early lung function may yet to be realised.     

系统性呼吸功能训练对哮喘-慢性阻塞性肺疾病重叠综合征患者肺功能及呼吸指标的影响

目的 探讨系统性呼吸功能训练对哮喘-慢性阻塞性肺疾病重叠综合征(asthma-COPD overlap syndrome,ACOS)患者肺功能和呼吸指标的影响。方法 选择笔者所在医院2019年5月-2020年10月收治的102例ACOS患者作为研究对象,采用随机数字表法将其分为对照组和研究组,各51例。对照组行常规护理,研究组在对照组基础上融合系统性呼吸功能训练。比较2组干预前后的肺功能指标和呼吸指标。结果 干预后,研究组的肺功能各项指标均明显优于对照组(P<0.05);气道阻力各项指标显著优于对照组(P<0.05),呼吸困难程度轻于对照组(Z=-2.996,P=0.003)。结论 对ACOS患者在护理过程中融合系统性呼吸功能训练,可明显降低患者气道阻力指标,对改善肺功能、缓解患者呼吸困难具有明显效果。