温肾方对高ALT水平慢性乙型肝炎肾阳虚证患者TLR4/IL-6信号通路的影响

目的:研究中药温肾方对高丙氨酸氨基转移酶(alanine aminotransferase,ALT)水平慢性乙型肝炎肾阳虚证患者Toll样受体4(toll-like receptor 4,TLR4)/白细胞介素-6(interleukin-6,IL-6)信号通路的影响。方法:选取成都中医药大学附属医院2013年7月至2014年5月收治的68例高ALT慢性乙型肝炎患者,采用前瞻性、平行对照方法设计,将入组病例按1∶1比例随机分组,各34例。治疗组给予温肾方+替比夫定;对照组予安慰剂+替比夫定。疗程均为24周。分别在0,12,24周检测外周血乙型肝炎病毒(HBV)DNA,HBV标志物,IL-6;采用实时荧光定量PCR检测外周血单个核细胞TLR4 mRNA的表达;流式细胞学技术检测辅助性T细胞17(T helper cells 17,Th17)/调节性T细胞(regulatory T cells,Treg)。结果:两组基线资料具有可比性。随着治疗时间延长,两组外周血HBV DNA阴转率,HBe Ag阴转率及血清转换率均依次递增。治疗结束后,治疗组在外周血HBV DNA阴转率,HBe Ag阴转率及血清转换率方面均优于对照组(P0.05)。治疗过程中,治疗组外周血IL-6水平,TLR4 mRNA水平及Th17/Treg均呈先升高后降低趋势,在12周达到顶点,明显高于本组治疗前(P0.05)。治疗12,24周后,治疗组外周血IL-6,TLR4 mRNA水平及Th17/Treg均高于对照组(P0.05)。结论:温肾方可提高肾阳虚型高ALT水平慢性乙型肝炎患者的抗病毒疗效,其机制可能是提高TLR4活性,促进IL-6/STAT3信号转导通路表达而调控Th17/Treg平衡。     

翼状胬肉切除联合角膜干细胞移植术后配戴绷带镜的效果评价

目的：评价翼状胬肉切除联合角膜干细胞移植术后配戴绷带镜的临床效果。

方法：本研究为前瞻性分析,选择2015-08/2018-02入我院行翼状胬肉切除联合角膜干细胞移植术患者110例110眼,随机数字表法将其分为对照组和观察组各55例55眼,对照组术后常规观察,观察组术后配戴绷带镜; 采用视觉模拟评分(VAS)比较术后1、3d,1wk的疼痛情况,采用荧光素钠染色法(FL)评估角膜上皮愈合情况及并发症发生率。

结果：观察组术后1、3d,1wk VAS评分和角膜上皮愈合评分均明显低于对照组,差异均有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。

结论：翼状胬肉切除联合角膜干细胞移植术后配戴绷带镜有较好的应用安全性和有效性,可减轻胬肉手术后疼痛,促进上皮愈合。     

补益心脾对产后抑郁症大鼠模型Th1/Th2平衡细胞免疫调节作用的影响

目的:观察产后抑郁症大鼠模型Th1和Th2细胞比例的变化并探讨参芪解郁方对产后抑郁症Th1/Th2平衡的调节作用机制。方法:选取SD雌性大鼠90只,随机分为正常组、模型组、假手术组、中药组、西药组,每组6只,设灌胃1、2、4周3个时间点。采用流式细胞术检测3个时间点各组大鼠外周血Th1细胞和Th2细胞比例,并计算Th1/Th2比值。结果:1周模型组Th1及Th2细胞比例较正常组降低,差异有统计学意义(P 0. 05),2周、4周模型组较正常组升高,差异有统计学意义(P 0. 05); 1周模型组Th1/Th2比值较正常组升高,差异有统计学意义(P 0. 05),2周、4周模型组较正常组降低,差异有统计学意义(P 0. 05) 3、1周中药组Th1细胞比例较模型组升高,2周、4周中药组较模型组降低,差异有统计学意义(P 0. 05)。1周中药组Th2细胞比例较模型组升高(P 0. 05); 2周、4周中药组较模型组降低,差异有统计学意义(P 0. 05)。1周中药组Th1/Th2比值较模型组降低; 2周中药组较模型升高(P 0. 05),4周中药组升高明显,差异有统计学意义(P 0. 05)。结论:Th1/Th2平衡细胞参与产后抑郁症大鼠模型的发生发展,参芪解郁方通过对产后抑郁症Th1/Th2失衡状态的调节而发挥其效用。     

Glycaemic control and hypoglycaemia with insulin glargine 300 U/mL versus insulin glargine 100 U/mL in insulin-naïve people with type 2 diabetes: 12-month results from the EDITION 3 trial

AimTo explore if efficacy and safety findings for insulin glargine 300 U/mL (Gla-300) versus insulin glargine 100 U/mL (Gla-100), observed over 6 months in insulin-naïve people with type 2 diabetes, are maintained after 12 months.MethodsEDITION 3 was a phase 3a, randomized, multicentre, open-label, parallel-group, treat-to-target study of once-daily Gla-300 versus Gla-100 (target fasting self-monitored plasma glucose, 4.4–5.6 mmol/L [80–100 mg/dL]). Participants completing the initial 6-month treatment phase continued their previously allocated basal insulin.ResultsOf 878 participants randomized, 337/439 (77%) and 314/439 (72%) assigned to Gla-300 and Gla-100, respectively, completed 12 months of treatment. Improved glycaemic control was sustained until 12 months in both treatment groups, with similar reductions in HbA_1c from baseline to month 12 (difference: −0.08 [95% confidence interval (CI): −0.23 to 0.07] % or −0.9 [−2.5 to 0.8] mmol/mol). Relative risk of experiencing ≥ 1 confirmed (≤ 3.9 mmol/L [≤ 70 mg/dL]) or severe hypoglycaemic event with Gla-300 versus Gla-100 was 0.86 (95% CI: 0.69 to 1.07) at night and 0.92 (0.82 to 1.03) at any time of day. For events with a glycaemic threshold of < 3.0 mmol/L (< 54 mg/dL) these numbers were 0.76 (0.49 to 1.19) and 0.66 (0.50 to 0.88). A similar pattern was seen for documented symptomatic events. No between-group differences in adverse events were identified.ConclusionOver 12 months, Gla-300 treatment was as effective as Gla-100 in reducing HbA_1c in insulin-naïve people with type 2 diabetes, with lower overall risk of hypoglycaemia at the < 3.0 mmol/L threshold.     

中文版护士对触摸的舒适感量表的信效度研究

目的汉化护士对触摸的舒适感量表(Nurses' Comfort with Touch Scale,NCTS),并对其中文版的信度、效度进行检测。方法翻译、回译,文化调适,形成中文版NCTS,由专家小组对其内容效度进行评定;采用中文版NCTS对410名临床护士进行调查,对量表的结构效度,内部一致性进行评定。结果中文版NCTS探索性因子分析共提取5个公因子,累计方差贡献率为81.769%,验证性因子分析结果显示数据拟合良好。量表的Cronbach'α系数为0.966,重测信度为0.921,内容效度为0.901。结论中文版的NCTS具有良好的信度和效度,可以用来评估护士触摸病人时的内心舒适程度,探讨其触摸意愿,为今后触摸疗法在护理领域广泛应用提供理论依据。     

Efficacy of preoperative ibuprofen and meloxicam on the success rate of inferior alveolar nerve block for teeth with irreversible pulpitis

Objective: The purpose of this study was to determine whether premedication with ibuprofen or meloxicam increases the success rate of anaesthesia in teeth with irreversible pulpitis. Materials and methods: In this parallel, double-blind clinical trial, 92 patients diagnosed with irreversible pulpitis were randomly divided into four groups of 23 patients. The first group (the no-premedication group) received no premedication, the second group (the meloxicam group) received 7.5 mg of meloxicam, the third group (the ibuprofen group) received 600 mg of ibuprofen, and the fourth group (the placebo group) received placebo 1 hour before intervention. Before taking the medication, electrical pulp testing (EPT) and the Heft–Parker visual analogue scale (VAS) were used to evaluate sensitivity and pain at baseline. Then, local anaesthesia was injected, and after 15 minutes, EPT was used again to evaluate tooth sensitivity. The pain during access preparation was also recorded using the Heft–Parker VAS. Results: Ninety-two patients were analysed. The success rates of local anaesthesia were 21.7%, 34.8%, 78.3% and 73.9% in the no-premedication, placebo, ibuprofen and meloxicam groups, respectively, according to the EPT values. Considering the Heft–Parker VAS values, no premedication gave a 21.7% success rate, placebo gave a 34.8% success rate, ibuprofen gave an 82.6% success rate and meloxicam gave a 65.2% success rate. The ibuprofen and meloxicam groups showed significantly better results than the placebo and no-premedication groups (P < 0.001). However, the difference between meloxicam and ibuprofen groups was not significant. Conclusions: Premedication with meloxicam and ibuprofen significantly increased the success rates of inferior alveolar nerve block anaesthesia for teeth with irreversible pulpitis; however, neither drug provided profound anaesthesia.Key words: Anaesthetic success, electrical pulp testing, premedication, visual analogue scale     

Spontaneous activity in the visual cortex is organized by visual streams

Large‐scale functional networks have been extensively studied using resting state functional magnetic resonance imaging (fMRI). However, the pattern, organization, and function of fine‐scale network activity remain largely unknown. Here, we characterized the spontaneously emerging visual cortical activity by applying independent component (IC) analysis to resting state fMRI signals exclusively within the visual cortex. In this subsystem scale, we observed about 50 spatially ICs that were reproducible within and across subjects, and analyzed their spatial patterns and temporal relationships to reveal the intrinsic parcellation and organization of the visual cortex. The resulting visual cortical parcels were aligned with the steepest gradient of cortical myelination, and were organized into functional modules segregated along the dorsal/ventral pathways and foveal/peripheral early visual areas. Cortical distance could partly explain intra‐hemispherical functional connectivity, but not interhemispherical connectivity; after discounting the effect of anatomical affinity, the fine‐scale functional connectivity still preserved a similar visual‐stream‐specific modular organization. Moreover, cortical retinotopy, folding, and cytoarchitecture impose limited constraints to the organization of resting state activity. Given these findings, we conclude that spontaneous activity patterns in the visual cortex are primarily organized by visual streams, likely reflecting feedback network interactions. Hum Brain Mapp 38:4613–4630, 2017. © 2017 Wiley Periodicals, Inc.     

The efficacy of treadmill training on balance dysfunction in individuals with chronic stroke: a systematic review

Background: Physical activity and exercise interventions are useful in facilitating the functional recovery of those with chronic stroke and, routinely, are gait-specific. While treadmill training has proven useful in gait performance recovery post-stroke, its efficacy on balance dysfunction has not been systematically reviewed.

Objectives: The purpose of this systematic review was to determine the effect of treadmill training (TT) interventions on balance dysfunction in individuals with chronic stroke.

Methods: A systematic literature search of PubMed, EMBASE, and CINAHL was performed. Eligible randomized controlled trials were published between 2007 and 2016. Selected trials investigated TT interventions in persons with chronic stroke and implemented at least one objective balance measure. Methodological quality was assessed using PEDro criteria.

Results: Eight studies met eligibility criteria and were included in the qualitative analysis. Studies differed in TT implementation and use of adjunctive treatments; however, all trials demonstrated improvements in balance measures that were as effective, if not more so, than conventional physical therapy treatments, including targeted balance training.

Conclusions: This review recognized moderate evidence in favor of TT interventions in balance and stroke rehabilitation programs. With TT, intensity may be a more critical factor than specificity and may offer additional carryover to recovery parameters of postural control and balance, beyond gait performance. It is recommended that clinicians utilizing TT incorporate objective measures of balance to assess the potential for skill transference and improvements in balance. Higher quality studies and additional research are needed to denote critical parameters by which improvements in balance may be optimized.