“龙虎交战”针法针刺八脉交会穴对偏头痛患者头痛天数及血清CGRP表达的影响＊

目的 观察“龙虎交战”针法针刺八脉交会穴对无先兆偏头痛（Migraine without aura，MO）患者头痛天数及外周血降钙素基因相关肽（Calcitonin gene related peptide，CGRP）表达水平的影响。方法 按照头痛程度将90例MO受试者区层随机分为治疗Ⅰ组、治疗Ⅱ组和对照组各30例。治疗Ⅰ组施以“龙虎交战”针法针刺八脉交会穴（外关和足临泣），治疗Ⅱ组施以平补平泻针法针刺八脉交会穴（外关和足临泣），对照组施以平补平泻针法针刺非经非穴点，每次留针30分钟，5次/周，共治疗20次。于治疗前、治疗结束4周后的随访分别记录三组患者头痛天数的变化情况以判定疗效，并采集患者治疗前、治疗结束4周后随访的肘部静脉血用ELISA法检测血清中的CGRP含量的变化。结果 ①各组治疗前患者的头痛天数无显著差异（Ｐ > 0.05），治疗Ⅰ组、治疗Ⅱ组和对照组治疗结束4周后随访的头痛天数较治疗前均显著降低（Ｐ < 0.05）；治疗Ⅰ组头痛天数的降低显著优于治疗Ⅱ组和对照组（Ｐ < 0.001），治疗Ⅱ组头痛天数的降低显著优于对照组（Ｐ < 0.05）；②3组治疗前CGRP的表达无显著差异，治疗Ⅰ组、治疗Ⅱ组治疗结束4周后随访CGRP的表达较治疗前均显著下降（Ｐ < 0.001），对照组治疗结束4周后随访CGRP的表达较治疗前差异无显著性（Ｐ > 0.05）；治疗Ⅰ组CGRP治疗结束4周随访的表达较治疗Ⅱ组和对照组均显著下降（Ｐ < 0.01），治疗Ⅱ组CGRP的表达较对照组显著下降（P < 0.01）。结论 ①八脉交会穴施以“龙虎交战”针法针刺能明显改善MO患者的头痛天数，同时降低MO患者血清CGRP的表达水平，这可能是针刺八脉交会穴治疗MO的机制之一；②非经非穴点的针刺效应无持续性，而八脉交会穴的针刺效应具有持续性；③八脉交会穴可以充分发挥复式针刺手法的治疗效应，提示我们在临床上治疗疾病时不仅要注意腧穴配伍，恰当的针刺手法更是提高临床疗效、事半功倍的关键。     

改良八珍糕治疗小儿厌食症43例

目的:观察改良八珍糕治疗小儿厌食症的临床疗效。方法:将86例小儿厌食症患儿随机分为观察组和对照组,每组各43例。观察组患儿给予改良八珍糕,对照组患儿给予现有八珍糕。比较两组患儿的临床疗效及便秘改善情况。结果:观察组有效率为95.3%,对照组有效率为86.0%,两组患儿临床疗效比较,差异具有统计学意义(P0.05)。观察组开始出现便秘时间为4.6 d,对照组为9.1 d;观察组便秘率为18.6%,对照组为51.2%,两组患儿便秘情况比较,差异均有统计意义(P0.01)。结论:改良八珍糕治疗小儿厌食症疗效明显,且可显著减少便秘的不良反应。     

八段锦对2型糖尿病焦虑状态的影响

目的:观察八段锦对2型糖尿病患者焦虑状态的影响.方法:将141例2型糖尿病伴焦虑状态患者随机分为对照组70例和试验组71例.两组患者均给予常规糖尿病药物治疗,试验组另给予八段锦干预治疗.结果:试验组干预后焦虑自评量表评分、症状自评量表总分、生存质量特异性量袁评分和空腹血糖值均优于对照组(P＜0.05).结论:八段锦对改善2型糖尿病患者焦虑状态有较好疗效.     

八维钙锌片中维生素D_2含量测定方法的改进

目的改进八维钙锌片中维生素D2含量测定的方法。方法采用HPLC法,以Thermo硅胶(250 mm×4.6 mm,5μm)为色谱柱;流动相:正己烷-异丙醇(110∶1);流速:1.0 mL·min-1;检测波长:254 nm;柱温:35℃。结果维生素D2的线性范围为质量浓度0.5~10 mg.L-1,相关系数为0.995 8,回收率为100.8%(n=9)。结论该方法简便准确,重复性好,可作为控制八维钙锌片中维生素D2的含量测定方法。     

Surgical interventions in a cohort of patients with haemophilia A and inhibitors: an experiential retrospective chart review

Strategies for the management of perioperative bleeding in patients with haemophilia and inhibitors have evolved rapidly as a result of the development of the bypassing agents Factor Eight Inhibitor Bypassing Activity, Anti-inhibitor Coagulant Complex (FEIBA) and activated recombinant factor VII (rFVIIa). However, there are currently no established guidelines for perioperative use of bypassing agents, and few controlled clinical studies have been carried out. Thus, case reports, such as those presented here, provide useful anecdotal evidence to guide the treatment of inhibitor patients. The purpose of this report was to describe experiences in the use of bypassing agents in a small cohort of patients with haemophilia A and inhibitors undergoing surgical procedures. Cases from five treatment centres were reviewed. Twenty-two procedures using FEIBA, rFVIIa or a combination of both agents were compiled from seven inhibitor patients (six with an alloantibody inhibitor and one with an acquired autoantibody inhibitor). Eleven procedures used FEIBA monotherapy, two employed rFVIIa monotherapy and nine were performed using combination therapy. Supplemental therapies were required to manage bleeding in some cases. Haemostatic control was achieved in all cases, and treatment regimens were generally well tolerated. One thrombotic adverse event was reported: evidence of disseminated intravascular coagulation (DIC) was found after rFVIIa use in one case, although the direct cause of DIC was unknown. The experiences in this case review demonstrate that both major and minor surgical procedures can be safely performed in patients with haemophilia and high-titre inhibitors under the cover of bypassing agents, with a high expectation of success.     

固本通络电针法联合八脉交会穴针刺治疗气虚血瘀型糖尿病周围神经病变的疗效及对SOD、MDA、hs-CRP水平影响

目的:探讨固本通络电针法联合八脉交会穴针刺治疗气虚血瘀型糖尿病周围神经病变的疗效及对SOD、MDA和hs-CRP水平的影响。方法:选取我院收治的气虚血瘀型糖尿病周围神经病变患者60例,采用简单随机化原则分为两组,各30例。对照组给予八脉交会穴针刺治疗,治疗组在对照组基础上给予固本通络电针法治疗,对比治疗后的临床疗效、VAS评分、TCSS评分、神经传导速度及SOD、MDA和hs-CRP水平。结果:经过治疗后,治疗组总有效率高于对照组(P<0.05);两组患者VAS评分和TCSS评分较治疗前均明显降低(P<0.05),且治疗组降低较多(P<0.05);两组患者MCV和SSCV较治疗前均显著升高(P<0.05),且治疗组升高较多(P<0.05);两组患者MDA、hs-CRP水平较治疗前显著降低,SOD水平显著升高(P<0.05),且治疗组改善程度较大(P<0.05)。结论:采用固本通络电针法联合八脉交会穴针刺治疗气虚血瘀型糖尿病周围神经病变具有较好的治疗效果,能改善SOD、MDA和hs-CRP水平,安全性较高,值得在临床上推广应用。     

八段锦对社区血脂轻度异常的痰湿体质人群脂代谢的影响

目的：探讨八段锦配合健康宣教对社区血脂轻度异常的痰湿体质者脂代谢的影响。方法将符合入选标准的上海市徐汇区枫林街道社区卫生服务中心中医科门诊及社区团队管理居民121人,按随机数字表法分为八段锦组61例、宣教组60例。宣教组居民采用日常健康宣教进行干预,八段锦组在宣教组基础上配合习练八段锦,24周后检测并比较2组受试者的血脂,评价临床疗效。结果受试后,八段锦组血清 TC[4.15(2.06,5.08)mmol/L 比5.34(3.18,6.08)mmol/L , Z＝-2.113]、TG[1.55(0.39,1.89)mmol/L 比1.77(0.38,2.07)mmol/L,Z＝-1.289]、LDL-C[2.20(0.42,3.52)mmol/L比2.50(0.87,3.69)mmol/L,Z＝-1.237]水平均较宣教组明显降低(P＜0.05)。八段锦组总有效率为91.8%(56/61),宣教组为76.7%(46/60),2组比较差异有统计学意义(χ2＝4.155,P＝0.042)。结论八段锦配合健康宣教可明显改善社区痰湿体质人群的脂代谢,降低受试者TC、TG、LDL-C水平。     

Biomechanical investigation of two long bone growth modulation techniques by finite element simulations

Implants used to correct pathological varus–valgus deformities (VVD) and leg length discrepancies (LLD) may not be optimized for the specific treatment, as suggested by their off‐label use. Detailed analysis of this issue has been limited by the poorly understood mechanical behavior of the growing physis and ignorance of the loads acting on the implants. The aim of this study was to predict and compare the loading conditions of a growth modulation implant in VVD and LLD treatments. Idealized finite element (FE) models of the juvenile distal femur treated with the Eight‐Plate implant were developed for VVD and LLD. Bone growth was simulated using thermal strains. The axial force in the plate was compared between the two treatments. Case‐specific plate forces were predicted by virtually reproducing the screw deformation visible on radiographs of LLD (N = 4) and VVD (N = 4) clinical cases. The simple FE models reproduced the clinical implant deformations well. The resulting forces ranged from 129 to 580 N for the VVD patients. For LLD, this range was from 295 to 1002 N per plate, that is, 590–2004 N for the entire physis. The higher forces in LLD could be explained by restricted screw divergence in the double‐sided implant application. For the first time, the loading conditions of a growth modulation implant were investigated and compared between two treatments by FE analyses, and the range of case‐specific loads was predicted. These simulation tools may be utilized for guiding appropriate usage and for efficient development of implants. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1398–1405, 2018.

     

“动-定序贯八法”治疗早期2型糖尿病30例疗效观察

目的 观察运用“动-定序贯八法”治疗早期2型糖尿病临床疗效.方法 将某院门诊2009年12月～2011年5月诊断为早期2型糖尿病的患者共90人作为研究对象,随机分为纯中药治疗组、拜糖苹对照组及单纯饮食运动对照组各30例,其中纯中药治疗组应用“动-定序贯八法”对患者进行辨证施治,各组均治疗6个月,观察治疗前后的有效率.结果 3组比较,纯中药治疗组有效率达到83.3％,拜糖苹治疗组有效率80％,两组差异无统计学意义(P＞0.05).纯中药治疗组、拜糖苹治疗组均高于单纯饮食运动治疗组,差异有统计学意义(P＜0.05).结论 运用“动-定序贯八法”治疗早期2型糖尿病疗效显著,可在临床中推广应用.     

JNK信号通路调控大鼠再生肝8种细胞的增殖和凋亡

目的 从基因转录水平了解JNK信号通路在大鼠再生肝8种细胞中的作用。方法 用密度梯度离心和免疫磁珠等方法分离肝细胞（HC）、胆管上皮细胞（BEC）、卵圆细胞（OC）、肝星形细胞（HSC）、窦内皮细胞（SEC）、库普弗细胞（KC）、陷窝细胞（PC）、树突状细胞（DC）等8种肝脏细胞,用大鼠Genome 230 2.0芯片检测大鼠再生肝8种细胞的基因表达谱,用生物信息学和系统生物学等方法分析基因表达变化预示的JNK信号通路在调控大鼠再生肝8种细胞增殖、凋亡中的作用。用实时荧光定量PCR方法验证了芯片结果的可靠性。结果 JNK信号通路涉及240个基因和42条途径,其中,225个基因与大鼠肝再生相关。基因协同作用分析显示,在大鼠肝再生启动阶段,JNK信号通路启动HC和KC增殖,促进OC凋亡,启动部分PC和SEC增殖和促进部分PC和SEC凋亡;在进展阶段,JNK信号通路促进HC、BEC、KC和DC增殖,促进部分PC增殖、部分PC凋亡。在终止阶段,JNK信号通路促进HC、OC和PC凋亡,促进部分KC增殖、部分KC凋亡。结论 大鼠肝再生中JNK信号通路的42条途径和225个基因参与调控大鼠再生肝8种细胞的增殖和凋亡。