四君子汤对脾胃虚弱证型消化性溃疡患者肠道微生态变化及COX-1、COX-2、PGE2表达的影响

目的探讨中药方剂四君子汤对脾胃虚弱症型消化性溃疡患者肠道菌群变化、环氧化酶(COX-1、COX-2)及前列腺素E2表达水平的影响。方法从2017年1月-2018年12月收治的消化性溃疡患者中按年龄组、性别、溃疡类型1∶1匹配后,随机分配于试验组与对照组(试验组与对照组各240名患者)。其中,对照组患者给予思密达治疗,试验组使用思密达协同四君子汤,分别治疗8周。比较治疗前后2组患者的治疗效果、肠道微生态变化、环氧化酶及前列腺素E2水平表达情况。结果治疗后,试验组的阳性与阴性杆菌数减少,阳性球菌数增多,且阳性球菌与阴性球菌数量均高于对照组。而对照组的阳性、阴性杆菌与阴性球菌均显著减少(P<0.05);2组的COX-1、COX-2、PGE2表达水平均增高(P<0.05),且中药组显著高于对照组(P<0.05)。结论在思密达基础上加用四君子汤治疗脾胃虚弱症型消化性溃疡可有效调节其胃肠道菌群平衡、增强对胃黏膜的覆盖保护作用。     

A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome

BackgroundThis study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery.MethodsThe subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue).Results35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases.ConclusionsThe use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury.     

基于内蒙古地区的非传统脂质参数与脑卒中的关联性研究

  目的  非传统脂质参数已被证实与心血管疾病有关,而内蒙古地区作为脑卒中高发和特定的血脂特征地区,非传统脂质参数与脑卒中风险的关联性研究较少。本研究利用内蒙古地区“心血管病高危人群早期筛查与综合干预项目”探索内蒙古地区非传统脂质参数与脑卒中的关联。  方法  2015―2017年,收集中国北部内蒙古地区35~75岁常住人群的人口学基本信息及各项血脂指标,最终纳入32 518人参与本项研究。将各脂质参数分为四分位,以第1四分位为参照,采用多因素Logistic回归分析模型探索非传统脂质参数与脑卒中的OR值及95% CI值。  结果  本研究含脑卒中患者1 949人,以脑卒中为因变量,调整相关因素后的Logistic回归分析模型结果表明,以各非传统脂质参数第1四分位为参照,第4四分位的TC/HDL-C、LDL-C/HDL-C、TG/HDL-C与脑卒中有关,其对应OR值分别为1.390(95% CI: 1.206~1.601)、1.380(95% CI: 1.201~1.585)及1.473(95% CI: 1.276~1.699);且随着各脂质参数水平的升高,脑卒中风险增加(均有P < 0.001)。在不同性别、年龄中除非高密度脂蛋白胆固醇(Non-high density lipoprotein-cholesterol, Non-HDL-C)外,TC/HDL-C、LDL-C/HDL-C及TG/HDL-C与脑卒中风险相关。  结论  TC/HDL-C、LDL-C/HDL-C及TG/HDL-C为脑卒中的危险因素,相比于传统脂质参数,非传统脂质参数与脑卒中的关联更强,其可作为脑卒中风险分层及一级预防的新指标。     

A nationwide post-marketing survey of knowledge,attitude and practice toward human papillomavirus vaccine in general population: Implications for vaccine roll-out in mainland China

BackgroundHuman papillomavirus (HPV) vaccine has been increasingly discussed in mainland China since its first approval in 2016. To date, nearly all studies assessing HPV vaccine perceptions and attitudes were implemented during pre-licensure period. Therefore, the nationwide post-marketing survey was conducted to update knowledge, attitudes and practice on HPV vaccine among general population in mainland China.MethodsParticipants aged 18–45 years living in mainland China were recruited in April 2019 by multi-stage non-randomized sampling. Sociodemographic factors, HPV and HPV vaccine related awareness, knowledge, attitudes, vaccine uptake and potential obstacles were assessed in questionnaires. Bivariate analysis and multivariate regression were used to identify disparity among subgroups with different sociodemographic characteristics.Results4,000 women (32.1 ± 7.81y) and 1,000 men (31.8 ± 7.96y) were included in final analysis. Less than one third of participants had heard of HPV (female: 31%; male: 22%) and HPV vaccine (female: 34%; male: 23%). Knowledge score was also unfavorable on HPV (female: 3 out of 13; male: 1.8 out of 13) and HPV vaccine (female: 3 out of 6; male: 2 out of 5). Only 3% females had been vaccinated three years after HPV licensure in China, although willingness to get vaccinated among those unvaccinated were high (mean willingness score ± SD: female: 3.3 ± 0.97; male: 3.0 ± 0.98). Industry of employment and household income were the major factors related to awareness and knowledge of vaccine, whereas HPV and HPV vaccine awareness were key influential factors for willingness. The main obstacles of vaccination were safety concerns, lack of knowledge, and high price of HPV vaccines.ConclusionsFindings highlight a lack of vaccine awareness, knowledge, and poor uptake in mainland China and underscore the necessity of health education campaigns. The identified priority groups, contents to be delivered and practical obstacles could furthermore provide insight into health education to reduce disparities and accelerate HPV vaccine roll-out in China.     

中国八城市老年人能量及蛋白质摄入与肌肉衰减症的关系

目的探究中国八城市老年人能量、蛋白质摄入水平与肌肉衰减症的关系。方法数据来源于2016年的"中国城市成年人群膳食与健康关系研究"。采用立意抽样和多阶段整群抽样相结合的方法,抽取65岁及以上研究对象427人,采用问卷调查的方法获得社会人口学特征和生活习惯,采用24小时膳食回顾调查法获得调查对象膳食摄入情况并根据《中国食物成分表》计算能量、蛋白质摄入。使用四分位数将研究对象按照能量摄入水平分为4组:Q1(<1197.6 kcal/d)、Q2(1197.6~1531.4 kacl/d)、Q3(1531.4~1984.1 kcal/d)、Q4(≥1984.1 kacl/d);使用四分位数将研究对象按照蛋白质摄入水平分为4组:Q1(<36.8 g/d)、Q2(36.8~50.4 g/d)、Q3(50.4~68.6 g/d)、Q4(≥68.6 g/d)。生物电阻抗法测量四肢骨骼肌质量,使用手持握力计测量骨骼肌力量,四米步速测试测量骨骼肌功能。根据亚洲肌肉衰减症工作组的标准评价调查人群的骨骼肌健康现状。结果与Q1组相比,能量摄入水平较高的Q2~Q4组的四肢骨骼肌质量、握力、步速以及肌肉衰减症检出率差异无统计学意义。与Q1组相比,蛋白质摄入Q2组具有较大的握力(β=0.12,95%CI 0.03~0.21,P=0.009)和较快的步速(β=0.20,95%CI 0.07~0.34,P=0.003)。结论膳食蛋白质摄入水平与中国老年人握力及步速存在关联,但与肌肉衰减症检出率无显著关联。     

饮水中低浓度甲基汞对小鼠仔代生长发育及神经行为的影响

[目的]ICR小鼠通过饮水暴露于低浓度氯化甲基汞(MeHgCl),观察其子代生长发育和行为及可能产生的毒作用。[方法]ICR孕鼠随机分为对照组、低浓度组(0.01mg/L)和高浓度组(0.1mg/L),于怀孕第6天起分别自由饮用蒸馏水、氯化甲基汞含量为0.01mg/L、0.1mg/L的蒸馏水直至哺乳期结束,观察母鼠和仔鼠的一般状况、仔鼠的早期发育、行为反射和学习认知能力等指标。[结果]在低浓度甲基汞作用下(相当于饮用水汞卫生标准8倍和80倍水平),亲仔两代均未出现明显的毒性反应。染毒组仔鼠的各项神经发育指标与对照组相比差异无显著性(P>0.05),但是仔鼠的学习能力显著降低(P<0.05)。[结论]在饮水中低浓度甲基汞虽然对子代的生长和行为发育没有明显的损害,但是子代的学习能力已受影响。     

氯化甲基汞染毒对亲仔两代ICR小鼠脑、肝、肾中汞分布的影响

[目的]通过ICR孕鼠饮水接触低剂量氯化甲基汞,研究汞在亲仔两代小鼠脑、肝、肾及血清中的分布及其相关性。[方法]ICR孕鼠随机分为对照组、低剂量组(0.01mg/L)和高剂量组(0.10mg/L),于怀孕第6天起分别自由饮用蒸馏水及氯化甲基汞含量分别为0.01、0.10mg/L的蒸馏水直至哺乳期结束,用原子荧光法测定汞在各脏器内的含量,并做血清汞和脏器汞含量的相关性分析。[结果]在低剂量甲基汞作用下,亲仔两代未出现明显的毒性反应。随着染毒剂量的增加,亲仔两代小鼠血清中的总汞含量增加,对照组、低剂量组和高剂量组母鼠血清中总汞含量分别为1.228、2.358和6.195μg/L,仔鼠为0.801、3.217和3.763μg/L,高剂量组和对照组间差别有显著性(P<0.05);随着染毒剂量的增加,各脏器中的总汞含量也增加,对照组、低剂量组和高剂量组母鼠肾脏总汞含量分别为13.890、25.780、253.980ng/g组织湿重,肝脏为3.710、11.520、100.820ng/g组织湿重,脑组织为2.820、3.070、23.810ng/g组织湿重;对照组、低剂量组和高剂量组仔鼠肾脏总汞含量分别为6.940、13.090、102.170ng/g组织湿重,肝脏为2.660、5.450、38.850ng/g组织湿重,脑组织为1.600、2.660、8.120ng/g组织湿重;母鼠和仔鼠脏器中总汞蓄积的模式一样:肾脏>肝脏>脑组织。在低剂量下,母鼠血清总汞含量与肝脏、肾脏、脑组织中的总汞含量的相关系数分别为0.830、0.967、0.802;在高剂量下,与肝脏、肾脏、脑组织的相关系数分别为0.997、0.833、0.850,均有较高的相关性(P<0.05)。而仔鼠在高剂量下血清总汞与肝脏、肾脏、脑组织的相关系数分别为0.737、0.672、0.702,其血清总汞和脏器总汞也有相关性(P<0.05);在低剂量时血清总汞与肝脏、肾脏、脑组织总汞的相关系数分别为0.040、0.300、0.080,没有相关性(P>0.05)。[结论]母鼠接触低剂量甲基汞即可在亲仔两代各脏器中蓄积,亲代血清总汞含量和脏器总汞含量具有明显的相关性;仔代在高剂量时血清总汞含量和脏器总汞含量有明显的相关性,而在低剂量下无相关性。