基于文献分析多囊卵巢综合征的中医证型分布及用药规律

目的:通过文献探析中医治疗多囊卵巢综合征(PCOS)的证型分布及临床用药规律。方法:检索2003年至2018年1月1日中国期刊全文数据库(CNKI)、万方、维普3个中文数据库中相关中医治疗PCOS的临床研究文献,建立中医治疗PCOS的整体证型及临床用药数据库,并对数据进行处理、分析。结果:①共纳入符合标准的文献252篇,方剂284首;②涉及证型共37种,其中常见证型为肾虚血瘀证、痰湿证、肾虚痰瘀证,共占43.31%;③涉及病位要素以肾为主,其次为肝、脾;涉及病性要素以血瘀、痰、湿为主;④涉及药物193味,按功效共分为16类,补虚药占41.44%,活血化瘀药占16.20%,化痰祛湿药占14.90%;⑤中医治疗PCOS药性以温、平为主,药味以甘为主,辛、苦次之。结论:PCOS病因病机复杂,以肾虚为本,血瘀、痰湿为标,治疗以补肾活血、化湿祛痰为主。     

兰州百合多糖BHP-1的化学结构与形貌分析

目的:以兰州百合鳞茎中分离和纯化得到的多糖BHP-1为主要研究对象,综合运用仪器分析和化学反应等手段研究其初步的形貌特征和化学结构。方法:采用热重分析(TG)及扫描电镜(SEC)技术分别分析多糖BHP-1的热稳定性和形貌结构特征;通过气相色谱-质谱联用(GC-MS)技术,结合部分酸水解、高碘酸钠氧化-Smith降解以及核磁共振波谱(NMR)分析等方法对多糖BHP-1的化学结构进一步的进行解析。结果:BHP-1是以1,4连接的α-D-吡喃葡萄糖和1,4连接的β-D-吡喃甘露糖为基本骨架的甘露葡聚糖,在葡萄糖和甘露糖的2位和/或3位形成主要的分支,主链或支链的末端残基主要为T-α-D-吡喃葡萄糖,同时在其结构片段中含有少量的O-乙酰基。热重分析显示BHP-1在220℃开始发生降解,520℃基本结束,说明BHP-1热稳定性良好。形貌分析显示BHP-1表面光滑有大量凹陷,凹陷处多为片层结构错落紧密堆积而成,并交织下陷呈不规则的孔洞。结论:多糖BHP-1是一种热稳定性良好,表面光滑有大量的凹陷和孔洞,并含少量O-乙酰基的甘露葡聚糖,其化学结构为首次报道。     

Bioprosthetic aortic valve replacement in elderly patients: Meta-analysis and microsimulation

ObjectiveTo support decision-making in aortic valve replacement (AVR) in elderly patients, we provide a comprehensive overview of outcome after AVR with bioprostheses.MethodsA systematic review was conducted of studies reporting clinical outcome after AVR with bioprostheses in elderly patients (mean age ≥70 years; minimum age ≥65 years) published between January 1, 2000, to September 1, 2016. Reported event rates and time-to-event data were pooled and entered into a microsimulation model to calculate life expectancy and lifetime event risks.ResultsForty-two studies reporting on 34 patient cohorts were included, encompassing a total of 12,842 patients with 55,437 patient-years of follow-up (pooled mean follow-up 5.0 ± 3.3 years). Pooled mean age was 76.5 ± 5.5 years. Pooled early mortality risk was 5.42% (95% confidence interval [CI], 4.49-6.55), thromboembolism rate was 1.83%/year (95% CI, 1.28-3.61), and bleeding rate was 0.75%/year (95% CI, 0.50-1.11). Structural valve deterioration (SVD) was based on pooled time to SVD data (Gompertz; shape: 0.124, rate: 0.003). For a 75-year-old patient, this translated to an estimated life expectancy of 9.8 years (general population: 10.2 years) and lifetime risks of bleeding of 7%, thromboembolism of 17%, and reintervention of 9%.ConclusionsThe low risks of SVD and reintervention support the use of bioprostheses in elderly patients in need of AVR. The estimated life expectancy after AVR was comparable with the general population. The results of this study inform patients and clinicians about the expected outcomes after bioprosthetic AVR and thereby support treatment decision-making. Furthermore, our results can be used as a benchmark for long-term outcomes after transcatheter aortic valve implantation in patients who were eligible for surgery and other (future) alternative treatments (eg, tissue-engineered heart valves).     

Neuroimaging the pain network – Implications for treatment

In this chapter, we provide an overview of neuroimaging studies in chronic pain. We start with an introduction about the phenomenology of pain. In the following section, the application of functional and structural imaging techniques is shown in selected chronic pain syndromes (chronic back pain, fibromyalgia syndrome (FMS), phantom limb pain, and complex regional pain syndrome (CRPS)), and commonalities and peculiarities of imaging correlates across different types of chronic pain are discussed. We conclude this chapter with implications for treatments, with focus on behavioral interventions, sensory and motor trainings, and mirror and motor imagery trainings.     

基于结构方程模型构建护理本科生人文关怀对职业精神态度的影响模式

目的 应用结构方程模型构建人文关怀对职业精神态度的影响模式,了解人文关怀、社会支持及职业精神态度之间的关系。方法 采用分层随机整群抽样法从南京和南通两所高等护理院校抽取全日制在校护理本科一年级至三年级在校学生450名进行问卷调查,应用AMOS 21.0构建人文关怀对职业精神态度的影响模式。 结果 人文关怀对职业精神态度影响模式的结构方程模型最终模型适配度指标分别为RMSEA = 0. 066、GFI = 0. 951、AGFI = 0. 918、NFI = 0. 901、ＲFI = 0. 860、IFI = 0. 932、TLI = 0. 903、CFI = 0. 931、PGFI = 0. 573、PNFI = 0.641、PCFI = 0. 663、χ_²/DF=2.965,说明模型拟合效果较好；人文关怀对社会支持的直接效应为0.571,社会支持对职业精神态度的直接效应为0.778,人文关怀对职业精神态度的总效应为0.554。结论 此模型可用于护生职业精神态度评价与干预工作,进一步提高护生人文关怀能力、社会支持水平及职业精神态度水平。