二补助育汤对胚胎着床障碍小鼠子宫血管生成相关因子表达的影响

目的：探讨二补助育汤对胚胎着床障碍模型小鼠子宫内膜形态及血管生成素-1（Ang-1）mRNA、血管内皮生长因子（VEGF）mRNA的表达和定位的影响。方法：24只ICR雌性小鼠随机分为空白组、模型组、戊酸雌二醇组、二补助育汤组，每组6只，用米非司酮建立胚胎着床障碍动物模型，各组给予相应药物灌胃，妊娠第5天处死小鼠后，检测各组妊娠率、平均着床位点数、子宫内膜Ang-1和VEGF mRNA表达量及其蛋白定位。结果：模型组小鼠平均胚胎着床位点数、Ang-1 mRNA、VEGF mRNA表达量明显低于空白组（均P<0.05）；与模型组比较，二补助育汤组平均胚胎着床位点数、Ang-1 mRNA、VEGF mRNA表达量显著提高（均P<0.05）。结论：二补助育汤可提高子宫内膜Ang-1和VEGF蛋白表达量，促进子宫内膜血管生成，从而提高子宫内膜容受性。     

国医大师王琦教授中医体质学理论在疼痛性疾病诊疗中的临床应用

慢性疼痛涉及临床各科的多种疾病，包括一些重大疾病和疑难疾病。中医体质学是中医学的新兴学科，其体质分类、体病相关思想以及“辨体论治”的诊疗方法已广泛应用到临床各科疾病的诊疗中。文章探讨了以中医体质学思想指导疼痛性疾病诊疗的若干理论问题，认为疼痛性疾病的发生与患者体质类型存在密切的关系。因此，在临床辨治疼痛性疾病时要考虑患者体质因素。所施方药不仅要符合病证特点，也要针对患者体质类型。并列举国医大师王琦教授辨体论治慢性前列腺炎盆腔疼痛综合征、偏头痛、过敏性头痛等疼痛性疾病的案例加以分析，以期为相关领域同仁提供参考。     

针刺辅助治疗难治性肠易激综合征临床试验方案关键点设计的思考＊

肠易激综合征（Irritable bowel syndrome，IBS）是临床常见病、多发病，其治疗方法丰富，但部分患者疗效欠佳，发展成难治性IBS。目前国内外关于针灸治疗难治性IBS的临床随机对照试验尚不多见。本文立足试验方案设计的“PICOS”原则，从研究对象及诊断标准、干预措施、对照措施、结局指标四个方面入手，重点探讨针刺辅助治疗难治性肠易激综合征临床试验设计的关键要点。从选择特色优势病种、明确诊断标准、制定符合临床实际的干预方案、运用符合目标的安慰针刺、结合研究设计和目的选定结局指标几个角度，阐述试验相关环节设计的原因和思考。     

基于复杂网络的《新针灸学》与《经络腧穴学》比较分析研究（英文）

提取《新针灸学》《经络腧穴学》中穴位名称、主治病症信息,基于复杂网络建立穴-症网络,分析两者穴位数量、相互关联程度及主治规律变化,借助拓扑学数据解释变化原因,为传统针灸知识体系的结构化、标准化研究提供具体思路和方法。共纳入《新针灸学》386穴、773种症状、形成152163个穴位配伍对,《经络腧穴学》403穴、253种症状、28755个穴位配伍对。两本教材的穴-症网络存在丰富的差异性,其所载的病症结构化程度随医学知识的更新而提升。《新针灸学》模型具有更加典型的小世界效应,或因其以病症为主要分类手段的优势体现。两本教材穴位定位与主治方面发生许多变化,学科发展、时代背景等方面是变化的主要原因。     

Acupoint stimulation for long COVID: A promising intervention: 穴位刺激治疗长新冠:一种有前景的干预措施

“Long COVID” is a sustained symptom following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to recent statistics, at least 65 million people have long COVID, which poses a long-term threat to human health. The pathogenic mechanisms of coronavirus disease 2019 (COVID-19) are complex and affect multiple organs and systems. Common symptoms include palpitations, breathing difficulties, attention and memory deficits, fatigue, anxiety, and depression. It is difficult to achieve satisfactory treatment effect with a single intervention. Currently, treatment strategies for long COVID are still in the exploratory stage, and there is an urgent need to find appropriate and effective methods for long COVID treatment. Traditional Chinese medicine is effective in treating the various phases of COVID-19. Previous studies have shown that acupoint stimulation therapy is effective in improving palpitations, dyspnea, cognitive impairment, anxiety, depression, and other symptoms in patients. According to previous studies, acupoint stimulation may improve various symptoms related to long COVID. This paper discusses the potential application value of acupoint stimulation in the treatment of long COVID-related symptoms, based on the common sequelae of various systems involved in long COVID, and the effect of acupoint stimulation in the treatment of similar symptoms and diseases in recent years.     

胫骨高位截骨联合外侧支持带松解治疗内翻型膝骨性关节炎合并髌骨外侧高压综合征

目的:探讨胫骨高位截骨术联合关节镜下髌骨外侧支持带松解术在内翻型膝骨性关节炎膝关节屈曲功能的临床疗效。方法:对2017年10月至2019年4月采用胫骨高位截骨联合关节镜下髌骨外侧支持带松解治疗的43例内翻型膝关节骨性关节炎合并髌骨外侧高压综合征患者进行回顾性分析,其中男15例,女28例;年龄53~72(62.05±5.17)岁。分别于术前,术后2周,3和12个月采用疼痛视觉模拟评分(visual analogue scale,VAS),Lysholm评分及膝关节主动屈曲活动度评定膝关节疼痛,功能改善情况,并于术前与术后12个月测量髌股吻合角(congruence angle,CA),髌骨倾斜角(patellar tilt angle,PTA)及股胫角(femora-tibial angle,FTA)评价髌股关节的对合与下肢力线的改善情况。结果:43例患者均获得随访,时间14~28(19.60±4.50)个月。VAS评分由术前的6.65±0.65降至术后2周、3和12个月的2.16±0.95、0.51±0.77、0.33±0.64,各时间点比较差异有统计学意义(P<0.001)。Lysholm评分由术前的43.02±8.54增至术后2周,3、12个月的46.84±2.81、72.42±5.30、93.40±5.44,差异有统计学意义(P<0.001)。膝关节主动屈曲活动度由术前的(86.97±5.02)°增至术后2周,3、12个月的(99.38±3.27)°、(110.13±4.13)°、(113.03±4.85)°,各时间点比较差异有统计学意义(P<0.001)。CA由术前的(7.81±1.21)°降至术后12个月的(5.82±4.10)°;PTA由术前的(15.87±2.89)°降至术后12个月的(13.79±4.26)°;FTA由术前的(182.61±2.07)°降至术后12个月的(170.89±0.89)°,差异有统计学意义(P<0.05)。1例术后小腿肌间静脉血栓,予适当制动、抗凝,1周后复查消失;14例术后肿胀,2周后肿胀消退。结论:胫骨高位截骨联合关节镜下髌骨外侧支持带松解治疗内翻型膝骨性关节炎即可缓解膝关节冠状位负重疼痛,又能改善矢状位膝关节屈曲功能。     

应用德尔菲法确定骨质疏松高风险人群评估工具及评价指标

目的运用德尔菲法筛选骨质疏松高风险人群的评估工具和评价指标,为临床骨质疏松高风险人群的辨识提供依据。方法在文献研究基础上,结合专家意见设计调查问卷,对骨质疏松领域专家进行两轮调查,统计分析专家积极系数、意见集中程度和协调程度。结果第一轮发放问卷20份收回20份,第二轮发放30份收回28份,专家积极系数分别为100%和93.33%。结果显示,骨质疏松风险一分钟测试题、中医评估量表和亚洲人骨质疏松症自我筛查工具可作为骨质疏松高风险人群的风险评估初筛工具;双能X线吸收检测法、骨转换指标、血钙血磷3项应作为主要的辅助检查内容;骨密度、中医证候积分、血钙血磷、平衡能力、生活质量评分、骨转换指标、疼痛视觉模拟评分、跌倒次数、骨折发生次数可作为重点的评价指标。结论基于德尔菲法确定了骨质疏松高风险人群的评估工具及评价指标,为骨质疏松高风险人群的筛选评价提供参考。     

Methods for development of a core outcome set for clinical trials integrating traditional Chinese medicine and Western medicine

Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine (TCM) and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review. The excluded studies are therefore less widely disseminated, and even valid studies are less likely to yield impact. This problem may be addressed by developing core outcome sets (COSs) for integrative medicine in specific healthcare areas. The first stage of development is to define the scope of the COS for integrative medicine, the second stage is to establish the need for such a COS, and the third stage is to develop a protocol and register the COS. The final stage involves three steps: (i) development of a comprehensive list of outcomes (including efficacy outcomes and safety outcomes and TCM syndromes) using systematic review, qualitative or cross-sectional research, and reviews of package inserts and medical records; (ii) merging and grouping of outcomes within domains; (iii) conducting two rounds of Delphi survey and consensus meetings with a range of stakeholders. The final COS will include a general COS and core TCM syndrome- set. Development of COSs for clinical trials of integrative medicine may help to standardize outcome reporting and reduce publication bias in the future.     

《妇科玉尺》治疗月经病学术思想探析

《妇科玉尺》为清代著名医家沈金鳌所撰，是一部颇有影响的临床实用妇科专著。沈氏临床经验丰富，精通内外妇儿各科，特别在妇科治疗方面多有创见。沈氏论述月经诸病证治，平正可法，示人以规矩准绳，提供规范，且有论有方，取舍精当，议论中肯。文章拟对《妇科玉尺》治疗月经病的学术思想进行探讨，以期对临床辨证月经病有所裨益。