当归通痹汤联合中药热敷治疗膝关节骨性关节炎的疗效及对IL-1β、MMP-3和TNF-α水平的影响

目的:探讨当归通痹汤联合中药热敷治疗膝关节骨性关节炎的疗效及对白细胞介素(IL)-1β、基质金属酶(MMP)-3和肿瘤坏死因子(TNF)-α水平的影响。方法:选取我院收治的膝关节骨性关节炎患者140例,随机分为两组各70例。对照组给予中药热敷治疗,治疗组在对照组基础上给予当归通痹汤,对比两组治疗后的临床疗效、VAS评分、WOMAC指数和ADL评分,以及IL-1β、MMP-3和TNF-α水平。结果:治疗后,治疗组的总有效率为94.29%,高于对照组的81.43%,差异有统计学意义(P<0.05);两组ADL评分明显升高,WOMAC指数、VAS评分明显降低(P<0.05);且治疗组比对照组明显改善(P<0.05);两组患者治疗后的IL-1β、MMP-3和TNF-α水平均显著低于治疗前(P<0.05);且治疗组低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论:膝关节骨性关节炎患者采用当归通痹汤联合中药热敷治疗,具有较好的临床疗效,能够改善患者膝关节功能,值得在临床上推广应用。     

银黄洗剂治疗下肢血栓性浅静脉炎的临床疗效观察

目的:观察银黄洗剂治疗下肢血栓性浅静脉炎的临床疗效。方法:将62例诊断为下肢血栓性浅静脉炎的患者随机分为对照组和观察组,各31例。对照组在常规治疗的基础上应用硫酸镁湿敷,观察组在常规治疗的基础上应用银黄洗剂湿敷,疗程均为10 d。比较两组患者临床症状评分(皮肤颜色、患肢肿胀、硬索结节及疼痛的评分)、相关实验室指标(超敏C反应蛋白及纤维蛋白原)的变化情况以及总有效率。结果:观察组总有效率90.32%,高于对照组的64.52%(P<0.05)。与治疗前比较,两组症状体征评分明显改善,超敏C反应蛋白及纤维蛋白原明显降低(P<0.05)。观察组在改善症状体征及降低炎性反应方面较对照组更明显(P<0.05),两组治疗后纤维蛋白原数值比较,差异无统计学意义(P>0.05)。结论:银黄洗剂治疗下肢血栓性浅静脉炎,可有效改善患者临床症状及降低炎性反应,明显提高临床疗效。     

10%盐水冰袋的研制及临床应用

目的　探讨有效实用的临床物理降温方法。方法　选内、外科发热病人及五官科术后病人 10 0例随机分为对照组和观察组各 5 0例 ,对照组采用传统的冰块冰袋 ,观察组用自行研制的 10 %盐水冰袋 (冰霜状 )进行物理降温。结果　 10 %盐水冰袋低温持续时间长 ,冰袋松软 ,接触体表充分 ,易于固定 ,病人自觉舒适 ,降温、止血、止痛效果明显优于传统的清水冰袋 (P <0 0 5 )。结论　 10 %盐水冰袋制作简单、操作方便 ,在临床、社区、家庭护理中可广泛推广使用。     

药物联合物理疗法治疗MGD所致干眼的疗效观察

目的：比较左氧氟沙星眼凝胶与妥布霉素地塞米松眼膏治疗睑板腺功能障碍(MGD)所致的蒸发过强型干眼的疗效。

方法：将确诊为MGD所致干眼(蒸发过强型)180例360眼患者随机分组。A组应用左氧氟沙星眼凝胶+玻璃酸钠滴眼液治疗; B组采用妥布霉素地塞米松眼膏+玻璃酸钠滴眼液治疗。A、B两组患者均采用综合治疗：用棉棒挤压排出阻塞在睑板腺管内的分泌物,每周1次,连续4wk为一个疗程; 热毛巾湿热敷眼睑,水温45℃左右,每天3次,每次15min,使残留在睑板腺管内的油脂稀薄软化脂质排出。每次眼睑湿热敷完毕后,A组将左氧氟沙星眼凝胶滴入结膜囊内并涂抹在眼睑睫毛根部,B组将妥布霉素地塞米松眼膏涂抹在眼睑睫毛根部,两组患者均滴玻璃酸钠滴眼液每天4次。观察患者术后的疗效。

结果：两组患者治疗后,临床症状评分、分泌物性状评分、泪膜破裂时间评分和泪液分泌试验评分差异均无统计学意义(Z_症状=-0.64,P_症状=0.524; Z_分泌物=-1.37,P_分泌物=0.171; Z_破裂时间=-1.06,P_破裂时间=0.288; Z_分泌时间=-1.06,P_分泌时间=0.288)。角膜荧光染色评分：A组治愈83.3%,好转11.1%,无效5.6%; B组治愈55.6%,好转27.8%,无效16.7%; A组疗效优于B组(Z=-4.02,P<0.001)。

结论：治疗MGD所致的蒸发过强型干眼,以物理疗法为主,药物治疗为辅,除了患病时间长、病情严重的患者可短期使用妥布霉素地塞米松眼膏外,一般均使用左氧氟沙星眼凝胶完全能达到消炎抗菌、安全稳定、无毒副作用的治疗效果,二者药物之间在治疗效果没有明显的差异。     

钩活术配合中药热敷治疗颈椎病182例

目的：探讨钩活术配合中药热敷治疗颈椎病的临床疗效。方法：局麻下利用无菌操作技术,在颈三穴部位钩治,椎动脉型颈椎病加风府穴钩治。钩针的针尖不能超过横突后结节,边进针边钩提,慢用力,向上钩提,钩提3～5次不等,有落空感即可。术毕用牛痘疫苗兔皮致炎提取物3 mL、维生素B120.5 mL、红花注射液0.5 mL、注射用水0.5 mL混合液各针眼注射1 mL左右以防粘连,无菌敷料覆盖针眼,用胶布加压包扎,观察15分钟,4天后除去敷料。7～15天治疗1次,若疗效不满意,进行第2次治疗,3次为1个疗程,每次取1～2个穴位（双侧）,可轮流取穴。若1次治疗症状缓解达70%以上,不进行第2次钩活术治疗,4天后行中药热敷治疗。结果：1次治愈96例,占52.75%;2次治愈42例,占23.08%;3次治愈18例,占9.89%;总治愈率85.72%,总有效率96.15%。结论：钩活术配合中药热敷治疗颈椎病操作简单,疗效满意。     

Small-Town Doctor Provides Big-Time Care

In brief: Two related studies were conducted to determine whether fast walking is intense enough to elicit a training heart rate (THR), which is defined as ≥ 70% of maximal heart rate. In one study, 343 subjects (165 men, 178 women) walked a mile as fast as possible. Ninety-one percent of all the women and 83% of men aged 50 and older reached a THR. In the second study, ten men with high V o₂ max values were instructed to achieve and maintain a THR and were provided with visual feedback of their heart rate (HR) during a 30-minute walk. These subjects maintained a THR for an average of 25 minutes during the walk. Thus, it seems that fast walking may indeed offer an adequate aerobic training stimulus for most adults.     

协定肢伤Ⅰ方口服、热敷治疗四肢闭合损伤大样本随机平行对照研究

[目的]观察协定肢伤I方口服热敷治疗四肢闭合损伤疗效。[方法]使用大样本随机平行对照方法,将2468例门诊及住院患者按掷骰子法随机分为两组。对照组1212例协定肢伤I方(红花、延胡索各15g,桃仁、川芎、赤芍、生三七粉另包冲服、当归、泽泻、桂枝、牛膝、山楂各10g),1剂/d,水煎300mL,早晚温服;蜡疗机熬化粗石蜡装塑料袋敷于患处,12h/次。治疗组1256例协定肢伤I方药渣加水送入湿热敷机内与敷布同煮30min,于伤后或术后24h将敷布外套棉布贴敷于伤处,30min/次,2次/d;协定肢伤I方口服同对照组。连续治疗7d为1疗程。观测临床症状、疼痛积分、肿胀指数、不良反应。治疗1疗程,判定疗效。[结果]治疗组痊愈922例,显效248例,有效63例,无效23例,总有效率98.16%。对照组痊愈705例,显效278例,有效105例,无效124例,总有效率89.76%。治疗组疗效优于对照组(P0.05)。相关指标两组均有改善(P0.05),治疗组改善优于对照组(P0.05)。[结论]协定肢伤I方口服热敷治疗四肢闭合损伤效果显著,值得推广。     

Critical slowing down suggests that the western Greenland Ice Sheet is close to a tipping point

The Greenland Ice Sheet (GrIS) is a potentially unstable component of the Earth system and may exhibit a critical transition under ongoing global warming. Mass reductions of the GrIS have substantial impacts on global sea level and the speed of the Atlantic Meridional Overturning Circulation, due to the additional freshwater caused by increased meltwater runoff into the northern Atlantic. The stability of the GrIS depends crucially on the positive melt-elevation feedback (MEF), by which melt rates increase as the overall ice sheet height decreases under rising temperatures. Melting rates across Greenland have accelerated nonlinearly in recent decades, and models predict a critical temperature threshold beyond which the current ice sheet state is not maintainable. Here, we investigate long-term melt rate and ice sheet height reconstructions from the central-western GrIS in combination with model simulations to quantify the stability of this part of the GrIS. We reveal significant early-warning signals (EWS) indicating that the central-western GrIS is close to a critical transition. By relating the statistical EWS to underlying physical processes, our results suggest that the MEF plays a dominant role in the observed, ongoing destabilization of the central-western GrIS. Our results suggest substantial further GrIS mass loss in the near future and call for urgent, observation-constrained stability assessments of other parts of the GrIS.

During the last century, the Greenland Ice Sheet (GrIS) has lost mass at an accelerating rate (1, 2). The mass loss is caused by solid ice discharge into the North Atlantic and surface melting due to increasing temperatures. The relative contribution of the latter has increased from 42% before 2005 to 68% between 2009 and 2012, and surface runoff caused 84% of the increase in mass reduction since 2009 (3). The complete melting of the GrIS would cause a global sea level rise of more than 7 m (4, 5). Continued melting of the GrIS has been suggested to potentially lead to a collapse of the Atlantic Meridional Overturning Circulation via increased freshwater flux into the North Atlantic (6, 7), which may, in turn, trigger a cascade of transitions in additional tipping elements such as the Amazon rainforest and the tropical monsoon systems (6, 8–10).In addition to the centennial-scale variability associated with the increasing trend in mean temperatures related to anthropogenic climate change, the pace of mass loss has decadal-scale fluctuations caused by natural variations in external oceanic and atmospheric forcing. The imprints of these natural, decadal-scale fluctuations are spatially heterogeneous across the GrIS. Since the early 2000s, periods of persistently negative phases of the North Atlantic Oscillation (NAO) and a positive phase of the East Atlantic Pattern (11) have led to a weakening and southward shift of the jet stream, and more persistent blocking (12) over Greenland during summer, resulting in overall increased mass reduction rates (2, 13). On the other hand, a slowing down of mass loss since 2013—which inverted again in 2019—was caused by more periods with a persistent positive NAO (14). Moreover, recent observations show that the Jakobshavn glacier has been advancing again since 2016 due to anomalous wintertime heat loss in the boundary current around southern Greenland (15). However, these natural fluctuations do not have a sustained impact on melt rates comparable to the longer-term trend toward overall increasing melt rates caused by anthropogenic global warming (Fig. 1A).Open in a separate windowFig. 1.(A) Summer sea level temperatures from the Ilulissat station in CWG (25) (blue curves) and Arctic temperature anomalies (26) (red curves). The linear trend of the station data (dashed blue curve) corresponds to 1.3 °C warming per century. Arctic temperature anomalies are shown only for comparison; only the station data (blue curves) are used for our analysis. (B) Melt rates from the CWG ice core stack (blue curve) and the NU peninsula core (red curve), given as z scores with respect to a normal distribution (18). (C) Detrended logarithmic CWG (blue curve) and NU (red curve) melt rates. A Gaussian filter with bandwidth σ=30 y was used for detrending. The runoff and melt time series are preprocessed in this way before computing the EWS indicators to exclude potential biases by underlying trends; in particular, we take the logarithm of the melt rates in order to account for skewed data distributions. (D) The variance of the CWG (blue curves) and NU (red curves) melt rates. (E) The AC1 of the CWG (blue curves) and NU (red curves) melt rates. Note that the AC1, despite a significantly positive trend, appears to have at least temporarily stabilized in the last few decades. It should be noted, however, that the AC1 is generally influenced by (multi)decadal variability (27). The window size for computing the variance and the AC1 is w=70 y, and values are plotted at the windows’ endpoints. Data for the first w=70 y are omitted to ensure that all windows contain the same number of data points. The dashed lines in D and E indicate linear trends of the variance and AC1, and P values for positive slopes as determined from a phase surrogate test are indicated in the legend (see Materials and Methods). The statistical significance of the positive trends is robust across wide ranges of the bandwidth σ and the sliding window size (SI Appendix, Fig. S1).Early model simulations suggest that melting of the GrIS is inevitable beyond a critical global mean temperature threshold of 0.8 °C to 3.2 °C above preindustrial levels, with a best estimate of 1.6 °C (16). More recent comprehensive modeling results show that, for the representative concentration pathway 8.5 (RCP8.5), the GrIS melts entirely until AD 3000 (5). Arctic temperatures have increased more than the global average (17) (Fig. 1A), and the nonlinear increase in GrIS melt rates and runoff that have recently been detected (18) (Fig. 1B) suggests that the critical temperature threshold may be closer than previously thought. We emphasize that the surface mass balance turning negative is not a necessary condition for stability loss, and the temperature may reach a critical threshold years before a turning point in the mass balance (16).Idealized models of critical transitions in natural systems suggest that the loss of stability of an equilibrium (fixed point) is observable before the abrupt transition (19). In dynamical systems with random forcing, one can show that, if a system approaches a bifurcation where an equilibrium point loses its stability, the variance of the fluctuations around the equilibrium will increase, as will the characteristic decay time of the autocorrelation function of these fluctuations. The change in dynamics that occurs as stability is lost is often called critical slowing down, and the associated statistical precursor signs in terms of rising variance and lag-one autocorrelation (AC1) are called early-warning signals (EWS) (19). Such statistical EWS associated with critical slowing down are, for example, detectable in the temperature proxy from the North Greenland Ice Core Project before several of the Dansgaard–Oeschger events of the last glacial interval (20, 21), as well as before other abrupt transitions in past climates (22). In the context of anthropogenic global warming, EWS are expected to precede potential abrupt transitions in the Earth system’s major tipping elements, such as the polar ice sheets, the Atlantic Meridional Overturning Circulation, or the tropical monsoon systems (23). We investigate here a possible tipping point for the GrIS based on the theory of critical slowing down.In the following, we will first show that central-western Greenland (CWG) melt rates exhibit robust and significant EWS. We then reconstruct the corresponding CWG ice sheet height changes and show that they can be captured well by a simple model focusing on the melt elevation feedback (MEF). We then demonstrate that pronounced EWS can also be found in the fluctuations of the reconstructed ice sheet height around the equilibrium of the model and show that these EWS are consistent with the theoretical expectations provided by the MEF model.     

止血镇痛冰块的研制及临床应用效果观察

目的 寻找扁桃体摘除术后局部止血镇痛的有效方法。方法 自行研制了止血镇痛冰块(下称药冰)。100例扁桃体摘除术后患者(观察组)术后2小时起含化药冰,每1～2小时1次,每日8～12次;对照组(50例同期行扁桃体摘除术的患者)术后2小时舌根部含化冰淇淋或雪糕。观察两组术后出血疼痛、伤口愈合等情况。结果 观察组术后疼痛明显减轻,24小时出血量少,进食情况较好,与对照组相关指标比较,P均<0.01。结论药冰制作简单、价格低廉、无异味,止血、镇痛、促伤口愈合效果可靠,优于传统方法。