Correction results of atypical clubfeet managed with modified Ponseti technique: A meta-analysis of 354 feet

Background/purposeAtypical clubfeet are distinct from idiopathic clubfeet. It is resistant to correction by conventional casting methods and often requires a modification of Ponseti's casting technique. Although the initial correction rates are reasonable, relapse and complications are frequent. There is limited literature on the results of modified Ponseti casting of these feet. We conducted this meta-analysis to study a few important aspects of atypical/complex clubfeet treatment by the modified Ponseti technique.Research questionWhat are the results of atypical or complex clubfeet after treatment by the modified Ponseti technique?MethodologyFive electronic databases (PubMed, Embase, Scopus, Ovid, and Cochrane Library) were searched for articles reporting on the results of atypical/complex clubfeet treated by the modified Ponseti technique. Details of the number of casts required for correction, rate of percutaneous Achilles tenotomy (PAT), other soft tissue procedures required, complications, and relapse rates were extracted into spreadsheets, and meta-analysis was carried out using OpenMeta Analyst software.ResultsTen studies were included for analysis with a total of 240 patients with 354 clubfeet. The initial correction was achieved in all feet. A pooled analysis of the data showed that a mean of six casts was required for the initial correction. The rate of PAT was 98.3%. The overall complication rate was 16.8%. 7.2% required an additional soft tissue procedure apart from the PAT, and relapse of the deformity was observed in a mean of 19.8% cases.ConclusionModified Ponseti technique is effective in the initial management of atypical/complex clubfeet. Although the PAT rate is slightly higher in the Modified Ponseti technique, the remaining result parameters are comparable with the results of idiopathic clubfoot managed with the Ponseti method of casting. However, these children should be kept under follow-up for a longer duration to find the exact relapse rates.     

滋肾育胎丸加减方预防ACA阳性者不良妊娠结局的效果及机制研究＊

目的 探讨滋肾育胎丸加减方预防抗磷脂抗体（ACA）阳性者不良妊娠结局的效果及机制研究。方法 选取2016年2月至2019年2月我院收治的89例ACA阳性，先兆性流产或有习惯性流产（RSA）史患者，将采用西医治疗的40例作为对照组，将采用西医联合滋肾育胎丸加减方治疗的49例作为观察组，比较两组中医证候疗效、中医证候积分、ACA-IgA、ACA-IgM、ACA-IgG、凝血指标［血小板聚集功能（PAF）、活化蛋白C（PC）、抗凝血酶（AT）、纤溶酶原激活抑制物-1（PAI-1）］、Th1/Th2细胞因子［干扰素γ（IFN-γ）、白介素-2（IL-2）、白介素-4（IL-4）、白介素-10（IL-10）］、妊娠结局、安全性。结果 治疗2周后检测ACA，观察组2例未降低，对照组11例未降低，观察组未降低患者占比低于对照组（P<0.05）；观察组总有效率100.00%高于对照组85.00%（P<0.05）；观察组治疗4周、7周后中医证候积分低于对照组（P<0.05）；观察组治疗4周、7周后ACA-IgA、ACA-IgM、ACA-IgG低于对照组（P<0.05）；观察组治疗4周、7周后PAF、PAI-1低于对照组，PC、AT高于对照组（P<0.05）；观察组治疗4周、7周后IFN-γ、IL-2低于对照组，IL-4、IL-10高于对照组（P<0.05）；观察组活产率95.92%高于对照组80.00%（P<0.05）；组间不良反应总发生率比较，差异无统计学意义（P>0.05）。结论 动态监测ACA对滋肾育胎丸加减方精准应用具有指导意义，指导滋肾育胎丸加减方通过调理脏腑、气血、经络功能，改善先兆性流产或有RSA史患者临床症状及凝血因子指标，降低ACA水平，并可改善患者免疫耐受功能，提高胎儿活产率，且安全性高。     

基于网络药理学和实验验证研究柴胡疏肝散治疗慢性萎缩性胃炎的作用机制＊

目的 通过网络药理学的方法进行预测，再深一步进行动物实验验证来研究柴胡疏肝散治疗CAG的作用机制。方法 首先在TCMSP数据库中检索柴胡疏肝散的所有活性成分与药物靶点；通过收集PharmGkb、OMIM、GeneCards和DrugBank数据库中收录的慢性萎缩性胃炎的相关靶点。将药物靶点与疾病靶点进行映射筛选出交集靶点，将得到的交集靶点构建PPI网络与活性成分-共同靶点网络，并对其进行GO和KEGG富集分析。最后利用Vina软件进行分子对接实验验证，并通过免疫印迹法验证柴胡疏肝散对两种受体蛋白EGFR和STAT1的影响。结果 最终筛选得到柴胡疏肝散活性成分104个，潜在靶点238个，与慢性萎缩性胃炎的交集靶点52个；GO与KEGG富集分析分别得到2166条目和148条目，主要涉及到JAK-STAT信号通路、TNF信号通路、HIF-1信号通路等；分子对接结果显示EGFR、STAT1两个靶点能够与核心活性成分能够自发结合成较为稳定的构像；免疫印迹法实验证明柴胡疏肝散能够降低大鼠胃黏膜组织EGFR和STAT1蛋白表达。结论 通过网络药理学和实验验证，发现柴胡疏肝散可能通过调节EGFR和STAT1蛋白表达来共同调控胃黏膜细胞增殖与凋亡，进而发挥着治疗慢性萎缩性胃炎的效果，为深入进行柴胡疏肝散治疗慢性萎缩性胃炎的作用机制研究提供新思路和新方法。     

Selective Laser Melting of Al-Based Matrix Composites with Al2O3 Reinforcement: Features and Advantages

Aluminum matrix composites (AMC) are of great interest and importance as high-performance materials with enhanced mechanical properties. Al₂O₃ is a commonly used reinforcement in AMCs fabricated by means of various technological methods, including casting and sintering. Selective laser melting (SLM) is a suitable modern method of the fabrication of net-shape fully dense parts from AMC with alumina. The main results, achievements, and difficulties of SLM applied to AMCs with alumina are discussed in this review and compared with conventional methods. It was shown that the initial powder preparation, namely the particle size distribution, sphericity, and thorough mixing, affected the final microstructure and properties of SLMed materials drastically. The distribution of reinforcing particles tends to consolidate the near-melting pool-edges process because of pushing by the liquid–solid interface during the solidification process that is a common problem of various fabrication methods. The achievement of an homogeneous distribution was shown to be possible through both the thorough mixing of the initial powders and the precise optimization of SLM parameters. The strength of the AMCs fabricated by the SLM method was relatively low compared with materials produced by conventional methods, while for superior relative densities of more than 99%, hardness and tribological properties were obtained, making SLM a promising method for the Al-based matrix composites with Al₂O₃.     

改良眶隔法和传统睑板法切开重睑术的术后重睑形态、瘢痕发生率、角膜暴露率比较研究

目的 比较改良眶隔法和传统睑板法切开重睑术中的应用效果及对术后重睑形态、瘢痕发生率、角膜暴露率的影响。方法 选取2020年3月-2021年3月首都医疗爱育华医院收治的80例单睑患者，采用随机数字表法将其分对照组和观察组，各40例。对照组接受传统睑板法切开重睑术，观察组接受改良眶隔法切开重睑术，比较两组术后重睑形态、瘢痕发生率、角膜暴露率、并发症发生率。结果 观察组总有效率高于对照组，差异有统计学意义（P＜0.05）；观察组GAIS评分高于对照组，VAS评分低于对照组，差异有统计学意义（P＜0.05）；观察组右侧角膜暴露率增加值、左侧角膜暴露率增加值高于对照组，差异有统计学意义（P＜0.05）；观察组并发症发生率为5.00%，低于对照组的22.50%，差异有统计学意义（P＜0.05）。结论 相比于传统睑板法切开重睑术，改良眶隔法切开重睑术不会过度增加术后角膜暴露率，术后瘢痕发生率更低，重睑形态更理想，患者接受度更高。     

Cold-passaged isolates and bat-swine influenza a chimeric viruses as modified live-attenuated vaccines against influenza a viruses in pigs

Swine influenza A virus (swIAV) infections in pig populations cause considerable morbidity and economic losses. Frequent reverse zoonotic incursions of human IAV boost reassortment opportunities with authentic porcine and avian-like IAV in swine herds potentially enhancing zoonotic and even pre-pandemic potential. Vaccination using adjuvanted inactivated full virus vaccines is frequently used in attempting control of swIAV infections. Accelerated antigenic drift of swIAV in large swine holdings and interference of maternal antibodies with vaccine in piglets can compromise these efforts. Potentially more efficacious modified live-attenuated vaccines (MLVs) bear the risk of reversion of MLV to virulence. Here we evaluated new MLV candidates based on cold-passaged swIAV or on reassortment-incompetent bat-IAV-swIAV chimeric viruses. Serial cold-passaging of various swIAV subtypes did not yield unambiguously temperature-sensitive mutants although safety studies in mice and pigs suggested some degree of attenuation. Chimeric bat-swIAV expressing the hemagglutinin and neuraminidase of an avian-like H1N1, in contrast, proved to be safe in mice and pigs, and a single nasal inoculation induced protective immunity against homologous challenge in pigs. Reassortant-incompetent chimeric bat-swIAV vaccines could aid in reducing the amount of swIAV circulating in pig populations, thereby increasing animal welfare, limiting economic losses and lowering the risk of zoonotic swIAV transmission.     

基于《金匮要略》头风摩散结合摩法治疗偏头痛思路探究

偏头痛是临床常见头面部疾病,现在医学多采用特异性治疗药物跟非特异性止痛药物治疗。长期服药造成一定的并发症及不良反应,中西医结合治疗偏头痛是临床研究的重点。张仲景《金匮要略.中风历节病脉证并治》篇中初次记录头风摩散,该外治方的主要功效是用来治疗头风病,同时开创了摩顶膏法的先河。 摩法是最古老、最常用的手法之一。记载摩法的古代文献颇多,可追溯至《素问.病能》曰；“摩之切之。” 《素问.至真要大论》曰：“摩之、浴之。”并由此演绎出一系列实用手法。本文旨在探究摩法结合头风摩散治疗偏头痛的操作应用及其原理,进一步考究摩法与头风摩散结合治疗偏头痛的协同作用,以期对临床有一定指导意义。     

《邵氏医案》从血辨治痛经浅析

[目的]分析总结浙江近代著名临床医家邵兰荪治疗痛经的经验,以期为临床治疗提供借鉴。[方法]通过研读裘吉生编《邵氏医案》,筛选出其中治疗痛经的医案十余则,并结合邵氏在妇科方面的学术思想,进一步分析其辨证立法遣方特色,从而总结邵氏治疗痛经的临证经验。[结果]邵氏治疗痛经多从血辨治,且分虚实两端,其中属虚者血虚内热用益母胜金丹养血清热、活血止痛,血虚肝风治以养血柔肝、息风止痛;属实者水结血瘀用五苓散利水散瘀、行气止痛,气阻血滞治从行气活血、调经止痛。[结论]在治疗妇人痛经方面,邵氏辨治遣方确有独特经验,这些经验可为中医药治疗此类疾病拓宽诊治思路,有助于提高临床疗效。     

荧光染色法与改良膨胀萎陷法判定段间平面在解剖性肺段切除术中的病例对照研究

目的相较于目前常用的改良膨胀萎陷法，探讨荧光染色法判定段间平面在胸腔镜解剖性肺段切除术中的可行性及安全性。 方法回顾性分析解放军总医院第一医学中心胸外科2017年3月至2019年9月行胸腔镜解剖性肺段切除术的157例临床资料，其中荧光染色组60例，女41例、男19例，年龄36～76岁；改良膨胀萎陷组97组，女62例、男35例，年龄27～85岁。荧光染色组采用反向染色法，分离出预切除肺段的肺动脉分支并切断，经外周静脉快速推注吲哚菁绿25 mg行保留肺脏部分的荧光显影从而判定段间平面。改良膨胀萎陷法，在分离出预切除肺段的支气管分支并切断后，双肺通气使肺脏完全膨胀后恢复单肺通气，一段时间后可形成较明显的段间平面。记录两组的临床资料并进行统计学分析。 结果与改良膨胀萎陷组相比，荧光染色组的段间平面形成时间更早、手术时间缩短，两组差异具有统计学意义[20 s(8～25 s)比1 008 s(884～1 200 s)，P＝0.031；(103.3±7.3)min比(132.8±10.4)min，P＝0.021]；两组的术中出血量、淋巴结清扫数目、术后置管时间、术后住院时间、并发症发生率比较，差异无统计学意义(P均>0.05)。 结论相较于目前常用的改良膨胀萎陷法，荧光染色法术中不需反复膨肺，同样符合肿瘤学要求，是安全、有效的。