中药复方治疗绝经后骨质疏松症疗效及其机制的研究进展

为了促进对绝经后骨质疏松症（postmenopausal osteoporosis，PMOP）中药治疗疗效的提高及其作用机制的进一步研究，笔者检索了CNKI数据库中2012年至2021年间常用中药复方治疗PMOP的文献，并梳理总结了PMOP的辨证分型、常用的治疗方药及其机制，发现中药治疗PMOP可有效缓解疼痛、提高患者骨密度、改善雌二醇水平，提升患者生活质量。在机制方面，可通过调节OPG/RANKL、Wnt/β-catenin、JAK/STAT信号通路，或通过提高OX、ERmRNA和蛋白表达等，达到促进成骨细胞分化，减少破骨细胞生成，提高骨密度、平衡骨代谢等作用。中药治疗PMOP机制研究已深入到分子甚至基因水平，建议今后可从骨代谢、骨免疫、骨微结构、肠道菌群、氧化应激与炎症反应、铁过载等方面进一步研究，丰富中药治疗PMOP的机制，阐明中药的作用靶点，增强科学性。     

NLRP3炎性小体在激素性股骨头坏死骨代谢及其稳态中的作用

大量的糖皮质激素使用导致股骨头中骨代谢及稳态失衡是激素性股骨头坏死的重要机制之一。细胞焦亡关键因子NLRP3炎性小体在SANFH机制中发挥着重要作用，明确NLRP3炎性小体的结构，激活途径和调控机制，以及NLRP3炎性小体和下游炎性因子IL-1β、IL-18对激素性股骨头坏死中成骨细胞、破骨细胞以及骨髓间充质干细胞的作用机制，将为激素性股骨头坏死的防治提供新的思路与靶点。该文对NLRP3炎性小体在骨代谢及稳态中的相关作用机制进行综述，系统阐述NLRP3炎性小体与SANFH成骨和破骨分化中的具体作用机制，以期为临床治疗和基础研究提供一定的借鉴。     

药物防治激素性股骨头坏死的研究进展

随着激素性股骨头坏死发病机制研究的深入，使药物防治激素性股骨头坏死成为可能。本文回顾了近年来一些国内外学者根据其发病机制进行的药物预防激素性股骨头坏死的研究，提出降脂、抗凝药联用不能完全预防激素性股骨头坏死的发生，激素性股骨头坏死是以脂肪代谢紊乱和血管内凝血为主要发病机制，其他一些病理机制共同作用的结果。     

低温脑复苏机理探讨

低温脑复苏作用机制主要有：①降低脑代谢、氧耗和延缓ＡＴＰ耗竭；②减少乳酸生成，减轻酸中毒；③抑制兴奋性神经递质释放；④维持离子体内平衡；⑤减慢自由基与脂类氧化的联锁；⑥降低白三烯水平，减轻缺血后脑水肿。各机制间相互影响，相互作用，低温脑复苏作用机制很可能是多个机制的复合。     

Hippo信号通道在非创伤性股骨头坏死的作用

Hippo信号通道介导细胞内外信号传递，其调节细胞增殖、分化、凋亡进程，可在骨代谢、脂代谢及血管新生等方面发挥作用。故该通道可能对非创伤性股骨头坏死发病机制有重要意义。本文主要通过Hippo通道相关蛋白结构、功能在骨代谢、脂代谢及血管新生方面的作用机制进行探讨，寻找其在NONFH中的作用机制，从而为NONFH提供新的临床研究靶点。     

中枢脱髓鞘病变的免疫机制与胰性脑病

胰性脑病(pancreatic encephalopathy。PE)是急性胰腺炎(acute pancreafifis，AP)的严重并发症之一．早期诊断困难，发病机制不完全清楚，但已知脱髓鞘这一病理改变是该病的重要病理特征。本文综述中枢神经系统脱髓鞘病变的免疫机制，旨在为胰性脑病免疫发病机制研究、早期诊断研究提供线索。     

软骨细胞线粒体功能异常对骨关节炎发病机制的研究

骨关节炎(osteoarthritis, OA)主要是关节软骨退变导致的慢性炎症性关节疾病，病因及发病机制复杂，最新研究发现，软骨细胞中的线粒体功能异常与OA发病机制密切相关。线粒体通过调控软骨细胞衰老、凋亡、氧化应激、炎症抑制，参与OA发病进程。此外，线粒体相关信号通路AMPK/SIRT3对于调节软骨细胞的代谢过程很重要，表明这些可能是OA治疗的目标。因此，该文论述软骨细胞线粒体功能异常与OA的发病机制的相关性。     

周期性特发性水肿研究进展

周期性特发性水肿临床表现多种多样，发病机制仍不明确，可能并非单一机制所致。继续研究其发病机制是今后工作的重中之重。根据不同的发病机制，制定合理的治疗方案，才能更好地控制这种非炎性水肿综合征。     

脑缺血预处理神经保护作用的分子机制

脑缺血预处理具有神经保护作用，其分子机制成为近年来国内外学者研究的热点，普遍认为这种作用是通过多种因素、多种途径产生的、但其确切分子机制尚不清楚。本文从脑缺血预处理的信号转导途径对其神经保护作用的可能分子机制作一综述。     

炎症信号转导与危急疾患

90年代后期以来，对SIRS炎性反应的机制进行了更深入的研究，得到一些宝贵的新认识，尤其在细胞炎性信号转导和细胞周期调控机制方面，并提出对ARDS、SIRS、MODS、CARS等重症疾患认识的新概念－统属“炎性免疫信号转导紊乱疾患”。近年来，炎症信号转导领域的几个重大突破，如Toll受体的发现，MAPK通路的初步阐明，NF－κB活性调控机制及免疫细胞凋亡机制的新认识等，涉及到从胞膜→胞质→胞核信号转导全过程，使我们看到了炎性重症治疗的曙光。虽然我们尚未彻底认识炎症反应本质，但目前的进步已经大大不同于以往的抗细胞外介质治疗时代，似乎标志着一个新的野程碑，进入胞内信号和细胞周期调控的新阶段。随着我们对炎症机制认识的不断深入，将为危急疾患的早期诊断提供更敏感的信号指标，也必将指导产生全新的治疗理念和更有效的治疗策略。     

基因组护理学：现代护理学发展的动力

基因研究已经取得重大进展,基因组学相关的卫生保健研究也正在迅速发展。护理研究正处于共享基因组学研究前景以实现临床结局最优化的重要时机,本文结合对国外基因组护理学研究方向、研究实例、临床实例的分析,探讨如何将基因组学融入护理研究与实践中。     

Interest in Surgical Research

ABSTRACT

Interest in surgical research is a decisive factor in the surgical advances seen in the 20th century since interest in research represents the first key to the progress of the surgical sciences.How do you stimulate interest in research by non-believers or those not attracted to the research enterprise? This is the critical question that needs to be answered in order to achieve the best participation possible. We believe that intermixing the interest in research and research results observed today demonstrates the benefit of research in the clinical sciences and patient care. Furthermore, bringing the importance of research interest into medical and surgical staff meetings represents the best way to position its prominence among all attendees.

Knowing that research is the basis for evidence-based medicine makes it obvious that having interest in research would facilitate the understanding and application of evidence-based principles. In this regard, then, interest in research becomes of paramount importance.     

成人高校护理大专生科研论文训练初探

目的 探索医学高等院校成人护理大专生科研训练的内容和方法。方法 选择3个年级3个班74名学生为训练对象，通过安排选题，开题报告，研究中的指导，成文过程中的提炼等方法进行科研训练。结果 74名学生在研究内容方面，专科护理占37.8%，心理护理占32.4%。基础护理占13.5%，护理管理占12.2%，护理教育占4.1%；在研究类型方面，描述性研究占47.3%，相关性研究占35.1%，实验性研究占17.6%；学生科研论文的优良率为77.0%。结论 学生的研究内容是合理的，研究方法是正确的，成绩优良，此项训练方法达到了培养学生科学的思维方法，掌握研究方向，学会科研设计，提高科研水平的目的。     

Examining consent for interventional research in potential deceased organ donors: a narrative review

In the last decade, research in transplant medicine has focused on developing interventions in the management of the deceased organ donor to improve the quality and quantity of transplantable organs. Despite the promise of interventional donor research, there remain debates about the ethics of this research, specifically regarding gaining research consent. Here, we examine the concerns and ambiguities around consent for interventional donor research, which incorporate questions about who should consent for interventional donor research and what people are being asked to consent for. We highlight the US and UK policy responses to these concerns and argue that, whereas guidance in this area has done much to clarify these ambiguities, there is little consideration of the nature, practicalities and context around consent in this area, particularly regarding organ donors and their families. We review wider studies of consent in critical care research and social science studies of consent in medical research, to gain a broader view of consent in this area as a relational and contextual process. We contend a lack of consideration has been given to: what it might mean to consent to interventional donor research; how families, patients and health professionals might experience providing and seeking this consent; who is best placed to have these discussions; and the socio-institutional contexts affecting these processes. Further, empirical research is required to establish an ethical and sensitive model for consent in interventional donor research, ensuring the principles enshrined in research ethics are met and public trust in organ donation is maintained.     

Clinical research in surgery: questions but few answers

Background: Surgeons must be prepared to be questioned about their understanding, activities, and achievements in basic and clinical research in terms of structural, organizational, and financial support of surgical research. Results: Clinical research today comprises basic research related to accumulation of knowledge about biological systems, disease-related research including experimental research with animals, and in vitro research with biological material and clinical studies with the strongest empirical basis in data derived from controlled clinical trials. Most clinical methods related to diagnosis and treatment have been introduced into the practice of everyday medicine even in university hospitals without passing a prospective evaluation protocol. To test the efficacy of a new drug or a newly developed surgical technique, the controlled prospective clinical trial is the best method; however, fewer than 50% of clinical questions can be answered by controlled clinical studies. In Germany the frequency of controlled clinical trials for answering clinical questions is presently low; this is particularly true for surgery, in comparison with other countries. The concept of evidence-based medicine is based on the principles of data generation from controlled trials and meta-analyses of those studies. Best-evidence synthesis means a reasonable synthesis of evident knowledge, experience and intuition. The challenge of professionalization of clinical research in surgery is linked to the establishment of full time positions for basic scientists and clinical researchers and the establishment of clinical research teams and of research professorships including basic scientists in surgical departments. Conclusion: Clinical research can be effective only if there is good cooperation between clinicians and basic scientists, if high grade scientific methods are established in clinical research institutions, if there is sufficient financial and personal supply, and if there are enough laboratories and animal operating facilities. There is an urgent need for structures integrating basic scientists in clinical research groups, for more interdisciplinary research projects and more multidisciplinary research, independent of clinical care in terms of manpower. Received: 20 May 1998 / Accepted: 21 September 1998     

A critical review of research paradigms and strategies and their role in chiropractic research

The allopathic medical approach to research is leaning heavily towards evidence based practice, utilising a quantitative model in order to analyse statistics and measure the potential variables An important initial step in any research is how best to study the research question. The approach chosen is the keystone to the structure in which the research question is answered but should allow for the research question to drive the approach rather than the other way around. Qualitative and quantitative research methods are critically assessed in this paper in order that an understanding is reached on whether individually or joint approaches are the best tools to answer important chiropractic research questions in the future The profession is currently heading quickly into a researched based mode led by its academic institutions. It is hoped that chiropractic has both the maturity and methodology to dictate its own research direction for the benefit of all concerned.     

Surgical outcomes research--a new paradigm for clinical research?

OBJECTIVE: To define outcomes research in terms of a paradigm, grouping six existing research methodologies. BACKGROUND: Although outcomes research is becoming an increasingly popular area in clinical research, an accepted definition is difficult to find. The term 'outcomes research' is often used in the context of a research methodology. METHODS: Topics in dinical research which have been termed 'outcomes research' are discussed including: databases, quality of life studies, effectiveness studies, economic evaluations, small-area rate variation analysis and volume outcome studies, as well as practice guideline development. RESULTS: Outcomes research is not a research methodology in its own right, but a paradigm which groups existing methodologies, providing a structured approach to evaluating the outcomes which are most important to patients, society and those who pay for health care.     

So you wanted to do surgery and they keep talking about research: a discussion for the surgical resident and intern

Surgical residents and interns frequently misunderstand the relation between surgery and research, and the contribution of surgical research to clinical practice. The problem is that the effects of research must be viewed in the long term. Once the resident can do this, the importance of research to surgery is evident and surgical research can be seen for what it is, the growing surface of surgery. Training to do surgical research has many parallels with clinical training. A core-training period in investigation provides the resident with the right mental approaches to investigation so that training in a specific area of research may be done later. Surgical scientists must be excellent clinicians as well as scientists and so long training periods are required. Four years of clinical practice training and 3 of research training are probably ideal. Shorter periods of research training may be valuable for many surgical residents, particularly those who have had little research experience. Training should be tailored to the trainee's desired role in surgery.     

Why is priority setting important for global burn care research?

The use of robust evidence is a key component of providing high quality care to patients. Synthesised evidence to support clinical decision-making is lacking for many aspects of clinical burn care. Identifying the most important areas of care that lack high quality evidence and requires research is necessary, as funding for primary research is limited. Priority setting research studies are a joint endeavour between patients, carers and clinicians to identify and rank topics for research in a healthcare area in order to reduce research waste. Such an exercise has yet to be undertaken in burns. The aim of this paper is to outline the importance of research prioritisation in burn care, to discuss how it facilitates the maximum benefit from limited research funding and to explain the methodologies used.