中药镇痛膏治疗癌性疼痛的临床研究

目的观察对60例癌症病人的疗效。方法治疗组：先确定痛点，然后清洁皮肤，根据病灶疼痛范围大小选用不同剂量止痛膏，膏药厚度为0．1cm，外盖以无纺纱布固定，每24小时换1次。对照组：选用强痛定100mg肌注，至疼痛再发作时用。临床观察30d。结果镇痛膏对癌性疼痛具有较好的镇痛效果，其有效率为83.3％，略高于强痛定对照组；在起效时间上与强痛定对照组无差异，而在持续减轻时间上优于对照组（P〈0．05）：从其疗效与中医辨证分型，疼痛程度的关系看：镇痛膏对气滞血淤型疼痛最好，缓解率为90．91％；痰湿夹瘀型次之，缓解率为81．82％；气阴两虚型疗效最差，缓解率为75％。统计学处理无意义：对中度疼痛显著缓解率为91．67％，对重度疼痛缓解率为77，78％，统计学处理无意义。结论该药癌症病人癌性疼痛的疗效是有效的。     

Differential Regulation of Lipid Metabolism Genes in the Brain of Acetylcholinesterase Knockout Mice

Mice deficient in acetylcholinesterase (AChE; EC3.1.1.7) exhibited significant phenotypical and biochemical changes when compared with wild-type littermates. They showed a delay of growth in weight and size, immature external ears, and persistent body tremor, and they circled when walking. The molecular mechanisms underlying these changes have not been investigated yet. Here, we studied the profiles of both the messenger RNA (mRNA) and protein expression in the brain of AChE-deficient mice using mRNA microarray, quantitative PCR, and two-dimensional difference gel electrophoresis (2D DIGE) coupled to protein identification with matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry. Analysis of gene expression profile was conducted by DAVID (http://david.abcc.ncifcrf.gov) and Ingenuity Pathway Analysis (IPA, http://www.ingenuity.com). Previous results implicated that there is a close relationship between lipid metabolisms which were associated with central nervous system development. Here, we demonstrated that the mRNA expressions of brain specific fatty acid protein 7 (fabp-7) and phospholipase A2 group IV (pla2g4) were significantly downregulated in AChE-deficient mice. These results suggested that AChE may play a role in neurogenesis and neurodegeneration by specifically regulating lipid metabolism in the brain.     

Is wound drainage necessary in hip arthroplasty? A meta-analysis of randomized controlled trials

Purpose

The use of closed suction drainage systems for hip arthroplasty (HA) is a common practice. However, the effectiveness and safety are still questionable. Thus, the aim of this meta-analysis was to review the advantages and adverse effects of closed suction drainage systems in hip arthroplasty.

Methods

All randomized or quasi-randomized trials comparing the use of closed suction drainage systems with no drainage systems for hip arthroplasty were searched in PubMed, Medicine, EMBASE and other internet databases. We assessed the methodological quality of the studies and abstracted the relevant data independently.

Results

Sixteen studies involving 1,663 participants with surgical wounds comparing HA with and without the use of drainage were included in our analysis. Our results demonstrated blood transfusion was required more frequently the same as the persistent discharge in those who received drains. No significant differences in the incidence of wound hematoma, dehiscence or deep vein thrombosis were found between those allocated to drains and the non-drained wounds. Wound infection and the range of movement of the joint after surgery were similar between the two groups.

Conclusions

Based on the current evidence, there is insufficient evidence to support the routine use of closed suction drainage in hip arthroplasty. At the same time, our meta-analysis study suggested that using of closed suction drainage in HA increased requirement for postoperative blood transfusion. However, there is a moderate possibility of selection bias and publication bias in this review. Because of the limited number of studies which may weaken the strength of the evidence of our results, more samples, high-quality randomized trials are needed to increase the reliability of evidences.

Level of evidence

II.     

Lumbar spinal fusion with β-TCP granules and variable Escherichia coli–derived rhBMP-2 dose

Background contextThe ideal tissue-engineered solution for any bone graft substitute is to assist in the rapid formation of bone and facilitate fusion.PurposeThe present study aims to evaluate this E-BMP-2 (Escherichia coli–derived human bone morphogenetic protein-2) in ovine posterolateral lumbar fusion (PLF) to examine the influence of dose and overall performance in a model with similar graft size and diffusive challenges to the human.Study design/settingIn vivo large animal model study.MethodsAn adult ovine PLF was performed in 30 animals with groups of E-BMP-2 with a beta-tricalcium phosphate (β-TCP) carrier at three different dosages, β-TCP alone, and autograft from the iliac crest. The fusions were assessed by radiography (X-ray and microcomputed tomography), mechanical testing, and hard-tissue histology with bone labels at 6, 8, and 10 weeks along with routine paraffin histology at 12 weeks.ResultsResults showed increasing new bone and fusion rate with E-BMP-2 dose, whereas β-TCP alone was largely resorbed and did not achieve fusion in this model at 12 weeks. Autograft showed similar grading for the amount of bone between the transverse processes but a lower fusion rate than β-TCP/E-BMP-2 groups. Bone labels revealed new bone formation at all time points for the E-BMP2 groups, whereas the autograft group showed active bone formation at 10 weeks. Beta-tricalcium phosphate displayed reliable incorporation into the decorticated host bone, whereas limited new bone was found between the transverse processes. At the center of the fusion mass, increased E-BMP-2 dose led to increased incorporation of β-TCP by new bone.ConclusionsThese results suggest that E-BMP-2 was capable of producing posterolateral fusion in the ovine model that is equal to or superior to autologous graft in terms of fusion rate and mechanical strength. E-BMP-2 dose had considerable influence on β-TCP granule resorption.     

The Relationship between Recent Stressful Life Events,Personality Traits,Perceived Family Functioning and Internet Addiction among College Students

Internet addiction (IA) is an emerging social and mental health issue among youths. Analysis of risk factors, as well as their interactions, is crucial for understanding the development of IA. This study investigated the relationship between recent stressful life events, personality traits, perceived family functioning and IA in 892 college students. Subjects were classified into categories (non‐addicted, mild IA or severe IA) using the Chen Internet Addiction Scale. Stressful life events, personality traits and family functioning were assessed using the Adolescent Self‐Rating Life Events Checklist, the Eysenck Personality Questionnaire, and the Family Adaptability and Cohesion Scale, respectively. The results indicated that compared with non‐addicted subjects, subjects with severe IA (9.98%) had lower family functioning, lower extraversion, higher neuroticism and psychoticism, and more stressful life events, and subjects with mild IA (11.21%) had higher neuroticism and more health and adaptation problems. Neuroticism and health and adaptation problems were potential predictors of IA. An interaction effect between psychoticism and total life stress on IA was also found. These findings highlight the role of personality traits and life stress and their interactions in college students' IA. Further research should explore the mechanisms underlying the interaction effect of psychoticism with life stress on IA. Copyright © 2013 John Wiley & Sons, Ltd.     

超声波对早孕蜕膜中免疫活性细胞影响的研究

采用诊断超声强度经腹部辐照宫腔.取早孕蜕膜,检测其中的免疫活性细胞,以探讨超声波对早孕蜕膜中免疫活性细胞的影响。结果表明:诊断超声强度未能影响早孕蜕膜中T淋巴细胞及其亚群的状态,却可使巨噬细胞数目减少,或许在一定程度上会削弱宫腔局部的抗感染能力。     

Induction of Retinol Dehydrogenase 9 Expression in Podocytes Attenuates Kidney Injury

The intracellular concentration of retinoic acid is determined by two sequential oxidation reactions that convert retinol to retinoic acid. We recently demonstrated that retinoic acid synthesis is significantly impaired in glomeruli of HIV-1 transgenic mice (Tg26), a murine model of HIV-associated nephropathy. This impaired retinoic acid synthesis correlates with reduced renal expression of retinol dehydrogenase 9, which catalyzes the rate-limiting step of retinoic acid synthesis by converting retinol to retinal. Because retinoic acid has renal protective effects and can induce podocyte differentiation, we hypothesized that restoration of retinoic acid synthesis could slow the progression of renal disease. Herein, we demonstrate that overexpression of retinol dehydrogenase 9 in cultured podocytes induces the expression of podocyte differentiation markers. Furthermore, we confirm that podocyte-specific overexpression of retinol dehydrogenase 9 in mice with established kidney disease due to either HIV-associated nephropathy or adriamycin-induced nephropathy decreases proteinuria, attenuates kidney injury, and restores podocyte differentiation markers. Our data suggest that restoration of retinoic acid synthesis could be a new approach to treat kidney disease.Retinoic acids (RAs) are derivatives of vitamin A and have multiple cellular functions, including inhibition of proliferation, induction of cell differentiation, and inhibition of inflammation.¹ In addition to their established benefits in the treatment of a variety of cancers, RA has also been shown to protect against renal injury in multiple experimental models of kidney disease,² including HIV-associated nephropathy (HIVAN).³ Both in vitro and in vivo studies suggest that RA restores the expression of podocyte differentiation markers, including nephrin, podocin, and synaptopodin.^3,4 These studies provide strong evidence supporting the therapeutic benefit of RA in kidney diseases with podocyte injury. In fact, a phase II clinical trial examining the efficacy of RA for treatment of podocyte diseases, including minimal change disease, FSGS, or collapsing glomerulopathy, is ongoing (ClinicalTrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT00098020","term_id":"NCT00098020"}}NCT00098020). However, clinical use of RA is challenging because of its side effects.⁵After cellular uptake, retinol is converted to RA by two sequential oxidation reactions. Retinol dehydrogenases (RHDs) oxidize retinol to retinal,⁶ which is further metabolized to retinoic acid by retinaldehyde dehydrogenases (ALDHs).⁷ The expression of these enzymes varies greatly among different cell types and at different stages of cell differentiation.⁷ Both the synthesis and metabolism of the bioactive metabolites of retinol are impaired in cancer cells.⁸ The kidney is a major organ for retinoid metabolism. However, not much is known regarding how retinoid metabolism is altered in renal disease.Our previous work showed that although the expression of retinoic acid receptor-α–target genes is suppressed in kidneys of a murine model of HIVAN (Tg26) and of patients with HIVAN, the expression of retinoic acid receptor-α is not different between normal and diseased kidneys.⁹ The concentration of RA, however, is significantly reduced in the kidney cortex and isolated glomeruli of Tg26. We also found that the glomerular concentration of RA is >10-fold higher than the concentration in the kidney cortex.⁹ Examination of enzymes involved in RA metabolism reveal that two key enzymes in the RA synthetic pathway, retinol dehydrogenase type 1 and type 9 (RDH1 and RDH9), were significantly downregulated in Tg26 glomeruli.⁹ RDH9 is a rate-limiting enzyme in RA synthesis. Because it is known that RA has renal protective effects and is able to induce podocyte differentiation, we hypothesize that overexpression of RDH9 to restore endogenous RA synthesis could slow the progression of renal disease.Consistent with our findings, recent studies also showed that endogenous RA synthesis is impaired in kidneys of diabetic db/db mice¹⁰ and TGF-β transgenic mice.¹¹ These data together with ours suggest that endogenous RA synthesis is impaired in diseased kidneys. Thus, a better understanding of RA metabolism in kidney disease could help us to identify potential new therapy for kidney diseases.