箭叶淫羊藿不同时期根际微生物群落组成及其与有效成分累积的相关性分

目的 通过分析箭叶淫羊藿Epimediumsagittatum不同生育期根际微生物群落结构及其与主要药用有效成分累积之间的相关性,探讨箭叶淫羊藿根际土壤微生物对其药材有效成分的影响,为箭叶淫羊藿的优质高产栽培提供科学依据。方法 以三年生箭叶淫羊藿的根际土为研究对象,采用高通量测序技术对根际细菌和真菌群落结构进行分析,同时测定根际土壤理化性质、酶活性及不同生育期药材总黄酮、淫羊藿苷等有效成分含量,通过皮尔逊相关性分析探究土壤生态因子与有效成分之间的关系。结果 高通量测序结果显示,箭叶淫羊藿根际细菌优势菌属包括Candidatus＿Solibacter、苔藓杆菌属、嗜酸栖热菌属、芽单胞菌属等,其中,Candidatus＿Solibacter属在5个生长时期的平均丰度值最高。根际真菌优势菌属中被孢霉属相对丰度占比最大,在花蕾期样品中的丰度值高达44.27%。UPGMA聚类和非度量多维标定法（NMDS）分析表明,花蕾期、盛花期、果实膨大期及盛果期的根际土壤细菌和真菌结构相似,而药材质量稳定期与前4个时期的根际微生物群落结构存在明显差异。同时,皮尔逊相关性分析结果显示：总黄酮含量与有效磷呈显著正...     

基于熵权法评价干燥方法对经典名方华盖散基准样品质量属性的影响

目的 优选经典名方华盖散基准样品的干燥方法。方法 采用真空干燥、真空带式干燥、喷雾干燥、冷冻干燥方法制备华盖散基准样品,应用扫描电子显微镜、差式扫描量热分析、HPLC等方法测定基准样品的质量属性,以得粉率、玻璃化转变温度及成分含量转移率等为评价指标,运用熵权法对各指标赋予权重进行综合评价。结果 喷雾干燥基准样品粒子呈类球形、粒径最小,冷冻干燥基准样品不规则、蓬松、溶化性好。指标成分盐酸麻黄总碱、苦杏仁苷、橙皮苷、甘草苷、甘草酸转移率分别为85.66%～104.78%、90.81%～104.16%、91.42%～94.86%、83.98%～94.69%、87.85%～94.45%,指纹图谱相似度均大于0.9。结论 经综合评价得出冷冻干燥方法最佳,3批验证工艺重复性、可行性较好,为经典名方基准样品质量属性研究提供了理论依据和实践价值。     

经典名方甘草泻心汤基准样品的量值传递研究

目的 建立经典名方甘草泻心汤（Gancao Xiexin Decoction,GXD）基准样品的HPLC图谱及指标性成分含量测定方法,研究GXD基准样品量值传递规律。方法 制备15批GXD基准样品,建立特征图谱并选用《中药色谱指纹图谱相似度评价》软件进行相似度评价,明确特征峰并对其进行归属。测定指标性成分甘草苷、甘草酸、黄芩苷、盐酸小檗碱、表小檗碱、黄连碱、巴马汀的含量,计算指标成分转移率,分析指标成分在饮片-基准样品中量值传递的规律。结果 15批GXD基准样品指纹图谱相似度均大于0.90,共指认22个共有峰,甘草5个、黄芩5个、甘草和黄芩共有3个、黄连6个、黄芩和黄连共有2个、干姜1个;各指标成分从药材-饮片平均转移率分别为98.69%、98.13%、96.94%、94.59%、91.76%、88.08%、94.16%;饮片-基准样品平均转移率为49.08%、42.24%、28.34%、26.72%、29.32%、33.62%、47.93%。结论 特征图谱与多指标成分含量测定方法相结合,对GXD药材-饮片-基准样品的量值传递过程进行分析研究,为经典名方GXD制剂开发提供参考。     

北京地区老年髋部脆性骨折患者术后抗骨质疏松症药物治疗现状及影响因素分析

目的 评估北京地区老年髋部脆性骨折患者术后抗骨质疏松症药物（AOM）治疗现状并探讨其影响因素。方法 横断面研究。纳入2018年11月—2019年11月北京积水潭医院、北京医院、北京安贞医院、北京市昌平区医院、北京市顺义区医院、北京市房山区良乡医院收治的髋部脆性骨折患者1 963例,总结其人口学特征,并收集患者入院后30、120、365 d的临床资料,AOM治疗及健康基本补充剂使用情况。通过单因素和多因素logistic回归分析AOM治疗的影响因素。结果 1 963例老年髋部脆性骨折患者,住院时年龄65~102（79.3±7.2）岁,≥80岁患者占56.7%（1 113/1 963）;男性患者占30.8%（604/1 963）,女性患者占69.2%（1 359/1 963）;股骨颈骨折846例,股骨粗隆间骨折1 077例,股骨粗隆下骨折40例。综合3个时间点,在髋部骨折后1年内,33.0%（648/1 963）的患者接受过AOM治疗,71.0%（1 394/1 963）的患者使用过健康基本补充剂。入院后30、120、365 d患者AOM治疗率分别为23.0%（451/1 963）、17.9%（353/1 963）、21.0%（412/1 963）,健康基本补充剂使用率分别为59.0%（1 158/1 963）、45.0%（883/1 963）、38.0%（746/1 963）。单因素分析结果显示,年龄≥80岁[粗比值比（OR）=0.645,95%可信区间（CI） 0.495~0.840]、男性（粗OR=0.760,95% CI 0.581~0.996）、共管模式（粗OR=3.025,95% CI 0.973~9.405）、居住地农村（粗OR=0.523,95% CI 0.388~0.704）、AOM服用史（粗OR=7.612,95% CI 2.227~26.020）、既往骨质疏松症史（粗OR=5.065,95% CI 3.149~8.147）、骨质疏松评估（粗OR=1.379,95% CI 1.105~2.451）是AOM治疗的影响因素。多因素分析结果显示,年龄≥80岁（调整后OR=0.618,95% CI 0.488~0.781）、男性（调整后OR=0.716,95% CI 0.565~0.908）、居住地农村（调整后OR=0.492,95% CI 0.375~0.645）是AOM治疗的危险因素;共管模式（调整后OR=2.632,95% CI 1.004~6.897）、AOM服用史（调整后OR=4.870,95% CI 2.080~11.402）、既往骨质疏松症史（调整后OR=4.804,95% CI 3.253~7.096）、骨质疏松评估（调整后OR=1.393,95% CI 1.041~1.862）是AOM治疗的保护因素。结论 北京地区老年髋部脆性骨折患者的AOM治疗率偏低。年龄≥80岁、男性、在农村居住的髋部脆性骨折患者治疗率较低,可采取共管模式,术前进行骨质疏松诊断与评估,提高骨质疏松治疗率。     

节段内U形钛棒固定系统结合峡部植骨治疗腰椎峡部裂的临床效果

目的 研究U形钛棒内固定系统结合峡部植骨治疗腰椎峡部裂的临床疗效.方法 纳入2015年2月～2018年12月本科收治的50例不伴有椎间盘突出及腰椎滑脱的单纯性腰椎峡部裂患者;累及节段L34例,L414例,L532例.采用节段内U形钛棒固定系统结合峡部植骨治疗30例(U形钛棒组),节段间椎弓根螺钉系统结合峡部植骨治疗20例(椎弓根钉组).对比两组术前及末次随访时的VAS评分、ODI指数以及腰椎活动度以及并发症发生情况.通过腰椎CT评价峡部骨折愈合情况.结果 所有患者随访12～24个月,平均(18.2±7.3)个月.末次随访时两组疼痛VAS评分、ODI指数较术前均显著降低(P<0.05),但两组间差异无统计学意义(P>0.05),但U形钛棒组腰椎活动度显著大于椎弓根钉组,差异有统计学意义(P<0.05).末次随访两组患者峡部裂骨性愈合时间无显著性差异(P>0.05).所有手术切口均Ⅰ期愈合,植骨骨性融合,无感染、慢性疼痛、内固定松动等并发症发生.结论 对于不伴有椎间盘突出及腰椎滑脱的单纯性腰椎峡部裂患者,节段内U形钛棒固定与节段间椎弓根钉固定结合峡部植骨治疗均能取得良好疗效,但前者更有利于保留腰椎的活动度.     

内蒙古自治区不同生态系鼠疫自然疫源地动物鼠疫流行现状及流行风险简析

内蒙古面临着多种类型疫源地鼠疫流行和复燃的风险。蒙古旱獭疫源地虽然暂未在国内发现动物间鼠疫流行,但过去检出过阳性血清,同时蒙古旱獭种群数量持续增加且分布范围不断扩大,毗邻的蒙古国和俄罗斯联邦的蒙古旱獭疫源地动物间鼠疫持续流行;达乌尔黄鼠疫源地动物间鼠疫时隐时现;长爪沙鼠疫源地动物间鼠疫流行猛烈,并频频波及人间。由于蒙古旱獭和达乌尔黄鼠鼠疫耶尔森菌菌株毒力明显高于长爪沙鼠鼠疫耶尔森菌菌株,且在历史上曾给当地带来深重灾难,因此内蒙古自治区鼠疫防控重点应在常规鼠疫监测的基础上,进一步加强蒙古旱獭和达乌尔黄鼠疫源地流行动态的监测,警惕该两个疫源地复燃并波及人间。     

内镜下全腹膜外Sublay修补在腹壁疝中的应用

目的评价腹壁疝内镜下全腹膜外Sublay(TES)手术的效果并总结经验。方法回顾性总结国内10所医院自2016年3月至2019年7月115例腹壁疝内镜下TES手术的患者资料。分析患者情况、疝的特点、手术经过和结果。结果115例计划实施TES的患者中,因严重腹膜破损中转为IPOM修补患者1例,其余均成功手术。可以缝合缺损患者108例(94.74%),需要永久补片固定患者15例(13.16%)。放置引流患者76例(66.67%),中位手术时间为144 min,术中无严重并发症发生。随访时间3~45个月,总并发症发生率为20例(17.54%),其中出现血清肿患者5例(4.38%)。绝大多数患者术后仅出现轻微疼痛,未出现慢性疼痛。结论在腹壁疝的治疗中,对熟悉腹壁解剖的外科医师而言,TES是一种有效、安全的修复手段。在熟悉手术的基础上适应症可逐步拓展。     

Surgical Treatment and Proposed Modified Classification for Harrington Class III Periacetabular Metastases

ObjectivesThis study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification.MethodsThis study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P < 0.1 as significant.ResultsIn phase 1, the mean surgical time was 273.1 (180 to 390) min and the mean intraoperative hemorrhage was 2425.0 (400.0 to 8000.0) mL, respectively. The mean follow‐up time was 18.5 (2 to 54) months. Recurrence was found in 4 patients and the 2‐year RFS rate was 62.4% (95% confidence interval [CI] 31.6% to 93.2%). The mean postoperative MSTS93 score was 56.5% (20% to 90%). Based on the periacetabular bone destruction, we categorized the lesions into two subgroups: with the bone destruction distal to or around the inferior border of the sacroiliac joint (IIIa) and the bone destruction extended proximal to inferior border of the sacroiliac joint (IIIb). Six patients with IIIb lesions had significant prolonged surgical time (313.3 vs 249.0 min, P = 0.022), massive intraoperative hemorrhage (3533.3 vs 1760.0 mL, P = 0.093), poor functional outcome (46.7% vs 62.3%, P = 0.093), and unfavorable local control (31.3% vs 80.0%, P = 0.037) compared to the 10 patients with IIIa lesions. We then modified the surgical strategy for two subgroup of class III lesions: Harrington/modified Harrington procedure for IIIa lesions and en bloc resection followed by modular hemipelvic endoprosthesis replacement for IIIb lesions. Using the proposed modified surgical classification, 62 patients in the phase 2 study demonstrated improved surgical time (245.3 min, P = 0.086), intraoperative hemorrhage (1466.0 mL, P = 0.092), postoperative MSTS 93 scores (65.3%, P = 0.067), and 2‐year RFS rate (91.3%, P = 0.002) during a mean follow‐up time of 19.9 (1 to 60) months compared to those in the phase 1 study.ConclusionThe Harrington surgical classification is insufficient for class III lesions. We proposed modification of the classification for Harrington class III lesions by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. Our proposed modified classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for Harrington class III lesions.     

Novel glucose-lowering drugs for non-alcoholic fatty liver disease

BACKGROUNDThe efficacy of novel glucose-lowering drugs in treating non-alcoholic fatty liver disease (NAFLD) is unknown.AIMTo evaluate the efficacy of glucose-lowering drugs dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors in treating NAFLD and to perform a comparison between these treatments.METHODSElectronic databases were systematically searched. The inclusion criteria were: Randomized controlled trials comparing DPP-4 inhibitors, GLP-1 RAs, or SGLT2 inhibitors against placebo or other active glucose-lowering drugs in NAFLD patients, with outcomes of changes in liver enzyme [alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST)] from baseline.RESULTSNineteen studies were finally included in this meta-analysis. Compared with placebo or other active glucose-lowering drug treatment, treatment with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors all led to a significant decrease in ALT change and AST change from baseline. The difference between the DPP-4 inhibitor and SGLT2 inhibitor groups in ALT change was significant in favor of DPP-4 inhibitor treatment (P < 0.05). The trends of reduction in magnetic resonance imaging proton density fat fraction and visceral fat area changes were also observed in all the novel glucose-lowering agent treatment groups.CONCLUSIONTreatment with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors resulted in improvements in serum ALT and AST levels and body fat composition, indicating a beneficial effect in improving liver injury and reducing liver fat in NAFLD patients.