牵伸应力对假性肌腱组织结构影响的实验研究

目的：探讨假性肌腱在牵伸应力作用下组织学结构的变化，以及用于治疗肌腱缺损的可行性。方法：取健康成年日本大耳白兔36只，建立肌腱牵伸延长的动物模型，设立实验组、对照组和空白对照组，术后第7d开始延长，速度为1mm/d，分早晚两次进行，3w后停止延长，此时开始被动活动踝关节，每日两次，以增加局部的应力刺激，术后分别于3、6、9、12w取材，大体观察形成的假性肌腱的长度及光镜观察组织学结构的变化。结果：实验组的假性肌腱在大体标本上明显长于对照组，假性肌腱内胶原的含量较对照组明显增多，胶原纤维多数沿应力方向排列，组织内部的纤维细胞较对照组趋向成熟。结论：假性肌腱在牵伸应力下能够逐渐延长，实验组形成的假性肌腱在组织学结构上明显不同于对照组，应力作用能促进胶原纤维的台成并能使胶原纤维沿其纵轴重新排列。     

Copy number variant analysis from exome data in 349 patients with epileptic encephalopathy

Infantile spasms (IS) and Lennox–Gastaut syndrome (LGS) are epileptic encephalopathies characterized by early onset, intractable seizures, and poor developmental outcomes. De novo sequence mutations and copy number variants (CNVs) are causative in a subset of cases. We used exome sequence data in 349 trios with IS or LGS to identify putative de novo CNVs. We confirm 18 de novo CNVs in 17 patients (4.8%), 10 of which are likely pathogenic, giving a firm genetic diagnosis for 2.9% of patients. Confirmation of exome‐predicted CNVs by array‐based methods is still required due to false‐positive rates of prediction algorithms. Our exome‐based results are consistent with recent array‐based studies in similar cohorts and highlight novel candidate genes for IS and LGS. Ann Neurol 2015;78:323–328     

椎动脉型颈椎病功能评定量表的初步建立

目的：初步建立椎动脉型颈椎病功能评定量表(FS-CSA)。方法：在国外相关量表的基础上结合临床实际情况制订FS—CSA。采用访谈式测评111例椎动脉型颈椎病(CSA)患者，并对其中14例进行重复测评。用SPSSl0．0进行量表的信度、效度检验。结果：FS—CSA包括功能状态、心理功能两个方面内容，共11个条目。FS—CSA的功能状态维度、心理功能维度及总量表的克朗巴赫值分别为0．8759、0．6453、0．8796；重测信度值分别为0．8603、0．7148、0．8237：因子分析显示提取的公因子与两个构想维度相吻合。结论：FS—CSA具有较好的信度、效度，可作为独立的测量工具，量化CSA对患者生存质量的影响。     

Evaluation and proposal for optimalization of neurophysiological tests in migraine: part 1--electrophysiological tests

Neurophysiological testing has become a valuable tool for investigating brain excitability and nociceptive systems in headache disorders. Previous reviews have suggested that most neurophysiological tests have limited value for headache diagnosis, but a vast potential for exploring the pathophysiology of headaches, the central effects of certain pharmacological treatments and phenotype-genotype correlations. Many protocols, however, lack standardization. This meta-analytical review of neurophysiological methods in migraine was initiated by a task force within the EUROHEAD project (EU Strep LSHM-CT-2004–5044837-Workpackage 9). Most of the neurophysiological approaches that have been used in headache patients are reviewed, i.e. evoked potentials, nociception-specific blink reflex, single-fibre electromyography, neuroimaging methods (functional MRI, PET, and voxel-based morphometry) and the nitroglycerin attack-provoking test. For each of them, we summarize the results, analyse the methodological limitations and propose recommendations for improved methodology and standardization of research protocols. The first part is devoted to electrophysiological methods, the second to neuroimaging techniques and the NTG test.     

仙人掌对小鼠实验性高脂血症的降脂作用

目的研究仙人掌对实验性高血脂小鼠血清脂质含量的影响。方法以3月龄的40只雄性小鼠为实验对象,随机分为4组空白对照组、以猪油造成的高脂模型对照组、仙人掌干粉实验组、仙人掌浸出液实验组。15天后小鼠断头取血测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C),并计算出动脉硬化指数(AI)。结果与高脂对照组比较,仙人掌干粉组和仙人掌浸出液组小鼠的血清TC、TG含量和AI均极显著的降低(P<0.01),并且HDL-C含量也极显著升高(P<0.01)。结论饲喂仙人掌能够显著降低实验小鼠血清TC、TG含量及AI水平,明显升高HDL-C含量。仙人掌有可能成为一种具有降血脂作用的天然保健品。     

Provider perspectives on service delivery modifications to maintain access to HIV pre‐exposure prophylaxis during the COVID‐19 pandemic: qualitative results from a PrEP implementation project in Kenya

IntroductionHIV pre‐exposure prophylaxis (PrEP) is an essential prevention strategy being scaled up for priority populations in Kenya, including for HIV serodiscordant couples. The COVID‐19 pandemic posed challenges to PrEP rollout. We conducted a qualitative study of PrEP providers to understand how clinics adjusted PrEP delivery during the COVID‐19 pandemic.MethodsSince 2017, the Partners Scale‐Up Project has integrated PrEP into 25 HIV clinics in Central and Western Kenya. We conducted qualitative interviews with 40 purposively sampled clinic personnel. We interviewed personnel once during the first pandemic wave (May–Aug 2020) and again after some decline in COVID‐19 rates (Nov–Jan 2021). We analysed data using inductive memo‐writing and summarized data by themes along the PrEP delivery cascade, guided by the Framework for Reporting Adaptation and Modifications (FRAME).ResultsWe interviewed 27 clinical officers, five nurses, four health records and information officers, and four counsellors from Central (n = 20) and Western (n = 20) Kenya. About half (n = 19) were female, with a median age of 32 (IQR: 29–34) and 2.3 years of experience delivering PrEP (IQR: 2–3). All participants reported clinic changes in PrEP demand creation and service delivery during the pandemic. Modifications occurred during PrEP implementation and sustainment phases, were partly reactive to the pandemic and also facilitated by interim Ministry of Health guidance on PrEP delivery during COVID, and were made by PrEP delivery teams, clients and clinic managers. Commonly reported modifications included dispensing multiple‐month PrEP refills, intensifying phone‐based client engagement and collaborating with other HIV clinics to ensure that clients with prolonged stays in other regions could continue to access PrEP. Some clinics also adopted practices to streamline visits, such as within clinical‐room PrEP dispensing, pre‐packing PrEP and task‐shifting. Most providers liked these changes and hoped they would continue after the pandemic subsides.ConclusionsCOVID‐19 served as a catalyst for PrEP delivery innovations in Kenya. HIV clinics successfully and rapidly adapted their PrEP demand creation, refill and retention strategies to promote PrEP uptake and effective use. These modified implementation strategies highlight opportunities to streamline the delivery of PrEP, as well as other HIV and chronic care services, and strengthen engagement with populations post‐pandemic.     

网络药理学评价方法指南

本指南遵守了世界中医药学会联合会发布的《世界中联国际组织标准管理办法》和《标准制定和发布工作规范》(SCM0001-2009),版权归世界中医药学会联合会所有. 网络药理学是人工智能和大数据时代药物系统性研究的新兴、交叉、前沿学科,强调从系统层次和生物网络的整体角度出发,解析药物及治疗对象之间的分子关联规律,被广泛应用...