基于组分中药理论的薏苡仁-知母药对治疗糖尿病患者的配伍特点

药对是源于中医传统经方或验方,依据中药配伍原则,能长期应用并指导临床实践的两味药物相对固定的配伍形式,具有协同增效或配伍减毒的作用。薏苡仁-知母为典型的清热滋阴药对,二者相辅相成,治疗阴虚热盛型糖尿病患者效果显著。其成分知母皂苷、知母多糖、芒果苷、薏苡仁多糖等对糖尿病均有较好的干预作用。现从中医理论及现代药理学研究等层面探究薏苡仁-知母药对治疗糖尿病的配伍特点,剖析主要活性成分的降糖作用和作用机制,为治疗糖尿病的新药研究提供理论基础。     

Early changes in corneal densitometry after FS-LASIK combined with accelerated corneal cross-linking for correction of high myopia

AIM: To observe the effects of femtosecond laser-assisted excimer laser in situ keratomileusis combined with accelerated corneal cross-linking (FS-LASIK Xtra) on corneal densitometry after correcting for high myopia. METHODS: In this prospectively study, 130 patients underwent FS-LASIK or FS-LASIK Xtra for high myopia. Their right eyes were selected for inclusion in the study, of which 65 cases of 65 eyes in the FS-LASIK group, 65 patients with 65 eyes in the FS-LASIK Xtra group. Patients were evaluated for corneal densitometry at 1, 3, and 6mo postoperatively using Pentacam Scheimpflug imaging. RESULTS: Preoperative differences in corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups in different ranges were not statistically significant (P>0.05). Layer-by-layer analysis revealed statistically significant differences in the anterior (120 μm), central, and total layer corneal densitometry between the FS-LASIK and FS-LASIK Xtra groups at 1 and 3mo postoperatively (all P<0.05), the FS-LASIK Xtra group is higher than that of the FS-LASIK group. Analysis of different diameter ranges showed statistically significant differences between the FS-LASIK group and the FS-LASIK Xtra group at 1mo postoperatively in the ranges of 0–2, 2–6, and 6–10 mm (both P<0.05); At 3mo postoperatively, the FS-LASIK Xtra group is higher than that of the FS-LASIK group in the ranges of 0–2 and 2–6 mm (P<0.05). At 6mo postoperatively, there were no statistically significant differences in corneal densitometry between the FS-LASIK group and the FS-LASIK Xtra group in different diameter ranges (all P>0.05). CONCLUSION: There is an increase in internal corneal densitometry during the early postoperative period after FS-LASIK Xtra for correction of high myopia. However, the densitometry values decreased to the level of conventional FS-LASIK at 6mo after surgery, with the most significant changes observed in the superficial central zone.     

应用脱钙骨基质和硫酸钙颗粒治疗骨缺损的初期结果

目的探讨使用骨移植替代物脱钙骨基质（DBM）和硫酸钙颗粒（OSTEOSET）治疗骨缺损的疗效。方法对同期手术治疗的52例骨缺损患者的缺损处,分别于术后第1、4、8周及3、6、12个月进行随访并摄X线片直至骨缺损愈合。统计分析患者的临床资料、X线片辅助分析骨缺损修复程度和并发症。结果随访8-12个月,植骨术后6、12个月分别有95%和99%患者的骨缺损显示有明显的新骨形成,修复水平为60%-100%。并发症为3例（5.77%）,经换药后治愈,未发生骨缺损不愈合。结论DBM和OSTEOSET在骨愈合早期可加速骨缺损的修复,并可作为新鲜自体髂骨的替代物。     

胃肠道间质瘤21例临床分析

目的:探讨胃肠道间质瘤(GIST)的诊断和治疗方法。方法:收集21例GIST临床资料,进行回顾性分析。结果:21例平均年龄56.2岁,主要临床表现为腹部胀痛、腹部包块、黑便及贫血,2例无任何不适于查体时发现。9例经超声内镜检查确诊。21例均行根治性手术,肿瘤位于胃14例,小肠5例,肠系膜2例。21例均经术后病理检查及免疫组化确诊GIST,免疫组化表型以CD117、CD34阳性率较高。根据Miettinen等原则分类,良性5例,低度恶性10例,中等度恶性3例,高度恶性3例。结论:GIST的术前诊断有赖于纤维内镜、超声内镜、B超、CT等检查的综合应用,病理检查及免疫组化表型分析是确诊金标准,手术切除是最有效的治疗手段。     

Socioeconomic status,individual behaviors and risk for mental disorders: A Mendelian randomization study

BackgroundThere is increasing attention on the association of socioeconomic status and individual behaviors (SES/IB) with mental health. However, the impacts of SES/IB on mental disorders are still unclear. To provide evidence for establishing feasible strategies on disease screening and prevention, we implemented Mendelian randomization (MR) design to appraise causality between SES/IB and mental disorders.MethodsWe conducted a two-sample MR study to assess the causal effects of SES and IB (dietary habits, habitual physical activity, smoking behaviors, drinking behaviors, sleeping behaviors, leisure sedentary behaviors, risky behaviors, and reproductive behaviors) on three mental disorders, including bipolar disorder, major depressive disorder and schizophrenia. A series of filtering steps were taken to select eligible genetic instruments robustly associated with each of the traits. Inverse variance weighted was used for primary analysis, with alternative MR methods including MR-Egger, weighted median, and weighted mode estimate. Complementary methods were further used to detect pleiotropic bias.ResultsAfter Bonferroni correction and rigorous quality control, we identified that SES (educational attainment), smoking behaviors (smoking initiation, number of cigarettes per day), risky behaviors (adventurousness, number of sexual partners, automobile speeding propensity) and reproductive behavior (age at first birth) were causally associated with at least one of the mental disorders.ConclusionsMR study provides robust evidence that SES/IB play broad impacts on mental disorders.     

Study of Optimal Perimetric Testing In Children (OPTIC): developing consensus and setting research priorities for perimetry in the management of children with glaucoma

BackgroundPerimetry is important in the management of children with glaucoma, but there is limited evidence-based guidance on its use. We report an expert consensus-based study to update guidance and identify areas requiring further research.MethodsExperts were invited to participate in a modified Delphi consensus process. Panel selection was based on clinical experience of managing children with glaucoma and UK-based training to minimise diversity of view due to healthcare setting. Questionnaires were delivered electronically, and analysed to establish ‘agreement’. Divergence of opinions was investigated and resolved where possible through further iterations.Results7/9 experts invited agreed to participate. Consensus (≥5/7 (71%) in agreement) was achieved for 21/26 (80.8%) items in 2 rounds, generating recommendations to start perimetry from approximately 7 years of age (IQR: 6.75–7.25), and use qualitative methods in conjunction with automated reliability indices to assess test quality. There was a lack of agreement about defining progressive visual field (VF) loss and methods for implementing perimetry longitudinally.Panel members highlighted the importance of informing decisions based upon individual circumstances—from gauging maturity/capability when selecting tests and interpreting outcomes, to accounting for specific clinical features (e.g. poor IOP control and/or suspected progressive VF loss) when making decisions about frequency of testing.ConclusionsThere is commonality of expert views in relation to implementing perimetry and interpreting test quality in the management of children with glaucoma. However, there remains a lack of agreement about defining progressive VF loss, and utilising perimetry over an individuals’ lifetime, highlighting the need for further research.Subject terms: Paediatrics, Glaucoma     

Development and Optimization of Broadband Acoustic Metamaterial Absorber Based on Parallel–Connection Square Helmholtz Resonators

An acoustic metamaterial absorber of parallel–connection square Helmholtz resonators is proposed in this study, and its sound absorption coefficients are optimized to reduce the noise for the given conditions in the factory. A two–dimensional equivalent simulation model is built to obtain the initial value of parameters and a three–dimensional finite element model is constructed to simulate the sound absorption performance of the metamaterial cell, which aims to improve the research efficiency. The optimal parameters of metamaterial cells are obtained through the particle swarm optimization algorithm, and its effectiveness and accuracy are validated through preparing the experimental sample using 3D printing and measuring the sound absorption coefficient by the standing wave tube detection. The consistency between the experimental data and simulation data verifies feasibility of the proposed optimization method and usefulness of the developed acoustic metamaterial absorber, and the desired sound absorption performances for given conditions are achieved. The experimental results prove that parallel–connection square Helmholtz resonators can achieve an adjustable frequency spectrum for the low frequency noise control by parameter optimization, which is propitious to promote its application in reducing the noise in the factory.     

左冠状动脉曲率与左前降支狭窄对局部血流动力学的影响

目的 探究不同的左前降支(left anterior descending, LAD)狭窄程度和分叉血管曲率对血流动力学的影响。方法 建立不同分叉血管曲率半径和 LAD 分支狭窄率的理想模型,使用流固耦合( fluid-structure interaction, FSI)方法评估不同曲率半径和不同狭窄率情况下对血流和壁面剪切力相关指标的影响。 结果 LAD 发生狭窄后,高震荡剪切指数(oscillatory shear index, OSI)和高相对滞留时间(relative residence time, RRT)区域主要分布于 LAD 分叉脊对侧、弯曲外侧狭窄位置下游近端和弯曲内侧下游远端,并且随着狭窄程度的增加会扩大其区域与程度;由于曲率半径减小,弯曲内侧中的高 OSI 和 RRT 会向 LAD 下游远端分布,高 RRT 区域面积相对整个血管面积平均降幅能够达到 35. 68% 。 结论 LAD 狭窄的存在会增加狭窄位置下游和 LAD 分叉脊对侧发生继发性狭窄的风险。 曲率降低会促进弯曲内侧斑块的形成与发展,但从整个血管来看,又会细微地降低斑块形成概率。 研究结果可为治疗 LAD 病变与预防继发性狭窄提供方案设计与优化的理论参考。     

Patients' experiences across the trajectory of atrial fibrillation: A qualitative systematic review

AimThis study aimed to synthesize qualitative evidence on experiences of patients with atrial fibrillation (AF) during the course of diagnosis and treatment. We addressed three main questions: (a) What were the experiences of patients with AF during the course of diagnosis and treatment? (b) How did they respond to and cope with the disease? (c) What were the requirements during disease management?DesignIn this study, qualitative evidence synthesis was performed using the Thomas and Harden method.Data SourcesElectronic databases, including PubMed, the Cochrane Library, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the China Biomedical Database, the WanFang Database, Chinese National Knowledge Infrastructure and VIP, were searched. The databases were searched from inception to August 2021.Review MethodsTwo researchers independently selected studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis.ResultsA total of 2627 studies were identified in the initial search and 15 studies were included. Five analytical themes were generated: ‘Diagnosing AF’; ‘The impact of AF on the patients’; ‘Self‐reorientation in the therapeutic process’; ‘Living with AF and QoL’; and ‘External support to facilitate coping strategies.’ConclusionsOur findings point out unique experiences of patients across the trajectory of AF related to delayed diagnosis, feelings of nonsupport, disappointment of repeated treatment failure and multiple distress associated with unpredictable symptoms. Future research and clinical practice are expected to improve the quality of medical diagnosis and treatment, optimize administrative strategy and provide diverse health support for patients with AF.ImpactUnderstanding the experiences and needs of patients with AF in the entire disease process will inform future clinical practice in AF integrated management, which would be helpful in improving the professionalism and confidence of healthcare providers. In addition, our findings have implications for improving the effectiveness of AF diagnostic and treatment services.Patient or Public ContributionThis paper presents a review of previous studies and did not involve patients or the public.     

Anticholinergic treatment for sialorrhea in children: A systematic review

BackgroundSialorrhea in children can be associated with adverse physical and social effects. Treatment using anticholinergic medications has been shown to offer symptomatic relief, but there is no consensus regarding which treatment is the most efficacious.ObjectiveTo examine the effectiveness of anticholinergic medications for sialorrhea in children.MethodsA systematic review was carried out in Medline, EMBASE, Cochrane, Scopus, and the Web of Science from inception until April 29, 2020. Studies reporting original data on the efficacy of anticholinergic medications in the management of sialorrhea in children aged 0 to 17 years of age were included. This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Data on study design, setting, population, pharmacologic intervention(s), comparator(s), outcomes, and results were extracted and summarized.ResultsThe search strategy identified 2,800 studies of which 27 articles were included in the synthesis, including five randomized controlled trials. Each anticholinergic undergoing experimental study (glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine) showed evidence of efficacy. Adverse side effects were common. Significant heterogeneity exists in the studies’ methodology and the variability of outcome measures used between studies precluded a meta-analysis.ConclusionsGlycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine have all shown efficacy in the treatment of sialorrhea in children. The small number of reports and the variability in study design precluded a meta-analysis. More studies are needed with uniformity in outcome measures to help guide evidence-based decision making. A guidance table is presented.