三伏天穴位拔罐敷贴治疗支气管炎、哮喘112例临床观察

目的 观察三伏天穴位拔罐贴敷对支气管炎、哮喘的临床疗效。方法 对112例患者，采用本院自制”伏贴膏”．在背部钉穴拔罐后，将药饼用胶布贴于穴位上，4-6h后患者自行去掉。结果 显效63例，有效45例．无效4例．总有效率为96．43%。结论 三伏天穴位拔罐、药物贴敷对防治支气管炎、哮喘有较好的疗效。     

基于化学成分与肠道菌群探讨消癌解毒方中黄连-乌梅药对的配伍机制

目的 探讨黄连-乌梅药对与消癌解毒方水煎液中部分生物碱类成分的含量差异,并比较药对与全方对小鼠肠道菌群的影响。方法 采用Extend-C₁₈(100 mm×2.1 mm,1.8 μm)色谱柱,以0.1%甲酸水（A）-乙腈（B）进行梯度洗脱,流速0.3 mL/min,柱温35 ℃,进样量2 μL;离子化模式为电喷雾离子化（ESI）,以正离子模式检测,开展方法学验证和含量测定研究。按照给药不同将小鼠分为正常组、全方高浓度组、全方低浓度组、药对高浓度组和药对低浓度组,连续灌胃给药7 d,每组分别收集粪便样本,进行16S rRNA基因测序。结果 建立的含量测定方法在一定浓度范围内线性关系良好,方法学验证结果均符合相关要求,木兰花碱与非洲防己碱在黄连、药对以及全方中的含量分别为:(4.433±0.133)(8.905±0.154) mg/g,（3.545±0.033）（9.170±0.051） mg/g,（5.287±0.038）（13.861±0.690） mg/g。全方组和药对组中拟杆菌门Bacteroides的丰度均高于正常组,而全方组和药对组中厚壁菌门Firmicutes的丰度均低于正常组。药对高浓度组中的疣微菌门Verrucomicrobia和变形菌门Proteobacteria的丰度高于其他组。结论 液质联用方法和相关参数简便、可靠,可用于有关成分的含量检测。与单味药中含量相比,经过药对配伍后,非洲防己碱含量增加,而木兰花碱含量则略有降低;经过全方配伍后,2种成分的含量均增加。此外,肠道菌群实验表明无论是药对还是全方在给药后,会不同程度地影响肠道菌群内部占比改变,其可能对调节肠道系统平衡,具有一定帮助作用,从而为进一步阐释黄连-乌梅在消癌解毒方中配伍机制提供了参考和依据。      

Epidemiologic Correlation and Drug Resistance Analysis of Pathogenic Bacteria in Different Open Limb Injury External Conditions

ObjectiveTo study the epidemiological correlation and drug resistance of external factors of infection caused by open injury of limbs to pathogens.MethodsThis experiment is a retrospective study. We took the geographical location and climate of Nanchang, Jiangxi Province, China as the background, analyzed 2017 strains of pathogens from 1589 patients with limb trauma infection in a University Affiliated Hospital from 2012 to 2017. Patients were divided into three groups according to the type of incision: I, In‐hospital infection of clean limb incision, II, In‐hospital infection with open injury, III, Community infection with open injury of the limb. Groups II and Groups III were divided into six subgroups according to the causes of trauma, including: accidents from non‐motor vehicles, machinery, cutting/piercing, pedestrian injuries, struck by/against, pedal cycles, and other injuries. We found eight common pathogens of orthopedic infection, which were mainly divided into Gram‐positive bacteria (G+, mainly including Staphylococcus) and Gram‐negative bacteria (G‐, mainly Enterobacteriaceae). The relationship between main pathogens and damage mechanism, apparent temperature and relative humidity was discussed in this study. SPSS v22.0 was used for statistical analysis of the data. Friedman''s two‐way ANOVA was used to analyze the difference between the injury mechanism and incidence of pathogenic bacteria. Linear regression was used to determine the trend between the incidence of major pathogens and seasonal temperature and humidity. The level of significance was set as P < 0.05.ResultsThere was no significant difference in the distribution of pathogens between Groups II and Groups III (P>0.05). The drug resistance of Groups III was significantly higher than that of Groups II and Groups I. G+ bacteria were resistant to cephalosporin, ceftriaxone and other cephalosporins and erythromycin and other macrolides. They were sensitive to vancomycin and linezolid. G‐ were resistant to the first‐ and the second‐generation cephalosporins, including cefotetan and cefazolin, and ampicillin and other penicillins, while they were sensitive to third‐generation cephalosporins, such as ceftazidime, as well as to levofloxacin and other quinolones, meropenem, and other beta‐lactamases. The correlation between the injury mechanism and infection of pathogenic bacteria was not significant. The monthly average apparent temperature and relative humidity were correlated with the infection rate of pathogenic bacteria.ConclusionIn open injury of extremities, apparent temperature and relative humidity is an important risk factor for infection by pathogenic bacteria and the drug resistance of pathogenic bacteria in out‐of‐hospital infection was lower than that of hospital infection.     

乳铁蛋白对大鼠成骨细胞增殖与分化的影响

目的观察乳铁蛋白(Lf)对大鼠成骨细胞增殖分化的影响,初步探讨Lf对成骨细胞的作用机制。方法用不同浓度的Lf干预成骨细胞,在不同时间分别测定细胞数目的增殖、细胞内碱性磷酸酶活性,并用半定量RT-PCR法检测成骨细胞内RANKL/OPG mRNA基因的表达。结果Lf呈时间和浓度依赖性地促进大鼠成骨细胞增殖及碱性磷酸酶活性,每组实验在不同时间的差异均有显著的统计学意义(P<0.05),其中400μg/ml组在72h时细胞增殖数目达到最大。在碱性磷酸酶活性方面,400μg/ml组在72h时则有所下降。不同浓度Lf、不同作用时间均能促使成骨细胞中OPG mRNA表达增加,同时抑制RANKL mRNA表达。结论Lf能促进成骨细胞的增殖分化,并且能够调节成骨细胞RANKL/ OPG mRNA表达,从而抑制破骨细胞介导的骨吸收。     

HPV及HLA在宫颈癌发生中的免疫机制研究进展

人乳头状瘤病毒(HPV),尤其是高危型HPV感染是导致宫颈癌的必要非充分条件.近年研究提出,宿主自身免疫遗传背景不仅参与病毒感染,而且参与肿瘤免疫,并在介导免疫识别、免疫应答、自然杀伤细胞自然杀伤作用和免疫调节力等方面发挥关键作用.深入探讨HPV病毒感染与人白细胞抗原(HLA)基因多态性的易感性、宫颈癌类型与人白细胞抗原(HLA)及其配体杀伤细胞免疫球蛋白样受体(KIR)易感性成为医学多学科共同研究的热点.现对HPV及HLA在宫颈癌发生中的免疫机制的最新研究进展给予综述.     

Thyroid dysfunction during PD-1 inhibitor treatment in patients with cancer: Incidence and association with progression-free survival

The use of programmed cell death-1 (PD-1) inhibitors has recently been approved in China. As a consequence, the identification of relevant prognostic markers that can assess the efficacy of these compounds is required. Therefore, the present study aimed to explore the incidence of thyroid dysfunction and its ability to predict progression-free survival (PFS) in Chinese patients with cancer who received PD-1 inhibitor treatment. Data from 72 patients with cancer who received treatment with PD-1 inhibitors alone or in combination with chemotherapy or targeted drugs were analyzed. Moreover, the expression levels of free triiodothyronine, thyroxine, and thyrotropin during treatment were assessed to evaluate thyroid dysfunction. A total of 26 (36.1%) patients who had received PD-1 inhibitors developed thyroid dysfunction. Specifically, the incidence of thyroid dysfunction was 35.6% in patients with lung cancer, 25.0% in patients with malignant melanoma, and 46.7% in patients with other types of cancer. In addition, the median PFS was 7.0 (95% confidence interval, 4.9-9.1) months, whereas the 1- and 2-year PFS rates were 35.1 and 26.2%, respectively. Generally, patients with thyroid dysfunction exhibited longer PFS compared with those without thyroid dysfunction (P=0.001). Subgroup analyses were subsequently performed, which demonstrated that thyroid dysfunction was associated with longer PFS in patients with malignant melanoma (P=0.039) and other types of cancer (P=0.002), but not in those with lung cancer (P=0.083). These findings were noted in patients who received PD-1 inhibitor monotherapy (P=0.003), but not PD-1 inhibitor plus chemotherapy (P=0.172) or PD-1 inhibitor plus targeted therapy (P=0.582). Finally, thyroid dysfunction [P=0.001; hazard ratio (HR)=0.260] and PD-1 inhibitor monotherapy (P=0.015; HR=2.231) were identified as independent factors that could predict PFS. In conclusion, the present study demonstrated that thyroid dysfunction during PD-1 inhibitor treatment could be used as a potential marker for the prognosis of favorable PFS in patients with cancer.     

Comparing the efficacy of different intra-articular injections for knee osteoarthritis: A network analysis

Background:The findings on the effectiveness of platelet-rich plasma, ozone, and hyaluronic acid in the treatment of osteoarthritis of the knee are controversial, and the existing original studies and meta-analyses are mostly comparisons of a single joint cavity injection method, lacking direct and indirect comparisons of different drugs in the joint cavity. The lack of direct and indirect comparisons of different drugs in the joint cavity makes it difficult to have a clearer and more comprehensive understanding of joint cavity injection methods. In this study, the efficacy of platelet-rich, ozone, sodium hyaluronate, and combined knee cavity injections were compared directly or indirectly using a reticulated meta-analysis in this field, and the efficacy of treatment measures was ranked to provide more comprehensive and reliable evidence-based clinical evidence for the selection of knee cavity injections in osteoarthritis of the knee.Objective:To compare the effects of platelet-rich plasma, ozone, and sodium glassate injection interventions on the efficacy of osteoarthritis of the knee through reticulated Meta-analysis, and to comprehensively compare the clinical effectiveness of platelet-rich plasma, ozone, and sodium glassate injection joint cavity injection for the treatment of osteoarthritis of the knee.Methods:The PubMed, CBM, CNKI, VIP, and Wan-Fang databases were searched for information on the effectiveness of platelet-rich plasma, ozone, and sodium vitrate injection for the comparative treatment of osteoarthritis of the knee, with a search time frame of each database from the date of creation to July 20, 2021. Two investigators independently screened the literature, extracted data according to inclusion and exclusion criteria, and evaluated the quality of the literature in parallel. Statistical analysis was performed using Stata 16.0 software to compare the differences in the efficacy of each treatment measure using the ratio and 95% confidence interval as effect indicators and to rank the efficacy.Results:Thirty-three RCTs with 7003 patients with osteoarthritis of the knee were included, involving 5 therapeutic measures. Meta-analysis showed that the efficacy of platelet-rich plasma injection was superior to both ozone and hyaluronic acid therapies. Hyaluronic acid+ozone and platelet-rich plasma+hyaluronic acid were both superior to ozone and hyaluronic acid monotherapy. The differences in efficacy between hyaluronic acid and ozone compared with platelet-rich plasma were statistically significant, and the differences in efficacy between the 2 combination therapies (platelet-rich plasma+hyaluronic acid, hyaluronic acid+ozone) and the 3 monotherapies (platelet-rich plasma, ozone, hyaluronic acid) were statistically significant. Platelet-rich plasma+hyaluronic acid, hyaluronic acid+ozone compared with 3 monotherapies (platelet-rich plasma, ozone, hyaluronic acid) were statistically significant, except for the difference in efficacy with platelet-rich plasma, which was not statistically significant, indicating that this platelet-rich plasma+hyaluronic acid and Hyaluronic acid+ozone combination therapy was superior to monotherapy. Also, the efficacy of platelet-rich plasma was better than hyaluronic acid and ozone and the difference was statistically significant, indicating that platelet-rich plasma was more effective than ozone and sodium glass in the treatment of osteoarthritis of the knee in monotherapy.Conclusion:It is believed that in the course of clinical practice, hyaluronic acid+ozone or platelet-rich plasma+hyaluronic acid combination therapy or platelet-rich plasma therapy can be preferred for patients with osteoarthritis of the knee.     

微卡胸膜腔注入治疗恶性胸腔积液的临床观察 5839

目的观察微卡胸膜腔内注入治疗恶性胸腔积液的效果和不良反应。方法2005年8月至2006年12月病理确诊的原发性支气管肺癌并恶性胸腔积液患者52例,胸膜腔内置入细管并接负压瓶,引流完胸腔积液后,随机分为两组,一组共27例胸腔内注入微卡225ug(微卡组);另一组共25例注入高聚生4000单位(高聚金组),观察对比两组的效果和不良反应。结果微卡组治疗效果CR6例、PR15例、NC4例、PD2例,有效率77.8%;高聚金组CR4例、PR16例、NC5例,有效率80.0%,两组的有效率无差异显著性(P>0.05)。微卡组患者80.0%(16/20),高聚金组81.2%(13/16)治疗后气促胸闷症状均有不同程度的改善甚至消失,两组比较无差异显著性(Fisher′s精确检验,P=1.00)。两组kamofsky评分治疗后比治疗前提高,微卡组平均提高(17.8±7.5)分;高聚金组(20.8±8.6)分,两组比较无差异显著性(t=1.35,P=0.183),两组均无严重不良反应事件,微卡组发热发生率33.3%,高聚生组48.0%,以低、中度发热为主,持续1～3d,经对症处理可缓解。结论微卡用于治疗恶性胸腔积液效果较好,不良反应轻微。     

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。     

皮肤分枝杆菌感染的研究进展

皮肤分枝杆菌感染是一类复杂的皮肤疾病,临床和病理无特异表现,易漏诊误诊。临床上大致分为3类,皮肤结核、麻风、非结核分枝杆菌感染性皮肤病。本文就各类分枝杆菌感染相关的皮肤疾病进行流行病学特征、临床表现、诊断及治疗进展进行综述。