中西医结合治疗216例哮喘儿童的临床效果与生活质量评价

目的对中西医结合治疗支气管哮喘（简称哮喘）患儿临床疗效与生活质量进行评价,并以单纯西医治疗为对照,探讨哮喘中西医结合治疗的优势。方法在GINA方案的基础上将444例哮喘患儿随机分为观察组和对照组,观察组加用中药汤剂及穴位贴敷,总疗程2年,观察两组治疗前后临床疗效指标及生活质量变化。结果在改善肺功能、减少呼吸道感染次数方面,两组比较差异有统计学意义（P〈0．01）,观察组优于对照组。观察组在住院率、急诊率、缺课率（节）、心理障碍率、运动受限率等方面优于对照组,P〈0．01,提高哮喘患儿生活质量方面优于对照组。结论中西医结合治疗小儿哮喘能显著改善哮喘患儿临床症状及肺功能,具有较好的远期疗效,并能显著提高哮喘患儿的生活质量。     

Neonatal clavicular fracture: clinical analysis of incidence, predisposing factors, diagnosis, and outcome

The objective of this study is to identify maternal, perinatal, and fetal risk factors for clavicular fracture in a single institution. We performed a prospective study of all deliveries during a 14-month period to identify confirmed cases of neonatal clavicular fracture. The control group consisted of the deliveries immediately preceding and following the index cases. Fifty-three cases of clavicular fracture were identified among the 4789 deliveries from October 1995 through November 1996 for an incidence of 1.11%. Three neonates in the clavicular fracture group were delivered through cesarean section. Neonates with fracture were significantly heavier at birth than those without (3564 vs. 3283 g, p <0.001), and had a lower mean head-to-abdominal circumference ratio (0.93 vs. 1.08, p <0.001), history of giving birth to a macrosomia (21 vs. 4%, p <0.05). The anterior shoulder was the predominant site of fracture (30/53). Fracture was detected mostly during the first 3 days of neonatal life (46/53). The outcome was benign, with complete recovery in all cases and no associated neurological sequelae. Neonatal clavicular fracture tended to be associated with neonatal somatometric characteristics and difficult deliveries. Considering the benign nature of this birth trauma, more invasive intrapartum management to lower its incidence is not advised.     

Elucidating the mechanism of nucleation inhibition of pathology crystallization of gout based on the evidence from amorphous form and in solution

The first gout attack in a hyperuricaemic patient may be regarded as a nucleation event which is caused by monosodium urate monohydrate (MSUM) deposition in the synovial fluid. The effect of Tailor-Made Inhibition (TMI) may be effective as drugs for the prevention of aberrant nucleation and crystallization. Therefore, the understanding of the underlying mechanisms in inhibiting the MSUM nucleation by TMI has proven to be of great significance. Yet most of the published studies about nucleation inhibition have tended to focus on simpler molecular models with a hydrogen-bonded acceptor and donor, which may be not suitable for the uric acid molecule with multiple hydrogen-bonded acceptors and donors under physiological conditions. Herein, the mechanisms of nucleation inhibition of MSUM were explored in a simulated biological environment (0.15 M Na⁺ and pH 7.40) in the presence and absence of TMI. And the evidence of nucleation inhibition by TMI in solution and the amorphous form of MSUM was investigated by HNMR, IR, Raman, PXRD, Dynamic light scattering (DLS), induction time measurements, and density functional theory (DFT) calculations. Results showed that the inhibition comes from a combination of kinetic and thermodynamic effects, with an impact of kinetics as the TMI inhibition effects far exceeded what could be accounted for by changes in usual factors of classical nucleation theory. The data demonstrated that the complex between urate and TMI disturbed the formation of two-dimensional sheets of sodion and purine rings parallel to the (011) plane and further impeded the formation of a three-dimensional structure with aromatic stacking interactions in solution. To our knowledge, the nucleation inhibition of TMI is achieved by suppressing interplanar stacking, which is a mechanism proposed for the first time.

Xanthine, a tailor-made inhibitor, could suppress nucleation in the crystallization of gout pathology by blocking the dominant interplanar accumulation in a solution.     

Association between paternal age and risk of schizophrenia: a nationwide population–based study

PurposeTo study the association between paternal age and schizophrenia in offspring.MethodsThis report describes a nationwide population-based cohort study from 1997 to 2013. Data from Taiwan’s National Health Insurance Research Database were utilized to answer the research question. A total of 17,649 offspring with schizophrenia were selected from 11 million offspring in the general population. Additionally, we established the offspring without schizophrenia as the comparison group by matching the study cohort by age, gender in a 1:4 ratio (n = 70,596).ResultsThe median age at first presentation with schizophrenia was 20 years (interquartile range (IQR), 17 to 24). Comparison of the schizophrenia and non-schizophrenia groups indicated that father’s age at birth (30.0 (IQR), 27 to 33 vs. 29.0 (IQR), 26 to 32 years), mother’s age at birth (26.0 (IQR), 24 to 29 vs. 26.0 (IQR), 23 to 29 years), paternal schizophrenia (2.6% vs. 0.6%), and maternal schizophrenia (4.4% vs. 0.7%) were all significantly greater in the schizophrenia group. In addition, each 5-year increase in father’s age increased the odds of being diagnosed with schizophrenia (model 1: aOR = 1.22; 95% CI 1.20, 1.24; model 2: aOR = 1.20; 95% CI 1.18, 1.23). Subgroup analysis showed that each 5-year increase in father’s age increased the odds of being diagnosed with schizophrenia in male and female offspring, as well as in offspring of mothers and fathers with or without schizophrenia (aOR = 1.20 to 2.20, all p values < 0.01).ConclusionThis study indicated that advanced paternal age increased the risk of schizophrenia in offspring. Offspring born to fathers older by 5-year increments were at heightened risk of schizophrenia.     

头皮针联合康复训练对脑卒中后轻度认知障碍患者脑血流动力学及血管内皮功能的影响

目的:观察头皮针联合康复训练对脑卒中后轻度认知障碍患者血管内皮功能及脑血流动力学的影响。方法:选取2011年3月至2017年3月辽宁中医药大学附属第二医院收治并确诊为脑卒中(缺血性脑梗死与脑出血)后合并轻度认知障碍的患者100例,按照入选的先后顺序分为观察组与对照组,每组50例,对照组给予常规药物治疗与康复训练治疗,观察组在对照组基础上给予头皮针治疗,连续治疗3个月。治疗前与治疗过程中(2周、1个月、3个月)比较2组脑循环参数[经颅多普勒超声(TCD)测量双侧椎动脉(VA)、大脑中动脉(MCA)、大脑前动脉(ACA)阻力指数(RI)]、血管内皮功能[血清一氧化氮(NO)、内皮素-1(ET-1)]的变化。结果:治疗后2组的双侧VA、MCA、ACA的RI均低于治疗前,差异有统计学意义(P 0. 05),且治疗后各时间点观察组低于对照组,差异有统计学意义(P 0. 05);治疗过程中(2周、1个月、3个月) 2组的血清NO均高于治疗前,差异有统计学意义(P 0. 05),且治疗后各时间点观察组高于对照组,差异有统计学意义(P 0. 05),治疗后2组的血清ET-1均低于治疗前,差异有统计学意义(P 0. 05),且治疗后各时间点观察组低于对照组,差异有统计学意义(P 0. 05)。结论:头皮针结合康复训练能通过改善脑卒中后合并轻度认知障碍患者的血管内皮功能而调节血流动力学。     

PCI术后双联抗血小板导致消化道大出血的相关因素分析

目的：探讨冠心病经皮冠状动脉介入术(PCI)术后双联抗血小板治疗中消化道大出血的相关危险因素。方法：收集湖南省人民医院2015年1月～2020年12月冠心病PCI术后患者1335例为研究对象,因消化道大出血再入院患者46例(占3.4%),纳入消化道大出血组;无消化道出血者1289例(占96.6%)用等距随机抽样法选出50例作为对照组。比较两组患者的性别、年龄、肾功能、低蛋白血症、糖尿病史、高血压史、高脂血症、吸烟史、饮酒史、联合口服PPI、血管病变支数等相关情况,探讨冠心病双联抗血小板治疗中消化道大出血的相关危险因素。结果：单因素logistic回归分析显示PCI术后消化道大出血组年龄≥65岁、肾功能异常、低蛋白血症、吸烟史占比高于对照组,联合口服PPI占比低于对照组。差异具有统计学意义,出血组与对照组在性别、高血压史、糖尿病史、饮酒史、血管病变支数病史两组比较差异无统计学意义。多因素logistic回归分析显示低蛋白血症是消化道大出血的独立危险因素。结论：高龄、肾功能异常、低蛋白血症、吸烟史等是PCI术后双联抗血小板导致消化道大出血的危险因素,尤其低蛋白血症是消化道大出血的独立危险因...     

老年住院患者社会衰弱与生理衰弱的相关性

目的 采用横断面研究分析≥60岁住院患者的社会衰弱情况,并探讨其与躯体功能的关系.方法 选取首都医科大学宣武医院老年医学综合科≥60岁的住院患者258例,应用社会衰弱量表(HALFT)评估社会衰弱情况,将评分≥3分患者纳入社会衰弱组,其中1～2分患者纳入社会衰弱前期组,0分患者纳入无社会衰弱组,分析社会衰弱的患病情况及...     

急性冠状动脉综合征中医辨证分型与冠状动脉SYNTAX积分及短期预后的关系

目的探讨急性冠状动脉综合征（ACS）患者中医辨证分型与冠状动脉病变的关系及对短期预后的影响。方法252例ACS患者根据中医辨证分型分为4组：D血瘀阻证组（178例）、气阴两虚证组（50例）、心肾阴虚证组（14例）和痰阻心脉证组（10例）。经冠状动脉造影明确冠状动脉病变,分析不同证型对住院期间和短期预后的影响。结果252例患者中,三支和二支病变者182例（72．2％）,B型和C型病变214例（85．0％）,左主干病变44例（17．5％）,慢性完全闭塞病变68例（27．0％）。痰阻心脉证组（10例）、心血瘀阻证组（178例）、心肾阴虚证组（14例）、气阴两虚证组（50例）患者SYNTAX评分分别为（33．2±2．0）、（29．7±2．3）、（27．6±1．9）、（28．5±2．5）分,痰阻心脉证组SYNTAX评分明显高于心肾阴虚证组及气阴两虚证组,差异有统计学意义（P〈0．05）。痰阻一tk,脉证组三支病变（7／10）、左主干病变（5／10）、慢性完全闭塞性病变（4／10）、c型病变（9／10）比例均明显高于其他3组,差异有统计学意义（P〈0．05）。住院期间4组均无主要心血管不良事件（MACE）发生。随访半年时痰阻心脉证组MACE发生率（3／10）高于心血瘀阻证组[3．9％（7／178）]、气阴两虚证组[4．0％（2／50）]和心肾阴虚证组（0）。结论ACS主要中医证型为心血瘀阻证。尽管痰阻心脉证患者较少,但冠状动脉SYNTAX积分高,病变高危复杂,短期预后较差,临床上应该高度重视这一证型的患者,及早行冠状动脉检查以明确病变并规范治疗。     

反相高效液相色谱荧光检测法测定血浆及膀胱中阿霉素的浓度

目的建立测定血浆及膀胱组织中阿霉素含量的反相高效液相色谱法。初步应用于膀胱癌患者膀胱内灌注阿霉素预防膀胱肿瘤术后复发的疗效观察。方法血浆中样品用二氯甲烷-异丙醇混合液提取,膀胱组织制成匀浆后经二氯甲烷-异丙醇混合液提取,Hypersil ODS柱(4.6 mm×200 mm,10μm)为分析柱,甲醇-0.01 mol.L-1磷酸二氢钾-冰醋酸(85∶15∶0.5)为流动相,检测波长为E4X75 nm、E54M5 nm,以柔红霉素为内标。结果血浆及膀胱组织中阿霉素的线性范围分别为10~300 ng.ml-1和0.1~1.0μg.g-1,日内、日间误差RSD均小于10%,平均回收率分别为104.39%和94.52%。结论本法测定血浆及膀胱组织中阿霉素含量准确、简便,适用于阿霉素药代动力学的研究。