翁维良老师治疗酒精性心肌病经验

翁维良教授从事中西医内科临床工作50余年,擅用活血化瘀治疗心血管病及各种慢性疑难疾病。结合多年临床经验,翁老认为酒精性心肌病病机多属以心气(阳)亏虚为主,湿热、瘀血、痰饮、毒热内蕴为标的虚实夹杂证。治疗时,在完全戒酒的基础上,配合中药益气温阳扶助正气,同时辨证应用健脾、祛湿、活血、祛痰、解毒等祛除实邪治法,疗效肯定。文章旨在介绍翁维良教授辨治酒精性心肌病的临证经验。     

108例支气管哮喘患者舌脉象特征分析

目的：探讨对支气管哮喘临床辨证有意义的舌脉象客观指标,以辅助临床诊断。方法：应用TP—I型中医舌脉象数字化分析仪检测108例患者舌脉象参数,分析支气管哮喘发作期与缓解期的舌脉象特征。结果：108例支气管哮喘患者的舌象中,舌色以淡红舌、淡紫舌多见,舌苔以白苔、黄苔、薄苔为多见;脉象以弦脉、滑脉、弦滑脉为多见;舌脉象参数中舌色指数、苔色指数、厚苔指数、胖瘦指数在哮喘发作期各证型中有显著性差异（P〈0．05）;RPSR1、RPSR3、RPSR4、RBF、RLMS2、PLMP2、RLMS3、RLMP3在哮喘发作期与缓解期有显著性差异（P〈0．05）。结论：支气管哮喘患者的脉象参数、舌色指数、苔色指数、厚苔指数、胖瘦指数、RPSR1、RPSR3、RPSR4、RBF、RLMS2、PLMP2、RLMS3、RLMP3对其辨证分型有重要参考价值。     

抗炎-中药治疗动脉粥样硬化的有效途径

动脉粥样硬化发病机制的“炎症-损伤-反应”学说得到广泛支持和认可。炎性反应贯穿于动脉粥样硬化发生、发展的整个过程，并与急性心脑血管事件的发生密切相关；干预AS炎症反应可能是中药治疗动脉粥样硬化的有效途径。本文从动脉粥样硬化发生、发展过程的病理基础角度，总结了炎性反应在动脉粥样硬化形成早期、进展期、成熟期、破裂期的重要作用，并提出了从抗炎角度研究、筛选、治疗动脉粥样硬化中药的思路和方法。     

Increasing nodal vulnerability and nodal efficiency implied recovery time prolonging in patients with supplementary motor area syndrome

Supplementary motor area (SMA) syndrome is a surgery‐related complication that commonly occurs after removing SMA glioma, and needs weeks to recover. However, susceptible factors of patients suffering from SMA syndrome remain unknown. Graphic theory was applied to reveal topological properties of sensorimotor network (SMN) by processing resting‐state functional magnetic resonance images in 66 patients with SMA gliomas. Patients were classified into SMA and non‐SMA groups based on whether they suffered from SMA syndrome. We collected recovery time and used causal mediation analysis to find association between topological properties and recovery time. Compared with the non‐SMA group, higher vulnerability (left: p = .0018; right: p = .0033) and lower fault tolerance (left: p = .0022; right: p = .0248) of the whole SMN were found in the SMA group. Moreover, higher nodal properties of lesional‐hemispheric cingulate cortex (nodal efficiency: left, p = .0389; right, p = .0169; nodal vulnerability: left, p = .0185; right, p = .0085) and upper limb region of primary motor cortex (PMC; nodal efficiency: left, p = .0132; right, p = .0001; nodal vulnerability: left, p = .0091; right, p = .0209) were found in the SMA group. Nodal efficiency and nodal vulnerability of cingulate cortex and upper limb region of PMC were important predictors for SMA syndrome occurring and recovery time prolonging. Neurosurgeons should carefully deal with upper limb region of PMC and cingulate cortex, and protect them if these two region were unnecessary to damage during SMA glioma resection.     

妊娠期糖代谢异常与妊娠期高血压疾病的关系

目的:探讨妊娠期糖代谢异常与妊娠期高血压疾病的关系。方法:回顾分析2003年至2007年在我院住院分娩的6748例孕妇的临床资料,分析不同程度糖代谢异常孕妇妊娠期高血压疾病的发生情况;将妊娠期糖代谢异常并发高血压疾病(PHD)患者分为妊娠期高血压组(Ⅰ组)、轻度子痫前期组(Ⅱ组)和重度子痫前期组(Ⅲ组),比较3组孕妇不同糖负荷后血糖水平(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数的差异。结果:(1)6748例孕妇发生PHD252例,发生率3.7%(252/6748),妊娠期糖代谢异常孕妇1402例,发生率20.8%(1402/6748);妊娠期糖代谢异常孕妇82例并发PHD,发生率5.8%(82/1402);糖代谢正常孕妇PHD发生率为3.2%(170/5346),差异有统计学意义(P<0.001);(2)82例妊娠期糖代谢异常并发PHD患者中,糖尿病合并妊娠(DM)、妊娠期糖尿病(GDM)、妊娠期糖耐量降低(GIGT)、妊娠期50g葡萄糖筛查(GCT)(+)的PHD发生率分别为8.5%(12/141),7.9%(45/571),3.4%(9/265),3.8%(16/425);DM、GDM组与GIGT、GCT(+)组的差异有统计学意义(P=0.010、0.001);DM组与GDM组的差异无统计学意义(P=0.805);GIGT组与GCT(+)组相比及两组与糖代谢正常组的差异无统计学意义(P=0.801、0.535)。(3)82例妊娠期糖代谢异常并发PHD患者,妊娠期高血压(Ⅰ组)27例、轻度子痫前期(Ⅱ组)24例、重度子痫前期(Ⅲ组)31例,3组血糖(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数无统计学差异。结论:妊娠期糖代谢异常的孕妇更易发生妊娠期高血压疾病;随糖代谢异常程度加重,妊娠期高血压疾病发病率呈增加趋势。     

巨噬细胞极化及其在动脉粥样硬化发生发展中的作用

动脉粥样硬化（As）是心脑血管疾病的重要病理基础,其发病机制一直是血管生物学研究领域的热点问题。炎症是As发生、发展过程中的主要因素,而与炎症发生关系最紧切的细胞是单核-巨噬细胞。近几年随着对As炎症机制研究的不断深入,巨噬细胞极化分型引起了研究者们的关注。在不同环境影响下,巨噬细胞可分为M1型和M2型,一般认为M1型（经典活化型）为促炎亚型,分泌促炎因子,因此促进As的进展;而M2型（替代活化型）为抑炎亚型,可以抑制促炎因子的产生,其有可能延缓As发展进程。该文就巨噬细胞的极化分型,以及在As的形成和发展过程中的影响等予以综述,并展望中药在防治As 中的机制。     

Th17/Treg细胞在健脾方防治克罗恩大鼠中的作用机制

目的:观察Th17/Treg细胞平衡在健脾方防治TNBS诱导的克罗恩大鼠中的作用机制;方法:24只清洁级雄性SD大鼠随机分为:1)正常对照组NG(n=8):从造模第2周起双蒸水灌胃,1次/d,灌胃量按1 mL/100 g,共3周;2)TNBS模型组MG(n=8):从第1周开始TNBS灌肠,灌肠剂量(m L)=体重(g)×0.003 m L/g,1次/周,造模持续共4周;3)模型+健脾方防治组JP(n=8):从造模第2周开始,在TNBS灌肠后的第2天新增中药健脾方灌胃治疗,灌胃量按1 m L/100 g,1次/d,灌胃持续3周;采用ELISA、免疫组织化学、real-time PCR等技术观察各组大鼠血液、结肠黏膜中与Th17、Treg分化和功能密切相关的IFN-γ、IL-17、RORγt、FoxP3蛋白与基因的表达差异;结果:健脾方能通过下调Th1细胞释放的IFN-γ,进而来调节Th1/Th2的平衡,同时也能通过下调Th17细胞分泌IL-17、RORγt炎性反应因子的分泌和促进Treg细胞分泌的抗炎因子FoxP3来调节Th17/Treg的平衡,进而达到防治TNBS诱导的大鼠克罗恩病的作用。结论:健脾方能够通过调节Th17/Treg细胞平衡中多个关键细胞因子和转录因子的方式,达到预防和治疗TNBS诱导的大鼠克罗恩病炎性反应程度之目的。     

儿童肱骨内上髁骨折不同手术切口的比较分析

目的：探讨采用肘关节纵切口与横切口治疗儿童肱骨内上髁骨折的疗效差异。方法：回顾性分析我院手术治疗新鲜的儿童肱骨内上髁骨折并得到随访的106例患儿的资料,男67例,女39例,年龄7.3～16.2 岁,平均年龄１2.7 岁。61例手术采用肘内侧纵切口和45例采用横切口进行切开复位骨折,并用克氏针、空心钉或可吸收钉、棒固定。术后石膏托固定3～5周后行功能训练,待骨折完全愈合后再取出内固定。结果：获得随访106例,随访时间7～60月,平均随访时间25月。纵切口组手术时间50～70 min,平均（60.00±3.60） min;手术切口6～9 cm,平均（7.5０±0.18） cm。横切口组手术时间20～30 min,平均（23.00±2.66） min;手术切口2.0～2.5 cm,平均（2.2０±０.13） cm。1例术后发生骨不连,105例患儿术后2～3月随访X片显示骨折骨性愈合,无迟发性尺神经损伤表现。2种方法各有1例术后出现桡神经损伤症状,拔针后神经损伤很快恢复,症状消失,无需进行二次手术。肘关节内侧无压痛,外观无明显外翻畸形,外翻应力试验稳定。肘关节功能评分：99例优,6例良,1例中。结论：经肘关节２种切口都可以用于儿童肱骨内上髁骨折的手术治疗,但肘内后横切口具有切口小、创伤小、手术易操作、花时少、愈合后瘢痕小的优点,是一种更好的手术入路。     

Nano carriers for drug transport across the blood–brain barrier

Effective therapy lies in achieving a therapeutic amount of drug to the proper site in the body and then maintaining the desired drug concentration for a sufficient time interval to be clinically effective for treatment. The blood–brain barrier (BBB) hinders most drugs from entering the central nervous system (CNS) from the blood stream, leading to the difficulty of delivering drugs to the brain via the circulatory system for the treatment, diagnosis and prevention of brain diseases. Several brain drug delivery approaches have been developed, such as intracerebral and intracerebroventricular administration, intranasal delivery and blood-to-brain delivery, as a result of transient BBB disruption induced by biological, chemical or physical stimuli such as zonula occludens toxin, mannitol, magnetic heating and ultrasound, but these approaches showed disadvantages of being dangerous, high cost and unsuitability for most brain diseases and drugs. The strategy of vector-mediated blood-to-brain delivery, which involves improving BBB permeability of the drug–carrier conjugate, can minimize side effects, such as being submicrometre objects that behave as a whole unit in terms of their transport and properties, nanomaterials, are promising carrier vehicles for direct drug transport across the intact BBB as a result of their potential to enter the brain capillary endothelial cells by means of normal endocytosis and transcytosis due to their small size, as well as their possibility of being functionalized with multiple copies of the drug molecule of interest. This review provids a concise discussion of nano carriers for drug transport across the intact BBB, various forms of nanomaterials including inorganic/solid lipid/polymeric nanoparticles, nanoemulsions, quantum dots, nanogels, liposomes, micelles, dendrimers, polymersomes and exosomes are critically evaluated, their mechanisms for drug transport across the BBB are reviewed, and the future directions of this area are fully discussed.     

Visual targeted therapy of hepatic cancer using homing peptide modified calcium phosphate nanoparticles loading doxorubicin guided by T1 weighted MRI

Effective treatment and real-time monitoring of hepatic cancer are essential. A multifunctional calcium phosphate nanoparticles loading chemotherapeutic agent doxorubicin and magnetic resonance imaging contrast agent diethylenetriaminepentaacetic acid gadolinium (A54-CaP/Gd-DTPA/DOX) was developed for visual targeted therapy of hepatic cancer via T1-weighted MRI in real-time. A54-CaP/Gd-DTPA/DOX exhibited a higher longitudinal relaxivity (6.02?mM^?1?s^?1) than commercial MR contrast agent Gd-DTPA (3.3765?mM^?1?s^?1). The DOX release from the nanoparticles exhibited a pH dependent behavior. The cellular uptake results showed that the internalization of A54-CaP/Gd-DTPA/DOX into BEL-7402 cells was1.9-fold faster than that of HepG2 cells via A54 binding. In vivo experiments presented that A54-CaP/Gd-DTPA/DOX had higher distribution and longer retention time in tumor tissue than CaP/Gd-DTPA/DOX and free DOX, and also displayed great antitumor efficacy (95.38% tumor inhibition rate) and lower toxicity. Furthermore, the Gd-DTPA entrapped in the nanoparticles could provide T1-weighted MRI for real-time monitoring the progress of tumor treatment.