中医药在脊髓损伤神经源性肠道功能障碍的研究进展

脊髓损伤(spinal cordin jury,SCI)后神经源性肠功能障碍对患者身心健康和生活质量的严重影响,目前越来越受到国际关注.但国内对此尚未普遍开展.中医理论在SCI及SCI后出现的排便异常尚未作相关总结.现有研究中医药对肠道自主神经系统已经成熟,其有效性获得国内外普遍承认,并较药物更易接受.为SCI肠功能障碍的研究打下基础.但目前国内对SCI后排便异常缺乏专业认识、项目资助和人员管理,临床研究欠规范,中医理论有待完善.现主要针对SCI神经源性肠功能障碍出现的排便异常,在中医病名、病机、主要方法、有效性、优势及存在问题作一综述.     

Body Surface Area (BSA) is a Better Osteoporosis Associated Anthropometric Parameter Than Other Anthropometric Parameters in Elderly Population

Body surface area (BSA) is widely used for adjusting drug dose, while few studies have yet systematically evaluated its association with osteoporosis and compared its advantage with other anthropometric parameters in osteoporotic risk prediction. A total of 10,021 Chinese individuals aged over 65 years were enrolled in our study. Bone mineral density (BMD) was measured, and demographic information was also collected. Pearson correlation analysis, receiver operating characteristic (ROC) curves and predictive analysis were performed to assess the clinical practice of BSA for osteoporosis. BSA had the strongest correlation with BMD (0.544, p < 0.001) compared with conventional anthropometric indices. Besides, BSA had the highest power in osteoporosis prediction, with an area under the curve (AUC) reaching 0.81. After incorporating BSA into the osteoporosis risk prediction model, the AUC improved from 0.82 to 0.83 (p < 0.01). We found BSA provided additional diagnostic value beyond conventional anthropometric information with continuous and category NRIs were 30.40% (p < 0.01) and 3.29% (p < 0.01), respectively, and the IDI was 1.85% (p < 0.01). BSA was positively associated with osteoporosis and showed superior discriminative ability for osteoporosis risk prediction compared with other anthropometric parameters in the Chinese elderly population.     

抵当汤联合吉西他滨治疗非肌层浸润性膀胱癌术后患者的疗效评价

目的:观察抵当汤联合吉西他滨膀胱灌注化疗治疗非肌层浸润性膀胱癌术后患者的临床疗效。方法:选择2015年1月至2019年9月期间于江苏省第二中医院、江苏省中医院就诊的非肌层浸润性膀胱癌患者100例随机分为观察组和对照组,其中观察组50例给予抵当汤联合吉西他滨膀胱灌注治疗,对照组50例给予安慰剂联合吉西他滨膀胱灌注治疗。在治疗周期前后,检测两组患者的血生化、免疫T细胞亚群(CD3⁺,CD4⁺,CD8⁺及CD4⁺/CD8⁺)评估治疗组安全性及免疫功能变化;采用膀胱癌患者生命质量核心量表(EORTC QLQ-C30)与浅表性膀胱癌患者特异性量表(EORTC QLQ-BLS24)量化反映治疗前后患者的躯体、角色、情绪与社会等功能情况,疲劳、疼痛、恶心呕吐、气促、失眠、食欲减弱、腹泻和便秘等症状情况及治疗产生问题、未来担心、肠道症状及尿路症状等膀胱癌特异症状。结果:两组患者年龄、性别、病程和肿瘤分期等均无差异。在治疗周期内,两组均无复发病例及不良反应事件,且观察组中医疗效较对照组明显升高(χ²=7.23,P=0.02)。相较对照组治疗后,观察组中的CD3⁺,CD4⁺细胞数量以及CD4⁺/CD8⁺都有明显升高(P<0.05)。与治疗前相比,两组在角色功能、社会功能和总体健康领域均较治疗前明显升高(P<0.05)。此外,观察组的治疗后疲劳、腹泻、便秘、肠道症状以及尿路症状较对照组明显降低(P<0.05)。结论:抵当汤可减轻非肌层浸润性膀胱癌患者术后吉西他滨灌注化疗期间的不良临床症状,改善尿道、肠道不适反应,改善免疫功能,提高患者的生活质量。     

Metabolomics in the development and progression of rheumatoid arthritis: A systematic review

ObjectiveA systematic review and analysis of data from several rheumatoid arthritis metabolomics studies attempts to determine which metabolites can be used as potential biomarkers for the diagnosis of rheumatoid arthritis and to explore the pathogenesis of rheumatoid arthritis.MethodsWe searched all the subject-related documents published by EMBASE, PubMed, Web of Science, and Cochrane Library from the database to the September 2019 publication. Two researchers independently screened the literature and extracted the data. QUADOMICS tool was used to assess the quality of studies included in this systematic review.ResultsA total of 10 studies met the inclusion criteria of systematic review, including 502 patients with rheumatoid arthritis and 373 healthy people. Among them, the biological samples utilised for metabolomic analysis include: serum (n = 8), urine (n = 1) and synovial fluid (n = 1). Some metabolites play an important role in rheumatoid arthritis: glucose, lactic acid, citric acid, leucine, methionine, isoleucine, valine, phenylalanine, threonine, serine, proline, glutamate, histidine, alanine, cholesterol, glycerol, and ribose.ConclusionsMetabolomics provides important new opportunities for further research in rheumatoid arthritis and is expected to elucidate the pathogenesis of rheumatoid arthritis that has not been fully understood before.     

Inhalation of glycopyrronium inhibits cigarette smoke-induced acute lung inflammation in a murine model of COPD

Glycopyrronium bromide (GB) is a muscarinic receptor antagonist that has been used as a long-acting bronchodilator in chronic obstructive pulmonary disease (COPD) patients. The aim of this study was to investigate the anti-inflammatory activity of inhaled GB in a cigarette smoke-induced acute lung inflammation mouse model. We found that aerosol pre-treatment with GB suppresses the accumulation of neutrophils and macrophages in the bronchoalveolar lavage fluid (BALF) in cigarette smoke (CS)-exposed mice. GB at doses of 300 and 600 μg/ml significantly inhibited the CS-induced increases in the mRNA and protein expression levels of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, monocyte chemotactic protein (MCP)-1 and transforming growth factor (TGF)-β1 in lung tissues and the BALF. Moreover, GB at a dose of 600 μg/ml significantly inhibited the CS-induced changes in glutathione (GSH) and myeloperoxidase (MPO) activities in the BALF, decreased the CS-induced expression of matrix metalloproteinases (MMP)-9, and increased the CS-induced expression of tissue inhibitor of metalloproteinases (TIMP)-1, as determined through the immunohistochemical staining of lung tissue. Our results demonstrate the beneficial effects of inhaled GB on the inflammatory reaction in COPD.     

Predicción de resultados de cistoscopias en la práctica

ObjectiveOur objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy.Materials and methodsWe recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables.ResultsFrom August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P = .026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours.ConclusionIn a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.