心理治疗与痛泻要方相结合治疗腹泻型肠易激综合征临床疗效观察

目的:观察心理治疗与痛泻要方相结合治疗腹泻型肠易激综合征的疗效。方法:将本院门诊纳入符合标准的65例腹泻型肠易激综合征病人,随机分为两组,治疗组35例,根据中医辨证分型用痛泻要方和心理治疗相结合治疗;对照组30例用痛泻要方治疗。结果:治疗组的疗效明显优于对照组,两组总有效率比较差异有统计学意义(P<0.05)。结论:心理治疗与痛泻要方相结合组治疗肠易激综合征患者疗效明显优于痛泻要方组。     

基于牙胚细胞的组织工程化牙齿研究进展（综述）

牙齿组织工程是近年来口腔医学领域的热点,随着组织工程、材料学、纳米技术和干细胞等技术的发展,在组织工程化牙齿的研制方面已经取得了一些突破性进展,该文就基于牙胚细胞的组织工程化牙齿的研究现状、目前的研究目标等方面作一综述。     

Habitual intakes of sugar-sweetened beverages associated with gut microbiota-related metabolites and metabolic health outcomes in young Chinese adults

Background and aimsReducing consumption of sugar-sweetened beverages (SSBs) is a global public health priority because of their limited nutritional value and associations with increased risk of obesity and metabolic diseases. Gut microbiota-related metabolites emerged as quintessential effectors that may mediate impacts of dietary exposures on the modulation of host commensal microbiome and physiological status.Methods and resultsThis study assessed the associations among SSBs, circulating microbial metabolites, and gut microbiota–host co-metabolites, as well as metabolic health outcomes in young Chinese adults (n = 86), from the Carbohydrate Alternatives and Metabolic Phenotypes study in Shaanxi Province. Five principal component analysis-derived beverage drinking patterns were determined on self-reported SSB intakes, which were to a varying degree associated with 143 plasma levels of gut microbiota-related metabolites profiled by untargeted metabolomics. Moreover, carbonated beverages, fruit juice, energy drinks, and bubble tea exhibited positive associations with obesity-related markers and blood lipids, which were further validated in an independent cohort of 16,851 participants from the Regional Ethnic Cohort Study in Northwest China in Shaanxi Province. In contrast, presweetened coffee was negatively associated with the obesity-related traits. A total of 79 metabolites were associated with both SSBs and metabolic markers, particularly obesity markers. Pathway enrichment analysis identified the branched-chain amino acid catabolism and aminoacyl-tRNA biosynthesis as linking SSB intake with metabolic health outcomes.ConclusionOur findings demonstrate the associations between habitual intakes of SSBs and several metabolic markers relevant to noncommunicable diseases, and highlight the critical involvement of gut microbiota-related metabolites in mediating such associations.     

Cumulative burden of abnormal visceral adiposity index and its components on the risk of hyperuricemia

Background and aimsThe visceral adiposity index (VAI), a gender-specific surrogate maker of adipose tissue distribution and function, is associated with risk of hyperuricemia. However, the impact of time-burden of abnormal VAI and its components on the risk of hyperuricemia remains unknown.Methods and resultsWe included 56,537 participants without hyperuricemia and underwent two health examinations during 2006–2008 from the Kailuan study. Abnormal VAI burdens were evaluated as follows: (1) cumulative number of abnormal VAI presented at each examination (0–2 times); (2) cumulative number of each abnormal VAI component presented at each examination (0–2 times per component); (3) cumulative number of total abnormal VAI components presented at each examination (0–8 times).During a median follow-up of 8.81 years, 10,762 participants were diagnosed with hyperuricemia. The risk of hyperuricemia showed a positive association with cumulative number of abnormal VAI, the adjusted hazard ratio (HR) with 95% confidence interval (CI) of 2 times compared to 0 times was 1.69 (1.58–1.81). All four components of abnormal VAI, when diagnosed repeatedly, were independently associated with an increased risk of hyperuricemia, adjusted HR (95% CI) from 1.15 (1.02–1.28) for low high-density lipoprotein to 1.68 (1.58–1.79) for elevated triglyceride. The risk of hyperuricemia also gradually as abnormal components was accumulated from 0 to 8 counts, reaching an adjusted HR (95% CI) of 3.72 (2.64–5.23). Furthermore, the effect of cumulative abnormal VAI was more pronounced in females than males (P-interaction < 0.0001).ConclusionsCumulative abnormal VAI burdens were positively associated with the risk of hyperuricemia, especially in females.     

Changes in abdominal fat depots after bariatric surgery are associated with improved metabolic profile

Background and aimsObesity associated with a change in the quantity and quality of fat depots. Using computed tomography (CT), we analyzed abdominal fat depots in patients with obesity after bariatric surgery according to their metabolic health status.Methods and resultsWe recruited 79 individuals with metabolically unhealthy obesity before bariatric surgery and compared them with age-sex matched healthy controls. The volume and fat attenuation index (FAI) of fat depots were measured using CT scans that were conducted prior to and a year after bariatric surgery. ‘Metabolically healthy’ was defined as having no hypertension, normal fasting glucose and a waist-to-hip ratio of <1.05 for men and <0.95 for women. Individuals who achieved a metabolic health status conversion (MHC) (n = 29, 37%)—from unhealthy to healthy—were younger (p < 0.001) as compared to individuals without MHC. Pre-surgery BMI and reduction of BMI did not differ between the two groups (p = 0.099, p = 0.5730). Bariatric surgery reduced the volume and increased the FAI of fat depots. Baseline lower abdominal periaortic adipose tissue (AT) volume (p = 0.014) and great percent reduction in renal sinus AT volume after surgery (p = 0.019) were associated with MHC after surgery. Increased intraperitoneal AT FAI (p = 0.031) was also associated with MHC.ConclusionMHC was not associated with improvement in general obesity, based on indicators such as reduction of BMI after surgery. Weight reduction induced specific abdominal fat depot changes measured by CT are positively associated with MHC.     

跨理论模型指导下的护理干预对COPD患者戒烟及生活质量的影响

目的:探讨跨理论模型指导下的护理干预对COPD患者戒烟依从性及生活质量的影响。方法:将在某医院肺病科住院的吸烟COPD患者65例随机分为干预组32例和对照组33例,干预组实行针对性跨理论模型指导下的护理干预,对照组实施常规护理。观察2组患者16周内戒烟行为改变阶段的不同及生活质量变化情况。结果:干预组出院后16周内戒烟行为改变阶段较入组时提高(P0.05),对照组干预前后比较差异无统计学意义(P0.05);2组患者的生活质量评价比较无统计学差异(P0.05)。结论:跨理论模型指导下护理干预模式可提高吸烟COPD患者的戒烟依从性。     

急性心肌梗死患者血浆LP(a) Hcy hs-CRP和cTnI水平检测的临床意义

目的探讨急性心肌梗死(AMI)患者血浆脂蛋白(a)[Lp(a)]、同型半胱氨酸(Hcy),超敏C反应蛋白(hs-CRP)和肌钙蛋白I(cTnI)水平监测的临床应用。方法对162例AMI患者和165例健康体检者(对照组)进行血浆LP(a)、Hcy、hs-CRP和cTnI水平测定,并进行统计分析。结果 AMI患者治疗前的血浆LP(a)、Hcy、hs-CRP和cTnI水平与对照组比较,均显著增高(P<0.01)。在AMI患者治疗后,与对照组比较,97例治疗好转患者血浆hs-CRP恢复至正常水平(t=1.586,P>0.05),而血浆cTnI水平降低明显(t=3.322,P<0.01);36例治疗无效死亡患者血浆Hcy、hs-CRP和cTnI水平均明显升高(P<0.01)。结论血浆LP(a)、Hcy、hs-CRP和cTnI是治疗前诊断AMI有价值的指标,对患者治疗预后判断和随访最有价值的指标是血浆hs-CRP和cTnI。     

3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation

ObjectivesThe aim of this study was to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiographic guidance among all comers undergoing second-generation drug-eluting stent (DES) implantation.BackgroundThe multicenter randomized ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions) trial showed a lower incidence of 1-year TVF after IVUS-guided DES implantation among all comers compared with angiographic guidance. However, the 3-year clinical outcomes of the ULTIMATE trial remain unknown.MethodsA total of 1,448 all comers undergoing DES implantation who were randomly assigned to either IVUS guidance or angiographic guidance in the ULTIMATE trial were followed for 3 years. The primary endpoint was the risk for TVF at 3 years. The safety endpoint was definite or probable stent thrombosis (ST).ResultsAt 3 years, TVF occurred in 47 patients (6.6%) in the IVUS-guided group and in 76 patients (10.7%) in the angiography-guided group (p = 0.01), driven mainly by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%; p = 0.05). The rate of definite or probable ST was 0.1% in the IVUS-guided group and 1.1% in the angiography-guided group (p = 0.02). Notably, the IVUS-defined optimal procedure was associated with a significant reduction in 3-year TVF relative to that with the suboptimal procedure.ConclusionsIVUS-guided DES implantation was associated with significantly lower rates of TVF and ST during 3-year follow-up among all comers, particularly those who underwent the IVUS-defined optimal procedure compared with those with angiographic guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions; NCT02215915)     

两种外周静脉穿刺方法在系统性硬化症患者中的应用研究简

目的 探讨能提高系统性硬化症患者一次性静脉穿刺成功率,减轻穿刺时疼痛的静脉穿刺方法.方法 选择2011年1月～2012年11月张家港市中医医院系统性硬化症9例患者为研究对象,以静脉输液治疗日期为单数者为对照组,日期为双数者为观察组.对照组采用传统的静脉穿刺法,观察组采用改良式静脉穿刺法.比较两组静脉穿刺的一次性成功率及穿刺时患者的疼痛程度.结果 观察组一次性静脉穿刺成功率（87.1％）明显高于对照组（73.3％）,差异有统计学意义（P＜ 0.05）;观察组和对照组中度以上疼痛分别为9例和24例,观察组总体疼痛感低于对照组（P＜0.05）.结论 改良式静脉穿刺法能提高系统性硬化症患者静脉穿刺成功率,减轻患者穿刺时的疼痛感.     

中药汤剂联合化疗治疗乳腺癌临床疗效系统评价

目的:系统评价中药汤剂联合化疗治疗乳腺癌的临床疗效,得出相对可靠的目前中药汤剂联合化疗治疗乳腺癌疗效的循证医学证据。方法:计算机检索Cochrane Library、MEDLINE、EMBASE、CNKI、VIP、CBM。全面收集有关中药汤剂联合化疗治疗乳腺癌的随机对照试验,评价纳入研究的质量并提取资料,并用RevMan 5.0软件进行统计分析;运用频率分析法对中药进行归类统计。结果:共纳入21篇RCTs,分析结果显示:与单纯化疗方案相比,中药汤剂联合化疗方案可以提高乳腺癌患者的客观疗效有效率[OR=1.86,95%CI(1.38~2.50)]、体能状态评分有效率[OR=3.77,95%CI(2.47~5.74)],降低重度骨髓抑制发生率[OR=0.26,95%CI(0.16~0.40)]和重度消化道反应发生率[OR=0.22,95%CI(0.11~0.42)],差异均有统计学意义。结论:中药汤剂联合化疗可提高乳腺癌客观疗效有效率和体能状态评分有效率,降低重度骨髓抑制发生率和重度消化道反应发生率;配合化疗的中药汤剂多以益气养血与活血化瘀药物配伍使用。