论中医痰病学说对临床的指导意义

以中医古籍文献和现代临床研究为基础,总结归纳中医痰病的病因、病机,指出中医痰病多与肺、脾肾、肝有关。同时通过对现代临床研究的归纳,阐明“百病皆生于痰”、“怪病由痰治”的理论。进而论述中医痰病学在临床上的指导意义。     

活血化瘀治疗高血压病理论探讨

活血化瘀在目前高血压病治疗中逐渐受到重视,临床研究表明可以提高治疗高血压病的疗效,减少其并发症。文章从高血压病的中医发病机制、现代基础研究,活血化瘀中药的作用、优势及本病治疗要求等方面探讨高血压病活血化瘀治疗的理论基础,为临床治疗开拓思路。     

Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease

BackgroundIn patients with end-stage renal disease (ESRD), surgical aortic valve replacement is associated with higher early and late mortality, and adverse outcomes compared with patients without renal disease. Transcatheter aortic valve replacement (TAVR) offers another alternative, but there are limited reported outcomes.ObjectivesThe purpose of this study was to determine the outcomes of TAVR in patients with ESRD.MethodsAmong the first 72,631 patients with severe aortic stenosis (AS) treated with TAVR enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) TVT (Transcatheter Valve Therapies) registry, 3,053 (4.2%) patients had ESRD and were compared with patients who were not on dialysis for demographics, risk factors, and outcomes.ResultsCompared with the nondialysis patients, ESRD patients were younger (76 years vs. 83 years; p < 0.01) and had higher rates of comorbidities leading to a higher STS predicted risk of mortality (median 13.5% vs. 6.2%; p < 0.01). ESRD patients had a higher in-hospital mortality (5.1% vs. 3.4%; p < 0.01), although the observed to expected ratio was lower (0.32 vs. 0.44; p < 0.01). ESRD patients also had a similar rate of major vascular complications (4.5% vs. 4.6%; p = 0.86), but a higher rate of major bleeding (1.4% vs. 1.0%; p = 0.03). The 1-year mortality was significantly higher in dialysis patients (36.8% vs. 18.7%; p < 0.01).ConclusionsPatients undergoing TAVR with ESRD are at higher risk and had higher in-hospital mortality and bleeding, but similar vascular complications, when compared with those who are not dialysis dependent. The 1-year survival raises concerns regarding diminished benefit in this population. TAVR should be used judiciously after full discussion of the risk-benefit ratio in patients on dialysis.     

中医儿科临床辨病与辨证结合探析

中医儿科临床应用现代诊断手段,拓展传统中医四诊,将西医辨病与中医辨证相结合,有助于理解中医证候,全面了解疾病和判断预后,具有优化治疗方案的优势,还可开拓中医科研思维,同时指出对诊断不明确、疗效不确切的疾病适宜中医辨证论治。旨在将中医辨证与西医辨病相结合,如何取长补短,让患儿获得更好的疗效,是今后努力的方向。     

Development of aceclofenac nanovesicular system using biomaterial for transdermal delivery: physical characterization,ex vivo,in vivo,and anti-inflammatory studies

Context: Aceclofenac is an important NSAID; however, it causes GI disturbances whereas employing transdermal route would require permeation enhancer for systemic application, thereby causing skin damage. Ceramide 2 is a natural lipid having an important role in the maintenance of skin. Objective: Aceclofenac-loaded nanovesicles of ceramide-2, cholesterol, palmitic acid, and cholesteryl sulfate were formulated and analyzed for physical and biological properties. Materials and method: Film hydration method was used to prepare the vesicles and physical parameters, in vitro drug release and stability were evaluated. Then, they were formulated into gel and evaluated against a commercial formulation (CF) and gel-containing plain drug (CPG) for ex vivo, in vivo drug permeation, and anti-inflammatory activity. Results: The developed formulations showed best physical profile and ACV-1 gave 92.89% drug release in in vitro studies. Ex vivo studies showed drug permeation between 15.32–31.12?μg/cm², whereas CPG and CF released 0.47 and 2.81?μg/cm², respectively. ACVG-1 and CF showed C_max of 8.1 and 1.2?μg/ml at 8 and 4?h, respectively. ACVG-1 showed 11.6 times AUC than CF. ACVG-1 inhibited edema by 44% in first hour itself. Discussion: Ceramide 2 and palmitic acid played an important role in the formulation and promotes the drug permeation through stratum corneum and dermis. Ceramide content of the formulation also contributes towards stability and skin protection. Conclusion: The composition of the vesicle formulation performs an important role in physical properties and drug permeation, thereby producing an optimum formulation.     

Coalescence of Extracellular Matrix (ECM) from Porcine Urinary Bladder (UBM) with a Laser-Activated Chitosan-Based Surgical Adhesive

Abstract

Urinary bladder matrix (UBM) has been extensively investigated as a naturally occurring biomaterial in therapeutic applications for tissue repair or regeneration, while other strategies involve biopolymers such as chitosan for tissue reconstruction. The coalescence of UBM with chitosan has considerable potential in enhancing tissue reconstruction. Characterisation of a novel, laser-activated, chitosan-based, thin-film surgical adhesive with UBM in various morphologies showed that the films had increased surface rugosities and crystallinities (R_a approx. 0.83 um, approx. 12% crystallinity) when compared to the chitosan adhesive alone (R _a = 0.74 um, 7% crystallinity). Tensile strength of the films was significantly increased by the addition of UBM in particulate form (12.1–32.4 MPa). Furthermore, tissue adhesion strengths using these hybrid biomaterials were maintained at approx. 15 kPa compared to 3 kPa for fibrin glue. Histological analysis demonstrated that laser irradiation of the UBM-chitosan adhesive biomaterial caused no thermal damage to tissue. Examination of the cellular response at the material interface showed that 3T3 fibroblasts maintained their regular morphology with enhanced growth compared to films of both chitosan and its adhesive form. These results suggest that coalescence of UBM with a chitosan-based adhesive supports the development of biomaterial devices for sutureless wound closure that could enhance tissue repair and reconstruction.     

Biomimetic mineralization of collagen fibrils induced by amine-terminated PAMAM dendrimers – PAMAM dendrimers for remineralization

Objective: Achieving biomimetic mineralization of collagen fibrils by mimicking the role of non-collagenous proteins (NCPs) with biomimetic analogs is of great interest in the fields of material science and stomatology. Amine-terminated PAMAM dendrimer (PAMAM-NH₂), which possesses a highly ordered architecture and many calcium coordination sites, may be a desirable template for simulating NCPs to induce mineralization of collagen fibrils. In this study, we focused on the ability of PAMAM-NH₂ to mineralize collagen fibrils. Design: Type-I collagen fibrils were reconstituted over 400-mesh formvar-and-carbon-coated gold grids and treated with a third-generation PAMAM-NH₂ (G3-PAMAM-NH₂) solution. The treated collagen fibrils were immersed in artificial saliva for different lengths of time. The morphologies of the mineralized reconstituted type-I collagen fibrils were characterized by transmission electron microscopy. Results: No obvious mineralized collagen fibrils were detected in the control group. On the contrary, collagen fibrils were heavily mineralized in the experimental group. Most importantly, intrafibrillar mineralization was achieved within the reconstituted type-I collagen fibrils. Conclusions: In this study, we successfully induced biomimetic mineralization within type-I collagen fibrils using G3-PAMAM-NH₂. This strategy may serve as a potential therapeutic technique for restoring completely demineralized collagenous mineralized tissues.