补肾活血法对强直少动型帕金森病患者生活质量的影响

目的观察补肾活血法中药对强直少动型帕金森病(PD)患者生活质量的影响。方法采用随机对照试验,共纳入PD患者60例,1例剔除、2例脱落,完成研究者57例,其中试验组(中西医结合组)29例,对照组(西药组)28例,疗程共3个月。以UPDRS评分、H-Y分级、PDQ-39的变化评价治疗的有效率、生活质量的改善情况等。结果试验组UPDRS总分及UPDRSⅡ评分显著低于对照组(P<0.05);试验组有效率达48.28%,疗效明显优于对照组的14.29%(P<0.05);试验组H-Y分级呈下降趋势,对照组呈上升趋势。与治疗前相比,试验组PDQ-39总分及8项类别评分均显著下降(P<0.05或P<0.01),对照组仅总分及2项类别评分显著下降(P<0.05或P<0.01)。与对照组相比,试验组在改善患者的日常生活能力、情感障碍、认知、躯体不适等非运动症状方面作用更为突出。结论补肾活血法从多靶点、多途径起到神经保护作用,能够增效减毒,从根本上改善PD患者的生活质量。     

健脾益肾活血中药对早期2型糖尿病肾病的临床疗效分析

目的探讨健脾益肾活血中药对早期糖尿病肾病（DN）的临床疗效。方法研究对象为我院收治的140例早期2型DN患者,将其随机分为洛汀新组、健脾活血组、益肾活血组、健脾益肾活血组、健脾活血洛汀新组、益肾活血洛汀新组及健脾益肾活血洛汀新组,每组各20例,8周为1个疗程,观察各组治疗前后相关指标的变化。结果健脾益肾活血洛汀新组治疗后血纤溶酶原激活物抑制剂-1（PAI-1）、血内皮素-1（ET-1）、24 h尿白蛋白排泄率（UAER）、血纤维蛋白原（Fg）、血超敏C反应蛋白（hsCRP）、血转化生长因子-β1（TGF-β1）、血肿瘤坏死因子（TNF-α）、血糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、空腹血糖（FPG）、餐后2 h血葡萄糖（2 h PG）等指标显著降低,趋于正常水平;血总胆固醇（TC）、血三酰甘油（TG）、血低密度脂蛋白胆固醇（LDL-C）、血高密度脂蛋白胆固醇（HDL-C）显著好转;健脾益肾活血洛汀新组与其他各组间相比,以上15个指标差异均有统计学意义（均P〈0.05）。结论健脾益肾活血中药对早期2型DN疗效确切,可延缓病情进展,提高患者的生活质量,值得临床上推广应用。     

扶阳法治疗汗证临床探析

中医的汗证主要包括自汗和盗汗两种。传统以益气固表,调和营卫,滋阴降火,清化湿热为主要治疗方法,但应用于临床,疗效并不理想。现代人生活方式加之抗生素、激素及苦寒药的滥用,极度损伤人体阳气。所以现代临床上由于阳虚导致的疾病很多见,汗证亦不例外。肾阳为人体阳气之本,立命之根,真阳虚衰,不能统摄肾阴,阴火沸腾,虚阳外越则汗出不止。应用扶阳法治疗,临床疗效颇佳。     

益气养阴活血方治疗系统性红斑狼疮的探讨

目的探讨益气养阴活血方对系统性红斑狼疮患者治疗的免疫学基础和临床变化。方法利用实时荧光定量PCR技术检测SLE患者治疗前后外周血单核细胞(PBMC)中Foxp3 mRNA的表达;用酶联免疫吸附试验(ELISA)检测SLE患者治疗前后血清中IL-10和TGF-β水平变化;观察SLE患者治疗前后临床症状和实验室指标的改善情况。治疗组应用糖皮质激素加用益气养阴活血方;对照组应用糖皮质激素。结果治疗组治疗后Foxp3 mRNA和TGF-β表达较对照组上升明显,差异有统计学意义(P均<0.05),IL-10表达较对照组下降明显,差异有统计学意义(P<0.05)。治疗组治疗后患者皮损、关节痛、乏力的症状较对照组改善明显,差异有统计学意义(P均<0.05);而光敏感和脱发两组间差异无统计学意义。治疗组治疗后ESR较对照组降低明显,差异有统计学意义(P<0.05);Hb,WBC两组治疗后均上升,差异有统计学意义,但组间比较无差别;补体C3两组治疗前后均无明显变化。患者激素的用量及复发率治疗组均较对照组明显减少,差异有统计学意义(P<0.05和P<0.01)。结论加用益气养阴活血方可通过调节SLE相关的转录因子及细胞因子的分泌,调动了机体免疫系统,发挥其临床治疗效应。     

Pre-cementation treatment of glass-ceramics with vacuum impregnated resin coatings

ObjectiveThe study aimed to investigate the effectiveness of a vacuum impregnation process to eliminate the porosity at the ceramic-resin interface to optimize the reinforcement of a glass-ceramic by resin cementation.Methods100 leucite glass-ceramic disks (1.0 ± 0.1 mm thickness) were air-abraded, etched with 9.6 % HF acid, and silanated. Specimens were randomly allocated to 5 groups (n = 20). Group A received no further treatment (uncoated control). Groups B and D were resin-coated under atmospheric pressure, whereas groups C and E were resin-coated using vacuum impregnation. The polymerized resin-coating surfaces of specimens in groups B and C were polished to achieve a resin thickness of 100 ± 10 µm, while in groups D and E no resin-coating modification was performed prior to bi-axial flexure strength (BFS) determination. Optical microscopy was undertaken on the fracture fragments to identify the failure mode and origin. Comparisons of BFS group means were made by a one-way analysis of variance (ANOVA) and post-hoc Tukey test at α = 0.05.ResultsAll resin-coated sample groups (B–E) showed a statistically significant increase in mean BFS compared with the uncoated control (p < 0.01). There was a significant difference in BFS between the ambient and vacuum impregnated unpolished groups (D and E) (p < 0.01), with the greatest strengthening achieved using a vacuum impregnation technique.SignificanceResults highlight the opportunity to further develop processes to apply thin conformal resin coatings, applied as a pre-cementation step to strengthen dental glass-ceramics.     

杨洪涛从脾肾论治慢性肾脏病医案举隅

慢性肾脏病主要临床表现为血尿、蛋白尿、水肿及肾功能损害等。在现代医学积极治疗的情况下,肾脏疾病的患病率及病死率仍然就高,中医药独具特色的辨证论治在治疗慢性肾脏病方面有着较好的疗效。杨洪涛教授认为,慢性肾脏病病程日久,病机总属本虚标实,虚实夹杂。杨师临证时精于辨证,在治疗慢性肾脏病时注重健脾补肾,屡获良效。     

Effect of exercises according to the circadian rhythm in type 2 diabetes: Parallel-group,single-blind,crossover study

Background and aimTo evaluate the effectiveness of structured exercise appropriate the circadian rhythm in terms of blood sample test (BST), functionality and quality of life (QoL) in individuals with type 2 diabetes.Methods and resultsThis was a parallel-group, single-blind, crossover study. Thirty individuals with type 2 diabetes aged 35–65 years were enrolled in the study and allocated into 2 groups as the Morning Chronotype (MC) Group (n = 15) and the Evening Chronotype (EC) Group (n = 15) using Morningness-Eveningness Questionnaire which was used to determine the chronotypes. Participants were evaluated in terms of BST, functionality and QoL at the beginning of the study (T0), at 6 (T1), 12 (T2), and 18 (T3) weeks after the study started. A structured exercise program for 3 days a week over 6 weeks was applied in accordance with the chronotypes (T1-T2) and cross-controlled for the chronotypes (T2-T3). Significant differences were found in favor of the exercise given at the appropriate time for the chronotype in all parameters in both groups within groups (T0-T1-T2-T3) (p < 0.05). In the time1group interactions, exercise in accordance with the appropriate chronotype in both groups provided the highest statistical improvement in all parameters (p < 0.05).ConclusionIt was concluded that structured exercise performed at the appropriate time for chronotype improves HbA_1c, fasting blood glucose, HDL-LDL cholesterol, triglyceride, total cholesterol, functionality and quality of life in type 2 diabetes. This variation in blood values was observed to reflect the quantitative effects of exercise administered according to the circadian rhythm in individuals with type 2 diabetes.Trial registrationClinicalTrials.gov (NCT04427488). The protocol of the study was registered at ClinicalTrials.gov (NCT04427488).     

脉冲激光射线强化金属材料的几个问题

本文讨论了激光脉冲射线强化金属材料的几个问题:强化图形,材料性能,加工用量及表面涂层对被强化表面性能的影响。     

从“伏邪”论治系统性红斑狼疮

本文基于伏邪理论探讨系统性红斑狼疮的病因病机、发病特点和论治规律。笔者认为正气亏虚为系统性红斑狼疮的发病之本,而正虚使致病之邪内伏,六淫、疫气、情志等因素引动伏邪而发病。根据系统性红斑狼疮症状特点可分为急性期和缓解期,在急性发作期以清热解毒、活血祛瘀为主;缓解期以补益肝肾、滋阴祛邪为主,根据不同分期辨证审因,灵活选方用药进行论治,以期提高临床疗效。     

预防医院感染中强化护理管理的价值体会

目的探讨在预防医院感染中应用强化护理管理的价值。方法遵循护理管理差异分组原则,选择我院2019年9月～2020年3月68例患者分为对照组(32例,常规护理管理)和观察组(36例,强化护理管理);观察管理前后两组护理质量、医院感染发生率及护理满意度。结果管理后观察组环境质量、基础护理、服务态度、消毒灭菌护理质量各指标评分较高(P0.05)。管理后观察组呼吸道感染、泌尿系统感染等医院感染发生率较对照组低(5.5%vs 25.0%)(P0.05)。管理后观察组患者护理满意度各指标评分较高(P0.05)。结论在预防医院感染中应用强化护理管理价值显著,可有效改善护理质量、降低医院感染发生率并提升患者护理满意度。