枳术丸加减治疗胃食管反流病的临床观察

目的：观察枳术丸加减方治疗胃食管反流病(gastro—esophaageal reflux disease,GERD)的疗效,并探讨其作用机制。方法：将63例GERD患者随机分为治疗组(30例)和对照组(33例),治疗组以枳术丸加减方治疗,每日1剂,分2次服,每次100ml,餐前0．5h服;对照组以雷尼替丁片0．15g,每天2次,西沙比利片10mg,每天3次,均餐前服,疗程均为8周。分别检测和记录两组治疗前后症状评分、内镜检查、食管压力测定、24hpH监测和胃动素,观察上述指标治疗前后两组间变化情况。结果：两组治疗后其症状积分、食管压力测定、24hDH监测和血胃动素水平均较治疗前有改善(P<0．05),且治疗组较对照组改善更为明显(P<0．05)。结论：枳术丸加减方具有较好的治疗GERD效果。     

不同中医治法对异丙肾上腺素致大鼠心肌肥大的比较研究

目的观察不同中医治法对异丙肾上腺素致大鼠心肌肥大的干预作用。方法以异丙肾上腺素20 mg/kg1、0 mg/kg、5mg/kg递减皮下注射,3 mg/kg维持7 d制备大鼠心肌肥大模型,给予金匮肾气丸、真武汤、补阳还五汤及生脉饮5周,观察大鼠血流动力学指标、心输出量、心脏指数、左心室指数以及血清心房利钠肽(ANP)、脑钠肽(BNP)、血管紧张素Ⅱ(AngⅡ)及去甲肾上腺素(NE)含量的变化。结果异丙肾上腺素造模5周后,模型组大鼠血流动力学处于代偿状态,与正常组比较差异无统计学意义(P>0.05);但心输出量明显降低,血清ANP、BNP含量显著升高,心脏指数及左心室指数增加(P<0.05)。与模型组比较,补阳还五汤组及金匮肾气丸组能够有效提高心输出量,降低血清ANP、BNP水平,降低心脏指数(P<0.05)。生脉饮组和真武汤组能够降低血清ANP含量,对于模型大鼠心脏指数及血清BNP含量均无明显作用(P>0.05),但是有降低心输出量及心肌收缩功能的作用。结论益气活血法和温补肾阳法能够有效改善异丙肾上腺素致大鼠心肌肥大的血流动力学状况,改善过度激活的神经体液水平。     

软肝健脾丸治疗慢性乙型肝炎肝纤维化的临床研究

目的：观察自制中药软肝健脾丸对慢性乙型肝炎肝纤维化的临床疗效。方法：将87例慢性乙型肝炎肝纤维化患者随机分为两组：治疗组44例,服用软肝健脾丸,对照组43例,服用安络化纤丸;治疗前后检测患者血清透明质酸（HA）、层粘蛋白（LN）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-C）的水平,并观察主要症状、肝功能相关指标及肝脏B超声像图情况。结果：两组临床疗效比较,治疗组的显效率和总有效率分别为52.27%和88.63%;对照组分别为25.58%和67.44%,差异均有显著性意义（P〈0.01、P〈0.05）。HA、LN、PCⅢ、Ⅳ-C的水平治疗组患者治疗前后比较,差异有显著性意义（P〈0.01）;与对照组治疗后比较,差异均有显著性意义（P〈0.01、P〈0.05）。治疗组患者治疗前后ALT、AST、TBil、Alb比较差异有显著性意义（P〈0.01）,但与对照组治疗后比较差异无显著性意义（P〉0.05）。两组间在改善主要症状、脾脏回缩、肝脏声像图改变方面比较,差异有显著性意义（P〈0.05）。结论：软肝健脾丸对慢性乙型肝炎患者有较好的抗肝纤维化作用。     

Factors affecting first-month adherence to antiretroviral therapy amongHIV-positive adults in South Africa

This study explores the influence of baseline factors on first-month adherence to highly active antiretroviral therapy (HAART) among adults. The study design involved a review of routinely collected patient information in the CAPRISA AIDS Treatment (CAT) programme, at a rural and an urban clinic in KwaZulu-Natal Province, South Africa. The records of 688 patients enrolled in the CAT programme between June 2004 and September 2006 were analysed. Adherence was calculated from pharmacy records (pill counts) and patients were considered adherent if they had taken at least 95% of their prescribed drugs. Logistic regression was used to analyse the data and account for confounding factors. During the first month of therapy, 79% of the patients were adherent to HAART. HAART adherence was negatively associated with a higher baseline CD4 count. Women had better adherence if they attended voluntarily testing and counselling or if they had taken an HIV test because they were unwell, while men had higher adherence if they were tested due to perceived risk of HIV infection. HAART adherence was positively associated with higher age among patients who possessed cell phones and among patients who provided a source of income in the urban setting, but not in the rural setting. Though long-term data from this cohort is required to fully evaluate the impact of non-adherence in the first month of treatment, this study identifies specific groups of patients at higher risk for whom adherence counselling should be targeted and tailored. For example, first-month HAART adherence can be improved by targeting patients initiated on treatment with a high CD4 count.     

芪参益气滴丸联合左西孟旦治疗慢性心力衰竭的临床研究

目的观察芪参益气滴丸联合左西孟旦治疗慢性心力衰竭(CHF)的临床疗效。方法选择2014年1月—2016年12月我院收治的CHF病人178例,依据随机数字表法分为联合组与左西孟旦组,每组89例。联合组在常规药物治疗基础上行芪参益气滴丸联合左西孟旦治疗,左西孟旦组行常规药物治疗联合左西孟旦治疗。观察两组治疗前及治疗7d后N末端脑利钠肽前体(NTproBNP)、血清促生长因子-1(IGF-1)、肌钙蛋白(cTnT)水平;两组每搏心输出量(SV)、左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD);中医证候积分及不良反应等指标。结果治疗后,联合组血清IGF-1水平高于左西孟旦组,血浆NT-proBNP及血清cTnT水平低于左西孟旦组(P<0.05)。治疗后,联合组SV高于左西孟旦组,差异有统计学意义(P<0.05)。联合组LVEF、LVESD、LVEDD与左西孟旦组差异无统计学意义(P>0.05)。治疗后,联合组中医证候积分低于左西孟旦组,差异有统计学意义(P<0.05)。联合组总有效率(85.39%)高于左西孟旦组(73.03%),差异有统计学意义(P<0.05)。治疗期间,联合组不良反应发生率(4.49%)与左西孟旦组(3.37%)比较差异无统计学意义(P>0.05)。结论芪参益气滴丸联合左西孟旦治疗CHF可减少心肌损伤,改善心功能。     

心痛灵滴丸预适应对兔心肌缺血再灌注损伤保护作用的研究

目的：探讨心痛灵滴丸预适应对兔心肌缺血再灌注损伤的保护作用。方法：采用冠状动脉粥样硬化(AS)家兔在体心肌缺血再灌注损伤模型，观察心痛灵滴丸预适应对兔心肌组织形态结构和脂质过氧化的影响。结果：心痛灵滴丸预适应能减轻缺血再灌注时心肌组织及细胞超微结构的形态学损伤，能显著提高兔血清超氧化物歧化酶(SOD)活性，降低血清丙二醛(MDA)含量，而且能加强缺血预适应对兔心肌缺血再灌注损伤的保护作用。结论：心痛灵滴丸预适应能诱导缺血预适应样心脏保护作用，其机制可能与清除氧自由基、抑制脂质过氧化反应有关。     

Efficacy and safety of Xihuang pill for gastric cancer: A protocol for systematic review and meta-analysis

Background:Xihuang pill has been widely applied as a promising adjunctive drug for gastric cance. However, the exact effects and safety of Xihuang pill have yet to be systematically investigated. We aimed to summarize the effificacy and safety of Xihuang pill for the treatment of advanced GC through the meta-analysis, in order to provide scientific reference for the design of future clinical trials.Methods:The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant randomized controlled trials were searched from PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and echnology Periodical Database, and Chinese Biomedical Literature Database. Papers in English or Chinese published from their inception to October 2020 will be included without any restrictions. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. The RevMan 5.4 and Stata 16.0 software will be applied for statistical analyses. Statistical heterogeneity will be computed by I² tests. Sensitivity analysis will be conducted to evaluate the stability of the results. The publication bias will be evaluated by funnel plots and Egger test. The quality of evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluate system.Results:The results of our research will be published in a peer-reviewed journal.Conclusion:The conclusion of this study will provide helpful evidence of the effect and safety of Xihuang pill for the treatment of GC in clinical practice.OSF registration number:10.17605/OSF.IO/VFJAK.     

速效救心丸对比硝酸甘油治疗心绞痛急性发作疗效和安全性的系统评价

目的系统评价速效救心丸对比硝酸甘油治疗心绞痛急性发作的疗效和安全性。方法计算机检索PubMed、EMbase、Web of SCI、the Cochrane Library、中国知网(CNKI)、维普中文科技期刊全文数据库(VIP)、万方数据资源系统(WanFang Data)、中国生物医学文献服务系统(SinoMed)等数据库,纳入速效救心丸对比硝酸甘油治疗心绞痛急性发作的随机对照试验(RCT),检索时限均为建库至2019年10月30日。由两位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果纳入6项RCT,共651例心绞痛急性发作病人。Meta分析结果显示,试验组不良反应发生率低于对照组[RR=0.37,95%CI(0.20,0.69),P=0.002];两组心绞痛改善率[RR=1.00,95%CI(0.94,1.06),P=0.97]和心电图改善率[RR=0.94,95%CI(0.84,1.05),P=0.26]差异均无统计学意义。结论当前证据表明,舌下含服速效救心丸或硝酸甘油片在心绞痛急性发作的治疗方面疗效均较好,但速效救心丸不良反应更少,安全性好。     

Adherence to Antiretroviral Therapy Assessed by Unannounced Pill Counts Conducted by Telephone

BACKGROUND: Unannounced pill counts conducted in patients' homes is a valid objective method for monitoring medication adherence that is unfortunately costly and often impractical. Conducting unannounced pill counts by telephone may be a viable alternative for objectively assessing medication adherence. PURPOSE: To test an unannounced pill count assessment of adherence conducted by telephone. METHODS: HIV-positive men and women (N = 77) in Atlanta GA completed an unannounced telephone-based pill count immediately followed by a pill count conducted in an unannounced home visit. RESULTS: A high degree of concordance was observed between phone and home-based number of pills counted (Intraclass correlation, ICC = .997, 95% CI .995-.998, P < .001) and percent of pills taken (ICC = .990, 95% CI .986-.992, P < .001). Concordance between adherence above/below 90% and phone/home counts was 95%, Kappa coefficient = .995. Concordance between pill counts was not influenced by participant education or health literacy and was maintained when the data were censored to remove higher levels of adherence. Analyses of discordant pill counts found the most common source of error resulted from overcounted doses in pillboxes on the telephone. CONCLUSIONS: Unannounced phone-based pill counts offer an economically and logistically feasible objective method for monitoring medication adherence.