M-Tang法肌腱缝合技术的生物力学研究及其在Ⅱ区屈肌腱修复中的应用

目的报道一种新的肌腱缝合方法 M-Tang法的生物力学特性及临床应用结果。方法本研究采用36根猪后足屈肌腱作为实验材料,在相当于Ⅱ区水平造成切割伤后,18根用Tang法、18根用M-Tang法进行修复。将修复后的肌腱分别进行直线和90°成角状态下的拉伸,用Instron力学测定仪测定2 mm间隙形成负荷及断裂负荷。M-Tang法用于临床修复Ⅱ区屈肌腱65例共96指,术后均采用保护性主、被动活动相结合的锻炼计划。采用Strickland标准进行功能评价。结果在直线拉伸模式下,M-Tang法的2 mm间隙形成负荷为(46.2±5.2)N,断裂负荷为(61.9±6.0)N,与Tang法相近;在90°成角拉伸模式下,M-Tang法的2 mm间隙形成负荷为(35.9±3.6)N,与Tang法相近,断裂负荷为(57.0±4.5)N,高于Tang法。65例患者术后平均随访26个月,临床运用M-Tang法修复的Ⅱ区屈肌腱无1例发生断裂,根据Strickland TAM标准,其中优78指,良10指,可8指,优良率91.6%。结论 M-Tang法具备Tang法的生物力学强度,操作简便,使用缝线和外露线结少,能满足肌腱早期保护性主动活动的需要,是Ⅱ区屈肌腱修复的优选方法之一。     

Partial Component–Retained 2-Stage Reconstruction in the Treatment of Infected Hip Arthroplasty

BackgroundIt is considered the gold standard treatment for infected hip arthroplasty to remove and reimplant the corresponding whole set of implant components before and after infection control, but it usually causes substantial bone loss to remove the well-fixed cup or stem, which may increase the difficulty in reconstruction. We would like to determine whether infected hip arthroplasty can be treated without removal of a well-fixed cup or stem.MethodsPatients with infected hip arthroplasty and a radiographically well-fixed, cementless cup or stem were selected. During the first surgical stage, we retained the stem or cup if these cannot be removed using a stem or cup extractor. We performed the reimplantation surgery after control of infection.ResultsFrom January 2008 to December 2016, 26 patients underwent partial component–retained 2-stage reconstruction. All the patients were free of infection with a mean follow-up time of 43.85 months.ConclusionPartial component–retained 2-stage reconstruction may be a treatment option for infected total hip arthroplasty with a well-fixed component in patients.     

补阳还五汤对肺纤维化中HMGB1-RAGE信号通路的调控作用

目的:观察肺纤维化中诱导免疫损伤和异常修复的高迁移率族蛋白Box-1(high mobility group Box-1 protein,HMGB1)及晚期糖基化终产物受体(receptor of advanced glycation end-product,RAGE)的表达,及补阳还五汤对HMGB1-RAGE信号通路的调控作用。方法:144只SD大鼠随机分为6组,分别为正常组,博莱霉素(BLM)模型组,补阳还五汤低、中、高剂量组(6.83,13.66,27.32 g·kg~(-1)),阳性药组(强的松,4.2 mg·kg~(-1)),动物实验采用博莱霉素气管注入法复制肺纤维化模型后,分别给予补阳还五汤高、中、低剂量和强的松灌胃,于造模后第7,14,28天分批提取样本。采用逆转录-聚合酶链式反应(RTPCR)法检测肺组织中的HMGB1,RAGE mRNA的表达;采用蛋白质免疫印记法(Western blot)检测HMGB1,α-平滑肌肌动蛋白(alpha-smooth muscle action,α-SMA)的表达。细胞实验采用含药血清药理学的实验方法,以5%,10%,15%,20%的补阳还五汤含药血清和空白血清来干预HMGB1诱导刺激的人肺成纤维细胞(HFL1),采用Western blot法检测α-SMA蛋白的表达。结果:动物实验中,与正常组比较,模型组在第28天显著上调HMGB1 mRNA(P0.01),在第7天和第14天显著上调RAGE mRNA(P0.01),在各时间点显著上调HMGB1,α-SMA(P0.01);与BLM模型组比较,补阳还五汤高剂量组在第14天和第28天显著下调HMGB1 mRNA(P0.01),在第7天和第14天显著下调RAGE mRNA(P0.01),在各时间点显著下调HMGB1和α-SMA蛋白(P0.01)。细胞实验中,与空白组比较,20%空白血清预培养加HMGB1组显著升高α-SMA蛋白(P0.01);与20%空白血清预培养加HMGB1组比较,不同剂量的补阳还五汤含药血清显著下调细胞中α-SMA蛋白(P0.01)。结论:补阳还五汤可抑制HMGB1在大鼠肺组织中和人肺成纤维细胞中所引起的RAGE,α-SMA的表达增加。提示补阳还五汤可能通过阻断HMGB1/RAGE信号通路,减少肌成纤维细胞生成,对肺纤维化的发生发展起到防治作用。     

化浊祛瘀汤治疗酒精性肝病的实验研究

目的探讨化浊祛瘀汤对酒精性肝病大鼠影响的机理。方法通过乙醇梯度灌胃的方法建立酒精性肝病（ALD）大鼠模型,并使用化浊祛瘀汤给大鼠灌胃,观察化浊祛瘀汤对酒精性肝病肝损伤大鼠NF—κB表达,NF—α、CAT等水平的影响,并进行HE染色,观察肝脏组织基本病理改变。结果模型组大鼠NF—κB表达明显增强（P〈0．01）,TNF—α含量显著增加（P〈0．01）,CAT含量明显降低（P〈0．01）;化浊祛瘀汤治疗组NF—κB表达明显减弱,TNF—α含量明显降低（P〈0．01）,CAT含量明显升高（P〈0．01）;中药高剂量组与西药组比较有显著性差异（P〈0．01）。结论化浊祛瘀方药能够抑制酒精性肝病时NF—κB、TNF—α的表达,改善ALD脂质过氧化过程。     

加味桃红四物汤对骨髓基质干细胞体外诱导的实验研究

目的研究加味桃红四物汤对骨髓基质干细胞早期促缺氧诱导因子（HIF-1）与血管内皮生长因子（VEGF）分泌的影响。方法骨髓基质干细胞取材,设置中药组及生理盐水组,观察HIF-1、VEGF表达。结果中药组对骨髓干细胞培养第2d HIF-1α表达量开始出现,第5、7天后中药组HIF-1α mRNA的表达量显著低于生理盐水组。而第3、5、7、14天VEGF表达中药组表达较生理盐水组强,在第5、7天VEGF表达达到峰值。结论加味桃红四物汤可以诱导骨髓基质干细胞向血管祖细胞分化,并促相关生长因子表达。     

独活寄生汤对风寒湿痹型关节炎患者关节液中炎症因子、氧化应激及脂肪细胞因子的影响

目的:观察独活寄生汤对风寒湿痹型关节炎患者的疗效,并探讨其对关节液中炎症因子、氧化应激及脂肪细胞因子的影响。方法:选取东莞市中医院诊断及治疗的风寒湿痹型关节炎患者124例,按随机数字表法分组,对照组(62例)予以常规治疗,观察组(62例)在对照组基础上予以独活寄生汤治疗,观察并记录两组患者临床症状评分、关节液指标及脂肪细胞因子水平,同时比较两组患者临床疗效及并发症状况。结果:对照组治疗有效率低于观察组(P0.05);与治疗前比较,两组患者治疗后视觉模拟评分法(visual analogue scale,VAS),西安大略和麦克马斯特骨关节炎调查量表(Western Ontario and Mc Master Universities Osteoarthritis,WOMAC)评分均降低,Lyshom评分升高,关节液中肿瘤坏死因子-α(tumor necrosis factoralpha,TNF-α),白细胞介素-6(interleukin-6,IL-6)及白细胞介素-1β(interleukine-1 beta,IL-1β)表达水平降低,关节液一氧化氮(nitric oxide,NO),丙二醛(malondialdehyde,MDA)水平降低,超氧化物歧化酶(superoxide dismutase,SOD)水平升高,脂联素(adiponectin,APN)水平升高,瘦素(leptin)及内脂素(visfatin)水平降低(P0.05);与对照组比较,观察组治疗后VAS,WOMAC量表评分较低,Lyshom评分较高,关节液TNF-α,IL-6及IL-1β水平较低,关节液NO,MDA水平较低,SOD水平较高,APN水平较高,leptin及visfatin水平较低(P0.05)。结论:独活寄生汤能够使关节炎患者受益,可能与其减少关节液中炎症因子表达及抑制氧化应激有关。     

当归补血汤不同剂型及配伍对骨髓抑制小鼠造血调控的实验研究

 目的本实验通过比较当归补血汤煎剂及颗粒剂对骨髓抑制小鼠造血机能调控的影响来比较它们之间的疗效差异。旨在为中药颗粒剂的疗效提供实验室依据。方法本实验用高效液相色谱仪检测了当归补血汤不同制剂中阿魏酸、黄芪甲苷的含量差异;采用造血祖细胞培养术、外周血像计数法、ELISA等方法对造血祖细胞集落数、外周血像的变化及造血微环境中EPO,TPO,G-CSF的变化进行检测。结果当归补血汤煎剂、颗粒剂能通过平衡骨髓微环境中EPO,TPO,GM-CSF的表达;促进骨髓造血细胞从G_{0/G1期进入G2/M期和S期;促进造血祖细胞增殖,从而提高骨髓抑制小鼠外周血像和骨髓像。结论当归补血汤煎剂、颗粒剂均能改善骨髓抑制小鼠的造血机能,其中配方颗粒剂疗效较为突出。}     

Traditional Chinese medicine Jia Wei Gui Pi Tang improves behavioural and psychological symptoms of dementia and favourable positive emotions in patients

Background

Behavioural and psychological symptoms of dementia (BPSD) are challenging to manage, leading to caregiver burden and often to subsequent transfer of patients to a nursing home or psychiatric hospital for treatment. Eliciting favourable positive emotions should be an important goal in the treatment of negative emotions associated with BPSD. To date, no data have indicated that antipsychotic medications can improve positive emotions. BPSD are known to be associated with anxiety in patients with dementia. The traditional Chinese medicine Jia Wei Gui Pi Tang is officially indicated and approved for anxiety treatment in Japan.

Methods

Here, we performed a multicentre, randomised, observer-blind control study of the effect of Jia Wei Gui Pi Tang on BPSD in Alzheimer's disease (AD) patients. Patients with AD or AD with cerebral vascular disease were randomly divided into the Jia Wei Gui Pi Tang treatment group and the control group that received no traditional Chinese medicine. BPSD were scored using the Neuropsychiatric Inventory Nursing Home Version (NPI-NH) and by favourable positive emotions using the Delightful Emotional Index (DEI).

Results

A total of 63 participants (18 male and 45 female; mean age: 83.3 ± 6.0 years) were included in the study. Changes in NPI-NH scores differed significantly between the two groups (one-way analysis of variance, P < 0.001). Within the treatment group, there was a significant improvement in the NPI-NH score from 29.8 ± 17.3 at baseline to 13.2 ± 9.4 at the endpoint (paired t-test, P < 0.001), whereas there was no statistically significant change in the control group. Changes in DEI scores differed significantly between the two groups. Within the treatment group, there was a significant improvement in the DEI score from 24.3 ± 23.0 at baseline to 32.5 ± 21.2 at the endpoint (paired t-test, P = 0.001), whereas there was no statistically significant change in the control group.

Conclusion

The traditional Chinese medicine Jia Wei Gui Pi Tang significantly improved both BPSD and positive emotions.     

消幻汤含药血清对人神经母细胞瘤细胞增殖及形态的影响

目的初步探讨消幻汤含药血清对人神经母细胞瘤细胞SH—SYSY的增殖及形态的影响。方法通过连续7d给家兔灌胃给药,制备消幻汤含药兔血清、利培酮含药免血清及空白兔血清。将上述血清作用于SH—sY5Y细胞24～72h,通过倒置显微镜观察舍药血清干预48h的SH—SY5Y细胞的形态,并且每24小时采用MTT法检测SH～SY5Y细胞的增殖情况。结果消幻汤含药血清处理48h的SH—SY5Y细胞突起较长,细胞间接触紧密,并且伸出伪足,虽表现为增殖旺盛,但消幻汤含药血清对SH—SY5Y细胞的增殖与空白血清相比,差异无统计学意义（P〉0．05）,而利培酮含药血清则可显著增加sH—SY5Y的细胞数量,呈现对数增殖趋势,与其他各组比较,差异有统计学意义（P〈0．05）。结论消幻汤含药血清对SH—SY5Y细胞的正常形态有促进作用,而对SH—SY5Y细胞的正常增殖无显著干预作用,与利培酮舍药血清作用不同。     

玉液汤对糖尿病性黄斑水肿的疗效观察及机制探讨

目的:观察玉液汤对糖尿病性黄斑水肿的临床疗效及其与IL-6、VEGF的影响。方法:将60例糖尿病性黄斑水肿患者随机分成2组,治疗组给予玉液汤+激光光凝治疗,对照组予激光光凝治疗,观察治疗4周后2组视力、视网膜厚度、视网膜血管情况等;应用ELISA检测2组患者血清中IL-6、VEGF含量表达情况。结果:2组经不同方法治疗4周后视力、视网膜厚度、视网膜血管情况比较差异有统计学意义(P0.05),治疗组经玉液汤口服治疗与对照组比较,IL-6、VEGF的血清含量情况明显低于对照组,差异有统计学意义(P0.05)。结论:玉液汤治疗糖尿病性黄斑水肿可以有效提高视力、改善视网膜厚度、视网膜血管情况,是一种安全有效的治疗方式,值得临床推广应用,而调节IL-6和VEGF可能是玉液汤发挥治疗作用的重要靶点。