Impact of Dissection after Drug-Coated Balloon Treatment of De Novo Coronary Lesions: Angiographic and Clinical Outcomes

PurposeDissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions.Materials and MethodsA total of 227 patients with good distal flow (Thrombolysis in Myocardial Infarction flow grade 3) following DCB treatment were retrospectively enrolled and stratified according to the presence or absence of a non-flow limiting dissection. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization, and target vessel thrombosis).ResultsThe cohort consisted of 95 patients with and 132 patients without a dissection. There were no between-group differences in LLL (90.8%) returning for angiography at 6 months (0.05±0.19 mm in non-dissection and 0.05±0.30 mm in dissection group, p=0.886) or in TVF (6.8% in non-dissection and 8.4% in dissection group, p=0.799) at a median follow-up of 3.4 years. In a multivariate analysis, the presence of dissection and its severity were not associated with LLL or TVF. Almost dissections (93.9%) were completely healed, and there was no newly developed dissection at 6-month angiography.ConclusionThe presence of a dissection following successful DCB treatment of a de novo coronary lesion may not be associated with an increased risk of LLL or TVF (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; {"type":"clinical-trial","attrs":{"text":"NCT04619277","term_id":"NCT04619277"}}NCT04619277).     

膳食维生素C与代谢综合征风险的meta分析

目的用meta分析的方法定量评估膳食维生素C与代谢综合征(metabolic syndrome,MetS)风险的关系,为MetS的预防与治疗提供依据。方法系统检索PubMed、EMBASE、中国知网(CNKI)、万方数据库(WanfangData)以及维普数据库(VIP)中由建库至2021年12月公开发表的关于膳食维生素C与MetS风险关系的流行病学观察性研究。提取数据后,应用Stata 12.0软件进行meta统计分析。结果共纳入7篇文献,总样本量为29363人,包括8300例MetS患者。meta分析结果显示,膳食维生素C摄入量最高组发生MetS的风险较最低组低7%(RR=0.93,95%CI:0.89~0.98)。剂量-反应meta分析结果显示,膳食维生素C与MetS风险之间呈线性关系(非线性P>0.10),摄入量每增加50 mg/d并不能明显降低MetS的发生风险(RR=0.97,95%CI:0.92~1.02)。结论MetS与膳食维生素C摄入量之间存在关联性,高膳食维生素C摄入可降低MetS的风险。     

经典名方中藿香类药材的本草考证

通过查阅古代相关本草、医籍、经史及近现代文献资料,笔者对藿香类药材的名称、基原、产地、品质评价、栽培、采收加工及炮制方法等进行了系统梳理与考证,可为含藿香类药材的经典名方开发利用提供依据。通过本草考证分析可知,历代本草多以“藿香”为正名,所用主流基原均为Pogostemon cablin,为区别于明代以来我国民间习用的同科另一种植物土藿香Agastache rugosa及推崇道地产区而有“广藿香”之名;广藿香原产于越南等东南亚国家,早期因作香料经广东等地传入我国,宋代以来便已在我国南方引种成功;药用部位多为其干燥地上部分,亦有将其叶、梗分开单独使用;历代推崇的道地产区为广东,现广东广州、肇庆、湛江和海南省多有栽培,以石牌所产最为知名;广藿香主要为扦插繁殖,二月生苗,六月采收;产地加工方法主要为闷晒法,放置阳光下反复闷晒至有芳香气味、颜色转黄;炮制方法多以净选后生品入药。基于考证结果,建议养胃汤中所用藿香以P. cablin为基原,取叶片生品入药,而藿朴夏苓汤则建议选择土藿香A. rugosa除去根及老茎的生品入药。     

基于Nrf2/HO-1通路的中医药干预溃疡性结肠炎研究进展

溃疡性结肠炎（UC）是临床常见的一种慢性消化系统疾病,其病情反复且治疗难度大,发病机制复杂,与氧化应激反应相关。核转录因子E₂相关因子2（Nrf2）是抗氧化反应中的重要因子,可调控其下游血红素加氧-1（HO-1）的表达,发挥维持机体氧化还原稳态的作用。UC的病程中Nrf2与HO-1的生物活性及含量水平均下降,组织抗氧化和抗炎能力减弱,肠上皮细胞损伤,肠黏膜屏障破坏。目前西医临床上主要以控制炎症和缓解症状治疗为主,虽有一定疗效,但存在停药后易复发、长期用药不良反应多等问题。研究表明,中医药治疗手段丰富,治疗方法灵活,在UC的防治上有广阔的应用前景。近年来,以Nrf2/HO-1通路为切入点,中医药领域开展了大量关于UC中该信号的基础和临床实验,结果表明Nrf2/HO-1通路是中医药治疗UC的重要潜在靶点。基于虚实夹杂的病因病机,中医药以清热解毒燥湿、活血化瘀止痛、益气补中温里和标本兼治等法调控Nrf2/HO-1通路,提高组织抗氧化应激能力,维持促炎因子与抗炎因子平衡,缓解炎症反应,发挥对UC的治疗作用。该文总结和分析了中医药靶向Nrf2/HO-1信号通路干预UC的机制和作用,以期为科研人员更为全面认识中医药对UC中Nrf2/HO-1通路的作用机制提供帮助,旨在推动今后中医药合理运用于临床UC的防治。     

治疗儿童呼吸系统疾病中成药的临床研究证据的概况性综述

目的：该研究使用概况性综述的方法,对治疗儿童呼吸系统疾病的中成药说明书信息及临床研究证据进行全面分析总结并报告。方法：通过检索2021年版《国家基本医疗保险、工商保险和生育保险药品目录》、2018年版《国家基本药物目录》、2020年版《中华人民共和国药典》（一部）,三大药品目录,获得治疗儿童呼吸系统疾病中成药;再检索中英文数据库获得相关文献,最后进行数据统计与可视化分析。结果：经筛选分析后,共纳入中成药52种。涉及9种剂型;主要组成为黄芩、苦杏仁、连翘等;功效以清热解表、止咳化痰等为主;主要治疗小儿风热感冒、咳嗽等;药物不良反应与禁忌证均只有19.23%(10/52)的中成药给与说明,其余均为尚不明确。纳入文献279篇,其中中文核心期刊文献277篇,英文科学引文索引扩展版（SCIE）2篇,包括随机对照研究253篇（含剂型/剂量比较6篇）、基于医院管理信息系统（HIS）数据的回顾性分析11篇、病例系列1篇、系统评价与Meta分析13篇（含网状Meta分析2篇）、经济学评价1篇。72.76%(203/279)的研究发表在中国科技核心期刊上;文献只涉及33种中成药,关于小儿肺热咳喘口服液的研...     

经典名方中石决明的本草考证

通过查阅历代本草、医籍、方书及现代文献资料,笔者对经典名方中所用石决明药材进行系统本草考证,涉及名称、基原、产地、品质评价、采收加工及炮制等方面内容,以期为含石决明的经典名方开发提供依据。经考证可知,历代皆以石决明为正名,亦有以其功效、性状及近音字而命名的“千里光”“九孔螺”“珍珠母”等异名。唐代以前石决明药材动物基原因形态描述过于简练,仅能考订为鲍科鲍属动物;宋元明清时期主流基原为杂色鲍Haliotis diversicolor与皱纹盘鲍H. discus hannai;民国时期开始将鲍属多种动物作为石决明基原使用,品种繁杂并延续至今。古今我国国内主要产区为海南、广东及山东地区,国外产地主要为日本及越南。古籍中对石决明品质评价大致以呼水孔的开孔数量为准,以七孔和九孔的鲍壳为佳;近现代则以性状个大整齐、无破碎、内外洁净并有光彩、壳厚者为佳。基于考证结果,结合石决明散的记载年代,建议开发该经典名方时石决明药材使用杂色鲍H. diversicolor或皱纹盘鲍H. discus hannai的贝壳,且以生品入药。     

经典名方当归补血汤的古代文献分析与考证

当归补血汤出自金元时期李东垣《内外伤辨惑论卷中·暑伤胃气论》,是一首被历代医家传承发扬的补气生血经典名方,已被收录于2018年国家中医药管理局公布《古代经典名方目录（第一批）》。通过系统梳理古籍文献及现代文献,并结合古代经典名方关键信息考证原则,对经典名方当归补血汤的历史源流、组成、剂量、炮制、制法与煎服法、功效与应用进行考证分析。共收集相关古籍文献信息604条,其中涉及中医古籍186部,其中40部（金元5部,明19部,清16部）中医古籍详细记载了组成、炮制、剂量等内容。有关当归补血汤组成,主要为当归和黄芪;根据古今剂量折算,黄芪37.3~38.1 g,当归7.5~7.6 g;黄芪宜采用蜜炙,当归为酒当归;加入水600 mL,煎至300 mL,饭前温服。该方古籍主要记载功效为血虚发热,证见肌热、燥热,烦渴引饮,目赤面红,昼夜不息,脉洪大而虚,重按无力,是补气生血名方。现代研究表明,当归补血汤常用于治疗各种贫血、糖尿病肾病、肿瘤、心脑血管疾病。上述研究结果为经典名方当归补血汤后期开发研究提供了参考依据。     

经典名方中杜仲的本草考证

通过查阅历代本草、医籍、方书并结合近现代文献资料,笔者对杜仲药材的名称、基原、产地、品质评价、采收加工、炮制历史沿革及产地变迁情况进行了系统梳理及考证,以期为含杜仲的经典名方开发提供参考依据。经考证可知,历代本草均以杜仲为正名,基原为杜仲科植物杜仲Eucommia ulmoides的干燥树皮,古今一致;杜仲最早的产地为河南、山西、陕西、四川一带,自明代以来产地扩展至全国大部分地区,且推崇四川、陕西、重庆、贵州、湖北等地为杜仲的道地产区;近代以来总结其品质以皮厚、块大、粗皮刮净、断面多丝、内表面色暗紫为佳;杜仲的古代炮制加工方法主要有去粗皮切制生用和加酥蜜、姜汁、盐水、酒等辅料炮制,近现代以来炮制方法日趋简化,沿用的炮制方法主要为净制后切制生用、盐炙,建议挖掘不同杜仲炮制品的现代科学内涵,通过标准恢复传统主流炮制方法。基于宋代陈自明的三痹汤中杜仲“去皮,切,姜汁炒”的要求,根据考证结果,建议使用姜杜仲,即参考2020年版《中华人民共和国药典》炒法,以姜汁为辅料进行炮制后入药。     

Social Representations of Drinking Water in Schoolchildren and Parents from Two Schools in Zapopan,Mexico

Childhood obesity and children being overweight has increased recently; although they are multi-causal problems, an unhealthy diet is a critical component. In Mexico, drinking water consumption in children from 9 to 18 years only reaches 30% of total fluid consumption. The aim of our study was to describe the social representations (SR) of drinking water in school-children and parents of two schools in Zapopan, Mexico. Associative free listing was used as an information gathering technique. Schoolchildren aged 8 to 12 years (n = 50) and parents (n = 23) from two elementary schools were selected by a convenience sampling from April to June 2015. A similarity analysis was performed using the co-occurrence index; with this, a similarity graph was obtained. Prototypical analysis was performed to explore the structure of the SR. Three dimensions were described in the children’s SR: a functional dimension related to health and nutrition, a practical dimension that describes the instruments used for its consumption, and a theoretical dimension that specifies the characteristics of water and its relationship with nature. In the parents’ SR, a functional dimension was also found; another dimension was described regarding the integral well-being that drinking water provides. A practical dimension describes the features related to its consumption. The investigation describes the structure of the water SR, which help to contextualize and explain the actions of schoolchildren and their parents regarding drinking water consumption.