自杀基因联合中医药疗法治疗肿瘤的设想

自杀基因疗法是一种具有良好应用前景的肿瘤治疗新措施。但如何有效提高疗效是目前仍须解决的关键性问题。由于免疫机制在自杀基因疗法旁杀伤效应中的重要作用，激活荷瘤机体的免疫功能，改善自杀基因抗肿瘤作用的炎症免疫微环境，是提高肿瘤自杀基因疗法疗效的主要策略。中医中药在调节机体免疫状态方面具有肯定的作用，与其他方法比较具有明显优势。因而，将自杀基因疗法与中医中药联合应用，有可能起到提高肿瘤自杀基因疗法疗效，防止肿瘤复发的作用。提出了自杀基因联合中医药疗法治疗肿瘤的新设想，为肿瘤基因治疗提供了一种新的思路和模式。     

Best Performance Parameters of HR-pQCT to Predict Fragility Fracture: Systematic Review and Meta-Analysis

Osteoporosis is a systemic skeletal disease characterized by low bone mass and bone structural deterioration that may result in fragility fractures. Use of bone imaging modalities to accurately predict fragility fractures is always an important issue, yet the current gold standard of dual-energy X-ray absorptiometry (DXA) for diagnosis of osteoporosis cannot fully satisfy this purpose. The latest high-resolution peripheral quantitative computed tomography (HR-pQCT) is a three-dimensional (3D) imaging device to measure not only volumetric bone density, but also the bone microarchitecture in a noninvasive manner that may provide a better fracture prediction power. This systematic review and meta-analysis was designed to investigate which HR-pQCT parameters at the distal radius and/or distal tibia could best predict fragility fractures. A systematic literature search was conducted in Embase, PubMed, and Web of Science with relevant keywords by two independent reviewers. Original clinical studies using HR-pQCT to predict fragility fractures with available full text in English were included. Information was extracted from the included studies for further review. In total, 25 articles were included for the systematic review, and 16 articles for meta-analysis. HR-pQCT was shown to significantly predict incident fractures and/or major osteoporotic fractures (MOFs). Of all the HR-pQCT parameters, our meta-analysis revealed that cortical volumetric bone mineral density (Ct.vBMD), trabecular thickness (Tb.Th), and stiffness were better predictors. Meanwhile, HR-pQCT parameters indicated better performance in predicting MOFs than incident fractures. Between the two standard measurement sites of HR-pQCT, the non-weight-bearing distal radius was a more preferable site than distal tibia for fracture prediction. Furthermore, most of the included studies were white-based, whereas very few studies were from Asia or South America. These regions should build up their densitometric databases and conduct related prediction studies. It is expected that HR-pQCT can be used widely for the diagnosis of osteoporosis and prediction of future fragility fractures. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Effectiveness of iontophoresis of anti-inflammatory medications in the treatment of common musculoskeletal inflammatory conditions: a systematic review

Abstract

Background: The Trendelenburg Test was developed by Friedrich Trendelenburg, an orthopaedic surgeon, in 1895. Contemporary evidence shows the Trendelenburg Test is now being used internationally by a wide variety of practitioners.

Method: This review describes the evolution of the Trendelenburg Test and its role within the examination of gait and examines the evidence relating clinical assessment using the Trendelenburg Test to the mechanics of walking. Literature was reviewed from electronic databases CINAHL, Medline, ScienceDirect, Ovid. Papers written in English were reviewed.

Results: The possible outcomes of the Trendelenburg Test and its interpretation are defined. The outcomes and interpretation for the future use of the Trendelenburg Test are discussed.

Conclusion: Further research is required into the biomechanics of the Trendelenburg Test and its relationship to functional anatomy and to investigate its reliability and validity within specific populations.     

Interpenetrating Polymer Networks as a Route to Tunable Multi-responsive Biomaterials: Development of Novel Concepts

Novel concepts are proposed for interpenetrating polymer networks (IPNs) that can be used in biomaterials responsive to multiple types of environmental stimuli. The IPNs can be a route to the tunable biomaterials whose chemical structure and/or morphology can be adjusted to the type of task to be performed. The significance of utilizing new types of processes in polymer chemistry such as the Suzuki polycondensation and living/controlled radical polymerizations to the possibility of extending/modifying component networks in the IPNs and fine-tuning their properties is emphasized. Incorporation of nanofillers into IPNs and application of monomers other than traditional alkylacrylamides as a way to enhance versatility of IPNs are also considered.     

Bioactive glasses for in situ tissue regeneration

Historically the function of biomaterials has been to replace diseased or damaged tissues. Recent findings show that controlled release of the ionic dissolution products of bioactive glasses results in regeneration of tissues. The mechanism for in situ tissue regeneration involves upregulation of seven families of genes that control the osteoblast cell cycle, mitosis and differentiation. In the presence of critical concentrations of Si and Ca ions, within 48 h osteoblasts that are capable of differentiating into a mature osteocyte phenotype begin to proliferate and regenerate new bone. Osteoblasts that are not in the correct phase of the cell cycle and unable to proceed towards differentiation are switched into apoptosis by the ionic dissolution products. A controlled release of soluble Ca and Si from bioactive glass - resorbable polymer composites leads to vascularised soft tissue regeneration. Gene activation by controlled ion release provides the conceptual basis for molecular design of a third generation of biomaterials optimised for in situ tissue regeneration.     

Risk assessment tools to identify women with increased risk of osteoporotic fracture: Complexity or simplicity? A systematic review

A huge number of risk assessment tools have been developed. Far from all have been validated in external studies, more of them have absence of methodological and transparent evidence, and few are integrated in national guidelines. Therefore, we performed a systematic review to provide an overview of existing valid and reliable risk assessment tools for prediction of osteoporotic fractures. Additionally, we aimed to determine if the performance of each tool was sufficient for practical use, and last, to examine whether the complexity of the tools influenced their discriminative power. We searched PubMed, Embase, and Cochrane databases for papers and evaluated these with respect to methodological quality using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) checklist. A total of 48 tools were identified; 20 had been externally validated, however, only six tools had been tested more than once in a population‐based setting with acceptable methodological quality. None of the tools performed consistently better than the others and simple tools (i.e., the Osteoporosis Self‐assessment Tool [OST], Osteoporosis Risk Assessment Instrument [ORAI], and Garvan Fracture Risk Calculator [Garvan]) often did as well or better than more complex tools (i.e., Simple Calculated Risk Estimation Score [SCORE], WHO Fracture Risk Assessment Tool [FRAX], and Qfracture). No studies determined the effectiveness of tools in selecting patients for therapy and thus improving fracture outcomes. High‐quality studies in randomized design with population‐based cohorts with different case mixes are needed.     

Key determinants of AIDS impact in Southern sub-Saharan Africa

To investigate why Southern sub-Saharan Africa is more severely impacted by HIV and AIDS than other parts of sub-Saharan Africa, I conducted a review of the literature that assessed viral, host and transmission (societal) factors. This narrative review evaluates: 1) viral factors, in particular the aggregation of subtype-C HIV infections in Southern sub-Saharan Africa; 2) host factors, including unique behaviour patterns, concomitant high prevalence of sexually transmitted diseases, circumcision patterns, average age at first marriage and immunogenetic determinants; and, 3) transmission and societal factors, including levels of poverty, degrees of literacy, migrations of people, extent of political corruption, and the usage of contaminated injecting needles in community settings. HIV prevalence data and published indices on wealth, fertility, and governmental corruption were correlated using statistical software. The high prevalence of HIV in Southern sub-Saharan Africa is not explained by the unusual prevalence of subtype-C HIV infection. Many host factors contribute to HIV prevalence, including frequency of genital ulcerating sexually transmitted infections, absence of circumcision (compiled odds ratios suggest a protective effect of between 40% and 60% from circumcision), and immunogenetic loci, but no factor alone explains the high prevalence of HIV in the region. Among transmission and societal factors, the wealthiest, most literate and most educated, but also the most income-disparate, nations of sub-Saharan Africa show the highest HIV prevalence. HIV prevalence is also highest within societies experiencing significant migration and conflict as well as in those with government systems experiencing a high degree of corruption. The interactions between poverty and HIV transmission are complex. Epidemiologic studies currently do not suggest a strong role for the community usage of contaminated injecting needles. Areas meriting additional study include clade type, host immunogenetic determinants, the complex interrelationship of HIV with poverty, and the community usage of contaminated injecting needles.     

The use of pursed lips breathing in stable chronic obstructive pulmonary disease: a systematic review of the evidence

Abstract

Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable chronic obstructive pulmonary disease (COPD). Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management.

Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means.

Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to the grading of recommendations assessments, development and evaluation (GRADE) system; the remaining studies were of low quality. Although no high quality evidence was identified, the direction of effect for PLB was consistently towards benefit, with the exception of one low quality study. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate at rest and reduces time taken to recover to pre-exercise breathlessness levels. One RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB: those with moderate to severe COPD are most likely to benefit.

Conclusion: High quality studies are required to identify PLB responders from non-responders and to determine whether short-term effects translate into clinically significant benefit.     

Non-surgical management of piriformis syndrome: a systematic review

Abstract

The aim of this review was to identify and evaluate the evidence for the non-surgical management of Piriformis Syndrome. A systematic review of electronic databases was carried out up to February 2006. This was supplemented by hand searching journals and 'snow-balling' from reference lists. Strict inclusion/exclusion criteria were applied. Five independent observers reviewed the methodological quality of the core studies using the published Physiotherapy Evidence Database (PEDro) critique tool. Differences were resolved by consensus. Two studies met the inclusion/exclusion criteria. PEDro scores were 6/10 and 10/10. Both studies demonstrated positive effects for botulinum toxin type A (Botox) injections compared to a placebo or control treatment. One study identified this positive effect in addition to a physiotherapy protocol. Evidence implies that Botox is a potentially successful treatment for Piriformis Syndrome; however, a paucity of high-quality clinical trials limits evidence of its overall efficacy. Further clinical trials of the effectiveness of non-surgical measures in the management of this syndrome are indicated.