Objective:To investigate the effects of astragalus polysaccharide(APS)on hippocampal neuron injury in rats with Alzheimer's disease(AD).Methods:A total of 180 healthy Wistar rats were divided into normal group,model group,low APS(APS-L),medium APS(APS-M),high APS dose(APS-H)group and piracetam(PIR)group by random number table method.Except the normal group,the AD rat model was prepared by bilateral hippocampal injection of β-amyloid 1-42 fragments(Aβ1-42).APS-L,APS-M and APS-H groups were given 200,400 and 800 mg/kg APS intragastatically,respectively.The PIR group were given 500 mg/kg PIR intragastatically.The normal group and model group were given 0.9％sodium chloride solution intragastatically,once a day,for 30 days.Hematoxylin-eosin(HE)staining was used to observe the pathological changes of neurons in CA1 region of hippocampus.Transmission electron microscopy was uesd to observe the ultrastructure of neurons.Superoxide dismutase(SOD),glutamate glutathione peroxidase(GSH-Px)activity and malondialdehyde(MDA)content in hippocampus were detected by spectrophotometry.The levels of tumor necrosis factor-α(TNF-α),interleukin(IL)-1β and IL-6 were detected by enzyme-linked immunosorbent assay(ELISA).The mRNA expression of nuclear factor E2-related factor 2(Nrf2)and heme oxygenase-1(HO-1)were measured by reverse transcription polymerase chain reaction(RT-PCR).The expressions of Nrf2,HO-1,cytoplasmic nuclear factor-κB p65(NF-κB p65),and nuclear NF-κB p65 were detected by Western Blot.Results:Compared with model group,the pathological morphological and ultrastructural changes of neurons in hippocampal CA1 region of rats in APS-L,APS-M,APS-H group,and PIR group improved with different degrees.The pathological grade of neurons in hippocampal CA1 region significantly decreased in APS-M,APS-H and PIR groups(P<0.05),the activities of SOD and GSH-Px significantly increased and the content of MDA significantly decreased(P<0.05),and the levels of TNF-α,IL-1β and IL-6 significantly decreased(P<0.05),Nrf2 and HO-1 mRNA and protein expressions significantly increased(P<0.05),while nuclear NF-κB p65 expression and nuclear NF-κB p65/cytoplasmic NF-κB p65 expression significantly decreased(P<0.05).APS showed a dose-dependent effect on each index,and the effect of APS-H group on each index was better than piracetam group(P<0.05).Conclusion:APS shows a dose-dependent protective effect on hippocampal neuron injury in AD rats.The mechanism may be related to activation of Nrf2/HO-1 pathway,inhibition of NF-κB nuclear translocation,and inhibition of oxidative stress.

目的 分析血清胃饥饿素(Ghrelin)、肥胖抑制素(Obestatin)、同型半胱氨酸(Hcy)水平与老年缺血性脑卒中后并发认知功能障碍的相关性.方法 选取2019年9月至2022年2月邯郸市中心医院收治的120例老年缺血性脑卒中后并发认知功能障碍患者作为观察组,110例老年缺血性脑卒中后无认知功能障碍患者作为对照A组,100例体检健康者作为对照B组.酶联免疫吸附试验测定血清Ghrelin、Obestatin、Hcy水平;使用简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)对观察组进行评分,根据MMSE评分将观察组分为轻度组(50例)、中度组(30例)、重度组(40例);分析观察组血清Ghrelin、Obestatin、Hcy水平与MMSE、MoCA评分的相关性,老年缺血性脑卒中患者发生认知功能障碍的影响因素,血清Ghre-lin、Obestatin、Hcy水平对老年缺血性脑卒中患者发生认知功能障碍的诊断价值.结果 观察组、对照A组、对照B组血清Ghrelin水平依次升高(P<0.05),Obestatin、Hcy水平依次降低(P<0.05);轻度组、中度组、重度组血清Ghrelin水平、MMSE、MoCA评分依次降低(P<0.05),重度组血清Obestatin、Hcy水平高于轻度组(P<0.05);老年缺血性脑卒中后并发认知功能障碍患者血清Ghrelin水平与MMSE、MoCA评分均呈正相关(P<0.05),血清Obestatin、Hcy水平与MMSE、MoCA评分均呈负相关(P<0.05);血清Ghrelin水平升高为影响老年缺血性脑卒中患者发生认知功能障碍的保护因素,Obestatin、Hcy水平升高为影响老年缺血性脑卒中患者发生认知功能障碍的独立危险因素(P<0.05);血清Ghrelin、Obestatin、Hcy三者联合诊断老年缺血性脑卒中患者发生认知功能障碍的曲线下面积(AUC)为0.904,明显高于血清Ghrelin、Obestatin、Hcy水平单独诊断的AUC(P<0.05).结论 老年缺血性脑卒中后并发认知功能障碍患者血清Ghrelin呈低水平,Obestatin、H cy呈高水平,及时检测三者水平可能对评估患者认知功能障碍发生及病情严重程度具有重要意义.

[目的]研究芹菜素(APG)对血管性痴呆(VD)大鼠认知功能的保护作用及机制.[方法]通过结扎双侧颈总动脉复制VD大鼠模型,设置假手术组、模型组、APG低剂量组、APG高剂量组和尼莫地平(NMP)组,每组30只.APG低剂量组、高剂量组分别1次/天腹腔注射20、40 mg/kg APG,NMP组1次/天腹腔注射2 mg/kg NMP,假手术组和模型组给予生理盐水,疗程28天.Morris水迷宫实验检测大鼠的认知功能,HE染色和TUNEL染色观察海马体CA1区神经元病理特点和凋亡状况,通过电子显微镜观察神经元超微结构变化,分光光度法检测海马体丙二醛(MDA)含量和超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活性;RT-PCR和Western blot检测海马体核因子E2相关因子2(Nrf2)、血红素加氧酶1(HO-1)mRNA和蛋白的表达.[结果]与模型组相比,APG高剂量组和NMP组大鼠的认知功能明显改善;海马体CA1区神经元数量、形态结构病理学改变、超微结构改变和凋亡状况均明显改善,病理分级和凋亡指数(AI)降低;海马体MDA含量降低,SOD、GSH-Px活性升高,Nrf2、HO-1 mRNA和蛋白的表达升高.APG高剂量组各指标的改善均优于NMP组.[结论]APG对VD大鼠的认知功能具有明显改善作用,可能与APG激活Nrf2/HO-1通路,抑制氧化应激而减轻大脑海马体损伤有关.

目的 探讨振源胶囊联合沙库巴曲缬沙坦钠片治疗慢性心力衰竭的临床疗效.方法 选取2021年1月—2022年1月在邯郸市中心医院诊治的106例慢性心力衰竭患者,按随机数字表法分为对照组(53例)和治疗组(53例).对照组口服沙库巴曲缬沙坦钠片,初始剂量为50～100 mg/次,2次/d,根据患者血压耐受性逐步增加剂量,直至200 mg/次,2次/d,并维持.治疗组在对照组基础上口服振源胶囊,2粒/次,3次/d.两组患者均治疗16周.观察两组患者临床疗效,比较治疗前后两组患者超声心动图指标左心室射血分数(LVEF)、左室舒张末期内径(LVEDd)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)和校正体表面积后计算左心室心肌质量指数(LVMI)水平,运动能力指标最大运动功率(Wmax)、最大运动时间(tmax)、峰值氧耗量(Peak VO2)和无氧阈氧耗量(VO2AT)水平,实验室检测指标N末端B型利钠肽原(NT-proBNP)、高迁移率族蛋白1(HMGB1)、可溶性生长刺激表达基因2蛋白(sST2)、半乳糖凝集素-3(Gal-3)和中性粒细胞/淋巴细胞比值(NLR)水平.结果 治疗后,治疗组总有效率为96.23％,对照组总有效率为84.91％,两组比较差异具有统计学意义(P<0.05).治疗后,两组患者LVEF水平较治疗前均显著提高,而LVEDd、LVPWT、IVST、LVMI水平显著下降(P<0.05),且治疗组患者超声心动图指标水平比对照组改善更明显(P<0.05).治疗后,两组患者Wmax、tmax、Peak VO2、VO2AT指标水平较治疗前均显著提高(P<0.05),且治疗组患者运动能力指标水平比对照组提高更明显(P<0.05).治疗后,两组患者NT-proBNP、NLR、HMGB1、sST2、Gal-3水平较治疗前均显著下降(P<0.05),且治疗组患者比对照组下降更明显(P<0.05).结论 振源胶囊联合沙库巴曲缬沙坦钠治疗慢性心力衰竭具有良好临床疗效,可有效改善患者心功能,增加射血分数,提高运动能力,减轻炎性反应,改善心室重构,且安全性较高.

BACKGROUND:Changes in vascular function are closely associated with the development of cardiovascular disease (CVD). Pulse wave velocity (PWV) is a potential indicator of vascular dysfunction; it allows noninvasive assessment of arterial stiffness. Currently, evidence for the effects of different classes of antidiabetic drugs on arterial stiffness remains limited. In this study, a network meta-analysis (NMA) was performed to explore the associations between changes in arterial stiffness and first-line antidiabetic drugs by evaluating PWV in patients with different metabolic abnormalities. METHODS:We systematically searched several electronic databases for randomized controlled trials (RCTs) published from inception until 25 August 2022, without language restrictions. The primary outcome was the change in PWV (ΔPWV) in all included studies; subgroup analysis was performed for patients with abnormal glucose metabolism, including prediabetes and diabetes mellitus. NMA was performed to calculate the mean differences (MDs) with 95% confidence intervals (CIs) as effect sizes to evaluate the ΔPWV. RESULTS:Among the 2257 candidate articles identified in the initial search, 18 RCTs were eventually included in the analysis. In all studies, two classes of new antidiabetic drugs, glucagon-like peptide-1 receptor (GLP-1R) agonists and sSodium-glucose co-transporter 2 (SGLT-2) inhibitors, improved arterial stiffness by decreasing PWV compared with placebo (MD = -1.11, 95% CI: -1.94 to 0.28) and (MD = -0.76, 95% CI: -1.45 to -0.08). A conventional antidiabetic drug, metformin, also showed similar efficacy compared with placebo (MD = -0.73, 95% CI: -1.33 to -0.12). Finally, in subgroup studies of patients with abnormal glucose metabolism diseases, GLP-1R agonists (MD = -1.06, 95% CI: -2.05 to -0.10) significantly decreased PWV compared with placebo. CONCLUSION:Three classes of antidiabetic drugs-GLP-1R agonists, SGLT-2 inhibitors, and metformin-have the potential to improve arterial stiffness. Among the six classes of antidiabetic drugs analyzed, GLP-1R agonists constitute the only class of drugs that improves arterial stiffness in patients with abnormal glucose metabolism diseases.

Caregiver education program has been applied to stroke patients, while its effect on mental health in stroke patients is still obscure. This study aimed to assess the impact of the WeChat-based caregiver education (WBCE) program on cognition, anxiety, and depression in stroke patients. Totally, 170 patients with ischemic stroke were included. They were randomized at a 1:1 ratio to the WBCE group (N = 86) and control care (CC) group (N = 84), and their caregivers received WBCE or CC for 12 months, respectively. Mini-mental state examination (MMSE) score was increased in the WBCE group compared with that in the CC group at the 9th month (M9) (27.2 ± 1.9 vs 26.6 ± 1.6, P = 0.017) and M12 (27.1 ± 1.8 vs 26.5 ± 1.5, P = 0.015), while cognitive impairment rate was decreased in WBCE group compared with that in CC group at 12th month (M12) (30.2% vs 45.2%, P=0.043). In the meantime, the Hospital Anxiety and Depression Scale (HADS) for Anxiety score (6.5 ± 3.1 vs 7.5 ± 2.8, P = 0.020), HADS for depression score (6.7 ± 3.1 vs 7.7 ± 3.3, P = 0.040) and depression rate (33.7% vs 48.8%, P = 0.046) in WBCE group were reduced compared with those in CC group at M12. Besides, an elevation in the satisfaction score of patients at M12 (8.0 ± 1.2 vs 7.4 ± 1.2, P = 0.002) and that of caregivers at 6th months (M6) (6.6 ± 1.1 vs 6.2 ± 1.3, P = 0.038) and M12 (7.2 ± 1.1 vs 6.8 ± 1.4, P=0.042) were found in WBCE group compared with CC group. WBCE program not only improves the satisfaction of stroke patients and caregivers but also attenuates cognitive impairment and depression in stroke patients.

目的 探究针刺联合固元宁神汤治疗心肾不交型围绝经期失眠症的临床疗效.方法 选取2016年3月—2018年3月在邯郸市中心医院治疗的心肾不交型围绝经期失眠症患者120例,随机分为观察组、对照组各60例.对照组给予固元宁神汤治疗,观察组在对照组治疗基础上给予针刺治疗,2组均治疗2周.观察2组临床疗效及治疗前后中医症状积分、匹兹堡睡眠质量指数(PSQI)评分、爱泼沃斯思睡量表(ESS)评分、改良kupperman量表评分、性激素水平变化,评估安全性.结果 观察组总有效率为90.00％(54/60),高于对照组的73.33％(44/60),差异有统计学意义(P<0.05).治疗后,2组中医症状积分、PSQI量表评分、ESS评分、改良kupperman量表评分及血清FSH、LH水平均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05);2组血清E2水平均明显高于治疗前(P均<0.05),且观察组明显高于对照组(P<0.05).2组患者均未发生明显不良反应.结论 针刺联合固元宁神汤治疗心肾不交型围绝经期失眠疗效优于单纯固元宁神汤治疗,可明显改善患者中医症状、睡眠质量,安全性良好.

目的:探究维生素D(Vit-D)对糖尿病(DM)大鼠模型主动脉中层厚度的影响及其蛋白激酶受体样内质网激酶(PERK)和真核翻译起始因子2α(eIF2α)(PERK/eIF2α)通路的作用机制.方法:选用30只Sprague-Dawley(SD)雄性大鼠,采用随机数表法将其分为对照组、DM组和DM+Vit-D组,每组10只.通过给每只大鼠腹腔注射链脲佐菌素建立大鼠DM模型,DM+Vit-D组大鼠使用活性形式的Vit-D3灌胃(0.1μg·kg-1·d-1).比较各组大鼠的血糖水平、主动脉损伤情况、血清一氧化氮(NO)和内皮素(ET)水平,并采用Western blot检测主动脉组织中PERK/eIF2α通路中的蛋白表达水平.结果:DM模型大鼠的血糖水平均>16.7 mmol·L-1,干预后DM组和DM+Vit-D组的尾静脉空腹血糖(FBG)水平差异无统计学意义.DM组的收缩压和脉搏波传导速度(PWV)显著高于对照组,其差异有统计学意义(t=5.263,t=4.956,P<0.05);DM+Vit-D组的收缩压和PWV显著低于DM组,其差异有统计学意义(t=5.016,t=4.332;P<0.05).DM组大鼠的主动脉中层厚度[(103.24±4.98)μm]显著高于对照组[(90.15±3.24)μm],DM+Vit-D组的主动脉中层厚度[(96.74±4.21)μm]显著低于DM组[(80.25±2.86)μm],差异有统计学意义(t=3.521,t=3.852;P<0.05).DM组的NO水平为(51.49±6.85)μmol·L-1显著降低、ET水平为(110.28±11.39)pg·ml-1显著升高,与对照组比较差异有统计学意义(t=4.585,t=5.677;P<0.05);DM+Vit-D组的NO水平[(61.18±8.21)μmol·L-1]显著升高,ET水平[(101.44±11.32)pg·ml-1]显著降低,与DM组比较差异有统计学意义(t=5.029,t=5.881;P<0.05).DM组大鼠的PERK和eIF2α蛋白水平显著高于对照组,差异有统计学意义(t=3.612,t=4.083;P<0.05);DM+Vit-D组的PERK和eIF2α蛋白水平显著低于DM组,差异有统计学意义(t=3.506,t=3.892;P<0.05).结论:Vit-D可通过抑制DM大鼠的主动脉中PERK/eIF2α通路水平,缓解主动脉损伤和血管内皮功能.

目的 构建基于岗位管理的三级医院临床科室综合评价指标体系.方法 采用德尔菲法,对32名专家进行两轮有效函询,获得专家一致性意见,确立临床科室综合评价指标.结果 两轮函询问卷有效回收率分别为94.12％、100％,最终构建的指标体系包含8个一级指标,64个二级指标.结论 基于岗位管理的临床科室综合评价指标体系构建方法具有科学性,可为提升护理工作,实现目标化管理提供依据.

Objective To observe the clinical efficacy of Guanxinjing Capsules in treatment of stable exertional angina pectoris. Methods The stratified random, double blind, single dummy, and parallel control of positive drugs method were applied to this study. Patients (448 cases) were randomly divided into control group (112 cases) and treatment group (336 cases). Patients in the control group were po administered with Shenshao Capsules, 4 grains/time, twice daily, in the morning and evening. And they were po administered with simulation of Shenshao Capsules, 4 grains/time, once daily, at noon. Patients in the treatment group were po administered with Guanxinjing Capsules, 4 grains/time, three times daily. The patients in two groups were treated for 4 weeks. Clinical efficacy of pectoris symptoms, ECG efficacy, Duke risk assessment, and stopping and decreasing rate of nitroglycerin were observed. And the medication security was evaluated. Results The curative rates of treatment and control groups in pectoris symptoms were 82.14% and 89.88%, and the clinical curative rates of both groups in ECG efficacy were 74.11% and 80.65%. And there were differences between two groups (P < 0.05). The Duke risk rate in the treatment group (85.12%) was lower than that in the control group (98.21%) with significant difference (P < 0.05). The stopping and decreasing rate of nitroglycerin of treatment and control groups were 87.80% and 98.36%, respectively, and there were differences between two groups (P < 0.05). There was no adverse event in two groups, and general physical examination indicators were normal. Conclusion Guanxinjing Capsules has a good clinical efficacy in the treatment of stable exertional angina pectoris with good safety, which has a certain clinical application value.

目的：对应用长春西汀与丁苯酞氯化钠对患有急性脑梗死的患者进行治疗的临床效果进行对比研究。方法将此次所收治的56例急性脑梗死患者，按照随机数字表法进行分组，分成治疗组和对照组，分别为28例。对照组患者采用长春西汀治疗。治疗组采用丁苯酞氯化钠治疗。结果比较两者患者的治疗有效率以及神经功能缺损评分改善情况以及治疗时间、临床症状改善时间等，治疗组明显优于对照组，差异显著，具有统计学意义（ P＜0.05）。两组患者治疗期间均未出现不良反应。结论在临床上，对急性脑梗死患者采用丁苯酞氯化钠进行治疗，其能够有效地改善患者的临床症状，缩短患者的治疗时间，促进患者的康复，提高患者的生活质量，同时没有发生明显性的不良反应，值得在临床上进行推广和应用。

This Article retrieved literatures about the relationship between the time of administration antihypertensive drugs and the circadian rhythm of blood pressure, evaluated the effect of administration antihypertensive at bedtime, provided recommendation of how to take antihypertensive. Firstly, most patient should to take antihypertensive in the morning. Secondly, about 20 percent of patient show abnormal circadian rhythm of blood pressure, that is mean non-dipper hypertension through ambulatory blood pressure monitoring, should adjust the medication administration from morning to night or morning and night. Thirdly, antihypertensive which are chosen to administrate at bedtime should be long time acting. Administration hypertensive at bedtime will help restore the normal circadian rhythm of blood pressure, alleviate the morning surge, and reduce even reverse the damage to target organs.

目的：探讨预防老年患者跌倒的有效方法。方法应用“防范混着跌倒危险因素评估表”，对老年患者评分≥4分者制定个性化的预防护理措施。结果应用该评估表后，老年患者跌倒发生率明显降低，护理人员预防患者跌倒的意识增强。结论应用该评估表后，提供护理措施更具计划性、目的性、针对性，降低和消除了跌倒的危险，保障护理安全。