目的 探究2型糖尿病合并阻塞性睡眠呼吸暂停综合征(OSAS)患者睡眠呼吸暂停低通气指数(AHI)与血管损伤标志物的相关性.方法 选取2019年4月至2021年4月中国中医科学院广安门医院南区收治的2型糖尿病合并OSAS患者85例作为OSAS组,及同期收治的单纯2型糖尿病患者88例作为无OSAS组.采用多导睡眠监测仪监测患者AHI、氧减指数(ODI)、最低血氧饱和度(L-SaO2),并根据AHI结果将85例2型糖尿病合并OSAS患者分为轻度OSAS组(33例)、中度OSAS组(28例)和重度OSAS组(24例).采用酶联免疫吸附(ELISA)法检测其血清可溶性血管细胞黏附分子1(sVCAM-1)、内皮素-1(ET-1)、血管性血友病因子(vWF)水平.采用Pearson检验分析2型糖尿病合并OSAS患者AHI、ODI、L-SaO2与血管损伤标志物sVCAM-1、ET-1、vWF的关系.结果 OSAS组患者AHI、ODI及血清sVCAM-1、ET-1、vWF水平明显高于无OSAS组(P<0.05),L-SaO2明显低于无OSAS组(P<0.05).重度、中度OSAS组患者血清sVCAM-1、ET-1、vWF水平明显高于轻度OSAS组(P<0.05),重度OSAS组患者血清sVCAM-1、ET-1、vWF水平明显高于中度OSAS组(P<0.05).2型糖尿病合并OSAS患者AHI与血清sVCAM-1、ET-1、vWF水平均呈正相关(r=0.390、0.405、0.368,P<0.05),ODI与血清sVCAM-1、ET-1、vWF水平均呈正相关(r=0.395、0.412、0.381,P<0.05),L-SaO2与血清sVCAM-1、ET-1、vWF水平均呈负相关(r=-0.394、-0.401、-0.374,P<0.05).结论 2型糖尿病合并OSAS患者AHI与sVCAM-1、ET-1、vWF密切相关,参与病情进展,且可能与血管内皮细胞损伤程度有关.

目的 观察天麻素对高血压病左心室肥厚大鼠心室重构的影响,从Ras同族体基因家族成员A(Ras homolog gene family member A,RhoA)/Rho激酶(Rho-associated kinase,ROCK)通路探究其作用机制.方法 将100只SD雄性大鼠随机分为假手术组,模型组,天麻素低剂量(16 mg/kg)、中剂量(24 mg/kg)、高剂量(32 mg/kg)组和依那普利组(1.5 mg/kg),每组15只.采用腹主动脉缩窄法复制左心室肥厚模型.采用酶联免疫吸附法测定大鼠血清血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)和白细胞介素6(interleukin-6,IL-6)水平,计算左心室肥厚指数(left ventricular hypertrophy index,LVHI);苏木精-伊红染色和Masson染色观察心肌的组织形态学变化;qRT-PCR和Western blot法检测心肌组织RhoA、ROCK mRNA及蛋白表达水平.结果 与假手术组比较,模型组大鼠尾动脉收缩压、LVHI及血清AngⅡ、IL-6水平显著升高(P<0.05),心肌组织纤维化程度升高,RhoA、ROCK mRNA及蛋白表达水平均显著升高(P<0.05).与模型组比较,天麻素低、中、高剂量组和依那普利组尾动脉收缩压、LVHI及血清AngⅡ、IL-6水平均显著下降(P<0.05),心肌纤维程度降低,RhoA、ROCK mRNA及蛋白表达水平均显著降低(P<0.05).依那普利组大鼠心肌组织RhoA、ROCK mRNA及蛋白表达水平最低,天麻素的作用具有剂量依赖性.结论 天麻素能有效降低高血压病大鼠尾动脉血压、LVHI和血清AngⅡ、IL-6水平,改善其心室重构,其机制与抑制RhoA/ROCK信号通路有关.

Differences and relations between effects of acupuncture therapy and sham acupuncture are systematically analyzed in this article through the influential factors of acupuncture effect. And it is held that sham acupuncture effect is not exactly equal to placebo effect. The effects of both acupuncture and sham acupuncture are composed by specific effects and non-specific effects, and the differences of non-specific effects between acupunc ture and sham acupuncture can be minimized furthest with blinding and randomized method. Therefore, the difference of acupuncture and sham acupuncture treatment rests with the degree of differences of the specific effects. Only when both of the specific effect of acupuncture and the effect of acupuncture are minimized, can it be applied as the ideal placebo control. Consequently when placebo acupunture are setted up, factors such as the body condition, site of stimulation and stimulation parameters which can influence the specific effect of acupuncture should be taken into consideration to produce the relatively minimum specific effect.

Objective:To investigate the protective effects of baicalin on liver in hepatic precancerous mice induced by diethylnitrosamine(DEN).Methods:Hepatic precancerous model was obtained by administration of DEN through intraperitoneal injection to male mice,and the pharmacologic effects of baicalin were assayed by histopathologic examination and levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),gultathione-S-transferases(GST) and alkaline phosphatase (ALP).Results:The liver functions were serious damaged by administration of DEN,which showed up as morphologic changes and abnormal structure in model mice,such as hver cirrhosis,hepatic fibrosis which divided the liver lobule,liver cell denaturation, hyperplasia,intranuclear inclusions and tendency to atypia,and heavy local infiltration by macrophages was observed,at the same time,enzymatic activities in serum were increased abnormally(P0.05).Situations of mice treated by baicalin were much better,and hepatic fibrosis was decreased,which was failed to divide the liver lobule,and scarce liver cell denaturation,atypical hyperplasia,intranuclear inclusions could be observed.Enzymatic activities in serum were decreased markedly compared with those in model mice(P0.05).Conclusion:Baicalin is partly effective to protect the liver functions in hepatic precancerous mice induced by DEN.

In the present article, the authors made an overview about the existing problems of placebo acupuncture design in accordance with the neurological basis of acupuncture analgesia. The neuron-segmental and systemic mechanisms initiated by local somesthetic stimuli at different intensities are involved in acupuncture analgesia. When the local pain locus and the stimulated point are in the same spinal segmental region, stimuli of either higher intensity or lower intensity may produce an obvious anaIgesia effect. If the stimulation site is far from the pain locus (in remote spinal segment region), only higher intensity stimulation works. From this viewpoint, the placebo acupuncture design in current clinical trials for pain treatment exists some unreasonable aspects. Both pain focus and intensity of acupuncture stimulation should be taken into consideration together. The optimal placebo acupuncture design for the treatment of pain conditions is that lower intensity acupuncture stimulation is given for longer distance between the pain origin locus and the stimulated acupoint.

Context: Pharmacokinetics of drug may be altered by abnormal physiological functions in illness, which will affect its pharmacodynamic efficacy in turn.Objective: To assess the preventive effects of tetramethylpyrazine (TMPZ) phosphate on hepatocarcinogenesis and its pharmacokinetic differentiations in model mice.Methods: Diethylnitrosamine (DEN) was adopted to induce hepatic precancerous model in mice through intraperitoneal injection, and prevention efficacy of TMPZ at a dose of 162 mg/kg was examined by liver histological analysis and activities of serum marker enzymes. Pharmacokinetic variations of TMPZ between control and model mice were measured for single oral administration.Results: DEN initiation led to a remarkable increase of serum marker enzymes, and abnormality such as bile canaliculi hyperplasia and presence of tumor cells were observed in liver histopathological examination in model mice, while the control ones revealed normal architecture. Oral treatment of TMPZ resulted in a marked reduction in serum marker enzymes and improvement in liver histopathology compared with model ones. In pharmacokinetic study, values of AUC and T-max of TMPZ became significantly greater with increase of doses in both control and model mice, which elucidated the absorption was enhanced and delayed; meanwhile, its elimination was not affected markedly. When the mice were treated at same dose, the adsorption of TMPZ in model mice was greatly improved than that in control ones, while T-max and MRT had no significant difference.Conclusion: TMPZ was partly effective to protect liver from carcinogenesis initiated by DEN, and hepatic insufficiency could change its pharmacokinetics.

Objective: To confirm the protective effect of curcumin on diethylnitrosamine(DEN)-induced hepatic precancerous lesions in mice.Method: The male mice were randomly divided into four groups.The hepatic precancerous lesions in mice were replicated with DEN(95 mg·kg-1) intraperitoneal administration once a week for 10 weeks,meanwhile curcumin(120.0 mg·kg-1) with or without Rhizoma Dioscoreae(3.03 g·kg-1) was administrated intragastrically once a day to protect the hepatic precancerous lesions.On the 71st day,the blood was collected to detect the hepatic injury biomarkers,and partial liver was fixed to observe the pathological changes.Result: Compared with those in the control mice,the hepatic precancerous lesions in the model mice were confirmed as the alterative and proliferative changes of liver,the proliferative hepatocytes were demonstrated as the atypia similar to hepatic carcinoma,the alterative changes were supported by the elevated activities of serum ALT(195.57±91.56) U·L-1,AST(39.68±24.20) U·L-1 and GST(42.31±8.19)U·L-1.The administration of curcumin relieved the hepatic precancerous lesions significantly(P<0.01),and the combination use of curcumin and Rhizoma Dioscoreae could enhance the effect(P<0.05) in the treatment groups with ALT(82.75±38.54) U·L-1,AST(30.32±7.80) U·L-1and GST(24.61±7.58) U·L-1,respectively.Conclusion: Curcumin can protect the hepatic precancerous lesions in the mice attacked by diethylnitrosamine,and combination use of curcumin and Rhizoma Dioscoreae can be more effective.

OBJECTIVE:To investigate the statement on randomized controlled trials on Wenxin granule for treatment of atrial fibrillation and to judge whether those trials could offer high quality evidence or not, thus improve design level and quality.METHOD:RCTs were searched from home and abroad about atrial fibrillation treated with Wenxin granule, which reported before October, 2010. Jadad scale and CONSORT statement were used.RESULT:There were 66 RCTs retrieved that met inclusion criteria. Using Jadad rating scale, only 2 literatures gain score 4 and 1 literature gains score 3, 54 literatures gain score 2, 7 literatures gain score 1, 2 literatures gain score 0. Only 2 literatures described random number table as the method of grouping. None of the RCTs was reported the allocation concealment. Only 1 literature was used blinding. Fifty-nine literatures were mentioned the lost to follow-up conditions. According to the CONSORT standards, only six literatures (9.1%) mentioned the method of generating the random sequence. Four literatures (6.1%) were quasi-random. Nineteen literatures (28.8%) had inclusion criteria. Six literatures (9.1%) had the follow-up record. Fifty one literatures (77.3%) described the adverse events. None had the estimation of the sample size, intention-to-treat analysis and stratified analysis. None had the ethical approval or informed consent.CONCLUSION:The quality of clinical trials of Wenxin granule in treating atrial fibrillation needs to be improved.

Patient Reported Outcome(PRO) is an outcome used in the measurement and evaluation of a disease.PRO is directly from patients' perception of their own health condition.It includes symptoms,physiology,psychology and treatment satisfaction.This article introduced the current condition of PRO study and its application in traditional Chinese medicine(TCM).It emphasized on Evaluating the Measurement of Patient-Reported Outcomes(EMPRO).The EMPRO contains 39 items in eight key attributes,which are the conceptual and measurement model,reliability,validity,responsiveness,interpretability,burden,alternative modes of administration,and cross-cultural and linguistic adaptations.This study showed that the EMPRO has high reliability and validity.It has already been used in the assessment of the SF-36 Health Survey,the Nottingham Health Profile,the COOP/WONCA Charts,the EuroQol-5D,and the EORTC-QLQ-C30.

目的 通过深度访谈法从医生的角度解析中医专家治疗艾滋病的真实感受,为完善中医药治疗艾滋病的评价指标体系提供参考.方法 采用定性研究中深度访谈的方法,访谈者由艾滋病疗效评价的专门人员担任,围绕中医药治疗艾滋病疗效评价为核心的访谈主题,分别对8名专家展开深度访谈,将录音转录成文字稿存档,对每个访谈记录进行整理研究.结果 中医药疗效评价指标应该包括基于患者自身感受所研制出的量表和安全性指标、中医药对西药的辅助作用、医生和患者之间良好的沟通有助于医生对病情和疗效的判断3个方面关于疗效判定的重要信息.结论 通过对临床专家进行深度访谈的范例研究,可以帮助完善中医药治疗艾滋病疗效评价的内容和指标,同时为中医临床疗效评价领域引入深度访谈法奠定了相关基础.

In the world of Traditional Chinese Medicine(TCM),the realization to the dream could go back to the age of The Medical Classic of the Yellow Emperor.Through the improvement with every generation,its system was gradually completed.Although its etiology and pathogenesis is very complex,it can be attributed to the various of causes which lead to Maladjustment,Dysfunctional organs,Heart and Liver not hiding the soul.All these results led to such terrible that the soul could not hide in the Liver and body perform more than a dream.

Grading of recommendations Assessment,Development and Evaluation is a international standard regarding to study design,study quality,consistency,directness,balance between desirable and undesirable effects,resource use,importance of outcomes.According to it,observational study is also important resource of evidence.It becomes the milestone of evidence based medicine.Our article introduces the origin and framework of GRADE,represents the necessity,procedure,methods in developing international sub-health standard.Meanwhile,we advocate to use GRADE in TCM clinical evaluation,thus promote the modernization and internationalization of Traditional Chinese Medicine.

The dried jujube of Henan Neihuang was used as raw material to study the brewing process of the date wine with the excellent ZJ16 yeast which was selected from the soil of the Date Garden.The single factor experiments of the ratio of gardenia to liquid,yeast inoculums' size,fermentation temperature and sugar content were respectively investigated,and through the single factor experiments the appropriate level of the four factors selected for four factors and three levels of the orthogonal experiment,the alcohol,sensory as indicators experimental results of orthogonal range analysis,the best fermentation conditions of the date wine were that the ratio of gardenia to liquid was 1:6,the yeast inoculums' was 4%,the fermentation temperature was 23℃,the sugar content was 20%.The results showed that under the optimum conditions the date wine had outstanding aroma,distinctive color and gloss,good and pure taste.The alcohol content could reach 11%,typicality was prominent.