Traumatic central nervous system injury can cause imbalance in intestinal microenvironmental homeostasis by disrupting intestinal barrier function,while the disturbed intestinal microenvironment can react on the central nervous system and aggravate the secondary injury of it.A large number of studies suggest that the intestinal barrier plays an important role in the pathophysiological process of traumatic central nervous system injury and can be an important target for the action of central nervous system injury.This paper reviews the structural and functional changes of intestinal microbial,chemical,mechanical and immune barriers after traumatic central nervous system injury and their bidirectional interaction with the central nervous system,summarizes the possible mechanisms leading to the disruption of intestinal barrier,including malnutrition,ischemia-reperfusion injury,inflammatory response and the release of neurotransmitters and hormones,to provide theoretical basis and new ideas for the development of research on the intestinal microenvironment after traumatic central nervous injury.

ObjectiveTo explore the regulatory role and molecular mechanism of sodium butyrate（NaB）in lipopolysaccharide（LPS）induced inflammatory phenotype in BV2 microglia cells and the molecular mechanism.MethodsBV2 cells were treated with different concentrations of NaB alone or combined with LPS. CCK8 assay was used to detect the change of cell viability and to screen the optimal concentration of the drug. Then the BV2 cells were divided into control, LPS group, low- and high-dose NaB groups（0.125 and 0.25 mmol/L）. An inflammatory model of BV2 cells were established by pretreatment with NaB for 17 h followed by LPS treatment for 24 h. Griess assay was used to measure the NO content in the supernatant, and ELISA was employed to determine the contents of IL-1β, TNF-α and IL-10 in culture medium. The mRNA levels of iNOS and CD206 were detected by RT-qPCR. Immunofluorescence staining was used to observe the expression of iNOS and CD206. The protein levels of TLR4, NF-κB p65m, IKB-α and p-IKB-α were detected by Western blotting. Cytoplasmic and nuclear proteins were isolated to detect the nuclear translocation of NF-κB p65.ResultsGriess assay showed that the secretion of NO in the high- and low-dose NaB groups were lower than that in the LPS group（P<0.05）. ELISA results indicated that the high- and low-dose NaB groups had lower secretion levels of IL-1β and TNF-α, but high secretion level of IL-10 than the LPS model group（all P<0.05）. RT-qPCR revealed that high- and low-dose NaB treatment significantly decreased the mRNA expression of iNOS（M1 phenotypic marker）and promoted that of CD206（M2 phenotypic marker）（both P<0.05）. Immunofluorescence staining presented similar results as RT-qPCR（P<0.05）. Western blot results displayed that high- and low-dose NaB resulted in significantly inhibited protein expression of TLR4, NF-κB p65 and p-IKB-α as well as nuclear translocation of NF-κB p65 when compared with the LPS group（P<0.05）.ConclusionNaB significantly reduces LPS-induced neuroinflammatory responses in BV2 cells, which might be associated with its inhibition of TLR4/NF-κB signaling pathway and promotion of BV2 cells shifting from M1 to M2 phenotype.

Parkinson's disease (PD) is a common neurological disorder of the brain. In recent years, there is increasing evidence that intestinal flora dysbiosis is closely related to the occurrence and development of PD. This suggests that intestinal microorganisms may be a new strategy for the treatment of PD. Probiotics are a group of active microorganisms that can colonize the host gut and play a beneficial role in the health of the body, and are of great significance to maintaining the intestinal microecological balance. Studies have shown that probiotics can effectively prevent and improve PD through the gut-brain axis, and the potential mechanisms of action include regulating intestinal microecology, alleviating inflammatory response and oxidative stress damage, and promoting the expression of neurotrophic factors. This article reviews the changes of intestinal flora in PD, the mechanisms of intestinal flora in the pathogenesis of PD, and the improvement effect and mechanisms of probiotics on PD-related symptoms, in order to provide a theoretical basis for probiotics to prevent and alleviate PD.

目的 观察肌骨超声定位下放散式体外冲击波疗法(Radial extracorporeal shock wave therapy,rESWT)治疗冈上肌肌腱炎(Supraspinatus tendinitis,ST)的临床疗效.方法 选取冈上肌肌腱炎患者54例,按照随机数字表法分为观察组与对照组,各27例.对照组给予痛点结合体表解剖标志定位行rESWT治疗,并辅以常规康复治疗,观察组在对照组基础上予以肌骨超声定位下行rESWT治疗.在治疗前、治疗后即刻和治疗后5周、12周,采用视觉模拟评分法(Visual analogue scale,VAS)、加州大学肩关节评分(University of California at Los Angeles,UCLA)、肌骨超声疗效评价对两组患者疗效进行比较.结果 两组治疗后即刻、5周及12周的VAS及UCLA肩关节评分比较,差异有统计学意义(P<0.05);两组治疗前后VAS及UCLA肩关节评分比较,差异有统计学意义(P<0.05);观察组的治愈率和治疗有效率均高于对照组,但两组比较差异无统计学意义(P>0.05).结论 肌骨超声定位下rESWT治疗可有效改善ST患者肩部疼痛及关节功能,有较好的临床推广应用价值.

脊髓损伤(spinal cord injury,SCI)是影响人类健康的重大疾病,在过去30年中,全球SCI患者已从每百万人口 236例增加到1298例,全球每年新发患者约25万～50万[1],造成了重大的经济和社会负担.SCI后多出现脊髓缺血和水肿、氧化应激、细胞凋亡、脱髓鞘、离子失衡等病理变化,最终导致神经元死亡和脊髓组织破坏.这些病理变化在临床上多表现为损伤平面以下的运动感觉障碍和自主神经功能障碍,且多伴有并发症,如肺部感染、尿路感染、深静脉血栓及关节挛缩等,是阻碍SCI患者康复进程的主要原因[2].目前临床上的治疗策略主要是通过手术减压、抑制炎症和调节免疫,促进神经修复[3、4].肠道微生物(gut microbe,GM)参与SCI后的病理变化,可通过调节免疫、控制炎症等发挥神经保护作用,这可能为SCI的治疗提供新思路.笔者从SCI后GM的特征、调控GM的策略、调控GM对SCI功能康复的影响及发生机制的相关研究进展进行综述,以期为调控GM治疗SCI提供参考.

目的 探讨芳香烃受体/细胞因子信号传导抑制因子2/核转录因子-κB(AHR/SOCS2/NF-κB)信号通路在隔日限食(EODF)疗法减轻脊髓损伤炎症反应中的作用.方法 36只雄性Sprague-Dawley大鼠随机分为假手术组、模型组和EODF组,每组12只.后两组复制C5脊髓半侧钳夹模型.术后EODF组予24 h禁食和摄食交替,不限水,共2周.术前和术后1 d、7 d、14 d行梳理试验.术后14 d取各组脊髓组织,每组4只行HE染色观察病理损伤,4只采用Western blotting检测AHR、SOCS2和NF-κB水平,4只采用逆转录实时定量聚合酶链反应检测AHR、SOCS2、核因子κB抑制因子α(IκBα)、NF-κB、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的mRNA水平.结果 与假手术组相比,另两组各时间点梳理试验评分降低(P<0.05),出现空腔、水肿、结构紊乱等病理改变;与模型组相比,EODF组术后14 d梳理试验评分增加(P<0.05),损伤减轻.与模型组相比,EODF组AHR、SOCS2 mRNA和蛋白表达增高(P<0.05),NF-κB mRNA和蛋白表达降低(P<0.05),IκBαmRNA表达增高(P<0.05),TNF-α、IL-6 mRNA表达降低(P<0.05).结论 EODF可促进脊髓损伤大鼠患侧前肢运动功能恢复,减轻损伤和炎症反应,可能与激活AHR/SOCS2/NF-κB信号通路有关.

China is seeing an increasing prevalence of inflammatory bowel disease (IBD) . During the process of exploring treatments for IBD, gut microbiota has been found to be crucial to the development of IBD along with the discovery of microbial-host interactions, suggesting that modulating gut microbiota may be a new strategy for the treatment of IBD. Recent studies have shown that Lactobacillus rhamnosus GG (LGG) , one most widely used probiotic strain, can achieve IBD alleviation by regulating intestinal microbial composition, maintaining intestinal epithelial barrier integrity, modulating intestinal immune response, inhibiting oxidative stress, and improving anxiety-depression status. Therefore, this paper presents a review of the mechanism of action of LGG in improving IBD, providing theoretical support for its clinical application.

The intestinal barrier plays a role in maintaining the stability of the intestinal environment, which relies on the dynamic regulation of the intestinal microbiota. Lactobacillusreuteri (L.reuteri) is a lactic acid bacterium reported to be naturally present in the intestines of almost all vertebrates and mammals, and has been shown to affect the function of the intestinal barrier and safeguard the health of body through various pathways. This paper reviews the role and possible mechanisms of action of L.reuteri in regulating intestinal physical, chemical, immune and microbial barrier functions, with the aim of providing a theoretical basis and new ideas for the clinical application of L.reuteri in treating related diseases.

目的:研究化痰通络汤联合康复训练对脑卒中后偏瘫患者的影响.方法:选择124例脑卒中后偏瘫患者进行研究,按照随机数字表法分为对照组(n=62)和试验组(n=62).对照组采用康复训练,试验组在对照组基础上联合化痰通络汤治疗,比较两组临床疗效、血液流变学、神经功能恢复情况及下肢肌力情况.结果:治疗后,试验组总有效率为90.32％,明显高于对照组的75.81％,差异有统计学意义(P<0.05).治疗后,试验组美国国立卫生院制定的卒中量表(NIHSS)评分低于对照组,Fugl-Meyer运动功能评分(FMA)高于对照组,差异有统计学意义(均P<0.05).治疗后,试验组中医症状积分均低于对照组,差异有统计学意义(均P<0.05).治疗后,试验组全血黏度、血浆黏度及纤维蛋白原含量均低于对照组;试验组脑卒中专用生活质量量表(SS-QOL)评分高于对照组,差异有统计学意义(均P<0.05).治疗后,试验组髋关节、膝关节伸展肌力及踝关节背曲肌力均高于对照组,差异有统计学意义(P<0.05).结论:化痰通络汤联合康复训练治疗脑卒中后偏瘫临床效果较好.

慢性便秘是常见的健康问题,也是许多高死亡率疾病的诱发因素,严重影响人类的健康和生存质量,给家庭和社会带来沉重的精神和经济负担,而目前针对慢性便秘的治疗方法疗效有限,故需寻找一种便捷、经济、有效的方法.运动在慢性便秘的预防和治疗中发挥着重要作用,并且运动可调节肠道菌群的组成,而有研究表明便秘后发生的肠道菌群紊乱使肠腔内菌群代谢物〔如短链脂肪酸(SCFA)、5-羟色胺(5-HT)〕含量降低,抑制肠道运动,加速慢性便秘的发展,提示运动、菌群与便秘三者间存在密切联系.本文就运动对便秘的调节作用、肠道菌群在便秘中的调控机制和运动对肠道菌群的影响进行综述,以此探索运动通过调节肠道菌群的组成改善慢性便秘的可能性,希望能进一步完善运动缓解便秘的作用机制.

目的 探讨蜘蛛香环烯醚萜类成分对急性脊髓损伤大鼠神经细胞焦亡的影响,及其发挥神经保护作用的相关机制.方法 健康雄性Sprague-Dawley大鼠24只,随机分为假手术组、模型组和治疗组,每组8只.后两组建立大鼠急性脊髓损伤模型,假手术组只摘除椎板.术后4 h,治疗组灌胃蜘蛛香环烯醚萜类成分溶液10 mg/kg,模型组和假手术组灌胃等体积羧甲基纤维素钠(CMC-Na)溶液,每天1次,连续7 d.7 d后处死大鼠,HE染色观察脊髓组织病理情况,计算剩余组织残存面积,TUNEL法检测细胞死亡情况,ELISA检测血清中白细胞介素(IL)-1β和IL-18含量,Western blotting测定焦亡蛋白NLRP3、Caspase-1、GSDMD的表达水平.结果 与假手术组相比,模型组脊髓组织残存面积减少(P<0.05);TUNEL染色阳性率,IL-1β、IL-18含量以及焦亡蛋白NLRP3、Caspase-1、GSDMD的相对含量增加(P<0.05);与模型组比较,治疗组脊髓组织病理情况有所改善,组织残存面积增加(P<0.05),TUNEL染色阳性率,IL-1β、IL-18含量以及焦亡蛋白NLRP3、Caspase-1、GSDMD的相对含量降低(P<0.05).结论 蜘蛛香环烯醚萜类成分能减轻大鼠脊髓损伤后的炎症反应,发挥神经保护作用,其机制可能与调控NLRP3/Caspase-1通路抑制急性脊髓损伤大鼠的神经细胞焦亡有关.

目的 探讨穴位贴敷治疗肠易激综合征(irritable bowel syndrome,IBS)用药及选穴规律.方法检索建库至2020年3月期间在中国知网、维普、万方、PubMed数据库发表的穴位贴敷治疗IBS的临床研究文献,对纳入文献的用药及选穴做频次分析、聚类分析和关联规则分析.结果 共纳入90篇文献,涵盖98味中药及29个腧穴.最常用贴敷药物为肉桂、吴茱萸、丁香、白术、白芥子、白芍,高频药物主要归属温里药、理气药和补益药.高频药物聚类分析可分3个小聚类,关联规则分析显示干姜/吴茱萸-肉桂、白芥子-细辛-延胡索常配伍使用;最常用腧穴为神阙、天枢、脾俞、中脘、足三里、关元,高频腧穴主要归属任脉、足太阳膀胱经和足阳明胃经,多属特定穴之背俞穴、募穴.高频腧穴聚类分析、关联规则分析显示神阙穴常单独使用,关元-天枢、中脘-天枢-足三里、肝俞-脾俞、脾俞-胃俞多配伍,肝俞-胃俞-气海-肾俞-关元多联合应用.结论 临床运用穴位贴敷治疗IBS常用温补、理气之中药,贴敷于神阙穴、俞募穴,从肝脾肾论治.

肠道菌群作为一个复杂的微生态系统,与宿主建立了密切联系,在调节与营养、免疫系统激活和宿主防御相关的生理功能中起着核心作用.肠道菌群与宿主之间相互作用的主要方式之一是通过代谢产物.色氨酸(tryptophan,TRP)作为一种必需氨基酸,参与体内多种生理功能,影响人体的生长和健康.TRP代谢的异常与许多疾病有关.肠道菌群产生的TRP分解代谢物是微生物群落以及宿主-微生物之间相互作用的重要信号分子,在维持健康和疾病发病机理中具有重要作用.通过系统阐述肠道菌群的分类和功能,肠道菌群对TRP代谢途径及其相关疾病影响的研究,以及肠道菌群影响TRP代谢的潜在机制,为疾病发病机制和治疗等临床研究提供新的视角.

目的 系统评价靶向线粒体治疗脊髓损伤动物模型的有效性,为临床治疗提供实验依据和新思路.方法 计算机检索PubMed、Web of Science、Web of Knowledge、CNKI和万方数据库,纳入靶向线粒体治疗脊髓损伤动物实验,检索年限自建库至2021年2月.3名研究者独立筛选文献和提取资料,采用定性分析方法归纳总结纳入研究的结果.结果 共纳入11个动物实验研究,包括548个脊髓损伤动物.6项研究选用雄性或雌性Sprague-Dawley大鼠,8项研究大鼠体质量150～275 g,所有模型集中于T9～T11挫伤性脊髓损伤,但使用的脊髓打击器和打击力度存在差异,干预药物的种类、使用时间、频率、浓度和剂量等均不相同.由于纳入研究在动物种属、动物模型和结局指标测量等方面存在较大的异质性,因此仅进行定性分析.结论 靶向线粒体治疗脊髓损伤动物能促进运动功能恢复,受损脊髓组织减少和残存组织增加,抗氧化和抗凋亡能力增强,线粒体生物发生增强.受限于纳入研究数量和质量,上述结论尚待更多高质量研究予以验证.

肠易激综合症(Irritable bowel syndrome,IBS)是消化系统最常见的一种异质性疾病,中国的普通人群IBS总体患病率为6.5％.急性高原暴露后,官兵由于处于军事应激环境,容易伴有焦虑、抑郁等负面情绪,同时高原的低氧环境也容易引起胃肠道功能障碍,从而使得IBS患病率高于普通人群.控制和改善急性高原暴露后IBS症状的主要措施包括心理干预和饮食控制.此外,适当的药物治疗也可改善急性高原暴露后IBS的症状.遗憾的是,目前关于急性高原暴露后IBS的发病情况和致病机理的相关研究还较少,有待后续研究进一步阐明,从而为预防和治疗急性高原暴露后IBS提供依据.

目的 探究应用重复经颅磁刺激(rTMS)干预阈下抑郁受试者3w后的转归.方法 将符合纳入标准的30例患者按就诊顺序随机分为磁刺激组和对照组(假刺激组),每组15例.磁刺激组应用重复经颅磁刺激治疗仪进行干预,疗程3 w,每周连续治疗5次,每周定期评定1次;对照组应用和磁刺激组相同的治疗设备,但仅为假刺激,对照组前3 w,1次/w评定;第8w两组进行随访.两组均用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)进行评定分析,总体疗效标准为HAMD减分率.结果 治疗3w后,磁刺激组疗效有效率(100％)明显优于对照组有效率(26.67％)(P＜ 0.05),且磁刺激组SDS评分较治疗前下降明显(P＜0.05),与对照组同时间点组间进行比较,差异均有统计学意义(P＜ 0.05);第8w随访磁刺激组疗效维持明显高于对照组.结论 (1)重复经颅磁刺激干预阈下抑郁受试者的HAMD、SDS的评分显著下降;(2)重复经颅磁刺激可明显降低病情加重风险.

目的 分析低频重复经颅磁刺激(rTMS)联合虚拟现实(VR)训练治疗脑卒中后抑郁伴认知障碍的临床效果及对患者炎性因子、脑源性神经营养因子(BDNF)表达水平以及事件相关电位P300的影响.方法 将90例脑卒中后抑郁伴认知功能障碍患者随机分为对照组(n=45)和观察组(n=45).对照组接受rTMS,观察组接受rTMS联合VR训练治疗.比较两组患者临床疗效以及治疗前后汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分、改良Barthel指数(modified Barthel index,MBI)评分、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)以及血清肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)和BDNF水平和事件相关电位P300潜伏期和波幅情况.结果 观察组治疗总有效率显著高于对照组(93.33％vs.73.33％,P＜ 0.05).两组治疗后HAMD评分分级明显改善,观察组治疗后HAMD评分分级明显优于对照组.两组MBI评分和MoCA评分以及血清BDNF水平均较治疗前明显增加,血清TNF-α、IL-6水平明显降低(P＜0.05).观察组治疗后MBI评分和MoCA评分、血清BDNF水平以及P300波幅均高于对照组,血清TNF-α、IL-6水平以及P300潜伏期明显低于对照组(P＜0.05).结论 在常规康复治疗基础上联合应用rTMS和VR康复训练能够提高脑卒中后抑郁伴认知障碍治疗效果,更有利于减轻患者抑郁程度,提高认知功能和生活能力,缓解炎性反应,有效保护神经元.

背景:目前对抑郁症的诊断和研究缺乏客观的生物学指标,功能性近红外光谱作为一种新兴无创的脑功能成像技术,可能是抑郁症识别和辅助诊断的潜在生物标记物.目的:综述功能性近红外光谱技术在抑郁症研究中的相关应用,为临床研究提供指导.方法:以"functional near-infrared spectroscopy,oxyhemoglobins,prefrontal cortex,depressive Disorder"为英文检索词,以"功能性近红外光谱,氧合血红蛋白,前额叶皮层,抑郁症"为中文检索词,由第一作者检索中国知网、万方、维普、PubMed和Web of Science数据库1996至2020年发表的文献,经过筛选最终获得50篇文献进行综述.结果与结论:功能性近红外光谱信号可能是抑郁症潜在的生物标记物.功能性近红外光谱技术主要从额叶的血流动力学变化方面进行抑郁症的认知功能障碍研究,可用于抑郁症的鉴别诊断.但是目前对于功能性近红外光谱的研究还处于探索阶段,还存在一些缺陷,可以增加研究样本量和监测指标,同时将功能性近红外光谱与其他技术相融合,提高时间和空间分辨率,更加系统、全面、准确地研究抑郁症的神经机制.

人体肠道内寄居着数量庞大、种类繁多的微生物,形成肠道微生态稳态,而肠道微生态失衡与多种肠内、肠外疾病相关.随着人们对肠道菌群在宿主健康及疾病中作用的深入认识,粪菌移植(faecal microbiota transplantation,FMT)被给予厚望,其作为重建肠道菌群的有效手段,已成功应用于艰难梭菌感染(Clostridioides difficile infection,CDI)等疾病的治疗和探索性研究,并被认为是近年的突破性医学进展.随着近几年FMT研究的深入,人们发现FMT对各系统疾病皆有潜在的治疗作用.在1990年之前,菌群移植都是经灌肠实施,近几年随着粪菌移植研究的深入,粪菌移植途径也呈多样化发展.本文对粪菌移植途径、临床应用和存在的问题等作一综述.