ABSTRACT Purpose: To evaluate the protective effect of Cuscuta chinensis Lam. polysaccharides (PCCL) on 5-fluorouracil-(5-FU)-induced intestinal mucositis (IM) in mice. Methods: PCCL was orally administered at a dose of 20 mg·kg–1 for 7 days and its protective effect on 5-FU-induced IM (5-FU, 50 mg·kg–1 for 5 days) was evaluated by monitoring changes in body weight, degree of diarrhea, levels of tissue inflammatory factors (tumor necrosis factor α, interleukin 6, and interleukin 1β levels), apoptosis rates, and the expression levels of caspase-3, Bax and Bcl-2. Results: The severity of mucosal injury (as reflected by body weight changes, degree of diarrhea, height of villi, and damage to crypts) was significantly attenuated by PCCL administration. PCCL also reduced the levels of tissue inflammatory factors, the apoptosis rate, and the expression of caspase-3 and Bax, and increased Bcl-2 expression. Conclusions: PCCL administration may be significantly protective against 5-FU-induced IM by inhibiting apoptosis and regulating the abnormal inflammation associated with it.

原发性肝癌(PLC)是我国第4位常见恶性肿瘤及第2位肿瘤致死病因,严重威胁人民的生命健康[1,2].在我国,中晚期肝癌的治疗手段主要包括放化疗、介入治疗、靶向治疗、免疫治疗及中医药治疗等,但许多患者临床疗效欠佳[3].老年中晚期肝癌患者是比较特殊的群体,老年人常合并有多脏器功能减退、心脑血管等多系统的慢性病,肝脏储备功能较差,因此老年中晚期肝癌患者一般无法耐受放化疗等治疗,使得治疗非常棘手.另一方面,老年肝癌患者的肿瘤进展相对青壮年较慢,"带瘤生存"的理念在老年患者中常被提倡,而中医药在这一特殊群体的治疗中具有其特殊的作用和较好的疗效.

并指畸形是指相邻指间软组织和(或)骨骼不同程度的融合,是最常见的手部先天性畸形之一,手术分离是其最重要的治疗手段.通过引入精准康复理念,对并指畸形术后康复方案进行全面优化,可以进一步提高患者康复疗效.本共识以循证医学证据为依据,经过全国专家组反复讨论,同时借鉴和参考国内外近年来的研究成果,供全国手外科医师、康复医师、康复治疗师、康复工程师、护理人员等在临床工作中参考使用.本共识主要内容包括先天性并指畸形术后康复的目标、关注的问题、治疗的主要内容、团队的组成与职责、治疗手段与措施以及推荐康复方案等.

在不到20年的时间里,先后发生了严重急性呼吸道综合征、埃博拉出血热、中东呼吸综合征、新型冠状病毒性肺炎等,给人类带来了巨大的灾难,如何加强防治是全人类面临的重要问题.中医中药在这方面积累了丰富的经验,中医对病原学有更加务实的认识,认为病毒、细菌等具有强烈传染性的病原体是自然界所存在的"异气",这种"异气"具有非常强的传染性,不论男女老少都有被感染的可能.而人体感染的主要途径在于口、鼻,即人体的上部诸窍.并且对这类疾病的流行性、传播方式均有较为系统的认识.历代医家根据这类疾病发生的季节性和潜伏性,提出了未病先防和既病防变的预防方法和原则.在治疗方面更是积累了丰富的经验,采取中药内服、外洗、熏蒸、针灸等多种措施综合应用的治疗方式,强调早期、及时治疗,在注意祛除病邪的同时,尤其重视扶正固本.这种思想是现代西方医学所不及的.另外,历代医家还明确提出了本类疾病的治疗过程中所采取的服药方式也要不拘一格,因病而异.在疾病的恢复期则强调预防疾病的复发和后遗症的形成.如何继承和发扬中医中药在防治烈性传染病方面的优势,采取中西医结合的方式防止新型冠状病毒感染的发生、发展是目前中医必须解决的问题之一.

少趾并趾畸形是一种少见的足部畸形[1-3].少趾是指足趾的缺失,数目少于5个;并趾是足趾之间有软组织或骨性连结.少趾并趾畸形常合并其他系统的先天性异常,或有家族发病倾向[4,5].

Objective:To investigate the efficacy and safety of three-dimensional navigation template assisted osteotomy for fracture malunion of lateral condyle of humerus in children.Methods:Eighteen children with ma-lunion of fracture of lateral condyle of humerus were treated in Southern Medical University Third Affiliated Hospital from August 2012 to December 2019 and analyzed retrospectively.Among them, 12 cases were treated with routine ope-ration: according to CT reconstruction and empirical osteotomy during the operation, the location of deformity was analyzed.Six cases were treated with navigation template assisted osteotomy: according to the CT data of bilateral elbow joints, a three-dimensional bone model was established, and the coronal and sagittal deformities of the distal humerus were evaluated by comparing the images of the distal humerus of the affected side with the distal humerus of the healthy side, so as to determine the best plane of osteotomy and the target position of reduction.The preoperative simulation was carried out on the computer, and the osteotomy navigation template and reduction navigation template were designed.The navigation template was printed out with a 3D printer.During the operation, the osteotomy was corrected with the assistance of navigation template, and the broken end of osteotomy was fixed with hollow screw and fixed with 80 degree flexion plaster.The X-ray films of the two groups were reexamined regularly after operation.The amount of intraoperative blood loss, operation time, incidence of postoperative complications (necrosis of humeral head and trochlea, delayed ulnar nerve paralysis, and bone nonunion) and the recovery of flexion and the extension function of elbow joint were observed in the 2 groups.Results:The elbow joint activity of all children basically returned to normal, the orthopedic site of osteotomy achieved bony healing, and the orthopedic effects were satisfactory.All the 18 cases were followed up for 6-24 months (mean 15 months). According to the postoperative Dhillon score, the navigation template group was excellent in 1 case and better in 5 cases, while in the routine group, 11 cases were batter and 1 case was fair.There were no significant differences in Dhillon score between the 2 groups after operation ( P>0.05). There were no significant differences in the range of the motion of elbow joint between the 2 groups ( P>0.05). In the comparison of operation time and intraoperative blood loss, the navigation template group [(200.0±24.2) min, (85.0±10.9) mL]was better than the routine group[(232.0±20.1) min, (139.1±18.3) mL](all P<0.001). Conclusions:The application of three-dimensional humerus reconstruction and mirror image contrast to evaluate the distal humerus deformity of the affected side, and the design of osteotomy and reduction navigation template auxiliary operation can restore the normal anatomical structure of elbow joint to the greatest extent.Accurate correction, and the function of elbow joint recover well after operation, which optimizes the operation procedure, improves the safety and effectiveness of the operation.

目的 探讨维康颗粒对乳腺癌肿瘤相关性疲劳的作用及其机制.方法 将小鼠随机分为正常(NC)组和待处理组.在待处理组小鼠上建立荷4T1乳腺癌小鼠模型,并将其随机分为肿瘤对照(TC)组、紫杉醇(PTX)组、维康颗粒(WKKL)组、维康颗粒+紫杉醇(WKKL+ PTX)组.WKKL 6g/kg,灌胃给药,每天1次;PTX 10mg/kg,腹腔注射,每2天1次.给药21天,并观察小鼠体重、肿瘤体积、瘤重、生存时间、力竭游泳时间指标的变化,并计算各组脏器指数的差异.结果 TC组小鼠的体重均较NC组显著减轻、PTX组小鼠的体重均较TC组显著减轻(P＜0.05,P＜O.01)、WKKL+ PTX组小鼠的体重较PTX组显著增加(P＜0.05,P＜0.01).与TC组相比,WKKL+ PTX组、WKKL组和PTX组3组小鼠的生命延长率分别为21.61％、13.07％和8.54％.与PTX组比较,NC组、WKKL组、WKKL+ PTX组小鼠的力竭游泳时间显著延长(P＜0.05,P＜0.01).与TC组比较,WKKL+ PTX组、WKKL组和PTX组3组小鼠的抑瘤率分别为22.24％、15.36％和16.89％.与NC组比较,其余4组的脾指数、胸腺指数均显著升高,TC组、PTX组的肾上腺指数显著升高(P＜0.01).与TC组比较,WKKL+ PTX组小鼠的肾上腺指数显著降低(P＜0.05).与HX组比较,WKKL组、WKKL+ PTX组(P＜0.01)小鼠的胸腺指数显著升高.结论 维康颗粒可能通过改善小鼠免疫功能发挥抗乳腺癌肿瘤相关性疲劳的作用.

[目的]比较肘内翻肱骨髁上截骨矫形外固定与内固定的临床效果.[方法]回顾性分析2013年1月—2019年12月本院手术治疗的肘内翻患儿75例.依据术前医患沟通结果,将患儿分为两组,47例采用截骨外固定架固定治疗,28例采用截骨钢板内固定治疗.比较两组围手术期、随访与影像资料.[结果]两组均顺利手术,术中均无血管神经损伤.外固定组在手术时间、术中出血量、手术切口长度均显著优于内固定组(P＜0.05).两组患儿恢复肘关节完全负重活动时间的差异无统计学意义(P＞0.05).随术后时间推移,两组患儿肘伸屈ROM和前臂旋转ROM均显著增加(P＜0.05),相应时间点,两组间肘伸屈ROM和前臂旋转ROM的差异均无统计学意义(P＞0.05).末次随访按Bellemore标准评估临床效果,外固定组,优43例,良4例,优良率为91.49％;内固定组,优25例,良3例,优良率为89.29％.影像方面,与术前相比,两组患儿末次随访时肱骨前倾角和提携角均显著增加(P＜0.05),相应时间点,两组间肱骨前倾角和提携角的差异均无统计学意义(P＞0.05),两组截骨愈合时间的差异无统计学意义(P＞0.05).[结论]肘内翻矫形截骨术后采用外固定具有手术时间短、切口小的优势,较内固定更具优越性.

目的:总结数字化设计导航模板在儿童肘内翻矫形截骨术中的研究进展。方法:在中国知网、万方数据库、中国生物医学文献数据库和Web of Science、PubMed、EMBASE数据库上进行文献检索，分别以"3D打印""导航模板""数字化""三维重建""矫形""肘内翻"和"3D printing""navigational template""three-dimensional reconstruction""orthopedics""cubitus varus"为中英文关键词，检索2010年1月—2020年4月有关数字化设计导航模板辅助儿童肘内翻矫形截骨术的中英文文献。从数字化设计导航模板在儿童肘内翻的畸形评估、术前模拟、导航模板设计、术后效果、应用优势与局限性等方面进行归纳总结。结果:根据纳入及排除标准，最终纳入35篇文献(英文27篇，中文8篇)。相比传统手术，数字化设计导航模板应用于儿童肘内翻截骨，术前矫形能准确地进行肘部畸形三维评估，使得术中操作与术前模拟一致，可实现个性化矫形，截骨精准、创伤小，但手术成本较高。结论:数字化设计导航模板辅助儿童肘内翻截骨矫形具有较好的手术效果和应用前景。

目的 观察五子衍宗丸(WYP)对5-氟尿嘧啶(5-FU)引起的肠道炎的保护作用并探讨其作用机制.方法 将小鼠随机分为正常组、对照组、雷莫司琼(RAM)组、五子衍宗丸高剂量(HWYP)组、五子衍宗丸中剂量(MWYP)组、五子衍宗丸低剂量(LWYP)组,对照组、WYP组和RAM组使用5-FU造模.观测小鼠腹泻和体质量情况;将小鼠处死后,取小鼠空肠组织,通过测量小肠绒毛高度和隐窝深度进行形态学评价,检测小肠组织IL-1β、IL-6、TNF-α的含量,测定组织细胞凋亡率.结果 给药第5天,WYP组、RAM组5-FU引起的体质量减轻、腹泻;缓解5-FU对小肠绒毛、隐窝的损伤;与RAM组相比,HWYP组、MWYP组小鼠空肠隐窝深度更小(P<0.05).与对照组相比,WYP组、RAM组TNF-α、IL-1β、IL-6水平显著更低(P<0.05或P<0.01).给药后1 d(24 h)或第3天,与对照组比,MWYP组凋亡率均显著降低(P<0.01).结论 五子衍宗丸能显著改善5-FU引起的肠道黏膜炎症状,对空肠隐窝的保护作用优于雷莫司琼,其作用机制可能与其抑制TNF-α、IL-1β、IL-6水平和抗细胞凋亡的作用有关.

目的 观察不同中医证型晚期肺鳞癌化疗疗效及其中医干预临床疗效.方法 入选经确诊的初治晚期肺鳞癌患者,设单纯化疗组(A组):气阴两虚型化疗组(A1组)、瘀阻肺络型化疗组(A2组);化疗联合中医干预组(B组):化疗联合补中益气汤合沙参麦冬汤治疗组(B1组);化疗联合血府逐瘀汤治疗(B2组);给予GP方案化疗.从治疗肿瘤效果、生存质量、药物毒性反应、中医症状评分4个方面评价临床疗效.结果 单纯化疗组比较:A2组较A1组有效率明显更高、不良反应发生率更低、中医临床评分明显更低(P<0.05).化疗联合中医干预组与单纯化疗组比较:与A组相比,B组生存质量提高率及提高稳定率明显高更高,不良反应发生率更低,中医症状评分明显更低(P<0.05).结论 瘀阻肺络型肺鳞癌患者对GP化疗方案的疗效明显好于气阴两虚型.中医经辨证论治干预,能显著提高患者生存质量、减少不良反应,改善症状.

信息技术引入到肿瘤舌诊的研究与应用中,让肿瘤的中医舌诊辨治逐步走向客观化、定量化和标准化.在近几年的研究中,各类肿瘤不同临床阶段的舌象特点逐渐显现,证明舌象信息对肿瘤具有一定的辅助诊治价值.人工智能、大数据等最新信息技术与中医的传统理论相结合,利用现代化科技手段采集、分析、自我学习和自我判断肿瘤患者舌象信息,找寻中医肿瘤舌象数据的内在规律,提升中医舌诊诊治肿瘤地精确性和指导性.

Objective:To summarize the progress of research on 3D-printing technology in pediatric orthopedics and serve as a theoretical reference for the improved integration of 3D printing into this field.Methods:Using "three-dimensional printing" "pediatric orthopaedic" "anatomical mode" "deformity orthopaedic" "orthopaedic" and "bone tumour" as keywords, we searched CNKI, Wanfang, PubMed, Web of Science, and other databases from January 2010 to 2019 September for literatures on the application of 3D-printing technology in children's orthopedics.Results:We retrieved 1 197 studies (540 in Chinese and 657 in English). We excluded repetitive research, inconsistent content, and unavailability of full text, and 3D-printing technology applied to adult patients and related literature in the field of craniofacial surgery. A total of 34 articles were included and analyzed. 3D-printing technology was found to produce individualized anatomical models, simulate surgical operations to design surgical plans, manufacture navigation templates to guide surgery, and create individualized scaffolds. This technology also made certain progress in bone-tissue engineering.Conclusions:3D printing technology has the characteristics of being fast, accurate and personalized, which promotes the development of personalized and minimally invasive orthopedic surgery. In the future, 3D printing technology can improve surgical outcomes through surgical education, preoperative planning and customized manufacturing (implants, prosthesis and surgical guides) and tissue engineering applications.

Objective. Gestational diabetes mellitus (GDM) is a pathological condition, affecting an increasing number of pregnant women worldwide. Safe and effective treatment for GDM is very important for the public health. In this study, we utilized a high-fat diet-induced GDM model to evaluate the effects of LBP on GDM and examined the changes of exosomal microRNA expression profiling to decipher the potential underlying mechanism of LBP.Methods. Female C57BL/6J mice were fed a control diet, HFD, or 150 mg/kg LBP-supplemented HFD for 6 weeks before conception and throughout gestation. Oral glucose tolerance test and plasma lipid levels were determined, and liver histopathology was assessed. Sequencing was used to define the microRNA expression profiling of plasma exosomes in the three groups of mice, and protein expression levels of the candidate target genes were analyzed.Results. LBP significantly relieved glucose intolerance, abnormal plasma lipid levels, and pathomorphological changes of liver histopathology in HFD-induced GDM mice. Moreover, we found that this effect of LBP was mediated by downregulation of the increase of 6 miRNAs (miR-93-3p, miR-188-5p, miR-466k, miR-1188-5p, miR-7001-3p, and miR-7115-5p) and reversing the increase of the protein expression of CPT1A, which is the target gene of miR-188-5p.Conclusions. Our findings provide novel insights into the biological activities of LBP in the treatment of GDM.

肝细胞癌(HCC)是全球癌症相关死亡的主要原因之一,存在较高的病死率和复发率,生存率极低.环状RNA(circR-NAs)是一类具有组织发育特异性表达模式的单链闭合环状RNA分子,在生物体内发挥调控作用,这些circRNAs通过充当miRNA海绵和靶向蛋白编码基因来调节HCC的进展,但其基本机制仍不清楚.归纳了circRNAs的形成机制及其生物学功能,并综述了circRNAs在HCC发病机制中的作用,提出其作为HCC诊断标志物和治疗靶点的潜在价值.

Objective:To introduce a method of using intramedullary nail to fix the ulna and Kirschner wire to fix the radius to treat the severely displaced fracture of distal radius and ulna transition zone in children.Methods:From January 2016 to December 2018, 11 patients with severe displacement were treated in our department (excluding the cases of fracture of diaphysis, distal end and epiphysis). All the operations were performed closed reduction under the fluoroscopy of C-arm machine. The fracture end of distal ulna was fixed by intramedullary nail, and the fracture end of distal radius was fixed by Kirschner wire avoiding epiphyseal plate. After operation, the long arm elbow flexion tube plaster was used for fixation for 4 to 6 weeks. The average follow-up time was 12 months (range, 6 to 15 months).Results:All the cases were healed. The average healing time was 12 weeks (range, 11 to 16 weeks) for radius and 10 weeks (range, 9 to 13 weeks) for ulna. All the fractures had good reduction, satisfactory internal fixation position, firm fixation, and no epiphysis injury. During the follow-up period, no internal fixation displacement, fracture and infection of nail tract were found. No deformity union, delayed union, nonunion, forearm and wrist joint movement limitation, epiphyseal injury and other complications were found at the fracture end of all children.Conclusion:The intramedullary nail fixation of ulna combined with cross Kirschner wire fixation of radius is a safe, minimally invasive and effective surgical method to treat the severely displaced fracture of distal radius and ulna transition zone in children. The effect is reliable and the postoperative complications are few without fixation of epiphysis.

目的 观察小儿先天性肌性斜颈患儿治疗中联用手法牵引和按摩的临床疗效.方法 抽取2018年9月～2019年9月间因先天性肌性斜颈就诊的40例患儿作为研究对象,应用抽签法将所有患儿分为实验组和对照组两组,其中实验组行手法牵引和按摩治疗,对照组则应用胸锁乳突肌双切口手术,对两种治疗方式的临床应用价值进行比较分析.结果 经统计学软件验证比较后发现,两组患儿治疗有效率均较高,组间差异无统计学意义(P﹤0.05),对照组患儿治疗后各项美容评分显著高于实验组,P<0.05.结论 手法牵引结合按摩在小儿先天性肌性斜颈患儿治疗中有效良好的效果,无需开刀,有效避免了患儿术后黏连、留疤等,临床应用价值较高.

目的 观察脂必泰胶囊治疗动脉粥样硬化性脑梗死恢复期的临床疗效.方法 将符合标准的84例动脉粥样硬化性脑梗死恢复期病人随机分为观察组与对照组,各42例.对照组予以阿司匹林、阿托伐他汀等治疗,观察组在对照组基础上加用脂必泰胶囊治疗,两组均治疗14d.观察并比较两组血脂水平、临床疗效、美国国立卫生研究院卒中量表(NIHSS)评分、治疗前后中医证候积分改善情况.结果 治疗前,两组血脂各项比较,差异无统计学意义(P＞0.05);治疗后,两组总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平与治疗前比较,差异有统计学意义(P＜0.01),且观察组总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平明显低于对照组(P＜0.05或P＜0.01),高密度脂蛋白胆固醇明显高于对照组(P＜0.05).治疗前,两组NIHSS评分比较,差异无统计学意义(P＞0.05);治疗后,两组NIHSS评分较治疗前降低,差异有统计学意义(P＜0.01),且观察组低于对照组(P＜0.05).治疗后,观察组总有效率高于对照组(78.13％与53.13％,x2=4.433,P=0.035).治疗前,两组中医证候积分比较,差异无统计学意义(P＞0.05);治疗后,两组中医证候积分明显降低,差异有统计学意义(P＜0.01),且观察组低于对照组(f =5.153,P=0.000).结论 脂必泰胶囊联合常规西药治疗动脉粥样硬化性脑梗死恢复期,可调节病人血脂,并改善中医症状.

目的:运用数据挖掘技术分析名中医王昌俊教授辨治原发性肝癌的门诊处方,探讨王昌俊教授的用药规律.方法:通过医院处方系统收集王昌俊教授经辨治为原发性肝癌的门诊处方,提取方药信息,用EXCEL建立处方用药数据库,应用频数分析、聚类分析进行数据挖掘,并结合专家体会对数据结果进行分析.结果:共纳入病例69例,有效门诊方处共295首,使用中药共142味,142味中药按功效可分为17类,用药频次排前5类中药分别为的为补虚药、清热药、活血化瘀药、理气药、利水渗湿药;药性前3位依次为寒、温、平;药味前3位依次为甘、苦、辛.聚类分析显示可归为5类中药:补气行气类、健脾益胃类、清热散结类、活血通络类和理气和胃类.结论:王昌俊教授辨治肝癌用药规律以调理气机的中药为主,注重健脾益胃类中药的运用,辨证用药与辨病用药相结合,辅以活血化瘀类中药.

目的:观察土精方对痛风性关节炎的防治作用.方法:将符合诊断标准的痛风患者随机分为观察组和对照组,观察组在西医常规治疗的基础上加用土精方进行治疗,对照组单纯用西药治疗,分别于治疗前、后抽血及收集尿液检测血尿酸(SUA)、尿尿酸(UUA)、肝肾功能、C反应蛋白(CRP)等指标.观察并记录患者急性痛风性关节炎发作的频率、疼痛的轻重程度、止痛药的使用量及完全止痛时间的长短.结果:与对照组比较,观察组患者的血尿酸、CRP显著降低,尿尿酸显著升高,急性痛风性关节炎每年发作的次数显著减少,疼痛的程度显著减轻,止痛药的使用量显著减少,达到完全止痛所需时间显著缩短.两组患者肝功能无显著差异.结论:土精方对痛风有一定的防治作用,值得作进一步的研究.