BACKGROUND:Acupuncture has been widely used for chronic musculoskeletal pain syndrome (MPS). Due to the strong influence of sham acupuncture (SA) in clinical trials, the treatment of MPS by acupuncture remains controversial. Different types of SA procedures might produce different responses. The purpose of this systematic review was to assess the effect of SA on MPS. METHODS:We searched 8 literature databases for randomized controlled trials (RCTs) on acupuncture for chronic MPS with SA as a control from database inception to November 29, 2022. SA included superficial acupuncture on non-acupoints (SANAs), non-penetration on acupoints (NPAs), and non-penetration on non-acupoints (NPNAs). Two independent reviewers assessed the risk of bias and conducted the research selection, data extraction, and quality assessment of the included RCTs. We conducted data analysis using the RevMan 5.3 and STATA 14 software packages, and traditional meta-analysis was adopted for direct comparison. A network meta-analysis (NMA) was executed using frequency models in which we combined all available direct and indirect evidence from RCTs. The pain-related indicators were set as primary outcomes, and GRADEpro online was implemented for the assessment of evidence quality. RESULTS:Forty-two RCTs were included in this study, encompassing a total of 6876 patients and incorporating 3 types of SA procedures. In our traditional meta-analysis, true acupuncture (TA) was more effective than SANAs, NPAs, and NPANAs concerning MPS. In the NMA, TA was the most effective modality, followed by SANAs, NPAs and NPANAs, and then the blank control (BC). In this NMA and according to the therapeutic effects in the pain indicators, the rankings of SA were as follows: SANA (surface under the cumulative ranking curve [SUCRA], 65.3%), NPA (SUCRA, 46.2%), and NPANA (SUCRA, 34.2%). The quality of the evidence for outcomes ranged from "low" to "moderate." CONCLUSIONS:Compared with SA, TA was effective in treating MPS. The effects produced by different SA procedures were different, and the order of effects from greatest to least was as follows: SANA, NPA, and NPANA.

火针是临床治疗疾病的重要辅助手段之一,已被广泛应用于多类疾病的治疗中.火针疗法具有促进血液循环、抗炎、刺激机体免疫应答、促进自我修复等功效.针对患者采用火针治疗疾病,安全性强,疗效显著,操作简单,所花时间短,适用人群广泛.结合实际情况,本文全面分析火针的临床应用及作用机制,旨在为相关人员的研究工作提供参考资料.

Background： Wall-eyed bilateral internuclear ophthalmoplegia syndrome ( WEBINO) is a rare disorder comprising bilateral exotropia, bilateral internuclear ophthalmoplegia, and impaired convergence. It is usually caused by a midbrain lesion. Case presentation ：We describe a rare case of WEBINO, with the lesion located in the lower pons, in a 69-year-old man with acute ischemic stroke. Conclusions ：Our report alerts physicians to the possibility of bilateral WEBINO due to unilateral infarction.

OBJECTIVE: Clinical practice recommendations issued by the American Diabetes Association in 2019 include the health status and quality of life of people with diabetes as part of their daily care , and believe that it’s important to strengthen physical exercise for diabetic patients. Previous studies have shown that the Baduanjin, a traditional Chinese sport, can regulate blood glucose and blood lipids, weight loss and improve immunity.This study was aimed at investigating the effects and safety of Modified Baduanjin on patients with type 2 diabetes. METHODS: Forty patients were divided into the Modified Baduanjin group (Α group, n=22) and the control group (Β group, n=18) for 12 weeks according to their individual motivation. On the basis of conventional hypoglycemic treatment, Group Α practiced Baduanjin for 30 minutes per day, 4 times per week, while no exercise intervention was given in group Β. The main study outcomes included changes in fasting blood glucose, blood lipids, glycosylated hemoglobin,Quality of Life score( QoL score, 100 in total), muscle endurance, and flexibility after 12 weeks. RESULTS: There were no significant differences in patient characteristics between the two groups at baseline. Group Α in glycosylated hemoglobin (pre 6.56±0.70 vs post 6.28±0.70) , QoL score (pre 80.18±9.02 vs post 86.64±9.91) , muscle endurance (pre 3.76±4.38 vs post 6.91±5.73) and flexibility (pre 2.86±9.69 vs post 5.88±9.75) . All the above results were statistically significant (P<0.05).There were no statistical significance in group Β (P>0.05) . 2) Few changes were found in fasting blood glucose and lipid parameters both in two groups(P>0.05). 3) All patients completed the exercise programme with no adverse effects. CONCLUSION: Chinese traditional exercise is effective and safe in regulating and control the level of blood glucose, enhancing physical fitness and improving the quality of life.

PURPOSE: It was reported that early diabetic nephropathy (DN) is associated with sedentary lifestyle, and proper exercise can improve its symptoms and prognosis. However, limited data evaluated the effects and safety of traditional Chinese exercise in patients with early DN. This study was aimed at observing the effects and safety of traditional Chinese exercise on early DN. METHODS: Participants (n=21) were divided into the traditional Chinese exercise group (A group, n=12) and the control group (B group, n=9) for 12 weeks. On the basis of foundation treatment, group A was given the exercise 30 minutes per day, 4 times a week while no exercise intervention was given in group B. Fasting blood glucose, glycated hemoglobin (HbA1c), serum creatinine, urea, and the MUNSH scale were taken at baseline and 12 weeks later. RESULTS: 1) Significant differences were found in group A in HbA1c (6.90±0.92 vs 6.43±0.78, P < 0.05), BMI (26.30±3.49 vs 25.83±3.06, P < 0.05) and VO2peak (15.43±1.49 vs 16.14±1.89, P < 0.05) compared with group B (Ps > 0.05). The differences of MUNSH scale were significantly greater: positive emotion (6.75±3.14 vs 7.92±2.97, P < 0.01), positive experience (8.08±4.03 vs 10.00±3.77, P < 0.05), total score (32.67±11.28 vs 38.33±12.27, P < 0.01). 2) No adverse reactions were observed during the trail. Few changes were found in renal function and urinary protein in two groups (P > 0.05). CONCLUSIONS: Traditional Chinese exercise therapy was safe and effective in treating early DN patients. It also has effects on improving the physical and mental health. Supported by JDZX2015136

目的 观察不同运动方式下12周前后2型糖尿病患者糖脂代谢、生存质量的变化.方法 60例2型糖尿病患者分别进行为期12周的改良八段锦锻炼、快走及对照,12周训练前后所有患者检测空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、血脂(TC、TG、HDL-C、LDL-C),并采用WHOQOL-BREF量表对其生存质量进行评估,观察不同运动方式对2型糖尿病患者糖脂代谢、生存质量的影响.结果 改良八段锦可以降低2型糖尿病患者HbA1c水平,减少降糖药物使用;患者WHOQOL-BREF量表总分干预前后差异有统计学意义(P＜0.01);在生理领域方面,干预前后差异有统计学意义(P＜0.05).结论 改良八段锦与快走运动相比,可降低2型糖尿病患者平均血糖水平,改善患者生存质量.

今人或因饮食不节,或因嗜食肥甘厚腻之品,亦或因情志不遂等,脾胃病者十之八九,而脾运失常者其达病所之药力能有几何;加之药不雄峻,其疾不了,中药、西药实乃以毒制毒之品,其毒性副作用甚是严峻;再者随着环境污染的严重,杂病怪病愈来愈多,故单凭内治之法难免有独脚难行,孤掌难鸣之感.中医外治法通过药物或者针灸等器具作用于孔窍、腧穴、经络避免胃肠吸收,在急症、疑难杂症治疗上独具一格,当然也存在其一定的局限性. 尤在泾在《医学读书记》中说道:"兵无向导,则不达贼境;药无引使,则不达病所."中药内治疗人以四气五味之偏性,而中医外治法善引经通络,直达病源,故两者结合治疗内科疾病有势如破竹,直捣黄龙之势. 现将临床内科疾病外治的重要性及其临床分类、应用总结如下,以飨读者.

糖尿病肾脏病(DKD)是糖尿病常见的微血管并发症之一,是导致终末期肾病的主要原因之一,其发病率逐年上升,近年来很多研究重点在于对于糖尿病肾病的治疗方法,而忽视了患者有效管理对于延缓病程进展方面的重要作用.汇总吕仁和教授在临床诊疗过程中关于管理糖尿病肾病患者的有效方案.

目的:系统评价中西医结合治疗2型糖尿病胰岛素抵抗的疗效.方法:应用计算机检索2006-2016年中国知网、万方数据库、维普数据库、Sinomed、The Cochrane Library数据库,手工检索纳入文献的参考文献,查找有关中西医结合治疗2型糖尿病胰岛素抵抗的随机对照试验(RCT),按纳入和排除标准筛选文献,提取资料和评价纳入研究的方法学质量后,采用RevMan5.3软件进行Meta分析.共纳入16篇文献,1 253例患者,其中观察组644例,对照组609例,各研究均明确指出基线均衡,具有可比性.结果:Meta分析结果显示,中西医结合治疗2型糖尿病胰岛素抵抗在提高临床疗效(RR=1.73,95％CI[1.46,2.05])、提高胰岛素敏感指数(MD =0.26,95％CI[0.22,0.3])、降低胰岛素抵抗指数(MD=-1.02,95％CI[-1.16,-0.87])、降低体重指数(MD=-0.78,95％CI[-1.26,-0.3])、降低血脂TC:(MD=-0.57,95％CI[-0.73,-0.42]、TG:(MD=-0.78,95％CI[-1.26,-0.30])、LDL-C:SMD=-0.46,95％CI[-0.59,-0.32]、空腹胰岛素(SMD=-0.69,95％CI[-0.81,-0.57])、空腹血糖(MD=-0.9,95％ CI[-1.09,-0.7])、糖化血红蛋白(MD=-0.77,95％CI[-1.28,-0.26])等方面优于单纯西药治疗,差异有统计学意义.结论:中西医结合治疗2型糖尿病胰岛素抵抗具有一定的优势,受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究予以验证.

Through the analysis of the papers about kinesitherapy intervention in chronic renal insufficiency in CNKI and Wanfang of recent 5 years,and chronic renal insufficiency can be divided into dialysis stage and non-dialysis stage.The traditional exercise therapy for chronic renal insufficiency was summarized ,and the current shortcomings were analyzed .The appropriate exercise pre-scription was preliminarily explored in order to postpone the progress of chronic kidney disease .