目的 比较睡眠维持困难型失眠与其他失眠亚型的睡眠精神特征.方法 收集 2022 年 11 月至 2023 年 3月就诊于北京中医药大学第三附属医院综合门诊及脑病科睡眠障碍门诊、北京第一中西医结合医院名医堂门诊、北京中医药大学国医堂、黄家医圈中医医院及通过线上海报进行社会招募的睡眠维持困难型失眠患者(观察组141 例)和其他失眠亚型患者(对照组 60 例).比较两组一般资料信息和失眠严重程度指数(ISI)、匹兹堡睡眠指数量表(PSQI)及各因子评分、焦虑自评量表(SAS)、抑郁自评量表(SDS).结果 两组年龄、婚姻状况、文化程度、合并甲状腺疾病比较,差异有统计学意义(P＜0.05).两组ISI、PSQI总分、PSQI因子评分中的睡眠质量、入睡时间、睡眠时间、睡眠效率、催眠药物比较,差异有统计学意义(P＜0.05).多元线性回归分析结果显示,睡眠维持困难型失眠是ISI、PSQI因子评分中的睡眠时间、睡眠效率、睡眠障碍及SDS评分的影响因素(P＜0.05).结论 睡眠维持困难型失眠会导致与其他亚型总和相近的失眠水平和抑郁、焦虑水平,临床损害较重.

ObjectiveThe present study aimed to use CiteSpace to analyze the status of insomnia and circadian rhythm, identify the hot spots and trends, and provide a basis for future study.MethodThe Web of Science database was searched for studies related to insomnia and circadian from its inception to 14 April 2023. CiteSpace was used to generate online maps of collaboration between countries and authors and revealed hot spots and frontiers in insomnia and circadian rhythm.ResultsWe searched 4,696 publications related to insomnia and circadian rhythm. Bruno Etain was the most prolific author with most publications, i.e., with 24 articles. The USA and the University of California were the leading country and the top institution in this field of study, with 1,672 and 269 articles, respectively. There was active cooperation between institutions, countries, and authors. Hot topics focused on circadian rhythm sleep disorders, circadian clock, light therapy, melatonin, and bipolar disorder.ConclusionBased on the CiteSpace results, we recommend a more active collaboration between various countries, institutions, and authors to conduct clinical and basic research related to insomnia and circadian rhythm. Ongoing research focuses on the interaction of insomnia with circadian rhythms and the corresponding pathways of clock genes and by extension, the role of circadian rhythms in disorders such as bipolar disorder. Modulation of circadian rhythms may be a hot spot for future insomnia therapies (such as light therapy and melatonin).

《全国名医验案类编》由清代著名医家何廉臣征集编纂而成,内容宏富,纲目分明,按语精妙,是中医治疗急性外感热病的重要参考资料,具有很高的理论研究与临床实践价值.本文通过对《全国名医验案类编八大传染病案》中的疫病医案进行分类归纳与解析,总结出何廉臣包括将六淫偏向性作为重要发病诱因,重视外感病与患者个人体质因素之结合,中西医理论融合汇通施治,疫病康复期注重个性化调养护理在内的四大疫病辨治及康复特色,并与现代疫病研究结合进行探讨,以期探究何氏疫病诊治思想历久弥新之精华,体现其在当代疫病治疗中的指导作用与实践意义.

A systematic review of randomized controlled trials (RCTs) was conducted to assess the potential effect of therapeutic massage/Tuina on functional dyspepsia (FD) patients. Twelve databases and three clinical trial registries were searched until December 2021, for RCTs that compared Tuina combined with or without conventional therapy versus conventional therapy in FD. We assessed the methodological quality of included trials by the Cochrane Risk of Bias tool, and graded the quality of the evidence. The data were presented as risk ratio (RR) or mean difference (MD) respectively with their 95% confidence interval (CI). In total, 14 RCTs with 1128 FD participants were included. Compared with conventional therapy, Tuina showed significant beneficial effects on improving overall symptom (RR = 1.12, 95% CI 1.06 to 1.19, low certainty evidence), and early satiation (MD −0.44 scores, 95% CI −0.72 to −0.16, very low certainty evidence). Compared with conventional therapy, Tuina plus conventional therapy also significantly improved overall symptom (RR = 1.14, 95% CI 1.06–1.23, low certainty evidence), quality of life (MD 10.44 scores, 95% CI 7.65–13.23, low certainty evidence), and epigastric pain (MD −0.76 scores, 95% CI −1.11 to −0.41, low certainty evidence). No adverse events related to Tuina and cost-effectiveness were reported. Low certainty evidence showed that Tuina significantly improved overall symptom of FD participants compared with conventional therapy. Low certainty evidence showed that Tuina plus conventional therapy obviously improved overall symptom and quality of life of FD participants compared with conventional therapy.

[目的]通过对新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)文献资料进行统计分析,探讨COVID-19患者的舌象特征.[方法]检索中国知网(China National Knowledge Infrastructure,CNKI)和PubMed、Web of Science数据库中COVID-19舌象、证候的临床研究,发表时间范围为2019年12月至2020年11月.提取纳入文献中的舌象特征,系统整理后建立数据库,分别统计COVID-19患者的舌色、舌形、苔色、苔质等舌象情况.[结果]共纳入48篇文献,其中中文文献47篇,外文文献1篇,涉及4750例COVID-19病例,患者舌象以绛红舌(32.11％)、腻苔(54.29％)最为常见,同时黄苔占有一定比例(40.88％),除轻型病例外,腻苔为COVID-19各病程主要苔质特征.在COVID-19不同的病程阶段,患者舌色、舌形、苔质、苔色呈现差异,同时随着病程的进展加重,COVID-19的主要舌象特征从淡红舌转为绛红舌,薄苔转为厚苔,体现了COVID-19不同病程阶段舌象的变化.对比轻型和普通型、重型和危重型两类患者舌象特征,发现随着病情的加重,厚苔、青紫舌比例增加,体现邪气的增长,病邪的深入,也说明了COVID-19病程进展后期容易出现"瘀""闭"的特性.通过对病例的地域分类统计,发现病例样本主要集中在华中地区(59.83％),不同地域患者的舌象呈现差异,舌色方面,东北地区以青紫舌为主,华北、华南、华东地区以绛红舌为主;腻苔为各地域共同的主要苔质特征.[结论]腻苔为COVID-19的主要舌象特征,因此"湿邪"为本病重要特征,病程进展不同、地域差异使得患者舌象呈现差异.

Review question / Objective: The aim of this systematic review is to explore the magnitude of the placebo effect in randomized controlled trials for diarrhea-type irritable bowel syndrome and to understand possible relevant factors that affect the placebo effect. Condition being studied: Irritable bowel syndrome is a chronic functional gastrointestinal disorder characterized by abdominal pain related to defecation and a change in frequency and form of stool. Epidemiological study indicates that the prevalence of irritable bowel syndrome in different countries is high. It is estimated conservatively that direct costs related to irritable bowel syndrome causes a huge economic burden in the United States. In the latest Rome IV criteria, irritable bowel syndrome is divided into 4 subtypes based on abnormal bowel habits: irritable bowel syndrome with predominant constipation, irritable bowel syndrome with predominant diarrhea, irritable bowel syndrome with mixed bowel habits, and irritable bowel syndrome unclassified. Regarding treatment for irritable bowel syndrome, there is no cure or curative treatment. Any agent should be compared with placebo to identify its efficacy. In fact, the placebo response rate of irritable bowel syndrome is high. However, the placebo response rate of IBS-D and the moderators of the magnitude of the placebo response rate are not clear.

In recent years, the incidence of fatigue has been increasing, and the effective prevention and treatment of fatigue has become an urgent problem. As a result, the genetic research of fatigue has become a hot spot. Transcriptome-level regulation is the key link in the gene regulatory network. The transcriptome includes messenger RNAs (mRNAs) and noncoding RNAs (ncRNAs). MRNAs are common research targets in gene expression profiling. Noncoding RNAs, including miRNAs, lncRNAs, circRNAs and so on, have been developed rapidly. Studies have shown that miRNAs are closely related to the occurrence and development of fatigue. MiRNAs can regulate the immune inflammatory reaction in the central nervous system (CNS), regulate the transmission of nerve impulses and gene expression, regulate brain development and brain function, and participate in the occurrence and development of fatigue by regulating mitochondrial function and energy metabolism. LncRNAs can regulate dopaminergic neurons to participate in the occurrence and development of fatigue. This has certain value in the diagnosis of chronic fatigue syndrome (CFS). CircRNAs can participate in the occurrence and development of fatigue by regulating the NF-κB pathway, TNF-α and IL-1β. The ceRNA hypothesis posits that in addition to the function of miRNAs in unidirectional regulation, mRNAs, lncRNAs and circRNAs can regulate gene expression by competitive binding with miRNAs, forming a ceRNA regulatory network with miRNAs. Therefore, we suggest that the miRNA-centered ceRNA regulatory network is closely related to fatigue. At present, there are few studies on fatigue-related ncRNA genes, and most of these limited studies are on miRNAs in ncRNAs. However, there are a few studies on the relationship between lncRNAs, cirRNAs and fatigue. Less research is available on the pathogenesis of fatigue based on the ceRNA regulatory network. Therefore, exploring the complex mechanism of fatigue based on the ceRNA regulatory network is of great significance. In this review, we summarize the relationship between miRNAs, lncRNAs and circRNAs in ncRNAs and fatigue, and focus on exploring the regulatory role of the miRNA-centered ceRNA regulatory network in the occurrence and development of fatigue, in order to gain a comprehensive, in-depth and new understanding of the essence of the fatigue gene regulatory network.

亚健康是介于健康和疾病的中间状态,因其没有器质性病变往往被漏诊而不能及时救治,迁延日久给人类生命和财产安全带来更大的危害.本文系统回顾了目前市面上可用的亚健康人群身心状况客观评测技术,并发现国内对于亚健康领域多偏重科研和教学,而市场反馈较好的多为海外研发产品.本文提出国内亚健康评估市场应进一步开发简、廉、快、验的客观诊断工具,为亚健康的防治贡献一份力量.

Background: To assess the efficacy and safety of auriculotherapy based on syndrome differentiation for constipation. Methods: A retrieval on studies concerning treatment of constipation with auriculotherapy based on syndrome differentiation was carried out in databases of VIP, CNKI, Wangfang, Sinomed and PubMed, Cochrane. And the systematic review was conducted on randomized controlled trial (RCT) which met the enrolling requirements. The quality of the included studies was evaluated by using the bias risk assessment recommended by the Cochrane manual 5.1.0, and the meta-analysis was performed by using RevMan5.3 software. Descriptive analysis was performed on the literature that could not be combined. Results: A total number of six papers involving 468 patients were concluded and the methodological quality of these studies was not high; The results indicated that mean defecation time after auriculotherapy based on syndrome differentiation is lesser than after western medicine and statistical significance can be found [Z=2.36, P<0.05, relative risk (RR) =−0.41, 95% confidence interval (CI): −0.75, −0.07]. In the comparison of affective rate, auriculotherapy based on syndrome differentiation is higher than the western medicine (Z=2.84, P<0.05, RR =1.23, 95% CI: 1.07, 1.42). Discussion: Auriculotherapy based on syndrome differentiation is effective to treat constipation no worse than routine western medicine treatment on the part of mean defecation time. Also it’s long-term result and safety are better. However, no definitive conclusion can be made, high-quality and further rigorous RCTs adopting internationally recognized outcomes are warranted to confirm the effect and safety of auriculotherapy for constipation.

疲劳是指开展或维持随意活动过程中出现障碍的表现,既可作为独立的疾病,又可作为多种疾病中出现的症状.疲劳发生率高,严重影响人们的身心健康,防治疲劳成为亟待解决的重要问题.疲劳的发病机制主要包括能量损耗、代谢产物堆积、递质分泌失常、线粒体功能下降、下丘脑-垂体-肾上腺轴功能失调等,目前国内外还没有形成统一的认识.疲劳的基因学研究是目前的研究前沿,基因表达谱研究为疲劳的机制研究提供了新的方法,基因芯片技术与中医学理论相结合,有望给疲劳的发病机制研究带来突破性进展.在疲劳的基因芯片研究中,信使RNA(mRNA)和微小RNA(miRNA)是常见的研究对象,而围绕某一具体信号通路对疲劳的基因表达规律及中医药治疗疲劳有效调控靶点的探索较少.近年来,中枢神经系统奖励和抑制作用的功能失调成为研究热点,尤其是γ氨基丁酸(GABA)和多巴胺(DA)分别作为抑制作用和奖励机制的主导物质备受关注.GABA和DA主导的抑制作用和奖励机制维持平衡则机体无疲劳感,而平衡一旦被打破,则疲劳感形成.同时,DA和GABA受体还可通过调控环磷酸腺苷(cAMP)信号通路来影响机体的疲劳感.运用基因芯片技术对GABA/DA平衡机制及相关cAMP信号通路中的关键基因进行研究有望深入揭示疲劳的发病机制.采用基因芯片的方法,检测疲劳人群和正常人群中GABA/DA信号通路及相关cAMP信号通路中关键基因表达的变化,可以深入探讨疲劳的发病机制.基于此,该文对和疲劳相关的GABA/DA平衡机制及相关cAMP信号通路中的关键基因进行总结归纳,为从基因学研究角度有针对性地深入探讨疲劳的发病机制并进行有效防治提供依据.

目的 观察低、中、高三种剂量脾虚1号方对功能性消化不良(functional dyspepsia,FD)大鼠降钙素基因相关肽(calcitonin gene-related peptide,CGRP)、胆囊收缩素(cholecystokinin,CCK)和血管活性肠肽(vasoactive intestinal peptide,VIP)的影响.方法 碘乙酰胺灌胃复合水环境小平台站立法复制大鼠FD模型.将大鼠随机分成5组:对照组、模型组、西药组、脾虚1号方低剂量组(以下简称低剂量组)、脾虚1号方中剂量组(以下简称中剂量组)和脾虚1号方高剂量组(以下简称高剂量组).使用Elisa检测血清中CGRP、CCK和VIP的含量;使用rt-PCR检测下丘脑和胃窦中CGRP mR-NA、CCK mRNA和VIP mRNA的表达情况.结果 与对照组相比,模型组大鼠血清中CGRP、CCK和VIP的含量均上升;与模型组相比,低剂量组大鼠血清中VIP含量下降,中剂量组大鼠血清中CGRP、CCK和VIP的含量下降,高剂量组大鼠血清中CGRP的含量降低.与对照组相比,模型组大鼠下丘脑中CGRP mRNA、CCK mRNA和VIP mRNA的含量均上升;与模型组相比,低剂量组大鼠下丘脑中VIP mRNA的含量下降,中、高剂量组大鼠下丘脑中CGRP mRNA、CCK mRNA和VIP mRNA的含量下降.与对照组相比,模型组大鼠胃窦中CGRP mRNA、CCK mRNA和VIP mRNA的含量均上升;与模型组相比,低剂量组大鼠胃窦中VIP mRNA的含量下降,中剂量组大鼠胃窦中CGRPmRNA、CCK mRNA和VIP mRNA的含量下降,高剂量组大鼠胃窦中CGRP mRNA和VIP mRNA的含量下降.结论 脾虚1号方治疗FD的生物学基础与调节CGRP、CCK和VIP的表达有关.

目的 研究复方宁神精油治疗对氯苯丙氨酸(PCPA)致失眠大鼠行为学及下丘脑伽马氨基丁酸(GABA)和谷氨酸(GLU)含量的影响.方法 50只SD大鼠随机分为:空白组、模型组、复方宁神精油高浓度组、复方宁神精油中浓度组、复方宁神精油低浓度组.除空白组外,其余各组大鼠均采用腹腔注射PCPA建立大鼠失眠模型.造模后,各复方精油组分别采用1％、0.5％、0.25％3种不同浓度精油香熏治疗,空白组和模型组采用蒸馏水香薰.连续7天每天于上午10:00熏治1 h.第7天给药结束后,观察并记录各组大鼠一般状况,通过翻正实验、旷场和高价十字迷宫实验对比各组给药后的差异;采用酶联免疫吸附法(Elisa)测定各组大鼠下丘脑中GABA、Glu含量并统计其比值差异,通过气相色相质谱分析(GC—MS)探究复方宁神精油的化合物活性成分.结果 复方宁神精油高浓度组的睡眠潜伏期减少最明显、睡眠持续时间增高最显著(P<0.01,P<0.01);旷场实验中,复方宁神精油高浓度组可明显增多失眠大鼠总活动距离和总穿格数(P<0.01,P<0.01),显著减少修饰次数及中央格停留时间(P<0.01,P<0.05);高架十字迷宫实验中,复方宁神精油高浓度组的开放臂停留次数和停留时间百分比数据增量最明显(P<0.01,P<0.01);各复方宁神精油组下丘脑GLU含量差异无统计学意义,复方宁神精油高浓度组的下丘脑GABA含量增多(P<0.01).各复方精油组GLU/GABA均极著性降低(P<0.01),其中复方宁神精油高浓度组其比值降低最明显.结论 复方宁神精油高浓度组能明显缩短失眠大鼠睡眠潜伏期并延长睡眠持续时间,有效缓解失眠所致的紧张焦虑情绪,激发大鼠自发活动能力和探究能力.其作用靶点可考虑为调节失眠大鼠下丘脑中GABA和GLU含量,从而平衡中枢神经系统功能,精油中的有效活性成分或可考虑为改善失眠调节情绪的主要成分.这为临床推广使用复方宁神精油治疗失眠提供了参考.

目的 探讨薰衣草精油对睡眠剥夺大鼠行为学及血清中胃饥饿素、瘦素含量的影响.方法32只雄性Wistar大鼠随机分为空白组、模型组、薄荷组和薰衣草组.采用改良多平台法进行连续72 h睡眠剥夺,造模结束后,正常组和模型组给予蒸馏水熏蒸,薄荷组和薰衣草组分别给予对应的1％浓度精油熏蒸,每组45 min.治疗结束后,进行抓握力、旷场、高架十字迷宫测试,并测定大鼠血清中胃饥饿素和瘦素含量.结果与空白组相比,模型组大鼠肌张力降低、旷场总活动距离、总穿格数减少、修饰时间增加、直立次数减少、直立时间减少、高架迷宫中开放臂停留时间百分比减少、血清中胃饥饿素含量增加,差异有统计学意义(P均<0.05);与模型组相比,薄荷组大鼠肌张力升高,旷场总活动距离、总穿格数、直立次数、直立时间增加,高架迷宫开放臂进入次数百分比和开放臂停留时间百分比增加、血清中胃饥饿素含量减少,差异有统计学意义(P均<0.05);与模型组相比,薰衣草组大鼠肌张力升高、旷场总活动距离、总穿格数增加、修饰时间减少、直立次数、直立时间增加、高架迷宫开放臂进入次数百分比和开放臂停留时间百分比增加、血清中胃饥饿素含量减少,差异有统计学意义(P均<0.05).结论薰衣草精油香薰治疗可能是通过调节体内胃饥饿素的含量,达到改善睡眠剥夺大鼠的焦虑情绪并提高活动量的目的.

失眠是常见的睡眠问题之一,且已成为中医治疗的优势病种.中医从整体观和辨证论治的角度出发,治疗方法多样、疗效显著且副作用小,值得推广.舌诊作为中医的特色诊法,对揭示疾病的发生、发展及转归有重要的意义.笔者以中医理论为指导,研究从舌诊辨治失眠的理论基础,探讨失眠证型的特征舌象,分析其病机演变,旨为临床诊疗用药提供理论基础和参考依据.

BACKGROUND:Tai Chi has been reported to be potentially effective for health and well-being of cancer survivors. It is worth to assess the effectiveness and safety of Tai Chi on immunological function in people with cancer.METHODS:All relevant randomized controlled trials (RCT) will be reviewed on Tai Chi for immunological function in cancer survivors. Literature searching will be conducted until March 9, 2019 from major English and Chinese databases: Cochrane Library, Excerpta Medica Database (EMBASE), PubMed, CINAHL, Sprotdicus, American Association for Cancer Research Journals, Sino-Med database, China National Knowledge Infrastructure, Chinese Science and Technique Journals Database, and Wanfang Data Chinese database. Two authors will conduct data selection and extraction independently. Quality assessment will be conducted using the risk of bias tool recommended by the Cochrane Collaboration. We will conduct data analysis using Cochrane's RevMan software (V.5.3). Forest plots and summary of findings tables will illustrate the results from a meta-analysis if sufficient studies with the same outcomes are identified. Funnel plots will be developed to evaluate reporting bias.RESULTS:This review will summarize the evidence on Tai Chi for immunological function in cancer survivors.CONCLUSIONS:We hope that the results of this study will provide significant evidence to assess the value Tai Chi practice on immunological function in cancer survivors.ETHICS AND DISSEMINATION:Ethics approval is not required as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication.

噪声性耳聋是伴随工业文明发展而出现的一种职业性疾病,中医古籍中鲜有相关的论述.目前,关于噪声性耳聋的中医病因认识并不统一,根据噪声性耳聋的发病特点,笔者认为噪声是一种毒邪.历代医家对毒邪不断探索,对毒邪的认识也愈加深入、全面.因此,文章从毒邪角度认识噪声,分析其与外毒、瘀毒的异同,以探讨噪声性耳聋的中医病因.