Autonomic functions and gastric motility in children with functional abdominal pain disorders

BACKGROUND Abdominal pain-predominant functional gastrointestinal disorders(AP-FGIDs)are the most common cause of recurrent abdominal pain in children. Despite its high prevalence, the underlying pathophysiology of this condition is poorly understood.AIM To assess the role of gastric dysmotility and autonomic nervous system dysfunction in the pathophysiology of AP-FGIDs.METHODS One hundred children, fulfilling Rome III criteria for AP-FGIDs, and 50 healthy controls, aged 5 to 12 years, were recruited after obtaining parental consent. All patients were investigated for underlying organic disorders. Gastric motility and cardiovascular autonomic functions were assessed using validated non-invasive techniques.RESULTS The main gastric motility parameters assessed(gastric emptying rate [45.7 vs 59.6 in controls], amplitude [48.7 vs 58.2], frequency of antral contractions [8.3 vs 9.4],and antral motility index [4.1 vs 6.4]) were significantly lower in children with AP-FGIDs(P < 0.05). The post-prandial antral dilatation at 1 min after the test meal significantly correlated with the severity of abdominal pain(P < 0.05).Assessment of autonomic functions in AP-FGID patients showed neither a significant difference compared to the control group, nor a correlation with gastric motility abnormalities(P > 0.05). The duration of pain episodes negatively correlated with the parasympathetic tone(maladaptive parasympathetic tone)(P< 0.05).CONCLUSION Children with AP-FGIDs have abnormal gastric motility but normal cardiovascular autonomic functions. There is no relationship between abnormal gastric motility and autonomic functions. The pathogenesis of AP-FGIDs is not related to cardiovascular autonomic dysfunction.

Effect of low-level laser therapy on tooth-related pain and somatosensory function evoked by orthodontic treatment

Low-level laser therapy(LLLT) may have an effect on the pain associated with orthodontic treatment. The aim of this study was to evaluate the effect of LLLT on pain and somatosensory sensitization induced by orthodontic treatment. Forty individuals(12–33 years old; mean ± standard deviations: 20.8 ± 5.9 years) scheduled to receive orthodontic treatment were randomly divided into a laser group(LG) or a placebo group(PG)(1:1). The LG received LLLT(810-nm gallium-aluminium-arsenic diode laser in continuous mode with the power set at 400 mW, 2 J·cm–2) at 0 h, 2 h, 24 h, 4 d, and 7 d after treatment, and the PG received inactive treatment at the same time points. In both groups, the non-treated side served as a control. A numerical rating scale(NRS) of pain, pressure pain thresholds(PPTs), cold detection thresholds(CDTs), warmth detection thresholds(WDTs), cold pain thresholds(CPTs), and heat pain thresholds(HPTs) were tested on both sides at the gingiva and canine tooth and on the hand. The data were analysed by a repeated measures analysis of variance(ANOVA). The NRS pain scores were significantly lower in the LG group(P = 0.01). The CDTs,CPTs, WDTs, HPTs, and PPTs at the gingiva and the PPTs at the canine tooth were significantly less sensitive on the treatment side of the LG compared with that of the PG(P < 0.033). The parameters tested also showed significantly less sensitivity on the nontreatment side of the LG compared to that of the PG(P < 0.043). There were no differences between the groups for any quantitative sensory testing(QST) measures of the hand. The application of LLLT appears to reduce the pain and sensitivity of the tooth and gingiva associated with orthodontic treatment and may have contralateral effects within the trigeminal system but no generalized QST effects. Thus, the present study indicated a significant analgesia effect of LLLT application during orthodontic treatment.Further clinical applications are suggested.

Glucomannan for abdominal pain-related functional gastrointestinal disorders in children:A randomized trial

AIM:To assess the efficacy of glucomannan(GNN) as the sole treatment for abdominal pain-related functional gastrointestinal disorders(FGIDs).METHODS:We conducted a double-blind,placebocontrolled,randomized trial.Patients were recruited among children referred to the Department of Paediatrics,Medical University of Warsaw.Included in the study were children aged 7-17 years with abdominal pain-related FGIDs classified according to the Rome Ⅲ diagnostic criteria.The children were randomly assigned to receive GNN,a polysaccharide of 1,4-D-glucose and D-mannose,a soluble fiber from the Japanese Konjac plant,at a dosage of 2.52 g/d(1 sachet of 1.26 g 2 times a day),or a comparable placebo(maltodextrin) at the same dosage.The content of each sachet was dissolved in approximately 125 mL of fluid and was consumed twice daily for 4 wk.RESULTS:Of the 89 eligible children,84(94%) completed the study."No pain" and "treatment success"(defined as no pain or a decrease ≥ 2/6 points on the FACES Pain Scale Revised) were similar in the GNN(n = 41) and placebo(n = 43) groups [no pain(12/41 vs 6/43,respectively;RR = 2.1,95%CI:0.87-5.07) as well as treatment success(23/41 vs 20/43;RR = 1.2,95%CI:0.79-1.83)].No significant differences between the groups were observed in the secondary outcomes,such as abdominal cramps,abdominal bloating/gassiness,episodes of nausea or vomiting,or a changed in stool consistency.GNN demonstrated no significant influence on the number of children requiring rescue therapy,school absenteeism,or daily activities.CONCLUSION:In our setting,GNN,as dosed in this study,was no more effective than the placebo in achieving therapeutic success in the management of FGIDs in children.

Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults

This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials, the majority of which are multi-modal in orientation, incorporating elements of cognitive behavioral therapy, social learning, and relaxation. Based on this review, we offer methodological and clinical suggestions: (1) Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible, active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

The Effects of Functional Training on Pain, Function, and Performance in Taekwondo Players with Mechanical Low Back Pain

Background: The aim of this study was to assess the effects of functional training (FT) on pain, function, and performance in elite male taekwondo players with CMLBP. Method: 27 elite male taekwondo players (mean ± standard deviation: age 24.4 ± 4.9 years, body mass 75.7 ± 15.1 kg, height 181.4 ± 7.8 cm) were allocated to two experimental (n = 15) and control (n = 12) groups. The eight-week FT was divided into four distinct phases for the subjects of the experimental group. Variables of pain and function were assessed by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. The movement time of Ap Douliou Chagi kick (MTAK) and speed of Ap Douliou Chagi kick (SAK) was used for the variable of performance. Results: Considering the results of pretest before the implementation of the scores protocol, after FT intervention, VAS (p = 0.004), ODI (p = 0.005), MTAK on the right leg (p = 0.029) and the left leg (p = 0.013) decreased and SAK on both legs (p = 0.000) increased significantly in comparison with the control group. Conclusion: It is assumed that FT can reduce the pain intensity and improve the function and performance in taekwondo players.

Non-pharmacological management of pediatric functional abdominal pain disorders:Current evidence and future perspectives

Functional abdominal pain disorders(FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome Ⅲ, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.

Therapeutic effect of different treatment methods on functional anorectal pain

Objective： To observe the clinical efficacy of oral traditional Chinese medicine （Jiaweitiaoqi decoction）, electroacupuncture, biofeedback, and combined treatment on functional anorectal pain （FAP）. Methods： A total of 200 patients with FAP were randomly divided into 4 groups, with 50 patients in each group. Group 1 was given oral Jiaweitiaoqi decoction; group 2 was given electroacupuncture at the lumbosacral acupoints; group 3 was given biofeedback training; and group 4 was given combined treatment. The numeric rating scale （NRS）, Short Form-36 （SF-36） quality of life scale, static pressure of the anal canal, and maximum systolic pressure were observed in the 4 groups. Results： The observation indices of the 4 groups were all improved after treatment compared with those before treatment, and the fourth group showed the most obvious improvement. Regarding NRS scores, the static pressure of the anal canal, and maximum systolic pressure, group 4 had lower values than the other 3 groups （P 〈 0.05 for all）. In the SF-36 quality of life score, group 4 showed a higher value than the other 3 groups （P 〈 0.05）. Conclusion： Non-drug therapy including acupuncture and physical exercise can enhance the clinical efficacy of single Chinese medicine in the treatment of FAP .

Validation of the functional rating index for the assessment of athletes with neck pain

AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated and responded to the PFRI. Fifty athletes with NP completed the PFRI for at least 7 d later to establish test-retest reliability. RESULTS: The athletes with NP responded to all items, indicating excellent clinical utility. No floor and ceiling effects were found, indicating content validity and responsiveness. The PFRI revealed capability to discriminate between the athletes with NP and healthy athletes. The PFRI demonstrated strong correlation with the Numerical Rating Scale(Spearman's rho = 0.94), and the Persian Neck Disability Index(Pearson r = 0.995), supporting criterion and construct validity. Internal consistency reliability was high(Cronbach's α coefficient: 0.97). The test-retest reliability was excellent(ICCagreement = 0.96). The absolute reliability values of standard error of measurement and smallest detectable change were 3.2 and 8.84, respectively. An exploratory factor analysis yielded one factor explaining 78.03% of the total variance. CONCLUSION: The PFRI is a valid and reliable measure of functional status in athletes with NP.

Abnormalities of interhemispheric functional connectivity in individuals with acute eye pain: a resting-state fMRI study

AIM: To study the changes of the resting state functional connectivity(rsFC) between acute eye pain(EP) subjects and healthy controls(HCs) in the two hemispheres by using voxel-mirrored homotopic connectivity(VMHC) method.METHODS: Totally 20 patients with EP and 20 HCs were enrolled, sex, age, and education were matched, and all subjects were examined by functional magnetic resonance imaging(fMRI) scans at resting-state. The changes of rs FC between the hemispheres were evaluated by the VMHC method according to Gaussian random field(GRF) theory. In order to identify the VMHC, as biomarkers for distinguishing EP and from HC, the receiver operating characteristic curves(ROC) had been analyzed. The relationships were evaluated with Pearson correlation analysis between the mean VMHC signal values and clinical features in these patients.RESULTS: By comparing with health subjects, the significant decreased VMHC values was observed in lingual/calcarine(Brodmann area, BA 30), precentral/postcentral gyrus(PreCG/PosCG; BA 4) and medial frontal gyrus(MFG; BA 8)(false discovery rate corrected <0.01) in the acute EP individuals. The accuracy of area under curve was excellent indicated by the ROC curve analysis of each brain regions.CONCLUSION: Our study demonstrates preliminary evidence of disrupted interhemispheric rsFC in acute EP in sensorimotor and limbic system and somatosensory cortex, which might give some useful information for understanding the neurological mechanisms in acute EP individuals.

Action mechanism of Zhitong Rushen Decoction in treating functional anorectal pain based on network pharmacology

Objective:Network pharmacology method was adopted in this study to screen the target of Zhitong Rushen Decoction of the treatment to Functional Anorectal Pain(FAP)and explore its mechanism of treatment.Methods:Chemical components and selected targets related to the ten traditional Chinese medicine(TCM)herbs were searched through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).Through GeneCards database,OMIM database,disease targets of FAP were searched.R language was used to screen the common targets between drugs and disease,and then the interaction network diagram of the targets was constructed by String.Cytoscape3.7.0 was applied to construct the active ingredients-targets interacted network.GO enrichment analysis and KEGG enrichment analysis of targets were based on R language.Results:Four main chemical components including quercetin,wogonin,fisetin and kaempferol were screened,and four key targets including ESR1、NOS2、PGR and CHRM3 were identified.In GO enrichment analysis,66 molecular function entries,1040 biological process entries,26 cell component entries were obtained.KEGG pathway enrichment analysis showed that zhitong rushen decoction played a therapeutic role in functional anorectal pain by regulating AGE-RAGE signaling pathway in diabetic complications,Bladder cancer,Estrogen signaling pathway,HIF-1 signaling pathway.Conclusion:Zhitong rushen decoction for the treatment of functional anorectal pain may be related to its multi-component effect on multiple targets and multiple signaling pathways,providing theoretical basis for further study of active ingredients and mechanism of action.

Association between functional abdominal pain disorders and asthma in adolescents: A cross-sectional study

AIM To find the association between asthma and different types of functional abdominal pain disorders(FAPDs) among teenagers. METHOD A cross-sectional study was conducted among 13 to 15-year-old children from six randomly selected schools in Anuradhapura district of Sri Lanka. Data were collected using translated and validated selfadministered questionnaires(Rome Ⅲ questionnaire, International Study on Asthma and Allergies in Childhood questionnaire, and Pediatric Quality of Life Inventory 4.0) and administered under an examination setting after obtaining parental consent and assent.RESULTS Of the 1101 children included in the analysis, 157(14.3%) had asthma and 101(9.2%) had at least one FAPDs. Of children with asthma, 19.1% had at least one type of FAPDs. Prevalence rates of functional abdominal pain(FAP)(8.9% vs 3.3% in nonasthmatics), functional dyspepsia(FD)(2.5% vs 0.7%), and abdominal migraine(AM)(3.2% vs 0.4%) were higher in those with asthma(P < 0.05, multiple logistic regression analysis), but not in those with irritable bowel syndrome(4.5% vs 3.1%, P = 0.2). Severe abdominal pain(10.8% vs 4.6%), bloating(16.6% vs 9.6%), nausea(6.4% vs 2.9%), and anorexia(24.2% vs 16.2%) were more prevalent among asthmatics(P < 0.05). Lower gastrointestinal symptoms did not show a significant difference. Scores obtained for health related quality of life(HRQoL) were lower in those with asthma and FAPDs(P < 0.05, unpaired t-test).CONCLUSION Asthma is associated with three different types of FAPDs, namely, FD, AM, and FAP. HRQoL is significantly impaired in teenagers with asthma and FAPDs.

Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain

AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose amitriptyline(10 mg at bedtime)to a conventional dose of rabeprazole(20 mg/d)(group A,n = 20)vs a double-dose of rabeprazole(20 mg twice daily)(group B,n = 20)for patients with FCP whose symptoms were refractory to PPI.The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.RESULTS:The between-group difference in global symptom scores was statistically significant during the last week of treatment(overall mean difference;3.75 ± 0.31 vs 4.35 ± 0.29,the between-group difference;P < 0.001).Furthermore,70.6% of patients in group A had their symptoms improve by > 50%,whereas only 26.3% of patients in group B had a similar treatment response(70.6% vs 26.3%,P = 0.008).Specifically,patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B(52.37 ± 17.00 vs 41.32 ± 12.34,P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84,P = 0.01,respectively).CONCLUSION:Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.

浮针治疗早中期膝骨关节炎对软骨厚度的影响

目的观察浮针疗法治疗早中期膝骨关节炎对关节软骨厚度的影响。方法将60例早中期膝骨关节炎患者随机分为治疗组和对照组,每组30例。治疗组采用浮针治疗,对照组采用电针治疗。观察两组治疗前后疼痛视觉模拟量表(visual analog scale,VAS)评分、疼痛开始缓解时间、Lysholm膝关节功能评分、平衡功能及股骨内侧和外侧髁软骨厚度的变化。结果治疗组疼痛开始缓解时间短于对照组(P<0.05)。治疗后,两组VAS评分以及平衡功能的横向标准差和前后标准差均较治疗前降低(P<0.05),Lysholm膝关节功能评分、平衡功能的稳定极限均较治疗前升高(P<0.05)。治疗后3个月,两组VAS评分较治疗前降低(P<0.05),Lysholm膝关节功能评分较治疗前升高(P<0.05),膝关节内外侧髁软骨厚度均较治疗前增加(P<0.05)。治疗后和治疗后3个月,治疗组VAS评分均低于对照组(P<0.05),Lysholm膝关节功能评分均高于对照组(P<0.05)。治疗后,治疗组横向标准差低于对照组(P<0.05),稳定极限高于对照组(P<0.05)。结论浮针治疗早中期膝骨关节炎起效速度优于电针治疗,能有效缓解疼痛症状及提高膝关节功能,可改善软骨损伤。

Clinical Research on Alleviating Pain for Patients with Ankylosing Spondylitis and Their Active Function by Acupuncture with Chinese Medicine Fuming and Steaming

OBJECTIVE: To investigate clinical effect of acupuncture combined with TCM fumigation on pain and active function improvement in patients with ankylosing spondylitis. METHODS: 42 patients with ankylosing spondylitis were selected in hospital from October 2016 to October 2017, who were randomly divided into 2 groups by number table method. 21 patients received conventional treatment as control group. 21 patients combined with acupuncture, TCM fumigation treatment as observation group. Clinical indicators, activity function, pain scores were evaluated before and after treatment. RESULTS: Erythrocyte sedimentation rate, C reactive protein, alkaline phosphatase, macrophage migration inhibitory factor, BASDAI score, BASFI score, VAS score after treatment decreased in two groups compared with before treatment(P<0.05). Chest mobility, lumbar pitch, Schober test, occipital wall distance, lumbar lateral flexion after treatment increased in two groups compared with before treatment(P<0.05). Refers to distance, morning stiffness time, rump length after treatment reduced in two groups compared with before treatment(P<0.05). Erythrocyte sedimentation rate, C reactive protein, alkaline phosphatase, macrophage migration inhibitory factor, BASDAI score, BASFI score, VAS score in observation group were lower than control group after treatment(P<0.05). Chest mobility, lumbar pitch, Schober test, occipital wall distance, lumbar lateral flexion in observation group were higher than control group after treatment(P<0.05). Refers to distance, rump length in observation group were smaller than control group after treatment(P<0.05). Morning stiffness time in observation group was less than control group after treatment(P<0.05). CONCLUSIONS: Acupuncture combined with TCM fumigation can significantly improve pain and active function in patients with ankylosing spondylitis, which is worthy of clinical promotion.

老年膝骨性关节炎患者治疗期望及其影响因素分析

目的探讨老年膝骨性关节炎(knee osteoarthritis,KOA)患者治疗期望及其影响因素。方法将2021年10月至2022年12月180例老年KOA患者作为研究对象,采用可信度/期望问卷(CEQ)中期望量表评估治疗期望,并评估不同人口特征间治疗期望差异;采用多元线性回归分析老年KOA患者治疗期望的影响因素。结果所有老年KOA患者治疗期望得分(16.64±3.00)分,其中年龄>75岁、KOA严重程度Kellgren-Lawrence(KL)为Ⅲ~Ⅳ级、焦虑评分<8分、疼痛灾难化评分<38分者治疗期望得分较年龄60~75岁、KOA严重程度为Ⅰ~Ⅱ级、焦虑评分≥8分及疼痛灾难化评分≥38分者高(P<0.05)。以治疗期望为因变量,年龄、焦虑、KOA严重程度、疼痛灾难化为自变量进行多元线性逐步回归,结果显示,年龄、KOA严重程度与老年KOA患者治疗期望呈正相关(β=0.048、0.992),焦虑、疼痛灾难化与老年KOA患者治疗期望呈负相关(β=-0.272、-0.068)(P<0.05)。结论老年KOA患者治疗期望与年龄、焦虑程度、KOA严重程度及疼痛灾难化有关。

系统化快速康复训练在老年股骨颈骨折患者术后的应用效果

目的探究系统化快速康复训练在老年股骨颈骨折患者术后的应用效果。方法选取江苏省南通市第三人民医院2019年1月至2022年1月收治的老年股骨颈骨折患者94例,应用奇偶分组法将其分为对照组和观察组,各47例。对照组行常规训练干预,观察组在对照组的基础上加用系统化快速康复训练。比较两组疼痛情况、行动功能、生活质量及髋关节功能。结果整体分析发现:两组疼痛组间、时间点及交互作用比较差异均有统计学意义(P<0.05)。进一步两两比较,组内比较:两组组内各时间点疼痛评分比较,差异均有统计学意义(P<0.05);组间比较:观察组术后各时间点疼痛评分均低于对照组,差异有统计学意义(P<0.05)。干预后,两组行动功能评分及髋关节评分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。干预后,两组生活质量评分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论系统化快速康复训练能够提高老年股骨颈骨折术后患者的行动功能及生活质量,降低患者的疼痛水平,具有重要的应用意义。

基于恐惧-回避模型的康复护理方案在老年慢性心力衰竭患者中的应用

目的减轻老年慢性心力衰竭患者康复运动恐惧心理,促进其运动康复。方法便利抽取70例心内科住院老年慢性心力衰竭患者,按入院时间分为两组各35例;两组均行常规治疗护理,同时对照组行常规康复护理,干预组构建和实施基于恐惧-回避模型的康复运动方案,持续干预至出院后1个月评价效果。结果干预后干预组心功能指标显著优于对照组(均P<0.05),心脏病运动恐惧得分、明尼苏达州心力衰竭生活质量得分显著低于对照组(均P<0.05);运动方案实施过程中未发生运动相关不良事件。结论对老年慢性心力衰竭患者实施基于恐惧-回避模型的康复运动方案能减轻患者运动恐惧心理,改善心功能,提高生活质量。

针灸肌筋膜触发点作用机制研究进展

肌筋膜触发点(myofascial trigger points,MTrPs)为骨骼肌绷紧带中的过敏结节,可引发压痛、特征性转移痛、运动功能障碍和自主神经现象。近年来,基于MTrPs特殊的病理生理机制,采用针灸治疗非器质性神经肌纤维的疼痛综合征取得了满意的效果。针刺干预MTrPs对于组织修复、恢复功能活动具有重要的指导价值,为临床治疗肌筋膜疼痛综合征(myofascial pain syndrome,MPS)提供了有效手段。但针刺MTrPs作用机制尚未完全阐明,今后还需从多层次、多角度、多领域深入探究,以期为临床针灸施治提供有力的理论依据。

关节镜下双Endobutton钛板固定治疗单侧Rockwood Ⅲ型急性肩锁关节脱位的临床疗效观察

目的探讨关节镜辅助下双Endobutton钛板固定治疗患者单侧RockwoodⅢ型急性肩锁关节脱位的临床疗效。方法采用回顾性研究方法,选取2022年1月至2023年7月在首都医科大学附属北京友谊医院收治的单侧RackwoodⅢ型急性肩锁关节脱位的患者49例,根据手术方式的不同分为观察组(n=27)和对照组(n=22)。观察组接受关节镜辅助下肩锁关节脱位复位、双Endobutton钛板内固定手术治疗,对照组接受传统的切开复位锁骨钩钢板内固定手术治疗。所有患者进行门诊随访,记录术前、术后12周和末次随访时患者的视觉模拟疼痛评分(VAS)、美国加州大学洛杉矶分校肩关节系统评分(UCLA)以及肩关节正位X线上肩锁关节间距(ACD)和喙锁关节间距(CCD),并比较两种治疗方法的临床疗效。结果所有患者得到完整随访,随访时间为25.3~30.6周,平均(28.8±2.1)周。所有患者均未出现血管和神经损伤并发症。术后12周和末次随访,两组患者的VAS评分较术前有明显降低,UCLA肩关节评分均较术前升高,差异均有统计学意义(P<0.05);观察组和对照组术后12周和末次随访的VAS[(3.1±0.5)分vs.(3.3±0.6)分,(2.8±0.6)分vs.(2.7±0.8)分]、UCLA肩关节评分[(33.5±3.6)分vs.(33.7±3.2)分,(34.1±2.9)分vs.(34.7±2.6)分]比较,差异均无统计学意义(P>0.05)。术后12周和末次随访,两组患者的ACD和CCD均小于术前,差异均有统计学意义(P<0.05);两组间术后12周和末次随访的ACD[(5.2±1.8)分vs.(5.6±2.1)分,(5.1±1.7)分vs.(5.5±2.0)分]和CCD[(7.4±2.9)分vs.(7.2±2.5)分,(7.5±2.6)分vs.(7.1±2.6)分]比较,差异均无统计学意义(P>0.05)。末次随访观察组和对照组的优良率比较(81.6%vs.81.8%),差异无统计学意义(P>0.05)。结论关节镜下复位单侧RockwoodⅢ型急性肩锁关节脱位并使用双Endobutton钛板固定能够获得良好的治疗效果,与传统的切开复位钩钢板固定没有临床疗效的差异。

基于网络药理学的柴胡-枳壳配伍治疗功能性消化不良的机制研究

目的基于网络药理学筛选柴胡-枳壳配伍治疗功能性消化不良(FD)的机制。方法通过TCMSP平台收集柴胡、枳壳的成分及靶点。通过GeneCards数据库收集FD的基因,使用STRING 11.0数据库进行分析。结果共获得柴胡成分349个、枳壳17个。FD疾病相关基因1561个,药物与疾病共有的靶点为59个。蛋白互作(PPI)网络发现VEGFA、MAPK8、EGFR等可能是柴胡-枳壳配伍治疗FD的关键靶点。涉及PI3K-AKT、AGE-RAGE、HIF-1等经典信号通路。结论柴胡-枳壳配伍治疗FD具有多途径、多靶点作用的特点,为接下来的实验验证提供了参考和依据。