“Parenchyma transection-first”strategy is superior to“tunnel-first”strategy in robotic spleen-preserving distal pancreatectomy with conservation of splenic vessels

Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with splenic vessel preservation(Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura’s procedure. Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy(P-F) group and a “tunnel-first” strategy(T-F) group and analyzed. Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time(146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0(20.0–55.0) m L vs. 50.0(20.0–100.0) m L, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the TF group and 2.4% in the P-F group( P = 0.14). The grade 3/4 complications were similar between the two groups( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. Conclusions: The pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura’s procedure.

Electro-acupuncture at Conception and Governor vessels and transplantation of umbilical cord bloodderived mesenchymal stem cells for treating cerebral ischemia/reperfusion injury

Mesenchymal stem cell transplantation is a novel means of treating cerebral ischemia/reper- fusion, and can promote angiogenesis and neurological functional recovery. Acupuncture at Conception and Governor vessels also has positive effects as a treatment for cerebral ischemia/ reperfusion. Therefore, we hypothesized that electro-acupuncture at Conception and Governor vessels plus mesenchymal stem cell transplantation may have better therapeutic effects on the promotion of angiogenesis and recovery of neurological function than either treatment alone. In the present study, human umbilical cord blood-derived mesenchymal stem cells were isolated, cultured, identified and intracranially transplanted into the striatum and subcortex of rats at 24 hours following cerebral ischemia/reperfusion. Subsequently, rats were electro-acupunctured at Conception and Governor vessels at 24 hours after transplantation. Modified neurological severity scores and immunohistochemistry findings revealed that the combined interventions of electro-acupuncture and mesenchymal stem cell transplantation clearly improved neurological impairment and up-regulated vascular endothelial growth factor expression around the isch- emic focus. The combined intervention provided a better outcome than mesenchymal stem cell transplantation alone. These findings demonstrate that electro-acupuncture at Conception and Governor vessels and mesenchymal stem cell transplantation have synergetic effects on promot- ing neurological function recovery and angiogenesis in rats after cerebral ischemia/reperfusion.

Effects of decompression joint Governor Vessel electro-acupuncture on rats with acute upper cervical spinal cord injury

Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui（GV14） and Baihui（GV 20）（2 Hz,15 minutes） once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression（48 hours） is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression（12 hours） can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.

艾灸督脉调控Wnt/β-catenin信号通路对APP/PS1双转基因小鼠自噬水平的影响

目的:探讨艾灸督脉对淀粉样前体蛋白/早老素1(APP/PS1)双转基因小鼠自噬及Wnt/β-catenin信号通路相关蛋白表达的影响,为防治阿尔茨海默病提供实验依据。方法:将12只C57BL/6J雄性小鼠设为正常组,另48只同龄同背景APP/PS1双转基因小鼠随机分为模型组、艾灸组、雷帕霉素组、艾灸+抑制剂组,每组12只。艾灸组隔附子饼灸百会,温和灸大椎、风府,20 min/d;雷帕霉素组腹腔注射2 mg/kg雷帕霉素;艾灸+抑制剂组在艾灸组基础上,腹腔注射3-甲基腺嘌呤1.5 mg/kg。以上3组均每日干预1次,干预2周,每周停1次。正常组和模型组小鼠仅固定,不采取任何干预措施。各组小鼠在干预前后均行水迷宫实验检测逃避潜伏期,透射电镜观察小鼠海马脑区自噬体和自噬泡的数量及形态,免疫组化检测脑区β-淀粉样蛋白1-42(Aβ_(1-42))表达差异,实时荧光定量聚合酶链式法(qRT-PCR)检测海马脑区Aβ_(1-42)mRNA相对表达量,免疫印迹(WB)法检测小鼠海马组织微管相关蛋白轻链3Ⅱ(LC3Ⅱ)/微管相关蛋白轻链3Ⅰ(LC3Ⅰ)、泛素结合蛋白62(p62)、雷帕霉素靶蛋白(mTOR)、Wnt家庭成员3a(Wnt3a)、糖原合成激酶-3β(GSK-3β)、β-连环蛋白(β-catenin)表达情况。结果:干预后,与模型组比较,艾灸组、雷帕霉素组逃避潜伏期缩短(P<0.05)。模型组和艾灸+抑制剂组海马区自噬泡和自噬体较少,艾灸组和雷帕霉素组自噬泡和自噬体较多。与正常组比较,模型组Aβ_(1-42)阳性表达颗粒数增多(P<0.05);与模型组比较,艾灸组、雷帕霉素组Aβ_(1-42)阳性表达颗粒减少(P<0.05)。与正常组比较,模型组Aβ_(1-42)mRNA相对表达量增多(P<0.05);与模型组比较,艾灸组、雷帕霉素组Aβ_(1-42)mRNA相对表达量减少(P<0.05)。与正常组比较,模型组p62、mTOR、GSK-3β蛋白表达均升高(P<0.05),LC3Ⅱ/LC3Ⅰ、Wnt3a、β-catenin蛋白表达均降低(P<0.05);与模型组比较,艾灸组、雷帕霉素组p62、mTOR、GSK-3β蛋白表达均下降(P<0.05),LC3Ⅱ/LC3Ⅰ、Wnt3a、β-catenin蛋白表达均升高(P<0.05);与艾灸+抑制剂组比较,艾灸组、雷帕霉素组p62、mTOR、GSK-3β蛋白表达均降低(P<0.05),LC3Ⅱ/LC3Ⅰ、Wnt3a、β-catenin蛋白表达均升高(P<0.05)。结论:艾灸督脉可加速APP/PS1双转基因小鼠脑内Aβ的清除,其作用机制可能与艾灸督脉激活Wnt信号通路,进而促进细胞自噬有关。

CLINICAL OBSERVATION ON TREATMENT OF 205 CASES OF CERVICAL SPONDYLOPATHY BY ACUPUNCTURE AND MOXIBUSTION ON THE GOVERNOR VESSEL OF THE NECK

This article involves 325 patients suffering from cervical spondylopathy,amongthem 205 cases were treated by acupuncture and moxibustion on the governor vessel of the neck（treatment group）,the other 120 cases were treated by common acupuncture（control group）.Itwas observed that the cure rate,the total effective rate was 91.2％,98.5％ in the treatmentgroup,and 55.8％,87.5％ in the control group.There were statistically significant differences（P【0.01）in the cure rate and total effective rate between the two groups.It is concluded thatacupuncture and moxibustion on the governor vessel of the neck may improve Yang Qi circulationwithin the Dumai and promote the micro-circulation in the diseased areas.Thus it evidently in-creases the therapeutic effects.

The role of small vessel disease in development of Alzheimer's disease

Classically Alzheimer＇s disease and vascular dementia have been considered as two different entities, with their own clinical criteria, but relatively recent epidemiological and clinicopathological studies suggest an overlap between them sharing not only most of the risk factors and some clinical aspects but also pathophysiological mechanisms. Cerebrovascular lesions, especially small vessel disease （lacunar infarcts, white matter hyperintensities and microbleeds）, may magnify the effects of mild Alzheimer＇s disease pathology and promote the progression of cognitive decline and may also be a precursor of neuronal damage and dementia. ＂Vascular hypothesis＂ of Alzheimer＇s disease would open a window for new approaches and treatments.

Development of S11306+SA516Gr70 roll-bonded clad steel plate for pressure vessels

To meet the demand of the pressure vessel industry, Baosteel has developed an S11306 ＋ SA516Gr70 roll-bonded clad steel plate. Comprehensive inspections of the composition, microstructure, and properties are performed to systematically evaluate the steel plate in normalized state and normalized ＋ stress relieved state. The results show the cladding interface of the Sl1306 ＋ SA516Gr70 roll-bonded clad steel plate has high shear strength, and the base metal has good mechanical properties. The performance is fully consistent with the technical requirements of the roll-bonded clad steel plate for pressure vessels.

Indirect inguinal hernia containing portosystemic shunt vessel: A case report

BACKGROUND Inguinal hernia repair is one of the most common general surgical operations worldwide.We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.CASE SUMMARY We report a 72-year-old man who had a 4 cm×4 cm swelling in the right inguinal region,which disappeared with light manual pressure.Abdominal-pelvic computed tomography(CT)revealed a right inguinal hernia containing an expanded portosystemic shunt vessel,which had been noted for 7 years due to liver cirrhosis.We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring.Then,we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen.The hernia sac was returned as well.We encountered no intraoperative complications.After discharge,groin seroma requiring puncture at the outpatient clinic was observed.CONCLUSION If an inguinal hernia patient has portal hypertension,ultrasound should be used to determine the contents of the hernia.When atypical vessels are visualized,they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.

Microstructure and properties of S30403+Q345R roll-bonded clad steel plate for pressure vessels

To meet the demand of the domestic pressure vessel industry for roll-bonded clad steel plates, Baosteel has developed an S30403 ＋ Q345R roll-bonded clad steel plate. Comprehensive inspections of the composition, microstructure, and properties are made to systematically evaluate the steel plate in the normalized and normalized ＋ stress relieved states. The results show the cladding interface of the S30403 ＋ Q345R roll-bonded clad steel plate has high shear strength, the base metal has good properties, and the mechanical properties of the steel plate head and tail are uniform. The performance is fully consistent with the technical requirements of the roll-bonded clad steel plate for pressure vessels.

Free Vibration Analysis of FG-CNTRC Cylindrical Pressure Vessels Resting on Pasternak Foundation with Various Boundary Conditions

This study focuses on vibration analysis of cylindrical pressure vessels constructed by functionally graded carbon nanotube reinforced composites(FG-CNTRC).The vessel is under internal pressure and surrounded by a Pasternak foundation.This investigation was founded based on two-dimensional elastic analysis and used Hamilton’s principle to drive the governing equations.The deformations and effective-mechanical properties of the reinforced structure were elicited from the first-order shear theory(FSDT)and rule of mixture,respectively.The main goal of this study is to show the effects of various design parameters such as boundary conditions,reinforcement distribution,foundation parameters,and aspect ratio on the free vibration characteristics of the structure.

Uplift Resistance Calculation and Sensitive Analysis of Jack-up Wind Installation Vessels

The uplift resistance calculation is an important basis for the construction decisions of the jack-up wind installation vessel and the design of the jacking system,and determines the operation risk and reliability in the installation process of the wind turbine. The influence factors of the pile shoe's penetration depth and uplift resistance are analyzed,and the calculation model and flow of the uplift resistance are given. Based on a construction example,the influence rules are analyzed for the change of the pile shoe's structural parameters on the penetration depth and uplift resistance.The analysis results show that the penetration depth is more sensitive to the width of the pile shoe,and the height has greater influence on the uplift resistance than the length and width of the spud. With the increase of the height,the uplift resistance may increase rapidly.Although the decreases of the length,width and height of the pile shoe may reduce the uplift resistance,the penetration depth may increase in the meantime. This will increase the pulling pile time and reduce the construction efficiency. So the parameters of the pile shoe should be optimized according to the adaptable geology condition so as to obtain the optimal uplift resistance and working efficiency.

The Use of Anti-Platelet and/or Anticoagulant Agents in the Prevention of Large Vessel Vasculitis-Associated Ischemic Complications: A Meta-Analysis

Objective: To determine the effectiveness of antiplatelet and/or anticoagulant therapy (AP/AC) at reducing ischemic events in patients with Large Vessel Vasculitis (LVV). Methods: We performed a random effects meta-analysis of studies examining antiplatelet and/or anticoagulant therapy (AP/AC) and ischemic events in Takayasu’s Arteritis (TAK) or Giant Cell Arteritis (GCA). Severe ischemic events were defined as stroke, ischemic ocular manifestations and claudication symptoms. Any ischemic event included jaw claudication in addition to the above manifestations. Results: Seven studies met inclusion criteria: 1 TAK and 6 GCA. The majority of patients (>80%) were treated with ASA and treatment was initiated prior to diagnosis of LVV. Risk of severe and any ischemic event in patients with LVV treated with AP/AC versus no treatment was not significantly different (OR 0.570, 95% CI 0.243, 1.340 and OR 0.594, 95% CI 0.248, 1.421, respectively). For studies with follow-up data (26-76 months), AP/AC was protective for severe ischemic events (OR 0.18, 95% CI 0.04, 0.83). Findings were similar when excluding studies that did not account for potential confounders, such as cardiovascular risk factors. Conclusion: At follow-up, antiplatelet therapy significantly decreases ischemic events in patients with LVV. However, in most cases of GCA, the treatment was initiated prior to the diagnosis of vasculitis. The benefit of initiating anti-platelet therapy at the time of GCA diagnosis remains unclear.

Retinal thickness and vascular parameters using optical coherence tomography in Alzheimer's disease:a meta-analysis

Examining the retinal tissue has the potential to provide a unique method and technique to quantify Alzheimer’s disease-related changes in participants at various stages of the disease.In this metaanalysis,we aimed to investigate the association of various optical coherence tomography parameters with Alzheimer’s disease and whether retinal measurements can be used to diffe rentiate between Alzheimer’s disease and control subjects.Scientific databases including Google Schola r,Web of Science,and PubMed were systematically searched for published articles that evaluated retinal nerve fiber layer thickness and retinal microvascular network in Alzheimer’s disease and control subjects.Seventy-three studies(5850 participants,including 2249 Alzheimer’s disease patients and 3601controls) were included in this meta-analysis.Relative to controls,Alzheimer’s disease patients had a significantly lower global retinal nerve fiber layer thickness(standardized mean difference [SMD]=-0.79,95% confidence intervals [CI]:-1.03 to-0.54,P <0.00001) as well as each quadrant being thinner in Alzheimer’s disease versus controls.Regarding macular paramete rs,values measured by optical coherence tomography were significantly lower in Alzheimer’s disease than controls for macular thickness(pooled SMD:-0.44,95% CI:-0.67 to-0.20,P=0.0003),foveal thickness(pooled SMD=-0.39,95% CI:-0.58 to-0.19,P <0.0001),ganglion cell inner plexiform layer(SMD=-1.26,95% CI:-2.24 to-0.27,P=0.01) and macular volume(pooled SMD=-0.41,95% CI-0.76 to-0.07,P=0.02).Analysis using optical coherence tomography angiography parameters revealed mixed results between Alzheimer’s disease and controls.Superficial vessel density(pooled SMD=-0.42,95% CI:-0.68 to-0.17,P=0.0001) and deep vessel density(pooled SMD=-0.46,95% CI:-0.75 to-0.18,P=0.001) were found to be thinner in Alzheimer’s disease patients whereas the foveal avascular zone(SMD=0.84,95% CI:0.17-1.51,P=0.01) was larger in controls.Vascular density and thickness of various retinal laye rs were decreased in Alzheimer’s disease patients compared to controls.Our results provide evidence for optical coherence tomography technology having the potential to detect retinal and microvascular changes in patients diagnosed with Alzheimer’s disease and aid in monito ring and early diagnosis methods.

血液在S型血管中流动的数值模拟

运用SIMPLE(semi-implicit Method for Pressure Linked Equations)算法数值模拟了2D(2 Dimensional)和3D(3 Dimensional)情况下S型血管内血液的流动,探讨了不同入口速度下血管内血液流动速度、压强等的分布;比较了2D和3D情况下流场分布的异同。不同的入口速度对血管内血液的流场、压强分布有很大影响,入口速度较大时,血管内血液流动速度更大、压降更大;在速度相同的情况下,3D血管内的速度和压强要大于2D血管内的速度和压强,流场分布也存在较大不同。本结论有望为分析常见的血管类疾病及研究血管中血液的流动机理提供数据支撑。

艾灸督脉组穴对血管性痴呆大鼠海马p38 MAPK信号通路及细胞凋亡的影响

目的基于p38丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)通路探究艾灸督脉组穴对血管性痴呆(vascular dementia,VD)大鼠的脑保护机制。方法将60只SPF级健康雄性SD大鼠随机分为假手术组(12只)和实验组(48只);实验组大鼠采用双侧颈总动脉永久结扎法复制VD大鼠模型,随后将模型复制成功的大鼠分为模型组、艾灸组、阻滞剂组、艾灸+阻滞剂组,每组12只;艾灸组大鼠取“百会”“大椎”“风府”穴,采用温和灸法治疗,每次30 min,每日1次,治疗6 d,休息1 d,连续治疗4周;阻滞剂组在模型复制前30 min腹腔注射p38 MAPK阻滞剂(10μmol/L SB203580),模型复制成功后隔日注射1次,每次每只大鼠按1 mL/kg注射10μmol/L SB203580,连续注射4周;艾灸+阻滞剂组大鼠在阻滞剂组干预方法基础上进行艾灸治疗。采用Morris水迷宫实验检测大鼠认知功能,TUNEL法检测大鼠海马组织CA1区神经元凋亡率,Western blot法和RT-qPCR法分别检测大鼠海马组织CA1区p38 MAPK、Bcl-2、Caspase-3、Caspase-9蛋白及mRNA表达水平。结果与模型组比较,艾灸组、阻滞剂组、艾灸+阻滞剂组大鼠平均逃避潜伏期均显著缩短(P<0.05),穿越平台次数显著增加(P<0.05),海马组织CA1区神经元凋亡率显著降低(P<0.05),p38 MAPK、Caspase-3、Caspase-9蛋白及mRNA表达水平均显著降低(P<0.05),Bcl-2蛋白及mRNA表达水平均显著升高(P<0.05);艾灸+阻滞剂组大鼠平均逃避潜伏期较艾灸组、阻滞剂组显著缩短(P<0.05),穿越平台次数显著增加(P<0.05),海马组织CA1区神经元凋亡率显著降低(P<0.05),p38 MAPK、Caspase-3、Caspase-9蛋白及mRNA表达水平均显著降低(P<0.05),Bcl-2蛋白及mRNA表达水平均显著升高(P<0.05)。结论艾灸督脉组穴对VD大鼠的认知功能具有一定的改善作用,其作用机制可能与调控p38 MAPK信号通路抑制海马神经元凋亡有关。

基于“督脉入络脑”探讨针刺督脉经穴治疗脑病的神经传导机制

“督脉入络脑”理论阐释了督脉无论在循行还是功能上都与脑有着密切联系。基于该理论,古今医者治疗脑病首选督脉穴位。针刺督脉效应的产生依赖于穴位下的感受器将针刺刺激转换为神经信号传导至中枢各级水平,然而针刺督脉经穴治疗脑病从外周到中枢的神经传导途径尚未全面总结。从现代神经生物学角度归纳外周感觉传入神经和中枢核团的诸多研究,分析了针刺督脉体表刺激治疗脑病相关联的神经生物学基础及调控途径。

分期针刺任督经穴治疗早发性卵巢功能不全的临床观察

目的观察分期针刺任督经穴治疗早发性卵巢功能不全(POI)的临床疗效。方法选取2021年6月至2022年12月就诊于上海市静安区中医医院的104例POI患者作为研究对象,按照完全随访化方法分为分期组、任脉组、督脉组、西药组,各26例。比较各组患者治疗前后血清性激素水平、窦卵泡计数(AFC),以及治疗和随访过程中共5个访视点的Kupperman(K)表和月经不调症状分级量化(MDQ)表评分。结果治疗后,四组血清卵泡刺激素(FSH)水平下降,雌二醇(E_(2))水平上升(P<0.05);西药组、督脉组和分期组AFC升高(P<0.01),分期组AFC改善优于任脉组(P<0.05)。西药组K表和MDQ表评分在治疗期间下降(P<0.01);随访期间K表不再下降(P>0.05),MDQ表上升(P<0.01)。任脉组K表评分在1MC和随访期间下降(P<0.05),MDQ表评分在3MC下降(P<0.01)。督脉组K表和MDQ表评分在3MC下降(P<0.01);随访期间MDQ表评分下降(P<0.05)。分期组K表评分在每个访视点均下降(P<0.05),MDQ表评分在3MC和随访期间下降(P<0.01)。结论分期针刺任督经穴治疗POI的临床疗效显著。

督灸配合中药治疗重症肌无力的疗效观察

目的 观察督灸配合益髓健肌颗粒治疗重症肌无力的临床疗效。方法 将94例重症肌无力患者随机分为治疗组和对照组,每组47例。治疗组采用督灸配合益髓健肌颗粒治疗,对照组采用口服甲泼尼龙片治疗。观察两组治疗前后英国医学研究理事会(Medical Research Council, MRC)肌力评测表评分、重症肌无力肌群耐力评分量表(myasthenia gravis muscular endurance scale, MGMES)评分、肌肉含量及各项实验室指标[滤泡辅助性T细胞(T follicular helper cells, Tfh)、滤泡调节性T细胞(T follicular regulatory cells, Tfr)、Tfr/Tfh比值、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素-2(interleukin-2, IL-2)、白细胞介素-17(interleukin-17, IL-17)、鸢尾素(irisin)、过氧化物酶体增殖物激活受体-γ共激活因子-1α(peroxisome proliferator-activated receptor-γ coactivator 1-α, PGC-1α)、Ⅲ型纤连蛋白结构域蛋白5(fibronectin typeⅢdomain-containing protein 5, FNDC5)、磷脂酰肌醇-3-激酶(phosphoinositide3-kinase, PI3K)、蛋白激酶B(AKT)、雷帕霉素靶蛋白(mammalian target of rapamycin, mTOR)]的变化情况,比较两组临床疗效、不良反应发生率及随访6个月复发率。结果 治疗组总有效率为95.7%,明显高于对照组的81.4%(P<0.05)。两组治疗后MRC肌力评测表评分及肌肉含量均较同组治疗前显著上升,MGMES评分均显著下降,差异均具有统计学意义(P<0.05)。治疗组治疗后Tfr、Tfr/Tfh、irisin水平均较同组治疗前显著上升,Tfh、TNF-α、IL-2、IL-17、PGC-1α、FNDC5、PI3K、AKT、mTOR水平均显著下降,差异均具有统计学意义(P<0.05)。对照组治疗后Tfr、Tfr/Tfh水平均较同组治疗前显著上升,Tfh、TNF-α、IL-2、IL-17水平均显著下降,差异均具有统计学意义(P<0.05)。治疗组治疗后MRC肌力评测表评分、MGMES评分、肌肉含量及各项实验室指标与对照组比较,差异均具有统计学意义(P<0.05)。治疗组治疗期间不良反应发生率和随访6个月复发率分别为2.2%和6.8%,明显低于对照组的32.6%和42.9%(均P<0.05)。结论 督灸配合益髓健肌颗粒可增强重症肌无力患者的肌肉张力,调节Tfh、Tfr平衡,拮抗血清促炎因子分泌,改善血清肌肉调节因子和PI3K/AKT/mTOR通路水平,安全性好。

针刺联合督灸治疗强直性脊柱炎的疗效观察

目的 观察针刺联合督灸治疗强直性脊柱炎的临床疗效及对AKT/PI3K/mTOR信号通络的影响。方法将96例强直性脊柱炎患者随机分为两组(观察组和对照组),每组48例。对照组口服美洛昔康治疗,观察组予针刺联合督灸治疗。观察两组治疗前后巴氏强直性脊柱炎病情评测指数(Bath ankylosing spondylitis disease activity index,BASDAI)和巴氏强直性脊柱炎活动能力量表(Bath ankylosing spondylitis functional index,BASFI)评分、血清炎性因子[核因子-κB(nuclear factor-κB,NK-κB)、巨噬细胞移动抑制因子(macrophage migration inhibitory factor,MIF)、CC趋化因子受体6(CC chemokine receptor 6,CCR6)和单核细胞趋化蛋白-4(monocyte chemokine protein-4,MCP-4)]水平、骨化相关蛋白[基质金属蛋白酶组织抑制剂-2(matrix metalloproteinase tissue inhibitor-2,TIMP-2)、高迁移率族蛋白B1(high mobility group protein box 1,HMGB1)、Dickkopf相关蛋白-1(dickkopf-related protein-1,DKK-1)和骨硬化蛋白(sclerostin,SOST)]水平以及AKT/PI3K/mTOR信号通路[蛋白激酶B(protein kinase B,AKT)、磷脂酰肌醇-3-激酶(phosphatidylinositol-3-kinase,PI3K)和雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)]水平的变化。比较两组临床疗效及不良反应发生情况。结果 观察组总有效率为97.9%,高于对照组的81.8%(P<0.05)。观察组治疗后、随访3个月及6个月BASDAI和BASFI评分均低于对照组(P<0.05)。观察组治疗后血清NK-κB、MIF、CCR6、MCP-4、TIMP-2、HMGB1、AKT、PI3K和mTOR水平均低于对照组(P<0.05),DKK-1和SOST水平高于对照组(P<0.05)。结论 针刺联合督灸可明显缓解强直性脊柱炎患者的临床症状,疗效优于口服美洛昔康治疗,并可调节AKT/PI3K/mTOR信号通络的表达。