用社会学的观点定性研究澳大利亚的病人、理疗医生及中医师对手法理疗和中医推拿的看法(英文)

目的:本研究从澳大利亚病人的角度去理解和感受他们对手法治疗的看法,并从中分析手法治疗师们所用的手法特点。方法:本研究采用社会学研究的观点进行定性研究,对在一个特定环境中的服务对象(病人)对治疗服务的特定感受进行调查。本文的主要研究设计是用非结构性访谈,访谈的方法和临床观察方法相结合。本研究纳入了30个符合纳入标准的研究参与者,最后有19名病人,5名中医师参与调研。结果:本研究中,大多数病人是通过新闻媒体和家庭医生的推荐知晓物理治疗的;很多病人在物理治疗师的手法理疗后,希望体验中医推拿。虽然94%的病人对推拿治疗满意,但是很多病人并不能区别推拿和手法理疗在手法技术上的不同。一部分病人认为推拿是一种比较昂贵的治疗选择。大多数治疗师喜欢用比较强的压力性手法作用在肌肉敏感点上,而那些受过推拿正规训练的治疗师则喜欢用比较温和的手法。结论:澳大利亚病人通常将手法理疗作为缓解其疼痛的首选治疗方案。由于缺少恰当的私人医疗保险,病人通常把推拿当作最后的治疗选择。大多数病人参与者比较喜欢类似推拿类的比较温和的手法,不喜欢强性压力性手法。本研究提示病人的感受和需要可能影响治疗的效果,如果手法治疗课程能含有相应的教育内容,鼓励手法治疗师的进一步教育以及鼓励病人参与制定手法治疗方案或许能提高对患者的治疗质量。

下腰背部疼痛的针刺随机对照试验的临床定性评估(英文)

背景:很多随机对照试验和系统综述得出了针刺对下腰背部疼痛无效的结论并且认为针刺和安慰性针刺对于下腰背部疼痛的治疗疗效并没有区别。目的:本研究是从临床的角度,特别是从专业针灸医师的角度来评估近年来发表的有关针刺治疗下腰背部疼痛的随机对照试验和系统综述的价值。数据来源和搜集:对Cochrane图书馆、PubMed/MEDLINE、EMBASE进行检索,检索的时间范围是从2007年1月至2010年1月。本研究共纳入18个用英语写作的关于针刺治疗下腰背部疼痛或者针刺作为治疗手段之一的随机对照试验。评估方法:临床定性批评性价值评估是本文的研究特点。运用临床基本技能和知识以及统计学概念,建立5个价值评估标准对被纳入的随机对照试验和系统综述的质量和可靠性进行价值评估。这种评估方法与随机对照试验中的纳入和排除标准评估很相似。通过使用这种评估方法,尽管随机对照试验和系统综述有较完善的内部有效性,它们之中的不足之处、局限性和错误就会暴露出来。结果:下腰背部疼痛的研究使用了很多种定义。纳入的18个研究中,16个(80%)随机对照试验中没有使用医学诊断;所有的随机对照试验没有使用客观的测量方法去判断研究的结果。由于使用了多种治疗方法或多个治疗师参与治疗,使这些随机对照试验产生了很大的变异;10个(55%)试验运用了针刺联合其他治疗的方法,其中6个(33%)试验使用了非甾体抗炎药或镇痛剂。由于没有使用医学诊断,所有的试验的外部有效性均不可靠。所有这些被纳入的随机对照试验和系统综述都没有使用logistic回归的方法去解决研究中的异质性问题。结论:所有被纳入的随机对照试验在应用本研究设定的价值评估标准衡量时,都不能完全符合这些标准。这些随机对照试验的主要问题在于没有正确的医学诊断和没有客观的测量方法去判断治疗效果,导致了纳入及排除标准制定的不正确,配对的不恰当和数据进入统计分析前记录的不精确。由于治疗效果测量的主观性,随机对照试验和以随机对照试验为基础的系统综述就出现了过于泛化或是含有交叉结论的偏倚估算。此外,在治疗过程中产生的众多变量是很难控制和估算的,这种不确定因素影响了随机对照试验结论的可靠性。基于上述原因,在将来的随机对照试验和系统综述中应该考虑在随机分配之前建立一个恰当的医学诊断和设立一个与临床相关的客观的结局测量方法。

Neddylation is a novel therapeutic target for lupus by regulating double negative T cell homeostasis

Systemic lupus erythematosus(SLE),a severe autoimmune disorder,is characterized by systemic inflammatory response,autoantibody accumulation and damage to organs.The dysregulation of double-negative(DN)T cells is considered as a crucial commander during SLE.Neddylation,a significant type of protein post-translational modification(PTM),has been well-proved to regulate T cell-mediated immune response.However,the function of neddylation in SLE is still unknown.Here,we reported that neddylation inactivation with MLN4924,a specific inhibitor of NEDD8-activating enzyme E1(NAE1),or genetic abrogation of Ube2m in T cells decreased DN T cell accumulation and attenuated murine lupus development.Further investigations revealed that inactivation of neddylation blocked Bim ubiquitination degradation and maintained Bim level in DN T cells,contributing to the apoptosis of the accumulated DN T cells in lupus mice.Then double knockout(KO)lupus-prone mice(Ube2m-/-Bim-/-lpr)were generated and results showed that loss of Bim reduced Ube2m deficiency-induced apoptosis in DN T cells and reversed the alleviated lupus progression.Our findings identified that neddylation inactivation promoted Bim-mediated DN T cell apoptosis and attenuated lupus progression.Clinically,we also found that in SLE patients,the proportion of DN T cells was raised and their apoptosis was reduced.Moreover,compared to healthy groups,SLE patients exhibited decreased Bim levels and elevated Cullin1 neddylation levels.Meantime,the inhibition of neddylation induced Bim-dependent apoptosis of DN T cells isolated from SLE patients.Altogether,our findings provide the direct evidence about the function of neddylation during lupus,suggesting a promising therapeutic approach for this disease.

Reduning injection for fever, rash, and ulcers in children with mild hand, foot, and mouth disease: a randomized controlled clinical study

OBJECTIVE： To assess the efficacy and safety of Re- duning injection for fever, rash, and ulcers in chil- dren with mild hand, foot, and mouth disease （HFMD）. METHODS： A stratified-block randomized, dou- ble-blind, parallel-controlled, and multicenter clini- cal trial was conducted with 360 patients in five hospitals across China： Quanzhou Children＇s Hospi- tal, Shijiazhuang No. 5 Hospital, Shanghai Public Health Centre, Hunan Provincial Children＇s Hospi- tal, and Kaifeng Children＇s Hospital. Patients were randomized into three groups with 120 in each. Group A was treated with Western Medicine, group B with Reduning injection, a Chinese herbal medi- cine, and group C with both Reduning injection and Western Medicine. Results were compared for treatment efficacy and safety on HFMD. The clinical outcomes were observed as follows： fever and on- set time of antifebrile effect （time to bring the body temperature down 〉0.5~C after medication）; cumu- lative time for fever recovery （body temperature re- covering to normal and lasting more than 24 h without medication）; cumulative time for rash dis- appearance （without new rashes or ulcers appear- ing and the original ones fading away）; and cumula- tive time for mouth ulcer disappearance. RESULTS： For the onset time of the antifebrile ef- fect, there was no statistical difference between groups A and B （P〉O.05） and groups B and C （P〉 0.05）. However, there was a statistical difference be- tween groups A and C （P〈0.05）, and the effect ingroup C was the best. For the cumulative time for rash disappearance, there was no statistical differ- ence between groups A and B （P〉0.05）. There were statistical differences between groups A and C, and groups B and C （P〈0.05）, and the effect in group C was the best. For the cumulative time for mouth ul- cers disappearance, there were no statistical differ- ences among the three groups （P〉0.05）. CONCLUSION： Reduning injection with Western Medicine for symptomatic treatment is most effec- tive for mild HFMD. No adverse reactions were ob- served.

Acupuncture and moxibustion for incomplete adhesive intestinal obstruction:A randomized controlled trial

Objective:To investigate the clinical efficacy of acupuncture and moxibustion for incomplete adhesive intestinal obstruction.Methods:A total of 100 patients with incomplete adhesive intestinal obstruction were randomly divided into an observation group and a control group,and there were 50 patients in each group.The control group was treated with routine western medicine treatment,while the observation group was treated with acupuncture and moxibustion therapy on the foundation of the routine western medicine treatment of the control group.Zhongwan(中脘CV12),Tianshu(天枢ST25),Zusanli(足三里ST36),Shangjiuxu(上巨虚ST37),Zhigou(支沟TE6),Dachangshu(大肠俞BL25),and Xiaochangshu(小肠俞BL27)were taken when acupuncture was performed.Moxibustion was performed with moxibustion box on abdomen after acupuncture.The time of abdominal pain relief,the first anal exhausting,the first defecation and intestines sound recovery,surgery conversion rate and clinical efficacy were observed in the two groups.Results:The time of abdominal pain relief,the first anal exhausting,the first defecation and intestines sound recovery in the observation group were all shorter than those of the control group.There were statistically significant differences between the two groups(all P<0.01).The surgery conversion rate of the observation group was lower than that of the control group,there was statistically significant difference between the two groups(P<0.01).The clinical efficacy of the observation group was superior to that of the control group,the difference between the two groups was statistically significant(P<0.05).Conclusions:Acupuncture and moxibustion therapy on the foundation of the routine western medicine treatment,which can reduce the surgical conversion rate and cut down the time of treatment,was superior to routine western medicine treatment on the clinical efficacy of incomplete adhesive intestinal obstruction.

Acupuncture treatment for Subacute Non-specific Low Back Pain A Retrospective Cohort Study in the Role of the Back Exercise in Acupuncture Services for Low Back Pain Sufferers

Objective： To investigate the interrelationship between back exercise and acupuncture curative effect, and unveil the reason that recovery usually delays in a number of low back pain sufferers. Method： The study is designed as a retrospect investigation. Seventy patients who were newly diagnosed with low back pain were sequentially selected and divided into two groups, 44 cases in the observation group treated with acupuncture plus exercise, and 26 cases in the control group only treated with acupuncture. The recurrence rates in the one-year follow.up after the acupuncture service were compared between the two groups. Result and Conclusion： Back exercise is a risk factor associated with frequent back pain recurrence. In contrast, acupuncture is an effective intervention method for the treatment and prevention of non-specific low back pain.

Case for non-specific pain on waist of a pregnant woman

The patient was in conception 27 weeks+6 days,and got right waist pain,complicated with nausea,vomiting(vomit as gastric content),which was diagnosed as non-specific pain on waist after consultations of many departments.The patient received acupuncture with the following acupoints:Shuǐgōu(水沟 GV26),Yìntáng(印堂 EX-HN3),left Hégǔ(合谷 LI4),and right Tàichōng(太冲 LR3).On the first date of acupuncture,the patient felt pain relieved obviously,occasionally with slight pain that did not influence normal diet and rest.On the next day,the patient took acupuncture continuously,the doctor added Tàixī(太溪 KI3)acupoint.The patient received acupuncture for 3 times in all.The pain and soreness of the patient almost disappeared,only with slight discomfort occasionally that did not influence the normal life.Through follow-up half a year,the patient born a live male infant by cesarean section on March 20,2019,both the mother and her infant were safe.