功能性认知障碍的临床诊治研究进展

功能性认知障碍(FCD)是指患者主诉存在持续的认知下降, 认知下降具备"内部不一致性"特征, 并且不能用其他疾病解释的一组临床综合征。FCD在临床很常见, 但存在普遍认识不足、诊断率低的现状。在老龄化社会认知障碍高发和新冠肺炎疫情大流行后的公共卫生问题背景下, FCD的识别和规范诊治显得尤为重要。本文对FCD的概念演变、临床表现与诊断进行阐述, 分析其与相似疾病概念的关系, 探讨其临床诊断的重要性, 并对其病理生理学机制和治疗现状进行综述。元认知受损被认为是FCD的关键机制, 非药物治疗可能对FCD尤其重要, 药物治疗尚有待研究。客观、标准化的诊断工具是FCD亟待解决的临床问题。     

病毒感染相关性肾小球肾炎的诊断与治疗

许多种病毒感染后都可能导致肾脏损害.随着器官移植的推广和免疫抑制剂的广泛应用,病毒感染造成的肾脏疾病显著增多.病毒导致肾脏病变的机制复杂,目前尚未完全阐明;不同病毒造成的肾脏病理改变和临床特点有所不同,甚至一种病毒感染也可导致多种形式的肾脏损害.目前对病毒导致肾脏疾病的诊断和治疗尚缺乏严格统一的标准或规范,尤其在治疗方面存在较大分歧.本文将着重介绍几种在我国比较常见的病毒感染相关性肾炎.     

血压变异性的研究进展

血压变异的概念已提出多年,许多研究以表明血压变异性与心脑血管及其他许多疾病密切相关。本文就血压变异性的概念、机制、影响因素、靶器官损害及相关疾病和治疗简单综述。     

咳嗽在中西医治疗中存在的问题及其中西药合理应用

咳嗽在呼吸系统疾病中十分常见,而无指导的、或缺乏正确指导的用药很容易出现咳嗽反复不愈或演变为其他疾病。一些较严重疾病引起的咳嗽也易被忽视。本文就目前咳嗽在中西医治疗中存在的问题进行了探讨,并论述了咳嗽的中西药合理治疗与用药。以期对咳嗽患者进行及时、正确、合理地治疗及预防建议,以提高咳嗽的治疗效果。     

急性外伤性脊髓损伤的药物治疗

急性外伤性脊髓损伤 (ＡｃｕｔｅＳｐｉｎａｌＣｏｒｄＩｎｊｕｒｙ ,ＡＳＣＩ)的主要病理变化为不可逆性脊髓中央坏死。关于其损伤机制除脊髓原发损伤外 ,近年来多项研究认为与循环障碍、脂质过氧化反应、钙离子通道紊乱以及内啡呔的释放等继发损害有关[1] 。本文仅对目前常用的治疗药物作一简要的综述。1　类固醇类激素治疗大剂量此类药物是治疗ＡＳＣＩ的首选药物。其机理为 :可预防或减轻脊髓水肿 ,以减少神经损害 ;在组织血液灌注量不足时 ,能保护细胞膜使之不受损害 ,保持血管的完整性 ;有防止溶酶体及其他酶释放的作用 ;能保持神经细…     

浅析中医治未病思想对防治卵巢储备功能下降的指导作用

起源于《黄帝内经》的中医＂治未病＂思想在临床防治卵巢储备下降（DOS）中具有重要的指导作用,主要包括三方面：首先生活干预,包括有调摄精神、调节饮食、体育锻炼等方面,是防治DOS关键的基础治疗;其次药物干预,应该注重调理气血,平衡阴阳,不能盲目以＂补＂为主;最后其他干预,即治疗对卵巢功能有抑制作用的原发疾病,杜绝或减少药物和手术对卵巢功能损害。     

干细胞移植治疗慢性肾衰竭一例

慢性肾衰竭(chronic renal failure,CRF)是指各种原发性或继发性慢性肾脏疾病患者进行性肾功能损害所出现一系列症状或代谢紊乱的临床综合征.目前,透析和肾移植是最基本的治疗方法,但其存在各种并发症及供体短缺、免疫抑制剂副作用大等问题.研究发现:干细胞具备很强的增殖能力和分化潜能,在肾脏疾病损伤修复方面,显示了很好的应用前景.本院2009年9月采用干细胞移植治疗1例慢性肾衰竭患者,现报道如下.     

超声心动图对非典型川崎病早期诊断的作用

0 引言 川崎病(KD)对心脏的损害已成为儿童最常见的后天性心脏病病因之一[1].近年来KD发病率呈上升趋势,尤其是非典型KD上升比例明显.非典型或不完全KD的概念是只有个别的几项符合第三届国际KD修订的诊断标准[2],无特异性,目前较难与其他疾病进行有效的鉴别诊断,从而为该病的早期诊断带来较大困难,患儿往往不能得到及时有效的治疗,从而延误病情,加重预后.     

浅谈轻度认知功能障碍的中医治疗

轻度认知功能障碍(mild cognitive impairment, MCI),是指存在于正常衰老和老年痴呆之间的不稳定的过渡状态的一种疾病,其主要临床表现为记忆障碍及伴或不伴其他认知功能损害。在全球范围内,MCI患病率在逐年递增。近年来,西医治疗MCI疗效欠佳,而中医在治疗上表现出一定的优势。本文对中医治疗轻度认知功能障碍进行综述。     

乙型肝炎治疗存在的困惑与建议

乙型肝炎是一种传播广、感染率高,至今仍没有药物能清除乙肝病毒,阻止肝脏损害并最终恢复正常的一种疾病。目前在临床工作和社会上,常碰到对乙肝治疗方面的困惑。困惑只要打开电视,翻开报刊杂志,都能见以治疗乙肝的药物或专科治疗肝病广告。声称效果如何如何好,彻底根治,又有专     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.