医用臭氧介入治疗腰椎间盘突出症临床疗效分析

目的：对比观察医用臭氧介入治疗腰椎间盘突出症与常规理疗治疗腰椎间盘突出症的临床效果，为临床治疗作出指导。方法：选择我院自2010年1月～2011年7月收治的77例腰椎间盘突出症患者为研究对象，随机分为两组。观察组39例给予医用臭氧介入治疗，对照组38例给予常规理疗治疗，对比观察两组患者治疗后的总有效率。结果：观察组优21例，良11例，中5例，差2例，总有效率82．05％；对照组优16例，良9例，中7例，差6例，总有效率64．10％，观察组总有效率明显高于对照组，比较具有统计学差异（P＜0．05）。结论：医用臭氧介入治疗腰椎间盘突出症的临床疗效明显，值得推广。     

赤凤迎源针法联合中药热敷治疗急性期重度腰椎间盘突出症的疗效

目的比较赤风迎源针法联合中药热敷和常规针刺法治疗急性期重度腰椎间盘突出症的疗效。方法急性期重度腰椎间盘突出症患者lOl例,随机分为赤凤迎源针法联合中药热敷组（治疗组,57例）及常规针刺组（对照组,44例）。治疗组采用赤凤迎源针法针刺腰阳关、大肠俞、环跳等穴,然后行腰骶部中药热敷治疗。对照组采用常规针刺法。结果治疗两个疗程后,治疗组优29例、良18例、可8例、差2例;对照组优15例、良10例、可11例、差8例。治疗组总有效率96．5％（55／57例）高于对照组81．8％（36／44例）（P〈0.05）。结论赤风迎源针法联合中药热敷治疗急性期重度腰椎间盘突出症的疗效较常规针刺治疗法的疗效好。     

椎间盘镜与开放式手术治疗腰椎间盘突出症的比较研究

目的：比较椎间盘镜手术（MED）与开放式手术（OLD）治疗腰椎间盘突出症的疗效及适应证。方法：87例腰椎间盘突出症行MED，93例腰椎间盘突出症行OLD，并随访6－18个月。结果：按Nakai分级。MED组：优74例，良9例，可4例，优良率为95．40％；OLD组：优64例，良18例，可11例，优良率为88．17％。经χ^2检验，两组优良率及腿痛相关不显著（P＞0．05）；但术后两组腰痛相差非常显著（P＜0．01），腰部前屈程度相关显著（P＜0．05），恢复工作时间（＜12周）相差显著（P＜0．05）。结论：MED可显著减少术后腰痛及腰部僵硬，较早恢复工作，效果满意，为治疗腰椎间盘突出症的首选手术方法。但并不是所有腰椎间盘突出症均可采用MED，某些类型的腰椎间盘突出症仍需采用开放式手术才能达到治疗目的。     

显微椎间盘镜治疗多节段腰椎间盘突出症56例

目的观察在同一后路镜径路下作多节段腰椎间盘突出治疗的近期疗效。方法腰椎间盘突出症患者56例,采用后路显微椎间盘镜技术,在同一个切口下同时摘除多节段椎间盘突出症患者髓核,术后采用改良Macnab疗效评价标准评定治疗效果。结果优48例,良5例,可2例,差1例。总有效率98．21％。结论显微椎间盘镜治疗多节段腰椎间盘突出症疗效明显。     

椎间盘镜髓核摘除术治疗腰椎间盘突出并椎管狭窄103例疗效观察

目的探讨椎间盘镜治疗腰椎间盘突出并椎管狭窄的临床治疗效果。方法对我院收治的231例腰椎间盘突出并椎管狭窄患者,分为2组,椎间盘镜组和传统手术组,比较2组疗效。结果椎间盘镜组手术时间、出血量、住院时间明显少于传统手术组（P〉0.05）。无不良反应发生,随访3～18个月,按Nakai分级：椎间盘镜组优56例,良35例,可9例,差3例,优良率达88.3%。结论椎间盘镜髓核摘除术有效维持了脊柱的稳定性,是治疗腰椎间盘突出并椎管狭窄的有效方法。     

Destandau及MED椎间盘镜治疗腰椎间盘突出症疗效比较

目的 比较研究Destandau及MED椎间盘镜治疗腰椎间盘突出症的差别，进一步探讨手术指征、疗效及应用中的注意问题。方法 通过采用Destandau及MED椎间盘镜分别治疗腰椎间盘突出症30例。结果 疗效按照Macnab改良标准：Destandau组优27例，良2例，可1例；MED组优24例，良2例，可4例。结论 用Destandau比MED椎间盘镜治疗部分腰椎间盘突出症，都具有切口小、对脊柱稳定性结构破坏小、操作简便、康复快等优点，但Destandau椎间盘镜操作范围更广，彻底地解决神经根的压迫，同时避免伤及神经根及硬膜囊，同时扩大了内镜椎间盘手术的适应证。     

后路椎间盘镜手术治疗腰椎间盘突出合并椎管狭窄症32例疗效观察

目的:观察椎间盘镜手术治疗腰椎间盘突出合并椎管狭窄症的临床疗效。方法:椎间盘镜手术治疗32例腰椎间盘突出症合并腰椎管和(或)侧隐窝狭窄,并对术后疗效进行分析。结果:随访时间4~38个月。按Nakai评价标准评定优25例,良4例,可2例,差1例,优良率90.6%(29/32);按脊柱显微内镜治疗腰椎间盘突出症的疗效评价标准评定优25例,良3例,可3例,差1例,优良率87.5%(28/32)。结论:后路椎间盘镜手术治疗腰椎间盘突出合并椎管狭窄症创伤小,术后康复快,疗效佳。     

显微内镜椎间盘切除系统在上移型腰椎间盘脱出中的应用价值

目的：探讨显微内镜椎间盘切除系统在治疗上移型腰椎间盘脱出的安全性和有效性。方法回顾性分析采用显微内镜椎间盘切除系统治疗的32例上移型腰椎间盘脱出患者的病例资料,分别统计手术时间、出血量及术后并发症;采用MacNab分级标准及疼痛视觉模拟评分（ VAS评分）评价其临床疗效。结果所有患者均通过门诊或电话获得随访,平均随访时间为（19.40±8.61）个月,平均手术时间为（48.27±10.13） min;平均出血量为（35.63±11.29）mL;术后1年按MacNab标准,优23例（71.87％）,良7例（21.87％）,可2例（6.25％）,差0例,优良率为93.75％;术后腰、腿痛VAS评分与术前比较差异有统计学意义（P＜0.05）。结论显微内镜椎间盘切除系统治疗上移型腰椎间盘脱出具有创伤小、出血少、满意度高的优点,是一种值得推广且有着广阔应用前景的技术。     

椎间盘镜下髓核摘除术治疗腰椎间盘突出症48例

目的探讨椎间盘镜下髓核摘除术治疗腰椎间盘突出症的临床疗效。方法48例腰椎间盘突出症患者采用椎间盘镜下髓核摘除术进行治疗,根据Nakal疗效评定标准进行评价,总结治疗效果。结果本组48例患者中优34例,良10例,可4例,差0例,优良率91．7％。均未发生脑脊液漏、神经损伤等并发症。结论椎间盘镜下髓核摘除术由于其创伤小,出血少,手术时间短,安全性高,恢复快,效果可靠等优点,容易被广大患者所接受,已成为治疗腰椎间盘突出症的最有效手段之一。     

经皮内镜射频/钬激光腰椎间盘切除术在腰椎间盘突出症中的应用（附160例报告）

目的评价经皮内镜下椎间盘切除术（PELD）治疗腰椎间盘突出症的有效性,同时探讨影响其预后的因素。方法对160例腰椎间盘突出症患者采用后外侧入路/椎板间隙入路在局麻下行经皮内镜下钬激光/射频辅助椎间盘切除术。结果 160例术后随访平均15个月（7～24个月）,根据MacNab评价标准,结果为优117例,良19例,可12例,差12例,优良率为85%。结论 PELD治疗腰椎间盘突出症是有效的。尤其适用于腰椎间盘突出症传统开放手术复发患者。     

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…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.