X-刀治疗脑动静脉畸形54例分析

目的：评价X-刀治疗脑动静脉畸形后临床症状和影像学结果。方法：回顾性分析我院于1994年6月至2000年3月间对54例颅内动静脉畸形患者进行立体定向X-刀治疗，其中男性36例，女性18例。年龄11～52岁(平均26岁)。直径1．2～6．0cm(平均2．9cm)。其中按Spetzler-Martin分级，Ⅰ级13例，Ⅱ级15例，Ⅲ级21例，Ⅳ级5例。21例患者X-刀治疗前行1次或多次栓塞。5例患者(9．3％)既往行手术切除或清除血肿。50例患者用1个等中心照射，4例患者用2个等中心照射。病变边缘照射剂量为12～23Gy(平均17．9Gy)。结果：随访时间为24～82个月(平均64．8个月)。治疗后头痛、头晕等临床症状消失的为34例(62．2％)，减轻为5例(9．3％)；23例癫痫患者中9例(39．1％)癫痫症状完全缓解，10例(43．5％)患者症状减轻，4例(17．4％)患者症状无变化。2年后的完全闭合率为81．5％(44／54)。治疗后的再出血率为3／54(5．6％)，均于1年内出现，1例患者于治疗后9个月出现脑内血肿而行急诊开颅病灶切除及血肿清除术。2例患者(3．7％)出现症状性放射性脑水肿。结论：X-刀对治疗脑内动静脉畸形是安全有效的，尤其对脑深部和功能区的病变，能明显降低脑出血率，改善临床症状，降低致残率和死亡率。     

人工髋关节置换术护理

目的总结人工髋关节置换术患者的有效护理措施。方法回顾性分析我院骨科收治的5l例人工髋关节置换手术患者的临床资料。结果手术平均时间为3．5h，住院平均时间为17．5d。17例（33．0％）患者发生并发症，其中并发感染3例，下肢深静脉血栓2例，出血2例，经过对症治疗后痊愈。随访12～18个月发现，Harris评分为67～105分，平均为95．7分，其中80分以上者38例，优良率为75．0％。结论有效护理可以使得患者积极配合治疗，提高术后成功率，减少术后并发症的发生。     

小切口全髋关节置换术治疗8例髋臼发育不良

目的：探讨采用前外侧小切口人工全髋关节置换术治疗髋臼发育不良的可行性。方法：采用前外侧小切口全髋关节置换术对8例（10髋）髋臼发育不良患者进行了治疗．5例（6髋）髋臼进行了植骨。结果：手术切口长9～11cm，手术时间90～120min。术中出血200～400ml，平均312ml，Harris评分由术前38．40分恢复到术后92．80分。随访6个月～2年，平均1年2个月，无一例神经损伤，人工关节无松动．髋关节功能良好。结论：采用小切口全髋关节置换术可以选择性地治疗部分髋臼发育不良患者，出血少，创伤小．术后功能恢复快。     

单侧椎弓根穿刺椎体后凸成形术治疗骨质疏松性椎体压缩骨折

目的探讨单侧椎弓根穿刺椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床效果。方法2007年10月至2009年9月,应用单侧椎弓根穿刺椎体后凸成形术治疗17例骨质疏松性椎体压缩骨折患者,男6例,女11例;年龄58～86岁,平均69．5岁。患者均有腰背部疼痛,共18个椎体骨折,其中单节椎体16例,两个椎体1例,骨折部位：第12胸椎5例,第1腰椎5例,第2腰椎4例,第3腰椎2例,第4腰椎1例。随访观察患者的疼痛、日常功能以及影像学改变情况。结果18个椎体均单侧经椎弓根穿刺成功,手术时间30～60min,平均47min,骨水泥注射量均每个椎体（3．2±0．3）ml,少量椎管内渗漏1例,但无临床症状,无其他并发症发生;术后患者疼痛缓解,随访7～12个月,平均9．2个月;术前VAS评分（8．5±1．2）分,术后3d评分（3．1±1．0）分,术后评分明显改善;末次随访时为（2．8±1．3）分,与术前比较差异有统计学意义（P〈0．05）,与术后3d时比较差异无统计学意义;患者均在术后1个月内恢复受伤前的生活。结论单侧椎弓根穿刺椎体后凸成形术具有快速缓解疼痛,增强病椎强度,改善患者的生活质量。     

肾上腺皮质腺癌39例诊断与治疗体会

目的：探讨肾上腺皮质腺癌（ ACC）的诊断与治疗。方法回顾性分析39例ACC患者（ ACC组）诊断与治疗的临床资料,并随机调取同期39例肾上腺腺瘤（ ACA）患者（ ACA组）临床资料作对照。结果 ACC组肿瘤最大径（11.66±4.21）cm;Weiss评分：3～5分13例,＞5分26例。 ACA组肿瘤最大径（2.34±1.27）cm;Weiss评分：＜3分37例,3～5分2例,＞5分0例。 ACC组34例行肿瘤完整切除,5例仅行姑息性切除或活检术,术后1周内死亡2例;口服舒尼替尼治疗2例;随访32例,随访时间1～80个月,中位生存时间12个月,1年与5年生存率分别为45.7％和32.7％。 ACA组手术均顺利,术后随访33例,失访6例,随访时间2～176个月,均健在。结论 ACC分期晚,预后差,与ACA鉴别较困难,肿瘤大小应作为良恶性鉴别指标之一,根治性切除术后易复发转移,可尝试舒尼替尼分子靶向药物治疗。     

肺大细胞神经内分泌癌8例临床分析

目的 分析肺大细胞神经内分泌癌(LCNEC)的临床特征、治疗及预后情况.方法 回顾性研究8例LCNEC患者的临床资料,分析其临床特征,并随访治疗效果及预后.结果 全组患者无1例术前确诊,术后病理免疫组化分析符合LCNEC特点;术后病理分期为:Ⅰ A期1例,Ⅰ B期2例,ⅡB期1例,ⅢA期3例,ⅢB期1例.术后7例患者接受含铂类辅助化疗,1例患者接受免疫治疗;全组患者术后随访5～74月,平均34月;4例患者分别于术后9月、19月、15月、33月发生肿瘤复发或转移,平均无病生存期为19月;分别于13月、24月、28月、38月后死亡,平均生存时间25.75月;另外4例至今已分别无病生存5月、25月、64月、74月.全组1年生存率为85.7%,5年生存率为35.7%.结论 肺LCNEC为高度侵袭性肿瘤,易复发和转移,预后差,手术结合术后含铂类辅助化疗可能对延长患者术后无病生存时间有益.     

空心螺钉经前踝内固定治疗后踝关节骨折57例临床分析

目的分析空心螺钉经前踝内固定治疗后踝关节骨折的临床疗效。方法选择2008年10月-2013年6月收治的后踝骨折患者57例，均采用闭合复位空心螺钉经前踝内固定术治疗，并对其临床疗效进行评价。结果术后57例患者均获得6～36个月的随访，平均随访时间为18个月。骨折愈合时间8～12周，平均10周。依据美国AOFAS协会足踝评分系统对其临床疗效进行评估。57例患者得分为76～100分，平均96分，其中优54例（94．7％），良3例（5．3％），差0例，优良率为100％。结论闭合复位空心螺钉经前踝内固定治疗后踝关节骨折，具有创伤小、对周围血运破坏少，骨折愈合快，踝关节功能恢复好等优点，值得临床推广应用。     

复发性腰椎间盘突出症的微创手术治疗

目的：探讨微创手术通道下治疗复发性腰椎间盘突出症的临床效果。方法回顾性分析2009年7月到2013年7月行微创椎间盘切除术治疗的30例腰椎间盘突出症术后复发患者的临床资料,患者复发节段腰34（L34）1例,腰45（L45）10例,腰5骶1（L5S1）19例;统计描述患者的年龄、体质量指数、复发节段、手术时间、术中失血量、术后无痛行走的时间,采用疼痛视觉模拟评分（VAS）评估微创手术治疗的临床疗效。结果手术时间50～100min,平均65min;术中失血量100～180mL,平均145mL;住院时间9～16d,平均13d;平均住院费用7300元;术后无痛行走时间7～15d,平均11d;术后从事非体力劳动的时间27．3d,VAS分值由术前的（7．3±1．3）分降低到术后（3．1±0．9）分,末次随访时为（2．2±0．6）分,术后、末次随访VAS分值与术前比较,差异均有统计学意义（P＜0．05）。获得随访时间6～33个月,平均16．5个月。疗效优16例,良7例,可5例,差2例,优良率76％。结论微创手术是治疗复发性腰椎间盘突出症的有效方法之一。     

射频消融在较大原发性肝癌中的应用

目的：总结较大原发性肝癌（肿瘤最大直径≥4cm）射频消融后的治疗结局和经验。方法：1999年12月至2007年3月，我院共对441例失去手术机会的较大原发性肝癌患者实施了超声引导下的经皮射频消融。肿瘤最大直径4～8.2cm[平均（4．6±0．63）cm]。对患者进行随访以评估治疗后凝固性坏死结果、并发症、局部复发率和生存预后。结果：射频消融后肿瘤完全坏死率72．9％。与射频消融有关的并发症发生率20．9％，严重并发症发生率9．5％。与射频消融有关的死亡7例。随访1～62个月，359例患者的379个直径≥4cm的肿瘤得到有效随访资料，其中302个肿瘤术后完全坏死，130个肿瘤随访期间局部复发，局部复发率为43．0％。肿瘤直径4～5cm者中位生存期27个月，1、3、5年生存率分别为78．2％、48．1％和17．6％；肿瘤直径5～6cm者中位生存期为18个月，1、3、5年生存率分别为66．3％、36．4％和9．7％；直径≥6cm者中位生存期为11个月，1、3、5年生存率分别为53．6％、28．1％和0。结论：对于不可切除的较大原发性肝癌，射频消融是较有效的局部治疗方法，但应严格把握适应证。     

综合康复疗法治疗高龄退行性腰椎管狭窄症的观察

目的：探讨康复疗法治疗高龄退行性腰椎管狭窄症的有效性及其特点。方法：研究组100例患者。采用综合保守方法进行治疗，对短期疗效进行随访观察。设立对照组对治疗效果进行比较分析，对照组选取本院同期内因腰椎管狭窄症施行手术的患者56例。结果：研究组随访1年，治疗前JOA点数7～24点，治疗后12～29点，平均好转率为56．5％；治疗前出现间歇性跛行的距离为10～500m，治疗后为350～1000m，平均RIC为46．5％；治疗前平均VAS6．5，治疗后为2．4，随访1年后为1．9。对照组手术前JOA点数7～18点，手术后10～29点，平均好转率59．7％；手术前出现间歇性跛行的距离为0～500m，手术后为400～1000m，平均RIC为47．2％，两组比较差异无统计学意义。结论：综合康复治疗可作为治疗腰椎管狭窄症的方法之一，对不能接受手术的高龄患者的短期疗效是可靠的。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.