168例成人脊髓拴系综合征的显微外科治疗

探讨采用显微外科技术治疗成人脊髓系综合征的方法和疗效.方法回顾性分析2004年9月至2007年12月由本科收治的168饲脊髓拴系综合征志者的临床表现,病理类型、为微外科治疗方法以及疗效.168例成人脊髓拴系综合征在显微镜下切除脊髓北侧脂肪瘤,松解硬膜内外与脊髓的粘连,病变部位人工脊膜修补形成宽松椎管.结果本组术后在住院期间(14d)92例(84.7%)患者症状得到改善.159例获得随访,在随访期内(1～3年)治愈者占15.3%,有效30.7%,无效15.3%,恶化1例,总有效率为84.7%.13例出现脑脊.结论采用显微外科技术治疗成人脊髓系统综合征可获得满意疗效,对成年脊髓拴系综合征患者应采取积极的手术治疗. 收治的168饲脊髓拴系综合征志者的临床表现,病理类型、为微外科治疗方法以及疗效.168倒成人脊髓拴系综合征在显微镜下切除脊髓北侧脂肪瘤,松解硬膜内外与脊髓的粘连,病变部位人工脊膜修补形成宽松椎管.结果本组术后在住院期间(14d)92例(84.7%)患者症状得到改善.159例获得随访,在随访期内(1～3年)治愈者占15.3%,有效30.7%,无效15.3%,恶化1例,总有效率为84.7%.13例出现脑脊. 论采用显微外科技术治疗成人脊髓系统综合征可获得满意疗     

显微外科治疗脊髓栓系综合征21例诊治分析

目的：探讨利用显微手术治疗脊髓栓系综合征的临床疗效。方法：回顾性分析2004年1月-2008年3月收治的21例脊髓栓系综合征患者的临床表现、病理学改变以及对经手术行圆锥松解、终丝切断治疗的疗效进行分析。结果：21例患者中有20例获得随访,其中81％的症状得到改善．19％的临床症状无明显改善,在随访过程中亦无继续加重。结论：脊髓栓系综合征的早期诊断和显微神经外科手术充分松解切断增粗变短的终丝,是治疗并获得满意效果的关键。     

成人与小儿脊髓拴系综合征的显微外科治疗

目的：探讨成人与小儿脊髓拴系统合征的显微外科手术区别及操作要点。方法：比较10例小儿与6例成人脊髓拴系综合征患的临床特征及显微手术方法不同，并随诊其临床症状的改善程度。结果：16例脊髓拴系统综合征患逐渐加重的临床症状均得到控制，随诊疗效良好。结论：脊髓拴系综合征患行显微外科手术治疗可明显减少术中神经血管副损伤，防止术后并发症，成人患多合并椎管内肿瘤，可行肿瘤切除或部分节除，终丝不做处理，幼儿患要求早期治疗，术中需将增粗紧绷的终丝切断。     

脊髓栓系综合征的显微外科治疗

目的: 探讨采用显微神经外科技术治疗脊髓栓系综合征的方法和疗效. 方法: 回顾性分析1996-01/2002-08由我科同一手术组收治的76例脊髓栓系综合征患者的临床表现、病理学特征、显微外科治疗方法以及疗效. 结果: 本组术后在住院期间内(5～15 d)54例(71%)患者症状得到改善. 52例获得随访,在随访期内(0.5～7.0 a)治愈者占17%,显效46%,好转23%,无效13%,总有效率为86%;无严重并发症. 结论: 采用显微神经外科技术治疗脊髓栓系综合征可明显提高手术效果,对成年患者及首次手术未治愈的患者均应采取积极的手术治疗.     

29例脊髓栓系综合征诊疗体会

目的 探讨脊髓栓系综合征的影像学特点及手术治疗效果。方法 回顾性分析2004～2007年收治的29例脊髓栓系综合征患者的临床表现、影像学特点以及显微手术圆锥松解、终丝切断后的术后效果。结果 本组患者中71％的症状得到改善。29％临床症状无明显改善，在随访过程中其症状亦无继续加重。结论 脊髓栓系综合征的早期诊断、早期治疗是提高疗效的关键。显微外科手术切断、充分松解增粗、变短的终丝，是手术成功的关键。     

成年脊髓拴系综合征临床诊治(附14例报告)

目的：观察成年脊髓拴系综合征临床表现，对其手术及疗效进行评价。方法：对14例成年经MRI及手术探察证实为脊髓拴系综合征患者临床表现进行分析。手术采用脉冲式电刺激仪及显微外科技术，扩大狭窄椎管，切除占位病变，松解脊髓及粘连马尾神经，切断终丝。结果：全部病例随访1年以上，手术后感觉、运动、括约肌及性功能得到较好改善，其改善率的95％可信区间为(29％，82％)。结论：手术采取原发和继发疾病同时治疗，效果确切。     

29例脊髓栓系综合征的显微神经外科治疗

目的：探讨采用显微神经外科技术治疗脊髓栓系综合征的疗效及术后并症。方法：分析1995年～2003年间新疆医科大学一附院手术治疗的29例患者。结果：好转21例，无变化8例。其中运动感觉的恢复情况较大小便功能的恢复情况佳。结论：早期诊断及采用显微神经外科技术是治疗并获得良好手术效果的关键，提倡早期手术。     

改良小切口显微术式治疗Chiari＇s畸形合并脊髓空洞症

目的 介绍一种新型改良小切口显微术式在治疗Chiari＇s畸形合并脊髓空洞症（ACM-SM）中的疗效及特点。方法 总结我院近1年共计76例Chiari＇s畸形合并脊髓空洞症患者的治疗及预后情况进行回顾性分析。结果76例患者中症状明显改善71例（93％），随访发现43例脊髓空洞在术后3个月内消失，27例脊髓空洞明显缩小，6例改善不明显，未见加重患者。结论新型改良小切口显微术式在治疗Chiari＇s畸形合并脊髓空洞症中疗效显著并能减小患者创伤，缩短患者平均住院时间。     

脊髓栓系综合征的手术治疗方法探讨

根据脊髓栓系综合征的病理基础探讨其手术方法。方法；基于本症的病理基础和神经功能恢复的潜力，用显微神经外科技术，扩大椎板切除减压，分离松解园锥，马尾束，切断终丝和脊膜膨出修补等。结果；对脊柱裂伴黄韧带增厚，牵拉终丝，泌尿系症状较轻者其手术效果良好。     

超声与胎儿MRI对胎儿脊髓神经管畸形的产前检出率比较

背景 胎儿脊髓神经管畸形的产前准确诊断相对困难,但意义重大.目的 探讨产前超声与胎儿MRI在脊髓神经管畸形产前诊断中的准确性和优缺点.?方法 收集2018年8月-?2020年8月,解放军总医院第一医学中心神经外科门诊接诊的产前超声检查怀疑脊髓神经管畸形的胎儿病例资料,超声诊断后72?h内进一步行胎儿MRI.出生后1个月内行MRI,并以此为标准,评估两种检查手段下脊髓神经管畸形的检出率.?结果 共纳入疑似脊髓神经管畸形的胎儿35例,随访中29例选择继续妊娠,6例放弃妊娠.已出生胎儿24例,另5例仍在妊娠中.24例胎儿出生后MRI检查显示有脊柱裂17例,脂肪瘤型脊髓拴系12例,单纯型脊髓拴系6例.产前超声对胎儿脊柱裂的检出率高于胎儿MRI?[64.7％(11/17)?vs 41.1％(7/17)],但对胎儿脂肪瘤型脊髓拴系的检出率低于MRI?[58.3％(7/12)?vs?75.0％(9/12)],对胎儿单纯型脊髓拴系的检出率也低于MRI?[66.7％(4/6)?vs?83.3％(5/6)],但组间差异均无统计学意义(P均>0.05).?结论 超声对脊柱裂的产前诊断比胎儿MRI更有优势;胎儿MRI对脂肪瘤型脊髓拴系的产前诊断比超声更有优势;两者对单纯型脊髓拴系的产前诊断效果相仿.     

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…     

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.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…