亚低温治疗对急性外伤性脑梗死患者炎性因子水平及神经功能的影响

目的:探讨亚低温治疗对急性外伤性脑梗死患者炎性因子水平及神经功能的影响.方法:将50例急性外伤性脑梗死患者分为常规治疗组(对照组,n=25)及亚低温治疗组(观察组,n=25).治疗7 d后,评估治疗效果,并采用美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷评分(GCS)评估患者神经功能及昏迷情况;采用酶联免疫吸附测定(ELISA)法测定患者血清炎性因子C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及神经营养因子神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)水平.结果:治疗7 d后,观察组患者NIHSS评分低于治疗前及对照组(P＜0.05),而GCS评分高于治疗前及对照组(P＜0.05).观察组患者治疗总有效率高于对照组(92.00％vs.80.00％,P＜0.05).治疗7 d后,观察组患者血清CRP及IL-6水平均低于治疗前及对照组(P＜0.05),血清IL-10水平高于治疗前及对照组(P＜0.05).治疗7 d后,观察组患者血清NSE水平低于治疗前及对照组(P＜0.05),血清BDNF及NGF水平高于治疗前及对照组(P＜0.05).结论:在常规治疗的基础上联合亚低温疗法有利于改善急性外伤性脑梗死患者炎性因子及神经营养因子水平,减轻神经功能损伤,提高治疗效果.     

心力衰竭后交感神经重构的机制及美托洛尔联合神经生长因子干预效果的研究

目的 探讨心力衰竭(HF)后交感神经重构的机制及美托洛尔联合神经生长因子(NGF)的干预作用.方法 40只Wistar大鼠分为HF组34只和正常对照组(NC组)6只,HF组采用阿霉素4 mg/kg腹腔注射建立模型.6周后心脏超声评估大鼠心功能,并检测血浆NGF.将HF组存活大鼠分为HF对照组5只(HF-C组)、美托洛尔干预组5只(HF-M组)、NGF注射组5只(HF-N组)、NGF注射+美托洛尔干预组6只(HF-N-M组),其中鼠NGF以60 μg/(kg·d)尾静脉注射,美托洛尔以0.25 mg/(kg·d)灌胃,共4周.干预4周后进行心律失常诱发,测定各组大鼠心功能和血浆NGF表达,并检测心脏组织的酪氨酸羟化酶(TH)、生长相关蛋白43(GAP43)、NGF的表达.结果 与NC组比较,建模后HF组大鼠左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV)明显升高,而左室射血分数(LVEF)和血浆NGF表达明显下降(P＜0.05).干预4周后,与HF-C组比较,HF-M组、HF-N组和HF-N-M组LVEF及NGF表达明显升高,LVESV明显降低(P＜0.05);HF-N-M组的NGF水平较HF-M组和HF-N组升高,且LVESV明显降低(P＜0.05).HF-C组、HF-M组、HF-N组和HF-N-M组TH、GAP43、NGF mRNA和蛋白表达较NC组明显降低(P＜0.05),但HF-M组、HF-N组和HF-N-M组TH、GAP43、NGF mRNA和蛋白表达较HF-C组明显升高(P＜0.05),而HF-N-M组与HF-M组、HF-N组比较,差异无统计学意义(P＞0.05).NC组、HF-C组、HF-M组、HF-N组、HF-N-M组心律失常诱发率分别为0、80.00％、20.00％、20.00％、16.67％.结论 Wistar大鼠腹腔注射阿霉素可以成功诱发HF模型,HF后交感神经重构与TH、GAP43、NGF有关,而美托洛尔和NGF可以改善HF后交感神经重构及心功能,降低心律失常的发生率.     

甘露醇开放血脑屏障后应用神经生长因子对重型颅脑损伤治疗的研究

目的:观察甘露醇开放血脑屏障后应用神经生长因子(NGF)局部注射促进重型颅脑损伤患者预后的效果。方法:将368例重型颅脑损伤患者随机分为对照组、治疗组和特殊治疗组。对照组给予常规神经外科治疗;治疗组在对照组基础上给予神经生长因子12μg肌注,1次/d,连续15d;特殊治疗组在肌注神经生长因子12μg后20min即快速静注20%甘露醇250ml,连续15d。以三组患者3个月后GOS评分为预后观察指标对三组患者恢复情况作出对比分析。结果:三组病例均获随访,经统计学处理,治疗组疗效优于对照组(P0.05),特殊治疗组疗效优于对照组和治疗组(P0.05)。结论:甘露醇开放血脑屏障后应用神经生长因子(NGF)能提高外源性神经生长因子的疗效,对改善重型颅脑损伤患者预后能起到较为明确的作用。     

体感诱发电位对神经生长因子治疗大鼠脑缺血再灌注损伤的评价

目的 观察神经生长因子(NGF)对脑缺血再灌注损伤大鼠的疗效.方法 选用健康雄性Wistar大鼠24只制作脑缺血再灌注模型,然后将造模成功的大鼠随机分为3组,神经生长因子组、胞磷胆碱钠组和生理盐水组,采用肌肉注射法,分别用神经生长因子(NGF)、胞磷胆碱钠(CS)和生理盐水(NS)给予治疗,于治疗前后分别观察各组动物神经病学评分和体感诱发电位潜伏期的改变.结果 ①与治疗前比较,神经生长因子和胞磷胆碱钠组治疗后神经病学评分均降低(P<0.05),但这些指标在两治疗组间差异无显著性.治疗后NGF组和CS钠组神经病学评分与NS对照组比较,均明显降低(P<0.05).②NGF组和CS组所有体感诱发电位波潜伏期缩短和与治疗前比较差异有显著性(P<0.05).治疗后,神经生长因子组的P1,N1,P2潜伏期均短于盐水对照组(P﹤0.05) ;CS组仅P2潜伏期短于盐水对照组(P<0.05).③大鼠模型体感诱发电位潜伏期与神经病学评分呈高度正相关(r=0.97～0.99,P<0.05).结论 NGF可明显促进脑缺血再灌注损伤大鼠神经功能的恢复.体感诱发电位可用于脑缺血再灌注损伤的疗效观察.     

微创颅内血肿清除术治疗高血压脑出血的护理干预

目的 探讨微创颅内血肿清除术治疗高血压脑出血(HICH)的护理效果.方法 将48例HICH患者随机分为两组,每组各24例,对照组采用常规的内科保守治疗,观察组则在对照组基础上采用微创颅内血肿清除术,两组均采取对症的护理干预,并于3个月后对两组患者的临床效果进行评价和比较.结果 观察组的死亡和Ⅳ级患者显著低于对照组(P＜0.05);Ⅰ～Ⅲ级患者明显多于对照组(P＜0.05);观察组的总有效率为83.33％,对照组为45.83％,两组比较差异有统计学意义(P＜0.05).结论 微创颅内血肿清除术能有效地引流颅内血肿,降低脑出血的病死率和致残率,配合精心而严密的护理干预,不但可以提高手术治疗效果,还可提高患者的生存质量.     

神经生长因子对精子活动力的影响

目的 影响精子活动力的因素较多.文中研究拟通过动物实验观察神经生长因子(never growth factor,NGF)对人精子活动力的影响,以找出更多的临床治疗弱精子症的手段并分析其机制.方法 将NGF粉剂配成0、10、50、100μg/L 4个浓度溶液,作用于人精液30、60、90min后,观察精子活率和活动力的变化.大鼠肌注100μl(0.1μg)NGF,连续注射14d,观察大鼠附睾尾精子数目和活力.结果 NGF处理精液60min后,浓度为50μg/L时活率显著高于正常对照组和100μg/L组(P＜0.05),其他各组与对照组相比,精子活率差异均无统计学意义(P＞0.05).不同浓度NGF处理不同时间后,各组间精子活力差异无统计学意义(P＞0.05).NGF注射后,实验组大鼠附睾尾精子计数和精子活力明显增加,附睾尾精子相对计数显著高于对照组(P＜0.05).结论 NGF能促进精子的发生,对精子的活动力具有调控作用,有望为男性不育的治疗提供新思路.     

ratNGF、NaHS对哮喘大鼠气道炎症的调节作用

目的 观察神经生长因子(NGF)及外源性硫化氢钠(NaHS,即H2S供体)处理后哮喘大鼠肺中黏蛋白基因的表达情况,探讨其在哮喘发病中的作用.方法 36只SD大鼠随机分为正常对照组(n=8)和实验组(其中哮喘组9例、NGF干预组10例及NaHS干预组9例),实验组于第1、8天腹腔注射卵白蛋白(OVA)致敏,第15～22天采用1%的OVA溶液雾化激发,每次雾化前30 min哮喘组腹腔注射生理盐水,NGF干预组腹腔注射NGF(80 ng/kg),NaHS干预组腹腔注射NaHS(14 μmol/kg).正常对照组分别于各相对时点以同量生理盐水注射及雾化.各组激发后24 h(第23天)解剖大鼠,用免疫组化的方法测定大鼠肺中黏蛋白基因Muc5ac的表达情况.结果 哮喘组肺Muc5ac蛋白表达高于正常对照组(P＜0.01).与哮喘组相比,NGF干预组肺Muc5ac蛋白含量表达明显增多,而NaHS干预组肺Muc5ac蛋白含量表达减少(P＜0.05).结论 大鼠黏蛋白基因Muc5ac表达和哮喘的发生发展密切相关,NGF可加重气道炎症,而NaHS可以减轻哮喘气道炎症.     

中等量高血压性脑出血不同治疗手段的临床疗效比较

目的 比较保守治疗、微创颅内清除术和开颅手术治疗中等量高血压性脑出血的疗效.方法 收集符合纳入标准的出血量约30～50 mL的高血压性脑出血患者71例,根据患者及家属意愿分为三组,分别给予保守治疗,微创治疗及开颅手术治疗.比较三组患者治疗7d、14 d及28 d神经功能恢复的情况,治疗1个月的临床疗效及6个月的日常生活能力(ADL).结果 治疗7d和14 d,微创组评分低于保守组及手术组(P＜0.05),手术组评分低于保守组(P＜0.05);治疗28 d,微创组评分低于保守组(P＜0.05).治疗1个月微创组总有效率为65.2％,手术组总有效率为62.5％,均高于保守组的25.0％;微创组死亡率30.4％,手术组死亡率为33.3％,均低于保守组的66.7％,P均＜0.05,差异有统计学意义.治疗6个月保守组ADL分级Ⅰ-Ⅱ级1例,Ⅲ-Ⅴ级6例.微创组Ⅰ-Ⅱ级13例,Ⅲ-Ⅴ级3例.手术组Ⅰ-Ⅱ级5例,Ⅲ-Ⅴ级10例.微创组与保守组、微创组与手术组相比,差异均有统计学意义(P＜0.05).结论 微创术后患者存活率高,短期神经功能恢复快,长期独立生活能力优于手术组和保守组,是30 ～ 50 mL高血压性脑出血治疗的首选.     

穴位注射鼠神经生长因子对脑卒中患者临床疗效观察

目的 观察采用穴位注射鼠神经生长因子（NGF）对脑卒中患者的临床疗效.方法 将120例脑卒中患者随机分为三组,治疗1组50例,治疗2组50例,对照组20例.治疗组、对照组均采用脑卒中内科常规治疗,治疗1组在常规治疗基础上加用穴位注射NGF,治疗2组采用臀部肌注法.分别于治疗前、治疗14d（1个疗程）、治疗28 d（2个疗程）对神经功能缺损程度进行美国国立卫生院脑卒中量表（NIHSS）评分并比较.结果 治疗前两组脑卒中患者神经功能缺损NIHSS评分无统计学意义（P＞0.05）,治疗后第一疗程,治疗1组与治疗2组患者神经功能缺损NIHSS评分无统计学意义（P＞0.05）,但治疗组与对照组相比评分有统计学意义（P＞0.05）.第二疗程治疗1组、治疗2组患者神经功能缺损NIHSS评分治疗组显著低于对照组（P＜0.0 5）,且治疗1组评分显著低于治疗2组.结论 穴位注射NGF能较快速地促进患者的神经功能恢复,采用穴位注射方法能更好的增强疗效.     

益生菌对重型颅脑损伤后高血糖反应的影响

目的 观察益生菌对重型颅脑损伤患者高 血糖反应的影响.方法 选取重型颅脑损伤患者40例,在取得患者家属知情同意后按照随机数字表法分别纳入试验组(18例)和对照组(22例).试验组在人院后24 ～ 72 h内,将益生菌制剂研磨后加入20 mL温水经鼻胃管注入,对照组单纯给予20 mL温水.于营养开始第0、4、7、15天检测患者血糖水平,比较干预前后GCS评分.结果 2组患者血糖水平在干预第0天差异无统计学意义(P＞0.05),在干预第4、7、15天,试验组血糖水平均低于对照组(P＜0.05);试验组、对照组在干预后GCS评分均高于干预前(P＜0.05),试验组干预后GCS评分高于对照组(P＜0.05).结论 益生菌能改善重型颅脑损伤后高血糖反应.     

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…     

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.     

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.