40例重症肌无力手术治疗体会

目的总结1993年3月～2005年12月手术治疗重症肌无力并发胸腺瘤，胸腺增生的手术疗效。方法对40例MG并发胸腺瘤，胸腺增生患者行胸腺及胸腺瘤切除术，随访结果进行分析。结果术后患者肌无力症状缓解13例（占32．5％），改善19例（占47．5％），无效5例（占12．5％），恶化2例（占5．0％），死亡1例（占2．5％），患者手术后的疗效与Osserman分型、胸腺的病理类型及术前病程的长短有关，与性别、年龄无关。结论胸腺切除治疗MG的效果满意，对MG患者应及早手术治疗。     

Long-term prognostic analysis of thymectomized patients with myasthenia gravis

目的　探讨重症肌无力胸腺切除术后影响远期生存的因素。 方法　采用胸腺切除术治疗170例重症肌无力患者,其中124例术后获得超过40个月的远期随访,运用COX回归模型分析可能影响远期预后生存的有关因素,包括胸腺的各病理类型、性别、年龄、病程、术前临床Osserman分型和治疗。 结果　本项研究表明,胸腺的不同病理类型是影响胸腺切除术后远期生存的唯一重要因素,术后远期生存率有明显差异,表现为胸腺增生>良性胸腺瘤>胸腺萎缩>恶性胸腺瘤（P<0.05）。 结论　胸腺的不同病理类型是影响重症肌无力胸腺切除术远期生存的重要因素。     

重症肌无力84例胸腺和胸腺瘤切除疗效评价

目的:研究胸腺和胸腺瘤切除对重症肌无力的疗效。方法：采用手术切除胸腺治疗各型重症肌无力的患者共84例，其中存在胸腺瘤的有47例。结果：手术完全切除81例，手术中无死亡。术后随访73例，按Mondon标准来判定疗效，缓解29例，改善33例，无变化或加重8例，死亡3例。结论：认为胸腺和胸腺瘤切除是治疗重症肌无力的一种较为有效的方法，应及早手术，同时重症肌无力的远期疗效与性别、胸腺病理无关，与手术切除的彻底性、年龄差别、Osserman临床分型及病程有关。     

21例重症肌无力外科治疗体会

目的评价外科治疗重症肌无力（MG）的效果,探讨影响术后肌无力危象发生及治疗效果的因素。方法回顾我院2000-2007年外科治疗21例重症肌无力患者的临床资料,对其疗效及影响术后肌无力危象发生及影响治疗效果的因素进行分析。结果重症肌无力的症状完全缓解有5例（23.8％）部分缓解14例（66.7％）无效1例（4.8％）,死亡1例（4.8％）。病程长短、Osserman分型和胸腺的病理类型是术后肌无力危象发生的相关危险因素,治疗效果与病程、Osserman临床分型有关。结论外科治疗重症肌无力有良好的效果及可行性。     

胸腺瘤外科治疗体会

目的：了解胸腺瘤及合并有重症肌无力患者的手术治疗与预后的关系。方法：回顾总结128例胸腺瘤患者的一般资料及治疗方法。结果：完整手术切除109例（85．2％），姑息性切除14例（10．9％），探查活检5例（3．9％），其中有1例死亡（0．8％）。结论：胸腺瘤治疗应尽可能完整地切除肿瘤及部分周围组织，以达到手术彻底切除。胸腺瘤合并重症肌无力的围手术期处理至关重要。     

重症肌无力173例胸腺切除远期疗效及预后分析

目的 探讨重症肌无力胸腺切除术后的预后因素。方法 对173例经胸骨正中切口行胸腺切除术的重症肌无力患进行定期随访,并扫性别、年龄、病程、临床分型、病理分型、伴发甲亢、伴发危象等因素进行统计分析。结果 缓解49例,改善82例,无变化20例,恶化12例,晚期死亡10例,总缓解率28．3％,有效率75．7％。结论 胸腺切除治疗重症肌无力临床切实可行,以病程较短、临床Ⅱ型、胸腺增生可获得较好疗效;伴胸腺瘤及50岁以上患疗效较差;伴发危象或甲亢不影响疗效。     

胸腺切除后出现重症肌无力实施护理干预的临床分析

目的探讨胸腺切除术后护理干预工作对重症肌无力患者生活质量的影响。方法选取我院2011年3月-2013年6月42例拟行胸腺切除术治疗成人重症肌无力患者作为试验组，行护理干预；另外取同一时期50例胸腺切除满3年的成人重症肌无力患者为对照组，行常规护理。采用调整后的欧洲癌症研究与治疗组织QLQ—C30量表，随访3年后比较二组患者的生活质量。结果二组的SAS、SDS评分均较治疗前下降，差异有统计学意义（P均=0．000），观察组的SAS、SDs评分下降幅度大于对照组，差异有统计学意义（t=5．766，P=0．000；t=6．788，P=0．00），试验组患者的生活质量较对照组的生活质量有明显改善。结论护理干预可有效改善成人重症肌无力胸腺切除术后患者心理健康程度，降低患者心理压力，进而改善患者术后恢复，改善患者远期的生活质量。     

13例重症肌无力胸腺扩大切除术疗效分析

目的探讨胸腺扩大切除术治疗重症肌无力的远期疗效以及影响预后的相关因素。方法回顾性分析1999年3月至2009年7月13例重症肌无力胸腺扩大切除术的病例资料以及术后的远期疗效。结果在平均为5年（0.5～10年）的随访期内,13例患者中完全缓解8例,部分缓解3例,无效2例,完全缓解率为61.5%,有效率为84.6%。不同性别、年龄的患者有效率差异无统计学意义。术前病程短和Ossermann分型为I型I、Ia型的患者有效率更高。术后病理中胸腺囊肿或增生者的有效率显著高于胸腺瘤者。结论胸腺扩大切除术治疗重症肌无力可以获得较好的疗效;术前病程、Osserman分型以及胸腺病理为胸腺瘤者可能是影响疗效的相关因素。     

单纯胸腺瘤与胸腺瘤合并重症肌无力的外科治疗及预后分析

目的：探讨外科治疗单纯胸腺瘤与合并重症肌无力的胸腺瘤的临床、病理差异及预后分析。方法：回顾性分析 2008年1月—2018年12月于南京医科大学第一附属医院胸外科接受手术治疗的胸腺瘤患者临床和术后病理资料，对比分析单纯胸腺瘤患者与合并重症肌无力胸腺瘤患者围术期疗效及远期预后之间的差异。结果：共354例患者纳入本研究。单纯胸腺瘤组301例，男139例，女162例，平均年龄（54.11±12.57）岁，平均肿瘤直径（6.42±2.94）cm，Masaoka-Koga分期：Ⅰ期147例 （48.8%）、Ⅱ期68例（22.6%）、Ⅲ期15例（5.0%）、Ⅳ期71例（23.6%），腔镜手术比例55.5%，R0切除比例96.3%，后续治疗患者比例21.9%。胸腺瘤合并重症肌无力组共53例，男31例，女22例，平均年龄（53.74±10.21）岁，平均肿瘤直径（5.12±2.11）cm， Masaoka-Koga 分期：Ⅰ期24例（45.3%）、Ⅱ期16例（30.1%）、Ⅲ期4例（7.6%）、Ⅳ期9例（17.0%），腔镜手术比例56.6%，R0切除比例98.1%，后续治疗患者比例13.2%。两组术后总生存率差异无统计学意义。多因素分析提示，年龄≥55岁、肿瘤直径 ≥6 cm、术后病理分型为 B 型、Masaoka-Koga 分期Ⅲ~Ⅳ期及需要后续治疗是影响胸腺瘤患者预后的独立因素。结论：相比单纯胸腺瘤，胸腺瘤合并重症肌无力患者更年轻，肿瘤直径更小。完整切除是改善胸腺瘤患者预后的重要因素，术后准确的病理分型及分期可以更好地预测患者预后。     

重症肌无力的临床和胸腺病理分析(附173例报告)

目的研究重症肌无力患者胸腺的病理改变、临床分型和分期的临床意义。方法回顾性分析173例行胸腺切除重症肌无力患者的术后病理所见与临床特点。结果173例胸腺组织表现为胸腺增生88例(50.87%),胸腺瘤79例(45.66%),正常胸腺4例(2.31%),胸腺萎缩2例(1.16%);胸腺增生组14例(15.91%)、胸腺瘤16例(20.25%)出现术后肌无力危象;重症肌无力患者Osserman临床分型、Masaoka临床病理分期、病理类型间有一定的相关性;多数重症肌无力患者有一种或多种免疫学指标异常。结论综合分析重症肌无力患者的临床资料,结合免疫学的检测结果,有助于该病的有效防治。     

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…