黄光英教授治疗先兆流产合并宫腔积血临证经验

先兆流产是指妊娠28周内出现少量阴道流血,时下时止,常伴有阵发性下腹痛或腰背痛,中医称为“胎漏”“胎动不安”。研究[1]表明,大约50%的女性在一生中都经历过流产,流产不仅会给女性带来身体创伤,还会造成长期的心理影响[2]。宫腔积血,即绒毛膜下出血,是指B超检查时出现在孕囊和子宫壁之间的液性暗区,常伴随先兆流产出现。研究[3-4]显示,先兆流产合并宫腔积血不仅会增加妊娠早期的自然流产率,还会增加妊娠中晚期的早产率和胎盘早剥率,以及产后出血率,甚至影响胎儿的生长发育。     

针刺改善大鼠胚泡着床障碍机制初探

目的 观察针刺对胚泡着床障碍大鼠胚泡着床的影响,并初步探讨其作用机制.方法 早孕大鼠随机分为正常组、模型组及针刺组,观察各组大鼠着床率及平均着床胚泡数;放免法检测血清雌二醇（E2）、孕酮（P4）及泌乳素（PRL）的水平;免疫组化及RT—PCR法检测着床点孕激素受体（PR）及泌乳素受体（PRLR）表达的差异。结果 针刺组着床率及平均着床胚泡数较模型组显著提高（P〈0．01）,模型组血清P4、PRL水平、PR、PRLR蛋白及mRNA表达水平均低于正常组和针刺组（P〈0．05）。结论 针刺可在一定程度上促进大鼠胚泡着床,其作用机制可能与针刺调节大鼠体内性激素及其受体表达有关,     

针刺对克罗米芬治疗的多囊卵巢综合征大鼠子宫内膜容受性的影响

目的 观察针刺对促排卵治疗的多囊卵巢综合征(PCOS)大鼠子宫内膜容受性的影响,探讨其作用机制.方法 对24日龄雌性SD大鼠皮下注射脱氢表雄酮(DHEA)的麻油溶液制作多囊卵巢综合征(PCOS)大鼠模型,对照组(Con)同期皮下注射麻油.PCOS大鼠随机分为模型组(M)、克罗米芬组(C)、克罗米芬+针刺组(C+A),其中M组不作任何处理,其它各组均于80日龄起进行干预5 d.治疗结束后,各组部分大鼠断头处死,留取子宫和子宫内膜标本.以RT-PCR法检测各组大鼠子宫内膜雌激素受体(ER)、孕激素受体(PR)、同源盒基因A10(HOXA10)、白血病抑制因子(LIF)mRNA表达,Western blot法检测ER、PR、HOXA10、LIF及整合素αvβ3(Integrin αvβ3)蛋白的表达.各组其余大鼠与雄鼠交配,于妊娠第8天处死,观察大鼠胚泡着床情况.结果 与C组相比,C+A组大鼠子宫内膜发育更好,上述子宫内膜容受性的标志分子蛋白及mRNA表达水平也更接近对照组(P<0.05).结论 针刺能显著改善克罗米芬促排卵治疗导致的子宫内膜容受性不良状态,可能通过调节子宫内膜容受性的标志分子蛋白及mRNA表达而实现.     

兔VX2肝种植瘤盐酸消融治疗两周后CT灌注参数分析

目的:肝癌的盐酸消融治疗是一种局部、微创、安全、可以重复进行的治疗方法,与手术相比,能减少对正常组织的损伤,避免开腹手术对患者的打击,减少手术相关发病率和死亡率,并且花费低、住院时间短.盐酸消融对高风险、不能手术的患者很大程度上能起到代替手术的作用.目前,在评估盐酸消融疗效方面还存在争议,但是随着技术的进步和经验的累积,盐酸消融必将在腹部肿瘤的治疗中有着更加广阔的前景.本实验通过建立兔VX2肝种植瘤模型探讨了不同时相VX2肿瘤的CT灌注参数特征,为进一步评价功能影像学在肝种植瘤盐酸消融疗效预测提供实验依据,探讨血流动力学参数对盐酸消融治疗疗效预测的可能性及血流动力学参数变化的特点.本实验通过观察兔肝VX2种植瘤盐酸消融治疗2周后CT灌注参数的变化及盐酸消融组(治疗组)与空白对照组(对照组)CT灌注参数的变化进而为临床肝癌治疗提供科学的依据.方法:新西兰大白兔20只,采用组织块种植法制成兔肝VX2模型,随机分为治疗组和对照组,2周后治疗组兔接受盐酸消融治疗.于治疗后14 d分别对两组行CT灌注扫描动态监测.选取肿瘤中央区、周边区和瘤周正常肝组织的感兴趣区(ROI),分别测量灌注值(PV)、强化峰值增量(PEI)、达峰值时间(TTP)、血容量(BV).统计学处理采用独立样本的t检验及自身配对t检验分析治疗组与对照组及每组自身灌注参数的变化.结果:治疗组与对照组肿瘤中央区及瘤周区PV、PEI、BV存在明显差异(P＜0.05);治疗组与对照组肿瘤中央区及瘤周区TTP无显著差异(P＞0.05).结论:PV、PEI、BV灌注参数的变化可以反映兔VX2肝移植瘤内部血流动力学的差异,早期区别肿瘤细胞血流稀疏区和增殖旺盛的集区,为从微观角度观察兔VX2肝移植瘤盐酸消融提供了基础,对临床盐酸消融患者提高生活质量及远期预后意义重大.     

De-qi, not psychological factors, determines the therapeutic efficacy of acupuncture treatment for primary dysmenorrhea

<正>Objective:To study the impact of De-qi(得气,obtaining qi) and psychological factors on the efficacy of acupuncture treatment for primary dysmenorrhea,with an attempt to explore the relationship among De-qi, psychological factors,and clinical efficacy.Methods:The patients with primary dysmenorrhea were randomly assigned to a group of acupuncture with manual manipulation(manipulation group,n=67) and an acupuncture group without manipulation(non-manipulation group,n=64).Pain intensity and pain duration were used as measures for evaluating the therapeutic efficacy of the acupuncture treatment.De-qi,the sensations a patient experienced during the acupuncture treatment,was scored on a 4-point scale by the subjects.In addition,the psychological factors,including belief in acupuncture,the level of nervousness,anxiety,and depression,were quantitatively assessed.The personality of the subject was assessed using the Eysenck personality questionnaire (EPQ) and 16 personality factor questionnaire(16PF).Results:Complete data were obtained from 120 patients,60 patients in each group.There were statistically significant differences in pain intensity(W=2410.0,P0.01) and pain duration(W=3181.0,P0.01) between the two groups.The number of De-qi acupoints(W=1150.5,P0.01) and the average intensity of De-qi(W=1141.0,P0.01) were significantly higher in the manipulation group as compared with their non-manipulation counterparts.The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy.Conclusions: Compared with the psychological factors,De-qi contributed more to the pain-relieving effect of acupuncture in subjects with primary dysmenorrhea.Moreover,manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations,and De-qi is critical for achieving therapeutic effects.     

敲除缝隙连接蛋白Cx 43基因对针刺抑制小鼠内脏痛反应的影响

目的:探讨缝隙连接蛋白43(Cx43)影响针刺镇痛作用的可能中枢和外周机制。方法:将野生型(WT)和Cx43基因敲除杂合子(HT)小鼠随机分为6组:WT空白对照组、WT模型组、WT针刺组、HT空白对照组、HT模型组和HT针刺组,每组18只,腹腔注射0.6%醋酸(0.1 mL/10 g)制造内脏痛模型。针刺"中脘"、双侧"足三里"穴,每5 min捻针30 s,共30 min。比较各组小鼠首次扭体潜伏期、20 min扭体反应次数。放射免疫法检测下丘脑β-内啡肽(β-EP)和血清前列腺素E2(PGE2)含量。结果:HT与WT空白对照组小鼠首次扭体潜伏期、20 min扭体反应次数、下丘脑组织β-EP和血清PGE2含量差异均无显著性意义(P>0.05)。与对照组比较,HT和WT内脏痛模型组小鼠首次扭体潜伏期明显缩短(P<0.01),20 min扭体反应次数显著增加(P<0.01),下丘脑β-EP和血清PGE2含量明显升高(P<0.05);两模型组间上述各指标差异均无显著性意义(P>0.05)。与模型组比较,WT针刺组小鼠首次扭体潜伏期明显延长(P<0.01),扭体反应次数明显减少(P<0.01),下丘脑组织β-EP含量显著升高(P<0.05),血清PGE2含量显著降低(P<0.05)。HT针刺组小鼠各项指标与模型组比较差异无显著性意义(P>0.05)。HT针刺组首次扭体潜伏期、下丘脑β-EP含量明显低于WT针刺组(P<0.05),而HT针刺组扭体反应次数和血清PGE2含量明显高于WT针刺组(P<0.05)。结论:针刺缓解腹腔内脏痛的作用可能是通过促使中枢和外周镇痛物质β-EP增加、致痛物质PGE2减少而实现的。Cx43与针刺镇痛效应有着密切联系。     

针刺对大鼠局灶性脑缺血再灌注损伤后神经元凋亡的影响

应用大脑中动脉线栓法建立脑缺血再灌注损伤模型,应用免疫组化、免疫印迹法和Tunel法分别检测海马神经元内细胞周期素(cyclin)D 1的表达和细胞凋亡。结果:再灌注48 h后海马cyclin D 1表达升高,凋亡细胞增多;针刺后cyclin D 1表达和凋亡细胞明显减少(P<0.01)。认为针刺对脑缺血再灌注损伤有保护作用,其机制可能与调控细胞周期因子从而抑制凋亡有关。     

健侧颈7神经移位术修复脑卒中上肢运动功能障碍患者的围术期护理

目的:探讨健侧颈7神经根经椎前路经腓肠神经桥接转位术修复脑卒中上肢运动功能障碍患者的围术期护理方法及效果。方法:2016年1月对3例脑卒中上肢运动功能障碍患者采取健侧颈7神经根经椎前路经腓肠神经桥接转位手术,术前注重心理护理干预、风险评估及安全指导、基础病干预,术中注意手术保护,术后重点做好患侧健侧肢体正确护理、预见并发症及观察与处理、健康教育、康复锻炼指导,观察临床效果。结果:3例患者手术都获得成功,无并发症发生,患者手部屈肌痉挛有一定改善。结论:做好健侧颈7神经根经椎前路经腓肠神经桥接转位术患者的围术期护理,是保证患者手术成功的关键,可促进患者早日康复。     

MR灌注检测肺癌血流入流出率在肿瘤用药相关性研究

目的观察42例局部晚期非小细@W3er4t,胞肺癌患者MR灌注检测肺癌血流入流出率均偏低的患者行支气管动脉置管持续泵入的疗效,方法 42例患者治疗前均行MR灌注检测为流入流出率均偏低的患者,随机分成观察组(22例)和对照组(20例)。对照组采用传统支气管动脉灌注化疗,观察组行支气管动脉灌注细胞周期非特异性药物(给药速度、时间据MR检测流入流出率决定)后,再行支气管动脉置管持续泵入细胞周期特异性药物(泵药速度、时间据MR检测流入流出率决定),结果观察组CR9例(41%),PR10例(45.5%),RR(CR﹢PR)86.5%,SD 2例(9.1%),PD 1例(4.5%),对照组CR3例(15%),PR7例(35%),RR(CR﹢PR)50%,SD 5例(25%),PD 5例(25%)。结论 MR检测肺癌血流入流出率均偏低的患者行支气管动脉灌注和动脉置管持续泵入药物治疗局部晚期非小细胞肺癌近期有效率,副反应不明显,可在临床推广应用。     

Effects of Bu-Shen-An-Tai recipe and its two components on endometrial morphology during peri-implantation in superovulated mice

The aim of this study was to investigate the effect of Bu-Shen-An-Tai recipe （BSATR） and its two components （Bushen recipe, and Huoxue recipe） on endometrial morphology during peri-implantation in superovulated mice. Mice were randomly divided into five groups, including the normal （N）, model （M）, Bushen （BS）, Huoxue （HX） and Bu-Shen-An-Tai （BH） groups. The uteri were collected on day 4 of pregnancy, and the endometrium thickness, microvessel density （MVD） and number of pinopodes observed. Compared with the M group, the endometrial thickness in the BS, HX and BH groups was significantly increased and there was a significant difference in endometrial thickness between the BS and the BH groups. The mean MVD was significantly lower in the M group than in the N group, and there was a significant increase in MVD in the BS, HX and BH groups as compared with the M group. Compared with the M group, the pinopode scores in the en- dometrium were significantly increased in the HX and BH groups; and the BS group had significantly higher pinipode scores than the HX and BH groups. In conclusion, the results of the present study demonstrated that the recipes （Bushen, Huoxue and BSATR） could improve the endometrial envi- ronment by regulating the endometrial thickness, MVD and the number of pinopodes at the window of implantation. Moreover, the Huoxue recipe and the BSATR were more efficient than the Bushen recipe, with the BSATR tending to have the most beneficial effects.