应用“鸟巢”护理早产儿的临床研究

目的探讨“鸟巢”对早产儿的生命体征、胃肠功能、体质量及生长发育的影响。方法将456例早产儿按出生单双号随机分为暖箱组和鸟巢组各228例。暖箱组采用常规护理，鸟巢组在常规护理基础上加用“鸟巢”护理，即在暖箱内加放“鸟巢”，让早产儿睡在预热的“鸟巢”内，比较2组早产儿的情况。结果出生第1天，2组在呼吸、心率、进奶量、体质量方面比较差异无统计学意义（P〉0．05）。出生后第7，14天，鸟巢组早产儿呼吸、心率平稳，奶量和体质量增加快，与暖箱组比较差异有统计学意义（P〈0．05）。鸟巢组早产儿睡眠时间长，减少了体温波动，住院时间短，与暖箱组比较差异有统计学意义（P〈0．01）。结论早产儿使用“鸟巢”后，可促进疾病恢复，缩短了住院天数，有利于早产儿智力和身心发育。     

淫羊藿-五味子药对治疗非酒精性脂肪肝机制的网络药理学研究

目的:基于网络药理学探讨淫羊藿-五味子药对治疗非酒精性脂肪肝的作用靶点及机制。方法:通过中药系统药理学数据库与分析平台(TCMSP)、中医药综合数据库(TCMID)获取淫羊藿和五味子的化学成分和靶点,并构建成分-靶点网络,其中化学成分的筛选条件为口服生物利用度(OB)≥30%和类药性(DL)≥0.18。通过GenCards和OMIM数据库筛选出淫羊藿-五味子治疗非酒精性脂肪肝的潜在作用靶点。利用Cytoscape软件构建疾病-成分-靶点之间网络图,进一步进行基因本体(GO)富集分析和京都基因和基因组百科全书(KEGG)富集分析。结果:共筛选出药效成分31个,药物与疾病作用交集靶点69个,涉及109条通路,显示“淫羊藿-五味子”可能通过作用于IL6、AKT1、CXCL8等关键靶点,主要参与转录正调控DNA模板、免疫应答、细胞对肿瘤坏死因子的反应等生物学过程,从而调节AGE-RAGE、NAFLD等通路,达到治疗作用。结论:通过中药网络药理学,初步探讨出“淫羊藿-五味子”治疗非酒精性脂肪肝的作用机制,为下一步实验验证提供基础。     

管氏两仪生化六法针刺手法探微

文章阐述了管氏两仪生化六法的源流,论述管氏两仪生化六法的适应证与手法操作,分析阳中隐阴、阴中隐阳、龙虎交战、子午捣臼、龙虎升降、凤凰展翅针刺手法的学术特点,结合典型病案举例,阐述管氏针灸学术流派两仪生化六法的手法特点和临床应用,探讨名老中医学术经验。     

Immediate effects of scalp acupuncture with twirling reinforcing manipulation on hemiplegia following acute ischemic stroke：a hidden association study

Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the speciifc lines between the bilateralBaihui(GV20) andTaiyang (EX-HN5). We collected neurologic deifcit score, simpliifed Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-relfex to the maximal M-wave (Hmax/Mmax), muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artiifcial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of “Deifciency and Excess”. The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and neg-ative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was > 0 or < 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acu-puncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, relfected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.     

如意金黄散茶调治疗老年患者PICC置管术后发生静脉炎的疗效观察

目的 探讨如意金黄散茶调治疗老年患者PICC置管术后静脉炎的疗效.方法 将42例PICC置管术后长期输注化疗药物出现静脉炎的老年血液肿瘤病患者随机分成两组,治疗组21例,采用如意金黄散与温茶水调敷的方法治疗处理;对照组21例,接受超短波治疗与局部护理.观察两组治疗后静脉炎恢复情况.结果 治疗组静脉炎的治愈率(85.71%)明显高于对照组(28.57%),差异有统计学意义(P<0.01).结论 如意金黄散茶调对老年患者PICC置管术后发生的静脉炎有良好的治疗效果.     

Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial

Background: Neck pain is a frequent complaint in office workers. This pain can be caused by myofascial trigger points (MTrPs) in the trapezius muscle. This study aimed to determine the effectiveness of deep dry needling (DDN) of active MTrPs in the trapezius muscle.

Methods: A randomized, single blinded clinical trial was carried out at the Physical Therapy Department at Physiotherapy in Women's Health Research Group at Physical Therapy Department of University of Alcalá, in Alcalá de Henares, Madrid, Spain. Forty-four office workers with neck pain and active MTrPs in the trapezius muscle were randomly allocated to either the DDN or the control group (CG). The participants in the DDN group were treated with DDN of all MTrPs found in the trapezius muscle. They also received passive stretch of the trapezius muscle. The CG received the same passive stretch of the trapezius muscle only. The primary outcome measure was subjective pain intensity, measured using a visual analogue scale (VAS). Secondary outcomes were pressure pain threshold (PPT), cervical range of motion (CROM) and muscle strength. Data were collected at baseline, after interventions and 15?days after the last treatment.

Results: Differences were found between the DDN group and the CG for the VAS (P?P?P?P?Discussion: Deep dry needling and passive stretch seems to be more effective than passive stretch only. The effects are maintained in the short term. The results support the use of DDN in the management of trapezius muscle myofascial pain syndrome in neck pain.     

Renal damage caused by warm ischaemia during laparoscopic and robot-assisted partial nephrectomy: an assessment using Tc 99m-DTPA glomerular filtration rate

Background

Few studies assessing the functional change of each kidney following warm ischaemia after partial nephrectomy are available.

Objectives

Our aim was to identify the effects of the warm ischaemic time (WIT) on renal function after partial nephrectomy under the pneumoperitoneum.

Design, setting, and participants

Forty-four consecutive patients who underwent laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RAPN) from June 2008 to May 2009 for a single cT1 renal tumour were included in this prospective protocol.

Measurements

Technetium Tc 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scintigraphy was used to determine the glomerular filtration rate (GFR) of both kidneys and each kidney individually. Tc 99m-DTPA GFR was performed preoperatively and 3 mo postoperatively. In addition, we analysed Tc 99m-DTPA scintigraphy GFR regionally in the healthy areas of the affected kidney.

Results and limitations

Patients with WIT >28 min had a significantly greater decrease in the GFR of the affected kidney (p = 0.031). The GFR of the affected kidney showed a significant decrease perioperatively (46.4 ± 14.3 to 37.9 ± 11.9 ml/min per 1.73 m²; p = 0.003). The functional change of the nonaffected kidney showed an increasing trend (47.5 ± 13.8 to 51.4 ± 14.3 ml/min per 1.73 m²), although it was not statistically significant (p = 0.103). Regional Tc 99m-DTPA GFR of both affected kidney and nonaffected kidney showed no significant differences perioperatively (6.3 ± 1.8 to 6.1 ± 1.9 ml/min per 1.73 m²; p = 0.641; 6.6 ± 1.9 to 7.1 ± 2.0 ml/min per 1.73 m²; p = 0.200). On multivariate analysis, preoperative GFR, resected volume of marginal healthy tissue, and WIT were independent predictors for functional reduction of the affected kidney (p < 0.05). The study was limited by small numbers and short follow-up periods.

Conclusions

Stationary overall renal function after LPN or RAPN is masked possibly by functional compensation of the contralateral healthy kidney. The damage of the affected kidney estimated by scintigraphy occurs when WIT exceeds 28 min during partial nephrectomy under the pneumoperitoneum.     

Every Minute Counts When the Renal Hilum Is Clamped During Partial Nephrectomy

Background

The safe duration of warm ischemia during partial nephrectomy remains controversial.

Objective

Our aim was to evaluate the short- and long-term renal effects of warm ischemia in patients with a solitary kidney.

Design, setting, and participants

Using the Cleveland Clinic and Mayo Clinic databases, we identified 362 patients with a solitary kidney who underwent open (n = 319) or laparoscopic (n = 43) partial nephrectomy using warm ischemia with hilar clamping.

Measurements

Associations of warm ischemia time with renal function were evaluated using logistic or Cox regression models first as a continuous variable and then in 5-min increments.

Results and limitations

Median tumor size was 3.4 cm (range: 0.7–18.0 cm), and median ischemia time was 21 min (range: 4–55 min). Postoperative acute renal failure (ARF) occurred in 70 patients (19%) including 58 (16%) who had a glomerular filtration rate (GFR) <15 ml/min per 1.73 m² within 30 d of surgery. Among the 226 patients with a preoperative GFR ≥ 30 ml/min per 1.73 m² and followed ≥30 d, 38 (17%) developed new-onset stage IV chronic kidney disease during follow-up. As a continuous variable, longer warm ischemia time was associated with ARF (odds ratio: 1.05 for each 1-min increase; p < 0.001) and a GFR < 15 (odds ratio: 1.06; p < 0.001) in the postoperative period, and it was associated with new-onset stage IV chronic kidney disease (hazard ratio: 1.06; p < 0.001) during follow-up. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of partial nephrectomy in a multivariable analysis. Evaluating warm ischemia in 5-min increments, a cut point of 25 min provided the best distinction between patients with and without all three of the previously mentioned end points. Limitations include the retrospective nature of the study.

Conclusions

Longer warm ischemia time is associated with short- and long-term renal consequences. These results suggest that every minute counts when the renal hilum is clamped.     

Robot-Assisted Partial Nephrectomy: An International Experience

Background

Robot-assisted partial nephrectomy (RAPN) is emerging as a viable approach for nephron-sparing surgery (NSS), though many reports to date have been limited by evaluation of a relatively small number of patients.

Objective

We present the largest multicenter RAPN experience to date, culling data from four high-volume centers, with focus upon functional and oncologic outcomes.

Design, setting, and participants

A retrospective chart review was performed for 183 patients who underwent RAPN at four centers between 2006 and 2008.

Surgical procedure

RAPN was performed using methods outlined in the supplemental video material. Though operative technique was similar across all institutions, there were minor variations in trocar placement and hilar control.

Measurements

Perioperative parameters, including operative time, warm ischemic time, blood loss, and perioperative complications were recorded. In addition, we reviewed functional and oncologic outcomes.

Results and limitations

Mean age at treatment was 59.3 yr. Mean tumor size was 2.87 cm. Mean total operative time was 210 min while mean ischemic time was 23.9 min. Calyceal repair was required in 52.1% of procedures. Mean estimated blood loss was 131.5 ml. Sixty-nine percent of excised tumors were malignant, of which 2.7% exhibited positive surgical margins. The incidence of major complications was 8.2%. At up to 26 mo follow-up, there have been no documented recurrences and no significant change in serum creatinine (1.03 vs 1.04 mg/dl, p = 0.84) or estimated glomerular filtration rate (eGFR) from baseline (82.2 vs 79.4 mg/ml per square meter, p = 0.74). The study is limited by its retrospective nature, and the outcomes are likely influenced by the robust prior laparoscopic renal experience of each of the surgeons included in this study.

Conclusions

RAPN is a safe and efficacious approach for NSS, offering short ischemic times, as well as perioperative morbidity equivalent to other standard approaches. Moreover, RAPN is capable of providing patients with excellent functional and oncologic outcomes.     

温通针法治疗腰椎管狭窄症临床观察

目的观察温通针法和普通针刺治疗腰椎管狭窄症（LSS）疗效差异性,提倡临床运用针刺手法。方法 154例LSS患者按随机数字表随机分为对照组（77例）和治疗组（77例）,在治疗前后采用LSS症状体征评分、脊髓功能评分、生活质量评分、疗效、随访等方面比较。结果两种方法治疗LSS在症状体征评分、脊髓功能评分、生活质量评分、疗效、随访等方面有差异（P〈0.05）。结论 两种针刺方法对LSS都有治疗作用,温通针法疗效优于普通针刺方法,且疗效较稳定。