重灸中脘穴对脾胃虚寒型糖尿病胃轻瘫患者胃肠激素、胃动力学的影响

目的观察重灸中脘穴对脾胃虚寒型2型糖尿病胃轻瘫患者胃肠激素、胃动力学的影响。方法选取符合纳入标准的88例脾胃虚寒型糖尿病胃轻瘫患者,按随机数字表法分为治疗组和对照组,每组44例。对照组采用常规药物治疗,治疗组采用重灸中脘穴治疗。疗程结束后记录并对比分析两组临床疗效、胃肠激素[胃泌素(GAS)、胃动素(MTL)]、胃动力学(胃收缩频率、胃排空时间、胃排空率)、主要临床症状评分等变化。结果治疗组临床疗效明显优于对照组,差异具有统计学意义(P<0.05);两组治疗后GAS、MTL均明显优于治疗前(P<0.05),且治疗组明显优于对照组(P<0.05);两组治疗后胃收缩频率、胃排空时间、胃排空率均明显优于治疗前(P<0.05),且治疗组明显优于对照组(P<0.05);两组治疗后主要临床症状评分均明显优于治疗前(P<0.05),且治疗组明显优于对照组(P<0.05)。结论在常规药物治疗基础上重灸中脘穴治疗脾胃虚寒型2型糖尿病胃轻瘫,可调节胃肠激素,改善胃肠动力,促进胃肠功能恢复。     

Dynamic Indicators That Impact the Outcomes of Thoracic Endovascular Aortic Repair in Complicated Type B Aortic Dissection

PurposeTo investigate dynamic variables obtained from retrospective computed tomography angiography for ability to predict thoracic endovascular aortic repair (TEVAR) outcomes in patients with complicated type B aortic dissection (cTBAD).Materials and MethodsSeventy-nine patients with cTBAD who received TEVAR from March 2009 to June 2018 were retrospectively enrolled. Relative true lumen area (r-TLA) was computed at the level of tracheal bifurcation every 5% of all R-R intervals. Parameters that reflect the state of intimal motion were evaluated, including difference between maximum and minimum r-TLA (D-TLA) and true lumen collapse. The endpoints comprised early (≤ 30 days) and late (> 30 days) outcomes after intervention.ResultsOverall early mortality rate was 13.9% (11/79), and early adverse events rate was 24.1% (19/79). Patients who received TEVAR within 2 days of symptom onset demonstrated the worst outcomes. A longer time of r-TLA < 25% in 1 cardiac cycle (P = .049) and larger D-TLA (P < .001) were correlated to an increased early death. In addition, D-TLA was an independent predictor of early mortality. Area under the curve of D-TLA was 0.849 (95% confidence interval 0.730–0.967) for predicting early mortality and 0.742 (95% CI 0.611–0.873) for predicting early adverse events. Survival and event-free survival rates during follow-up were decreased in the D-TLA > 21.5% group compared with the D-TLA ≤ 21.5% group (all P < .001).ConclusionsLarger D-TLA is correlated with worse postoperative outcomes and might be a crucial parameter for future risk stratification in patients with cTBAD.     

基于“凡土脏取决于胆”议从胆论治阿尔茨海默病

阿尔茨海默病(Alzheimer’s Disease,AD)归属于中医"痴呆""呆病""健忘"等范畴,历代医家认为此病多以肾精失养,髓海空虚为主要病机,治疗多从脾、肾两脏着手,鲜有提及从胆论治。从中医学"凡土脏取决于胆"理论切入,以土脏与AD发病的关系为着眼点,并结合胆内藏精汁,助脾胃腐熟运化水谷;胆主升清降浊,疏利中土;胆内寄相火,参与腐熟水谷的生理功能和特性,阐述从胆论治AD的理论基础,以期为中医临床更加有效的防治阿尔茨海默病提供参考。     

预见习在精神病学教学中的作用研究

目的探讨预见习在精神病教学中的作用。方法选取120名本科学生,随机分为预见习组(n=60)和对照组(n=60)。预见习组在学习精神病学理论课程前一学期开始实施带教老师带领学生预见习、见习、实习全程教学,对比两组学生实践操作、理论知识成绩和学生满意度。结果干预后,导师制预见习组实践操作和理论知识成绩显著高于对照组(P<0.05)。导师制预见习组学生满意度显著高于对照组(P<0.05)。结论预见习教学有助于学生全面发展,提高精神病学教学水平。     

Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients

ObjectiveConventional deep brain stimulation (DBS) systems with ring-shaped leads generate spherical electrical fields. In contrast, novel directional leads use segmented electrodes. Aim of this study was to quantify the impedance variations over time in subjects with the directional Cartesia-Boston® system.MethodsImpedance records, programming settings, and clinical data of 11 consecutive Parkinsonian patients implanted with DBS directional leads in two Italian centers (Udine and Vicenza) were retrospectively evaluated. Data were collected before starting stimulation (in the operating room and at days 5 and 40) and after switching stimulation on at the successive follow-up visits (1, 6 and 12 months).ResultsDirectional leads have significantly higher impedance than ring leads. Stimulated contacts had always lower impedance compared to non-stimulated contacts. Before DBS-on, all contacts had higher impedance in the operating room, with an initial decrease five days post-surgery and a subsequent increase at day 40, more evident for directional contacts. The impedance of directional leads increased post-implantation at 1 and 6 months with a plateau at 12 months.ConclusionsThere was a significant difference between the directional and ring leads at baseline (before activation of DBS) and during follow-up (chronic DBS).SignificanceOur study reveals new information about the impedance of segmented electrodes that is useful for patient management during the initial test period, as well as during long-term DBS follow-up.     

Clinicopathological features,diagnosis, and treatment of sessile serrated adenoma/polyp with dysplasia/carcinoma

Sessile serrated adenoma/polyps (SSA/Ps) are early precursor lesions in the serrated neoplasia pathway, which results in BRAF‐mutated colorectal carcinomas with not only high levels of microsatellite instability but also microsatellite stable. SSA/Ps with advanced histology, including cytological dysplasia or minimally invasive carcinomas, are important lesions because SSA/Ps are considered major contributors to “interval cancers” and these lesions can rapidly become dysplastic or invasive carcinomas. Clinicopathologically, SSA/Ps with dysplasia or invasive carcinoma were associated with advanced age, female sex, and proximal colon. Although SSA/Ps with submucosal invasive carcinoma were smaller and invaded less deeply into the submucosal layer than conventional tubular adenomas with submucosal invasive carcinoma, SSA/Ps with submucosal invasive carcinoma frequently had a mucinous component and exhibited a higher potential for lymphatic invasion and lymph node metastasis. In an SSA/P series, endoscopic characteristics, including (semi)pedunculated morphology, double elevation, central depression, and reddishness, may help accurately diagnose SSA/Ps with advanced histology. Removal of SSA/Ps with dysplasia or invasive carcinoma was recommended. Endoscopic treatment such as endoscopic mucosal resection or endoscopic submucosal dissection is useful for those lesions. However, surgical resection with lymph node dissection might be indicated when SSA/Ps with invasive carcinoma are endoscopically suspected, because these have the high risk of lymph node metastasis. Greater awareness may promote further research into improving the detection, recognition, and complete resection rates of SSA/Ps with dysplasia or invasive carcinoma and reduce the interval cancer rates.     

Visumax飞秒激光辅助制瓣LASIK术中不透明气泡层及相关因素

目的：研究Visumax飞秒激光辅助的准分子激光原位角膜磨镶术（LASIK）术中不透明气泡层（OBL）产生的类型、相关影响因素及其临床意义。方法：回顾性分析。收集2016 年7 月1 日至8 月20 日在南京医科大学附属眼科医院行飞秒LASIK的患者154 例（300 眼）的临床资料，等效球镜度为（-5.88±1.51）D。飞秒激光采用Zeiss公司 Visumax飞秒激光仪，将术中产生的OBL分为瓣外OBL、瓣内快速OBL和瓣内慢速OBL。300 眼按角膜曲率平均K值分为A组（<42 D）、B组（42～46 D）和C组（>46 D）；按角膜瓣的厚度分为D组（100 μm）、E组（110 μm）和F组（120 μm）；按角膜厚度分为G组（<500 μm）、H组（500～540 μm）和I组（>540 μm）。统计不同角膜曲率、角膜瓣厚度、角膜厚度情况下3 种OBL产生的比例，并采用多元Logistic回归模型进行统计分析。结果：300 眼均发生OBL。以瓣外OBL作为参照，角膜瓣越薄，越容易出现瓣内快速OBL（r=-0.719，P=0.034）和瓣内慢速OBL（r=-0.875，P=0.044）。以瓣内慢速OBL作为参照，角膜曲率越高，越容易出现瓣内快速OBL（r=0.923，P=0.046）；角膜瓣越厚，越容易出现瓣外OBL（r=0.897，P=0.044）。结论：OBL的产生与角膜曲率、角膜瓣厚度、角膜厚度均存在一定的相关性，但瓣外OBL、瓣内快速OBL和瓣内慢速OBL对Visumax飞秒激光辅助的LASIK术后视觉质量的影响及远期疗效仍有待进一步观察研究。