浮刺法与巨刺法结合治疗周围性面瘫急性期的疗效观察

目的观察浮刺法与巨刺法相结合治疗周围性面瘫急性期的临床疗效。方法选择周围性面瘫急性期患者62例,随机分为观察组(32例)和对照组(30例)。观察组采用浮刺法结合巨刺法治疗,对照组采用常规针刺法治疗,观察两组临床疗效。结果观察组治疗后愈显率为90.6%,对照组治疗后愈显率为66.7%,两组患者的临床疗效比较差异明显(P0.05),具有统计学意义。结论针刺治疗面瘫效果良好;在周围性面瘫急性期时,用浮刺法与巨刺法相结合治疗具有协同增效作用。     

NLRP3 inflammasome: a new therapeutic target for high-risk reproductive disorders?

The NOD-like receptor protein 3 (NLRP3) inflammasome is a key regulator of the host''s immune response, and many immune and metabolic disorders are linked to its activation. This review aimed to investigate and clarify the relationship between this inflammasome and high-risk reproductive disorders. Papers cited here were retrieved from PubMed up to August 2020 using the keywords “NLRP3” or “NALP3”, “caspase-1”, “endometriosis”, “gestational diabetes”, “interleukin (IL)-18”, “IL-1β”, “pre-eclampsia (PE)”, “preterm birth”, “polycystic ovarian syndrome (PCOS)”, “recurrent spontaneous abortion (RSA)”, and combinations of these terms. The results show that NLRP3 inflammasome is associated with various high-risk reproductive disorders and many inflammatory factors are secreted during its activation, such as IL-1β induced during the development of endometriosis. PCOS is also associated with activation of the NLRP3 inflammasome, especially in overweight patients. It also participates in the pathogenesis of RSA and is activated in fetal membranes before preterm birth. The placentas of pregnant women with PE show higher expression of the NLRP3 inflammasome, and gestational diabetes mellitus occurs simultaneously with its activation. Current evidence suggest that the NLRP3 inflammasome plays an important role in female reproductive disorders. New treatment and management methods targeting it might help reduce the incidence of such disorders and improve neonatal outcomes.     

唐巍教授针灸治疗动眼神经麻痹经验

[目的]总结分析唐巍教授针刺治疗动眼神经麻痹的中医学术思想及临床经验。[方法]通过跟师临证,整理唐巍教授医案等,对唐巍教授治疗动眼神经麻痹的辨治方法、选穴思路的独特之处加以归纳总结,并列举验案一则加以佐证。[结果]唐巍教授认为动眼神经麻痹总属先天不足,脏腑气血失调,引起内外之风邪,从而致病,涉及经脉主要有肝、胆、膀胱、小肠、三焦、脾、肾经、阴阳跷脉。治疗上将患者按虚实分类,重视从阴阳经搭配选穴,强调滋补先后天;辨证选穴并配合交会穴、奇穴以调畅腑气、补虚泻实;刺法以平补平泻为主。所举验案中患者诊断为肝肾失养型动眼神经麻痹,病机总属因实致虚,虚实夹杂,治以滋补肝肾、平衡阴阳、调畅精气,治疗后患者症状明显改善,未见复发。[结论]唐巍教授针刺治疗动眼神经麻痹,注重平衡阴阳,调节先天后天,选穴力求精准,辨证准确,疗效突出,值得进一步深入学习和推广应用。     

先天性单眼上斜肌麻痹不同手术方式疗效观察

目的:探讨不同手术方式治疗先天性单眼上斜肌麻痹的疗效以及术后双眼视觉功能的恢复重建情况。方法:回顾性病例研究。选择2016-05/2019-05郑州市第二人民医院斜视与小儿眼科收治的82例先天性上斜肌麻痹患儿作为研究对象,根据患者第一眼位垂直斜视度、患眼下斜肌功能亢进程度、单眼及双眼运动情况等术前检查结果,设计相应的手术方式。包括下斜肌断腱术(3例)、下斜肌部分切除术(63例)、下斜肌徙后术(6例)、健眼下直肌徒后术(4例)、下斜肌减弱+对侧/同侧直肌术(5例)、上斜肌折叠术(1例)。结果:和手术前比较,手术后同时知觉、融合功能、远立体视、近立体视、矫正视力、代偿头位均得到明显改善(P<0.05);有无代偿头位患儿手术后立体视无差异(P>0.05)。结论:根据先天性单眼上斜肌麻痹病情严重程度选择不同的手术方式,在改善患儿视力、代偿头位方面具有积极意义,有助于重建双眼视觉功能。     

早期激素治疗颅底骨折致迟发性面瘫的临床疗效

目的：观察颅底骨折致迟发性面瘫患者早期皮质激素治疗的疗效。方法回顾性分析颅底骨折致迟发性面瘫患者38例,早期（人院后立即给予）激素治疗20例,发现面瘫后给予激素治疗18例。治疗时间均1～2周,其他治疗相同。结果38例患者经保守治疗后均好转恢复,早期激素治疗的患者有效率95.0％（19/20）,恢复时间快;发现面瘫后给予激素治疗的有效率77.8％（14/18）,恢复时间慢。结论颅底骨折致迟发性面瘫患者早期激素治疗,可以明显提高迟发性面瘫患者的临床疗效。     

康复训练联合高压氧治疗手足口病所致弛缓性麻痹的疗效研究

目的探讨康复训练联合高压氧治疗手足口病所致弛缓性麻痹的疗效。方法将70例手足口病所致弛缓性麻痹患儿随机分为治疗组和对照组,每组各35例。对照组予隔离、抗感染、营养支持、护脑、鼠神经生长因子穴位注射等常规治疗,治疗组在对照组基础上加用康复训练及高压氧。通过徒手肌力评定、日常生活活动能力(ADL)评定和FMA运动功能评分评定疗效。结果治疗组肌力恢复程度好于对照组,BI指数评分、FMA评分均高于对照组,差异有统计学意义(P0.05)。结论康复训练联合高压氧治疗手足口病所致弛缓性麻痹可明显提高麻痹肢体的肌力,提高患儿BI指数评分及FMA评分,减轻致瘫致残比例,提高患儿日常生活能力,其总体效果优于常规治疗。     

TACE后二期手术治疗小肝癌破裂出血的临床研究

目的 探讨小肝癌破裂出血行TACE后二期手术的治疗效果.方法 21例小肝癌破裂出血患者先行TACE治疗,并于1～2个月后行手术切除（联合治疗组）;同时以18例小肝癌破裂出血患者行急诊手术切除作为对照（对照组）;比较两组止血成功率、围手术期输血量、住院病死率、术后并发症、术后生存率和住院天数.结果 两组患者止血成功率均为100％,联合治疗组与对照组相比围手术期输血量少、并发症发生率低、住院天数短,差异有统计学意义（P＜ 0.01）,但病死率和生存率无差异（P＞0.05）.结论 TACE治疗后二期手术治疗小肝癌破裂出血虽然不能延长患者生存时间,但更具安全性,是临床值得应用的治疗方法.     

原发卵巢癌致自发性肾盂破裂1例报告并文献复习

目的:探讨自发性肾盂破裂的临床特点。方法:回顾1例自发性肾盂破裂女性患者的临床资料,并结合文献分析其常见病因、机制和诊治方法。结果:通过静脉肾盂造影及逆行造影明确尿外渗,MRI对病因的诊断提供了帮助,通过经皮肾穿刺造瘘解决了尿外渗的问题。结论:肾盂自发性破裂临床少见,恶性肿瘤是其病因之一,对于此类患者,经皮肾穿刺造瘘是较好的治疗方法。     

The Elevated High-Sensitivity Cardiac Troponin T Pilot: Diagnoses and Outcomes

ObjectiveTo identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values.Patients and MethodsConsecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed.ResultsOf 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these “missed” patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction.ConclusionThere were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non–ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values.     

电视辅助胸腔镜手术早期治疗首次发作原发性自发性气胸的研究——附273例报告

目的:探讨电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在早期干预治疗首次发作原发性自发性气胸(primary spontaneous pneumothorax,PSP)的临床价值.方法:按手术前接受保守治疗方法的不同将273例首次发作PSP患者分为3组,其中,直接行VATS治疗的104例为A组、行胸腔穿刺术抽气治疗后再行VATS治疗的113例为B组、行胸腔闭式引流术治疗后再行VATS治疗的56例为C组.对3组的手术时间、胸腔引流时间、术后持续发热时间、白细胞恢复正常时间、住院时间、气胸复发率、复张后肺水肿发生率、术后漏气发生率、镜视肺大疱检出率、病理肺大疱检出率、胸腔感染率、伤口感染率、中转开胸率及治疗费等指标进行回顾性对比分析.结果:与B组、C组比较,A组的手术时间、胸腔引流时间、术后持续发热时间、白细胞恢复正常时间、住院时间均较短(均为P＜0.05);气胸复发率、复张后肺水肿的发生率、术后漏气发生率、胸腔感染率、伤口感染率及治疗费用均较低(均为P＜0.05);而镜视肺大疱检出率、病理肺大疱检出率和中转开胸率差异无统计学意义.结论:应用VATS早期干预治疗首次发作PSP可明显缩短病人治疗时间,减轻病人痛苦,减少并发症的发生率及降低病人的治疗费用,值得临床推广使用.