奥曲肽治疗对食管胃底静脉曲张出血的肝静脉压力梯度及血流速度的影响观察

目的:观察奥曲肽治疗肝硬化门静脉高压食管胃底静脉曲张出血肝静脉压力梯度(HVPG)等的变化,探讨奥曲肽止血机制.方法:采用随机对照的方法,病例分为低剂量奥曲肽治疗组(A组,n=18);高剂量奥曲肽治疗组(B组,n=18)和对照组(C组,n =18).治疗肝硬化食管胃底静脉曲张出血,在基础治疗(禁食、输液、输血、对症处理)的基础上,全部病例予以奥美拉唑注射液40 mg,每12h1次静脉滴注抑酸.治疗组A、B组分别以奥曲肽注射液25、50 μg/h的速度微泵静脉维持治疗.观察治疗前后HVPG,门静脉内径,血流速度及呕血、黑便等的改变情况.结果:治疗前与治疗后24、72 h,两治疗组HVPG比较对照组显著降低,有统计学差异(P =0.00,P=0.00).而治疗组A、B治疗后24 h HVPG有统计学差异(P=0.00),治疗后72 h HVPG无统计学差异(P=0.14).治疗组比较对照组门静脉内径减小有统计学差异(P＜0.05);治疗组A、B与对照组在治疗24、72 h呕血,黑便量相比较明显减少,有统计学差异(P＜0.05).结论:奥曲肽能显著降低HVPG,减少门静脉内径,较高浓度奥曲肽在24 h内疗效更快,奥曲肽联合奥美拉唑比较单独奥美拉唑止血疗效更显著.     

HPLC-DAD法测定“武当三号金银花”不同部位中芦丁和木犀草苷的含量

目的：建立HPLC－DAD法测定“武当三号金银花”不同部位中芦丁和木犀草苷的含量。方法采用Fortis Xi Phenyl柱（250 mm ×4．6 mm,5μm）;流动相为乙腈（A）—0．5％冰醋酸溶液（B）进行线性梯度洗脱;检测波长为354 nm;柱温：30℃。结果芦丁和木犀草苷在各自测定的范围内均呈良好的线性关系（r≥0．9994）,平均回收率分别为99．4％、99．3％。结论该法操作简单,灵敏度高,重现性好,为控制“武当三号金银花”不同部位芦丁和木犀草苷的质量提供了一种可靠的方法。     

MSCs 2种分离培养方法及其培养液中的 VEGF、SDF-1α浓度比较

目的：通过2种分离培养方法所得骨髓间充质干细胞（MSCs）的生长特征和微环境中细胞因子的比较,提供一种可以快速、安全、高效地为临床和实验提供大量优质MSCs的方法。方法提取C57BL／c小鼠的骨髓,分别作密度梯度离心法和全骨髓贴壁培养分离法分离培养MSCs ,通过流式细胞仪检测细胞表面CD29＋、CD31－、CD34－、CD45－表达水平,并比较各自所得细胞的生长曲线;ELISA检测培养液中的血管内皮生长因子（VEGF）、SDF‐1α浓度并比较二者的差异。结果与密度梯度离心法比较,全骨髓贴壁分离法所得原代细胞有较快的生长速度,较短的生长周期;培养液中VEGF和SDF‐1α浓度也稍高于密度梯度离心法。结论全骨髓贴壁培养法可以快速、方便、有效地为临床和实验提供大量MSCs ,所得细胞的培养环境优于密度梯度离心法,减少了对细胞功能的损害。     

圆柱螺旋弹簧横向刚度的计算方法

刚度是弹簧最重要的性能指标之一。圆柱螺旋弹簧的刚度分为纵向刚度和横向刚度两种。目前对于纵向刚度的研究较为深入,能够实现精确的计算,但对横向刚度的研究均是在假设和近似的前提下进行的,得到的横向刚度近似为常数,这与实际不吻合。本文针对横向受载的圆柱螺旋弹簧进行研究,通过力学分析建立了横向刚度的计算模型,并结合一个计算实例研究了圆柱螺旋弹簧的各参数对横向刚度的影响规律,得出具体的变化曲线,并对这些曲线进行了分析。     

中西医结合治疗强直性脊柱炎临床护理体会

目的:探讨并且规范强直性脊柱炎在中西医结合治疗中的护理方法,以提高强直性脊柱炎的临床治疗的护理效果。方法:选取我院2010年至2013年住院接受中西医结合治疗的强直性脊柱炎的患者58例,对其临床资料进行回顾性分析,按住院先后随机分为两组,对照组29例进行一般常规护理,实验组29例在一般常规护理基础上进行专业化护理,评价进行专业化护理对提高强直性脊柱炎治疗效果的影响。结果:两组强直性脊柱炎患者接受护理后在疼痛、晨僵、脊柱活动度的缓解率等方面有显著差异,实验组临床治疗效果明显高于对照组,差异有统计学意义(P<0.05)。结论:针对性的专业化护理有助于提高强直性脊柱炎的治疗效果,改善患者的生活质量,值得临床推广。     

中西医结合治疗骨折后膝关节粘连性僵硬的临床疗效

目的：探讨中西医结合治疗骨折后膝关节粘连性僵硬患者的临床效果。方法：运用随机抽样的方法选取我院2013年1月～2014年9月收治的140例骨折后膝关节粘连性僵硬患者,依据随机数字表法将这些患者分为研究组和对照组两组,各70例。给予对照组患者单纯西医治疗,给予研究组患者中西医结合治疗,然后对两组患者的临床疗效进行统计分析。结果：研究组患者中显效46例,有效22例,治疗的总有效率为97.1%（68/70）;对照组患者中显效36例,有效18例,治疗的总有效率为77.1%（54/70）。研究组患者治疗的总有效率显著高于对照组。结论：中西医结合治疗骨折后膝关节粘连性僵硬患者的临床效果显著。     

Can nurses exclude middle-ear effusion without otoscopy in young asymptomatic children in primary care?

Objective. Scandinavian guidelines recommend controlling middle-ear effusion (MEE) after acute otitis media. The study aim was to determine whether nurses without otoscopic experience can reliably exclude MEE with tympanometry or spectral gradient acoustic reflectometry (SG-AR) at asymptomatic visits. Design. Three nurses were taught to perform examinations with tympanometry and SG-AR. Pneumatic otoscopy by the study physician served as the diagnostic standard. Setting. Study clinic at primary health care level. Patients. A total of 156 children aged 6–35 months. Main outcome measures. Predictive values (with 95% confidence interval) for tympanometry and SG-AR, and the clinical usefulness, i.e. the proportion of visits where nurses obtained the exclusive test result from both ears of the child. Results. At 196 visits, the negative predictive value of type A and C1 tympanograms (tympanometric peak pressure > −200 daPa) was 95% (91–97%). Based on type A and C1 tympanograms, the nurse could exclude MEE at 81/196 (41%) of visits. The negative predictive value of SG-AR level 1 result was 86% (79–91%). Based on SG-AR level 1 results, the nurse could exclude MEE at 29/196 (15%) of visits. Conclusion. Tympanograms with tympanometric peak pressure > −200 daPa (types A and C1) obtained by nurses are reliable test results in excluding MEE. However, these test results were obtained at less than half of the asymptomatic visits and, thus, the usefulness of excluding MEE by nurses depends on the clinical setting.     

Ultrasound Diagnosis of Carotid Artery Stiffness in Patients with Ischemic Leukoaraiosis

The pathophysiology of ischemic leukoaraiosis (ILA) is unknown. It was recently found that ILA patients have increased aortic stiffness. Carotid stiffness is a more specific parameter and could have value as a non-invasive diagnostic value for ILA. Therefore, using color-coded duplex sonography, we compared local carotid stiffness parameters of 59 patients with ILA with those of 45 well-matched controls. The diagnosis of ILA was based on exclusion of other causes of white matter changes seen on magnetic resonance imaging. Pulse wave velocity β (PWVβ, m/s), pressure–strain elasticity modulus (E_p, kPa), β index and augmentation index (A_ix, %) values were higher and arterial compliance (AC, mm²/kPa) values were lower in the ILA group; however, only E_p and PWVβ reached statistical significance (p ≤ 0.05). β, E_p and PWVβ exhibited an increasing trend with higher Fazekas score, though only E_p reached significance (p = 0.05). The main conclusion was that E_p and PWVβ could have a diagnostic role in patients with ILA.