国医大师刘柏龄治疗脊髓型颈椎病用药规律探析＊

目的 挖掘、分析国医大师刘柏龄治疗脊髓型颈椎病的用药特点及组方规律。方法 收集120份符合纳入标准的刘柏龄教授治疗脊髓型颈椎病的验案，利用Epidata 3.0软件建立方药数据库，使用IBM SPSS Modeler 18.2软件中基于关联规则的Apriori算法，对处方中的中药及其分类的使用频次、中药之间的应用关系进行分析。结果 纳入处方共涉及中药104味，其中使用频次较高的中药依次为黄芪、当归、附子、丹参、赤芍等，用药以补虚药、活血化瘀药、祛风湿药、平肝息风药为主，辅以解表、温里、化湿等药。在关联规则集中，在支持度20%和置信度90%的情况下分析得到二阶、三阶和四阶关联规则，核心药物群包括黄芪、当归、赤芍、附子、红花、桃仁、鸡血藤、地龙、川芎等。结论 刘柏龄治疗脊髓型颈椎病用药具有补虚祛邪并重的鲜明特点，主要采取益气温里助阳、活血化瘀通络、补肾强骨、祛除风湿之邪的治疗原则。     

Prognosis impact of posttreatment pelvic MRI in patients treated for stage IB2-IIB cervical cancer with chemoradiation therapy

ObjectivesTo evaluate the performances of systematic posttreatment pelvic magnetic resonance imaging (PPMRI) in predicting prognosis of patients treated with chemoradiation therapy (CRT) for locally advanced cervical cancer (LACC).Materials and methodsMulti-institutional data from 216 patients presenting FIGO IB2-IIB cervical cancer for which PPMRI was performed following CRT were retrospectively reviewed. Incomplete response was defined as the identification of persistent lesion on PPMRI. Primary endpoints were patients’ 5-year recurrence free (RFS) and overall (OS) survivals. Secondary endpoint was the identification of residual histologic disease on hysterectomy specimens when completion surgery was performed.ResultsPPMRI identified an incomplete response in 102 (47.2%) cases. A 70% or more reduction in tumor size on PPMRI was identified as the best predictive cut-off for recurrence (37.7% sensitivity and 78.7% specificity) and death (50% sensitivity and 77.9% specificity) with significant impact on those risks (HRa: 0.42; 95%CI: 0.23–0.77 and HRa: 0.18; 95%CI: 0.06–0.50, respectively). Completion hysterectomy was performed in 117 (54.4%) cases, with histologic residual disease in 55 (47.4%). PPMRI demonstrated 74.5% sensitivity and 50.8% specificity in predicting residual disease. Although survival of patients with complete response at PPMRI was not impacted by completion hysterectomy, it significantly increased 5-year RFS and OS of those with incomplete response: 38.7% vs. 65.3% (p < 0.001) and 63% vs. 82.9% (p = 0.038), respectively.ConclusionA 70% or more reduction of in tumor size on PPMRI following CRT in patients with LACC is predictive of RFS and OS. PPMRI could help triaging patients who could benefit from completion hysterectomy.     

Lateral Corticospinal Tract and Dorsal Column Damage: Predictive Relationships With Motor and Sensory Scores at Discharge From Acute Rehabilitation After Spinal Cord Injury

ObjectiveTo determine if lateral corticospinal tract (LCST) integrity demonstrates a significant predictive relationship with future ipsilateral lower extremity motor function (LEMS) and if dorsal column (DC) integrity demonstrates a significant predictive relationship with future light touch (LT) sensory function post spinal cord injury (SCI) at time of discharge from inpatient rehabilitation.DesignRetrospective analyses of imaging and clinical outcomes.SettingUniversity and academic hospital.ParticipantsA total of 151 participants (N=151) with SCI.InterventionsInpatient rehabilitation.Main Outcome MeasuresLEMS and LT scores at discharge from inpatient rehabilitation.ResultsIn 151 participants, right LCST spared tissue demonstrated a significant predictive relationship with right LEMS percentage recovered (β=0.56; 95% confidence interval [CI], 0.37-0.73; R=0.43; P<.001). Left LCST spared tissue demonstrated a significant predictive relationship with left LEMS percentage recovered (β=0.66; 95% CI, 0.50-0.82; R=0.51; P<.001). DC spared tissue demonstrated a significant predictive relationship with LT percentage recovered (β=0.69; 95% CI, 0.52-0.87; R=0.55; P<.001). When subgrouping the participants into motor complete vs incomplete SCI, motor relationships were no longer significant, but the sensory relationship remained significant. Those who had no voluntary motor function but recovered some also had significantly greater LCST spared tissue than those who did not recover motor function.ConclusionsLCST demonstrated significant moderate predictive relationships with lower extremity motor function at the time of discharge from inpatient rehabilitation, in an ipsilesional manner. DC integrity demonstrated a significant moderate predictive relationship with recovered function of LT. With further development, these neuroimaging methods might be used to predict potential deficits after SCI and to provide corresponding targeted interventions.     

颈椎横突后结节间沟神经阻滞麻醉治疗颈椎间盘突出的效果

目的研究颈椎横突后结节间沟神经阻滞麻醉治疗颈椎间盘突出的效果。方法60例颈椎间盘突出患者,根据随机分配法将其分为实验组和参照组,每组30例。参照组患者在基础检查后实施颈椎后根神经阻滞麻醉治疗,实验组患者在基础检查以后实施颈椎横突后结节间沟神经阻滞麻醉治疗。比较两组患者治疗后日本骨科协会评估治疗分数(JOA)评分、复发及不良反应发生情况、治疗效果。结果治疗后,实验组患者临床症状、临床检查以及日常生活评分分别为(24.38±5.19)、(25.01±4.39)、(26.34±2.94)分,均高于参照组的(13.29±5.37)、(15.34±5.49)、(15.97±4.13)分,差异均具有统计学意义(P<0.05)。实验组复发率3.33%、不良反应发生率6.67%均低于参照组的20.00%、26.67%,差异具有统计学意义(χ²=4.043、4.320,P=0.044、0.038<0.05)。实验组优良率93.33%高于参照组的73.33%,差异具有统计学意义(χ²=4.320,P=0.038<0.05)。结论在颈椎间盘突出治疗中,实施颈椎横突后结节间沟神经阻滞麻醉治疗可以明显改善患者的临床症状,具有很高的临床应用价值。     

The retrospective study for effectiveness of cervical cerclage in preventing recurrent preterm birth

ObjectiveThis study aimed to clarify the effectiveness of cervical cerclage in preventing recurrent preterm births.Materials and methodsA retrospective study was conducted using the perinatal registration database of the Japan Society of Obstetrics and Gynecology for the Perinatal Center from 2014 to 2016. The efficacies of history-indicated, ultrasound-indicated, and physical examination-indicated cerclage as preventive treatments for women with a history of preterm birth were evaluated by comparing cerclage and non-cerclage cases. Fisher's exact test was performed to evaluate any significant differences in patient backgrounds. Prior to the evaluation, propensity score matching was performed for history-indicated and ultrasound-indicated cerclage patients.ResultsFor this study, 6060 multiparous women with a history of preterm birth were reviewed. After excluding 17 patients with unknown indications for cervical cerclage, 6043 patients were included in the study. History-indicated and ultrasound-indicated cerclage did not reduce the risk of preterm birth in subsequent pregnancies for any of the pregnancy periods (p = 0.413, p = 1.000). In contrast, physical examination-indicated cerclage significantly reduced the risk of subsequent preterm births for all pregnancy periods (p < 0.001).ConclusionSubsequent preterm births were effectively prevented only in physical examination-indicated cerclage cases. For history- or ultrasound-indicated cerclage, statistically significant differences in subsequent preterm births were not evident.     

宫颈癌合并梅毒螺旋体抗体阳性患者的临床分析与护理

目的 总结宫颈癌患者合并梅毒护理过程中的经验和体会.方法 回顾性分析2008年1月 -2011年12月我院妇瘤外科收治的宫颈癌合并梅毒住院患者34例.结果 我科住院拟手术治疗患者宫颈癌329例中 ,梅毒螺旋体抗体阳性者共34例.结论 宫颈癌患者合并梅毒为常见病 ,有效的护理干预提高了宫颈癌合并梅毒感染患者的生活质量 ,规范了临床工作的流程及降低了医护人员职业暴露的发生率.     

Tumor‐associated macrophages induce lymphangiogenesis in cervical cancer via interaction with tumor cells

Our studies were conducted to investigate the clinical and functional significance of tumor‐associated macrophages (TAMs) in cervical tumor lymphatic metastasis. We found that the increase in macrophages in tumor stroma is significantly associated with lymphatic metastasis (p = 0.017), through performing immunohistochemical staining in 111 cervical samples (55 invasive squamous carcinomas of uterine cervix, 27 cervical intraepithelial neoplasms III, and 29 normal cervix). The human lymphatic endothelial cells (HLEC), which were cultured in conditioned medium of cervical cancer cell‐macrophage coculture, formed more tube‐like structures in vitro, when compared with those in conditioned mediums of LEC, normal cervical epithelium, single macrophage, and single cervical cancer cell (all p < 0.001). The mRNA expressions of IL‐1β and IL‐8 in cervical cancer cells cocultured with macrophages were increased, compared with those in cervical cancer cell cultured alone (p_IL‐1β < 0.05 and p_IL‐8 < 0.01). Meanwhile, the mRNA expression of VEGF‐C and VEGF‐A was increased in macrophages cocultured with cervical cancer cells, compared with the expression in those macrophages cultured alone (both p < 0.05). Taken together, the results suggest that TAMs promote lymphangiogenesis mainly through interaction with surrounding cervical cancer cells.     

Extensive cervical prevertebral haemorrhage with airway obstruction after low-energy hyperextension injury

A 45-year-old man developed a massive prevertebral cervical haematoma after a low-energy hyperextension trauma with an anterior teardrop fracture of the C4 vertebra. He required urgent nasotracheal intubation because of acute respiratory obstruction. During surgical removal of the haematoma, a small segmental artery arising from the vertebral body of C4 was identified as the source of the bleeding. The anterior longitudinal ligament was intact. The patient recovered uneventfully and was discharged six days after surgery without neurological sequelae.Large prevertebral retropharyngeal hematomas in non-geriatric patients after low-energy cervical hyperextension injury are very rare, especially when the discoligamentary structures are intact. This is, to our knowledge, the first report of a small segmental artery being identified as the source of acute bleeding in such circumstances. The treatment team must be alert to the possibility of a prevertebral haematoma when dyspnoea and dysphonia arise a short time after a cervical hyperextension injury, even in cases of low-energy trauma.     

瘦素及其受体在宫颈癌浸润、转移中的表达

目的：观测不同分组宫颈癌组织中瘦素及其受体的表达。方法宫颈癌患者依照病理分为 A 组（正常宫颈组织）20例；B 组（无周围淋巴结侵润的宫颈癌组织）23例；C 组（无远位转移但有淋巴结周围淋巴结转移的宫颈癌组织）19例及 D 组（有远位转移的宫颈癌组织）18例。采用免疫组化 S_p 方法检测不同分组宫颈癌组织中的瘦素及瘦素受体的表达，用光密度值对其进行测定。结果瘦素表达：A 组175,45±14,07，B 组146,93±12,31，C 组125,12±17,05，D 组103,23±15,09。组间比较差异均有统计学意义（ p ＜0,05）。瘦素受体表达：A 组169,56±11,78，B 组143,93±10,56，C 组124,07±14,87，D 组101,45±19,34。各组间比较除 B 组与 C 组比较差异无统计学意义（p ＞0,05），其余各组比较差异均有统计学意义（p ＜0,05）。结论瘦素及其受体在不同分组组织中的表达依次升高，提示瘦素及其受体促进宫颈癌的转移、复发。