拉莫三嗪联合丙戊酸钠治疗小儿癫痫临床观察

目的探讨拉莫三嗪联合丙戊酸钠治疗小儿癫痫的效果及安全性。方法 116例癫痫患儿根据治疗方法分为联合组（拉莫三嗪联合丙戊酸钠治疗）58例,对照组（单用丙戊酸钠治疗）58例,比较2组总治疗效果、不同癫痫发作类型的治疗效果及不良反应。结果治疗12个月后,联合组无发作36例,显效10例,有效6例,无效6例,总有效率89.7%;对照组无发作30例,显效7例,有效5例,无效16例,总有效率72.4%,2组总有效率比较差异有统计学意义（P〈0.05）;联合组治疗单纯部分发作、复杂部分发作、继发性全身发作、全身强直阵挛发作及肌阵挛发作有效率均高于对照组（P〈0.05）;不良反应发生率联合组（12.1%）与对照组（10.3%）比较差异无统计学意义（P〉0.05）。结论拉莫三嗪联合丙戊酸钠治疗各种类型癫痫效果均较好,且不良反应轻。     

Expression of 5-HT3 receptors and TTX resistant sodium channels (NaV1.8) on muscle nerve fibers in pain-free humans and patients with chronic myofascial temporomandibular disorders

Background

Previous studies have shown that 5-HT₃-antagonists reduce muscle pain, but there are no studies that have investigated the expression of 5-HT₃-receptors in human muscles. Also, tetrodotoxin resistant voltage gated sodium-channels (Na_V) are involved in peripheral sensitization and found in trigeminal ganglion neurons innervating the rat masseter muscle. This study aimed to investigate the frequency of nerve fibers that express 5-HT_3A-receptors alone and in combination with Na_V1.8 sodium-channels in human muscles and to compare it between healthy pain-free men and women, the pain-free masseter and tibialis anterior muscles, and patients with myofascial temporomandibular disorders (TMD) and pain-free controls.

Methods

Three microbiopsies were obtained from the most bulky part of the tibialis and masseter muscles of seven and six healthy men and seven and six age-matched healthy women, respectively, while traditional open biopsies were obtained from the most painful spot of the masseter of five female patients and from a similar region of the masseter muscle of five healthy, age-matched women. The biopsies were processed by routine immunohistochemical methods. The biopsy sections were incubated with monoclonal antibodies against the specific axonal marker PGP 9.5, and polyclonal antibodies against the 5-HT_3A-receptors and Na_V1.8 sodium-channels.

Results

A similar percentage of nerve fibers in the healthy masseter (85.2%) and tibialis (88.7%) muscles expressed 5-HT_3A-receptors. The expression of Na_V1.8 by 5-HT_3A positive nerve fibers associated with connective tissue was significantly higher than nerve fibers associated with myocytes (P < .001). In the patients, significantly more fibers per section were found with an average of 3.8 ± 3 fibers per section in the masseter muscle compared to 2.7 ± 0.2 in the healthy controls (P = .024). Further, the frequency of nerve fibers that co-expressed Na_V1.8 and 5-HT_3A receptors was significantly higher in patients (42.6%) compared to healthy controls (12.0%) (P < .001).

Conclusions

This study showed that the 5-HT_3A-receptor is highly expressed in human masseter and tibialis muscles and that there are more nerve fibers that express 5-HT_3A-receptors in the masseter of women with myofascial TMD compared to healthy women. These findings indicate that 5-HT₃-receptors might be up-regulated in myofascial TMD and could serve as potential biomarkers of chronic muscle pain.     

左甲状腺素钠治疗老年甲状腺功能减退症的临床疗效分析

目的探讨应用左甲状腺素钠治疗老年甲状腺功能减退症的临床疗效。方法选取2011年1月到2012年12月间的48例老年甲状腺功能减退症患者为研究对象,按照随机数字法分为研究组与对照组,对照组给予常规甲状腺片治疗,研究组给予左甲状腺素钠治疗,观察两组患者的甲状腺激素水平、血脂和临床疗效。结果研究组总有效率95.8%,明显的高于对照组的79.2%,差异具有统计学意义(P0.05)。治疗前两组的游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、总胆固醇(CHO)、三酰甘油(TG)指标比较,差异无统计学意义(P0.05);治疗后两组的FT3、FT4、TSH、CHO、TG指标较治疗前的指标均有所改善,且研究组优于对照组,差异具有统计学意义(P0.05);研究组不良反应发生率为4.2%,低于对照组的12.5%,但差异无统计学意义(P0.05)。结论临床中老年甲状腺功能减退症应用左甲状腺素钠治疗效果显著,改善其脂代谢,不良反应少,治疗安全性高,值得临床中应用。     

低温联合钠曲线透析模式预防血液透析中低血压

目的 研究低温联合钠曲线透析模式预防血液透析过程中低血压的发生.方法 26例低血压患者分别采用钠曲线透析、低温透析及联合模式透析,每一患者均行3种透析模式的单盲交叉治疗,连续治疗8次.分析治疗期间患者体质量、血压、肾功能、电解质等的变化,以及自觉症状等.结果 在联合透析模式患者头晕出汗、恶心呕吐和肌肉痉挛症状发生率明显低于其它模式（χ2分别为8.980,11.160,7.100,P＜0.05）.方差结果分析,除联合模式对舒张压无影响外（F =2.08,＞0.05）,其它模式对收缩压和舒张压均有显著变化（F值10.240～26.640,P＜0.01）.相比其它2种模式,低温模式对收缩压和舒张压的影响相对较大.透析后血钠在钠曲线和联合透析模式时略有增高,低温模式透析后血钠明显低于联合模式（t=2.360,P＜0.05）. 结论 低温联合钠曲线模式对患者透析中的血压影响小,更适合有低血压倾向的透析患者,且不影响患者的透析效果.     

Ultrasound‐guided Prolotherapy with Polydeoxyribonucleotide Sodium in Ischiofemoral Impingement Syndrome

Ischiofemoral impingement syndrome is an uncommon disorder defined by hip pain caused by the narrowing of the space between the ischial tuberosity and lesser trochanter with associated entrapment of the quadratus femoris muscle. We effectively treated two male patients using ultrasound‐guided prolotherapy with polydeoxyribonucleotide sodium mixed with local anesthetics. A 24‐year‐old male patient with no history of trauma or surgery complained of bilateral hip and groin pain; magnetic resonance imaging demonstrated slight narrowing of the bilateral ischiofemoral spaces with mild enhancement of the left quadratus femoris muscle. A 23‐year‐old male patient with a history of iliotibial band release and iliopsoas tendon release complained of left hip and groin pain; magnetic resonance imaging revealed swelling of the left quadratus femoris muscle. After the fifth treatment session of prolotherapy, the pain severity score using the visual analog scale was found to be minimal (0–1/10), and follow‐up magnetic resonance imaging revealed a slightly decreased enhancement of the quadratus femoris muscle compared with that on previous images. Prolotherapy with polydeoxyribonucleotide sodium was an efficacious treatment for two patients with ischiofemoral impingement syndrome who were not candidates for surgery.     

铁叶绿酸钠片治疗缺铁性贫血临床研究

目的观察铁叶绿酸钠治疗成人和儿童缺铁性贫血的有效性和安全性。方法采用随机、对照、多中心的临床研究方法,以琥珀酸亚铁薄膜衣片为对照,对2776例受试者进行试验。结果试验组总有效率79．84％,显效率58．52％;能提高红细胞计数、血红蛋白、血细胞比容、红细胞平均体积、红细胞平均血红蛋白量、红细胞平均血红蛋白浓度、缩小红细胞体积分布宽度,而且对白细胞系及血小板系也有一定作用;它能改善铁代谢,提高血清铁（Fe）、转铁蛋白饱和度（TS）、铁蛋白（SF）,降低总铁结合力（TIBC）、转铁蛋白（Tf）、血清可溶性转铁蛋白受体（sTfR）。结论铁叶绿酸钠片治疗缺铁性贫血是安全有效的药物。     

脑心通治疗下肢深静脉血栓临床观察

目的观察脑心通治疗下肢深静脉血栓的临床疗效及其对血液流变学、血脂、血糖的影响。方法将36例下肢深静脉血栓患者随机分为治疗组20例和对照组16例。治疗组用脑心通联合低分子肝素钠治疗,对照组用低分子肝素钠治疗,10天为一疗程,共2个疗程。对2组临床疗效、治疗前后实验室指标进行比较、统计学分析。结果2个疗程后,2组患者在临床疗效、实验室指标均有明显改善,但治疗组改善更明显,优于对照组。结论脑心通联合低分子肝素钠治疗下肢深静脉血栓疗效显著,且能明显改善患者血液流变学、血脂、血糖指标。     

高效液相色谱法测定安乃近片的含量

目的建立高效液相色谱法测定安乃近的含量.方法采用Accuil-C18色谱柱,甲醇∶水(60∶40)为流动相,231 nm为检测波长,室温下对安乃近片中安乃近进行含量测定.结果安乃近在4.04～40.4 mg*L-1范围内,峰面积与其浓度线性关系良好(r=0.999 9);样品平均回收率为99.87%,精密度RSD为1.21%.结论该法简便、快速、专属性强.     

综合疗法联合神经节苷脂治疗中老年重症脑卒中的疗效

目的探讨综合疗法联合神经节苷脂治疗中老年重症脑卒中的疗效。方法选择2010年9月至2012年9月在重庆市第五人民医院确诊为中老年重症脑卒中患者150例,利用随机数字表法分为试验组和对照组,每组75例,试验组采用综合疗法联合神经节苷脂法,对照组采用综合疗法。比较两组患者治疗前后的血清参数-神经元特异性烯醇化酶(NSE)、超氧化物岐化酶(SOD)以及血流动力学参数,并分析神经功能缺损程度(NDS)、日常生活活动量(ADL)等临床指标。结果试验组经治疗后的血清中NSE、ODS的浓度显著低于对照组[(13.96±1.18)μg/L vs(25.16±0.45)μg/L,(8.39±0.63)μmol/L vs(14.71±0.66)μmol/L,P<0.05];全血高切黏度、全血低切黏度显著低于对照组[(3.68±1.05)m Pa·s vs(5.67±1.34)m Pa·s,(6.95±0.72)m Pa·s vs(9.73±0.86)m Pa·s,P<0.05],红细胞沉降率显著高于对照组[(26.2±1.1)mm/h vs(17.9±1.2)mm/h,P<0.05];NDS评分显著低于对照组[(12.2±2.1)分vs(23.5±1.8)分,P<0.05];ADL评分显著高于对照组[(75.5±1.2)分vs(57.4±1.4)分,P<0.05]。结论综合疗法联合神经节苷脂能够改善病变的血管,修复受损的神经系统,临床应用价值高。     

外源性硫化氢对海洛因成瘾大鼠及正常大鼠的学习记忆能力的影响

目的：研究外源性硫化氢对海洛因成瘾大鼠及正常大鼠学习记忆能力的影响.方法：SD雌性大鼠随机分为4组：对照组、海洛因成瘾组（Heroin组）、硫氢化钠组（NaHS组）和硫氢化钠十海洛因成瘾组（NaHS＋ Heroin组）,每组10只.Heroin组和NaHS＋ Heroin组分别通过递增法皮下注射海洛因,对照组和NaHS组注射等量的生理盐水,在皮下注射前30 min,NaHS组和NaHS＋ Heroin组腹腔注射NaHS,对照组和Heroin组则注射等量的生理盐水.采用Morris水迷宫对4组大鼠进行学习记忆能力的检测.结果：Heroin组在纳洛酮促戒断症状中与其他3组相比,差异有统计学意义（P＜0.01）;Heroin组的逃避潜伏期的时间明显比对照组的时间延长（P＜0.01）,NaHS＋Heroin组的逃避潜伏期时间比Heroin组缩短（P＜0.01）;Heroin组穿越平台的次数明显比对照组减少（P＜0.01）,NaHS＋ Heroin组穿越平台的次数比Heroin组明显多（P＜0.01）.结论：海洛因成瘾对大鼠的学习记忆能力有损害作用;外源性H2S可以减轻海洛因成瘾对大鼠的学习记忆能力的损害;H2S对正常大鼠的学习记忆无影响.