咳嗽从肾论治

基于中医有关古代文献和个人的临床经验，作者举例说明咳嗽不仅能从肺治疗，从肾治疗也是行之有效的方法。     

166例涎腺腺样囊性癌的临床病理分析

目的 分析涎腺腺样囊性癌的临床病理特点。方法 对166例涎腺腺样囊性癌行临床资料总结和HE组织学观察。结果 本组腺样囊性癌占涎腺上皮性肿瘤的11．5％，占涎腺癌的27．0％；男性略多于女性；中年以上好发；发生于小涎腺者多于大涎腺，以腭部为最常见；腺样型103例，管状型42例，实性型2l例；Ⅰ级17例，Ⅱ级128例，Ⅲ级2l例。结论 需与基底细胞腺癌、涎腺导管癌、多形性低度恶性腺癌、上皮-肌上皮癌鉴别诊断；浸润性极强是其显著特点，手术治疗以局部大块切除为主要原则。     

Clinical Experience in Application of the Point Zhaohai

Zhaohai (KI 6) is a point on the Kidney Channel of Foot Shaoyin, and it is one of the eight confluent points, connecting with the Yinqiao Channel. It is located in the depression of the lower border of the medial malleolus, indicated for the disorders along the distributing courses of the Foot Shaoyin Channel and Yinqiao Channel. Connecting with the kidney and bladder collaterally, it gives the effect of reinforcing the kidney and strengthening qi, and promoting the function of the bladder.     

三维心电场的有限元仿真方法—心电场仿真三维模型的理论基础

心电场仿真是心电的前没课题。本文提出了心电场耗散能量的数学模型及有限元求解方程揭示 场活动规律。     

血清胃蛋白酶原检测在胃癌筛查中的价值

背景:我国在亚太地区属于胃癌高危地区。亚太地区胃癌预防共识指出,低血清胃蛋白酶原(PG)Ⅰ水平和低PGⅠ/PGⅡ比值可作为筛查胃癌高危人群的标记物。目的:明确血清PG检测在胃癌筛查中的价值。方法:纳入1880例2010年3月～2011年12月南京市市级机关医院的健康体检人员以及有上腹部不适症状的门诊患者,行血清PGⅠ、PGⅡ检测,其中1028例(包括所有血清PG筛查结果阳性者和部分筛查结果阴性但有上腹部不适症状或胃癌家族史者)接受胃镜和活检组织病理检查。结果:各年龄段受检者血清PGⅠ、PGⅡ水平差异均无统计学意义,≥70岁年龄段组PGⅠ/PGⅡ比值显著低于其他各年龄段组(P<0.05)。萎缩性胃炎组、上皮内瘤变组和胃癌组血清PGⅠ水平和PGⅠ/PGⅡ比值显著低于正常/非萎缩性胃炎组(P<0.01)。以PGⅠ<70 ng/mL+PGⅠ/PGⅡ<3.0为界值,血清PG检测筛查胃癌的敏感性为74.1%,特异性为84.9%,阳性似然比为4.93,阴性似然比为0.30。结论:血清PG检测用于胃癌初筛具有敏感性高、易于接受、成本低等优势,适用于大面积人群普查,结果阳性者应进一步行胃镜筛查。     

椎动脉型颈椎病经颈夹脊穴温针灸+手法治疗的临床效果研究

目的:评价椎动脉型颈椎病经颈夹脊穴温针灸+手法治疗的临床效果。方法:选取2016年5月~2018年6月在我院进行治疗的116例椎动脉型颈椎病患者,按随机数表法分为两组,各58例。对照组采用颈夹脊穴温针灸治疗,观察组采用颈夹脊穴温针灸+手法治疗。对比两组治疗前后眩晕问卷调查表评分(DHI)、各临床症状评分以及椎动脉血管相关指数。结果:观察组治疗后DHI评分为(50.97±3.21)分,明显低于对照组的(62.24±4.53)分,差异有统计学意义(P<0.05)。观察组头痛、眩晕、耳鸣、颈痛、视物模糊及旋颈试验评分均明显高于对照组,差异有统计学意义(P<0.05)。观察组双侧椎动脉PI、RI指数均明显低于对照组,差异有统计学意义(P<0.05)。结论:椎动脉型颈椎病经颈夹脊穴温针灸+手法治疗的效果较明显,不仅可改善双椎动脉血流状态,缓解头痛、眩晕、耳鸣、颈痛及视物模糊等临床症状,还有利于颈部动力平衡的恢复。     

筋骨草显微鉴别的研究

目的：建立筋骨草的显微鉴别方法。方法：采用石蜡切片、表面制片及数码显微成像等技术,研究筋骨草根、根茎、茎、叶和花等部位的显微特征。结果：确立了筋骨草根、根茎、茎、叶、花等部位的显微鉴别特征。结论：实验建立的显微鉴别特征可作为筋骨草鉴别的参考依据。     

青风藤醇提物与青藤碱治疗胶原诱导关节炎大鼠药效的比较研究

目的:以胶原诱导关节炎大鼠为研究对象,比较青风藤醇提物与青藤碱单体对类风湿性关节炎的疗效。方法:乙醇回流法提取青风藤干燥藤茎中包括青藤碱在内的成分,治疗Ⅱ型胶原酶诱导关节炎大鼠,以青藤碱治疗组为阳性对照组,并设立模型组与对照组,进行关节评分/体重记录,以及实验结束后各组大鼠血清中白介素-17、NF-κB配位体受体活化剂以及可溶性蛋白骨保护素水平测定。结果:青藤碱与青风藤醇提物均能有效缓解胶原诱导的关节肿胀,与模型组相比显著降低关节评分(P<0.05);与模型组相比,青风藤醇提物能够显著降低白介素-17的水平(P<0.05),然而青藤碱组白介素-17与模型组相比无显著差异(P>0.05);青风藤醇提物与青藤碱均能有效提高骨保护素水平(P<0.05);与模型组相比,青藤碱不能有效降低血清中NF-κB配位体受体活化剂水平(P>0.05),然而青风藤醇提物却能显著抑制NF-κB配位体受体活化剂的分泌(P<0.05)。结论:青藤碱能够提高骨保护素水平,而青风藤对NF-κB配位体受体活化剂、白介素-17分泌的抑制作用优于青藤碱,提示青风藤醇提物中可能存在其他青藤碱类似物,亦能发挥抗炎抗骨破坏的作用。     

Covalent attachment of a three-dimensionally printed thermoplast to a gelatin hydrogel for mechanically enhanced cartilage constructs

Hydrogels can provide a suitable environment for tissue formation by embedded cells, which makes them suitable for applications in regenerative medicine. However, hydrogels possess only limited mechanical strength, and must therefore be reinforced for applications in load-bearing conditions. In most approaches the reinforcing component and the hydrogel network have poor interactions and the synergetic effect of both materials on the mechanical properties is not effective. Therefore, in the present study, a thermoplastic polymer blend of poly(hydroxymethylglycolide-co-ε-caprolactone)/poly(ε-caprolactone) (pHMGCL/PCL) was functionalized with methacrylate groups (pMHMGCL/PCL) and covalently grafted to gelatin methacrylamide (gelMA) hydrogel through photopolymerization. The grafting resulted in an at least fivefold increase in interface-binding strength between the hydrogel and the thermoplastic polymer material. GelMA constructs were reinforced with three-dimensionally printed pHMGCL/PCL and pMHMGCL/PCL scaffolds and tested in a model for a focal articular cartilage defect. In this model, covalent bonds at the interface of the two materials resulted in constructs with an improved resistance to repeated axial and rotational forces. Moreover, chondrocytes embedded within the constructs were able to form cartilage-specific matrix both in vitro and in vivo. Thus, by grafting the interface of different materials, stronger hybrid cartilage constructs can be engineered.     

季节对儿童睡眠呼吸暂停及低通气综合征临床表现的影响

目的通过对同一睡眠呼吸暂停低通气综合征（OSAHS）儿童患者在夏季和冬季不同表现的研究，探讨季节因素对儿童OSAHS的影响。方法对分别在夏季和冬季进行过PSG监测的21例儿童OSAHS的各指标数据进行分析，包括呼吸暂停/低通气指数（AHI）、平均血氧饱和度（ASaO2）、最低血氧饱和度（LSAO2）、≥3%的氧减指数（≥3%ODI）、仰卧位呼吸暂停低通气指数(supineAHI)、鼾声指数(SI)进行配对的t检验，以及鼻咽侧位片腺样体N/A值的比较，观察其在夏季和冬季的差异性。结果同一儿童OSAHS在夏季和冬季的PSG监测，在腺样体N/A值（P=0.261?2）差异无统计学意义的情况下，除ASaO2（P=0.062?2）无显著性差异外，在AHI(P=0.000?0)、LSaO2(P=0.003?1)、≥3%ODI(P=0.002?8)、supineAHI(P=0.010?2)、鼾声指数(SI)(P=0.004?6)等指标上差异均有统计学意义。 结论儿童OSAHS的临床所表现和严重程度随季节改变会有较大的变化，和成人有很大的不同。