阿帕替尼联合化疗作为二线及以上方案治疗晚期胃癌或胃食管结合部腺癌的疗效观察

目的评估阿帕替尼联合化疗作为二线及以上治疗方案在晚期胃癌(GC)或胃食管结合部腺癌(AGEJ)患者中的疗效。方法分析行肿瘤介入治疗的129例晚期GC或AGEJ患者的临床资料,包括性别、年龄、ECOG分级、化疗方案、病理分级、原发病灶部位、既往是否行胃切除术、转移情况、转移灶个数、既往化疗及是否接受放疗,并记录无进展生存期(PFS)。按照治疗方法不同分为单独化疗组(77例,接受单独化疗)和联合化疗组(52例,接受阿帕替尼联合化疗),分析比较两组的临床资料。结果联合化疗组患者疾病控制率(DCR)高于单独化疗组(P＜0.05)。联合化疗组PFS显著长于单独化疗组患者(P＜0.05),转移灶个数≤2个患者的PFS显著长于转移灶个数＞2个的患者(P＜0.05)。多因素Cox回归分析结果显示,转移灶个数＞2个和阿帕替尼联合化疗方案是PFS的独立影响因素。结论与单独化疗比较,阿帕替尼联合化疗方案作为二线及以上方案,可以显著提高既往至少一线化疗失败的晚期GC或AGEJ患者疾病控制率,延长患者的无进展生存期,且不良反应可控。     

综合康复治疗对急性脑梗死患者吞咽障碍的疗效观察

目的 探讨电针结合神经肌肉电刺激(NMES)对急性脑梗死(ACI)吞咽障碍的疗效.方法 180例ACI吞咽障碍患者随机分为功能训练组(45例)、电针治疗组(45例)、NMES组(45例)和综合治疗组(45例)4组.治疗前和治疗3周后采用洼田试验评分评定疗效.结果 4组治疗后洼田试验评分均优于治疗前(P<0.05);电针治疗组、NMES组和综合治疗组治疗后洼田试验评分和临床有效率优于功能训练组(P<0.05),综合治疗组较NMES组、电针治疗组更优(P<0.05),电针治疗组与NMES组洼田试验评分和有效率无显著性差异(P>0.05).结论 综合康复治疗可以明显提高急性脑梗死吞咽障碍的疗效.     

用病人自评功能量表对膝关节功能障碍病人的测量

38名膝关节功能障碍病人在初次、治疗2～3周后用病人自评功能量表(PSFS)与SF-36量表对比,进一步确定该量表测评-再测评的信度、结构效度和变化的灵敏度。结果显示测评-再测评的信度、对变化的灵敏度非常好,效度也得到肯定。本文进一步提供了支持PSFS信度、效度的证据。     

电针对脑缺血再灌注大鼠神经黏蛋白表达和脑含水量的影响

目的观察电针对易卒中型肾血管性高血压大鼠脑（RHRSP）缺血后再灌注不同时间神经黏蛋白表达、脑组织含水量的干预作用。方法将180只SD大鼠先用环形银夹狭窄双侧肾动脉,制成RHRSP,再用线栓法制成一侧大脑中动脉闭塞（MCAO）脑缺血再灌注模型。随机分为空白组、假手术组、电针组和对照组,分别观察缺血2h后再灌注1d、7d、14d、30d大鼠神经黏蛋白、脑组织含水量的变化。结果脑缺血再灌注1d,对照组脑缺血区周围出现神经黏蛋白阳性表达细胞,7d明显增多,14d表达到高峰,30d下降。电针组神经黏蛋白阳性表达细胞在7d、14d、30d时较对照组明显减少（P〈0.05或P〈0.01）,脑缺血1d、7d,电针组大鼠脑组织含水量明显小于对照组（P〈0.05或P〈0.01）。结论电针减轻脑缺血再灌注损伤后脑水肿,促进缺血损伤区神经功能修复,可能与其下调神经抑制因子神经黏蛋白的表达机制密切相关。     

功能性电刺激及促通技术对急性脑梗死患者下肢运动功能的疗效评价

目的评价功能性电刺激疗法(FES)及促通技术(FT)对急性脑梗死(ACI)患者偏瘫下肢运动功能的疗效。方法 135例急性脑梗死患者随机分为FES+FT组、FT组和空白组各45例,FES+FT组在常规药物治疗基础上加功能性电刺激和促通技术,FT组在常规药物治疗基础上加促通技术,空白组仅予常规药物治疗。治疗前、治疗后21 d及随访阶段(中风后60 d和90 d)分别用改良的Barthel指数(MBI)、美国国立卫生研究院卒中量表(NIHSS)、修正RANKIN标准(mRS)、中风专门生存质量量表(SS-QOL)及简化Fugl-Meyer评分(FMA)评定ACI患者偏瘫下肢的运动功能变化。结果 FES+FT组和FT组、空白组治疗后MBI、NIHSS、mRS、SS-QOL及FMA评分均有显著改善(P均<0.05),但FES+FT组各项评分较FT组和空白组改善更显著(P均<0.01)。结论早期运用FES和FT康复技术可明显改善ACI患者偏瘫下肢的运动功能。     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

脊髓型颈椎病45例临床特点及病因分析

０引言脊髓型颈椎病早期临床表现隐匿，不易引起患者重视，常被临床医生忽视，容易漏诊。为提高临床诊断率，更全面了解脊髓型颈椎病的特点，对近期收住４５例脊髓型颈椎病患者的病因及临床特点加以分析。１材料和方法２０００－０１／２００２－０６本科收治的脊髓型颈椎病患者４５例，男２８例，女１７例；年龄２９～６７岁，平均４６岁；病程２０d～９年，平均８１d，＜１年１８例，１～５年２０例，手、臂麻木感２４例，头晕、恶心７例，反复落枕的５例；头枕痛１４例，上背痛３０例，心慌、胸闷６例，足底痛１例；上肢无力、取物坠地１…     

血管内介入治疗输卵管妊娠42例分析

目的 探讨血管内介入治疗输卵管妊娠的疗效和安全性.方法 42例输卵管妊娠患者在数字减影血管造影（DSA）电视透视下行双侧子宫动脉插管、子宫动脉灌注氨甲蝶呤（MTX）和明胶海绵颗粒栓塞治疗.结果 40例患者治疗后血β-HCG值下降,妊娠包块吸收.2例栓塞后妊娠包块出血,急诊手术治疗,但出血量〈400 ml.结论 血管内介入治疗输卵管妊娠能够保留输卵管正常功能,对未生育的女性尤为适用.