田代华从不同年龄阶段论治月经病

田代华教授认为年龄与月经关系密切,不同年龄阶段月经病的病因、病机、病证及患者体质各有不同,治疗方法应各有侧重。青春期月经病多由肾气虚及脾胃功能失常导致,体质以气虚质、血虚质多见,治疗重在补肾健脾、益气养血;生育期月经病多由肝郁气滞及血虚肾虚导致,体质以血虚质、气滞质、血瘀质多见,治疗重在疏肝理气、补肾养血;围绝经期月经病多由肾脏功能衰退及肝郁脾虚导致,体质以气虚质、阴虚质、气滞质、血瘀质多见,治疗重在补肾活血、疏肝健脾。总结田老师临床治疗各年龄阶段月经病常用处方,并随症加减,临床收效甚佳。附验案3则。     

克唑替尼靶向治疗非小细胞肺癌疗效及EML4-ALK的表达情况分析

目的探讨克唑替尼靶向治疗非小细胞肺癌患者对EML4-ALK的表达的影响。方法选取2010年2月-2016年3月在我院接受治疗的EML4-ALK阳性非小细胞肺癌患者的临床资料。根据其治疗方式分为传统化疗组和克唑替尼靶向治疗组,克唑替尼靶向治疗组在传统化疗的基础上给予克唑替尼靶向治疗。观察治疗6个月后两组患者EML4-ALK阳性表达率和肿瘤标志物水平的变化,比较两组患者1年生存率的差异,分析EML4-ALK阳性表达率与肿瘤标志物水平和生存率的相关性。结果两组患者治疗前EML4-ALK阳性表达率均为100%,治疗后,靶向治疗组EML4-ALK阳性表达率低于传统化疗组(P0.05);两组患者治疗前的CEA、NSE和CYFRA21-1等肿瘤标志物水平无明显差别,治疗后,靶向治疗组低于传统治疗组(P0.05);靶向治疗组1年生存率明显高于传统化疗组;患者的EML4-ALK阳性表达率与CEA、NSE、CYFRA21-1明显正相关,与生存率明显负相关。结论克唑替尼靶向治疗可明显降低非小细胞肺癌患者的EML4-ALK阳性表达率,提高其生存率。     

肺岩宁方通过RANK-RANKL途径调节肺癌骨转移中破骨细胞活化机制的研究

目的:探讨肺岩宁方对肺癌骨转移裸小鼠模型转移性骨破坏及破骨细胞活化的影响。方法:将40只BALB/c裸鼠随机分为空白组、模型组、唑来膦酸组、肺岩宁组,每组10只,除空白组外均采用骨髓腔内注射人肺腺癌A549细胞悬液的方法建立骨转移模型,各干预组给予对应药物治疗,共28d,期间记录体重及生存状态,28d后取骨组织进行Mirco-CT摄片分析、HE染色及抗酒石酸的酸性磷酸酶(TRAP)染色。结果:肺岩宁组和唑来膦酸组小鼠体重及生存质量较模型组更高;模型组见明显溶骨性骨破损、肿瘤细胞密集、TRAP(+)细胞数量增多,肺岩宁组和唑来膦酸组骨组织轻度破坏、肿瘤细胞减少、TRAP(+)细胞数量减少。结论:肺岩宁方可能通过抑制RANK-RANKL途径达到减少转移性骨质破坏及破骨细胞活化的作用,显示其作为抗肺癌骨转移药物的应用前景。     

从肝治心组方调控铁自噬保护缺血/再灌注损伤心肌细胞机制研究

目的 探讨从肝治心组方改善心肌缺血/再灌注损伤的机制。方法 将50只SD大鼠随机分为假手术组、模型组、从肝治心组方组、麝香保心丸组、地尔硫?组,每组10只,制备心肌缺血/再灌注损伤大鼠模型,干预组分别给予从肝治心组方[5.32 g/(kg·d)]、麝香保心丸[10.27 mg/(kg·d)]、地尔硫?[6.86 mg/(kg·d)]灌胃给药,假手术组和模型组给予等量生理盐水灌胃,干预14天后取材,HE染色观察心肌组织形态,透射电子显微镜观察心肌细胞线粒体形态,RT-PCR及Western Blot检测核受体共激活因子4(NCOA4)、铁蛋白重链1(FTH1)、前列腺素G/H合酶2(PTGS2)mRNA和蛋白表达情况。H9c2大鼠心肌细胞分为正常组、模型组、空白血清组、中药组、铁死亡抑制剂组(Ferrostatin-1)、铁死亡诱导剂组(Erastin)、中药诱导剂组,缺氧12 h复氧2 h造模,检测各组细胞存活率、活性氧(ROS)含量、线粒体膜电位水平、Fe²⁺水平,RT-PCR及Western Blot检测NCOA4、FTH1、PTGS2 mRNA和蛋白表达情况...     

Study on the mechanisms of electroacupuncture for promoting gastrointestinal motility in rats with diabetic gastroparesis

Objective

To observe the effect of electroacupuncture (EA) at Zusanli (ST 36) on the gastrointestinal motility and the ultrastructures of pacemaker cells [the interstitial cells of Cajal (ICC)] in diabetic gastroparesis (DGP) rats and explore the mechanism of EA for DGP.

Methods

A total of 50 Sprague-Dawley (SD) rats were randomly divided into group A, group B, group C, group D and group E, with 10 rats in each group. Group A was the blank control; a single intraperitoneal injection of 2% streptozotocin (STZ) was performed in rats of group B, group C, group D and group E, with high glucose and high fat diet for 8 weeks to establish the DGP rat models. Group B was the model group and the rats did not receive any treatment; group C was EA at acupoint group and the rats received EA at Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6); group D was EA at non-acupoint group and the rats received EA at the control points of Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6); group E was metoclopramide group and the rats were treated by intragastric administration of metoclopramide. Blood glucose was detected using ONE TOUCH blood glucose meter; gastric emptying rate and small intestine migration rate were measured using intragastric phenol red; ultrastructures of gastric antrum ICC were detected by transmission electron microscopy.

Results

The differences of blood glucose between group B, group C, group D, group E versus that of group A were statistically significant after modeling (P<0.01); after treatment, the differences of blood glucose between group D, group E versus that of group C were statistically significant (P<0.05, P<0.01); the gastric emptying rate of rats in group B was statistically significant different from that in group A (P<0.01); the gastric emptying rate of rats in group C was statistically significant different from that in group B (P<0.01). The migration rates of rats’ small intestines in group B, group C, group D and group E were all statistically significant different from that in group A (P<0.01); the migration rate of rats’ small intestines in group C was statistically significant different from that in group B (P<0.01). The ultrastructure of rat’s ICC in group B showed apoptosis compared with that in group A; rat‘s ICC in group C had complete basement membrane, more cytoplasm mitochondria, Golgi and rough endoplasmic reticulum, showing clear structure, occasional mitochondria swelling and gap junctions with adjacent smooth muscle cells; there were no significant differences between group D, group E versus group B.

Conclusion

EA at Zusanli (ST 36) plus other acupoints can regulate the blood glucose and promote gastrointestinal motility in DGP rats, and the mechanism may be related to repairing the damaged ICC structure.

     

首发精神分裂症未治疗精神病持续时间与脑皮质形态学关系的磁共振研究

  目的  从多角度对精神分裂症患者脑结构分析以探讨患者精神病未治疗持续时间（duration of untreated psychosis,DUP）与临床结局间的关系。  方法  对85例患者及86例对照,进行临床症状和认知功能评估,通过磁共振扫描（magnetic resonance imaging, MRI）并采用free surfer分析提取脑区皮层厚度、表面积和体积等皮层结构值,基于患者组DUP的分布及中位数,以3个月、6个月、2年为界将患者分为4组,对上述指标进行组间比较及相关分析。  结果  DUP与左岛叶、眶部和右海马旁回、额上回、额颞极的表面积有关联;与左后扣带回、中央后回,右外侧枕叶皮质、岛盖部、内侧眶额皮质和双侧中央前回的皮质厚度有关;对皮质体积,DUP主要影响左中央后回,右楔前叶、外侧枕叶皮质、岛盖部、舌回、颞上回,双侧半球的楔叶、距状旁回、中央前回、顶上小叶和岛叶;发病后前三月是脑皮层结构和临床功能恶化的关键期。  结论  首发精神分裂症的DUP与颞叶、中央前回、眶额区皮质及枕叶内侧面的大部分脑区的皮质形态改变有关,对患者进行早期干预是非常重要的。     

癔球症的研究进展

癔球症是食管功能性疾病的一种,确切的病理机制尚不明确,可能与胃食管反流(GER)、精神心理因素及食管运动功能等有关。治疗方面主要包括控制反流、重视精神心理作用及催眠疗法等综合治疗。     

PDCA法在肠道准备中提高肠道清洁度的应用及效果评价

目的探讨运用PDCA循环方法在肠道准备中提高肠道清洁度的应用及效果。方法对照组对肠镜检查患者行常规肠道准备,完成肠道清洁,医师对肠道清洁度进行评分、记录肠镜进镜至回盲瓣时间、患者饮水量及不良反应情况,并且统计出肠道清洁度不合格率。实验组通过PDCA方法,查找出肠道清洁度差的原因,并积极改进。比较两组患者肠道清洁度差异情况,以确定PDCA在提高肠道清洁度的效果。结果两组均有肠道清洁度不合格的患者,但观察组不合格率(3.05%),低于对照组合格率(8.297%),差异有统计学意义(P0.05)。经肠道准备及清洁效果问卷调查发现,观察组和对照组患者肠道清洁度评分[(6.63±0.733)分VS (5.98±0.779)分]、进镜时间评分[(5.62±2.856)min VS (6.73±4.809)min]、饮水量评分[(2837.38±503.667)mL VS(2590.93±512.64)mL]比较,差异均有统计学意义(P0.05)。不良反应评分[(1.4505±0.72468)分VS(1.6270±0.60311)分],差异有统计学意义(P0.05)。结论对肠镜检查前完善肠道准备患者,实施PDCA可以更好地提高肠道清洁率,缩短肠镜检查时间,提高肠镜检查效率、降低不良反应,减轻患者痛苦。