关节腔内注射自体富血小板血浆治疗膝关节骨性关节炎的临床疗效

目的 探讨关节腔内注射自体富血小板血浆(PRP)治疗膝关节骨性关节炎(KOA)的临床疗效.方法 选取KOA患者66例随机为对照组21例、玻璃酸钠组25例及PRP组20例,3组患者均口服依托考昔片,玻璃酸钠组及PRP组给予关节腔内注射玻璃酸钠注射液及PRP.于治疗前和治疗后3、6、9、12个月时采用视觉模拟评分法(VAS)、安大略西部和麦克马斯特大学骨关节炎指数(WOMAC)及日本骨科协会(JOA)评分对患者进行评估,并观察不良反应发生情况.结果 治疗后各个时间点,PRP组的VAS及WOMAC评分均低于其他两组,而JOA评分高于其他两组(P<0.05),治疗后6、9个月,玻璃酸钠组的VAS及WOMAC评分低于对照组,而JOA评分高于对照组(P<0.05).治疗后各个时间点,PRP组的VAS及WOMAC评分均低于治疗前,而JOA评分高于治疗前(P<0.05);玻璃酸钠组及对照组中,治疗后3、6、9个月的VAS评分及治疗后3、6个月的WOMAC评分低于治疗前,而治疗后3、6个月的JOA评分高于治疗前(P<0.05).3组均未发生严重不良反应,PRP组注射后出现局部红肿、疼痛及皮温升高,不良反应发生率为10.43％(12/115).结论 采用关节腔内注射PRP治疗KOA的疗效优于口服药物及关节腔内注射玻璃酸钠,患者的症状缓解更为持久,且不良反应发生率较低.     

关节腔注射富血小板血浆与臭氧治疗膝关节骨性关节炎的疗效观察

目的 观察关节腔注射富血小板血浆(PRP)与臭氧(O₃)治疗膝关节骨性关节炎(KOA)的临床疗效。方法 选取膝关节骨性关节炎患者40例作为研究对象，采用随机双盲法将其分为PRP组20例，O₃组20例，均采取每周1次，连续3次进行关节腔注射PRP或O₃的治疗，记录治疗前、治疗后1周、1个月、3个月、6个月的VAS评分及WOMAC评分，采用末次随访时Macnab疗效评价指标评价疗效。结果 PRP组治疗后1周、1个月、3个月、6个月VAS评分及WOMAC评分均优于O₃组(P<0.05)。PRP组临床治愈19例，显效1例，治疗改善率为85%;O₃组临床治愈13例，显效3例，有效4例，治疗改善率为75%。结论 富血小板血浆(PRP)治疗膝关节骨性关节炎短期疗效优于关节腔注射O₃治疗膝关节骨性关节炎。     

PRP和HA治疗膝关节早期骨关节炎的临床疗效观察

目的:比较关节腔内注射富血小板血浆(PRP)和透明质酸钠(HA)治疗Ⅰ～Ⅲ期膝关节骨性关节炎的临床疗效。方法:选择86例Keligren Lawrence分级(K-L分级)为Ⅰ～Ⅲ期的膝骨关节炎患者,采用随机数字表法将其分为HA组45例和PRP组41例。两组患者分别采用关节镜探查清理后,关节腔内注射2.5 mL HA和3 mL PRP进行治疗。患者在治疗前和完成全部注射后的1、3、6、12个月均进行检查并记录美国西部Ontario与Mc Master大学骨关节炎指数(WOMAC)评分。比较两组治疗效果以及不同时间点的疗效。结果:治疗后,两组患者WOMAC评分较治疗前均明显降低(P<0.05);治疗后1、3个月,两组WOMAC评分无统计学差异(P>0.05);治疗后6个月和12个月,PRP组WOMAC评分明显低于治疗后1个月和3个月时(P<0.05),且PRP组WOMAC评分明显低于HA组(P<0.05)。结论:关节内注射PRP治疗膝关节软骨退行性病变安全有效,可缓解疼痛,改善患者肢体功能,提高患者治疗后长期疗效及其生活质量。     

富血小板血浆关节腔注射联合穴位注射治疗膝骨性关节临床研究

目的：探讨自体富血小板血浆（PRP）关节腔注射联合穴位注射治疗膝骨性关节炎的方法和疗效。 方法：选取2015年6月至2016年6月在我院骨科就诊的60例膝骨关节炎患者为研究对象,将其随机分为观察组（联合注射组）和对照组（关节注射组）,每组各30例。观察组应用PRP关节腔注射联合穴位注射治疗,对照组采用PRP关节腔注射治疗。分别采用安大略西部和麦克马斯特大学骨关节炎指数（WOMAC）评分系统和《中医病症诊断疗效标准》中关于骨痹的疗效判定标准对两组患者在治疗前后的膝关节功能进行评价。 结果：两组患者均无严重并发症发生,治疗前后两组WOMAC评分均得到明显改善（Ｐ＜0.05）。治疗后３个月和6个月,两组间WOMAC评分比较无统计学差异（Ｐ＞0.05）,治疗后12个月,两组间WOMAC评分比较显示观察组膝关节功能改善更佳,两者差异有统计学意义（Ｐ＜0.05）。根据《中医病症诊断疗效标准》中关于骨痹的疗效判定标准,对治疗后12个月两组患者的膝关节功能进行评价,观察组总有效率为93．33％。对照组总有效率为76．67％,观察组总有效率优于对照组,但两者差异尚不具有统计学意义(Ｐ＞0.05)。 结论：富血小板血浆关节腔注射联合穴位注射与关节腔注射均能改善膝骨性关节炎临床症状,但联合注射较关节腔注射获得了更持久的疗效,是一种治疗膝骨性关节炎的有效方法。     

骨髓PRP关节腔内注射治疗膝骨性关节炎效果观察

目的：研究骨髓间充质干细胞（BMSCs）及富血小板血浆（PRP）成分对骨性关节炎的作用。方法：选取膝关节骨性关节炎患者180例（206膝）随机分为观察组92例（112膝）,对照组88例（94膝）。观察组在关节腔内注射2mL富集干细胞及PRP悬液,6周后再注射1次,对照组采用关节腔内注射透明质酸钠2mL,每周1次,共5次。治疗3个月、6个月后对患者进行随访,并通过WOMAC评分评估两组患者的临床疗效。结果：WOMAC评分观察组治疗前45.88±9.54分,治疗后3个月25.26±6.67分,治疗后6个月22.44±5.19分;对照组治疗前46.76±8.06分,治疗后3个月32.12±5.35分,治疗后6个月33.34±6.32分。观察组和对照组治疗后WOMAC评分均得到改善,与治疗前比较差异有统计学意义（P<0.05）;观察组与对照组WOMAC评分比较差异有统计学意义（P<0.05）。观察组临床控制21膝（18.75%）,显效38膝（33.93%）,有效46膝（41.07%）,无效7膝（6.25%）,总有效率93.75%,对照组临床控制5膝（5.32%）,显效28膝（29.79%）,有效39膝（41.49%）,无效22膝（23.40%）,总有效率76.60%。观察组治疗总有效率明显高于对照组,两组比较具有统计学意义（P<0.05）。结论：观察组在治疗膝关节骨性关节炎方面效果明确,值得在临床推广应用。     

医用臭氧用于骨性关节炎治疗的新探索

目的:探讨臭氧联合施沛特关节腔内注射治疗骨性关节炎的临床疗效.方法:60例骨性关节炎的患者随机分为实验组和对照组,每组30例,实验组30例患者向关节腔内注射臭氧联合施沛特,对照组向关节腔内注射施沛特.观察2组病历治疗前和治疗后VAS评分,随访6个月并评价临床效果.结果:2组患者治疗后VAS 与治疗前相比明显降低(P <0.01),治疗后1个月2组VAS与治疗效果差异无意义,治疗后2个月B组与A组相比较差异有统计学意义(P <0.05).臭氧联合透明质酸钠治疗组有效率显著高于对照组(P<0.05).结论:医用臭氧联合施沛特治疗膝骨性关节炎能有效解除关节疼痛,改善关节功能,临床疗效满意,且操作简单、见效快、成本低、无明显副作用,是一种治疗膝骨性关节炎的好方法.     

富血小板血浆联合透明质酸关节腔内注射治疗膝骨关节炎疗效分析

目的 分析自体富血小板血浆(PRP)联合透明质酸(HA)关节腔注射治疗膝骨关节炎(OA)的临床效果。 方法 收集2009年3月—2015年3月在温州医科大学附属第二医院治疗符合标准的150例膝OA患者的临床资料,随机分为A、B、C 3组,3组患者的一般资料具有可比性,A组单纯采用关节腔注射6 ml HA,B组单纯采用关节腔注射6 ml PRP,C组采用关节腔注射4 ml PRP联合2 ml HA,间隔1周,5周为1个疗程,记录3组患者治疗前和治疗后3、6、12个月美国西部Ontario和McMaster大学骨关节炎指数评分(WOMAC评分)、国际膝关节文献委员会膝关节评估表(IKDC)评分、Lequesne指数以及注射过程中的不良反应。 结果 C组患者治疗后WOMAC评分、Lequesne指数明显低于其余2组,IKDC评分明显高于其余2组,B组患者WOMAC评分、Lequesne指数明显低于A组,IKDC评分明显高于A组,差异均具有统计学意义(P＜0.05),3组患者在治疗过程中均未发现严重药物相关的不良反应。 结论 PRP联合HA关节腔内注射治疗膝OA患者疗效显著,早期即能缓解疼痛、改善关节功能,同时有较高的安全性,值得临床推广。      

富血小板血浆关节腔注射治疗早、中期膝骨关节炎的临床观察

目的观察富血小板血浆(platelet-rich plasma,PRP)关节腔注射治疗早、中期膝骨关节炎的临床效果。方法选择2016年8月至2018年6月河南中医药大学第一附属医院收治的84例早、中期膝骨关节炎病人,采用随机数字表法分组,实验组42例采用PRP关节腔注射治疗,对照组42例采用玻璃酸钠注射液(haluronic acid,HA)关节腔药物注射治疗。收集并比较两组病人治疗前及完成全部药物注射治疗后第4、12、24周的西安大略和麦克马斯特大学(the western ontario and mcMaster universities,WOMAC)骨关节炎指数。结果实验组41例、对照组39例病人完成关节腔注射治疗和完整随访。两组病人治疗后各观察时间点的WOMAC评分均较治疗前明显降低,其中实验组的得分呈持续下降趋势,对照组治疗后4周时的疗效评分最低,而后有所回升。两组治疗后4周、12周时的WOMAC评分比较,差异均有统计学意义(P均0.05)。实验组、对照组治疗的总有效率分别为97.56%(40/41)、76.92%(30/39),差异有统计学意义(P=0.001)。结论关节腔注射PRP与HA治疗早、中期膝骨关节炎,短期(治疗后4周)效果无统计学差异;但关节腔注射PRP长期疗效较关节腔注射HA效果显著,明显延缓膝骨关节炎的进展。     

微创关节冲洗联合关节腔内注射给药治疗膝骨性关节炎50例临床观察

目的观察微创关节冲洗联合关节腔内注射给药治疗膝骨性关节炎的临床疗效。方法选择100例膝骨性关节炎患者作为研究对象,依据患者住院次序编号,随机分为治疗组和对照组,各50例。对照组予玻璃酸钠、复方倍他米松关节腔内注射治疗,治疗组予微创关节冲洗联合玻璃酸钠、复方倍他米松关节腔内注射治疗。比较2组患者治疗前,治疗后1周、1月的视觉模拟疼痛评分法(VAS)评分及膝关节功能(HSS)评分的变化情况及临床疗效。结果治疗组总有效率为96%,对照组为88%,2组总有效率比较,差异有统计意义(P0.05);与同组治疗前比较,2组治疗后1周、1月的VAS评分显著降低,HHS评分显著升高,差异均有统计意义(P0.05),且治疗组VAS及HHS评分的改善程度均显著优于对照组,差异有统计意义(P0.05)。结论微创关节冲洗联合关节腔内注射给药治疗膝骨性关节炎能有效减轻患者膝关节疼痛,改善膝关节功能,疗效显著。     

玻璃酸钠关节腔内注射联合伤柏膏外敷对膝骨性关节炎的临床疗效分析

【目的】探讨玻璃酸钠关节腔内注射联合伤柏膏外敷治疗膝骨性关节炎(knee osteoarthritis,KOA)的临床疗效。【方法】将60例单侧膝骨性关节炎病例随机分为治疗组和对照组各30例,分别给予玻璃酸钠关节腔内注射联合伤柏膏外敷及单纯使用玻璃酸钠关节腔内注射治疗,观察2组治疗前后膝骨性关节炎临床疼痛指标WOMAC量表评分、关节肿胀度、活动度改变、Lysholm膝关节功能评分结果以及膝关节液中白细胞介素-1(IL-1)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平的变化情况。【结果】全部患者均完成5周治疗。治疗后,治疗组与对照组的WOMAC疼痛指标、膝关节活动度、肿胀度及Lysholm功能评分均显著改善,与治疗前比较差异均有统计学意义(P0.05),但治疗组的改善作用均优于对照组(P0.01)。治疗后,2组的膝关节液IL-1、IL-6、TNF-α水平均较治疗前有所下降(P0.05),但治疗组的下降作用更为显著,与对照组比较差异均有统计学意义(P0.05)。【结论】运用玻璃酸钠关节腔内注射联合伤柏膏外敷治疗膝骨性关节炎,具有中西医结合疗效优势,临床效果满意,并发症少。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.