疏肝散结汤联合安珂微创手术治疗非哺乳期乳腺炎肿块期的效果

目的:观察疏肝散结汤联合安珂微创手术治疗非哺乳期乳腺炎肿块期的临床疗效。方法:选取非哺乳期乳腺炎肿块期患者69 例,按随机数字表法分为3 组,A 组25 例,B 组23 例,C 组21 例,其中A 组予疏肝散结汤、抗生素及安珂微创手术,B 组予疏肝散结汤、抗生素及传统肿块切除手术,C 组予抗生素及安珂微创手术,观察3 组患者的总治愈时间、术后愈合时间、术后疼痛程度、瘢痕长度、乳房外观改变及复发率等情况。结果:A 组总治愈时间、术后愈合时间、术后疼痛程度、瘢痕长度、乳房外观改变均优于B 组,差异有统计学意义(P <0.05),两组的复发率无明显差异(P >0.05)。A组总治愈时间、复发率均优于C 组,差异有统计学意义(P <0.05);A 组术后愈合时间、术后疼痛程度、瘢痕长度、乳房外观改变评分与C 组无明显差异(P >0.05)。结论:疏肝散结汤联合安珂微创手术治疗非哺乳期乳腺炎肿块期安全有效,且     

肝胃同治法联合激素治疗非哺乳期乳腺炎急性肿块期的临床疗效

目的观察肝胃同治法联合激素治疗非哺乳期乳腺炎急性肿块期的临床疗效。方法:选取2019 年1 月—2020 年12 月南通市中医院乳腺外科收治的非哺乳期乳腺炎急性肿块期患者90 例，按随机数字表法分为A 组、B 组与C 组，A 组31 例，B 组29 例，C 组30 例。其中A 组予口服醋酸泼尼松及疏肝散结汤，B 组予口服醋酸泼尼松，C 组予口服疏肝散结汤，均治疗8 周。观察患者临床症状体征积分(肿块大小、肤色、肤温、疼痛)、总有效率、炎性因子[ 白细胞计数(WBC)、C 反应蛋白(CRP)、白细胞介素(IL)-2、IL-4、IL-6]、免疫球蛋白(IgA、IgM、IgG)。结果:三组治疗前临床症状体征积分、炎性指标、免疫指标差异无统计学意义(P >0.05)，治疗后三组各项指标均较治疗前显著降低(P <0.05)，且治疗后A 组各指标低于B 组(P <0.05)，肿块大小积分与C 组无明显差异(P >0.05)，其余各指标均低于C 组(P <0.05)，B 组肿块大小积分高于C 组，其余指标均低于C 组(P <0.05)，总有效率与C 组无明显差异(P >0.05)。A 组与B 组不良反应发生率差异无统计学意义，但均高于C 组，差异有统计学意义(P <0.05)。结论:肝胃同治法联合激素能有效缩小非哺乳期乳腺炎患者肿块，控制炎症，调节自身免疫，临床疗效显著，安全有效。     

中西医结合治疗浆细胞性乳腺炎肿块期肝郁胃热证的临床效果研究

目的：观察疏肝散结汤联合蓝丁格尔乳腺治疗仪及抗生素治疗对浆细胞性乳腺炎急性肿块期肝郁胃热证的临床疗效。方法：选取我院2020年1月—2021年8月收治的浆细胞性乳腺炎急性肿块期肝郁胃热证患者共41例,根据随机数字表法将患者分为治疗组21例和对照组20例。对照组予以蓝丁格尔乳腺治疗仪治疗4周,抗生素静脉滴注2周,口服2周;治疗组在对照组基础上予以疏肝散结汤口服4周。观察项目包括症状体征指标（肿块大小、疼痛、肤色、肤温）、实验室指标[白细胞计数（WBC）、C反应蛋白（CRP）、白细胞介素6(IL-6)、红细胞沉降率（ESR）、肝素结合蛋白（HBP）及血清泌乳素（PRL）]、中医疗效判定（中医临床疗效、中医症状和体征积分）及焦虑抑郁评分。结果：治疗组患者症状体征指标、中医临床疗效、中医症状和体征积分及焦虑抑郁评分均明显改善,差异有统计学意义（P<0.05）,两组均无不良事件发生。结论：疏肝散结汤联合蓝丁格尔乳腺治疗仪及抗生素治疗能有效改善浆细胞性乳腺炎患者的局部及全身症状,改善中医症状体征,缓解患者的焦虑抑郁情绪,安全且有效。     

彩超引导下脓肿穿刺置管引流术治疗哺乳期乳腺炎

探讨彩超引导下脓肿穿刺置管引流术治疗哺乳期乳腺炎的的临床应用效果。2018年5月—2019年7月,手术治疗哺乳期乳腺脓肿形成患者98例,随机分为对照组和研究组,每组49例。研究组行彩超引导下脓肿穿刺置管引流术,对照组行传统脓肿切开引流术,观察两组患者的疼痛、切开瘢痕、复发率情况。结果显示,术后两组患者均未出现复发。研究组术后6、24 h疼痛视觉模拟量表(VAS)评分低于对照组(均P<0.05)。研究组瘢痕VSS评分和瘢痕长度小于对照组(均P<0.05)。结果表明,彩超引导下的脓肿穿刺置管引流术对哺乳期乳腺脓肿治疗效果较好,创伤小,瘢痕少,疼痛轻和低复发率风险。     

一种新的微创腔镜技术在哺乳期乳腺脓肿治疗中的应用

背景与目的：哺乳期乳腺炎发展至乳腺脓肿的阶段,常规治疗手段为手术切开引流,但传统方法具有创伤大、换药时疼痛剧烈、治疗时间长、愈合后瘢痕明显等缺点,甚至部分患者被迫终止哺乳。因此,本研究尝试采用一种新的微创腔镜技术治疗哺乳期乳腺脓肿,并分析其疗效。 方法：选择2012年2月—2018年2月收治并符合本研究入组标准的哺乳期乳腺脓肿患者,随机分为两组,分别采用超声引导下脓腔穿剌,腔镜下探查冲洗置管引流进行治疗（微创腔镜组）或常规开放手术纱条引流进行治疗（常规组）。比较两组患者的相关临床疗效指标。 结果：共纳入97例患者,其中微创腔镜组49例,常规组48例,患者均为女性,两组患者治疗前一般临床资料无统计学差异（均P>0.05）。微创腔镜组患者换药次数、治愈时间、治疗费用、术后美容效果明显优于常规组（均P<0.05）;微创腔镜组患者的手术创伤、术后疼痛明显轻于常规组,乳瘘、回乳并发症发生率明显低于常规组（均P<0.05）。两组治疗后均无复发情况。 结论：微创腔镜技术在哺乳期乳腺脓肿治疗中效果显著,能够减轻术后疼痛、减少换药次数、缩短治疗时间、减少治疗费用、降低并发症发生率,且微创美容,值得临床推广及应用。     

快速康复外科理念下不同后路内固定术治疗胸腰椎骨折的疗效对比

目的 快速康复外科（ERAS）理念下比较3种后路内固定术（传统后路、经皮微创入路、Wiltse入路）治疗胸腰椎骨折的疗效。方法 选择鄂尔多斯市中心医院2020年4月—2022年10月收治的90例胸腰椎骨折患者,采用随机数字表法分为3组：A组30例采用传统后路内固定术治疗,B组30例采用经皮微创内固定术治疗,C组30例采用Wiltse入路内固定术治疗。记录患者一般资料、手术基本情况,以及手术前后肌酸激酶（CK）水平、肌红蛋白（Mb）水平、多裂肌脂肪浸润程度（FIR）、伤椎Cobb角和疼痛视觉模拟量表（VAS）评分。结果 所有手术顺利完成,所有患者随访时间> 6个月。A组手术时间长于B、C组,术中出血量A组> B组> C组,术中X线透视次数B组高于A、C组,差异均有统计学意义（P <0.05）。术后20 h CK、Mb水平A组高于B、C组,差异有统计学意义（P <0.05）;术后6个月多裂肌FIR A组> B组> C组,差异有统计学意义（P <0.05）。术后1 d、6个月伤椎Cobb角B组大于A、C组,差异有统计学意义（P <0.05...     

哺乳期乳腺脓肿行微创与开放性引流的对照性研究

目的:探讨哺乳期乳腺脓肿微创引流与开放性切开引流术在哺乳期乳腺脓肿治疗中的效果。方法:将84例哺乳期乳腺脓肿患者随机分成2组,微创组41例行乳腺脓肿微创切开引流术,开放组43例行开放性脓肿切开引流术,比较各组手术时间、术后疼痛程度、术后换药时间、脓肿复发率以及切口美容效果。结果:两组手术时间无明显差异;微创组疼痛程度、术后换药时间、切口美容效果及术后复发率方面明显优于开放组。结论:哺乳期乳腺脓肿微创引流术相对开放性切开引流术创伤更小、换药时间大幅缩短,患者痛苦明显减轻,术后复发率低,术后美观,值得推广。     

穿刺置管引流微创治疗乳腺脓肿的疗效观察

目的通过使用穿刺置管、持续冲洗引流术的微创手段治疗急性乳腺炎并脓肿形成的患者并评价其效果。方法观察组48例采用一次性使用双腔中心静脉导管的组装器械,对有明确脓肿形成的患者进行脓肿穿刺置管排脓,双腔分别接输液器持续冲洗及普通引流;对照组31例使用传统切开手术方式。结果两组在手术时间、VAS疼痛评分、术后换药次数、脓腔愈合时间、术后疤痕等方面存在显著差异,观察组临床效果优于对照组(P0.001)。结论利用一次性使用双腔中心静脉导管行乳腺脓肿穿刺置管,并持续引流有利于有明确脓肿形成的乳腺炎患者的快速康复。     

女性绝经后骨质疏松症阿仑膦酸钠联合骨化三醇治疗 的疗效

目的分析女性绝经后骨质疏松症患者应用阿仑膦酸钠联合骨化三醇治疗的效果。方法资料随机选自2009年9 月一2012年12月在本院诊治的PMO患者72例,按照年龄分组为A组、B组与C组,其中A组年龄50 -59岁20例,B组年龄 60 -69岁30例,C组年龄70 -79岁22例,均予以阿仑磷酸钠联合骨化三醇,比较三组治疗前后VAS评分、TRACP-5b、BLAP 骨代谢生化等指标。结果予以药物前三组VAS评分、TRACP-5b、BLAP骨代谢生化指标,随年龄增长呈正相关性（P < 0.05),骨密度值BMD随年龄增长呈负相关性（P <0. 05);治疗后三组VAS评分均有下降,A组下降的幅度均比B、C组多,B 组下降的幅度比C组多（P <0.05);三组骨密度值BMD均有提髙,A组上升幅度,均比B、C组多（P <0.05,P <0. 01),B组上 升幅度比C组多（P <0.05);三组TRACP-5b、BLAP骨代谢生化指标均降低,A组降低幅度,均比B、C组多（P <0.05,P <0..01）, B组降低幅度比C组多（P <0. 05)。结论不同年龄女性绝经后骨质疏松症应用阿仑膦酸钠联合骨化三醇的效果均 较显著,且疗效与年龄增长呈现负相关性。     

超声引导下置管引流术治疗高位肛周脓肿对照临床观察研究

目的：观察超声引导置管引流术治疗高位肛周脓肿的疗效。方法：将 120 例高位肛周脓肿患者按照随机数字表法分为治疗组和对照组各 60 例,治疗组采用超声引导下置管引流术治疗,对照组采用常规置管引流术治疗,比较两组术后第 3、7、1 天肛门疼痛和脓腔渗液情况,出现出血（大于 20 mL）、尿潴留、发热（>38.5 ℃）等并发症的情况,术后 1 个月总有效率、创面愈合时间,随访 6 个月的脓肿复发率及成瘘率。结果：治疗组创面完全愈合时间明显少于对照组（P<0.01）;两组间术后第 3 天疼痛评分和渗液评分差异无显著性统计学意义（P>0.05）,术后第 7、14 天疼痛评分和渗液评分有显著性差异（P<0.05）;两组术后出现出血、尿潴留的发生率无显著差异（P>0.05）,治疗组出现发热的发生率（3.33%）明显优于对照组（13.33%）（P<0.05）。术后 1 个月总有效率,治疗组明显优于对照组（P<0.05）;随访半年,两组复发形成肛瘘病例,治疗组（13.33%）明显少于对照组（30%）（P<0.05）。结论：超声介入高位肛周脓肿置管引流术的术前、术中、术后,安全可行,疗效显著。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

---

Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果,提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件,并用于临床教学。结果:该课件在本校园网上运行半年余,2000余人次对其进行访问,受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法,实现护理教学的直观性和交互性,对护理教学和临床带教指导有一定的借鉴作用。