直流中药离子导入与电针联合治疗膝关节骨性关节炎的临床疗效观察

目的直流中药离子导入与电针联合治疗膝关节骨性关节炎的临床疗效观察。方法选取我院骨科2016年1月至2017年3月收治的106例膝关节骨关节炎患者为研究对象。将所选患者按照治疗方式的不同分为对照组,观察组。对照组采用电针治疗,观察组采用直流中药离子导入联合电针治疗,观察两组临床疗效。结果 (1)治疗前两组WOMAC评分无统计学意义(P0.05),治疗后两组WOMAC评分均低于治疗前,观察组明显低于对照组(P0.05);(2)观察组总有效率为86.79%明显高于对照组的58.49%,两组比较,差异具有统计学意义(P0.05)。结论直流中药离子导入与电针联合治疗膝关节骨性关节炎临床效果显著,可减轻患者痛苦,改善膝关节功能。     

中药熏蒸联合手法推拿、股四头肌锻炼对膝骨性关节炎患者关节液内脂肪因子visfatin及chemerin含量的影响

【目的】研究中药熏蒸、手法推拿、股四头肌锻炼综合治疗对膝骨性关节炎患者关节液中脂肪因子visfatin及chemerin含量的影响,探讨中药熏蒸联合手法推拿、股四头肌锻炼治疗膝骨性关节炎的可能机理。【方法】选取膝骨性关节炎患者60例,按照完全随机方法分为治疗组和对照组各30例,治疗组给予中药熏蒸+中医手法推拿+股四头肌锻炼治疗,对照组单纯给予中药熏蒸治疗。治疗2个疗程(2周)后,观察2组临床疗效及治疗前后膝关节西安大略和麦克马斯特大学骨关节炎调查量表(WOMAC)评分,并检测关节液中脂肪因子visfatin和chemerin含量。【结果】(1)经2个疗程治疗后,治疗组总有效率为96.7%,对照组为83.3%,治疗组疗效优于对照组(P0.01)。(2)治疗后,2组WOMAC评分均明显下降(P0.01),且治疗组的下降作用更为明显(P0.01)。(3)治疗后,2组关节液visfatin和chemerin含量均较治疗前明显下降(P0.01),且治疗组的下降作用优于对照组,差异均有统计学意义(P0.05)。【结论】中药熏蒸联合手法推拿、股四头肌锻炼治疗膝骨性关节炎临床疗效明显,并能明显减少关节液内visfatin和chemerin含量,这可能是中药熏蒸联合手法推拿、股四头肌锻炼治疗膝骨性关节炎的机理之一。     

短刺法配合电针肌肉起止点治疗膝骨关节炎的临床观察

目的观察短刺法配合电针肌肉起止点治疗膝骨关节炎的临床疗效。方法将60例膝骨关节炎患者随机分为治疗组和对照组,每组30例。治疗组予短刺法配合电针肌肉起止点治疗,对照组予塞来昔布治疗,两组疗程均为4周。通过观察治疗前与治疗结束后及治疗结束后4周的膝关节WOMAC量表评分、VAS评分,比较两组患者临床疗效。结果 (1)治疗结束后:两组总有效率差异无统计学意义(P0.05);WOMAC量表评分及VAS评分,两组自身比较差异有统计学意义(均P0.01),组间比较差异无统计学意义(P0.05);(2)治疗结束4周后:两组总有效率差异有统计学意义(P0.05);与治疗前比较,两组WOMAC量表评分降低差异有统计学意义(P0.01),治疗组VAS评分降低差异有统计学意义(P0.01),对照组差异无统计学意义(P=0.05);组间比较,两组WOMAC量表评分及VAS评分差异均有统计学意义(P0.05)。结论短刺法配合电针肌肉起止点对改善膝关节功能、减少疼痛近期疗效与塞来昔布等效,中期疗效优于塞来昔布。     

两种灸法治疗轻中度膝骨关节炎的疗效对照研究

目的:观察雷火-热敏灸与单纯雷火灸治疗轻中度膝骨关节炎的临床疗效差异。方法:将60例轻中度KOA患者随机分为治疗组和对照组,每组30例,治疗组采用雷火灸条施以热敏灸法治疗,对照组采用单纯雷火灸条悬灸治疗。分别于治疗后2周及治疗4周后,观察两组疼痛VAS评分及骨关节炎指数(WOMAC评分),并比较两组临床疗效。结果:治疗后2周,两组VAS评分及WOMAC各项评分与治疗前比较,差异均具有统计学意义(P0.01);治疗组与对照组比较,VAS评分差异显著(P0.05),WOMAC疼痛评分、WOMAC身体功能评分、WOMAC总分差异极显著(P0.01)。治疗后4周,两组WOMAC僵硬评分与治疗后2周比较,差异显著(P0.05);两组VAS评分、WOMAC疼痛评分、WOMAC身体功能评分及WOMAC总分与治疗后2周比较,差异极显著(P0.01);治疗组与对照组比较,WOMAC身体功能评分、WOMAC总分差异显著(P0.05)。治疗后4周,治疗组与对照组总有效率分别为96.67%和93.33%,两组比较差异具有统计学意义(P0.01);治疗后3个月随访,治疗组与对照组总有效率分别为96.55%和96.30%,两组比较差异具有统计学意义(P0.05)。结论:雷火-热敏灸较单纯雷火灸治疗KOA在短期内疗效更优,且疗效稳定。     

中药熏蒸联合玻璃酸钠关节腔注射治疗髋关节骨性关节炎50例临床观察

目的 观察中药熏蒸联合玻璃酸钠关节腔注射治疗髋关节骨性关节炎的临床疗效。方法 将100例髋关节骨性关节炎患者采用随机数字表法分为对照组和治疗组,各50例。对照组予玻璃酸钠注射液20 mL关节腔注射,治疗组在对照组治疗方法的基础上联合中药熏蒸,治疗4周后比较2组的临床疗效以及治疗前后的西安大略和麦克马斯特大学骨关节炎(WOMAC)指数、Harris评分、视觉模拟评分法(VAS)评分、髋关节活动度。结果 对照组总有效率为74%(37/50),治疗组为90%(45/50),2组比较差异有统计学意义(P<0.05);治疗后2组WOMAC指数、VAS评分明显降低,Harris评分及髋关节屈伸、外展活动度明显升高,与同组治疗前比较差异均有统计学意义(P<0.05),且治疗组改善更明显,与对照组治疗后比较差异均有统计学意义(P<0.05)。结论 中药熏蒸联合玻璃酸钠关节腔注射治疗髋关节骨性关节炎可有效改善患者髋关节功能,减轻疼痛,增加髋关节活动度,值得临床推广应用。     

膝关节腔内臭氧注射治疗髌股关节炎中期疗效评估

目的:观察医用臭氧治疗髌股关节炎的中期疗效。方法:髌股关节炎患者随机分为两组,每组30膝。其中治疗组患者关节腔内注射20 m L(质量浓度30 mg·L-1)的医用O3,1周后重复,2次为1个疗程;对照组患者关节腔注射玻璃酸钠2 m L,每周1次,5次为1疗程。随访观察5 a,比较两组患者治疗前后视觉模拟评分和Lysholm评分。结果:两组患者治疗后视觉模拟评分、Lysholm评分要明显优于治疗前,差异有统计学意义(P<0.01)。其中治疗组治疗后视觉模拟评分、Lysholm评分要明显优于对照组,差异有统计学意义(P<0.05)。结论;医用O3治疗单纯性髌股关节炎能有效缓解关节疼痛,改善关节活动度,能够获得良好的中期疗效。     

补肾通络法和中药熏蒸内外合治膝骨性关节炎的临床疗效研究

目的探究补肾通络法和中药熏蒸内外合治治疗膝骨性关节炎(KOA)的临床疗效。方法将2017年1月至2017年12月期间收治的126例KOA患者采用随机数字表的方式随机分为对照组63例及治疗组63例。对照组给予KOA的常规治疗,治疗组予补肾通络法和中药熏蒸内外合治,两组均治疗4周。治疗后观察两组临床疗效、膝关节功能(WOMAC评分)、疼痛程度(VAS评分)、血清中相关炎症因子[白细胞介素1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)]水平变化。结果治疗过程中,共有6例患者脱落,其中对照组4例,治疗组2例,实际共有120例患者。治疗后,对照组的有效率为76. 27%,治疗组为88. 52%,两组比较差异有统计学意义(P 0. 05)。两组患者治疗后WOMAC、VAS评分均显著下降,与治疗前比较差异有统计学意义(P 0. 01),且治疗组优于对照组(P 0. 01)。两组血清炎症因子治疗后改善程度与治疗前比较,差异有统计学意义(P 0. 05),且治疗组优于对照组(P 0. 05)。结论补肾通络法和中药熏蒸内外合治KOA可改善临床症状、膝关节功能、改善炎症因子水平,安全性好,值得临床推广。     

中医手法联合关节镜手术治疗髌股关节炎临床疗效分析

目的探究中医手法联合关节镜手术治疗髌股关节炎的临床效果。方法随机选取2018年3月至2018年7月的34例患单纯髌股关节炎的患者,随机分为治疗组与对照组。对照组采用关节镜下清理联合髌外侧支持带松解术,治疗组在此基础上加以中医手法髌骨内推治疗,比较两组术前及术后3月IKDC、VAS评分。结果治疗组IKDC评分改善(13.65+3.22)分,明显优于对照组IKDC评分改善程度(6.82+4.43)分(P0.05),分别记录治疗组与对照组VAS评分改变,差异具有统计学意义(P0.05)。结论中医手法联合关节镜下清理与髌外小切口髌外侧支持带松解术治疗髌股关节炎,具有创伤小、并发症轻,患者症状恢复好,功能改善明显等优点,具有良好的临床意义。     

Effect of traditional Chinese medicine fumigation and nursing intervention on the quality of life in patients with rheumatoid arthritis

目的 研究中药熏蒸治疗类风湿性关节炎的护理干预及其对患者生活质量的影响.方法 将120例类风湿关节炎患者随机分为对照组与观察组,每组60例.给予对照组患者常规治疗及护理,观察组患者在常规治疗护理基础上加用中药熏蒸,比较两组患者临床疗效、治疗前后关节疼痛评分、心理状况及生活质量的差异.结果 观察组与对照组临床治疗总有效率分别为93.3％和83.3％,观察组显著优于对照组(P＜0.01);观察组关节疼痛评分、SAS及SDS评分显著低于对照组,差异具有统计学意义(P＜0.05);观察组生活质量各项评分及总分显著高于对照组(P＜0.01).结论 中药熏蒸治疗类风湿关节炎并加强护理干预,可显著减轻患者疼痛,提高疗效,并显著改善患者心理状态及生活质量.     

中医特色疗法结合健康管理治疗膝关节骨性关节炎

目的:探讨中药熏蒸、温针疗法以及膝关节功能锻炼综合疗法治疗膝关节骨性关节炎的临床疗效。方法:选择100例膝骨关节炎患者,随机分为两组。治疗组给予中药熏蒸、温针及八步膝关节锻炼法,对照组给予中药熏蒸、温针治疗,分别对患者治疗前后Lequesne膝关节功能评分、生存质量进行评价。结果:治疗组临床疗效优于对照组,差异有统计学意义(P0.05);治疗组Lequesne膝关节功能评分日常生活、下蹲或下跪、上下楼梯、走不平的路等评分较治疗前明显改善,差异有统计学意义(P0.05),对照组只有下蹲或下跪评分较治疗前明显改善,差异有统计学意义(P0.05)。治疗组生存质量中生理、心理评分较治疗前明显改善(P0.05)。结论:中医特色疗法技术操作简单,结合健康管理,可以缓解膝关节疼痛,显著改善患者的生存质量。     

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.