隔药灸脐治疗脾肾阳虚型慢性疲劳综合征的临床观察

[目的]观察隔药灸脐治疗脾肾阳虚型慢性疲劳综合征的临床疗效,为临床治疗慢性疲劳综合征提供方法和思路。[方法]选取2018年1月至2019年2月就诊我院的脾肾阳虚型慢性疲劳综合征患者90例,随机分为观察组与对照组各45例。对照组予以普通针刺治疗,观察组在对照组基础上予隔药灸脐治疗。对比分析两组患者治疗前后主要症状(记忆力减退、失眠抑郁、紧张焦虑)评分、疲劳严重度量表(fatigue severity scale,FSS)、健康调查简表(the MOS item short from health survey,SF-36)评分,并比较临床疗效。[结果] 治疗后,观察组临床疗效明显优于对照组,差异具有统计学意义(P＜0.05)。两组治疗后的主要症状评分、FSS评分、SF-36评分均明显优于治疗前,差异具有统计学意义(P＜0.05);治疗后观察组主要症状评分、FSS评分、SF-36评分均明显优于对照组,差异具有统计学意义(P＜0.05)。[结论] 隔药灸脐联合普通针刺治疗脾肾阳虚型慢性疲劳综合征,疗效优于单纯常规针刺治疗,说明隔药灸脐治疗在改善疲劳症状、提高生活质量方面具有一定优势。     

隔药灸脐法与口服枸橼酸氯米芬胶囊治疗排卵障碍性不孕症患者的疗效差异研究

目的:研究隔药灸脐法与口服枸橼酸氯米芬胶囊治疗排卵障碍性不孕症患者的疗效差异。方法:回顾性分析本院60例排卵障碍性不孕症患者临床资料,按治疗方法不同分为隔药灸脐组(隔药灸脐法+口服枸橼酸氯米芬胶囊模拟剂)和对照组(隔模拟剂灸脐法+口服枸橼酸氯米芬胶囊),各30例。一个疗程为1个月经周期,均治疗3个疗程。比较两组疗效、子宫内膜厚度、优势卵泡直径、宫颈黏液(Insler)评分、排卵率、妊娠率。结果:经3个疗程后,隔药灸脐组临床疗效优于对照组(P0.05);治疗后,隔药灸脐组子宫内膜厚度、优势卵泡直径、Insler评分均优于对照组,差异均有统计学意义(P0.05);经3个疗程后,隔药灸脐组排卵率、妊娠率均高于对照组(P0.05)。结论:隔药灸脐法用于治疗排卵障碍性不孕症疗效要好于口服口服枸橼酸氯米芬胶囊,能提高临床排卵率及妊娠率。     

朱氏盆炎汤治疗盆腔炎性疾病后遗症(湿热瘀结型)疗效观察

目的观察朱氏盆炎汤治疗盆腔炎性疾病后遗症的临床疗效。方法 112例盆腔炎性疾病后遗症患者随机分为两组,治疗组(朱氏盆炎汤)60例,对照组(妇科千金胶囊)52例,分别治疗3个月,观察治疗前后患者体征变化以及对疼痛缓解程度进行疗效判定。结果治疗组和对照组体征总有效率为72%、37%,疼痛总缓解率分别为94%、86%,两组总有效率、疼痛总缓解率比较差异有统计学意义(P0.05);两组治疗后体征、疼痛评分与本组治疗前比较差异有统计学意义(P0.05),治疗后组间比较,差异有统计学意义(P0.05)。结论朱氏盆炎汤治疗湿热瘀结型盆腔炎性疾病后遗症临床疗效确切,能够显著改善患者体征及疼痛程度。     

隔药灸脐法对原发性痛经患者下腹部疼痛及额外卧床时间的影响

目的 观察隔药灸脐法对原发性痛经患者下腹部疼痛时间、疼痛程度、额外卧床时间的影响。方法 将符合纳入标准的75名原发性痛经患者随机分为隔药灸脐组、隔淀粉灸脐组、针三阴交组,每组各25例,采用COX 痛经症状量表评价3组患者治疗前、第1、2、3月经期及随访期下腹部疼痛情况及疼痛引起的额外卧床时间。结果 第2、3月经期,隔药灸脐组对下腹部疼痛时间及疼痛程度改善优于隔淀粉灸脐组和针三阴交组（P＜0.05~0.01）;对额外卧床时间的改善优于针三阴交组（P＜0.01）。随访期隔药灸脐组对下腹部疼痛时间及疼痛程度、额外卧床时间的改善优于隔淀粉灸脐组和针三阴交组（P＜0.05~0.01）。结论 隔药灸脐组对原发性痛经患者下腹部疼痛时间及疼痛程度、额外卧床时间改善明显,且远期疗效较好。      

针刺结合隔药灸治疗膝骨关节炎的临床疗效观察

目的 观察针刺结合隔药灸治疗膝骨关节炎的临床疗效。方法 选取符合诊断为膝骨关节炎患者68例,随机分为针刺结合隔药灸治疗组(观察组)和单纯针刺治疗组(对照组),每组34例,对照组选取血海、犊鼻等局部穴位,配合辩证取穴,行针刺治疗;观察组在针刺治疗的基础上于局部穴位给予隔药灸治疗。并对比两组患者治疗前后WOMAC指数评分、临床体征积分,观察症状、体征改善情况,综合分析以评定疗效。结果 观察组患者膝骨关节炎WOMAC指数和临床体征积分均显著降低,患者临床症状及体征改善明显,效果明显优于对照组(P＜0.05)。结论 针刺结合隔药灸对膝骨关节炎临床疗效显著,值得推广应用。     

葫芦灸联合中药贴敷在寒湿凝滞证盆腔炎性疾病后遗症患者中的应用效果

目的：探讨葫芦灸联合中药贴敷在寒湿凝滞证盆腔炎性疾病后遗症患者中的应用效果。方法：选取2019年2月—2020年2月山东中医药大学附属医院收治的70例盆腔炎性疾病后遗症患者作为研究对象，以随机数字表法分为对照组与观察组，各35例。对照组实施艾灸联合中药贴敷治疗，观察组实施葫芦灸联合中药贴敷治疗。比较两组治疗效果及疼痛缓解情况。结果：观察组治疗总有效率高于对照组，差异有统计学意义(P<0.001)。两组疼痛缓解率比较，差异无统计学意义(P>0.05)。结论：葫芦灸联合中药贴敷对寒湿凝滞证盆腔炎性疾病后遗症患者的治疗效果显著，且操作简便，值得临床应用并予以推广。     

针药结合法治疗盆腔炎性疾病后遗症的临床效果观察

目的 研究针药结合方案在治疗盆腔炎性疾病后遗症中的效果优势.方法 入组180例符合盆腔炎性疾病后遗症的患者,随机分为三组进行疗效对比,三组分别为针药组、中药组和西药组,每组各60例.分别治疗3个月,观察治疗前后肝肾功能、血常规、盆腔B超以及不良反应,并比较三组在治愈率、总有效率及症状积分等方面的差异.结果 ①治愈率和总有效率：针药组（96.7％）与中药组（91.7％）差异无统计学意义（P＞0.05）,针药组与西药组（61.7％）差异有统计学意义（P＜0.05）,中药组与西药组差异有统计学意义（P＜0.05）.②症状积分比较：针药组与中药组差异有统计学意义（P＜0.05）,针药组与西药组差异有统计学意义（P＜0.05）,中药组与西药组差异有统计学意义（P＜0.05）.③下腹痛症状总有效率比较：针药组（96.7％）和中药组（93.3％）均优于西药组（80.0％）（均P＜ 0.05）,针药组与中药组无明显差异.④不良反应比较：针药组和中药组均无不良反应,西药组有3例.结论 在提高盆腔炎性疾病后遗症的治愈率方面,针药结合治疗的综合治疗方案较中药口服和西药口服方案更有发展潜力.     

隔药灸脐治疗功能性便秘实证患者的临床观察

目的:观察隔药灸脐法治疗功能性便秘实证患者的临床疗效。方法:将符合纳入标准的60例便秘实证患者随机分为治疗组和对照组,每组30例。治疗组给予隔药灸脐法治疗,对照组给予隔淀粉灸脐法治疗,以4周为1个疗程。采用Cleveland便秘评分系统(constipation scoring system,CSS)评价患者的便秘严重程度;采用便秘患者生活质量自评量表(Patient Assessment of Constipation Quality of Life scale,PACQOL)评价患者的生活质量。结果:治疗后,两组患者的CSS评分较治疗前均明显降低(P<0.05),且治疗组患者的评分低于对照组(P<0.05)。治疗后,两组患者的PAC-QOL生理因子、社会心理因子、担忧因子、满意度因子评分及总分较治疗前均显著降低(P<0.05),且治疗组患者的各因子评分及总分均低于对照组(P<0.05)。结论:隔药灸脐法治疗功能性便秘实证患者疗效确切,能很好地改善患者的便秘症状,提高其生活质量。     

隔药饼灸治疗寒湿凝滞型原发性痛经临床研究

目的：观察隔药饼灸治疗寒湿凝滞型原发性痛经的临床疗效。方法：120例确诊为寒湿凝滞型原发性痛经患者随机分为治疗组和对照组各60例,治疗组采用隔药饼灸,对照组口服布洛芬缓释胶囊（芬必得）,观察对比两组治疗前后的临床症状。结果：治疗组有效率为93．33％,对照组有效率为85．00％,两组比较,差异有统计学意义（P ＜0．05）;两组治疗前后的疼痛积分比较,差异均具有统计学意义（P ＜0．01）,两组比较,差异无显著统计学意义（P ＞0．05）。结论：隔药饼灸治疗寒湿凝滞型原发性痛经疗效显著,且无不良反应。     

“隔药灸脐法”对乳腺癌患者免疫功能的影响

目的研究"隔药灸脐法"对乳腺癌术后化疗患者免疫功能的影响,探讨其提高乳腺癌术后患者免疫力的临床价值。方法将60例乳腺癌术后患者随机分成治疗组和对照组,每组30例。两组患者均给予CAF方案化疗,治疗组在化疗同时给予"隔药灸脐法"治疗,21 d为1个治疗周期,疗程为6个周期。观察两组患者免疫功能指标的变化。结果两组患者治疗前各指标评分比较,差异无统计学意义(P>0.05)。治疗组总有效率为80%,对照组为43%,治疗组疗效明显优于对照组。治疗组在治疗后的T淋巴细胞亚群(CD4、CD8、CD4/CD8)和免疫球蛋白(IgA、IgM、IgG)数值明显高于对照组,两组比较差异有统计学意义(P<0.01)。结论隔药灸脐法能有效的提高乳腺癌术后化疗患者免疫功能。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.