温针灸联合西医综合治疗老年膝骨关节炎的效果及对血清炎症因子的影响

目的：研究温针灸联合西医综合治疗对老年膝骨关节炎患者的影响。方法：选择2020年7月-2022年3月景德镇市中医医院收治的94例老年膝骨关节炎患者,按照随机数字表法进行分组,两组各47例。研究组采取温针灸联合西医综合治疗,对照组仅接受西医综合治疗。比较两组总有效率、症状积分、炎症因子、视觉模拟评分法（VAS）评分、膝关节功能（Lysholm膝关节评分）、肢体运动功能[Fugl-Meyer评定量表（FMA）]、日常生活能力（ADL）及不良反应情况。结果：研究组总有效率为91.49%,高于对照组的74.47%(P<0.05)。两组治疗前各项症状积分、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白（hs-CRP）、白介素-6(IL-6)、白介素-17(IL-17)、VAS、Lysholm、FMA、ADL评分比较,差异均无统计学意义（P>0.05）;治疗后研究组各项症状积分、IL-1β、TNF-α、hs-CRP、IL-6、IL-17、VAS评分均低于对照组,Lysholm、FMA、ADL评分均高于对照组（P<0.05）。研究组不良反应发生率比较,差...     

放射状冲击波治疗膝骨关节炎的临床研究

目的:分析体外放射状冲击波(RSWT)治疗膝骨关节炎(KOA)的临床效果。方法:将确诊为膝骨关节炎的患者106例,按随机数字表法分为对照组51例和研究组55例。对照组采用传统的超声波治疗,研究组采用RSWT治疗。分别在治疗前及治疗结束时、治疗后1周、治疗后1个月采用视觉类比疼痛评分(VAS)及膝关节功能评分(Lysholm)评价其临床疗效,治疗期间均需观察患者出现的不良反应。结果:治疗结束时及治疗后1周,研究组和对照组患者的VAS和Lysholm评分较治疗前均明显改善,差异均有统计学意义(P0.05),但两组比较差异均无统计学意义(P0.05)。治疗后1个月,对照组患者的VAS评分较治疗前有明显改善(P0.05),Lysholm评分与治疗前比较虽有所下降,但差异无统计学意义(P0.05);研究组患者VAS和Lysholm评分均优于治疗前及对照组,差异均有统计学意义(P0.05)。对照组的不良反应发生率为3.9%(2/51),与研究组的3.6%(2/55)比较,差异无统计学意义(P0.05)。结论:放射状冲击波治疗膝骨关节炎是一种安全有效、患者易于接受的物理疗法。     

基于经筋理论指导下治疗膝骨关节炎的临床观察

目的:探讨基于经筋理论指导下治疗膝骨关节炎的临床疗效。方法:选择2015年2月-2016年12月安徽中医药大学第一附属医院针灸康复科收治的90例膝骨关节炎患者,随机分为治疗组和对照组各45例。两组选取犊鼻、阳陵泉、血海、足三里、内膝眼、梁丘、阴陵泉、鹤顶、阿是穴、委中、三阴交、膝阳关,对照组给予常规针刺,观察组在此基础上运用经筋理论进行治疗。两组每周治疗5次,每次约30 min,共治疗8 w。观察两组患者治疗前、治疗4 w后以及治疗8w后临床疗效、膝关节Lysholm评分以及视觉模拟量表(VAS)评分的变化。结果:治疗8 w后,两组患者Lysholm评分较本组治疗前明显提高,VAS评分明显降低,差异均有统计学意义(P0.05),且治疗后,观察组Lysholm评分高于对照组,VAS评分低于对照组,差异有统计学意义(P0.05);两组患者治疗后总有效率比较差异有统计学意义(P0.05)。结论:基于经筋理论指导可有效治疗膝骨关节炎,改善患者Lysholm评分和VAS评分。     

独活寄生汤内服联合非甾体抗炎药治疗膝关节骨性关节炎临床疗效及对关节软骨的影响

目的:评价独活寄生汤内服联合非甾体抗炎药治疗膝骨关节炎的临床疗效及对关节软骨的影响。方法:选择2016年1月—2017年6月来医院治疗的膝骨关节炎患者120例,根据随机表格法将患者分为研究组和对照组,每组60例。研究组给予硫酸氨基葡萄糖胶囊联合补肾活血方治疗,对照组给予内服硫酸氨基葡萄糖胶囊治疗,共治疗4周。比较两组治疗疗效,治疗前后VAS、WOMAC评分,治疗前后IL-1β、TGF-β1、TIMP-1及MMP-3水平和MDA、SOD水平。结果:研究结果显示,研究组治疗总有效率为91.1%高于对照组治疗总有效率的79.5%(P0.05),和治疗前相比,两组治疗后VAS、WOMAC评分均有所降低,组间比较结果显示,研究组治疗后VAS、WOMAC评分低于对照组(P0.05);两组治疗后MMP-3、IL-1β低于治疗前,TIMP-1、TGF-β1高于治疗前。组间结果比较显示,研究组治疗后MMP-3、IL-1β低于对照组,TIMP-1、TGF-β1高于对照组(P0.05);两组治疗后MDA低于治疗前,SOD高于治疗前。组间结果比较显示,研究组治疗后MDA低于对照组,SOD高于对照组(P0.05)。结论:独活寄生汤内服联合非甾体抗炎药治疗能显著改善膝骨关节炎患者的临床症状,提高治疗效果,减轻炎性反应,纠正氧自由基代谢紊乱,具有保护膝关节软骨的作用。     

关节镜微骨折术治疗膝骨关节炎合并软骨损伤效果评估

目的:分析评估对膝骨关节炎合并软骨损伤患者采用关节镜微骨折术进行治疗的临床效果。方法:选取2017年2月～2019年1月收治的膝骨关节炎合并软骨损伤患者给予关节镜微骨折术治疗的30例为关节镜微骨折术组,同期膝骨关节炎合并软骨损伤患者给予常规手术治疗的30例为常规手术治疗组。观察比较关节镜微骨折术患者与常规手术患者的膝关节功能评分(Lysholm)与VAS疼痛评分。结果:两组患者治疗后Lysholm评分均高于治疗前,且关节镜微骨折术组患者高于常规手术治疗组患者,差异均有统计学意义(P<0.05)。两组患者治疗后VAS评分低于治疗前,且关节镜微骨折术组患者低于常规手术治疗组患者,差异均有统计学意义(P<0.05)。结论:采用关节镜微骨折术对膝骨关节炎合并软骨损伤患者进行治疗效果更优,且患者膝关节功能恢复更快,患者疼痛感亦能得以有效减缓。     

中药隔物外敷联合TDP治疗膝骨关节炎的临床研究

目的观察中药隔物外敷联合特定电磁波(TDP)法治疗膝骨关节炎(KOA)的疗效及安全性,明确该疗法的临床作用特点与优势,为临床应用提供依据。方法选取KOA患者共60例。随机分为治疗组(30例)和对照组(30例)。两组均给予盐酸氨基葡萄糖胶囊作为基础治疗,治疗组中药外敷联合TDP治疗,对照组联合美洛昔康治疗,疗程均为2周。两组患者于治疗前、后分别应用膝骨关节炎症状分级量化表及国际上公认的五种评分表(VAS疼痛评分表、Lequesne指数评分表、WOMAC骨关节炎评分量表、Lysholm膝关节功能评分表、WHO生存质量量表)进行评分,并对该疗法的不良反应进行安全性评价。结果两组治疗后膝骨关节炎症状积分、VAS评分、Lequesne评分、WOMAC量表积分、Lysholm评分、生活质量评分均较治疗前有改善,差异有统计学意义(P0.01)。治疗后治疗组膝骨关节炎症状积分、VAS评分、Lequesne评分、WOMAC积分改善情况优于对照组,差异有统计学差异(P0.05,P0.01);Lysholm评分及患者生活质量评分两组比较,差异无统计学意义(P0.05)。提示中药隔物外敷联合TDP治疗组疗效优于西药对照组。两组不良反应比较差异无统计学意义(P0.05)。结论中药隔物外敷联合TDP疗法能有效缓解KOA患者的疼痛症状,改善膝关节活动功能,提高患者的生活质量,是安全的治疗手段,具有较好的临床应用价值。     

膝痹汤及舒膝散治疗膝关节退行性骨关节炎的分析

目的:探讨膝痹汤及舒膝散治疗膝关节退行性骨关节炎的疗效。方法:收集我院膝关节退行性骨关节炎的患者,分为:研究组(治疗方案为膝痹汤联合舒膝散)和对照组(治疗方案为膝痹汤)。对比(1)两组治疗前后膝关节退行性骨关节炎中医证候评分。(2)两组治疗前后VAS及WOMAC评分。结果:两组治疗前膝关节退行性骨关节炎中医证候评分、VAS及WOMAC评分比较无差异(P0.05);两组治疗后膝关节退行性骨关节炎中医证候评分、VAS及WOMAC评分比较有差异(P0.05)。结论:膝痹汤及舒膝散治疗膝关节退行性骨关节炎的疗效肯定,值得临床推广。     

杜氏手法结合臭氧注射治疗膝骨关节炎的临床研究

目的探讨单用手法治疗与杜氏手法配合关节腔臭氧(O3)注射治疗膝骨关节炎的疗效。方法选择确诊的膝骨关节炎患者60例,分为手法治疗组和手法加O3关节腔注射治疗组(关节腔注射治疗组)。手法治疗组予以杜氏手法,每次20min,每周2次;关节腔注射治疗组在手法治疗组治疗基础上予以关节腔注射浓度为40μg/ml的O31次/周,20 ml/次,疗程均为20周。通过疼痛视觉模拟评分(VAS)、膝关节功能评分(HSS)、关节软骨缺损评分(Noyes)来评价疗效。结果研究中发现每组治疗前后VAS评分、HSS评分、Noyes评分自身比较差异有统计学意义(P<0.05)。2组治疗后组间比较:VAS评分手法治疗组(3.18±0.76)分,关节腔注射治疗组(2.62±0.55)分,差异有统计学意义(P<0.05);HSS评分2组比较差异无统计学意义(P>0.05);Noyes评分手法治疗组治疗后(3.32±0.98)分,关节腔注射治疗组治疗后(2.79±1.2)分,差异有统计学意义(P<0.05)。结论研究中单纯手法治疗和手法配合关节腔O3注射治疗膝骨关节炎均有良好效果,手法配合关节腔O3注射在疼痛控制和促进关节软骨修复方面较单纯手法治疗效果好,值得进一步研究应用。     

独活寄生汤内服联合中药外洗治疗肝肾亏虚型膝骨关节炎患者的效果

目的:观察独活寄生汤内服联合中药外洗治疗肝肾亏虚型膝骨关节炎患者的效果。方法:选取160例膝骨关节炎患者为研究对象,按照随机数字表法分为对照组和观察组各80例。对照组采用塞来昔布治疗,观察组在对照组基础上采用独活寄生汤内服联合中药外洗治疗,比较两组临床疗效、治疗前后膝关节功能(膝关节Lysholm评分、Kujala主观评分法)、疼痛程度[视觉模拟评分法(VAS)],以及不良反应发生率。结果:观察组治疗总有效率为92.50%(74/80),显著高于对照组的77.50%(62/80),差异有统计学意义(P<0.05);治疗后,观察组Lysholm评分和Kujala主观评分均高于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在塞来昔布治疗基础上采用独活寄生汤内服联合中药外洗治疗肝肾亏虚型膝骨关节炎患者可提高治疗总有效率和关节功能评分,降低VAS评分,效果优于单纯塞来昔布治疗。     

探究关节镜下膝骨关节炎给予关节清理扩创术与运动疗法联合治疗的效果

目的探究关节镜下膝骨关节炎给予关节清理扩创术与运动疗法联合治疗的效果。方法选择本院2017年12月至2018年12月就诊的膝骨关节炎患者100例作为研究对象,随机分为对照组和观察组,每组50例。对照组实施关节镜下关节清理扩创术治疗,观察组在实施关节镜下关节清理扩创术同时实施运动疗法联合治疗。对比两组患者治疗效果。结果观察组总有效率为98.0%,明显高于对照组的82.0%(P0.05)。两组患者治疗前疼痛评分无明显差异(P0.05),治疗后疼痛评分均明显下降(P0.05),但观察组治疗180 h后疼痛评分明显低于对照组,差异有统计学意义(P0.05)。两组患者治疗前Lysholm膝关节功能评分无明显差异(P0.05),治疗后Lysholm膝关节功能评分均明显上升(P0.05),观察组治疗180h后Lysholm膝关节功能评分明显高于对照组(P0.05)。结论关节镜下关节清理扩创术联合运动疗法治疗膝骨关节炎,可提高手术成功率和治疗效果,缓解疼痛,促进膝关节恢复。     

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.