瘢痕疙瘩药物治疗的进展

瘢痕疙瘩是一种特殊的病理性瘢痕,继发于各种不同原因外伤,呈现炎症反应与纤维化过度的特点,不同个体临床表现不同,治疗效果也不尽相同。目前,瘢痕疙瘩的病因尚不清楚,单纯手术切除术后复发率高,且手术治疗相对复杂、并发症风险较高。因此,药物治疗联合手术切除或放疗是目前治疗瘢痕疙瘩的主要方案。该文通过对瘢痕疙瘩治疗药物进行研究,对不同药物治疗瘢痕疙瘩的药理作用和临床效果进行分析,旨在为瘢痕疙瘩药物治疗提供参考。     

瘢痕疙瘩术后联合~(90)Sr/~(90)Y敷贴疗效观察

目的:观察瘢痕疙瘩手术切除后早期联合90Sr/90Y敷贴治疗与单用90Sr/90Y敷贴治疗的疗效比较。方法:56例瘢痕疙瘩患者行手术切除后早期联合90Sr/90Y敷贴治疗(A组),60例瘢痕疙瘩患者行单纯90Sr/90Y敷贴治疗(B组),治疗结束后所有患者随访观察1年,比较其临床疗效。结果:A组56例患者均治疗有效,总有效率为100%,其中痊愈47例,总治愈率为83.9%;B组60例患者均治疗有效,总有效率为100%,其中痊愈50例,总治愈率为83.3%。两组总有效率、治愈率比较差异均无统计学意义(P0.05)。A组治疗疗程较B组短,不良反应较B组少,差异均有统计学意义(P0.05)。结论:手术切除早期联合90Sr/90Y敷贴治疗瘢痕疙瘩疗程短、安全、不良反应较少、临床效果令人满意。     

楔形切除耳廓瘢痕疙瘩的疗效观察

目的：探讨楔形切除耳廓瘢痕疙瘩联合放射治疗等疗法的临床效果。方法：本研究主要选取直径1．0～1．5cm耳廓瘢痕疙瘩行楔形切口，完整切除瘢痕组织及暴露的部分耳轮软骨，对位缝合，重塑耳轮外形，修复耳廓形态。术后1周内行放射治疗。对有复发倾向者行局部注射激素类抗瘢痕药物，每周1次，视瘢痕变化情况逐渐减量。结果：本组11例患者，术后随访1年，治愈9例（82％），显效2例（11％），有效率100％。结论：一定范围耳廓瘢痕疙瘩行楔形切口手术，重塑耳轮外形，耳廓形态完整，结合早期放疗，可取得满意效果，是治疗耳廓瘢痕疙瘩的选择方案之一。     

手术切除联合药物注射及电子束照射综合治疗瘢痕疙瘩

目的：探讨应用综合疗法治疗瘢痕疙瘩的临床效果。方法：对33例患者共42块瘢痕疙瘩采用手术切除后局部注射康宁克通及结合电子束照射的综合方法治疗。结果：随访1～3年,经综合治疗的33例42处瘢痕疙瘩中有32处临床症状消失,伤口无复发。获痊愈,占76％;6处局部复发,4处完全复发。所有患者均无并发症。结论：手术切除联合药物注射及电子束照射治疗的综合疗法是治疗瘢痕疙瘩的一种安全可靠的有效方法。     

直线加速器电子线防治病理性瘢痕

目的 观察直线加速器电子线防治病理性瘢痕的临床效果。方法 在病理性瘢痕手术切除后24h内、采用直线加速器电子线照射病人切口部位，3—4次为一疗程，每次300—400cGy，观察其临床效果，并比较其对增殖性瘢痕及瘢痕疙瘩的防治效果。结果 1996年以来，共治疗109例，经4—48个月随访，总有效率为87．16％，其对增殖性瘢痕及瘢痕疙瘩的防治无显著性差异。结论 直线加速器电子线对病理性瘢痕是一种较有效的防治方法。     

皮肤软组织扩张术加β射线照射治疗瘢痕疙瘩

目的 瘢痕疙瘩是一种常见病，单纯用手术切除治疗瘢痕疙瘩无意义。为此，进行了以皮肤软组织扩张术加用β射线照射治疗瘢痕疙瘩的探讨。方法 距瘢痕疙瘩边缘内约0．3cm作切口，在瘢痕疙瘩周围正常皮肤的皮下植入皮肤软组织扩张器，定期对扩张器进行注水以扩张正常皮肤，达到瘢痕疙瘩切除后的切口无张力缝合；术后应用医用电子直线加速器β射线对切口及周围组织连续照射3～5天不等。结果 治愈率85％，有效率100％，治疗效果满意，经随访时间最长4年未见复发。结论 皮肤软组织扩张术可使瘢痕疙瘩切除后的切口无张力缝合，明显减少瘢痕增生，有效地防止瘢痕疙瘩的复发。辅助以β射线照射治疗效果更理想。     

手术切除联合放射线治疗瘢痕疙瘩体会

目的 探讨手术切除联合放射线治疗瘢痕疙瘩的效果.方法 手术切除瘢痕疙瘩,美容缝合后行放射线治疗一个疗程. 结果 本组55例各种原因引起的瘢痕疙瘩经上述治疗效果好,无复发. 结论应用手术切除联合放射线治疗瘢痕疙瘩是较为理想的一种方法.     

微波热疗联合前列安栓治疗尿道炎后前列腺炎

目的 探讨微波热疗联合前列安栓治疗尿道炎后前列腺炎的疗效。方法 对160例经门诊确诊的本病患者，随机分为治疗组和对照组。治疗组80例，采用微波热疗并同时使用前列安栓。对照组80例，仅用前列安栓纳肛，疗程均为4周。结果 治疗组总有效率93．75％，对照组总有效率73．75％。两组总有效率差异有统计学意义（P〈0．05）。两组发生不良反应均为轻度，且持续较短时间。结论 微波热疗联合前列安栓对尿道炎后前列腺炎的疗效优于单用前列安栓。     

手术加药物注射治疗瘢痕疙瘩

目的分析手术联合皮质类固醇激素注射方法治疗瘢痕疙瘩的临床疗效。方法手术切除病灶,术中注射醋酸曲安奈德注射液,术后每2周拆线1次,视患者切口瘢痕情况,可行第2次,甚至第3次注射治疗,间隔1个月。结果治疗瘢痕疙瘩总有效率为97.5%。结论手术联合皮质类固醇激素注射治疗瘢痕疙瘩疗效显著,复发率低。     

手术切除联合电子线放射治疗耳垂瘢痕疙瘩疗效分析

[目的]探讨耳垂瘢痕疙瘩的有效治疗方法。[方法]对33例耳垂瘢痕疙瘩患者采用手术切除瘢痕,整形美容方法缝合切口,并联合术后24 h内电子线放射方法治疗,采用4 MeV电子束照射,每疗程照射9次,总剂量12Gy。观察疗效。[结果]随访12个月,治愈21例,有效9例,总有效率为90.9%,未发生放射治疗引起的全身不良反应及伤口感染等并发症。[结论]手术切除联合电子线放射能够有效治疗耳垂瘢痕疙瘩。     

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.