十二指肠镜治疗胆总管结石的临床应用研究

目的评价十二指肠镜在胆总管结石治疗中的应用价值。方法胆总管结石患者,根据病情分别采用内镜下十二指肠乳头括约肌切开术、内镜下乳头括约肌气囊扩张术、网篮取石术、机械碎石术、气囊取石术,经内镜鼻胆管引流术等治疗。结果本组116例患者中,107例常规ERCP造影成功,成功率92.2%,行乳头预切开后及乳头开窗术后,113例ERCP造影成功,成功率为97.4%,取石成功110例,成功率94.8%。其中24例行机械碎石取石术,23例取石成功,碎石取石成功率95.8%,8例行单纯乳头括约肌气囊扩张取石术,7例成功,取石成功率87.5%。结论十二指肠镜治疗胆总管结石是一安全、有效的治疗方法。     

内镜下十二指肠乳头括约肌切开取石术28例的护理

目的 探讨内镜下十二指肠乳头括约肌切开取石术患者的护理特点.方法 回顾性分析内镜下十二指肠乳头括约肌切开取石术28例患者的临床资料及护理措施.结果 28例行内镜下十二指肠乳头切开取石术全部成功:气囊或网篮取石术24例,机械碎石4例.4例结石直径大于1cm,24例结石直径小于1cm.结论 内镜下十二指肠乳头括约肌切开取石术是安全、有效的,具有创伤小、严重并发症少、术后恢复快等特点,针对患者不同情况采取有效的护理措施是保证EST 取石术成功的基础和保障.     

经内镜行胆总管机械性碎石及网篮取石术的配合

经内镜行胆总管机械性碎石及网篮用石术是目前治疗胆总管结石的最佳方法。它在纤维十二指肠镜直视下用高频电刀将十二指肠乳头括约肌切开，将碎石器导管或取石网篮导管通过内镜下送入胆总管而进行碎石取石。我院自1989年～1997年3月共碎石取石168例，除2例取石失败，其余均达到放石目的，获得成功，现将手术护理进行总结。l适应证原发胆总管结石；术后胆总管残留结石。2术前准备2．1心理护理：消除其紧张情绪，向患者介绍手术方法日的，使其配合手术。2．2常观测量患者血压、脉搏、体温、血常规及出凝血时间。2．3术前当日禁食水。2．4术前1…     

胆总管结石合并壶腹周围憩室的内镜治疗价值分析

目的 探讨内镜对胆总管结石合并壶腹周围憩室治疗的价值.方法 回顾分析该科1989年6月～2008年8月接受经内镜逆行胰胆管造影(ERCP)诊治患者6 221例.其中,389例胆总管结石合并壶腹周围憩室的患者接受了内镜下十二指肠乳头括约肌切开术(EST)、经内镜网篮取石术(ESR)及碎石器机械碎石取石术等治疗,与同时期行同样治疗的400例无壶腹周围憩室的胆总管结石患者相比较.结果 389例胆总管结石合并壶腹周围憩室的患者经内镜治疗后胆总管结石取净率为97.43%(379/389),内镜治疗后无急性重症胰腺炎,无出血和穿孔等严重并发症发生,无1例死亡.结论 内镜下乳头括约肌切开术及取石和碎石器机械碎石术对胆总管结石合并壶腹周围憩室是一种具有微创、取石成功率高的安全、有效的治疗手段.     

胆总管结石内镜下乳头切开取石术加鼻胆引流术的护理体会

目的经内镜下胆道(胰管)取石术已成为一种主要的治疗手段,是治疗胆胰管结石的一种安全有效的方法,本文探讨内镜下乳头切开取石术加鼻胆引流术的术前、术中、术后护理体会。方法对180例内镜下乳头切开取石后放置引流管的患者,行术前全面细致的准备、术中密切的配合及观察、术后精心的护理。结果 180例患者,手术成功179例,穿孔1例,转外科手术治疗,11例碎石后取石成功,5例结石较多较大行2次取石成功,手术成功率达99.4%。结论内镜下乳头切开取石后放置引流管治疗胆总管结石安全有效,可减少并发症,术前保障用物齐全,做到耐心细致的心理护理、严格的消毒,做好碘过敏试验及抗生素过敏试验;术中严格无菌操作,业务熟练,操作迅速敏捷,与医生配合默契,术后严密观察生命体征、引流液的量、颜色,保持引流管通畅,严密观察并发症的发生,及早预防是手术成功的保障。     

胆总管结石内镜下十二指肠乳头括约肌切开术取石术护理

目的 通过对89例胆总管结石内镜下十二指肠乳头括约肌切开术、取石术的阐述来探讨该种治疗方法的术前术后护理;方法内镜下进行该种手术,术前术后采用专业护理;结果 89例EST术全部成功,成功率达100%,无1例发生严重并发症.结论 胆总管结石内镜下十二指肠乳头括约肌切开、取石术的术前术后护理十分重要.     

腹腔镜胆囊切除术中十二指肠镜下乳头切开取石术121例报告

目的探讨腹腔镜胆囊切除术中十二指肠镜下乳头切开取石术治疗胆囊结石继发胆总管结石的手术方法和适应征。方法腹腔镜下行胆囊切除术,经胆囊管残端插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜至十二指肠乳头,针式刀或弓式刀在输尿管导管或斑马导丝指引下对乳头施行切开术,用十二指肠镜取石网或球囊取石。结果施行术中十二指肠镜下乳头切开取石术121例,109例乳头切开取石成功,7例乳头切开成功,5例中转为其他术式。术后轻症胰腺炎7例。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡。结论只要选择合适的患者,腹腔镜胆囊切除术中十二指肠镜下乳头切开取石术是可行、有效和安全的。     

不同胰管支架置入时机对双导丝插管ERCP术后胰腺炎及高胰酶血症的影响

目的 研究不同时机置入胰管支架对双导丝法插管ERCP术后胰腺炎及高胰酶血症的影响。方法 选取该科2019年9月—2021年6月行双导丝法插管ERCP术的86例胆总管结石患者按照随机数字表法分为早期置入胰管支架组和晚期置入胰管支架组,每组43例。早期置入组在胆管插管成功后即沿胰管导丝置入胰管支架,移除胰管导丝后行十二指肠乳头切开（扩张）及取石,结石取尽后留置鼻胆管;晚期置入组在胆管插管成功后保留胰管导丝,先行十二指肠乳头切开（扩张）及取石,结石取尽后沿胰管导丝置入胰管支架,最后留置鼻胆管。统计并对比二组手术时间、术后胰腺炎、高胰酶血症、出血、消化道穿孔、住院时间等的差异。结果 二组手术时间、住院时间无统计学意义（P>0.05）,早期置入组胰腺炎及高胰酶血症的发生率均低于晚期置入组,有统计学意义（P<0.05）。结论 对于双导丝法插管行ERCP取石的胆总管结石患者,早期置入胰管支架能更好地预防ERCP术后胰腺炎的发生。     

内镜下十二指肠乳头括约肌切开取石术的护理

目的探讨内镜下逆行胰胆管造影及十二指肠乳头括约肌切开取石术治疗胆总管结石的护理。方法回顾性分析108例患者实施治疗胆总管结石的临床护理。结果 108例中,106例成功取石,其中有4例出现急性胰腺炎表现,2例出现迟发性出血,经治疗护理,无死亡病例。结论术前完善各项检查,做好患者及家属的心理护理,术中配合,术后密切观察病情,严格管理饮食,积极预防处理并发症是保证手术成功的关键。     

经内镜乳头括约肌切开术治疗腹腔镜胆囊切除术后胆管残余结石6例分析

我们自 2 0 0 1年 3月至 2 0 0 2年 3月行腹腔镜胆囊切除 (ＬＣ)术共 61 2例 ,术后发现胆管结石残留 6例 ,均行经内镜乳头括约肌切开(ＥＳＴ)术治疗痊愈 ,现报道如下。1　临床资料1 .1　一般资料6例患者 ,男性 2例 ,女性 4例 ,年龄 2 9-62岁 ,平均 42岁。肝外胆管残余结石 5例 ,肝内胆管残留结石 1例。1 .2　治疗方法对患者先行逆行性胆胰管造影 (ＥＲＣＰ) ,显示结石部位、大小及数量 ,后行ＥＳＴ术 ,以网篮取石为主 ,配合机械碎石 ,取石术后常规放置鼻胆管引流 ,并使用利胆中药。1 .3　结果6例病人 5例 1次取石成功 ,1例经 2次取石取净。2…     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

表皮生长因子受体酪氨酸激酶抑制剂在非小细胞肺癌应用的瓶颈——获得性耐药

以表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI）分子靶向治疗研究为肇始,转化性研究使基础实验和临床实践间的鸿沟迅速填平,改变着人们认识治疗肺癌的视角。无可否认,EGFR-TKI上市后极大地延伸了肿瘤学家治疗肺癌的手段,但不管从临床经验、临床研究数据、分子生物学层面还是文献计量学的角度,     

WHO西太区与“世界中医药学会联合会”中医名词术语国际标准比较研究：精、神、气、血、津、液部分

精、神、气、血、津、液是中医理论中6个非常重要的概念，有关术语在《WHO西太区传统医学国际标准名词术语》中一共收录了59条，“世界中医药学会联合会”（以下简称世中联）《中医基本名词术语中英对照国际标准》中收录了58条。血、津、液的内涵较为具体，有一定的物质基础，理解并不困难。翻译上虽有差异，但亦不难统一。精、神、     

Liuwei Dihuang,a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats

OBJECTIVE： To investigate the anti-inflammatory, anti-oxidative stress, and adipokine-ameliorating effects of Liuwei Dihuang （LWDH）, a traditional Chinese herbal formula, in obese rats. METHODS： After 2 weeks of acclimation with free access to regular rodent chow and water, obese-prone-caesarean-derived （OP-CD） rats were fed a modified AIN-93G diet containing 60% energy from fat. Treatment was performed twice daily by gavage feeding with 500, 1 500, or 3 500 mg/kg body weight LWDH suspended in water （n=12 rats per group）. Twelve obese-resistant-CD （OR-CD） rats were fed the atherogenic diet and gavaged with water, and served as the normal control. Blood biomarkers of inflammation, oxidative stress and adiponectin were measured post-sacrifice and used to determine the treatment effect of LWDH and assess the suitability of OR/OP-CD rats for studying these parameters. RESULTS： After 9 weeks of treatment, LWDH lowered serum C-reactive protein （CRP） and tumour necrosis factor-α （TNF-α） levels. Serum interleukin-6 （IL-6） levels showed a tendency towards reduction, but were not significantly different from the OP-CD control. Liver superoxide dismutase （SOD） activity was increased in response to all three doses of LWDH, while the levels of reduced （GSH） and oxidized glutathione （GSSG） and thiobarbituric acid reactive substances （TBARS） were unchanged. Serum adiponectin levels were increased in response to oral administration of LWDH at the dose of either 500 or 1 500 mg/kg body weight. In addition, comparisons between OR-CD and OP-CD rats revealed differential, and for some biomarkers, conflicting characteristics of high-fat diet-fed OP-CD rats in reference to obese human subjects in terms of inflammatory and oxidative stress biomarkers and circulating adiponectin levels. CONCLUSION： The results show, for the first time, the anti-inflammatory, anti-oxidative stress and adiponectin-ameliorating effects of LWDH in obese rats. The suitability of the OP-JOP-CD rat model as     

New Mechanism of Herb-herb Interaction between Ginseng and Trogopterus Based on CYPs in Rat Livers

The study was designed to investigate the potential mechanism of herb-herb interaction between ginseng and Trogopterus （Trg） based on Cytochrome P450 isozymes （CYPs） in rat livers. We estimated the influence on CYP1A2, CYP2E1, and CYP3A1/2 activity caused by ginseng and Trg used in combination. The CYP1A2 and CYP2E1 enzyme activity were induced by ginseng and Trg used in combination. And this induction effect was caused via inducing CYP1A2 and CYP2E1 protein expression which was supposed caused by inducing the gene expression of CYP1A2 and CYP2E1.     

中医疗法治疗运动性疲劳的研究进展

随着竞技体育的发展，运动员经常承受着大负荷、超强度的体力训练，因此极易产生运动性疲劳。疲劳的出现使肌内压增高，局部缺血，造成氧化代谢、H^＋排出率与pH值降低，血乳酸增高，从而影响肌纤维神经传导速度和肌内收缩力量，减弱了肌肉保护能力。致使较多的冲击力传到骨骼上，故易导致疲劳骨折的发生,严重影响了运动员的训练和比赛成绩，对运动员身心产生不必要的伤害。运动性疲劳消除手段的研究一直是竞技体育工作和运动医学关注和研究的焦点。     

Effects of tacrolimus and cyclosporine treatment on metabolic syndrome and cardiovascular risk factors after renal transplantation: a meta-analysis

Background The therapeutic success of renal transplantation has been largely attributable to the development of effective and balanced immunosuppressive treatment regimens.This study provides a meta-analysis of a series of randomized controlled trials that compared the effects of tacrolimus and cyclosporine on metabolic syndrome （MetS） and cardiovascular risk factors after renal transplantation.Methods We searched various electronic databases and bibliographies,including MEDLINE,the Cochrane Central Register of Controlled Trials,and EMBASE,for relevant studies published prior to October 2012.Results Our meta-analysis included five randomized controlled trials that examined a total of 923 patients.The tacrolimus group and the cyclosporine group exhibited no significant differences in MetS incidence after renal transplantation; risk ratio （RR）：1.06,95％ confidence interval （C/）：0.73-1.55,P=0.76.Cyclosporine treatment was associated with a higher incidence of hyperlipidemia （RR：0.50,95％ CI：0.39-0.64,P ＜0.01）.Although there were no statistically significant differences,cyclosporine treatment was associated with a higher incidence of hypertension （RR：0.91,95％ CI：0.83-1.00,P=0.06） after renal transplantation compared to tacrolimus treatment,and tacrolimus treatment was associated with a higher incidence of diabetes after renal transplantation （RR：1.79,95％ CI：0.98-3.27,P=0.06） compared to cyclosporine treatment.Conclusions Compared to tacrolimus treatment,cyclosporine treatment was associated with a higher incidence of hyperlipidemia.Future large-scale studies are expected to be conducted to further confirm our findings.     

程丑夫教授论治情志病验案举隅

程丑夫是国家级名老中医,湖南中医药大学第一附属医院主任医师、教授、博士生导师,享受政府特殊津贴专家,出身于中医世家,从医40余年,经验丰富,对于内科系统及疑难杂症的治疗颇有心得,笔者有幸跟师学习,聆听教诲,受益匪浅,现将程师论治情志病的经典验案略陈一二。1思虑伤脾案患者肖某,女,27岁。初诊：2014年5月20日。半年前因婚变后出现忧心忡忡,多思多虑,近1月来反复腹部胀满,刻诊：腹胀,食后为甚,呃逆,无反酸,通气后可减轻,无腹痛,不欲食,夜寐不安,二便调。舌红苔厚白腻,脉弦,BP：110／70mmHg。     

补肾活血方对PCOS大鼠模型卵巢中PAI-1mRNA表达的影响

目的探讨补肾活血方对大鼠PCOS模型卵巢局部纤溶酶原激活物抑制因子-1（PAI—1mRNA）表达的影响。方法选用未成年24d龄SD雌性大鼠60只,随机分为模型组、克罗米酚组、补肾活血方高剂量组、补肾活血方低剂量组、正常对照组5组。用Bogovich法建立大鼠多囊卵巢病理模型。以克罗米酚为对照。用原位杂交法观察补肾活血方对多囊卵巢大鼠局部PAI—1mRNA的影响。结果模型组卵巢局部PAI—1mRNA存在卵泡膜间质细胞显著增高,用补肾活血方高、低剂量与克罗米酚药后,卵巢局部PAI-1mRNA的表达明显降低．差异具有统计学意义（P〈0．05、P〈0．01）。补肾活血方高剂量组与克罗米酚组比较,差异具有显著统计学意义（P〈0．01）;低荆量组与克罗米酚组比较差异无统计学意义（P〉0．05）,补肾活血方高、低剂量组比较,低剂量组卵泡膜间质细胞上PAI-1的基因表达增高更明显,但二者差异无统计学意义（P〉0．05）。结论PAI-1mRNA可能与多囊卵巢综合征的发病机制有关。以补肾活血立法的补肾活血方能降低多囊卵巢大鼠局部PAI—1mRNA的显著增高表达．降低PAI—1mRNA卵巢局部的作用。提示补肾活血方可能通过PAI—1mRNA途径促进卵巢排卵的机制。     

UniPron is A Fully Effective Non-hormonal Reversible Contraceptive in Baboon Model （Papio Anubis）

Objective To determine the safety and efficacy of UniPron as a reversible contraceptive.
Methods Vaginal swabs were obtained before and after UniPron administration, cultured onto appropriate culture media and bacteria identification was done based on type of media used, Gram stain reactions, colony morphology and biochemical tests. Vaginal biopsy tissues were processed using paraffin wax method, stained with hematoxylin and eosin and examined under light microscopy to determine the effect of the product on vaginal tissues. The effect of UniPron on sperm was examined by mixing the product with electroejaculated spermatozoa in vitro at different concentrations. For efficacy studies, male baboons of proven fertility were mated with UniPron treated or untreated females of proven fertility during the fertile stages.
Results All the five females （100%） that were treated with UniPron did not conceive and they regained total fertility when the treatment was stopped while all the controls conceived. At a concentration of 40%, UniPron completely immobilized spermatozoa in an in-vitro system. UniPron mechanism of action was by lowering the vaginal pH and on application in baboon, the pH was lowered for at least 3 h after which it went back to normal.
Conclusions As we plan for a study to test UniPron as a microbicide to prevent STIs including HIV, our current study has established that this novel product is effective in contraception and harmless to vaginal tissues and vaginal microbial flora in a baboon model （Papio anubis）.