TACE联合阿帕替尼治疗中晚期原发性肝癌的临床疗效分析

【摘要】 目的 观察中晚期原发性肝癌(hepatocellular carcinoma,HCC)患者应用经皮肝动脉介入化疗栓塞术(transcatheter arterial chemoembolization,TACE)后联合使用阿帕替尼的临床疗效,并与联合索拉非尼进行对比。方法 将42例中晚期原发性肝癌患者分为两组,介入化疗栓塞加阿帕替尼联合治疗（实验组）及介入化疗栓塞加索拉非尼联合治疗（对照组）各21例,对两组间临床疗效、AFP、不良反应进行分析比较。结果 实验组客观缓解率、疾病控制率、1年生存率与对照组相比差异无统计学意义(P＞005);两组间不良反应比较,实验组出现高血压、皮肤粘膜反应高于对照组,差异有统计学意义(P＜005),不良反应经对症处理后均缓解;治疗后3月两组甲胎蛋白均较治疗前明显下降,差异有统计学意义(P＜005),实验组甲胎蛋白下降幅度与对照组相比差异无统计学意义（P＞005)。结论 肝动脉介入化疗栓塞术后联合使用阿帕替尼或索拉非尼治疗中晚期原发性肝癌,其临床获益率均较高,可明显降低甲胎蛋白,不良反应可控,值得临床推广应用。     

分段切断内括约肌加纵切横缝术治疗环状混合痔的临床疗效观察

【摘要】 目的 观察分段切断内括约肌加纵切横缝术治疗环状混合痔的临床疗效及其并发症情况。方法 选取环状混合痔患者80例， 随机分为对照组和治疗组各40例，对照组采用外剥内扎术治疗，治疗组采用分段切断内括约肌加纵切横缝术治疗，观察并记录两组患者术后7天、1月、3月大便顺畅程度、肛缘水肿程度、肛门括约肌功能、治愈率及复发率，比较两组间临床疗效的差异，评定其效果。采用SPSS 170软件对数据进行统计分析，以P＜005为差异有统计学意义。结果 与对照组比较，治疗组患者排便更为顺畅，肛缘水肿程度较小，差异有统计学意义（P＜005）；治疗组患者及对照组患者肛门括约肌功能损伤程度一致，差异不具有统计学意义（P＞005）；治疗组患者与对照组患者治愈率及复发率差异亦无统计学意义（P＞005），说明两种手术方式远期疗效一致。结论 分段切断内括约肌加纵切横缝术治疗环状混合痔，疗效良好。     

高能量CO2点阵激光与点阵射频治疗萎缩性痤疮瘢痕的疗效评价

【摘要】 目的 对比高能量CO2点阵激光与点阵射频治疗萎缩性痤疮瘢痕的临床效果, 为临床选择治疗方法提供参考。方法 采用前瞻性研究方法, 选择2014年2月～2016年4月在我院诊治的萎缩性痤疮瘢痕患者128例, 采用随机数字表法原则分为观察组与对照组；每组各64例, 观察组给予高能量CO2点阵激光治疗, 对照组给予点阵射频治疗, 1次/周, 共治疗5次, 记录两组患者治疗效果。结果 观察组的治疗总有效率明显高于对照组(P＜005)；观察组与对照组治疗后的皮损积分,都明显低于治疗前(P＜005)，且观察组明显低于对照组(P＜005)；两组治疗后的水分丢失明显减少, 而含水量明显增加, 与治疗前比较差异且有统计学意义(P＜005)，同时，观察组治疗后的水分丢失、含水量与对照组对比差异有统计学意义(P＜005)；两组治疗期间的疼痛、红斑、色素沉着、增生性瘢痕等不良反应发生情况对比无明显差异(P＞005)。结论 相对于点阵射频技术, 高能量CO2点阵激光在萎缩性痤疮瘢痕的应用能促进皮肤生理指标的改善, 从而有利于皮损症状的消失与提高治疗疗效, 且安全性好。     

短节段椎弓根钉内固定治疗非相邻型多节段脊柱骨折的临床研究

【摘要】 目的 探讨短节段椎弓根钉内固定治疗非相邻型多节段脊柱骨折的效果。方法 非相邻型多节段脊柱骨折患者108例根据随机数字表法分为治疗组与对照组各54例，对照组给予后路长节段椎弓根钉内固定治疗；治疗组给予短节段椎弓根钉内固定治疗。结果 治疗后，治疗组在出血量和手术时间，明显低于对照组(P＜005)；治疗组并发症发生率明显低于对照组(P＜005)。两组术后的伤椎前缘高度比值明显增加，而Cobb角明显减少，与术前对比均有明显差异(P＜005)，但治疗组的伤椎前缘高度与Cobb角单优于照组，差异在统计学上均有意义(P＜005)。两组术后神经功能均较术前有一定程度的恢复(P＜005)，临床治疗效果上，治疗组明显优于对照组(P＜005)。两组术前JOA评分无明显差异，术后JOA评分治疗组明显高于对照组(P＜005)。结论 短节段椎弓根钉内固定治疗非相邻型多节段脊柱骨折临床效果明显且具有更加微创安全的特点，还可促进神经功能与腰椎功能的恢复。     

高压氧治疗弥漫性轴索损伤的临床疗效分析

【摘要】 目的 探讨高压氧治疗弥漫性轴索损伤（DAI）的临床疗效以及开始治疗时机对疗效的影响。方法 84例DAI患者根据是否接受高压氧治疗分为治疗组和对照组各42例, 采用格拉斯哥预后评分（GOS）及简明精神状态检查量表（MMSE）和日常活动能力量表（ADL）进行临床疗效及预后比较分析。治疗组患者42例根据伤后高压氧治疗开始时间分为A、B两组,比较治疗效果。结果 按GOS评分评定预后,治疗组预后良好20例（4762%）,对照组预后良好8例（1905%）,两组预后良好率差异有统计学意义（P＜005）。治疗组治疗前后MMSE、ADL评分两者差异有统计学意义（P＜005）。对照组治疗前后MMSE、ADL评分差异有统计学意义（P＜005）。治疗组的MMSE、ADL评分均较对照组有统计学差异(P＜005)。治疗组的42例患者中, A组与B组的MMSE、ADL评分比较差异有统计学意义（P＜005）。结论 高压氧辅助治疗弥漫性轴索损伤可以明显降低病死率,同时强调早期治疗可改善患者的预后。     

不同手术入路PCI治疗STEMI患者与CCU入住时间对疗效的影响

【摘要】 目的 分析不同手术入路对经皮冠脉介入术(PCI)治疗ST段抬高型心肌梗死(STEMI)患者的疗效与入住重症监护室(CCU)时间的影响。方法〓收集2015年1月~2016年5月我院收治的接受急诊PCI治疗的STEMI患者110例,其中经桡动脉介入穿刺60例(TRI组),经股动脉介入穿刺50例(TFI组),收集两组患者临床资料,比较治疗效果,统计穿刺成功率、PCI成功率、穿刺时间、X线暴露时间、球囊扩张时间、造影导管数、造影剂使用量、手术时间、穿刺点压迫时间、CCU入住时间、总住院时间,记录两组患者手术并发症及随访不良事件发生率及复发率。结果〓两组穿刺成功率、PCI成功率比较差异无统计学意义(P＞005);TRI组造影导管数少于TFI组（P＜005）;穿刺点压迫时间、术后卧床时间、CCU入住时间及总住院时间均短于TFI组(P＜005);TRI组迷走神经反射、尿潴留发生率均低于TFI组(P＜005),但随访不良事件发生率及复发率比较差异无统计学意义(P＞005)。结论〓TRI、TFI下急诊PCI治疗STEMI疗效均肯定,但TRI可缩短患者卧床时间、CCU入住时间及住院时间,减少手术并发症。     

子宫背带式缝合术治疗剖宫产术中产后出血的效果

【摘要】 目的 探讨子宫背带式缝合术治疗剖宫产术后出血的临床效果。方法 纳入我院2015年6月～2017年9月剖宫产术后出血患者86例，根据患者止血治疗方法的不同分为观察组和对照组各43例。观察组给予子宫背带式缝合术治疗，对照组进行传统的子宫动脉结扎、宫腔填塞纱条等治疗。对比两组的临床效果。结果 观察组止血有效率显著高于对照组，差异有统计学意义(2=356，P＜005)；观察组患者的术后出血量少于对照组（P＜005），手术与住院时间均短于对照组（P＜005），术后并发症较对照组少（P＜005）。结论 子宫背带式缝合术治疗剖宫产术后出血治疗效果优于传统方法，能够快速止血，减少术后并发症，安全性高，临床效果显著，具有临床应用价值。     

微生态制剂联合低聚果糖治疗对抗生素诱发腹泻患儿肠道菌群的影响

【摘要】目的 探讨口服二甲双胍控糖效果不佳糖尿病患者起始胰岛素治疗方案的选择及安全性。方法 选取口服二甲双胍控糖效果不佳的2型糖尿病患者126例随机分为3组,在二甲双胍治疗基础上,分别联用西格列汀、起始剂量10 U/d胰岛素、起始剂量15 U/d胰岛素分别作为A组、B组、C组,治疗期间均根据血糖控制情况调整用药剂量,达到并维持空腹血糖≤56 mmol/L。记录3组血糖达标率、达标时间、低血糖反应;计算治疗前后体重指数(BMI)、体重差值,统计三组治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋(HbA1c)、胰岛素抵抗指数(HOMA IR)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL C)。结果〓本研究中A组5例脱落,B组7例脱落,C组8例脱落。3组患者血糖达标率、低血糖反应发生率比较差异无统计学意义(P＞005);C组血糖达标时间短于A组、B组(P＜005),但A组、B组比较差异无统计学意义(P＞005)。3组治疗后FPG、2hPG、HbA1c、HOMA IR均下降,FINS上升,同组治疗前后差异有统计学意义(P＜005),但3组组间比较差异无统计学意义(P＞005)。A组治疗前后BMI、体重差值低于B组、C组,差异有统计学意义(P＜005),但B组、C组比较差异无统计学意义(P＞005)。结论〓口服二甲双胍控糖效果不佳2型糖尿病患者联合西格列汀、甘精胰岛素均可获得理想的降糖效果,且加大基础甘精胰岛素方案起始用药剂量可缩短血糖达标时间,但西格列汀在控制体重上更具优势。     

糖尿病患者起始胰岛素治疗方案的选择及安全性评价

【摘要】目的 探讨口服二甲双胍控糖效果不佳糖尿病患者起始胰岛素治疗方案的选择及安全性。方法 选取口服二甲双胍控糖效果不佳的2型糖尿病患者126例随机分为3组,在二甲双胍治疗基础上,分别联用西格列汀、起始剂量10 U/d胰岛素、起始剂量15 U/d胰岛素分别作为A组、B组、C组,治疗期间均根据血糖控制情况调整用药剂量,达到并维持空腹血糖≤56 mmol/L。记录3组血糖达标率、达标时间、低血糖反应;计算治疗前后体重指数(BMI)、体重差值,统计三组治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋(HbA1c)、胰岛素抵抗指数(HOMA IR)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL C)。结果〓本研究中A组5例脱落,B组7例脱落,C组8例脱落。3组患者血糖达标率、低血糖反应发生率比较差异无统计学意义(P＞005);C组血糖达标时间短于A组、B组(P＜005),但A组、B组比较差异无统计学意义(P＞005)。3组治疗后FPG、2hPG、HbA1c、HOMA IR均下降,FINS上升,同组治疗前后差异有统计学意义(P＜005),但3组组间比较差异无统计学意义(P＞005)。A组治疗前后BMI、体重差值低于B组、C组,差异有统计学意义(P＜005),但B组、C组比较差异无统计学意义(P＞005)。结论〓口服二甲双胍控糖效果不佳2型糖尿病患者联合西格列汀、甘精胰岛素均可获得理想的降糖效果,且加大基础甘精胰岛素方案起始用药剂量可缩短血糖达标时间,但西格列汀在控制体重上更具优势。     

经额锁孔血肿清除术治疗脑室出血的疗效及

【摘要】 目的 探讨经额锁孔血肿清除术治疗原发性脑室出血手术前后炎症因子表达及临床疗效。方法 选取我院神经外科2011年1月～2015年12月收治的原发性脑室出血患者68例,根据手术方式不同分为观察组和实验组两组,每组各34例,对照组采用双侧侧脑室钻孔引流术,试验组采用经额锁孔血肿清除术;于术前、术后1、2、3d、1、2w采集患者静脉血标本检测肿瘤坏死因子a(Tumer Necrosis Factor,TNF a)及C 反应蛋白(C Reaction Protein,CRP),同时观察术后临床疗效。结果 两组患者术后TNF a的表达均较术前降低,术后第3d试验组与对照组比较,差异有统计学意义(P＜005);两组患者术后CRP的表达均较术前降低,术后第3d、1w试验组与对照组比较,差异有统计学意义(P＜005);两组患者术后颅内再次出血、肺部感染、尿路感染发病率差异不显著(P＞005);术后试验组脑积水的发生率低于对照组(P＜005),两组患者引流管留置时间、颅内感染发生率、意识恢复时间、ICU住院天数比较差异无统计学意义(P＞005);术后两组患者格拉斯哥预后评分(GOS)差异无统计学意义(P＞005)。结论 原发性脑室出血后采用经额锁孔血肿清除术及双侧脑室钻孔引流术均能明显降低体内炎症反应,两组患者术后并发症发生率及临床疗效无明显差异;但经额锁孔血肿清除术组患者术后脑积水发生率明显低于双侧脑室钻孔引流组。     

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.