纳米银抗菌敷料应用对糖尿病足患者感染控制的研究

目的探讨纳米银抗菌敷料对糖尿病足患者感染控制效果。方法选择2017年1月～2018年1月在我院治疗的糖尿病足患者60例为研究对象,随机分为干预组与对照组,各30例。两组均严格控制血糖水平。清创后干预组采用纳米银抗菌敷料包扎,对照组采用凡士林敷料包扎。分别于入组时、治疗4周对伤口疼痛程度、伤口溃疡严重程度、溃疡面积进行评价。统计两组患者溃疡愈合时间、换药次数。结果干预后,两组Wagner分级均较治疗前显著改善,差异有统计学意义(P0.05);治疗后干预组Wagner分级显著优于对照组,差异有统计学意义(P0.05)。干预后,两组溃疡面积显著低于干预前(P0.05);干预组溃疡面积干预后较对照组小(P0.05)。两组VAS干预后显著低于干预前(P0.05);干预组VAS干预后显著较对照组低(P0.05)。溃疡愈合时间干预组显著较对照组短,差异有统计学意义(P0.05);换药次数显著少于对照组,差异有统计学意义(P0.05)。结论纳米银抗菌敷料应用对糖尿病足可促进溃疡的愈合,缩小溃疡面积,改善Wagner分级,减少换药次数。     

重组人表皮生长因子联合含银敷料治疗中重度糖尿病足溃疡的疗效及安全性观察

目的 探讨重组人表皮生长因子(rh-EGF)联合含银敷料(德湿银)治疗Wagner Ⅱ、Ⅲ级糖尿病足溃疡的临床效果及安全性.方法 将45例Ⅱ、Ⅲ级糖尿病足溃疡患者随机分为3组.对照组15例,采用常规外科换药治疗;治疗组15例,在上述治疗基础上加用德湿银敷料;联合治疗组15例,使用rh-EGF局部喷洒加德湿银治疗.观察治疗8周后3组患者的疗效及安全性.结果 联合治疗组伤口愈合情况及有效率(86.7%)均显著高于治疗组(66.7%)和对照组(46.7%),差异有统计学意义(P＜0.05).3组均未观察到明显皮肤过敏及其他不良反应.结论 rh-EGF联合含银敷料治疗中重度糖尿病足溃疡疗效好,有加速伤口愈合的作用,且临床应用安全.     

银离子敷料在糖尿病足伤口治疗中的应用研究

目的银离子敷料在糖尿病足伤口治疗中的应用研究。方法按照WHO糖尿病及糖尿病足的诊断和分级标准,将2016年9月至2017年10月在巴州人民医院门诊和住院治疗的糖尿病足患者,将患者以踝肱比≥0.7的根据,按照随机和自愿纳入治疗组和对照组,银离子敷料治疗组的伤口配合应用亲水纤维银敷料换药。结果治疗组伤口愈合程度高于对照组,治疗组的伤口愈合面积减小率高于对照组,治疗组的治疗时间明显优于对照组。差异有统计学意义(P0.05)。结论亲水纤维银敷料用于治疗糖尿病足溃疡操作简单,换药次数减少,减轻患者痛苦并有效缩短了创面的愈合时间。     

新型敷料在糖尿病足护理应用中的效果观察

目的 探讨新型敷料在糖尿病足护理中的应用效果.方法 随机将83例糖尿病足患者分为两组,实验组采用新型敷料进行换药,对照组采用传统敷料进行换药.对两组局部溃疡的愈合率、愈合时间和换药次数进行比较.结果 实验组平均愈合时间较对照组缩短,换药次数低于对照组,且实验组局部溃疡愈合率明显高于对照组,两组之间有统计学差异（P＜0.05）.结论 新型伤口护理敷料能最大限度地减少糖尿病足伤口及周围皮肤的损伤,促进肉芽组织生长,降低截肢率,减少致残率,提高患者的生活质量.     

德赛恩液体敷料治疗糖尿病足溃疡的疗效观察

目的:比较德赛恩液体敷料治疗糖尿病足溃疡与常规治疗后溃疡愈合情况及愈合时间,分析德赛恩液体敷料治疗糖尿病足溃疡的疗效。方法:将糖尿病足患者共42例随机均分为试验组和对照组,两组均严格控制血糖、血压、抗感染、营养神经等常规治疗,在常规治疗的同时,试验组足部溃疡给予德赛恩液体敷料治疗,对照组使用庆大霉素治疗,记录两组治疗后的溃疡愈合情况及愈合时间。结果:试验组总有效率明显高于对照组(P<0.05);试验组平均创面愈合时间明显短于对照组(P<0.05),差异有统计学意义。结论:德赛恩液体敷料治疗糖尿病足溃疡,可有效控制感染,促进溃疡愈合。     

康惠尔系列敷料治疗糖尿病足溃疡63例疗效观察

目的观察康惠尔系列敷料治疗糖尿病足溃疡的临床疗效。方法将123例住院糖尿病足溃疡患者随机分为两组,常规组(60例)采用常规治疗及局部换药方法;新型康惠尔系列敷料组(63例)在常规治疗的基础上针对创面不同的愈合阶段,应用不同类型敷料,促进创面愈合。结果总有效率常规组为40%,治疗组为81%,两组疗效比较,差异有统计学意义(P<0.05)。治疗组各级糖尿病足溃疡愈合时间均显著缩短,明显优于常规组(P<0.05)。结论新型康惠尔系列敷料治疗糖尿病足溃疡为临床提供方便,具有较好的清创效果和加快伤口肉芽组织生长并促进愈合的作用。     

中西医结合治疗糖尿病足体会

目的：观察中药联合西医治疗糖尿病足治疗中的临床效果。方法：选择我院住院治疗糖尿病足患者40例,随机分为观察组和对照组。观察组除降糖、降脂、创面处理等基础治疗外,采用中药内服外用。对照组进行常规治疗。2个疗程后观察2组溃疡愈合情况。结果：观察组治疗总有效率90．0％显著高于对照组的75．0％,差异具有统计学意义（P＜0．01）。结论：中药结合西医基础治疗能够有效缓解糖尿病足溃疡,促进糖尿病足创面愈合,安全可靠。     

新型伤口护理敷料在治疗糖尿病足应用中的临床研究

目的:探讨新型伤口护理敷料在治疗糖尿病足中的应用。方法:将50例住院糖尿病足患者,随机分为两组:实验组24例,对照组26例,实验组采用新型伤口护理敷料进行换药,对照组采用常规敷料进行换药。并对两组局部溃疡的愈合率、愈合时间和换药次数进行比较。结果:实验组局部溃疡愈合率明显高于对照组(P<0.05),平均愈合时间较对照组明显缩短(P<0.05),且换药次数明显少于对照组(P<0.05)。结论:新型伤口护理敷料在治疗糖尿病足中的应用优于常规敷料,能最大限度地减少对伤口和周围皮肤的损伤促进肉芽组织生长,缩短愈合时间,减少换药次数,减少致残率,提高生活质量。     

重组人表皮生长因子联合软聚硅酮泡沫敷料治疗糖尿病足的疗效观察

目的：探讨重组人表皮生长因子联合软聚硅酮泡沫敷料治疗糖尿病足的临床疗效。方法：将82例糖尿病足患者分为治疗组48例与常规组34例,治疗组患者局部用重组人表皮生长因子联合软聚硅酮泡沫敷料进行治疗,与常规组对照,比较2组患者溃疡的愈合率和愈合时间。结果：治疗组的溃疡愈合率明显高于常规组（P〈0.05）,且平均愈合时间较常规组明显缩短（P〈0.01）。结论：重组人表皮生长因子联合软聚硅酮泡沫敷料局部治疗糖尿病足,其溃疡愈合率高于对照组,且创面平均愈合时间明显短于对照组。     

中药湿敷对糖尿病足溃疡患者血管介入术后疗效影响

〖H观察中药湿敷干预糖尿病足溃疡脉络瘀热证血管介入术后的临床疗效。方法 将57例糖尿病足溃疡患者随机分为治疗组和对照组,治疗组29例,对照组28例。2组均给予下肢动脉血管介入术及基础治疗,治疗组在对照组基础上给予中药湿敷创面,治疗8周后观察临床疗效。结果 治疗组、对照组临床总有效率分别为93.10%和78.57%,治疗组优于对照组（P＜0.05）。经血管介入治疗,2组踝肱比(ABI)水平均比治疗前明显减小（P＜0.01）,组间比较,P＞0.05。治疗后2组中医证候积分均有改善（P＜0.01）,治疗组明显优于对照组（P＜0.01）。2组创面面积、伤腔容积均比治疗前明显减小（P＜0.01）,治疗组改善优于对照组（P＜0.05）;治疗后2组创面愈合率组间比较,治疗组优于对照组（P＜0.05）。结论 糖尿病足溃疡患者经血管介入治疗后,血供状况得以改善,联合中药湿敷能进一步促进创面愈合,优于单纯接受血管介入治疗。     

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.