度洛西汀联合硫辛酸治疗糖尿病痛性神经病变的临床研究

目的 探讨度洛西汀联合硫辛酸治疗糖尿病痛性神经病变的临床效果.方法 将62例糖尿病痛性神经病变患者按照随机数字表法分为三组:A组22例用度洛西汀联合硫辛酸治疗,B、C组各20例分别用度洛西汀和硫辛酸治疗;其他治疗方案相同.疗程均为6周.比较三组患者治疗前后疼痛缓解程度及神经传导速度的变化.结果 A、B、C组患者治疗后疼痛均有明显改善(P＜0.01);总有效率分别为86.4%(19/22)、70.0%(14/20)、50.0%(10/20),差异有统计学意义(P＜0.05);从治疗后2周开始A组视觉模拟评分(VAS)明显低于B组和C组(P＜0.05);A、C组神经传导速度均有改善,与治疗前比较差异有统计学意义(P＜0.01);但治疗后A、C组神经传导速度比较差异无统计学意义(P＞0.05);B组治疗前后神经传导速度比较差异无统计学意义(P＞0.05).结论 度洛西汀联合硫辛酸可提高治疗糖尿病痛性神经病变的临床效果.

Abstract：

Objective To investigate the clinical curative effects of duloxetine combined with thioctic acid on diabetic painful peripheral neuropathy. Methods Sixty-two patients with diabetic painful peripheral neuropathy were divided into three groups by random digits table: group A(22 patients, duloxetine combined with thioctic acid group), group B (20 patients,duloxetine group) and group C (20 patients,thioctic acid group). The other treatments were same. All patients were treated for six weeks. The pain remission level and nerve conductive velocity were compared among three groups. Results The pain level in three groups was significantly alleviated after treatment (P ＜ 0.01 ). The general effective rate was 86.4%(19/22),70.0% (14/20) and 50.0% (10/20) in group A,group B and group C,respectively (P ＜ 0.05). Visual analogue scales (VAS) in group A was significantly lower than that in group B and group C from the second week after treatment (P ＜ 0.05 ). Nerve conductive velocity was improved in both group A and group C after treatment (P＜0.01),but there was no significant difference between two groups (P＞0.05). In group B,compared with that before treatment,nerve conductive velocity had no significantly improved after treatment (P＞ 0.05). Conclusion Duloxetine combined with thioctic acid can enhance the clinical curative effects on diabetic painful peripheral neuropathy.     

儿童复杂性尿道狭窄的治疗

目的 探讨儿童复杂性尿道狭窄手术方法的选择及成功的关键。方法 25例复杂性尿道狭窄采用不同的手术方法治疗30次，其中采用口腔粘膜管状重建尿道3例。口腔粘膜补片尿道成形3例；经耻骨径路尿道端端吻合11例，膀胱壁瓣尿道成形2例；经会阴径路尿道端端吻合8例；双阴唇带蒂皮瓣Ⅰ期尿道成形2例；带蒂包皮内板Ⅰ期尿道成形1例。结果 术后随访2-36个月。平均18.5个月。一次手术后排尿通畅20例。术后效果不佳5例。经再次手术后排尿通畅4例。结论 儿童尿道狭窄手术方法的选择应根据尿道狭窄段的长短，位置选择合适的术式；口腔粘膜具有取材方便。创伤小，有较强的抗感染力的优点，是一种较好的尿道替代物。     

精神紧张致咬合紊乱1例

<正>1临床资料患者,女性,16岁,高中二年级学生,特长画画。头痛不适3 d,晚餐后突然头向左侧倾斜后仰,下颌向左侧偏斜,头颈部活动及开闭口受限,颞下颌关节处持续性疼痛半小时来我院就诊。查体:神智清晰,营养中等,查体合作,心、肺、腹未见异常。专科检查:头向左侧倾斜后仰,下颌向左偏,颈部及下颌侧向运动障碍,触之左侧颈前区僵硬并有     

Trends in cardiovascular risk factor levels in Finnish children and young adults from the 1970s: The Cardiovascular Risk in Young Finns Study

OBJECTIVES: The Cardiovascular Risk in Young Finns Study is an ongoing multicentre study of atherosclerosis precursors in Finnish children and young adults. The aim of the present report is to describe the secular trends in cardiovascular risk factors between 1980 and 2001 in children and young adults. METHODS: Data on cardiovascular risk factors were collected in a cohort of subjects (original n=3596) that were followed with serial cross-sectional studies from childhood to adulthood. The study was initiated in 1980, and the latest follow-up (after 21 years) was performed in 2001 (with n=2285 participants). To assess secular trends up to the year 2001, selected risk variables were analyzed (ie, total cholesterol, low density lipoprotein [LDL] cholesterol, high density lipoprotein [HDL] cholesterol, triglycerides, apolipoproteins A1 and B, blood pressure, body mass index [BMI] and daily intake of energy and quality of fat) in subjects with complete data for the years 1980, 1986 and 2001 (n=1758). RESULTS: From 1980 to 1986, LDL-cholesterol concentrations decreased 0.32 mmol/L (P<0.0001) in subjects aged 15 to 18 years. From 1986 to 2001, LDL concentrations did not change in 24-year-old subjects (delta=-0.12 mmol/L, P>0.05). HDL-cholesterol concentrations decreased 0.28 mmol/L (P<0.0001) from 1986 to 2001. Triglyceride concentrations increased 0.21 mmol/L (P<0.0001) from 1980 to 1986 and 0.26 mmol/L (P<0.0001) from 1986 to 2001. In female subjects, BMI increased both from 1980 to 1986 (delta=0.5 kg/m(2), P=0.03) and from 1986 to 2001 (delta=1.7 kg/m(2), P=0.0002). Systolic blood pressure levels decreased 3.7 mmHg (P<0.0001) from 1980 to 1986 and 7.0 mmHg (P<0.0001) from 1986 to 2001 in all subjects. CONCLUSION: The authors conclude that between 1986 and 2001, the decreases in LDL-cholesterol concentrations among young adults in Finland stopped. During the same time, HDL-cholesterol concentrations started to decrease, and triglyceride concentrations continued to decrease, and in female subjects, BMI continued to increase. However, also during this time, blood pressure levels continued to decrease in all subjects.     

胸腺肽与干扰素联合治疗慢性乙型肝炎58例观察

目的 :观察胸腺肽与干扰素联合应用与单用干扰素治疗慢性乙肝的疗效对比。方法 :选择慢性乙肝 5 8例 ,胸腺肽与干扰素联合组 32例 ,干扰素组 2 6例 ,根据用药时间观察各化验指标。结果 :血清HBeAg/抗HBe转换率至治疗第 6个月 ,联合组达 5 0 % ,干扰素组达 30 .7% ,联合组疗效显著高于干扰素组(P <0 0 5 )。两组治疗中 ,联合组HBVDNA阴转率高于干扰素组 (P <0 .0 5 )。结论 :胸腺肽与干扰素联用具有协同作用 ,治疗慢性乙肝优于干扰素组。     

Hyaluronic acid: a unique topical vehicle for the localized delivery of drugs to the skin

Hyaluronic acid (HA) is a naturally occurring polyanionic, polysaccharide that consists of N-acetyl-D-glucosamine and beta-glucoronic acid. It is present in the intercellular matrix of most vertebrate connective tissues especially skin where it has a protective, structure stabilizing and shock-absorbing role. The unique viscoelastic nature of HA along with its biocompatibility and non-immunogenicity has led to its use in a number of clinical applications, which include: the supplementation of joint fluid in arthritis; as a surgical aid in eye surgery; and to facilitate the healing and regeneration of surgical wounds. More recently, HA has been investigated as a drug delivery agent for various routes of administration, including ophthalmic, nasal, pulmonary, parenteral and topical. In fact, regulatory approval in the USA, Canada and Europe was granted recently for 3% diclofenac in 2.5% HA gel, Solaraze, for the topical treatment of actinic keratoses, which is the third most common skin complaint in the USA. The gel is well tolerated, safe and efficacious and provides an attractive, cost-effective alternative to cryoablation, curettage or dermabrasion, or treatment with 5-fluorouracil. The purpose of this review is to describe briefly the physical, chemical and biological properties of HA together with some details of its medical and pharmaceutical uses with emphasis on this more recent topical application.     

Chronic encapsulated mediastinal abscess presenting with remote cutaneous fistulization 12 years after redo aortic valve replacement for prosthetic valve endocarditis

Chronic encapsulated mediastinal abscess is an unusual complication of previous open heart surgery. We report on the case of a 79 year old male who presented with epigastric fistulization of an encapsulated anterior mediastinal abscess 12 years after a redo aortic valve replacement for prosthetic valve endocarditis. The encapsulated abscess and its complex branching tracts and the cutaneous fistula were excised completely except the thin longitudinal strip of the ascending aorta which formed part of the posterior wall of the infected tract. This was covered with transposed greater omentum based on right gastroepiploic artery pedicle. Patient remains fit and well 2 years after his operation.     

人原始生殖细胞分离培养的初步研究

[目的]探讨分离培养人原始生殖细胞的最佳条件。[方法]用胰蛋白酶消化5～9周人流组织中的人胚生殖嵴,获取人原始生殖细胞。以小鼠胚胎成纤维细胞作饲养层,在高糖DMEM培养基中添加10μmol/L福司克林(forskolin)和5～μg/L碱性成纤维细胞生长因子(bFGF)的培养液中培养、传代,并对子代细胞进行碱性磷酸酶活性检测和体外分化实验。[结果]原代培养时形成许多大小不等,形态各异的由人原始生殖细胞组成的集落,约5～7d传代。传代后,集落生长,变大。细胞培养到第七代,检测碱性磷酸酶染色为强阳性,体外分化实验有拟胚体形成。[结论]人原始生殖细胞可以用胰蛋白酶消化分离培养。用高糖DMEM培养基,添加forskolin和bFGF有利于人原始生殖细胞增殖。体外分化实验初步证实人原始生殖细胞具有多向分化潜能。