名老中医经验共性规律及个性差异比较研究

名老中医共性及个性经验的知识发现.结果:发现了名老中医运用某些治法、方剂及药物的特点得出了不同名老中医针对中、西医疾病的异病同治规律,从而总结出不同老中医临床经验的共性规律及个性差异.结论:比较名老中医经验的异同,有利于更加深入地认识中医个体化医学的核心内涵,发现其共性规律,明确个性经验产生的原因,为今后开展验证性研究,形成更加科学的中医经验理论提供了基础.同时,为后学者博采众长、学习和汲取多位名老中医经验提供了示范,对促进中医药的传承和发展具有一定意义.     

基于临床医疗科研信息共享系统AECOPD证症相关性分析研究

目的：利用复杂网络开展慢性阻塞性肺疾病急性加重期（AECOPD）证症相关性分析研究,为AECOPD 证候诊断标准的修订提供科学依据,并探索有关技术方法的推广应用。方法：利用当前我院临床医疗科研信息共享系统,开展大数据（2011 年8 月~2013 年1 月间3 000 份格式化电子病历数据）导入数据库,通过ETL 软件进行数据处理,运用复杂网络进行数据挖掘。获取AECOPD 常见证候常见症状的相关度MISCR 值（证候与症状的相关性）,并与现有标准对比分析。结果：痰热壅肺、肺肾气虚、痰浊阻肺等各证候对应的症状群与现有标准对应分析发现临床所见证候多虚症、实症夹杂,但个别症状与对应的证候相矛盾。结论：基于临床医疗科研信息共享系统,开展AECOPD 证症相关性分析研究,为中医证候诊断 标准的验证和修订提供有力的证据和方法学研究。     

Material properties and bone marrow stromal cells response to in situ crosslinkable RGD-functionlized lactide-co-glycolide scaffolds

In situ crosslinkable biomaterials with degradation profiles that can be tailored to a particular application are indispensable for treating irregularly shaped defects and for fabrication of shape-selective scaffolds. The objective of this work was to synthesize ultra low molecular weight functionalized PLA and PLGA macromers that can be grafted with bioactive peptides and crosslinked in situ to fabricate biodegradable functional scaffolds. In situ crosslinkable lactide-co-glycolide macromer (cMLGA; "c" for crosslinkable, "M" for macromer, and "LGA" for lactide-co-glycolide) was synthesized by anionic polymerization of lactide and glycolide monomers followed by condensation polymerization with fumaryl chloride. The cMLA (100% L-lactide) and cMLGA macromers formed porous crosslinked scaffolds with NVP as the crosslinker. The mass loss of the crosslinked cMLA and cMLGA was linear with incubation time in vitro (zero-order degradation) and the degradation rate depended on the ratio of lactide to glycolide. cMLGA scaffold with 1:1 lactide to glycolide ratio completely degraded after 4 weeks while the cMLA lost less than 40% of its initial mass after 35 weeks. When cMLA scaffold was functionalized with acrylated integrin-binding Ac-GRGD amino acid sequence, bone marrow stromal (BMS) cells attached and spread on the cMLA scaffold and exhibited focal-point cell adhesion. The mRNA expression levels of collagen-1alpha, osteonectin, and osteopontin for BMS cells seeded in the scaffolds with 1 and 5% Ac-GRGD were upregulated compared with those without Ac-GRGD. cMLGA is attractive as in situ crosslinkable macromer for fabrication of functional scaffolds with degradation characteristics that can be tailored to a particular application.     

基质金属蛋白酶-2在盐型高血压大鼠心脏中的表达及不同种类降压药物的影响

目的探讨基质金属蛋白酶-2/基质金属蛋白酶-2特异性组织抑制因子(MMP-2/TI MP-2)在脱氧皮质酮(DOCA)-盐型高血压大鼠(DHR)心脏微小血管重塑中的作用及其可能的调节机制。方法30只雄性SD大鼠,等分和制作为对照组、模型组、波生坦组、氨氯地平组和雷米普利组。5周末处死动物,检测心脏微小血管密度和MMP-2/TI MP-2蛋白与基因的表达。结果在DHR左心室心内膜下心肌中存在微小动脉密度增加和毛细血管密度减少,MMP-2的mRNA和MMP-2/TI MP-2的蛋白表达上调;波生坦和氨氯地平能明显减轻微小血管损害,下调MMP-2/TI MP-2的mRNA和蛋白表达;雷米普利不能减轻微小血管损害,也不影响MMP-2/TI MP-2的mRNA和蛋白表达;MMP-2的表达同微小血管密度间具有良好的相关性。结论在DHR心脏中存在微小血管病变,MMP-2/TI MP-2表达可能参与微小血管病变的病理机制,内皮素-1和血压可能是通过调节MMP-2/TI MP-2表达参与微小血管病变。     

慢性鼻-鼻窦炎-鼻息肉伴哮喘患者鼻内镜围手术期药物治疗

目的 探讨慢性鼻-鼻窦炎-鼻息肉(CRSwNP)伴支气管哮喘患者鼻内镜围手术期药物治疗原则及效果。方法 收集2010年6月至2013年12月山东大学齐鲁医院耳鼻咽喉科收治的109例CRSwNP伴支气管哮喘患者行鼻内镜手术(ESS)的临床资料。术前均对哮喘进行全面评估, 哮喘完全控制6个月后行ESS手术治疗, 围手术期采用雾化吸入及全身糖皮质激素等药物治疗。结果 围手术期无哮喘急性发作, 仅1例患者术后第2天因口服镇痛剂出现喘息;术后随访1~3年, 采用鼻内镜检查并行ESS临床疗效评估, 病情完全控制者5例(4.59%), 病情部分控制者94例(86.24%), 病情未控制10例(9.17%);仅1例术后13个月因股骨头坏死行手术治疗。结论 全面细致的哮喘病情评估和ESS围手术期药物治疗有利于防止围手术期哮喘发作及控制术后CRSwNP患者鼻息肉复发, 有利于提高手术疗效。     

Osteogenic Differentiation of Marrow Stromal Cells on Random and Aligned Electrospun Poly(l-lactide) Nanofibers

The fibrillar structure and sub-micron diameter of electrospun nanofibers can be used to reproduce the morphology and structure of the natural extracellular matrix (ECM). The objective of this work was to investigate the effect of fiber alignment on osteogenic differentiation of bone marrow stromal (BMS) cells. Random and aligned poly(l-lactide) (PLLA) nanofibers were produced by collecting the spun fibers on a stationary plate and a rotating wheel, respectively, as the ground electrode. Morphology and alignment of the BMS cells seeded on the fibers were characterized by SEM. The effect of fiber orientation on osteogenic differentiation of BMS cells was determined by measuring alkaline phosphatase (ALPase) activity, calcium content, and mRNA expression levels of osteogenic markers. There was a strong correlation between the fiber and cell distributions for the random (p = 0.16) and aligned (p = 0.81) fibers. Percent deviation from ideal randomness (PDIR) values indicated that cells seeded on the random fibers (PDIR = 6.5%) were likely to be distributed randomly in all directions while cells seeded on the aligned fibers (PDIR = 86%) were highly likely to be aligned with the direction of fibers. BMS cell seeded on random and aligned fibers had similar cell count and ALPase activity with incubation time, but the calcium content on aligned fibers was significantly higher after 21 days compared to that of random fibers (p = 0.003). Osteopontin (OP) and osteocalcin (OC) expression levels of BMS cells on fibers increased with incubation time. However, there was no difference between the expression levels of OP and OC on aligned vs. random fibers. The results indicate that BMS cells aligned in the direction of PLLA fibers to form long cell extensions, and fiber orientation affected the extent of mineralization, but it had no effect on cell proliferation or mRNA expression of osteogenic markers.     

血管神经离断术治疗顽固性乳腺增生症的临床观察

目的 :研究血管神经离断术对顽固性乳腺囊性增生症的临床治疗作用及血管分布的影响。 方法 :对 10 0例患者采用随机分组进行研究。治疗组采用血管神经离断术 ,对照组使用药物治疗。采用物理检查和CDI动态观察疗效。 结果 :治疗组和对照组各为 5 0人 ,术后 1月、3月、6月、12月检查 ,治疗组在疼痛、肿块及血管分布方面的变化情况明显优于对照组(P <0 0 5 ) ,CR 96 % ,PR 98%。 结论 :血管神经离断术对乳腺囊性增生症疼痛和肿块的消退及新生血管的生成等方面具有明显的干预作用。采用微创性手术则起到了既治疗疾病又兼顾美容的目的     

乙型肝炎病毒感染标记家庭分布规律的探讨

本文用SPRIA检测了99个家庭424人血清标本的乙型肝炎病毒(HBV)感染标记,并用二项分布理论分析了HBsAg携带者、抗-HBs和抗-HBc阳性者以及HBV感染者的家庭分布规律。结果显示,HBsAg携带者的家庭分布不符合二项分布,提示有家庭聚集性;而抗-HBs、抗-HBc阳性者以及HBV感染者的家庭分布符合二项分布,无家庭聚集性。HBV感染标记的家庭分布规律不同,提示不同家庭的成员获得HBV持续感染和获得抗HBV感染的免疫力的机理是不同的。作者推测,遗传因素可能是造成HBsAg携带者呈家庭聚集性的主导因素之一。     

后颅窝枕下减压术治疗大面积小脑梗死的预后分析

目的分析后颅窝枕下减压术治疗大面积小脑梗死的手术时机、手术方式及预后。 方法回顾性分析济南军区总医院神经外科自2010年1月至2018年2月符合纳入标准的大面积小脑梗死患者的临床资料。所有患者于CT及MRI检查确诊后24 h内行后颅窝枕下减压术,如有急性脑积水发生,先行脑室外引流术,再进行后颅窝枕下减压术。 结果本组患者12例,术前CT显示出现脑积水者4例,先行脑室穿刺外引流术,后行颅窝减压术。根据GOS评分评价患者外科治疗效果：良好7例,中残2例,重残1例,植物生存1例,死亡1例。 结论后颅窝减压术能避免大面积小脑梗死临床症状恶化进行性发展,改善预后。     

乳管镜对乳腺导管内疾病的诊断及介入治疗--附100例临床分析

目的:探讨乳管镜在乳腺疾病诊断和治疗中的作用.方法:应用乳腺纤维导管内视镜对100例伴乳头溢液的乳腺导管性疾病进行诊断或介入治疗.结果:13例导管内占位性疾病得到了正确诊断,87例渗出性导管病经治疗后治愈.结论:乳管镜对乳管内病变的正确诊断及手术方式可提供依据,并可对渗出性病变进行介入治疗.