经阴道子宫输卵管声诺维三维超声造影诊断输卵管性不孕症的初步探讨——附36例检测报告

目的：探讨经阴道子宫输卵管声诺维三维超声造影（3D-SonoVue-HyCoSy）诊断输卵管性不孕症的可行性及诊断效能。方法：选择36例不孕症患者共72条输卵管,利用经阴道子宫输卵管3D-SonoVue-HyCoSy诊断输卵管的通畅性和盆腔黏连情况,以腹腔镜下通液检查结果为标准,评价3D-SonoVue-HyCoSy对输卵管通畅性的诊断效能。结果：3D-SonoVue-HyCoSy诊断输卵管阻塞的阳性预测值为87%,诊断输卵管通畅的阴性预测值为84%,诊断通而不畅的符合率为20%,判断输卵管通畅与否的准确度是76%,诊断输卵管阻塞的敏感度为84%,诊断输卵管通畅的特异度为75%。在通畅及通而不畅的35条输卵管的3D-SonoVue-HyCoSy图像中,83%输卵管可见伞端溢出,通畅的25条输卵管中88%可见同侧卵巢周边造影剂溢出环,10条通而不畅的输卵管中7条可见同侧卵巢周边少量溢出;检出盆腔黏连的敏感度15%。结论：经阴道子宫输卵管3D-SonoVue-HyCoSy诊断输卵管性不孕症是可行和有效的,自动三维容积成像功能和声诺维超声造影剂的使用明显提高了输卵管内造影剂持续流动信号的探测水平和输卵管伞端造影剂溢出的识别水平。     

输卵管声诺维三维超声造影的临床综合评价

目的：探讨经阴道子宫输卵管声诺维三维超声造影（3D-HyCoSy）诊断输卵管性不孕症的诊断效能及优势。方法收集1043例行输卵管3D-HyCoSy 检查不孕症患者的造影资料,分析3D-HyCoSy的影像分级、其诊断输卵管通畅的三维特征以及不良反应。总结95例随后行腹腔镜下通液检查不孕症患者的输卵管3D-HyCoSy及腹腔镜下通液检查结果,以腹腔镜下通液检查为金标准,分析3D-HyCoSy对输卵管阻塞的诊断效能。结果1043例患者的3D-HyCoSy检查结果中,易读图像为853例,占81.8％。在通畅的输卵管中,鸟尾状或树枝状伞端溢出的出现率为93.9％。检查过程中仅8例有明显痛感。以腹腔镜下输卵管通液为金标准,3D-HyCoSy检查诊断95例患者输卵管阻塞的敏感度为93％、特异度为88％、总符合率为90％、阳性预测值为86％,阴性预测值为94％。3D-HyCoSy和腹腔镜下输卵管通液检查的一致性检测的Kappa值为0.8550（P＜0.01）,超过0.75,有良好的一致性。结论子宫输卵管3D-HyCoSy检查具有其独特的三维影像学特征,用于评估不孕症患者输卵管通畅性安全、有效,可作为目前无创性判断输卵管通畅性的首选方法之一。     

穴位埋线疗法的优势病种及应用规律

目的:分析穴位埋线疗法在临床各科疾病中的优势,并探讨其临床应用规律,为临床治疗提供参考依据。方法:采用现代计算机技术,建立穴位埋线数据库,对近40年来与穴位埋线相关的文献进行筛选、录入、审核、提取、统计分析。结果:①录入1075篇文献,穴位埋线疗法在临床各科均有应用,尤其在内科中治疗病种最多,占所有病种的48.54%(50/103),以治疗胃脘痛为主,频次为102次,肥胖病频次为74次;其次是外科疾病,占所有病种的14.56%(15/103),以治疗腰腿痛为主,频次为79次;皮肤科以治疗牛皮癣为主,频次30次;五官科以治疗重睑术为主,频次为30次。②纳入的文献研究中,穴位选择以近部选穴和远部选穴为主;埋线工具有多种,主要以改制的腰穿针为主,在线的选择上以不同型号羊肠线为多。③疗效分析显示,穴位埋线疗法治疗各科疾病疗效显著,尤其以外科和皮肤科最为突出,总有效率均达90%以上。结论:穴位埋线疗法主要优势病种是内科的胃脘痛、肥胖病、痫证、哮喘、腹痛、面瘫、便秘;外科的腰腿痛;皮肤科的牛皮癣和五官科的重睑术。     

穴位埋线疗法病谱初探(英文)

目的:初步探讨穴位埋线疗法的临床适用病种,整理并分析穴位埋线疗法病谱。方法:采用文献研究方法及数据挖掘技术,经过对1971年—2011年6月发表的与穴位埋线疗法相关的临床研究论文进行筛选、录入、审核、提取有效信息等环节后,归纳总结穴位埋线疗法病谱。结果:穴位埋线疗法适用于103种疾病,涉及6个科属。内科最多,共50种,占总病谱的48.54%;其余依次是外科、五官科、妇科和皮肤科,分别为15种、12种、11种、11种;儿科最少,共4种。同时,按照"效能针灸等级病谱"的规则,初步对该疗法治疗的病种进行等级分类,获得穴位埋线疗法Ⅰ级病谱26种,Ⅱ级病谱30种,Ⅲ级病谱8种。结论:穴位埋线疗法临床运用广泛,病谱不断扩大,值得临床推广应用。     

Effects of electroacupuncture of different frequencies on SP and VIP expression levels in colon of rats with slow transit constipation

Objective

To observe the effects of electroacupuncture (EA) of different frequencies on the expression levels of substance P (SP) and vasoactive intestinal peptide (VIP) in the colon of rats with slow transit constipation (STC).

Methods

One hundred healthy male Sprague-Dawley (SD) rats were randomly divided into a normal group, a model group, a low-frequency EA group, a high-frequency EA group and a variable-frequency EA group, with 20 rats in each group. The rats in the normal group were fed with normal diet. The rats in the other groups were fed with phenethylpiperidine in the diet at a dose of 8 mg/(kg·bw) per day, for 120 d, to establish the STC model. Rats in the normal group and the model group did not receive any treatment; rats in the low-frequency EA group were treated with 2 Hz continuous wave EA, rats in the high-frequency EA group were treated with 100 Hz continuous wave EA, and rats in the variable-frequency EA group were treated with 2 Hz/100 Hz sparse-dense EA. The current intensity of the EA was determined by the slight vibration of the rat limbs without painful screaming. The intervention was performed once a day, 15 min/time for continuous 15 d. After treatment, the intestinal transit function and the expression levels of SP and VIP in the colon of the rats in each group were determined.

Results

After treatment, the defecation duration of the first dark stool in the model group was significantly longer than that in the normal group (P<0.05); the defecation durations of the first dark stool in the low-frequency EA group, high-frequency EA group and variable-frequency EA group were significantly shorter than the duration in the model group (all P<0.05); compared with the low-frequency EA group, the first dark stool defecation duration of rats in the variable-frequency EA group was significantly shorter (P<0.05); compared with the normal group, the SP and VIP expression levels in the colon of the model group were significantly decreased (both P<0.01); the SP and VIP expression levels in the colon of the low-frequency EA group, the high-frequency EA group and the variable-frequency EA group were significantly higher than those in the model group (all P<0.05); compared with the high-frequency EA group, the SP expression levels in the colon in the low-frequency EA group and the variable-frequency EA group were significantly increased (both P<0.05); compared with the low-frequency EA group, the VIP expression levels in the colon in the high-frequency EA group and the variable-frequency EA group were significantly increased (both P<0.05).

Conclusion

EA improves the intestinal function of STC model rats by regulating the expression levels of SP and VIP in rat colon. The EA stimulation with 100 Hz continuous wave, 2 Hz/100 Hz sparse-dense wave shows a better improvement in the colonic transit function in STC rats, followed by 2 Hz continuous wave.

     

近年热敏灸疗法的研究概况

通过收集2010年6月－2015年3月近5年内关于热敏灸疗法的临床、实验研究文献,结合刺灸法数据挖掘课题组所采集热敏灸在各科的数据信息,筛选出在5个科属中具有代表性的病种及临床研究试验进行了归纳。     

长时间放置cook球囊支架预防宫腔粘连术后复发的临床应用

目的探讨长时间放置cook球囊支架预防宫腔粘连(IUA)术后复发的有效性及安全性。方法 134例中、重度IUA患者,行宫腔镜下宫腔粘连分离术(TCRA),术后宫腔放置cook球囊2~3个月预防宫腔粘连术后复发,随访效果。结果所有患者均无支架嵌顿;手术前后宫腔粘连美国生育协会(AFS)预后评分分别为(8.01±1.33)、(0.45±0.75)分,差异有统计学意义(P<0.05)。手术前后AFS月经模式评分分别为(1.61±1.23)、(0.69±0.97)分,差异有统计学意义(P<0.01)。患者累积妊娠率为60.48%,累积活产率为20.90%。放置支架所需时间为(7.3±5.1)min;1例放置支架扩张宫颈时导致子宫穿孔;4例支架放置失败;4例因症中途取出支架;5例术后经间期少量出血,2例术后出血≥500 ml;1例发生术后急性生殖道感染;15例在未达规定时间支架下移或脱出;带器妊娠1例。结论宫腔粘连分离术后宫腔内长时间放置cook球囊在重建宫腔形态、预防术后再粘连、改善月经模式及远期生育结局方面有较明显的成效。     

穴位埋线疗法治疗单纯陛肥胖症有效性的系统评价

目的：系统评价穴位埋线疗法对单纯性肥胖症的治疗效果。方法：计算机检索中国知网（CNKI）、万方数据资源系统、中国生物医学文献数据库中关于穴位埋线疗法对单纯性肥胖症效果的随机对照试验,用ladad质量计分法对纳入研究的质量进行评价,结局指标采用ReviewManage5．1软件分析。结果：最终纳入16．g随机对照试验文献。Meta分析结果显示,穴位埋线治疗单纯性肥胖症总有效率与对照组相比,差异有统计学意义[OR=2．51,95％可信区间（1．74,3．63）,Z=4．91,P〈0．000011;文献质量评价显示,仅1篇文献得3分,其余15篇文献得分≤2分,文献质量普遍较低,发表存在偏倚,且对盲法、退出失访及随访的追踪报道过少;统计治疗选穴共有27个穴位,以天枢、中脘、丰隆、水分、阿是穴、大横等穴为主。结论：穴位埋线治疗单纯性肥胖症疗效肯定,但其临床有效性尚缺乏充分证据,因此．还需进一步临床研究才能为今后临床决策提供可靠依据。     

基于数据挖掘的刺络疗法中放血量与方法的研究

通过计算机技术和数据挖掘手段,以收集到的期刊文献中关于刺络放血病例的治疗为样本数据,采用数据挖掘技术中的关联规则方法,根据自建的刺络放血数据库平台,录入筛选归纳总结,最后提取所需内容,进行刺络放血疗法中关于放血量与方法的挖掘,总结其应用规律和临床意义,以更好的指导临床实践。期刊文献中放血针具共涉及9种,以三棱针使用频次最高,占84.4%(1239/1468);将放血量人为分为6个等级,其中放血量为少许(少于0.1mL)的出现频次最高,为401次。数据挖掘结果显示,刺络治疗在针灸临床中应用极为广泛,放血针具以三棱针最为普遍,放血量以少许(少于0.1mL)最多,但总体上未呈现特别集中趋势。     

某评价检测机构擅自更改、简化职业卫生技术服务程序和相关内容案

目的 为提高卫生健康监督人员的办案能力和技巧,加强对职业卫生技术服务机构的监督力度.方法 通过分析对某职业卫生技术服务机构监督检查中发现的问题,依据相关法律法规的要求分析监督人员办案过程中的重点和难点.结果 某职业卫生技术服务机构已接受行政处罚,并对违法行为进行了整改.结论 提高职业卫生技术服务机构的工作质量,为职业卫...