胺碘酮合用小剂量β受体阻滞剂治疗老年阵发房颤临床观察

目的 比较胺碘酮与小剂量β受体阻滞剂合用对老年阵发性房颤的疗效。方法 回顾分析30名老年阵发房颤患者,根据房颤复律后维持用药的不同,分为3组：单用胺碘酮组（n=11);单用β阻滞剂组（n=9);胺碘酮与小剂量β阻滞剂合用组（n=10)。比较3组患者用药后12个月中房颤控制情况及心室率、心脏传导情况。结果 单用胺碘酮组显效率54．5％,有效率45．5％,无效率0％;单用β受体阻滞剂组显效率22．2％,有效率44．5％,无效率33．3％;胺碘酮与小剂量β受体阻滞剂合用治疗房颤,显效率90％,有效率10％,其疗效明显优于单用胺碘酮（P＜0．05）或单用β阻滞剂（P＜0．01）组,且未见明显副作用：3组间心室率未见显著差别。结论 胺碘酮与小剂β受体阻滞剂合用可有效地控制老年阵发性心房纤颤的发作。     

700 kPa空气和氮氧混合气条件下大鼠脑电图的变化

目的：探讨700kPa空气和氮氧混合气对大鼠脑电活动的影响。方法：将清醒大鼠分别在700kPa空气和氮氧混合气（PO2为22kPa)中暴露15min,通过头皮针电极记录其脑电图及功率谱。结果：和加压前对比,700kPa空气中,大鼠脑电频率和波幅均无显著变化;700kPa氮氧混合气中,大鼠脑电频率变慢（P＜0．05）,波幅无显著变化。结论：700kPa空气对大鼠脑电影响不明显;700kPa氮氧混合气中,即氮分压达到678kPa时可对大鼠脑电活动产生较明显影响。     

清咳平喘颗粒治疗痰热郁肺型咳嗽的临床疗效观察

目的 观察清咳平喘颗粒治疗痰热郁肺型咳嗽的临床有效性。方法 选取2020年1月—2021年6月上海中医药大学附属龙华医院呼吸科门诊就诊的痰热郁肺型咳嗽患者100例,按随机数字表法分为对照组和治疗组各50例,对照组为西医常规治疗,治疗组在西医常规治疗基础上联合清咳平喘颗粒治疗。两组均连续治疗2周。观察两组患者治疗前后的中医证候、咳嗽症状、气道反应（血清免疫球蛋白E、外周血嗜酸性粒细胞）、肺功能［最大呼气流量、第1秒用力呼气容积（forced expiratory volume for 1 second,FEV1）与用力肺活量（forced vital capacity,FVC）的比值］、生活质量及不良反应情况。结果 治疗后,对照组和治疗组的总有效率分别是90%、94%,两组比较差异无统计学意义（P>0.05）。治疗后,两组患者中医证候评分、日间及夜间咳嗽积分较治疗前降低,且治疗组明显低于对照组（P<0.05）。治疗后,两组血清免疫球蛋白E、外周血嗜酸性粒细胞较治疗前明显下降,且治疗组气道反应指标改善好于对照组（P<0.05）。治疗后,两组最大呼气流量、FEV1/FVC较治疗前明显上升（P<0.05）,但两组比较差异无统计学意义（P>0.05）。随访时两组患者的生活质量评分较治疗前均显著升高,治疗组评分改善优于对照组,两组比较差异具有统计学意义（P<0.05）。治疗期间两组均未发生不良反应。结论 清咳平喘颗粒在治疗痰热郁肺型咳嗽安全性良好,有助于改善咳嗽症状,改善肺通气,提高患者生活质量。     

疏肝益肾起痿汤联合他达拉非片治疗5-羟色胺再摄取抑制剂类抗抑郁药所致勃起功能障碍临床研究

目的：观察疏肝益肾起痿汤联合他达拉非片治疗5-羟色胺再摄取抑制剂（SSRIs） 类抗抑郁药所 致勃起功能障碍（ED） 患者的效果。方法：选取112 例肝郁肾虚型SSRIs 类抗抑郁药所致ED 患者,采用随机 数字表法分为2 组各56 例,对照组给予他达拉非片治疗,观察组给予疏肝益肾起痿汤联合他达拉非片治疗, 2 组均治疗8 周。对比2 组临床疗效,治疗前后评定中医证候评分、勃起功能［勃起硬度评价量表（EHS） 评 分、国际勃起功能评分量表（IIEF-5） 评分］、心理状态［抑郁症筛查量表（PHQ-9） 评分］、血管内皮功能 ［血清内皮素-1（ET-1）、一氧化氮（NO）,血管扩张功能（FMD）］,观察治疗期间的不良反应。结果：治疗 后,观察组临床疗效优于对照组（P＜0.05）。2 组性欲下降、阴茎痿软不举、阴茎举而不坚、忧愁善感、小便 淋漓评分及PHQ-9 评分均较治疗前降低（P＜0.05）,观察组6 项评分均低于对照组（P＜0.05）。2 组EHS 评 分、IIEF-5 评分均较治疗前升高（P＜0.05）,观察组EHS 评分、IIEF-5 评分均高于对照组（P＜0.05）。2 组 ET-1 水平均较治疗前降低,NO 水平及FMD 值均较治疗前升高,差异均有统计学意义（P＜0.05）。观察组 ET-1 水平低于对照组,NO 水平及FMD 值均高于对照组,差异均有统计学意义（P＜0.05）。2 组患者均未发 生明显不良反应。结论：采用疏肝益肾起痿汤联合他达拉非片治疗肝郁肾虚型SSRIs 类抗抑郁药所致ED 效果 明显,能够改善患者的心理状态和血管内皮功能,提高勃起功能,安全性高。     

梯度平衡法改善猪卵巢组织玻璃化保存效果

目的研究梯度平衡法对卵巢组织玻璃化冷冻后组织形态学及凋亡的影响。方法取新鲜猪卵巢切成小块,未进行任何处理的为对照组、采用梯度平衡法冷冻的为梯度平衡组、采用直接平衡法冷冻的为直接平衡组。HE染色观察3组组织形态,原位末端转移酶标记(TUNEL)技术检测细胞凋亡情况。结果与对照组相比,梯度平衡组和直接平衡组卵泡的正常率均下降(均P<0.05),但后两组比较无显著差异(P>0.05)。与对照组相比,梯度平衡组与直接平衡组的细胞凋亡率均显著增加(P<0.05),但梯度平衡组相对于直接平衡组,卵母细胞、颗粒细胞、基质细胞凋亡率(分别为14.8%vs.17.6%、13.8%vs.15.2%和15.7%vs.18.5%)均显著降低(P<0.05)。结论梯度平衡法可以减少玻璃化冻融卵巢组织过程中的细胞凋亡。     

The PROMIS Upper Extremity Computer Adaptive Test Correlates With Previously Validated Metrics in Patients With Carpal Tunnel Syndrome

Background: The Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) computer adaptive test was developed to improve precision and reduce question burden. We hypothesized that in patients with carpal tunnel syndrome (CTS): (1) PROMIS UE would correlate with established patient-reported outcome measures (PROs); (2) the time and number of questions required would be lower than current metrics; (3) there would be no floor or ceiling effects; and (4) PROMIS UE would not correlate with disease severity. Methods: Patients undergoing electrodiagnostic evaluation found to have a primary diagnosis of unilateral CTS prospectively completed PROMIS UE, Quick Disabilities of the Arm, Shoulder and Hand (qDASH), and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Electrophysiologic and clinical severity was recorded. The relationships among PROs were described with Spearman coefficients. A floor or ceiling effect was confirmed if >15% of patients achieved the lowest or highest possible score, respectively. Results: Fifty-one patients (average, 53.9 years) were enrolled. An excellent correlation was identified between PROMIS UE and qDASH (R = −0.76, P < .001). There was a good correlation between PROMIS UE and BCTQ (R = −0.58, P < 0.001). The PROMIS UE required less time and fewer questions than qDASH and BCTQ (P = .02 and P < .001). There were no floor or ceiling effects. Neither neurophysiologic nor clinical severity correlated with PROMIS UE (R = 0.24, P > .05 and R = −0.18, P > .05). Conclusions: The PROMIS UE has an excellent correlation with qDASH and a good correlation with BCTQ in patients with CTS. Furthermore, PROMIS UE required less time and fewer questions than established PROs. Used as a single PRO, PROMIS UE represents a practical alternative to current metrics in patients with CTS.     

PROMISE: Working with the CF community to understand emerging clinical and research needs for those treated with highly effective CFTR modulator therapy

Highly effective CFTR modulator drug therapy is increasingly available to those with cystic fibrosis. Multiple observational research studies are now being conducted to better understand the impacts of this important therapeutic milestone on long-term outcomes, patient care needs, and future research priorities. PROMISE is a large, multi-disciplinary academic study focused on the broad impacts of starting elexacaftor/tezacaftor/ivacaftor in the US population age 6 years and older. The many areas of investigation and rationale for each are discussed by organ systems, along with recognition of remaining important questions that will not be addressed by this study alone. Knowledge gained through this and multiple complementary studies around the world will help to understand important health outcomes, clinical care priorities, and research needs for a large majority of people treated with these or similarly effective medications targeting the primary cellular impairment in cystic fibrosis.     

二尖瓣成形测瓣器的研制和临床应用

目的为在二尖瓣成形术中准确迅速判断瓣环和瓣叶病损的部位及程度,提高二尖瓣成形术的成功率。方法解剖测量30例国人正常新鲜心脏的二尖瓣,术中观察二尖瓣病理变化特点后研制了一种新型二尖瓣成形测瓣器。结果用测瓣器行二尖瓣成形术35例,成形手术时间由原来的(57±11)min减少到(35±15)min,手术死亡率由11％下降到3．3％。结论使用此种测瓣器可使二尖瓣成形术省时、准确,成功率明显提高。     

Tomography versus computed tomography for assessing step off in intraarticular distal radial fractures

Computed tomography scans have supplanted conventional tomography for many applications and often are considered the imaging study of choice for assessing intraarticular distal radial fractures. Concern about cost containment in healthcare delivery prompts the question of whether the two studies provide comparable information and at what cost. Common intraarticular distal radial fractures were created in 12 lightly embalmed cadaveric specimens. The fractures were fixed with radiolucent Kirschner wires. Articular step off was measured with a caliper. Plain radiographs, computed tomography scans, and trispiral tomograms were obtained of each specimen. Maximal step off was measured blindly by two musculoskeletal radiologists and four hand surgeons. The radiographic measurements were compared with the actual step off and expressed as a positive or negative deviation from the actual value. There was no statistically significant difference between computed tomography scans and tomograms in predicting step off. In addition, the difference between actual and radiographic measurements was insignificant in tomogram readings and different in one of the computed tomography measurements. In the authors' institution, a tomogram costs $200, and a computed tomography scan costs $562. Trispiral tomography is more accurate and cost effective than computed tomography, and thus when available should be considered the imaging modality of choice for assessing articular step off in distal radius fractures.