新冠肺炎疫情下艾灸防治帕金森病的临床应用分析＊

帕金森病（Parkinson''s disease，PD）是仅次于阿尔茨海默病的世界第二大神经系统退行性疾病，随着老龄化社会的到来，PD患病率呈明显上升趋势。全球爆发的新型冠状病毒肺炎（简称新冠肺炎）是一种急性传染性疾病，严重威胁人们的身体健康和生命安全。PD患者大多为老年人且合并有基础疾病，体质普遍较弱，是新冠肺炎的易感人群，一旦染病则发展为重症的风险很高。中医艾灸疗法在治疗PD及防治疫病方面发挥了很好的辅助治疗效果。通督扶阳灸法联合强壮穴艾灸治疗，既可以帮助PD患者改善临床症状，延缓病情进展，又可以提高机体免疫功能，增强抗病能力而防治新冠肺炎。     

冠心病合并其他器质性心脏病的外科治疗

目的分析冠心病合并其他器质性心脏病的临床特点,探讨一期外科治疗的方法和临床疗效。方法分析2004年4月至2006年4月冠心病合并其他器质性心脏病患者13例,其中风湿性心脏病联合瓣膜病1例,二尖瓣病变4例,二尖瓣退行性病变3例,主动脉瓣关闭不全3例,升主动脉瘤1例,继发孔房缺1例。因冠心病首诊入院5例,以其他器质性心脏病首诊入院8例。术前有心绞痛症状者8例,无心绞痛5例。体外循环下一期外科治疗。结果无死亡病例,13例均顺利出院。冠脉搭桥+瓣膜置换8例,冠脉搭桥+瓣膜成形3例,冠脉搭桥+Bentall+室壁瘤切除1例,冠脉搭桥+房缺修补1例。手术中搭桥1～3支,平均(1.92±0.73)支。术后1周,左心室舒张末内径(LVDD)为(51.77±2.64)mm,较术前[(58.92±3.81)mm]明显缩小(P<0.05)。随访3个月,心绞痛症状完全消失,心功能(NYHA)明显提高(P<0.05)。结论冠心病合并其他器质性心脏病临床症状无特异性,容易漏诊。虽然手术风险性和难度增加,但未得到血液重建,对患者更将是致命性的灾难,应争取一期手术。     

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目的对儿童血管迷走性晕厥(VVS)的传统诊断程序与新诊断程序进行卫生经济学评价。方法采用回顾分析方法,根据不同的诊断程序(即传统诊断程序和新诊断程序),将1995年1月至2005年5月北京大学第一医院儿科确诊的81例VVS患儿分为2组,分别计算其就诊费用、检查费用、住院日、确诊日等,运用经济学最小成本分析法进行评价。结果新诊断程序的平均就诊费用比传统诊断程序少耗费1668.80元;新诊断程序的平均就诊检查费用比传统诊断程序少耗费1413.30元。结论新诊断程序对确诊儿童血管迷走性晕厥具有良好的经济学效益,值得临床推广。     

60Co-γ射线全身低剂量率辐照对小鼠血浆中IL-12和IL-10的影响

目的研究低剂量电离辐射对小鼠免疫系统影响的剂量率效应。方法以^60Co-γ射线为辐照源，低、中和高3个辐射剂量（0．075、0．5、2．0Gy），恒定剂量率（0．5mGy／min）全身一次性照射小鼠，ELISA检测照射4h后血浆IL-12和IL-10的含量。结果低、中剂量照射后，血浆中IL-12、IL-10和IL-12／IL-10出现程度几乎相同地下降；但高剂量照射后，IL-12进一步显著下降，而IL-10上升至对照组水平，IL-12／IL-10比值进一步下降。结论恒定0．5mGy／min剂量率的^60Co-γ射线照射可损伤机体免疫功能，在0．075～0．5Gy剂量范围内损伤轻微，在2．0Gy时损伤明显，表明低剂量率电离辐射对免疫系统具有损伤作用。     

Long-term vardenafil therapy improves hemodynamics in patients with pulmonary hypertension.

The phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, has been reported to produce sustained pulmonary vasodilatation in patients with pulmonary hypertension (PH). Recently, vardenafil, a more potent and selective PDE-5 inhibitor than sildenafil, has been approved for the treatment of erectile dysfunction. However, the long-term effects of oral vardenafil in patients with PH are unknown. We studied five consecutive patients with PH; one with primary pulmonary hypertension, two with chronic pulmonary thromboembolism, one with Eisenmenger syndrome (ventricular septal defect) and one with secondary pulmonary hypertension after a ventricular septal defect closure operation. In an acute hemodynamic trial, vardenafil (5 mg) significantly decreased both the pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) with an increase in cardiac output. In a chronic hemodynamic trial, the maintenance dose of vardenafil (10 to 15 mg) for 3 months significantly decreased the PVR, but not the SVR, with a 20.7% reduction of the PVR/ SVR ratio. Plasma brain natriuretic peptide (BNP) levels were also significantly decreased after 3 months. This pilot study demonstrates that long-term oral vardenafil therapy may be a safe and effective treatment for patients with PH.     

血清S100ββ变化与老年患者腹部手术后认知功能障碍的关系

目的观察老年患者腹部手术后S100ββ蛋白的变化以及术后认知功能障碍(POCD)的发生情况,并探讨二者的关系。方法26例65岁以上的老年患者ASAⅡ~Ⅲ级,行腹部手术。监测术前、术毕、术后6、24、48、72h血清S100ββ的变化,并评定术前及术后1周内的认知功能。结果老年患者血清S100ββ蛋白在术毕最高(P<0·01),术后6h和24h逐渐下降,但术后48h再次上升(P<0·01),术后72h回复至术前水平。26例老年患者腹部手术后1周内有7例发生POCD。POCD组与非POCD组相比,术毕及术后6h血清S100ββ蛋白水平明显增高(P<0·05)。结论老年患者腹部手术后POCD的发生与血清S100ββ蛋白的变化有密切关系。血清S100ββ蛋白可作为评估老年患者术后发生POCD的重要指标。     

重型颅脑损伤的手术治疗

目的探讨重型颅脑损伤梯度减压的手术方法对预防术中脑膨出、降低死亡率及致残率的效果。方法对100例重型颅脑损伤患者采用分次减压手术方式及去骨瓣后，硬膜与颞肌筋膜瓣减张缝闭硬膜切口方法。结果40例脑肿胀患者术中脑嘭出6例占15．0％，死亡19例占47．5％；60例脑内血肿病人未发生脑膨出，死亡12例占20％。结论脑外伤后脑血管调节麻痹及血肿压迫继发脑水肿易造成脑膨出.术中分次减压降低了骨窗部位脑组织的顺应性，从而降低了局部的压力梯度，避免脑血管急性扩张，能有效防止脑膨出，降低死亡率及致残率。     

Risk factors and ankle brachial indexes in cerebral infarction combined with peripheral arterial disease

BACKGROUND: Ankle brachial index(ABI)is widely involved in researches and clinical application of peripheral vascular injury of patients with diabetes (DM);however ,the application in cerebral infarction(CI)is rare.OBJECTIVE: To investigate the possible risk factor of cerebral infarction plus peripheral arterial disease(PAD),compare metabolic characteristics of patients who having CI plus PAD or only having CI,and understand the significance of ABI on screening and diagnosing CI plus PAD of lower limb.DESIGN: Contrast observation based on CI patients.SETTING: Deparment of Neurology,Nanxishan Hospital of Guangxi Zhang Autonomous Region.PARTICIPANTS:A total of 124 CI patients were selected from Department of Neurology.Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2005 to April 2006,including 72 males and 52 females aged from 45 to 88 years.All patients met the diagnostic criteria of cerebrovascular disease established by National Academic Conference of Cerebrovascular Diseases in 1995 and determined as cerebral infarction with MRI or CT examination.All patients provided informed consent.There were 46 cases(37.2%)with CI plus PAD and 78 cases(62.8%)only with CI.METHODS: Blood pressure of bilateral ankles and upper extremities was measured at plain clinostatism with DINAMAP blood pressure monitor(GE Company).The ratio between average systolic pressure of lateral ankle and average systolic pressure of both upper extremities was regarded as ABI.The normal ABI was equal to or more than 0.9.If ABI＜0.9 occurred at one side,patients were diagnosed as PAD.On the second morning after hospitalization,blood was collected to measure fasting blood glucose(FBG),2-hour postprandial blood glucose(PBG2h),glycosylated hemoglobin(HbAlc),triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C).Among them,blood glucose.lipid and other biochemical markers were measured with enzyme chemistry assay and HbA1c was measured with HbA1c meter based on high liquid phase.Measurement data and enumeration data were compared with t test and Chi-square test.and multiple factors were deat with Logistic regression analysis and multivariate linear regression analysis.MAIN OUTCOME MEASURES: Results of correlation between ABI and metabolic markers with multivariate linear regression analysis;risk factors of CI plus PAD with Logistic regression analysis;comparisons of metabolic markers between PAD and non-PAD patients.RESULTS:All 124 patients with acute CI were involved in the final analysis.①Comparisons of metabolic markers:Levels of serum LDL-C and uric acid(UA)were higher of PAD patients than those of non-PAD patients(t=2.051 9,3.339 1,P＜0.05);however,there were no significant differences among other metabolic markers(P＞0.05).②Results of multivariate linear regression analysis:PBG2h,LDL.C and UA were obvious correlation with ABI of posterior tibial artery of lower limb and dorsal pedis artery rpartial regression coefficient:-0.231 to-1.010,P＜0.05).③Risk factors of CI plus PAD with Logistic regression analysis:Age.Smoking history,sum of CI focus(≥3)and LDL-C were independent risk factor of CI plus PAD(OR=1.524-5.422,P＜0.05-0.01 ).CONCLUSION:①Levels of serum LDL-C and UA of patients with CI plus PAD are high.②ABI of lower limbs is correlation with PBG2h,LDL-C and UA.In addition,measuring ABI is beneficial for early diagnosing PAD of lower limbs of patients who have poorly controlled blood glucose,abnormal lipid and poor renal function.③Age,LDL-C and sum of CI focus(≥3)are independent risk factors of CI plus PAD.It is of significance for screening non-PAD patients to evaluate risk degrees and prognosis and select therapeutic methods based on ABI measurement.     

VEGF在膀胱移行细胞癌中的表达研究

目的研究血管内皮生长因子（VEGF）在膀胱移行细胞癌（TCC）中的表达。方法应用免疫组织化学染色方法观察62例TCC标本VEGF的表达情况。结果TCC组中VEGF的阳性表达率为56．5％（35，62），而8例正常膀胱粘膜组织VEGF表达均为阴性，两组比较差异有高度显著性p〈0．01（x^2=9．032）；VEGF表达与膀胱肿瘤病理分级、临床分期、复发密切相关。结论VEGF的异常表达在TCC的发生、发展过两组比较差异有程中起重要作用；该指标的检测有助于预后判断。     

脊椎转移瘤增强减影MR成像

目的评估增强减影在脊椎转移瘤MR I中的应用价值。方法50例脊椎转移瘤病人进行MR I增强扫描,对比剂采用Gd-DTPA(0.1 mmol/kg),然后用T1W I增强后的图像与增强前的图像进行减影。通过对比噪声比(CNR)、信噪比(SNR)以及肿瘤边界清晰程度的比较,对MR I减影与否进行评估。结果MR I对比增强减影图像比传统的T1W I增强图像显示更清晰、更直观。所有脊椎转移瘤图像MR I减影的CNR和SNR比常规T1W I增强图像的CNR和SNR高。MR I减影CNR为155.05±24.73(x±SD),常规T1W I增强图像的CNR为11.11±14.26(t=35.65,Ρ<0.001)。MR I减影SNR为192.82±32.89(x±SD),常规T1W I增强图像的SNR为46.03±28.22(t=23.95,Ρ<0.001))。MR I对比增强减影图像比传统的T1W I增强图像能更好地显示脊椎转移瘤的边界和侵犯情况(2χ=29.34,Ρ<0.005)。结论MR I增强减影为探查和评估脊椎转移瘤提供了一个新的诊断方法。