不同针刺干预时机对女性全麻腹腔镜手术患者围手术期免疫功能及术后恶心呕吐的影响

目的 探讨不同针刺干预时机对全麻腹腔镜手术患者围手术期免疫功能及术后恶心呕吐(postoperative nausea and vomiting,PONV)的影响.方法 将符合入选标准的行全麻腹腔镜手术的女性患者104例,按随机数表法分为A、B、C、D组,每组26例.A组于麻醉前0.5h针刺,B组于术中针刺,C组于术后针刺,D组不针刺.分别于麻醉诱导前0.5h(T0)、手术结束(T1)、术后第1天(T2)、术后第3天(T3)检测总T淋巴细胞(CD3+)、T辅助细胞(CD4+)和T抑制细胞(CD8+),并计算CD4+/CD8+比值;采用混悬计检法检测血液中的免疫球蛋白IgA、IgM、IgG水平;分别于术后6h(T4)、术后12h(T5)和术后48h(T6)观察患者PONV发生情况并进行评分.术后1周,观察并记录患者的不良反应.结果 T3时,A组CD3+[(62.12±8.37)%比(58.15±3.92)%、(57.15±7.83)%、(55.32±7.66)%,F=132.238]、CD4+[(37.99±6.92)%比(34.03±6.32)%、(34.00±6.49)%、(33.85±6.73)%,F=2.794]、CD8+[(25.07±5.06)%比(22.89±1.32)%、(22.91±1.24)%、(22.78±1.75)%,F=2.849]、CD4+/CD8+[(1.30±0.34)比(1.27±0.34)、(1.29±0.31)、(1.25±0.27),F=5.413]、IgA[(151.15±36.83)IU/ml比(135.24±15.17)IU/ml、(135.16±16.09)IU/ml、(132.05±17.37)IU/ml,F=3.044]、IgM[(169.35±53.69)IU/ml比(146.26±23.06)IU/ml、(145.73±24.66)IU/ml、(143.12±21.43)IU/ml,F=2.839]、IgG[(131.89±28.13)IU/ml比(118.88±15.35)IU/ml、(116.92±20.25)IU/ml、(115.06±20.55)IU/ml,F=3.165]水平均高于B、C、D组(P<0.05).T5时,A组患者PONV评分[(1.76±0.24)分比(1.98±0.31)分、(1.96±0.37)分、(2.09±0.33)分,F=4.918]低于B、C、D组(P<0.05);T6时,PONV评分[(1.33±0.36)分比(1.52±0.26)分、(1.54±0.28)分、(1.73±0.35)分,F=6.984]低于B、C、D组(P<0.05);A组患者不良反应发生率[11.5%(3/26)比38.5%(10/26),χ2=5.026]低于D组(P<0.05).结论 术前针刺可有效改善全麻腹腔镜手术患者围手术期免疫抑制状态,降低PONV发生率及PONV评分,减轻不良反应.     

浙江道地药材於术与白术的质量对比研究

目的:通过对白术与於术的性状、显微、薄层色谱和化学成分进行比较,阐明於术的道地性。方法:采用显微镜进行显微鉴别比较,采用薄层色谱仪进行薄层色谱鉴别比较,采用高效液相色谱仪测定活性成分的含量测定。结果:白术与於术的显微鉴别中石细胞、纤维和导管结构相似,但是白术的菊糖少,针晶、石细胞较多而於术的菊糖多,针晶、石细胞较少;薄层色谱鉴别中於术与白术在相同位置同时出现桃红色主斑点;含量测定中於术的白术内酯I较高,白术内酯II以及苍术素较低,新昌白术的白术内酯I、白术内酯II、白术内酯III和苍术素均较高,磐安白术的白术内酯I和白术内酯III均较高,太阳镇白术的白术内酯I、白术内酯II和白术内酯III均较低。结论:通过以上几项研究,阐明了於术药材的道地性,从而为白术的资源开发、质量评价以及在临床上更多的合理应用提供了一定的依据。     

桃红四物汤结合认知功能锻炼对脑卒中患者功能障碍恢复的效果观察

目的:研究桃红四物汤结合认知功能锻炼对脑卒中患者功能障碍恢复的临床效果。方法:选取2014年11月至2016年10月惠州市中心人民医院收治的脑卒中认知功能障碍患者98例,按照随机抽签法随机分为观察组(n=50)和对照组(n=48)。对照组仅给接受知功能康复锻炼,观察组在对照组治疗的基础上给予桃红四物汤治疗,比较2组患者治疗前后的HAMD评分、血液流变学、MMSE评分、Fugl-Meyer评分及Barthel指数。结果:治疗后,观察组患者的HAMD评分显著低于对照组;观察组的血浆黏度、红细胞压积、全血高切黏度及全血低切黏度显著低于对照组;观察组患者的MMSE评分、Fugl-Meyer评分及Barthel指数均显著高于对照组;对照组的总有效率是64. 6%,观察组的总有效率是88. 0%,观察组显著高于对照组,差异有统计学意义(P 0. 05)。结论:对于伴有认知功能障碍的脑卒中患者而言,给予桃红四物汤结合认知功能锻炼治疗能有效改善临床症状。     

2017年云南省肿瘤登记地区恶性肿瘤发病与死亡分析

目的 分析2017年云南省肿瘤登记地区恶性肿瘤发病和死亡情况。方法 收集云南省各肿瘤登记处上报的2017年恶性肿瘤发病、死亡数据和人口资料,按照性别和年龄分层计算云南省肿瘤登记地区恶性肿瘤的发病(死亡)率、中国人口年龄标化发病(死亡)率(简称中标率)、世界人口年龄标化发病(死亡)率(简称世标率)、0~74岁累积发病(死亡)率,同时分别对全省前五位发病和死亡的恶性肿瘤进一步分析。结果 云南省肿瘤登记地区恶性肿瘤发病率215.28/10万(男性227.56/10万,女性202.58/10万),中标率154.80/10万(男性164.57/10万,女性146.61/10万),世标率150.72/10万(男性162.67/10万,女性140.32/10万);恶性肿瘤发病率在40-岁年龄组前处于较低水平,之后开始快速上升,至80-岁年龄组达到高峰,之后有所下降;发病前五位的恶性肿瘤依次为肺癌、乳腺癌、结直肠癌、肝癌和宫颈癌。云南省肿瘤登记地区恶性肿瘤死亡率133.62/10万(男性163.62/10万,女性102.58/10万),中标率91.06/10万(男性114.85/10万,女性68.28/10万),世标率90.17/10万(男性114.40/10万,女性67.05/10万);恶性肿瘤死亡率在45-岁年龄组后快速上升,至85+岁年龄组时达到高峰;死亡前五位的恶性肿瘤依次为肺癌、肝癌、结直肠癌、胃癌和乳腺癌。结论 肺癌、肝癌、乳腺癌和结直肠癌为云南省较为严重的恶性肿瘤,应作为我省恶性肿瘤防控的重点,此外,中老年人恶性肿瘤死亡状况不容乐观,应及时掌握癌情特点,做好防控工作。     

Safety and efficacy of lenalidomide (Revlimid) in recurrent ovarian and primary peritoneal carcinoma

OBJECTIVES: To conduct a phase I trial to determine the safety and toxicity profile of a novel immunomodulatory drug, lenalidomide, in recurrent ovarian and primary peritoneal cancer. The secondary objective is to evaluate the efficacy profile and quality of life (QOL) parameters in patients receiving this treatment. METHODS: Patients with recurrent ovarian or peritoneal cancer who received standard staging surgery and at least one prior platinum-based chemotherapy regimen were treated with single-agent oral lenalidomide 25 mg daily for 21 days of a 28-day cycle. Toxicities were monitored by patient report, physical exam, and laboratories. Response was assessed by imaging, physical exam, and CA-125. Therapy was discontinued with disease progression and/or unacceptable toxicity. RESULTS: 20 patients with recurrent ovarian or peritoneal cancer were enrolled and received 70 completed 28-day cycles and 10 partial cycles of lenalidomide therapy. The majority of adverse events were grades 1-2, including fatigue (25/80 cycles), nausea/vomiting (23/80), constipation (13/80), abdominal pain (17/80), rash (12/80), neutropenia (12/80), and anemia (12/80). Grade 3 toxicities occurred in 12 of 80 cycles (14%) and no grade IV toxicities were observed. Eleven patients completed > or = 2 cycles and were evaluable for response. Nine achieved stable disease (SD) of at least 3 months, with four patients maintaining SD for > 6 months. The mean time to progression was 5.8 months (range 2-12 months). CONCLUSION: Overall, oral lenalidomide was well tolerated and may have some activity as a single agent in this heavily pre-treated population. Further studies combining lenalidomide with cytotoxic treatments may be warranted in this disease setting.     

Investigation of Friction and Wear Behavior of Cast Aluminum Alloy Piston Skirt with Graphite Coating Using a Designed Piston Skirt Test Apparatus

A piston skirt friction and wear apparatus that simulates the contact and the relative motion of piston and cylinder liner in a real engine has been designed and constructed. With this apparatus, the friction and wear behavior of a cast aluminum alloy piston with a graphite coating under different loads was studied, and the effectiveness of the apparatus was confirmed. The total wear of the piston skirt was higher under a higher load, and the upper part of the skirt surface (around the height of the piston pin) was worn more severely. The wear mechanisms were studied and, based on the test results and surface analyses, three main wear modes were believed to occur in the wear process of the piston skirt: abrasive, adhesive, and fatigue wear. The effects of skirt profile design, coating, and surface texturing on the friction and wear behavior of the piston skirt can be investigated well using the proposed apparatus, which can truly reflect actual working conditions and is useful to improve the tribological performances of piston skirts.     

唑来膦酸与伊班膦酸治疗癌性骨痛临床分析

目的:评价注射用唑来膦酸与伊班膦酸治疗癌性骨痛的临床疗效和安全性。方法:入选恶性肿瘤骨转移患者52例,其中唑来膦酸组26例,伊班膦酸组26例,采用平行对照研究方法。每组各用药2～4个周期。观察用药后患者临床获益率、起效时间、持续时间及骨扫描的变化。不良反应中注意观察发热、血钙及肾功能的变化。结果:12d时,唑来膦酸组临床获益率92.3%,伊班膦酸组临床获益率88.5%,P=0.015。56d时,唑来膦酸组临床获益率96.2%,伊班膦酸组临床获益率92.4%,P=0.065。两组止痛中位起效时间均为第5天,止痛持续整个周期,6个月后复查骨扫描均有改善。两组不良反应主要为低热和乏力。用药4d内骨转移部位疼痛有加重现象,严重程度与骨质损害一致。两组各有高血钙3例,用药2个周期后均恢复至正常范围。两组治疗前后血清肌酐均未见明显变化。结论:两者均是高效双膦酸类药,有良好的耐受性。止痛疗效唑来膦酸组略优于伊班膦酸组,且唑来膦酸静脉滴入时间短(15min),使用更方便。两者毒副反应均较轻,按推荐剂量使用均未见肾功能损害。     

Biological Characteristics of Infectious Laryngotracheitis Viruses Isolated in China

Infectious laryngotracheitis virus (ILTV) causes severe respiratory disease in chickens and results in huge economic losses in the poultry industry worldwide. To correlate the genomic difference with the replication and pathogenicity, phenotypes of three ILTVs isolated from chickens in China from 2016 to 2018 were sequenced by high-throughput sequencing. Based on the entire genome, the isolates GD2018 and SH2017 shared 99.9% nucleotide homology, while the isolate SH2016 shared 99.7% nucleotide homology with GD2018 and SH2017, respectively. Each virus genome contained 82 ORFs encoding 77 kinds of protein, 31 of which share the same amino acid sequence in the three viruses. GD2018 and SH2017 shared 57 proteins with the same amino acid sequence, while SH2016 shared 42 and 41 proteins with the amino acid sequences of GD2018 and SH2017, respectively. SH2016 propagated efficiently in allantoic fluid and on chorioallantoic membranes (CAMs) of SPF chicken embryo eggs, while GD2018 and SH2017 proliferated well only on CAMs. GD2018 propagated most efficiently on CAMs and LMH cells among three isolates. SH2016 caused serious clinical symptoms, while GD2018 and SH2017 caused mild and moderate clinical symptoms in chickens, although the sero of the chickens infected with those three isolates were all positive for anti-ILTV antibody at 14 and 21 days after challenge. Three ILTVs with high genetic homology showed significant differences in the replication in different culture systems and the pathogenicity of chickens, providing basic materials for studying the key determinants of pathogenicity of ILTV.     

Insights on Skin Quality and Clinical Practice Trends in Asia Pacific and a Practical Guide to Good Skin Quality from the Inside Out

ObjectiveWe sought to examine the current skin quality trends and gaps in clinical practice in the Asia Pacific region and develop a practical guide to improve skin quality.MethodsMedical practitioners from 11 countries in the Asia Pacific region completed an online survey on current trends in skin quality treatment. A panel of 12 leading experts convened for a virtual meeting to develop a practical guide for skin quality improvement.ResultsA total of 153 practitioners completed the survey. The four most common skin quality issues were uneven skin tone, skin surface unevenness, skin laxity, and sebaceous gland hyperactivity and enlarged pores. Most practitioners reported using a combination of treatment modalities for each skin quality issue. It was also observed that each treatment modality could be used to treat several skin quality issues. A multimodal approach targeting different interrelated issues across the tissue planes was recommended for balanced results. The panel developed a practical guide for the appropriate combinations and sequence of treatments, and created treatment protocols for specific skin quality outcome goals. The guide employed an “inside-out” approach, treating the deeper tissue planes prior to the superficial layers to achieve harmonious results.LimitationsFuture studies are needed to support the recommended treatment protocols for skin quality improvement.ConclusionThese findings provide valuable insights on current skin quality trends and gaps in clinical practice. The practical guide provides a framework for practitioners to customize their treatment plan according to each patient’s needs.