原发性结肠冗长的外科治疗

目的：探讨原发性结肠冗长的诊断,手术适应症,手术中注意的要点和并发症等。方法：回顾7例原发性结肠冗长引起顽固性便秘并发肠梗阻的外科治疗经过。结果：原发性结肠冗长分为全结肠型及乙状结肠型,本组乙状结肠型4例,全结肠型3例,行乙状结肠切除4例,左半结肠切除2例,右半结肠切除1例,其中择期手术3例,紧急手术4例,术后随访1－10年,1例因全结肠型半结肠套叠行右半结肠切除效果稍差,其余6例腹痛及便秘症状消失,结论：外科治疗原发性结肠冗长效果较好。手术中注意左,右半结肠切除时一定要消除结肠肝脾曲折叠的锐角,乙状结肠切除时一定要消除脾折叠,这有助于防止各种并发症。     

白血病与心脏损害

大量研究表明 ,多种因素可通过不同的机理造成白血病患者心脏的损害 ,但这些损害容易被忽略 ,然而 ,一旦出现了较严重的心脏损害 ,如不及时纠正 ,则会影响抗白血病治疗的顺利进行 ,故防治这种损害也不容忽视。     

Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Background

The need for accessible and motivating treatment approaches within mental health has led to the development of an Internet-based serious game intervention (called “Plan-It Commander”) as an adjunct to treatment as usual for children with attention-deficit/hyperactivity disorder (ADHD).

Objective

The aim was to determine the effects of Plan-It Commander on daily life skills of children with ADHD in a multisite randomized controlled crossover open-label trial.

Methods

Participants (N=170) in this 20-week trial had a diagnosis of ADHD and ranged in age from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomized to a serious game intervention group (group 1; n=88) or a treatment-as-usual crossover group (group 2; n=82). Participants randomized to group 1 received a serious game intervention in addition to treatment as usual for the first 10 weeks and then received treatment as usual for the next 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10 weeks and crossed over to the serious game intervention in addition to treatment as usual for the subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and child self-report) outcome measures were administered at baseline, 10 weeks, and 10-week follow-up.

Results

After 10 weeks, participants in group 1 compared to group 2 achieved significantly greater improvements on the primary outcome of time management skills (parent-reported; P=.004) and on secondary outcomes of the social skill of responsibility (parent-reported; P=.04), and working memory (parent-reported; P=.02). Parents and teachers reported that total social skills improved over time within groups, whereas effects on total social skills and teacher-reported planning/organizing skills were nonsignificant between groups. Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study. Participants in group 2, who played the serious game during the second period of the study (weeks 10 to 20), improved on comparable domains of daily life functioning over time.

Conclusions

Plan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV).     

椎旁肌肌间隙入路联合伤椎椎弓根螺钉内固定治疗无神经损伤胸腰椎骨折

目的：观察经椎旁肌肌间隙入路伤椎置钉短节段椎弓根螺钉内固定对单节段无神经损伤胸腰椎骨折的治疗效果。方法选取单节段胸腰椎骨折患者13例,采用椎旁肌间隙入路伤椎置钉短节段椎弓根螺钉内固定治疗,观察患者术后伤椎矢状面Cobb角、伤椎椎体前缘高度、疼痛、脊柱功能和并发症发生情况。结果本组患者手术均顺利完成,术后均获1年随访,切口甲级愈合;术后伤椎矢状面Cobb角均较术前明显缩小,手术前后比较差异有统计学意义（ P﹤0.05）;术后伤椎椎体前缘高度较术前明显增高（ P﹤0.05）;术后VAS评分及ODI均较术前明显下降（ P﹤0.05）。治疗过程中均无感染、内固定松动或断裂等并发症发生。结论经椎旁肌肌间隙入路伤椎置钉短节段椎弓根螺钉内固定能有效纠正单节段胸腰椎骨折伤椎前缘高度,纠正后凸畸形,不良反应少。     

感染Ad-HGF对高糖诱导的人脐静脉内皮细胞Bax和Bcl-2蛋白表达的影响

目的 探讨高糖条件下感染携带肝细胞生长因子的重组腺病毒(Ad-HGF)对人脐静脉内皮细胞(humanumbilical vein endothelial cells,HUVECs)凋亡相关蛋白Bax、Bcl-2表达的影响.方法 将HUVECs分为低糖组(LG组,5.5 mmol/L)、高糖组(HG组,35 mmol/L)、腺病毒对照组(HG+ Ad-GFP组)和实验组(HG+ Ad-HGF组).检测4组HUVECs增殖情况、细胞内活性氧(ROS)水平及凋亡相关蛋白Bax、Bcl-2的表达.结果 HG组、HG+ Ad-GFP组HUVECs存活率低于LG组,HG+ Ad-HGF组高于HG组(P＜0.05,P＜0.01).HG组、HG+ Ad-HGF组HUVECs内ROS水平高于LG组,但HG+ Ad-HGF组低于HG组(P＜0.05).HG组、HG+ Ad-GFP组Bax、Bax/Bcl-2高于LG组,Bcl-2低于LG组,但HG+ Ad-HGF组Bax、Bax/Bcl-2低于HG组,Bcl-2高于HG组(P＜0.05).结论 感染Ad-HGF可通过降低细胞内ROS水平和Bax/Bcl-2减少细胞凋亡,进而对高糖诱导的HUVECs起到保护作用.     

历代医家对痛经的认识及诊疗经验

历代医家对痛经的治疗,大多以理气行气药、活血化瘀药、补益药、温里药为主。其中汉唐时期以《金匮要略》《小品方》的通治方为主,相对的补益药为多;到了宋金元时期,大多以活血化瘀、温里、补益药为主,体现了此时期调气血的理论,治法基本是理气、活血、补气、养血、散寒五个方面;明代医家基本传承宋金元时期,以活血化瘀药和补益药的运用为主,增加清热药物的运用,并以经前痛多为实,经后痛多为虚为虚实辨证的原则;清代和民国医家,用药多重视补益,以著名医家傅青主为典范,认为治疗痛经应当重视调补肝肾法,用以补肾水、调肝气之药,反应了该时期用药的特色。     

针刺蝶腭穴治疗鼻鼽

中医认为肺、脾、肾三脏功能失调,是引起鼻鼽的主要原因,肺为鼻之窍、肺气虚弱、卫表不固、不能抵抗外邪,又因脾为后天之本,气血生化之源,故脾气之输布使得肺气充沛,脾气虚则肺气虚。而先天之本为肾,肾虚则摄纳无权,气不归元,阳气易于耗散,风邪得以内侵而致病。故治疗上应扶正祛邪、在内补益肺脾肾,在外祛风邪,通鼻窍。鼻鼽产生的病因内因为肺脾肾的功能失调、外因为感受风邪,针刺蝶腭穴可以促进鼻窍附近的经络气血,治疗鼻炎有立竿见影之效,能够有效控制病程的发展,减轻患者痛苦,是治疗鼻炎的特效穴。     

化脓性颞下颌关节炎的特征与诊断

目的探讨化脓性颞下颌关节炎的临床特征及其早期诊断方法。方法收集我科近5年的30例化脓性颞下颌关节炎患者,对其临床症状,关节液的性质和量,关节液的组织学和细菌学表现,影像学检查,其它实验室检查及后遗症进行分析。结果患者主要为成年人(>18岁占29/30);血源性感染多见;多数(25/30)局部症状轻,全身反应不明显;关节液组织学检查见大量粒细胞,可伴纤维蛋白或纤维软骨碎片;15/30患者关节液细菌学检查见到细菌,培养出的病原菌主要为金黄色葡萄球菌和腐生葡萄球菌;后遗症轻,主要为继发性骨关节病。结论当今化脓性颞下颌关节炎表现出感染源隐匿性、症状不典型性、后遗症轻等特点;关节腔穿刺和关节液分析是其必要的诊断手段。     

Prevalence and consequences of low back problems in the Netherlands, working vs non-working population, the MORGEN-study

Objective: To study the burden of illness of low back problems—prevalence and consequences—in the working and the non-working population.Methods: Data from the Monitoring Project on Risk factors for Chronic Diseases, the MORGEN-study, were used. This project provided data on a probability sample of the general population aged 20–59 y in the Netherlands. Cross-sectional questionnaire data on 6317 men (24% non-working) and 7505 women (47% non-working) gathered over the period 1993–1995 were analysed.Results: The 12 month period prevalence of low back problems for the working and non-working population was 44.4% and 45.8% for men, and 48.2% and 55.0% for women. Larger differences were found for chronic low back problems, and activity limitation and use of health services due to low back problems. More than one-third of those who were disabled were so because of low back problems. When those unable to work because of disability (work disabled) were excluded, the prevalence and consequences of low back pain were still higher in the non-working group in comparison with the working population. Most of the non-working women were housewives and this group was both large in size and had a high prevalence of low back problems.Conclusions: Among the men studied, more than a quarter of the total burden of low back problems in those aged 20–59 y were found in the non-working population, among women this was 50%. Both research on causes and determinants of low back pain and the development of preventive actions—now being extensively focused on the working population—should also be translated to the non-working population.