腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床效果

目的 探究及观察腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床效果,为急性结石性胆囊炎治疗方式的选择提供参考依据。方法 选取本院2019年1月—2021年1月80例急性结石性胆囊炎患者为研究对象,将其随机分为对照组（开腹胆囊切除术组）和观察组（腹腔镜胆囊切除术组）,每组各40例。比较两组的手术时间、术中出血量、胃肠功能恢复时间、并发症发生率、术前及术后1、3 d的创伤反应指标,包括炎性反应[Toll样受体4(TLR-4)及C-反应蛋白（CRP）]及应激反应[促肾上腺皮质激素（ACTH）及皮质醇（Cor）]指标水平。结果 观察组在手术时间、胃肠功能恢复时间、术中出血量及并发症发生率方面均显著优于对照组,差异有统计学意义（P <0.05）;术前两组的创伤反应指标比较,差异无统计学意义（P> 0.05）,术后1、3 d两组的炎性反应指标持续降低,应激反应指标先升后降,且观察组的上述创伤反应指标显著低于对照组,差异有统计学意义（P<0.05）。结论 腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床效果较好,对于手术性创伤的控制效果较好,在急性结石性胆囊炎患者中的应用价值较高。     

JAK2/STAT3信号通路介导灯盏花乙素抗人心脏微血管内皮细胞缺氧-复氧损伤

Objective: To investigate the antagonistic cell injury effect and molecular mechanism of scutellarin(SCU)in hypoxia reoxygenation(HR) treated human cardiac microvascular endothelial cells(HCMECs).Methods: The method of 12 h hypoxia following by 12 h reoxygenation was used to culture HCMECs in vitro to built cell injury model. The groups were divided into control group, model(HR) group, and HR + SCU(0.1 μmol/L, 1 μmol/L, and 10 μmol/L) group. The cell viability was determined by MTT, and oxidative stress was detected by malondialdehyde(MDA) levels by biochemical assay kit. Protein expression of JAK2/p-JAK2 and STAT3/p-STAT3 were evaluated by Western blot.Results: The results of MTT and MDA showed that HR decreased the cell viability(P 0.05) and increased MDA level significantly(P 0.05), SCU played a contrary role in these processes. Western blot analysis indicates that, the expression of JAK2 and p-JAK2, STAT3, and p-STAT3 were increased in model group when compared with control group(P 0.05); Compared with model group, their expression were reduced by SCU(P 0.05).Conclusion: SCU took a protective effect on HR-treated HCMECs, and the molecular mechanism may be associated with the inhibition of JAK2/STAT3 signal transduction pathway.     

Antioxidative and in vitro hepatoprotective activity of Bupleurum kaoi leaf infusion

The roots of Bupleurus spp. have been used in traditional Chinese herbal medicine for curing liver diseases. Although bioactive saikosaponins have been detected in the leaves as well as in the roots, the aerial parts of the plants are discarded as waste. In the present study, a leaf infusion of B. kaoi Liu, Chao et Chuang, an indigenous Bupleurus species in Taiwan, was prepared and the antioxidant properties and in vitro hepatoprotective activity were demonstrated. The results show that the leaf infusion exerted DPPH free radical scavenging activity, inhibitory capacity on superoxide anion formation and superoxide anion scavenging activity. The hepatotoxicity of acetaminophen (APAP) and carbon tetrachloride (CCl4) on the rat liver cells were also decreased by the leaf infusion.     

翁维良老师治疗酒精性心肌病经验

翁维良教授从事中西医内科临床工作50余年,擅用活血化瘀治疗心血管病及各种慢性疑难疾病。结合多年临床经验,翁老认为酒精性心肌病病机多属以心气(阳)亏虚为主,湿热、瘀血、痰饮、毒热内蕴为标的虚实夹杂证。治疗时,在完全戒酒的基础上,配合中药益气温阳扶助正气,同时辨证应用健脾、祛湿、活血、祛痰、解毒等祛除实邪治法,疗效肯定。文章旨在介绍翁维良教授辨治酒精性心肌病的临证经验。     

108例支气管哮喘患者舌脉象特征分析

目的：探讨对支气管哮喘临床辨证有意义的舌脉象客观指标,以辅助临床诊断。方法：应用TP—I型中医舌脉象数字化分析仪检测108例患者舌脉象参数,分析支气管哮喘发作期与缓解期的舌脉象特征。结果：108例支气管哮喘患者的舌象中,舌色以淡红舌、淡紫舌多见,舌苔以白苔、黄苔、薄苔为多见;脉象以弦脉、滑脉、弦滑脉为多见;舌脉象参数中舌色指数、苔色指数、厚苔指数、胖瘦指数在哮喘发作期各证型中有显著性差异（P〈0．05）;RPSR1、RPSR3、RPSR4、RBF、RLMS2、PLMP2、RLMS3、RLMP3在哮喘发作期与缓解期有显著性差异（P〈0．05）。结论：支气管哮喘患者的脉象参数、舌色指数、苔色指数、厚苔指数、胖瘦指数、RPSR1、RPSR3、RPSR4、RBF、RLMS2、PLMP2、RLMS3、RLMP3对其辨证分型有重要参考价值。     

抗炎-中药治疗动脉粥样硬化的有效途径

动脉粥样硬化发病机制的“炎症-损伤-反应”学说得到广泛支持和认可。炎性反应贯穿于动脉粥样硬化发生、发展的整个过程，并与急性心脑血管事件的发生密切相关；干预AS炎症反应可能是中药治疗动脉粥样硬化的有效途径。本文从动脉粥样硬化发生、发展过程的病理基础角度，总结了炎性反应在动脉粥样硬化形成早期、进展期、成熟期、破裂期的重要作用，并提出了从抗炎角度研究、筛选、治疗动脉粥样硬化中药的思路和方法。     

健脾调肝汤治疗晚期原发性肝癌对生活质量的影响

目的:观察健脾调肝汤治疗晚期原发性肝癌对生活质量的影响。方法:将60例患者随机分成治疗组与对照组各30例,2组患者均采用相同的西药(保肝、降酯、止痛等)治疗;治疗组同时加用健脾调肝汤治疗。2组均治疗1个月为1个疗程,2个疗程后评价疗效。观察2组中医证候变化、生活质量、体重变化、肝功能变化及不良反应。结果:2组中医临床证候变化比较,治疗组与对照组总改善率分别83.3%与60.0%(P0.05);2组治疗后生活质量及体重变化比较,生活质量、体重治疗组高于对照组(P0.05);2组治疗后肝功能变化比较,2组治疗后肝功能3项指标(ALT、AST、TBIL)较治疗前均有明显改善(P0.05),其中ALT、AST水平治疗组较对照组改善更明显(P0.05)。不良反应2组未见明显发生。结论:健脾调肝汤治疗晚期原发性肝癌可改善临床症状,减轻肝损害及不良反应,提高生活质量、延长生存期。     

Increasing nodal vulnerability and nodal efficiency implied recovery time prolonging in patients with supplementary motor area syndrome

Supplementary motor area (SMA) syndrome is a surgery‐related complication that commonly occurs after removing SMA glioma, and needs weeks to recover. However, susceptible factors of patients suffering from SMA syndrome remain unknown. Graphic theory was applied to reveal topological properties of sensorimotor network (SMN) by processing resting‐state functional magnetic resonance images in 66 patients with SMA gliomas. Patients were classified into SMA and non‐SMA groups based on whether they suffered from SMA syndrome. We collected recovery time and used causal mediation analysis to find association between topological properties and recovery time. Compared with the non‐SMA group, higher vulnerability (left: p = .0018; right: p = .0033) and lower fault tolerance (left: p = .0022; right: p = .0248) of the whole SMN were found in the SMA group. Moreover, higher nodal properties of lesional‐hemispheric cingulate cortex (nodal efficiency: left, p = .0389; right, p = .0169; nodal vulnerability: left, p = .0185; right, p = .0085) and upper limb region of primary motor cortex (PMC; nodal efficiency: left, p = .0132; right, p = .0001; nodal vulnerability: left, p = .0091; right, p = .0209) were found in the SMA group. Nodal efficiency and nodal vulnerability of cingulate cortex and upper limb region of PMC were important predictors for SMA syndrome occurring and recovery time prolonging. Neurosurgeons should carefully deal with upper limb region of PMC and cingulate cortex, and protect them if these two region were unnecessary to damage during SMA glioma resection.     

妊娠期糖代谢异常与妊娠期高血压疾病的关系

目的:探讨妊娠期糖代谢异常与妊娠期高血压疾病的关系。方法:回顾分析2003年至2007年在我院住院分娩的6748例孕妇的临床资料,分析不同程度糖代谢异常孕妇妊娠期高血压疾病的发生情况;将妊娠期糖代谢异常并发高血压疾病(PHD)患者分为妊娠期高血压组(Ⅰ组)、轻度子痫前期组(Ⅱ组)和重度子痫前期组(Ⅲ组),比较3组孕妇不同糖负荷后血糖水平(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数的差异。结果:(1)6748例孕妇发生PHD252例,发生率3.7%(252/6748),妊娠期糖代谢异常孕妇1402例,发生率20.8%(1402/6748);妊娠期糖代谢异常孕妇82例并发PHD,发生率5.8%(82/1402);糖代谢正常孕妇PHD发生率为3.2%(170/5346),差异有统计学意义(P<0.001);(2)82例妊娠期糖代谢异常并发PHD患者中,糖尿病合并妊娠(DM)、妊娠期糖尿病(GDM)、妊娠期糖耐量降低(GIGT)、妊娠期50g葡萄糖筛查(GCT)(+)的PHD发生率分别为8.5%(12/141),7.9%(45/571),3.4%(9/265),3.8%(16/425);DM、GDM组与GIGT、GCT(+)组的差异有统计学意义(P=0.010、0.001);DM组与GDM组的差异无统计学意义(P=0.805);GIGT组与GCT(+)组相比及两组与糖代谢正常组的差异无统计学意义(P=0.801、0.535)。(3)82例妊娠期糖代谢异常并发PHD患者,妊娠期高血压(Ⅰ组)27例、轻度子痫前期(Ⅱ组)24例、重度子痫前期(Ⅲ组)31例,3组血糖(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数无统计学差异。结论:妊娠期糖代谢异常的孕妇更易发生妊娠期高血压疾病;随糖代谢异常程度加重,妊娠期高血压疾病发病率呈增加趋势。     

复方丹参滴丸联合辅酶Q10对病毒性心肌炎患儿的心肌保护作用

目的:研究复方丹参滴丸联合辅酶Q10对病毒性心肌炎患儿的心肌保护作用。方法:95例病毒性心肌炎患儿随机分为观察组48例和对照组47例,对照组患儿给予辅酶Q10治疗,观察组患儿给予复方丹参滴丸联合辅酶Q10治疗。观察并记录胸闷、胸痛、心悸、乏力、呼吸困难等临床症状;比较治疗前后两组患儿超声心动图指标及实验室指标变化情况。结果:观察组临床总有效率高于对照组(91.67% vs 74.47%, χ2=5.015, P<0.05)。治疗后,观察组心肌酶谱、肌酸激酶和肌酸激酶同工酶水平显著降低且低于对照组(P<0.05),肌钙蛋白I和hs-CRP水平显著降低且低于对照组(P<0.05)。结论:复方丹参滴丸联合辅酶Q10可以有效恢复心肌酶水平,改善心电图结果,保护心肌细胞。