坐骨棘筋膜固定术的临床解剖学研究

Objective The study was to explore the safety, firmness and convenience of the fascia around the ischial spine as a new fixation site for the vaginal fornix. Methods Between June 2007 and January 2008, detailed dissections and related measurements of the regions around the ischial spine were performed on 10 Chinese female cadavers (3 unembalmed and 7 embalmed cadavers). At the same time, the sacrospinous ligament,the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were exposed and the pull-out strength sequentially tested using a digital push-pull force gauge. Results The fascia on the ischial spine was firm and strong, with a thickness of 3 about mm. No major vessels or nerves were observed on the ischial spine. The greatest pullout strengths of the sacrospinous ligament,the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were (102±26),(64±15),(33±8)and(32±6)N, respectively. Conclusion The fascia at 1 cm from anterior lateral ischial spine, free of major vessels and nerves, is safe and strong and could be used as a new site for suspension in vaginal prolapse.     

压力性尿失禁问卷评分对女性压力性尿失禁诊断的价值

目的:探讨压力性尿失禁问卷评分(SS)对女性压力性尿失禁(SUI)的诊断价值。方法:对我院妇科确诊为压力性尿失禁的44例患者进行压力性尿失禁问卷评分,分析1小时尿垫实验(1HPTV)与SS之间的相关性。结果:1HPTV与SS之间有相关性;Lg[1HPTV]与SS之间有非常明显相关性。SS评分对于中度SUI诊断的敏感性为70.0%,特异性为76.5%;对于诊断重度SUI患者,SS评分诊断的敏感性为75.0%,特异性为91.7%。身高、体重、年龄和Lg[1HPTV]是影响SS的主要因素。结论:SS是协助临床诊断女性压力性尿失禁的简捷、经济、无创、准确的一种新方法。     

795例肠外营养支持的回顾性分析

目的:对795例患者的肠外营养支持进行回顾性分析.方法:对行肠外营养支持的399例患者进行治疗前后淋巴细胞计数、血浆白蛋白和血浆锌离子浓度等营养学指标的比较,并选择行肠外营养的患者198例与行单一静脉营养的患者198例进行营养学指标的比较,同时比较不良反应和依从性.另选择25例有单一静脉营养史患者25例,分为足量组13例和低氮组12例,分别按照1.0～1.5和0.6 g·kg-1·d-1逐渐在3 d内递增到1.0～1.5 g·kg-1·d-1给予氨基酸,其余营养支持相同, 进行营养学指标的比较.结果:与治疗前比较,行肠外营养支持后患者的白蛋白、淋巴细胞计数、锌离子浓度等均显著增加(P<0.05).与单一静脉营养相比较,行肠外营养患者的白蛋白、淋巴细胞计数、锌离子浓度等也均显著增加(P<0.05),同时不良反应和依从性较好.足量组与低氮组比较,白蛋白值显著增加,而淋巴细胞计数、锌离子浓度无显著性差异.结论:肠外营养支持可以显著改善营养不良.     

新安宫牛黄颗粒治疗急性脑血管疾病51例临床观察

为了观察新安宫牛黄颗粒对急性脑血管疾病的临床疗效,采用随机单盲对照方法将83例患者随机分为2组：新安宫牛黄颗粒治疗组51例和安宫牛黄丸对照组32例,进行临床疗效判定、各症状积分比较、血脂水平检测.结果：治疗组和对照组临床疗效分别为64.71%、46.88%,具有显著性差异（P＜0.05）;中风的症状积分比较表明治疗组明显优于对照组,在综合功能积分指标中具有明显差异（P＜0.05）;治疗组对血脂TC、TG水平具有明显降低作用（P＜0.01）.结论：新安宫牛黄颗粒对急性脑血管疾病具有明显的临床疗效,治疗效果优于安宫牛黄丸,具有一定的开发前景.     

自然衰老对小鼠免疫功能的影响

目的 探讨自然衰老对小鼠免疫功能的影响.方法 测量8周龄(青年组)和16月龄(老年组)ICR雄性小鼠各8只体重和免疫器官指数.流式细胞术检测两组小鼠脾脏组织和外周血中T淋巴细胞亚群(CD3+、CD4+、CD8+)、髓源性抑制细胞(MDSC)及其亚型单核细胞样MDSC(M-MDSC)细胞比例,分析两种细胞比例相关性.结果 与青年组比较,老年组体重、脾脏指数和肾脏指数升高(P＜0.05),脾脏组织中CD3+、CD4+和CD8+细胞比例降低,而CD4+/CD8+比值升高(P＜0.05或P＜0.01),外周血中CD3+和CD4+细胞比例降低(P＜0.05),脾脏组织和外周血中MDSC和M-MDSC细胞比例升高(P＜0.01).老年组CD3+、CD4+、CD8+细胞比例与MDSC、M-MDSC细胞比例呈负相关(P＜0.01).结论 T淋巴细胞亚群与MDSC密切相关,可能是自然衰老影响小鼠免疫功能的机制之一.     

盐酸替罗非班在ST段抬高急性心肌梗死治疗的临床应用

目的观察和分析盐酸替罗非班对ST段抬高心梗患者急诊经皮冠状动脉介入治疗中血流的影响和临床疗效。方法选取2013年2月~2014年4月我院收治的急诊入院36例STEMI急性心肌梗死行PCI患者,随机分成两组,每组各18例,其中观察组PCI术前开始采用盐酸替罗非班,对照组采用常规PCI术,观察两组患者术前和术后冠状动脉血流情况。结果 观察组患者恢复TIMI3级血流比例明显高于对照组,观察组术后TIMI血流3级发生率为(94.4%),常规PCI的对照组术后TIMI血流为(83.3%),P0.05。结论 在对STEMI患者进行急诊经皮冠状动脉介入治疗采用替罗非班可改善患者梗死相关血管的TIMI血流。     

自身免疫性肝病的病理学新进展

自身免疫性肝病是指由于机体免疫系统攻击自体肝组织引起的肝组织损伤和肝功能异常的一组免疫性疾病,包括有自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)和原发性硬化性胆管炎(PSC).通常情况下这三种肝脏疾病独立存在,约有6％～9％的患者可以在同一时段或病程中出现两种疾病的临床表现、血清学和组织学特征,称为重叠综合征.近年来随着对自身免疫性肝病认识水平的提高以及自身抗体检测方法的不断改进,一些学者在自身免疫性肝病的经典肝组织学病变特点的基础上,提出了一些见解,介绍如下.     

心脑脉通胶囊的微乳薄层色谱鉴别

目的 探讨微乳薄层色谱法同时分离鉴别心脑脉通胶囊中多种有效成分。 方法 以聚酰胺薄膜为固定相,微乳液为展开剂,对处方中蓝萼香茶菜、葛根、丹参、川芎四味药材进行定性鉴别,并考察了十二烷基硫酸钠(SDS)、油相、水相等因素对分离效果的影响。 结果 以含水量 75% 的微乳液[SDS-正丁醇-正庚烷-水,g/g]-甲酸-丙酮(5:1:1) 为展开剂,可同时分离鉴别心脑脉通中的蓝萼香茶菜、葛根、丹参、川芎,斑点清晰,且阴性对照无干扰,分离效果理想。 结论 微乳薄层色谱法操作简便,结果准确,重现性好,可同时分离鉴别中成药中的多种有效成分。     

磁共振扩散峰度成像的临床研究进展

磁共振扩散峰度成像(diffusional kurtosis imaging,DKI)是一种可量化组织内水分子扩散非高斯运动的磁共振新技术,是扩散张量成像技术的延伸,对于描绘组织微观结构具有独特优势。DKI技术在神经系统已有较多研究,并已取得较好的成果。近年来,DKI逐渐应用于其他系统疾病研究,也取得了初步成果,展现出一定的临床价值。现综述DKI的成像原理及其在全身各系统中的研究进展。     

Comparison of the antianginal efficacy of isosorbide dinitrate (ISDN) 40 mg and verapamil 120 mg three times daily in the acute trial and following two-week treatment

Fourteen male patients with exertion-related angina pectorisand reproducible ST-segment depression on stress testing wereeach treated with isosorbide dinitrate (ISDN) 40 mg three timesdaily, verapamil 120 mg three times daily and placebo threetimes daily for two weeks according to a double-blind cross-overprotocol. The mean improvement of exercise-induced ST-segment depressionamounted to 73% on the first day of ISDN treatment (P < 0.001)and to 54% following acute administration of verapamil (P <0.001). On the last day of continuous treatment, the antianginalefficacy of ISDN was somewhat mitigated (reduction of ST-segmentdepression: 54%; P<0.001), while the effect of verapamilremained unchanged (55%, P<0.001). The double product (heartrate x systolic blood pressure) at the end of stress testingdecreased most pronouncedly on day 1 of ISDN treatment ( - 21%;P<0.01). On chronic testing, both drugs similarly influencedthis parameter: 10–11% (P<0.05). The mean global ejectionfraction (EF) assessed by gated blood pool scintigraphy on day13 showed a stress-induced fall from 49 to 44% (P<0.05) afterthe administration of placebo. The respective values with ISDNwere 53% at rest and 52% on exercise (n.s.), and after givingverapamil 50% and47% (n.s.). Thus, ISDN 40 mg and verapamil 120 mg displayed beneficial anti-ischaemiceffects in patients with stable exertion-related angina pectorisafter acute and chronic administration. The efficacy of ISDNdeclined somewhat in the course of the two-week treatment, whereasthat of verapamil remained unchanged. Beneficial effects ofboth drugs were also demonstrated with regard to the rate pressureproduct. Isosorbide dinitrate 40 mg and verapamil 120 mg administeredthree times daily can be recommended for the acute and chronictherapy of patients with stable angina.