硬膜下积液治疗经验总结（附27例临床分析）

目的总结不同类型硬膜下积液治疗经验。 方法对解放军总医院第六医学中心神经外科自2009年1月至2014年10月手术治疗并完整随访的27例硬膜下积液患者进行回顾性分析。根据术前影像学特征鉴别积液是否为血性,将患者分为血性硬膜下积液患者（9例）和非血性硬膜下积液患者（18例）。根据积液是否为血性选择个性化治疗方案,观察其疗法。 结果9例血性硬膜下积液患者接受钻孔外引流手术,8例积液消退,另外1例无效,之后接受硬膜下腹腔分流后治愈。非血性硬膜下积液患者中14例接受硬膜下腹腔分流,12例有效,2例术后出现脑积水,经脑室-腹腔分流术治愈;2例术前合并脑积水接受脑室-腹腔分流术,均有效;另外2例最初接受积液外引流,无效,之后行硬膜下腹腔分流后积液消退。 结论对于硬膜下积液患者,术前需仔细评估积液是否为血性,是否合并脑积水。血性积液采取钻孔外引流,非血性积液采取硬膜下腹腔分流,合并脑积水的积液采取脑室-腹腔分流手术方式,给予个体化治疗,可获得满意疗效。     

养心汤对同型半胱氨酸致大鼠血管内皮功能障碍的影响

目的通过高蛋氨酸饲料喂养SD大鼠建立血管内皮功能障碍模型,观察中药养心汤对血管内皮功能障碍的影响并对其相关机制进行探讨。方法 SD雄性大鼠40只,按随机数字表法分为空白组、模型组、叶酸组、养心汤组,每组10只。空白组喂养常规普通饲料,模型组、叶酸组、养心汤组喂养含3%L-蛋氨酸的常规普通饲料,共12周,建立血管功能障碍模型。模型建立成功后,空白组和模型组大鼠灌胃等体积纯净水;叶酸组大鼠灌胃叶酸片混悬剂1.8 mg/(kg·d),养心汤组大鼠灌胃养心汤浸膏混悬剂2.34 g/(kg·d),灌胃4周。实验结束后,大鼠麻醉称重取材,取胸主动脉电镜观察血管内皮超微结构变化;腹主动脉取血离心,ELISA法检测血清一氧化氮(NO)、内皮素-1(ET-1)、同型半胱氨酸(Hcy)、蛋白C受体(sEPCR)、可溶性血栓调节蛋白(s TM)水平。结果电镜下可见空白组大鼠血管内皮完整连续未见明显损伤,与空白组比较,模型组大鼠血管内皮大部分脱落,偶见残存内皮,损伤程度明显加重;与模型组比较,养心汤组大鼠血管内皮基本连续完好,损伤程度明显减轻;ELISA检测结果可见,与空白组比较,模型组大鼠血清NO水平降低、...     

山东泰安地区两个自然村人群血脂状况调查

目的:调查了解山东泰安地区农村人群的血脂水平,为该地区农民心脑血管疾病的预防提供基础数据。方法:实验于2006-06随机选取泰安市两个自然村650人进行健康检查,男270人,女380人,年龄2～88岁。①650人均于早晨空腹采集静脉血3mL,静置凝固后,2h内分离血清,采用全自动生化分析仪常规测定患者血脂指标总胆固醇、三酰甘油水平。②总胆固醇>5.2mmol/L判定为高胆固醇血症,三酰甘油>1.7mmol/L判定为高三酰甘油血症。结果:650人全部完成血样采集与血脂指标检测。①不同性别血脂水平比较:被检人群男性三酰甘油水平显著高于女性[(1.16±1.47),(0.95±0.84)mmol/L,P<0.05];男女总胆固醇水平基本相似(P>0.05)。②不同年龄段血脂水平比较:8人因具体年龄段不祥被排除,剩余642人分为3个年龄段:2～30岁、31～50岁、51～88岁。结果31～50岁人群三酰甘油水平显著高于2～30岁人群[(1.14±1.47),(0.88±0.70)mmol/L,P<0.05],略高于51～88岁人群(P>0.05);51～88岁人群总胆固醇水平>31～50岁人群>2～30岁人群,相邻年龄段间比较差异均有显著性意义(P<0.001)。③各年龄段男女间血脂水平比较:2～30岁人群和51～88岁人群三酰甘油水平性别间差异均无显著性意义(P>0.05),但总胆固醇水平女性均显著高于男性[(2.38±1.47),(1.85±1.26)mmol/L,P<0.05;(4.48±0.92),(4.18±0.76)mmol/L,P0.01]。31～50岁人群男性三酰甘油水平显著高于女性[(1.51±2.06),(0.90±0.80)mmol/L,P<0.01],总胆固醇水平基本相似(P>0.05)。④各年龄段男女高血脂症构成比:31～50岁人群高三酰甘油血症构成比显著高于2～30岁、51～88岁人群(23.1%,5.5%,9.3%,P<0.01);随着年龄增高,各年龄段高胆固醇血症构成比逐渐升高,相邻年龄段间差异均有显著性意义(2.7%,8.6%,15.6%,P<0.01)。31～50岁人群男性高三酰甘油血症、高胆固醇血症的构成比显著高于女性(P<0.01);2～30岁、51～88岁人群男女间高血脂症的构成比基本相似(P>0.05)。结论:①山东泰安地区农村人群高三酰甘油血症,31～50岁年龄段患病率最高;高胆固醇血症患病率随年龄增长逐步上升,提示中年人健康体检尤为重要。②高脂血症应从青少年开始加大预防和保健力度,进行广泛和反复的健康教育,倡导健康的生活方式和生活行为。     

A multicenter retrospective study of transurethral prostate split for benign prostate hyperplasia

BackgroundTransurethral split of the prostate (TUSP) is effective in treating benign prostatic hyperplasia (BPH). However, there is still a lack of research focusing on the optimal target population for TUSP. This study aimed to compare the efficacy of TUSP in patients with different prostate volumes or ages.MethodsThe study was a multicenter retrospective study. The outcomes of TUSP in BPH patients with different prostate volumes or different ages were compared. A total of 439 patients were included in the study. Patients were divided into two groups according to prostate volume, with a cut-off value of 50 mL. Similarly, the cut-off value for the age groups was 70 years. Baseline patient characteristics and perioperative outcomes were recorded. Follow-up was performed at 1, 6, and 12 months after surgery.ResultsThe mean age of the patients was 73.4 years, and the mean prostate volume was 51.2 mL. At 12-month follow-up after TUSP treatment, the patients’ International Prostate Symptom Scores (IPSS), quality of life (QoL) scores, and postvoid residual (PVR) volumes decreased significantly, while peak urinary flow rate (Qmax) increased significantly. Intraoperative hemoglobin (Hb) reduction was significantly lower in the small volume group than in the large volume group. The incidence of postoperative urinary urgency and transient incontinence was lower in the small volume group. IPSS score, PVR, and Qmax in the small volume group showed more remarkable changes at several time points compared to the preoperative period. Postoperative pain scores were higher in the small volume group than in the large volume group. There were no differences between the two groups in terms of long-term complications. The younger group showed greater variation in PVR and Qmax at some time points but less variation in QoL than the older group.ConclusionsTUSP is overall safe and effective in treating BPH. This study showed differences in the outcomes of TUSP in treating different prostate volumes or ages of BPH patients. The optimal surgical approach for BPH patients might be selected clinically based on a combination of prostate volume or patient age.     

艺术疗法对乳腺癌患者焦虑和抑郁情绪影响的Meta分析

目的 评价艺术疗法对改善乳腺癌患者焦虑和抑郁情绪的疗效.方法 检索PubMed、Embase、Web of science、Scopus、Cochrane library、Google scholar等外文数据库及中文数据库包括维普数据库、中国生物医学数据库、知网期刊数据库、万方期刊数据库中艺术疗法对乳腺癌患者焦虑和抑...     

高龄高血压患者降压治疗中的常见问题及处理

临床上一般将年龄大于80岁的高血压患者称为高龄高血压患者。尽管高龄高血压患者降压治疗的受益还缺乏大量的循证医学的支持（目前世界上唯一一个针对80岁以上的较大规模的试验是HYVET试验）,但国内外临床医学工作者仍然认为如同HYVET试验的结论一样,     

Comparative study on the immunogenicity between Hsp70 DNA vaccine and Hsp65 DNA vaccine in humanMycobacterium tuberculosis

Summary The BALB/c mice were immunized with Hsp70 DNA and Hsp65 DNA vaccines in humanMycobacterium tuberculosis. Eight weeks after immunization, the eyeballs were removed, blood and spleen taken, and intraperitoneal macrophages were harvested. The lymphocytic stimulating index (SI) was used to measure the cellular proliferating ability and NO release to measure the phagocytic activity of the macrophages. With ELISA kit, the levels of interleukin-2 (IL-2) and interferon-γ (IFN-γ) in serum and the splenic lymphocytic cultured supernatant were detected. The results showed that after the mice were immunized with 100 μg/mouse of Hsp70 DNA vaccine intramuscularly, the splenic lymphocytic proliferating ability in the mice was significantly increased as compared with that in the control group, vector group and Hsp65 DNA vaccine group (P<0.01); The contents of NO in the intraperitoneal macrophages of the mice were significantly lower than in the control group and Hsp65 DNA vaccine group (P<0.01); The levels of serum IL-2 in the mice were significantly higher than in the control group, but there was no statistical difference between Hsp65 DNA group and vector group (P>0.05); The contents of serum IFN-γ in the mice were significantly higher than in the control group, but significantly lower than in the Hsp65 DNA vaccine group (P< 0.05). It was indicated that immunization with Hsp70 DNA vaccine could obviously enhance the immune response, but its intensity seemed inferior to Hsp65 DNA vaccine. The anti-infection mechanisms and clinical use in the future of the vaccines of Hsp70 DNA and Hsp65 DNA are worth further studying. This project was supported by a grant from National Natural Sciences Foundation of China (No. 39870663).     

几种嗓音疾病的声学分析和听感知分级的评价

目的评价嗓音声学分析和主观听感知评估对几种嗓音疾病测试的客观性及科学性。方法①研究对象：嗓音障碍患者72例,正常对照组30例。②主观听感知评估：采用日本言语语音协会的声音嘶哑评估标准GRBAS系统中的总嘶哑度G、粗糙声R、气息声B主观评估受试者的嗓音质量。③嗓音的客观检测：以/e/音作声样,进行嗓音声学和电声门图测试。结果随声嘶程度加重,反映声带振动的稳定性的基频微扰（jitter）、振幅微扰（shimmer）、电声门图-基频微扰（E-jitter）、电声门图-振幅微扰（E-shimmer）增大;反映声门闭合程度的标准化噪声能量（NNE）、电声门图-标准化噪声能量（E-NNE）,接触商微扰（CQP）增大;谐噪比（HNR）减小。嗓音客观参数在主观听感知评估分析患者间的差异有显著统计学意义（P〈0.05）,能区分出不同的嗓音障碍组,但在不同的疾病组间缺乏特异性。结论本实验中所选客观参数可客观评价嗓音疾病,为临床治疗提供依据。     

毒物分析用于1例苯巴比妥中毒患者抢救

目的：为临床提供大剂量苯巴比妥中毒患者血药浓度与临床症状的关系。方法;介绍一例进行中毒药物测定的患者,报告并解释其抢救过程血药浓度与相应的临床症状。结果：中毒患者在血药浓度指导下,成功地采用血液灌流进行抢救。结论：毒物分析能有效指导临床苯巴比妥中毒患者抢救,血药浓度与临床症状密切相关。