基于“同气相求”理论的激痛点疗法治疗顽固性偏头痛15例

笔者基于"同气相求"理论,遵循经络辨证,以"求同气、通经络"为治则,针刺患侧或双侧手足少阳经远端激痛点及井穴,同时按揉近端激痛点,治疗顽固性偏头痛15例,现报道如下。1临床资料15例患者均为2018年1月至2018年6月包头医学院第二附属医院针灸科门诊就诊的顽固性偏头痛患者,其中男6例,女9例;单侧头痛9例,双侧6例;年龄15~65岁,平均46岁;病程0.5~15年,平均2年。均表现为单侧或双侧颞部反复发作的搏动性疼痛,伴失眠、健忘,痛甚者恶心,行头颅CT或MRI检查未见异常。     

电感耦合等离子体原子发射光谱法分析珍宝类藏药七十味珍珠丸中汞的5种形态和分布

目的：研究藏药七十味珍珠丸中汞的5种存在形态和分布。方法：将七十味珍珠丸中汞的形态分为水溶态汞、溶于盐酸的无机汞和有机汞、络合汞、单质汞和残渣态汞,通过电感耦合等离子体原子发射光谱（ICP-AES）法分析5种形态汞的含量和分布。结果：藏药七十味珍珠丸中总汞的93.8%是以惰性汞形式存在的硫化汞,6.18%是与锌、铝、钙等金属氧化物形成的络合汞,0.01%是单质汞,0.04%是溶于盐酸的无机汞和有机汞,0.03%为水溶态汞。结论：通过震荡提取藏药七十味珍珠丸中不同形态汞,且5种汞形态的含量总和基本等于总汞含量。这种提取方式能够全面分析七十味珍珠丸中汞的形态,从而为控制珍宝类藏药的安全性提供了科学依据。     

四川省自贡市儿童1型糖尿病发病率研究

为摸清我省儿童１型糖尿病的发病情况,按ＷＨＯ儿童糖尿病多国研究计划方案,我们在自贡市（四区,两县）对１９８９～１９９６年儿童１型糖尿病发病率进行了调查研究。１　材料与方法１．１　病例来源　第一来源：自贡市３０个县区级有１型糖尿病诊断能力的医院。第二来...     

载脂蛋白B基因EcoRI、XbaI、MspI及载脂蛋白AI基因-75bp、+83bp位点多态性与哈萨克族血脂异常的关系

目的:分析载脂蛋白B(apoB)基因EcoRI、XbaI、MspI位点和载脂蛋白AI(apoAI)基因-75bp、+83bp位点多态性与哈萨克族(哈族)人血脂异常的关系。方法:采用聚合酶链式反应-限制性片段长度多态性分析法检测275例哈族血脂异常患者(血脂异常组)和252例哈族血脂正常对照者(对照组)的apoB基因EcoRI、XbaI、MspI位点和apoAI基因-75bp、+83bp位点多态性。检测甘油三酯、血浆总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、apoB、apoAI的水平。结果:(1)各个位点各基因型及等位基因频率在两组之间差异无显著性。(2)血脂异常组和对照组各基因型联合的总体分布不同(χ2=19.26,P<0.05)。E+-/X--/Ms++/M1/M2(联合10)的比率在血脂异常组(45/275)显著高于对照组(22/+-++252,χ2=5.37,P<0.05)。E++/X+-/Ms+-/M1/M2(联合11)的比率在血脂异常组(30/275)显著高于对照组+-++(13/252,χ2=4.94,P<0.05)。(3)血脂异常组中基因型联合10和11(基因型联合10～11)的TC均值显著高于本组中除基因型联合10及11(基因型联合1～9)的均值,apoAI/apoB均值显著低于本组中基因型联合1～9的均值。对照组中基因型联合10～11的apoAI/apoB水平也显著低于本组中基因型联合1～9。(4)E++/X+-/Ms++/M1/M2(基因型联合2)的TC在两组中都分别低于基因型联合10～11,apoAI/apoB在两组+-+-中都分别高于基因型联合10～11。(5)apoAI/apoB无论在血脂异常组还是在对照组都与TC、LDL-C负相关,与HDL-C正相关。结论:apoB基因EcoRI、XbaI、MspI位点和apoAI基因-75bp、+83bp各位点基因型多态联合中,基因型联合10及11与哈族人血脂异常相关。基因型联合2可能是预防血脂异常的因素。其中的机制可能与载脂蛋白基因变异引起apoAI/apoB的改变进而引起血脂的变化有关。     

Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery

Background: The aim of the present study was to determine the mechanisms underlying Type 2 diabetes remission after gastric bypass (GBP) surgery by characterizing the short‐ and long‐term changes in hormonal determinants of blood glucose. Methods: Eleven morbidly obese women with diabetes were studied before and 1, 6, and 12 months after GBP; eight non‐diabetic morbidly obese women were used as controls. The incretin effect was measured as the difference in insulin levels in response to oral glucose and to an isoglycemic intravenous challenge. Outcome measures were glucose, insulin, C‐peptide, proinsulin, amylin, glucagon, glucose‐dependent insulinotropic polypeptide (GIP), glucagon‐like peptide‐1 (GLP‐1) levels and the incretin effect on insulin secretion. Results: The decrease in fasting glucose (r = 0.724) and insulin (r = 0.576) was associated with weight loss up to 12 months after GBP. In contrast, the blunted incretin effect (calculated at 22%) that improved at 1 month remained unchanged with further weight loss at 6 (52%) and 12 (52%) months. The blunted incretin (GLP‐1 and GIP) levels, early phase insulin secretion, and other parameters of β‐cell function (amylin, proinsulin/insulin) followed the same pattern, with rapid improvement at 1 month that remained unchanged at 1 year. Conclusions: The data suggest that weight loss and incretins may contribute independently to improved glucose levels in the first year after GBP surgery.     

染色体9p21多态性与急性非心源性脑梗死患者颈动脉斑块的易感性分析

目的: 探讨急性非心源性脑梗死患者染色体9p21区域rs10757274、rs7044859、rs4977574和rs496892基因多态性与颈动脉斑块的相关性。方法: 应用聚合酶链反应-连接酶检测反应（polymerase chain reaction-ligase detection reaction, PCR-LDR）对新疆和上海地区共411例急性非心源性脑梗死患者（无颈动脉斑块组181例,伴有颈动脉斑块组230例）的染色体9p21区域rs10757274、rs7044859、rs4977574和rs496892这4个位点进行基因多态性分析。结果: 在新疆和上海地区的中老年脑梗死患者中,颈动脉斑块组的携带rs4977574的G等位基因百分比明显多于无颈动脉斑块组,分别是52.6% 比41.7%（校正后P=0.006）;颈动脉斑块组患者rs4977574的GG基因型携带百分比高于无颈动脉斑块组,分别是26.5%比 20.4%(P=0.002)。位点rs10757274与rs4977574之间、位点rs7044859与 rs496892之间存在强的连锁不平衡关系。结论: 在新疆和上海地区的中老年脑梗死患者中,染色体9p21区带中rs4977574的基因多态性与颈动脉斑块的发生可能有一定关联。     

Left Ventricular Mechanical Assist Devices and Cardiac Device Interactions: An Observational Case Series

Background: Nonpulsatile left ventricular assist devices (LVADs) are increasingly used for treatment of refractory heart failure. A majority of such patients have implanted cardiac devices, namely implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy-pacemaker (CRT-P) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. However, potential interactions between LVADs and cardiac devices in this category of patients remain unknown.
Methods: We reviewed case records and device logs of 15 patients with ICDs or CRT-P or CRT-D devices who subsequently had implantation of a VentrAssist LVAD (Ventracor Ltd., Chatswood, Australia) as destination therapy or bridge to heart transplantation. Pacemaker and ICD lead parameters before and after LVAD implant were compared. In addition, ventricular tachyarrhythmia event logs and potential electromagnetic interference reports were evaluated.
Results: Right ventricular (RV) sensing decreased in the first 6 months post-LVAD. Mean R-wave amplitude preimplant was 10.9 ± 5.25 mV compared with 7.2 ± 3.4 mV during follow-up (P = 0.02). RV impedance also decreased from 642 ± 240 ohms at baseline to 580 ± 212 ohms at follow-up (P = 0.007). There was a significant increase in RV stimulation threshold following implantation of the LVAD from 0.8 ± 0.6 V at baseline to 1.4 ± 1.0 V in the first 6 months postimplant (P = 0.01). A marked increase in ventricular tachyarrhythmia burden was observed in three patients. One patient displayed electromagnetic interference between the LVAD and defibrillator, resulting in inappropriate defibrillation therapy.
Conclusions: LVADs have a definite impact on cardiac devices in respect with alteration of lead parameters, ventricular tachyarrhythmias, and electromagnetic interference.     

彩色多普勒超声在移植肾急性排异反应中的应用

目的 应用彩色多普勒超声寻找移植肾急性排异反应较为特异的诊断指标.方法 经移植肾穿刺活检证实的急性排异反应患者42例,经长期随访(1年以上)和临床检查证实的功能稳定期患者115例.对两组移植肾长径、宽径、厚径、实质厚度以及主肾动脉和弓状动脉的阻力指数(RI)进行统计学比较;选取肾体积增大,锥体肿大回声减低、RI＜0.7、RI≥0.7及RI≥0.8作为诊断标准,按诊断试验评价原则分别计算灵敏度、特异度、误诊率、漏诊率和符合率;并绘制ROC曲线,确定诊断界值.结果 两组的移植肾长径、宽径、厚径及实质厚度差异有统计学意义(P＜0.05);急性排异反应组肾内血流灌注减少,肾动脉舒张期血流速度明显下降,RI明显增高,与移植肾功能稳定期比较差异有统计学意义(P＜0.05);各诊断标准对应的灵敏度分别为55.30%,55.20%,42.10%,57.90%和31.60%;特异度分别为71.30%、87.10%、25.70%、74.20%、98.20%.结论 肾体积增大、肾锥体肿大、回声减低、RI升高对诊断移植肾急性排异反应有特异性.