艾灸改善非小细胞肺癌化疗期间胃肠道不良反应临床研究

目的:观察艾灸防治非小细胞肺癌患者化疗期间胃肠道不良反应的临床疗效。方法:将50例非小细胞肺癌患者随机分为对照组和治疗组,每组各25例。对照组采用TP方案化疗,治疗组在对照组的基础上艾灸神阙穴与双侧足三里穴。观察两组患者化疗后恶心、呕吐的发生情况。结果:治疗组有效率明显高于对照组,差异有统计学意义(P0.05)。结论:艾灸对化疗所致消化道不良反应具有一定的防治作用,且操作方便、安全性高、经济实惠。     

The Expression of Calcitonin Gene-related Peptide on the Neurons Associated Zusanli (ST 36) in Rats

Objective:To investigate the biochemical characteristic of the neurons associated Zusanli(ST 36)in the rat by using Alexa Fluor 594 conjugated cholera toxin subunit B(AF594-CTB)neural tracing and calcitonin gene-related peptide(CGRP)fluorescent immunohistochemical techniques.Methods:Four male Sprague Dawley rats were injected with AF594-CTB into the corresponding area of the Zusanli in the human body.After 3 surviving days,the rat's spinal cord and dorsal root ganglia(DRGs)at lumbar segments were dissected following perfusion with 4%paraformaldehyde,cut into sections,and then stained with CGRPfluorescent immunohistochemical method.Results:AF594-CTB labeled sensory neurons were detected in the L3-L6 DRGs with high concentration in L4 DRG,and the labeled motor neurons located in the dorsolateral and intermediate regions of laminaⅨfrom L3-L5 segments with high concentration at L4.Meanwhile,CGRPpositive neural labeling distributed symmetrically on both sides of DRGs,anterior and dorsal homs of spinal cord.In the AF594-CTB labeled neurons,37%sensory neurons and 100%motor neurons expressed CGRPpositive.Conclusion:These findings present the morphological evidence to demonstrate that the sensory and motor neurons associated Zusanli in the rat distributed with segmental and regional patterns,and contained CGRP-expression.     

低频电针足三里对2型糖尿病大鼠糖代谢的影响

目的研究低频电针单侧足三里对2型糖尿病(T2DM)大鼠模型糖代谢的影响,探讨低频电针足三里对T2DM大鼠的疗效机制。方法将30只8周龄雄性Wistar大鼠随机分为空白组10只和造模组20只。造模组造模后将造模成功的16只大鼠随机分为模型组8只和针刺组8只。针刺组予电针单侧足三里治疗,模型组只束缚不干预。比较3组大鼠空腹血糖(FBG)、空腹胰岛素(FI)及定量胰岛素敏感检测指数(QUICKI),观察胰岛β细胞的形态。结果 FBG治疗前与空白组比较,针刺组和模型组均有显著升高(P<0.05),针刺组与模型组比较差异无统计学意义(P>0.05);治疗后与空白组比较,针刺组和模型组均有显著升高(P<0.05),针刺组与模型组比较显著降低(P<0.05)。FI治疗前各组间比较差异均无统计学意义(P>0.05);治疗后各组间比较差异均无统计学意义(P>0.05)。QUICKI治疗前与空白组比较,针刺组和模型组均降低(P<0.05),针刺组与模型组比较差异无统计学意义(P>0.05);治疗后针刺组与空白组比较差异无统计学意义(P>0.05),模型组较空白组降低(P<0.05),针刺组较模型组升高(P<0.05)。在光镜下,针刺组胰腺组织分布均匀度与空白组接近,胰岛结构比较完整,细胞密度略低于空白组,胰岛β细胞胞浆见少量肿胀,纤维组织稍有增生。结论电针足三里能有效控制高糖高脂饮食联合链脲佐菌素(STZ)诱导的T2DM大鼠模型的病情发展,改善胰岛素敏感度及胰岛β细胞的形态。     

比较电针"合谷""足三里"穴对IBS模型大鼠结肠动力及结肠M3受体表达的影响

目的观察并比较电针"合谷""足三里"穴对肠易激综合征(IBS)模型大鼠结肠动力及结肠M_3受体免疫反应物阳性表达的影响,初步探讨电针不同穴性及不同神经节段支配的穴位对IBS的效应差异及结肠动力改变的相关机制。方法选取新生wistar大鼠40只,随机分为空白对照组、模型对照组、合谷组和足三里组。除空白对照组外,均采用新生期母婴分离、醋酸灌肠及结直肠扩张刺激(CRD)的方法联合制备IBS大鼠模型。大鼠9周龄时,合谷组和足三里组分别给予电针(EA)干预,隔日1次,共5次。空白对照组及模型对照组不予干预。治疗结束后,按照Bristol大便分类法观察电针前后IBS大鼠的便型,采用腹部回撤反射(AWR)对大鼠进行肠道敏感性及平滑肌收缩强度评估,观察潜伏期、收缩波个数、起始波压力值;采用免疫组织化学法检测结肠M_3受体的表达。结果与针前相比,针后合谷组及足三里组大鼠的大便评分显著降低(P0.01)。与空白对照组相比,模型对照组大鼠的大便评分显著增高(P0.01),潜伏期明显缩短(P0.01),收缩波个数明显增多(P0.01),起始波压力值明显降低(P0.01),结肠内M_3受体免疫反应物阳性表达水平明显增强(P0.01);合谷组结肠内M_3受体免疫反应物阳性表达水平增强(P0.05)。与模型对照组相比,合谷组和足三里组大鼠针后的大便评分均显著降低(P0.01),潜伏期均明显延长(P0.01),合谷组和足三里组收缩波个数明显减少(P0.01,P0.05),起始波压力值均明显增高(P0.01),结肠内M_3受体免疫反应物阳性表达水平明显下降(P0.01)。与合谷组相比,足三里组大鼠的大便评分降低(P0.05),起始波压力值显著降低(P0.01),结肠内M_3受体免疫反应物阳性表达水平下降(P0.05)。结论电针"合谷""足三里"穴均可抑制IBS模型大鼠肠道收缩,改善肠道敏感性,缓解IBS症状。但"合谷"穴缓解腹痛效果更佳,而"足三里"穴减轻腹泻作用更强。说明电针不同穴性及不同神经节段支配的穴位对IBS疗效具有经穴效应特异性。     

Responsiveness and Minimal Clinically Important Differences after Cholecystectomy: GIQLI Versus SF-36

Introduction  To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life (GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic hospitals. Patients and Methods  All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation was used to derive 95% confidence intervals for differences in the responsiveness estimates. Results and Discussion  Mean changes in all GIQLI and the SF-36 subscales were statistically significant (p < 0.05). Comparisons of effect size (ES), standardized response means (SRM), and relative efficiency (>1) indicated that the responsiveness of the GIQLI was superior to that of the SF-36. In the equivalence test, all lower or upper confidence limits presented no equivalence (>5), indicating good MCID. The ES and SRM for emotions and physical function in the GIQLI significantly differed from those of the SF-36 (p < 0.05). Conclusion  The data in this study indicate that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes.     

Comparison of the responsiveness of the SF-36 and WOMAC in patients undergoing total hip arthroplasty

This study examines the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) in patients undergoing total hip arthroplasty. Eighty-nine patients completed the WOMAC and SF-36 preoperatively and postoperatively. Standardized response means (SRMs) and effect sizes (ES) were used to measure responsiveness. Mean follow-up was 17 months. The SRMs for the WOMAC ranged from -0.93 to -1.49, and the ES ranged from -1.02 to -1.53. The SRMs for the SF-36 ranged from 0.22 to 1.64, and the ES ranged from 0.20 to 1.97. The highest values occurred with the physical functioning, bodily pain, and Physical Component Summary Scales. This study demonstrates a similar level of responsiveness of the WOMAC and several components of the SF-36. This suggests that the isolated use of the SF-36 may be adequate to monitor outcomes after total hip arthroplasty. There may still be a role for the WOMAC when comparing outcomes of specific designs or techniques of total hip arthroplasty.     

电针足三里穴对兔肺缺血再灌注损伤的影响

目的探讨电针足三里穴对兔肺缺血再灌注损伤的影响及其机制。方法健康成年雄性新西兰家兔28只,体重1．7～2．3kg,随机分为4组,每组7只,假手术组（A组）：左侧开胸游离支气管和肺动脉、肺静脉后机械通气180min；缺血再灌注组（B组）：左侧开胸游离支气管和肺动脉、肺静脉后阻断左肺门60min后,开放左肺门行机械通气120min；非穴位＋缺血再灌注组（C组）：阻断左肺门60min后,开放左肺门行机械通气即刻电针双侧足三里穴旁5mm处30min,继续机械通气90min；足三里穴＋缺血再灌注组（D组）：阻断左肺门60min后,开放左肺门机械通气即刻电针双侧足三里穴30 min,继续机械通气90min。记录各组缺血30、60min、再灌注30、45、60、90、120min时平均动脉压（MAP）和心率（HR）,颈动脉抽血,行动脉血气分析,抽血后立即处死大鼠,取左肺,测定丙二醛（MDA）和髓过氧化物酶（MPO）水平及肺组织湿/干重比（W/D）。结果各组HR差异无统计学意义（P＞0．05）；与A组比较,C组再灌注90、120min MAP降低,B组和C组肺组织MDA和MPO水平、W/D及PaCO2升高,pH值和PaO2降低（P＜0．05或0．01）；与B组比较,C组再灌注期间MAP降低,D组肺组织MDA和MPO水平、W/D及PaCO2降低,pH值和PaO2升高（P＜0．05或0．01）。结论电针足三里穴可明显减轻家兔肺缺血再灌注损伤,其机制可能与降低脂质过氧化反应、抑制中性粒细胞的浸润有关。     

A pilot study of the assessment of the quality of life, functional results, and complications in patients with an ileal neobladder for invasive bladder cancer

OBJECTIVE: To assess the functional results, health-related quality of life (QOL) outcomes, and complications in patients with an ileal neobladder in comparison to those with cutaneous diversion (ileal conduit and cutaneostomy). METHODS: Between September 1992 and February 2003, we consecutively performed an ileal neobladder (the Studer method) in 30 patients and cutaneous diversion in 38 patients. In August 2004, questionnaires were mailed to 54 patients. The questionnaire included the validated health-related quality of life (QOL) questionnaire, SF-36 General Health Survey, and a urinary incontinence questionnaire. We also evaluated the functional results in patients with an ileal neobladder and the postoperative complications in patients with both urinary diversions. RESULTS: The data from 41 patients (21 ileal neobladder procedures and 20 cutaneous diversions) were available for the analysis. No differences in the overall QOL were observed between the two groups. Complete daytime and night-time urinary continence was achieved in the 21 patients (100%) and 13 patients (61.9%), respectively. The mean value of the maximum flow rate was 15 +/- 12 mL/min in the 21 neobladder patients. There were 19 early complications in 18 patients (60.0%) and seven late complications in six patients (20.0%) with an ileal neobladder. However, there were 15 early complications in 14 patients (36.8%) and eight late complications in six patients (15.8%) with cutaneous diversions. CONCLUSION: The findings regarding the health-related QOL and the frequency of complications in the neobladder group and those in the cutaneous diversion group were similar. However, the functional results and the status of urinary continence in the neobladder patients were satisfactory.     

醛固酮瘤CYP11B2基因C-344T位点单核苷酸多态性与其发病关系

目的探讨醛固酮瘤CYP11B2基因启动子区C-344T位点单核苷酸多态性与醛固酮瘤患者发病之间的关系。方法应用RT-PCR检测醛固酮瘤（醛固酮瘤肿瘤组织标本34例,醛固酮瘤肿瘤病理切片标本44例）和正常肾上腺组织（13例）中SF-1基因的mRNA表达水平,PCR-RFLP技术检测醛固酮瘤CYP11B2基因C-344T位点基因型。结果在醛固酮瘤中SF-1基因的表达与正常肾上腺组织的无明显差别（P=0.919）,醛固酮瘤病例中CYP11B2基因启动子区C-344T位点C等位点频率明显高于正常人,差异有统计学意义（χ2=6.876,P=0.009）。结论醛固酮瘤CYP11B2基因启动区C-344T位点中C等位点与类固醇合成因子结合率高于T等位点,C等位点与醛固酮瘤患者高醛固酮血症有关。     

心理疏导联合健康宣教对高位复杂肛瘘术后患者换药时切口疼痛的效果评价

目的：探讨心理疏导联合健康宣教对高位复杂肛瘘术后患者换药时切口疼痛的效果。方法将77例行肛肠外科手术治疗的高位复杂性肛瘘患者根据其术后护理方法分为对照组（n＝38）与观察组（n＝39）。对照组采用常规护理,观察组在此基础上采用心理疏导联合健康宣教。比较2组患者换药时及换药后10 min视觉模拟评分（ VAS评分）、健康教育达标率及护理工作满意度、换药后生活自理能力。结果（1）2组患者换药后10 min VAS评分与换药时比较差异有统计学意义（P＜0．05）,且从术后第2天开始,观察组患者换药后10 min VAS评分均显著小于对照组患者换药后10 min VAS评分,差异有统计学意义（P＜0．05）;（2）观察组患者健康教育达标率及护理工作满意度（94．84％,100％）均显著高于对照组（86．84％,89.47％）,差异有统计学意义（P＜0．05）;（3）观察组患者换药后生活自理能力优良率（89．74％）高于对照组（81.58％）,差异有统计学意义（P＜0．05）。结论心理疏导联合健康宣教可有效缓解高位复杂肛瘘术后患者换药时切口疼痛,改善患者生活质量,提高护理满意度及生活自理能力。