头针配合颈夹脊穴治疗枕神经痛疗效观察

目的 :探讨头针配合颈夹脊穴治疗枕神经痛的临床疗效,为针灸治疗本病提供临床依据。方法 :将63例符合纳入标准的枕神经痛患者随机分为两组,其中试验组31例,采用针刺头部感觉区双侧上2/5、足运感区、率谷、百会及左右神聪,颈部颈2及颈3夹脊穴治疗,每日1次,每次留针30 min,14次为1个疗程,共治疗2个疗程。对照组32例,给予口服卡马西平片治疗。治疗2个疗程后,比较两组治疗前后目测类比评分法(VAS)得分的变化,比较两组的临床疗效。结果:对照组治愈7例,有效15例,无效8例,总有效率为73.33%;试验组治愈20例,有效8例,无效2例,总有效率为93.33%,优于对照组(P0.05)。结论:头针配合颈夹脊穴治疗枕神经痛的临床疗效显著,且优于口服卡马西平片治疗。     

柴胡桂枝汤挥发油的GC-MS分析及对人肺腺癌A549细胞体外增殖的抑制作用研究

目的:研究复方柴胡桂枝汤挥发油的组成成分,并评价其对人肺腺癌A549细胞体外增殖的抑制作用。方法:根据2015年版《中国药典》(四部)通则2204挥发油测定法中甲法提取柴胡桂枝汤中的挥发油。采用气相色谱-质谱联用法(GC-MS)结合Kováts指数分析其挥发油成分,并采用峰面积归一化法计算各成分的相对含量。以不同质量浓度顺铂(4、8、16、32、64 mg/L)为阳性对照,采用MTT法检测不同质量浓度柴胡桂枝汤挥发油(25、50、100、200、400 mg/L)作用48 h后对A549细胞体外增殖的抑制作用;另设阴性对照组(加细胞但不加药物)。结果:从挥发油中共分离出71个成分,鉴定出其中59个成分,其峰面积之和占总峰面积的84.99%。其中,相对含量较高的成分为芳姜黄烯(17.65%)、β-甜没药烯(9.57%)、β-罗勒烯(7.05%)、α-姜黄烯(5.35%)、2,5-二甲基苯甲醛(4.24%)、异丁酸芳樟酯(2.70%)、α-雪松烯(2.48%)、δ-杜松烯(2.07%)。与阴性对照组比较,4~64 mg/L顺铂组和25~400 mg/L柴胡桂枝汤挥发油组细胞的增殖率均显著降低(P<0.05);顺铂和柴胡桂枝汤挥发油对A549细胞体外增殖的半数抑制浓度分别为10.150、73.526 mg/L。结论:柴胡桂枝汤挥发油中主要以芳姜黄烯、β-甜没药烯、β-罗勒烯、α-姜黄烯等成分为主,其对A549细胞的体外增殖具有一定的抑制作用。     

电针太阳穴治疗偏头痛肝阳上亢证的控制发作效应研究

目的：探讨电针与药物治疗偏头痛肝阳上亢证的控制发作效应差异。方法：采用三中心随机对照研究方法，将合格受试者300例随机纳入治疗组（符合方案者146例）和对照组（140例），分别给予电针太阳穴和口服药物（去痛片、麦角胺咖啡因、安定）治疗，观察总体疗效及治疗前后头痛评分、伴随症状、心理及社会适应评分、生活质量评分、中医症状总积分、随访结果的变化。结果：2组控制发作疗效，治疗组临床控制率47．3％，显效率73．3％，有效率90．4％，其临床控制率、显效率优于对照组的效果（临床控制率35．7％，显效率61．4％，有效率85．7％），P〈0．01，其疗效差异主要体现在中度患者身上；2组治疗后中医证候总积分变化，差异有显著性或非常显著性意义（P〈0．05，P〈0．01），但组间头痛评分变化的差异无显著性意义（P〉0．05），而伴随症状评分变化的差异则有非常显著性意义（P〈0．01）；2组远期控制发作效应不甚理想，组间复发率相当（P〉0．05），但治疗组复发患者的头痛程度较治疗前减轻且好于对照组（P〈0．01），头痛频度较治疗前减少且治疗后2月内的情况好于对照组（P〈0．01）；治疗组患者未出现对照组普遍嗜睡、部分患者面色发红的副作用。结论：电针太阳穴治疗偏头痛肝阳上亢证具有明确的控制发作效应，其在改善患者伴随症状、克服药物毒副作用方面较常规西药治疗具有优势。     

Index of microcirculatory resistance in the assessment of coronary microvascular dysfunction in hypertrophic cardiomyopathy

Introduction and objectivesCoronary microvascular dysfunction (CMD) is one of the most important pathophysiological features in hypertrophic cardiomyopathy (HCM). The index of microcirculatory resistance (IMR) is an invasive method to assess the coronary microcirculation. The aim was to assess CMD in patients with HCM by IMR.MethodsAdult patients with HCM without epicardial coronary artery disease underwent cardiac catheterization for the assessment of CMD by IMR (normal cut-off value ≤22.0) and coronary flow reserve (CFR) (normal cut-off value ≥2). Cardiovascular magnetic resonance (CMR) was performed to assess the ischemic burden by perfusion imaging during regadenoson-induced hyperemia, and the extent of myocardial fibrosis was assessed by late gadolinium enhancement (LGE), native T1 mapping and extracellular volume (ECV).ResultsFourteen patients were enrolled with a mean age of 62.8±6.2years, 8 (57.1%) males, of whom 9 (64.3%) had obstructive HCM. Using IMR, CMD was detected in 4 (29%) patients. Among four patients with an IMR>22.0, all had non-obstructive HCM and two had angina. CFR<2 was reported in eight patients (57%). Concordance between IMR and CFR (both normal or both abnormal) was verified in 6 patients (43%). Among four patients with IMR>22.0, perfusion defects were found in two of the three patients who underwent stress CMR. Increased ECV (>28%) was documented in two of the patients with IMR>22 and in three of the patients with IMR≤22.0. LGE was >15% in 2 of the patients with IMR>22 and in 4 with IMR≤22.0.ConclusionsIMR assessment in HCM is feasible and safe. Patients with abnormal IMR seemed to have more significant tissue abnormalities on CMR.     

Acute right atrial and ventricular infarction

Acute coronary syndromes involving the right side of the heart are associated with increased mortality, a complex clinical course, and lengthy hospitalization, as well as with frequent mechanical and electrical complications. It is important that the signs and symptoms associated with the spread of ischemic disease to the right heart chambers are recognized so that the patient can be given appropriate treatment, which can improve short-term and long-term prognosis. The purpose of this review was to summarize key aspects of the diagnosis, prognosis and treatment of this condition.     

Anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral: ¿qué actitud se debe seguir?

Recent years have witnessed a change in our perception of congenital coronary artery anomalies. From being regarded as simple coronary angiographic observations of little clinical significance, they have come to be seen as potential causes of sudden death in young people and of myocardial ischemia in adults. Diagnostic difficulties, a lack of knowledge about the mechanisms through which they produce myocardial ischemia, and their highly variable incidence have made congenital coronary artery anomalies of great interest to cardiologists. This article focuses on the group of coronary artery anomalies that is responsible for most clinical events: anomalies that have their origin in the contralateral sinus of Valsalva. Coronary artery anomalies are defined, their incidence is discussed, diagnostic criteria are given, and finally a treatment algorithm based on current knowledge is proposed.