个体化健康教育方案对高龄不孕症患者辅助生殖技术中自我管理的影响

目的：探讨个体化健康教育方案对高龄不孕症患者辅助生殖技术中自我管理的影响。方法：选取2018年1月—2020年12月在我科就诊的高龄不孕症患者200例,按随机数字表分为观察组(n=100)和对照组(n=100)。观察组采用个体化健康教育方案,对照组采用常规健康教育。观察并统计分析干预前和干预12周周期自我管理能力中遵医嘱治疗、定期检查、合理饮食、坚持运动及依从性5项评分、自我效能评定量表评分、医学应对问卷面对、回避、屈服评分及焦虑和抑郁负性情绪评分。结果 干预12周后,2组周期自我管理能力遵医嘱治疗、定期检查、合理饮食、坚持运动及依从性5项评分高于干预前(P＜0.05); 且观察组5项评分均高于对照组(P＜0.05)。干预后,2组自我对照效能评定量表评分干预前(P＜0.05),且观察组评分高于对照组(P＜0.05)。干预后,2组医学应对问卷各项维度评分中面对项评分明显高于干预前(P＜0.05),回避、放弃项评分明显低于干预前(P＜0.05),且观察组评分更优于对照组(P＜0.05)。干预后,2组SAS、SDS评分明显低于干预前(P＜0.05),且观察组评分低于对照组(P＜0.05)。结论：采用个体化健康教育方案后可提高对高龄不孕症患者对生殖技术的基本正确,提高自我管理意识和自我效能,从而改善负性情绪,利于高龄不孕症提高妊娠率。     

电针为主治疗腰椎间盘突出所致坐骨神经痛:多中心随机对照试验

目的:筛选以电针为主治疗腰椎间盘突出所致坐骨神经痛的简便优效方案。方法:开展多中心随机对照试验,将198例腰椎间盘突出所致坐骨神经痛患者随机分成电针治疗组(A组)66例、电针联合牵引治疗组(B组)67例、电针联合牵引治疗组(C组)65例。3组均第1~2 w,5次/w,第3~4 w每周治疗3次,第5~6 w每周治疗2次,第12 w随访。比较各组治疗前后腿痛VAS视觉模拟评分(Vas LP)、改良罗兰功能问卷(Roland)、Likert总体恢复自我评价量表的改变。结果:治疗6 w后,3组Vas LP评分、Roland评分均显著降低(均P0.01),Likert总体恢复评分逐渐增高,且在治疗后第12 w疗效更加显著。3组Vas LP评分、Roland评分、Likert总体恢复组间差异均无统计学意义(均P0.05)。结论:三种治疗方案对腰椎间盘突出所致坐骨神经痛均有减轻患腿疼痛、增强患腿运动功能、促进总体恢复的疗效,且三者疗效相当,并未随着疗法的增加出现明显的疗效叠加效应。     

Difficult removal of fully covered Self Expandable Metal Stents (SEMS) for benign biliary strictures: The “SEMS in SEMS” technique

BackgroundRemoval of biliary Fully Covered Self Expandable Metal Stents can fail due to stent migration and/or hyperplastic ingrowth/overgrowth.MethodsA case series of 5 patients with benign biliary strictures (2 post-cholecystectomy, 2 following liver transplantation and 1 related to chronic pancreatitis) is reported. The biliary stricture was treated by temporary insertion of Fully Covered Self Expandable Metal Stents. Stent removal failed due to proximal stent migration and/or overgrowth. Metal stent removal was attempted a few weeks after the insertion of another Fully Covered Metal Stent into the first one.ResultsThe inner Fully Covered Self Expandable Metal Stent compressed the hyperplastic tissue, leading to the extraction of both the stents in all cases. Two complications were reported as a result of the attempt to stents removal (mild pancreatitis and self-limited haemobilia).ConclusionIn the present series, the “SEMS in SEMS” technique revealed to be effective when difficulties are encountered during Fully Covered Self Expandable Metal Stents removal.     

Opioidergic modulation of ethanol self-administration in the ventral pallidum

Background: Striatopallidal medium spiny neurons have been viewed as a final common path for drug reward and the ventral pallidum as an essential convergent point for hedonic and motivational signaling in the brain. The medium spiny neurons are GABAergic, but they colocalize enkephalin. Purpose of this study was to investigate the role of the opioidergic mechanisms of the ventral pallidum in ethanol self‐administration behavior. Methods: Effects of bilateral microinjections of μ‐, δ‐, and κ‐opioid receptor agonists and antagonists into the ventral pallidum on voluntary ethanol consumption were monitored in alcohol‐preferring Alko Alcohol (AA) rats using the 90‐minute limited access paradigm. Results: Stimulation of μ‐opioid receptors with DAMGO (0.01 to 0.1 μg) or morphine (1 to 10 μg) in the ventral pallidum decreased ethanol intake dose‐dependently. Conversely, blocking μ‐receptors with CTOP (0.3 to 3 μg) increased ethanol intake significantly. Unlike CTOP, DAMGO also increased locomotor activity. Consumption of ethanol was not modified significantly by a broad‐spectrum opioid receptor antagonist naltrexone, by δ‐opioid receptor agonist DPDPE or antagonist naltrindole, or by a κ‐opioid receptor agonist U50,488H or antagonist nor‐BNI. Conclusions: The study provides evidence for μ‐ but not δ‐ or κ‐opioid receptors in the ventral pallidum playing a role in the regulation of voluntary ethanol consumption. Furthermore, present findings give support to earlier work, suggesting an essential role of pallidal opioidergic transmission in drug reward.