运动康复对脊髓型颈椎病术后患者疗效的影响

目的探讨运动康复对脊髓型颈椎病术后患者疗效的影响。方法309例脊髓型颈椎病术后患者,随机分为常规处理组和运动康复组,随访12个月,采用t3本骨科协会JOA评分标准,通过观察术前、随访时的JOA评分,计算恢复率并评价康复效果。结果运动康复组和常规处理组患者的JOA评分均有改善,两组改善率比较差异有统计学意义（P〈0．05）,运动康复组改善程度较常规护理组患者明显。结论加强运动康复训练有助于促进脊髓型颈椎病术后患者的康复。     

APE1在宫颈癌的表达及其与锎-252中子放疗预后的关系

目的探讨脱嘌呤／脱嘧啶核酸内切酶（APE1）基因在宫颈癌中的表达情况及其与临床病理和锎-252中子放射治疗预后的关系。方法应用免疫组织化学法检测10例正常宫颈组织、15例子宫颈上皮内肿瘤（CIN）组织、89例宫颈癌组织（接受锎-252中子刀放疗）中APE1的表达,并分析其与宫颈癌临床病理及患者预后的关系。结果宫颈癌组织APE1表达水平明显高于正常宫颈组织和CIN病例（P〈0．01）。APE1在正常宫颈组织和CIN病例均呈胞核表达,宫颈癌组织中APE1呈胞核表达（59例）、单纯胞浆表达（8例）或核浆共同表达（22例）。APE1表达强度与宫颈癌FIGO分期、病理分级和淋巴结转移情况有关（P〈0．05）,与年龄和病理分型无关。APE1亚细胞定位情况与FIGO分期、病理分级有关（P〈0．01）,与淋巴结转移情况无关。生存分析显示在APE1核表达组（中位生存时间70．9月）和APE1低表达组（中位生存时间75．8月）的生存时间明显长于APE1浆表达组（中位生存时间57．8月）和APE1高表达组（中位生存时间56．5月）（P=0．025,0．001）。结论APE1胞质异位表达可能与宫颈癌的发生、发展相关,APE1亚细胞定位和表达水平对锎-252中子放射治疗宫颈癌的疗效有提示作用。     

腹腔镜手术治疗59例子宫颈癌患者的近期疗效观察

目的 探讨腹腔镜手术在宫颈癌治疗中的临床价值.方法 将2010年10月～2013年6月行宫颈癌根治术的132例Ⅰ a2～Ⅱa2期的宫颈癌患者分为腹腔镜组和开腹组,比较两组的手术时间、淋巴结切除数、术中出血量、术后病理等指标.结果 59例宫颈癌腹腔镜手术均顺利完成,其术后病理结果、并发症、切除淋巴结数与开腹手术均无明显差异（P＞0.05）,但其手术时间、术后并发症、出血量、术后补充治疗间隔时间较开腹组少（P＜0.05）.结论 腹腔镜下手术治疗子宫颈癌安全可靠.     

ⅡB期宫颈鳞癌不同方案同步放化疗与单纯放疗的疗效及毒副反应比较

目的 比较ⅡB期宫颈鳞癌单纯放疗、单药顺铂（P方案）同步放化疗、顺铂联合多西他赛（TP方案）同步放化疗的疗效及毒副反应.方法 收集收治的ⅡB期宫颈鳞癌患者1 12例,34例选择单纯放疗,78例选择同步放化疗的患者按入院顺序随机分为P方案同步放化疗组（40例）和TP方案同步放化疗组（38例）.3组患者均给予相同的根治性放疗,P方案同步放化疗组在放疗第1、8、15、22、29天给予顺铂40 mg· （m2）-1静脉滴注;TP方案同步放化疗组在放疗第1、22天给予多西他赛75 mg· （m2）-1、顺铂50mg＆#183; （m2）-1静脉滴注.结果 单纯放疗组、P方案同步放化疗组、TP方案同步放化疗组,完全缓解率（CR）分别为82.35％、95.00％、92.11％;3年生存率分别为81.70％、94.60％、83.20％ （P ＜0.05）;3年无病生存率分别为69.10％、86.10％、77.50％ （P＜0.05）.单纯放疗组、P方案同步放化疗组、TP方案同步放化疗组≥3级白细胞下降发生率分别为32.35％、42.50％、52.63％（P＞0.05）;2级恶心、呕吐发生率分别为29.41％、27.50％、55.26％ （P ＜0.05）.结论 ⅡB期宫颈鳞癌同步放化疗与单纯放疗比较,有效率及生存率均有提高趋势,同步放化疗P方案较TP方案更易耐受.     

宫颈糜烂聚焦超声治疗后宫颈VEGF表达及临床指征的变化

目的探讨聚焦超声对糜烂面积、阴道流液时间及创面血管生成的影响。方法选择60例宫颈糜烂患者,随机分为聚焦超声组和微波组2组,观察糜烂面积、阴道流液时间,检测治疗前、治疗后1周、2周、3周、4周宫颈渗液VEGF的浓度。结果两组在糜烂面积均较治疗前减少,但减少幅度分别为（37．18＋17．68）％、（34．72＋11．83）％,组间比较差异无统计学意义（P＞0．05）。超声组VEGF浓度在1周达峰,微波组在2周达峰,分别为（1664±363．5）pg/ml、（1073±378．4）pg／ml;超声组阴道流液时间（13．9±4．2）a,微波组（24．2±6．7）d,差异有统计学意义（P〈0．05;P〈0．01）。结论聚焦超声对中、重度以上的再治疗者单纯评价宫颈糜烂面积的减少并无明显优势,但能缩短阴道流液时间,可能与宫颈局部渗液VEGF浓度达峰时间更早有关。     

艾司洛尔预防颈丛阻滞后心血管副反应的临床观察

目的：观察艾司洛尔对预防颈丛阻滞后心血管反应的效果。方法：60例颈部手术患者,随机分为艾司洛尔组(观察组、n=30),生理盐水组(对照组、n=30),颈丛阻滞药液为1％利多卡因加0．25％布比卡因混合液、总量20ml。两组均以C4一针法行双侧颈浅丛和颈深丛阻滞。观察组颈丛阻滞后即静推艾司洛尔0．5mg／kg,1min静推,对照组颈丛阻滞后即静推生理盐液5ml。结果：观察组明显优于对照组。结论：艾司洛尔能有效地预防颈丛阻滞引起的一过性窦性心动过速和高血压,降低心肌耗氧量和心律失常的发生率。     

辅助抗生素治疗宫颈癌前病变并发幽门螺杆菌感染的疗效观察

①目的探讨辅助抗生素治疗对宫颈癌前病变并发幽门螺杆菌（Hp）感染的治疗效果。②方法采用快速Hp尿素酶检测法筛选宫颈癌前病变的相关病例，用阴道镜和组织病理学进行诊断证实。对各类宫颈癌前病变创伤性治疗的同时，规范采用甲硝唑治疗。观察幽门螺旋杆菌阳性率的改变和临床表现的变化。③结果Hp感染与宫颈癌前病变发展为宫颈癌有相关性；除了手术治疗外，规范的甲硝唑治疗可以降低Hp感染的阳性发生率，同时，可以对宫颈癌起病因学治疗作用。④结论辅助抗生素治疗对宫颈癌前病变并发Hp感染的患者．可以起到消除潜在癌变的诱因和提高疗效的作用。     

葛根素联合西比灵治疗颈性眩晕40例临床分析

目的:总结葛根素联合西比灵治疗颈性眩晕的疗效。方法:对40例颈性眩晕患者应用葛根素注射液静滴联合西比灵口服治疗,与40例应用西比灵口服进行对比观察,对二组病人的临床疗效进行比较。结果:葛根素联合西比灵治疗组总有效率97.5%,西比灵治疗组总有效率82.5%,两组临床疗效对比有统计学意义(P<0.05)。结论:葛根素联合西比灵治疗颈性眩晕,临床疗效比应用西比灵明显提高,且未见明显不良反应。     

Factors associated with Pap smear screening among French women visiting a general practitioner in the Rhône-Alpes region

BackgroundTo help prevent cervical cancer, three yearly opportunistic Pap smear screening is recommended in France for women aged 25–65 years. Pap smear screening coverage varies with age and socioeconomic level. The aim of this cross-sectional study was to identify factors associated with a low uptake of Pap smear screening among women with no limited access to healthcare.MethodsWe analyzed data from women aged 25–65 living in the Rhône-Alpes region who completed a self-administered questionnaire given to them by general practitioners between June and August 2008. The questionnaire covered knowledge about cervical cancer and its prevention as well as the women's history of Pap smear screening and other health-related behaviors. The relationship between low uptake of Pap smear screening – defined as not having had the test within the past 3 years – and a range of possible contributing factors was investigated using logistic regression.ResultsOf 1186 women with an intact uterus who completed the questionnaire, 89.1% said they had had a Pap smear within the past 3 years. On multivariate analysis, the 10.9% who had not were significantly more likely to live alone (1.76 [1.13–2.74]), to have no children (2.17 [1.31–3.62]), to have never used contraception (5.35 [2.98–9.62]), to have less knowledge about Pap smear screening (3.40 [1.55–7.49]), and to be unvaccinated against hepatitis B (0.55 [0.35–0.87]).ConclusionDespite high overall compliance with Pap smear screening recommendations among women who consulted general practitioners, several factors were significantly associated with a low uptake of the service. Considering these factors may help to refine messages aimed at cervical cancer prevention.     

A simulated passive intervertebral motion task: observations of performance in a cross-sectional study

Abstract

Introduction: Passive motion palpation is an integral component in examination, diagnosis or classification, and treatment of persons with mechanical disorders of the cervical spine. If the magnitude of force application during passive movement assessment is associated with greater palpatory accuracy has not been established.

Methods: This investigation used a novel mechanical model as a basis for assessing the palpatory force of students and clinicians. The model included multiple palpable resistance and displacement levels similar to that observed in humans. The ability of the subjects to discriminate the various levels of resistance and displacement offered by the model was concurrently measured.

Results: Large variability occurred in the amount of force applied by the subjects in completing the palpatory examination. The data indicated no major differences in palpatory accuracy across the student and clinician groups with different training and experience levels beyond basic competency. Those subjects applying less force in the palpatory exam demonstrated greater accuracy of palpatory assessment with one measure.

Discussion: The data indicate training and experience had minimal relationship to palpatory interpretation precision beyond the basic level and individual natural discriminatory ability may be a factor in accuracy of palpatory skill. The results demonstrate remarkable inconsistency in palpatory force among examiners and suggest that palpatory accuracy may be related to less force application.