天麻钩藤汤加减治疗肝阳上亢型原发性高血压疗效观察及对神经递质节律的影响

目的:观察天麻钩藤汤加减治疗原发性高血压肝阳上亢型患者的临床治疗效果及对神经递质节律影响。方法:选取2017年1月至2018年1月郑州市第六人民医院收治的原发性高血压肝阳上亢型患者100例作为研究对象,将达到病例选择范围的93例患者按照治疗药物不同分为对照组(n=44)和观察组(n=49)。对照组采取西药基础治疗,观察组采用西药基础治疗+天麻钩藤汤加减治疗。疗程结束后,观察2组血压水平、神经递质节律、中医症状积分。结果:1)观察组晨起平均收缩压、24 h平均收缩压、夜间平均收缩压、晨起平均舒张压、夜间平均舒张压、24 h平均舒张压明显低于对照组(P<0.05);2)观察组神经肽Y、神经元特异性烯醇化酶、血管加压素、强啡肽-A显著低于对照组(P<0.05),P物质、脑源性神经营养因子显著高于对照组(P<0.05);3)观察组甘氨酸、γ-氨基丁酸显著低于对照组(P<0.05),天冬氨酸、谷氨酸显著高于对照组(P<0.05);4)观察组治疗后中医症状总积分显著低于对照组(P<0.05)。结论:针对原发性高血压肝阳上亢型患者,在西药治疗基础上,增加天麻钩藤汤加减治疗,能够有效促进患者神经递质节律的恢复,调节血压,同时对降低中医症状积分,值得临床推广应用。     

原发性胆汁性肝硬化合并局灶节段性肾小球硬化一例并文献复习

病例资料 患者,女,50岁.2018 年2 月 15 日患者无明显诱因出现双下肢及颜面水肿,至当地镇医院就诊,多次查尿蛋白均为(2+),遂于2018年2月28日至启东市人民医院就诊,查血肌酐(serum creatinine,Scr)48μmol/L,白蛋白(albumin, Alb)25 g/L,碱性磷酸酶(alka...     

中西医结合治疗原发性痛风性关节炎30例总结

目的:观察中西医结合治疗原发性痛风性关节炎的临床疗效。方法:对照组采用西医常规治疗,治疗组采用中西医结合治疗,主要观察两组治疗前后血尿酸、血肌酐水平以及血清K 、Na 、Cl-、Ca2 水平、体重等指标变化情况。结果:治疗组血尿酸指标的下降程度明显优于对照组(P<0.05);但两组血清K 、Na 、Cl-、Ca2 水平及体重等指标比较无明显改变(均P>0.05);治疗组痛风发作次数也明显少于对照组(P<0.05)。结论:中西医结合治疗本病疗效满意。     

A Prospective Observational Study on Short-Term Functional Outcome of Arthroscopic Anterior Cruciate Ligament Repair of Proximal Tears Using Knotless Single Suture Anchor Technique

PurposeTo assess the clinical outcomes in patients with anterior cruciate ligament (ACL) proximal tears undergoing arthroscopic primary repair with knotless single suture anchor technique.MethodsThe first twenty-two consecutive patients with proximal ACL tears (Sherman types I and II and high-grade partial tears) treated with arthroscopic primary repair with single suture anchor technique were evaluated until 6 months post-operatively. Patients were evaluated with validated functional outcome measures (IKDC and Lysholm scores) and clinical tests for ACL stability.ResultsAt 6-month follow-up, 91% of patients (n = 20) achieved excellent outcome measures for IKDC and Lysholm scores and had complete stability of the ACL to clinical testing. Two patients with poor outcomes at six weeks; one with subjective instability and the other underwent revision surgery represented a failure rate of 9%. The median Lysholm score was 96 (IQ range, 96–100) and median IKDC subjective score was 87.40 (IQ range, 78.20–88.50) at 6-month follow-up. The improvement in Lysholm and IKDC scores over a period of six months post-operatively was statistically significant when compared to preoperative scores (p ≪ 0.0001). Maximum improvement in clinical outcomes is achieved in the first 6 weeks post-surgery with a slower increase thereafter, a time interval which may be considered as a figurative yield point for future work in this field.ConclusionArthroscopic ACL primary repair with knotless single suture anchor technique provides excellent short-term clinical outcomes in a carefully selected subset of patients with proximal ACL tears. More powered and longer duration studies are needed to understand longer term outcomes.Level of EvidenceLevel IV, therapeutic case series.     

Iguratimod in treatment of primary Sjögren’s syndrome concomitant with autoimmune hemolytic anemia: A case report

BACKGROUNDPrimary Sjögren''s syndrome (pSS) concomitant with autoimmune hemolytic anemia (AIHA) but without eye and mouth dryness is exceedingly rare. Iguratimod (IGU) has been widely used in the treatment of pSS. However, there are few reports about the application of IGU in pSS concomitant with AIHA. CASE SUMMARYHere, we present the case of a patient with pSS concomitant with AIHA but without eye and mouth dryness. The patient was initially diagnosed with hyperplastic anemia and AIHA while pSS was missed, and was finally diagnosed with pSS concomitant with AIHA. The patient was treated with IGU along with prednisone and hydroxychloroquine, and her hemoglobin, reticulocytes and IgG returned to normal levels.CONCLUSIONIGU was effective for and well tolerated by our patient with pSS concomitant with AIHA, and may be a promising therapy for the treatment of this disease.     

12例原发性甲状腺鳞状细胞癌的临床及生存分析

目的 探讨原发性甲状腺鳞状细胞癌(PSCCT)的临床特征、生存分析及预后影响因素。方法 回顾性分析12例PSCCT患者的临床表现、甲状腺超声特点、治疗方式、组织病理学特点及预后情况。采用Kaplan-Meier法及Log-rank检验、Cox比例风险回归模型进行生存分析。结果 单因素分析显示,是否合并乳头状癌与甲状腺鳞癌总生存期(OS)相关;多因素分析显示,未合并乳头状癌是OS的危险因素。结论 PSCCT是罕见的甲状腺恶性肿瘤,恶性程度高,病情发展迅速,预后差。临床在诊断PSCCT的同时确定其是否合并乳头状癌,选择恰当的治疗方式是提高患者生存率的关键。     

Frequency and outcomes of primary central sleep apnea in a population-based study

BackgroundPrimary central sleep apnea (PCSA) is believed to be rare and data regarding its prevalence and long-term outcomes are sparse. We used the Rochester Epidemiology Project (REP) resources to identify all Olmsted County, Minnesota, residents with an incident diagnosis of PCSA and their clinical outcomes.MethodsWe searched the REP database for all residents with polysomnography (PSG)-confirmed diagnoses of central sleep apnea (CSA) between 2007 and 2015. From these, we reviewed the PSGs and medical records to find those who had PCSA based upon accepted diagnostic criteria. Data based on detailed review of the medical records, including all clinical notes and tests were recorded for analysis.ResultsOf 650 patients identified with CSA, 25 (3.8%; 23 male) had PCSA, which was severe in most patients (n = 16, 64%). Of those, 23 (92%) patients were prescribed and 18/23 (78.2%) adherent to positive airway pressure therapy. Median duration of follow-up was 4.4 years (IQR:4.2). Four (16%) patients were subsequently diagnosed with cardiac arrhythmias, one (4%) with unstable angina, two (8%) with heart failure, five (20%) with mild cognitive impairment (MCI)/dementia and two (8%) with depression. Six (25%) patients died (median time to death = 5 years; IQR:4.8), three of whom had Lewy body dementia.ConclusionsIn this population-based study, PCSA was rare and when present, was severe in a majority of patients. The mortality rate was high. Most frequently observed disorders during follow-up were mild cognitive impairment (MCI)/dementia followed by cardiac arrhythmias; it is possible that these entities were present and not recognized prior to the diagnosis of PCSA.     

Altered sensorimotor cortex noradrenergic function in idiopathic REM sleep behaviour disorder – A PET study

IntroductionNoradrenergic denervation is thought to aggravate motor dysfunction in Parkinson's disease (PD). In a previous PET study with the norepinephrine transporter (NART) ligand ¹¹C-MeNER, we detected reduced NART binding in primary sensorimotor cortex (M1S1) of PD patients. Idiopathic rapid-eye-movement sleep behaviour disorder (iRBD) is a phenotype of prodromal PD. Using ¹¹C-MeNER PET, we investigated whether iRBD patients showed similar NART binding reductions in M1S1 cortex as PD patients. Additionally, we investigated whether ¹¹C-MeNER binding and loss of nigrostriatal dopamine storage capacity measured with ¹⁸F-DOPA PET were correlated.Methods17 iRBD patients, 16 PD patients with (PD^RBD+) and 14 without RBD (PD^RBD−), and 25 control subjects underwent ¹¹C-MeNER PET. iRBD patients also had ¹⁸F-DOPA PET. Volume-of-interest analyses and voxel-level statistical parametric mapping were performed.ResultsPartial-volume corrected ¹¹C-MeNER binding potential (BP^ND) values in M1S1 differed across the groups (P = 0.022) with the iRBD and PD^RBD+ groups showing significant reductions (controls vs. iRBD P = 0.007; control vs. PD^RBD+ P = 0.008). Voxel-wise comparisons confirmed reductions of M1S1 ¹¹C-MeNER binding in PD and iRBD patients. Significant correlation was seen between putaminal ¹⁸F-DOPA uptake and thalamic ¹¹C-MeNER binding in iRBD patients (r² = 0.343, P = 0.013).ConclusionsThis study found altered noradrenergic neurotransmission in the M1S1 cortex of iRBD patients. The observed reduction of M1S1 ¹¹C-MeNER binding in iRBD may represent noradrenergic terminal degeneration or physiological down-regulation of NARTs in this prodromal phenotype of PD. The correlation between thalamic ¹¹C-MeNER binding and putaminal ¹⁸F-DOPA binding suggests that these neurotransmitter systems degenerate in parallel in the iRBD phenotype of prodromal PD.