从胰岛微循环探索“脾气散精”环节对血糖稳态的调节机制

减少血糖波动是目前干预糖尿病和预防并发症的重点,也是中医药在糖尿病治疗中的优势所在。越来越多的研究表明,胰岛微循环障碍是胰岛功能下降进而引发血糖波动的关键病理环节,而胰岛微循环局部肾素-血管紧张素系统(renin-angiotensin system,RAS)的过度激活作为胰岛功能失代偿的使动环节,与胰岛内分泌细胞功能密切相关,是研究胰岛功能的关键靶点。中医学认为糖尿病血糖波动与"脾气散精"障碍密切相关,脾不散"精"(血糖),精滞为浊,浊邪壅塞,是血糖稳态失衡的使动环节,亦为糖尿病全病程的关键病机。通过补益"脾"气以促进"胰"中精微物质的布散能够恢复糖调节激素间的平衡,从而减少血糖波动。目前,"脾气散精"对血糖波动的调节机制尚不明确。作者基于以往的临床和科研工作基础,提出"脾气散精"环节通过促进机体胰岛微循环从而发挥其改善胰岛功能、调节血糖稳态的作用,其机制可能与抑制胰岛微循环局部RAS的激活状态相关。RAS系统在胰岛微循环中各信号通路的相互拮抗关系,与中医理论中脾气散精与固精作用的对立制约关系相类似。因此"脾气散精"环节对血糖波动的调节机制有必要从胰岛微循环RAS整体调控的角度进行深入探索,以此揭示中医药调节机体内环境稳态,减少糖尿病患者血糖波动的科学内涵。     

Right sided spleen laying retro-duodenal: A case report and review of the literature

IntroductionUnlike left sided accessory spleen that are seen in 10–30% of cases at autopsy, cases of right accessory spleens are extremely rare. This congenital body of healthy splenic tissue simulates tumors from neighboring organs and presents a challenge in formulating a differential diagnosis.Presentation of caseWe present the case of a patient whose CT scan of the abdomen showed a large mass, 11 × 8 cm, arising retro-duodenal and lying just anterior to the right kidney. To the best of our knowledge, this is the only case where the accessory spleen was found retro-duodenal, directly anterior to the kidney and completely separate from the supra-renal gland. The chief complaint of the patient was right upper quadrant pain, radiating to the back, and colicky in nature. The patient was diagnosed with duodenal gastro-intestinal stromal tumor and a retro-peritoneal sarcoma. The mass was removed via a Kocher’s incision and immunohistological examination showed that it was a right sided accessory spleen. The patient’s left sided spleen appeared normal.DiscussionEfforts to distinguish an accessory spleen from a retroperitoneal tumor with available scans, percutaneous biopsy or biochemical tests are inconclusive. Differential diagnosis between a retroperitoneal tumor and an accessory spleen can only be made after surgical exploration.ConclusionThis case highlights the fact that surgeons should consider the possibility of an accessory spleen when making a differential diagnosis of retroperitoneal tumors.     

高强度聚焦超声（HIFU）治疗肝癌肝硬化脾功能亢进的疗效观察

目的：观察高强度聚焦超声(HIFU)治疗肝癌肝硬化脾功能亢进的疗效。方法收集我院消化内科的住院患者,收集时间为2011年11月~2013年12月,共计21例,所有研究对象均诊断为由于肝癌肝硬化脾功能亢进,男16例,女5例,平均年龄(54.2±17.5)岁,随机分为A组,B组,C组,分别接受高强度聚焦超声90次、60次、30次。结果研究对象中最多见的不良反应是发热,共计5例,体温(37.6±0.4)℃,4例研究对象在治疗后1天有局部红肿,蜕皮,在皮肤科治疗后症状消失,继续治疗。所有研究对象在治疗间期均无内出血、腹腔积液增多、胸腔积液、周围脏器受损、及血尿现象。我们发现A组接受高强度聚焦超声治疗最多90次,其组在0月、1月、2月、3月时的白细胞、血红蛋白以及血小板最高,肿瘤缩小最大,C组接受高强度聚焦超声治疗最少30次,其组在0月、1月、2月、3月时的白细胞、血红蛋白以及血小板最低,肿瘤缩小最小,差异有统计学意义(P<0.05)。结论随着高强度聚焦超声治疗次数的增加,肝癌肝硬化脾功能亢进患者白细胞、血红蛋白以及血小板恢复的越好,肿块缩小最大。     

去大骨瓣减压颞肌贴敷术治疗大面积脑梗死患者几种护理模式的临床应用效果

目的:对比研究不同护理模式在去大骨瓣减压颞肌贴敷术治疗大面积脑梗死患者临床护理中的应用价值。方法:将襄阳市中心医院收治的120例大面积脑梗死患者随机分为A组、B组、C组,各组40例。A组进行常规护理,B组进行临床护理路径表护理,C组进行循证护理。于3组患者护理干预前后,根据美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分标准评价患者神经功能缺损程度,并根据格拉斯哥预后分级(Glasgow outcome scale,GOS)评价3组患者预后情况。结果:护理3个月、6个月后,C组患者NIHSS评分低于A组、B组(P<0.05),A组、 B组比较,差异无统计学意义(P> 0.0 5)。在预后良好率,A组、 B组、 C组依次为5 0%、6 2.5%、 8 2.5%, C组高于A组、 B组(P <0.0 5), A组、 B组比较,差异无统计学意义(P> 0.0 5)。结论:于大面积脑梗死患者行去大骨瓣减压颞肌贴敷术治疗中行循证护理能有效提高护理效果,改善患者神经功能缺损程度及预后。     

Homozygote C/C at rs12543318 was risk factor for non‐syndromic cleft lip only from Western Han Chinese population

Non‐syndromic cleft lip with or without cleft palate (NSCL/P) is a complex disorder, and it results from both of the genetic modifiers and environmental factors, with genetic modifiers contributes to it more than environmental factors. GWASs made great progress in identifying the candidate genes for NSCL/P, but the findings need to be replicated in other populations. In this study, we selected eleven SNPs from recent GWASs and GWAS meta‐analysis to investigate their associations among 308 NSCL/P trios (134 non‐syndromic cleft lip only (NSCLO) trios and 174 non‐syndromic cleft lip with cleft palate (NSCLP) trios) from Han Chinese population. All SNPs were genotyped using SNPscan method and analyzed the data with FBAT, PLINK, and R package. Allelic TDT analysis showed that allele A at rs12543318 was associated with NSCLO trios (P = .0032, OR = 0.57, 95% CI: 0.39‐0.83), and parent‐of‐origin effect analysis indicated that allele A at rs12543318 was significantly maternally undertransmitted among NSCLO (P = .0046), which implied the potential influence of genomic imprinting; global TDT further confirmed this association. Individual genotypic TDT showed homozygote C/C at rs12543318 was overtransmitted among NSCLO (Z = 3.79, P = .00015) and NSCL/P groups (Z = 3.83, P = .00013), which indicated that it could increase the risk to have cleft babies. Our findings indicated that rs12543318 was associated with NSCLO from Western Han Chinese population, which will give new scientific evidence for later researches in the etiology of NSOCs.     

Staphylococcal scalded skin syndrome: An uncommon symptomatology revealing an immune deficiency

Primary immune deficiencies associated with hyper-IgE syndrome are rare diseases with clinical features dominated by recurring cutaneous and visceral bacterial infections, particularly infections due to Staphylococcus species. Most of these infections are associated with milder inflammation compared to normal. We report a primary immune deficiency associated with a hyper-IgE syndrome revealed by a staphylococcal scalded skin syndrome in a 5-year-old girl. The patient presented with a severe staphylococcal infection with extensive skin lesions and disseminated intravascular coagulation. She received intravenous fluids to compensate for fluid losses and anti-staphylococcal antibiotics. Coagulopathy was also corrected. However, the progression was rapidly fatal.     

双镜联合技术在胃间质瘤治疗中的应用

目的探讨双镜联合（胃镜联合腹腔镜）治疗胃间质瘤的安全性和有效性。方法2010年至2013年间采用双镜联合、单纯胃镜、单纯腹腔镜、传统开腹手术治疗的胃间质瘤患者共107例，比较4种治疗方式的操作时间、术中出血量、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间，以及术后并发症发生和肿瘤复发情况。结果所有病例手术顺利，术后无死亡及治疗相关并发症，随访至今无复发。双镜联合组、单纯胃镜组，单纯腹腔镜组、传统开腹组肿瘤直径分别为（3．7±2．8）em、（2．1±1．2）em、（3．8±2．4）em和（4．2±2．6）em，操作时间分别为（1．8±1．0）h、（0．8±0．5）h、（2．4±1．0）h和（2．5±1．0）h，术中出血量分别为（39．4±42．7）ml、（35．0±37．2）ml、（59．3±54．6）ml和（236，7±332．2）ml，术后胃肠道功能恢复时间分别为（2．6±1．3）d、（0．5±0．1）d、（3．7±1．4）d和（5．3±2．4）d，术后下床活动时间分别为（0．5±0．1）d、（0．4±0．1）d、（0．6±0．2）d和（3．7±0．7）d，术后住院时间分别为（7．1±5．1）d、（2．0±1．8）d、（9．2±3．1）d和（11．5±4．0）d。双镜联合组操作时间、术后胃肠道功能恢复时间显著短于单纯腹腔镜组（P〈0．05），操作时间、术中出血量、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间均显著短于或少于传统开腹组（P〈0．05），肿瘤直径、操作时间、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间明显大于或长于单纯胃镜组（P〈0．05）。结论双镜联合治疗胃间质瘤安全可行，适用范围广，且创伤小、术后恢复快，近期疗效令人满意，其远期疗效仍需进一步随访。     

育胞养膜颗粒联合芬吗通对肾阳虚薄型子宫内膜的影响

目的观察育胞养膜颗粒联合芬吗通对肾阳虚薄型子宫内膜的影响。方法选取2015年6月～2017年6月在我院中医科就诊的肾阳虚薄型子宫内膜不孕患者62例,随机分为研究组与对照组,各31例,研究组芬吗通阴道上药同时口服育胞养膜颗粒,对照组芬吗通阴道上药同时口服阿司匹林。治疗3个月,比较两组子宫内膜厚度、卵泡发育情况、妊娠率和不良反应发生率。结果与各自治疗前比较,治疗后两组子宫内膜厚度均增加,差异有统计学意义(P0.05),两组成熟卵泡平均直径均增加,研究组治疗前后差异显著(P0.05),对照组治疗前后无显著差异(P0.05);治疗后组间比较,研究组子宫内膜厚度、成熟卵泡平均直径均大于对照组(P0.05),研究组宫内妊娠率高于对照组(P0.05)。两组均未发生明显不良反应。结论育胞养膜颗粒联合芬吗通可有效改善子宫内膜厚度和卵泡发育情况,提高妊娠率,疗效优于芬吗通联合阿司匹林。