益气活血法联合丁苯酞治疗急性脑梗死64例

目的:观察益气活血法联合丁苯酞治疗急性脑梗死的临床疗效,并观察其对血液流变学和炎症因子的影响。方法:将125例患者随机分为治疗组64例和对照组61例。对照组采用丁苯酞治疗,治疗组在对照组的基础上联合益气活血法。两组患者的临床疗效、治疗前后血液流变学、炎症因子水平、神经功能缺损评分及治疗期间不良反应发生情况等。结果:治疗组有效率为90.63%,对照组有效率为77.05%,两组有效率比较,差异具有统计学意义(P0.05);两组患者治疗后血浆黏度、红细胞压积、全血低切黏度、全血高切黏度显著低于治疗前,且治疗组低于对照组,差异均有统计学意义(P0.05);两组患者治疗后血清白介素-6(interleukin-6)、肿瘤坏死因子-α(tumor necrosis factor,TNF-α)水平低于治疗前,且治疗组低于对照组,差异均有统计学意义(P0.05);两组患者治疗后神经功能缺损评分低于治疗前,且治疗组低于对照组,差异均有统计学意义(P0.05);两组均未发生明显不良反应。结论:益气活血法联合丁苯酞治疗急性脑梗死患者临床疗效显著,可能与降低炎症因子和改善血液流变学相关,且安全性良好。     

Cartilage grafting in the knee: where are we now?

Focal cartilage defects in the knee are a common and debilitating pathology. High arthroplasty revision rates in the <55-year-old population continue to make arthroplasty a limited primary surgical option. Advancements in surgical techniques and more robust long-term data on cartilage procedures have increased greatly in the last few years. Results vary and are dependent on matching suitable procedures to lesion and patient type. In this difficult-to-manage group, offering the right procedure to the right patient at the first instance has an important impact on outcomes. In this paper we review the evidence and new guidelines in the management of focal cartilage lesions of the knee.     

关节软骨的损伤与修复：自体移植、基质诱导、内置支架及组织工程化培养

背景：由于缺乏血管和淋巴分布,关节软骨组织的自我修复能力较差。目的：概述自体软骨细胞移植的研究进展,介绍基质诱导自体软骨细胞移植、内置支架、以及应用于软骨损伤修复的组织工程技术;并对自体软骨细胞移植未来的发展方向做出展望。方法：以articular cartilage, transplantation, stem cells, tissue engineering为检索词,检索ISI Web of Knowledge,PubMed数据库(1979/2009-02);以关节软骨、修复、组织工程为检索词,检索CNKI数据库(1979/2009-02)。文献检索语种限制为英文和中文。纳入自体软骨细胞移植、基质诱导的自体软骨细胞移植、内置支架技术和相关组织工程技术的内容。排除关节软骨损伤的医学成像观察、细胞信号转导路径、基因治疗等研究。结果与结论：计算机初检得到824篇文献。根据纳入排除标准,对自体软骨细胞移植、基质诱导自体软骨移植、内置支架及相关的组织工程技术进行分析。自体软骨细胞移植是过去10年中临床修复关节软骨损伤的最佳方案。近年来,传统的软骨细胞移植出现了很多改进和发展,其中基质诱导自体软骨移植、内置支架技术和相关组织工程技术是目前发展得相对成熟的几个方面,但仍然存在一些亟待解决的问题。基质诱导自体软骨移植目前正在逐步取代传统的自体软骨移植,但其长期效果还需要进一步的临床研究和确认。新的内置支架技术和相关组织工程技术也从材料学、细胞生物学及分子遗传生物学的方向,推动了关节软骨损伤修复的发展。     

Rehabilitation following osteochondral injury to the knee

Articular cartilage injuries of the knee can be debilitating if not treated properly. Once an articular cartilage injury is sustained there are a variety of surgical interventions depending on the severity of the injury. The most common of these procedures are: osteochondral autograft transplantation (OATS), autologous chondrocyte implantation (ACI) and microfracture. The rehabilitation outlined in this article is specific to the exact surgical procedure performed and the location in the knee. The outcomes of these procedures are also discussed.     

阿替普酶静脉溶栓治疗急性脑梗死患者的出血情况、临床疗效及不良反应分析

目的分析阿替普酶静脉溶栓治疗急性脑梗死患者的出血情况、临床疗效及不良反应。方法选取2017年10月～2019年10月收治的116例ACI患者为研究对象,随机分为对照组和实验组,每组58例,对照组予临床常规治疗,实验组在对照组基础上予阿替普酶静脉溶栓治疗,对比两组的临床疗效、NIHSS评分、血清炎症因子指标、神经元损伤指标、不良反应。结果实验组的临床总有效率(96.55%)高于对照组(75.86%),差异有统计学意义(P0.05);实验组治疗1周后的NIHSS评分、血清TNF-α、IL-1β、CRP、ET、NSE因子低于对照组,差异有统计学意义(P0.05);实验组治疗1周后的血清SOD因子高于对照组,差异有统计学意义(P0.05);两组患者的不良反应发生率比较,差异无统计学意义(P0.05)。结论阿替普酶静脉溶栓可有效减轻ACI患者神经功能受损程度及炎症反应,且并未增加牙龈出血等出血事件发生率,安全性较高,值得推广和应用。     

Pulsatile GnRH secretion: Roles of G protein-coupled receptors,second messengers and ion channels

The pulsatile secretion of GnRH from normal and immortalized hypothalamic GnRH neurons is highly calcium-dependent and is stimulated by cAMP. It is also influenced by agonist activation of the endogenous GnRH receptor (GnRH-R), which couples to multiple G proteins. This autocrine mechanism could serve as a timer to determine the frequency of pulsatile GnRH release by regulating Ca²⁺- and cAMP-dependent signaling and GnRH neuronal firing. The firing of individual and/or bursts of action potentials (APs) in spontaneously active GnRH neurons is followed by afterhyperpolarization (AHP) that lasts from several milliseconds to several seconds. GnRH-induced activation of GnRH neurons causes a significant increase in medium AHP that is partially sensitive to apamin. GnRH-induced modulation of Ca²⁺ influx and the consequent changes in AHP current suggest that the GnRH receptors expressed in hypothalamic GnRH neurons are important modulators of their neuronal excitability. The coexistence of multiple regulatory mechanisms could provide a high degree of redundancy in the maintenance of this crucial component of the reproductive process. It is also conceivable that this multifactorial system could reflect the gradation from simple to more complex neuroendocrine control systems for regulating hypothalamo-pituitary function and gonadal activity during the evolution of the GnRH pulse generator.     

ACI患者治疗前后血浆ET-1和血清NSE、NPY联检的临床意义

目的:评估了急性脑梗死(ACI)患者治疗前后血浆内皮素-1(ET-1)和血清神经元特异性烯醇化酶(NSE)、神经肽-Y(NPY)水平的变化及临床意义.方法:应用放射免疫分析对32例ACI患者进行了治疗前后血浆ET-1和血清NSE、NPY检测,并与35名正常健康人作比较.结果:在治疗前血浆ET-1和血清NSE、NPY水平...     

中药注射剂治疗急性脑梗死的药物经济学分析

目的：探讨中药注射剂治疗急性脑梗死的有效性和经济性。方法：检索获取不同中药注射剂治疗急性脑梗死的Meta分析文献,按不同治疗方法分为灯盏细辛（A组）、参麦（B组）、苦楪子（C组）、复方丹参（D组）,其中D组为对照组。统计各量效数据,分别以药品成本和总成本分析成本与产出关系。结果：总计急性脑梗死患者2552例,A组与C组比较,两组成本、产出均无明显统计学差异,可判定为相同方案。A/C组、B组和D组的药品成本效果比和总成本效果比计算结果不一致,因药品成本在总成本中所占比例较小,应以总成本计算为准确。同时考虑疗效与期望成本,B组为最佳方案。结论：参麦注射剂为治疗急性脑梗死效优价廉的中药注射剂,临床可结合患者的辨证结果,选择疗效佳、价格合理的方案。     

Residual Impact Performance of ECC Subjected to Sub-High Temperatures

Despite the fact that the mechanical properties of Engineered Cementitious Composites (ECC) after high-temperature exposure are well investigated in the literature, the repeated impact response of ECC is not yet explored. Aiming to evaluate the residual impact response of ECC subjected to sub-high temperatures under repeated drop weight blows, the ACI 544-2R repeated impact test was utilized in this study. Disk impact specimens (150 mm diameter and 64 mm thickness) were prepared from the M45 ECC mixture but using polypropylene fibers, while similar 100 mm cube specimens and 100 × 100 × 400 mm prism specimens were used to evaluate the compressive and flexural strengths. The specimens were all cast, cured, heated, cooled, and tested under the same conditions and at the same age. The specimens were subjected to three temperatures of 100, 200 and 300 °C, while a group of specimens was tested without heating as a reference group. The test results showed that heating to 100 and 200 °C did not affect the impact resistance noticeably, where the retained cracking and failure impact numbers and ductility were higher or slightly lower than those of unheated specimens. On the other hand, exposure to 300 °C led to a serious deterioration in the impact resistance and ductility. The retained failure impact numbers after exposure to 100, 200, and 300 °C were 313, 257, and 45, respectively, while that of the reference specimens was 259. The results also revealed that the impact resistance at this range of temperature showed a degree of dependency on the compressive strength behavior with temperature.     

纤溶酶联合奥扎格雷钠治疗急性脑梗死50例临床分析

目的探讨纤溶酶联合奥扎格雷钠治疗急性脑梗死的临床疗效。方法将我院2009年11月到2010年12月收治的急性脑梗死患者100例随机分为对照组与治疗组,每组50例。对照组采用奥扎格雷钠单独治疗;治疗组给予纤溶酶和奥扎格雷钠联合治疗,1周为一个疗程,两组均治疗两个疗程。治疗前后采用中国卒中量表（CSS）和Barthel指数（BI）评价神经功能、检测血液流变学指标,评定临床疗效和不良反应发生情况。结果疗后,治疗组的神经功能缺损评分低于对照组（P〈0.05）;治疗组的BI评分高于对照组（P〈0.05）;治疗组的各项血液流变学指标均优于对照组（P〈0.05）;治疗组临床有效率为96.0%明显高于对照组的86.0%（P〈0.05）;两组不良反应比较差异无统计学意义（P〉0.05）。结论纤溶酶联合奥扎格雷钠治疗急性脑梗死的临床疗效确切,不良反应小,值得推广应用。