精制桂枝茯苓胶囊治疗原发性痛经(血瘀证)的随机双盲对照临床试验

目的：评价精制桂枝茯苓胶囊治疗原发性痛经（血瘀证）的安全性、有效性。设计：分层区组随机、双盲单模拟、阳性药平行对照、多中心试验，共入组病例240例，其中对照组120例，试验组120例。试验组：精制桂枝茯苓胶囊1粒＋精制桂枝茯苓胶囊模拟剂2杉次，3次／日，口服。对照组：桂枝茯苓胶囊3籼次，3次／日，口服。从月经前7天开始，服药10天（经期服3天），连续服用3个月经周期，痊愈病例随访1个月经周期。结论：精制桂枝茯苓胶囊治疗原发性痛经（血瘀证）安全、有效。     

抗槲皮素抗体的研制

目的 通过人工抗原的构建,制备针对槲皮互泊特异性抗体。方法 采用混合酸酐法合成的槲皮素卵清蛋白结合物作为包被抗原,将槲皮素与载体蛋白牛血清白蛋白（ＢＳＡ）结合,制成人工抗原,用人工抗原免疫家兔,制备了针对桷皮素的特异性抗体,并用双向琼脂扩散试验和ＥＬＩＳＡ方法对抗体进行了鉴定。ＩＲ,ＵＶ,ＴＬＣ和熔点分析表明,中间体结合物为新的化合物。结果 理想的包被抗原浓度为４００ｎｇ／ｍｌ,相应抗血清工作浓度     

Catecholaminergic, GABAergic, and hippocamposeptal innervation of GABAergic "somatospiny" neurons in the rat lateral septal area

This study deals with the neurochemical characterization of the rat lateral septal area (LSA) somatospiny neurons and their innervation by hippocamposeptal, catecholaminergic, and GABAergic fibers. Electron microscopic single and double immunostaining methods were used to label catecholaminergic fibers and GABAergic cells and boutons. Axon terminals originating in the hippocampus were labeled by acute anterograde axon degeneration induced by fimbria-fornix transection 36 hours before sacrifice. Three types of experiments were performed. The convergent catecholaminergic and hippocamposeptal innervation of LSA somatospiny neurons was studied by combining immunostaining for tyrosine hydroxylase (TH) with fimbria-fornix transection. GABAergic neurons and their hippocamposeptal afferents were identified and characterized in colchicine pretreated animals immunostained for glutamic acid decarboxylase (GAD) combined with fimbria-fornix transection. The third experiment aimed at simultaneously visualizing the relationships between catecholaminergic boutons, hippocamposeptal excitatory amino acid containing axon terminals and GABAergic profiles by double immunostaining for TH (the PAP technique) and GAD (the immunogold method) combined with fimbria-fornix transection. The results are summarized as follows: 1) The same LSA somatospiny neurons receive synaptic inputs from the hippocampus and TH immunoreactive fibers which form pericellular baskets around these cells. 2) LSA somatospiny neurons are GABAergic and are postsynaptic targets of GABAergic boutons with unknown origin and hippocamposeptal axon terminals. 3) The double immunostaining experiment, finally, provided direct evidence that the same GABAergic somatospiny neurons are postsynaptic targets of both catecholaminergic and hippocamposeptal afferents. The synaptic interconnections described in this study provide anatomical basis for a better understanding of the action of catecholamines, excitatory amino acids, and GABA on the activity of LSA neurons.     

肠腔内、 外双套管负压引流在低位直肠癌一期切除 吻合术中的应用

目的 探讨肠腔内、 外双套管负压引流在低位直肠癌一期切除吻合中的可行性与安全性。方法 回顾性 收集 2009 年 1 月—2014 年 12 月期间收治的 650 例低位直肠癌患者资料, 分为对照组 （n=220）、 造口组 （n=205） 和引 流组 （n=225）。对照组采用 Dixon 术 （直肠低位前切除术）; 造口组行 Dixon 术加预防性末端回肠造口术, 二期手术还 纳; 引流组行 Dixon 术, 术中放置肠腔内、 外双套管持续灌洗负压引流。比较 3 组患者手术时间、 术中出血量、 术后排 气时间、 住院费用的差异。术后进行随访, 分析 3 组术后吻合口漏及术后感染等并发症发生情况。结果 3 组手术 时间、 术中出血量以及术后排气时间差异无统计学意义（P > 0.05）; 引流组患者住院时间和住院费用低于造口组 （P＜0.05）。在并发症方面, 3 组患者的吻合口漏发生率、 切口感染、 盆、 腹腔感染、 肺部感染的发生率差异无统计学 意义（P > 0.05）。术后随访结果显示, 3 组患者的复发、 转移及死亡比例差异均无统计学意义（P > 0.05）。结论 肠 腔内、 外双套管负压引流可缩短低位直肠癌患者 Dixon 术后的住院时间, 减轻患者负担, 能否降低术后吻合口漏发生 率需进一步证实。     

关节镜下改良McLaughlin手术与双排锚钉固定治疗肩袖撕裂效果比较

目的:比较关节镜下改良McLaughlin手术与双排锚钉固定治疗肩袖撕裂的疗效。方法:回顾性研究我院自2007年3月至2009年9月间,随访到的采用上述两种修补方法治疗的32例肩袖撕裂患者(33肩)的疗效,其中骨道组17例(17肩),患者采用全关节镜下改良McLaughlin手术;锚钉组15例(16肩),患者采用关节镜下双排锚钉固定治疗。至少随访13个月,平均随访22个月,随访包括并发症、关节活动度、肌力、术后恢复日常生活的时间、恢复运动的时间、达到满意评分的时间、MRI评价术后肩袖愈合情况等,并进行两组手术前后UCLA、VAS评分比较。结果:两组患者手术后恢复日常生活时间、恢复运动时间差别有统计学意义;两组患者术后UCLA、VAS评分均较术前有明显改善,差异有统计学意义(P<0.01);但术后两组评分组间比较无统计学意义(P>0.05)。MRI发现锚钉组再撕裂1例,骨道组无再撕裂,两组差别无统计学意义(P>0.05)。所有病例最终均对手术效果满意。结论:采用关节镜下McLaughlin手术与双排锚钉固定治疗肩袖损伤效果均优良,无统计学差异。前者在术后疼痛消失时间、恢复运动时间方面较后者更快,但两组患者的最后满意度无显著性差异。     

痰脱落细胞涂片结合TCT及痰沉渣琼脂石蜡双包埋切片在肺癌高危人群筛查中的应用

目的 观察痰脱落细胞涂片结合液基薄层细胞学(TCT)、痰沉渣琼脂石蜡双包埋切片(APSM)在肺癌高危人群筛查中的临床效果.方法 选择2014年8月至2016年6月期间在医院及社区搜集符合本研究高危人群定义的287名南海经济开发区居民实施肺癌筛查.肺癌高危人群定义为年龄＞40岁,并且均符合下列任何一项者:每年＞20包香烟的吸烟史;具有肺癌家族史;肺部既往病史包括慢性阻塞性肺病(COPD)、肺结核(Tuberculosis);职业接触史.结果 在287名疑似肺癌患者痰液标本中,自荧光支气管镜(Fluorescent bronchoscopy,FB)技术和手术切除标本病理组织学检查临床医师确诊为肺癌273例(95.12％).痰脱落细胞涂片、TCT及APSM法检测肺癌细胞结果之间比较差异无统计学意义(x2=2.399 5、8.134 9、1.734 0,P＞0.05);TCT+APSM细胞学联合检测肺癌细胞检出阳性率为97.80％,显著高于痰脱落细胞涂片检测的74.36％(x2-62.609 6,P＜0.05).结论 TCT+APSM细胞学联合两种制片的应用在肺癌高危人群筛查中支气管刷检制片、染色等方面,是便于实施质量控制的一项新技术,有效地减少假阴性,并且.减少可疑癌报告例数,显著地提高痰恶性肿瘤细胞的检出率.     

肺结核大咯血急症手术的麻醉处理体会

目的:总结肺结核大咯血急症手术的麻醉处理方法及术中管理经验,以期提高此类手术的麻醉水平.方法:对我院2006年1月至2011年1月收治的92例肺结核大咯血急症手术患者实施麻醉,并详细记录术前准备、麻醉诱导、术中呼吸、循环管理及术后苏醒等经过.结果:本组病例均顺利完成手术,87例患者在手术室拔除气管插管后安返病房;5例患者因呼吸恢复不佳,带管转入ICU.结论:肺结核大咯血的麻醉处理关键是:双腔气管插管的位置准确,加强呼吸道管理,保证健肺通气;维持循环稳定,保持麻醉平稳.     

Medicare Policy Initiatives and the Relative Utilization of “Double-Scan” CT

PurposeCommonly called “double scans” by the media, combined pre- and postcontrast thoracic and abdominal CT examinations have been the focus of recent CMS policy initiatives. The aim of this study was to examine trends in the relative utilization of double-scan CT before and after 2006 legislation mandating relevant Medicare reporting initiatives.MethodsMedicare Physician Supplier Procedure Summary Master Files from 2001 through 2012 were used to identify claims for thoracic and abdominal CT examinations. Double-scan rates by billing physician specialty and place of service were analyzed over time. Rates of double-scan CT between radiologists and nonradiologists were compared using t tests.ResultsFrom 2001 to 2006, double-scan rates for thoracic and abdominal CT examinations declined by 1.7% and 7.5% for radiologists, respectively (from 6.0% to 5.9% and from 22.6% to 20.9%) but increased by 15.8% and 23.6% for nonradiologists (from 5.7% to 6.6% and from 28.8% to 35.6%). From 2006 through 2012, double-scan rates declined by 42.3% and 35.2% (from 5.9% to 3.4% and from 20.9% to 13.5%) for radiologists but only by 31.8% and 8.1% (from 6.6% to 4.5% and from 35.6% to 32.7%) for nonradiologists. Double-scan rates were significantly lower for radiologists than nonradiologists for all years for abdominal CT (P < .001) and for all years after 2006 legislation for thoracic CT (P < .05).ConclusionsReductions in thoracic and abdominal CT double-scan rates followed legislation mandating CMS initiatives designed to reduce costs and radiation. For nonradiologists, double-scan rates were consistently higher and declined more slowly than those for radiologists. Medicare policy initiatives directed toward imaging utilization seem to influence behavior differently for radiologists compared with nonradiologists.