52例针灸结合刺络放血治疗骨性膝关节炎临床观察及护理

[目的]观察针灸结合刺络放血法治疗骨性膝关节炎的临床疗效和护理效果.[方法]对52例骨性膝关节炎病人采用针灸结合刺络放血治疗,并给予活动与功能锻炼指导,将治疗前和治疗20 d后病人疼痛程度、晨僵、肿胀、日常步行活动能力以及疼痛缓解时间进行分级评分比较.[结果]治疗前后各项指标的差异均有统计学意义(P＜0.01).[结论]针灸配合刺络放血法结合活动指导及功能锻炼治疗骨性膝关节炎,能够快速缓解病人关节疼痛、肿胀、晨僵,改善步行能力,从而提高生活质量.     

自制苏芪合剂联合治疗Ⅲ～Ⅳ级IgA肾病的临床疗效观察

目的 探讨自制苏芪合剂对Ⅲ～Ⅳ级IgA肾病患者的疗效及患者T细胞功能的改善.方法 28例Ⅲ～Ⅳ级IgA肾病患者随机分为两组,对照组:醋酸泼尼松-日1mg,kg,隔日晨起顿服,盐酸苯那普利-日10mg;治疗组:在上述用药的基础上加用自制苏芪合剂.8周后,观察患者缓解率、T细胞功能及不良反应.结果 治疗组患者在缓解率、T细胞功能改善等方面优于对照组,且因糖皮质激素的使用而出现的不良反应少于对照组.结论 苏芪合剂联合治疗Ⅲ～Ⅳ级IgA肾病疗效显著并能有效改善T细胞功能.     

慢性肾功能不全患者血管活性物质测定在血液净化中的临床研究

目的 评价血管紧张素Ⅱ、氨甲酰血红蛋白、醛固酮及甲状旁腺激素等在血液净化充分性中的意义。方法 120例慢性肾功能衰竭患者，按采用不同的透析膜分为3组：即聚砜膜、醋酸膜、铜仿膜。用放射免疫法测定其血管紧张素Ⅱ（AngⅡ）及醛固酮（ALD）浓度，化学发光法测甲状旁腺激素（PTH）。采用不同的血流量200ml／min及250ml／min比较。结果 对体内中、小分子物质清除率，聚砜膜〉醋酸膜〉铜仿膜。结论 高血流量、高通透性人工合成聚砜膜，对治疗慢性肾功能衰竭，提高肾功能不全患者的身心健康及生活质量、延长患者生命有很重要的临床意义。     

P17 Pharmacology in the integrated course ＂Basic Medical Sciences＂ in Zhejiang University School of Medicine

According to traditional teaching mode, the courses in preclinical medicine including pharmacology are separately run. This mode causes a series of disadvantages including loose connection between knowledge in different disciplines and weak ability to bridge basic preclinical knowledge and clinical practice. In order to overcome the disadvantages and promote the teaching efficiency, we constructed a new integrated course-Course of Basic Medical Sciences, which includes 6 traditional courses, anatomy, histology and embryology, physiology, pathology, pathophysiology and pharmacology. We integrated these courses based on the human organ systems and according to the principle-＂ From macro to micro, From morphological to functional, From normal to abnormal and From disease to drug therapy＂ and published the series of textbook in 2004. The contents of pharmacology are taught just after pathology and pathophysiology in every organ system. In comparison with the traditional teaching mode, teachers of pharmacology need not spend a lot of time to review preceding knowledge of anatomy and histology, physiology, pathophysiology and pathology. This is helpful in saving time and improving the teaching efficiency.     

综合疗法治疗腰椎间盘突出症40例

目前治疗腰椎间盘突出症主要用椎间的旋转复位法，包括定点旋转复位和侧卧斜扳复位。自2004年8月以来，笔者在临床中遇到部分患者不配合或不能完成旋转复位法，因而采用自创凿击复位法，取得满意效果，现报告如下。     

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND: Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal.OBJECTIVE: To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method.DESIGN: 1:1 paired grouping according to gender and controlled observation.SETTING: Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University.PARTICIPANTS Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items.According to 1:1 paired principle in gender, 90 enrolled patients were assigned into treated group (n=45)and control group (n=45). There were 39 male and 6 female in the treatment group, and they were aged (76±6)years, ranging from 71 to 84 years, and hospitalized at the 14th to 76th hours after onset. There were 39 male and 6 female in the control group, and they were aged (76±6)years , ranging from 70 to 82years, and hospitalized at the 16th to 72th hours after onset.METHODS: Therapeutic method: Patients of treated group received modified hemodilution combined therapy.200 mL whole blood of patients was exchanged with 500 mL dextran-40 (including 20 mL danshen parenteral solution and 32 mg heparin) at the beginning of therapy; From the 2nd day, compound huangqi tea bag (Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid) was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4 ℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton(Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ) and 50 g/L glucose of 500 mL, 75 mg coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference (1995) was used to evaluate the recovery of neurological function effect were observed at the same time.effect of drug.RESULTS: Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died ulation index and platelet aggregation rate: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group: (18.4±1.9),(41.8±2.1), (19.7±1.7)s, Before therapy in treated group: (13.4±1.3), (35.8±1.3), (12.5±0.9)s, After therapy in control group: (16.9±1.5), (39.1±1.1), (11.9±2.1) s, P ＜ 0.05] ;Concentration of fibrinogen (Fbg) after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group: (3.4±0.4) g/L; Before therapy in treated group: (4.3±0.7) g/L;After therapy in control group:(4.0±0.6) g/L; P ＜ 0.05]. Platelet aggregation rate decreased from (37.92of total cholesterol (TC), triacylglycerol(TG) and Iow density lipoprotein cholesterol (LDL-C) of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group: (5.2±0.9), (1.9±0.9), (2.08±1.1) mmol/L, before therapy in treated group:(5.9±1.2), (2.8±0.9), (3.94±0.5) mmol/L, After therapy in control group: (6.0±1.1), (2.6±0.8), (3.84±0.9) mmol/L,after therapy than before therapy [Before therapy: (43.84±4.55)% ;After therapy: (40.48±4.02)% ;P ＜ 0.05].cantly lower than of control group 14 days after therapy. The total effective rate after therapy was signifiadverse effect.CONCLUSION: Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit,increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.BACKGROUND: Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal.OBJECTIVE: To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method.DESIGN: 1:1 paired grouping according to gender and controlled observation.SETTING: Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University.PARTICIPANTS:Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items.According to 1:1 paired principle in gender, 90 enrolled patients were assigned into treated group (n=45)and control group (n=45). There were 39 male and 6 female in the treatment group, and they were aged (76±6)years, ranging from 71 to 84 years, and hospitalized at the 14th to 76th hours after onset. There were 39 male and 6 female in the control group, and they were aged (76±6)years , ranging from 70 to 82years, and hospitalized at the 16th to 72th hours after onset.METHODS: Therapeutic method: Patients of treated group received modified hemodilution combined therapy.200 mL whole blood of patients was exchanged with 500 mL dextran-40 (including 20 mL danshen parenteral solution and 32 mg heparin) at the beginning of therapy; From the 2nd day, compound huangqi tea bag (Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid) was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4 ℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton(Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ) and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index: Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference (1995) was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5th, 7th and 14th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time.MAIN OUTCOME MEASURES: ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug.RESULTS: Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group: (18.4±1.9),(41.8±2.1), (19.7±1.7)s, Before therapy in treated group: (13.4±1.3), (35.8±1.3), (12.5±0.9)s, After therapy in control group: (16.9±1.5), (39.1±1.1), (11.9±2.1) s, P ＜ 0.05] ;Concentration of fibrinogen (Fbg) after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group: (3.4±0.4) g/L; Before therapy in treated group: (4.3±0.7) g/L;After therapy in control group:(4.0±0.6) g/L; P ＜ 0.05]. Platelet aggregation rate decreased from (37.92±0.85)% before therapy to (26.42±1.01)% after therapy (P ＜ 0.01). ②Change of blood lipid level: Levels of total cholesterol (TC), triacylglycerol(TG) and Iow density lipoprotein cholesterol (LDL-C) of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group: (5.2±0.9), (1.9±0.9), (2.08±1.1) mmol/L, before therapy in treated group:(5.9±1.2), (2.8±0.9), (3.94±0.5) mmol/L, After therapy in control group: (6.0±1.1), (2.6±0.8), (3.84±0.9) mmol/L,P ＜ 0.05]. ③ Change of hemorheology index: Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy: (43.84±4.55)% ;After therapy: (40.48±4.02)% ;P ＜ 0.05].④ Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [(90±1.2), (97±2.1) cm/s,P ＜ 0.01]. ⑤ NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group (93%,78%, P ＜ 0.05). ⑥There was no obvious adverse effect.CONCLUSION: Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit,increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.     

GENERAL SURGERY——Breast The effect of HO-1 activated via P38α pathway in the genesis and chemotherapy resistance of breast carcinoma

Objective To investigate the role of p38a pathway and HO-1 in the genesis and chemotherapy resistance of breast cancer. Methods The proliferation and apoptosis of human breast cancer cells were examined by MTT assay. The expression of p38a and HO-1 mRNA were examined by RT-PCR. Results The p38a mRNA level in 78 % of samples was significantly greater than that in the normal tissue and the p38a mRNA level in patients with lymph node metastasis was higher than that without lymph node metastasis （P 〈 0.01 ）. The HO-1 activated with 5 μmol/L pirarubicin increased more in MCF-7/adr cells than in MCF-7 cells, and was completely blocked by p38a inhibitor in MCF-7/ADR but only partially in the MCF-7 cell line.     

脑梗死急性期降压治疗对预后的影响

目的 研究脑梗死急性期降压及在不同时间进行降压治疗对患者近期预后的影响.方法 据发病后是否降压及进行降压的时间,将198例急性脑梗死患者分为6组,观察各组患者神经功能缺损程度及心脑血管事件的再发生率和病死率.结果 在发病后进行降压治疗的患者中其心脑血管事件再发率和病死率明显低于未降压组（P＜0.01） 3d后降压组患者神经功能恢复的程度明显好于未降压组（P＜0.01）.结论 降压治疗可以降低患者心脑血管事件的发生率和病死率3d后进行降压治疗的患者神经功能恢复明显要好.     

血管内皮生长因子与妊娠高血压综合征发病的关系

目的　探讨血管内皮生长因子 (VEGF)在妊娠高血压综合征发病中的作用。方法　分别采用酶联免疫吸附试验检测 40例妊高征孕妇的血清VEGF水平 ,免疫组化检测胎盘及蜕膜组织VEGF及CD3 4表达情况 ,35例正常孕妇作对照。结果　①妊高征组孕妇的外周血VEGF水平及胎盘组织MVD明显低于正常妊娠组 (P <0 0 5 ) ;②两组胎盘绒毛滋养叶细胞和蜕膜组织中均有VEGF阳性表达 ,胎盘组织强阳性表达高于蜕膜。与对照组比较 ,其胎盘组织VEGF强阳性表达的轻度妊高征无显著性差异 ;而中度和重度妊高征与对照组相比 ,则明显降低 ,差异显著 (P <0 0 5 )。各组孕妇蜕膜组织中VEGF的表达强度和差异无显著性。③孕妇外周血VEGF水平与新生儿出生体重 (r =0 2 9,P <0 0 5 )和胎盘重量 (r =0 34,P <0 0 1)均存在直线正相关关系。结论　妊高征患者血清VEGF水平和胎盘组织MVD降低 ,胎盘组织VEGF表达明显下降 ,都可能在妊高征的发病中起一定的作用。     

螺旋CT多功能重建在骨关节外伤中的应用

目的 探讨螺旋cT功能重建在骨与关节外伤中的应用，提高重建技术的使用能力和诊断水平。方法 对使用双层螺旋CT，SSD，MPR，MIP等多种方式重建检查的49例复杂的骨与关节外伤病例进行回顾性分析。结果 49例骨关节外伤重建成像，其中，颅底3例，颌面部7例，颈、胸、腰、骶椎共17例，肩胛骨3例，髋关节8例，膝关节11例。SSD在显示碎骨片明显移位的空间关系方面较MIP，MPR为佳，它可以直观地、立体地、清晰地、多角度显示骨关节损伤，而MIP在显示骨折细节方面较优，尤其在外伤中颅窝观察有关神经孔方面。结论 螺旋CT的SSD，MPR和MIP技术的综合应用，对复杂的骨折、关节损伤的显示效果良好，具有较高的临床应用价值。