舍曲林联合伐地那非治疗早泄的疗效分析

目的探讨舍曲林联合应用伐地那非治疗早泄的疗效。方法将85例早泄患者随机分为综合组（服用舍曲林和伐地那非）和对照组（服用舍曲林）,以治疗前、治疗2w以及治疗4w后的阴道内射精潜伏期时间（ILET）、患者性生活满意度评分（IIEF）来评价疗效。结果与治疗前相比,两组患者在治疗2w、治疗4w时的ILET和IIEF均提高,但治疗2w和4w相比无显著性差异（P〉0.05）;两组患者相比较,在治疗2w和4w后,综合组患者的ILET和IIEF均比对照组高,差异有统计学意义（P〈0.05）。结论治疗早泄患者,舍曲林联合伐地那非能提高疗效。     

高压氧联合药物治疗脊柱术后谵妄的临床疗效观察

目的:探讨高压氧联合药物治疗脊柱术后谵妄的临床疗效。方法:选取2012年12月至2018年9月入住临沂市中心医院骨科的脊柱术后谵妄患者124例,依据患者或其家属的意愿分为高压氧加药物组和单纯药物组各62例。单纯药物组进行常规药物治疗,高压氧加药物组在常规药物治疗基础上增加高压氧治疗,2组治疗7 d后用简明精神病评定量表和临床总体印象量表评定临床疗效。结果:治疗前高压氧加药物组简明精神病评定量表、临床总体印象量表评分与单纯药物组比较差异无统计学意义( P>0.05)。治疗7 d后高压氧加药物组简明精神病评定量表评分为(20.2±2.7)分,临床总体印象量表评分为(2.05±0.73)分,均明显低于单纯药物组[(29.7±4.7)分、(3.99±1.70)分],差异均有统计学意义( P<0.05)。 结论:高压氧联合药物治疗脊柱术后谵妄能够更好地缓解临床症状,提高患者生活质量。     

早期高压氧联合激素干预预防一氧化碳中毒大鼠迟发性脑病的实验研究

目的 观察早期高压氧联合激素干预对预防一氧化碳中毒大鼠迟发性脑病(DEACMP)发生的影响,探讨DEACMP的发病机制.方法 46只雄性Wistar大鼠按数字表法随机分成4组:健康对照组(NC组)10只,一氧化碳中毒组(COP组)12只,一氧化碳中毒+高压氧组(HBO组)12只,一氧化碳中毒+ HBO+激素组(DEX组)12只.制备急性一氧化碳中毒动物模型,采用Morris水迷宫评估比较大鼠智力状态,以连续2次逃逸潜伏期延长认定为发生DEACMP,以逃逸潜伏期延长后的平均时间与该大鼠治疗期间共19 d的平均逃逸潜伏时间之差(△逃逸潜伏期)判定DEACMP的严重程度.结果 染毒后各组均出现不同程度逃逸潜伏期延长,总体趋势为染毒后第3天出现延长,第11天达高峰,随后逐渐下降;△逃逸潜伏期:DEX组为(1.24±1.54)s,HBO组为(2.26±1.16)s,COP组为(6.93 ±2.86)s,3组比较差异均有统计学意义(P＜0.05);结论 早期HBO联合激素治疗较单纯HBO治疗能更明显地减轻DEACMP病变的严重程度,支持DEACMP发病的自身免疫学说.     

阴茎离断再植一例

患者,男性,31岁。1994年2月3日被割断阴茎,当时立即用毛巾将阴茎及会阴部包住。伤后2h入院。查体:阴茎根部整齐离断,创面严重污染,龟头青紫色。用生理盐水,1‰。新洁尔灭液清洗会阴部及阴茎,分别游离出近端阴茎和离体阴茎的背侧血管和神经,用16号导尿管经尿道进入膀胱,用4-0铬肠线端端缝合尿道粘膜及海绵体,阴茎深动脉未结扎,缝合阴茎海绵体白膜及中隔。在手术显微镜下用8-0尼龙线吻合阴茎背动静脉及神经,血循环重建后龟头转红润,再依次缝合筋膜、皮肤。给予膀胱造瘘后将阴茎固定仰伸位。术后补液、应用抗生素及罂     

卡维地洛的药理学特性和临床治疗意义

卡维地洛是一种无内在拟交感活性的第三代非选择性β受体阻断药，还具有α1受体阻断、抗氧化、抗调亡及钙拮抗性质，有良好的心脏保护作用，在心血管疾病治疗中有广泛的应用前景。     

血红素加氧酶-一氧化碳系统舒张离体大鼠阴茎海绵体平滑肌作用的研究

 目的 探讨血红素加氧酶-一氧化碳(HO-CO)系统对离体大鼠阴茎海绵体平滑肌的舒张效应,并初步探讨其舒张作用的机制.方法 采用离体大鼠阴茎海绵体肌条张力记录法,观察氯高铁血红素(Hemin)诱导的HO-CO系统对去氧肾上腺素(PE)预收缩的阴茎海绵体肌条的舒张作用;采用放射免疫法,观察Hemin诱导的HO-CO系统对离体大鼠阴茎海绵体组织中cGMP和cAMP水平的影响.结果 Hemin对10 μmol/L PE诱导收缩的离体大鼠阴茎海绵体肌条具有浓度依赖性松弛作用,1、3、10、30、100 μmol/L的Hemin对PE诱导收缩的阴茎海绵体肌条的松弛效应分别为(3.2±1.2)%、(10.6±2.2)%、(21.5±2.7)%、(38.0±3.1)%和(66.5±3.8)%(P<0.01);100 μmol/L的Hemin对大鼠阴茎海绵体组织中cGMP和cAMP的水平均无影响.结论 HO-CO系统能有效舒张离体大鼠阴茎海绵体平滑肌,其机制可能与CO- cGMP或CO-cAMP通路无关.     

选择性门静脉栓塞术联合肝动脉化疗栓塞术治疗肝转移癌的对照研究

目的探讨选择性门静脉栓塞术(PVE)联合肝动脉化疗栓塞术(TACE)治疗肝转移癌的疗效和安全性。方法将49例无法或拒绝接受手术切除肝转移癌的患者分为对照组和治疗组。对照组(26例)单纯行TACE,治疗组(23例)在此基础上联合选择性门静脉栓塞术,观察比较2种疗法对患者术后肝功能、肝脏体积、不良反应、并发症及近期疗效和累积生存率的影响。结果①术后6个月治疗组有效率65.2%(15/23)高于对照组30.8%(8/26)(P=0.04);治疗组肿瘤最长径总和由术前(9.92±2.63)cm下降为术后(7.32±2.61)cm,对照组由术前(10.34±3.12)cm下降为术后(9.13±3.42)cm,治疗组优于对照组;治疗组和对照组中位生存时间分别为21个月及13个月,累积生存率比较P<0.05。②肝脏体积变化比较:对照组术后肝脏体积无明显变化;治疗组术前非栓塞叶体积为(481±251)cm3,术后2,4,8周分别为(523±250)cm3,(548±249)cm3,(552±249)cm3,分别比术前增加(10.1±7.6)%,(16.1±10.9)%,(17.2±11.5)%。③术后肝功能:两组患者术后血浆白蛋白水平变化均不明显,治疗组术后第1,3天,ALT、AST、TB等指标较术前明显升高,至术后第7天下降(P>0.05)。两组相比,术后第1天、第3天ALT、AST、TB治疗组高于对照组,第7、14天差异无统计学意义。结论选择性PVE联合TACE能够有效的控制和缩小肝转移癌,改善患者累积生存率,是治疗无法手术切除肝转移癌安全有效的选择,值得进一步研究应用。     

许旺细胞植入去细胞异体神经修复大鼠面神经缺损

目的 观察体外分离、培养的许旺细胞对去细胞异体神经修复面神经长距离缺损的促进作用. 方法 30只大鼠随机分成A组、B组和c组(每组10只),制成而神经缺损12 mm模型,分别以去细胞异体神经联合许旺细胞、去细胞异体神经和自体神经移植修复.术后5个月分别行神经电生理、再生神经形态及数量等检测. 结果 A组神经肌肉动作电位的波幅恢复率(术侧/健侧)为(35.8±2.5)%,潜伏期恢复率(健侧/术侧)为(65.8±2.9)%;神经移植段再生轴突数为(1 570±188)个,髓鞘厚度为(0.383±0.031)μm.A组的各项指标优于B组(P<0.05),与C组差异无统计学意义(P>0.05). 结论 许旺细胞植入去细胞异体神经可促进面神经长距离缺损的修复.     

间歇性阻断腹主动脉联合剖宫产术与常规剖腹产术治疗凶险性前置胎盘并胎盘植入的对照研究

目的 对比分析间歇性阻断腹主动脉联合剖宫产术与常规剖腹产术治疗凶险性前置胎盘并胎盘植入的疗效.方法 搜集2013年1月至2014年7月本院62例前置胎盘合并胎盘植入的患者.32例患者行间隔性阻断腹主动脉联合剖宫产术(联合组),30例患者行常规剖腹产术(对照组).结果 联合组中31例患者和对照组中的23例患者成功进行剖腹产并保留子宫.联合组与对照组相比能有效减少术中出血[(586±355) mlvs (2485±560) ml,P＜0.05],缩短手术时间[(65.5±10.6)min vs(109.4±21.9)min,P＜0.05],减少宫腔填塞序贯子宫动脉栓塞术(2例vs 10例,P＜0.05)及子宫动脉结扎例数(1例vs 6例,P＜0.05),降低子宫切除率(1例vs 7例,P＜0.05),缩短剖宫产术后住院时间[(5.5±2.6)d vs (9.0±3.4)d,P＜0.001].联合组中累计球囊阻断时间为(22.4±7.2) min,胎儿接受射线剂量为(4.2±2.9)mGy.结论 凶险性前置胎盘并胎盘植入患者剖宫产术前行间歇性阻断腹主动脉,术后行子宫动脉栓塞可降低子宫切除风险、子宫动脉结扎/栓塞率,减少剖宫产出血量、缩短手术时间及术后住院时间.     

三维超声对压力性尿失禁妇女的盆底超声分析

目的运用三维超声探究盆底超声检测在压力性尿失禁妇女中的应用。方法选取2015年5月～2017年3月在我院进行盆底超声检查的163例患者,按照是否确诊为压力性尿失禁疾病将其分为观察组和对照组,观察组为有明显压力性尿失禁症状,如腹压增加时尿液会不自主地流出的患者共78例,对照组为无压力性尿失禁的患者共85例,采用盆底超声测量比较两组患者的膀胱颈移动度(Mu)、尿道旋转角(θ)、Valsalva状态下膀胱尿道后角(αs、αr)等超声指标,并研究观察组中Mu、θ、αs、αr与疾病严重度是否有相关性及术前术后Mu、θ、αs、αr指标的变化。结果观察组患者的膀胱颈移动度Mu(1.79±0.24)cm、尿道旋转角θ(29.79±5.13)°和膀胱尿道后角αs(135.71±14.32)°、αr(120.04±11.27)°明显高于对照组的Mu(0.87±0.14)cm、θ(15.36±2.62)°、αs(103.82±8.94)°、αr(92.87±6.29)°,差异具有统计学意义(P0.05);观察组治疗后的Mu(0.76±0.17)cm、θ(16.34±2.72)°、αs(98.65±9.56)°、αr(90.28±7.59)°超声指标明显低于治疗前的Mu(1.24±0.21)cm、θ(29.87±5.37)°、αs(135.13±14.02)°、αr(120.78±11.75)°,差异有统计学意义(P0.05)。结论盆底超声检测膀胱颈移动度、尿道旋转角和膀胱尿道后角等指标对于诊断压力性尿失禁具有重要价值,并为患者术后治疗效果的检验提供理论依据。     

单纯运动或感觉神经损伤在骨骼肌萎缩中的致凋亡作用

目的探讨单纯运动神经或感觉神经损伤在骨骼肌萎缩中的致凋亡作用。方法健康成年SD大鼠30只,随机分为前根切断组(切断左侧L4-L6脊神经前根)、后根切断组(切断左侧L4-L6脊神经后根)和坐骨神经切断组(切断左侧坐骨神经),每组10只。10周后取左右两侧腓肠肌,应用荧光标记、电镜技术以及免疫组化方法观察单纯运动或感觉神经损伤后骨骼肌细胞的凋亡表现及Fas/FasL的表达变化。结果失神经支配10周后,骨骼肌细胞出现各种凋亡变化,细胞核凋亡形态明显,其中后根切断组、前根切断组和坐骨神经切断组的细胞核排列密集程度依次增加,Fas/FasL表达依次增强。电镜观察可见失神经支配的骨骼肌细胞未见典型的凋亡小体,但出现凋亡前期的形态改变。结论运动神经损伤对骨骼肌萎缩的影响大于感觉神经损伤,临床治疗失神经支配的骨骼肌萎缩应优先考虑重建运动神经。     

Percutaneous CT-guided Cryoablation of the Dorsal Penile Nerve for Treatment of Symptomatic Premature Ejaculation

PurposeTo evaluate expansion of image-guided interventional cryoablation techniques usually employed for pain management to address the feasibility, safety, and efficacy of treatment for a urologic condition with otherwise limited treatment options, premature ejaculation (PE).Materials and MethodsProspective institutional review board approval was obtained, and 24 subjects with PE were enrolled. All patients underwent unilateral percutaneous computed tomography–guided cryoablation of the dorsal penile nerve (DPN). Postprocedural intravaginal ejaculatory latency times (IELTs) and PE Profile (PEP) results served as outcome variables. In addition, subjects were asked whether they would have the procedure done again based on their experience at the 180- and 360-day marks.ResultsThe technical success rate was 100%. Baseline average IELT was 54.7 seconds±7.8 (n = 24), which increased to a maximum of 256 seconds±104 (n = 11; P = .241) by day 7 and decreased to 182.5 seconds±87.8 (n = 6; P = .0342) by day 90. The mean IELT remained at 182.5 seconds±27.6 at day 180 (n = 23; P<.0001) and decreased to 140.9 seconds±83.6 by 1 year (n = 22; P<.001). PEP scores improved overall, IELTs significantly improved at 180 and 360 days, and 83% of subjects reported that they would undergo the procedure again if given the same opportunity. There were no procedure-related complications.ConclusionsCT-guided percutaneous unilateral cryoablation of the DPN is a feasible, safe, single-day outpatient procedure for the treatment of symptomatic PE.     

Line scan diffusion spectrum of the denervated rat skeletal muscle

PURPOSE: To detect the earlier changes of the skeletal muscle of rats after peripheral nerve injury by measuring the apparent diffusion coefficient (ADC) on diffusion MR spectroscopy. MATERIALS AND METHODS: The posterior tibial nerve was transected in six rats (nerve transection group) and was only dissected in six rats (control group). At one, three, five, seven, 14, and 28 days after the surgery, both the T2 value and the ADC of gastrocnemius muscle were measured using a line-scan diffusion spectrum on a 1.5T clinical MR imager on both groups. RESULTS: In the nerve transection group, the T2 ratio compared to the contralateral side increased gradually over four weeks after the transection, while the ADC ratio increased right after the surgery and began to decrease at five days. Four weeks after the transection, the ADC ratio returned to normal while the T2 ratio stayed at a high value. The control group indicated an almost constant T2 and ADC ratio during the experimental periods. CONCLUSION: The ADC of the skeletal muscle increased quickly after the transection of the dominant peripheral nerve and was detectable one day after the surgery. Diffusion MRI can be a useful tool for early detection of peripheral nerve injury instead of T2-weighted MRI or electromyography (EMG).     

中枢和周围神经损伤对降钙素基因相关肽含量及骨折愈合的影响

目的 研究骨折合并中枢和周围神经损伤后大鼠的血浆、脊髓前角运动神经元及背根神经节中降钙素基因相关肽(calcitonin gene-related peptide,CGRP)的含量变化及对骨折愈合的影响. 方法 健康成年SD大鼠72只,随机平均分成4组:左侧胫骨骨折组(A组)、左侧坐骨神经损伤+左侧胫骨骨折组(B组)、T9-11脊髓横断+左侧胫骨骨折组(C组)和右侧大脑皮层损伤+左侧胫骨骨折组(D组).每组大鼠于伤后即刻、2 d、1周、2周及4周,放射免疫法测定血清中CGRP含量;于伤后1周、2周及4周对骨折处拍摄x线片,放射免疫法测定脊髓前角运动神经元及背根神经节中CGRP含量;2周取骨折局部骨痂做HE染色. 结果 各组大鼠1周及2周X线片骨折线清晰,4周除B组外,其余各组骨折线消失.2周HE染色显示骨痂量变化:B组少于A组;C组及D组多于A组.各组大鼠在血清中及脊髓前角运动神经元中各时间点CGRP含量变化差异无统计学意义(P>0.05).在脊髓背根神经节中CGRP含量变化:1周时,B组及D组与A组比较,差异无统计学意义(P>0.05),C组低于A组(P<0.01);2周时,B组及D组与A组比较,差异无统计学意义(P>0.05),但D组高于B组(P<0.05),C组高于A组(P<0.01);4周时,与A组比较,其余各组大鼠CGRP含量均升高,其中C组最明显(P<0.01). 结论 骨折合并周围神经损伤后,骨折愈合慢,而骨折合并脊髓损伤及大脑皮层损伤后,骨折愈合快,提示合并中枢损伤能促进骨折愈合,此现象可能与CGRP有一定的相关性.     

New oral cut-off time limits in NSW

Standard collection procedure for the investigation of allegations of penile - oral assault has traditionally been the oral swab. Review of both the literature and NSW forensic laboratory results from oral swabbing has highlighted the sub-optimal nature of this method for the recovery of both sperm and offender DNA.554 oral swabs, collected in NSW from 2010 to 2015, were analysed. Sperm detection occurred in only 4.2%. In the same period there was analysis of 104 oral rinses (of which 16.4% were positive for sperm) and 71 peri-oral samples (of which 18.3% were positive for sperm).As a result, a decision was made to revise forensic collection guidelines for sample collection in cases of penile - oral assault. Oral swabbing is no longer recommended. Current NSW forensic collection guidelines recommend the collection of both an oral rinse and a peri-oral (lip) swab. Samples are to be taken in the first 12 h after a penile - oral assault in all cases where there is a suspicion of oral assault. Oral collections may be extended to 24 h post penile - oral assault in those cases where there is either a clear recollection of ejaculation into the mouth (or ejaculation elsewhere prior to penile penetration of the mouth) or in those cases where a complainant is clear that there had been penile penetration of the mouth but is unable to recall whether or not ejaculation has taken place.     

中西医结合药物治疗的基础上应用运动疗法与单纯应用药物治疗心绞痛的临床疗效对比分析

目的：观察分析中西医结合药物治疗的基础上应用运动疗法与单纯应用药物治疗心绞痛患者的临床疗效情况。方法：将患者随机分为两组,单纯药物治疗组患者采用中西医结合药物进行常规治疗;联合运动治疗组患者在中西医结合药物治疗的基础上应用运动疗法进行治疗。结果：中西医结合药物治疗联合运动疗法的患者经治疗后心绞痛和心电图的疗效情况均明显好于单纯药物治疗组患者;治疗后,联合运动疗法组患者的射血分数及左室短轴缩短率均较单纯药物治疗组患者明显增加（P〈0.05）。结论：中西医结合药物治疗的基础上应用运动疗法对于心绞痛患者的治疗较单纯硬要药物治疗更为有效,可有效改善患者临床症状,安全性高。     

声学定量技术对ARB与ACEI在高血压病治疗中单用与联用优势的评价

目的 应用超声心动图声学定量技术评价血管紧张素Ⅱ受体拮抗剂（ARB）与血管紧张素Ⅱ转换酶抑制剂（ACEI）在原发性高血压病治疗中单独用药与联合用药的疗效.方法 随机选择150例1～3级原发性高血压病患者分为ARB组、ACEI组及ARB-ACEI联合用药组,每组50例,ARB组应用缬沙坦80 mg/d、ACEI组应用雅施达4 mg/d、ARB-ACEI联合用药组应用缬沙坦80 mg/d及雅施达4 mg/d口服治疗,3组疗程均为12个月.观察治疗前、治疗后患者血压及症状体征的变化情况、声学定量技术评价心脏形态学、室壁运动状态及心脏整体功能变化情况.结果 （1）3组用药方式均在治疗2 w后血压开始下降,5 w后趋于平稳.（2）3组受检者的心脏形态学参数在治疗12个月后均明显降低（P〈0.01）并趋于稳定,左室壁运动状态及心脏整体功能均随之明显改善（P〈0.01）.（3）3组用药方式降压作用均较为明显,但联合用药作用稍优于单独用药（P〈0.05）,ACEI组在逆转左室重构的疗效较ARB稍优（P〈0.05）.结论 （1）ARB及ACEI均能有效逆转原发性高血压病所导致的左室重构,明显改善心脏整体功能,1级及2级高血压可视情况选用单药治疗,而3级高血压可采用联合用药治疗.（2）声学定量技术能够全面、客观地评价心脏结构、室壁运动状态及心脏整体功能情况.     

Clinical usefulness of a dual L/N-type Ca2+ channel blocker, cilnidipine, in patients with chronic heart failure: assessment with 123I-MIBG myocardial scintigraphy

Sympathetic nerve system is activated as a compensatory mechanism in heart failure. However, excessive activation of sympathetic nerve system deteriorates disease state. Sympathetic nerve system can be suppressed with N-type Ca2+ channel blocker. An antihypertensive drug, cilnidipine, is a dual L/N-type Ca2+ channel blocker. We studies usefulness of cilnidipine in treating with chronic heart failure with 123I-MIBG myocardial scintigraphy. We enrolled 24 patients with stable chronic heart failure. Twelve patients were treated with ACE-inhibitors, diuretics and cardiotonics (control group), and the other 12 patients were treated with ACE-inhibitors, diuretics, cardiotonics and cilnidipine (cilnidipine group). We examined blood pressure, heart rate, norepinephrine level, brain natriuretic peptide (BNP) level, cardiothoracic ratio on chest X-ray, ejection fraction of left ventricle on two-dimensional echocardiography, count rate of heart to mediastinum (H/M) and washout rate (WOR) on 123I-MIBG myocardial scintigraphy before and six months after medication. Symptom was improved in 8 patients in the control group and 10 patients in the cilnidipine group after medication. And another parameters were also improved in the both groups after medication. However the degree of change in blood pressure (mmHg) was 21.2 +/- 8.0 in the cilnidipine group and 10.8 +/- 9.1 in the control group, that in heart rate (/min) was 24.1 +/- 6.8 and 16.2 +/- 11.0, that in BNP level (pg/ml) was 65.2 +/- 12.0 and 42.8 +/- 11.1, that in H/M was 0.30 +/- 0.08 and 0.19 +/- 0.09, that in WOR was 19.4 +/- 5.6 and 12.2 +/- 7.0, respectively. And the degree of these changes were larger in the cilnidipine group (p < 0.05). These findings suggested that cilnidipine, a dual L/N-type Ca2+ channel blocker, might be useful in treating with chronic heart failure.     

加巴喷丁联合经皮神经电刺激治疗带状疱疹后遗神经痛临床观察

目的观察加巴喷丁联合经皮神经电刺激治疗带状疱疹后遗神经痛的疗效。方法 40例带状疱疹后遗神经痛患者,随机分成两组,A组（n=20）给予口服加巴喷丁治疗;B组（n=20）服用与A组相同剂量加巴喷丁,同时在其患处给予每日1次经皮神经电刺激治疗,分别观察两组患者治疗前以及治疗后3d,5d,7d,14d,28d的疼痛程度变化,以视觉模拟评分（VAS）评定治疗效果。结果治疗后两组患者VAS评分均明显下降（P〈0.05）,且B组VAS评分明显低于A组（P〈0.05）。结论加巴喷丁联合经皮神经电刺激是治疗带状疱疹后遗神经痛的一种有效方法。