泪囊黏液囊肿的鼻泪管支架植入治疗观察

目的 评价鼻湘管支架植入术在治疗泪囊黏肿中的应用价值。方法 对21例（21眼）泪囊黏滚囊肿患者行鼻泪管支架植入术，逆行扩张鼻泪道后植入特制的鼻泪管支架，术前术后行数字减影泪道造影检查，分析其疗效。结果 21眼均成功植入鼻泪管支架，手术成功率为100%，术后随访2—43个月，有效率为100%。无严重并发症的发生。结论 鼻泪管支架植入术治疗泪囊黏液囊肿操作简便，具有良好的临床效果，值得推广。     

Impaired white matter microstructure associated with severe depressive symptoms in patients with PD

Brain Imaging and Behavior - Depression is a common occurrence in patients with Parkinson's disease (PD); however, its pathophysiology is still unclear. This study assessed the association...     

A REHABILITATION PROGRAMME FOCUSSING ON PELVIC FLOOR MUSCLE TRAINING FOR PERSISTENT LUMBOPELVIC PAIN AFTER CHILDBIRTH: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo evaluate the effects of a rehabilitation programme for lumbopelvic pain after childbirth.MethodsWomen with lumbopelvic pain 3 months postpartum were included in a randomized controlled trial. Patients in the intervention group (n = 48) received pelvic floor muscle training combined with neuromuscular electrical stimulation of the paraspinal muscles for 12 weeks, while patients in the control group (n = 48) received neuromuscular electrical stimulation for 12 weeks. Outcomes were measured with the Triple Numerical Pain Rating Scale (NPRS), Modified Oswestry Disability Questionnaire (MODQ) and Short-Form Health Survey-36 (SF-36).ResultsThe NPRS score was significantly better in the intervention group at 12 weeks compared with the control group (p = 0.000). The MODQ score was significantly better at 6 and 12 weeks compared with the control group (p = 0.009 and p = 0.015, respectively). The mean value of the Physical Components Summary of the SF-36, was significantly better in the intervention group at 6 weeks (p = 0.000) and 12 weeks (p = 0.000) compared with the control group, but there was no significant improvement in Mental Components Summary of the SF-36.ConclusionA postpartum programme for women with lumbopelvic pain is feasible and improves the physical domain of quality of life.LAY ABSTRACTPostpartum lumbopelvic pain is common, and there are a range of treatments available. The aim of this study was to establish a programme for use in clinical practice, comprising pelvic floor muscle training combined with other traditional treatments. The programme was shown to reduce pain and improve patients’ quality of life. No adverse events occurred.Key words: lumbopelvic pain, biofeedback, myoelectric stimulation, pelvic floor, postpartum women

Lumbopelvic pain refers to self-reported pain in the lower back, sacroiliac joints, or a combination of these locations, among pregnant and postnatal women (1). The pain may radiate into the posterior thigh and is also experienced in conjunction with, or separately from, symphysis pubis pain. Approximately 50% of pregnant women report lumbopelvic pain to some degree (1). Although the majority of women recover within 3 months of delivery, in a substantial number of women the pain persists, with prevalence ranging from 26.5% to 91.0% 2–3 years after delivery (2). Risk factors for such pain include maternal age, parity, body mass index, education, and uncomfortable working conditions (3). Recent studies indicate the importance of hip extensors, pelvic floor muscle (PFM) and transverse abdominal muscle (TrAM) in the development of lumbopelvic pain (4). Moreover, pelvic instability, asymmetry and insufficient compression of the sacroiliac joints contribute to continuous lumbopelvic pain after delivery (5). Studies have demonstrated the importance of choosing an optimal treatment strategy in clinical practice, and 5 subgroups of self-rated pain locations have been identified in the pelvic area (6). This study focused on pelvic girdle pain (PGP), or PGP in combination with lumbar pain, since these groups have been shown to have the highest impact on activity levels and health-related quality of life (6).Stabilization exercises that include dynamically controlling the lumbar segments and pelvic joints have been shown to result in functional improvement in patients with lumbopelvic pain (7). Different treatments have been used, including drugs, specific exercises, shortwave therapy, ultrasound, neuromuscular electrical stimulation, corsets, acupuncture and massage (2). The most frequently used interventions are strengthening exercises for the TrAM, PFM training, and a technique involving manipulation of the lumbar multifidus. Although several studies have shown that correct PFM contractions cause co-contractions of the abdominal muscles (8, 9), to date, studies of exercise programmes for treatment of lumbopelvic pain have shown mixed findings and there is insufficient evidence to guide clinical practice in this area. There was also variability across existing randomized controlled trials (RCTs) in the components of programmes, modes of delivery, follow-up times and outcome measures (3, 4, 7). It is therefore not known whether PFM training works well alone, or in combination with other therapies. There is a strong need for the development of a validated postpartum programme.A common concept in PFM training is the use of standardized exercises or electromyographic activity of the PFM (10). Physical therapists are frequently needed to give instructions on how to contract the PFM correctly at hospital or at home. A new validated myoelectric activation method, using biofeedback registration, was used in the current study (11). This technique can be regarded as an adjuvant electromyography, allowing both patients and physical therapists to observe PFM functioning and assess muscle integrity. This technique has been shown to improve self-reported subjective success and satisfaction in patients with pelvic floor dysfunction (11).The aim of the current study was to investigate whether a rehabilitation programme focusing on biofeedback-assisted PFM training is sufficient as treatment for women with PGP or combined pain postnatally.     

强电脉冲治疗肿瘤提高抗癌药物疗效的研究

报道了用强电脉冲结合抗癌药物环磷酰胺作用于昆明小鼠S-180肉瘤。实验结果表明，电场 药物组的治疗效果最佳，与对照组相比，呈显著差异。同时观察到电场的作用可以抑制肿瘤的微血管形成，这样就减少了对癌细胞的营养供应、降低其新陈代谢，从而抑制了肿瘤的生长。     

利多卡因-表阿霉素-超液化碘油混合乳剂在肝癌TACE相关疼痛管理中的应用

目的探讨利多卡因-表阿霉素-超液化碘油乳剂在缓解TACE术中及术后患者疼痛的有效性及安全性。方法采用前瞻性随机对照的研究方法,共纳入55例患者。运用最小化法动态随机将患者分为A组(n=28)与B组(n=27)。A组在栓塞前通过导管一次性注入利多卡因100 mg,再注入表阿霉素-超液化碘油乳剂,B组在栓塞术中注入利多卡因-表阿霉素-超液化碘油乳剂。两组利多卡因用量均为100 mg。观察并记录患者术中及术后72 h内的疼痛评分(使用视觉疼痛评分量表),比较两组患者的一般情况,术后不良反应及其他止痛药物使用量。计量资料用均数±标准差或中位数(四分位间距)表示,计数资料用百分比表示;两组患者之间计量资料比较使用独立样本t检验或Mann-Whitney U检验,计数资料比较用χ2检验或者Fisher精确检验;以P<0.05为差异有统计学意义。结果两组患者的一般情况、碘油使用总量、TACE手术时长、表阿霉素用量及术后不良反应均无统计学差异(P>0.05)。B组在术中及术后4 h、8 h、24 h的疼痛评分均明显小于A组(P<0.01),而在术前,术后48 h、72 h两组间的疼痛评分差异无统计学意义(P>0.05)。B组患者TACE术后曲马多使用量小于A组患者(P<0.05),两组患者术后哌替啶使用量差异无统计学意义(P>0.05)。结论利多卡因-表阿霉素-超液化碘油乳剂具有延长利多卡因止痛时长的作用,可以在TACE术中和术后有效减轻患者疼痛程度,达到长时间的止痛效果,从而提高患者住院期间生活质量。     

电化学治疗肿瘤研究进展

利用细胞电穿孔结合抗肿瘤药物治疗肿瘤 ,称为肿瘤的电化疗 (Electrochemotherapy ,ECT)。离体肿瘤细胞和活体肿瘤组织电穿孔的最低电场强度分别为 4 5 0～ 6 5 0V/cm和 4 0 0～ 6 0 0V/cm。治疗肿瘤时常用脉冲个数 8个 ,脉冲宽度 10 0 μs,场强 6 0 0～130 0V/cm .,频率 1Hz的电场。已经有 10余种抗肿瘤药物用于电化学治疗肿瘤的研究 ,其中博莱霉素的效果最好 ,其次为顺式铂氨等。电化学治疗肿瘤 ,从体外培养细胞株到体内实体瘤 ,从实验室到临床 ,都已经取得了一些成果。电场参数、电极针的直径、电场磁力线的几何分布、肿瘤的大小、给药方式和药物种类等影响电化学治疗的效果。电化学治疗肿瘤运用于临床治疗还面临着一些问题 ,比如临床药物的选择和剂量、给药方式、对正常组织的影响、治疗机理等。     

电化学治疗昆明小鼠肉瘤及其机理分析

研究了电化学治疗昆明小鼠肉瘤的疗效,并分析其机理。在体外将S-180细胞用不同参数的电场处理,研究适合电化学治疗的电场条件。通过复制肉瘤模型,将肉瘤小鼠随机分成4组:对照组、电疗组、化疗组、电化疗组。研究了不同处理组的肿瘤抑瘤率、治愈率以及小鼠的自由基代谢水平。结果电化疗组的抑瘤率、治愈率都显著高于化疗组和电疗组(P<0.05),电化疗组小鼠受到氧自由基的攻击显著降低,免疫力提高。分析机理发现,电化学治疗肿瘤的机理可能至少涉及细胞膜通透性提高、细胞的耐药性降低、机体的免疫力提高三个方面。     

多层螺旋CT灌注成像评价肺癌的血供特征

目的:运用多层螺旋CT灌注成像技术,研究不同细胞学类型肺癌血供特征。方法:经组织病理学证实的45例肺癌患者,先行常规肺部CT平扫,确定病变部位,而后以6ml/s的速度注射碘浓度为300mg/mL的非离子增强剂50ml,对病变行同层动态扫描。在西门子工作站用Body Perfusion软件中的Lung Cancer子软件处理数据,计算肿瘤的灌注参数。应用方差分析比较不同类型肺癌的灌注值。结果:腺癌灌注起始时间要迟于鳞癌和小细胞未分化癌。鳞癌达峰时间要早于腺癌和小细胞未分化癌。肺癌的其它灌注值在细胞学类型之间没有统计学意义上的差异。结论:肺癌灌注起始时间和灌注达峰时间在肺癌不同病理类型中有差异,它们对判断肺癌的细胞学分型的价值还可能需要更进一步的研究和探讨。其它灌注值在肺癌的细胞学分型没有统计学差别,可能对于肺癌分型的鉴别作用不大。     

直接型颈动脉海绵窦瘘的血管内治疗

探讨血管内治疗对直接型颈动脉海绵窦瘘的价值。材料和方法：38例患者在治疗前均行脑血管造影检查，所有病例均采用经动脉途径，用可脱球囊导管进行栓塞治疗。结果：38例患者中有36例栓塞成功，其中34例患者瘘口完全闭塞。36例患者中有32例于栓塞后保留颈内动脉，4例行颈内动脉球囊闭塞术。术后36例患者的海绵窦综合症均有不同程度的好转。3例患者曾行经静脉途径可脱球囊栓塞治疗，但由于海绵窦内分隔的阻挡作用，球囊不能进入海绵窦及其瘘口附近而告失败。2例患者由于球囊早脱并移位于大脑中动脉分支血管内，导致患者发生失语和一侧肢体偏瘫。结论：血管内可脱球囊栓塞治疗直接型颈脉海绵窦瘘，其瘘口闭塞率高，死亡率低，是直接型颈动脉海绵窦瘘的首选治疗手段。     

Carotid stenosis degree in CT angiography: assessment based on luminal area versus luminal diameter measurements

The aim of this study was to investigate CT angiography (CTA) luminal area measurements in the assessment of carotid artery stenosis compared with the current clinically used criteria based on lumen diameter measurements. Seventy-two vessels in 36 patients were evaluated by CTA and digital subtraction angiography (DSA). Two observers measured area and diameter stenosis degrees using automated 3D CTA analysis software. The ratio of the largest/smallest luminal diameter at the level of maximal stenosis (L/S ratio) was used to describe lumen morphology. Diagnostic agreement between CTA and DSA was calculated. For the assessment of area stenosis, interobserver and intraobserver correlation coefficients were 0.898 and 0.906 (p<0.001). The correlation coefficient between the diameter stenosis and area stenosis was lower in stenoses with extremely noncircular lumen (L/S ratio 1.5) (r=0.797, p<0.001) compared with stenoses with circular lumen (LS ratio <1.2) (r=0.978, p<0.001). Only satisfactory agreement ( 0.54-0.77, p<0.001) was obtained between area stenosis on CTA and diameter stenosis on DSA. Assessment of stenosis degree with area measurements on 3D CTA proved to be reproducible. Area stenosis provides a less-severe estimate of the degree of carotid stenosis but might theoretically express the real hemodynamic significance of the lesion better than diameter stenosis, especially in stenoses with noncircular lumen.