实例探究原发性血小板增多症之临床医治方法

目的通过实例探究原发性血小板增多症之临床医治方法。方法对2008年11月至2010年2月期间48例原发性血小板增多症患者的治疗过程进行分析。结果患者发病年龄大多处于40-60岁，一般都有出血症状或血栓的形成，骨髓中巨核细胞过度增殖，α干扰素合并羟基脲进行治疗，有效率达到100％，对患者随访6个月，无1例患者转为急性髓系白血病和骨髓增生异常综合症。结论对于原发性血小板的临床症状在诊治时一定要予以重视，以此避免误诊现象的发生。

前置胎盘产后出血的相关因素及临床诊疗回顾性分析

目的:针对前置胎盘产后出血的高危因素展开研究,分析不同治疗方式的效果,以期采取相应的预防措施及处理方法来有效的降低前置胎盘产妇发生产后出血的风险。方法:选取2015-09~2018-09于我院接受剖宫产且发生产后出血的100例产妇作为病例组,选取同期诊断前置胎盘行剖宫产手术但未发生产后出血的100例产妇为对照组,对比和研究产妇年龄、既往人工流产次数、既往有无剖宫产史、术前有无阴道流血史、前置胎盘类型、胎盘附着位置、有无合并胎盘植入等影响因素的差异,同时将病例组中因胎盘植入发生产后出血的76例产妇随机分成两组,常规组38例产妇给予加强子宫收缩、子宫压迫缝合等方式止血,实验组38例产妇则给予胎盘植入病灶切除联合局部“8”字缝合的术式止血,对比两种治疗方法的止血时间、术中出血量、术后24h出血量的差异。结果:(1)前置胎盘产妇产后出血的导致和影响因素条件:经此次回顾性对比与研究可以看出,前置胎盘发生产后出血与产妇年龄无关,病例组与对照组对比无统计学意义;病例组中有多次人流史、剖宫产史的前置胎盘产妇发生产后出血的比例高于对照组(P<0.05);病例组中中央型前置胎盘产妇发生产后出血的比例高于对照组(P<0.05);病例组中合并胎盘植入的产妇发生产后出血的比例高于对照组(P<0.05);(2)对比两种不同手术方式,可以看出38例实验组产妇术中止血所需要的时间、术中出血量和术后第一天的出血量情况均明显比常规组少(P<0.05)。结论:产妇的年龄对前置胎盘剖宫产发生产后出血的影响较小。多次人流史、剖宫产史、前壁前置胎盘病症、孕期中央型前置胎盘病症、胎盘植入是前置胎盘产妇在接受手术期间发生出血的高危因素;剖宫产史是导致手术期间发生出血的独立高危因素;前壁胎盘合并穿透性植入是前置胎盘产妇术中子宫切除的高危因素。通过对比,胎盘植入病灶切除联合局部“8”字缝合的止血方式优于常规止血方式。

小儿湿疹中医临床治则举要

中医认为,小儿湿疹多是脾虚湿热内生,复感风邪,内外相合,发溢于肌肤所致,结合小儿生理及病理特点,提出"清热凉血,健脾利湿,养血祛风""佐以消食通便,祛风润燥""慎用苦寒燥湿药"的中医治疗原则,增强脾胃转运水湿之功能,标本兼治,减少复发。同时注意:1)饮食宜清淡而易于消化,多饮温水,不宜吃辛辣、煎炸油腻等食物。2)注意多休息。3)防止因搔抓导致皮肤溃烂感染。4)尽量减少外用激素类药物,避免热水刺激患处皮肤,保持皮损部干洁。5)尽量穿棉质衣物,以免刺激小儿皮肤。

口腔正畸医治中微型种植体支抗的稳定和安全性

目的研究口腔正畸医治中微型种植体支抗的稳定与安全性.方法：挑选 80 名自 2015 年 3 月至 2017 年 3 月入院的患者,根据患者进行医治的时间主次及医治方法为标准,将患者等分为试验组与对照组,试验组采用微型种植体支抗医治,对照组采用口外弓加强支抗正畸医治,通过两组的对比效果来检验疗效.结果：试验组患者医治成功率为90.0%,明显高于对照组患者（75.0%）,两组间存在显著性差异（P〈0.05）;试验组患者术后的医治效果均强于对照组,并存在显著性差异（P 〈 0.05）;对照组患者（25%）不良反应症状病发率明显高于试验组患者（5%）,同时存在显著性差异（P〈0.05）.讨论：微型种植体在口腔正畸医治中疗效显著,其稳定性与安全性得到了实践检验,值得进行临床推广.

Increasing the use of biocompatible,glucose-free peritoneal dialysis solutions

A major concern inhibiting some clinicians from embracing peritoneal dialysis(PD) as the preferred first modality of dialysis is the effects of PD solutions on the peritoneal membrane. These anatomical and functional changes predispose to complications like peritonitis,encapsulating peritoneal sclerosis and ultrafiltration failure. In recent years, "biocompatible" and glucosesparing PD regimens have been developed to minimize damage to the peritoneal membrane. Can the use of these more expensive solutions be justified on current evidence? In this review of the literature, we explore how we may individualize the prescription of biocompatible PD fluid.

The expression of TGF-β_1,ADAM12 and HB-EGF in primary hepatic carcinoma

Objective: To detect the expression and location of TGF-β1, ADAM12 and HB-EGF in primary hepatic carcinoma and study their effect on the growth and metastasis of hepatoma carcinoma cell. Methods: TGF-β1, ADAM12 and HB-EGF were detected by RT-PCR and immunohistochemistry in 30 cases of hepatic carcinoma tissues, 30 cases of adjacent carci- noma tissues and 5 cases of normal hepatic tissues. Results: RT-PCR analyses showed that the mRNA expression of TGF-β1, ADAM12 and HB-EGF were markedly increased in each hepatic carcinoma tissue compared with its adjacent tissue (P < 0.01), but no signal was detected in normal hepatic tissue. Immunohistochemistry showed the same outcome on the expression of above three factors in hepatic tissues as RT-PCR. Proteins location analyses showed the proteins of TGF-β1, ADAM12 and HB-EGF all distributed in the stroma of hepatic carcinoma tissues. The positive correlation was found between TGF-β1 and ADAM12 (r = 0.6137, P < 0.05), as well as ADAM12 and HB-EGF (r = 0.5763, P < 0.05). The protein expression of TGF-β1, ADAM12 and HB-EGF were correlated with the size of tumors, degree of differentiation of hepatoma carcinoma cells, portal vein thrombus and the metastasis of absorbent glands, especially with hepatic cirrhosis caused by hepatitis B virus. Conclu- sion: TGF-β1, ADAM12 and HB-EGF possibly play an important role in the process of growth, invasion and metastasis of hepatoma carcinoma cell, meanwhile, the above three factors may collectively participate in the transition from hepatic cirrhosis caused by hepatitis B virus to hepatocellular carcinoma.

Overview on metabolomics in traditional Chinese medicine

Metabolomics has been widely used in the modern research of traditional Chinese medicine （TCM）. At the same time, the world is increasingly concerned about TCM, and many studies have been conducted to investigate different aspects of TCM. Among these studies, metabolomic approach has been implemented to facilitate TCM development. The current methods for TCM research are diverse, including nuclear magnetic resonance, gas chromatography-mass spectrometry, and liquid chromatographymass spectrometry. Using these techniques, some advantageous results have been obtained in the studies of TCM, such as diagnosis and treatment, quality control, and mechanisms of action. It is believed that the further development of metabo-lomic analytical techniques is benefcial to the modernization of TCM. This review summarizes potential applications of metabolomics in the area of TCM. Guidelines for good practice for the application of metabolomics in TCM research are also proposed, and the special role of metabolomics in TCM is highlighted.

Chronic hepatitis C:Treat or wait? Medical decision making in clinical practice

AIM:To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.METHODS:This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α2 a/ribavirin,involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings).A structured questionnaire had to be answered prior to the treatment decision,which included demographic data,information about the personal life situation of the patients,anamnesis and symptomatology of hepatitis C,virological data,laboratory data and data on concomitant diseases.A second part of the study analyzes patients treated with pegylated interferon α2a.All questionnaires included reasons against treatment mentioned by the physician.RESULTS:Overall treatment uptake was 45%.By multivariate analysis,genotype 1/4/5/6,HCV-RNA ≤ 520 000 IU/mL,normal alanine aminotransferase (ALT),platelets ≤ 142 500/μL,age > 56 years,female gender,infection length > 12.5 years,concomitant diseases,human immunodeficiency virus co-infection,liver biopsy not performed,care in private practice,asymptomatic disease,and unemployment were factors associated with reduced treatment rate.Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems.Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.CONCLUSION:Some reasons against treatment were medically based whereas others were related to fears,socio-economical problems,and information deficits both on the side of physicians and patients.

BRIEF INTRODUCTION TO THEORETICAL INTENTION OF "NEEDLING METHOD FOR TRANQUILLIZATION AND CALMING THE MIND" FOR TREATMENT OF INSOMNIA

A set of scientific theories and an effective acupuncture therapy for insomnia about ＂the needling method for tranquillization and calming the mind＂ are gradually formed through many years＇theoretical and clinical studies. In this paper, the theoretical intention about ＂the needling method for tranquillization and calming the mind＂ for treatment of insomnia are briefly introduced mainly from the cause of disease, pathogenesis, therapeutic method and characteristics of composition of a prescription, etc. in order to provide a new train of thoughts and a new method for working out scientific and standard prescriptions in the treatment of insomnia.

ACUPUNCTURE FOR PRI MARY DYSMENORRHEA──A meta-analysis

Recent literature search showed that up to now there are a total of 9 theses abo ut clinical treatment of primary dysmenorrhea with acupuncture therapy, among th em 5 clinical trials are from Chinese journals and the rest 4 from foreign journals. Majority of the tri als have some methodological and/or reporting shortcomings. The frequency and in tensity of dysmenorrhea are divided into intermittent and continuous types. Resu lts of quantitative meta-analysis with Revman 4.1 software showed that the exis t ing evidence supports the value of acupuncture for the treatment of dysmenorrhea . However, the quality of evidence is not fully convincing. There is an urgent n eed for well-planned, large-scale and multiple-center studies to assess the e ffe ctiveness and cost-effectiveness of acupuncture under real-life conditions.

A novel understanding about oxidization of glucose in term of Wuxing TCM theory

Yin-yang theory and Wuxing theory are the core parts of Traditional Chinese Medicine（TCM）. Most of researches on Wuxing theory are based on the paradigm of TCM or Traditional Chinese Culture. It is an evitable challenge to interpret Wuxing theory in the term of biomolecular, biochemistry, stem cell and so on. The oxidation of glucose is the important pathway in cell and there are five basic factors which will be responsible for the undergoing of this reaction. The relationships among these factors are similar to Wuxing theory just like inter-promotion and inter-restraint. So, this understanding on Wuxing theory maybe take some advancement for the modernization of TCM.

Prevalence of left ventricular dyssynchrony in patients with heart failure assessed by a novel programmer-cardioGRAF

Objectives Left ventricular systolic dyssynchrony is the most important determinant of response to cardiac resynchronization therapy （CRT）, playing a vital role to predict improvement of systolic function or LV reverse remodeling. CardioGRAF is a novel programmer based on the ECG gated single photon emission computed tomography （G-SPECT） imaging to detect LV systolic and diastolic dyssynchrony simultaneously. This study was to investigate the prevalence of systolic and diastolic left ventricular （LV） dyssynchrony in patients with heart failure. Methods We retrospectively studied 69 patients with heart disease, including 31 patients who had symptoms of heart failure （NYHA class Ⅱ-Ⅲ）, and 38 patients who had no symptoms of heart failure. （NYHA class Ⅰ）. G- SPECT data were analyzed by cardiaGRAF, and measurements included the time to end systole （TES）, the time to peak ejection （TPE）, the time to peak filling （TPF）, TES＋TPF and maximal difference （MD） of each parameters were obtained, using the 95th percentile of the control group as a cutoffof 150 ms for MD-TES, 139 ms for MD-TPE, 345 ms for MD-TPF and 315 ms for MD-TES＋TPF. Results The prevalence of LV systolic dyssynchrony was significantly higher in heart failure patients with reduced LV ejection fraction （LVEF）〈45% （72% for MD-TES; 64% for MD-TPE） compared with heart failure patients with preserved LVEF=45% （14% for both MD-TES and MD-TPE; P=0.002, P=0.005, respectively）; The prevalence of MD-TES〈150 ms was higher in NYHA class Ⅲ patients （64%） compared with NYHA class Ilpatients （27%, P=0.049）. However, the prevalence of the LV diastolic dyssynchrony were high but not difference between NYHA class III（47% for both MD-TPF and MD-TES＋TPF） and class Ⅲ（63% for MD-TPF; 69% for MD-TES＋TPF; P=NS） patients as well as between patients with preserved LVEF （43% for both MD-TPF and MD-TES＋TPF） and patients with reduced LVEF（64% for MD-TPF; 72% for MD-TES＋TPF; P=NS）. Conclusions The prevalence of LV systolic dyssynchrony was high in heart failure patients with reduced LVEF. Diastolic dyssynchrony was common in patients with heart failure. CardioGRAF maybe a useful method to detect LV dyssynchrony （J Gerlatr Cardio12009; 6：151-156）.

ACUPUNCTURE COMBINED WITH INHALATION OF OXYGEN FOR TREATMENT OF 60 CASES OF EXTENSIVE ANXIETY

Objective: To observe the therapeutic effects and adverse effects of "channel-oxygen therapy" for extensive anxiety. Methods: Sixty cases of extensive anxiety patients were treated with "channel-oxygen therapy" once daily and continuously for 4 weeks. Neiguan(内关PC 6) and Zusanli(足三里ST 36) were needled in combination with nasal inhalation of oxygen, 30 min each session. The therapeutic effects were assessed by Hamilton Anxiety Scale (HAMA) and the adverse effects by Treatment Emergent Symptom Scale (TESS). Results: Of the 60 cases, 35 were cured, 13 improved and 12 were ineffective, with the effective rate being 80.0% and the cured rate 58.3%. No evident adverse effects were found. Conclusion: The "channel-oxygen therapy" is safe and effective for extensive anxiety.

Role of surgery in severe ulcerative colitis in the era of medical rescue therapy

Despite the growing use of medical salvage therapy,colectomy has remained a cornerstone in managing acute severe ulcerative colitis(ASC) both in children and in adults.Colectomy should be regarded as a life saving procedure in ASC,and must be seriously considered in any steroid-refractory patient.However,colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems,including fecal incontinence,pouchitis,irritable pouch syndrome,cuffitis,anastomotic ulcer and stenosis,missed or de-novo Crohn's disease and,in young females,reduced fecundity.This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon.Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine,tacrolimus and infliximab,which seem equally effective in the short term.Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85%-95%.This accuracy is sufficiently high for initiat-ing medical therapy,but usually not colectomy,early in the admission without delaying colectomy if required.This approach has reduced the colectomy rate in ASC from 30%-70% in the past to 10%-20% nowadays,and the mortality rate from over 70% in the 1930s to about 1%.In general,restorative proctocolectomy(ileoanal pouch or ileal pouch-anal anastomosis),especially the J-pouch,is preferred over straight pullthrough(ileo-anal) or ileo-rectal anastomosis,which may still be considered in young females concerned about infertility.Colectomy in the acute severe colitis setting,is usually performed in three steps due to the severity of the inflammation,concurrent steroid treatment and the generally reduced clinical condition.The first surgical step involves colectomy and constructing an ileal stoma,the second-constructing the pouch and the third-closing the stoma.This review focuses on the role of surgical treatment in ulcerative colitis in the era of medical rescue therapy.

THEORETICAL ANALYSIS ON THE AUTOPLOIDY BETWEEN THE TWELVE YUAN (SOURCE) POINTS AND THEIR CORRESPONDING ZANGFU-ORGANS

In the present paper, the authors make a theoretical analysis on the autoploidy between the twelve Yuan （source） points and their corresponding Zangfu-organs from 1 ） historical development, 2） correlation, 3） clinical application, 4） experimental research results about the relationship between Yuan points and the Zangfu-organs, and between meridians and Zangfu-organs, and 5） literature description. The twelve Yuan points have an important role in clinical diagnosis and treatment of diseases, and a close association with the Zangfu-organs.

Radiation Recall Reaction:Two Case Studies Illustrating an Uncommon Phenomenon Secondary to Anti-Cancer Agents

Radiation recall phenomenon is a tissue reaction that develops throughout a previously irradiated area,precipitated by the administration of certain drugs.Radiation recall is uncommon and easily neglected by physicians;hence,this phenomenon is underreported in literature.This manuscript reports two cases of radiation recall.First,a 44-year-old man with nasopharyngeal carcinoma was treated with radiotherapy in 2010 and subsequently developed multi-site bone metastases.A few days after the docetaxel-based chemotherapy,erythema and papules manifested dermatitis,as well as swallowing pain due to pharyngeal mucositis,developed on the head and neck that strictly corresponded to the previously irradiated areas.Second,a 19-year-old man with recurrent nasal NK/T cell lymphoma initially underwent radiotherapy followed by chemotherapy after five weeks.Erythema and edema appeared only at the irradiated skin.Both cases were considered chemotherapeutic agents that incurred radiation recall reactions.Clinicians should be knowledgeable of and pay attention to such rare phenomenon.

EFFECT OF MOXIBUSTION ON CATECHOLAMINE

Objective：To investigate whether moxibustion affects the secretion of catecholamine as adrenalin, noradrenaline and dopamine. Methods： Twenty Wistar rats were allocated to two groups. One was moxibustion-group （10 rats）, and the other was non-moxibustion-group （10 rats）. Four ignited moxa-cones were applied to bilateral “Shenshu” （肾俞 BL 23）. When a moxa-cone burned out, another one was replaced. At the end of each experiment, blood sample （2 mL/rat） was collected from the heart for assaying plasma adrenalin, noradrenaline and dopamine contents with high pressure liquid chromatography. Results： The presented results showed that plasma adrenalin and noradrenaline contents of moxibustion-group are significantly higher than those of non-moxibustion-group （P 〈 0.01）. However, there is no significant difference of dopamine between moxibustion-and non-moxibustion-groups （P 〉 0.05）. Conclusion： These results demonstrated that moxibustion stimulates the secretion of adrenaline and noradrenaline in normal rats.

Analysis of 610 cases inpatients with chronic heart failure

Objective： To analyze the clinical characteristics and medical treatment of hospitalized patients with chronic heartfailure, and provide medication for the patients. Methods： According to medical records of inpatients, demographicinformation, etiology, clinical features and treatment information were collected. Results： A total of 610 cases withheart failure from our hospital between July 2010 and June 2016 were analyzed. The average age of all the patientswas 63. Males accounted for 50.49%. There were 82.7% patients with NYHA functional classification at III-IV.31.3% patients with coronary artery disease, 28.4% with rheumatic heart diseases and 21.8% with expansion ofheart disease. 27.4 percent of the patients with the left ventricular ejection fraction lower than 40%. There were78.9% patients received aldosterone antagonist treatment, 63.4% received ACEI/ARB, 62.1% received digoxin,59.8% received beta blockers, and 75.4% patients received decoction, and 80.8% received Chinese patent medicine.Conclusion： The study has shown that high utilization of traditional Chinese medicine is to highlight theadvantages of the combination of traditional Chinese and western medicine in the treatment of heart failure. Theusage of spironolactone, ACEI/ARB, beta blockers in our hospital was lower than the ratio reported, higher thanthat of the national average. However, the use of diureticis is lower than that of national average, which may relateto the use of damp-clearing herbs. Clinicians should pay attention to the high utilization rate of digoxin. Patientswith the left ventricular ejection fraction 〉 50% accounted for 61.1%, which required more attention should be paidto the diagnosis and treatment of patients with heart failure of the ejection fraction remains.

Development of Intellectual Negative Pressure Aspirator

Along with the development of biomedical ergigineering, negative pressure aspirator is more and more widely applied in clinical treatment and patients rescuing. The study of negative pressure aspi- rator is an important goal pursued in emergency treatment, became it can boost aid success. Given this need, this device based on MXT8051 single-chip is developed. The device can use Pulse Width Modulation （PWM） signal to drive the motor of negative pressure pump and it can adjust the motor＇s speed through the Proportional In- tegral Derivative （PID） algorithm to realize the setting negative pressure rapidly, aoctarately and stably. The control requiroemnt is accomplishedthrough the nmn-machine interface. This device has the advantage of simple operation, low cost and good practicability.