天麻钩藤饮合杞菊地黄丸配合西药治疗肾性高血压46例

目的:观察中西医结合治疗肾性高血压的疗效。方法:采用滋补肝肾、柔肝化瘀、清热渗湿方(天麻钩藤饮合杞菊地黄丸加减)配合西药治疗本病46例,并设对照组比较。结果:治疗组疗效明显优于对照组(P<0.05)。结论:中西医结合治疗肾性高血压,临床疗效满意。

中西医结合治疗肾病综合征的临证体会

肾病综合征(简称'肾综')的治疗目前首选药物是肾上腺皮质激素(激素),由于其副作用多,且需长期服用,因此会引起许多不良反应,甚至影响治疗.那么,如何增加激素的疗效,减轻激素的副作用就成为临床上治疗肾病综合征的首要问题.笔者采取分阶段应用中药配合激素治疗成人肾病综合征33例,现报道如下.

普济消毒饮加减治疗流行性腮腺炎68例临床观察

流行性腮腺炎是由腮腺炎时邪（腮腺炎病毒）引起的一种急性传染病，以发热、耳下腮部肿胀疼痛为主要特征，一年四季均可发生，以冬春两季易于流行，多发于3岁以上儿童。我们在临床中以普济消毒饮加减治疗本病效果明显，现总结报道如下。

自拟甜杏白术地黄汤治疗功能性便秘26例

功能性便秘系本虚标实之证，多因肺虚肃降无能、脾虚运化无力、肾虚气化无权，使肠道传化失司，糟粕停滞而致。笔者临床用自拟甜杏白术地黄汤加减治疗该病26例，收效甚好，现报告如下。

正在进行的晚期胰腺癌临床试验

吉西他滨30分钟静脉滴注是晚期胰腺癌的标准治疗方案。为了更好的提高吉西他滨的疗效和改善胰腺癌患者的预后,临床上正在进行各种试验:更改用药方法;与其它化疗药物联合应用或替换为更有效的化合物。本文以互连网上注册的临床试验数据库(www.clinicaltrials.gov)为主要来源,检索了目前美国已注册的、正在进行的有关胰腺癌的临床试验,将其略作整理分类作一综述。

生大黄、水牛角制剂联合卒中单元对急性脑梗死痰热腑实证者神经功能的改善效果

目的:通过与单纯神经内科常规处理的比较,观察黄角颗粒联合卒中单元治疗急性脑梗死痰热腑实证患者的临床疗效。方法:以2001-10/2003-03武汉市中西医结合医院神经内科住院患者为观察对象,根据全国第2次脑血管病学术会议制定的脑梗死诊断标准和1993-10中华人民共和国卫生部制订的《中药新药治疗中风病的临床研究指导原则》选择急性脑梗死,中医辨证属痰热腑实证者。2001-10/2002-03间患者103例作为对照组,2002-10/2003-03间患者120例作为观察组。对照组给予单纯神经内科常规处理,连续21d;观察组在对照组治疗的基础上,口服黄角颗粒(黄角颗粒为自拟方药,由生大黄、水牛角两味中药组成,由武汉市中西医结合医院制剂室提供,批号:021120)10g,3次/d,入院后生命体征稳定后,即对患者进行语言康复、物理康复等治疗,连续21d。采用1995年全国第四届脑血管病学术会议通过的临床疗效评定标准,观察两组治疗前后神经功能缺损程度积分,言语、面瘫、上,下肢肌力功能缺损程度评分各段例数,日常生活活动Barthel指数积分分段例数,临床疗效和呃逆、便秘症状例数。结果:观察组120例和对照组103例患者均进入结果分析,无脱失。①治疗后两组神经功能缺损程度积分比较治疗前均有显著性降低(20.8±5.6,27.2±11.5;24.3±8.2,28.1±13.2;t=5.078,2.482,P<0.01～0.05),且观察组神经功能缺损程度积分显著低于对照组(t=3.577,P<0.01)。②治疗后观察组和对照组面瘫、言语、上肢,下肢肌力等均治疗前有显著改善,其中语言、肌力、面瘫的改善程度观察组均优于对照组(P<0.05)。③治疗后两组间日常生活活动Barthel指数积分分段例数显著多于对照组(χ2=8.71,P<0.01)。④观察组患者基本痊愈率高于对照组,恶化、近期病死率低于对照组,差异有显著性意义(P<0.05)。⑤治疗后观察组和对照组患者呃逆、便秘症状例数经χ2检验,差异有显著性意义(5,10;11,28;χ2=4.77,12.47,P均<0.05)。结论:黄角颗粒联合卒中单元治疗急性脑梗死痰热腑实证患者能明显提高患者的早期日常生活能力,减少神经功能缺损,改善患者脑梗死后便秘、呃逆症状。

舒芬太尼或曲马多复合罗哌卡因在剖宫产术后硬膜外镇痛中的比较观察

【目的】比较观察舒芬太尼或曲马多分别复合罗哌卡因用于剖宫产术后硬膜外自控镇痛（PECA）的效果及对催乳素的影响。【方法】选择120例择期行剖宫产的孕妇，随机分为舒芬太尼组（S组）和曲马多组（T组），术毕行PCEA48h，S组用0．15％罗哌卡因＋0．4μg／mL舒芬太尼，T组用0．15％罗哌卡因＋4mg／mL曲马多。观察记录两组孕妇的总用药量、追加（Bonus）次数、各时段[1h（T1），6h（T2），12h（T3），24h（T4），48h（T5）]视觉模拟评分法（VAS）评分、改良运动阻滞评分（Ramsay）评分、改良Bromage评分、不良反应发生情况及血清催乳素（PRL）浓度变化。【结果】S组总用药量及Bonus次数均小于T组（P〈0．05），T2～T5时点S组VAS评分低于T组（P〈0．05），两组Ramsay评分多在2～3分左右，T3～T5时点S组Ram—say评分高于T组（P〈0．05），两组Bromage评分无统计学差异（P〉0．05），两组均无严重并发症发生，T组恶心、呕吐发生率高于S组（P〈0．05），S组皮肤瘙痒发生率高于T组（P〈0．05），两组术后24h及48h血清催乳素浓度均高于术前（P〈0．05），S组升高更为显著（P〈0．05）。【结论】舒芬太尼或曲马多分别复合罗哌卡因用于剖宫产术后PCEA均安全有效，且不良反应较少，舒芬太尼复合罗哌卡因的镇痛效果优于曲马多，且镇静程度较曲马多深，但皮肤瘙痒发生率较高，而恶心、呕吐发生率较低。

《中国医学文摘·护理学》1999年全年主题词索引

【说明】 1.每篇文献标引一个或多个规范的主题词。 2.为了加强主题词的专指性,采用规范的主题词加以组配。组配符号为“-”。例如心脏病的诊断,标:心脏病-诊断 3.黑体字为主题词,宋体字为副主题词,主题词后面的数字为本卷文摘号。 4.主题词均按汉语拼音顺序排列。同音字按四声区别;同声字按笔画多少排列;第一字相同时,依次按第二。

Sunitinib for Taiwan Residents patients with gastrointestinal stromal tumor after imatinib treatment failure or intolerance

AIM:To report preliminary results of the efficacy and safety of sunitinib in the management of Taiwan Residents gastrointestinal stromal tumors (GIST) patients facing imatinib mesylate (IM) intolerance or failure.METHODS:Between 2001 and May 2010,199 Taiwan Residents patients with metastatic GIST were treated at Chang Gung Memorial Hospital.Among them,23 (11.6%) patients receiving sunitinib were investigated.RESULTS:Sixteen male and 7 female patients with a median age of 59 years (range:24-83 years) received sunitinib.Twenty-two GIST patients changed to sunitinib because of IM failure and 1 because of intolerance.The median duration of sunitinib administration was 6.0 mo (range:2-29 mo).The clinical benefit was 65.2% [2 complete response (CR),4 partial response (PR),and 9 stationary disease (SD);15/23].In 12 patients harboring mutations of the kit gene at exon 11,the clinical benefit rate (CR,PR,and SD) was 75.0% and 6 patients with tumors containing kit exon 9 mutations had a clinical benefit of 50.0% (not significant,P=0.344).The progression free survival (PFS) and overall survival (OS) did not differ between patients whose GISTs had wild type,KIT exon 9,or KIT exon 11 mutations.Hand-foot syndrome was the most common cause of grade Ⅲ adverse effect (26.1%),followed by anemia (17.4%),and neutropenia (13.0%).During the median 7.5-mo follow-up after sunitinib use,the median PFS and OS of these 23 GIST patients after sunitinib treatment were 8.4 and 14.1 mo,respectively.CONCLUSION:Sunitinib appears to be an effective treatment for Taiwan Residents with IM-resistant/intolerant GISTs and induced a sustained clinical benefit in more than 50% of Taiwan Residents advanced GIST patients.

latrogenic brachial artery injury during anterolateral plat- ing of humeral shaft fracture

There are several well defined indications for surgical management of humeral shaft fractures.Operative procedures on the humerus are associated with their own complications.Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously.We report a case of a 48 years old femalewho received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse.CT angiogram showed that there was segmental non-opacification of the brachial artery.There was distal reformation and the thrombosis was decided to be managed conservatively.We believe that the arterial injury was a result ofimproper surgical technique and the segmental block might be due to improper use of plate holding forceps.This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures

Objective： To study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractureS. Methods： The clinical data of 42 cases ofSehatzker IV- VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 re- ceived surgical treatment within 12 h after injury, （Group I）, the other 2 [ were first treated by traction or piaster fixation followed by a delayed internal fixation after soft tissue swell- i ing subsided （Group II）. The surgical time, comPlications, length of hospital stay, cost of hospitalization, and time for i fracture union, as well as functional recovery were analyzed and compared between the two groups. Results： After 10-28 months follow-up （mean 16.5 months）, except 5 cases who lost to follow-upl no differ-ences were found between the two groups regarding surgi- cal time, preoperative and postoperative complications, heal- ing time or the Hospital for Special Surgery （HSS） score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation （P〈0.05）. Conclusion： Under certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.

Real-time in vivo visualization of tumor therapy by a near-infrared-II Ag2S quantum dot-based theranostic nanoplatform

Real-time and objective feedback of therapeutic efficacies would be of great value for tumor treatment. Here, we report a smart Ag2S QD-based theranostic nanoplatform （DOX@PEG-Ag2S） obtained by loading the anti-cancer drug doxorubicin （DOX） into polyethylene glycol-coated silver sulfide quantum dots （PEG-Ag2S QDs） through hydrophobic-hydrophobic interactions, which exhibited high drug loading capability （93 wt.% of DOX to Ag2S QDs）, long circulation in blood （t1/2 = 10.3 h）, and high passive tumor-targeting efficiency （8.9% ID/gram） in living mice where % ID/gram reflects the probe concentration in terms of the percentage of the injected dose （ID） per gram of tissue. After targeting the tumor tissue, DOX from PEG-AgRS cargoes was selectively and rapidly released into cancer cells, giving rise to a significant tumor inhibition. Owing to the deep tissue penetration and high spatio-temporal resolution of Ag2S QDs fluorescence in the second near-infrared window （NIR-II）, the DOX@PEG-Ag2S enabled real-time in vivo reading of the drug targeting process and therapeutic efficacy. We expect that such a novel theranostic nanoplatform, DOX@PEG-Ag2S, with integrated drug delivery, therapy and assessment functionalities, will be highly useful for personalized treatments of tumors.

Complications in the management of closed high-energy proximal tibial plateau fractures

Purpose： To report complications in the management of complex closed proximal tibial fractures. Method： A retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 20tl and March 2014. Sixty two patients were included in the study. The mean patient age was （43.16 ±11.59） years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted. Results： The overall complication rate was 30.65% （19 out of 62）. Infectious complications were noted in 20.97% cases （13162）. In majority of the cases （8113）, superficial infection was seen which managed with regular dressing and antibiotic administration. The patients （5/13） who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention. Conclusion： Proximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

aseudoarthrosis of medial tibial plateau fracture role of alignment procedure

Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial fibial plateau nonunion with almost similar demo- graphic profile are reported in this paper. All the three pa- tients were managed by minimally invasive compressionfixation using lag screws supplemented with limb realign- ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation.

Near infrared light triggered nitric oxide releasing platform based on upconversion nanoparticles for synergistic therapy of cancer stem-like cells

Near infrared(NIR) light-driven nitric oxide(NO) release nano-platform based on upconversion nanoparticles(UCNPs) and light sensitive NO precursor Roussin's black salt(RBS) was fabricated to generate NO upon 808 nm irradiation. The application of 808 nm laser as the excitation source could achieve better penetration depth and avoid overheating problem. The combination of UCNPs and RBS could realize the on-demand release of NO at desired time and location by simply controlling the output of NIR laser.Cellular uptake results showed that more nanoparticles were internalized in cancer stem-like cells(CSCs)rather than non-CSCs. Therefore, a synergistic cancer therapy strategy to eradicate both CSCs and nonCSCs simultaneously was developed. Traditional chemo-drug could inhibit non-CSCs but has low killing efficiency in CSCs. However, we found that the combination of NO and chemotherapy could efficiently inhibit CSCs in bulk cells, including inhibiting mammosphere formation ability, decreasing CD44^+/CD24^- subpopulation and reducing tumorigenic ability. The mechanism studies confirmed that NO could not only induce apoptosis but also increase drug sensitivity by declining drug efflux in CSCs. This UCNPsbased platform may provide a new combinatorial strategy of NO and chemotherapy to improve cancer treatment.

Recent therapeutic applications of the theranostic principle with dendrimers in oncology

At the intersection between treatment and diagnosis, nanoparticles technologies are strongly impacting the development of both therapeutic and diagnostic agents.Consequently, the development of novel modalities for concomitant noninvasive therapy and diagnostics known as theranostics as a single platform has gained significant interests. These multifunctional theranostic platforms include carbon-based nanomaterials（e.g., carbon nanotubes）, drug conjugates, aliphatic polymers, micelles, vesicles, core-shell nanoparticles, microbubbles and dendrimers bearing different contrast agents and drugs, such as cytotoxic compounds in the oncology domain. Dendrimers emerged as a new class of highly tunable hyperbranched polymers, and have been developed as useful theranostic platforms. Magnetic resonance imaging, gamma scintigraphy, computed tomography and optical imaging are the main techniques developed with dendrimers in the theranostic domain in oncology. Different imaging agents have been used such as Gd（Ⅲ）,19F, Fe2O3（MRI）,76Br（PET）,111In,88Y,153Gd,188Re,131I（SPECT）,177Lu,gold（CT） and boronated groups, siliconnaphthalocyanines,dialkylcarbocyanines and QDs（optical imaging dyes）.