Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

Acute kidney injury in traumatic brain injury intensive care unit patients

BACKGROUND The exact definition of Acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is unknown.AIM To compare the power of the“Risk,Injury,Failure,Loss of kidney function,and End-stage kidney disease”(RIFLE),Acute Kidney Injury Network(AKIN),Creatinine kinetics(CK),and Kidney Disease Improving Global Outcomes(KDIGO)to determine AKI incidence/stage and their association with the inhospital mortality rate of patients with TBI.METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012,and 1648 patients were included.The subjects in this study were assessed for the presence and stage of AKI using RIFLE,AKIN,CK,and KDIGO.In addition,the propensity score matching method was used.RESULTS Among the 1648 patients,291(17.7%)had AKI,according to KDIGO.The highest incidence of AKI was found by KDIGO(17.7%),followed by AKIN(17.1%),RIFLE(12.7%),and CK(11.5%)(P=0.97).Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3%for stage 0,36.0%/91.5%/44.5%for stage 1,35.9%/90.6%/11.3%for stage 2,and 47.4%/89.5%/36.8%for stage 3.The in-hospital mortality rates increased with the AKI stage in all four definitions.The severity of AKI by all definitions and stages was not associated with inhospital mortality in the multivariable analyses(all P>0.05).CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages.This study revealed that KDIGO is the best method to define AKI in patients with TBI.

Formation of Superoxide Radical and Hydrogen Peroxide Enhanced by Trinitrotoluene in Rat Liver, Brain, Kidney, and Testicle in Vitro and Monkey Liver in Vivo

Trinitrotoluene (TNT) increased the formation of adrenochrome from adrenaline and the formation of formaldehyde from methanol in rat liver mitochondria and microsomes in vitro as well as in monkey liver mitrochondria and microsomes in vivo. The effects were more prominent at higher TNT concentrations. These findings indicate that TNT enhances the production of superoxide radicals (O_2^-) and hydrogen peroxide (H_2O_2). The production of O_2^- was more prominent in systems containing added TNT than in those containing added benzyl viologen. H_2O_2 production by mitochondria was more pronounced in the liver than in other organs, but its production by microsomes was more pronounced in the brain than in other organs. The results suggest that TNT undergoes cycling reduction which produces oxidative stress. 1989 Academic Press, Inc.

Chronic effect of olive oil on some neurotransmitter contents in different brain regions and physiological, histological structure of liver and kidney of male albino rats

Olive oil is an important source of mono-unsaturated fat and a prime component of the Mediterranean diet. The beneficial health effects of olive oil are due to both its high content of mono-unsaturated fatty acids and its high content of anti-oxidative substances. The objective of this study was to investigate the basis for the epidemiological information relating to the health benefits associated with the consumption of ex-tra-virgin olive oil (EVOO). The effect of olive oil on norepinephrine (NE), dopamine (DA), serotonin (5-HT) and gamm-aminobutyric acid (GABA) con-tents in different brain regions and histological structure of liver and kindey of male albino rats was studied. The chronic administration of olive oil (7.5 mg/kg body wt.) caused a significant increase in norepinephrine (NE), dopamine (DA) , serotonin (5-HT) and gamm-aminobutyric acid (GABA) con-tent in different brain regions (Cerebellum, striatum, cerebral cortex, hypothalamus, brain steam and hip-pocampus) of male albino rats. The increase in NE, DA, 5-HT, and GABA content in the different CNS areas of male albino rat may be due to the inhibition of Ca2+/calmodulin binding which plays an important role in the release of these neurotransmitters. The results, also, revealed that urea and creatinne con-centrations in rats with oral administration with olive oil were decreased. Meanwhile, the activities of the enzymes AsT, AlT and ALP were elevated. The pre-sent results indicated that there is no change in tis-sues of kidney after treated with virgin olive oil. Olive oil may potentially be safe for use as a sedative drug. improvement also led to the reductions in risk of Alzheimer’s and Parkinson’s diseases.

Clinical observation on efficacy of compound of warming yang, descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with Yin-Yang deficiency and blood stasis syndrome

Objective:To observe the clinical efficacy of compound of owarming yang,descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome.Methods:Seventy-six patients of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome were randomly divided into observation group and control group,thirty-eight cases in each group.The control group was given conventional western medicine treatment,while the observation group took compound of owarming yang,descending turbidity and dredging collaterals orally on the basis of conventional western medicine treatment.The course of treatment covered for one month.Before and after treatment,we observed the scores of traditional Chinese medicine symptoms,indicators of renal function[serum creatinine(Scr),blood urea nitrogen(BUN),microalbuminuria(MALB)],indicators of glucose metabolism[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbAlc)],indicators of hemorheology[plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB)],Cystatin-C(Cys-C),C-reactive protein(CRP)in the two groups.Results:After treatment,the clinical effect of the observation group was significantly better than the control group(P<0.05).The scores of traditional Chinese medicine symptoms,indicators of renal function(Scr、BUN、UAER),indicators of glucose metabolism(FPG、2hPG、HbAlc),indicators of hemorheology(PV、PAR、FIB),Cys-C and CRP in the two groups were decreased significantly compared with those before treatment(P<0.05),and the decrease in the observation group was superior to that in the control group(P<0.05).Conclusion:Compound of warming yang,descending turbidity and dredging collaterals has remarkable efficacy in treating of diabetic kidney disease patients with yin-yang deficiency and blood stasis syndrome by alleviating clinical symptoms,glucose metabolism,renal function and microcirculatory disturbance,and the mechanism related to alleviation of microinflammation.

Brain neural effects of the ’tonifying kidney and benefiting marrow’ method in the treatment of osteoporosis

In Traditional Chinese Medicine(TCM),the'tonifying kidney and benefiting marrow'(TKBM)method is based on the theory that kidney controls bones,while marrow moistens bones.There have been aboundant theoretical studies on kidney controlling bones since Huangdi's Internal Classics.Howev-er,there are too few ones about the marrow moistening the bones.Researchers generally use the tonifying kidney method instead of the TKBM method,which causes lack of a unified standard and theoretical basis in evaluating the TKBM method.Herein,we first proposed the hypothesis that deficiency of marrow sea causes osteoporosis.Next,we prove the scientific validity of this hypothesis from the side of the TCM theory on the relationship among kidney,bone and marrow sea physiologically and pathologically.Based on this,we find that the TCM theory provides theoretical basis for deficiency of marrow sea causing osteoporosis.On the other side,Western Medicine theory holds that(a)physiologically,the brain regulates the bone mass via three pathways:the neuro-osteogenic network,neuro-endocrine-bone network,and neuropeptide-bone network;(b)pathologically,brain impacts bone mass via three major passways including the regulation of the sympathetic nervous system,secreting hormones that directly act on bone cells and regulating the synthesis and secretion of hormones in the intermediary organs,and neuropeptides such as neuropeptide Y(NPY),substance P(SP),and calcitonin gene-related peptide(CGRP).Evidences involving estrogen deficiency,sympatheticotonia,or neuropeptides imbalance prove that brain-bone mass regulation plays an important role in the pathogenesis of osteoporosis.Finally,we find that kidney invigoration method can change the concentrations of central neurotransmitters of norepinephrine and glutamate to regulate neuro-osteogenic network,and promote the recovery of ovarian function and have an estrogen-like effect by regulating the hypothalamus-pituitary-ovarian axis,which thus influences bone metabolism without clinically significant estro-gen-like side effects,and regulate NPY,CGRP and SP involved in the bone metabolism.These further support our hypothesis by revealing the brain neural mechanism of the TCM kidney invigoration method for preventing and treating osteoporosis.In the future,neuroimaging techniques may be useful in exploring its neural effects and also aid in developing new strategies for treating osteoporosis.

Brain natriuretic peptide and copeptin levels are associated with cardiovascular disease in patients with chronic kidney disease

Background Cardiovascular disease （CVD） is the leading cause of death in patients with end-stage renal disease （ESRD）. We explored the relationship between CVD, plasma brain natriuretic peptide （BNP） and copeptin in non-dialysis patients with chronic kidney disease （CKD）. Methods BNP and copeptin were measured using ELISA in 86 non-dialysis patients with different degrees of CKD and in 20 control patients. The effects of BNP, copeptin levels and other biochemical indices on carotid ultrasound echocardiography and CVD history were determined using correlation analysis. Results BNP and copeptin levels were significantly higher in the CKD group than in the control group. Both indices increased progressively, in parallel with the decline in glomerular filtration rate （GFR）. BNP levels were （184.25±65.18） ng/L in early phase CKD, （975.245±354.09） ng/L in middle phase CKD, and （1463.51±614.92） ng/ml in end phase CKD compared with levels of （101.56±42.76） ng/L in the control group （all P 〈0.01）. Copeptin levels in the middle phase （（20.36±9.47） pmol/L） and end phase groups （（54.26±18.23） pmol/L were significantly higher than in the control group （（9.21±2.64） pmol/L; both P 〈0.01）. There was no difference in copeptin levels between early phase CKD （（10.09±5.23） pmol/L） and control patients. Stepwise multiple regression analysis identified GFR, intima-media thickness （IMT）, left ventricular hypertrophy （LVH）, and previous history of CVD as independent risk factors for elevated BNP and copeptin levels. Conclusion BNP and copeptin appear to provide sensitive biological markers for the evaluation of atherosclerosis in non-dialysis patients with CKD.

Outcome of kidney transplantation between controlled cardiac death and brain death donors： a meta-analysis

Background Our goal was to evaluate the outcomes of kidney transplants from controlled cardiac death donors compared with brain death donors by conducting a meta-analysis of cohort studies.Methods The PubMed database and EMBASE were searched from January 1980 to July 2013 to identify studies that met pre-stated inclusion criteria.Reference lists of retrieved articles were also reviewed.Two authors independently extracted information on the designs of the studies,the characteristics of the study participants,and outcome assessments.Results Nine cohort studies involving 84 398 participants were included in this meta-analysis; 3 014 received kidneys from controlled cardiac death donors and 80 684 from brain death donors.Warm ischemia time was significantly longer for the controlled cardiac death donor group.The incidence of delayed graft function was 2.74 times （P 〈0.001） greater in the controlled cardiac death donor group.The results are in favor of the brain death donor group on short-term patient and graft survival while this difference became nonsignificant at mid-term and long term.Sensitivity analysis yielded similar results.No evidence of publication bias was observed.Conclusion This meta-analysis of retrospective cohort studies suggests that the outcome after controlled cardiac death donors is comparable with that obtained using kidneys from brain death donors.

Hydroxyethylstarch revisited for acute brain injury treatment

Infusion of the colloid hydroxyethylstarch has been used for volume substitution to maintain hemodynamics and microcirculation after e.g., severe blood loss.In the last decade it was revealed that hydroxyethylstarch can aggravate acute kidney injury, especially in septic patients.Because of the serious risk for critically ill patients, the administration of hydroxyethylstarch was restricted for clinical use.Animal studies and recently published in vitro experiments showed that hydroxyethylstarch might exert protective effects on the blood-brain barrier.Since the prevention of blood-brain barrier disruption was shown to go along with the reduction of brain damage after several kinds of insults, we revisit the topic hydroxyethylstarch and discuss a possible niche for the application of hydroxyethylstarch in acute brain injury treatment.

Kidney donation after cardiac death

There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death （DCD） and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to con-trolled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function （DGF） and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that signifcantly infuences the outcome of allografts, for example, limiting it to 〈 12 h markedly reduces DGF. DCD kidneys from donors 〈 50 function like stan-dard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled dona-tion, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kid-neys from DCD include： implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

Effect of thermal therapy using hot water bottles on brain natriuretic peptide in chronic hemodialysis patients

Introduction: The use of repeated thermal therapy for improving the symptoms of chronic heart failure (CHF) has been recently demonstrated. Usually, thermal therapy requires an infrared dry sauna. However, it is difficult for small clinics to acquire such an expensive and extensive system. The author assessed the efficacy of its substitution with hot water bottles. Moreover, there are no prior studies demonstrating the efficacy of thermal therapy in hemodialysis patients with chronic heart failure. Methods: The author evaluated plasma brain natriuretic peptide (BNP) levels in 98 hemodialysis patients in a clinic. A total of nine patients whose BNP levels were more than 500 pg/mL agreed to be enrolled in this study and received thermal therapy using hot water bottles. Results: Plasma BNP levels, a potential marker for CHF, tended to decrease (891 ± 448 pg/mL to 680 ± 339 pg/mL), but the difference was not significant (P = 0.0845). The oral temperature changed from 36.44℃± 0.45℃ to 37.04℃ ± 0.48℃ (+0.597℃, P < 0.0001). No side effects were experienced during the therapy. Moreover, most patients had an improvement in their symptoms and the ability to perform activities of daily living. Conclusion: Thermal therapy using hot water bottles is very safe and tends to reduce plasma BNP levels in hemodialysis patients with CHF.

An Investigation of Postmortem Urotensin II Receptor Levels in Brain and Kidney Tissues in a Rat Model of Cardiac Ischemia

This study aimed to investigate changes in postmortem urotensin Ⅱ receptor(UTR)levels in brain and kidney tissues in a rat model of cardiac ischemia.The rats were divided into two groups:a control group and a cardiac ischemia-induced group.Cardiac ischemia was created by an intraperitoneal injection of a single lethal dose of isoproterenol(ISO;850 mg/kg).Plasma UT,blood urea nitrogen,and creatinine levels were determined 0 h postmortem.Brain and kidney UTR mRNA expression levels were determined 0,1,3,6,12,24,4&and 72 h postmortem.The histopathological appearance of brain and kidney tissues was also evaluated.Plasma UT and plasma creatinine levels were increased in the cardiac ischemia-induced group as compared with those in the control group(P<0.001).Ischemia resulted in histopathological changes in brain and cerebellum tissue.The morphological evaluation revealed Purkinje cell degeneration(P=0.037)and dark neurons(P=0.004).The UTR expression level decreased after 1 h postmortem in the brain and after 3 h postmortem in the kidneys in the cardiac ischemia-induced group as compared with that in the control group(P<0.001).The observed changes in UTR expression levels may be valuable in clinical practice in the field of forensic medicine.These changes may be used as a marker in postmortem evaluations of sudden death caused by ischemia-induced cardiac shock.

Overview of Kidney Transplantation: A Single Centre Report from China

Introduction: Worldwide, End Stage Renal Disease (ESRD) is one of the leading disease with prolong morbidity. Kidney transplantation offers the best solution for the problem. The shortage of donor kidney is even bigger problem due to transplantation being one of the routine procedures. The use of deceased donor definitely increases the pool of donor with excellent immediate and long-term follow-up proven results. Aim: The aim is to analyze and summarize the outcome of Kidney transplantation. Methods & Materials: A total of 78 cases of Kidney Transplantation were selected for the study and categorized as: Group I—41 (living Donor), Group II—23 (DCD) & Group III—15 (DBD). Perspective study was done with clean data recorded & maintained pre-operatively, post-operatively and follow-up from Jan 2011 to Dec 2015 in our hospital. Post-operative graft status, complications and at least 1-year follow-up were area of main focus. Results: All patients underwent successful kidney transplantation. In Group I, the number of living donor kidney transplantation is 41 whereas in Group II (DCD) & III (DBD), the number of deceased donor transplantation is 23 and 15 respectively. The Normal functioning of graft (NGF) was 38 (87.8%), 16 (69.6%) & 11 (73.3%) in Group I, II & III respectively along with Poor Graft function (PGF) in Group I—4 (9.7%), II—5 (21.7%) & III—2 (13.3%) managed by continuing dialysis. Delayed graft function (DGF) was noted I-1 (2.4%), II-2 (8.6%) & III-1 (6.6%) in respective group, which returned to normal function post intervention. Therefore, 1st year graft survival was >93% [(Group I (97.6%), Group II (95.6%) & Group III (93.3%) respectively]. Manageable surgical complication were found in Group I—8 (19.5%), Group II—5 (21.7%) & Group III—2 (13.3%) like hematoma, hydronephrosis, leakage except one emboli related nephrectomy of transplanted kidney & one pneumonia led death in Group II. The overall survival was greater than 90% [(Group I (97.6%), Group II (91.3%) & Group III (93.3%) respectively] in all three groups after at least 1-year follow-up study, which was an excellent prognosis. Conclusion: Kidney Transplantation is safe, effective and the best method of treatment for ESRD. Significant improvement in quality of life is the hallmark merit over dialysis. Paired donation program should be encouraged in order to overcome shortage of kidney, which increases living donor pool. Outcome in living donor Kidney transplantation is always better than deceased donor transplantation. The prognosis of deceased donor transplantation (1 year Graft survival > 93% & 1 year patient survival > 90%) is also satisfactory with promising results. Therefore all the results were under acceptable standard limit. Thus, kidney transplantation (live or deceased donor) should be encouraged as primary modalities in the treatment of End Stage Renal Disease (ESRD).

Clinical observation of kidney tonifying and collateral tonifying acupuncture combined with thermosensitive moxibustion in the treatment of knee osteoarthritis and its effect on TRACP and CTX-I

Objective:To observe the clinical effect of kidney-tonifying and colllateral-tonifying acupuncture combined with thermosensitive moxibustion in the treatment of knee osteoarthritis and cold congealing syndrome and the effect on Tartrate-resistant Acid Phosphatase(TRACP)andⅠcollagen C-terminal foreign body peptide(CTX-I).Methods:Totally 90 patients with knee osteoarthritis were divided into three groups:acupuncture group,thermosensitive moxibustion group and routine group with 30 cases in each group.In the conventional group,sodium hyaluronate was injected into the joint cavity and diclofenac sustained release tablets were taken orally.Thermosensitive moxibustion group was given thermosensitive moxibustion on the basis of conventional treatment.Acupuncture and moxibustion group in the heat sensitive moxibustion group treatment was given kidney tonifying acupuncture.VAS score,JKOM score and Ly-Sholm knee score were observed before and after treatment and followed up for 2 weeks.The levels of TRACP and CTX-I in serum before and after treatment.Results:Before treatment,there were statistically significant differences in VAS score,JKOM score and Ly-Sholm knee score among all groups(P>0.05).After treatment,the VAS score and JKOM score decreased,and the decrease degree was the greatest in the acupuncture group(P<0.05).Ly-Sholm knee score increased,and the change degree was the greatest in acupuncture group(P<0.05).Before treatment,the levels of TRACP and CTX-I in serum of all groups were significantly different(P>0.05).After treatment,serum TRACP and CTX-I levels were decreased,and the decrease degree was the greatest in acupuncture group(P<0.05).The total effective rates of the acupuncture group,the thermal sensitive moxibustion group and the conventional group were 96.7%,80%and 66.7%,respectively,and the difference between each group was statistically significant(P<0.05).Conclusion:Kidney-tonifying and collature-tonifying acupuncture combined with thermosensitive moxibustion can significantly relieve knee pain and other symptoms of knee osteoarthritis in patients and cold congealing syndrome,which is worthy of clinical promotion.

基于“毒损脑络”理论探讨黄连改善卒中后认知功能障碍的研究

中医学认为,卒中后认知功能障碍(PSCI)病位在脑,“毒损脑络”为PSCI病因病机。从“毒损脑络”角度出发,阐述“毒邪”理论与卒中后认知功能的相关性。并以“解毒通络”为着手点,针对“热毒”“糖毒”“脂毒”“瘀毒”,分别探讨“毒邪”致PSCI的病机,逐步验证“毒损脑络”学说为PSCI的病因病机,为PSCI的中医诊疗提供思路。梳理解毒中药黄连改善认知障碍的文献记载,探析其理论内涵,开拓黄连临证辨证思路,提高解毒中药改善认知障碍的认识。

从“毒损脑络-从化”理论探讨脑卒中后认知障碍病机及针刺治疗思路

毒损脑络理论以毒邪和络脉为切入点,探讨脑络、气血、脑神与机体功能活动的生理病理联系;从化理论从邪气自身性质从化、体质从化等角度阐释疾病的病机。脑卒中后认知障碍(PSCI)强调脑卒中与认知功能之间潜在的因果关系,从毒损脑络理论探讨较为贴合,同时其发展转归、临床表现与从化理论相契合,故可从“毒损脑络-从化”理论出发,探讨PSCI的病机特点及针刺治疗思路。由此认为,浊毒是PSCI发病的物质基础,脑络损伤、脑神失养是PSCI发病的关键所在,基于此,治疗以解毒通络为首,毒邪去则络脉不再受损而易复,络脉通则气血畅,神机自复。此外,PSCI波动期邪多从火而化,蕴化热毒,故治以清热泻火;PSCI稳定期邪多从体质而化,因人而异,治宜调平体质。

基于络病学说从血络气络论治血管性痴呆

血管性痴呆(VD)是脑血管病变导致的认知功能障碍,发病率逐年上升。中医称为“呆病”“善忘”“痴呆”。现代医家对络病理论不断深入,广泛将其应用于临床。络脉-络病学说相关文献研究发现,络脉病变对VD发病的影响较大,其中气郁、痰浊、血瘀导致的血络瘀阻是VD的基本病机,病理产物蕴积生毒,毒邪滞络进而损害血络。气络中真气、宗气、卫气、营气受损则导致神经-内分泌-免疫(NEI)网络受损,致脑神失用。血络、气络共同作用于VD。

从络病探析功能性肛门直肠痛

络病广泛存在于各类外感重症及内伤疑难杂病之中,功能性肛门直肠痛作为肛肠科非器质性难治性疾病,往往缠绵难愈,给患者的身心健康以及日常生活带来极大困扰,其契合络病“久病入络”的病程演变规律。现代医学认为其主要与肠-脑互动异常、盆腔神经肌肉功能紊乱、精神心理等因素相关。本文重点阐述从络病论治功能性肛门直肠痛的理论,认为本病的病位在肠络,络中气血升降失常,清阳浊阴交争导致络脉绌急是本病发生的关键。对于功能性肛门直肠痛的治疗策略应当以复通络脉中气血升降有序为着眼点,病在局部而治在整体,采用补虚以荣络、辛温以通络、祛瘀以通络、藤虫以搜络等法,充分展现中医辨证论治以及络病学说的特色,以期对临床诊疗提供进一步导向。

TCD对颈内动脉重度狭窄引起大脑中动脉血流动力学变化及侧支循环的评估价值

目的探讨经颅多普勒超声(TCD)对颈内动脉重度狭窄引起大脑中动脉血流动力学变化及侧支循环的评估价值。方法选取2020年10月至2022年10月在洛阳市中心医院就诊的96例颈内动脉狭窄患者作为研究对象,根据数字减影血管造影(DSA)结果分为轻度狭窄、中度狭窄、重度狭窄,采用TCD测量大脑中动脉血流动力学参数[收缩期峰值血流速度(Vs)、搏动指数(PI)、脑血流储备能力(CVR)],分析大脑中动脉血流动力学参数与颈内动脉狭窄程度相关性及评估价值,并比较有无侧支循环开放患者大脑中动脉血流动力学参数及DSA、TCD对侧支循环开放检出率。结果不同颈内动脉狭窄程度患者Vs、PI、CVR比较:重度狭窄<中度狭窄<轻度狭窄(P<0.05);经相关性分析显示,大脑中动脉血流动力学参数Vs、PI、CVR与颈内动脉狭窄程度均呈负相关(P<0.05);Vs、PI、CVR对轻度与中度颈内动脉狭窄诊断曲线下面积(AUC)分别为0.798、0.763、0.854,联合诊断AUC为0.893,对轻度、中度与重度颈内动脉狭窄诊断AUC分别为0.832、0.795、0.856,联合诊断AUC为0.927;与无侧支循环患者比较,有侧支循环患者Vs、PI、CVR较高(P<0.05);TCD、DSA对于侧支循环开放检出率比较,差异无统计学意义(P>0.05)。结论TCD可评估颈内动脉重度狭窄引起的大脑中动脉血流动力学变化,为临床早期诊断颈内动脉狭窄程度、侧支循环建立提供参考,以针对性制定治疗方案,改善预后。

清热解毒药治疗缺血性脑白质病变的研究进展

近年来缺血性脑白质病变(WMIL)的检出率不断提高,热毒的形成与演变贯穿WMIL的发病过程,内生热毒损伤脑络在WMIL病理机制中占重要地位。针对WMIL“虚、热、毒、瘀”的病机,清热解毒药通过抑制炎症过程干扰缺血级联反应、清除痰瘀热毒等有害物质的产生,从而发挥解毒祛邪的作用。临床常用的清热解毒药(如牛黄、大黄、黄芩、黄连)在WMIL治疗中疗效明确,可显著改善患者脑缺血状态,延缓或阻止WMIL等神经退行性疾病的发展,为有效治疗脑白质病提供新思路。