Objective To investigate the effect of autologous bone marrow stem cells transplantation on diabetic foot.Methods From March 2010 to June 2013,21 patients with diabetic foot( 23 vessels) were chosen,they all given autologous bone marrow stem cells transplantation: at first,obtain autologous bone marrow blood 200- 240 ml,then turbid liquid( 3 ml)of mononuclear cells were isolated,at last given local muscle injection on the ill lower limb. Ischemic index of lower limb were measured,and recent symptoms and signs were observed before transplantation,after 1 month,3 month of transplantation. Results Lower limb pain score,creeping chill score,intermittent claudication score after 1 month,3 month of transplantation were lower than those before transplantation,and skin temperature and transcutaneous oxygen pressure were higher( P 0. 05).A total of 16 cases underwent digital angiography( DSA) after 3 month of transplantation,the results showed newborn collateral vessels were formed,13 out of them got foot ulcer healed,3 out of them decreased,and 5 patients' amputation( toe) level was lower. Conclusion Autologous bone marrow stem cell transplantation is effective in the treatment of diabetic foot,which has a satisfactory results and can effectively improve blood circulation of the ill foot.

目的 研究糖尿病足患者采用胫骨横向搬移术联合负压引流(VSD)技术治疗的临床价值.方法 选取 2019 年 10 月至 2021 年 10 月糖尿病足患者 64 例,按治疗方法不同分为 2 组,对照组 30 例予以VSD技术治疗,观察组 34 例基于对照组条件施加胫骨横向搬移术治疗,比较 2 组处理情况.结果 观察组治疗 12 周后总有效率高于对照组,差异有统计学意义(P<0.05).2 组治疗前足部疼痛评分比较,差异无统计学意义(P>0.05);治疗 12 周后,观察组足部疼痛评分比对照组更低,差异有统计学意义(P<0.05).观察组治疗后麻木、疼痛、冷感、间歇性跛行改善优于对照组(P<0.05).观察组治疗后ABI(1.04±0.25)、TcPO2(42.82±8.12)mm Hg高于对照组,差异有统计学意义(P<0.05).观察组患者创面肉芽组织中VEGF(8077.65±147.42)IOD、SDF-1α(5224.09±125.45)IOD、CXCR4(14279.86±289.94)IOD水平显著高于对照组,2 组比较差异有统计学意义(P<0.05).结论 胫骨横向搬移术联合VSD技术用于糖尿病足患者的治疗效果显著,并可加快疼痛缓解,促进创面恢复,值得临床推荐.

背景与目的:虽然甲状腺微小乳头状癌(PTMC)进展缓慢,但仍常伴有颈部淋巴结转移.有研究提示,BRAFV600E突变及Wnt/β-catenin信号通路中相关蛋白表达异常,可能与PTMC发生发展、颈部淋巴结转移有关.因此,本研究进一步探讨临床淋巴结阴性(cN0)PTMC病变组织中BRAFV600E突变及 β-catenin、cyclin D1 表达及意义.方法:收集2018年3月—2021年9月120例确诊为cN0期PTMC患者的手术标本及临床病理资料,用免疫组化法检测BRAFV600E突变及β-catenin、cyclin D1蛋白在标本中的表达,并分析其与患者临床病理特征的关系.结果:BRAFv600E突变蛋白、β-catenin、cyclin D1蛋白表达阳性率在PTMC组织中阳性表达均明显高于癌旁组织(70％vs.31.7％、35.8％vs.20.8％、57.5％vs.34.2％,均P＜0.05).cyclin D1 蛋白阳性表达与肿瘤直径有关,BRAFV600E突变蛋白阳性表达与病灶数目有关,BRAFV600E、β-catenin、cyclin D1蛋白阳性表达均与中央区淋巴结转移有关(均P＜0.05).结论:cN0期PTMC组织中BRAFV600E突变及β-catenin、cyclinD1蛋白表达明显增强,它们的表达可能是PTMC进展及中央区淋巴结转移的重要原因.

目的 对甲状腺微小乳头状癌(PTMC)患者的临床病理特征与中央区淋巴结转移(CLNM)相关性进行分析,旨在为临床实施精准化、科学化治疗提供参考依据.方法 回顾性分析经手术治疗的440例PT-MC患者病历资料,应用χ2检验及Logistic多因素回归模型对入选患者性别、年龄、肿瘤大小、多灶性、双侧癌、包膜侵犯及BRAFV600E突变、中性粒细胞/淋巴细胞计数比值(NLR)、血小板/淋巴细胞计数比值(PLR)水平与CLNM相关性进行单因素及多因素分析.结果 单因素相关性分析结果显示,患者性别、年龄与CLNM发生无明显相关性(P>0.05);肿瘤直径≥5 mm、肿瘤多灶性、双侧癌、包膜侵犯、NLR≥2.5、PLR≥175及BRAFV600E突变与CLNM发生风险明显相关(P<0.05),是CLNM的独立危险因素.Logistic多因素分析结果显示:肿瘤大小、肿瘤多灶性、包膜侵犯、BRAFV600E突变、NLR以及PLR是CLNM的独立危险因素(P<0.05).性别、年龄、双侧癌与CLNM无明显相关(P>0.05).肿瘤直径≥5 mm、肿瘤多灶性、包膜侵犯、BRAFV600E突变、NLR≥2.5及PLR≥175的患者发生CLNM的风险更高.其中,BRAFV600E突变及NLR≥2.5是影响CLNM最重要的两个独立危险因素.结论 肿瘤直径≥5 mm、肿瘤多灶性、包膜侵犯及BRAFV600E突变、NLR≥2.5、PLR≥175均为PTMC发生CLNM的独立危险因素;对于存在包膜侵犯、BRAFV600E突变及NLR值≥2.5的患者应着重考虑行预防性中央区淋巴结清扫(pCLND).

目的 观察针灸结合常规西药治疗糖尿病周围神经病变(DPN)的临床效益.方法 选取2016年6月至2019年12月于中国人民解放军陆军第八十一集团军医院内分泌科住院的90例DPN患者,按照随机数字表法分为结合组和西药组,各45例.西药组应用硫辛酸注射液及甲钴胺注射液(或片)治疗,结合组在西药组基础上加以针灸治疗.本研究一般规定疗程18 d,如症状好转后,依据患者意愿,复查肌电图后,可提前办理出院.观察患者治疗总有效率、治疗前后正中神经和腓总神经的运动神经传导速度(MNCV)和感觉神经传导速度(SNCV)、住院天数及费用.结果 结合组治疗总有效率高于西药组[95.6％ (43/45)比75.6％ (34/45)],差异有统计学意义(x2=22.010,P=0.047).治疗后,2组正中神经和腓总神经MNCV、SNCV均明显高于治疗前,且结合组高于西药组,差异均有统计学意义(均P＜0.05).结合组住院天数少于西药组、住院费用低于西药组[(13±4)d比(15 ±6)d、(6269±524)元比(7875±404)元],差异均有统计学意义(t=3.356,P=0.046;t=20.557,P=0.044).结论 针灸结合硫辛酸注射液、甲钴胺注射液(或片)治疗DPN可以明显改善糖尿病患者神经传导速度,缩短住院日,减少住院费用.

Objective: To compare the clinical effect differences between western medication, acupuncture, and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy. Methods: Ninety-three patients were randomized into western medication group, acupuncture group, and combination group, with 31 cases in each. The patients in western medication group were treated with lipoic acid injection and mecobalamin injection/tablets. The patients in acupuncture group were treated with acupuncture, and the acupoints were selected according to the symptoms. The needles were retained for 30 min, once a day. The patients in combination group were treated with both western medication and acupuncture, specific methods as the above. The treatments were for 18 days in succession in all of three group. The motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of median nerve and common peroneal nerve, as well as the changes of symptoms and signs of patients were observed before and after treatment. The clinical effect was evaluated. Results: After treatment, the median nerve MNCV in the three groups, the median nerve SNCV and common peroneal nerve MNCV in acupuncture group and combination groups, and the common peroneal nerve SNCV in acupuncture group were all higher than those of before treatment, with significantly statistical differences (all P < 0.05). After treatment, the MNCV and SNCV of median nerve and common peroneal nerve in combination group were higher than those in western medication group and acupuncture group, with significantly statistical differences (all P < 0.05). After treatment, the number of patients in the three groups with the symptoms and signs was lower than that of before treatment. The effective rate in combination group was 96.8% (30/31), higher than those of western medication group, 74.2% (23/31), and acupuncture group, 83.8% (26/31), with significantly statistical differences (both P < 0.05). Conclusion: Acupuncture combined with western medication in the treatment of diabetic peripheral neuropathy can improve the nerve conduction velocity and improve the symptoms and signs of diabetic patients, with a better effect than those of western medication and simple acupuncture. (C) 2021 World Journal of Acupuncture Moxibustion House. Published by Elsevier B.V. All rights reserved.

背景:以往研究表明骨髓间充质干细胞在促进创面愈合方面已经取得了一定成效,能明显促进创面皮肤的恢复,但关于基因及药物调控的相关研究目前尚未取得突破性进展。目的:分析人参皂苷诱导骨髓间充质干细胞对糖尿病皮肤溃疡大鼠愈合作用及其对Wnt/β-catenin信号表达的影响。方法:选取SPF级Wistar雄性大鼠61只,其中1只行骨髓间充质干细胞培养,另外60只随机数字表法将模型大鼠分成4组,空白组、糖尿病皮肤溃疡组、骨髓间充质干细胞组及人参皂苷诱导骨髓间充质干细胞组,除空白组,其他各组大鼠制备糖尿病皮肤溃疡模型,造模后6h糖尿病皮肤溃疡组和空白组大鼠由尾静脉注入1 mL细胞培养液,骨髓间充质干细胞组注入1 mL骨髓间充质干细胞悬液(细胞浓度2.0×10~9 L -1 ),人参皂苷诱导骨髓间充质干细胞组注入1 mL人参皂苷诱导分化骨髓间充质干细胞悬液(细胞浓度2.0×10~9 L -1 )。实验方案经已于2016年12月获得解放军二五一医院动物伦理学委员会批准开展进行,批准号:20161211。结果与结论:与空白组相比,糖尿病皮肤溃疡组大鼠血清白细胞介素1、超敏C-反应蛋白、肿瘤坏死因子α含量上升,血小板衍生生长因子、血管内皮生长因子、碱性成纤维因子含量下降;与糖尿病皮肤溃疡组相比,骨髓间充质干细胞组及人参皂苷诱导骨髓间充质干细胞组大鼠血清白细胞介素1、超敏C-反应蛋白、肿瘤坏死因子α含量下降,血小板衍生生长因子、血管内皮生长因子、碱性成纤维因子含量上升;与骨髓间充质干细胞组相比,人参皂苷诱导骨髓间充质干细胞组大鼠血清白细胞介素1、超敏C-反应蛋白含量下降,血小板衍生生长因子、血管内皮生长因子、碱性成纤维因子含量上升;与空白组相比,糖尿病皮肤溃疡组大鼠成纤维细胞数和新生毛细血管数密度下降;与糖尿病皮肤溃疡组相比,骨髓间充质干细胞组,人参皂苷诱导骨髓间充质干细胞组大鼠成纤维细胞数和新生毛细血管数密度上升;与骨髓间充质干细胞组相比,人参皂苷诱导骨髓间充质干细胞组大鼠成纤维细胞数和新生毛细血管数密度上升;与空白组相比,糖尿病皮肤溃疡组大鼠Wnt4及β-catenin mRNA表达上升;与糖尿病皮肤溃疡组相比,骨髓间充质干细胞组、人参皂苷诱导骨髓间充质干细胞组大鼠Wnt4及β-catenin mRNA表达下降;与骨髓间充质干细胞组相比,人参皂苷诱导骨髓间充质干细胞组大鼠Wnt4及β-catenin mRNA表达下降。提示人参皂苷诱导骨髓间充质干细胞可显著降低糖尿病皮肤溃疡大鼠血清炎性因子含量,提升生长因子含量,下调Wnt/β-catenin信号路径内相关蛋白表达加速创面愈合。

Objective To investigate the clinical effect of acupuncture and moxibustion combined with thioctic acid injection and mecobalamin on diabetic peripheral neuropathy.Methods Totally 112 cases of diabetic peripheral neuropathy were enrolled from May 2011 to May 2016 at the 251st Hospital of the Chinese People's Liberation Army.The patients were randomly divided into observation group and control group,with 56 cases in each group.The control group was treated with thioctic acid injection and mecobalamin;the observation group was treated with acupuncture and moxibustion combined with thioctic acid injection and mecobalamin.Motor nerve conduction velocity(MNCV) and sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve were analyzed before and after treatment.Results Total effective rate in observation group was significantly higher than that in control group [94.6％ (53/56) vs 71.4％ (40/56)] (P ＜ 0.05).There were no significant differences of MNCV and SNCV of median nerve and common peroneal nerve between groups before treatment (P ＞ 0.05).After treatment,MNCV and SNCV of median nerve and common peroneal nerve were significantly higher than those before treatment;the differences in observation group were more significant than those in control group[median nerve:(6.4 ± 1.9)m/s vs (2.8 ±0.6)m/s,(4.3 ±0.5) m/s vs (1.3 ±0.4)m/s;common peronealnerve:(5.2±0.4)m/s vs (1.1 ±0.6)m/s,(4.4 ±0.6)m/s vs (1.3 ±0.5)m/s](P＜0.05).Conclusion Acupuncture and moxibustion combined with thioctic acid injection and mecobalamin treating diabetic peripheral neuropathy can effectively improve median nerve and common peroneal nerve conduction velocity.

<正>1病例资料【例1】女,74岁。主因血糖升高12年,尿频、尿急、尿痛3 d入院。查尿白细胞(+++),血白细胞10.70×109/L,中性粒细胞0.72。入院诊断:糖尿病;泌尿系感染。自行皮下注射优泌林70/30 1年,日剂量为30 U,未曾出现低血糖症状。

1 病历摘要 患者男,82岁,主因双膝关节腔感染,应用甲磺酸加替沙星分散片0.4g 1/日,1天后出现心慌、四肢颤抖、多汗,未就诊,第二天自觉上诉症状加重,并伴恶心、呕吐,急测手指血糖1.60mmol/L,以低血糖收入我科,通过询问病史,停服加替沙星,静点10%葡萄糖500ml后,症状缓解不明显,急查静脉血糖1.7mmol/L;之后再次给予10%葡萄糖500ml,血糖升高缓慢,之后给予静滴地塞米松注射液10mg,症状逐渐缓解,血糖渐升高致正常,2天后症状缓解.患者既往有糖尿病病史10余年.