目的 观察罗哌卡因星状神经节阻滞联合穴位注射治疗颈性眩晕的临床疗效.方法 将76例颈性眩晕患者随机分为治疗组与对照组,每组38例,观察组患者采用罗哌卡因星状神经节阻滞联合穴位注射疗法,对照组采用传统颈椎针刺疗法(华佗夹脊穴).观察比较两组治疗疗效及治疗前后C6水平侧椎动脉血流参数:峰值流速(PSV)、均速(Vm)、血管阻力指数(RI)的改变.结果 经过治疗后,治疗组总有效率为94.74％,优于对照组(68.42％),差异具有统计学意义(P<0.05),且观察组痊愈率、显效率和总有效率明显高于对照组(P<0.05);两组患者治疗后血流参数均优于治疗前(P<0.05),观察组椎动脉PSV、Vm、RI的改变均明显优于对照组(P<0.05).结论 与传统针刺疗法相比较,采用罗哌卡因星状神经节阻滞联合穴位注射治疗对患者的临床症状改善明显,疗效更佳,超声能够明确定位,安全性高,值得临床推广应用.

目的观察针刀疗法结合艾灸治疗跟痛症的效果。方法选取80例跟痛症患者,随机分为治疗组及对照组各40例,治疗组:针刀疗法结合艾灸治疗;对照组:单纯针刀疗法。结果治疗总有效率为90.00%,显著高于对照组的77.50%,差异有统计学意义（P＜0.05）。治疗组患者VAS评分（2.24±4.15）明显低于对照组（3.11±5.06）,差异具有统计学意义（P＜0.05）。结论针刀结合艾灸治疗跟痛症疗效显著。

目的:探讨加味补阳还五汤(MDIY)对七氟烷麻醉处理后的早期糖尿病肾病(DN)大鼠肾足细胞的影响.方法:将早期DN大鼠随机分为4组(每组n=16):MDIY组(A组),罗格列酮组(B组),MDIY+罗格列酮组(C组)和模型对照组(D组),另设正常大鼠(E组)为空白对照组.连续治疗7周,每天收集大鼠死亡数和葡萄糖(GLU)、肌酐(CR)、尿素氮(BUN)和尿微量白蛋白(UAL).七氟烷麻醉处理后采集标本,通过苏木精和伊红染色(H&E)收集肾脏和肾病理变化检查.应用实RT-PCR和western blotting检测评估肾足突细胞各m-RNA的表达水平,包括nephrin、podocin、α-SMA和desmin的表达.结果:在治疗周期中,A组、B组和C组的GLU和UAL水平均低于D组(P＜0.01),且7周后3组的GLU、CR和BUN水平也都远低于D组(P＜0.05).其中,C组的上述生化指标远低于A组和B组(P＜0.05).相比于正常SD大鼠,通过H&E染色,观察各组的肾小球疾病、慢性肾小管间质损伤和肾小球足细胞损伤的发病率.然而,只有C组显示更能优化改善上述损伤的发病率.在A组、B组和C组与D组比较,α-SMA和desmin的表达减少,而nephrin和podocin的表达明显增加(P＜0.05);C组不仅nephrin和podocin mRNA 表达(P＜0.05),而且在蛋白表达方面均观察有协同效应.结论:MDIY对早期DN引起的肾功能损害是一种保护作用,可以大大提高与罗格列酮相结合的治疗效果,其机制是通过增加nephrin、podocin的表达和减少α-SMA、desmin的表达,从而推测MDIY具有显著的协同治疗DN作用.七氟烷预处理能改善糖尿病肾病足细胞结构和功能,对围术期外科快速康复有利.

AbstractBackgroundDespite its rarity, studies have shown the incidence of gastric neuroendocrine tumors (G‐NETs) is increasing. This study investigated the risk factors affecting the survival of G‐NETs patients and their prognosis over time.MethodA retrospective analysis of 506 G‐NETs patients who underwent surgery for nonmetastatic disease from the Surveillance, Epidemiology and End Result database from 1988 to 2011 was conducted. Multivariate Cox regression analyses identified the prognostic factors affecting overall survival (OS) and disease‐specific survival (DSS). Three‐year conditional survival (COS3 and CDS3) estimates at “x” year after treatment were calculated as follows: COS3 = OS(x + 3)/OS(x) and CDS3 = DSS(x + 3)/DSS(x).ResultsThe 1‐, 3‐, and 5‐year OS rates of all patients after surgery were 90.2%, 77.3%, and 68.8%, respectively. The 1‐, 3‐, and 5‐year DSS rates after surgery were 93.9%, 84.5%, and 80.9%, respectively. In the multivariate analysis, age, tumor grade, and T stage were independent prognostic factors of OS and DSS (all P < 0.05). With 1‐, 3‐, and 5‐year survivorship, the COS3 improved by +5.2 (82.2%), +7.2 (84.4%), and +8.5 (85.5%), respectively, and the CDS3 improved by +4.4 (89.4%), +9.1 (94.1%), and +12.5 (97.5%), respectively. Notably, the CDS3 improved dramatically among patients with advanced stage disease (eg, N0 stage: 93.0%‐98.9%, Δ5.9% vs N1 stage: 52.0%‐95.7%, Δ43.7%).ConclusionFor G‐NETs patients, age, tumor grade, T stage, and N stage were the clinicopathological factors significantly associated with prognosis. There were excellent outcomes for most G‐NETs patients, with a CDS3 of greater than 90% across all independent prognostic factors after 5 years of survival.