目的 ·探讨高强度高频率重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗抑郁症自杀意念的效果及安全性,以及对于自杀意念症状的快速缓解程度.方法 ·共有14例伴有严重自杀意念的门诊抑郁症患者入组,接受5 Hz高强度左侧背外侧前额叶rTMS治疗,每日重复3～4次,连续治疗3d,共计10次20 000个刺激脉冲;rTMS治疗期间抗抑郁药剂量不变.分别在基线入组时以及入组后第4日、第2周、第4周进行自杀意念量表(Scale for Suicidal Ideation,SSI)、汉密尔顿抑郁量表17项(Hamilton Depression Scale-17,HAMD17)、临床疗效总评量表严重度分量表(Clinical Global Impression-Severity of Illness,CGI-SI)评定.结果 ·5Hz高频rTMS治疗安全,患者耐受性好.SSI总分在rTMS治疗结束后各随访时点均显著下降(F=15.788,P=0.000),以rTMS治疗结束的次日(第4日)SSI分值下降最显著,其抗自杀意念效果可持续至入组4周以后.自杀意念下降程度与HAMD 17分值下降存在相关性(t=5.658,P=0.000),与CGI-SI分值不存在相关性(t=-1.058,P=0.295).高强度高频率rTMS治疗对抑郁症状改善显著,入组4周后总显效率达78.57％.结论 ·高强度高频率rTMS治疗能快速减少抑郁症患者自杀意念,安全性好;自杀意念缓解程度与rTMS抗抑郁疗效相关,且其疗效可以维持.

Purpose: The utility of transcranial magnetic stimulation (TMS) has been growing rapidly in both neurocognitive studies and clinical applications in decades. However, it remains unclear how the responses of the stimulated site and the site-related functional network to the external TMS manipulation dynamically change over time. Methods: A multi-session combining TMS-fMRI experiment was conducted to explore the spatiotemporal effects of TMS within the fronto-limbic network. Ten healthy volunteers were modulated by intermittent theta-burst stimulation (iTBS) at a precise site within the left dorsolateral prefrontal cortex (DLPFC, MNI coordinate [-44 36 20]), navigated by individual structural MRI image. Three-session resting-state fMRI images were acquired before iTBS (TP1), immediately after iTBS (TP2), and 15 min after iTBS (TP3) for each participant. Seventy-four regions of interests (ROIs) within the fronto-limbic network were chosen including the bilateral superior frontal gyrus (SFG), middle frontal gyrus (MidFG), inferior frontal gyrus (IFG), orbital gyrus (OrG), cingulate gyrus (CG), and subcortical nuclei (hippocampus and amygdala). Regional fractional amplitude of low-frequency fluctuation (fALFF) and ROI-to-ROI functional connectivity (FC) were compared among TP1, TP2, and TP3. Results: The immediate iTBS effect was observed at the stimulated site. FC between the left dorsolateral SFG and left dorsal IFG and between the left rostral IFG and right MidFG increased at TP2 as compared to at TP1 (all FDR-p < 0.05), while FC within the left OrG decreased. The relatively long-term iTBS effect transmitted with decreased FC between the left IFG and right amygdala, increased FC between the left MidFG and left OrG, and decreased FC between bilateral IFG and OrG at TP3 than at TP1 (all FDR-p < 0.05). Meanwhile, mean fALFF values over the left SFG, MidFG, ventral CG, and IFG were significantly increased at TP3 as compared to those at TP2 (all p < 0.05 with Bonferroni correction). Conclusion: By combining TMS and fMRI, it becomes possible to track the spatiotemporal dynamics of TMS after-effects within the fronto-limbic network. Our findings suggested that the iTBS effect dynamically changed over time from the local neural activation at the stimulated site to its connected remote regions within the fronto-limbic network.

自杀意念是精神疾病中较为严峻的问题.药物治疗起效慢,对自杀意念的干预效果有限.物理治疗作为辅助治疗方法被广泛应用,其主要通过物理性(如电、磁等)作用对中枢神经系统进行调节,常用方法包括电休克治疗、重复经颅磁刺激、磁抽搐治疗和迷走神经刺激术等神经调控技术.该文主要围绕临床中常用的物理神经调控干预对精神疾病患者自杀意念的疗效进行综述.

目的:探讨老年腹股沟斜疝丙泊酚麻醉术后低血压的危险因素及护理方法.方法:将行腹股沟斜疝手术的老年男性患者100例,根据麻醉复苏期间血压分为低血压(32例)和非低血压(68例),计算麻醉时间及丙泊酚剂量判断低血压发生的ROC曲线及曲线下面积;应用多因素Logistic回归分析丙泊酚术后低血压发生的独立危险因素;针对高危患者采取强化护理.结果:低血压与非低血压在体重指数(BMI)、低密度脂蛋白胆固醇(LDL-C)、收缩压、平均压、空腹血糖、高血压病史、糖尿病史、吸烟史、麻醉时间、丙泊酚用量上比较差异有统计学意义(P<0.01).丙泊酚剂量及麻醉时间诊断低血压的曲线下面积(AUC)分别为0.68(95%CI:0.533~0.827),0.67(95%CI:0.735~0.979).多因素Logistic回归分析显示,LDL-C、平均压、麻醉时间、丙泊酚剂量为高龄患者丙泊酚麻醉术后复苏发生低血压的独立危险因素(P<0.05).结论:腹股沟斜疝丙泊酚麻醉复苏期间低血压的发生与麻醉时间、丙泊酚剂量、LDL-C及平均压有关,在麻醉复苏室应予以强化护理.

OBJECTIVE To study the clinical curative effect of Qigui Yishen decoction in the treatment of patients with chronic kidney diseases of spleen and kidney deficiency.METHODS Patients with chronic kidney diseases met the diagnosis criteria were divided into two groups.Both groups were given the high quality low protein,low salt,low fat,low phosphorus diet,and also given basic treatments such as correcting water and electrolyte disorders,acidosis,anemia,lowering blood pres-sure,anticoagulation and regulating lipid.On the basis of this,the treatment group was also given Qigui Yishen decoction o-rally.Objective indexes including kidney function,serum plasminogen activator inhibitor-1(PAI-1),transforming growth fac-tor-β1(TGF-β1)and changes of TCM syndrome scores were observed after four weeks.RESULTS After the treatment,TCM syndrome scores in two groups decreased significantly compared with pre-treatment(P<0.05~0.01),and the treatment group was better than the control group(P<0.05~0.01).PAI-1,ALB/Cr,TGF-β1 and IL-6 levels in two groups decreased significantly after treatment(P<0.05~0.01),and the treatment group was better the control group(P<0.05~0.01). CONCLUSIONS Qigui Yishen decoction has definite curative effect on protecting renal function and alleviating the progress of renal fibrosis,and its therapeutic effect may be related to the improvement of blood coagulation and endothelial cell function.

目的:观察滋肾降浊汤治疗老年难治性肾病综合征(refractory nephropathy syndrome,RNS)的临床疗效,并分析其作用机制.方法:80例老年RNS患者随机平均分为对照组和观察组.对照组应用泼尼松治疗,观察组在对照组基础上予以中药滋肾降浊汤治疗,比较两组患者临床疗效、免疫炎症因子、肝肾功能指标及不良反应.结果:观察组有效率为87.50％,对照组有效率为65.00％,两组有效率比较,差异有统计学意义(P＜0.05);观察组中医证候有效率为85.00％,对照组中医证候有效率为60.00％,两组有效率比较,差异有统计学意义(P＜0.05);治疗后两组总胆固醇、三酰甘油、白细胞介素-2(interleukin-2,IL-2)、IL-6、IL-8、肿瘤坏死因子-α及中医证候积分均显著降低(P＜0.05),且观察组低于对照组(P＜0.05);治疗后两组的CD3+、CD4+、CD8+及CD4+/CD8+均显著改善,且观察组优于对照组(P＜0.05);观察组不良反应率(7.50％)显著低于对照组不良反应率(25.00％)(P＜0.05).结论:滋肾降浊汤能够抑制炎性反应、调节机体免疫功能、纠正脂质代谢紊乱、稳定肾脏功能,缓解老年RNS的临床症状,临床疗效显著.

目的:了解太仓地区消化道疾病患者幽门螺杆菌(HP)感染现状.方法:对江苏太仓2010年1月至2012年7月的4.468例具有胃肠道症状的患者进行研究,年龄13～ 88岁,采用改良Warthin-Starry银染法检测幽门螺杆菌.结果:太仓地区HP感染率为44.85％,男性的感染率高于女性,男性与女性之间感染率差异有统计学意义(P＜0.05).不同年龄组HP阳性感染率有差异性(P＜0.01),随着年龄的增长HP感染率呈现下降趋势.除10～ 30岁年龄组外,其他不同年龄组消化性溃疡HP感染阳性率均高于浅表性胃炎组、萎缩性胃炎组及胃癌组.结论:江苏太仓地区具有消化道症状的人群HP感染率为44.85％,男性感染率高于女性,随着年龄的增长HP感染率有明显的下降趋势,消化性溃疡HP感染的阳性率明显升高.

目的 研究在中医辩证论治原则指导下,加味当归补血汤与西药治疗对慢性肾小球肾炎患者的微炎症状态控制情况与肾功能保护作用之间关系的临床研究.方法 将慢性肾小球肾炎患者进行随机分组,分别使用加味当归补血汤和参考《美国NKF-K/DOQI工作组制定的治疗指南》西药对于慢性肾小球肾炎治疗之间的差别,在治疗终点应用统计学方法分析两种不同方法对患者临床疗效的差异.结果 治疗终点发现加味当归补血汤治疗组优于西药治疗组的临床疗效,组间比较有显著性差异(P＜0.05).通过统计分析微炎症主要临床指标与肾脏病本身的疗效指标如尿蛋白排泄量和肾小管损害指标等项目之间具有正相关,而且加味当归补血汤治疗组在抑制微炎症病变方面效果更加明显,组间比较同样具有显著性差异(P＜0.05).结论 在辨证论治原则指导下应用加味当归补血汤对于慢性肾小球肾炎治疗具有较好的临床疗效,疗效的取得可能与其对微炎症状态的调控作用有一定的相关性.

Objective:To discuss the protecting renal function by Kangai injection in cancer patients undergoing chemotherapy.Method:The randomized,controlled and single-blind study was used.The kidney function and urine trace protein levels were detected and traditional Chinese medicine(TCM) symptoms were evaluated,and other related symptoms were analyzed.Result:The general situation and renal function in treatment groupwas better than the control group.Conclusion:Kangai injection can reduce kidney damage and improve survival situation.

高校图书馆馆员素质的提升已成为提高图书馆服务质量的关键因素，本文从分析高校图书馆馆员的素质现状及存在的问题入手，阐述了高校图书馆馆员应具备的素养并就提高馆员素质的必要性及提高方法进行了探讨。

目的:研究在中医辨证论治原则指导下应用中药方剂及三金片对湿热下注类型的中老年男性患者慢性前列腺炎的临床研究。方法:将临床经过证实为慢性前列腺炎的患者进行随机分组,分别使用三金片和中药方剂辨证治疗与西药治疗进行比较,在治疗终点应用统计学方法分析2组患者组间疗效差异。结果:治疗终点发现以三金片为基础药物配合中药方剂的治疗组与西药治疗组对于慢性前列腺炎的疗效相关指标,如前列腺单次治疗疗程、复发频率、前列腺缩小情况以及医药经济学指标等项目差异具有统计学意义(P<0.05)。结论:三金片为基础的中医药辨证治疗对于前列腺炎具有较好的临床疗效。

目的:观察活血养阴类中药配合西药治疗狼疮性肾炎及对血清、尿液巨噬细胞移动抑制因子水平的影响。方法:采用活血养阴方(生地黄、茜草、赤芍、青蒿、丹皮、玄参、丹参、川芎、蛇舌草、蛇莓、半枝莲等)配合西药(激素)治疗本病20例,并设对照组,观察健康组的血清、尿液MIF水平,及治疗组和对照组治疗前后血清、尿液MIF水平、狼疮活动指数的变化。结果:治疗组和对照组在治疗前其血清、尿液MIF水平均较健康组高(P<0.01)。治疗组及对照组治疗前后的血清MIF水平改善不明显(P>0.05)。治疗组及对照组治疗前后的尿液MIF水平、狼疮活动指数均有不同程度的改善,且治疗组优于对照组(P<0.05)。结论:本方法对本病有活血祛瘀,解毒养阴的功效;可改善狼疮活动指数及尿液MIF水平的作用。

目的 观察苏子油软胶囊治疗中医辨证为痰浊遏阻证的高脂血症患者的临床疗效.主要是血脂改善程度、内皮细胞损害相关指标及中医证候积分等客观指标.方法 将符合诊断标准患者进行8周时间的治疗,在治疗前后观察患者的临床疗效,包括血脂指标如总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)和内皮细胞损伤相关细胞因子,如超敏C反应蛋白(HSCRP)、肿瘤坏死因子-α(TNF-α)、纤溶酶原激活物抑制剂-1(PAI-1)以及中医证候积分的改善情况.结果 患者治疗前后自身对照,血脂各项指标改善方面均有较好的临床疗效,统计学比较相关数据差异有显著性；内皮细胞各项指标及中医证候积分比较,统计学比较差异同样具有显著性.结论 中药苏子油软胶囊在降低血脂疗效确切,同时具有保护内皮细胞作用并有较好改善高血脂患者临床症状的作用.

目的 研究在中医辨证论治原则指导下的健脾益肾治疗方法 加西药基础治疗相配合与单纯西药基础治疗对于慢性肾小球肾炎的疗效差异.方法 将临床经过肾活检证实的肾小球肾炎患者进行随机分组,分别使用健脾益肾加西药基础治疗和单纯西药基础治疗,在治疗终点应用统计学方法 分析两种不同方法 对两组患者组间疗效差异.结果 治疗终点发现健脾益肾加西药基础治疗组与单纯西药治疗组对于慢性肾小球肾炎的疗效相关指标如24h尿蛋白定量、肾功能等项目差异具有统计学意义(P<0.05).结论 健脾益肾加西药基础治疗对于治疗慢性肾小球肾炎具有较好的临床疗效.

目的:了解尿α1-MG、尿β2-MG对系统性红斑狼疮(SLE)患者肾损害的诊断价值.方法:通过双抗体夹心酶联免疫法(ELISA)对60例SLE患者与20例健康对照组的尿α1-MG、尿β2-MG进行检测.结果:LN患者尿α1-MG、尿β2-MG明显高于正常对照组(P<0.01);随着病程的延长,SLE患者的尿α1-MG、尿β2-MG逐惭升高.结论:尿α1-MG、β2-MG.是反映SLE肾损害可靠的指标,能够较准确地反映肾小管间质损害严重程度.

近年来,笔者采用中两医结合方法治疗IgA肾炎34例,观察对肾小管指标的影响,并设立对照组,兹报告结果如下: 1 临床资料 收集本院完整资料病例68例,其中男27例,女41例;平均年龄(32.2±4.9)岁;病程(11.8±1.24)月.随机分为治疗组和对照组各34例.患者临床表现和实验室检查符合IgA肾炎的诊断标准[1],并排除继发性肾炎可能,所有病例行肾脏病理活检得以确诊.

OBJECTIVE:To explore the role of COX-2 in mediation of multidrug resistance in breast cancer by studying the effect of selective COX-2 inhibitor Nimesulide on breast cancer MDA-MB-231 and its effect on the expression of P-gp.METHODS:Human breast cancer MDA-MB-231 was taken as the target to investigate the effect of COX-2 inhibitor Nimesulide on the rate of apoptosis and the expressions of COX-2 and P-gp by flow cytometry.MTT assay was used to compare the inhibiting rate IC50 in breast cancer MDA-MB-231 cell line treated with Nimesulide alone or in combination with the different doses of Mitomycin.RESULTS:The cell line was treated with Mitomycin alone,and IC50 of MMC to cell line was 8.59±1.16,and the cell line was treated with 25 μmol/L Nimesulide in combination with MMC,and IC50 was 5.89±0.66,P=0.002.The cell line was treated with 50 μmol/L Nimesulide in combination with MMC,and IC50 was 3.31±0.30,P=0.003.It suggested nimesulide enhanced the chemotherapy sensitivity of mitomycin in breast cancer MDA-MB-231 in a dose-dependent manner in vitro.Flow cytometry showed nimesulide stimulated the apoptosis of MDA-MB-231 cell in dose-dependent manner(0.13±0.15→29.2±0.95),F=44.84,P=0.000.Nimesulide decreased the expressions of COX-2 and P-gp in dose-dependent manner.The expression of COX-2 was decreased from 70.37±1.98 to 9.60±2.11 and the expression of P-gp was decreased from 14.13±2.63 to 0.43±0.15,P0.05.CONCLUSIONS:Nimesulide can enhance the cytotoxicity of mitomycin in breast cancer MDA-MB-231 cell line.COX-2 is closely related to multdrug resistance,and perhaps it regulates the effect of multidrug resistance by P-gp.

千鼎健肾宝(Equiguard)是用于治疗肾阳虚证的一种中成药,本研究观察其临床疗效,并探讨千鼎健肾宝对老年患者肾阳虚的作用机制.现将结果报道如下.

Objective To investigate the relationship between clinical features and renal pathological classification in IgA nephropathy(IgAN).Methods Clinical features and renal pathological classification in 62 paients with IgAN were collected and analyzed.Results Mesangial proliferative glomerulonephtitis,focal proliferative glomerulonephritis and focal segmental glomerulosclerosis are the most common types(90.32%),Lee's pathological grade Ⅲ and Ⅳ are the most common types(82.26%).Blood pressure,serum creatinine,uric acid and 24-hour urinary protein levels increase with Lee's pathological grade increasing(P<0.05 or P<0.01).There is positive correlation between Katafuchi score and systolic blood pressure,serum creatinine,urea nitrogen,uric acid and 24-hour urinary protein levels(P<0.01).Conclusion Renal pathology in IgAN is significantly correlated with clinical features.

目的观察脂微球前列腺素E1治疗慢性肾功能不全的疗效。方法将70例慢性肾功能不全患者随机分为治疗组和对照组各35例,对照组给予一般对症治疗,治疗组在同对照组治疗的基础上给予脂微球前列腺素E1,观察两组患者治疗前后的血尿素氮、肌酐、血尿酸、24h尿蛋白定量、血红蛋白、血压等指标,并观察临床症状的变化。结果两组治疗前后血尿素氮、肌酐、尿酸均有明显变化,但治疗组作用尤为明显,差异均有统计学意义(均P<0.05);24h尿蛋白定量治疗组下降显著(P<0.05),对照组则不明显(P>0.05);血红蛋白、平均动脉压两组治疗前后都有不同程度的改善,但差异均无统计学意义(均P>0.05)。结论脂微球前列腺素E1对慢性肾功能不全患者有一定的治疗作用。