目的 分析呼吸康复治疗对农村地区慢性阻塞性肺疾病(COPD)稳定期患者BODE评分系统的影响。方法 将我院收治的60例COPD稳定期患者作为研究对象,随机分为对照组与观察组,每组30例。对照组常规治疗,观察组则给予呼吸康复治疗方案。比较两组患者治疗前后BOBE评分系统的变化。结果 治疗后,观察组BMI、FEV1%、MMRC分级、6MWD分别为(22.4±1.1)kg/m²,(68.6±3.6)%,(1.3±0.2)级,(256.3±36.3)m,BODE指数评分降低至(3.4±1.0)分,ADL为(78.2±6.4)分,QOL为(67.8±2.6)分,与对照组相比差异有统计学意义(P<0.05);且观察组炎性因子水平下降幅度高于对照组(P<0.05)。结论 在农村地区COPD稳定期患者的临床治疗中,采用呼吸康复治疗方案,患者BODE评分系统指标改善显著,值得推广。

Objective To analyze the influence of respiratory rehabilitation treatment on BODE coring system of patients with chronic obstructive pulmonary disease (COPD) in stable phase in rural areas. Methods 60 patients with COPD in stable phase admitted into the hospital were selected as the research object and were randomly divided into control group and observation group with 30 cases in each. The control group received conventional treatment while the observation group received respiratory rehabilitation treatment. The changes of BOBE coring system in the two groups before and after the treatment were compared. Results After the treatment, BMI, FEV1% MMRC classification and 6MWD of the observation group were (22.4±1.1) kg/m², (68.6±3.6)%, (1.3±0.2) and (256.3±36.3) m respectively. The BODE index score decreased to (3.4±1.0), ADL (78.2±6.4), and QOL (67.8 + 2.6).compared with those of the control group, the difference was statistically significant (P< 0.05). And the decline level of inflammatory factors in the observation group was significantly higher than that of the control group (P<0.05). Conclusion In the clinical treatment of patients with COPD in stable phase in rural areas, respiratory rehabilitation treatment were adopted, the improvement of BOBE coring system indexes is significant. It is worthy to be popularized.

目的 回顾性分析采用内镜下氩离子凝固术治疗胃出血的治疗效果,为临床治疗胃出血提供经验及理论基础。方法 选取2010年1月—2014年7月我院收治的胃出血患者199例,随机分为两组,分别对其进行内镜下氩离子凝固术治疗和内镜下高频电凝治疗,总结对比其治疗效果,并对其并发症情况进行统计。结果 经治疗后,A组28例胃黏膜溃烂出血患者未再出血27例(96.43%),E组22例胃黏膜溃烂出血患者未再出血例数17例(77.27%),差异有统计学意义(P<0.05);A组治疗后形成局部炎性肉芽肿及发生胃穿孔的百分比低于E组,差异有统计学意义(P<0.05)。结论 采用内镜下氩离子凝固术治疗胃出血,止血率高,并发症发生率低,效果良好,值得在临床中推广使用。

Objective A retrospective analysis was performed using endoscopic argon plasma coagulation treatment of stomach bleeding, to provide experience and theoretical basis for the clinical treatment of stomach bleeding. Methods January 2010-July 2014 199 cases of bleeding in patients admitted to our hospital.They were randomly divided into two groups and had therapeutic endoscopic argon plasma coagulation. We summarized the treatment effect and its complications statistics. Results After therapy, 27 gastric mucosa fester patients(96.43%) of 28 patients in group A stopped bleeding and 17 gastric mucosa fester patients(77.27%) of 22 patients in group B stopped bleeding and the difference is statistical significance(P<0.05), and the incidence rate of inflammatory granuloma and gastric perforation of group A is significant lower than that of group B (P<0.05). Conclusion Endoscopic argon plasma coagulation therapy is taken to treat gastrorrhagia, hemostasis rate is higher and complication rate is lower. It is worth widely using in the clinic.

目的 对兰索拉唑肠溶片联合氟哌噻吨美利曲辛治疗焦虑糜烂性胃炎患者的治疗效果进行研究。方法 选取2013年1月—2015年1月在我院收治的伴有焦虑情绪的糜烂性胃炎患者106例。随机分为对照组,给予兰索拉唑肠溶片治疗,观察组,给予兰索拉唑肠溶片联合氟哌噻吨美利曲辛治疗,并且对疗效进行比较。结果 治疗前,两组患者在腹痛、腹胀、反酸、嗳气以及黏膜糜烂各指标评分比较,差异无统计学意义(P>0.05);治疗后,2组患者以上指标均有所改善,并且观察组患者同期指标改善均优于对照组(P<0.05);治疗前,两组患者胃黏膜中PGE2和MDA含量无差异(P>0.05);治疗后,两组患者的PGE2均上升,而MDA则下降,并且观察组患者PGE2含量比对照组高,MDA则比对照组低,差异均有统计学意义(P<0.05);治疗前,两组患者HAMA、HAMD评分差异不明显,无统计学意义(P>0.05);治疗后,两组患者焦虑情况均有所改善,并且观察组患者情绪改善程度优于对照组患者,差异均有统计学意义(P<0.05);观察组不良反应发生率为5.6%,对照组不良反应发生率5.6%,差异无统计学意义,P>0.05。结论 兰索拉唑与氟哌噻吨美利曲辛联合应用有助于改善糜烂性胃炎患者的病情,并且可以缓解患者的焦虑情绪,安全性高,值得临床推广。

Objective To observe the clinical efficacy of lansoprazole enteric-coated tablets combined with flupentixol-melitracen in treating anxiety patients with erosive gastritis. Methods 106 patients with erosive gastritis and anxiety in our hospital from January 2013 to January 2015 were divided into an observation group and a control group, with 53 patients in each group. The control group was given lansoprazole enteric-coated tablets alone, and the observation group was treated with lansoprazole enteric-coated tablets and flupentixol-melitracen. Clinical symptoms and mucosal erosion were compared between the two groups of patients before and after treatment. Gastric mucosa malondialdehyde (MDA) and prostration E2 (PGE2) contents, anxiety and depression status were also assessed. Results After treatment, the scores of abdominal pain, bloating, acid reflux, belching, and mucosal erosions were significantly lower in the observation group than in the control group (P< 0.05). PGE2and MDA contents in the gastric mucosa in the observation group were different from those in the control group(P< 0.05). HAMA and HAMD scores were lower in the observation group than in the control group (P< 0.05). There was no difference of adverse reaction rate between the control group and the observation group (P>0.05). Conclusion Lansoprazole enteric-coated tablets combined with flupentixol-melitracen has better clinical efficacy than lansoprazole enteric-coated tablets only in patients with erosive gastritis and anxiety in terms of the improvement of clinical symptoms and mucosal erosion and the relief of negative emotions.

目的 探讨GDM孕早、中期脂肪细胞因子Chemerin、RBP4水平的变化。方法 采用前瞻性研究,测定38例GDM及40例正常孕妇孕早、中期血清Chemerin、RBP4水平,分析其与胰岛素抵抗的相关性。结果 GDM组孕妇孕早、中期血清Chemerin、RBP4水平及HOMA-IR均较对照组升高,差异有统计学意义(P<0.05);两组孕妇孕中期血清Chemerin、RBP4水平均较孕早期升高,差异有统计学意义 (P<0.05);Chemerin、RBP4水平与IR成正相关,差异有统计学意义(P<0.05)。结论 GDM孕妇孕早、中期脂肪细胞因子Chemerin、RBP4水平升高,Chemerin、RBP4水平的升高与IR有一定相关性。

Objective To discuss the serum levels of the Adipokine Chemerin、RBP4 of Gestational Diabetes Mellitus(GDM) in early pregnancy and middle pregnancy. Methods In prospective study, pregnant women, venous blood was collected from 40 controls and 38 GDM during early pregnancy (9-12weeks)and middle pregnancy (22-26weeks). Serum insulin, Chemerin, RBP4 were measured by enzyme-linked immunosorbent assay (ELISA). Results Mean serum levelsof Chemerin and RBP4 were significantly higher among GDM cases compared with controls during early pregnancy and middle pregnancy(P<0.05). In two groups, Mean serum levels of Chemerin and RBP4 in middle pregnancy were significantly higher than those in early pregnancy (P<0.05).During early pregnancy and middle pregnancy, the Chemerin and RBP4 levels were positively related with HOMA-IR (P＜0.05). Conclusion There is evidence of a positive association elevated Chemerin and RBP4 concentration of early pregnancy and middle pregnancy with increased GDM risk.

目的 探讨纵隔髓外造血(EMH)的临床特点,从而为其诊断、治疗提供参考意见。方法 总结分析我科收治的1例双侧后纵隔骨髓外造血组织多发瘤样增生,并对近10年来国内相关文献报道的27例病例进行回顾性分析。结果 患者需行手术活检取得病理诊断,确诊髓外造血。结论 纵隔髓外造血瘤样增生是一种罕见特殊的良性病变, 预后良好。但因其临床表现和影像学均缺乏特异性,当临床中遇到发生在后纵隔脊柱旁的占位性病变,同时患有贫血的患者应考虑EMH 的可能性,给予经皮穿刺或者胸腔镜下活检来取得细胞学诊断,从而避免不必要的手术治疗。

Objective To probe into the clinical features of mediastinal extramedullary hematopoiesis (EMH), for providing a reference for clinical diagnosis and treatment. Methods The clinical data was studied in a case of mediastinal EMH from our department, and 27 case reports from domestic published literatures over the last decade were analyzed retrospectively. Results Of the 27 patients, 15 received surgical excision, while the other 12 underwent needle biopsy. In our patient, the diagnosis of EMH was made by mini thoracotomy and open biopsy. Conclusion Mediastinal EMH is a rare disease and its prognosis is well. Because there is no obvious specific clinical symptoms and imaging appearances, the possibility of EMH should be considered when a patient with a mediastinal tumor associated with anemia is encountered. Diagnosis can be achieved by needle biopsy or video-assisted thoracic surgery (VATS) in order to prevent unnecessary surgical procedures.

目的 建立胎儿左、右肺面积及肺头比的正常参考值范围。方法 对501例正常单胎妊娠12～40周胎儿在标准四腔心切面应用手工描绘法分别描迹左肺、右肺面积,分别除以头围获得左、右肺头比。结果 获得正常妊娠胎儿左、右肺面积及肺头比各孕周参考值范围。胎儿左、右肺面积及肺头比均随孕周的增长而增大。结论 正常妊娠胎儿左、右肺面积及肺头比与孕周呈正相关。不同孕周LHR参考值的建立有利于临床评价膈疝及其他胸腔占位性疾病的预后。

Objective To establish reference intervals for fetal left and right lung areas and lung area to head circumference ratio (LHR). Methods In 501 cases of normal singleton pregnancy between 12 to 40 weeks, the left and right lung areas were measured respectively by ultrasound in the standard four chamber view, using manual tracing of the limits of the lungs. The left and right LHR were calculated when head circumferences were divided by the left and right lung area. Results Normal fetal reference intervals of left and right lung areas and LHR with gestational age were obtained. Fetal left and right lung areas and LHR increased with gestational age. Conclusion Fetal left and right lung areas and LHR values positively correlated with gestational age in normal pregnancy. Normal reference intervals of fetal LHR for every gestational age are valuable for evaluation of prognosis of fetal diaphragmatic hernia and other pulmonary peripheral space-occupying lesions.

目的 目前对于生物反馈发挥治疗作用的机理还未完全研究清楚,该实验借助近似熵(ApEn)这一新型的非线性研究方法,研究在生物反馈过程中心电的变化,从而希望发现生物反馈对心脏功能的潜在影响。方法 总数30人的健康正常受试者纳入研究,其中20人为生物反馈实验组,10人为正常对照组。该实验采用肌电生物反馈作为反馈方法,同时记录心电的变化。实验所得数据采用非线性动力学参数—近似熵(ApEn)进行研究。结果 实验组的平均心率在最后两个生物反馈阶段高于对照组。随着实验进展,实验组的心率标准差逐渐缩小,而心率和心电ApEn明显增高。结论 该实验发现生物反馈能够影响心电生理系统,使得心脏系统变得更加健康,展现出更强的抗应激能力,从而揭示了生物反馈潜在的治疗机理。

Objective The mechanism about biofeedback is not complete clear. Our aim was to study changes of cardiac function (electrophysiology) during biofeedback with the help of approximate entropy (ApEn), and a potential new mechanism about neurofeedback may be detected. Methods A total of 30 healthy volunteers participated in this study which consisted of the neurofeedback group(n=20) and the control group (n=10). We applied electromyogram neurofeedback as the feedback method, and simultaneously recorded electroencephalogram(EEG) and electrocardiogram(ECG). We applied the nonlinear analysis ApEn assess obtained data. Results In the biofeedback group the average of heart rate was higher than that of control group in the last two sessions. As the biofeedback experiment sessions were progressed, the standard deviation of heart rate gradually reduced and the ApEn of ECG increased with statistic significance in the biofeedback group. Conclusion We found that biofeedback can influence cardiac electrophysiological system and make cardiac systems progress healthily and achieve greater ability of anti-stress.

目的 水解乳清蛋白对炎症性肠病大鼠的抗炎作用及机制。方法 将40只雄性大鼠随机分为实验组和对照组,并建立炎症性肠病动物模型,分别喂食添加了水解乳清蛋白及普通蛋白的饲料,喂养4周后处死大鼠,每周检测体重,血清ALB、TNF-α、IL-2、IL-6等。结果 二组间体重及血清白蛋白无区别(P>0.05),实验组与对照组的TNF-α、IL-2及IL-6无区别(P>0.05),从第二周到第四周,实验组的炎症因子水平低于对照组(P<0.05)。结论 水解乳清蛋白具有抗炎作用,能够减少炎症性肠病大鼠动物模型的炎症因子的释放,并改善其营养状况。

Objective To evaluate the anti-inflammatory effects of whey protein on SD rats model of inflammatory bowel disease. Methods 40 SD rats model of inflammatory bowel disease were established and randomly divided into experimental and control groups equally. Experimental and control groups were fed whey protein and ordinary protein respectively. After 4 weeks, TNF-α, IL-2 and IL-6 were detected. Results There were no significant difference between the two groups of weights and the level of ALB. The level of TNF-α, IL-2 and IL-6 between groups were not significantly different in the first week(P>0.05). However, thelevels of TNF-α, IL-2 and IL-6 in experimental group were significantly lower than those of the control group in the follow weeks. Conclusion The whey protein could reduce the production of inflammatory cytokines.

目的 观察Bax抑制因子(Bax-inhibiting peptides,BIP)对肠上皮细胞的保护作用,并探讨其作用机制。方法 建立1日龄新生大鼠的坏死性小肠结肠炎模型。BIP于建模前腹腔内注射,建模后分别检测各组肠组织病理,并分别用流式细胞仪检测各组肠细胞凋亡率,western blot法检测bax下游凋亡蛋白细胞色素C、caspase 9和caspase 3含量。结果 与NEC组及Bax10 μg组比较,bax50 μg和100 μg可减轻肠上皮损伤,减少肠细胞凋亡率,降低bax下游凋亡蛋白细胞色素C、caspase9和caspase3含量。结论 一定剂量的Bax抑制肽可通过降低活性Caspase-3及CytC蛋白释放,保护线粒体膜,抑制肠上皮细胞调亡,发挥对肠上皮细胞的保护作用。

Objective To investigate the protective effects of Bax-inhibiting peptides(BIP) on intestinal epithelial cells and to explore its mechanism. Methods The model of neonatal necrotizing enterocolitis in 1 day neonatal rats were established. Before establishing the model, BIP was intraperitoneal injected to the rats. The pathological of intestinal tissue were detected respectively, the intestinal cell apoptosis rate were detected by flow cytometry, the levels of downstream apoptosis proteins of Bax were detected by Western blotting respectively. Results Compared to NEC and Bax10μg group, bax50μg and 100 μg can significantly reduce the intestinal epithelial damage and intestinal cell apoptosis rate and can decrease the levels of cytochrome C, caspase-9 and caspase-3, downstream apoptosis proteins of Bax,significantly. Conclusion A certain dose of Bax-inhibiting peptides can protect the mitochondrial membrane, inhibit the apoptosis of intestinal epithelial cells by reducing the level of Caspase-3 and CytC and play a protective effect on intestinal epithelial cells.

目的 探讨子宫内膜微腺体癌的临床病理特征、诊断及鉴别诊断。方法 对1例首诊误诊为子宫颈微腺体增生的子宫内膜微腺体癌病例进行临床、病理组织学及免疫组织化学特征的观察及总结,同时进行相关文献复习。结果 本例患者年龄61岁,因绝经后阴道不规则流血1年就诊,B超提示子宫内膜不规则增厚,并行分段诊刮术,先后两次诊刮标本光镜下均见黏液性柱状上皮呈乳头状及网格状结构,细胞轻度异型,核分裂罕见,间质内大量中性粒细胞浸润伴腺上皮内“微脓肿”形成;免疫组化示:上皮成分P16弥漫强(+),CEA小灶(+),Vimentin弥漫(+),ER约90%(+,中-强),PR约90%(+,弱),Ki-67约3%(+),间质细胞CD10(+)、CD34(-)。结论 子宫内膜微腺体癌是一种极为罕见的子宫内膜黏液腺癌,其组织学形态与子宫颈良性病变微腺体增生十分相似,易于混淆,但通过免疫组化检查及详细地临床病史资料收集、分析,可以与其鉴别,从而做出正确地诊断。

Objective To investigate clinical and histopathological features, dignosis and differential diagnosis of the endometrial microglandular adenocarinoma (MGA). Methods The clinical and pathological features of microglandular adenocarinoma in a patient were observed. Immunohistochemical staining and literature review were also used. Results In the case, the age of patient was 61 years. Clinical manifestation was vaginal irregular bleeding for 1 year. Type-B ultrasound suggested endometrium was irregular thickening. Histologically, it was mainly composed of irregular shape, closely spaced small glands, and glandular cells was mild atypical. Mitosis was rarely observed. The endometrial stromata between gland were rare, but neutrophil were much observed with the formation of neutrophil microabscess in the glandular epithelium. Immunohistochemical study showed neoplastic cells were diffuse and strongly positivity for P16, diffuse positivity for vimentin, focally positive for CEA. ER and PR expression was found in approximately 90% tumor cells. The index of Ki-67 was about 3%. Interstitial cells were positivity for CD10, negativity for CD34. Conclusion The microglandular adenocarcinoma is a rare endometrial adenocarcinoma. It can be differentiated from cervical microglandular hyperplasia(MGH) and cervical mucinous adenocarcinoma by immunohistochemistry and morphological characteristics.