浅析血管迷走性晕厥患者的临床诊治

血管迷走性晕厥是不伴有器质性病变,以心脏神经调节功能异常为主的一种疾病。其临床表现差异大,可见胸痛、胸闷、心悸、头晕、出汗、恶心及晕厥等多种症状,伴心率时快时慢,血压偏低等体征,故疾病指征特异性差,易导致临床误诊及漏诊。其主要发病机制为各种原因引起交感神经兴奋,迷走神经反射性张力增高抑制交感神经过度,而出现的"矫枉过正"现象。随着医疗技术迅速发展,对血管迷走性晕厥的检查技术也越来越多,其中以直立倾斜试验最为常用。治疗上有药物治疗和神经消融,以药物治疗为主。     

儿童直立调节试验对不明原因晕厥的诊断价值

目的:探讨直立倾斜试验对儿童不明原因晕厥的诊断价值,为临床诊断提供科学依据。方法:对208例不明原因晕厥的儿童给予进行直立倾料试验检查,持续进行心电监护监测,记录其血压、心率变化,分析试验结果。结果:145例(69.71%)出现阳性的血管迷走神经反应,73例(50.34%)为血管抑制型反应;19例(13.10%)呈心脏抑制型反应;53例(36.55%)为混合型反应型,并且诱发因子多为持久站立。结论:不明原因晕厥患者在直立倾斜试验中以血管迷走反应为主,持久站立是血管迷走神经性晕厥的主要诱因。     

不同治疗方式对冠心病合并心脏瓣膜炎患者血清炎性反应的影响

目的:比较不同治疗方式对冠心病合并心脏瓣膜炎的临床指标、生活质量及血清炎性反应的影响。方法:选取2014年2月~2016年6月期间于本院进行治疗的64例冠心病合并心脏瓣膜炎患者为研究对象,将其随机分为对照组和观察组每组各32例,对照组进行常规的药物治疗,观察组则进行外科手术治疗,然后将两组患者治疗前后的心脏功能指标、生活质量及血清炎性指标进行比较。结果:治疗前两组患者的心脏功能指标、生活质量及血清炎性指标比较,P均0.05,而治疗后观察组的心脏功能指标、生活质量及血清炎性指标均显著地好于对照组,P均0.05,均有显著性差异。结论:外科手术对冠心病合并心脏瓣膜炎患者血清炎症因子水平及生活质量具有积极的改善作用,适于临床进一步推广应用。     

三叉神经痛的临床治疗进展

三叉神经痛是一种常见的面部疼痛性疾病,目前对其病因的认识并不明确。普遍认为压迫可导致三叉神经痛,致病原因包括血管因素和非血管因素,其次创伤也可导致三叉神经痛,常见于口腔外科手术后。三叉神经痛的治疗方法较多,首选药物治疗,包括全身用药和局部用药,药物治疗初期效果明显,但很难治愈三叉神经痛,而且需要长期服药,副作用较大,当药物治疗无效或者患者难以耐受其副作用时,可采用外科疗法进行辅助治疗。三叉神经痛的外科疗法主要包括无创的微血管减压术及有创的射频热凝术、球囊压迫术和甘油毁损术。近年来采用放射外科对三叉神经痛进行治疗,取得了确切效果。此外,还有一些关于其他治疗方法的文献报道,均有一定效果。本文对三叉神经痛病因的认识及临床治疗进展作一回顾性综述。     

外周动脉疾病治疗进展

外周动脉疾病(PAD)与心血管疾病(CV)的发病率和死亡率有着密切的联系。ACCF/AHA指南建议无症状和症状性PAD患者戒烟并应用抗血小板/抗凝药物。对于存在严重肢体缺血(CLI)的PAD患者应考虑接受腔内与开放保肢手术治疗。即便存在CLI的PAD患者接受如上治疗,有时仍无法为患肢提供足够的血流灌注以消除症状。为建立有效血供,许多研究已经深入细胞治疗层面。内皮干细胞、单核细胞和骨髓间充质干细胞在临床应用中得到了很好的研究。血管内皮生长因子、成纤维细胞生长因子和肝细胞生长因子(HGF)也被应用于PAD患者,以诱导血管生成。其中,HGF最有优势,因为它可诱导血管生成却不伴有反应性血管炎及血管通透性增高。同时,血管腔内治疗器械及技术,如药物涂层球囊等也获得较快发展。本文将PAD治疗进展综述如下。     

血管生成在冠心病治疗中的应用进展

随着心血管治疗药物与技术方法的进步 ,冠心病患者的生活质量有所改善 ,但是晚期冠心病 (ｅｎｄ ｓｔａｇｅｃｏｒｏｎａｒｙｈｅａｒｔｄｉｓｅａｓｅ)患者对于常规药物治疗反应较差 ,而且由于病人年龄偏大或冠状动脉的弥漫性病变等原因而不适于进行传统的心肌血管重建术 ,如冠状动脉搭桥术 (ｃｏｒｏｎａｒｙａｒｔｅｒｙｂｙｐａｓｓｇｒａｆｔ ,ＣＡＢＧ)和经皮穿刺冠状动脉腔内血管成型术 (Ｐｅｒ ｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌｃｏｒｏｎａｒｙａｇｉｏｐｌａｓｔｙ ,ＰＴＣＡ )等 ,因此如何改善晚期冠心病患者的生活质…     

癌性疼痛患者药物止痛治疗依从性调查

目的 了解癌性疼痛患者对药物治疗依从性情况,为规范三阶梯止痛治疗提供指导.方法 采用调查研究方法,应用自制的调查问卷方式对178例癌性疼痛患者药物治疗的遵医行为进行调查,并分析影响其行为的因素.结果 178例癌性疼痛患者均不能正确遵医嘱进行治疗,主要是对药物止痛治疗知识缺乏,如恐惧药物依赖成瘾、担心药物影响肿瘤治疗、害怕药物不良反应,其次是对医护人员不信任及经济问题等.结论 癌性疼痛患者药物止痛治疗依从性有待提高,需医务人员关心体贴患者,加强止痛药物知识的宣教,消除患者的依赖成瘾恐惧感,及时处理药物不良反应;家庭及社会提供经济支持.     

转移性结直肠癌抗血管生成靶向治疗的研究进展

近年来,由于各种新的化疗药物及分子靶向药物的使用,转移性结直肠癌(metastatic colorectal cancer,m CRC)的个体化治疗逐步取得了重要的成果。研究表明,抗血管生成靶向药物与化疗药物的联合使用作为转移性结直肠癌的一线治疗方案,可明显改善治疗效果,延长患者的生存时间。血管内皮生长因子(vascularendothelial growth factor,VEGF)是肿瘤血管生成过程中最主要的因子。贝伐单抗是通过基因工程技术得到的针对血管内皮生长因子-A(VEGF-A)的单克隆抗体,作为抗血管生成靶向药物用于转移性结直肠癌的临床治疗。本文对近年来转移性结直肠癌的抗血管生成靶向治疗,尤其是贝伐单抗治疗的相关研究进展进行综述并展望未来抗血管生成靶向治疗的发展前景。     

子宫内膜异位症的药物治疗

子宫内膜异位症(EMS)是妇科常见病,近年来发病率逐年上升,仅次于子宫肌瘤。虽然为良性疾病,却表现为恶性行为,主要特征为疼痛、不孕及性交困难,导致生活质量下降。其治疗目的在于消除病灶、缓解疼痛和解决生育问题,降低术后复发也不可忽视,因此,药物治疗尤为重要,不同的药物有不同的作用机理、副作用及用药时间。不同的患者需要根据其治疗目的、身体情况及经济状况选择不同的治疗方案。所以药物治疗应注意个体化、阶梯化和规范化。本文就近年来内异症的药物治疗做一综述。     

扩张型心肌病治疗研究进展

扩张型心肌病是一种以单侧或双侧心腔扩大和收缩功能障碍等为特征,治疗困难、预后较差的临床常见疾病,致病因素及临床表现复杂多样,其治疗方法一直是医学研究的热点。扩张型心肌病的治疗手段涵盖常规药物治疗及非药物治疗,后者包括手术治疗及不断发展的免疫治疗、干细胞移植和基因治疗等,且每种治疗方法都有各自的优缺点,本文针对扩张型心肌病治疗方法的最新研究进展进行综述,以期为临床治疗提供新的依据和方向,提高扩张型心肌病患者的生活质量和生存率。     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

The structure, reproduction and taxonomy of Vidalia and Osmundaria (Rhodophyta, Rhodomelaceae)

Comprises species occurring mostly in subtidal habitats in tropical, subtropical and warm-temperate areas of the world. An analysis of the type species, V. spiralis (Sonder) Lamouroux ex J. Agardh, a species from Australia, establishes basic characters for distinguishing species in the genus. These characters are (1) branching patterns of thalli, (2) flat blades that may be spiralled on their axis, (3) width of the blade, (4) primary or secondary derivation of sterile and fertile branchlets and (5) position of sterile and fertile branchlets on the thalli. Application of the latter two characters provides an important basic method for separation of species into three major groups. Osmundaria , a genus known only in southern Australia, was studied in relation to Vidalia , and its separation from the Vidalia assemblage is not accepted. Species of Vidalia therefore are transferred to the older genus name, Osmundaria. Two new species, Osmundaria papenfussii and Osmundaria oliveae are described from Natal. Confusion in the usage of the epithet, Vidalia fimbriala Brown ex Turner has been clarified, and Vidalia gregaria Falkenberg, described as an epiphyte on Osmundaria pro/ifera Lamouroux, is revealed to be young branches of the host, Osmundaria prolifera.     

New or rare chromosome counts in Artemisia L. (Asteraceae, Anthemideae) and related genera from Kazakhstan

Fifteen chromosome counts of six Artemisia taxa and one species of each of the genera Brachanthemum, Hippolytia, Kaschgaria, Lepidolopsis and Turaniphytum are reported from Kazakhstan. Three of them are new reports, two are not consistent with previous counts and the remainder are confirmations of very scarce (one to four) earlier records. All the populations studied have the same basic chromosome number, x = 9, with ploidy levels ranging from 2x to 6x. Some correlations between ploidy level, morphological characters and distribution are noted.     

肝癌中HBV和HCV基因和抗原的分布及意义

采用原位分子杂交方法检测HCV RNA及HBV X基因;采用免疫组织化学方法研究HCV核心抗原,非结构区C33c抗原及HBxAg在肝细胞肝癌中的定位及分布.结果表明(1)HCV RNA、HBV X基因在肝细胞肝癌组织检出率分别为40%(55/136)和82%(112/136).HCV RNA定位于癌细胞的胞浆内,阳性细胞呈散在、灶状及弥漫分布三种形式;HBV X基因在肝癌细胞中的分布呈胞浆型、核型及核浆型,阳性细胞也呈上述三种分布形式;(2)HCV C33c抗原、核心抗原在肝细胞肝癌中的阳性率为81%(133/164)及86%(141/164).C33c抗原定位于癌细胞及肝细胞的胞浆内;核心抗原既定位于癌细胞核中,又可定位于胞浆中.C33c抗原阳性细胞以灶状分布为主;而核心抗原阳性细     

Selection with two alleles and complete dominance

For a plant selection model with frequency-independent viabilities, fertilities and selfing rates, it is shown that apart from global fixation, for certain parameter combinations a protected polymorphism and facultative fixation (either allele may become fixed according to initial frequencies) may both occur. Facultative fixation requires different selling rates for the dominant and recessive type. Protection of the polymorphism requires resource allocation for male and female function. In this connection the problem of purely genetically caused population extinction is discussed.
For general frequency dependence and regular segregation, the chances for establishment of a completely recessive gene are compared to those of a completely dominant gene. It is proven that the process of establishment of the recessive gene, despite a fitness advantage, may be considerably endangered by drift effects if random mating prevails. The recessive gene may reach the same effectivity in establishment as a dominant gene, only if the recessive homozygote mates exclusively with its own type during the period of establishment.