目的:觀察相同劑量不同濃度的羅哌卡因用于腰叢坐骨神經聯合阻滯的臨床效果。方法:擇期行單側下肢手術的患者90例,年齡18~65歲,ASAⅠ或Ⅱ級,隨機分為3組(n=30):A組給予0.3 ％的羅哌卡因腰叢36 mL、坐骨神經24 mL,B組給予0.36 ％的羅哌卡因腰叢30 mL、坐骨神經24 mL,C組給予0.4％羅哌卡因腰叢27 mL、坐骨神經18 mL。分別于給藥后2、5、10、15、20、25、30、35 min測定下肢的感覺、運動評分以及感覺阻滯的時間和運動阻滯的時間。結果:三組患者阻滯起效時間無明顯差別,高容量組完全阻滯的持續時間短于低容量組;高容量低濃度組患者完全阻滯率高于低容量組,但達到完全阻滯時間長于低容量組。結論:在劑量相同時羅哌卡因的濃度和容量會影響腰叢和坐骨神經的阻滯 效果;高容量羅哌卡因更有利于達到良好的感覺阻滯。
目的:探討全直腸系膜切除術(total mesorectal excision,TME)結合雙吻合器(DST)治療低位直腸癌的效果及臨床價值。方法:對我院85 例低位直腸癌患者采用 TME和DST聯合治療的方法,觀察治療后的排便功能及療效.結果:所有患者手術均順利,無吻合口瘺和狹窄,切割環均完整,無手術閉合失敗及手術死亡。隨訪時間6 個月～5年,局部復發率4例(4.7%)。排便控制功能:優75 例(88.2%),良9 例(10.6%),差1 例(1.2%)。結論:TME和 DST聯用治療低位直腸癌,保肛效果滿意,并發癥少,提高了患者的生存質量,值得臨床推廣。
ObjectivesTo systematically review the efficacy and safety of hydrotalcite in the treatment of reflux esophagitis (RE).MethodsCBM, CNKI, WanFang Data, VIP, PubMed, EMbase, The Cochrane Library, Web of Science and Scopus databases were searched online to collect randomized clinical trials (RCTs) of hydrotalcite or hydrotalcite plus PPI versus PPI alone in the treatment of RE from inception to June 30th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 1 655 patients were included. The results of meta-analysis showed that: after 4-8 weeks of treatment, there was no significant difference between hydrotalcite vs. PPI regarding RE healing rates (RR=0.87, 95%CI 0.76 to 1.00, P=0.05). However, there were significant increases in RE healing rate (RR=1.22, 95%CI 1.14 to 1.31, P<0.001) and symptom relief rate (RR=1.36, 95%CI 1.12 to 1.66,P<0.01) between hydrotalcite plus PPIvs. PPI alone. Similar increases of RE healing rate (RR=1.16, 95%CI 1.08 to 1.25, P<0.001) and symptom relief rate (RR=1.12, 95%CI 1.04 to 1.20,P<0.01) were seen in patients with refractory RE. No increase of adverse effect rate was shown with hydrotalcite or hydrotalcite plus PPI compared to PPI alone.ConclusionsCompared with PPI alone, hydrotalcite plus PPI confers a statistically significant improvement of healing rate and symptom relief rate, while it does not increase adverse effect rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Object ive To summa r i z e the advanc ement of cytoske l e ton and axon outgrowth of neuron. Methods The recent l iterature concerning cytoskeleton and axon outgrowth of neuron was reviewed and summarized. Results The actin filaments and microtubules in neuron were highly polarized and dynamic structures confined to the ti ps of axons and the reci procal interactions between these two major cytoskeletal polymers was also dynamic. Attractive or a repulsive cue whose final common path of action was the growth cone cytoskeleton mediated the growth of axons of neuron by intracellular signaling cascades. Regulating the actin filament and microtubule dynamics as well as their interactions in growth cones played a key role in neurite outgrowth and axon guidance. Rho-GTPases and glycogen synthase kinase 3β (GSK-3β), the two major intracellular signal ing pathways had emerged in recent years as candidates for regulating the dynamics of actin filaments and microtubules. Conclusion The axon outgrowth and guidance depend on well-coordinated cytoskeletal and reciprocal interaction dynamics which also mediate axon regeneration after spinal cord injury. Regulating activity of Rho-GTPases and GSK- 3β simultaneously may acts as key role to regulate the dynamics of cytoskeletal and to determine axon outgrowth.