螺旋CT肾脏灌注参数与肾功能生化检测指标的相关性研究

目的探讨64层螺旋CT肾灌注成像与肾功能生化检测指标的相关性。方法对29例患者行双侧肾脏64层螺旋CT灌注扫描，其中包括泌尿系统结石16例、肾囊肿5例、膀胱炎症4例、慢性肾功能不全4例。分别绘制肾门层面的肾皮、髓质及整体。肾实质的感兴趣区（ROI）的时间-密度曲线（TDC）。根据TDC计算。肾血流灌注参数，包括血流量（BF）、血容量（BV）、平均通过时间（MTT）、达峰时间（TTP）。收集灌注前3d患者血肌酐（SCr）和血尿素氮（BUN）值。分别将SCr和BUN与各部位灌注参数进行pearson相关性分析。结果皮质BF为（171±59）ml／（min·100g）、BV（72±25）ml／100g、MTT（44±57）S、TTP（16±6）S；髓质BF（39±10）ml／（min·100g）、BV（181±82）ml／100g、MTT（305±131）S、TTP（46±8）S；整体实质BF（96±29）ml／（min·100g）、BV（125±51）ml／100g、MTT（165±72）S、TTP（30士5）S。SCr值与。肾皮质BF、BV、MTT、TTP有显著相关性（r=-0.380、0.511、0.674、0.682，P〈0.05），与髓质及整体。肾实质的灌注参数无显著相关性（P〉0.05）；BUN值与肾脏各部位的灌注参数均无显著相关性（P〉0.05）。结论肾皮质64层螺旋CT灌注成像能精确反映肾功能，与SCr值有明显相关性。     

血清基质金属蛋白酶2和抑制因子与绝经后骨质疏松症的相关性

目的探讨绝经后妇女血清基质金属蛋白酶2（MMP-2）和抑制因子（TIMP-2）水平及其与绝经骨质疏松症指标的关系。方法将202名48～65岁绝经后妇女分为正常组、低骨量组和骨质疏松组，用酶联免疫吸附试验（EIJSA）测定的血清MMP-2、TIMP-2以及骨保护蛋白（OPG）、骨保护蛋白配体（OPGL），计算MMP-2／TIMP-2和OPG／OPGL比值，用双能X线吸收法（DEXA）测定腰椎正位、股骨颈、华氏区和大粗隆的骨密度（BMD）。结果①骨质疏松组中血清MMP-2的数值（1392±121）μg／L高于正常组（1123±141）μg／L（P〈0．05），而TIMP-2的数值（44．3±36．2）ng/ml低于正常组（47．8±30．2）ng/ml。②骨质疏松组中血清MMP-2和MMP-2／TIMP-2比值与骨密度、血精OPGL数值存在明显负相关性（P〈0．05），和OPG和OPG／OPGL比值存在明显正相关性（P〈0．05），TIMP-2和华氏区骨密度和OPG存在明显正相关性（P〈0．05）。结论血清MMP-2和MMP-2／TIMP-2比值与绝经后骨质疏松症妇女骨密度和骨代谢指标OPG、OPGL和OPG／OPGL比值具有关联性。血清MMP-2水平升高和MMP-2／TIMP-2比值降低可能为绝经后骨质疏松症伴随骨代谢转换过程增快的表现。     

经大粗隆双通道减压植骨加异体腓骨支撑治疗股骨头坏死的近期疗效观察

目的： 探讨经大粗隆双通道减压植骨加异体腓骨支撑治疗股骨头坏死的近期临床疗效。方法： 自2017年11月至2019年2月纳入股骨头坏死患者22例23髋,根据国际骨循环研究学会（Association Research Circulation Osseous,ARCO）分期：Ⅱ期组13髋,年龄20~48（32.5±8.5）岁;Ⅲ期组10髋,年龄18~45（32.7±8.6）岁。应用经大粗隆的单一入路行双通道下的减压植骨及异体腓骨支撑术。植入前、后均采用Harris评分系统对髋关节功能评估;植入后3、6、12、18个月摄髋关节正侧位X线片,观察股骨头修复以及坏死进展情况并加以分析。结果： 所有患者获随访,时间12~18（14.6±2.1）个月。Ⅱ期组和Ⅲ期组的Harris评分分别由术前73.2±5.5和66.5±3.4提高到末次随访时的87.6±8.7（P<0.001）和77.2±14.0（P<0.05）。随访患者12个月时的X线片提示：Ⅱ期组术后改善12髋,Ⅲ期组术后改善7髋。结论： 经大粗隆双通道减压植骨加异体腓骨支撑术治疗早中期股骨头坏死效果良好,尤其适用于中青年ARCOⅡ期的股骨头坏死患者。     

机器人辅助髓芯减压术和传统髓芯减压术治疗早期股骨头坏死的病例对照研究

目的：比较机器人辅助髓芯减压术和传统髓芯减压术治疗ARCOⅠ期股骨头坏死的临床疗效。方法：回顾性分析2018年2月至2020年2月行髓芯减压术的ARCOⅠ期股骨头坏死患者60例（均为单侧手术）,其中行骨科机器人辅助导航下髓芯减压术患者30例（RCD组）,男19例,女11例;年龄17~58（38.50±10.61）岁。行常规髓芯减压术患者30例（CCD组）,男20例,女10例;年龄20~55（40.63±10.63）岁。记录并比较两组患者术中X线透视次数、术中出血量和手术时间,并比较术前、术后24个月Harris评分、视觉模拟评分（visual analogue scale,VAS）。结果：所有患者获得随访,RCD组随访时间21~26（23.40±1.65）个月,CCD组21~26（23.30±1.66）个月,两组比较差异无统计学意义（P>0.05）。RCD组术中X线透视次数、术中出血量、手术时间分别为（9.43±1.14）次、（153.80±22.04） ml、（33.40±1.87） min,CCD组分别为（19.67±1.32）次、（165.04±20.41） ml、（54.75±3.46） min,两组比较差异有统计学意义（P<0.05）。两组术后24个月Harris评分、VAS比较差异无统计学意义（P>0.05）。结论：相比传统髓芯减压术,骨科机器人导航辅助下进行髓芯减压治疗ARCOⅠ期股骨头坏死可减少术中X线透视次数,缩短手术时间,降低手术风险。     

三级甲等医院护士继续教育学习障碍调查分析

目的了解三级甲等医院护士参与继续教育学习的障碍情况。方法对三级甲等医院的367名临床护士采用参与障碍普适量表（DPS-G）进行问卷调查。结果 DPS-G问卷总均分为2.14&#177;0.62,6个维度中时间限制得分最高（2.84&#177;0.98）,缺乏自信得分最低（1.57&#177;0.60）;34个条目中得分居前5位的为课程安排的时间不方便（3.05&#177;1.19）、不能够规律地参与（2.94&#177;1.27）、有些课程太泛化（2.87&#177;1.22）、课程安排的地点不方便（2.84&#177;1.23）及没有时间学习要求的内容（2.81&#177;1.26）;每年获得继续教育30学分以上的护士学习障碍感觉最明显,尤其感到课程缺乏相关性。结论护士参与继续教育的障碍较大,时间限制、课程缺乏相关性是首要障碍,信心不足和兴趣缺乏不是影响护士参与继续教育学习的重要因素。护理管理者应采取针对性措施减少障碍,提高护士继续教育参与率和学习效率。     

骶骨相关解剖参数的CT影像学测量研究

目的:探讨骶骨解剖参数CT测量了解新型骶骨蝶形钢板DenisⅠ区安全置钉通道。方法：回顾性分析2020年1月至2020年6月正常成年骶骨CT资料101例,女49例,男52例,年龄（49.11±15.02）岁。重建骶骨三维模型,根据所需测量平面重新分割三维模型,并进行数据测量及统计分析。结果：骶骨上关节突下缘至S₂骶后孔下缘的竖直距离为（42.55±4.73） mm;S₁、S₂、S₃孔平面骶外侧嵴至骶髂关节面的水平距离依次为（19.09±3.07） mm、（15.34±2.69） mm、（8.29±2.48） mm;S₁孔平面由骶外侧嵴向前进钉,内侧角、外侧角为（7.49±7.49）°、（24.07±4.89）°;S₂孔平面内侧角、外侧角为（-3.10±8.95）°、（24.95±5.74）°。不同性别间除S₁水平距离、S₁内侧角外其余差异均有统计学意义,年龄与所有数据均无相关性。结论：新型骶骨蝶形钢板在DenisⅠ区有足够的安全置钉范围;成年人骶骨形态间存在差异,差异主要与性别相关而与年龄无关。     

老年股骨颈骨折合并尿毒症患者行人工股骨头置换术的治疗体会

目的:探讨老年股骨颈骨折合并尿毒症患者行人工股骨头置换术的治疗方法及疗效。方法：2016年1月至2020年12月收治21例老年股骨颈骨折合并尿毒症患者行人工股骨头置换手术治疗,男3例,女18例;年龄65~83（77.2±1.9）岁。所有骨折患者合并尿毒症且需长期维持血液透析;患者透析龄2~11（6.3±1.6）年,血透次数2~3次/周。患者受伤至入院手术时间3~7（4.0±2.1） d。术前积极纠正患者的贫血及低蛋白血症,通过血液透析调整患者的血钾及血肌酐指标。结果：所有患者切口Ⅰ期愈合,无伤口感染、假体松动、脱位及深静脉血栓并发症发生。所有患者术后及时恢复日常血液透析维持血肌酐及血钾水平稳定。21例患者术后随访5~23（16.8±2.6）个月。Harris 评分由术前（24.8±2.5）分转为术后（87.2±3.1）分。结论：老年股骨颈骨折合并尿毒症患者行人工股骨头置换手术,只要围手术期处理得当,配合术后积极康复治疗,可以获得很好的临床疗效。     

内镜辅助经鼻蝶入路至斜坡区的显微解剖研究

目的研究内镜辅助经鼻蝶入路至斜坡区的显微解剖和显露范围，为临床提供解剖学参数。方法测量40例颅骨干标本的骨性结构，10例福尔马林固定的成人尸头标本模拟手术入路，用内镜和显微镜观察斜坡区显露范围，并进行解剖测量。结果前鼻棘至蝶窦口、鞍底、鞍结节中心、鞍背中点、枕骨大孔前端的距离分别为（55．62±4．23）mm、（71．50±6．21）mm、（79．02±4．97）mm、（81．04±8．02）mm、（91．08±5．20）mm；视神经管、颈内动脉隆起、颈动脉管外口、舌下神经管外口离正中线的距离分别为（5．78±1．94）mm、（5．44±2．02）mm、（25．07±2．77）mm、（16．98±1．99）mm；斜坡的长、高分别为（32．43±5．46）mm、（35．01±4．12）mm；上、中、下部的厚度分别为（17．23±3．12）mm、（9．96±3．10）mm、（6．35±2．95）mm。在内镜辅助下，经鼻蝶入路可以通过适当去除相应结构增加显露鞍后．斜坡区的解剖结构。结论内镜辅助经蝶入路可以通过良好的视角显露鞍后．斜坡等显微解剖结构，适用于鞍后．斜坡等颅底中央区病变的手术治疗。     

骨密度在股骨头缺血坏死后塌陷预测中的应用

目的研究股骨头松质骨弹性模量、骨密度及骨小梁形态及结构的相关性,以期用体外测定骨密度早期预测股骨头坏死后塌陷。方法取股骨头承重区松质骨,测量其弹性模量、骨密度值,应用图像分析系统测量组织形态学分析指标,进行相关回归分析,分析骨密度与弹性模量及组织形态学指标之间的相关性及相关关系。结果松质骨骨密度与弹性模量之间呈二次曲线相关关系;骨密度与组织形态学分析指标之间有很好的相关性。结论应用骨密度能较好的反映股骨头生物力学性能及松质骨细微结构,理论上可以应用于股骨头坏死后塌陷的预测。     

Hyperbaric Oxygen and N-Acetylcysteine Treatment in L-Arginine-Induced Acute Pancreatitis in Rats

ABSTRACT

Background: This study was designed to evaluate the combined effects of hyperbaric oxygen (HBO) and N-acetylcysteine (NAC) on acute necrotizing pancreatitis in rats. Methods: Experiments were performed in 50 male Wistar rats, which were divided into five groups (N = 10 for each group). The first group received normal saline (0.9% NaCl) intraperitoneal and served as the control group. In the second group, acute pancreatitis was induced by 3.2-g/kg body weight L-arginine intraperitoneal twice at an interval of 1 hr, which has been shown previously to produce severe necrotizing acute pancreatitis. In the third group, NAC treatment (1000 mg/kg) was given after 1 hr of the induction of acute pancreatitis twice 24 hr apart. In the fourth group, animals received HBO, 6 hr after the induction of pancreatitis twice 12 hr apart. In the fifth group, animals received together NAC as in Group 3 and HBO treatment as in Group 4. Groups 1, 2, and 3 were left under normal atmospheric pressures. Twelve hours after last treatment, the animals were killed by exsanguinations. Blood samples were studied for amylase, calcium, and lactate dehydrogenase (LDH), pancreatic histology, pancreatic tissue malondialdehyde, superoxide dismutase, and glutathione levels. Results: Acute pancreatitis is reduced by the treatment of NAC, HBO, NAC + HBO. HBO + NAC groups performed statistically the best in preventing L-arginine-induced acute necrotising pancreatitis. Conclusions: NAC especially combined with HBO, decreases oxidative stress parameters, serum amylase, calcium, and LDH levels, as well as histopathologic score.     

硝普钠阴茎海绵体内注射治疗阳萎的临床研究

本研究选择４２例阳萎患者，采用硝普钠进行阴茎海绵体注射（ＩＣＩ），并选择罂粟碱／酚妥拉明进行对照，结果表明，硝普钠ＩＣＩ后：（１）阴茎外形性状（长度、周径等）明显改变。（２）Ｖｉｒａｇ硬度计点表明硝普钠与罂粟碱／酚妥拉明效果之间无明显差别。（３）所有测试患者无一例出现低血压或局部不适等副反应，与罂粟碱／酚妥拉明相比各有优劣，但总体差异不大，这充分表明，硝普钠作为一种ＮＯ供体可导致阴茎平滑肌松弛，血窦充盈阴茎勃起，其副反应较小，有其临床应用之价值。     

糖皮质激素对肿瘤坏死因子引起的大鼠中性粒细胞粘附的影响

采用中性粒细胞（ＰＭＮ）与玻璃珠粘附和ＰＭＮ与血管内皮细胞（ＥＣ）粘附两种模型，以肿瘤坏死因子（ＴＮＦ），作为ＰＭＮ的刺激因子，研究糖皮质激素（ＧＣ）对ＴＮＦ引起的大鼠ＰＭＮ粘附的影响，同时给予糖皮质激素受体（ＧＲ）阻断剂ＲＵ３８４８６观察ＧＲ在粘附中的作用。结果发现，ＴＮＦ能明显增强大鼠ＰＭＮ的粘附（Ｐ＜０．０１）；Ｄｅｘ不能抑制经ＴＮＦ预处理的ＰＭＮ的粘附（Ｐ＞０．０５），但有一定的预防作用；经ＴＮＦ预处理再同时给予Ｄｅｘ和ＲＵ３８４８６的ＰＭＮ粘附同样明显增强（Ｐ＜０．０１）。     

Kelfiprim,a new sulpha-trimethoprim combination,versus cotrimoxazole,in the treatment of urinary tract infections: A multicentre,double-blind trial

Summary A new combination of trimethoprim with a sulphonamide, named Kelfiprim, differs from cotrimoxazole in that: a) the sulpha drug is sulphamethopyrazine instead of sulphamethoxazole; b) the trimethoprim to sulpha ratio is 5:4 instead of 1:5;c) the presence of a long-acting sulphonamide allows the administration of a daily dose of one capsule, following an initial loading dose of two capsules; d) a reduced amount of trimethoprim is given, as compared to cotrimoxazole, without any decrease of efficacy. Kelfiprim [KP] was compared to contrimoxazole [Co] in a multicentre double blind trial. Sixty four patients suffering from acute and chronic infections of the upper and lower urinary tract entered the study. Urine sterilisation and clinical improvement without relapses showed no differences from the two treatment groups. Tolerance was excellent except in two patients, one treated with KP and the other treated with Co, who showed a transient exanthema.     

Time-dependent hexaminolaevulinate induced protoporphyrin IX distribution after topical application in patients with cervical intraepithelial neoplasia: A fluorescence microscopy study

BACKGROUND AND OBJECTIVES: Compared to the conventional management of cervical intraepithelial neoplasia (CIN) the potential advantage of photodynamic therapy (PDT) for the treatment of cervical human papilloma virus (HPV)-related disease encompasses a minimal invasive procedure with reduced risk of profuse bleeding as a consequence of conization, and possibly more favorable long-term results avoiding cervical stenosis. At present little is known about the precise time-dependent distribution and histological localization of hexaminolaevulinate (HAL) induced protoporphyrin IX (PPIX) fluorescence in healthy tissue and in CIN. The aim of this study was to use ex vivo fluorescence microscopy to determine whether PPIX is selectively induced by neoplastic cells of the cervical epithelium at various times after topical application. STUDY DESIGN/MATERIALS AND METHODS: Cold cream containing 0.5% HAL was applied by means of cervical cap over various periods of time. We analyzed 52 healthy cervical mucosa and 84 CINs. RESULTS: At time delay 100 (+/-10) minutes, high epithelial fluorescence and a significant selectivity between epithelium and underlying lamina propria was found. By contrast, no significant difference between healthy and neoplastic tissues, or between low and high-grade epithelial dysplasia (P > or = 0.05), was observed at any time point. CONCLUSIONS: Application of HAL 0.5% cream to the cervix induced selective fluorescence in epithelial cells. The optimal ratio with a homogeneous PPIX distribution was obtained after 100 ( +/- 10) minutes cream application, which should be evaluated further for PDT.     

An updated review on the principles of intraoperative neurophysiological monitoring and the anaesthetic considerations

It is known that any surgery to the nervous system poses risks to neural structures and their surrounding structures. These mechanisms of injury are the result of mechanical manipulations, haemodynamic alterations, chemical or thermal injuries. Intraoperative neurophysiological monitoring (IONM), using various modalities, is employed to facilitate the assessment of the functional integrity of neural structures, and it is used to provide a real-time alerting system when changes caused by surgically induced insults are detected. The primary goal of IONM is reducing the risk of postoperative neurological deficits during these surgical procedures. It is used to provide information that allows the surgeon to correct any surgical interventions that may have compromised these systems and this also in turn provides guidance on what neurological deficits to anticipate postoperatively. Apart from being utilized as an alerting system to avoid catastrophic outcomes, IONM also assists as a guidance system using stimulation techniques to map out eloquent areas within the cortex, allowing identification of specific neuronal structures, particularly when landmarks cannot be easily recognized due to infiltration by pathological lesions.In this article, we focus on updating our previous paper published in 2019 and again, to provide attention to the various neurophysiological modalities that are employed in IONM. We will look at the basic underlying physiological principles and their individual indications for use clinically. We will explain the information that each modality provides. Importantly, and the primary reason for this article, we look at the various anaesthetic agents, their effects on each neurophysiological modality and other anaesthetic considerations such as haemodynamic and temperature effects. We will also recommend the use of an alert checklist for the multidisciplinary team should an intraoperative alert be issued during surgical procedures.