动力内固定系统预防腰椎融合内固定术后邻近节段退变

目的观察在头侧邻近节段加载动力内固定是否有助于降低刚性内固定术后邻近节段的退变。方法筛选2002年1月－2007年7月因腰腿痛（腰椎椎间盘突出症、腰椎椎管狭窄症及腰椎滑脱症）由同一组医师完成腰椎内固定手术的101名患者。分为A组和B组,A组为单纯刚性内固定（72名）,B组为在刚性内固定的头侧邻近节段加载动力内固定（29名）。比较2种手术术后邻近节度退变的发生率、Oswestry功能障碍指数（Oswestry disability index,ODI）及视觉模拟量表（visual analog scale,VAS）评分。结果 A组中有15例患者（20.83%）发生了邻近节段退变,B组中有1例（3.45%）发生了邻近节段退变,两者之间差异有统计学意义（P〈0.05）。只有最佳恢复期内B组比A组得到了更好的ODI及VAS评分结果且差异有统计学意义（P〈0.05）;至末次随访期时2组的ODI及VAS评分之间差异并无统计学意义（P〉0.05）。结论在刚性内固定的头侧邻近节段加载动力内固定确实能有效地预防邻近节段退变的发生,但是其并不能显著地提高远期临床效果。     

前路分节段减压术治疗多节段脊髓型颈椎病

目的探讨颈椎前路分节段减压术治疗多节段脊髓型颈椎病的手术方法及疗效。方法 2003年12月至2008年12月采用前路分节段减压术治疗多节段脊髓型颈椎病患者48例,男25例,女23例;3节段病变39例,4节段9例;术中采用1个椎体次全切除加1或2个椎间隙减压,同时行植骨融合钛板固定,术后定期复查颈椎正侧位及屈伸位X线片,观察植骨融合情况,采用JOA评分评价神经功能。结果手术时间70～220min,平均87min,术中出血量120～800 ml,平均210 ml。全部获得随访,术后随访12～60个月,平均26个月,所有病例均获骨性融合,融合时间3～9个月,平均6.2个月。术前JOA评分为（6.3±3.2）分,末次随访时JOA评分为（13.2±3.6）分,与术前比较有显著性差异（P〈0.01）,改善率为72.8%±16.2%,优良率为89.6%。结论颈椎前路分节段减压术是治疗多节段脊髓型颈椎病的一种可靠术式,可获得理想的植骨融合率及神经功能改善率。     

Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines

Biliary drainage is a radical method to relieve cholestasis, a cause of acute cholangitis, and takes a central part in the treatment of acute cholangitis. Emergent drainage is essential for severe cases, whereas patients with moderate and mild disease should also receive drainage as soon as possible if they do not respond to conservative treatment, and their condition has not improved. Biliary drainage can be achieved via three different routes/procedures: endoscopic, percutaneous transhepatic, and open methods. The clinical value of both endoscopic and percutaneous transhepatic drainage is well known. Endoscopic drainage is associated with a low morbidity rate and shorter duration of hospitalization; therefore, this approach is advocated whenever it is applicable. In endoscopic drainage, either endoscopic nasobiliary drainage (ENBD) or tube stent placement can be used. There is no significant difference in the success rate, effectiveness, and morbidity between the two procedures. The decision to perform endoscopic sphincterotomy (EST) is made based on the patient's condition and the number and diameter of common bile duct stones. Open drainage, on the other hand, should be applied only in patients for whom endoscopic or percutaneous transhepatic drainage is contraindicated or has not been successfully performed. Cholecystectomy is recommended in patients with gallbladder stones, following the resolution of acute cholangitis with medical treatment, unless the patient has poor operative risk factors or declines surgery.     

-15℃低温技术在长期储存冬虫夏草、西洋参中的应用

目的为解决大量冬虫夏草、进口西洋参等名贵中药材在长期储存中质量稳定、安全可靠的问题。方法从1990年初起,根据药材的不同性质,恰当控制含水量后分装,采用-15℃低温技术储存药材至2008年。结果18年来,冬虫夏草按1985年版《中国药典》性状项进行质量检查,西洋参按国家卫生部进口药材标准（WS4-16—86）性状和含量测定项进行检查,结果均符合规定。结论该研究突破了国内外均未见报道的名贵中药材0℃以下低温储存研究这一盲（禁）区,初步解决了名贵中药材长期储存时的质量稳定问题。     

Lipid peroxidation and vitamin E status in gestational diabetes mellitus

AIM: To investigate any correlation between plasma levels of lipid peroxides, antioxidant nutrient (alpha-tocopherol) and oxidized high-density lipoprotein (HDL) in patients with gestational diabetes and those with a normal pregnancy and the incidence of pre-eclampsia. METHODS: Sixty pregnant women attending an antenatal clinic were recruited for the study and were divided into two groups. Thirty women with gestational diabetes mellitus were recruited in the study group. The glucose-tolerance-test criteria, using 100 g of glucose taken orally, as laid down by the American College of Obstetricians and Gynecologists (1994) for diagnosis of gestational diabetes mellitus was used. Thirty gestation-matched pregnant women with normal glucose tolerance test results were recruited as controls. A 10 mL venous blood sample was collected from each subject at the time of recruitment and thereafter at 4 week intervals until the time of delivery. Samples were analyzed for malondialdehyde thiobarbituric acid reactive, oxidized HDL-cholesterol and alpha-tocopherol. The incidence of pre-eclampsia and its correlation with antioxidant and lipid peroxide levels were compared in both the groups. RESULTS: Ten subjects out of 30 in the study group and three subjects out of 30 in the control group developed pre-eclampsia. The incidence of preterm labor in both the groups was same (16.66%). The mean lipid peroxide level was lower in the study group at recruitment and later the levels kept falling, whereas levels of alpha-tocopherol and oxidized-HDL were higher in the study group and kept on rising at follow up. CONCLUSION: Gestational diabetes is not associated with increased levels of lipid peroxides and decreased levels of alpha-tocopherol.     

Variations in ATM protein expression during normal lymphoid differentiation and among B-cell-derived neoplasias

The ataxia telangiectasia mutated (ATM) protein plays a central role in the cellular response to DNA double-strand breaks (DSBs). Developmentally programmed DSBs are restricted to cellular subsets within lymphoid tissues and we asked whether ATM expression is differentially regulated during lymphoid differentiation. We showed that immature B cells in bone marrow and immature T cells of the thymic cortex were negative or weakly ATM-positive. T cells of thymic medulla and peripheral tissues strongly expressed ATM. High levels of ATM were present in the B lymphocytes of the mantle zone and in plasma cells, while the majority of germinal center B cells were negative or weakly labeled. Therefore, ATM expression appears to be down-regulated at those stages of lymphoid development where physiological DNA DSBs occur. In B-chronic lymphocytic leukemia and mantle cell lymphoma we observed two categories: ATM-negative tumors, most likely reflecting the presence of ATM mutation, and tumors with abundant ATM expression. Most follicular center-cell lymphomas and diffuse large B-cell lymphomas, which rarely show inactivation of the ATM gene, were negative or weakly ATM-positive. Tumor cells from most cases of Hodgkin's disease were ATM-negative. Therefore, unless ATM inactivation occurs, ATM expression in lymphoid tumors is likely to reflect their cellular origin. As a result, immunostaining to identify lymphoid neoplasias with ATM inactivation might only be feasible for tumors derived from the stages where ATM is constitutively highly expressed.     

Restoration modalities of severely injured anterior teeth--gingival integration, papillae support, and predictable imperfections

This article presents 4 cases, each describing a different dental trauma and a different treatment modality. Because of various limitations, none of the results presented is esthetically perfect, but the outcomes were acceptable to both the operators and the patients. Such limitations should be predicted and discussed with patients before beginning treatment and should be regarded as acceptable compromises, unless other less conservative treatments are to be used.     

一氧化氮合酶抑制剂长期作用对兔关节软骨缺损修复的影响

目的　探讨长期给予诱导型一氧化氮合酶 (iNOS)抑制剂对关节软骨修复的影响。方法　 2 4只新西兰大白兔双侧股骨髁间关节面造成全层软骨缺损。随机分为 (1)对照组 8只 ,关节软骨缺损不充填任何物质 ;(2 )骨形态发生蛋白 (BMP)组 8只 ,缺损应用BMP纤维蛋白凝胶复合物充填 ;(3)S 甲基异硫脲 (SMT)组 8只 ,缺损应用BMP纤维蛋白凝胶复合物充填 ,皮下注射iNOS抑制剂SMT(5mg·kg-1·12h-1) ,术后 1年处死动物。按组织形态学评分标准 ,作修复组织评价 ;化学比色法检测软骨修复组织一氧化氮 (NO)释放量和 (NOS)活性 ;天狼猩红和免疫组织化学染色检测胶原的分布 ;3 5S掺入法检测蛋白多糖的合成率 ;BrdU掺入法检测修复组织细胞活性。结果　形态学观察证实 ,1年后SMT组关节软骨缺损修复在边缘修复结合度、细胞形态和缺损区结构等评分方面均优于BMP组和对照组 (P <0 0 1) ;天狼猩红和免疫组织化学染色显示SMT组Ⅰ型胶原明显少于BMP组和对照组 ,Ⅱ型胶原多于BMP和对照组 ;3 5S检测显示SMT组蛋白多糖的合成率明显高于BMP组和对照组 (P <0 0 1) ;BrdU掺入显示SMT组术后 1年仍有增殖活力较强的细胞。结论　iNOS抑制剂SMT的应用能明显提高软骨修复的质量 ,延缓退变     

心钠素对血管紧张素-Ⅱ促家兔血管平滑肌细胞增殖的影响

本工作应用培养的家兔主动脉血管平滑肌细胞,以细胞计数和~3氢-胸腺嘧啶核苷参入为指标.观察到血管紧张素-Ⅱ可促进血管平滑肌细胞的增殖.这种效应可为心钠素所抑制。     

新型胸腰椎后路椎弓根钉板系统的研制及临床应用

目的 研制新型胸腰椎后路椎弓根钉板系统,观察其临床应用效果。方法 该系统采用医用钛合金材料（TC4）制成,包括长条形钢板及椎弓根固定螺栓。自1999年12月至2000年7月间,我院骨科应用该系统治疗胸腰段及腰椎伤患者63例,其中骨折／脱位33例,腰椎椎弓峡部裂并滑脱16例,腰椎椎弓峡部裂并椎间盘突出症6例,退变性腰椎不稳4例,强直性脊柱炎伴脊柱后凸畸形2例,脊柱结核2例。结果 33例骨折／脱位患者中,术后复位固定均满意,椎体高度恢复。术后1个月复查,除6例术前FrankelA级患者无恢复外,其他有神经损害者均有1－3级的恢复。 腰椎滑脱、双侧峡部裂合并椎间盘突出症,退变性腰椎不稳定26例中,术后神经根性症状均消失,其中Ⅰ度滑脱7例完全复位,Ⅱ度滑脱7例有7例完全复位,2例残留Ⅰ度滑脱。63例患者中有40例获得≥5个月的门诊随访,无钢板断裂,螺钉松动、断裂、脱落等并发症。结论 该新型胸腰椎后路内固定系统具有良好的生物稳定性,复位固定效果满意,操作简便、临床应用效果肯定。