影像学在盆底器官脱垂的应用

随着整体理论、吊床理论及肛提肌维持盆底器官的重要性等多种观点的提出,盆底器官脱垂(POP)发病机制复杂临床表现多样化,因此获得POP的完整信息,应结合临床检查及辅助检查手段,在辅助检查手段中应用最广泛、最有优势的影像学技术。多种影像学技术应用于盆底,包括静态及动态盆底影像学技术,帮助临床医师全面了解POP的发病机制、诊断并建立盆底治疗方案及完善的术后随访体系。     

香菇多糖抗炎作用的实验研究

目的:研究香菇多糖的抗炎作用。方法:用二甲苯所致小鼠耳肿胀、鸡蛋清所致小鼠足跖肿胀等急性炎症以及滤纸片诱发小鼠肉芽组织增生所致小鼠慢性炎症模型进行试验。结果:香菇多糖能抑制二甲苯所致的小鼠耳肿、鸡蛋清所致小鼠足跖肿胀;与此同时对滤纸片诱发小鼠肉芽组织增生形成有抑制作用。结论:香菇多糖具有一定抑制急慢性炎症反应作用。其抗炎作用的机制,值得进一步研究。     

Evaluation of corticospinal tract injury with three-dimensional diffusion tensor tract in patients with acute cerebral infarction

Three-dimensional diffusion tensor tract (DTT) is the newest imaging to describe the structure of white matter fiber in three-dimensions, it has great significance in dividing the concrete anatomic site of gray and white matter lesions, displaying the correlation with fibrous band and judging clinical prognosis, which is incomparable by other imagings.OBJECTTVE: To observe the conditions of corticospinal tract (CST) in acute cerebral ischemic stroke patients,and analyze the relationship between motor function and the severity of CST injury.DESIGN: A case-control observation.SETTTNG: Department of Medical Imaging, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.PARTTCTPANTS: Fifteen patients with acute cerebral infarction were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February to December in 2005. They all suffered from acute attack and motor disorder of hemiplegic limbs to different extent, and were conformed by CT or MRI.There were 9 males and 6 females, aging 16-87 years old, the median age was 51.7 years, and all were right handed. Fifteen right-handed normal subjects, who were matched by age and sex with the patients in the cerebral infarction group, were selected from the relatives of patients and physicians of the Imaging Department as the control group. All the subjects were informed and agreed with the study.METHODS: The patients with acute cerebral infarction and subjects in the control group received MR diffusion tensor imaging (DTI) with GE 1.5 T nuclear magnetic resonance system, fiber tracking with the software of dTV- Ⅱ. Fractional anisotropy (FA) maps and three-dimensional tractography of bilateral CST of all patients were created. Displacement, continuity and destroy of fibrous bands were observed. At the same time, muscle strength of ipsilateral hand of patients with cerebral infarction was measured with Brunnstrom standard. The correlation between the severity of CST injury and the muscle strength of ipsilateral hand was analyzed with spearman correlation analysis.MAIN OUTCOME MEASURES: ① FA values in the infarcted sites and those in the contralateral corresponding sites of patients with cerebral infarction; ② CST manifestations in the patients with cerebral infarction and the control group.RESULTS: All the 30 testees were involved in the analysis of results. ① The FA values in infarcted sites of white matter were significantly lower than those in the contralateral ones (t =4.570, P ＜ 0.001 ). ② In the control group, bilateral CST were reconstructed, they originated from precentral gyrus, went downwards to internal capsule, and extended to pontine and medulla oblongata, each fiber had good uniformity in continuous form. In the patients with cerebral infarction, the forms of contralateral CST were consistent with those in the control group with good continuity. Due to the involvement by the infarcted site to different extents, the ipsilateral CST manifested as continuous interruption and loss of uniformity in anatomic structure and form. The CST involvements were divided into three grades: integrated CST for grade I (n =2); integrated CST but compressed or displaced for grade 2 (n =5); interrupted CST for grade 3 (n =8). ③ The severity of CST injury was obviously correlated with the muscle strength of the ipsilateral hand (r=0.888, P＜ 0.05＝.CONCLUSION: ① CST is injured to different extents in patients with acute cerebral infarction, and the severity of injury is associated with muscle strength. It is indicated that it can be used to judge the prognosis of rehabilitative treatment. ②DTT can directly display the status of pyramidal tract more three-dimensionally.     

椎弓根钉辅助下后外侧融合在退变性腰椎管狭窄症手术中的应用

目的探讨退行性腰椎管狭窄症(degenerativelumbarspinestenosisDLSS)的特点、椎弓根钉辅助下的后外侧融合手术要点及其在退变性腰椎管狭窄症减压术中的作用和意义。方法回顾性分析2000年1月～2003年12月间59例腰椎管狭窄症患者的临床症状、椎管减压和椎弓根钉辅助下的后外侧植骨融合的手术和术后随访情况,手术结果通过问卷式调查由患者进行自我评价,评价内容分为:腰痛、腿痛、日常活动水平、是否服用止痛药物四个方面进行。结果59例患者随访6～48个月,平均22.5个月,8例患者1年后失访。其中治疗效果优21例(35.6%),良32例(54.2%),可4例(6.8%),差2例(3.4%)。术中术后的并发症主要有:神经根损伤、硬膜囊撕裂、FBSS(FailedBackSurgerySyndrome)、ASD(AdjacentSegmentDisease)、椎弓根钉断裂等。结论DLSS包括多部位狭窄性病理改变,术中减压应当按照一定的步骤全面减压。椎弓根钉辅助后外侧融合可以提供腰椎即刻稳定,提高了远期融合率,使得滑脱椎体复位并保持椎间高度,减少椎管狭窄的进展和再发,从而提高手术的治疗效果。     

消化性溃疡在某部军人中的发病情况及相关因素调查

目的 了解部队消化性溃疡（PU）的发病情况及幽门螺杆菌（Hp）感染情况，探讨军人Pu发生的危险因素。方法 采用多阶段分层整群随机抽样的方法，对南方战区某地6160名军人进行PU症状及危险因素问卷调查，并进行胃镜精查、Hp检测。结果 军人PU相关症状发生率（Sc≥5分）18．60％。标化后的PU患病率12．78％，其中军龄1年、南方籍、装甲部队军人PU患病率高。Hp感染率62．67％。Hp感染（OR4．60）、吸烟（OR3．8）、持续高强度军事训练（OR4．3）、驾驶战斗车辆（OR6．0）、经常精神紧张（OR3．7）等与PU症状发生的关系较大。辛辣饮食、常饮牛奶、是否独生子女等与PU发生无关。结论 军人PU患病率及Hp感染率均较高。军人PU发病情况在不同军龄、兵种、入伍前地域之间存在差别，Hp感染、军事训练、精神因素、某些不良生活习惯等与军人PU的发生密切相关。     

老年与青壮年脑挫裂伤组织NGF的表达差异及意义

目的 研究衰老对脑挫裂伤组织神经生长因子（NGF）基因表达的影响,进一步探讨老年颅脑损伤病人神经功能缺失程度较重的分子生物学机制.方法 收集重型颅脑损伤开颅手术中的脑挫裂伤组织,应用免疫组化和医学数码图像分析技术,观察老年组（≥60岁）和青壮年组（19～59岁）病人脑损伤后3～9 h脑挫裂伤组织NGF蛋白的表达差异.结果 脑损伤后NGF在老年和青壮年脑挫裂伤组织中的表达均明显增强;老年组脑挫裂伤组织中的NGF蛋白表达显著性低于青壮年组（P＜0.05）.结论 老年人脑挫裂伤后NGF表达水平下降明显,提示其受损神经元的修复和生存能力降低,这可能是老年颅脑损伤病人恢复不良的重要原因之一.     

外周血及移植肾内嗜酸性粒细胞变化的临床意义

为了解移植肾在急性排斥时外周血和移植肾内嗜酸性粒细胞（ＥＯ）变化的意义，动态观察３１例同种异体肾脏移植病人的外周血和移植肾内ＥＯ的变化。结果发现在急性排斥反应时，移植肾内ＥＯ数＞２％者占８０．９％，明显高于肾功能稳定时，Ｐ＜０．０１；重度排斥中血ＥＯ数＞４％者占８２．６％，明显高于肾功能稳定时和中度以下排斥者，Ｐ＜０．０１。结果认为，测定移植肾内的ＥＯ变化可以做为监测急性排斥反应的可靠指标，外周血中的ＥＯ明显增多常提示排斥反应较为严重。     

伴活动性肝炎的肝细胞癌围手术期处理

目的 探讨伴活动性肝炎的肝细胞癌的可切除性和安全性。方法 26例伴活动性肝炎的肝细胞癌，平均肿瘤直径7．7cm，经术前短期护肝治疗后行肝肿瘤切除术，术后继续护肝治疗。结果 26例肝癌均得到顺利切除，最常见的并发症为一过性肝功能损害，无手术死亡和严重并发症，平均手术时间65min，平均出血量328ml。结论 伴活动性肝炎的原发性肝癌的手术切除虽有一定的挑战性，只要围手术期处理得当，仍是安全可行的。     

SD大鼠骨组织冷冻预处理温度的选择

目的 探讨冷冻预处理温度对骨组织超微结构的影响，为吻合血管同种异体骨保存移植提供依据。方法 以15％二甲基亚砜(DMSO)为低温保护剂，采用两步冷冻步骤，对SD大鼠骨组织进行-45，-50，-55，-60，-65和-70℃冷冻预处理，-196℃液氮保存1周，复温后光镜和透射电镜观察。结果 温度-55℃冷冻预处理和液氮保存的大鼠骨组织超微结构保持良好，其余温度组的骨细胞轻度水肿，线粒体肿胀，嵴破坏，细胞核有固缩现象，部分骨细胞变性明显，甚者细胞膜不连续。结论 骨组织冷冻预处理温度在-50～-60℃之间，-55℃是最佳温度值，可获得最大部分生物活性的骨组织。     

羧甲基壳聚糖作为植入可降解缓释微球辅料的实验研究

羧甲基壳聚糖作为一种高分子材料 ,具有良好的组织相容性和生物可降解性。本实验试图利用羧甲基壳聚糖作为植入环丙沙星微球的缓释辅料 ,并探索这一剂型的制备工艺、结构形态和体外释药特性。首先我们采用乳化交联技术制备微球 ;然后用扫描电子显微镜、红外光谱、及示差热分析等方法研究微球的结构和形态 ;建立体外持续流动释放系统初步检测微球的体外释放特性。实验结果发现 :微球的结构和形态受制备工艺条件如温度、离子强度、搅拌速度等因素的影响 ;一定工艺条件下制备的环丙沙星微球的体外释放时间可达 7d以上 ,释放行为符合 Higuchi方程。因此 ,我们认为 :羧甲基壳聚糖可作为环丙沙星可降解植入微球的缓释辅料 ;乳化交联技术是制备这一微球的有效方法 ,工艺简单、稳定