尺神经前移在肱骨髁间骨折手术治疗中的应用

目的初步探讨尺神经前移在肱骨远端髁间骨折治疗中的手术方法及效果。方法 29例C型肱骨髁间骨折患者切开复位内固定后全部进行尺神经预见性前移。结果 29例随访患者中追踪8~38个月,平均18个月,术后2~4个月骨折全部愈合。按照Mayo肘关节功能评分标准,优良率79.3%,尺神经功能情况根据Asami评价标准,优19例（65.5%）,良7例（24.1%）,一般2例（6.9%）,差1例（3.4%）,其中3例功能不满意者均为术前既有尺神经损伤症状。结论尺神经前移可作为肱骨远端髁间型骨折手术治疗中的常规治疗方法,可有效避免尺神经麻痹现象发生。     

肝门部胆管癌神经浸润的病理学分析及临床意义探讨

目的分析肝门部胆管癌神经浸润的发生率、方式与规律及影响因素。方法光镜下观察52例肝门部胆管癌患者的484张组织病理切片,分析肿瘤神经浸润的发生率、方式与规律;使用关联分析统计学方法分析神经浸润与淋巴结转移、血清CA19-9水平、血清CEA水平、血清总胆红素水平和肿瘤侵犯胆管壁程度的关系。结果肝门部胆管癌神经浸润总发生率为90.38%(47/52);高、低及未分化腺癌间神经浸润发生率比较差异均无统计学意义(P0.05)。神经浸润发生率与患者的肿瘤Bismuth-Corlette分型、血清CA19-9水平、血清CEA水平、血清总胆红素水平及淋巴结转移均无关(P0.05),而与胆管壁浸润程度有关(P0.01)。肿瘤浸润神经主要有4种方式,其发生率由高至低依次是:Ⅱ型Ⅲ型Ⅳ型Ⅰ型。浸润方式与肿瘤分化程度有关(χ2=31.04,P0.01)。结论肝门部胆管癌具有神经亲嗜性,神经浸润发生率高;肝门胆管癌神经浸润有多种浸润方式,浸润方式与肿瘤分化程度有关;肿瘤是否浸润神经与淋巴结转移、肿瘤分化程度无关,而与侵犯胆管壁程度有关。     

Wall Imaging for Unilateral Intracranial Vertebral Artery Hypoplasia with Three-dimensional High-isotropic Resolution Magnetic Resonance Images

Background:

There are few studies for evaluating wall characteristics of intracranial vertebral artery hypoplasia (VAH). The aim of this study was to determine wall characteristics of VAH with three-dimensional volumetric isotropic turbo spin echo acquisition (3D VISTA) images and differentiate between acquired atherosclerotic stenosis and VAH.

Methods:

Thirty patients with suspicious VAH by luminograms were retrospectively enrolled between January 2014 and February 2015. The patients were classified as “acquired atherosclerotic stenosis” or “VAH” based on 3D VISTA images. The wall characteristics of VAH were assessed to determine the presence of atherosclerotic lesions, and the patients were classified into two subgroups (VAH with atherosclerosis and VAH with normal wall). Wall characteristics of basilar arteries and vertebral arteries were also assessed. The clinical and wall characteristics were compared between the two groups.

Results:

Five of 30 patients with suspicious VAH were finally diagnosed as acquired atherosclerotic stenosis by 3D VISTA images. 25 patients were finally diagnosed as VAH including 16 (64.00%) patients with atherosclerosis and 9 (36.00%) patients with normal wall. In the 16 patients with atherosclerosis, plaque was found in 9 patients, slight wall thickening in 6 patients, and thrombus and wall thickening in 1 patient. Compared with VAH patients with normal wall, VAH patients with atherosclerosis showed atherosclerotic basilar arteries and dominant vertebral arteries more frequently (P = 0.000).

Conclusions:

Three-dimensional VISTA images enable differentiation between the acquired atherosclerotic stenosis and VAH. VAH was also prone to atherosclerotic processes.     

Search for clinical predictors of good glycemic control in patients starting or intensifying oral hypoglycemic pharmacological therapy: A multicenter prospective cohort study

AimsOur aim was to search for clinical predictors of good glycemic control in patients starting or intensifying oral hypoglycemic pharmacological therapy.MethodsA multicenter, prospective cohort of 499 diabetic subjects was enrolled in this study: patients with newly diagnosed diabetes (NDM group) or poor glycemic control with oral antidiabetic drugs (OADs) (PDM group). All subjects then started or intensified OADs therapy and followed up for 91 days. Glycemic control was determined according to HbA1c at day 91 with HbA1c <7% considered good.ResultsThe proportions of patients with good glycemic control after follow up for 91 days were 66.9% and 34.8% in NDM group and PDM group respectively. Logistic regression analysis showed that the change in GA at 28 days was the only predictor of good glycemic control in NDM patients (OR = 1.630, 95% CI 1.300–2.044, P < 0.001). In PDM patients, changes in GA at 28 days, CPI, baseline HbA1c, diabetic duration, and BMI were all independent predictors of good glycemic control (All P < 0.05).ConclusionsGA decline is a good predictor of future success in newly diagnosed patients. In patients intensifying therapy, beside GA decline, other individualized clinical characteristics should also be considered.     

The animal experiment of a new optimised distraction implant

Our aim was to evaluate the function of a new optimised distraction implant. Six dogs with alveolar bone defects had a total of 18 distraction, and 6 normal, implants inserted into edentulous mandibular ridges after osteotomy. Five days after insertion the distraction implants were activated at a rate of 1 mm/2 days to achieve a distraction height of 6 mm. Radiographs were taken at 0, 1, 2, and 3 months after distraction. Two dogs were killed after 1, 2, and 3 months, respectively, and 12 distraction implants taken from the different time points were evaluated by microcomputed tomographic (MicroCT) scanning and histological examination. The other 6 distraction, and the 6 normal, implants were compared after osseointegration with a fatigue test. The results showed that all the distraction implants had successfully distracted the bone to the anticipated height. Radiographs showed that the density of the regenerated bone increased steadily during the consolidation period. MicroCT showed that the regenerated bone was comparable with the native bone 3 months after distraction. Both native and regenerated bone had osseointegrated histologically by 1 month and 3 months after distraction. The experiment successfully confirmed the usefulness and feasibility of this new distraction implant, and suggests interesting clinical uses.     

重度磨耗对大鼠三叉神经节中CGRP表达的影响

目的：探讨重度磨耗对大鼠三又神经节中降钙素基因相关肽（calcitonin gene—related petide,CGRP）表达的影响。方法：8周龄雄性SD大鼠75只,随机平均分为操作对照组、空白对照组和实验组,每组各25只,实验组用人工逐次磨低大鼠牙冠高度的方法建立重度磨耗动物模型。各组分别于干预后3、7、14、21、28天处死5只动物,取出双侧三叉神经节,通过免疫荧光染色的方法观察三叉神经节中CGRP的表达变化。结果：与空白对照组和操作对照组相比,实验组3天组和7天组的CGRP阳性神经元数量明显增加（P〈0．05）,14天组和21天组CGRP阳性神经元数量有所减少,但仍明显多于对照组（P〈0．05）,28天组基本恢复正常（P〉0．05）。结论：重度磨耗可导致大鼠三叉神经节内CGRP表达的可逆性变化。     

XCY2002—1／200野战X线诊断车的使用及性能评价

叙述了XCY2002—1／200野战X线诊断车的使用方法，在使用过程中体会其各项性能优劣，给出了对各项性能的评价，指出了存在的问题，提出了相应的改进设想。     

临床药师参加会诊的典型病例分析

目的:总结临床药师参加会诊的典型病例,以便为临床药师的工作提供参考。方法:结合以往临床药师参加的会诊工作,从个体化给药方案的制定、药品不良反应的判别、参与中毒急救、不良反应监测、围术期预防性使用抗菌药物的选择等几个方面进行总结。结果:通过参加会诊,临床药师能够为临床提供帮助,对药师的工作有一定的指导作用。结论:通过以上会诊工作的开展,临床药师的建议得到临床医生的采纳,药师自身素质明显提高。     

住院患者首次服用二甲双胍的不良反应监测与分析

目的:调查二甲双胍的不良反应发生特点及临床表现,为临床合理用药提供参考.方法:对某院内分泌科二病区2010年11月- 2011年11月收治患者进行ADR集中监测,对首次服用二甲双胍的病例发生ADR情况进行分析,同时对此ADR集中监测模式进行初步评价.结果:在首次服用二甲双胍的117例患者中,发生ADR的男性有29例(61.70％),女性18例(38.30％),平均年龄(48.21±12.62)岁;未发生ADR的男性有56例(80.00％),女性14例(20.00％),平均年龄(44.71±13.09)岁.ADR累及器官或系统主要为胃肠道损害(88.75％)、中枢神经系统损害(5.00％)、全身性损害(3.75％),皮肤及附件损害(2.50％).二甲双胍普通片ADR发生率为40.74％,二甲双胍肠溶片为27.27％.结论:二甲双胍引起ADR可能存在性别差异,肠溶片ADR发生率低于普通片.病区集中监测是ADR监测模式的有益补充.