过伸性颈椎颈髓损伤的手术入路疗效比较

目的探讨过伸性颈椎颈髓损伤后三种手术入路疗效的比较。方法我们对2000年9月～2004年10月间收治的47例过伸性颈椎颈髓损伤并接受手术治疗的患者进行回顾性分析，根据手术方式不同分成三组：前路入路组、后路入路组、前后联合入路组，比较其疗效。结果所有患者经6～12个月随访，比较三组间手术前、后的Frankel的分级变化和ASIA评分改变。三组术后神经功能均较术前有明显改善；前路减压、植骨内固定和前后联合入路减压、植骨内固定均较后路减压、植骨内固定术后神经功能恢复好，两两间差异有显著性意义（P〈0．05）；前后联合入路减压最彻底，但其预后与单纯前路减压内固定差异无显著性意义（P〉0.05）。结论前路减压内固定是过伸性颈椎颈髓损伤首选的手术方式，后路是辅助的手术方法，而前后联合入路应谨慎选用。     

基于肠促胰岛素的药物的研究进展

基于肠促胰岛素的药物包括胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)受体激动剂和二肽基肽酶-4抑制剂,目前已获准用于治疗2型糖尿病,而其未来的发展方向可能主要在于如何优化自身特点和扩展临床适应证,具体包括延长GLP-1受体激动剂的有效作用时间、开发能口服的GLP-1受体激动剂、寻找可促进GLP-1分泌的新靶点、开发其他胃肠-胰腺生物活性肽类新药以及探求此类药物在1型糖尿病、肥胖症、心血管疾病和神经退行性疾病治疗领域中的临床应用前景等。     

胃癌侵袭性和根治手术对患者血清透明质酸浓度的影响

为研究胃癌侵袭性和根治手术对患者血清透明质酸浓度的影响,通过应用酶联免疫吸附方法(ELISA)测定20例胃,8患者血清透明质酸(hyaluronic acid,HA)浓度,结果发现,胃癌组明显高于对照组(P<0.001),BorrmannⅢ、Ⅳ组或伴有淋巴结转移组分别显著高于Borrmann Ⅰ、Ⅱ组或无淋巴结转移组(P<0.001),切除瘤体后上述各组的HA均显著下降(P<0.01～0.001)。结果提示,血清HA可能与胃癌的浸润和转移密切相关。     

20-HETE contributes to ischemia-induced angiogenesis

Angiogenesis is an important adaptation for recovery from peripheral ischemia. Here, we determined whether 20-hydroxyeicosatetraenoic acid (20-HETE) contributes to ischemia-induced angiogenesis and assessed its underlying molecular and cellular mechanisms using a mouse hindlimb-ischemia angiogenesis model. Hindlimb blood flow was measured by Laser Doppler Perfusion Imaging and microvessel density was determined by CD31 and tomato lectin staining. We found that systemic and local administration of a 20-HETE synthesis inhibitor, DDMS, or a 20-HETE antagonist, 6,15-20-HEDGE significantly reduced blood flow recovery and microvessel formation in response to ischemia. 20-HETE production, measured by LC/MS/MS, was markedly increased in ischemic muscles (91 ± 11 vs. 8 ± 2 pg/mg in controls), which was associated with prominent upregulation of the 20-HETE synthase, CYP4A12. Immunofluorescence co-localized increased CYP4A12 expression in response to ischemia to CD31-positive EC in the ischemic hindlimb microvessels. We further showed that ischemia increased HIF-1α, VEGF, and VEGFR2 expression in gracilis muscles and that these increases were negated by DDMS and 6,15-20-HEDGE. Lastly, we showed that ERK1/2 of MAPK is a component of 20-HETE regulated ischemic angiogenesis. Taken together, these data indicate that 20-HETE is a critical contributor of ischemia-induced angiogenesis in vivo.     

丙戊酸钠对癫痫患儿糖代谢影响的临床研究

目的：观察癫痫患儿服用VPA后体重、体重指数（BMI）、血糖、胰岛素、胰岛素抵抗的变化,了解VPA对糖代谢的影响。方法：选择正常儿童65例为对照组,设置未服VPA治疗的癫痫患儿65例为Ⅰ组,65例癫痫患儿经治疗VPA3个月后为Ⅱ组,已单服VPA治疗达6个月者65例为Ⅲ组。分别检测体重、体重指数（BMI）、血糖、胰岛素、胰岛素抵抗指数。结果：治疗3个月的患者（Ⅱ组）,体重、体重指数及空腹胰岛素水平较治疗前明显增高（P〈0.01）;空腹血糖水平则明显降低（P〈0.05）。治疗6个月的患者（Ⅲ组）,体重、体重指数更为增高,但空腹胰岛素水平较治疗3个月者下降（P〈0.05）;空腹血糖水平较治疗3个月者稍有增高,但无统计学意义。胰岛素抵抗指数三组间变化不大。治疗6个月的患者,食欲增加者有47例,而治疗前食欲增加者仅20例,其差异有统计学意义（P〈0.05）。结论：服用VPA可导致癫痫患儿食欲增加、除不存在胰岛素抵抗外,体重、血糖和高胰岛素水平在治疗3月后已可产生明显变化。     

Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis

Purpose

Controversy remains as to whether enteral supplementation of ω-3 fatty acids (FA) could improve outcomes in patients with acute respiratory distress syndrome (ARDS). Thus, we did a meta-analysis and aimed to investigate the benefit and harm of enteral ω-3 FA supplementation in adult patients with ARDS.

Methods

Databases including PubMed, Embase, the Cochrane Register of Controlled Trials, and Google Scholar were searched to find relevant articles. Randomized controlled trials (RCTs) comparing enteral ω-3 FA supplementation with a control or placebo intervention in adult patients with ARDS were included. The primary outcome was all-cause 28-day mortality. We used the Cochrane Collaboration methodology.

Results

Seven RCTs with 955 adult patients qualified for inclusion, and all the selected trials were considered as at high risk of bias. The use of enteral ω-3 FA did not significantly reduce all-cause 28-day mortality [relative risk (RR), 0.90; 95 % confidence intervals (CI), 0.68–1.18; p = 0.44; I ² = 31 %; random effects]. Trial sequential analysis indicated lack of firm evidence for a 20 % RR reduction in all-cause 28-day mortality. PaO₂/FiO₂ ratio was significantly increased in the ω-3 FA group on day 4 [weighted mean difference (WMD), 45.14; 95 % CI, 16.77–73.51; p = 0.002; I ² = 86 %; random effects] and day 7 (WMD, 33.10; 95 % CI, 1.67–64.52; p = 0.04; I ² = 88 %; random effects). Meta-analysis using a random effects model showed no significant differences in ventilator-free days (VFD) (WMD, 2.47 days; 95 % CI, ?2.85 to 7.79; p = 0.36; I ² = 91 %) or intensive care unit-free days (ICU) (WMD, 2.31 days; 95 % CI, ?2.34 to 6.97; p = 0.33; I ² = 89 %) between the two groups.

Conclusions

Among patients with ARDS, enteral supplementation of ω-3 FA seemed ineffective regarding all-cause 28-day mortality, VFD, and ICU-free days. Routine use of enteral ω-3 FA cannot be recommended based on the available evidence.     

可吸收张力带和金属张力带治疗尺骨鹰嘴骨折疗效比较

目的 比较生物可吸收张力带（Ｂｉｏｆｉｘ棒和Ｂｉｏｐｏｌｙ人工韧带）与金属张力带（克氏针和钢丝）治疗尺骨鹰嘴骨折的疗效。方法 采用两种张力带治疗３５例尺骨鹰嘴骨折。其中,可吸收组１８例;金属张力带组１７例。随访时间８～３７月,平均２４月。根据术后Ｘ线片和关节功能恢复情况评定疗效。结果 平均骨折愈合时间为７周。可吸收张力带治疗组：优１６例,良２例,差０例;金属张力带治疗组：优１４例,良２例,差１例。两种治疗方法临床效果无统计学差别。结论 生物可吸收张力带象金属张力带一样是治疗尺骨鹰嘴骨折较理想的有效方法之一,并具有无需二期手术取出内固定物的优点。     

MRI对腰椎间盘突出症的诊断价值

目的 探讨ＭＲＩ对于腰椎间盘突出病理分型的诊断价值。方法 比较２４２例腰椎间盘突出症例的ＭＲＩ检查结果与手术所见。结果 手术证实２４２名患者中包含型椎间盘突出１２９例,非包含型１１３例。轴位ＭＲＩ区分含民非包含型椎间透突出的敏感性、特异性和准确性分别为７７．９％、７２．１％和７４．８％,矢状位为８０．５％、７６．０％和７８．１％。结论 根据ＭＲＩ检查结果区分包含型与非包含型椎间盘突出并不可靠。     

Apofix椎板钩治疗创伤性寰枢椎不稳

目的 评价Ａｐｏｆｉｘ椎板钩治疗创伤怀寰枢椎不稳的效果。方法 对创伤性寰枢椎不稳患者行Ｃ１－２后路融合、Ａｐｏｆｉｘ椎板钩内固定术。包括齿状突骨折５例,其中１例伴横韧带断裂。结果 术后随访３￣１１个月,颈椎侧位Ｘ线片检查,５例获骨性愈合。结论寰枢椎后路融合,Ａｐｏｆｉｘ椎板钩内固定术适于治疗创伤笥寰枢椎不稳;解剖复侠是手术成功的主要。