下睑缘切口皮瓣延伸肌皮瓣法切除睑袋的效果观察

目的探讨下睑缘切口皮瓣延伸肌皮瓣法切除睑袋的临床效果。方法于下睑缘睫毛根下1mm处平行下睑缘设计切口,由内眦至外眦,经外眦处与水平线呈15°～30°处向外下方斜行切开3～7mm,先向下皮下剥离约5mm,再切开眼轮匝肌,形成上方为皮瓣下方为肌皮瓣的复合瓣,复合瓣后方的眶隔脂肪充分显露,以眶下缘平面为基准,直视下切除疝出的眶隔脂肪,对有“泪槽”凹陷者将眶隔脂肪转移填充凹陷至下睑平整,最后,扇形切除多余的皮肤和肌肉,间断缝合切口。按照睑袋切除术后满意度标准,对术后效果进行评价,并记录各种并发症的发生情况。结果术后随访1～12个月,按照术后满意度评定标准,患者的满意率82％（262／319）;基本满意率14％（45／319）;不满意率4％（12／319）。本组中43例出现并发症,如轻度复视、轻度睑外翻、血肿等,均经术后7d至3个月逐渐恢复。但14例血肿患者中,有2例在术后6个月行手术切除血肿后,外观改善;6例术后7d拆线时出现切口裂开,经医用胶水粘合后恢复。所有患者术后睑袋畸形均得到不同程度地矫正,下睑皮肤皱纹明显减少或消失,瘢痕不显,无严重的并发症发生。结论采用下睑缘切口皮瓣延伸肌皮瓣法修复中老年人下睑皮肤松弛,效果良好,并发症少,值得临床推广应用。     

内镜辅助下经口径路咽旁间隙的解剖

目的 探讨内镜辅助下经口径路咽旁间隙的解剖结构,了解该径路重要的解剖标志及颈内动脉、颈内静脉及后组颅神经等解剖结构的毗邻关系,为内镜辅助下经口径路切除咽旁间隙肿瘤提供解剖学依据。方法 在内镜辅助下对新鲜尸头标本5例(共10侧)行经口径路咽旁间隙解剖。结果 茎突前间隙以咽上缩肌及翼内肌作为解剖标志,茎突咽肌、茎突舌肌是茎突前间隙的后界也是进入茎突后间隙的标志,重要的血管及后组颅神经（舌咽神经、迷走神经、副神经、舌下神经）位于茎突后间隙。以茎突尖端为标志测量距舌咽神经、舌下神经及迷走神经的水平距离分别为（3.05±0.08）mm（2.94～3.14 mm）、(2.94±0.04）mm（2.44～2.56 mm）、（1.50±0.03）mm（1.46～1.56 mm）;以茎突咽肌为标志进行测量,距舌下神经及迷走神经的水平距离分别为;（3.00±0.03）mm（2.96～3.04 mm）、（5.99±0.03）mm（5.94～6.04 mm）,而舌咽神经基本紧贴该肌内侧面。副神经的走行距离茎突及茎突咽肌较远,经口手术径路几乎不会碰到。结论 内镜辅助下经口径路可较好的暴露咽旁间隙结构,咽上缩肌、翼内肌、茎突咽肌、茎突舌肌是重要的解剖标志。     

A high level of serum neopterin is associated with rapidly progressive interstitial lung disease and reduced survival in dermatomyositis

Neopterin is primarily synthesized and released by activated macrophages/monocytes upon stimulation with interferon-γ and is considered as a marker for macrophage activation. This study aimed to analyze the serum levels of neopterin in patients with dermatomyositis (DM) in association with clinical manifestations, laboratory data and patient prognosis. One hundred and eighty-two consecutive DM patients and 30 healthy controls were retrospectively enrolled into the study. Serum levels of neopterin were significantly increased in DM patients compared to healthy controls (P < 0·001). High serum neopterin levels were associated with anti-melanoma differentiation-associated gene (MDA5) antibody, rapidly progressive interstitial lung disease (RP-ILD) and characteristic DM cutaneous involvement. Longitudinal assessment of serum samples revealed that the serum neopterin levels were closely correlated with disease severity (β = 30·24, P < 0·001). In addition, a significant increase in serum neopterin concentration of non-survivors was observed when compared to that of survivors (P < 0·001). Receiver operator characteristic curves showed that serum neopterin could distinguish non-survivors and survivors at an optimal cut-off level of 22·1 nmol/l with a sensitivity and specificity of 0·804 and 0·625, respectively (P < 0·001). Kaplan–Meier survival curves revealed that DM patients with serum neopterin > 22·1 nmol/l had a significantly higher mortality compared to the patient group with serum neopterin < 22·1 nmol/l (log-rank P < 0·001). Multivariate regression analysis identified high serum neopterin concentration to be an independent risk factor for poor prognosis in DM (adjusted hazard ratio = 4·619, 95% confidence interval = 2·092–10·195, P < 0·001). In conclusion, increased serum levels of neopterin were significantly associated with RP-ILD and reduced survival in DM patients, suggesting it as a promising biomarker in disease evaluation of DM.     

Polar metabolite of cholesterol induces rat cognitive dysfunctions

24-hydroxycholesterol, a major polar metabolite of brain cholesterol, has neurotoxic effects. However, little is known about the effects of this polar metabolite on the CNS. In the present study, the effects of 24-hydroxycholesterol on behavior changes were investigated. Rats were divided into three groups: (i) a control group; (ii) a sham group: 0.5 ml PBS was infused into the cerebral ventricle; (iii) a model group: 0.5 ml 24-hydroxycholesterol (10 μM) was infused into the cerebral ventricle. 24-hydroxycholesterol can obviously impair rats' acquisition and probe trial in the Morris Water Maze task. Compared with rats in the sham group, rats in the model group had longer escape latency time and traveled more distance, and performed worse in the probe trial task manifested by spending less time in the annulus and training quadrant, which probably was attributed to the neuronal degeneration in hippocampal CA1 area induced by 24-hydroxycholesterol as examined by histological assay and apoptotic assay. Our results revealed that the polar metabolites, such as 24-hydroxycholesterol, exert neurotoxic effects and exacerbate the neuron injury with their abnormal accumulation. These findings suggest that measures taken promptly to eliminate or inhibit the accumulation of polar metabolites should be a potential strategy to prevent neurological dysfunctions and promote the recovery of functional deficits after neurotoxic insult.     

医疗设备报废的政策研究

本文对医疗设备报废工作中的现实问题进行了分析,并就适当修正医疗设备的报废原则和报废标准提出了具体建议。     

原子吸收光谱法测定人血中铅含量

目的:研究以石墨炉原子吸收光谱法测定人血中铅含量。方法:取全血100μl,加入400μl0.1%TritonX-100稀释,于283.3nm波长处测定原子吸收。结果:血铅的检测浓度为40～640ng/ml(r=0.9999);石墨管管内变异RSD为2.63%～9.74%,管间变异RSD为14.31%～21.00%;方法回收率为98.4%～119.35%。结论:本方法简便、快速、准确,可用于测定人血中铅含量。     

MAGE—A1，A2，A3，A4在膀胱移行细胞癌组织及细胞株中基因表达的研究

目的：研究膀胱移行细胞癌（TCC）中黑色素瘤抗原（MAGE）基因表达。方法：逆转录聚合酶链反应（RT—PCa）技术检测20例膀胱TCC患者癌组织和3株膀胱TCC细胞株124、EJ、BIU87中MAGE—A1、A2、A3、A4基因mRNA表达。结果：20例膀胱，TCC癌组织中19例（95％）至少表达一种MAGE—A基因，12例MAGE—A1阳性（60％），16例MAGE—A2阳性（80％），11例MAGE—A3阳性（55％），18例MAGE—A4阳性（90％），MAGE—A1—4均阳性8例（40％）。膀胱，TCC细胞株T24中MAGE—A1—4基因均表达，口中MAGE—A3、A4基因表达，BIU87中MAGE—A2、A3、A4基因表达。结论：MAGE基因在膀胱TCC中有较高表达，可望成为膀胱，TCC免疫治疗的靶基因。     

原发性高血压与血管紧张素转换酶基因I/D多态性的研究

目的:探讨血管紧张素转换酶(ACE)基因多态性与原发性高血压的关系.方法:提取152例原发性高血压(EH)患者及111例正常对照组外周血白细胞的基因组DNA,应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术进行ACE基因I/D分型.结果:ACE I/D各基因型在EH组和正常对照组之间有显著差异(P＜0.01);ACE D等位基因在EH组中的频率显著高于正常对照组(0.48vs0.33,P＜0.01).性别分层后发现,此差异仅存在于男性患者.结论:D等位基因与原发性高血压相关,此相关性具有性别特异性.