早期气管切开治疗老年重型颅脑损伤的疗效分析及对预后的影响

目的探讨早期气管切开治疗老年重型颅脑损伤（sTBI）的临床效果及对患者预后的影响。 方法选取解放军总医院第七医学中心神经外科自2016年2月至2018年1月收治的106例sTBI老年患者作为研究对象,根据随机数字法分为对照组和观察组,每组53例。2组患者采用相同的治疗方案,对照组在损伤后>24 h行气管切开术,观察组在损伤后<24 h行气管切开术。比较2组患者治疗效果、血气指标变化、住院情况、肺部感染率及病死率。 结果观察组患者机械通气时间、ICU住院时间、总住院时间和控制感染时间均少于对照组,差异具有统计学意义（P<0.05）。观察组肺部感染发生率显著低于对照组,而感染控制率显著高于对照组,差异有统计学意义（P<0.05）。2组治疗后48 h的PaO₂、PaCO₂、SpO₂、PaO₂/FiO₂水平与治疗前比较,差异均有统计学意义（P<0.05）,观察组治疗后48 h的PaO₂、SpO₂和PaO₂/FiO₂水平高于对照组,差异有统计学意义（P<0.05）,PaCO₂水平显著低于对照组,差异有统计学意义（P<0.05）。2组患者GOS评分、病死率比较,差异均无统计学意义（P>0.05）。 结论伤后<24 h行早期气管切开更有利于改善老年重型颅脑患者低血氧症、通气功能和脑组织缺氧,降低肺部感染发生率,缩短住院时间,值得推广应用。     

椎间盘切除Dynesys动态稳定系统固定治疗腰椎间盘突出症的中长期疗效

目的 :回顾性分析椎间盘切除+Dynesys动态稳定系统固定治疗腰椎间盘突出症的中长期疗效。方法 :2008年7月~2012年7月因腰椎间盘突出症在我院行椎间盘切除+Dynesys动态稳定系统内固定治疗的患者84例,其中61例获得完整随访资料,男38例,女23例;年龄31~58岁(46.3±11.5岁),随访时间60~108个月(74±14个月)。术前、术后3个月和末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评估,同时行影像学评估,包括手术节段及上位相邻节段椎间隙高度、椎间活动度(rang of motion,ROM)、UCLA椎间隙退变分级(University of California at Los Angeles)以及椎间盘退变Pfirrmann分级。结果:术后3个月、末次随访时VAS评分和ODI均较术前明显改善(P0.05),所有病例均未见椎间盘突出复发。手术节段椎间隙高度术后3个月(12.3±2.3mm)较术前(11.8±1.8mm)增加,末次随访时(10.1±1.7mm)较术前降低(P0.05);上位相邻节段各时间点无显著性差异。手术节段椎间ROM在术后3个月及末次随访分别为5.3°±1.8°及3.6°±1.9°,与术前(8.1°±2.8°)比较均显著性降低(P0.05);上位相邻节段ROM在术后3个月和末次随访分别10.3°±3.8°和11.4°±3.7°,均较术前(8.5°±3.0°)显著性增加(P0.05)。末次随访时手术节段UCLA分级与术前比较有统计学差异(P0.05),12例(19.7%)上位相邻节段发生影像学退变,1例发生症状学退变(adjacent segment degeneration,ASD)。手术节段和上位邻近节段术前与末次随访椎间盘Pfirmman分级均有统计学差异(P0.05)。2例出现螺钉断裂,未发生螺钉松动等其他并发症。结论:腰椎间盘切除后应用Dynesys动态稳定系统内固定治疗腰椎间盘突出症可获得满意的中长期疗效,能维持手术节段稳定,保留手术节段部分椎间活动度。     

Effect of anti-VEGF treatment on retinopathy of prematurity in Zone II Stage 3+

AIM: To evaluate the effect of intravitreal ranibizumab injection for retinopathy of prematurity (ROP) in Zone II Stage 3+. METHODS: Data was collected for ROP patients with Zone II Stage 3+ who received intravitreal ranibizumab injections between October 2014 and Janu-ary 2017 at the Department of Ophthalmology in our hospital. No prior laser or other intravitreal treatment was done. Prior to the intervention and at each follow-up visit, fundus examination was performed. Gestational age at birth, sex, birth weight, ROP zone, ROP stage, post menstrual age (PMA) at treatment, and follow-up pe-riod were recorded. The final clinical status of the retina was evaluated for each patient. The primary outcome mea-sures included ROP recurrences requiring re-treatment, complete or incomplete peripheral vascularization. RESULTS: Eighty-six eyes of 46 premature infants with Zone II Stage 3+ ROP were enrolled in the study. The mean gestational age at birth was 28.18±1.67 (range: 25 to 33)wk and the mean birth weight was 1070.57±226.85 (range: 720.00 to 1650.00) g. The mean PMA at treatment was 38.32±2.99 (range: 32.29 to 46.00)wk. Seventy-one eyes (82.56%) were treated success-fully with intravitreal ranibizumab as monotherapy. Fifteen eyes (17.44%) developed recurrent disease. The mean interval between the treatment and retreatment was 5.96±3.22 (range: 1.86 to 11.71)wk. All eyes vascularized into zone III at the end of the study and among them 62 eyes (72.09%) achieved complete vascu-larization. CONCLUSION: Intravitreal ranibizumab injection is an effective treatment in Zone II Stage 3+ ROP patients. More patients with longer follow-up duration are necessary to confirm the safety and efficacy of this treatment.     

第二代测序技术诊断球形细胞脑白质营养不良1 例报告

目的探讨球形细胞脑白质营养不良(Krabbe病)的临床、影像学和GALC基因突变特征。方法回顾分析1例经基因检测确诊的Krabbe病患儿的临床和影像学资料,并应用目标序列捕获和第二代测序技术检测相关基因,采用Sanger测序验证突变位点,并对其父母样本进行突变位点的序列分析。结果患儿男,3岁5个月,为晚发婴儿型,主要临床表现为精神运动发育倒退、抽搐。头颅MRI显示双侧脑室后角旁白质、胼胝体压部、内囊后肢对称性长T1长T2信号。二代测序结果显示患儿GALC基因第15外显子1个杂合突变c.1832TC和第9外显子1个杂合突变c.979TG,分别引起氨基酸变化p.L611S和p.F327V,为复合杂合突变。Sanger测序结果显示2个突变分别来源于母亲和父亲,c.1832TC已有报道,c.979TG为首次报道。结论通过二代测序技术可以准确检测出Krabbe病的GALC基因突变,可协助临床诊断与鉴别。     

老年高血压患者血管弹性和红细胞携氧能力与其心肺功能和生活质量关系

目的:探讨老年高血压患者的血管弹性和红细胞携氧量与其心肺功能和生活质量的关系。方法:随机选择100名老年受试者分为两组:观察组为老年高血压患者（50例）;对照组为相对健康的老年人（50例）。对比两组:（1）血管弹性指标:大动脉和小动脉的弹性指数、动脉血管顺应性、血管僵硬度以及血管壁厚度;（2）红细胞血氧能力指标:测定血氧饱和度50%时的氧分压（P₅₀）,用ELISA检测患者红细胞内2,3-二磷酯甘油酸（2,3-DPG）及丙酮酸激酶（PK）含量;（3）心脏功能检测:主动脉直径、左房内径、左室舒张内径、右房内径、右室内经、肺动脉内径、左室射血分数、室间隔厚度、左室后壁厚度及左室前壁厚度;（4）静态肺功能检测:潮气量、每分钟通气量、肺活量、最大通气量、第1秒用力呼气量、第1秒率及深吸气量;（5）采用生存质量核心问卷（QLQ-C30）对患者进行生存质量评估。对检测结果进行统计学分析。结果:对照组大、小动脉弹性指数均明显高于观察组（P<0.05）;对照组血管顺应性明显高于观察组（P<0.05）;而观察组血管僵硬度则明显高于对照组（P<0.05）;观察组动脉内膜中层厚度大于对照组（P<0.05）;观察组动脉脉搏波速高于对照组（P<0.05）。观察组外周血P₅₀高于对照组（P<0.05）;观察组外周血2,3-DPG和PK含量均高于对照组（P<0.05）。对照组主要心肺功能指标均优于观察组（P<0.05）;观察组在躯体、角色、认知、情绪、社会等方面功能和整体生活质量各项指标评分均明显低于对照组（P<0.05）。结论:老年高血压患者动脉血管弹性降低、红细胞携氧能力下降,由此会进一步造成患者心肺功能的下降和生活质量的降低。     

H2S Relaxes Vas Deferens Smooth Muscle by Modulating the Large Conductance Ca2+‐Activated K+ (BKCa) Channels via a Redox Mechanism

IntroductionHydrogen sulfide (H₂S) is generated in mammalian cells mainly by one of the two pyridoxal‐5′‐phosphate‐dependent enzymes, cystathione‐γ‐lyase (CSE), and cystathione‐β‐synthase (CBS) using L‐cysteine as the main substrate. In previous studies, we found that CBS and CSE were functionally expressed in vas deferens (VD) and H₂S‐mediated VD smooth muscle relaxation. However, the detail mechanisms that H₂S‐relaxed VD smooth muscle were unknown so far.AimThe aim of this study is to explore the molecular target sites of H₂S in VD smooth muscle.MethodsIsolated rat VD smooth muscle strips were used for tension recording in vitro. Double immunofluorescence staining was used to identify the localization of large conductance Ca²⁺‐activated K⁺ (BK_Ca) channels.Main Outcome MeasuresChanges in tonic contraction of isolated rat VD smooth muscle strip were measured after the treatment of drugs. The expression of BKca channels in rat VD smooth muscle cells was also assessed.ResultsThe results showed that L‐NG‐nitroarginine methyl ester (a nitric oxide synthase inhibitor) did not affect the response of VD to sodium hydrosulphide (NaHS), suggesting that nitric oxide pathway was not involved. Further studies revealed that transient receptor potential (TRP) channels did not contribute to the NaHS‐induced relaxant effect. Glibenclamide, an ATP‐sensitive K channel blocker, did the same thing, whereas BK_Ca channel blockers iberiotoxin or tetraethylammonium largely reversed the relaxant effect, suggesting that H₂S may target BK_Ca channels. We also confirmed that BK_Ca channels were localized in VD smooth muscle cells. Then, studies revealed that NaHS‐induced VD smooth muscle relaxation was abolished by N‐ethylmaleimide, which was widely used as a sulfhydryl alkylation compound protecting thiols from oxidation, whereas DL‐Dithiothreitol, a strong reducing agent, did not affect the response of VD to NaHS.ConclusionsWe concluded that H₂S relaxed the VD smooth muscle by targeting BK_Ca channels via redox‐mediated mechanism. Li Y, Zang Y, Fu S, Zhang H, Gao L, and Li J. H₂S relaxes vas deferens smooth muscle by modulating the large conductance Ca²⁺‐activated K⁺ (BK_Ca) channels via a redox mechanism. J Sex Med 2012;9:2806–2813.     

Systemic lipopolysaccharide administration impairs retrieval of context–object discrimination,but not spatial,memory: Evidence for selective disruption of specific hippocampus-dependent memory functions during acute neuroinflammation

Neuroinflammation is implicated in impairments in neuronal function and cognition that arise with aging, trauma, and/or disease. Therefore, understanding the underlying basis of the effect of immune system activation on neural function could lead to therapies for treating cognitive decline. Although neuroinflammation is widely thought to preferentially impair hippocampus-dependent memory, data on the effects of cytokines on cognition are mixed. One possible explanation for these inconsistent results is that cytokines may disrupt specific neural processes underlying some forms of memory but not others. In an earlier study, we tested the effect of systemic administration of bacterial lipopolysaccharide (LPS) on retrieval of hippocampus-dependent context memory and neural circuit function in CA3 and CA1 (Czerniawski and Guzowski, 2014). Paralleling impairment in context discrimination memory, we observed changes in neural circuit function consistent with disrupted pattern separation function. In the current study we tested the hypothesis that acute neuroinflammation selectively disrupts memory retrieval in tasks requiring hippocampal pattern separation processes. Male Sprague–Dawley rats given LPS systemically prior to testing exhibited intact performance in tasks that do not require hippocampal pattern separation processes: novel object recognition and spatial memory in the water maze. By contrast, memory retrieval in a task thought to require hippocampal pattern separation, context–object discrimination, was strongly impaired in LPS-treated rats in the absence of any gross effects on exploratory activity or motivation. These data show that LPS administration does not impair memory retrieval in all hippocampus-dependent tasks, and support the hypothesis that acute neuroinflammation impairs context discrimination memory via disruption of pattern separation processes in hippocampus.     

同期双侧膝关节置换术的安全性及疗效研究

目的比较同期双侧膝关节置换和单侧膝关节置换的安全性和膝关节功能恢复情况。方法 2004年6月至2010年6月我院收治的行膝关节置换的患者共85例,行同期双侧膝关节置换的患者共34例,男性8例,女性26例;年龄48~81岁,平均61.5±1.4岁,住院时间10~55天,平均为25.3±1.8天;行单侧膝关节置换的患者共51例,男性14例,女性37例,年龄24~82岁,平均66.5±1.6岁,住院时间11~60天,平均为24.9±1.8天。比较两组患者术后6个月膝关节功能的恢复情况,术后全身和局部并发症的发生率及病死。结果同期双侧膝关节置换组发生1侧(1.5%)切口不愈合;单侧膝关节置换组发生2例(3.9%)深静脉血栓,1侧(2.0%)切口脂肪液化坏死。两组术后并发症发生率差异无统计学意义(P>0.05)。两组患者均无死亡病例发生。两组患者膝关节功能的恢复无统计学差异。结论对于术前评估可以耐受同期双侧膝关节置换的患者可选择同期双膝关节置换术。     

HPLC法测定奈米非肽中三氟醋酸含量

目的建立HPLC测定奈米非肽中三氟醋酸含量的方法。方法色谱柱：Apollo C18（4.6mm×250mm,5μm）;流动相：流动相A 0.7%磷酸水溶液（PH3.0）,流动相B甲醇;流速：1.2ml/min;检测波长：210nm;进样量：10μl。结果在12.0-961.2μg/ml浓度范围内,呈良好线性关系,线性方程为A=0.232 2X-0.062 6,r=0.999 6,平均回收率100.7%,RSD为0.73%（n=6）。结论本法简单可靠,重现性好,可作为奈米非肽中三氟醋酸含量测定方法。