金丝桃化学成分研究

从金丝桃的地上部分分得20种化合物,应用光谱分析和化学方法对其中的4种进行了结构鉴定,其结构分别为β-谷甾醇、金丝桃内酯丙、槲皮素和槲皮苷.其中化合物β-谷甾醇、槲皮素和槲皮苷系该植物中首次发现.     

实验性局灶性脑缺血再灌注后HSP70 mRNA的表达

目的：探讨脑缺血后HSP70mRNA表达变化，方法：采用沙土鼠短暂前脑缺血再灌注损伤模型。Northern blot定量检测HSP70m RNA表达，结果：沙土鼠前脑缺血6分钟再灌注后各时期HSP70 mRNA表达量增加（P＜0．05），热休克预处理能增加沙土鼠短暂前脑缺血再灌注后各时期HSP70 mRNA表达（P＜0．05），结论：沙土鼠前脑缺血6分钟再灌注后各时期HSP70 mRNA表达增加，热休克预处理增加HSP70mRNA表达。     

Reliability of current classification systems for periprosthetic distal femur fractures

IntroductionThis study aims to determine which Periprosthetic Distal Femur Fracture (PDFF) classification system is the most reliable. The secondary aim was to determine which classification system correlated most accurately with the surgical management recommended and delivered.MethodsBetween 2011 and 2019, 83 patients with 83 PDFFs that extended to the femoral component of a total knee arthroplasty (TKA) were retrospectively identified from a trauma database. Minimum follow-up was 1 year. Age, BMI, time from TKA, operative management, and Nottingham Hip Fracture Scores were collected, and AP and lateral radiographs used to classify all fractures using seven established classification systems by two observers blinded to management. In patients treated operatively (n = 69), preoperative radiographs were reviewed by two surgeons with expertise in trauma and knee revision who recommended fixation or distal femoral replacement (DFR) requirement.ResultsMean age was 80.7 years (SD9.4) and 50 (84.7%) were female. PDFFs occurred at a mean 9.5 years (SD5.2) after primary TKA. Mean follow-up was 3.8 years (SD2.9). Management was fixation in 47, DFR in 22 and non-operative for 14. The Fakler classification demonstrated highest interobserver reliability (ICC=0.948), followed by the Rorabeck (ICC=0.903), UCS (ICC=0.850) and Chen (ICC=0.906). The Neer classification demonstrated weakest agreement (ICC=0.633). Overall accuracy of predicting DFR requirement (as determined by two experts) was highest for the Fakler system (83.9%). Compared with actual management delivered the Rorabeck system was most accurate (94.1%). Multivariate regression demonstrated that the ultimate need for DFR (n = 22) was independently associated with medial comminution (HR 2.66 (1.12–6.35 95%CI), p = 0.027) and fractures distal to the anterior flange and posterior condyle of the femoral component (HR 2.45 (1.13–5.31), p = 0.024).ConclusionThe Fakler classification showed highest interobserver agreement and was most accurately predictive of the management recommended by two experts. No classification system accurately predicted the fractures that required DFR, and none included medial comminution which was independently associated with DFR requirement. There remains a need for a PDFF classification system that reliably guides operative management of PDFFs.     

Hyperglycemic hemianopia: A case report

BACKGROUNDNonketotic hyperglycemia (NKH) is characterized by hyperglycemia with little or no ketoacidosis. Diverse neurological symptoms have been described in NKH patients, including choreoathetosis, hemiballismus, seizures, and coma in severe cases. Homonymous hemianopia, with or without occipital seizures, caused by hyperglycemia is less readily recognized.CASE SUMMARYWe describe a 54-year-old man with NKH, who reported seeing round, colored flickering lights with right homonymous hemianopia. Cranial magnetic resonance imaging demonstrated abnormalities in the left occipital lobe, with decreased T2 signal of the white matter, restricted diffusion, and corresponding low signal intensity in the apparent diffusion coefficient map. He responded to rehydration and a low-dose insulin regimen, with improvements of his visual field defect.CONCLUSIONPatients with NKH may present focal neurologic signs. Hyperglycemia should be taken into consideration when making an etiologic diagnosis of homonymous hemianopia.     

铬对克山病病区粮喂养大鼠的甲状腺激素及cAMP水平的影响

为探讨铬对心肌损伤时Ｔ３、Ｔ４及ｃＡＭＰ水平的影响，应用克山病病区低硒粮、加铬、加硒及加铬加硒喂养大鼠，以放射免疫法测定血清Ｔ３、Ｔ４及心肌ｃＡＭＰ含量。结果显示病区粮组Ｔ３、Ｔ４及ｃＡＭＰ水平较对照组下降（Ｐ〈０．０１），加铬、加硒及加铬加硒组较对照组无差异（Ｐ〉０．０５），较病区粮组升高（Ｐ〈０．０５￣０．０１）。铬、硒能维持低硒心肌损伤时甲状腺激素及ｃＡＭＰ的正常代谢。     

完整结肠系膜切除术在结肠癌治疗中的应用价值分析

【摘要】〓目的〓探讨完整结肠系膜切除术(CME)在结肠癌治疗中的应用价值。方法〓回顾性分析60例结肠癌患者的临床资料,将所有病例分为观察组和对照组,每组30例。对照组采用传统根治术治疗,观察组采用CME治疗。比较两组手术时间、术中出血量、下床时间、排气时间、首次进食时间、术后住院时间、淋巴结清扫数量及并发症发生率。结果〓观察组手术时间、术中出血量、下床时间、排气时间、首次进食时间、术后住院时间均显著小于对照组(P<0.05),观察组淋巴结清扫数目显著大于对照组(P<0.05);观察组不良反应发生率显著低于对照组(P<0.05)。结论〓与传统根治术相比,CME在结肠癌治疗中的应用效果更为显著。     

胸背动脉穿支皮瓣修复乳房缺损畸形的临床应用

目的探讨胸背动脉穿支皮瓣或预扩张后胸背动脉穿支皮瓣,在乳房缺损畸形重建中的临床应用。方法2007年8月至2014年4月,对23例乳房缺损畸形患者,采用预扩张带蒂胸背动脉穿支皮瓣修复5例,单纯带蒂胸背动脉穿支皮瓣修复18例,皮瓣大小为12 cm×22 cm~7 cm×12 cm。结果 23例患者术后皮瓣均完全成活,供区无血肿、血清肿等并发症发生。术后随访3~26个月,皮瓣成活良好,外形恢复较好。结论胸背动脉穿支皮瓣较薄,穿支血管蒂较长且走行恒定,预扩张后可提供较大面积的皮瓣,是修复乳房浅表组织缺损畸形的良好选择。     

空军官兵鼻骨骨折40例临床分析

目的对空军官兵鼻骨骨折的诊治情况进行分析,得出简便准确的诊断方法和有效的复位方法。方法对在沈阳军区空军沈翔705医院诊治的40例空军官兵鼻骨骨折的病例进行分析。结果40例病例复位效果均比较满意。结论X线鼻骨轴侧位片及临床表现仍为诊断鼻骨骨折的最简便有效的诊断手段,对于复杂合并其他面部骨折的病例,CT扫描及三维CT重建,具有价值。鼻骨骨折复位的方法以鼻骨复位钳为最实用方法,而术后常规鼻腔填塞并非必要。     

江中牌健胃消食片快速鉴别法

目的:针对市场上“江中牌”健胃消食片假(冒)品按现行标准鉴别、含量测定均合格的情况下,建立其快速检验方法来鉴别该药品的真伪,以适用于药品检测车上的准确快速筛查.方法:根据“江中牌”健胃消食片的处方组成、质量标准的制法及市场上正品及假(冒)品的情况展开研究,采用显微鉴别法结合薄层色谱法同时鉴别中成药山药.结果与结论:该方法简便、快速、重复性好,且成本低,适用于药品检测车上“江中牌”健胃消食片的快速筛查,增加了山药的显微和薄层鉴别,补充了“江中牌”健胃消食片国家标准中的相关规定,具有较强的实用性.     

十二指肠乳头内生性腺瘤内镜下诊断与治疗（附8例报告）

目的探讨十二指肠乳头内生性腺瘤的内镜下诊治方法。方法2005年6月～2008年10月对8例B超、MRCP影像学检查提示胆总管及肝内胆管不同程度的扩张,乳头开口及下段狭窄,进一步行ERCP及IDUS检查,发现病变并予以治疗。结果2例绒毛管状腺瘤伴上皮中度不典型增生及1例管状腺瘤行胰十二指肠乳头切除术：1例绒毛管状腺瘤术后病理局部癌变,3个月后肝转移行介入化疗及栓塞2次,16个月全身复查未见异常;1例管状腺瘤伴上皮中度不典型增生者术后病理局部印戒细胞癌,术后6、14个月随访全身复查未见异常。1例管状乳头状腺瘤行十二指肠乳头内镜下切除术后置入胆管支架内引流,6个月后复发并癌变,术后10个月死亡;1例绒毛管状腺瘤伴上皮中度不典型增生行十二指肠乳头内镜下切除术后置入胆管支架内引流,术后6、12个月复查未见异常;1例绒毛管状腺瘤伴上皮中度不典型增生术后病理与术前相同,且切除干净,未随访。1例绒毛状管状腺瘤伴高级上皮内瘤变,胆道塑料支架置入术,术后4个月反复胆道感染,内镜下更换为金属支架。1例乳头状腺瘤置入胆管支架内引流,术后失访。1例管状腺瘤拒绝治疗,电话至12个月随访无异常不适。结论十二指肠乳头内生性腺瘤临床罕见,且易于癌变,对乳头切开后黏膜层及肌层增厚的患者尤其有增生性病变者应常规多点取活检,避免乳头内腺瘤及恶性变病灶的遗漏,并对相关病灶及时内镜下或手术治疗。