转TrkC基因神经干细胞移植对脊髓损伤的治疗作用

目的 研究转酪氨酸激酶C（tyrosine kinase C，TrkC）基因神经干细胞（neural stem cells，NSCs）移植治疗脊髓损伤的作用。方法 60只SD大鼠随机分成正常对照组（A组）、脊髓半切组（B组）、NSCs移植组（C组）、NSCs移植＋神经营养素（NT）-3局部使用（D）组、转TrkC基WNSCs移植组（E组）和转TrkC基因NSCs移植＋NT-3局部使用组（F组），每组10只。脊髓损伤后第9天进行细胞移植。各组大鼠在细胞移植后2个月，行体感诱发电位（SEP）和运动诱发电位（MEP）检查以及脊髓运动功能（BBB）评分。结果 细胞移植后2个月SEP和MEP发生潜伏期和峰峰波幅以及右后肢BBB评分的恢复均以下组最佳，与其他各组比较，差异有统计学意义（P＜ 0．05，0．01）。结论在局部给予的NT-3作用下，转TrkC基因NSCs能较好地促进损伤脊髓功能的恢复。     

高压氧预适应对大鼠高原颅脑损伤的作用研究

目的探讨高压氧（HBO）预适应对高原颅脑损伤（TBI）的神经保护作用。方法将78只SD大鼠随机分为平原组、高原组和高压氧预适应组，各组按Feeney自由落体撞击法制作TBI模型，并通过低压氧舱模拟高原环境。采用Longa评分法进行神经功能缺损评分，Moor DRT4激光多普勒血流监测仪和LICOX CMP组织氧分压监测仪分别监测伤区局部脑血流（rCBF）和局部脑组织氧分压（PbtiO2）变化，利用光镜观察伤区脑组织的病理学改变。结果伤后24h高原组较平原组神经功能缺损评分上升。rCBF和PbtiO2下降，病理损伤加重；高压氧预适应组较高原组神经功能缺损评分下降（P〈0.05），rCBF和PbtiO2升高（均为P〈0.05）病理损伤减轻。结论高压氧预适应可诱导对高原颅脑损伤的神经保护作用改善神经功能。     

多层螺旋CT扫描图像数据对经蝶窦入路穿刺三叉神经节及其分支的可行性研究

目的 探讨经蝶窦入路穿刺三叉神经节及其分支的可行性,分析两者的毗邻关系及相关限制因素.方法 对110例成年中国人头部薄层CT轴位原始资料进行多平面重组,观察圆孔、卵圆孔、翼腭窝（管）、Meckel腔与蝶窦外侧壁的关系,测量蝶窦外侧壁至诸结构的骨壁厚度.结果 ①圆孔紧靠蝶窦外侧壁的前外下方,骨壁厚度＜2 mm者84例（76%）;②重组图像可显示翼腭管全程,翼腭窝与蝶窦前下外侧壁之间的骨壁厚度＜2 mm者77例（70%）;③卵圆孔距离蝶窦外侧壁距离＞5 mm 98例（89%）;④由蝶窦腔内经颈内动脉管前方入路,斜向后下外方可及Meckel腔,骨壁厚度1～5 mm,颈动脉管为重要骨性标志.结论 经蝶窦内可分别穿刺或开放圆孔、翼腭窝和Meckel腔,而经蝶窦内穿刺卵圆孔基本不可行;经蝶窦入路至三叉神经节及其分支的可及性与蝶窦气腔的位置和扩展程度有关.     

老年与青壮年脑挫裂伤组织NGF的表达差异及意义

目的 研究衰老对脑挫裂伤组织神经生长因子（NGF）基因表达的影响,进一步探讨老年颅脑损伤病人神经功能缺失程度较重的分子生物学机制.方法 收集重型颅脑损伤开颅手术中的脑挫裂伤组织,应用免疫组化和医学数码图像分析技术,观察老年组（≥60岁）和青壮年组（19～59岁）病人脑损伤后3～9 h脑挫裂伤组织NGF蛋白的表达差异.结果 脑损伤后NGF在老年和青壮年脑挫裂伤组织中的表达均明显增强;老年组脑挫裂伤组织中的NGF蛋白表达显著性低于青壮年组（P＜0.05）.结论 老年人脑挫裂伤后NGF表达水平下降明显,提示其受损神经元的修复和生存能力降低,这可能是老年颅脑损伤病人恢复不良的重要原因之一.     

脊柱复合性损伤的救治风险与早期治疗

目的评估脊柱复合性损伤的特点和救治风险,探讨风险控制与最佳治疗的方法。方法采用AIS、ISS、TRISS及APACHEⅡ等评分方法对273例脊柱复合性损伤患者进行定量评价与救治分类,并依据伤后的损伤分级、参数评定及计量评分等指标进行量化分析和统计处理。结果颈椎合并伤115例,胸椎合并伤141例,胸腰椎合并伤294例,腰骶椎合并伤181例;患者的救治风险和脊椎伤的治疗选择或手术时机与其合并伤的解剖伤势及由此所构成的整体伤情密切相关(P<0.01或<0.05);高风险性伤员往往综合伤势严重,生存概率(Ps)趋低,并发症和死亡率高(P<0.01或<0.05)。结论脊柱脊髓损伤常合并有严重的多发伤,高危伤情不仅可增加其救治风险和脊柱伤的处理难度,且还易于丧失手术最佳时机。分类救治对伤员的风险控制和脊柱伤的专科治疗是有益的。     

Aesthetic aspects in reconstructive microsurgery

The reconstruction of a part of the body that has lost or inhibited function has been the most important aspect of reconstructive surgery in the past. Because of the existence of better techniques and the patient's wish for social reintegration, the plastic surgeon today is forced to consider the aesthetic results of his work more than in the past. Sometimes microsurgical procedures in reconstructive surgery are the only chance for the patient to be healed or palliated. Experience with more than 350 free tissue transfers gave us the opportunity to estimate the value of a donor flap with respect to the requirements of the receiving site. To satisfy the high aesthetic demands in these cases, it was necessary for the right place and shape the flap to fit as closely as possible, even if further corrections were necessary to achieve a satisfactory result. The transfer of latissimus dorsi and radial forearm flaps to the face and lower leg is discussed in cases of tumorus diseases and severe injuries of young and old patients.Presented to the IXth Congress of the International Society of Aesthetic Plastic Surgery, New York, October 13, 1987     

Lower limb blocks for children

Femoral and lateral cutaneous nerve of the thigh blocks have been performed in a group of 50 children; the method has not previously been described in paediatric practice. The technique was judged to have been successful in 48 (96%) of the children. There were no early or late complications. It is concluded that these blocks are easy to perform, even in small children and infants, and that they can produce reliable postoperative analgesia for a variety of orthopaedic and plastic procedures.     

唾液腺放射性损伤及其防护

放射治疗在头颈肿瘤的地位已得到广泛认同，但放疗并发症不容忽视，最常见的是放射性口干。其主要机制为放射诱导的唾液腺损伤，早期和晚期损伤的机制不同。目前对唾液腺放射防护的研究主要集中在放射防护剂、放射技术、基因转移技术等多个方面。     

The pattern evoked response in disorders of the optic nerve

The pattern evoked electroretinogram (PERG) was investigated in 11 patients with unilateral optic nerve disease and in a series of age-matched controls. The visually evoked potential (VEP) was also measured. The PERG showed a similar reduction to the VEP in optic nerve disease. Serial studies indicate that the PERG may not be affected immediately in some instances but may show a gradual decline over several months.