非特异性炎症致眶尖综合征临床特征分析

目的 总结眶尖非特异炎症导致眶尖综合征患者的临床特征。设计 回顾性病例系列。研究对象 2016年6月至2019年5月北京同仁医院神经眼科及北京市普仁医院眼科眼眶非特异性炎症致眶尖综合征15例（16眼）。方法 回顾患者的临床症状、体征、化验及影像学检查、激素治疗效果及病情转归。主要指标 临床表现、眼眶及头颅CT、MRI表现。结果 15例中男性8例，平均年龄（53±16）岁。14/15例单眼发病。病灶均局限于眶尖区，7例同时累及海绵窦。首先出现患侧眼眶疼痛，相继出现眶尖综合征表现。眼眶MRI均显示眶尖部条片状不规则实性病灶，呈等T1WI、等T2WI信号，均匀强化。经全身或眼球局部糖皮质激素治疗后14眼（87.5%）眼痛完全消失，13眼（81.3%）上睑下垂改善，11眼（68.8%）眼球运动及复视症状改善。3个月后复查眼眶MRI病灶均缩小。仅一半患者治疗后视力提高，其余8眼（50.0%）视力无改善。随访过程中2例（12.5%）病变复发。结论 局限于眶尖的非特异炎症可导致严重的眶尖综合征。早期无眼红肿等炎症表现，眼球突出亦不明显，表现为眶周疼痛、眼球运动障碍，继而视力进行性损伤，易被误诊。临床表现和神经影像学是诊断主要依据。糖皮质激素治疗能有效改善眼球运动障碍和疼痛，但视力恢复困难，且病变有复发可能。（眼科，2021，30： 56-61）     

额颞颧入路海绵窦眶尖肿瘤切除及脑神经保护

目的探讨海绵窦眶尖肿瘤显微手术及脑神经保护的方法。方法回顾性分析8例海绵窦眶尖肿瘤临床资料,均采用额颞颧入路显微神经外科手术切除肿瘤及神经电生理检测保护脑神经,术后定期随访。结果肿瘤全切除4例,次全切2例,大部分切除1例,活检1例。脑神经继发损伤症状出现率22%,脑脊液漏1例,无脑内感染及死亡病例。结论掌握海绵窦眶尖区解剖及熟练的显微神经外科技术,再加上神经电生理检测保护脑神经,可提高肿瘤切除程度,减少脑神经继发损伤。     

Comparison of measurements obtained with hand files or the Canal Leader attached to electronic apex locators: an in vitro study

AIM: The aim of the present in-vitro study was to combine directly the Canal Leader handpiece (SET, Olching, Germany) with the electronic apex locators ROOT ZX (Morita, Kyoto, Japan) and JUSTY (Yoshida, Tokyo, Japan) to find out whether the working length values thus obtained were identical to those resulting from the combination of the same electronic devices with hand files. METHODOLOGY: A total of 50 natural extracted teeth with single canals and mature apices were used. A radiograph was used as a control and the distance from the radiographic apex to the tip of the file was measured and compared with the results of the electronic length determination. RESULTS: For both electronic devices the differences amongst the distribution of the measurements were not statistically significant under the specified conditions (P > 0.05), indicating that the measurements with hand files and with the Canal Leader were identical for the majority of the cases. CONCLUSIONS: Under the conditions of this study the working length of canals obtained with electronically assisted hand files were similar to those obtained with the electronically assisted mechanical handpiece Canal Leader.     

金环蛇神经毒组分Ⅸ的研究

从金环蛇毒中分离得到一个作用于突触后膜的神经毒——组分Ⅸ。与通常的蛇毒突触后神经毒不同,组分Ⅸ对蛙腹直肌的乙酰胆碱量效曲线呈现非竞争性抑制。在有新斯的明存在时,高浓度乙酰胆碱使腹直肌产生相反的效应。在实验用浓度下,组分Ⅸ对¹²⁵Ⅱ标记的眼镜蛇神经毒与电鳐电器官膜碎片的结合无显著影响。应用电压固定技术的研究表明,组分Ⅸ能够抑制终板电流,最后使其完全消失,且能缩短终板电流的半衰期。增加衰减速率常数α值;对终板电流的平衡电位无显著影响.实验提示组分Ⅸ是通过乙酰胆碱受体以外的作用方式产生阻断作用的,作用部位可能在终板离子通道。     

The importance of surgical education in the accuracy of implant placement during hip fracture fixation

Background  Studies have found that tip apex distance (TAD) is the strongest independent predictor of lag screw cut-out following hip fracture fixation. The objective of this study was to understand the importance of introducing the concept of TAD to surgeons. The null hypothesis was that there were no differences between fractures fixed before awareness of TAD compared with fractures fixed after awareness of TAD. Materials and Methods  This study involved assessing 75 consecutive radiographs retrospectively (before introduction of “tip apex distance” to surgeons) and 83 consecutive radiographs prospectively (after introduction of “tip apex distance” to surgeons). Radiographs were measured using a radiograph digitizer and software. Results  Average TAD in radiographs measured retrospectively was 22.6 mm compared with 9.7 mm in radiographs analysed prospectively (P ≤ 0.001). The power of this study was 97%. Conclusion  This study demonstrates that introducing the concept of “TAD” to surgeons, will improve the accuracy of lag screw placement during fixation of an extracapsular fracture. The improvements in lag screw placement will undoubted reduce cut-out of the implant post-surgery. This study was supervised by the late Professor Harper, Professor of Orthopaedic Surgery at the University of Leicester, who sadly died in 2008. Our thoughts are with him.     

The effects of muscarine and atropine reveal that inhibitory autoreceptors are present on frog motor nerve terminals but are not activated during transmission

Summary The role of presynaptic muscarinic receptors in modulating neuromuscular transmission was studied in the isolated sartorius muscle of the frog using electrophysiological techniques. In low calcium solutions muscarine reduced mEPP frequency and the quantal of EPPs. In solutions containing the normal calcium concentration the effect of muscarine on quantal content, but not the effect on mEPP frequency, was somewhat attenuated. Muscarine-induced reductions in the parameters of ACh release were prevented by atropine. Irrespective of the calcium concentration, atropine had no effect on mEPP frequency except where fibres were pretreated with glycerol. In experiments where evoked acetylcholine release was maintained at physiologically relevant levels, atropine had no effect on the quantal content of EPPs evoked at low frequency or on the extent of rundown in trains of EPPs evoked at high frequency. Send offprint requests to the author at Department of Pharmacology, Faculty of Basic Medical Sciences, Queen Mary and Westfield College, University of London, Mile End Road, London E1 4NS, UK     

腰椎间盘突出症患者下腰椎终板矢状面形态特征

目的:观察腰椎间盘突出症(lumbar disc herniation,LDH)患者下腰椎(L3～S1)终板矢状面形态特征。方法:回顾性分析2016年6月～2017年7月就诊我院的腰椎间盘突出症患者和无明确腰椎疾病的志愿者。共纳入LDH患者141例,其中男61例,女80例,年龄61.6±10.1岁(41～79岁),身体质量指数(BMI)为26.3±3.4(18.3～33.2)。对照组纳入志愿者109例,其中男47名,女62名,年龄55.4±12.2岁(40～87岁), BMI为25.3±3.6 (17.6～32.5)。在腰椎CT正中矢状面重建图像上测量LDH患者椎间盘突出节段的终板形态和志愿者腰椎L3下终板至S1上终板的终板形态学参数,包括终板屈曲深度(ECD)、矢状面屈曲角(SCA)和终板屈曲顶点位置(ECA);相应节段椎间盘退变程度在MRI上通过Pfirrmann分级进行评估。应用t检验比较LDH组与对照组终板矢状面形态学参数;选择L4/5和L5/S1两节段中相同退变程度(PfirrmannⅢ级,PfirrmannⅣ级)的椎间盘,比较LDH组患者和对照组志愿者的终板矢状面形态。将LDH组患者和对照组志愿者终板数据合并后按照椎间盘退变程度分组(PfirrmannⅡ级～PfirrmannⅤ级),应用Kruskal-Wallis检验比较不同退变程度椎间盘终板形态参数的组间差异。结果:LDH组各节段终板ECD均显著低于对照组(L4上终板P=0.016,其余终板P0.01),SCA均显著大于对照组(P0.01);除L3下终板外(P=0.014),所有节段终板ECA的组间差异无统计学意义(P0.05)。L4/5和L5/S1节段中PfirrmannⅢ级和Ⅳ级椎间盘终板,相同节段和退变分级的组间比较结果显示,LDH组终板ECD显著小于对照组(P0.05),SCA显著大于对照组(P0.05),ECA未出现组间显著性差异(P0.05)。不同退变程度椎间盘终板形态参数组间比较显示,随着椎间盘退变进展,各节段ECD降低(P0.01),SCA增大(P0.01),ECA未出现一致的组间变化趋势。结论:LDH患者相比对照组志愿者,其下腰椎终板矢状面屈曲程度较低,退变程度较高的椎间盘其终板屈曲程度较小。     

心脏永久起搏器治疗对Ⅲ度房室传导阻滞伴发高血压患者的血压影响研究

目的：探讨心脏永久起搏器治疗对Ⅲ度房室传导阻滞伴发高血压患者的血压影响。方法：回顾性分析37例Ⅲ度房室传导阻滞伴发高血压患者起搏器植入术前后血压变化及起搏部位对血压的影响。结果：起搏器植入前后血压差异有统计学意义（P〈0.05）,起搏器植入右室流出道、右室心尖部前后的血压差值差异无统计学意义（P〉0.05）。结论：起搏器治疗能有效降低Ⅲ度房室传导阻滞伴发高血压患者的血压,起搏部位对血压无明显影响。     

Raypex 5根尖定位仪测定乳牙根管工作长度准确性的实验研究

目的探讨Raypex 5根尖定位仪测定乳牙根管工作长度的准确性。方法将90颗离体乳牙（共144个根管）根据有无根尖吸收分为甲组（牙根无吸收,70个根管）及乙组（牙根有吸收,74个根管）。将两组牙齿放置于测量槽中,用Raypex 5测量根管工作长度,与肉眼下测量的根管实际工作长度进行比较。结果 Raypex 5根尖定位仪测量甲组的准确率为95.7%,测量乙组的准确率为91.9%,两组准确率的差异无统计学意义（P〉0.05）。结论使用Raypex 5根尖定位仪能有效测量乳牙工作长度。