同心圆硬化的临床表现及影像特点分析

目的总结同心圆硬化（BCG）的临床表现及影像特点。方法对7例均为临床、影像和（或）病理证实的BCG进行分析，总结其临床、影像特点。结果中青年起病，性别差异不明显。多以淡漠、反应迟钝起病，病变多为多发，且病灶较大，但症状及体征相对少。磁共振成像（MRI）检查均可见同心圆改变。结论同心圆硬化是一种特殊类型的脱髓鞘病，发病机制不明，诊断主要依靠MRI检查，激素治疗有效，预后良好。     

牙周炎基因疫苗佐剂IL⁃15对SD大鼠肠系膜淋巴结B细胞增殖的影响

目的：观察牙周炎疫苗佐剂白细胞介素?15（interleukin?15,IL?15）对SD大鼠肠系膜淋巴结B淋巴细胞增殖的影响,初步探讨用IL?15提高基因疫苗免疫效应的可能性。方法：将牙周炎基因疫苗pVAX1?HA2?FimA/IL?15（A组）、pVAX1?HA2?FimA（B组）和生理盐水（C组）鼻滴免疫SD大鼠,采用磁珠分选法分离纯化肠系膜淋巴结B细胞,CCK?8法检测B细胞的数量,RT?qPCR法检测CKs2基因相对表达量变化,ELISA法检测培养液中特异性IgA的表达水平。结果：A组B细胞增殖水平高于B组和C组（P < 0.05）;A组B淋巴细胞CKs2 mRNA相对表达量稍高于B组,但差异无统计学意义（P＞0.05）。A组B淋巴细胞分泌的特异性IgA水平均高于B、C组（P＜0.05）。结论：IL?15是一种有效的基因疫苗佐剂,使用本课题组构建的牙周炎基因疫苗能够促进B细胞增殖,进而提高特异性IgA抗体的表达水平。     

关节镜下Endo—Button固定双束重建前交叉韧带

目的 总结膝关节镜下应运Endo-Button固定、四骨道双柬8股重建前交叉韧带的方法和疗效.方法 应用Endo-Button固定、双束8股方法重建前交叉韧带26例,术前和术后进行Lachman试验评估膝关节的稳定性,用Lysholm评分方法评定膝关节功能.结果 26例患者获得6～30个月随访,平均26个月.术前Lachman试验均为阳性,术后23例为阴性,3例为阳性,术前、术后差异有统计学意义（χ2=40.50,P＜0.01）.术前Lysholm评分38～83分,平均（53.30±5.20）分;术后82～100分,平均（91.2±6.20）分（t=3.20,P＜0.01）.术后膝关节功能均明显改善.结论 应用Endo-Button固定、四骨道双束8股重建前交叉韧带疗效满意,固定可靠,并发症少.     

排石合剂联合气压弹道碎石治疗输尿管结石的疗效观察

目的观察排石合剂联合气压弹道碎石术治疗输尿管结石的临床疗效。方法将我院泌尿外科行输尿管结石气压弹道碎石术后有结石碎粒残留的72例患者随机分为两组,对照组在手术后常规抗炎补液治疗;治疗组在对照组的基础上加用本院制剂排石合剂50mltidpo治疗,观察两组患者输尿管内结石碎粒的排石情况。结果治疗组一周结石排净率明显优于对照组,肾绞痛发生率及止痛剂的使用率明显低于对照组,且有统计学差异。结论排石合剂明显提高气压弹道碎石术后排石效率,值得临床推广应用观察。     

经鼻腔黏膜免疫途径投递防龋DNA疫苗的研究进展

20世纪90年代以来,因DNA疫苗具有其它疫苗不可比拟的优点——免疫原性强,制备简单,免疫应答持久,安全等特点,成为防龋疫苗的研究热点.为寻找免疫防龋的最佳途径,国内外许多学者在多种免疫方法和途径上进行了研究.唾液是口腔局部抗卷染的重生理屏障.以分泌型IgA (sIgA)作为主体液防御因子的黏膜免疫系统是机体抗感染的第一道防线,在抵抗感染方面起着极其重的作用.而且实验证明通过黏膜免疫之后,黏膜局部的抗体比血清抗体出现早、效价高,且维持时间长.鼻腔免疫它不仅能避免肝脏的首过效应,有效地诱导黏膜局部免疫和系统免疫应答,具有远隔共同黏膜效应,而且与其它免疫途径相比更加简便、安全、文明,无创伤.近年来鼻黏膜途径受到了基因免疫与基因治疗领域的广泛关注,因而对经鼻腔黏膜途径免疫的方式进行深入的研究,对将来防龋DNA疫苗的临床应用具有重的意义.     

胱硫醚β合酶基因突变对中青年脑梗死再发缺血性血管病的影响

目的 前瞻性研究观察胱硫醚β合酶(cystathionine β synthase CBS)T833C基因突变对中青年脑梗死患者再发缺血性血管病(脑梗死、TIA、心肌梗死、其他血管栓塞)的影响.方法 分别采用高压液相色谱法和扩增阻滞突变体系法检测152例中青年脑梗死患者和84例正常对照组的血浆总同型半胱氨酸(total homocystine tHcy)水平和CBS T833C基因型,在5年内对其随访追踪再发缺血性血管病的情况.结果 CBS T833C基因C/C纯合突变型、C/T杂合型和T/T野生型中青年脑梗死患者随访再发脑梗死的再发率C/C型(35.00%)依次高于C/T型(22.00%)和T/T型(13.41%);各基因型随访发生TIA、心肌梗死和其它血管栓塞,趋势是C/C型高于C/T和T/T型,C/T高于T/T型;不同基因型随访总的缺血性事件有显著性统计学差别(P ＜ 0.01),发生率分别为C/C型(60.00%)、C/T型(40.00%)和T/T型(23.17%);Logistic回归分析显示tHcy水平升高是中青年脑梗塞再发缺血性血管病的独立危险因素(OR为1.110;95%CI:0.989 ～ 1.245,P ＜ 0.05),而CBS T833C基因突变未进入回归模型.结论 血浆tHcy水平升高是中青年脑梗死再发缺血性血管病的独立危险因素,CBS T833C基因突变引起tHcy水平升高,可能是间接导致中青年脑梗死再发缺血性血管病的易感基因.     

肛门括约肌肌电图在鉴别诊断多系统萎缩、帕金森病及晚发型脊髓小脑共济失调中的作用

目的 分析多系统萎缩(multipe system atrophy,MSA)、帕金森病(Parkinson's disease,PD)、晚发型脊髓小脑共济失调(1ate-onset spinocerebellar ataxia,LOSCA)患者的肛门括约肌肌电图(external anal sphincter electromyography,EAS-EMG)的差异等电生理改变特点,为临床鉴别诊断提供依据.方法 分别对88例MSA、69例原发性PD、18例LOSCA患者的电生理检查结果进行回顾性分析.结果 EAS-EMG检查中MSA组有84例(95.5%)患者存在不同程度的神经源性受损,表现为运动单位电位(MUPs)平均时限[(12.92±2.59)ms]显著延长、平均波幅[(648.6±251.0)μV]增高、多相波百分比(42.6%±21.2%)增加、异常自发电位与卫星电位多见,与PD[(8.99±0.47)ms、(470.0±91.9)μV、24.2%±11.0%]及LOSCA组[(9.04±0.62)ms、(493.1±113.7)μV、22.0%±12.1%]相比差异有统计学意义(Welch值分别为:94.240、18.093、26.710,均P=0.000).PD及LOSCA组EAS-EMG检查未发现有神经源性受损,也未见自发电位与卫星电位.结论 MSA临床表现可与PD及LOSCA相似,有时容易相互误诊,EAS-EMG检查可提高MSA的正确诊断率,尤其与PD、LOSCA进行鉴别诊断时有较大价值.

Abstract：

Objective To observe the electrophysiological changes, especially in the examination of external anal sphincter electromyography ( EAS-EMG), with those patients diagnosed as multiple system atrophy ( MSA), Parkinson's disease (PD) and late-onset spinocerebellar ataxia (LOSCA) and explore its clinical diagnostic value as well as differential diagnostic value for the three diseases. Methods The clinical data, cranial magnetic resonance imaging (MRI) data as well as results of EAS-EMG for 3 groups patients, including 88-cases MSA, 69-cases PD and 18-cases LOSCA, were analyzed retrospectively.Results EAS-EMG showed that 84 cases (95.5%) in MSA group had varying degrees of neurogenic injury. Meanwhile, mean motor unit potentials (MUPs) duration (( 12.92 ± 2.59)ms), mean MUPs amplitude ( ( 648.6 ± 251.0 ) μV ), and MUPs polyphasicity ( percentage of polyphasic MUPs; 42. 6% ±21.2% ) in MSA group were significantly different from those in PD ( ( 8. 99 ± 0. 47 ) ms, (470. 0 ±91.9) μV, 24.2% ±11.0%) and LOSCA groups ((9.04 ±0.62)ms, (493.1 ± 113.7)μV,22.0% ±12. 1%; Welch:94. 240,18. 093,26. 710,all P =0. 000). The spontaneous potentials and satellite potentials showed more common in MSA group, but not in other groups. Conclusions MSA and PD and LOSCA are easily mutually misdiagnosed because of some similar syndromes, but the method of EAS-EMG could be effective and helpful to enhance accurate diagnostic rate of MSA and its differential diagnosis with PD and LOSCA.     

同心圆硬化12例临床及影像学分析

目的 探讨同心圆硬化的临床表现、影像学特征及其诊断价值.方法 回顾12例同心圆硬化患者(门诊2例,住院10例)的临床表现、实验室检查结果、影像学特点及病理结果,并对患者进行随访.结果 12例患者(男4例,女8例)发病年龄8～54岁(平均36.8岁),多以淡漠少语、反应迟钝起病(7例),病程中其他临床表现以智能减退(10例)、肢体活动障碍(8例)、大小便失禁(7例)、肌力减退(7例)、锥体束征阳性(6例)较多见.8例患者行脑脊液髓鞘碱性蛋白检查,其中7例增高.6例行脑活体组织检查,均可见分层脱髓鞘改变,有炎性细胞浸润.病灶数量1例为单发,11例为多发.4例患者行头颅CT检查,病灶均呈低密度影,增强后无强化.MRI检查均可见圆或类圆形影像,增强扫描8例可见环状或半环状强化,易被误诊为脑肿瘤;3例呈同心圆样强化.结论 同心圆硬化常亚急性或慢性起病,首发症状多为认知功能障碍,易被误诊,头颅MRI有特征表现,有诊断价值,激素治疗有效,预后良好,呈良性临床过程.

Abstract：

Objective To explore the clinical features, imaging and their diagnosis vaule of Baló's concentric sclerosis (BCS). Methods The clinical manifestation, laboratory examination, neuroimaging characteristics, pathology and follow-up of 12 (2 outpatients and 10 inpatients) cases of BCS were analyzed retrospectively. Results The onset age of 12 patients (male 4, female 8) ranged from 8 to 54 years old (mean 36.8 years). Unconcerned and slowness response were common in the disease onset (7 cases).Other symptoms and signs such as hypophrenia ( 10 cases), limitation of limb or hand movement (8 cases),urinary and fecal incontinence (7 cases), hypo-myodynamia (7 cases), positive pyramidal sign (6 cases)were not rare in course of disease. Eight cases underwent the examination of cerebrospinal fluid myelin basic protein, which increased in 7 cases. Demyelinating change and perivascular inflammatory infiltration were shown in 6 brain biopsies. The involvements of multi-lesions were found in 11 cases. Four patients underwent CT scanning and all the cases showed with hypodense lesions and couldn' t be enhanced. On MRI, all cases appeared round or round-like in shape. Enhanced lesions showed ring-like or half-ting-like shape (8 cases) and concentric ring (3 cases). It's easy to be misdiagnosed as brain tumor (8 cases).Conclusions BCS is a kind of demyelinating disease of subacute or chronic onset accompanied with cognitive disorder being the most common initiating symptoms. It's prone to be misdiagnosed. Diagnosis depends on MRI and corticosteroid treatment is effective. BCS has a good prognosis and presents with benign clinical course.     

多次烧结遮色瓷对金瓷修复体结合强度的影响

目的 探讨遮色瓷不同烧结次数对镍铬金瓷修复体结合强度的影响.方法 采用剪切强度测试法测量烧结遮色瓷1、3、5、7、9次后金瓷修复体的结合强度.结果 金瓷修复体剪切结合强度随遮色瓷重复烧结次数的增加呈明显下降趋势,1、3次烧结与5、7、9次烧结有统计学差异(P＜0.05).结论 制作金瓷修复体,其遮色瓷层的烧结不宜超过3...     

MTA对人根尖牙乳头干细胞体外增殖的影响

目的探讨MTA对人根尖牙乳头干细胞（stem cells from the apical papilla,SCAP）体外增殖活性的影响。方法 SCAP分别在含不同浓度的MTA培养基中培养,通过检测MTT,BrdU和细胞周期变化分析其对SCAP增殖作用的影响。结果与对照组相比,MTA可促进SCAP的MTT及BrdU值增加;并增加S期细胞比例及增殖指数。结论 MTA可显著促进人SCAP的体外增殖,在SCAP的自我更新中起重要作用。