两种手术体位下治疗腰椎间盘突出症的疗效比较

目的  比较两种不同体位下行开放性手术治疗腰椎间盘突出症的临床疗效,探讨简易跪式手术床在跪式体位下行椎板开窗减压髓核摘除术的临床优势。方法  选取2019年12月~2020年12月于河西学院附属张掖人民医院骨科收治的132例单节段单侧腰椎间盘突出症患者,行单侧椎板开窗减压髓核摘除术治疗。采用随机数字表法将患者进行分组,就采用简易跪式手术床在跪式体位下手术治疗的患者（观察组,n=67）和采用常规手术床在俯卧位下手术治疗的患者（对照组,n=65）手术效果展开对比。比较两组患者的手术时间、术中出血量、术后卧床时间、术后住院时间及并发症发生情况的差异;比较两组患者术前、术后1周及1、3、6月的Oswestry功能障碍指数、疼痛视觉模拟评分及两组患者术后6月的临床疗效（MacNab优良率）。结果  观察组的手术时间、术中出血量、卧床时间、住院时间及并发症例数均小于对照组（P < 0.05）;与术前相比,两组患者术后1周及1、3、6月的Oswestry功能障碍指数和视觉模拟评分均明显低于术前（P < 0.05）;与对照组相比,术后1周及1、3、6月,观察组患者的Oswestry功能障碍指数和视觉模拟评分均低于对照组（P < 0.05）;术后随访6月,观察组患者手术治疗后的临床疗效优于对照组（MacNab优良率91.04% vs 84.62%,P < 0.05）。结论  两种术式均可行椎板单侧开窗减压髓核摘除,消除神经症状。跪式体位下行椎板单侧开窗减压髓核摘除术能够明显缓解患者术后的疼痛程度,提高手术疗效,术后患者恢复快。     

小梁切除术后散瞳对防治浅前房的作用

目的：探讨散瞳防治青光眼小梁切除术（GTO）后浅前房的作用。方法：将GTO的病例分成二组：散瞳组和对照组,散瞳组77例96眼,给予积极、充分地散瞳,尽量把瞳孔散大到边;对照组89例107眼,一般不散瞳。结果：两组GTO后相比较：浅前房发生率差异（P＜0．01）、脉络膜脱离性浅前房发生率差异（P＜0．01）,和Ⅱ,Ⅲ级浅前房持续时间差异（P＜0．05）和发生率差异（P＜0．01）都有统计学显性意义。结论：散瞳防治GTO后浅前房具有高度显性效果。     

Astragaloside IV synergizes with ferulic acid to inhibit renal tubulointerstitial fibrosis in rats with obstructive nephropathy

BACKGROUND AND PURPOSE

The combination of Chinese herbs, Astragali Radix and Angelicae Sinensis Radix, could alleviate renal interstitial fibrosis. Astragaloside IV (AS-IV) and ferulic acid (FA) are the two major active constituents in this combination. In this study, we employed rats with unilateral ureteral obstruction to determine whether AS-IV and FA have the same renoprotective effects and investigated the mechanisms of this action.

EXPERIMENTAL APPROACH

Renal pathological changes were evaluated after treatment with AS-IV, FA or AS-IV + FA (AF) for 10 days. Meanwhile, the expression of transforming growth factor β₁ (TGF-β₁), fibronectin, α-smooth muscle actin (α-SMA), phosphorylation of c-Jun NH₂-terminal kinase (p-JNK) and nitric oxide (NO) production in kidney were determined. The expressions of fibronectin, α-SMA, mitogen-activated protein kinases [JNK, extracellular signal-regulated kinases (ERK), P38] in TGF-β₁-treated NRK-49F cells or interleukin-1-treated HK-2 cells after AS-IV, FA or AF were assessed.

KEY RESULTS

AF alleviated the infiltration of mononuclear cells, tubular atrophy and interstitial fibrosis; reduced the expression of fibronectin, α-SMA, TGF-β₁ and p-JNK; and dramatically increased the production of NO in obstructed kidneys. Neither AS-IV nor FA alone improved renal damage, but both increased NO production. AF inhibited α-SMA and fibronectin expression in NRK-49F or HK-2 cells. Furthermore, AF significantly inhibited IL-1β-induced JNK phosphorylation, without affecting ERK or P38 phosphorylation. Neither AS-IV nor FA alone had any effect on the cells.

CONCLUSIONS AND IMPLICATIONS

AS-IV synergizes with FA to alleviate renal tubulointerstitial fibrosis; this was associated with inhibition of tubular epithelial–mesenchymal transdifferentiation (EMT) and fibroblast activation, as well as an increase in NO production in the kidney.     

单侧经椎间孔入路椎间植骨融合术对慢性下腰痛的疗效分析

目的: 评价单侧经椎间孔入路椎间植骨融合术(TLIF)对慢性下腰痛的临床疗效.方法: 应用TLIF治疗慢性下腰痛患者39例,分别使用日本骨科学会(JOA)下腰痛评分标准和Oswestry下腰痛功能障碍问卷调查表(ODI评分表)对所选病例在术前1 d和术后6个月进行评分.结果: 入选病例随访时间7～34个月,平均21.4个月.JOA评分组术后6个月评分改善率为(74.42±11.96)%,与ODI评分组的(75.17±10.56)%相比,P＞0.05.JOA评分组改善优良率为94.87%,与ODI评分组的92.31%相比,P＞0.05.两种评价方法在患者的术后改善率及改善优良率方面无统计学差异.结论: TLIF手术方式对主要以腰椎不稳症和(或)腰椎间盘突出症所致的慢性下腰痛近期疗效满意,安全可靠.     

单孔内镜经腋窝行单侧甲状腺切除术临床研究

目的：对经腋窝单孔内镜行甲状腺单侧腺叶切除术的临床疗效进行探讨和分析。方法：选取我院在2011年4月至2013年4月进行了甲状腺单侧腺叶切除手术的患者共120例并将其分为两组,观察组60例患者采用经腋窝单孔内镜进行甲状腺单侧腺叶切除手术,对照组60例患者采用传统开放性手术方式进行手术。比较两组患者手术时间、术中出血量、术后住院时间、复发率等相关数据。结果：两组患者在手术时间、术中出血量、术后引流量和并发症发生率、复发率均无显著性差异（P〉0．05）;而观察组在术后止痛药物使用率方面则明显少于对照组（P〈O．05）,且术后住院时间也显著短于对照组（P〈O．05）,切口满意度方面观察组也明显优于对照组（P〈0．05）。结论：经腋窝单孔内镜行甲状腺单侧腺叶切除术是一种十分安全有效的治疗方式,其对患者产生的创伤小、患者术后疼痛感较轾且患者对其切口满意程度也十分高,值得临床推广。     

单侧唇裂术后继发唇鼻畸形的矫治

目的：探讨单倒唇裂术后继发唇鼻畸形部分手术方法的改进。方法：基于对唇裂术后唇算畸形病理解剖的认识。唇裂继发唇鼻畸形的二期修复包括上唇瘢痕的切除与松解，以及对上唇短曲外翻或过长，唇红、唇弓、唇珠畸形、鼻小柱、鼻中隔偏斜或短曲、鼻头低垂及鼻孔过大或偏小，鼻翼塌陷、卷曲等不同程度的畸形通过局部组织移位或填充等综合娇治的手术方法，使畸形得以纠正，使以上组织恢复正常的解剖形态。结果：自2003年1月以来，经过58例的，临床实践，术后鼻底丰满，上唇人中嵴，人中凹显现，通过二期综合矫治，皆获得了满意效果。结论：通过对某些术式进行改进．提高了手术疗效，减少了畸形复发。     

Delayed adrenal insufficiency long after unilateral adrenalectomy: Prolonged glucocorticoid therapy reduced reserved secretory capacity of cortisol

A 51-year-old woman with Cushing's syndrome underwent unilateral adrenalectomy for left adrenal adenoma. After 7 years of prednisolone treatment (with some interruptions), followed by 4 years of total withdrawal from prednisolone treatment, she presented with hypotension, weight loss, general fatigue, nausea, hyponatremia and hypoglycemia. These clinical features together with a low response in the rapid adrenocorticotropic hormone test led to the diagnosis of acute adrenal insufficiency. Relatively low serum adrenocorticotropic hormone levels in the face of increased demand for cortisol during adrenal crisis suggested a disordered hypothalamic-pituitary function, indicating secondary adrenal insufficiency. This patient demonstrated the etiology of acute adrenal insufficiency long after unilateral adrenalectomy in association with subsequent glucocorticoid therapy. A reduction in the reserved secretory capacity of cortisol after prolonged prednisolone treatment was considered to have induced secondary adrenal insufficiency, even after 4 years of total withdrawal from prednisolone.     

Interaction of exposure concentration and duration in determining acute toxic effects of sarin vapor in rats.

Sarin (GB) vapor exposure is associated with both systemic and local toxic effects occurring primarily via the inhalation and ocular routes. The objective of these studies was to develop models for predicting dose-response effects of GB vapor concentrations as a function of exposure duration. Thus, the probability of GB vapor-induced lethality was estimated in rats exposed to various combinations of exposure concentration and duration. Groups of male and female Sprague-Dawley rats were exposed to one of a series of GB vapor concentrations for a single duration (5-360 min) in a whole-body dynamic chamber. The onset of clinical signs and changes in blood cholinesterase activity were measured with each exposure. Separate effective concentrations for lethality in 50% of the exposed population (LC50) and corresponding dose-response slopes were determined for each exposure duration by the Bliss probit method. Contrary to that predicted by Haber's rule, the interaction of LC50 x time (LCT50) values increased with exposure duration (i.e., the CT for 50% lethality in the exposed population and corresponding dose-response slope was not constant over time). A plot of log (LCT50) versus log (exposure time) showed significant curvature. Predictive models derived from multifactor probit analysis of results describing the relationship between exposure conditions and probability of lethality in the rat are discussed. Overall, female rats were more sensitive to GB vapor toxicity than male rats over the range of exposure concentration and duration studied. Miosis was the initial clinical sign noted after the start of GB vapor exposure. Although blood cholinesterase activity was significantly inhibited by GB vapor exposure, poor correlation between cholinesterase inhibition and exposure conditions or cholinesterase inhibition and severity of clinical signs was noted.     

电刺激大鼠海马建立复杂部分性癫痫动物模型

目的　电刺激Wistar大鼠海马 (分为单侧、双侧点燃及左右侧交替点燃三组 )来建立复杂部分性癫痫的动物模型 ,探讨三种方法在建立癫痫动物模型中的可能机制。 方法　 健康Wistar大鼠 6 0只 ,随机分成三组 :单侧点燃组、双侧同时点燃组、双侧交替点燃组。按Goddard方法将电极分别植入左侧海马 (单侧 ,UK组 ) ,双侧海马(双侧 ,BK组 ;交替点燃组 ,AK组 ) ,每日接受电刺激 ,刺激条件为 :刺激强度 4 0 0 μA ,频率 6 0Hz,波宽 1ms。持续时间 1s。 结果　BK组与UK组相比 ,两者点燃率有显著差异 (10 0 %vs 5 5 % ,P <0 .0 5 )。点燃速度也显著减慢(P <0 .0 5 )。与AK组与UK组大鼠达到 5期惊厥的刺激次数 (19.36± 3.4 7)相比 ,AK组痫性发作出现的速度显著增快 (10 .85± 1.98) ,且点燃成功率为 10 0 % ,与UK组相比 (5 5 % )有显著差异 (P <0 .0 5 )。 结论　 大鼠单侧海马电刺激建立癫痫的动物模型时 ,出现点燃的延迟现象 ,表现为部分性发作和低水平的双侧海马ⅡS活动。大鼠双侧海马交替电刺激建立癫痫的动物模型时 ,表现出点燃的拮抗作用。     

大鼠单侧后牙缺失后颞颌关节内P物质、降钙素基因相关肽的表达变化

目的 :观察单侧后牙缺失造成偏侧咀嚼的大鼠颞颌关节内P物质 (substanceP ,SP)和降钙素基因相关肽 (calcitoningene relatedpeptide ,CGRP)的表达情况 ,进一步探讨颞颌关节病的发病机制。方法 :Wistar雄性大鼠 12只 ,随机分为 4组 ,包括 2个实验组及相应的对照组 ,每组 3只。拔除实验组动物右侧上、下颌磨牙 ,人为造成偏侧咀嚼。同一部位的切片分 2组 ,分别行SP ,CGRP免疫组织化学反应 (SABC法 )。光镜观察 ,并用LUZEX F型显微图像分析仪分别进行测定。结果 :每一实验组咀嚼侧和非咀嚼侧颞颌关节内单位面积内SP ,CGRP阳性纤维面积与各自对照组比较显著增加 (P <0 .0 1) ,但 3个月组较 1个月组有较低的增长趋势。在每一实验组内 ,非咀嚼侧单位面积内SP ,CGRP阳性纤维面积明显高于咀嚼侧 (P <0 .0 1)。结论 :SP ,CGRP均参与了偏侧咀嚼引起的颞颌关节病的病理变化过程 ,且在偏侧咀嚼条件下 ,两侧颞颌关节病理变化程度不同