口腔径路曲安奈德蝶腭神经节封闭治疗变应性鼻炎（附415例报告）

目的：探讨口腔径路曲安奈德蝶腭神经节封闭治疗变应性鼻炎的效果。方法：变应性鼻炎患者415例，男270例，女145例。用自制封闭针头于口腔径路行曲安奈德蝶腭神经节封闭术。结果：415例中，有效250例，好转63例，总有效率为99．5％。结论：经口腔径路用曲安奈德行蝶腭神经节封闭术是治疗变应性鼻炎的有效疗法。     

Tensile load on the flexor digitorum profundus tendon during palmar and lateral blocking exercises: Influence on blocking force and distal interphalangeal joint flexion angle

Study DesignThis is a basic science research.IntroductionIsolating excursion of the flexor digitorum profundus (FDP) in zones I and II is common practice in the current management after flexor tendon repair. During this procedure, the proximal interphalangeal joint is sometimes fully extended with unmeasured external forces at the middle phalanx when the distal interphalangeal joint is actively flexed.Purpose of the StudyThe purpose of the study was to investigate the incremental effect of external force with palmar blocking versus lateral blocking and increased angles of flexion on internal tendon forces at the repair site for a safer application of force by the treating therapist.MethodsEight human cadaveric fingers were studied. To simulate palmar or lateral finger blocking, a compression force of blocking was applied from 5N (510 grams) to 25N (2,550 grams) on the skin surface of the palmar or the lateral aspect of each of these middle phalanges in 5N increments. The tensile load on the FDP tendon during distal interphalangeal joint flexion from 0° to 60° was measured in 10° increments.ResultsDuring palmar blocking, the tensile load was significantly increased with increases in palmar blocking force. However, no significant increase in the tensile load on the FDP tendon was observed at any lateral blocking.DiscussionLateral blocking exercise can be performed with less tensile force on the FDP tendon when performing blocking exercise after flexor tendon injury repair.ConclusionsThis study supports the concept that lateral blocking with incremental joint angles allows a safer application of force for the healing tendon.     

反复自然流产患者血清中封闭抗体的检测

本文根据病史将反复自然流产(RSA)分类为原发性RSA 及继发性RSA,分别以单向混合淋巴细胞反应封闭试验及补体依赖微量细胞毒试验评价封闭抗体与两类流产的关系。结果发现,原发性RSA主要因封闭抗体缺乏所致;而继发性RSA 无封闭抗体缺乏迹象。因此,尽管原发性RSA 与继发性RSA 临床表现类似,但其免疫学病因及发病机理可能不同。     

Transparent blocks—an aid in simulation

The use of standard cutouts made of pressed wood¹ and lead solder is advocated for treatment simulation of blocked fields. The advantages offered are the ability to see “through” the block and the capability of planning simple or complex blocking within the limits of existing lead block shapes.     

The neurotrophic properties of progranulin depend on the granulin E domain but do not require sortilin binding

Progranulin (PGRN) is a growth factor involved in wound healing, inflammation, tumor growth, and neurodegeneration. Mutations in the gene encoding PGRN give rise to shortage of PGRN and cause familial frontotemporal lobar degeneration. PGRN exerts neurotrophic functions and binding of PGRN to the membrane receptor sortilin (SORT1) mediates the endocytosis of PGRN. SORT1-mediated uptake plays an important role in the regulation of extracellular PGRN levels. We studied the role of SORT1 in PGRN-mediated neuroprotection in vitro and in vivo. The survival-enhancing effect of PGRN seemed to be dependent on the granulin E (GRN E) domain. Pharmacologic inhibition of the GRN E–SORT1 interaction or deletion of the SORT1 binding site of GRN E did not abolish its neurotrophic function. In addition, the in vivo phenotype of PGRN knockdown in zebrafish embryos was not phenocopied by SORT1 knockdown. These results suggest that GRN E mediates the neurotrophic properties of PGRN and that binding to SORT1 is not required for this effect.     

Competition between an avoidance response and a safety signal: Evidence for a single learning system

Two experiments examined competition between an instrumental avoidance response and a Pavlovian safety signal for association with omission of electric shock in a human fear conditioning paradigm. Self-reported shock expectancies and skin conductance responses were consistent with blocking of learning of the instrumental contingency by prior training of the Pavlovian contingency, and vice versa. The results support the idea that a common learning mechanism underlies both Pavlovian and instrumental conditioning. The expectancy data suggest that this learning mechanism is cognitive in nature, and that Pavlovian and instrumental learning involve external and internal attributions, respectively. The procedure may thus serve as a laboratory model for attributional processes involved in the acquisition of threat expectancies in anxiety and anxiety disorders.     

再谈2019中国乙型肝炎母婴传播防治指南:证据,证据,还是证据

乙型肝炎病毒(HBV)母婴传播是导致慢性HBV感染的主要原因,因此如何阻断HBV母婴传播,实现HBV阳性母亲所生新生儿HBV“零感染”的目标一直是临床研究的热点问题,国际和我国的乙型肝炎防治指南中都重点讨论这个问题,也发表了相关共识。由中华医学会感染病学分会和GRADE中国中心制定的《中国乙型肝炎病毒母婴传播防治指南(2019年版)》(以下简称《指南》),并在《中华传染病杂志》发表.     

HLA—DQA1／DQB1组织相容性及不同来源淋巴细胞在免疫治疗中对复发性流产患者封闭抗体产生的影响

目的探讨夫妇双方HLA—DQA1／DQB1组织相容位点匹配个数及丈夫或第三方淋巴细胞免疫治疗（LIT）对复发性流产患者封闭抗体水平的影响。方法选取2010年10月至2012年6月在本院确诊为不明原因复发性流产患者177例。治疗前分别检测患者夫妇双方HLA—DQA1和HLA—DQB1基因型,根据血液传播疾病筛查结果选择丈夫（140例）或第三方健康个体（37例）淋巴细胞经皮内注射免疫治疗3次,分别在治疗前和治疗后以流式细胞术交叉配型实验（FCXM）检测抗丈夫淋巴细胞抗体（APLA）和抗第三方淋巴细胞抗体（ATLA）的水平。结果HLA—DQA1／DQB1组织相容性匹配程度不同的夫妇在LIT后APLA无统计学差异（P〉O．05）;丈夫和第三方LIT诱导产生的封闭抗体（包括APLA和ATLA）均显著高于治疗前（P〈O．05）;丈夫LIT诱导产生的APLA显著高于第三方LIT（P~0．05）;第三方LIT诱导产生的ATLA显著高于APLA（P〈O．05）。结论HLA—DQA1／DQB1组织相容性增高在LIT中对封闭抗体产生无影响。在封闭抗体生成水平上,丈夫LIT效果优于第三方uT。     

替诺福韦酯联合双重免疫方案阻断HBV携带孕妇母婴病毒传播效果研究

目的 观察应用替诺福韦酯联合双重免疫方案处理慢性乙型肝炎病毒(HBV)携带孕妇对母婴病毒传播阻断的效果。方法 2016年12月～2019年9月我院收治的HBV携带孕妇120例,采用随机数字表法分为对照组60例和观察组60例。对照组孕妇未进行抗病毒治疗,观察组孕妇在孕26～28个月时开始口服替诺福韦酯,治疗至分娩。所有新生儿出生后立即接种乙肝疫苗和乙型肝炎免疫球蛋白进行双重免疫。采用聚合酶链式反应法检测血清HBV DNA,采用胶体金法检测血清HBsAg和HBeAg。结果 在分娩时,观察组血清ALT水平为(23.2±3.6)IU/L,与对照组【(26.9±4.0)IU/L,P>0.05】比,无显著性差异,血清HBV DNA载量为(3.1±0.7) lg copies/mL,显著低于对照组【(5.9±0.8)lg copies/mL,P<0.05】;观察组新生儿Apgar评分为(9.7±0.3)分,与对照组【(9.9±0.5)分,P>0.05】比,无显著性差异,两组新生儿身高、体质量和头围比较,无显著性差异(P>0.05);在分娩时、出生后6个月和12个月,观察组婴儿HBV感染率为1.7%、1.7%和1.7%,与对照组(分别为11.7%、11.7%和13.3%,P>0.05)比,无显著性差异。结论 应用替诺福韦酯联合双重免疫方案处理HBV携带孕妇及其新生儿能显著降低孕妇血清HBV载量,可能降低婴儿HBV感染率,值得进一步扩大观察。     

选择性神经根阻滞在腰椎有限手术中的应用

目的：总结选择性神经根阻滞在腰椎有限手术中的临床应用结果。方法：2008年1月至2012年10月,对68例多平面腰椎管狭窄症患者采用选择性神经根阻滞,其中男47例,女21例;年龄45～80岁,平均56岁。神经根阻滞后64例为阳性患者进行了腰椎有限手术,另4例封闭后症状减轻不明显为阴性,难以确定手术平面或引起症状的神经根,放弃了手术治疗。术后采用Macnab腰腿痛手术治疗评定标准进行疗效评定。结果：神经根阻滞操作过程顺利,未发生与神经根阻滞相关的并发症,术后无神经损伤并发症。术后随访16～45个月,平均32个月。术后根据Macnab腰腿痛手术治疗评定标准进行疗效评定,优44例,良18例,差2例。结论：对腰椎管狭窄症的手术治疗重点应放在压迫引起症状的部位,而对无症状的部位不做预防性减压操作。应用神经根阻滞能准确判断责任椎与疼痛源,提高腰椎有限手术的疗效。