髂嵴高度与下腰椎退行性疾病相关性的探讨

目的探讨髂嵴高度与下腰椎退行性疾病的关系;为下腰椎退行性疾病的病因学研究提供依据。方法选取下腰椎疾病患者40例为观察组,健康志愿者40例为对照组,观察组平均年龄大于对照组,P〈0.05。两组均行腰椎X线平片（标准正侧位）检查测量髂嵴的绝对高度及相对高度（以L4椎体高度作为参照）;分析髂嵴高度与下腰椎退行性疾病的关系。结果两组髂嵴绝对高度及相对高度均无统计学差异;未发现髂嵴高度与下腰椎退行性疾病的发生有关。结论本研究未能证实髂嵴高度与下腰椎退行性疾病的发生有关。     

可吸收止血海绵在腰椎滑脱症手术中的应用效果观察

目的：观察可吸收止血海绵在腰椎滑脱症经椎间孔腰椎间融合术（ TLIF）中的临床应用效果。方法将78例腰椎滑脱症患者随机分成两组,手术方式均为TLIF;对照组术后常规放置负压引流,试验组联合使用可吸收止血海绵填塞于创面。观察两组术后引流量、引流时间及伤口愈合情况。结果试验组术后总引流量为（256．49±235．51）mL,对照组（524．49±191．68）mL,P＜0．05;试验组引流时间为（3．62±1．98）d,对照组（3．59±0．75）d, P＜0．05;试验组出现伤口渗出3例,对照组无伤口渗出,P＞0．05。结论腰椎滑脱症TLIF后应用可吸收止血海绵可减少术后引流量,但延长引流时间。     

影像参数对老年患者L4椎体发生退变性滑脱的影响

目的探讨影像参数对老年人群L4椎体发生退变性滑脱的影响。方法 45例L4椎体发生退变性滑脱的老年患者为观察组及75例L4椎体退变性但未滑脱的老年患者为对照组,均行腰椎影像学检查,X线上测量椎间盘高度、椎体大小、倾角、前凸角等,CT测量关节角。应用Logistic回归分析其对L4椎体发生退变性滑脱的影响。结果观察组L4Ⅰ度滑脱39例,占86.7%,Ⅱ度滑脱6例,占13.3%,滑脱指数为(0.18±0.05)。观察组女性比例高于对照组,骨密度低于对照组(P0.05),年龄、体重指数、病程差异无统计学意义(P0.05)。观察组椎间盘高度、L4椎体大小低于对照组,但椎间盘退变指数、L4椎体倾角、腰椎前凸角、骨盆折射角、关节突关节角、L3~4及L4~5关节突头尾差角高于对照组(P0.05)。L4椎体小,腰椎前凸角大、骨盆折射角大是老年椎体退变性滑脱的独立危险因素(P0.05)。结论老年患者L4椎体退变性滑脱与骨质疏松相关,L4椎体滑脱的发生多受到椎体小,腰椎前凸角大、骨盆折射角大的影响。     

椎间融合手术和后外侧融合治疗老年腰椎滑脱效果比较

目的：比较椎间融合手术和后外侧融合治疗老年腰椎滑脱效果,为此类疾病的治疗提供参考。方法选择我院2012年1月～2012年12月126例老年腰椎滑脱患者,采用隐藏数字随机法分为两组,A组63例患者采用椎间融合手术;B组63例患者采用后外侧融合手术治疗,比较两种方法手术时间和出血量,所有患者均随访3～12个月,对近远期疗效进行比较。结果 A组平均手术时间长于对照组,平均出血量多于对照组,两组比较差异具有显著性（ P＜0．05）。两组术后滑脱百分率、椎间隙高度比较差异无显著性（P＞0．05）。随访12个月,A组滑脱百分率丢失、椎间隙高度丢失值明显少于B组,A组融合率为100％,明显高于B组,两组比较差异具有显著性（P＜0．05）。结论两种融合方法均可有效融合,且各具优势,但从长远看椎间融合手术疗效更好。     

手术技术对椎体后凸成形术疗效的影响

目的观察手术技术对椎体后凸成形术（PKP）疗效的影响。方法对86例骨质疏松性单节段胸腰椎椎体压缩性骨折患者采用同种型号单球囊双侧扩张PKP治疗。其中采用标准PKP者（ss组）52例,采用非标准PKP者（NS组）34例。两组年龄、病情等近似（P〉0．05）,具有可比性。均根据VAS、椎体恢复高度和Cobb角的矫正度评估手术疗效,同时比较骨水泥渗漏情况。结果两组术后疼痛均有明显缓解或消失。ss组术后VAS为2．7分,椎体前缘高度恢复25．4％±12．7％,Cobb角矫正12．4°±10．5°,椎体骨水泥灌注量为（4．85±1．42）ml,骨水泥渗漏率为3．2％（主要渗漏至椎体血管内）;NS组分别为3．1分、24．5％±13．9％,10．9°±10．2°、（4．45±1．33）ml和29．1％（主要渗漏至椎体周围、椎间隙和血管内等）。两组比较,除VASP〉0．05外,余P均〈0．05。结论遵循标准手术操作规范行PKP治疗骨质疏松性单节段胸腰椎椎体压缩性骨折可明显提高手术疗效、降低骨水泥渗漏率。     

椎弓根内固定联合伤椎植骨治疗胸腰椎爆裂骨折疗效观察

目的探讨经椎弓根内固定联合伤椎椎弓根植骨治疗胸腰椎椎体骨折的疗效。方法将144例胸腰段脊柱骨折患者随机分为A、B、C组。三组均行后路复位短阶段椎弓根内固定,A组伤椎椎体内植入自体骨,B组植入同种异体骨。结果术后12个月A、B组患者伤椎椎体相对高度分别明显高于C组（P均〈0．01）。术后6个月A、C组VAS评分明显低于B组（P均〈0．01）。术后12个月时C组VAS评分明显高于A、B两组（P均〈0．05）。结论椎弓根内固定联合伤椎植入自体骨或同种异体骨治疗胸腰椎椎体爆裂骨折疗效较好。     

尼可地尔对经皮冠状动脉介入治疗后心绞痛合并2型糖尿病患者的疗效

目的评价尼可地尔对经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后再发心绞痛合并2型糖尿病患者的疗效和安全性。方法选取PCI治疗后再发心绞痛合并2型糖尿病患者60例．随机（电脑随机数字表法）分为两组,两组均给予常规治疗。试验组使用尼可地尔．对照组在常规治疗的基础上给予单硝酸异山梨酯片治疗。结果治疗1周后,试验组心绞痛发作次数[（6．5±2．8）次弧（10．2±4．8）次,P〈0．05]、持续时间[（1．5±0．9）min vs．（2．4±2．3）min,P〈0．05]、显效率[80．0％（24／30）vs.53．3％（16／30）,P〈0．05],心电图改善[80．0％（24／30）vs.40％（12／30）,P〈0．05]均优于对照组,差异有统计学意义（P〈0．05）。试验组出现轻中度头痛2例,对照组出现轻中度头痛4例,两组比较差异有统计学意义（P〈0．05）。两组均无明显低血压发生,对血糖也无明显影响。结论尼可地尔能明显降低冠状动脉粥样硬化性心脏病（冠心病）合并2型糖尿病患者PCI治疗后再发心绞痛的发生风险。     

经椎间孔椎体间融合联合椎弓根螺钉固定治疗老年退行性腰椎侧凸疗效观察

目的：观察经椎间孔椎体间融合（ TLIF）联合椎弓根螺钉固定治疗老年退行性腰椎侧凸的临床效果。方法老年退行性腰椎侧凸患者35例,均采用TLIF联合椎弓根螺钉固定治疗。统计手术时间、手术出血量,比较术前及术后随访腰部 VAS、下肢VAS、腰椎JOA评分、ODI评分、侧凸Cobb 角、椎间倾斜角。结果随访时间（27．85±8．25）个月,手术时间（184．38±60．98） min,估计术中出血量（619．23±387．05） mL,固定融合（4．62±0．87）个椎体。与术前比较,术后随访时腰部VAS、下肢VAS、ODI评分降低,侧凸Cobb角、椎间倾斜角变小腰椎JOA评分增加（P＜0．05或P＜0．01）。结论 TLIF联合椎弓根螺钉固定治疗老年退行性腰椎侧凸临床疗效较好。     

PKP和PVP治疗骨质疏松性椎体压缩性骨折效果比较

目的比较经皮椎体后凸成形术（PKP）和经皮椎体成形术（PVP）治疗骨质疏松性椎体压缩性骨折的临床疗效及安全性。方法将46例骨质疏松性椎体压缩性骨折患者随机分为观察组和对照组各23例,分别行PKP、PVP,术后1周分别记录两组VAS评分、Cobb角、椎体高度变化及并发症发生情况。结果两组术后VAS评分、Cobb角均显著减小,而椎体高度明显增加,尤以观察组为著（P〈0．05）;两组术后均无神经系统损伤表现,观察组和对照组分别有1例1个椎体、5例7个椎体出现少量骨水泥渗漏,两组发生率比较P〈0．05。结论PKP和PVP治疗骨质疏松性椎体压缩性骨折均可显著缓解疼痛,但前者恢复椎体高度效果更好、骨水泥渗漏发生率更低。     

阿仑膦酸钠治疗老年女性骨质疏松症效果观察

目的：观察阿仑膦酸钠（ ALN）对老年女性骨质疏松的治疗效果。方法选择老年女性骨质疏松症患者97例,随机分为观察组52例、对照组45例。对照组给予钙尔奇D片治疗,观察组在对照组基础上给予ALN治疗。治疗6个月后检测两组L2～4骨密度（BMD）,并应用SF-36量表对其生活质量进行评价。结果治疗6个月后,观察组L2～4BMD较治疗前有明显增加（P＜0．05）,对照组无明显变化（P＞0．05）,两组均未新发骨折;治疗6个月后,两组SF-36量表中生理机能、生理职能、躯体疼痛及活力4个维度评分较治疗前有明显改善（P均＜0．05）,治疗组改善更为显著（ P均＜0．05）;两组均完成治疗及随访,未发生严重不良反应。结论 ALN能显著增加老年骨质疏松患者腰椎BMD,有效提高患者的活动力,减少躯体疼痛,不良反应较少。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.