Significance of proteinuria in patients with acute ischemic brain disease]

Brain vascular diseases are ranked the third as the cause of morbidity and mortality in majority of the countries of the world. In about 80% of the cases of vascular brain diseases, it is ischemic brain disease (IBD). Atherosclerosis of main cerebral arteries is most frequently responsible for the occurrence and development of IBD. In recent years it was reported for the first time of the association of atherosclerosis and/or its complications and proteinuria. Assuming that there exists the significant association between the degree of proteinuria and clinical parameters of IBD, the aim of this study was to investigate the frequency and patterns of the association of proteinuria and clinical IBD parameters. The study was performed in 180 patients with IBD of atherothrombotic origin and 60 patients with the diseases of non-vascular origin, as the control group. In all patients quantitative determination of proteinuria was performed, and in the patients with IBD was determined the degree of IBD and afterwards the degree of functional and neurologic impairment prior to and at the end of treatment in acute phase using the standardized scales. The results of the study revealed the existence of significant frequency of proteinuria in the patients with IBD, as well as the significant association between the degree of proteinuria and severity of IBD. It was concluded that proteinuria in patients with IBD was probably associated with the atherogenic processes and physiopathologic processes of IBD, respectively, which could have predictive value for the outcome of the disease in the early stage.     

外周血中性粒细胞CD64及CRP在烧伤感染中的诊断价值探讨

目的分析探讨外周血中性粒细胞CD64及C反应蛋白(CRP)在烧伤感染中的诊断价值。方法选择2018年1月至2019年6月郑州大学第一附属医院烧伤科收治的92例烧伤患者作为研究对象,并按照感染程度将其分为脓毒症组(31例)、局部感染组(21例)和非感染组(40例),分别于治疗前和治疗第3、7天测定并对比外周血中性粒细胞CD64及CRP水平,绘制中性粒细胞CD64、CRP及两项指标联合检测对烧伤感染诊断价值的ROC曲线,分析其特异度和敏感度。结果治疗前3组患者中性粒细胞CD64及CRP水平对比,脓毒症组明显高于局部感染组与非感染组(P均<0.05),局部感染组明显高于非感染组(P<0.05);治疗第3、7天3组患者中性粒细胞CD64及CRP水平均呈现不同程度下降,但脓毒症组仍明显高于局部感染组与非感染组(P均<0.05),局部感染组仍明显高于非感染组(P<0.05)。ROC曲线分析结果显示:中性粒细胞CD64、CRP及两项指标联合检测的曲线下面积分别为0.719、0.655及0.872;两项指标联合检测的敏感度、特异度分别为88.46%、87.50%,明显高于中性粒...     

严重创伤及合并内毒素攻击后小鼠肝、肺组织巨噬细胞CD14和清道夫受体的表达及其意义

目的　进一步揭示创伤及合并内毒素攻击后 ,小鼠肝、肺组织内CD14和清道夫受体(scavengerreceptor,SR)的表达变化规律及器官间的差异性。　方法　小鼠 84只分为正常对照组 (4只 )、创伤组 (40只 )、创伤合并内毒素攻击组 (40只 )。采用双侧股骨骨折合并内毒素血症小鼠模型 ,以免疫组化方法检测肝、肺组织巨噬细胞CD14和SR在创伤后 2 ,4 ,6 ,9,13h时的动态变化。　结果　肝组织巨噬细胞CD14和SR分别在创伤后 9h发生上调和下调 (P <0 .0 5 ) ,肺组织巨噬细胞CD14和SR分别在创伤后 6h发生上调和下调 (P <0 .0 5 )。创伤合并内毒素攻击后 ,肝、肺组织巨噬细胞CD14和SR均于伤后 2h分别呈显著的上调和下调改变 (P <0 .0 5和 0 .0 1) ,并呈显著负相关关系 (r=- 0 .82 3,- 0 .797,P <0 .0 1) ,而且创伤后 6 ,9,13h时肺组织内CD14和创伤后 4hSR表达变化幅度大于肝组织 (P <0 .0 5和 0 .0 1)。　结论　创伤及合并内毒素攻击后 ,肝、肺组织内CD14和SR表达发生双向调节 ,CD14表达上调和SR表达下调可能与炎症反应由“自控”向“失控”转化有关。肝、肺组织内CD14和SR表达上的差异可能与创伤及合并内毒素攻击时器官功能损害的序贯性相关。     

肝硬化CT分型与中医证型相关性研究

目的:探索肝硬化CT分型与中医证型之间的关系及其意义。方法:通过分析142例肝硬化患者CT表现和中医征象,对其进行CT分型和中医辨证分型,并分析两种类型之间的关系。结果:142例肝硬化根据CT征象分为3个类型,均匀型32例(22.54%),节段型21例(14.79%),结节型89例(62.68%)。中医辨证分为6个证型,肝郁脾虚证17例(11.97%),湿热蕴结证18例(12.68%),气滞血瘀证31例(21.83%),水湿内停证41例(28.87%),脾肾阳虚证21例(14.79%),肝肾阴虚证14例(占9.86%)。均匀型和节段型肝硬化病例中大多为肝郁脾虚证和湿热蕴结证,分别占62.49%和47.62%;其次为气滞血瘀证和水湿内停证,分别占28.13%和42.86%;脾肾阳虚证和肝肾阴虚证最少,分别占9.38%和9.52%。而结节型肝硬化病例中以肝郁脾虚证和湿热蕴结证最少,占5.62%;其次为脾肾阳虚证和肝肾阴虚证,占33.71%;气滞血瘀证和水湿内停证最多,占60.67%,与均匀型和节段型具有显著性差异(χ2值分别为49.40和32.06,P值均小于0.001)。结论:肝硬化的CT分型与中医证型之间存在密切的关联,2种分型均与肝硬化肝损害的严重程度相关。     

Magnetic resonance imaging of the ovaries of healthy women: determination of normal values

PURPOSE: To establish normal values for the volume and maximal diameter of ovaries and ovarian follicles and for the number of ovarian follicles in magnetic resonance imaging (MRI) based on menstrual cycle phase and age. MATERIAL AND METHODS: We performed MRI of the pelvis on 100 healthy women. Volume of the ovaries and largest ovarian follicles and the number of ovarian follicles were determined by menstrual cycle phase and age. RESULTS: The mean volume of the ovaries significantly increased with age and reached its peak between 31 and 40 years, and subsequently decreased. The mean volume of the largest ovarian follicles also significantly increased with age to reach its peak at 41-50 years. The highest mean numbers of ovarian follicles were found at 20-40 years. When the volumes of ovaries and of the largest ovarian follicles, and the number of ovarian follicles were compared between the first and second phase of the menstrual cycle, no significant differences were found. CONCLUSION: The volume and maximal diameter of ovaries and ovarian follicles and the number of ovarian follicles differ significantly with age, but not between the two phases of the menstrual cycle. Knowledge of MRI-related normal values can be expected to aid the early identification of ovarian pathologies.     

Endoscopic treatment of calcaneo-fibular impingement

The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture and is linked to the decreased space between the tip of the fibula and the lateral wall of the calcaneus. The reasons for the painful symptoms are mixed with both bony and soft tissue involvement. The abnormal bony contact between the lateral calcaneal cortex and the tip of the fibula depends mainly on the size and localization of the lateral exostosis of the calcaneal wall. The soft tissue impingement is due to the fibrosis and scar tissues in the lateral gutter and to the compression of the peroneal tendons in the retromalleolar groove and under the tip of the malleolus. A 2-portal endoscopic technique is described for the treatment of calcaneo-fibular impingement with bone resection, soft tissue debridement and peroneal tendons release. One of the advantages of this endoscopic technique is the possibility of an assessment and treatment of associated lesions in the same procedure. A subtalar joint fusion can be done before if needed under arthroscopic control. As this endoscopic technique is very efficient to relieve symptoms of calcaneo-fibular impingement and is focused on the most relevant symptoms, it can thus be indicated for most of cases of calcaneal malunions, whatever the type of malunion and depending of the painful symptoms.     

甲亢突眼征眼部动脉血流频谱特征和血流动力学研究

目的:探讨甲亢突眼征眼部动脉血流频谱特征和血流参数变化的规律,及与眼轴、眼压等的关系。方法:应用彩色多普勒超声诊断仪对甲亢突眼征患者(31例,62只眼)和正常人(25例,50只眼)的眼动脉(OA)、睫状后短动脉(SPCA)、视网膜中央动脉(CRA)的收缩期峰值流速(PSV)、舒张期最小流速(EDV)和阻力指数(RI)以及眼轴等进行检测。结果:①6项超声指标中,甲亢突眼组与正常对照组比较,眼轴、球横径无显著性差异(P>0.05);球尖距、球后软组织周长、球后软组织面积及球后软组织体积差异显著(P<0.05或<0.01)。②甲亢突眼征眼部动脉频谱形态OA第一峰高尖,第二峰降低圆钝,甚至出现两峰融合,峰时延长、后移;SPCA第一峰增高且宽大,第二、三波峰圆钝,峰时后移;CRA第一峰上升速度明显加快,波峰较高,而第二峰峰时延长、后移。③眼部血流动力学变化特点为:甲亢突眼组与正常对照组比较OA、SPCA和CRA的PSV均明显增高(P<0.01),EDV和RI有显著性差异(P<0.05,P<0.01)。结论:甲亢突眼征眼部血流频谱形态特征、血流动力学参数和球尖距、球后软组织周长、球后软组织面积及球后软组织体积发生改变。     

正常人胼胝体膝部及嘴部年龄与性别差异的DTI研究

目的:研究胼胝体膝部和嘴部的DTI参数ADC值、部分各项异性(FA)值及神经密度在年龄及性别方面的差异,并获取其随年龄增长的变化规律。方法:将247例正常人按照年龄段分为10组,行颅脑DTI,测量胼胝体膝部和嘴部ROI的ADC值、FA值及神经纤维数,并计算神经密度。结果:①男性胼胝体膝部和嘴部的ADC值随年龄增长的差异均具有统计学意义;女性则差异均无统计学意义。②男性及女性胼胝体膝部和嘴部的FA值随年龄增长差异均具有统计学意义,其随年龄增长的变化规律基本上符合升高—相对稳定—下降的趋势。③男性及女性的胼胝体膝部和嘴部神经密度随年龄增长差异均无统计学意义。④在>3～6岁组,女性胼胝体嘴部的ADC值显著高于男性(P<0.01);在40岁以上男性,胼胝体膝部的神经密度显著高于女性(P<0.01);胼胝体膝部的ADC值和FA值、胼胝体嘴部的FA值和神经密度在各个年龄段内的性别差异均无统计学意义。结论:①胼胝体膝部和嘴部的ADC值、FA值随年龄增长的变化规律可以反映胼胝体膝部和嘴部生长发育及老化的整个过程。②本研究所获得的胼胝体膝部和嘴部的ADC值、FA值及神经密度可作为以后进一步研究的参考。     

Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament

For posterior cruciate ligament (PCL) reconstruction, two root, anterolateral and posteromedial bundles restruction are performed. However, little has been mentioned of anatomical measurements of the insertions to the bone of these bundles in previous publications. The aim of this study is to determine the precise anatomical measurements of the femoral and tibial insertions for anterolateral and posteromedial bundles of PCL. A total of 32 femur and 33 tibiae were selected from 50 cadavers after exclusion of knees that displayed macroscopically degenerative changes or evidence of trauma. PCL were divided into anterolateral bundles and posteromedial bundles to the insertion footprint, and those locations were measured and described. The distance from the center of the femoral insertions of the anterolateral and posteromedial bundles, and the Wrisberg ligament to the anterior margin of the medial femoral condyle averaged 9.6, 10.6, and 17.1 mm, respectively. The distance from the center of the femoral insertions of the anterolateral, posteromedial bundles, and Wrisberg ligament to the intercondylar roof averaged 4.8, 11.4, and 10.4 mm, respectively. The distance from the medial margin of the articular cartilage of the tibial plateau to the center of the tibial insertions of the anterolateral and posteromedial bundles averaged 51.0 and 50.0% of the total widest width of the tibial plateau, respectively. The vertical distance from the tibial insertion of the center of the posteromedial bundle to the plane of the tibial articular surface averaged 4.6 mm. This study leads to a better definition of the anatomy of the anterolateral and posteromedial bundles of PCL. It is very important to know the precise anatomy of PCL bundles when performing PCL reconstruction, and to evaluate PCL reconstruction surgery on an anatomical basis.     

ICHP conference: Towards disarmament—Combatting the use of chemical and biological weapons and exchanging information on diagnosis and treatment of victims of these weapons

The main objectives of an international conference in May 1989 on chemical and biological weapons (CBW) were: (1) To discuss and exchange information and experience of the protection and treatment of victims of the use of CBW; the investigation of allegations of use of CBW; the development of ways of collaboration between experts and the United Nations on issues of CBW; and the mobilization of public opinion against CBW. (2) To constitute a special committee out of the conference that could continue the work of the conference on the above issues and co‐ordinate the viewpoints of experts and concerned bodies; further, this committee could offer its services to the Secretary‐General of the United Nations, investigate allegations concerning the use of CBW, and report its findings to the Secretary‐General and to the Conference on Disarmament in Geneva.     

Predictive value of changes in the hemostasis system in patients with ischemic brain diseases

The aim of this research was to determine the importance of tracking the dynamics of changes of the hemostatic system factors (aggregation of thrombocytes, D-dimer, PAI-1, antithrombin III, protein C and protein S, factor VII and factor VIII, fibrin degradation products, euglobulin test and th activated partial thromboplastin time--aPTPV) in relation to the level of the severity of ischaemic brain disorders (IBD) and the level of neurological and functional deficiency in the beginning of IBD manifestation from 7 to 10 days, 19 to 21 day, and after 3 to 6 months. The research results confirmed significant predictive value of changes of hemostatic system with the predomination of procoagulant factors, together with the insufficiency of fibrinolisys. Concerning the IBD severity and it's outcome, the significant predictive value was shown in the higher levels of PAI-1 and the lower level of antithrombin III, and borderline significant value was shown in the accelerated aggregation of thrombocytes and the increased concentration of D-dimer. It could be concluded that the tracking of the dynamics of changes in parameters of hemostatic system proved to be an easily accessible method with the significant predictive value regarding the development of more severe. IBD cases and the outcome of the disease itself.     

健康成年人膝关节髁间窝宽度与高度的MRI研究及临床意义

目的:以MRI观察健康成年人髁间窝宽度、高度与年龄、性别的相关性,并分析其临床意义。方法:选取150例健康成年人,其中男71例,女79例。按年龄分为3组行膝关节MRI扫描,其中青年组20～29岁,中年组30～49岁,老年组≥50岁。在MRI T2WI图像上测量髁间窝宽度及高度,并分析髁间窝高度、宽度与性别、年龄的关系。结果:青年组50例,男25例,女25例,髁间窝宽度为(22.36±1.93)mm,髁间窝高度为(30.14±3.39)mm;中年组50例,男25例,女25例,髁间窝宽度为(20.98±1.71)mm,髁间窝高度为(28.41±2.51)mm;老年组50例,男21例,女29例,髁间窝宽度为(19.65±2.89)mm,髁间窝高度为(27.27±2.46)mm。髁间窝宽度、高度与年龄呈显著负相关(P<0.000,P<0.000),相关系数r分别为-0.455,-0.378。各组髁间窝高度及宽度的平均值差异均无统计学意义。结论:髁间窝的宽度、高度与年龄具有显著负相关性,即随着年龄的增长,髁间窝宽度与高度均有逐渐变小的趋势。MRI是测量髁间窝大小的准确可靠的影像学方法,具有重要的临床意义。     

建立重大呼吸道传染病医用救治物资二级库的体会

 目的 实现突发呼吸道传染病救治过程医用物资精细化管理。方法 针对突发呼吸道传染病救治政策及药品耗材供应特点,依据临床科室人员配比情况,制定医疗物资库存基数,建立适合临床科室管理维护的医疗物资二级库。结果 临床科室医疗物资二级库能降低科室医疗物资请领频次,减轻中心药站药师药品调配强度及其他医护人员工作量,提高计价医嘱正确率。结论 医疗物资二级库的建立,可降低医护人员体能消耗,提高疫情防治的精准化管理。     

Dynamics of returning the injured and ill to military and work responsibilities in wartime]

Returning of the injured and diseased to military and working duties in war have been trained and tested in the final training of members of the School of Reserve Medical Officers of the Military Medical Academy in the period 1985-1989. The time of returning of the injured and diseased members of the armed forces depends directly on the organization of the military medical and public health service, and especially of the preparedness of health personnel, well equipped military medical units and health institutions and the consistent application of the unique military doctrine.     

Systemic manifestations of idiopathic inflammatory myopathies--part one]

Dermatomyositis and polymyositis are the idiopathic inflammatory myopathies of autoimmune origin. Apart from muscle weakness, general symptoms such as the affection of visceral organs and altered indicators of humeral immunity occur in a minority of patients. The aim of the study was to establish whether the systemic manifestations of the disease, altered immunoserologic parameters and findings of muscle vasculitis occurred more frequently in patients with dermatomyositis or polymyositis. The frequency of clinic, serologic and histopathologic alterations in the groups of patients with dermatomyositis and polymyositis was determined. In order to determine the degree and importance of the frequency, the following parameters were calculated: the relative rations of frequencies and the importance of the difference in frequencies of particular alterations between the groups of patients. It was found that extramuscular manifestations of the disease such as arthritis, pulmonary, cardiac and renal changes, the increased activity of C3 and C4 complement components as well as vasculitis of muscle and skin tissue occurred more frequently in patients with dermatomyositis. This finding indicates that patients with DM, regardless of the degree of muscular affection, may have a more severe clinical course of the disease and a poor prognosis.     

脑干枪弹伤的超微结构研究

目的 观察脑干枪弹伤的形态学变化。方法 切取2例头部枪弹伤死亡后25min的脑干，对中服与服桥被盖部和延脑第四脑深部组织做电镜观察。结果 中脑枪弹伤波及整个脑干及小脑；脑干枪弹伤超微结构见烧灼伤和冲击、压力伤两种，其特点是广泛性神经轴索损伤重，神经元损伤轻；轴索烧灼伤呈现轴索水肿，髓鞘、轴浆及其线性体浓缩、变形；冲击、压力伤呈现轴突扭曲、变形、融合、挤压、缺损、破裂致轴浆内容物外流或缺失、错位、神经微丝与微管偏向轴索一侧等。结论 网状结构严重广泛性神经轴索损伤与对机体的致命性有着重要关系。     

Anatomy and biomechanics of theposterior cruciate ligament and posterolateral corner

In this article, the current state of knowledge of the anatomy and biomechanics of the posterior cruciate ligament(PCL) and posterolateral corner (PLC) is discussed, as well as implications for the clinical management of PCL and PLC injuries. The PCL consists of 2 functional components, the anterolateral (AL) and posteromedial (PM) bundles based on their reciprocal tensioning patterns. Based on its larger ultimate load, stiffness, and cross sectional area, the AL bundle has been the focus of single bundle PCL reconstructions to date. The PLC of the knee is comprised primarily of the popliteus complex and lateral collateral ligament (LCL). A significant functional interaction exists between the PCL and PLC, as they work in conjunction to provide both posterior and rotatory knee stability. This article will discuss the interaction between these structures, including the effects of PCL and PLC deficiencies and the effects of factors such as muscle and axial loads on their function. The effects of several surgical variables affecting PCL and PLC reconstruction will also be addressed, including number and placement of tunnels, graft fixation, and associated injuries. Continued understanding of the structure and function of the PCL and PLC will result in the development and improvement of techniques for their reconstruction, as well as more consistent clinical approaches to these complex knee injuries.