大鼠坐骨神经损伤后脊髓运动神经元捷状神经营养因子的表达及针刺干预后的变化

目的：观察了坐骨神经损伤后脊髓运动神经元睫状神经营养因子(ciliary newrotrophic factors，CNTF)表达水平及针刺、神经生长因子(nerve growth factor，NGF)干预后的相关变化，旨在探讨针刺促进周围神经损伤修复的机制。方法：选用160只Wister大鼠，分电针组、药物组(NGF)、手针及模型、假手术组5组。钳夹坐骨神经制造周围神经损伤模型，采用免疫组织化学染色同光、电镜相结合方法，利用图像分析系统检测不同干预手段、对不同时间点脊髓CNTF阳性运动神经元的计数和吸光度水平。结果：坐骨神经损伤后腰段脊髓CNTF阳性运动神经元数量和吸光度水平7d[模型组CNTF阳性神经元数为(61．42&;#177;0．42)％]开始下降，14d [50．94&;#177;2．96)％]明显下降，21d[42．72&;#177;4．51)％]达最低水平，28d[49．37&;#177;2．70]开始恢复，伤侧比对侧更为明显(P&;lt;0．05)；针刺及NGF治疗，能降低神经元死亡数量、减少其吸光度下降程度(P&;lt;0．05)，并能减轻神经元肿胀变性的形态学变化。结论：针刺及NGF能促进脊髓运动神经元存活、加快内源性CNTF水平的恢复；能减轻神经元的变性坏死程度，减少神经元的死亡。     

电针对大鼠坐骨神经损伤后脊髓运动神经元睫状神经营养因子水平的影响

目的探讨电针对大鼠坐骨神经损伤后脊髓运动神经元睫状神经营养因子 (ciliary neurotrophic factor,CNTF)的影响.方法取 Wistar 大鼠 56只 ,行左侧坐骨神经切断外膜缝合.电针组每天穴位电针 20 min,模型组不作任何处理.分别于术后 7,14,21和 28 d测定脊髓前角 CNTF阳性神经元计数、神经元平均积分光密度及 4周时损伤神经电生理.结果坐骨神经损伤后损伤脊髓前角 CNTF阳性神经元数量明显少于正常对照组,电针组损伤侧脊髓前角内 CNTF阳性神经元数量在各时间点明显高于模型组(P< 0.05),14 d时电针组伤侧脊髓前角内 CNTF阳性神经元数量为 (53± 11)个,模型组为 (29± 9)个.同时模型组神经元内 CNTF阳性神经元平均积分光密度在各时间点与正常组比较明显降低,在 14 d最低为 273.2± 33.7.而电针组 CNTF在各个时间点明显高于模型组(P< 0.05); 28 d康复组神经肌肉动作电位、运动神经传导速度均优于模型组 (P< 0.01).结论电针可提高损伤神经神经元内源性 CNTF水平,减少神经元变性、死亡,促进神经电生理的恢复.     

电针对大鼠坐骨神经损伤后脊髓运动神经元睫状神经营养因子水平的影响

目的：探讨电针对大鼠坐骨神经损伤后脊髓运动神经元睫状神经营养因子(ciliary neurotrophic factor，CNTF)的影响。方法：取Wistar大鼠56只，行左侧坐骨神经切断外膜缝合。电针组每天穴位电针20min，模型组不作任何处理。分别于术后7，14，21和28d测定脊髓前角CNTF阳性神经元计数、神经元平均积分光密度及4周时损伤神经电生理。结果：坐骨神经损伤后损伤脊髓前角CNTF阳性神经元数量明显少于正常对照组，电针组损伤侧脊髓前角内CNTF阳性神经元数量在各时间点明显高于模型组(P&;lt;0．05)，14d时电针组伤侧脊髓前角内CNTF阳性神经元数量为(53&;#177;11)个，模型组为(29&;#177;9)个。同时模型组神经元内CNTF阳性神经元平均积分光密度在各时间点与正常组比较明显降低，在14d最低为273．2&;#177;33．7。而电针组CNTF在各个时间点明显高于模型组(P&;lt;0．05)；28d康复组神经肌肉动作电位、运动神经传导速度均优于模型组(P&;lt;0．01)。结论：电针可提高损伤神经神经元内源性CNTF水平，减少神经元变性、死亡，促进神经电生理的恢复。     

电针对大鼠坐骨神经损伤后神经生长因子表达的影响

目的:探讨电针对大鼠坐骨神经损伤后脊髓前角细胞神经生长因子(nervegrowthfactor,NGF)的影响。方法:取Wistar大鼠60只,4只为正常组,56只行左侧坐骨神经切断外膜缝合。电针组每天穴位电针20min,模型组不作任何处理。分别于术后7,14,21和28d用原位杂交和免疫组化技术和测定脊髓前角NGF阳性神经元计数、阳性神经元平均积分光密度。结果:电针组损伤侧脊髓前角内NGF阳性神经元数量在各时间点明显高于模型组(P<0.05),28d时电针组伤侧脊髓前角内NGF阳性神经元数量为(48.12±1.11)个,模型组为(35.90±2.09)个。同时模型组神经元内NGF阳性神经元平均积分光密度在各时间点明显低于电针组(P<0.05)。结论:电针可提高损伤神经神经元内源性NGF水平,促进神经功能恢复。     

电针对大鼠坐骨神经损伤后神经生长因子表达的影响

目的：探讨电针对大鼠坐骨神经损伤后脊髓前角细胞神经生长因子(nerve growth factor，NGF)的影响。方法：取Wistar大鼠60只，4只为正常组，56只行左侧坐骨神经切断外膜缝合。电针组每天穴位电针20min，模型组不作任何处理。分别于术后7，14，21和28d用原位杂交和免疫组化技术和测定脊髓前角NGF阳性神经元计数、阳性神经元平均积分光密度。结果：电针组损伤侧脊髓前角内NGF阳性神经元数量在各时间点明显高于模型组(P＜0．05)，28d时电针组伤侧脊髓前角内NGF阳性神经元数量为(48．12&;#177;1．11)个，模型组为(35．90&;#177;2．09)个。同时模型组神经元内NGF阳性神经元平均积分光密度在各时间点明显低于电针组(P＜0．05)。结论：电针可提高损伤神经神经元内源性NGF水平，促进神经功能恢复。     

挤压伤后脊髓腹角和背角中神经营养因子-3和神经营养因子-4表达的时间演变规律(英文)

背景:神经营养因子-3和神经营养因子-4对体内、外神经元的发育、存活及功能维持具有重要的作用,是否对在挤压伤后脊髓神经元有保护和修复作用?目的:观察脊髓挤压伤模型大鼠伤后不同时间脊髓腹角和背角神经元神经营养因子-3和神经营养因子-4的表达,并分析其变化规律。设计:随机对照实验,单因素方差分析。单位:北京联合大学继续教育学院,昆明医学院人体解剖学教研室。材料:实验于2003-01/03在昆明医学院神经科学研究所完成,选择成年SD大鼠24只,随机分为4组,对照组,挤压伤24h组,挤压伤7d组及挤压伤21d组,每组6只。方法:挤压伤各组大鼠麻醉后,在T11行椎板切开后挤压大鼠T13脊髓节段,分别于术后24h,7d及21d断头处死动物,迅速取脊髓L1-L3节段制作20μm厚冰冻横切片。对照组不进行任何处理,和挤压伤24h组同时间点处死大鼠,制备切片过程相同。观察神经营养因子-3和神经营养因子-4样免疫反应阳性细胞在成年大鼠脊髓腹角和背角的分布,并计数两者相同面积内腹角和背角阳性有核细胞数。主要观察指标:①神经营养因子-3和神经营养因子-4在各组大鼠脊髓腹角和背角的分布。②神经营养因子-3和神经营养因子-4在各组大鼠脊髓腹角和背角神经元数量。结果:24只大鼠全部进入结果分析。①神经营养因子-3免疫阳性反应物主要在胞核着色,神经营养因子-4则胞浆及胞核均着色。②各组大鼠脊髓腹角和背角神经营养因子-3阳性神经元数量:挤压伤7d组和挤压伤21d组腹角阳性神经元数明显高于对照组和挤压伤24h组犤10.2±1.1,11.4±3.2,6.2±1.8,7.4±2.4,(P<0.01)犦;背角阳性神经元数仅挤压伤21d组高于对照组犤86.4±9.8,71.3±8.3,(P<0.01)犦,而挤压伤24h组及7d组低于对照组犤48.5±5.1,41.5±3.7,71.3±8.3,(P<0.01)犦。③各组大鼠脊髓腹角和背角神经营养因子-4阳性神经元数量:挤压伤24h组,挤压伤7d组和挤压伤21d组的腹角阳性神经元数高于对照组犤9.4±2.8,10.8±2.7,15.1±4.0,(P<0.05)犦,并且随时间的延长呈增加趋势(P<0.05);挤压伤7d组和挤压伤21d组背角的阳性神经元数较对照组和挤压伤24h组显著增加犤28.1±3.1,35.1±4.4,23.3±2.3,24.1±1.8,(P<0.01)犦,亦有随时间的延长呈增加趋势(P<0.01)。结论:脊髓挤压伤后,神经营养因子-3和神经营养因子-4神经元数量在脊髓腹、背角神经元中均有增加,但随时间的变化规律不完全一致,提示神经营养因子-3和神经营养因子-4在脊髓损伤修复中,对感觉和运动神经元发挥作用的时间可能不同.     

坐骨神经损伤后脊髓前角细胞脑源性生长因子的表达及针刺治疗的作用

目的探讨坐骨神经不完全性损伤后脊髓前角细胞脑源性神经生长因子(brain-derived neurotrophicfactor,BDNF)表达水平变化及针刺对BD-NF表达的影响.方法采用钳夹法制作大鼠左侧坐骨神经损伤模型,分为针刺组和对照组.用原位杂交、免疫组化技术检测相应节段脊髓前角细胞BDNF的表达水平,观察各组在1,7,4,21及28 d的变化.用计算机图像自动处理系统进行定量分析研究.结果对用原位杂交方法测得的坐骨神经损伤后大鼠脊髓前角BDNFmR-NA阳性细胞计数进行分析,组间和不同时间点比较差异均的非常显著性意义(P＜0.01);计算用免疫组化方法测得的坐骨神经损伤后大鼠脊髓前角BDNFmRNA阳性神经元光密度值,组间和不同时间点比较差异均的非常显著性意义(P＜0.01);坐骨神经损伤后损伤侧脊髓前角细胞中BD-NF表达水平在最初的3周内逐渐下降,然后开始恢复,但至第4周[(45.38±1.56)个]尚未恢复到健侧[(62.88±1.23)个]的水平.针刺组损伤侧脊髓前角细胞中BDNF表达水平除1,7 d组外其余均高于对照组(P＜0.01);而健侧BDNF表达水平在各时间点间相比较无明显差异.结论在正常情况下,BDNF在脊髓前角细胞中能够表达.坐骨神经损伤后,BDNF的表达下降.针刺能促进损伤侧脊髓前角细胞中BDNF表达水平的增加;而对健侧BDNF表达水平无明显作用.     

以电生理参数变化定量评估针刺对坐骨神经损伤的修复作用

目的:探讨针刺环跳、委中穴对大鼠损伤坐骨神经的修复效应。方法:实验于2004-12在福建医科大学机能实验室完成。70只SD大鼠用无齿血管钳夹伤坐骨神经造成坐骨神经损伤的模型,随机取4只检测造模,其余分为3组:实验组24只每日针刺环跳与委中穴,补法,留针30min,每2周后休息2d;对照组24只每日在中线旁1cm针刺小腿三头肌,补法,留针30min,每2周后休息2d;空白组18只不进行针刺治疗。共治疗6周,治疗的不同阶段,检测坐骨神经的传导速度、复合肌肉动作电位振幅、小腿三头肌单收缩力和强直收缩力及小腿三头肌湿重的恢复率。结果:66只大鼠接受电生理指标检测进入结果分析。①针刺2周坐骨神经传导速度恢复率:实验组明显高于对照组犤(17.52±3.73,13.80±3.79)%,(P<0.05)犦。②针刺4周强直收缩力恢复率:实验组明显高于对照组犤(50.96±6.61,45.18±5.57)%,(P<0.01)犦。③针刺6周小腿三头肌湿重恢复率:实验组明显高于对照组犤(68.55±5.68,63.224.01)%,(P<0.05)犦。④针刺4周复合肌肉动作电位振幅恢复率:实验组明显高于对照组犤(51.54±6.46,43.04±5.83)%,(P<0.05)犦。结论:以电生理参数定量评估坐骨神经损伤组和应用针刺环跳与委中穴位治疗组的大鼠坐骨神经的变化,结果显示针刺治疗后坐骨神经各项传导参数均得到改善,说明针刺环跳与委中穴位对周围神经的损伤有修复作用。     

睫状神经营养因子对外周神经损伤后运动神经元的保护作用

目的：研究睫状神经营养因子对大鼠坐骨神经损伤后运动神经的保护作用。方法：取成年SD大鼠27只，摸球法随机分为对照组、睫状神经营养因子(CNTF)组和生理盐水(NS)组。将大鼠右侧坐骨神经于梨状肌下缘0．5cm处锐性切断，硅胶管套接神经，将CNTF和生理盐水(NS)分别加入管中。于术后3，6，12，24d取L4-6脊髓作TUNEL标记检测，切片作苏木精-伊红染色计算脊髓内神经元的数目。结果：与对照组相比，CNTF组的神经元数目有明显的改善，其脊髓运动神经元计数3，6，12，24d分别为(83．3&;#177;1．2)％，(85．1&;#177;1．3)％，(85．6&;#177;1．2)％，(82．4&;#177;1．5)％(P&;lt;0．05，t=0．328)，TUNEL标记运动神经元个数3，6，12，24d分别为(3．1&;#177;1．2)％，(8．8&;#177;1．5)％，(5．6&;#177;1．1)％，(4．5&;#177;1．7)％(P&;lt;0．05，t=0．614)。结论：CNTF通过抑制运动神经元的凋亡对周围神经损伤后脊髓前角运动神经元损害具有保护作用。     

睫状神经营养因子对外周神经损伤后运动神经元的保护作用

目的:研究睫状神经营养因子对大鼠坐骨神经损伤后运动神经的保护作用。方法:取成年SD大鼠27只,摸球法随机分为对照组、睫状神经营养因子(CNTF)组和生理盐水(NS)组。将大鼠右侧坐骨神经于梨状肌下缘0.5cm处锐性切断,硅胶管套接神经,将CNTF和生理盐水(NS)分别加入管中。于术后3,6,12,24d取L4～6脊髓作TUNEL标记检测,切片作苏木精-伊红染色计算脊髓内神经元的数目。结果:与对照组相比,CNTF组的神经元数目有明显的改善,其脊髓运动神经元计数3,6,12,24d分别为(83.3±1.2)%,(85.1±1.3)%,(85.6±1.2)%,(82.4±1.5)%(P<0.05,t=0.328),TUNEL标记运动神经元个数3,6,12,24d分别为(3.1±1.2)%,(8.8±1.5)%,(5.6±1.1)%,(4.5±1.7)%(P<0.05,t=0.614)。结论:CNTF通过抑制运动神经元的凋亡对周围神经损伤后脊髓前角运动神经元损害具有保护作用。     

Recurrence of tuberculosis after hip replacement 58 years after primary infection

The paper presents the case of a 73-year-old patient with a history of tuberculosis of the hip in childhood who received an Exeter total hip prosthesis. Tuberculosis recurred 58 years after primary infection and 9 years after THA. The authors analyzed the available literature, which described only a few case reports, because Mycobacterium tuberculosis infections of a joint implant after THA are extremely rare. They are frequently the result of local reactivation of the pathogen or, less commonly, an overlooked diagnosis of tuberculosis at the time of endoprosthesis implantation. Proper diagnostic work-up of infection is particularly difficult because synovial fluid cultures are usually negative. In addition, a coexisting Staphylococcus aureus infection may obscure the clinical presentation. In post-THA patients, complete anti-TB treatment is recommended. Particular caution should be observed in patients from regions with high TB morbidity or with a history of pulmonary and operated joint tuberculosis.     

The influence of rewarming after therapeutic hypothermia on outcome after cardiac arrest

IntroductionTreatment with hypothermia has been shown to improve outcome after cardiac arrest (CA). Current consensus is to rewarm at 0.25–0.5 °C/h and avoid fever. The aim of this study was to investigate whether active rewarming, the rate of rewarming or development of fever after treatment with hypothermia after CA was correlated with poor outcome.MethodsThis retrospective cohort study included adult patients treated with hypothermia after CA and admitted to the intensive care unit between January 2006 and January 2009. The average rewarming rate from end of hypothermia treatment (passive rewarming) or start active rewarming until 36 °C was dichotomized in a high (≥0.5 °C/h) or normal rate (<0.5 °C/h). Fever was defined as > 38 °C within 72 h after admission. Poor outcome was defined as death, vegetative state, or severe disability after 6 months.ResultsFrom 128 included patients, 56% had a poor outcome. Actively rewarmed patients (38%) had a higher risk for poor outcome, OR 2.14 (1.01–4.57), p < 0.05. However, this effect disappeared after adjustment for the confounders age and initial rhythm, OR 1.51 (0.64–3.58). A poor outcome was found in 15/21 patients (71%) with a high rewarming rate, compared to 54/103 patients (52%) with a normal rewarming rate, OR 2.61 (0.88–7.73), p = 0.08. Fever was not associated with outcome, OR 0.64 (0.31–1.30), p = 0.22.ConclusionsThis study showed that patients who needed active rewarming after therapeutic hypothermia after CA did not have a higher risk for a poor outcome. In addition, neither speed of rewarming, nor development of fever had an effect on outcome.     

法洛四联症患儿体肺侧枝栓塞术并根治术的术后护理

法洛四联症是一种常见的发绀型先天性心脏病，在发绀型心脏病中居首位，存在肺动脉狭窄、室间隔缺损、主动脉骑跨、右心室肥厚4种畸形，根据病情可选择姑息术和根治术。重症患者体肺侧枝循环形成，术后渗血概率高，易并发低心排综合征、灌注肺等严重并发症。     

Psychotherapy of bereavement after homicide

The author presents guidelines for the assessment and initial treatment of bereavement after a homicide. Early interventions include nonverbal techniques applied in individual and group therapy. Because patients are over-whelmed and reactive, initial treatment strategy is supportive and focuses on reestablishing resiliency rather than on preexisting vulnerabilities (ambivalence, guilt, repression, denial). Adjustment to homicidal dying is lifelong, and therapist and patient should acknowledge that change may be limited.     

中耳乳突手术后治疗中耳内窥镜的应用

目的 探讨乳突根治术后耳内窥镜换药与常规换药相比是否具有优势.方法 2003年3月-2008年10月对89例共89只耳行开放式乳突根治术患者按随机数字表法随机分为试验组及对照组,试验组45例45只耳采用耳内窥镜换药,对照组44例44只耳常规换药;分别观察试验组和对照组的干耳人数及干耳的时间,计算干耳率及干耳的平均时间....     

Determinants of driving after stroke

OBJECTIVE: To identify variables that best predict a team's decision of driving ability in stroke patients from a predriving assessment. DESIGN: Retrospective study of a 2-year predriving evaluation. SETTING: Belgian Institute for Road Safety. PARTICIPANTS: One hundred four patients with sequelae of first stroke. INTERVENTIONS: Predriving assessments and road test. MAIN OUTCOME MEASURES: The suitability to resume driving based on a team decision and performance in the road test. RESULTS: Forty-one patients (39.4%) were judged suitable, 45 (43.3%) not immediately suitable, and 18 (17.3%) not suitable to drive. Correlation coefficients and comparisons between groups revealed that most variables had significant individual relationships with the team decision and performance on the road test. After logistic regression analysis, side of lesion, kinetic vision, visual scanning, and a road test led to the best model in predicting the team decision (R(2) =.53). The road test was the most important determinant (R(2) =.42). Multiple regression analysis showed that the combination of acuity of left and right eyes and the figure of Rey was the best subset to predict the road test (R(2) =.28). CONCLUSION: The predictive accuracy of the team's decision is limited, and the road test is even lower. Inclusion of more real-road-related tests in the predriving assessment is necessary.