磁刺激运动诱发电位在脊髓型颈椎病中的诊断价值研究

目的：采用磁刺激运动诱发电位（ＭＥＰｓ）与Ｆ波结合测定中枢运动传导时间（ＣＭＣＴ），并与体感诱发电位（ＳＥＰｓ）比较，评估该技术对脊髓型颈椎病脊髓传导功能异常的诊断价值。方法：对２０例影像学或手术证实的脊髓型颈椎病病人进行磁刺激ＭＥＰｓ与Ｆ波结合测定ＣＭＣＴ及ＳＥＰｓ的中枢感觉传导时间（ＣＳＣＴ）。并对年龄、身高匹配的２０例正常受试者进行相同的检查对比。结果：病人组ＭＥＰｓ的ＣＭＣＴ明显延长，与正常组相比差异有显著性意义（Ｐ＜０．０５），异常率为８０％，高于ＳＥＰｓ的ＣＳＣＴ异常率７０％。ＣＭＣＴ的延长与该病的受损程度相关。结论：无痛无创的磁刺激ＭＥＰｓ对脊髓型颈椎病运动下行通路受损程度可做定量判断，对该病有很大的诊断价值。     

脊髓型颈椎病磁刺激运动诱发电位的临床研究

目的：为脊髓型颈椎病（ＣＳＭ）早期诊断寻找一种客观、敏感的检查方法。方法：采用磁刺激运动诱发电位（ＭＥＰ）和电刺激Ｆ波相结合的方法，测定１９例脊髓型颈椎病人外展拇短肌（ＡＰＢ）和胫前肌（ＡＴ）的中枢运动传导时间（ＣＭＣＴ），并与２０例正常受试者作对照。结果：１８例（９４．７％）ＣＳＭ病人上、下肢ＭＥＰ异常，ＡＰＢ肌及ＡＴ肌ＣＭＣＴ明显延迟，并与临床功能障碍（ＪＯＡ评分）显著相关，与ＭＲＩ所示脊髓受压程度无相关性。结论：磁刺激ＭＥＰ作为检测ＣＳＭ患者运动功能状态的客观指标具有重要的诊断价值。     

磁刺激运动诱发电位在腰椎间盘突出所致的腰骶神经根病变…

在３５例有Ｌ５和／或Ｓ１神经根损害表现的腰椎间盘突出患者椎区进行磁刺激运动诱发电位检查，测定，主戏前肌，Ｍｕ展肌和小趾展肌ＭＥＰ的起始潜伏期。结果显示，３５例中至少有一条患侧肌肉ＭＥＰ异常３３例。     

臂丛根性损伤两种神经电图—肌电图检测方法的诊断符合率

目的比较两种神经电图－肌电图检测方法对臂丛根性损伤的诊断符合率。方法１９９７年前，对８２例臂丛根性损伤用上肢五大神经代表肌肉及肩胛带肌群肌电图（ＥＭＧ）、复合肌肉动作电位（ＣＭＡＰ）、运动神经传导速度（ＭＮＣＶ）、感觉神经诱发电位和传导速度（ＳＮＡＰ、ＳＮＣＶ）及体感诱发电位（ＳＥＰ）进行分析诊断。１９９７年起，对１１８例臂丛根性损伤加测颈椎旁肌ＥＭＧ、双侧膈肌的ＣＭＡＰ和斜方肌的ＥＭＧ、ＣＭＡＰ进行诊断。结果１９９７年至今，臂丛根性损伤神经电图－肌电图的诊断和术中发现相比，诊断完全符合率为８０％，完全及基本符合率为９５．４％，比１９９７年前分别提高１４．１％和１０．３％。结论臂丛神经根性损伤加测椎旁肌ＥＭＧ、膈神经、副神经肌电可提高臂丛根性损伤尤其是Ｃ５节后损伤的肌电诊断正确率。     

磁刺激腰骶部神经根的兴奋点及其在腰骶神经根病中的应用

采用磁刺激腰骶部的神经根运动诱发电位（MEPs）和磁刺激窝F波相结合的方法测定运动神经根传导时间（MRCT）。随机抽查50名正常受试者，在胫前肌（TA）和比目鱼肌（SOL）记录出可靠的运动神经传导时间（MNCT）和MRCT，并根据MRCT推算磁刺激腰骶部神经根的兴奋点位置，结合5例尸解测出的L5和S1神经根的长度，确定该兴奋点在椎间孔的近端。同样方法记录和观察40例手术证实单侧L5或S1神经根受压患者MNCT和MRCT的改变。结果显示：病人组与正常组相比MNCT无显著性差异，而MRCT有显著性差异，异常率为85％。作者认为，无痛无创的磁刺激MEPs对腰骶神经根病有很大的诊断价值。     

诱发电位对急性颈髓损伤后神经功能状态的诊断价值

目的：研究磁刺激运动诱发电位（ＭＥＰ）和体感诱发电位（ＳＥＰ）对颈髓损伤的诊断及预后判断价值。方法：Ｅａｇ２型磁刺激仪对２７例颈髓患者进行经颅磁刺激ＭＥＰ检查,在双侧外展拇短肌（ＡＰＢ）和径前肌（ＡＴ）进行记录,采用Ｋｅｙｐｏｉｎｔ肌电图诱发电位仪进行体感诱发电位（ＳＥＰ）检查,收集患者的临床资料按照ＡＳＩＡ９２运动评分和损伤标准分级。随访１５例,并以２０例健康志愿者做对照。结果：颈髓２组ＡＰＢ肌     

急性脊髓损伤后磁刺激运动诱发电位及体感诱发电位的诊断意义

目的 研究磁刺激运动诱发电位（ｍｏｔｏｒ ｅｖｏｋｅｄ ｐｏｔｅｎｔｉａｌｓ,ＭＥＰ）对脊髓损伤（ｓｐｉｎａｌ ｃｏｒｄ ｉｎｊｕｒｉｅｓ,ＳＣＩ）后运动传导功能的诊断价值。方法 采用Ｍａｇ－２型磁刺激仪对３２例ＳＣＩ患者进行经颅磁刺激ＭＥＰ检查,分别在双侧外展拇短肌（ａｂｄｕｃｔｏｒ ｐｏｌｌｉｃｉｓ ｂｒｅｖｉｓ,ＡＰＢ）和胫前肌（ａｎｔｅｒｉｏｒ ｔｉｂｉａｌｉｓ,ＡＴ）进行记录。同时检测Ｆ     

磁刺激运动诱发电位与脊柱外科临床

磁刺激运动诱发电位与脊柱外科临床１９８０年，Ｍｅｒｔｏｎ和Ｍｏｒｔｏｎ［１］通过头皮电极刺激大脑皮层，首次在外周靶肌记录到正常人的中枢运动诱发电位（ｍｏｔｅｒｅｖｏｄｅｄｐｏｔｅｎｔｉａｌ，ＭＥＰ）和中枢运动传导时间（ｃｅｎｔｒａｌｍｏｔｏｒｃｏｎｄ...     

TMS—MEP监测脊髓缺血性损伤的实验研究

为观察经颅磁刺激的不同刺激量和脊髓缺血性损伤对运动诱发电位的影响，采用兔脊髓可逆性缺血损伤模型进行磁刺激运动诱发电位（ＴＭＳ－ＭＥＰ）监测。发现在４０％～８０％的刺激量时，ＭＥＰ相对稳定。脊髓缺血损伤后ＭＥＰ潜伏期延长或消失，恢复血供后ＭＥＰ先于后肢运动功能恢复，至４～６小时完全恢复正常，当脊髓缺血后２４小时出现继发性损伤时，ＭＥＰ再次出现异常，ＭＥＰ的表现和后肢运动功能变化及病理改变相一致。证实ＴＭＳ－ＭＥＰ可敏感而准确的反映脊髓缺血后改变，可用于监测脊髓的缺血性损伤。     

颈髓肿瘤的运动诱发电位研究

目的：探讨颈髓肿瘤患者的运动诱发电位（ ＭＥＰ） 变化规律。方法：对经磁共振（ ＭＲＩ） 证实的３２例颈髓肿瘤患者进行了电刺激运动诱发电位测试,其中１８ 例进行复查。结果：颈髓肿瘤患者ＭＥＰ 的中枢运动传导时间（ＣＭＣＴ） 延长,异常率为９３ ．８ ％ （３０／３２） ,肌力减退愈重,ＭＥＰ 异常愈显著,颈髓腹侧肿瘤的ＭＥＰ 异常较侧后方肿瘤的 ＭＥＰ 异常更显著,术后 ＭＥＰ 的改变与肌力的改变明显相关。结论：ＭＥＰ 的改变较临床评估更为敏感,且能客观地反映运动功能的损害程度;ＭＥＰ 可预测预后,能作为评估手术效果的客观指标。     

慢性肾功能衰竭患者预防性抗结核治疗的临床价值

目的探讨慢性肾功能衰竭（ＣＲＦ）患者预防性抗结核治疗的价值。方法对实验组中具有并发结核危险因素的ＣＲＦ患者进行预防性抗结核治疗，历史对照组中具有同样危险因素者未作任何处理。结果实验组在观察期间活动性结核的发生率（０．７６％、２／２６１）明显低于对照组（４．７０％、３９／８３０）。按预防性治疗前病人具有的危险因素分层进行比较表明，血清抗ＰＰＤ－ＩｇＧ阳性的ＣＲＦ病人，接受预防性治疗者活动性结核的发生率明显低于未接受预防性治疗者。结论对具有危险因素的ＣＲＦ病人实施预防性抗结核治疗有助于降低这类病人活动性结核的发生率     

双加压“L”形钢板的设计及临床应用

作者自行设计的双加压“Ｌ”形钢板有纵向和横向加压作用，该钢板最大创新之处是在普通“Ｌ”形钢板的短臂上设有一导引孔，并可穿入一枚加压螺栓．该钢板可通过其短臂上的导引孔沿导引针准确地被打入预定的位置，从而避免膝内翻或膝外翻；该钢板上的螺栓还可对股骨髁间和胫骨平台骨折进行横向加压，其固定性能可靠，病人可早期在ＣＰＭ仪上进行功能锻炼．使用该钢板治疗股骨髁上、髁间骨折和胫骨平台骨折２４例，随访１～２．５年，总优良率达９１．７％．     

Effects of vitamin D compounds on renal and intestinal Ca2+ transport proteins in 25-hydroxyvitamin D3-1alpha-hydroxylase knockout mice

BACKGROUND: Vitamin D compounds are used clinically to control secondary hyperparathyroidism (SHPT) due to renal failure. Newer vitamin D compounds retain the suppressive action of 1,25(OH)(2)D(3) on the parathyroid glands and may have less Ca(2+)-mobilizing activity, offering potentially safer therapies. METHODS: This study investigated the effect of a single dose of compound (1,25(OH)(2)D(3), 1,24(OH)(2)D(2), or 1alpha(OH)D(2)) on renal and intestinal Ca(2+) transport proteins, including TRPV5 and TRPV6, and serum Ca(2+), in a novel SHPT model, the 25-OH-D(3)-1alpha-hydroxylase knockout mouse, which lacks endogenous 1,25(OH)(2)D(3) and is severely hypocalcemic. Animals were injected intraperitoneally with compound (100 ng/mouse). RESULTS: Serum levels of 1,25(OH)(2)D(3) and 1,24(OH)(2)D(2) peaked at four hours post-injection (pi), then declined rapidly. 1,25(OH)(2)D(2) generated from 1alpha(OH)D(2) peaked at 12 hours pi and then remained stable. Serum Ca(2+) was increased to near-normal within four hours by 1,25(OH)(2)D(3) and 1,24(OH)(2)D(2), and within 12 hours by 1alpha(OH)D(2). 1,25(OH)(2)D(3) and 1,24(OH)(2)D(2) up-regulated duodenal TRPV5 and TRPV6 mRNA to a similar degree within four hours; mRNA levels decreased by 12 hours after 1,24(OH)(2)D(2) treatment, and by 24 hours after 1,25(OH)(2)D(3) treatment. 1,25(OH)(2)D(3) increased kidney levels of TRPV5, calbindin-D(28K), and calbindin-D(9K) mRNA within four hours; 1,24(OH)(2)D(2) did not change kidney TRPV5 levels and modestly increased calbindin D(9K) by 48 hours. 1alpha(OH)D(2) produced later-onset effects, increasing duodenal TRPV6 and calbindin-D(9K) mRNA levels by 12 hours and TRPV5 by 48 hours. CONCLUSION: In kidney, 1alpha(OH)D(2) increased TRPV5, calbindin-D(28K), and calbindin-D(9K) mRNA levels by 12 hours. This study indicates that Ca(2+) transport proteins, including TRPV5 and TRPV6, are differentially up-regulated by vitamin D compounds.     

Investigation of serotonin receptors in the isolated penile bulb of rats

The aim of this study was to investigate serotonin (5-HT) receptors in the penile bulb, which have been suggested to play a role in penile erection. Serotonin (10(-7)-3 x 10(-4) M) contracted penile bulbs in a concentration-dependent manner. Ketanserin (5-HT(2A) antagonist, 10(-9)-10(-7) M) and prazosin (alpha(1)-adrenergic receptor blocker, 10(-9)-10(-7) M) suppressed the lower and upper parts of concentration-response curves to 5-HT, respectively. Guanethidine (adrenergic neuron blocker, 5 x 10(-5) M) reduced the responses to 5-HT at only 10(-4) and 3 x 10(-4) M concentrations. NAN-190 (5-HT(1A) antagonist, 10(-8), 10(-7) M) shifted the concentration-response curve to the right with a reduction in the maximum response to 5-HT. While ondansetron (5-HT(3) antagonist, 10(-6)-10(-5) M) and GR55562 (5-HT(1B/1D) antagonist, 10(-6)-10(-5) M) had no effect on the concentration-response curve to 5-HT. The 5-HT(1A) agonist 8-OH-DPAT (10(-7)-3 x 10(-4) M) contracted penile bulbs in a concentration-dependent manner with a lower pD(2) value than that of 5-HT. Sumatriptan (5-HT(1B/1D) agonist, 10(-8)-10(-4) M) did not produce any contractile response in the penile bulbs. Prucalopride, a selective 5-HT(4) agonist (R093877, 10(-7)-3 x 10(-4) M) produced concentration-dependent relaxation in penile bulbs contracted by phenylephrine (10(-5) M). 5-HT(4) agonists cisapride (10(-7)-10(-4) M) and metoclopramide (10(-7)-3 x 10(-4) M) also relaxed the tissue, concentration-dependently. Selective 5-HT(4) antagonists GR125487 (10(-6)-10(-5) M) and GR113808 (10(-6)-10(-5) M) slightly, but not significantly, decreased prucalopride- and cisapride-induced relaxation. Propranolol (beta-adrenergic receptor blocker, 10(-6)-10(-5) M) and L-NOARG (nitric oxide synthase inhibitor, 10(-4) M) had no effect on prucalopride-induced relaxation. These results suggest the existence of alpha(1)-adrenergic, 5-HT(1A) and 5-HT(2A) serotonergic receptors in the penile bulb of rats, which are responsible for 5-HT-induced contraction. Additionally, a serotonergic receptor resembling a 5-HT(4)-type plays a role in the relaxation. The latter receptor is activated by 5-HT(4) agonists, but is not antagonized by 5-HT(4) antagonists.     

Pre-operative sildenafil and pulmonary endothelial-related complications following cardiopulmonary bypass: a randomised trial in children undergoing cardiac surgery

In a randomised trial, we compared the effects of oral sildenafil (0.5 mg.kg(-1) ) and placebo, administered the day before cardiac surgery, in 24 children. In sildenafil vs placebo patients, pre-cardiopulmonary bypass median (IQR [range]) cyclic-guanosine-monophosphate was not significantly different (29.9 (2.1-208.1 [0.5-391.5]) vs 5.2 (0.3-54.6 [0-628.9]) pmol.ml(-1) , respectively). Post-cardiopulmonary bypass, nitrate/nitrite levels were also not significantly different (0.7 (0-8.0 [0-142.8]) vs 0 (0-2.7 [0-52.7]) μM, respectively). Postoperatively, mean (SD) pulmonary vascular resistance (2.64 (2.28) vs 1.90 (1.12) WU.m(-2) , respectively and oxygenation index (5.29 (4.60) vs 3.38 (2.54), respectively) remained unchanged, whilst oxygen delivery (57.18 (21.24) vs 74.13 (35.46) ml.min(-1) .m(-2) , respectively) and bi-ventricular systolic function (left ventricle 3.78 (0.94) vs 4.55 (1.08) cm.s(-1) , respectively; p=0.002; right ventricle 6.93 (1.47) vs 8.09 (2.25) cm.s(-1) , respectively; p<0.001) were significantly reduced in the sildenafil group. In this trial, pre-operative sildenafil did not affect postoperative pulmonary vascular resistance. There was, however, a negative impact on ventricular function and oxygenation.     

两个时期肾结核的临床比较

目的：探讨近年来肾结核的流行病学和临床变化趋势.方法：对收治的842例肾结核患者,以1980年底为界,分为先期组和近期组进行临床比较.结果：两组患者分别：占同期泌尿外科住院人数的8.74%和1.95%（P＜0.05）;就诊年龄中位数为28岁、38岁;病程平均为33.6个月、45.9个月.尿频91.1%,66.0%;血尿82.6%、64.7%;伴发肺结核18.4%、12.3%;伴发膀胱结核37.2%、19.6%;伴发附睾结核47.0%、36.6%（以上各项均P＜0.05）;IVU检查阳性率分别为90.0%、85.9%.结论：肾结核发病率近年来明显下降,其典型临床表现比例降低,不典型肾结核病例呈明显增加趋势.     

内镜超声检查和多层螺旋CT对胃癌术前T、N分期的比较研究

目的探讨内镜超声(endoscopicultrasonography,EUS)与多层螺旋CT(multi slicespiralCT,MSCT)在胃癌术前T、N分期中的临床应用价值。方法2000年10月至2002年5月,对89例活检证实的胃癌病人术前分别行内镜超声和多层螺旋CT检查,并与手术病理结果对照。结果EUS对胃癌术前T分期的准确率为75.6%,其中T176.5%,T268.8%,T384.4%,T464.7%;MSCT分别79.3%,58.8%,62.5%,90.6%和94.1%。两者差异无统计学意义(P>0.05)。EUS对胃癌术前N分期的准确率为57.5%,其中N095.8%,N145.8%,N232.0%;MSCT分别78.1%,70.8%,75.0%和88.0%。EUS和MSCT对胃癌淋巴结转移的敏感性分别为61.2%和91.8%。EUS对N0分期的准确率显著高于MSCT(P<0.05),MSCT对N和N2分期的准确率及淋巴结转移的敏感性均显著高于EUS(P<0.05,P<0.01,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前TN分期均有较高的准确性。     

Mineral metabolism and arterial functions in end-stage renal disease: potential role of 25-hydroxyvitamin D deficiency

In ESRD, arterial function is abnormal, characterized by decreased capacitive function (arterial stiffening) and reduced conduit function, shown by diminished flow-mediated dilation (FMD). The pathophysiology of these abnormalities is not clear, and this cross-sectional study analyzed possible relationships among arterial alterations and cardiovascular risk factors, including mineral metabolism parameters, such as serum parathormone, and vitamin D "nutritional" and "hormonal" status by measuring serum 25-hydroxyvitamin D [25(OH)D(3)] and 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] levels. Aortic stiffness (pulse wave velocity), brachial artery (BA) distensibility (echotracking; n = 42), BA FMD (hand-warming; n = 37), and arterial calcification scores (echography and plain x-rays) were measured in 52 stable and uncomplicated patients who were on hemodialysis. 25(OH)D(3) and 1,25(OH)(2)D(3) serum levels were low and weakly correlated (r = 0.365, P < 0.05). After adjustment for BP and age, multivariate analyses indicated that 25(OH)D(3) and 1,25(OH)(2)D(3) were negatively correlated with aortic pulse wave velocity (P < 0.001) and positively correlated with BA distensibility (P < 0.01) and FMD (P < 0.001). Arterial calcification scores were not independently associated with 25(OH)D(3) and 1,25(OH)(2)D(3) serum concentrations. These results suggest that nutritional vitamin D deficiency and low 1,25(OH)(2)D(3) could be associated with arteriosclerosis and endothelial dysfunction in patients who have ESRD and are on hemodialysis.     

免疫抑制剂对嗜铬细胞瘤12细胞和L929细胞增殖的影响

目的 初步探讨多种免疫抑制剂对嗜铬细胞瘤12（pheochromocytoma 12，PC12）细胞和L929细胞增殖的影响。方法 对数生长期PC12细胞和L929细胞传代，取细胞株复苏后第3代细胞均以1×10^6／ml密度接种于培养板中，分别加入10、10、10^-7和10^8mol／L环孢菌素A（cyclosporin A，CsA），10^-6、10^-7、10^-8和10^-9mol／LFK506以及10^-3、10^-4、10^-6和10^-8mol／L甲基强地松龙，并设立空白对照组。于培养24、48和72h后，取各浓度药物作用的细胞，采用MTT法检测细胞增殖。结果 高浓度（10mol／L）甲基强地松龙和较低浓度（10^-8～10^-7mol／L）CsA，在给药后48h内对PCI2细胞增殖有明显促进作用，此后促增殖作用不明显；而各个浓度的FK506均无促进PCI2细胞增殖的作用。高浓度甲基强地松龙（10^-3mol／L）和CsA（10^-6～10mol／L）作用24h后，对L929细胞增殖有显著抑制作用，FK506仅在较高浓度（10^-6mol／L）有一过性（仅出现于给药后48h）促进L929细胞增殖的作用。结论 10^-3mol／L甲基强地松龙和10^-8～10^-7mol／LCsA能够在短时间内促进PC12细胞增殖，而10^-3mol／L甲基强地松龙和10^-6～10^-5mol／L CsA对L929细胞增殖有显著抑制作用。     

Diabetic LDL triggers apoptosis in vascular endothelial cells

This study compares the effects of LDL glycated either in vitro (LDL(iv)) or in vivo in diabetic patients (LDL(D)) on apoptosis, proliferation, and associated protein expression in cultured human umbilical vein endothelial cells. At 100 mg/l, both LDL species considerably increase apoptosis (LDL(iv) 63%, LDL(D) 40%; P < 0.05) compared with intraindividual nonglycated LDL subfractions. Considering its lower degree of glycation (LDL(D) 5-10%, LDL(iv) 42%), LDL(D)'s relative proapoptotic activity is 2.7-fold greater than that of LDL(iv). Glycated LDL-induced apoptosis is associated with increased expression of apoptosis promotors (LDL(iv): bak 88%, CPP-32 49%; LDL(D): bak 18%, CPP-32 11%; P < 0.05) and is attenuated by caspase inhibitors. Glycated LDL's antiproliferative activity (LDL(iv) -34%, LDL(D) -9%; P < 0.01) relates to reduction (P < 0.05) of cyclin D3 (LDL(iv) -27%, LDL(D) -24%) and of hypo- (LDL(iv) -22%, LDL(D) -19%) and hyperphosphorylated (LDL(iv) -53%, LDL(D) -22%) retinoblastoma protein and is paralleled by reduced expression of endothelial nitric oxide synthase (LDL(iv) -30%, LDL(D) -23%). In response to lipoprotein lipase, LDL(D) more markedly triggers endothelial apoptosis (27.1-fold) compared with LDL(iv), suggesting that LDL(D) owns a higher potential for endothelial cell damage than LDL(iv). The observed behavior of LDL(D) versus LDL(iv) could be of clinical importance and well relate to differences in structure and cellular uptake of LDL(D) compared with LDL(iv).