前路经寰枢关节螺钉内固定钉道解剖学测量及临床意义术

背景:前路经寰枢关节螺钉内固定术在国外是治疗寰枢椎不稳定的一种新方法,国人相关解剖学数据文献报道极少.目的:测晕前路经寰枢关节内固定术钉道的相关解削学数据.设计、时间及地点:测量性实验,于2006.09/2008.04在南方医科大学解剖教研室和解放军广州军区武汉总医院骨科完成.材料:中国成人配套寰枢椎十燥标奉50套,不分性别、年龄,外观排除畸形和破损,采用国产电子游标卡尺(精度0.01 mm)及普通国产量角器(精度为0.5°)进行测量.方法:以枢椎前弓下缘与枢椎椎体侧缘交界点上方4 mm处即枢椎上关节面下骨凹陷处为进钉点,分别向寰椎侧块后外上角中部拧入1枚长度适当的螺钉,螺钉尖不得穿透寰椎上关节面.主要观察指标:①钉道最,小外偏角、最大外偏角、最小后倾角、最大后倾角.②内侧钉道距离、外侧钉道距离.③进钉点至枢椎正中的距离、枢椎体正中与枢椎横突孔内侧缘的距离、进钉点与枢椎横突孔内侧缘的距离.结果:50套寰枢椎干燥标本均进入结果分析.在矢状面上螺钉置入的最小外偏角左侧为(10.80±2.10)°,右侧为(10.76±2.40)°;最大外偏角左侧为(25.13±3.12)°,右侧为(25.12±2.86)°;冠状面上最小后倾角左侧为(8.85±2.12)°右侧为(9.28±2.65)°;最大后倾角左侧为(26.96±3.09)°, 右侧为(27.49±2.51)°;内、外侧钉道左侧长度分别为(17.48±2.10)mm和(25.41±2.59)mm,右侧为(17.4g±2.23)mm和(25.58±2.42)mm;枢椎正中至进钉点距离左侧为(9.8±0.69)mm,右侧为(9.81±0.66)mm;枢椎正中至枢椎横突孔内侧缘距离左侧为(14.12±1.28)mm,右侧为(14.60±1.38)mm;进钉点与枢椎横突孔内侧缘的距离左侧为(6.28±1.38)mm,右侧为(6.79±1.39)mm..结论:前路经寰枢关节螺钉置入中,两侧置入螺钉的理想钉道角度为外偏10°～25°,后倾9°～27°,理想的螺钉长度为17～25mm,由枢椎前缘正中向外分离显露不宜超过14 mm.     

Salicylate measurement: clinical usefulness and methodology

The salicylates are the most commonly used analgesic, antipyretic, and anti-inflammatory drugs. They are available in hundreds of preparations, many of which are over-the-counter medications. The easy access to large quantities of the drug and the widespread perception that the drug is harmless have contributed to salicylate intoxication becoming a serious and common problem, particularly among the pediatric and geriatric populations. Salicylate is still the major drug for the treatment of rheumatic diseases. The use of salicylate in high doses for the management of these patients requires close monitoring of serum salicylate levels because of the large interindividual variation in dose-serum level relationships and the narrowness of the therapeutic range. Thus, both for the management of patients intoxicated with salicylate and patients who are on high-dose salicylate therapy, the measurement of serum salicylate levels is an important clinical laboratory service. Recent research on the inhibitory effect of aspirin on platelet aggregation has led to the prophylactic use of aspirin in low doses as an antithrombotic drug. This new therapeutic use of aspirin can be aided by monitoring low serum levels of salicylate and perhaps aspirin itself. This article reviews the current state of the knowledge of the pharmacokinetics and clinical toxicology of salicylate, the clinical usefulness of salicylate measurement by the clinical laboratory, and recent development in the analytical technology for salicylate analysis.     

Free drug monitoring

The principles, technique of measurement, and clinical significance of free drugs are reviewed. Albumin, alpha-1-acid glycoprotein, and lipoprotein are the main drug-binding proteins in blood. Variations of the concentrations of these proteins owing to disease would result in changes in the free drug levels. These levels may be determined by equilibrium dialysis, ultrafiltration, and other techniques.     

宫颈癌中耐药基因的表达及其临床意义

目的探讨多药耐药基因LRP、GST-π在宫颈癌中的表达特点及临床意义。方法采用逆转录-聚合酶链反应(RT-PCR)技术检测LRP、GST-π基因在10例正常组织和52例宫颈癌组织中的mRNA表达情况。结果在宫颈癌组织中LRP、GST-π的阳性率表达分别为67.3%和59.6%。10例正常组织中LRP不表达,GST-π表达1例。宫颈癌组织中LRP、GST-π的表达高于正常组织(P<0.05)。两者的表达均与患者的淋巴转移、肿瘤分化程度、临床分期无关(P>0.05)。LRP、GST-π之间的表达无相关性。结论 LRP、GST-π在宫颈癌中较高的阳性率表达可能共同参与宫颈癌对顺铂的固有耐药机制,为协助临床选择化疗方案可能具有一定的指导意义。     

产超广谱β-内酰胺酶大肠埃希菌的临床特点及耐药监测

目的监测广州医科大学附属第三医院2014年和2015年大肠埃希菌的分离情况及其对抗菌药物的耐药状况,为临床合理使用抗菌药物提供依据。方法常规方法培养分离患者感染的病原菌,并采用全自动细菌鉴定分析仪鉴定到种,药敏试验方法按CLSI规定的标准进行,采用WHONET5.6软件进行数据统计分析。结果 2014年和2015年共分离到大肠埃希菌1 202株,标本分布前5位分别为尿液、血液、痰液、分泌物和组织,本次分离得到的大肠埃希菌对替加环素敏感率为99.9%,对亚胺培南敏感率为99.2%,对阿米卡星敏感率为97.7%,对哌拉西林/他唑巴坦敏感率为97.2%,对呋喃妥因敏感率为85.2%。2014年和2015年分离得到的产超广谱β-内酰胺酶(ESBLs)大肠埃希菌阳性菌共643株,占53.5%。2年分离得到的ESBLs阳性的大肠埃希菌对头孢曲松、氨苄西林、头孢唑啉耐药率达99.0%;而对亚胺培南、替加环素、阿米卡星、哌拉西林/他唑巴坦、呋喃妥因敏感率达80.0%以上。结论大肠埃希菌对多种抗菌药物的耐药趋势相对稳定,临床微生物实验室应加强对多重耐药菌株的监测,为临床合理使用抗菌药物提供依据。     

Cervical motion testing: methodology and clinical implications

BACKGROUND: Measurement of cervical motion (CM) is probably the most commonly applied functional outcome measure in assessing the status of patients with cervical pathology. In general terms, CM refers to motion of the head relative to the trunk as well as conjunct motions within the cervical spine. SPECIAL FEATURES: Multiple techniques and instruments have been used for assessing CM. These were associated with a wide variety of parameters relating to accuracy, reproducibility, and validity. Modern measurement systems enable recording, processing, and documentation of CM with a high degree of precision. SUMMARY: Cervical motion measures provide substantial information regarding the severity of motion limitation and level of effort in cervically involved patients. They may also be used for following up performance during and after conservative or invasive interventions.     

The significance of clinical change and clinical change of significance: issues and methods

The emphasis on systematic methods of demonstrating accountability in health care is affecting the delivery of human services at all levels, from hospitals and community centers to individual private practitioners. New procedures are being proposed to meet the accountability demands encountered by therapists. Several recently developed methods for documenting clinical change in patient status are presented, and the relationship of this documentation to traditional research methods is briefly explored. A clinical illustration of the procedures is provided along with a discussion of advantages and limitations.     

Economics in clinical cancer research: methodology and assessment

Methods used in the management of cancer disease need to be assessed in terms of their economic, social and ethical implications. Several methods for such assessments are discussed; screening for breast cancer is used as a case study.     

Proteasome inhibition measurements: clinical application

BACKGROUND: PS-341, a selective inhibitor of the proteasome, currently is under evaluation as an anticancer agent in multiple phase I clinical trials. In animal-model studies, PS-341 was rapidly removed from the vascular compartment and distributed widely, quickly approaching the limits of detection. An accurate pharmacodynamic assay has been developed as an alternative or complement to pharmacokinetic measurements. METHODS: Fluorogenic kinetic assays for both the chymotryptic and tryptic activities of the proteasome have been optimized for both whole blood and blood cells. Using the ratio of these activities and the catalytic mechanism of the proteasome, we developed a novel method of calculating percentage of inhibition, using two structurally unrelated inhibitors (PS-341 and lactacystin). RESULTS: This ratio method was demonstrated to be sensitive (detection limit of 13% inhibition with 10 microgram of cell lysate), specific to the proteasome (PS-341 provides >98% inhibition), accurate (112% analyte recovery), and precise (0% +/- 5% inhibition at 0 nmol/L PS-341 and 74.5% +/- 1.7% inhibition at 200 nmol/L PS-341). Using these assays, we found that both erythrocytes and leukocytes contain proteasome at 3 micromol/L. Pharmacodynamic results for PS-341 obtained from the whole-blood ratio method were comparable to those using leukocytes determined by another method. CONCLUSIONS: The described assay provides a reliable method for studying the pharmacodynamics of proteasome inhibitors and is now in use in concurrent phase I clinical trials with PS-341.     

Antiepileptic drug therapy: Clinical laboratory significance

When evaluating a patient who is taking an antiepileptic medication, it is important for the emergency physician to correlate the clinical presentation with the antiepileptic drug level. Therapeutic ranges have been suggested for most antiepileptic medications, but these must be interpreted in light of clinical efficacy and patient tolerance. When considering the efficacy of antiepileptic medications, it is necessary to consider the patient's unique metabolism, side-effect tolerance, and overall response to therapy. Suggested therapeutic ranges should be the first reference for the emergency physician. The purpose of this report is to discuss the laboratory values of commonly prescribed antiepileptic medications. Therapeutic ranges, side-effects, and common medication interactions are discussed concerning phenytoin, phenobarbital, carbamezapine, and valproic acid.     

3D-endosonography in gastroenterology: methodology and clinical applications.

Endoluminal ultrasonography allows detailed imaging of the gastrointestinal wall and adjacent structures. Three-dimensional (3D) imaging may improve visualisation of topographic relations and the nature of pathologic lesions. The objective of this report is to summarise current status of 3D-endosonography and to discuss the possible clinical impact of this new modality. 3D ultrasonographic images are usually generated from a series of digitised two-dimensional ultrasound pictures acquired in a manner that enables registration of their relative spatial position. Such acquisition can be accomplished with different ultrasound probes, but in most cases of endosonography, a controlled pullback of radial-scanning probes has been applied. Digital ultrasound images are obtained by frame grabbing of analogue video recordings or by direct transmission from digital scanners. Dedicated software programs have been developed for 3D reconstruction and visualisation, allowing interactive display and measurements. 3D endosonography provides new possibilities for clinical imaging, but the impact on therapeutic strategies and clinical outcome has yet to be established.     

Colonic lipomas: clinical significance and management

Colonic lipomas are uncommon tumors but do constitute the most common nonepithelial tumor of the gastrointestinal tract. They tend to occur in an older population and rarely cause symptoms. However, if a lipoma discovered by barium enema or colonoscopy is causing symptoms of obstruction or bleeding, the tumors may require surgical removal. Rarely, as in our patient, the bleeding lipoma may be sufficiently pedunculated to allow safe colonoscopic removal. In general, lipomas of the colon are curiosities that must be distinguished from adenomatous polyps.