脊髓纵裂合并脊髓栓系、脂肪瘤1例

患者女,11岁。渐进跛行2年。查体:背部有毛发,可扪及L1以下棘突增宽畸形。左下肢较右下肢细,左足内翻,左踝关节僵硬,左足背屈差,跖屈尚可。左下肢肌张力稍高,痛温触觉较右侧差,双下肢远端浅感觉较近侧差,未查见明显感觉障碍平面,深感觉无异常,肛门反射弱。MRI表现(图1~5):腰2椎体呈楔形,其两侧椎板在中线部不连,被脂肪组织充填,相应水平椎管变窄。腰2以下椎管扩大,脊髓圆锥位于腰4椎体水平,且分叉为两个独立的圆形结构,内部呈脑脊液信号,边缘为低信号包膜,部分层面显示两者之间有短T1、短T2及短T1、长T2组织分隔,横断层面显示两圆形结构…     

脐血库HLA匹配机率分析

对广州脐血库 1998年以来保存的 30 0 0份脐血和 10 6 0名患者进行回溯分析 ,分析患者在脐血库中搜寻非亲缘脐血的HLA匹配结果 ,以探讨患者找到适于移植的非亲缘脐血的可能性。结果表明 ,6 /6HLA全相合的患者有 119人 (11.2 3% ) ,4 /6以上相合的患者高达 992人 (93.5 8% )。其中 ,分别有 6 1.2 9% ,89.79%的患者可以找到总有核细胞 (TNC)剂量≥ 3.7× 10 7/kg ,≥ 2 .0× 10 7/kg的 4 /6以上HLA相合脐血 ,相应的体重最高者分别为 79kg和 175kg。结论 :脐血库容量在 30 0 0份以上就可以有HLA 93%的匹配率。由于不同体重对脐血TNC数量要求更高 ,广州脐血库能够满足 30 % - 80 %成人患者的需要。在为患者寻找造血干细胞移植非亲缘供者时 ,无论成人或儿童患者 ,在寻找骨髓供者的同时 ,都有必要寻找适宜的脐血供者。     

Umbilical cord blood: Current uses for transfusion and regenerative medicine

The past 20 years of experience with umbilical cord blood transplantation have demonstrated that cord blood is effective in the treatment of a spectrum of diseases, including hematological malignancies, bone marrow failure, hemoglobinopathies, and inborn errors of metabolism. However, only a few number of umbilical cord blood units collected have a cell content adequate for an allogenic hematopoietic stem cell transplantation. In the meanwhile, there is an increasing interest in exploiting cord blood derivatives in different fields. In this review, we will summarize the most recent updates on clinical applications of umbilical cord blood platelet derivatives for regenerative medicine, and we will revise the literature concerning the use of umbilical cord blood for autologous or allogeneic transfusion purposes. The methodological aspect and the biological characteristics of these products also will be discussed.     

持续性脊髓压迫对脊髓损伤程度的影响

目的 探讨脊髓损伤(SCI)后脊髓压迫时间对损伤程度的影响。方法 以大脑皮层诱发电位(CSEP)和不同压迫时间为参数,自行设计一种犬的运动—静止压迫型SCI模型,选择T13为损伤中心,压迫脊髓,当 CSEP波幅下降达基础值的 50%时,维持静止压迫。将28只犬随机分为A、B、C、D 4组,A、B、C组脊髓分别受压30 min、90 min和180 min,D组为对照组,观察各组动物的组织病理学、影像学和行为学变化。结果 损伤组脊髓组织学均有损害,MRI显示损害程度随脊髓受压时间的延长逐渐加重( P<0.01);至术后28 d,各损伤组动物后肢功能均有恢复,BBB分级评分法评估组间有显著性差异( P <0.05)。结论 SCI后持续性脊髓压迫能加重损伤程度,应尽早解除脊髓压迫。     

冠状动脉造影致室颤一例的启示

为探讨新生儿剪脐的适当时机，我们观察了１１６ 例新生儿的脐部处理，随机分为潮湿组、干燥组和过干组，分别观察各组剪脐时和剪脐后的出血率、局部分泌物情况和细菌培养以及剪脐前脐带干湿度与出生后时间的关系。结果表明：干燥组剪脐时和剪脐后出血率显著低于其他组，剪脐后局部干燥率高，细菌培养致病菌阳性率低，脐部愈合时间较短。新生儿出生后２８ ～３３ｈ ，脐带处于干燥状态的机会最大（ 占观察例数的７２ ．４１ ％ ） ，显著高于其他时间段。因此我们认为剪脐最合适的时机应以脐带干燥为准，而不能单纯以时间为准。如果从时间安排的角度来看，在新生儿出生后２８ ～３３ｈ ，大部分脐带属于干燥，此时大部分新生儿可以剪脐。     

Spinal cord injury pain.

Awareness that SCI pain is common emerged during the past decade. However, there are a number of unresolved issues. There is a need for variety of experimental models to reflect diversity of SCI pains. Current classification is not as user-friendly as it should be. More attention should be given to a condition of the spinal cord below and above the SCI lesion. A consensus for what is an optimal SCI functional assessment for patients with sensory complaints and pain should be developed. Further extensive SCI pain research is needed prior to spinal cord regeneration trials in order to be able to cope with a potential for newly developed pains that may appear during incomplete spinal cord regenerative attempts.     

Lateral Corticospinal Tract and Dorsal Column Damage: Predictive Relationships With Motor and Sensory Scores at Discharge From Acute Rehabilitation After Spinal Cord Injury

ObjectiveTo determine if lateral corticospinal tract (LCST) integrity demonstrates a significant predictive relationship with future ipsilateral lower extremity motor function (LEMS) and if dorsal column (DC) integrity demonstrates a significant predictive relationship with future light touch (LT) sensory function post spinal cord injury (SCI) at time of discharge from inpatient rehabilitation.DesignRetrospective analyses of imaging and clinical outcomes.SettingUniversity and academic hospital.ParticipantsA total of 151 participants (N=151) with SCI.InterventionsInpatient rehabilitation.Main Outcome MeasuresLEMS and LT scores at discharge from inpatient rehabilitation.ResultsIn 151 participants, right LCST spared tissue demonstrated a significant predictive relationship with right LEMS percentage recovered (β=0.56; 95% confidence interval [CI], 0.37-0.73; R=0.43; P<.001). Left LCST spared tissue demonstrated a significant predictive relationship with left LEMS percentage recovered (β=0.66; 95% CI, 0.50-0.82; R=0.51; P<.001). DC spared tissue demonstrated a significant predictive relationship with LT percentage recovered (β=0.69; 95% CI, 0.52-0.87; R=0.55; P<.001). When subgrouping the participants into motor complete vs incomplete SCI, motor relationships were no longer significant, but the sensory relationship remained significant. Those who had no voluntary motor function but recovered some also had significantly greater LCST spared tissue than those who did not recover motor function.ConclusionsLCST demonstrated significant moderate predictive relationships with lower extremity motor function at the time of discharge from inpatient rehabilitation, in an ipsilesional manner. DC integrity demonstrated a significant moderate predictive relationship with recovered function of LT. With further development, these neuroimaging methods might be used to predict potential deficits after SCI and to provide corresponding targeted interventions.     

广州脐血库3 605脐血供者6个月后随访

本研究回顾分析了脐血库对库存3605份脐血所进行的脐血供者6个月后的随访情况,探讨供者随访制度在脐血库运作过程中的作用。1998年6月至2004年2月间,通过电话、信函方式对捐献脐血满6个月的母亲进行了母婴健康调查随访,对脐血的质量作出了评估结果表明：有3195人接受了电话随访,18人婉拒、对于无法通过电话随访的,则采用信函调查形式．共发信392封,回信15封。电话随访每例平均耗时12分钟随访资料显示婴儿染色体异常2例、先天性甲状腺功能低下1例、粒细胞减少症1例、白化病1例、不明原因死亡5例。所有这些被查明为非正常婴儿供者的脐血均被废弃,总之：脐血库进行脐血供者6个月后的随访工作．能有效地提高库存脐血的质量。     

胚胎脊髓对损伤脊髓的修复作用研究

目的探讨不同条件下胚胎脊髓移值修复成鼠急性脊髓损伤(SCI)的能力。方法成鼠胸髓损伤后分别移植孕14d胚胎脊髓(FSC组)、游离正中神经加胚胎脊髓(P＋F组)、带血管蒂正中神经加胚胎脊髓(V＋F组),术后8周行组织学检查。结果V＋F组胚胎脊髓与受体融合佳,体积增长速度、神经纤维和神经元数目显著高于P＋F、FSC组（P<0.01）,细胞分化比较好,突触较成熟,界面区也无明显的胶质增生。结论带血管蒂周围胚胎脊髓联合移植,对FSC的生长发育、对损伤神经元的再生能力均有一定的促进作用。     

脐血造血干细胞短期冻存效果的评价

为了探讨脐血造血干细胞在液氮中短期冻存复苏后的效果，分别将各自为8例冻存6个月、1年、2年的脐血千细胞进行复苏，观察造血干细胞活性。有核细胞(NC)计数采用自动血细胞分析仪测定，CD34^ 细胞采用流式细胞技术测定，用体外造血细胞培养技术分析粒一巨噬细胞集落生成单位(CFU-GM)产率，台盼蓝染色法判断造血细胞存活率。结果表明：脐血造血干细胞在液氮中冻存6个月、1年、2年后解冻，其有核细胞、CD34^ 细胞、细胞活率、CFU-GM产率在3个不同冻存时间的差异无显著性。结论：脐血干细胞于液氯中短期冻存，其干细胞数量和细胞活性没有明显的变化，冻存效果较好。     

脐带绕颈围生儿预后及分娩方式的临床研究

目的:探讨脐带绕颈经阴道分娩的可行性。方法:选取94例经阴道试产的脐带绕颈孕妇作为研究组,产程中加强监护,回顾性分析不同分娩方式对围生儿的影响,不同绕颈周数对围生儿及分娩方式的影响;同时选择因脐带绕颈择期剖宫产的70例作为对照组,并进行比较。结果:观察组77.66%自然分娩,8.51%阴道手术产,13.83%剖宫产;胎儿窘迫发生率为27.66%,新生儿窒息率为5.32%,与对照组比较差异无统计学意义(P>0.05)。结论:在严密产程监护下脐带绕颈可经阴道试产、分娩。     

三氟啦嗪对脊髓损伤后脊髓血流量的影响

目的：观察三氟啦嗪对脊髓损伤后脊髓血流量的影响,探讨吩噻嗪类药物对脊髓损伤保护作用的机制。方法：Allen's重锤打击法致伤大鼠脊髓,采用三氟啦嗪治疗,利用氢清除法测量脊髓血流量,观察三氟啦嗪对脊髓损伤后平均系统动脉压和脊髓血流量的影响。结果：在肾上腺素维持系统动脉压的条件下,三氟啦嗪可明显改善脊髓损伤后脊髓血流量,单一肾上腺素无此效应。结论：三氟啦嗪可以改善脊髓损伤后脊髓血流量,吩噻嗪类药物对脊髓损伤的保护作用可能与其改善脊髓血流量的作用有关。     

54例非亲缘脐血造血干细胞移植回顾性分析

本研究对广州市脐血库1998年6月至2003年7月提供的54例非亲缘脐血移植进行回顾性分析,以研究脐血移植的相关影响因素.脐血均采自广州市妇婴医院正常分娩的足月顺产孕妇,脐血分离、冻存、复温方法参照纽约脐血库标准及相关文献;选择脐血的依据是HLA相合程度及有核细胞数量.结果表明1998年6月至2003年7月间,库存脐血3475份,与21家移植中心合作提供脐血99份,治疗患者85例.其中同胞脐血移植11例.对54例非亲缘关系脐血移植病例进行统计分析显示,在54例受者中,恶性病患者43例,占79.6%,非恶性病患者11例,占20.4%,受者中位年龄9.5(1.2-33)岁,中位体重27(10-60)公斤,TNC中位输入量6.82×107/kg,移植后60天植入43例(ANC＞500/μl的中位时间为17天),植入率为79.6%.脐血移植有核细胞重建时间与输入的有核细胞数以及疾病类型相关,同HLA相合程度不相关.急性Ⅲ-Ⅳ度GVHD发生率为21.6%,慢性GVHD发生率为5.4%.6例患者出现自体恢复(11.1%).存活率42.6%.结论非亲缘性脐血造血干细胞移植尤其在治疗小儿白血病方面具有良好的应用前景.     

High‐Frequency Sonographic Measurements of True and False Vocal Cords

Objective. The purpose of this study was to prospectively identify the normal sonographic values of human true and false vocal cords. Methods. In total, 229 healthy volunteers were divided into 8 groups according to their age and sex. High‐frequency sonography was used to measure the length, width, and thickness of both true and false vocal cords. Measurements were compared between groups, and correlations with age were analyzed. Forty of the 229 volunteers also participated in reliability and reproducibility studies. Results. The sonographic measurements had good reproducibility, with intraclass correlation coefficient ranges of 0.736 to 0.903 for interobserver reliability and 0.723 to 0.943 for intraobserver reliability. Measurements for the 3 parameters of both true and false vocal cords in male adults were greater than those in female adults (P < .001). The length, width, and thickness of true and false vocal cords in participants younger than 18 years were obviously correlated with age (r = 0.835–0.957; P < .001), but no significant correlation was found in the adult groups. The rates of visualization in male groups were significantly lower than those in female groups (P < .001) and gradually decreased with increasing age. Conclusions. Both true and false vocal cords can be shown by high‐frequency sonography, which can quantitatively measure both true and false vocal cords with good reliability and reproducibility.     

3种喉镜手术治疗声带息肉或小结的临床比较

目的：比较3种喉镜手术方法切除声带息肉、声带小结的疗效，探讨不同手术方法的临床应用。方法：330例声带息肉、声带小结患者随机等分为3组，分别采用纤维内窥镜、显微支撑喉镜和间接喉镜3种手术方法治疗，统计结果，比较其疗效；以筛选更好的手术方法。结果：纤维内窥镜组有效率96．45％；显微支撑喉镜组有效率97．26％；间接喉镜组有效率87．18％，纤维内窥镜纽和显微支撑喉镜组比较，无显著差异，纤维内窥镜组和间接喉镜组比较，有显著差异；3种手术疗效不同，临床应用存在不同的优缺点和适应证。结论：临床应根据患者病情不同，选择相应的手术方法。对于局限性声带息肉和小结患者，纤维内窥镜手术可以作为首选，值得推广；对基底宽广的较大息肉患者，应选择显微支撑喉镜手术方法为好；间接喉镜手术简便，有特定的手术应用范围，不应完全放弃。     

脊髓慢性压迫损伤动物模型实验研究

目的：建立一种理想、实用的慢性脊髓压迫模型,为进一步研究慢性压迫性脊髓损伤的病理生理机制奠定基础。方法利用自行设计一种脊髓压迫装置制作大鼠慢性压迫模型,通过术后大鼠后肢运动功能BBB评分、X线片、脊髓HE染色评价该模型的可靠性。结果 X线片示1周脊髓受压程度约21%,3周后脊髓受压程度58%。脊髓功能受损存在一定的隐匿性,3周压迫组 BBB评分与对照组无明显差异（P＝0.193）,6、9周压迫组BBB评分持续降低,3个压迫组间存在显著差异（P＜0.05）。HE染色示受压脊髓灰质神经元丢失,白质脱髓鞘改变,病变随受压时间的延长逐渐加重,3组间脊髓前角神经元密度存在显著性差异（P＜0.05）。结论此装置较好地模拟了慢性脊髓压迫症的临床特征,具有取材方便,方法简单、科学、重复性强的优点。     

自体脐带血的保存及临床应用

脐带血内含有丰富的造血干、祖细胞,脐血移植已成功应用于治疗白血病、淋巴瘤、骨髓异常增生综合征、再生障碍性贫血、血红蛋白病、代谢贮积病和免疫缺陷性疾病.随着脐血库的建立和临床脐血移植数量的增多,越来越多的父母选择将脐带血捐献给公共库或者是储存到自体库以备应用.本文就近年来自体脐带血保存的现状和临床应用做一综述.     

Partial molar pregnancy with a normal live fetus and umbilical cord abnormalities: A novel association with long‐term follow‐up: A case report

A euploid fetus in a partial molar pregnancy can develop umbilical cord abnormalities as pregnancy goes on. So, careful examination of the umbilical cord can determine fetuses at risk for ominous adverse effects.