前入路减压内固定术治疗胸腰椎爆裂骨折

目的：评价前入路减压植骨内固定治疗胸腰椎爆裂型骨折的效果。方法：对15例胸腰椎爆裂骨折患者行前路减压，切除椎体后缘骨块，解除对硬膜的压迫，上下椎体间植骨融合内固定。结果：随访6～24个月，平均9个月，神经功能平均有1级以上的恢复。植骨块全部融合，椎体高度恢复满意，椎管容量扩大，无骨片残留。结论：该术式疗效肯定，但要严格掌握手术要点、适应证。     

经前路、侧前方入路病灶清除一期植骨单钉棒内固定治疗腰椎单间隙感染的远期疗效

目的 探讨经前路、侧前方入路病灶清除一期植骨单钉棒内固定治疗腰椎单间隙感染的远期疗效。方法 回顾性分析2000年1月—2009年12月蚌埠医学院第一附属医院37例采用经前路、侧前方入路病灶清除一期植骨内固定治疗腰椎单间隙感染患者的临床资料。其中男18例,女19例;年龄19～59岁,平均(49.9±11.0)岁。观察对比患者术前与术后3天、2周、3个月、末次随访时体温、血常规(WBC和中性粒细胞百分比)和VAS评分情况,对比术前与术后7天、2周、3个月、末次随访时红细胞沉降率(ESR)、C反应蛋白(CRP)变化情况。术后定期复查腰椎病变节段正侧位X线片,观察椎间植骨融合情况。术后3个月、末次随访时根据患者VAS评分及X线片复查情况行疗效评价。结果 37例患者均顺利完成手术,结合患者病史、临床表现、影像学表现及术后细菌培养结果,均符合椎间隙感染诊断。所有患者切口达到一期愈合。术后37例患者均获随访,随访时间66～177个月,平均(120.7±30.8)个月。患者术后3天、2周、3个月、末次随访时VAS评分、体温均低于术前,差异均有统计学意义(P值均<0.05);患者术后3天WBC高于术前,术后2周、3个月、末次随访时WBC、中性粒细胞百分比均低于术前,差异均有统计学意义(P值均<0.05);患者术后7天、2周、3个月、末次随访时ESR、CRP均低于术前,差异均有统计学意义(P值均<0.05)。术后3个月评定疗效:优25例,良11例,可1例,优良率97.3%(36/37);末次随访时临床疗效均达优。结论 经前路、侧前方入路病灶清除一期植骨单钉棒内固定术是一种疗效明显、经济实用的手术方式,对于经保守治疗效果不佳、症状严重的患者值得推广应用。     

骶骨肿瘤手术入路和相关技术分析（附31例报告）

目的：探讨手术切除骶骨肿瘤的入路和相关技术问题。方法：手术治疗骶骨肿瘤31例,其中脊索瘤23例,骨巨细胞瘤3例,神经纤维瘤3例,动脉瘤样骨囊肿1例,平滑肌肉瘤1例。采用单纯后入路23例,前后入路8例,腰骶骨盆重建4例。结果：术后随访1—5a,平均32个月。围手术期感染2例,1例历经2年感染而死亡;5例手术后12个月内先后复发,其中3例再次手术、2例因肺部转移衰竭而死亡。4例行腰骶段重建,植骨愈合良好,无断钉断棒现象。结论：周密的术前计划、合适的入路选择、术中充分的瘤体外分离、骶1～3神经的保护、术后营养与引流是手术治疗的关键,侵犯骶1以上及骶髂关节时需腰骶骨盆重建。     

上胸椎结核患者两种手术方式治疗后的生活质量随访

目的观察前方经胸骨及侧前方经肩胛下入路治疗对上胸椎结核患者生活质量的影响。方法回顾性分析2003年1月~2011年1月我科手术治疗的27例上胸椎(T1-4)结核患者。经胸骨入路行一期病灶清除、前路减压、植骨融合及内固定术手术14例(A组),采用侧前方经肩胛下入路行一期病灶清除、减压、植骨融合及内固定手术13例(B组),术后随访时间12~52个月,平均27个月。记录患者术前及末次随访Oswestry功能障碍问卷调查评分(ODI)、疼痛视觉模拟评分(VAS)和SF-36量表的记分,比较组内和组间差异。结果两组患者术前与末次随访ODI评分、VAS评分和SF-36量表的记分有统计学意义(P0.05);两组之间上述三项指标无显著统计学意义(P0.05)。结论两种手术方式治疗上胸椎结核能明显提高患者生活质量及术后功能,术后患者生活质量与两种手术方式无关。     

经椎弓根入路不同植骨材料内固定治疗胸椎结核

背景：对于脊柱结核病灶清除后的骨质缺损,可以选择自体髂骨、自体肋骨、钛网加同种异体骨等多种植骨材料。 目的：对比椎弓根入路不同植骨材料内固定治疗胸椎结核的效果。 方法：纳入40例胸椎结核患者,其中18例伴有截瘫,15例存在后凸畸形,经正规抗结核治疗2-4周行后路椎弓根系统内固定,一期经椎弓根入路病灶清除植骨融合内固定,根据植骨材料的不同分为自体髂骨组、自体肋骨组、钛网加同种异体骨组。治疗后随访24个月,观察病灶愈合、植骨融合、截瘫恢复、后凸畸形矫正及不良反应发生率。 结果与结论：自体髂骨组植骨融合时间短于自体肋骨组、钛网加同种异体骨组(P < 0.05),后两组间植骨融合时间比较差异无显著性意义。3组均未发生植骨块及钛网脱落、断裂与移位,无骨不连及假关节等现象,无结核病灶复发。截瘫与脊柱后凸畸形患者经3-6个月的对症治疗,肌力基本恢复,脊柱后凸畸形基本矫正。表明自体髂骨治疗效果最好,自体肋骨、钛网加同种异体骨治疗效果相当。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

经肋横突入路病灶清除植骨加后路椎弓根内固定治疗进展性胸椎结核的临床疗效

目的观察经肋横突入路病灶清除植骨加后路椎弓根内固定治疗进展性胸椎结核的临床疗效。方法选择我院52例行经肋横突入路病灶清除植骨加后路椎弓根内固定术的进展性胸椎结核的患者为观察组(n=52),另选择50例同时期行前后路联合病灶清除植骨融合椎弓根内固定术的进展性胸椎结核患者视为对照组(n=50);对比两种手术方法的临床效果。结果两组患者手术前后Cobb’s角、血沉(ESR)差异显著(<0.05),但组间对比无显著差异(>0.05);两组患者在手术时间、术中出血量、住院时间方面差异显著(<0.05);两组患者的神经功能均有效改善,组间差异不大(>0.05)。结论经肋横突入路病灶清除植骨加后路椎弓根内固定可有效改善进展性胸椎结核患者的神经功能、纠正脊柱畸形,且手术时间短、术中出血量少、住院时间短,临床效果良好。     

胸腰段骨折经前入路切口的术后护理

胸腰段骨折及脱位是骨科创伤中的常见病手术解除压迫及稳定脊柱是治疗的重要手段之一,我科于1992年～1994年开展了经前入路切口椎管侧前方减压术17例,由于此手术术中需暴露充分波及胸腔,所以为确保手术成功,注重手术后护理尤为重要,现就将护理体会报告如下: 一、严密观察生命体征的变化:由于手术范围广,出血较多,引起生命体征的变化,故术后密切观察病人的血压,脉搏变化。每隔15～30分钟测量一次。平稳后每隔1～2小时测量一次,以后视病情而定。     

一期前后联合入路治疗胸腰段脊柱结核

目的探讨前路一期结核病灶清除植骨融合联合后路钉棒系统内固定治疗胸腰段椎体结核的疗效。方法 2007年2月～2009年10月手术治疗胸腰段椎体结核13例,均采用前路一期结核病灶清除取自体髂骨植骨融合联合后路钉棒系统内固定治疗胸腰段椎体结核,根据术前、术后X线平片分析植骨融合及术后畸形矫正效果。结果经6～18个月随访,脊髓神经功能得到不同程度的恢复,植骨融合满意,无内固定失败和脊柱结核病灶复发。结论前路一期结核病灶清除植骨融合联合后路钉棒系统内固定治疗胸腰段椎体结核具有椎管减压彻底,脊柱后凸侧弯畸形易于矫正,内固定远离病灶处等特点,是治疗胸腰段椎体结核的一种有效手术治疗方法。其缺点是手术创伤相对较大[1],术中操作相对繁琐。     

肽网支撑治疗胸腰椎结核30例分析

目的探讨胸、腰椎结核一期病灶清除加植骨融合内固定的疗效。方法本组30例,男16例,女14例;平均年龄32.4岁(17～55岁)。病变部位:胸椎9例,胸、腰段6例,腰椎15例。2个椎体21例,3个椎体7例,4个椎体1例,跳跃型1例。椎旁脓肿24例,髂窝流注性脓肿6例。本组患者伴有后凸畸形26例,平均Cobb角42.8°。术前血沉介于34～142mm/h。本组患者术前常规抗痨(异烟肼、利福平、乙胺丁醇、链霉素)1～2周,手术方式为一期病灶清除、脊髓减压、前方钛网支撑畸形矫正、自体髂骨(或肋骨)植骨融合内固定术。术后继续抗痨治疗12个月,定期复查胸腰椎正侧位片、血沉、肝肾功能等。结果切口皆一期愈合,无窦道形成。随访6～36个月(平均12个月),畸形矫正、植骨融合满意,未见内固定失败,疼痛等症状消失,脊髓功能皆明显恢复。2例出现神经根刺激症状,3例感伤口区麻木。术后血沉恢复正常时间平均为3～11个月。结论胸、腰椎结核行一期病灶清除、脊髓减压、植骨融合,同时前方钛网支撑畸形矫正和内固定治疗,在临床上取得了满意的疗效且不良反应少。     

前路病灶清除植骨并后路经椎弓根固定治疗腰骶部结核18例

目的采用前路病灶清除植骨并后路经椎弓根固定治疗腰骶部脊柱结核，探讨后路钉棒系统内固定的可行性及前路病灶清除植骨融合的可靠性。方法本组男12例，女6例；年龄32～54岁，平均42．3岁。18例均表现为持续的下腰痛，其中6例伴有单侧下肢痛，无明显潮热、盗汗等结核中毒症状。结核病灶累及L4～L59例，L5～S15例，L4～S14例。10例伴双侧腰大肌脓肿，5例伴单侧腰大肌脓肿，3例未见明显脓肿影。病灶破坏最严重处在L5椎体。3例CT检查提示，腰椎小关节增生内聚伴侧隐窝神经根管狭窄。术前常规抗痨治疗疗6～8周，常用链霉素、异烟肼、利福平和乙胺丁醇四联治疗，并加用氧氟沙星强化抗痨治疗1个月，每周复查血沉。待血沉控制在40mm／h左右，结核中毒症状有改善，体温低于37．5℃，营养不良基本纠正后进行手术治疗。所有患者均采用后路经椎弓根固定并前路病灶清除植骨融合术，其中有3例行侧椎管减压术。术后1～2周内采用异烟肼静脉给药，链霉素常规肌注，同时给予喹诺酮类药物以增强抗结核效果及预防混合感染，肛门排气、恢复进食后则加用利福平、乙胺丁醇口服给药，2周后改用原抗痨方案。结果本组18例获随访，随访时间12～36个月，平均20个月，按照结核治愈标准，所有随访患者结核症状消失，病灶治愈无复发。按Moon植骨成功后观察标准，本组病例植骨均愈合，愈合时间5～9个月，平均7．5个月。结论后路椎弓根固定稳定可靠，同时可行侧椎管减压、椎间植骨块加压固定有效避免植骨块松动。病椎椎弓根置人短螺钉可有效恢复脊柱正常序列，避免后期下腰痛的发生。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.