失神经支配的Wistar大鼠肌肉运动终板氯化金染色

临床或实验过程中经常需要确定肌肉组织神经支配情况，如神经元病变或神经损伤导致的肌肉失神经支配程度判定。传统的方法是测定神经及肌肉电活动，但缺少形态学依据。本实验将正常神经支配的肌肉运动终板染色加以改良。成功地完成了变性运动终板染色，以便为神经源性肌肉麻痹的诊断提供一种简单有效的诊断及实验方法。     

大脑终板的显微解剖

目的观察大脑终板的显微解剖结构及其与毗邻血管的关系。方法 10具（20侧）成人尸头,经翼点入路开颅并取出整个大脑,手术显微镜下对大脑终板进行观察、解剖和测量。结果大脑终板贴附在视交叉上,终板高6.5～10.0 mm,其底的长度为8.1～18.0 mm。全部暴露终板只需轻微牵拉,一般不需要移动大脑前动脉—前交通动脉复合体。结论大脑终板有明确的解剖位置,其内血管较丰富;与终板毗邻的结构较多,其中关系最密切的是大脑前动脉—前交通动脉复合体。     

中西医结合治疗椎间盘源性腰痛

目的研究中西医结合治疗椎间盘源性腰痛的临床疗效。方法回顾性分析我科2007年6月-2013年6月收治的椎间盘源性腰痛患者,共87例,其中男53例,女34例,年龄21-65岁,平均43.5岁。进行中西医结合保守治疗,观察临床疗效。结果所有患者均获随访,随访时间6个月-5年。根据日本Nakano标准[1],优:69例,占79%;良:13例,占15%;可:5例,占6%;差:0例。结论中西医结合治疗椎间盘源性腰痛临床疗效确切,能有效地解除症状。     

经皮激光椎间盘减压术治疗椎间盘源性腰痛及腰椎间盘突出症55例

目的观察经皮激光椎间盘减压术（PLDD）治疗椎间盘源性腰痛及腰椎间盘突出症的临床疗效。方法对16例椎间盘源性腰痛患者和39例腰椎间盘突出症患者进行PLDD治疗。采用腰背痛JOA评分法进行疗效评定并计算治疗改善率。结果本组55例均获得随访,穿刺均获得成功,无严重不良反应及并发症发生。随访时间6~24个月,16例椎间盘源性腰痛中,JOA评分优8例、良6例、可2例,优良率87.5%,39例腰椎间盘突出症患者中,优17例、良11例、可6例、差5例,优良率71.8%。结论 PLDD治疗椎间盘源性腰痛及腰椎间盘突出症疗效较好。     

椎间盘内电热疗法

慢性腰痛约40％为椎间盘源性,目前对椎间盘源性腰痛的治疗存在较大争议,保守治疗失败后通常采取椎间融合术或长期止痛药物治疗。椎间盘内电热疗法(intradiscal electrothermal therapy,IDET)于20世纪90年代末首先由美国康复医师Jeffrey Saal和Joel Saal设计并应用于临床。     

老年肾癌的临床特点

本对我院1981年至1994年问收冶的40例老年肾癌进行临床分析。结果：老年人肾癌典型三联征（腹块血尿．腰痛)仅75%，无症状性肾癌为17.5％a首发症状仍以血尿腹块为主。老年肾癌误诊率15％，肾B超检查是诊断无症状性肾癌的重要方法，尽管老年人并存疾病多，但肾墙根治性手术仍为其重要的治疗手段．     

颈椎间盘软骨终板的超微结构改变及其临床意义

目的 探讨人颈椎间盘软骨终板超微结构变化及其与椎间盘退变的关系。方法 取胎儿、正常青壮年、单纯颈椎间盘突出(CDH)和脊髓型颈椎病(CSM)患者(各10例)的颈椎间盘软骨终板,透射电镜观察其超微结构。结果 与胎儿相比,正常青壮年软骨终板细胞数量减少、细胞形态变化明显,而细胞外基质中胶原含量丰富;CDH患者细胞数量明显减少,细胞功能明显退变,细胞外基质中胶原含量减少;CSM患者细胞数目极少,多数细胞已经形成凋亡体或细胞碎片,细胞外基质中胶原含量稀少。结论 颈椎间盘软骨终板细胞的退变先于细胞外基质,正常青壮年已经出现退变;颈椎病的预防应从青壮年开始。     

改良椎管内减压术治疗椎间盘源性腰痛效果观察

目的观察改良椎管内减压术治疗椎间盘源性腰痛的疗效。方法对80例反复发作的椎间盘源性腰痛患者进行腰椎MRI及椎间盘造影检查确诊,行椎板单侧或双侧开窗、椎管内减压术,术中保留椎间盘、棘突和部分椎板,仅行分离粘连组织、松解神经根和椎弓根钉棒固定、后外侧植骨融合术。结果 80例术后均获随访,随访时间为1.5-2 a,腰痛症状均消失,活动良好。结论改良椎管内减压术治疗椎间盘源性腰痛,可有效消除该患者腰痛症状,长期疗效好。手术创伤明显减小。     

隐源性咯血的病因：从良性病变到危及生命的病理性血管病变

背景和目的：咯血的诊断通常根据查体、胸部X线和CT检查以及纤维支气管镜检查。即使采用所有的检查手段，临床上仍约有7％-25％的咯血病例找不到明确原因。这种原因不明的咯血（即隐源性咯血）的临床资料非常少见，其处理原则和预后仍存在争议。该研究描述了1组隐源性咯血病例，并对其临床疾病谱、处理措施以及短期和长期预后进行了分析。这些病例均首先通过病史和查体、X线和CT检查以及纤维支气管镜检查，     

腹水与肝脏疾病

肝源性腹水是常见的重要临床问题,随着液体活体组织检查、第二代测序技术等方法的研发,以及新型利尿剂、腹水引流泵、经颈静脉肝内门体分流术等治疗手段的使用,肝源性腹水从机制到治疗等方面的研究均进展迅速。现概述肝源性腹水的产生机制和腹水对肝脏疾病的诊断价值,并针对肝源性腹水低盐饮食、利尿剂使用、难治性腹水治疗新理念等临床关键点进行评述。     

Effects of endplate healing morphology on intervertebral disc degeneration after pedicle screw fixation for thoracolumbar fractures

The cartilage endplate plays an important role in the stress distribution and nutrition metabolism of the intervertebral disc. The healing morphology of the endplate after spinal fracture and its effect on the intervertebral disc degeneration are still unclear.This was a retrospective study. Patients with traumatic single-level thoracolumbar fractures treated in our orthopedic trauma service center from June 2011 to May 2019 were included and the relevant data were collected from the medical records. Based on combined computed tomography and MRI images, the endplate injury status was determined (no endplate injury, unilateral and bilateral endplate injury). According to the location of the injury, endplate injury was further divided into endplate central injury and endplate peripheral injury. The degree of posttraumatic disc lesions and disc degeneration during follow-up were classified based on the Sander classification and the Pfirrmann classification, respectively. According to the T1 image of MRI at the final follow-up, the healing morphology of endplates was determined and classified. Univariate analyses and correlation analyses were performed to evaluate the within- and between-group differences.There were in total 51 patients included in this study. Cartilage endplate fracture was significantly closely related to the degree of degeneration of the intervertebral disc (P = .003). Injuries in different parts of the endplate have no significant effect on the intervertebral disc degeneration (P = .204). The healing morphology after endplate fracture significantly affected the degree of intervertebral disc degeneration (P = .001). The comparisons of groups showed that the effects of irregular healing and traumatic Schmorl nodes on disc degeneration were not statistically significant, but were significantly significant with increased curvature.These results suggest that the irregular healing and the traumatic Schmorl nodes are closely related to intervertebral disc degeneration. The presence and severity of the endplate injury can provide valuable information for individualized clinical decision-making processes.     

IgA肾病合并急性肾盂肾炎

46岁女性患者,临床表现为寒战、发热、腰痛、尿频、尿急、尿痛,解茶色小便,伴血清肌酐升高,实验室检查发现尿白细胞阳性,中段尿培养大肠埃希菌阳性。经抗感染治疗后症状明显缓解,但仍存在较多蛋白尿和镜下血尿,肾活检组织学为IgA肾病,伴肾小管间质性肾炎,结合临床,考虑IgA肾病合并肾盂肾炎。     

Blockade of neuromuscular transmission by enzymatically active and inactive beta-bungarotoxin.

beta-Bungarotoxins have been shown to be presynaptic blockers of neuromuscular transmission. This paper reports experiments using the most positively charged beta-bungarotoxin that elutes from a CM-Sephadex C-25 column. The toxin is shown to be a single polypeptide with a molecular weight of approximately 11,000 and has phospholipase A2 activity. The application of the enzymatically active toxin to the frog sciatic nerve-sartorius muscle preparation results in an initial decrease in the average endplate potential amplitude followed by a temporary rebound in endplate potential amplitude, and finally a complete inhibition of endplate potentials. Similarly, minature endplate potential frequency is initially reduced upon toxin application but then increases dramatically. After the phospholipase A2 of the toxin is inactivated, treatment with the toxin results in only the initial decrease in transmitter release. There results suggest that this beta-bungarotoxin acts in two functionally separate steps: (i) by binding to a specific presynaptic site possibly associated with calcium entry, and (ii) by perturbing the presynaptic membrane by its enzyme action, which results in an increase and then a failure in transmitter release.     

Clinical study on symptoms in patients with strongyloidiasis]

We treated strongyloidiasis patients and obtained the following results: Of the 299 patients (184 males and 115 females), 81 patients (27.1%) had no complaints before treatment, 218 patients complaints of some symptoms, including arthralgia and/or lumbago (28.4%), abdominal pain and/or borborygmus (19.3%), numbness of extremities (18.1%), constipation (16.3%) and itching (15.7). We treated 219 patients with mebendazole and symptoms improved after treatment described below: Thirty-seven of the 63 patients (58.7%) with arthralgia and/or lumbago improved. Twenty-seven of the 36 patients (75.0%) with numbness of extremities improved. Thirty-one of the 32 patients (96.9%) with heartburn improved. We treated 26 patients with mebendazole plus thiabendazole and twelve of 14 patients (85.7%) with abdominal pain and/or borborygmus were improved after treatment. We treated 54 patients with ivermectin and five of 18 patients (27.8%) with arthralgia and/or lumbago were improved after treatment.     

Myasthenic serum selectively blocks acetylcholine receptors with long channel open times at developing rat endplates.

We have examined the physiological effects of antibodies from a highly specific myasthenic serum on acetylcholine receptors at developing rat endplates. The antibodies reduced the amplitude of miniature endplate potentials by 60% in 3- to 6-day-old animals but had no effect after day 14. Between days 7 and 12 the antibodies had an intermediate effect. This is the same period during which acetylcholine receptors with long channel open times (slow channels) disappear and receptors with short open times (fast channels) increase in number. Therefore, we examined the effect of the antibodies at endplates with a mixture of channel types more carefully. At all times tested, both noise analysis and analysis of miniature endplate currents showed that the antibodies reduced slow channel activity selectively. Single-channel recordings indicated that acetylcholine receptors that remained active after antibody treatment had normal gating properties. Thus, the antibodies appeared to silence slow channels selectively.     

Age-related deterioration in trabecular bone mechanical properties at material level: nanoindentation study of the femoral neck in women by using AFM

Despite general belief that the mechanical properties of bone material contribute to whole bone strength, it is still obscure what the age effects are on mechanical behavior of the bone material, particularly in the case of the femoral neck trabeculae. In this study, atomic force microscopy was used for imaging and measuring the size of mineral grains, as well as nano-scale mechanical characterization (nanoindentation) of the bone mineralized matrix of trabeculae, with the aim to explore the age effects on bone elasticity and give new insight into age-related bone fragility. The bone samples in this study comprised trabecular bone specimens of the femoral neck region, collected from eight skeletal healthy women (five young adults: 27-38yrs., three elderly: 83-94yrs.) at autopsy. Bone trabeculae in the elderly displayed a higher modulus and nanohardness, signifying a decreased amount of energy that can be accommodated by the bone tissue during loading. Regression analysis revealed that nearly 65% of variability in the bone matrix elastic modulus can be statistically explained by the changes in size of the matrix mineral grains. This study revealed that the bone trabeculae of elderly women express less elastic behavior at the material level, which makes them more vulnerable to unusual impact loads originating from a fall. The observed age-related structural and mechanical alteration at the bone material level adds new evidence for understanding why hip fractures are more frequent in elderly women.     

应用射频消融术治疗右室流出道频发室性早搏的疗效观察

目的评价经导管射频消融治疗频发单形性右室流出道室性早搏的方法和疗效。方法选择28例症状重、右室流出道室性早搏患者进行射频消融治疗。所有患者均无器质性心脏病,24h动态心电图（Holter）确定RVOT频发单形性室性早搏≥10000次／24h。采用起搏标测和激动顺序标测,前者以起搏标测诱发的QRS波与室性早搏QRS波形态完全相同为消融靶点,后者以早搏时最早心室激动点为消融靶点。其中26例起源于右室流出道间隔部,2例起源于右室流出道游离壁。结果消融即刻成功率92．9％（26／28）,其中右室流出道间隔部92.3％（24／26）,游离壁100％（2／2）。患者24h动态心电图记录消融前、后室性期前收缩分别为（16206±2030）次／24h和（100±110）次／24h,P〈0．01。随访6-20个月,1例复发,再次消融成功。结论经导管射频消融可有效治疗症状重、药物治疗无效或不能耐受的单形性右室流出道室性早搏。     

A case of leiomyosarcoma originating from pulmonary vein,occluding mitral inflow

Cardiac leiomyosarcoma is a very rare entity that is found in less than 0.2% of all cardiac tumors. Because of its rarity and classification problem, there are few prospective studies about therapy and outcomes. Generally, diagnosis is delayed because of the nonspecific nature of the symptoms and by the time of diagnosis, most cases present with large tumors. Primary treatment of these tumors is still complete surgical resection. In this study we present a myxoid leiomyosarcoma originating from a pulmonary vein and extending into the left atrium, occluding mitral inflow in a woman 49 years of age. The tumor was totally removed. Open heart surgery is the acceptable approach for the management of intracardiac tumors, which may cause obstruction of blood flow through the heart.     

A case of type 2 diabetes mellitus complicated with left iliopsoas abscess caused by a left femoral vein catheter during treatment for right pyothorax and right subphrenic abscess

A 78-year-old man was receiving regular treatment for diabetes and dementia at our hospital. Diabetes was diagnosed about 10 years previously, at which time the patient's HbA(1)c level had been maintained at 6% by diet therapy and an oral hypoglycemic agent. In July, 2008, he was admitted with fever and hospitalized for pneumonia, which improved with antibiotic treatment and chest drainage. However, pyothorax developed, and in October, 2008 he was admitted again with fever and inflammation. A chest computed tomography (CT) scan revealed a right subphrenic abscess, which improved with antibiotic treatment. He was readmitted for fever and lumbago in November, 2008, and an abdominal CT scan showed a left iliopsoas abscess that did not improve with antibiotic treatment, and had increased in size. Due to infection from the central vein catheter in the left femoral vein inserted at the end of October, the catheter was withdrawn at the end of November. There was a rapid reduction of the left iliopsoas abscess, his inflammation and lumbago symptoms reduced, and he was discharged in January 2009. In cases of dementia in elderly with diabetes, a catheter from a femoral vein is frequently used to prevent complications. However, this method has been known to result in infection at the site of the catheter, and to cause fever. The circumstances of this case strongly support the removal of such a catheter in elderly patients at the first indication of persistent infection.