90例无牙颌患者的临床调查分析

目的 研究无牙颌患者牙槽嵴的条件。方法 对我院普通门诊中收集的90例(男47例、女43例)无牙颌患者的临床资料进行分析。结果 90例患者中50岁以下牙槽嵴条件高：中：低=l：l：0;51-60岁牙槽嵴条件高：中：低=l：1．2：0．2;61-70岁牙槽嵴条件高：中：低=l：3.4：0．8;7l-80岁牙槽嵴条件高：中：低=l：2．3：09;8l-90岁牙槽嵴条件高：中：低=l：1．3：0．3．上下牙槽嵴条件均差者均为牙周病病人。统计分析结果表明无牙颌患者性别之间无显著性差异,但不同年龄段之间有显著性差异,以6l-70岁年龄段就诊的无牙颌患者最多,其次为7l-80岁。牙槽嵴条件之间也有显著性差异,以牙槽嵴条件中等者最多,其次为牙槽嵴条件较好者。此外。上下颌牙槽嵴条件有显著性差异,下颌牙槽嵴条件明显差于上颌;性别与牙槽嵴条件无显著性差异：不同年龄段患者牙槽嵴条件无显著性差异。结论 要求修复的无牙颌患者的年龄主要集中在60-70岁年龄段,其中牙槽嵴条件中等者占大多数,牙槽嵴条件下颌明显差于上颌。随着年龄的增长。牙槽嵴条件逐步变差。     

超声结合BRAFV600E基因突变检测在桥本甲状腺炎合并甲状腺结节鉴别中的应用价值

目的 采用超声、BRAFV600E基因突变检测桥本甲状腺炎合并甲状腺结节,探讨两者联合检测对桥本甲状腺炎合并甲状腺结节良恶性的诊断价值。方法 选取2017年9月—2019年10月在惠州市中心人民医院就诊的桥本甲状腺炎合并甲状腺结节患者329例为研究对象,根据病理确诊甲状腺结节良恶性分为恶性组（177例）和良性组（152例）。采用超声、BRAFV600E基因突变检测桥本甲状腺炎合并甲状腺结节情况,并分析超声、BRAFV600E基因突变及两者联合检测对桥本甲状腺炎合并甲状腺结节良恶性的诊断价值。结果 金标准、超声、BRAFV600E基因突变诊断甲状腺炎合并甲状腺结节恶性分别为177例、167例、163例,良性分别为152例、162例、166例。超声、BRAFV600E基因突变、两者联合检测桥本甲状腺炎合并甲状腺结节恶性的敏感性分别为72.31%、65.54%和85.31%,特异性分别为74.34%、69.08%和71.71%,准确度分别为73.25%、67.17%和79.03%。与超声比较,两者联合诊断敏感性较高（P <0.0125）,BRAFV600E基因突变诊断准确度较低（P <0.0125）;与BRAFV600E基因突变比较,两者联合诊断敏感性、准确度较高（P <0.0125）。结论 超声、BRAFV600E基因突变均对桥本甲状腺炎合并甲状腺结节良恶性具有一定诊断价值,单两者联合优于单独诊断。     

A special type of endovascular stent repair with complicated thoracic aneurysm and chronic type B dissection aligned in tandem: double perfusion in true and false distal aorta lumen

Aortic dissection and aortic aneurysm are two of the most common catastrophic events involving the aorta. Thoracic endovascular aortic repair is now considered as a promising alternative to open surgical graft replacement. The aim of endovascular repair of a thoracic aneurysm is to exclude, and thus depressurize, the aneurismal wall and the aim of the endovascular repair of type B aortic dissection is to obliterate all of the false lumen through thrombosis after sealing the primary entry tears, thus to ensure the true lumen perfusion. But in some special pathologies, such as when the aneurysm and chronic type B dissection are aligned in tandem, or when a visceral branch originates from the false lumen, how should the endovascular repair strategy proceed in this situation？ For the endovascular stent repair of some special chronic type B aortic dissection, the false lumen cannot be obliterated, and the true and false lumens in the dissected but with a normal diameter distal aorta need to be perfused at the same time, as practiced in the surgery treatment. In this report, we present a case of endovascular stent repair for a special thoracic aneurysm and chronic type B aortic dissection aligned in tandem.     

Expressions of voltage-gated K+ channel 2.1 and 2.2 in rat bladder with detrusor hyperreflexia

Background Voltage-gated K^＋ channel （Kv） plays a critical role in the modulation of detrusor contraction. This study was conducted to investigate the expressions of Kv2.1 and Kv2.2 in rat bladder with detrusor hyperreflexia （DH）. Methods Thirty adult female Sprague-Dawley rats （200-220 g） were randomly divided into the control group and the experimental group. The experimental group was subjected to spinal cord injury （SCI）. In the controls, the surgical procedure was identical with the exception that dura and spinal cord were transected. Four weeks after SCI, in vivo cystometry and mechanical pulling tests of isolated detrusor strips were performed, mRNA was extracted from the detrusors of normal and DH rats for the detection of expression of Kv2.1 and Kv2.2 by RT-PCR. Differences in expression between normal and overactive detrusors were identified by gel imaging. Results Fourteen rats in the experimental group exhibited uninhibited bladder contraction （〉8 cmH20） before voiding after SCI. One rat died from infection. The frequency of DH in the experimental group was significantly different from that in the control group with or without treatment with 4-aminopyridine （4-AP） （P 〈0.05）, while the amplitude of DH did not change markedly. The rates of variation of the automatic contractile frequency and amplitude were （66.8±12.4）% and （42.6±12.6）% respectively in the control group, and （38.4±9.8）% and （28.0±4.6）% respectively in the DH group. 4-AP increased the automatic contractile frequency apart from the automatic contractile amplitude in both the control and DH groups （P 〈0.05）. 4-AP increased the rate of variation of the automatic contractile frequency more markedly in the control group than in the DH group （P 〈0.05）. Significant expression of Kv2.2 was not detected in bladders in the control group. Compared to the mRNA levels of 13-actin, the mRNA level of Kv2.1 was 1.26±K）.12 in the control group and 0.66±0.08 in the DH group. SCI signific     

Risk factors related to hospital mortality in patients with isolated traumatic acute subdural haematoma: analysis of 308 patients undergone surgery

Background Acute subdural haematoma （ASDH） is a common traumatic brain injury with a relatively high mortality rate. However, few studies have examined the factors predicting the outcome of isolated traumatic ASDH. This clinical study examined the hospital mortality and analyzed the risk factors for mortality in patients treated surgically for isolated traumatic ASDH.
Methods We collected 308 consecutive patients who underwent neurosurgery for isolated traumatic ASDH between January 1999 and December 2007 and used multivariate Logistic regression analysis to evaluate the influence of 11 clinical variables on hospital mortality.
Results The overall hospital mortality was 21.75% （67/308）. Age （OR=1.807）, preoperative Glasgow Coma Score （OR=0.316）, brain herniation （OR=2.181） and the time from trauma to decompression （OR=1.815） were independent predictors of death, while no independent association was observed between hospital mortality and haematoma volume, midline shift, acute brain swelling or brain herniation duration, although these variables were correlated with hospital mortality in univariate analyses.
Conclusions This study identified the risk factors for hospital mortality in patients who underwent surgical treatment for isolated traumatic ASDH. An increased risk of death occurs in patients who are over 50 years of age and have lower preoperative Glasgow Coma Scores, the presence of brain herniation and a long interval between trauma and decompression. The findings should help clinicians determine management criteria and improve survival.     

Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome

Background Among the deaths due to trauma, about one half of the patients suffer from road traffic injury （RTI）. Most of RTI patients complicate acute respiratory distress syndrome （ARDS） and severe multiple injuries. ARDS is a major contributor to morbidity and mortality in trauma patients. Although many injuries and conditions are believed to be associated with ARDS independent risk factors in trauma patients, their relative importance in development of the syndrome are undefined. We hypothesize that not all of the traditional risk factors impacting mortality are independently associated with patients strictly identified by traffic injury. This study aimed to sieve distinctive risk factors in our RTI population, meanwhile, we also hypothesize that there may exist significantly different risk factors in these patients.
Methods This was a retrospective cohort study regarding RTI as a single cause for emergency intensive care unit （EICU） admission. Patients identified as severe RTI with post-traumatic ARDS were enrolled in a prospectively maintained database between May 2002 and April 2007 and observed. Twenty-three items of potential risk impacting mortality were calculated by univariate and multivariate Logistic analyses in order to find distinctive items in these severe RTI patients.
Results There were 247 RTI patients with post-traumatic ARDS admitted to EICU during the study period. The unadjusted odds ratio （OR） and 95% confidence intervals （CI） of mortality were associated with six risk factors out of 23： APACHE II score, duration of trauma factor, pulmonary contusion, aspiration of gastric contents, sepsis and duration of mechanical ventilation. The adjusted ORs with 95% Cl were denoted with respect to surviving beyond 96 hours EICU admission （APACHE II score, duration of trauma factor, aspiration of gastric contents）, APACHE II score beyond 20 EICU admission （duration of trauma factor, sepsis, duration of mechanical ventilation） and mechanical ventilation beyond 7 days EIC     

溶血磷脂酸对体外血脑屏障模型通透性的影响

目的 探讨溶血磷脂酸(LPA)对血脑屏障通透性影响及其可能机制.方法 将体外建立的血脑屏障模型随机分为空白对照组、LPA组和蛋白激酶C抑制剂(Ro31-8220)+LPA组.γ计数仪检测模型对125I-BSA的通过率;流式细胞仪检测PKC-α表达阳性的微血管内皮细胞(BMEC)比例;类鬼笔环肽染色观察BMEC的F-肌动蛋白变化;电子显微镜观察血脑屏障-紧密连接(BBB-TJ)改变;Western印迹法检测BBB-TJ内闭合蛋白5表达.结果 LPA组125I-BSA通过率(364 cmp±15cmp)和PKC-α阳性细胞率(77%±7%)均高于空白对照组和Ro31-8220+LPA组(184 cmp±10 cmp、223 cmp±9 cmp,42%±4%、52%±3%,均P＜0.01);闭合蛋白5表达则低于空白对照组和Ro31-8220+LPA组(0.353±0.04、1.00±0.03、0.574±0.07,均P＜0.01),同时LPA使BBB-TJ开放、F-肌动蛋白重组.结论 LPA可促使BBB-TJ开放,增加血脑屏障通透性,其机制可能与PKC-α信号途径激活进而促使闭合蛋白5表达下调以及F-肌动蛋白重组有关.     

帕金森病患者眼球运动预测性控制的临床观察

目的 研究帕金森病(PD)患者眼球运动预测性控制能力,探讨其临床意义.方法 利用视频眼震电图(VNG)对早中期原发性PD患者和年龄、性别相匹配的正常人做可预测性眼球扫视运动,比较两组的扫视潜伏期.结果 在随机性扫视方案中,PD组和对照组扫视潜伏期分别为284ms±58 ms和236 ms±37 ms,两者比较差异有统计学意义(P=0.003);在可预测性扫视方案中,PD组和对照组的扫视潜伏期分别为150 ms±138 ms和59 ms±102 ms,两组差异有统计学意义(P=0.002);在可预测扫视方案中,PD组出现预见性扫视的次数占21%,对照组则占31%,两者相比,差异有统计学意义(P=0.003).结论 PD患者存在眼球运动预见性机制缺陷,表明PD在疾病早期可能出现部分认知功能障碍.