兔骨髓基质细胞向成骨细胞分化过程的超微形态结构观察

目的观察并探讨骨髓基质细胞向成骨细胞诱导分化过程中细胞超微形态结构的变化及相互联系。方法抽取成年兔髂骨骨髓，分离、培养骨髓基质细胞，1周后分别采用含诱导因子的条件培养液和不含诱导因子的标准培养液继续培养，2周后收集细胞，应用透射电镜观察其超微结构；同时分别将上述两组细胞与煅烧骨体外复合并在原培养液中继续培养，分别于复合1、7、14d取出，用扫描电镜观察细胞表面超微形态。结果透射电镜下见诱导前的骨髓基质细胞浆少，核大，细胞器不发达，处于早期幼稚阶段，而诱导2周后的细胞核小、胞浆多，细胞器丰富，处于较为成熟阶段。扫描电镜下见复合培养2周内诱导前后的骨髓基质细胞均由圆盘形向多角形、条带状相互融合、重叠生长，诱导2周后的骨髓基质细胞间可见大量胶原纤维等基质成分以及钙盐颗粒，而诱导前的细胞始终未见基质分泌及钙盐颗粒。结论成骨诱导后，骨髓基质细胞内细胞器等超微结构极为丰富，细胞表面及细胞间有大量细胞外基质分泌和钙盐沉积。透射电镜和扫描电镜可动态观察骨髓基质细胞向成骨细胞分化过程中细胞超微形态结构的变化。     

Knee-ankle-foot orthosis in children with duchenne muscular dystrophy: user views and adjustment.

BACKGROUND: The use of knee ankle foot orthoses (KAFOs) to prolong independent mobility is a widely used rehabilitation strategy for children with Duchenne muscular dystrophy (DMD). AIMS: To explore views and adjustment of families with a child with Duchenne muscular dystrophy to the use of KAFOs. METHODS: interviews with families of children aged 8-18 years with DMD; questionnaires on psychiatric adjustment (SDQ for children; GHQ for parents). RESULTS: In total, 17 parents and 9 children took part. Families experienced the introduction of KAFOs as a signal for illness deterioration and a re-awakening of the feelings experienced at diagnosis. Nevertheless, the majority expressed a positive attitude and over two-thirds satisfaction with KAFOs use. High psychiatric risk was found in 2/17 children (12%; expected 10%) and 7/17 main carers (41%; expected 20-30%). CONCLUSION: Most families were satisfied with KAFOs use, and its implementation was well tolerated especially by the children. However, mental distress was high in main carers who emphasized the importance of full preparation and support in this rehabilitation technique.     

支气管动脉灌注化疗联合直线加速器放射治疗Ⅲa期非小细胞肺癌

目的　研究支气管动脉灌注化疗联合直线加速器放射治疗Ⅲa期非小细胞肺癌 (NSCLC)的可行性及临床价值。方法　 76例NSCLC患者随机分成A、B 2组 ,A组先行 2次支气管动脉灌注化疗 (BAI) ,第 2次BAI 1～ 2周后再行直线加速器放射治疗 (RT) ;B组单纯行 2次BAI (对照组 )。结果　临床疗效 ,A组 (BAI RT)和B组 (BAI)分别为 89.47%和 60 .5 3% (Ρ <0 .0 1) ;1、3年生存率 ,A、B组分别为 81.5 8%、5 0 .0 0 %和 60 .5 3%、2 1.0 5 % ( 0 .0 1<Ρ <0 .0 5 )。结论　支气管动脉灌注化疗联合直线加速器放射治疗Ⅲa期非小细胞肺癌的临床疗效和患者 1、3年生存率均显著提高     

Effect of a zinc-fortified formula on immunocompetence and growth of malnourished infants.

This study attempted to define the possible contribution of zinc nutrition to immunocompetence and growth in severely malnourished infants. The effect of zinc supplementation was evaluated in marasmic infants during nutritional rehabilitation by using a controlled double-blind design in which 19 infants fed a zinc-fortified formula were compared with 20 infants fed the same non-supplemented formula. Evaluation of immunocompetence, growth, and zinc, copper, and iron status was performed on admission and at 30, 60, and 105 d of nutritional rehabilitation. Although energy intake was similar in both groups, the zinc-supplemented infants had significantly higher linear growth gain, and their immune function improved as demonstrated by conversion of their delayed hypersensitivity skin reactions, enhanced lymphoproliferative response to PHA, and increased salivary IgA concentrations. Thus, the use of a zinc-fortified formula during nutritional rehabilitation can prevent the development of zinc deficiency and improve growth and immune function.     

关节镜下运用4股腘绳肌腱同期重建前后交叉韧带损伤

目的 关节镜下运用Intrafix和可吸收界面螺钉固定自体4股腘绳肌腱，同期重建前交叉韧带（anterior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL），评估其疗效。方法 ACL、PCL同时损伤的患者16例，关节镜下以自体4股胭绳肌腱作为重建移植物，应用可吸收界面螺钉固定移植物股骨端，Intrafix钉鞘和可吸收锥形钉固定胫骨端，同期行ACL和PCL损伤重建术。7例行内侧副韧带修补，4例行外侧副韧带复合结构修复，2例行内外侧同时修复。所有患者按照国际膝关节评分委员会（International Knee Documentation Committee，IKDC）评分标准进行术前评估，均为D级。术前Lysholm评分为（36．5±3．7）分。结果 随访时间为12～18个月，平均14．6个月。终末随访时，IKDC总体评价：A级6例（38％），B级9例（56％），C级1例（6％），无D级患者。Lachman试验0～2mm8例；3～5mm6例；6～10mm2例（P〈0．05）。屈70°前后总位移0～2mm10例；3～5mm5例；6～10mm1例（P〈0．05）。屈70°后位移0～2mm12例；3～5mm4例（P〈0．05）。术后2个月Lysholm功能评分为（90．4±2．9）分，终末随访时为（93．4±3．5）分，与术前相比差异均有统计学意义（P〈0．05）。结论 关节镜下以自体4股胭绳肌腱作为移植物，应用可吸收界面螺钉、Intrafix钉鞘和可吸收锥形钉固定股骨胫骨端同期重建ACL和PCL损伤，有利于早期积极的功能康复，膝关节功能恢复满意。     

可乐定透皮贴剂联合芬太尼静脉自控镇痛用于原发性高血压病人术后镇痛

目的 观察可乐定透皮贴剂联合芬太尼静脉自控镇痛(PCIA)用于原发性高血压(EH)病人术后镇痛的效果.方法 择期全麻下行腹腔镜胆囊切除术病人60例,均合并EH,依据术后镇痛方法的不同,随机均分为三组,肌注哌替啶组(P组)、芬太尼PCIA组(F组)和可乐定透皮贴剂联合芬太尼PCIA组(CF组).使用芬太尼1.0mg稀释至100ml,PCIA均采用负荷量-持续背景量-PCA量模式,背景剂量芬太尼20 μg/h,PCA追加剂量5 μg,锁定时间15 min.记录病人术后镇痛4、8、24、48 h VAS及Ramsay镇静评分,并记录不良反应和处理措施.监测入院时、术后24、48 h血浆内皮素(ET)及降钙素基因相关肽(CGRP)浓度、血糖(Glu),同时记录MAP、HR.结果 镇痛期间F、CF组VAS低于P组(P<0.01),CF组低于F组(P<0.05).Ramsay镇静评分F组高于P组(P<0.01),CF组高于F组(P<0.05),三组均无过度镇静.CF组MAP、HR术后较入院时明显降低(P<0.01),血浆ET、血浆CGRP浓度与入院时比较差异无统计学意义.术后ET、Glu浓度和MAP、HR F组低于P组,CGRP浓度高于P组(P<0.05).术后ET、Glu浓度和MAP、HR P组>F组>CF组;术后CGRP浓度:CF组>F组>P组(P<0.05).不良反应发生率三组差异无统计学意义.结论 对高血压病人,可乐定透皮贴剂增强芬太尼PCIA镇痛作用,使血流动力学更稳定.     

神经干细胞-脑源性神经营养因子基因工程细胞移植对大鼠缺血性脑损伤的治疗作用

目的 将脑源性神经营养因子(BDNF)基因转入大鼠海马原代培养的神经干细胞(NSCs)中,获得NSCs-BDNF基因工程干细胞并移植治疗大鼠缺血性脑损伤.方法 分离培养新生大鼠海马区NSCs,检测其增殖、分化等特性;构建逆转录病毒载体pLXSN-BDNF,转染NSCs,获得NSCs-BDNF基因工程干细胞,检测其BDNF的表达和活性;建立大鼠大脑中动脉局灶性脑缺血模型,通过立体定向技术将NSCs-BDNF移植入模型缺血侧海马,进行组织学和行为学检测.结果 NSCs-BDNF移植后可以观察到动物行为学的改善,术后4周Longa评分1.343±0.293,脑切片可以观察到海马齿状回神经元数目的增加,术后4周存活率87.5%±6.6%,较对照有统计学意义(P＜0.05).结论 NSCs-BDNF移植对实验性大鼠缺血性脑损伤有修复作用.     

152例肝移植术后肝功能异常的肝活检

目的评价肝活检在明确肝移植术后肝损害病因中的作用，分析组织学诊断存在误差的常见原因，进一步提高肝活检的准确性，以利临床治疗。方法260例肝活检来自于152例肝移植受者，术后出现临床无法解释的肝功能异常，肝功能检测结果高于正常值的2倍以上。回顾组织学改变及最终的临床诊断，评价相符程度。结果大部分的组织学诊断与最终的临床诊断相符，有7例组织学改变为胆管炎后经进一步临床检查证实4例为血管并发症、2例为败血症、1例为保存性损伤。2例组织学诊断为保存性损伤的病例后证实为药物性肝损害。结论移植后肝活检可明确许多肝功能异常的原因；评判病变的严重程度，指导临床治疗；对一些复杂病例应将以往的活检和整个临床病程、其他实验室检查及影像学检查进行综合考虑，可提高诊断的准确性。     

Behavior of the Common Bile Duct Diameter Before and 12 Years after Choledochostomy for Cholecystolithiasis and Choledocholithiasis. A Prospective Study

INTRODUCTION : In patients with common bile duct (CBD) stones, the diameter of the CBD is usually dilated. After surgery, the behavior of CBD diameter is not clearly known. OBJECTIVE : To determine at a late follow-up the width of CBD before and after choledochostomy for CBD stones. MATERIAL AND METHODS : In this prospective study, 39 patients with gallstones and CBD stones were included. They were 30 women and 9 men with a mean age of 52.6 years. In all ultrasound, determination of the CBD caliber before and 12 years after surgery was performed. RESULTS : The mean value of the inner diameter of the CBD before surgery was 11.6 and 12.3 mm in patients below or above 60 years, respectively. Measurement 12 years after surgery showed a mean decrease of nearly 50% of preoperative values, which was highly significant (p < 0.0001). However, either below or above 60 years, only 75% of the patients showed this decrease, whereas 25% remained unchanged. CONCLUSION : The dilated preoperative CBD returns to normal or near normal values in 3/4 of the patients after surgical exploration of the CBD and extraction of the stones.