低氧环境对椎间盘自发性吸收的影响及其作用机制

目的探讨低氧环境对椎间盘自发性吸收的影响及其作用机制。方法取SPF级成年日本大耳兔9只,雌雄不限,平均体质量2 kg。将兔处死后取脊柱髓核组织,经消化、分离、培养后获得传代髓核细胞,将生长良好的髓核细胞制成细胞悬液。根据不同时效的低氧环境将细胞分为5组对照组(常氧浓度下培养6 h)、低氧6 h组(2%O2浓度下培养6 h)、低氧12 h组(2%O2浓度下培养12 h)、低氧24 h组(2%O2浓度下培养24 h)和低氧48 h组(2%O2浓度下培养48 h)。采用实时聚合酶链反应法检测缺氧诱导因子(HIF)-1α、3型酸敏感离子通道(ASIC3)及水通道蛋白3(AQP3)mRNA表达水平,采用流式细胞仪检测各组髓核细胞凋亡情况。采用SPSS 24.0软件对数据进行分析。结果与对照组比较,低氧各组细胞凋亡率均明显升高,差异均有统计学意义(均P<0.01);与低氧12、24和48 h组比较,低氧6 h组细胞凋亡率最高,差异均有统计学意义(均P<0.01)。与对照组比较,低氧各组细胞HIF-1α和ASIC3 mRNA表达水平均明显上升,AQP3 mRNA表达水平均明显下降,差异均有统计学意义(均P<0.01);与低氧12、24和48 h组比较,低氧6 h组HIF-1α和ASIC3 mRNA表达水平最高,差异均有统计学意义(均P<0.01)。结论短时间低氧环境可以促进髓核细胞凋亡,从而加速椎间盘突出组织自发性吸收进程,其机制可能与HIF-1α和ASIC3的表达增加及AQP3的表达下降有关。     

One‐Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double‐Level Contiguous Adolescent Lumbar Disc Herniation

ObjectiveTo assess the clinical efficacy of one‐stage percutaneous endoscopic lumbar discectomy (PELD) for symptomatic double‐level contiguous adolescent lumbar disc herniation (ALDH).MethodsThis retrospective study included 16 patients who presented with back and/or leg pain due to double‐level disc herniation underwent PELD for symptomatic lumbar disc herniation (0.27%,16/5877) from January 2014 to September 2019. After follow‐up period of 17.3 months in average, numeric rating scale (NRS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Quantitative data were expressed as mean standard deviation (SD) and the data for the variation in the NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Analyses were performed with IBM SPSS Statistics for Windows, version 19.0 (IBM, Armonk, NY, USA). Values of P < 0.05 were considered significantly different.ResultsThere were 11 male and 5 female patients, with an average age of 19.3 years (range, 15–22 years). One case affected the L₂‐ L₃ /L₃‐L₄ level, seven cases affected the L₃‐ L₄ /L₄‐ L₅ level, and eight cases affected the L₄‐ L₅ /L₅‐S₁ level. The NRS scores decreased significantly in both early and late follow‐up evaluations and these scores demonstrated significant improvement in late follow‐up (P < 0.05). For the modified Macnab criteria, the final outcome results were excellent in 14 patients (87.5%), good in 1 patient (6.25%), fair in 1 patient (6.25%), and the overall success rate was 93.75%.ConclusionThis study''s data suggest that one‐stage PELD is promising treatment strategy for selected symptomatic double‐level contiguous adolescent lumbar disc herniation.     

保留灌肠肛管润滑方法的改进

目的 减轻保留灌肠肛管插入过程中对患者肛门黏膜的刺激程度,提高患者治疗舒适度.方法 将60例慢性结肠炎患者按入院单、双日分为观察组和对照组各30例,两组灌肠液、用具、灌肠方法(除外润滑方法)相同;观察组用无菌棉签蘸取适量液体石蜡润滑肛管前段25～30 cm.将仍带有液体石蜡的棉签轻轻涂抹患者肛门内壁后进行排气,然后将肛管插入肛门25～30 cm后按常规操作.对照组按常规润滑肛管前段15～20 am,排尽空气后将肛管自肛门插入直肠15～20 cm.结果 观察组灌肠不适(肛门水肿、肛门坠迫感及疼痛)发生率显著低于对照组(P＜0.01).结论 改进后的润滑方法可有效减轻肛管对肛门的刺激,增加患者舒适度.     

克罗米芬联合己酮可可碱治疗特发性少、弱精子症的临床研究

目的探讨克罗米芬＋己酮可可碱治疗特发性少、弱精子症的临床效果。方法选取门诊少、弱精子症患者300例,随机分为两组,A组（n=156）口服克罗米芬（50mg,q.d）＋己酮可可碱缓释片（400mg,b.i.d）＋VitE（100mg,t.i.d）;B组（n=144）只服用VitE（100mg,t.i.d）,共3个月,比较两组间各自用药前后的精液参数。进一步将A组患者分成少精子症（n=69）和弱精子症（n=87）2组,比较两者联合药物治疗前后精液各参数。结果（1）联合药物治疗3个月后,A组的精子活率、a级活动精子率、（a＋b）级活动精子率等参数明显增加（P〈0.05）,但精液量、精子密度和活动精子总数无明显差异（P〉0.05）;B组精液各参数没有明显变化。（2）少精子症组联合药物治疗后精子密度、精子活率、活动精子总数明显提高（P〈0.05）;而弱精子症组仅精子活率明显提高（P〈0.05）,精子密度和活动精子总数没有明显变化（P〉0.05）。结论克罗米芬＋已酮可可碱能显著提高特发性少精子症患者的精子密度、精子活率、活动精子总数,以及特发性弱精子症的精子活率。     

Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects

BACKGROUND: Reconstruction of defects involving the knee and proximal one third of the lower leg presents a challenging problem in plastic surgery. AIM: To evaluate the reversed anterolateral thigh adipofascial flap for covering such defects. METHODS: Between September 2006 and May 2007, one man and four women with defects around the knee and upper calf underwent reconstruction with reversed anterolateral thigh adipofascial flaps. The patients' average age was 45 years (25-72 years). The size of the transferred flap ranged from 6cmx8cm to 12cmx13cm. RESULTS: Four flaps with overlying skin grafts healed uneventfully; one skin graft showed minor necrosis due to haematoma, but the adipofascial flap survived well. Postoperatively the appearance of the reconstructive flap was acceptable. CONCLUSIONS: The reversed anterolateral thigh adipofascial flap is an effective option for covering defects of the knee and proximal calf.     

七氟烷复合靶控输注瑞芬太尼用于腹腔镜手术的临床评价

目的评价靶控输注(target controlled infusion,TCI)瑞芬太尼复合吸入七氟烷3种不同配伍剂量用于腹腔镜手术的麻醉效果和麻醉恢复情况。方法选择ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术或腹腔镜卵巢囊肿切除术45例,随机分为3组,每组15例。3组诱导方式均相同。麻醉维持:A组为瑞芬太尼血浆靶控输注6ng/ml复合吸入0.4MAC(minimal alveolar concentration,肺泡最低有效浓度)七氟烷;B组为瑞芬太尼血浆靶控输注4ng/ml复合吸入0.65MAC七氟烷;C组为瑞芬太尼血浆靶控输注2ng/ml复合吸入1.0MAC七氟烷。观察患者麻醉和术中脑电双频指数(bispectral index,BIS)、平均动脉压(meanarterial pressure,MAP)、心率(heartrate,HR)及术后呼吸恢复时间、睁眼时间、气管导管拔管时间、定向力恢复时间等指标。结果3组病人术中生命体征平稳,无须调整七氟烷和瑞芬太尼的用量。3组术中各时点MAP、HR无统计学差异(P>0.05)。术中各时点BIS值A组明显高于B组和C组,B组明显高于C组(P<0.05)。3组病人在麻醉恢...     

一侧睾丸扭转对侧睾丸预防性固定必要性的研究

目的探讨睾丸扭转对侧睾丸预防性固定必要性。方法分析31例睾丸扭转病人做预防性固定及末做预防性固定后盲发生睾丸扭转的机率。结果仅1例未做预防性固定后再发生睾丸扭转。结论 一侧睾丸扭转对侧睾丸的预防性固定有手术的必要性，但并非绝对必须。     

Steatocholecystitis: the influence of obesity and dietary carbohydrates

INTRODUCTION: We have recently demonstrated that obese and lean mice fed a high fat diet have increased gallbladder wall fat and decreased gallbladder contractility, cholecystosteatosis. Animal and human data also suggest that diets high in refined carbohydrates lead to gallstone formation. However, no data are available on the role of dietary carbohydrates on gallbladder wall fat and inflammation. Therefore, we tested the hypothesis that both obesity and dietary carbohydrates would increase gallbladder fat and cytokines, steatocholecystitis. METHODS: At 8 wk of age, 47 lean and 22 obese female mice were fed a 45% carbohydrate (CHO) diet while an equal number of lean and obese mice were fed a 75% CHO diet for 4 wk. All mice underwent cholecystectomy, and the gallbladders were snap-frozen. Individual and total lipids were measured by gas chromatography. Interleukin (IL)-1beta, tumor necrosis factor (TNF)-alpha, and IL-6 were measured by enzyme-linked immunosorbent assay. Data were analyzed by analysis of variance and Tukey test. RESULTS: Gallbladder total fat, triglycerides, and cholesterol were maximum (P < 0.001) in obese mice on the 75% CHO diet. Gallbladder TNF-alpha and IL-1beta as well as serum cholesterol levels showed a similar pattern (P < 0.001). Gallbladder saturated free fatty acids and IL-6 levels were highest (P < 0.001) in obese mice on the 45% CHO diet. CONCLUSIONS: These data suggest that (1) both obesity and dietary carbohydrates increase gallbladder total fat, triglycerides, cholesterol, TNF-alpha, and IL-1beta and (2) obesity also increases gallbladder free fatty acids and IL-6. Therefore, we conclude that obesity is associated with steatocholecystitis and that a high carbohydrate diet exacerbates this phenomenon.     

Intracranial bone marrow transplantation after traumatic brain injury improving functional outcome in adult rats

OBJECT: The authors tested the hypothesis that intracranial bone marrow (BM) transplantation after traumatic brain injury (TBI) in rats provides therapeutic benefit. METHODS: Sixty-six adult Wistar rats, weighing 275 to 350 g each, were used for the experiment. Bone marrow prelabeled with bromodeoxyuridine (BrdU) was harvested from tibias and femurs of healthy adult rats. Other animals were subjected to controlled cortical impact, and BM was injected adjacent to the contusion 24 hours after the impact. The animals were killed at 4, 7, 14, or 28 days after transplantation. Motor function was evaluated both before and after the injury by using the rotarod test. After the animals had been killed, brain sections were examined using hemotoxylin and eosin and immunohistochemical staining methods. Histological examination revealed that, after transplantation, BM cells survived, proliferated, and migrated toward the injury site. Some of the BrdU-labeled BM cells were reactive, with astrocytic (glial fibrillary acid protein) and neuronal (NeuN and microtubule-associated protein) markers. Transplanted BM expressed proteins phenotypical of intrinsic brain cells, that is, neurons and astrocytes. A statistically significant improvement in motor function in rats that underwent BM transplantation, compared with control rats, was detected at 14 and 28 days posttransplantation. CONCLUSIONS: On the basis of their findings, the authors assert that BM transplantation improves neurological outcome and that BM cells survive and express nerve cell proteins after TBI.