腓骨高位截骨在膝关节骨性关节炎的应用

目的:探讨腓骨高位截骨术对膝关节骨性关节炎的短中期疗效。方法:2014年10月至2016年7月,采用腓骨高位截骨治疗膝关节骨性关节炎76例,男22例,女54例;年龄47~82岁,平均61.62岁。术前查体膝关节内侧压痛,内侧麦氏征阳性,摄膝关节负重正侧位X线片显示内侧间隙变窄,术后行膝内侧间隙、股骨胫骨角、VAS疼痛评分及AKS评分进行评价。结果:术后随访10~18个月,平均8.9个月。与术前相比,术后膝内侧间隙明显变宽,股骨胫骨角度变大。术前VAS疼痛评分5.70±1.56,术后1周3.70±1.03,1个月3.20±0.95,3个月2.35±0.99,1年2.10±0.97。膝关节功能AKS评分术前疼痛14.45±1.76,活动度12.60±1.98,稳定性12.15±1.72;末次随访疼痛42.60±2.28,活动度21.80±2.14,稳定性20.85±2.16。VAS评分术前与术后各时间段相比差异有统计学意义,AKS评分术前与术后差异均有统计学意义。结论:腓骨高位截骨操作简单,并发症少,能有效减轻膝关节疼痛,改善膝关节功能,临床效果满意。     

原发性十二指肠恶性肿瘤的X 线诊断

目的　探讨X线诊断原发性十二指肠恶性肿瘤的价值。方法　回顾性分析 2 1例原发性十二指肠恶性肿瘤的X线所见并与手术病理对照。结果　X线表现包括充盈缺损、黏膜改变、肠腔狭窄和龛影。结论　根据临床及X线表现 ,术前可以正确诊断原发性十二指肠恶性肿瘤。     

Fatty acid-binding protein-4 as a biomarker predicting acromegaly-associated diabetes mellitus

Background/aimThe known pathogenesis of diabetes mellitus (DM) in acromegaly is mainly based on growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess. Fatty acid-binding protein 4 (FABP-4), a novel adipokine, is found to induce insulin resistance and type 2 DM. We aimed to investigate the possible effect of FABP-4 on glucose metabolism in patients with acromegaly.Materials and methodsThis case-control study included 28 patients newly diagnosed with acromegaly and 57 healthy volunteers. The patients with acromegaly were classified according to their glycemic status as with DM, prediabetes, and normal glucose tolerance. Anthropometric measurements, laboratory test results, and FABP-4 levels of the subjects were evaluated.ResultsAlthough no difference was observed in FABP-4 levels between acromegaly and control groups, the FABP-4 level was higher in the patients with acromegaly having DM compared to the patients with acromegaly having prediabetes and NGT, and the control group (p = 0.004, p = 0.001, p = 0.004, respectively). Logistic regression analysis suggested that the FABP-4 is an independent predictor of DM in acromegaly (β = 7.382, OR = 38.96, 95% CI: 1.52-5.76, p = 0.018).Conclusion The FABP-4 may be a helpful predictor of acromegaly-associated DM.     

Spontaneous splenic rupture during Pringle maneuver in liver surgery

During liver resection clamping of the hepato-duodenal ligament (the Pringle maneuver) is performed to reduce intraoperative blood-loss. During this maneuver acute portal hypertension may lead to spontaneous splenic rupture requiring rapid splenectomy in order to control blood loss. We present 2 case of patients with hemorrhage from the spleen during clamping for liver surgery. A review of the literature with an emphasis on the pathophysiology of splenic hemorrhage is presented.     

口服氨基葡萄糖联合关节腔内注射治疗膝骨性关节炎

目的 探讨口服氨基葡萄糖联合关节腔内注射治疗膝骨性关节炎的疗效.方法 门诊选取膝骨性关节炎患者402例,将患者按第1次关节腔内注射药物的不同分为透明质酸钠关节腔内注射组(214例)和三联针(透明质酸钠、醋酸曲安奈德、盐酸利多卡因)关节腔内注射组(188例),并在治疗后1、2、3、5周对患者按预先设定的疗效评价标准进行随访.结果 治疗后两组患者西安大略麦马斯特大学骨性关节炎指标可视化量表 (WOMAC) 疼痛指标和机体功能指标均明显下降,而且随观察时间延长,呈逐渐下降趋势,组间比较差异无统计学意义(P>0.05),但治疗后第1周随访,三联针关节腔内注射组疼痛指标下降趋势更明显,两组治疗期间塞来昔布用量比?差异有统计学意义(P<0.05).两组的不良反应发生率分别为8.9%(19/214)和8.5%(16/188),主要表现为轻中度的胃肠道不适和便秘.结论 口服氨基葡萄糖联合关节腔内注射在短期内能有效减轻膝骨性关节炎患者疼痛,改善关节功能,第1次关节腔内注射三联针能更快、更有效地缓解疼痛,减少了塞来昔布的用量.     

The spatiotemporal profile of cortical processing leading up to visual perception

Much controversy exists around the locus of conscious visual perception in human cortex. Some authors have proposed that its neural correlates correspond with recurrent processing within visual cortex, whereas others have argued they are located in a frontoparietal network. The present experiment aims to bring together these competing viewpoints. We recorded EEG from human subjects that were engaged in detecting masked visual targets. From this, we obtained a spatiotemporal profile of neural activity selectively related to the processing of the targets, which we correlated with the subjects' ability to detect those targets. This made it possible to distinguish between those stages of visual processing that correlate with human perception and those that do not. The results show that target induced extra-striate feedforward activity peaking at 121 ms does not correlate with perception, whereas more posterior recurrent activity peaking at 160 ms does. Several subsequent stages show an alternating pattern of frontoparietal and occipital activity, all of which correlate highly with perception. This shows that perception emerges early on, but only after an initial feedforward volley, and suggests that multiple reentrant loops are involved in propagating this signal to frontoparietal areas.     

Effect of fibroblasts on epidermal regeneration

BACKGROUND: There is little information on specific interactions between dermal fibroblasts and epidermal keratinocytes. The use of engineered skin equivalents consisting of organotypic cocultures of keratinocytes and fibroblasts offers an attractive approach for such studies. OBJECTIVES: To examine the role fibroblasts play in generation and maintenance of reconstructed epidermis. METHODS: Human keratinocytes were seeded on collagen matrices populated with increasing numbers of fibroblasts and cultured for 2 weeks at the air-liquid interface. RESULTS: In the absence of fibroblasts, stratified epidermis with only three or four viable cell layers was formed. In the presence of fibroblasts, keratinocyte proliferation was stimulated and epidermal morphology was improved. Epidermal morphogenesis was also markedly improved in epidermis generated in organotypic keratinocyte monocultures grown in medium derived from dermal equivalents or from organotypic keratinocyte-fibroblast cocultures. These observations clearly indicate the proliferation-stimulating activity of soluble factors released from fibroblasts. Under all experimental conditions, onset of keratinocyte differentiation was shown by the expression of keratin 10 in all suprabasal cell layers. With increasing numbers of fibroblasts incorporated into the collagen matrix, the expression of markers associated with keratinocyte activation, e.g. keratins 6, 16 and 17 and the cornified envelope precursor SKALP decreased, and involucrin localization shifted toward the granulosum layer. This fibroblast-mediated effect was even more pronounced when the fibroblasts were precultured in the collagen matrices for 1 week instead of overnight. The basement membrane proteins collagen VII and laminin 5 were present at the epithelial-matrix border. The expression of integrin alpha 6 beta 4 and of E-cadherin was comparable with that seen in native skin and was not significantly modulated by fibroblasts. Under all experimental conditions the expression of integrin subunits alpha 2, alpha 3 and beta 1 was upregulated, indicating keratinocyte activation. CONCLUSIONS: Our results illustrate that numbers of fibroblasts in the collagen matrix and their functional state is a critical factor for establishment of normal epidermal morphogenesis.     

Hypnotherapy: A Useful Adjunctive Therapeutic Modality in Hansen's Disease

Hypnotherapy is a useful adjunctive psychotherapeutic procedure used in various conditions such as pain disorders, atopic dermatitis, and alopecia areata. However, it is less utilized in the field of dermatology. Only limited data exist on its role in the management of various skin diseases. There is dearth of literature on the role of hypnotherapy in Hansen''s disease (HD). We report two cases of HD, one with very resistant neuralgia and the other with recurrent erythema nodosum leprosum (ENL). Both the patients were assessed using hospital anxiety and depression scale, dermatology life quality index and the neuralgia was assessed using the visual analog scale. Three sessions of hypnotherapy were given to both the patients. There was dramatic improvement in the incidence of ENL and neuralgia and we could rapidly reduce the dose of drugs used for both conditions.     

Boundary assignment in a recurrent network architecture

We describe a model and simulations of boundary assignment by cortical neurons, a process that assigns edges to figural image regions, as opposed to the background regions on the other side of the edge. The model is composed of several areas, resembling the hierarchical feedforward-feedback organization of areas in the visual cortex. In each successive area along the hierarchy, the visual image is represented at a coarser resolution. Model neurons tend to assign edges to convex image regions. Because of high spatial resolution, information about convexity is not immediately available to all neurons in lower-level areas. In higher-level areas, however, spatial resolution is low, and convexity is coded more reliably. Feedback connections propagate this information to the high-resolution neurons of lower-level visual areas, making it available at all network levels and at all spatial resolutions. The proposed connection scheme assigns edges faster and more reliable to objects than one with only horizontal connections. The model accounts for both psychophysical and neurophysiological data on figural assignment.     

Synthetic scaffold morphology controls human dermal connective tissue formation

Engineering tissues in bioreactors is often hampered by disproportionate tissue formation at the surface of scaffolds. This hinders nutrient flow and retards cell proliferation and tissue formation inside the scaffold. The objective of this study was to optimize scaffold morphology to prevent this from happening and to determine the optimal scaffold geometric values for connective tissue engineering. After comparing lyophilized crosslinked collagen, compression molded/salt leached PEGT/PBT copolymer and collagen-PEGT/PBT hybrid scaffolds, the PEGT/PBT scaffold was selected for optimization. Geometric parameters were determined using SEM, microcomputed tomography, and flow permeability measurements. Fibroblast were seeded and cultured under dynamic flow conditions for 2 weeks. Cell numbers were determined using CyQuant DNA assay, and tissue distribution was visualized in H&E- and Sirius Red-stained sections. Scaffolds 0.5 and 1.5 mm thick showed bridged connected tissue from top-to-bottom, whereas 4-mm-thick scaffolds only revealed tissue ingrowth until a maximum depth of 0.6-0.8 mm. Rapid prototyped scaffold were used to assess the maximal void space (pore size) that still could be filled with tissue. Tissue bridging between fibers was only found at fiber distances < or =401 +/- 60 microm, whereas filling of void spaces in 3D-deposited scaffolds only occurred at distances < or =273 +/- 55 microm. PEGT/PBT scaffolds having similar optimal porosities, but different average interconnected pore sizes of 142 +/- 50, 160 +/- 56 to 191 +/- 69 microm showed comparable seeding efficiencies at day 1, but after 2 weeks the total cell numbers were significantly higher in the scaffolds with intermediate and high interconnectivity. However, only scaffolds with an intermediate interconnectivity revealed homogenous tissue formation throughout the scaffold with complete filling of all pores. In conclusion, significant amount of connective tissue was formed within 14 days using a dynamic culture process that filled all void spaces of a PEGT/PBT scaffolds with the following geometric parameters: thickness 1.5-1.6 mm, pore size range 90-360 microm, and average interconnecting pore size of 160 +/- 56 microm.