弦式加载法延长面神经模型的建立

目的　为使神经延长术更简便地应用于临床 ,尤其是用于面神经缺损的修复 ;同时更科学地研究周围神经的生物力学特性。方法　自行研制一种新的神经延长器 ,以弦式加载方式对面神经进行快速和缓慢延长 ,观察延长前后面神经的电生理及病理形态学变化。结果　延长器放置部位的组织无变性坏死 ,伤口及创面无感染 ,动物进食功能无障碍 ,体温不升高 ;病理学观察可见快速组神经出现散在的 Sunderland 度损伤 ,偶见毛细血管断裂 ,而缓慢组神经变粗 ,神经束间、外膜成纤维细胞增生 ;颊肌肌电图及神经传导速度检测显示 ,神经可延长极限快速组为 (18.7± 2 .4) % ,缓慢组为 (30 .8± 2 .4) % (均已除去回缩率 )。结论　所建立的神经延长模式和方法具有科学性和实用性 ,可用于神经延长的基础和临床研究。     

A prediction rule for disease outcome in patients with undifferentiated arthritis using magnetic resonance imaging of the wrists and finger joints and serologic autoantibodies

Objective

To evaluate whether magnetic resonance imaging (MRI) of the wrists and finger joints and an analysis of serologic autoantibodies are clinically meaningful for the subsequent development of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA).

Methods

A total of 129 patients with UA, a disease status formally confirmed by a rheumatologist over a period of at least 1 year, were included. Gadolinium‐diethylenetriamine–enhanced MRI of both wrists and finger joints and serologic variables were examined upon admission to our Early Arthritis Clinic at Nagasaki University. After a prospective followup of 1 year, a predictive value for the development of RA was determined for each patient.

Results

The subjects were evaluated for their positive or negative status with respect to 3 objective measures at study entry: anti–cyclic citrullinated peptide (anti‐CCP) antibodies and/or IgM‐rheumatoid factor, MRI‐proven symmetric synovitis, and MRI‐proven bone edema and/or bone erosion. The patients who were positive for at least 2 of these measures progressed to RA at 1 year with a 79.7% positive predictive value (PPV), 63.0% negative predictive value, 75.9% specificity, 68.0% sensitivity, and 71.3% accuracy. Furthermore, in 22 UA patients positive for both anti‐CCP antibodies and MRI‐proven bone edema who were considered to have progressed to RA at 1 year, the PPV was increased to 100%. A close correlation was found between the present rule and that established in the Leiden Early Arthritis Cohort.

Conclusion

MRI‐proven early joint damage in conjunction with serologic autoantibodies is efficient in predicting progression from UA to RA. This method can be used to identify patients who would benefit from early treatment with disease‐modifying antirheumatic drugs.     

局部及静脉联合用药超前镇痛对椎管内麻醉穿刺的影响

目的探讨局部及静脉联合用药超前镇痛对椎管内麻醉穿刺过程临床镇痛效果、麻醉体位配合的满意度、麻醉穿刺一次成功率的影响。方法择期行腹股沟疝修补术的患者80例,年龄36～60岁,体重48～75kg,ASA分级Ⅰ～Ⅱ级,采用随机数字表法,将其随机分为两组各40例。A组患者入室后立即在椎管内麻醉穿刺点为中心2cm2的皮肤范围内用2%利多卡因均匀的涂布两遍,开放静脉通路后静注地佐辛10mg,C组穿刺点及静脉用等量生理盐水。记录两组患者皮肤局麻进针时(T1)、椎管内麻醉穿刺过程(T2)的疼痛评分,麻醉穿刺时患者体位变动(体动),麻醉穿刺一次成功率,患者满意度及不良反应(头晕、恶心、呕吐)。结果与C组比较,A组在T1、T2的VAS评分明显降低(P<0.05),患者体动明显减少(P<0.05),麻醉穿刺一次成功率明显增加(P<0.05),患者满意度高;两组患者恶心、呕吐及头晕发生例数比较差异无统计学意义(P>0.05)。结论局部及静脉联合用药超前镇痛对减轻患者椎管内麻醉穿刺过程的紧张、焦虑及疼痛效果确切,体位配合好,麻醉穿刺一次成功率高,患者满意度高,有明显的临床意义。     

晶状体后囊膜混浊的评价方法

为了对晶状体后囊膜混浊进行科学定量分析,已开发了多种晶状体后囊膜混浊分析评估系统,包括裂隙灯或眼底镜检查的主观观察法、Nd：YAG激光后囊膜切开率、视功能检查方法、计算机后囊膜混浊分析系统、数码照片计算机辅助图像分析系统等,但尚未能确立一个金标准。     

1 003例中医体质类型流行病学调查分析

目的:初步了解安徽省自然人群的中医体质类型分布状况。方法:采用标准化的9种中医体质量表对1 003例自然人群实施横断面现状调查。结果:平和质561例,单纯偏颇体质247例,兼夹偏颇体质195例。8种偏颇体质总的分布状况是,气虚质最多(235例,单纯气虚质与兼夹体质中气虚质例数之和,下同),其次为湿热质(128例)、气郁质(122例)、痰湿质(80例);阳虚质(71例)、阴虚质(52例)和瘀血质(42例)最少,阴虚质与瘀血质主要出现在兼夹体质中。结论:9种体质在人群中的分布存在一定的差异性,兼夹体质在人群中占有一定的比例。     

巨噬细胞铁死亡与动脉粥样硬化

动脉粥样硬化是多种心血管疾病的病理基础,其导致的心血管疾病仍然是全球人类死亡的主要原因。铁死亡是一种铁离子依赖性非凋亡形式的细胞死亡方式,与多种生理机制密切相关。近些年来研究发现巨噬细胞铁死亡对于动脉粥样硬化的发生发展具有十分重要的作用。文章从巨噬细胞铁代谢水平失衡出发,就巨噬细胞铁死亡与脂质过氧化、炎症、氧化应激等方面的相互作用,综述了巨噬细胞铁死亡与动脉粥样硬化之间的关系,以期为动脉粥样硬化发病机制的研究提供新的思路。     

腹腔及切口注入盐酸罗哌卡因对于减少腹腔镜胆囊切除术并发症及术后镇痛效果的研究

目的探讨腹腔镜胆囊切除术前后腹腔及切口内注入盐酸罗哌卡因对减轻术中胆心反射、术后胃肠道反应及术后镇痛效果的可行性。方法264．例患者随机分为A(对照组)、B(试验组)两组,试验组患者行胆囊切除术前先向胆囊表面喷0．75％盐酸罗哌卡因4ml,术毕(拔出穿孔器之前)再向胆囊床及肝膈间隙喷洒10ml,缝合腹壁切口前向每个切口局部注入相同药液2ml。若为4孔则均为1．5ml;对照组为空白对照。观察术中胆心反射发生情况,术后0、2、6、12、24h行VSA评分,记录术后患者右上腹、右肩背疼痛及腹壁切口疼痛情况及术后恶心呕吐(PONV)情况,并于术前30min、术后3h抽取静脉血2ml,测定血浆皮质醇浓度。结果A、B两组在胆心反射、术后12h内VSA评分、PONV及术后3h血浆皮质醇浓度等方面差异均有显著性,试验组优于对照组。结论腹腔镜胆囊切除术前后腹腔及切口注入盐酸罗哌卡因对防止术中胆心反射的发生及减轻术后疼痛、呕吐等并发症有良好效果,值得临床推广。     

背向散射参数测定对肥厚型心肌病患者心肌声学特性的研究

目的 应用背向散射参数测定方法研究肥厚型心肌病患者的心肌声学特性,探讨该方法在评价肥厚型心肌病方面的价值。方法 对２４例肥厚型心肌病患者和２０例正常个体进行了心肌背向散射参数（ＩＢＳ、ＣＶＩＢＳ和ＴＧＩＢＳ）的测定,采样部位为胸骨旁左室长轴切面室间隔及左室后壁。结果 肥厚型沁肌病室间隔ＩＢＳ较正常人增高,Ｐ＝０．０００２,ＣＶＩＢＳ减小Ｐ＝０．０１,且存在ＩＢＳ跨壁梯度,而左室较正常组对比无显著差     

慢性乙型肝炎患者应对方式、社会支持与生活质量的相关性调查

目的探讨慢性乙型肝炎住院患者应对方式、社会支持与生活质量的相关性。方法随机选择66例慢性乙型肝炎患者,对其采用医学应对问卷、领悟社会支持量表及SF-36健康测量工具进行问卷调查。结果慢性乙型肝炎患者的生活质量各维度的得分均低于对照组（P=0．00）;采用面对应对方式的得分低于常模（P＜0．05）,采用回避和屈服应对方式的得分高于常模（P＜0．01）;采用面对方式的与躯体功能、躯体疼痛、总体健康感觉、精力、情感功能及心理健康呈正相关,采用回避应对方式的与总体健康感觉及情感功能呈负相关;采用屈服应对方式的与社会功能呈负相关;领悟社会支持与生活质量呈正相关。结论慢性乙型肝炎患者的生活质量偏低;应对方式及社会支持影响了慢性乙塑肝炎患者的生活质量。在临床工作中应评估患者所采取的应对方式及生活质量,通过有效的心理干预,帮助患者采用积极的应对方式,有效地利用社会支持,提高生活质量。     

氟砷污染对暴露人群骨代谢的影响

目的 探讨氟和砷对暴露人群骨代谢的影响.方法 2006年选择贵州省兴仁县雨樟镇交乐村152例氟砷联合暴露者以及位于交乐村约13 km无高氟高砷暴露史59例对照作为研究对象.分别检测尿氟、尿砷及骨代谢效应指标尿羟脯氨酸(UHYP)和尿Ⅰ型胶原交联氨基末端肽(UNTX)、骨强度指数(STI).结果 氟对UHYP、UNTX的主效应均有统计学意义(F=9.785、4.225,P均<0.01),对STI的主效应无统计学意义(F=0.183,P>0.05).砷对UNTX的主效应有统计学意义(F=2.660,P<0.05),对UHYP、STI的主效应无统计学意义(F=2.012、0.183,P均>0.05).氟、砷的交互作用对UNTX有统计学意义(F=2.429,P<0.01),但氟、砷交互作用对UHYP和STI无统计学意义(F=1.218、1.001,P均>0.05).结论 氟可影响胶原代谢及骨吸收,砷主要影响骨吸收.氟砷混合暴露时对骨吸收影响较显著.对氟、砷暴露人群进行健康监测时,UNTX可作为评价氟砷污染致暴露人群骨代谢交互作用的生物学标志.

Abstract：

Objective To explore the effect of fluoride and arsenic pollution on bone metabolism in exposed population. Methods One hundred and fifty-two fluoride and arsenic exposed people were selected from Jiaole village, Yuzhang town, Xingron county, Guizhou province in 2006, and 59 not exposed people from Daguoduo village 13 km away from Jiaole village were selected as control. Urinary fluorine(UF), urinary arsenic (UAs), urinary hydroxyproline (UHYP), cross-linked N-telopeptides of type I collagen (UNTX) and bone strength index(STI) were detected. Results The main effect of fluoride on UHYP and UNTX were statistically significant (F = 9.785, 4.225, P < 0.01 ), but was not significant on STI(F = 0.183, P > 0.05). The main effect of arsenic on UNTX was statistically significant (F = 2.660, P < 0.05 ), but was not significant on UHYP and STI(F = 2.012, 0.183,all P > 0.05). The interaction between fluoride and arsenic on UNTX was statistically significant (F= 2.429, P <0.01), but was not significant on UHYP and STI(F= 1.218, 1.001, all P> 0.05). Conclusions Fluoride exposure can affect the metabolism of collagen and bone resorption, and Arsenic exposure main affect bone resorption, fluoride and arsenic co-exposure have more significant effect on bone resorption. UNTX may be used as biological biomarker of bone metabolism for population co-exposed to fluoride and arsenic in health monitoring.