复合手术治疗颅内复杂破裂动脉瘤的效果分析

目的探讨应用复合手术治疗颅内复杂破裂动脉瘤的安全性及短期有效性。方法回顾性连续纳入2014年12月至2017年3月南方医科大学南方医院神经外科行复合手术治疗的复杂破裂动脉瘤患者14例,其中急性自发性蛛网膜下腔出血性动脉瘤13例,复发动脉瘤栓塞术中出血1例。12例动脉瘤行塑形夹闭术,术中均行DSA造影评估动脉瘤夹闭效果。2例动脉瘤行颅内外血管旁路移植并动脉瘤孤立术,DSA造影评估桥血管通畅性后行血管内球囊闭塞术孤立动脉瘤。结果 14例患者,11例造影后急诊行复合手术,2例择期手术,1例栓塞术中出血急诊行抢救性手术。12例动脉瘤夹闭术中造影提示3例需要调整动脉瘤夹,其中2例载瘤动脉狭窄,1例夹闭不全,调整后均夹闭满意。2例颅内外血管旁路移植术中造影均通畅,一期行动脉瘤孤立术。术后1例患者因严重血管痉挛,自动出院。1例术后出现灌注压突破,行血肿清除并减压术,出院时格拉斯哥预后评分(GOS)3分。余患者术后均无新发神经功能障碍。对13例患者术后3~24个月行临床随访,均无新发神经功能障碍,GOS 5分8例,4分5例。6例患者行DSA复查,其中4例动脉瘤夹闭未见动脉瘤复发,载瘤动脉通畅;2例血管旁路移植动脉瘤无复发,载瘤动脉及吻合血管通畅。结论初步观察,应用复合手术方式治疗颅内复杂破裂动脉瘤安全且有效。     

老年人血浆维生素K和D水平的季节变化

目的了解老年人群血浆维生素K和维生素D水平的季节变化。方法对85名健康老年人用放射免疫分析法测定春秋两季血浆维生素D(25(OH)D)和甲状旁腺素(PTH)含量,用高压液相色谱法测定血浆维生素K含量。结果血浆维生素K水平女性在春秋两季均明显高于男性,而男性和女性各自无季节性差异。无论男女秋季血浆维生素(25(OH)D)水平明显高于春季,同一季节内男女间差异无统计学意义。维生素D缺乏率女性春季为63.4%,秋季为7.3%。男性春季为65.9%,秋季无缺乏者。春季维生素D缺乏率显著高于秋季(P<0.05)。男女秋季血浆PTH浓度明显低于春季。老年女性春季血浆25(OH)D浓度和血浆PTH浓度之间呈负相关(r=-0.426,P<0.001)。结论该人群血浆25(OH)D和PTH有明显的季节变化,春季血浆25(OH)D水平低。而血浆维生素K没有季节变化。     

Influence of previous treatments on repeat surgery for recurrent craniopharyngiomas in children

Purpose

Craniopharyngioma is a common pediatric brain tumor, with a high rate of recurrence after primary treatment. This retrospective study investigated the effect of various primary treatments on surgical strategies and outcomes for recurrent craniopharyngiomas.

Methods

The study population comprised 35 children (mean age 8.77 years, range 1–16 years) with recurrent craniopharyngioma re-operated from January 1990 to January 2009. The recurrent craniopharyngiomas were excised whenever possible. For analysis, the patients were divided into four groups according to the primary treatment: radical tumor resection (A), incomplete tumor resection (B), radiotherapy + incomplete tumor resection (C), and Ommaya reservoir placement + incomplete tumor resection (D).

Results

Group B had a significantly shorter recurrence-free interval than groups A, C, or D. Outcomes were significantly different among the four groups. The hypothalamic status scores of groups A (2.38 ± 0.27) and C (2.28 ± 0.42) were significantly higher than that of group B (1.64 ± 0.20). There were no statistical differences between any two other groups.

Conclusions

In children, the primary treatments for craniopharyngioma should be considered when choosing the surgical strategy for recurrence. Radiotherapy before repeated surgery can result in a worse functional outcome and hypothalamic-pituitary function.

     

Application of stem cells derived from the periodontal ligament or gingival tissue sources for tendon tissue regeneration

Tendon injuries are often associated with significant dysfunction and disability due to tendinous tissue's very limited self-repair capacity and propensity for scar formation. Dental-derived mesenchymal stem cells (MSCs) in combination with appropriate scaffold material present an alternative therapeutic option for tendon repair/regeneration that may be advantageous compared to other current treatment modalities. The MSC delivery vehicle is the principal determinant for successful implementation of MSC-mediated regenerative therapies. In the current study, a co-delivery system based on TGF-β3-loaded RGD-coupled alginate microspheres was developed for encapsulating periodontal ligament stem cells (PDLSCs) or gingival mesenchymal stem cells (GMSCs). The capacity of encapsulated dental MSCs to differentiate into tendon tissue was investigated in vitro and in vivo. Encapsulated dental-derived MSCs were transplanted subcutaneously into immunocompromised mice. Our results revealed that after 4 weeks of differentiation in vitro, PDLSCs and GMSCs as well as the positive control human bone marrow mesenchymal stem cells (hBMMSCs) exhibited high levels of mRNA expression for gene markers related to tendon regeneration (Scx, DCn, Tnmd, and Bgy) via qPCR measurement. In a corresponding in vivo animal model, ectopic neo-tendon regeneration was observed in subcutaneous transplanted MSC-alginate constructs, as confirmed by histological and immunohistochemical staining for protein markers specific for tendons. Interestingly, in our quantitative PCR and in vivo histomorphometric analyses, PDLSCs showed significantly greater capacity for tendon regeneration than GMSCs or hBMMSCs (P < 0.05). Altogether, these findings indicate that periodontal ligament and gingival tissues can be considered as suitable stem cell sources for tendon engineering. PDLSCs and GMSCs encapsulated in TGF-β3-loaded RGD-modified alginate microspheres are promising candidates for tendon regeneration.     

纳洛酮治疗急性重型颅脑损伤的量效关系

目的观察盐酸纳洛酮治疗急性重型颅脑损伤病人的剂量疗效关系。方法将120例急性重型颅脑损伤病人随机分为6组(空白对照组以及0.1、0.2、0.4、0.6、0.8 mg.kg-1.d-1纳洛酮组),分别给予生理盐水及相应分组剂量纳洛酮,观察GCS、血压、脉搏、呼吸等生命体征,测定血浆β-内啡肽(-βEP)和C-反应蛋白(CRP)含量。随访3个月,观察GOS、肢体和语言功能评分。结果GCS、β-EP、CRP在小剂量纳洛酮组(0.1 mg.kg-1.d-1)与对照组间差异无统计学意义;大剂量纳洛酮组各组间(≥0.4 mg.kg-1.d-1)差异无统计学意义,但与空白对照组、小剂量组、中剂量组(0.2 mg.kg-1.d-1)间差异有统计学意义。血压、脉搏、呼吸在纳洛酮各组间差异无统计学意义,但与对照组间差异有统计学意义。随访3个月,GOS、肢体功能及语言功能评分在大剂量组与对照组、小剂量组、中剂量组之间的差异有统计学意义,且小剂量组恢复最差(P<0.05);但大剂量各组之间的差异无统计学意义结论①盐酸纳洛酮(≥0.2 mg.kg-1.d-1)对急性重型颅脑损伤有显著的治疗作用,能促进神经功能的恢复;②小剂量盐酸纳络酮(≤0.1 mg.kg-1.d-1)对颅脑损伤后的神经功能保护无意义,临床不提倡使用;③盐酸纳络酮剂量0.4～0.6 mg.kg-1.d-1为最佳临床推荐剂量。     

血清白细胞介素-10检测值对HBV感染者临床意义的研究

临床上检测HBV感染者血清IL～10水平,探讨其在HBV持续感染及肝细胞损伤过程中的临床诊断作用。分离104例HBV感染者临床血清标本,其中无症状携带者23例,慢性乙肝患者81例（轻度19例,中、重度62例）。用双抗体ELISA夹心法定量检测血清IL—10水平,以20例健康门诊体检者的血清为正常对照,经过对比可以发现,HBV感染者血清IL-10浓度明显高于正常对照组（P〈0．05）;无症状携带者及中、重度慢性乙肝患者组的明显高于轻度组（P〈0．05）;血清HBV—DNA高载量者明显高于低载量者（P〈0．05）。由此我们可以判断出慢性乙肝患者血清IL～10浓度升高与HBV持续感染、HBV—DNA高载量复制及肝损伤有关;无症状携带者IL-10浓度升高可能与其诱导的免疫耐受有关。     

多点执业在植入式合作医疗中的作用

<正>1目前多点执业的方式、作用和现状作为医改的重要举措,医师多点执业已开展两年余。在卫生部关于医师多点执业有关问题的通知中,医师多点执业明确实行分类管理:①医师执行政府指令任务。②多个医院以整合医疗资源、方便患者就医和提高医疗     

四甲氧基硅烷与甲醇混合性气体所致四例眼损伤报告

本文报告四例四甲氧基硅烷与甲醇混合气体引起眼损伤，前者主要引起眼部刺激症状及角膜上皮脱落，后者可导致视神经受损，两者同时的协同作用可使眼损害加重。由于早期采取了有效的保护视神经及其他有效治疗措施，四例患者眼损伤完全恢复，无视神经损伤及视力受损后遗症。     

福州市新生儿低体重危险因素的病例—对照研究

对福州市300例低体重新生儿作1:1病例—对照研究,采用单因素 X~2检验和多因素条件Logistic 回归分析,结果表明;异常孕周(<37周或≥42周)、胎儿宫内发育迟缓、孕期膳食无改善、产前检查指导次数少、孕期情绪焦虑、被动吸烟、28～36孕周的高危因素、孕期睡眠时间≤8h/d、妊娠高血压等是福州市新生儿低体重发生的主要危险因素。