细胞衰老在眼表疾病中的研究进展

细胞衰老是指细胞生理功能的衰减,包括增生能力下降、细胞周期停滞、细胞凋亡、衰老相关基因表达增加等现象.近年来随着人们对衰老的进一步认识及细胞衰老检测方法的不断补充与升级,为临床治疗衰老相关性疾病提供了新思路和新方法.目前发现眼表的诸多疾病与衰老相关,如干眼症、睑板腺功能障碍、结膜松弛症、Fuchs角膜内皮营养不良、翼状...     

登革热脑炎伴降钙素原升高1例报道

该文报道了1例患登革热脑炎的年轻女性患者。收集了患者的临床症状和体征、生化标志物、影像学表现、宏基因检测等资料,并查阅相关文献。该患者以“发热、头痛4 d,腹泻、呕吐3 d,全身抽搐伴意识障碍3 h”为主诉被陆军军医大学第一附属医院收入院。入院第2天脑脊液宏基因组学检测（RNA）结果显示,登革热病毒1型,且伴有降钙素原升高,明确了登革热脑炎的诊断。临床上遇到发热、头痛、腹泻、呕吐,伴随降钙素原水平升高的患者,应怀疑登革热脑炎,并进行登革热血清学检查和脑脊液登革热RNA检测。 [国际神经病学神经外科学杂志, 2024, 51(2): 69-72]     

脑氧饱和度监测在重症动脉瘤性蛛网膜下腔出血术后管理的应用研究

目的分析以局部脑氧饱和度(rScO 2)监测为目标导向的重症动脉瘤性蛛网膜下腔出血(SaSAH)术后神经重症集束化管理的应用价值。方法该研究为单盲随机对照试验。前瞻性连续纳入2017年6月至2019年6月河南省人民医院神经外科重症监护室(ICU)收治的符合纳排标准的SaSAH手术治疗患者,采用随机数字表法进行随机分组,对照组实施常规的神经重症监护治疗,试验组在此基础上实施以rScO 2为目标导向的神经重症集束化管理干预,包括神经系统专科监测、血流动力学管理、体温管控、癫痫的预防与控制等。比较两组患者的基本临床资料以及术后随访90 d时主要有效性评价指标[改良Rankin量表(mRS)、细化型格拉斯哥预后量表(GOS-E)]、次要有效性评价指标(ICU住院时间)及安全性评价指标[迟发性脑缺血(DCI)、颅内感染、脑积水、死亡]的差异。结果共209例SaSAH手术治疗的患者符合纳入标准并纳入入组。试验组104例,其中98例获得临床随访,失访6例;对照组105例,其中98例获得临床随访,失访7例。两组研究对象基本临床资料差异均无统计学意义(均P>0.05);试验组ICU住院时间和并发症如DCI、脑积水发生率均低于对照组,差异均有统计学意义[分别为(12±6)d比(15±8)d,3.1%(3/98)比10.2%(10/98)、4.1%(4/98)比12.2%(12/98);t=-2.775,χ^2值分别为4.037、4.356,P值分别为0.006、0.045、0.037];试验组在随访90 d时的mRS评分及GOS-E评分均优于对照组[(3.6±0.9)分比(4.1±0.8)分,(6.2±1.8)分比(5.5±2.5)分],差异均有统计学意义(P值分别为<0.01、0.015)。结论以rScO2监测为目标导向的SaSAH术后神经重症集束化管理,能有效缩短患者的住院周期,改善临床治疗的有效性及安全性。     

Electrocardiogram evolution of acute anterior ST‐segment elevation myocardial infarction following pericarditis

Electrocardiogram is a powerful tool for differentiating acute ST‐segment elevation myocardial infarction (STEMI) and pericarditis. However, an unusual ECG presentation of the simultaneous occurrence of the two conditions has not been reported previously. In this article, we report a case of ECG evolution of acute anterior STEMI following pericarditis with pericardial effusion (PE) and find that QRS complex widening in ECG lead with maximal ST‐segment elevation is also applicable for identifying STEMI even in patients with prior pericarditis. Undoubtedly, our case can help prevent emergency physicians from making incorrect diagnoses and administering inappropriate treatments.     

水杨酸钠对大鼠下丘神经元L-型钙通道的影响

目的 了解L-型钙通道在水杨酸钠导致耳鸣的机制中所起的作用.方法 利用全细胞膜片钳技术研究水杨酸钠对急性分离的大鼠下丘神经元L-型钙通道的影响.结果 水杨酸钠抑制L-型钙通道电流(ICa,L),且具有浓度依赖性.水杨酸钠抑制ICa,L的半抑制浓度值为1.99 mmol/L.水杨酸钠不影响ICa,L的电导-电压曲线和稳态激活曲线,水杨酸钠将ICa,L的稳态失活曲线向超极化方向移动8 mV,并且延长ICa,L失活后恢复的时间.结论 水杨酸钠对ICa,L的抑制作用,可能通过减少下丘部位γ-氨基丁酸的释放,从而导致耳鸣.     

Minimally invasive pedicle screw fixation,including the fractured vertebra,combined with percutaneous vertebroplasty for treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals: A prospective clinical study

To evaluate the feasibility, efficacy, and safety of minimally invasive pedicle screw (MIPS) fixation, including the fractured vertebra, combined with percutaneous vertebroplasty (PVP) for the treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals.Between January 2016 and August 2019, a total of 30 patients, with a mean age of 69.4 years (range, 58–75 years), who experienced thoracic or lumbar fracture without neurological deficits, underwent the MIPS procedure combined with PVP. Preoperative and postoperative pain were assessed using a visual analog scale and Oswestry Disability Index. Cobb angles and anterior column height were measured on lateral radiographs before surgery and at 3 days, 1, 3, and 6 months, and 1 and 2 years at final follow-up after surgery.All patients underwent surgery successfully, with a mean follow-up of 18.2 ± 5.7 months (range, 12–45 months). Mean preoperative visual analog scale score decreased from 7.3 ± 2.2 to 1.4 ± 0.3 at the final follow-up (P < .05). Mean preoperative Oswestry Disability Index decreased from 84.2 ± 10.3 to 18.8 ± 7.5 (P < .05) at the final follow-up. The Kyphosis angle of operative segment was improved from preoperative (21.38 ± 1.68)° to (4.01 ± 1.38)° 3 days postoperatively and (5.02 ± 1.09)° at final follow-up (P < .05). The anterior vertebral height was improved from preoperative (49.86 ± 6.50)% to (94.01 ± 1.79)% 3 days postoperatively and (91.80 ± 1.88)% at final follow-up (P < .05). No significant changes in vertebral body height restoration were observed during 2 years of follow-up after surgery. In addition, there were no instrumentation failures or complications in any of the patients.MIPS, including the fractured vertebra, combined with PVP, was a reliable and safe procedure, with satisfactory clinical and radiological results for the treatment of thoracolumbar osteoporotic compression fracture in patients without neurological deficits.     

Genetic analysis combined with 3D‐printing assistant surgery in diagnosis and treatment for an X‐linked hypophosphatemia patient

BackgroundHypophosphatemia is mainly characterized by hypophosphatemia and a low level of 1alpha,25‐Dihydroxyvitamin D2 (1,25‐(OH)₂D2) and/or 1alpha,25‐Dihydroxyvitamin D3 (1,25‐(OH)₂D3) in the blood. Previous studies have demonstrated that variants in PHEX and FGF23 are primarily responsible for this disease. Although patients with variants of these two genes share almost the same symptoms, they exhibit the different hereditary pattern, X‐link dominant and autosome dominant, respectively. Three‐dimensional (3D) printing is a method which can accurately reconstruct physical objects, and its applications in orthopedics can contribute to realizing a more accurate surgical performance and a better outcome.MethodsAn X‐linked hypophosphatemia (XLH) family was recruited, with four patients across three generations. We screened candidate genes and filtered a duplication variant in PHEX. Variant analysis and co‐segregation confirmation were then performed. Before the operation of our patient, a digital model of our patient''s leg had been rebuilt upon the CT scan data, and a polylactic acid (PLA) model had been 3D‐printed.ResultsA novel duplication PHEX variant c.574dupG (p.A192GfsX20) was identified in a family with XLH. Its pathogenicity was confirmed by the co‐segregation assay and online bioinformatics database. The preoperative plan was made with the help of the PLA model. Then, arch osteotomy and transverse osteotomy were performed under the guidance of the previous simulation. The appearance of the surgical‐intervened leg was satisfactory.ConclusionsThis study identified a novel PHEX variant and showed that 3D printing tech is a very promising approach for corrective osteotomies.     

Effect of Cu Content on the Precipitation Behaviors,Mechanical and Corrosion Properties of As-Cast Ti-Cu Alloys

Ti-Cu alloys have broad application prospects in the biomedical field due to their excellent properties. The properties of Ti-Cu alloys are strongly dependent on Cu content, microstructures, its Ti₂Cu phase and its preparation process. The aim of this work is to investigate the effect of Cu content on the precipitation behaviors, mechanical and corrosion properties of the as-cast Ti-Cu alloys. The microstructures and phase evolution were characterized by SEM and TEM, and the properties were studied by tensile and electrochemical test. The results show that the volume fraction of Ti₂Cu phase increases with the increase of Cu content. The Ti₂Cu phase presents a variety of microscopic morphologies with different Cu content, such as rod, granular, lath and block shaped. The crystal orientation relationships between the Ti₂Cu and α-Ti matrix in Ti-4Cu and Ti-10Cu alloys are (103)_Ti2Cu//(0[11¯11)_α-Ti, [3¯01]_Ti2Cu//[21¯1¯0]_α-Ti, and (103)_Ti2Cu//(0002)_α-Ti, [3¯31]_Ti2Cu//[12¯10]_α-Ti, respectively. The tensile strength, Vickers hardness and Young’s modulus of the Ti-Cu alloys increase with the increase of Cu content, whereas the elongation decreases. The fracture morphologies of these alloys reveal ductile, ductile-brittle hybrid, and cleavage brittle mode, respectively. The corrosion resistance of the Ti-Cu alloys in SBF solution can be described as: Ti-4Cu alloy > Ti-10Cu alloy > Ti-7Cu alloy. The volume fraction of Ti₂Cu phases and the “protective barrier” provided by the fine lath Ti₂Cu phases strongly affected the electrochemical performances of the alloys.     

Crystallography and Microstructure of 7M Martensite in Ni-Mn-Ga Thin Films Epitaxially Grown on (1 1 [... formula ...] 0)-Oriented Al2O3 Substrate

Epitaxial Ni-Mn-Ga thin films have been extensively investigated, due to their potential applications in magnetic micro-electro-mechanical systems. It has been proposed that the martensitic phase in the <1 1 0>_A-oriented film is much more stable than that in the <1 0 0>_A-oriented film. Nevertheless, the magnetic properties, microstructural features, and crystal structures of martensite in such films have not been fully revealed. In this work, the <1 1 0>_A-oriented Ni_51.0Mn_27.5Ga_21.5 films with different thicknesses were prepared by epitaxially growing on Al₂O₃(1 1 2¯ 0) substrate by magnetron sputtering. The characterization by X-ray diffraction technique and transmission electron microscopy revealed that all the Ni_51.0Mn_27.5Ga_21.5 films are of 7M martensite at the ambient temperature, with their Type-I and Type-II twinning interfaces nearly parallel to the substrate surface.