软组织损伤引起慢性疼痛的治疗

目的：综述运动系统软组织损伤引起慢性疼痛的各种治疗方法的研究进展。资料来源：应用计算机检索Medline1980—01／2006—04与运动系统软组织损伤引起慢性疼痛的治疗相关文章，检索词“Soft tissue injury，pain．chronic，comprehensive therapy”，并限定文章语言种类为“English”；同时计算机检索中国期刊全文数据库1994—01／2006-04期间的相关文章，检索词“软组织损伤、慢性疼痛、治疗方法”，并限定语言种类为中文。同时手工查阅相关书籍。资料选择：对资料进行初审，所选文献内容符合：①软组织损伤引起的慢性疼痛药物治疗的研究。②软组织损伤引起的慢性疼痛微创治疗的研究。③软组织损伤引起的慢性疼痛运动疗法的研究。④软组织损伤引起的慢性疼痛心理治疗的研究。⑤软组织损伤引起的慢性疼痛其他疗法的研究。排除重复性研究的文献。资料提炼：共收集到40篇关于软组织损伤引起的慢性疼痛治疗方法的文献，均为全文，23篇符合纳入标准，排除17篇重复性研究。同时录入书籍3本。资料综合：软组织损伤引起的慢性疼痛的产生是生理、心理及社会因素复杂结合的结果，个体表现差异较大，目前尚无特效治疗方法，常用的治疗方法有：药物治疗、微创治疗、运动疗法、心理治疗、物理疗法及其他疗法。结论：对于软组织损伤引起的慢性疼痛的治疗必须以整体的观点对其进行合理的评估和个体化治疗，才能收到良好的效果。     

针灸治疗干燥综合征20例

目的：观察针灸治疗干燥综合征的临床疗效。方法：选穴：太溪、肾俞、合谷、廉泉，将穴位与电针仪连接。结果显示治疗后部分患者口干症状有明显改善。血中促黄体生成素（LH）和睾酮（T）指标降低。结论：电针疗法治疗干燥综合征疗效好、简便、安全、无毒副作用。     

胰岛素使用方法的研究进展

胰岛素治疗是糖尿病治疗的重要内容,也是使糖尿病患者血糖达标的有效方法。严格的血糖控制对糖尿病慢性并发症的预防和延缓发生有重要意义,然而目前各国的糖尿病血糖控制达标率均不足50%。患者甚至包括医生对低血糖的恐惧是启动胰岛素治疗和达到最佳胰岛素治疗的主要障碍之一。     

胰胆管合流异常动物模型的建立

目的建立胰胆管合流异常的动物模型。方法选用健康杂种猫10只。术前禁食12 h,3.5%戊巴比妥钠麻醉后,取上腹正中切口约6 cm切开各层至腹腔。于胆总管入十二指肠处旁边,切开胰腺背膜,解剖胰管;靠近十二指肠处分别纵向切开胰管、胆管长约4~6 mm的切口。6-0线间断吻合切口,造成类似人类的胰胆管合流的共同通道。术后20天胆道造影。结果术后动物精神、食欲良好,无萎靡、烦燥等表现,造影显示胰胆管合流共同通道延长。结论本动物模型最接近于人类的胰胆管合流异常生理,优于其他动物模型。     

Implant wear induces inflammation, but not osteoclastic bone resorption, in RANK(-/-) mice.

Signaling of RANK (receptor activator of nuclear factor kappa B) through its ligand RANKL appears critical in osteolysis associated with aseptic loosening (AL). The purpose of this study was to investigate the role of RANK in a murine osteolysis model developed in RANK knockout (RANK(-/-)) mice. Ultra high molecular weight polyethylene (UHMWPE) debris was introduced into established air pouches on RANK(-/-) mice, followed by implantation of calvaria bone from syngeneic littermates. Wild type C57BL/6 (RANK(+/+)) mice injected with either UHMWPE or saline alone were included in this study. Pouch tissues were collected 14 days after UHMWPE inoculation for molecular and histology analysis. Results showed that UHMWPE stimulation induced strong pouch tissue inflammation in RANK(-/-) mice, as manifested by inflammatory cellular infiltration, pouch tissue proliferation, and increased gene expression of IL-1beta, TNFalpha, and RANKL. However, the UHMWPE-induced inflammation in RANK(-/-) mice was not associated with the osteoclastic bone resorption observed in RANK(+/+) mice. In RANK(+/+) mice subjected to UHMWPE stimulation, a large number of TRAP(+) cells were found on the implanted bone surface, where active osteoclastic bone resorption was observed. No TRAP(+) cells were found in UHMWPE-containing pouch tissues of RANK(-/-) mice. Consistent with the lack of osteoclastic activity shown by TRAP staining, no significant UHMWPE particle-induced bone resorption was found in RANK(-/-) mice. A well preserved bone collagen content (Van Gieson staining) and normal plateau surface contour [microcomputed tomography (microCT)] of implanted bone was observed in RANK(-/-) mice subjected to UHMWPE stimulation. In conclusion, this study provides the evidence that UHMWPE particles induce strong inflammatory responses, but not associated with osteoclastic bone resorption in RANK(-/-) mice. This indicates that RANK signaling is essential for UHMWPE particle-induced osteoclastic bone resorption, but does not participate in UHMWPE particle-induced inflammatory response.     

Pick’s disease with Pick bodies combined with progressive supranuclear palsy without tuft‐shaped astrocytes: A clinical,neuroradiologic and pathological study of an autopsied case

We report clinical, neuroradiologic features, and neuropathologic findings of a 76‐year‐old man with coexistent Pick’s disease and progressive supranuclear palsy. The patient presented with loss of recent memory, abnormal behavior and change in personality at the age of 60. The symptoms were progressive. Three years later, repetitive or compulsive behavior became prominent. About 9 years after onset, he had difficulty moving and became bed‐ridden because of a fracture of his left leg. His condition gradually deteriorated and he developed mutism and became vegetative. The patient died from pneumonia 16 years after the onset of symptoms. Serial MRI scans showed progressive cortex atrophy, especially in the bilateral frontal and temporal lobes. Macroscopic inspection showed severe atrophy of the whole brain, including cerebrum, brainstem and cerebellum. Microscopic observations showed extensive superficial spongiosis and severe neuronal loss with gliosis in the second and third cortical layers in the frontal, temporal and parietal cortex. There were Pick cells and argyrophilic Pick bodies, which were tau‐ and ubiquitin‐positive in neurons of layers II–III of the above‐mentioned cortex. Numerous argyrophilic Pick bodies were observed in the hippocampus, especially in the dentate fascia. In addition, moderate to severe loss of neurons was found with gliosis and a lot of Gallyas/tau‐positive globus neurofibrillary tangles in the caudate nucleus, globus pallidus, thalamus, substantia nigra, locus coeruleus and dentate nucleus. Numerous thorned‐astrocytes and coiled bodies but no‐tuft shaped astrocytes were noted in the basal ganglion, brainstem and cerebellar white matter. In conclusion, these histopathological features were compatible with classical Pick’s disease and coexistence with progressive supranuclear palsy without tuft‐shaped astrocytes.     

密闭式吸痰管在机械通气病人气道护理中的应用

用循证医学的方法探索密闭式吸痰管应用在机械通气病人气道护理中的利弊.提出临床问题后,用主题"Endotracheal and Closed suction"检索Cochrane CDSR,ACP Journal Club,DARE,CCTR(OVID平台)、Medline、中国学术期刊全文数据库(CNKI)获得相关证据.吸痰时使用密闭式吸痰管,可明显减轻由吸痰引起的并发症症状,从而降低病人对吸痰的恐惧程度,避免由吸痰导致的不良事件的发生.     

丹参对持续癫痫幼鼠脑损伤保护作用的实验研究

目的 探讨丹参对持续癫痫发作诱发幼鼠脑神经元损伤是否具有保护作用。方法 皮下及腹腔注射贝美格针诱发健康幼龄鼠癫痫持续状态发作。光镜下观察神经元病变情况；电镜观察海马神经元超微结构的改变。结果 持续癫痴组幼鼠脑组织光镜下可见明显的神经元病变。电镜下可见海马区神经元的超微结构病变。丹参治疗组神经元病变均轻于持续癫痴组；而正常对照组未见类似病变。结论 丹参在组织、细胞和亚细胞水平对持续癫病幼鼠脑神经元损伤具有一定的保护作用，为临床有效防治小儿惊厥性脑损伤提供了可靠的实验依据。     

MBP对PBMC产生IFN-γ和NO的影响

目的探讨T细胞非特异性活化在CNS脱髓鞘性疾病中的作用。方法分离实验性自身免疫性脑脊髓炎(EAE)易感性BALB/c小鼠外周血单个核细胞(PBMC),采用体外细胞培养方法在体外与碱性髓鞘蛋白(MBP)共培养,测定培养上清液中IFN-γ、NO水平。结果经MBP刺激的PBMC产生IFN-γ[(43.83±6.06)pg/mL]和NO[(180.76±20.75)μmol/L]明显增加,与对照组产生的IFN-γ[(28.52±2.18)pg/mL]和NO[(95.61±13.09)μmol/L]相比差异有统计学意义(P<0.01)。结论在CNS脱髓鞘性疾病发病过程中,活化的T细胞、单核细胞等分泌致炎细胞因子和其他有害物质增多。     

计算机导航关节镜下前十字韧带重建术

目的介绍计算机导航技术辅助关节镜下前十字韧带重建术的术前规划和手术方法,比较导航技术辅助与单纯关节镜技术中股骨、胫骨隧道位置的优良率。方法根据术前标准正侧位X线片设计股骨、胫骨隧道的理想位置。术中“C”型臂X线机获得正侧位影像后输入计算机,形成虚拟工作界面。膝关节周围分别于股骨、胫骨侧安置“患者追踪器”。前十字韧带胫骨及股骨导向器上分别装配“工具追踪器”。经过注册及校准后,导航系统识别并捕获上述追踪器发射的信号,确定膝关节的位置,实时跟踪手术工具的位置和方向,并将隧道的虚拟路径叠加在工作界面上,供术者实时调整导向器的位置与方向,直至达到术前规划的要求。临床上完成计算机导航关节镜下前十字韧带重建术46例。对其中40例进行术后X线片测量,确定胫骨及股骨隧道的位置,并与同期进行的40例单纯关节镜下重建术隧道位置的测量结果进行比较。结果导航组胫骨隧道位置平均为45.35%±3.827%(37%￣53%),股骨隧道位置平均为62.25%±5.610%(52%￣73%);关节镜组胫骨隧道位置平均为41.05%±6.008%(25%～54%),股骨隧道位置平均为56.62%±7.316%(46%￣77%)。导航组的股骨及胫骨隧道位置较关节镜组偏后,差异有统计学意义(P<0.05),导航组的标准差小于关节镜组。结论计算机导航技术可以使关节镜下前十字韧带重建手术中胫骨及股骨隧道的位置更偏后,提高了手术准确性及可重复性。