Treatment of spinal cord compression caused by C2 osteochondroma with reconstruction and fusion after total resection: Case report and literature review

Context: Osteochondroma is the most common benign tumor of the bone, but spinal osteochondroma is rare. We report a case of cervical osteochondroma in multiple exostoses arising from the lamina of the C2 vertebra, presenting with features of compressive myelopathy in a 22-year-old male. Total resection of the tumor and atlantoaxial fixation and fusion after reconstruction of the C1 posterior arch were performed.Findings: The patient recovered significantly. He was asymptomatic and no sign of recurrence was observed after one-year follow-up.Conclusions: Osteochondroma should be considered as a rare cause of spinal cord compression. Entire removal of the tumor will result in complete decompression and can reduce the risk of recurrence. We provide a new approach to reconstruct after resection.     

肠-菌-肝轴及其在肠衰竭相关性肝损害发生发展中的作用

由于长期的肠道摄入不足,肠衰竭患者不得不依赖肠外营养(PN)来维持能量和正常的生理需求。然而PN在提供能量及营养物质的同时,也会引起肝脏损害。此外,由于肠道结构和内环境发生改变,IF患者往往伴随着肠道菌群失调及小肠细菌过度生长,过度生长的细菌代谢产生的毒性介质可诱导肠道炎性反应和胆汁酸代谢紊乱,最终导致肠黏膜屏障功能受损及肠衰竭相关性肝损害(IFALD)。自1998年Marshall首次提出肠-肝轴的概念以来,肠-肝轴紊乱在IFALD发生发展中的作用也备受关注。肠道-肝脏之间的"对话"是维持肝脏代谢和肠道内稳态平衡的关键,二者相互作用,互为因果。然而,作为一个"被遗忘的器官",肠道菌群在IFALD发病过程中的作用并没有得到很好的体现。因此,笔者首次提出肠-菌-肝轴这样一个全新的概念,试图强调肠道菌群是肠-肝轴中的重要一环,三者之间的相互作用在IF患者肠道和肝脏损害过程中扮演着重要的角色。对肠-菌-肝轴这一概念的理解和深入研究,将对理解IFALD的发病机制和改进防治措施具有重要意义。     

Radical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest

IntroductionPatients with renal cell carcinoma (RCC) with level 3 or 4 caval thrombus have a poor prognosis, with reported five-year survival rates of 30–40%. The aim of this study was to assess the perioperative morbidity and long-term oncological outcomes for radical nephrectomy with resection of vena cava thrombus using a combined surgical approach, including extracorporeal circulation and deep hypothermic circulatory arrest.MethodsA retrospective review was performed of the institutional case log to identify all radical nephrectomies with caval thrombus performed from January 2006 to May 2020.ResultsTwenty-five patients were identified with level 2 thrombus in one (4%), level 3 thrombus in eight (32%), and level 4 in 16 (64%). The median followup was 20.6 months (range 0.2–133.3). The median age at surgery was 68.4 years (range 44.2–85.5). Twenty-one (84%) patients were symptomatic at presentation. Six (24%) patients had distant metastases at diagnosis. The median circulatory arrest time was 15 minutes (range 6–35). The 30-day grade ≥3 complication rate was 8%. The 30-day mortality rate was 8%. The one-year, two-year, three-year, and five-year recurrence-free survival (RFS) rates were 53%, 18%, 10%, and 10%, respectively. The median time to systemic treatment was 7.7 months (range 1.2–25.7). The one-year, two-year, three-year, and five-year overall survival (OS) rates were 70%, 43%, 36%, and 31%, respectively.ConclusionsRadical nephrectomy with resection of vena cava thrombus using extracorporeal circulation and deep hypothermic circulatory arrest is associated with some morbidity and mortality but remains a safe and effective strategy for advanced RCC patients who would otherwise be managed palliatively.     

肉苁蓉炮制对微量元素含量及对动物体内DNA合成率的影响

对不同方法炮制的肉苁蓉进行了肝脾脱氧核糖核酸合成率以及金属微量元素的测定分析。结果表明,蒸制盐大芸对“阳虚”动物脱氧核糖核酸及微量元素锌、锰、铜、铁的含量均高于其他的传统炮制品。     

诊断超声对人胚胎安全性的研究

目的　探讨诊断级B超对人胚胎发育的安全性。方法　取 12 0名孕 6～ 8周拟行人工流产孕妇 ,随机分成正常对照组 (Ⅰ组 )、辐照 5min(Ⅱ组 )、10min(Ⅲ组 )、2 0min(Ⅳ组 )、30min(Ⅴ组 )于 1h内取绒毛 ,超声辐照 30min(Ⅵ组 )于 7～ 10d后取绒毛。检测绒毛的生物化学变化。结果　诊断剂量超声辐照 2 0min可致人体宫内绒毛发生生物化学变化。丙二醛 (MDA)值随超声剂量增加而升高 (PⅠ -Ⅲ >0 .0 5,PⅠ .Ⅳ <0 .0 1,PⅠ -Ⅴ <0 .0 1) ,而超氧化物歧化酶及谷胱甘肽过氧化物酶活性随超声辐照剂量增加而下降 (PⅠ -Ⅲ >0 .0 5,PⅠ -Ⅳ <0 .0 1,PⅠ -Ⅴ <0 .0 1)。对照组与Ⅵ组比较P >0 .0 5,提示损伤作用是可逆性的。结论　诊断超声辐照时间 2 0min以上时对绒毛可造成潜在危害     

COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

Objective. To review our preliminary experience and evaluate our early results of a combined intraopemtive iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angiOplasty and stenting combined with simultaneous femoro-pepliteal bypass were pedormed on 12 lower extremities of 10 patients suffering from multilevel athemsclemtic occlusive disease. There were 8 men and 2 women, average 72 years. The indicationsf or procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stem procedures combined with simultaneous 9 femoro-popliteal by-pass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stem placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femoro-femoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 -10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patencyrate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% (11/11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectivdy. The amputation rate was 8. 3%(1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively pedormed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C ann fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditionalsurgical intervention, and also, any angioplasty and stenting-related complications can be immediately corrected as well.     

金银花水煎剂对绿脓杆菌P29株R质粒体内体外消除作用的实验研究

目的 :探讨金银花对绿脓杆菌 R质粒消除作用。方法 :体外试验　金银花水煎剂亚抑菌浓度作用绿脓杆菌 P2 948h后 ,影印培养 ,计数消除子 ;体内试验　建立肠道去污染小鼠动物模型后 ,经口感染绿脓杆菌 ,同时给金银花水煎剂 ,灌胃给药 ,2 mg/只 ,2 4 h后再次给药 ,剂量同上 ,48h后处死小鼠 ,分离培养细菌 ,计数消除子数。消除子经质粒抽提琼脂糖凝胶电泳鉴定。结果 :金银花水煎剂对绿脓杆菌 P2 9株 R质粒体外消除率为 0 ,体内消除率为 8%。结论 :金银花水煎剂对去污染小鼠感染绿脓杆菌 P2 9株 R质粒具有消除作用 ,消除子主要表现对单一抗生素恢复敏感性 ;体外没有消除 R质粒作用。     

卵巢癌的p53基因治疗实验研究——人野生型p53基因真核细胞表达质粒的构建

目的 :本实验构建了人野生型 p53基因与真核表达载体 pc DNA3的重组体 ,为进行卵巢癌基因治疗研究打下基础。方法 :利用分子生物学基因克隆技术从质粒 p GEX-p53中用双酶切下目的片段 ,挤压法回收与 pc DNA3构成重组体。结果 :成功的构建了人野生型 p53基因真核细胞表达质粒。结论 :带有两个不同的酶切位点的目的片段定向克隆的方法使重组体的构建高效简便 ,挤压法回收目的片段经济有效。