中老年男性血清催乳素水平与良性前列腺增生的关系

目的　探讨中老年男性血清催乳素 (PRL)和睾酮 (T)的变化 ,研究PRL与良性前列腺增生的关系。　方法　将 84例健康中老年男性分为 4个年龄组 ,测定血清PRL和T水平 ,分析不同年龄组的数值变化。采用B超测定其中 38例的前列腺体积 ,与PRL进行相关性分析。　结果　 5 0、6 0、70和 80岁年龄组的T水平分别为 (2 5 .92± 2 .5 4)、(2 1.0 0± 1.92 )、(18.37± 2 .49)和 (14.75±2 .38)nmol/L ,不同年龄组之间T水平比较 ,差别有显著性意义 (F =3.44 ,P <0 .0 5 ) ;PRL水平分别为 (1.11± 0 .16 )、(0 .96± 0 .2 0 )、(0 .99± 0 .18)和 (0 .91± 0 .2 9)nmol/L ,组间比较差别无显著性意义(F =0 .12 ,P >0 .0 5 ) ;PRL水平与前列腺体积无显著相关性 (r =0 .2 5 ,P >0 .0 5 )。　结论　PRL通过雄激素在前列腺的生长过程中产生作用 ,但中老年男性雄激素水平不断降低 ,削弱了PRL在前列腺增生中的作用。     

氯化镧对内毒素诱导巨噬细胞肿瘤坏死因子表达的影响

目的　探讨稀土化合物氯化镧对内毒素效应的影响。　方法　分离培养小鼠腹腔巨噬细胞 (M) ,用内毒素 (lipopolysaccharide ,LPS)对其进行诱导实验。采用ELISA法及SYBRGreen荧光定量RT PCR方法 ,观察氯化镧对LPS诱导的小鼠M肿瘤坏死因子α(TNFα)分泌及TNFαmRNA表达的影响。BALB/C小鼠随机分为 2组 ,分别给予致死量LPS及经氯化镧处理的LPS ,观察 7d内小鼠死亡率。　结果　经氯化镧处理的LPS诱导的小鼠 ,MTNFα分泌量及TNFαmRNA表达水平均明显低于LPS组 (P <0 .0 1)。经氯化镧处理的致死量LPS攻击小鼠 ,其死亡率明显低于LPS对照组。　结论　氯化镧具有降低内毒素毒性、抑制LPS诱导小鼠MTNFα分泌及TNFαmRNA表达的作用     

Gamma钉固定治疗367例股骨转子间骨折的疗效分析

Objective To investigate the clinical effects of Gamma nails in treatment of intertroehanteric fractures.Methods From October 2000 to December 2006,we used Gamma nails to treat 367 patients with intertrochanteric fractures.They were 135 males and 232 females,aged from 20 to 103years(average,73.1 years).Low-impact injury was found in 309 patients and high-velocity injury in 58patients.By AO classification,there were 117 cases of type A1,208 cases of type A2 and 42 cases of type A3.The period from injury to operation was 4.7 days on average,ranging from 1 to 17 days.The postoperative hip radiographs and the patient's satisfaction were evaluated.The Harris hip score(HHS)self-report was used to compare hip functions before fracture and at the last follow-up. Results Of all the patients,331were followed up for 4 to106 months(mean,16.1 months).On average,99.7%of the fractures(330 cases)healed in 14.2 weeks(range,12 to 24 weeks).Postoperative complications occurred in 28 cases.The average HHS before fracture was 84.6±10.0 points(range,31 to 90),which significantly decreased at the finial follow-up to 75.8±12.8 points(range,19 to 90)(t=6.510,P=0.000).63.7%(135/212)of the patients rated the treatment outcome as excellent,31.6%(67/212)as good,2.8%(6/212)as fair,and 1.9%(4/212)as poor.51.4%(109/212)of the patients felt more or less pain in the hip. Conclusions Gamma nails are effective in treatment of intertroehanteric fractures.However,as the postoperative local pain is evident and the postoperative hip function decreases obviously,this operation needs to be improved.     

Wnt/β-catenin信号通路与骨病——作为药物靶标的潜力

分泌性蛋白家族Wnt蛋白在调节细胞生长、分化、功能及死亡等方面起着重要作用。Wnt蛋白家族激活信号时,它的经典通路Wnt/β-catenin信号通路通过一系列机制调节骨和软骨代谢,如刺激干细胞复制、促进软骨细胞成熟、诱导成骨细胞发生、阻碍成骨细胞和骨细胞凋亡等。该文就骨生物学中Wnt/β-catenin通路的研究现状、与该通路相关骨病、将该通路作为药物靶点的潜力等作一综述。     

老年隐匿性股骨颈骨折磁共振成像早期诊断和治疗

目的探讨磁共振成像(MRI)在早期诊断和治疗老年隐匿性股骨颈骨折中的应用价值。方法老年外伤后髋部疼痛临床怀疑股骨颈骨折而X线平片阴性的病例行MRI检查共32例,对这些病例的病史、放射学资料、治疗措施和随访疗效进行整理。结果MRI显示股骨颈骨折20例,股骨转子间骨折2例,耻骨支骨折1例,髋关节周围软组织损伤6例,阴性3例。22例髋部骨折患者中,13例进行了3枚空心加压螺钉治疗,9例非手术治疗。所有患者进行了6～24个月的随访。手术治疗组患者恢复良好,未出现骨折不愈合或股骨头坏死,非手术治疗组患者中2例出现骨折移位行人工股骨头置换术。MRI显示没有髋部骨折的10例在随访过程中复查X线片均呈阴性。结论老年人髋部外伤后疼痛临床怀疑股骨颈骨折而X线平片阴性时,髋关节MRI检查值得推荐以免延误诊治。     

后路经伤椎置钉短节段复位固定治疗胸腰椎骨折

目的：探讨后路经伤椎椎弓根置钉短节段复位固定治疗胸腰椎骨折的可行性、适应证及临床疗效。方法：自2007年3月至2009年3月,采用椎弓根螺钉系统同时经伤椎置钉复位固定治疗胸腰椎骨折患者43例,男31例,女12例;年龄26～56岁,平均36.6岁。其中单椎体骨折34例,双椎体骨折4例（邻近骨折3例,跳跃骨折1例）,骨折脱位5例。脊髓神经损伤按Frankel分级：A级5例,B级2例,C级9例,D级7例,E级20例。分别于术后3～5d、12个月、末次随访时复查X线片及CT,对伤椎Cobb角、椎体压缩百分比、椎管占位、内固定物状况进行随访;通过Frankel标准对脊髓神经功能进行评定。结果：所有病例均获得随访,时间12～36个月,平均18.3个月。所有病例均获得骨性融合,无假关节形成。未出现内固定物断裂、松动等现象。伤椎Cobb角由术前的（24.5±9.5）°矫正至术后（5.3±5.1）°,末次随访时（6.2±4.7）°;椎体压缩百分比由术前（42.3±11.1）%恢复至术后（5.1±5.2）%,末次随访时（6.5±5.4）%;术后与术前比较差异有统计学意义（P〈0.05）,末次随访时与术后比较差异无统计学意义（P〉0.05）。椎管矢状径占位率由术前的（34.9±11.2）%恢复至术后（5.3±4.7）%、术后12个月时（5.4±4.5）%,术后与术前比较差异有统计学意义（P〈0.05）,术后12个月与术后比较差异无统计学意义（P〉0.05）。脊髓神经功能除3例A级无变化外,其余均有1～2级的恢复。结论：后路经伤椎置钉短节段复位固定可纠正后凸畸形、椎体压缩及椎管占位,促进脊髓神经功能恢复,是治疗胸腰椎骨折的有效方法之一。     

786例乳腺癌的病理与临床

目的:探讨乳腺癌病理与临床治疗及预后的相关因素.方法:随访并回顾性分析近年来我院收治的乳腺癌病人的病理与临床分期、治疗方法、预后情况.结果:乳腺癌的预后与肿瘤大小、组织学类型、分期、激素等多种因素有关.结论:早发现、早诊断、早治疗、合理有效的综合治疗是乳腺癌预后好的关键因素.     

升主动脉替换联合三分支支架血管术中置入治疗急性A型主动脉夹层

目的 总结升主动脉人工血管替换联合三分支支架血管术中置入治疗急性Stanford A型主动脉夹层的初步经验.方法 2008年6月至2009年9月20例急性A型主动脉夹层病人接受了升主动脉人工血管替换和三分支支架血管置入术.体外循环鼻咽温度降至20℃时,停止下半身灌注,经无名动脉近端升主动脉横断切口,将三分支支架血管置入主动脉弓和近端胸降主动脉真腔内,并将其分支支架血管依次置入左锁骨下动脉、左颈总动脉和无名动脉.将主干支架血管的近端与无名动脉近端的升主动脉切口重建后与替换近端升主动脉的人工血管端端吻合.结果 所有病人术中均顺利地置入三分支支架血管,平均体外循环(163.2±19.2)min,主动脉阻断(89.4±10.0)min,低流量选择性脑灌注和下半身缺血(32.7±6.6)min.术后出现短暂性神智障碍1例,急性肾功能衰竭1例.20例均治愈出院.术后3个月电子束CT检查结果示,主干支架血管及分支支架血管通畅、无扭曲;支架血管置入部位夹层假腔闭合;16例远端胸降主动脉夹层假腔闭合.结论 三分支支架血管术中置入是简化急性主动脉夹层者主动脉弓重建、提高手术安全性的一种有效方法.主要适应证为弓内内膜无破口而需主动脉弓重建的急性A型主动脉夹层病人.支架血管大小、分支支架血管间的距离选择和放置过程中避免内膜损伤是术中三分支支架血管成功放置的关键.

Abstract：

Objective To report the primary experience of open placement of triple-branched stent graft for acute Stanford type A aortic dissection. Methods Between June 2008 and September 2009, 20 well-selected patients with acute Stanford type A aortic dissection underwent open placement of triple-branched stent graft for total arch reconstruction. When core cooling to a 20℃ nasophageal temperature, perfusion to the lower body was discontinued and the ascending aorta was transected at the base of the innominate artery. Through a transverse incision, the triple-branched stent graft was inserted into the true lumen of the arch and descending aorta, and each side arm of the stent graft was positioned one by one into the arch branches.The transected stump of the ascending aorta was reconstructed by inner proximal stent-free dacron tube of the main graft and outer teflon felt, and subsequently continuous anastomosis to the 1-branched dacron tube graft was made. Results Open placement of triple-branched stent graft was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and lower body arrest time were (163.2 ±19.2) min, (89.4 ±10.0) min and (32. 7 ±6. 6)min, respectively. Transient postoperative neurological dysfunction was observed in 1 patient and acute renal failure in 1 patient. All patients were discharged from the hospital. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened without distortion. In the vascular stent implantation site the dissected false lumen was eliminated. The false lumen of the descending aorta distal to the stent graft was closed with thrombus in 16 cases. Conclusion Open placement of triple-branched stent graft is a new effective technique for total arch reconstruction in acute type A aortic dissection. Patients have the indications of the extensive primary repair of the thoracic aorta without primary intimal tears in the arch may be the best candidates for this new technique. The size of the stent graft, the distances between two neighboring side arm grafts and the prevention of the intimal trauma during the placement are crucial for successful open placement of triple-branched stent graft.     

番茄红素对血液透析患者静脉铁剂诱导细胞因子的影响

目的：观察维持性血液透析（MHD）患者由静脉铁剂诱导的细胞因子,探讨番茄红素对其的干预作用。方法：60例MHD患者,随机分为两组（对照组和试验组,各30例）。对照组：在患者透析时给予蔗糖铁注射液100mg,2次/周,共10次,观察时间8周。试验组：除蔗糖铁注射液使用外,同时口服番茄红素胶囊,2粒/次,2次/d,用药8周,观察时间8周。观察并比较两组患者治疗前及治疗8周后的白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、白细胞介素-18（IL-18）、肿瘤坏死因子（TNF-α）等细胞因子指标的变化。结果：两组患者治疗后IL-1β、IL-6、IL-8、TNF-α、IL-18水平较治疗前均有显著性升高（P〈0.01或〈0.05）;但是试验组升高幅度显著性小于对照组（P〈0.01）。试验组患者治疗后IL-10水平较治疗前有显著性升高（P〈0.01）;并且试验组升高幅度显著性大于对照组（P〈0.05）。治疗后两组血清IL-1β、IL-6、IL-8、TNF-α、IL-18水平均与铁蛋白（SF）呈正相关（P〈0.01）。结论：静脉铁剂治疗加剧了MHD患者免疫细胞因子的调节;番茄红素可减少细胞因子过度调节而起到抗炎症作用。     

经皮微创撬拨复位内固定手术治疗跟骨骨折

目的探讨经皮微创撬拨复位内固定手术治疗跟骨骨折的疗效。方法应用经皮撬拨复位＋螺钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折13例（14足）。术中侧位透视观察Bhler和Gissane角,Broden位观察后关节面的复位情况。围手术期常规应用抗生素防止感染。结果13例均获随访,时间3～12（5.6±2.0）个月。骨折愈合时间2.5～3.2（2.8±0.3）个月。按Maryland足部评分系统：优9足,良4足,中1足。未发生皮缘坏死、伤口感染及腓肠神经损伤等并发症。结论经皮撬拨复位＋螺钉内固定技术,适用于骨折粉碎程度较轻,塌陷不严重的跟骨骨折,尤其是SandersⅡ型。具有术后伤口恢复快、并发症少的优点。