前路病灶清除植骨内固定术治疗胸腰椎结核

目的探讨在胸、腰椎结核外科治疗中,前路病灶清除植骨内固定术对清除结核病灶,对脊髓神经的减压及重建脊柱稳定性的重要性。方法对2000年10月~2004年6月共收治的胸、腰椎结核患者46例,采用前路病灶清除自体髂骨植骨38例,异体深冻骨植骨并胸、腰椎前路钛钢板内固定8例。结果经过平均18个月的随访,长达1~1.5年的抗结核治疗,44例患者结核治愈,植骨融合时间平均为5.2个月。术前截瘫、不全瘫或伴有神经症状者均有不同程度的恢复;1例内固定松动、异体深冻骨植骨未融合;1例复发,但其异体深冻骨植骨块及内固定位置良好,经继续抗结核治疗6个月后结核治愈。结论前路病灶清除,自体髂骨植骨,钛钢板内固定对胸、腰椎结核疗效肯定,异体深冻骨植骨存在融合慢或不融合的问题。     

The research for the function evaluation of facial nerve and the mechanisms of rehabilitation training

Background:Peripheral facial paralysis (PFP) is a common peripheral neural disease. Acupuncture treatment combined with PFP rehabilitation exercises is a routine method of PFP treatment. This article is to provide a new visual and objective evaluation method for exploring the mechanism and efficacy of acupuncture treatment on PFP, and develop an interactive augmented facial nerve function rehabilitation training system with multiple training models.Methods:This prospective and observational trial will recruit 200 eligible participants for the following study. In the trial, the laser speckle contrast analysis (LASCA) technology will be applied to monitor the microcirculation of facial blood flow during acupuncture, and real-time monitoring algorithms, data sampling, and digital imaging methods will be conducted by machine learning and image segmentation. Then, a database of patient facial expressions will be built, the correlation between surface blood flow perfusion volume and facial structure symmetry will be analyzed, combined with scale assessment and electrophysiological detection. In addition, we will also explore the objectivity and effectiveness of LASCA in the evaluation of facial paralysis (FP), and the changes in blood flow microcirculation before and after acupuncture treatment will be analyzed.Results:The standard image of the facial target area with facial nerve injury will be manually segmented by the convolutional neural network method. The blood flow images of the eyelid, cheek, and mandible of the patients’ affected and healthy side will be compared and evaluated. Laser speckle blood flow symmetry Pr and its changes in FP condition evolution and prognosis outcome will be measured, and relevant characteristic signals values will be extracted. Finally, COX regression analysis method is conducted to establish a higher accuracy prediction model of FP with cross-validation based on laser speckle blood flow imaging technology.Conclusions:We use modern interdisciplinary high-tech technologies to explore the mechanism of acupuncture rehabilitation training in PFP. And we will provide evidence for the feasibility of using the LASCA technique as a typing diagnosis of FP in the acupuncture rehabilitation treatment of PFP.Registration number:ChiCTR1800019463     

透明帽辅助内镜下取出食管异物疗效的Meta分析

目的评价透明帽辅助内镜下取出食管异物的临床价值。方法通过计算机检索Pubmed、CNKI数据库、Web of Knowledge、Cochrane图书馆对照试验注册库和万方数据库从建库至2017年的有关透明帽辅助内镜取出食管异物的相关文献,采用Cochrane协作网提供的RevMan 5.0版软件进行统计处理,对纳入资料的异质性进行分析,计算OR值和95%可信区间。结果按照入选标准,纳入了9项临床试验,共1 103例患者。Meta分析结果显示:透明帽辅助内镜异物取出术成功率更高(OR=8.58,95%CI:4.49～16.38,P 0.05)、视野更清晰(OR=7.35,95%CI:5.20～10.40,P 0.05)、并发症发生率低(OR=0.34,95%CI:0.25～0.46,P 0.05)、患者耐受性好(OR=2.78,95%CI:2.08～3.72,P 0.05)。结论透明帽辅助内镜下食管异物取出术是一种安全有效的内镜下取异物的方法,其患者耐受性好,可提供更好的内镜下操作视野,有利于提高手术成功率,值得进一步推广应用。     

Evaluation of angiosome-targeted infrapopliteal endovascular revascularization in critical diabetic limb ischemia

Objective To evaluate the rates of wound healing and limb preservation following angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia.Methods We performed a retrospective analysis of data gathered from 102 infrapopliteal angioplasty cases (60 males and 42 females; mean age, 72 ± 11 years) with Fontaine IV ischemia (ankle-brachial index, ABI: 0.16 ± 0.06). Forty-seven angioplasties were performed based on the angiosome concept (direct revascularization, DR), while 55 did not incorporate the angiosome concept (indirect revascularization, IR). The curative effects of angioplasty were assessed by postoperative determinations of ABI performed every 3 months during clinical follow-up visits conducted to assess healing of the ischemic wound. Amputation and death events were recorded throughout the study.Results All 102 patients were successfully revascularized without complications, and during a mean follow-up period of 18 ± 11 months, the mean postoperative ABI improved to 0.84 ± 0.10. The postoperative 6 and 12 month healing rates in the DR group were 85.1% and 93.5%, respectively, while the limb-salvage rates were 100% and 93.5%, respectively. The postoperative 6 and 12 month healing rates in the IR group were 60% and 76.4%, respectively, while the limb-salvage rates were 90.1%, and 85.5%, respectively.Conclusion Angiosome-based Infrapopliteal angioplasty was associated with better wound healing and higher rates of limb salvage in cases of critical diabetic foot ischemia. Revascularization should be provided to patients who have undergone indirect perfusion of the ischemic angiosome, as acceptable rates of limb salvage are obtained.     

两种恢复方式对士兵冲刺间歇训练效果的影响

 目的 探讨冲刺间歇训练时两种恢复方式(积极性恢复 vs. 消极性恢复)对士兵运动能力和训练效果的影响。方法 选取18名男性武警士兵完成6组冲刺间歇训练(30 s Wingate全力蹬车试验),间歇期(4 min)分别进行消极性恢复(即在功率自行车上休息)和积极性恢复(以1.1 W/kg负荷继续蹬车),每次Wingate试验时(不包括间歇期)记录峰值功率(PP)、平均功率(MP)、疲劳指数(FI)、总做功(TW)和心率(HR)等参数。结果 与消极性恢复比较,积极性恢复PP在第2次Wingate试验时降低(P<0.05),MP和HR在第4~6次Wingate试验时升高,差异均有统计学意义(P<0.05),FI和TW差异无统计学意义(P>0.05)。结论 积极性恢复可提高冲刺间歇训练后期的训练效果, 士兵应根据训练方案选择合理的恢复方式。     

Persistence of side population cells with high drug efflux capacity in pancreatic cancer

AIM： To investigate the persistence of side population （SP） cells in pancreatic cancer and their role and mechanism in the drug resistance. METHODS： The presentation of side population cells in pancreatic cancer cell line PANC-1 and its proportion change when cultured with Gemcitabine, was detected by Hoechst 33342 staining and FACS analysis. The expression of ABCB1 and ABCG2 was detected by real- time PCR in either SP cells or non-SP cells. RESULTS： SP cells do exist in PANC-1, with a median of 3.3% and a range of 2.1-8.7%. After cultured with Gemcitabine for 3 d, the proportion of SP cells increased significantly （3.8% ± 1.9%, 10.7% ± 3.7%, t = 4.616, P = 0.001 〈 0.05）. ABCB1 and ABCG2 expressed at higher concentrations in SP as compared with non-SP cells （ABCB1： 1.15 ± 0.72, 5.82 ± 1.16, t = 10.839, P = 0.000 〈 0.05; ABCG2： 1.16 ± 0.75, 5.48 ± 0.94, t = 11.305, P = 0.000 〈 0.05）, which may contribute to the efflux of fluorescent staining and drug resistance. CONCLUSION： SP cells with inherently high resistance to chemotherapeutic agents do exist in pancreatic cancers, which may be candidate cancer stem cells contributing to the relapse of the tumor.     

Plasma Levels of Interleukin 18, Interleukin 10, and Matrix Metalloproteinase-9 and -137G/C Polymorphism of Interleukin 18 Are Associated with Incidence of In-stent Restenosis After Percutaneous Coronary Intervention

This study aims to investigate the relationship between the levels of IL-18, IL-10, and MMP-9 and -137G/C polymorphism of interleukin 18 with the risk of in-stent restenosis (ISR). The study population consisted of 68 patients with ISR, 173 in non-ISR group, treated with drug-eluting stent and evaluated by coronary angiography post-procedure and at follow-up, and also 109 without angiographic evidence of coronary artery disease (CAD) which formed a reference control group (non-CAD group). The sequential plasma IL-18, IL-10, and MMP-9 levels were assessed at admission, 24 h, and 2 weeks after percutaneous coronary intervention. The -137G/C polymorphism of IL-18 was genotyped by the ligase detection reaction-polymerase chain reaction. Plasma IL-18 and MMP-9 increased significantly from admission, peaking after 24 h and fall after 2 weeks. Compared with the non-ISR group, the ISR group had higher levels of IL-18 and MMP-9, but IL-10 level was the opposite. The -137GG genotype of IL-18 was significantly higher than of the CG and CC genotypes. A significant higher frequency of -137G allele or GG genotype of IL-18 was observed in patients with ISR group compared with the non-ISR group. There is correlation between the changes of IL-18, IL-10, MMP-9, and ISR. IL-18 promoter -137G/C polymorphism influences IL-18 levels and the susceptibility to ISR, suggesting that IL-18-mediated pathways are causally involved in the process of ISR.     

Reliability of Lateral Cephalometric Radiographs in the Assessment of the Upper Airway in Children: A Retrospective study

ObjectivesTo test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue.Materials and MethodsThe records of 57 healthy Chinese children from a nonhospital population (mean age = 12.6 years, SD = 0.5, 28 males and 29 females) who received two consecutive LCRs in the natural head posture were retrospectively analyzed. Fifteen linear, angular, and area measurements were used to describe the airway, hyoid bone, soft palate, and tongue. The reliability between the two LCRs was assessed with the intraclass correlation coefficient (ICC) and F-test. Errors were estimated with the Dahlberg and Bland-Altman method, and intra- and inter-assessor agreements were determined.ResultsMeasurements of upper airway and hyoid bone had excellent method reliability, intra-assessor reliability, and inter-assessor reliability (ICC > 0.8). However, the method reliability and the inter-assessor reliability for soft palate and tongue was less favorable (ICC from 0.60 to 0.96). Soft palate area and thickness were the most critical parameters. Intra-assessor reliability was greater than both method reliability and inter-assessor reliability (which were similar).ConclusionsThe measurement of upper airway morphology, defined as the intramural space, and of the hyoid bone position were highly reliable on LCRs of children. However, the limited reliability in the assessment of tongue and soft palate area may compromise the diagnostic application of LCRs to these structures.     

抗结核药物研究进展

结核病病例一般集中在发展中国家。抗结核领域一直以来未受到学术界和制药企业的关注,随着多药耐药结核病和广泛耐药结核病不断出现,以及艾滋病患者感染结核杆菌的病例逐渐增加,抗结核药物的研究已成为药物研发领域中的一个热点。本文系统地总结了已上市抗结核药物及正处在研发阶段的新型化学实体,根据其作用机制划分为4个大类,同时结合近期文献报道对其作用机制进行了简要阐述。在过去40年中,只有两种全新作用机制的新药：贝达喹啉与德拉马尼上市,以ATP合成酶抑制剂为代表的具有新型作用机制的药物将有望成为抗结核药物研发的重点。