双侧经寰枢关节螺钉及寰椎椎板钩内固定系统的三维有限元研究

目的 探讨双侧经寰枢关节螺钉及寰椎椎板钩内固定系统的生物力学性能.方法 健康男性志愿者,年龄28岁,身高172 cm ,体重60 kg ,X线检查排除枕颈部畸形;对志愿者进行枕骨底到第三颈椎(C0-3)薄层CT扫描,建立具有详细解剖结构的上颈椎(C0-3)有限元模型并验证其有效性.在寰枢椎不稳的上颈椎模型中模拟双侧经寰枢关节螺钉及寰椎椎板钩固定并进行三维有限元对比分析.结果 上颈椎三维非线性有限元模型的仿真性好,可以进行生物力学分析.双侧经寰枢关节螺钉及寰椎椎板钩内固定系统中螺钉在经过寰枢关节部位时应力最大,有良好的生物力学稳定性.结论 双侧经寰枢关节螺钉及寰椎椎板钩固定是一种实用、有效的寰枢椎融合方式.     

胸腔镜或头灯光源辅助的小切口胸腰椎前路手术

目的：探讨胸腔镜或头灯光源辅助下小切口胸腰椎前路病灶清除和重建术的疗效及并发症。方法：63例胸腰椎疾病患者，胸腰椎爆裂性骨折25例，胸腰椎结核28例（均伴有腰椎冷脓肿或死骨），胸腰椎转移性肿瘤6例，嗜酸性肉芽肿1例，动脉瘤样骨囊肿1例，胸椎间盘突出症2例。神经功能Frankel分级：A级4例，B级4例，C级5例．D绒8例，E级42例。采用胸腔镜光源辅助下小切口手术35例，头灯光源辅助下小切口手术28例。病灶清除重建植骨术24例，病灶清除植骨钉板内固定39例。结果：切口长度5．7cm，平均5．8cm。平均手术时间210min，平均术中小血量650ml。术后神经功能A级4例，B级1例，C级2例，D级10例。E级46例。并发胸腔积液2例，肺不张2例，脑脊液漏1例，股外侧皮神经或肋间神经损害7例，经治疗均治愈。42例获半年～2年，平均1.1年随访，无植骨脱出或内固定失效，植骨均获愈合，畸形得到矫正，结核无复发，1例转移性肿瘤复发。结论：光源辅助下小切口腰腰椎前路手术克服了常规开胸手术切口长、创伤大、术后恢复慢等缺点，同时也克服了标准“锁孔”胸腔镜技术操作口过小、完全镜下操作、技术要求高、不易推广等缺点．是并发症较少、便于推广的较安全微创技术。     

老年腹股沟疝无张力修补术与传统修补术的比较

目的 比较无张力腹股沟疝修补术与传统腹股沟疝修补术在老年患者中应用的临床结果、术后生活质量和经济开支。方法 自2000～2001年60岁以上的老年患者42例行腹股沟疝无张力修补术与42例行传统腹股沟疝修补术者，分类比较。结果　无张力腹股沟疝修补术对于老年患者在复发率、术后镇痛、手术时间和术后下地时间方面均明显优于传统腹股沟疝修补术。结论　无张力腹股沟疝修补术运用在老年患者中，近远期效果均优于传统修补手术。     

Inhibition of Autophagy by 3-MA Enhances the Effect of 5-FU-Induced Apoptosis in Colon Cancer Cells

Background  5-fluorouracil-(5-FU)-based adjuvant chemotherapy is widely used for the treatment of colorectal cancer. However, 5-FU resistance in the course of treatment has become more common. Therefore, new therapeutic strategies and/or new adjuvant drugs still need to be explored. Methods  Two colon-cancer-derived cell lines, colon26 and HT29, were used to investigate the effect of 5-FU, 3-methyladenine (3-MA, an autophagy inhibitor), or their combination on apoptotic cell death and autophagy. MTT assay, Hochest plus propidium iodide (PI) staining, and DNA fragmentation assay were used to observe apoptosis. Meanwhile, monodansylcadaverine (MDC) was used to detect autophagy. Finally, immunoblotting assay was used to explore the molecular change that occurred. Results  We observed the apoptosis induced by 5-FU in colon cancer cells. Meanwhile, autophagy was also stimulated. The combination treatment of 3-MA and 5-FU significantly increased the apoptotic cell death. By isolating the subcellular fractions of mitochondria and cytosol, we observed that the release of cytochrome c was increased in combination-treated cells. Cytochrome c resulted in the activation of caspase-3, thus activating PARP. Moreover, the anti-apoptotic protein, Bcl-xL, was significantly downregulated by 3-MA. Conclusions  Our results suggest that 5-FU-induced apoptosis in colon cancer cells can be enhanced by the inhibitor of autophagy, 3-MA. Autophagy might play a role as a self-defense mechanism in 5-FU-treated colon cancer cells, and its inhibition could be a promising strategy for the adjuvant chemotherapy of colon cancer.     

Study of telomerase activity in pleural lavage fluid specimens in patients with non-small-cell lung cancer and its clinical significance

Objective: To detect telomerase activity in pleural lavage fluid specimens in patients with non-small-cell lung cancer (NSCLC) and to evaluate its clinical value. Methods: From July 2005 to May 2007, 167 pleural lavage fluid specimens were obtained from 135 patients with NSCLC and 32 patients with benign lung tumour during operation. Telomeric repeated amplification protocol (TRAP)-enzyme-linked immunosorbent assay (ELISA) was performed to measure the telomerase activity in these specimens. Pleural lavage cytology (PLC) analysis of the pleural lavage fluid specimens was used for comparison. All the above specimens were examined within 3 h. Results: The positive rate of telomerase activity and PLC in pleural lavage fluid from patients with NSCLC was 25.2% (34/135) and 8.1% (11/135), respectively, with a significant difference (P < 0.05). Telomerase activity was detected in all 11 specimens with positive cytological examination. Telomerase activity was negative in all 32 patients with benign lung tumour. There was a significant relationship between telomerase activity and pleural extension, T level, N level as well as the clinical TNM (tumour, node, metastasis) stage of lung cancer. A significant association was found between positive telomerase activity and overall survival rate, even stage I survival rate. Multivariate Cox regression analysis demonstrated that telomerase activity, as well as PLC and the TNM stage were independent predictors of prognosis. Conclusion: Telomerase activity is a useful adjunct for cytological method in the diagnosis of pleural micro-metastasis and was related to prognosis in a patient with NSCLC.     

Successful use of posterior instrumented spinal fusion alone for scoliosis in 19 patients with neurofibromatosis type-1 followed up for at least 25 months

Introduction  Posterior instrumented fusion alone has been considered inadequate to correct scoliosis in most patients with neurofibromatosis type-1 (NF-1) because of their weak bone structure. This study was undertaken to evaluate whether the extension of fusion one level beyond the conventional fusion level would enable posterior instrumented fusion alone to be as effective as anterior–posterior fusion in treating patients with NF-1 and scoliosis who are more than 10 years old and whose scoliosis is <90°. Methods  Nineteen patients with NF-1 were treated surgically with long, posterior instrumented fusion for scoliosis from 1998 to 2004. Among the patients, 3 had nondystrophic curves, and 16 had dystrophic curves. Posterior fusions were performed that used abundant bone grafts, and included neutral and stable vertebrae in both the coronal and sagittal planes and any coronal curves of more than 40°. Results  The mean coronal and sagittal Cobb’s angles in the nondystrophic curves were 79° and 16° before surgery, 31° and 12° after surgery, and 37° and 15° at follow-up, respectively. In the dystrophic thoracic curves, the Cobb’s angles in the coronal and sagittal planes before and after surgery and at follow-up were 68° and 31°, 27° and 28°, and 33°and 30°, respectively. There were no cases of coronal or sagittal decompensation, neurologic complications, or infections. There were eight (42.1%) complications, three intraoperative and five late. Pseudarthrosis with instrumentation failure that required revision surgery occurred in one (5.2%) patient. Conclusions  These results demonstrate that a satisfactory stabilization of scoliosis can be achieved by posterior fusion with instrumentation alone in patients with NF-1 who are more than 10 years old, and whose scoliosis is <90°. Contributions of authors: All authors meet the criteria for authorship. All authors accept full responsibility for the study, had access to the data, analyzed the data, and made the decision to publish.     

不同剂量罗库溴铵在颅脑手术中的肌松效应

目的比较罗库溴铵不同剂量配伍在颅脑手术麻醉诱导和维持中的肌松效应。方法择期颅脑手术患者45例,年龄20~60岁,随机分为三组,每组15例。诱导时分别接受罗库溴铵0.6mg/kg(Ⅰ组)、0.75mg/kg(Ⅱ组)和0.9mg/kg(Ⅲ组)。记录拇指肌诱发颤搐反应的抑制过程和恢复过程,在肌松作用消退25%时,三组分别追加罗库溴铵0.6、0.45和0.3mg/kg。评价给药前后血液动力学的波动及肌松起效时间、提供插管条件、肌松维持时间、恢复时间、总时效等效能指标。结果Ⅲ组拇指肌颤搐抑制5%的时间明显短于Ⅰ组和Ⅱ组(P<0.05),但达到最大抑制时间三组无显著性差异(P>0.05);插管条件Ⅲ组优秀率明显较Ⅰ、Ⅱ组高(P<0.05,P<0.01);诱导量恢复5%及25%的时间Ⅲ组明显延长(P<0.01)。三组维持量起效时间及维持时间比较有极显著性差异(P<0.01),但诱导量加维持量总时效无显著性差异;给药前后三组血液动力学变化无显著性差异(P>0.05)。结论罗库溴铵在颅脑手术麻醉中建议使用0.9mg/kg诱导,0.3mg/kg维持。     

经尿道前列腺电汽化切除加雄激素阻断治疗晚期前列腺癌

目的探讨经尿道前列腺电汽化切除加雄激素阻断治疗晚期前列腺癌的临床疗效。方法对31例前列腺癌晚期(D)患者采用经尿道前列腺电汽化切除及睾丸切除术,术后3~5d口服氟他胺做全雄激素阻断以及氟他胺加达菲林的药物去势治疗。结果随访3~42个月,生存者29例,2例患者生存超过5年,20例超过1年。其中7例骨转移病灶减少,6例骨痛患者治疗后疼痛消失。前列腺特异性抗原(PSA)从术前的75.37μg/L降至1.34μg/L(术后1个月),3个月后降为0.27μg/L。B超、胸片、骨扫描未见新的转移灶。结论经尿道前列腺癌电汽化切除加全雄激素阻断治疗晚期前列腺癌具有较好的临床疗效。     

胃代膀胱术远期疗效观察

目的 探讨胃代膀胱术的远期疗效。方法 对1991年5月至2003年10月30例胃代膀胱术患者的临床资料进行统计分析。其中膀胱肿瘤28例，结核性膀胱挛缩2例。结果 随访8～13年，平均10年。30例全身健康情况良好，日间排尿满意，3例偶有夜间尿失禁。1例术后19个月发生代膀胱穿孔，经抗酸和手术治疗痊愈。30例肾功能正常，无电解质紊乱；24例排尿前后胃泌素及尿液pH检查正常；4例有无症状菌尿。13例代膀胱黏膜活检为慢性炎症，壁细胞减少；9例免疫组化检查G细胞较正常减少。尿动力学检查代膀胱容量及顺应性正常，排尿期贮尿囊压力低于正常。10例行排尿期膀胱造影无输尿管返流，5例B超示肾集合系统轻度扩张。1例低压胃膀胱成形术，1例胃与后尿道逆蠕动吻合，剩余尿分别为150ml和250ml。1例出现血尿尿痛综合征，经抗酸及碱化尿液治疗后缓解。结论 胃代膀胱术远期疗效满意，是一种较好的尿流改道方法。