胸椎多节段爆裂性骨折伴完全性脱位1例

胸椎多节段爆裂性骨折伴完全性脱位是最严重的脊柱创伤之一,通常由高能量创伤引起,会导致复杂的脊柱脊髓损伤,大多同时伴有严重的合并伤,易危及患者生命,往往给治疗带来巨大挑战。虽然目前对这类损伤的手术时机、入路、复位方式及固定节段长度尚无明确共识,但为了重建脊柱序列和稳定性、减少骨折相关并发症、改善患者生活质量,都需要及时进行手术复位、椎管减压、植骨融合内固定。     

散发性帕金森病患者γ-synuclein基因的研究

目的 探讨γ-synuclein基因C243G和A377T多态在散发性帕金森病(Parkinson’s disease，PD)的疾病易感性中的意义。方法 采用聚合酶链反应-限制性片段长度多态法，对上海汉族人中145例PD患者和184名正常人进行γ-synuclein基因C243G和A377T多态分型，并作与PD的遗传关联研究。结果 PD患者与正常对照间γ-synuclein基因C243G和A377T多态分布的差异无显著性，两种多态与PD亦无关联(P值均大于0．05)。结论 上海地区汉族人群中γ-synuclein基因C243G和A377T多态与散发性PD无关。     

Hydrocelectomy under local anaesthesia in a Nigerian adult population

Background

Hydrocele is abnormal collection of serous fluid in the tunica vaginalis or a patent processus vaginalis. It is commonly encountered in our practice and often requires surgical treatment. However in our setting and in many underdeveloped countries, availability of general anaesthetic service is poor due to lack of trained personnel and equipment.

Objectives

To ascertain the practicability and acceptability of hydrocelectomy under sedation and local anaesthesia in Nigerian adults with hydrocele

Patients and Methods

A prospective study was carried out over a two year period on patients that had hydrocelectomy at the surgery unit of the Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa. Consecutive patients with diagnosis of hydrocele who consented had hydrocelectomy using intramuscular diazepam sedation and spermatic-cord block with 0.5% plane xylocaine and the scrotum infiltrated with same along the line of incision.

Results

Fifty adult patients were studied: age range 15–94 years. Eighty percent of the patients had unilateral hydrocele and the commonest type was vaginal hydrocele (94%). All patients had hydrocelectomy, 96% were under local anaesthesia while 4% were converted to general anaesthesia. All patients except one prefer to have future surgery under such local anaesthesia and sedation.

Conclusion

Hydrocelectomy under local anaesthesia and sedation is practicable and was tolerated and accepted by the adults patients studied.     

3.0T磁共振钆塞酸二钠磁共振胆管造影术在胆管疾病中应用

目的探讨3.0T磁共振钆塞酸二钠(Gd-EOB-DTPA)磁共振胆管造影术(MRC)在胆管疾病中的诊断价值。方法选取2016年7—12月解放军309医院收治的20例患胆道梗阻或其他病变需行Gd-EOB-DTPA MRC检查的患者,采用3.0T超导磁共振扫描仪,对所有20例患者行常规上腹部平扫+磁共振胰胆管造影(MRCP)+Gd-EOB-DTPA动态增强扫描,以及肝胆特异期、T1容积内插体部检查(VIBE)冠状位+轴位扫描,并将冠状位图像进行最大密度投影(MIP)重建,获得胆管树图像。对各序列的影像学特征做出诊断,并与穿刺、手术病理、内镜下逆行胰胆管造影术及相关临床资料进行对照。结果本组20例患者中,胆管解剖变异者7例。其中,胆囊管经胆总管前方汇入胆总管左侧壁1例,经胆总管后方汇入胆总管左侧壁3例,胆囊管开口于肝外胆管下1/3处2例,胆囊管汇入右肝管1例。胆管梗阻11例,其中,完全性梗阻8例(肝门部胆管恶性占位5例、胆总管恶性占位1例、胆总管下端结石1例,胆总管周围淋巴结转移1例);部分梗阻3例(胰头占位1例,胆总管结石1例,胃窦癌侵及胆总管1例)。胆漏2例。硬化性胆管炎1例。其中,1例患者同时有胆漏及胆囊管汇入右肝管变异。结论 Gd-EOB-DTPA MRC检查能够直接显示肝内外胆管系统解剖结构以及胆管通畅情况,能为胆管疾病的诊断提供更多的信息,可以进一步应用于胆管疾病的检查。     

病原真菌外排转运蛋白与真菌耐药的研究进展

病原真菌通过对抗机体防御系统和抗真菌药物的攻击,从而成功定植于宿主体内并最终导致机体感染,真菌外排转运蛋白在上述过程中起着重要作用,主要包括ATP结合盒转运蛋白(ATP-binding cassette transporters,ABC)与主要易化子超家族(the major facilitator super family,MFS),分别通过与ATP水解酶或质子梯度耦合来运输并清除真菌胞内的毒性物质。与其它生物相比,真菌基因组中具有更多转运蛋白家族编码基因,这些转运蛋白不仅对真菌致病过程中所产生的代谢产物和宿主细胞分泌的抗菌成分起外排作用;同时,在病原真菌对抗临床抗真菌药物中也发挥着重要作用。本文就这两个超家族的转运蛋白在主要病原真菌耐药性中所发挥的作用进行综述。     

兔骨髓间充质干细胞的体外分离培养、低温冻存及复苏研究

目的寻求体外培养、冻存、复苏兔骨髓间充质十细胞（bone marrow mesenehymal stein cell,BMMSC）的方法,观察体外培养BMMSC的形态及生长特性,研究低温冻存对兔BMMSC生长的影响,为兔BMMSC进一步的实验研究打下基础。方法取新西兰白兔胫骨穿刺获取骨髓液,密度梯度离心法联合贴壁培养法体外纯化扩增,并行液氮冻存3个月。通过倒置显微镜观察其生物学表现,并进行细胞增殖活性分析．绘制生长曲线。结果兔BMMSC为贴壁生长,形态为均匀成纤维细胞样,增殖能力强,传代及冻存后细胞仍然保持其生物学特性。结论兔BMMSC可采取密度梯度离心法联合贴壁培养法进行较好地纯化和扩增,并町长期保存于液氮中,在一定的条件下可复苏存活,冻存不影响细胞的增殖能力。     

磁共振尿路成像诊断肾移植输尿管坏死

目的:探讨磁共振尿路成像(MRU)诊断肾移植输尿管坏死的价值。材料和方法:12例肾移植术后怀疑输尿管坏死患者,临床表现为移植肾区肿痛、少尿或无尿,B超提示移植肾盂积水,输尿管扩张,移植肾周积液,用重T2WI快速自旋回波序列和脂肪抑制技术行MRU检查。结果:MRU均显示移植肾盂及肾盏扩张,输尿管上段扩张,重T2WI表现为高信号。输尿管连续性消失,其下方为局限性包裹液性区。在渗出的包裹性尿液邻近或下方可见高信号的膀胱影。12例患者均接受手术探查,术中均发现输尿管有坏死,坏死部位与MRU显示输尿管连续性消失部位一致,输尿管坏死下方可见渗出的尿液,与MRU所见局限性包裹液性区相吻合。结论:MRU诊断肾移植后输尿管坏死具有极高诊断价值。     

Heart rate variability as a predictor of hypotension following spinal for elective caesarean section: a prospective observational study

Post‐spinal hypotension remains a common and clinically‐important problem during caesarean section, and accurate pre‐operative prediction of this complication might enhance clinical management. We conducted a prospective, single‐centre, observational study of heart rate variability in 102 patients undergoing elective caesarean section in a South African regional hospital. We performed Holter recording for ≥ 5 min in the hour preceding spinal anaesthesia. The low‐frequency/high‐frequency ratio component of heart rate variability was compared, using a logistic regression model, with baseline heart rate and body mass index (BMI) as a predictor of hypotension (defined as systolic arterial pressure < 90 mmHg) occurring from the time of spinal insertion until 15 min after delivery of the baby. We also assessed clinically relevant cut‐point estimations for low‐frequency/high‐frequency ratio. Low‐frequency/high‐frequency ratio predicted hypotension (p = 0.046; OR 1.478, 95%CI 1.008‐1.014), with an optimal cut‐point estimation of 2.0; this threshold predicted hypotension better than previously determined thresholds (p = 0.003; c‐statistic 0.645). Baseline heart rate (p = 0.20; OR 1.022, 95%CI 0.988‐1.057) and BMI (p = 0.60; OR 1.017, 95%CI 0.954‐1.085) did not predict hypotension. Heart rate variability analysis is a potentially useful clinical tool for the prediction of hypotension. Future studies should consider a low‐frequency/high‐frequency ratio threshold of 2.0 for prospective validation.     

Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy

Background  

Computer-assisted surgery (CAS) can act as an intraoperative ruler in high tibial osteotomy (HTO) to visualize continuously the leg during surgery.