少、弱精子症中精子形态缺陷类型及发生率的检查分析报告

目的 探讨在少、弱精子症中精子形态缺陷类型及其发生率.方法 对精液常规和改良巴氏染色检查的结果进行统计学分析.结果 （1）男性不育症中畸形精子症的发生率约为75%;精子头部缺陷的发生率约为70%,各种头部缺陷中空泡头畸形的发生率占首位,约为20%.（2）少精子症患者的正常形态精子百分率的中位数约为2.97%（P=0）,弱精子症患者的中位数为6.67%（P=0.003）.结论 （1）精子头部缺陷是精子畸形的主要类型;（2）少、弱精子症的畸形精子比例升高;（3）精子形态缺陷分析对选择辅助助孕方式具有应用价值.     

pcDNA3/AFP/TK/Angio融合基因靶向性治疗人原发性肝癌的实验研究

目的研究pcDNA3/AFP/TK/Angio融合基因对人肝癌细胞系SMMC-7721裸鼠移植瘤模型的靶向性治疗作用。方法建立人原发性肝癌裸鼠皮下移植瘤模型,将荷瘤裸鼠随机分成肿瘤对照组、空质粒组、丙氧鸟苷（GCV）组、pcDNA3/TK/Angio组及pcDNA3/AFP/TK/Angio组5组。于瘤体内分别直接注射不同的质粒,同时于裸鼠腹腔内注射GCV,观察不同时段皮下肿瘤的生长情况并做病理学检查,免疫组化法检测肿瘤微血管密度（MVD）以及血管内皮细胞生长因子（VEGF）的表达量,原位末端标记（TUNEL）法检测细胞原位凋亡。放免法检测裸鼠血清甲胎蛋白（AFP）的变化,透射电镜观察肿瘤细胞超微结构的变化。结果裸鼠皮下成瘤率100%;pcDNA3/TK/Angio组及pcDNA3/AFP/TK/Angio组的肿瘤体积、血清AFP含量、肿瘤MVD和VEGF表达强度均明显低于对照组、空质粒组和GCV组（P〈0.05）,细胞凋亡指数都明显高于后3组（P〈0.05）,可见较多的凋亡细胞。而pcDNA3/AFP/TK/Angio组的肿瘤体积、AFP、MVD及VEGF表达强度又明显低于pcDNA3/TK/An-gio组（P〈0.05）,凋亡指数高于后者（P〈0.05）。结论pcDNA3/AFP/TK/Angio融合基因系统可显著抑制肿瘤的生长,有望成为治疗原发性肝癌的新型生物制剂之一。     

微创经皮肾造瘘输尿管镜取石术的并发症及处理

目的：探讨微创经皮肾输尿管镜碎石术（MPCNL）治疗复杂性上尿路结石中产生并发症的种类、原因及相应处理方法。方法：回顾性分析接受MPCNL治疗的246例复杂性上尿路结石患者的临床资料,记录所有产生的并发症及其相关处理和转归情况并进行分析。结果：共有84例（34．15％）患者术后存在不同程度的结石残留,11例（4．47％）输尿管支架管放置不到位,4例术后3天内造瘘管脱出肾实质外,另有3例等待二期MPC—NL治疗的患者术后8～10天时肾造瘘管脱出,发生率分别为1.63％和16．67％（P〈0．001）;8例（3．252％）术中出现穿刺位置肾脏皮质撕裂,2例（0．81％）出现肾盏颈部撕裂,手术穿刺穿破肾脏动脉段内分支共计4例（1．63％）,1例（O．41％）穿破肾脏中段分支动静脉,造成动静脉瘘,3例（1．22％）出现气胸,26例（10．57％）术后发生感染。结论：手术适应证的掌握、术者经验的积累和充分术前准备均有助于减少并发症,而在有些不可避免的并发症产生时,除作开放手术处理外,还可应用动脉数字显影等新技术干预或跨学科联合治疗。     

踝关节镜下治疗距骨剥脱性骨软骨炎

目的探讨踝关节镜技术在距骨剥脱性骨软骨炎治疗中的应用及效果。方法对17例距骨剥脱性骨软骨炎患者施行踝关节镜手术,在关节镜下对损伤关节面清创、搔刮及钻孔。结果随访14．54个月。踝关节Kofoed评分由术前平均56．5分提高至89．4分,17例中优6例,良8例,可2例,差1例,优良率为82．4％。结论踝关节镜下手术治疗距骨剥脱性骨软骨炎,疗效确切,具有创伤小、并发症少、恢复快等优点。     

血管变异型前臂背侧皮瓣修复手部皮肤软组织缺损

目的 探讨骨间后动脉血管变异时前臂背侧皮瓣的切取方法.方法 以骨间后动脉为蒂逆行岛状皮瓣转移修复手部皮肤软组织缺损时,遇到血管变异共9例,采取以骨间后动脉桡侧支为蒂切取逆行岛状前臂背侧皮瓣、以骨间后动脉近端为蒂切取游离骨间后动脉皮瓣、以骨间后动脉穿支为蒂切取游离前臂背侧穿支皮瓣等方法,进行皮瓣转移或移植修复手部创面.结果 9例皮瓣中有8例顺利存活;1例术后2 d皮瓣远端出现肿胀、青紫、小水泡,及时对症处理,5 d后部分皮缘形成干痂,皮瓣颜色恢复正常,脱痂后存活.9例随访3个月至2年,皮瓣质地柔软,弹性好,外形满意.结论 以桡骨间后动脉侧支为蒂的前臂背侧皮瓣逆行转移,以骨间后动脉近端或骨间后动脉穿支为蒂的前臂背侧皮瓣游离移植修复手部创面,是解决骨间后动脉血管变异较理想的方法.     

One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion

STUDY DESIGN: A retrospective clinical study of 1-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region (MTSUTR). OBJECTIVE: MTSUTR has rarely been documented in the literature. We present a retrospective clinical study of 23 patients with MTSUTR treated by anterior decompression, strut autografting, posterior instrumentation, and fusion. The purpose was to determine the clinical efficacy of such surgical treatment for MTSUTR. SUMMARY OF BACKGROUND DATA: It is considered safe and effective to treat surgically tuberculous spondylitis with local spinal cord compression. Many reports have documented a good clinical efficacy of surgical management for spinal tuberculosis. However, how to deal with MTSUTR is rarely reported in the literature. METHODS: There were 14 men and 9 women, with average age of 35 years. All patients underwent 1 stage anterior debridement, strut autografting, and posterior instrumentation and received combined medication antituberculosis chemotherapy for 12 to 24 months (average 18 mo). The following data were followed up for an average period of 42 months (24 to 60 mo) in these patients: deformity angle, neurologic function, and spinal bony fusion. RESULTS: The average preoperative deformity angle was 44 degrees, correcting to 20-degree postoperatively and 24 degrees at final follow up. In the series, 19 patients with preoperative neurologic deficit restored by 1.3 grades according to Frankel. All patients got bony spinal fusion within 6 months postoperatively. There was no recurrent tuberculous infection. CONCLUSIONS: Single-stage anterior debridement, strut autografting, posterior instrumentation, and fusion proved safe and effective for MTSUTR, which can achieve goals of complete spinal cord decompression and good deformity correction.     

重症急性胰腺炎死亡的高危因素分析

目的探讨与重症急性胰腺炎（SAP）死亡相关的高危因素。方法回顾性分析2001年1月至2005年10月收治的141例SAP患者的临床资料。将患者分为死亡组和生存组,对可能影响SAP预后的15个因素采用Logistic回归分析。结果141例SAP患者中死亡34例（24．1％）。死亡组患者在年龄、体重指数、住院时间、APACHEⅡ评分和并发多器官功能障碍综合征（MODS）、腹腔室隔综合征（ACS）等方面与生存组相比差异有统计学意义（P〈0．05）。多因素分析显示,MODS（OR=67．358,P〈0．01）、APACHEII评分（OR=9．716,P〈0．01）和ACS（OR=5．775,P〈0．05）是早期影响SAP预后的独立危险因素;胰腺感染（OR=9．652,P〈0．01）、MODS（OR=5．212,P〈0．05）和腹腔出血（OR=4．707,P〈0．05）则是后期影响SAP预后的独立危险因素。结论SAP早期死亡的主要原因是MODS,特别是呼吸功能障碍和肾功能障碍,而后期死亡的主要原因是感染、MODS和腹腔出血。对高危因素进行早期预防和及时处理是降低SAP病死率的关键。     

Surgical targeting accuracy analysis of six methods for subthalamic nucleus deep brain stimulation.

A commonly adopted surgical target in deep brain stimulation (DBS) procedures, the subthalamic nucleus (STN) is located deep within the brain and is surrounded by delicate deep-brain structures. Symptoms of Parkinson's disease can be reduced by precisely implanting a multi-electrode stimulator at a specific location within the STN and delivering the appropriate signal to the target. A number of techniques have recently been proposed to facilitate STN DBS surgical targeting and thereby improve the surgical outcome. This paper presents a retrospective study evaluating the target localization accuracy and precision of six approaches in 55 STN DBS procedures. The targeting procedures were performed using a neurosurgical visualization and navigation system, which integrates normalized and standardized anatomical and functional information into the planning environment. In this study, we employed as the "gold standard" the actual surgical target locations determined by an experienced neurosurgeon using both pre-operative image-guided surgical target/trajectory planning and intra-operative electrophysiological exploration and confirmation. The surgical target locations determined using each of the six targeting methods were compared with the "gold standards". The average displacement between the actual surgical targets and those planned with targeting approaches was 3.0 +/- 1.3 mm, 3.0 +/- 1.3 mm, 3.0 +/- 1.0 mm, 2.6 +/- 1.1 mm, 2.5 +/- 0.9 mm, and 1.7 +/- 0.7 mm for approaches based on T2-weighted MRI, a brain atlas, T1 and T2 maps, an electrophysiological database, a collection of final surgical targets from previous patients, and the combination of these functional and anatomical data, respectively. The technique incorporating both anatomical and functional data provides the most reliable and accurate target position for STN DBS.     

转染RhoA基因对树突状细胞抗胃癌功能的影响

目的 研究转染RhoA基因对树突状细胞(DC)免疫功能的影响,观察修饰后的DC在体外诱导高效而特异的抗胃癌免疫效应.方法 用增强型绿色荧光蛋白标记的RhoA重组腺病毒载体作为介质,将RhoA基因转染入DC,用RT-PCR法检测培养上清RhoA基因的表达.检测这种DC分泌细胞因子IL-12、TNF-α的功能,以及表面分子CD1α、CD83、MHC-Ⅱ、CD80、CD86的表达,用MTT法诱导人特异的细胞毒性T淋巴细胞的能力. 结果培养上清中均可以检测到RhoA基因表达;在这种转基因DC的上清中IL-12、TNF-α 含量分别为(301±24)和(418±64)pg/ml,明显比非转染的DC组高,P＜0.05;转基因DC表面高表达CD1α(70.13±0.03)、CD83(68.10±0.03)、MHC-Ⅱ(69.73±0.13)、CD80(78.73±0.25)、CD86(74.20±0.05),而在非转染的DC中是低表达的;经转染RhoA基因的DC提呈的T细胞对胃癌细胞的杀伤率为87%,而未修饰的DC杀伤作用较低. 结论RhoA基因转染修饰的DC能诱导细胞毒性T淋巴细胞的特异性,显著地提高DC的抗原提呈功能,在体外能诱导高效而特异的抗胃癌免疫效应.