病毒性心肌炎、扩张型心肌病患者TNF、sIL-2R、IL-6、IL-8、T细胞亚群的改变

目的 :研究免疫反应在病毒性心肌炎 (VMC)、扩张型心肌病 (DCM )发病中所起的作用。方法 :对 30例VMC患者、40例DCM患者分别采用放免法测定血清肿瘤坏死因子 (TNF)水平 ;ELISA法测定血清可溶性白细胞介素 2受体 (sIL -2R)、白细胞介素 6 (IL -6 )、白细胞介素 8(IL -8)水平 ;ABC染色法测定外周血T淋巴细胞亚群 ,并与 30例正常人 (NC)对照。结果 :VMC组、DCM组血清TNF、sIL -2R、IL -6、IL -8水平均显著高于NC组 (P <0 0 1～ 0 0 0 1) ,T细胞亚群中CD4、CD8显著低于NC组 (P <0 0 5～ 0 0 0 1) ,CD4/CD8显著高于NC组 (P <0 0 0 1)。结论 :一系列细胞因子介导的免疫、炎症反应 ,免疫调节网络功能的失衡在VMC、DCM的发生、发展中起重要作用     

应用二维斑点追踪技术评价特发性室性早搏对左心室功能的影响

目的 探讨二维斑点追踪技术（2D-STI）评价不同负荷特发性室性早搏（IPVCs）患者的左心室整体收缩功能。方法 纳入IPVCs患者55例为病例组,根据室早数量与24 h总心搏的比值分为室早负荷＜20％组（A组）,≥20％组（B组）,30例健康志愿者为对照组。采用普通超声心动图测量各组左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）和左室射血分数（LVEF）,采用2D-STI技术分析得出各组左室圆周收缩期峰值应变值（LVCS）和左室纵向收缩期峰值应变值（LVLS）。结果 各组间LVEDD、LVESD和LVEF比较差异均无统计学意义（P＞0.05）。病例组LVLS和LVCS分别为（17.68±2.49）%、（18.37±2.26）%,对照组LVLS和LVCS分别为（22.24±1.57）%、（22.91±1.83）%,病例组LVLS和LVCS均较对照组减低,差异有统计学意义（P＜0.01）。A组LVLS和LVCS分别为（-18.77±2.05）%、（-19.27±2.11）%,B组LVLS和LVCS分别为（-16.28±2.35）%、（-17.20±1.91）%,与A组比较,B组LVLS和LVCS减低更显著,差异有统计学意义（P＜0.01） 。结论 室性早搏可影响左心功能,并且负荷越大,影响越明显。2D-STI技术能较准确地定量评估IPVCs患者早期隐匿的左心功能损害。     

妊娠期糖尿病患者功能失调性态度与社会适应性的相关性分析

目的探讨妊娠期糖尿病患者功能失调性态度与社会适应性的关系,为提高患者的社会适应能力提供参考依据。方法选择2011年5月—2013年5月妊娠期糖尿病住院患者239例,运用功能失调性态度问卷和社会适应性量表进行测试。结果功能失调性态度分数为（4．50±0．50）分;社会适应性分数为（2．25±0．36）分;功能失调性态度与社会适应性具有显著相关性（P〈0．05）;功能失调性态度中完美化、强制性、寻求赞许3个维度能够联合预测社会适应性28．7％的变异量。结论妊娠期糖尿病患者功能失调性态度呈中等水平;社会适应性处于低等水平;功能失调性态度3个维度能有效预测患者的社会适应性,护士应控制患者的功能失调性态度水平以提高其社会适应能力。     

颅内外段椎动脉盗血频谱形态分级与锁骨下动脉近段狭窄程度的关系

目的评价锁骨下动脉狭窄程度与颅内、外段椎动脉盗血频谱形态分级的关系。方法 63例发出椎动脉之前狭窄(或闭塞)的锁骨下动脉患者,分析椎动脉颅内、外段频谱形态变化并进行分组比较。结果锁骨下动脉近段狭窄程度与椎动脉颅外段、颅内段盗血频谱形态变化呈正相关(r分别为0.721、0.793,P0.01),颅内段椎动脉的盗血频谱较颅外段更加敏感。结论椎动脉盗血频谱形态变化对间接判断锁骨下动脉狭窄程度具有一定的价值。     

Correlation of 3-T MRI and CT findings with patient symptoms and treatment outcome in radiofrequency ablation of osteoid osteoma

ObjectiveThe aim of this prospective study was to evaluate pre- and post-treatment MRI and CT findings of osteoid osteoma (OO) patients treated with radiofrequency thermo-ablation (RFTA) and to compare these findings with visual analog scale (VAS) scores.MethodsSixteen patients (4 females and 12 males; mean age of 18.87 ± 8.75 years (range: 8–37)) with OO were examined with CT and MRI, at baseline and at an average of 3 months following the procedure. On pre- and post-procedural CT and MRIs, OO-related findings were recorded. Treatment success was evaluated with VAS scores.ResultsBaseline VAS scores were 8 or 9 and follow-up scores were 0 or 1, indicating no early recurrences.Nidus diameters decreased significantly after the procedure (p = 0.027, p = 0.002, and p = 0.002; and p = 0.001, p = 0.001, p = 0.001 for AP, ML and CC nidus diameters for CT and MRI, respectively).The mean nidus volume were significantly decreased after the procedure (p = 0.001, for CT and MRI).On post-procedural images, cortical thickening, the signal intensity and contrast enhancement of the nidus and the extent of periostitis were significantly decreased (p = 0.019, p = 0.001, p = 0.001 and p = 0.034, respectively). There was no significant change in nidus calcification, perinidal cortical and intramedullary sclerosis, periosteal reaction, bone deformity, bone marrow and soft tissue edema, joint effusion and synovitis after the procedure (p = 0.253, p = 0.062, p = 0.245, p = 1, p = 1, p = 0.429, p = 0.371, p = 0.625, p = 1).ConclusionAlthough the changes in imaging findings may be helpful in early follow-up of OO patients treated with RFTA, these changes alone cannot be used with accuracy in predicting treatment response.Level of EvidenceLevel IV, Therapeutic Study.     

兔骨膜成骨细胞与肾血管内皮细胞间接共培养的体外实验研究

目的　探讨兔骨膜成骨细胞 (RPOB)和肾血管内皮细胞 (RRVEC)不同比例下间接共培养对成骨细胞增殖及功能的影响 ,优选细胞间接共培养的适宜比例。方法　取 RPOB和 RRVEC,采用细胞嵌盒培养系统 ,对照组、试验 1、2、3组分别以 RPOB和 RRVEC按 1∶ 0、2∶ 1、1∶ 1和 1∶ 2间接共培养 4天。通过细胞计数、碱性磷酸酶 (AL P)活性测定及 3H-脯氨酸掺入试验观察 RPOB和 RRVCE增殖分化能力及功能状态。结果　试验 1组 RPOB较对照组、试验2、3组增殖活跃 (P<0 .0 5 ) ,且 3H-脯氨酸掺入较高 (P<0 .0 5 ) ;试验 1组 AL P活性较对照组和试验 3组高 (P<0 .0 5 ) ,但与试验 2组无显著差异 (P>0 .0 5 )。结论　 RPOB和 RRVEC以 2∶ 1进行间接共培养时 RPOB增殖能力强、功能活跃 ,适宜进一步组织工程研究     

成人间活体肝移植肝动脉重建并发症预防

目的总结成人间活体肝移植(adult-to-adult living donor liver transplantation,A-A LDLT)肝动脉重建并发症的预防经验。方法总结2002年1月-2008年3月收治的127例A-A LDLT临床资料,分析肝动脉重建并发症的预防。131例供体中(移植右半肝127例,移植左半肝4例),男69例,女62例;年龄19～65岁,平均36.2岁。127例受体中男109例,女18例;年龄18～64岁,平均41.9岁。62例供体右肝动脉与受体右肝动脉吻合,34例与受体肝固有动脉吻合,7例与受体左肝动脉吻合,6例与受体肝总动脉吻合,8例与受体肠系膜上动脉发出的副右肝动脉吻合,5例与受体肝总动脉自体大隐静脉间搭桥,2例受体腹主动脉与供体右肝动脉自体大隐静脉搭桥,3例用尸体冷冻保存髂血管行受体腹主动脉与供体右肝动脉搭桥。结果术后1、7d,发生肝动脉血栓形成2例(1.6%),采用自体大隐静脉、肾下腹主动脉至供体右肝动脉搭桥术后痊愈;1例于术后46d发生肝动脉血栓形成,无临床症状未予处理。术后及随访期未发现肝动脉狭窄、肝动脉假性动脉瘤等并发症。围手术期无与肝动脉并发症有关的死亡患者。患者均获随访,随访时间9～67个月,术后1、2、3年实际生存率分别为82.2%、64.7%和59.2%。结论供、受体肝动脉解剖变异,受体肝动脉病理改变,以及肝动脉血管吻合技术是肝动脉重建并发症发生的重要影响因素。     

Isola spinal instrumentation system for idiopathic scoliosis

Since the definition of three-dimensional components of the scoliotic deformity, there have been important improvements in the surgical treatment of the problem. A derotation maneuver was proposed as a treatment option with CD instrumentation, but the reports of imbalance and decompensation with this system repopularized sublaminar wiring and translation as a corrective maneuver. Isola spinal instrumentation is one of the modern systems that utilizes vertebral translation instead of rod rotation. This study analyzes the results of 24 patients with idiopathic scoliosis who had been followed up for at least 2 years, and were surgically treated with titanium Isola Spinal Instrumentation in the Department of Orthopaedics and Traumatology, Ankara Social Security Hospital. Patients were grouped according to the King-Moe classification. Patients with type III, IV or V curves received only posterior instrumentation while this procedure followed anterior release and discectomy in the same session in patients with type I or II curves. A translation maneuver was utilized in the correction of scoliotic curves using the cantilever technique, either alone or supplemented by sublaminar wiring with Songer multifilament titanium cables. This study aimed to elucidate the effects of this technique in the frontal and sagittal plane curves and the trunk balance. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT), shift of stable vertebra (SS), and shift of head (SH) in vertebral units (VU). The postoperative correction was significant in the frontal plane for all types of curves (p < 0.05). The postoperative correction was 80.9% +/- 9.5% in type III curves. Overall, the mean Cobb angle of the major curve value in the frontal plane was 66.9 degrees +/- 18.8 degrees, and it was corrected by 62.8% +/- 20.1%. The correction loss of Cobb angles in the frontal plane was 5.4 degrees +/- 5.5 degrees at the last follow-up visit. A normal physiologic thoracic contour (30 degrees - 50 degrees) was achieved in 83.3% of the patients and normal lumbar contour (40 degrees - 60 degrees) in 66.7% of the patients in the sagittal plane. The correction was found to be significant in all balance values (p < 0.05). The postoperative correction in LT values correlated with the correction of the Cobb angle values in the frontal plane. All patients had complete balance (SH: 0 VU and SS: 0 VU) or balanced curves (0 VU < SH, SS < 0.5 VU).Finally, the study concluded that the translation maneuver, especially when used with the cantilever technique, resulted in high correction rates in the frontal plane. Additionally, the technique was also successful in obtaining normal sagittal contours and correcting balance values.     

驻守高原不同时间官兵的血常规比较研究

目的 观察高原某部驻守不同时间的驻训官兵血常规各指标的差异,为维护保障高原驻训官兵健康提供科学依据.方法 对153名进驻海拔4200～4500 m高原驻训1、2、5年的官兵进行血常规检测并进行统计学分析.结果 与驻训1年组相比,驻训2年组全血白细胞总数(WBC)、中性粒细胞总数(NEUT)、淋巴细胞比率(LYM％)、中...