弥漫性轴索损伤的临床分析

对闭合性颅脑损伤的一种特殊类型－弥漫性轴索损伤８４例的临床观察，发现均伴原发性意识障碍，ＣＴ表现以弥漫性脑肿胀，灰白质交界部位多发性小出血灶，脑干小脑挫裂伤和脑干环池周围积血为常见。死亡率为５１．２％，重残率为２０．２％。提示临床过程严重预后不佳，应积极处理继发病病理变化。     

IgG指数和IgG合成率在多发性硬化诊断中的应用

采用Ｂｅｃｋｍａｎ免疫化学仪（ＩＣＳ－Ⅱ）对４０例多发性硬化患者，２０例神经系统其他疾病患者及２２例神经系统正常者进行了ＩｇＧ指数和ＩｇＧ合成率的检测，并应用临床流行病学方法进行评价，结果显示：ＩｇＧ指数和ＩｇＧ合成率的敏感性分别是６３．０％，５０．０％，特异性均为６５．０％，阳性结果似然比分别是１．８和１．４。排除激素的影响后，ＩｇＧ指数和ＩｇＧ合成率的敏感性为８４．０％和７９．０％阳性结果似然比是２．４和２．３。还发现ＩｇＧ指数和ＩｇＧ合成率对判断有无器质性神经系统损害的特异性和阳性结果似然比相当高。并对上述结果的意义进行了讨论。     

河南省黄河流域有肾综合征出血热地理流行病学调查

<正> 有肾综合征出血热(下称“出血热”)是一种自然疫源性疾病。近年来,疫区不断扩大,发病人数逐年增多,1981年,我省黄河流域的一些县市相续发生了本病较大的流行。发病人数占全省当年发病人数的98.2％,严重危害着人民的身体健康,影响四化建设。因此,研究本病的疫区分布和自     

治疗腰椎间盘突出症三种术式的疗效比较

目的 比较经皮腰椎间盘髓核摘除术(automated pereutaneous lumbardiscectomy，APLD)、经后路显微内窥镜椎间盘髓核摘除术(microendoscopic discectomy，MED)、传统开窗椎间盘髓核摘除术3种术式对腰椎间盘突出症的治疗效果。方法 在相同时间段内，3组病例采用统一的选择标准、疗效评定标准、手术由专人操作。结果 均获12个月以上的随访，用Ridit分析法对3种治疗结果进行比较。结论 APLD是治疗包容性腰椎间盘突出症的较好方法；MED治疗腰椎间盘突出症是传统手术的微创化，其手术技能基本同传统开窗椎间盘髓核摘除术，可作为单间隙旁侧型腰椎间盘突出症手术治疗的首选术式。     

自体备血在儿麻后遗症矫治术中的应用

自体备血在儿麻后遗症矫治术中的应用甘肃省兰州武警总队医院（７３００５０）苏琼，张莉，刘鸣自１９８８年以来，我院以自体备血在儿麻后遗症矫治术中应用２８例，其中男１５例，女１３例。年龄１０～２８岁，平均１９岁。手术部位：髋关节１６例，脊柱８例，其它４例。...     

欧洲卒中研究动向——第七届欧洲卒中年会及其卫星会议简介

欧洲卒中研究动向———第七届欧洲卒中年会及其卫星会议简介华西医科大学附属第一医院神经内科（６１００４１）刘鸣第七届欧洲卒中年会于１９９８年５月２７日～３０日在英国爱丁堡举行。大会前后有至少六个与卒中有关的卫星会议。下面将作者参加的三个会议依时间顺序作...     

循证医学在临床实践中的应用(一)循证医学简介

1 循证医学的概念 循证医学(evidence-based medicine,EBM)即遵循证据的医学.指医生对病人的诊断、治疗、预防、康复和其他决策应建立在当前最佳临床研究证据、临床专业知识技能及病人的需求三者结合的基础之上.     

靶向特异基因小干扰RNA预防乙醇性股骨头坏死的研究

目的 观察靶向PPARγ基因小干扰RNA(siRNA)预防灌胃法家兔乙醇性股骨头坏死的效果.方法 将96只家兔随机分为4组,每组24只.N组:灌胃法给予生理盐水10ml/(kg·d).M组:灌胃法给予烈性酒(含乙醇度46%,V/V)10 ml/(kg·d);S组:实验1、3、5个月第1天,随机选择侧别手术,穿刺注入股骨头内25 μl siRNA重组腺病毒,同M组灌酒;CO组:同S组手术,同M组灌酒,不注入siRNA重组腺病毒.于2、4、6个月末分批处死家兔,观察血清学和股骨头组织病理学变化.结果　实验6个月时,N、M、CO、S组血清甘油三酯含量分别为(1.21±0.12)、(4.59±1.58)、(4.63±1.17)、(4.32±1.20)mmol/L;总胆固醇含量分别为(2.35±0.33)、(19.59±1.58)、(20.13±1.17)、(18.32±1.20)mmol/L;脂肪细胞平均直径分别为(40.89±2.41)、(48.65±2.93)、(49.45±2.63)、(42.52±2.57)μm;骨小梁面积分数分别为(41.80±2.47)%、(30.70±2.86)%、(29.80±2.69)%、(41.60±2.87)%;空骨陷窝计数分别为(12.30±1.73)%、(22.40±1.52)%、(23.10±1.62)%、(11.70±1.46)%;PPARγ表达量分别为(0.29±0.05)、(0.66±0.12)、(0.61±0.15)、(0.33±0.05);骨钙素mRNA表达量分别为(0.92±0.07)、(0.19±0.11)、(0.23±0.08)、(0.88±0.11);PPARγ蛋白表达量分别为(0.75±0.08)、(1.60±0.11)、(1.55±0.12)、(0.65±0.05).M、CO组病理变化明显,髓内造血组织减少,脂肪细胞增殖肥大,骨小梁变细、稀疏、部分断裂;S组股骨头内最大脂肪细胞平均直径、空骨陷窝计数、骨坏死发生率、PPARγ基因与蛋白表达量均明显低于M、CO组(P＜0.01,P＜0.05),S组与N组差异无统计学意义(P＞0.05).结论　靶向PPARγ基因siRNA腺病毒载体能够有效阻断乙醇诱导的家兔股骨头内MSCs中PPARγ基因表达及成脂分化,预防乙醇性ONFH的发生.

Abstract：

Objective To observe the effect of small interfering RNA (siRNA) adenovirus vectors targeting PPARγto prevent the alcohol-induced osteonecrosis of the femoral head (ONFH) in rabbits.Methods Ninety-six rabbits were randomly divided into four groups. In group N, normal saline ( 10 ml/kg every day) was poured into stomach. In group M, the strong wine (the volume fraction was 46% alcohol,10 ml/kg every day) was poured into stomach. In group S, under the randomly selected side and anesthesia, the animals were injected with 25 μl siRNA adenovirus drip into the femoral head and then the puncture hole was closed on the 1st day at the 1st, 3rd and 5th month of the experiment, and at the same time the strong wine (the volume fraction was 46% alcohol, 10 ml/kg every day) was poured into stomach. In group CO, animals were treated with the same method as the group S, but not injected with siRNA adenovirus drip. The animals were sacrificed in batches at 2nd, 4th and 6th month after the experiment. The serology and pathological changes of the femoral head were studied. Results At the 6th month, the triglyceride (TG, mmol/L) contents in groups N, M, CO and S were (1.21 ±0. 12), (4.59 ± 1.58), (4.63 ±1.17) and (4. 32 ± 1.20), the cholesterol levels ( CHO, mmol/L) were (2. 35 ± 0. 33), ( 19. 59 ±1.58), (20. 13 ± 1. 17) and ( 18.32 ± 1.20), the average diameter of the max adipocyte (μm) was (40. 89 ± 2. 41 ), (48.65 ± 2.93 ), (49. 45 ± 2. 63 ) and ( 42. 52 ± 2. 57 ), the trabeculace area fraction was (41.80 ±2. 47)%, (30. 70 ±2. 86)%, (29. 80 ±2. 69)% and (41.60 ±2. 87)%, the percentage of empty osteocyte lacunae was (12.30 ± 1.73)%, (22.40 ± 1.52)%, (23. 10 ± 1.62)% and (11.70 ±1.46)%, the expreasion levels of PPARγ mRNA were (0.29 ±0.05), (0.66±0. 12), (0.61±0.15) and (0. 33 ± 0. 05 ), the expression levels of osteocalcin mRNA were (0. 92 ± 0. 07 ), (0. 19 ± 0. 11 ), (0. 23 ±0. 08) and (0. 88 ± 0. 11 ), the expression levels of PPARγprotein were ( 0. 75 ± 0. 08 ), ( 1.60 ± 0. 11 ),(1.55 ±0. 12) and (0.65 ±0.05), respectively. In groups M and CO, the pathological changes were obvious; there was decreased hematopoietic tissue, proliferation and hypertrophy of the adipocytes, increased fatty tissue, and thinned, sparse or breoken bone trabeculae in the femoral head; the area fraction of the trabeculae was reduced. In group S, the average diameter of the max adipocyte, percentage of empty osteocyte lacunae, incidence of ONFH, the expressions of PPARγmRNA and protein were obviously reduced as compared with groups M and CO (P ＜0. 01,P ＜0. 05). There was no statistically significant difference between group S and group N (P ＞ 0. 05). Conclusion siRNA adenovirus vectors targeting PPARγcan efficaciously suppress the expression of PPARγ gene and adipogenic differentiation of the MSCs in the femoral head induced by alcohol, which may prevent the development of the alcohol-induced ONFH in rabbits.