脊柱侧弯患者术前术后骨盆矢状位参数分析

目的:探讨脊柱侧弯患者术前术后腰骶部的矢状位参数的相关性及临床意义。方法:回顾2009年1月至2011年9月资料完整的20例无症状成年志愿者与20例脊柱侧弯患者,均为男6例,女14例,排除其他脊柱后凸畸形及老年性脊柱退行性变,在包含双侧股骨头的全脊柱站立位片上测量腰椎前凸角(LL),骨盆入射角(PI),骶骨水平角(SS),骨盆倾斜角(PT)等参数,与健康成人组(20例)比较,并进行各参数间的相关性分析。结果:根据特发性脊柱侧弯术前及术后患者分组并与健康成人对比,PI、PT、LL与SS,差异均具有统计学意义(P<0.05),PT、SS均与LL轻度相关,PT与SS的相关系数无统计学意义。PI在正常人、术前、术后均与SS和PT存在明显相关性(P<0.05)。结论:手术前后的LL均与骨盆参数PI和SS存在明显相关性,术前评估骨盆参数有助于术中确定最适宜的LL值。     

人参总皂苷对脑损伤大鼠脑组织中炎性细胞因子的影响

目的 研究人参总皂苷治疗对脑损伤大鼠脑组织中促炎因子--肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、白介素-6(IL-6)及抗炎因子--白介素-10(IL-10)的影响,探讨人参总皂苷治疗脑损伤的作用机制.方法 运用改良Feeney法建立大鼠脑损伤模型,将动物随机分为假手术组、脑损伤组、人参总皂苷治疗组.24 h后处死,采用干湿质量法测量脑含水量,尼氏染色光镜下观察海马细胞形态,ELISA法测定脑组织中TNF-α、IL-1β、IL-6、IL-10的表达水平.结果 脑损伤大鼠脑含水量明显升高,海马损伤严重,脑组织内TNF-α、IL-6、IL-1β的水平明显升高,IL-10的水平明显下降;经过人参总皂苷治疗后脑含水量明显下降,海马细胞损伤减轻,TNF-α、IL-6、IL-1β的水平明显下降,IL-10的水平明显升高,差异有统计学意义(P＜0.05).结论 人参总皂苷对脑损伤后脑组织有保护作用,其机制可能与调节脑组织中IL-1β、IL-6、IL-10、TNF-α的表达,从而减轻炎症反应有关.     

3组原发性骨质疏松症治疗方案的费用-效果分析

目的:评价3组治疗方案对原发骨质疏松症的疗效及费用效果。方法:运用药物经济学成本-效果分析法对3组方案进行回顾性分析,其中A组为强骨胶囊+钙剂+Vit.A D胶丸,B组为仙灵骨葆胶囊+Vit.A D胶丸+钙剂,C组为骨疏康颗粒+Vit.A D胶丸+钙剂。结果:3组方案对原发性骨质疏松症均有较好的疗效,其中A组疗效高于B组和C组,但费用较高;B组费用较低,疗效与A组相近。结论:仙灵骨葆胶囊+Vit.A D胶丸+钙剂是治疗原发性骨质疏松症的最佳方案,值得推广。     

地塞米松调节骨髓基质细胞成脂及成骨分化的组织化学研究

目的：观察地塞米松对骨髓基质细胞分化成脂肪细胞的影响,探讨激素性股骨头缺血性坏死的发病机制。 方法：骨髓基质细胞在含有不同浓度地塞米松的培养基中培养,苏丹Ⅲ染色作脂肪细胞计数。采用生化分析仪 测定细胞内甘油三酯含量及碱性磷酸酶活性。结果：脂肪细胞数随地塞米松浓度增大及作用时间延长而增多。 实验组甘油三酯含量明显高于对照组。碱性磷酸酶活性随地塞米松浓度增大而降低。结论：地塞米松能够直接 诱导骨髓基质细胞分化成脂肪细胞,减少其向成骨细胞分化,这可能与激素性骨坏死的发病机制有关。     

后路经椎弓根半椎体切除融合内固定治疗半椎体畸形

目的 评价后路经椎弓根半椎体切除、植骨内固定治疗半椎体畸形的疗效.方法 回顾性分析2007年6月至2009年6月共30例接受经椎弓根半椎体切除、植骨内固定治疗的先天性半椎体畸形病例,比较术前、术后脊柱全长正侧位片及脊柱侧凸Cobb角.结果 术前冠状面主弯Cobb角平均46.52°,术后Cobb角14.64°,侧凸平均矫正率68.51%,术前术后主弯Cobb角比较差异有统计学意义(P<0.05);无内固定断裂、出现神经症状病例.结论 后路经椎弓根半椎体切除、融合内固定治疗半椎体畸形可有效地矫正畸形.     

地塞米松调节骨髓基质细胞成脂及成骨分化的研究

目的　观察激素对骨髓基质细胞脂肪特异性基因aP2mRNA及成骨基因Ⅰ型胶原mRNA表达的影响。方法　以地塞米松 (1× 10 -7mol/L)作为诱导剂 ,采用完整细胞斑点印迹分子杂交方法检测实验组和对照组中aP2和Ⅰ型胶原mRNA表达。结果　实验组aP2mRNA含量4847.7± 40 6 .4明显高于对照组 15 7.6± 10 .8,其Ⅰ型胶原mRNA含量 44 2 .3± 5 7.8明显低于对照组 5 35 3 .6± 36 4.6。结论　地塞米松能够从基因调控水平诱导骨髓基质细胞向脂肪细胞分化 ,减少其向成骨细胞分化 ,这可能与激素性骨坏死的发病机制有关。     

甲泼尼龙预干预脊髓缺血再灌注损伤对热休克蛋白27和肿瘤坏死因子α表达的影响

Objective To observe the effect of methylprednisolone (MP) pre-intervention on ex-pressions of heat shock protein 27 (HSP27) and tumor necrosis factor alpha (TNF-α) in cells in rat spinal cord following ischemia-reperfusion injury. Methods One hundred and fifty male Sprague-Dawley (SD) rats were randomly divided into 3 equal groups: group A (control) in which the abdominal aorta was exposed without any treatment, group B in which the abdominal aorta was clipped for 30 minutes before reperfusion for 3 bours to establish a model of ischemia- reperfusion injury, and group C in which intravenous MP injection was conducted 30 minutes before the establishment of the ischemia-reperfusion injury model. Three hours later the spinal cords were harvested. Pathological changes of spinal cord cells were observed with HE staining and expressions of HSP27 and TNF-α in spinal cord cells were observed with immunohistochemical staining. The motor function of hind-limbs before was evaluated before sample harvest. The data were analyzed with SPSS software. Results There were significant differences between groups A and B in the expressions of TNF-α and HSP27. Compared with group B, the expression of TNF-α decreased and HSP27 increased in group C, with statistically significant differences between the 2 groups. The motor function score of hind-limbs decreased in group B but improved in group C. Conclusions Since MP can decrease the expression of TNF-α and up-regulate the expression of HSP27, it has a potency of neuro-protection. Spinal cord ischemia-reperfusion injury can be avoided or decreased after MP pre-intervention.     

甲泼尼龙预干预脊髓缺血再灌注损伤对热休克蛋白27和肿瘤坏死因子α表达的影响

Objective To observe the effect of methylprednisolone (MP) pre-intervention on ex-pressions of heat shock protein 27 (HSP27) and tumor necrosis factor alpha (TNF-α) in cells in rat spinal cord following ischemia-reperfusion injury. Methods One hundred and fifty male Sprague-Dawley (SD) rats were randomly divided into 3 equal groups: group A (control) in which the abdominal aorta was exposed without any treatment, group B in which the abdominal aorta was clipped for 30 minutes before reperfusion for 3 bours to establish a model of ischemia- reperfusion injury, and group C in which intravenous MP injection was conducted 30 minutes before the establishment of the ischemia-reperfusion injury model. Three hours later the spinal cords were harvested. Pathological changes of spinal cord cells were observed with HE staining and expressions of HSP27 and TNF-α in spinal cord cells were observed with immunohistochemical staining. The motor function of hind-limbs before was evaluated before sample harvest. The data were analyzed with SPSS software. Results There were significant differences between groups A and B in the expressions of TNF-α and HSP27. Compared with group B, the expression of TNF-α decreased and HSP27 increased in group C, with statistically significant differences between the 2 groups. The motor function score of hind-limbs decreased in group B but improved in group C. Conclusions Since MP can decrease the expression of TNF-α and up-regulate the expression of HSP27, it has a potency of neuro-protection. Spinal cord ischemia-reperfusion injury can be avoided or decreased after MP pre-intervention.     

机器人辅助膀胱憩室切除术联合单纯前列腺切除术(附3例报告)

目的探讨机器人辅助腹腔镜下行膀胱憩室切除术(RABD)联合单纯前列腺切除术(RASP)的可行性和优越性。方法 2013年8月至2014年12月应用RABD联合RASP治疗良性前列腺增生(BPH)合并巨大膀胱憩室患者3例。前列腺体积分别为100、105、120 ml,术前残余尿分别为100、160、300 ml。膀胱憩室体积平均分别为90、150、280 ml。结果 3例手术均获成功,3例手术时间分别为90、110、130 min,术中出血量分别为60、100、120 ml,术后均膀胱冲洗2 d,住院时间分别为7、9、11 d,随访6~14个月无尿失禁及尿潴留发生。结论应用RABD联合RASP治疗BPH合并膀胱憩室患者使手术效率提高,操作更精确,手术更安全,疗效满意。     

公立医院开展高值医用耗材集中带量采购的实践探讨

以安徽省某三级公立医院为例,从联动管理、采购程序以及采购结果三方面分析医院高值医用耗材带量采购具体实践情况,提出“遵循政策,严格执行政策要求;协助沟通,保证采购工作顺利实施;灵活管理,保障临床正常诊疗;及时反馈,推动采购政策完善”的建议,以期促进高值医用耗材集中带量采购政策平稳落地,切实减轻患者医疗负担。