内固定应用于脊柱结核治疗的安全性探讨

Objective To investigate the efficiency and safety of instrumentation to treat spinal tu-berculosis. Methods Fifty-one patients of spinal tuberculosis were treated with one-stage or two-stage de-hridement, strut autografting, and anterior or posterior instrumentation with screw rod system, combined with one-year triple agents postoperative antituberculous chemotherapy from April 1985 to May 2005. There were 6 in cervical spine, 19 in thoracic spine, 16 in thoracolumbar spine and 10 in lumbosacral spine. The level of the lesion were 6 cases for single vertebrae, 30 for two vertebrae, 11 for three vertebrae and 4 for more than four vertebrae. All patients were given triple agents antituberculous chemotherapy at least two weeks before operation. The operative procedures included cervical anterior approaches in 6 cases for debridement, fusion and plate-screw fixation, upper lateral transthoracic procedures for debridement, fusion and screw rod fixation in 11, posterior debridement, fusion and transpedicular screw system fixation in 6, two-stage anterior and posterior operation in 18 cases. The instrumentation included 6 Luque, 3 Z-plate, 8 TSRH, 5 Ventrofix, 4 Kenada, 5 Moss-Miami, 6 Isola, 3 CDH, 2 Caspaz, 2 C-D, 1 Zielke, 1 Dick, 1 Oriell, 1 Ozion, 1 Zephir, 1 Tenor, and 1 USS. Results All patients were followed up prospectively for 3.2 to 23.5 years postoperatively. The back pain was obviously relieved postoperatively. Patients with neurological function deficiency im-proved. The solid fusion was achieved in all patients, except one patient due to tuberculosis recurrence. The major complication included one sinus formation and one case with temporary deterioration of neurological function, recovered with appropriate treatment. Average preoperative kyphosis angle was 34.17°, and that was 10.45° immediately after surgery. There was a 3.2° loss of kyphosis correction during follow-up period. Con-clusion Spinal tuberculosis treated with instrumentation is effective and safe.     

内固定应用于脊柱结核治疗的安全性探讨

Objective To investigate the efficiency and safety of instrumentation to treat spinal tu-berculosis. Methods Fifty-one patients of spinal tuberculosis were treated with one-stage or two-stage de-hridement, strut autografting, and anterior or posterior instrumentation with screw rod system, combined with one-year triple agents postoperative antituberculous chemotherapy from April 1985 to May 2005. There were 6 in cervical spine, 19 in thoracic spine, 16 in thoracolumbar spine and 10 in lumbosacral spine. The level of the lesion were 6 cases for single vertebrae, 30 for two vertebrae, 11 for three vertebrae and 4 for more than four vertebrae. All patients were given triple agents antituberculous chemotherapy at least two weeks before operation. The operative procedures included cervical anterior approaches in 6 cases for debridement, fusion and plate-screw fixation, upper lateral transthoracic procedures for debridement, fusion and screw rod fixation in 11, posterior debridement, fusion and transpedicular screw system fixation in 6, two-stage anterior and posterior operation in 18 cases. The instrumentation included 6 Luque, 3 Z-plate, 8 TSRH, 5 Ventrofix, 4 Kenada, 5 Moss-Miami, 6 Isola, 3 CDH, 2 Caspaz, 2 C-D, 1 Zielke, 1 Dick, 1 Oriell, 1 Ozion, 1 Zephir, 1 Tenor, and 1 USS. Results All patients were followed up prospectively for 3.2 to 23.5 years postoperatively. The back pain was obviously relieved postoperatively. Patients with neurological function deficiency im-proved. The solid fusion was achieved in all patients, except one patient due to tuberculosis recurrence. The major complication included one sinus formation and one case with temporary deterioration of neurological function, recovered with appropriate treatment. Average preoperative kyphosis angle was 34.17°, and that was 10.45° immediately after surgery. There was a 3.2° loss of kyphosis correction during follow-up period. Con-clusion Spinal tuberculosis treated with instrumentation is effective and safe.     

膀胱压、胃内压与腹内压的相关性研究

目的 探讨利用膀胱压、胃内压来间接监测腹内压的可行性．以便于腹腔间隔室综合征(ACS)的诊断。方法 对24例行腹腔镜胆囊摘除术(LC)患者进行前瞻性对照研究。在行LC时，在腹内压为10、15、20及25mmHg时同时测定膀胱压和胃内压。结果 腹内压与膀胱压的回归方程为Y=-10.193 1.228X．相关系数为0.941；腹内压与胃内压的回归方程为Y=-7.408 1.478X，相关系数为0.996。由此表明．腹内压与膀胱压和胃内压呈显著正相关。结论 腹内压与胃内压和膀胱压有很好的相关性，可以利用胃内压和膀胱压来反映实际腹内压。     

6例HIV单一感染者非肝硬化性门静脉高压症的临床特征分析

<正>HIV感染者在接受高效抗逆转录病毒疗法(highly active antiretroviral therapy, HARRT)治疗后生存期大大延长,除了典型的机会性感染和恶性肿瘤外,肝脏疾病仍是HIV感染者死亡的重要原因之一^[1-2],在HIV感染者中,常伴有HBV或HCV的合并感染,与HIV合并感染会加速病毒性肝炎患者的纤维化进程,导致肝硬化更快发展,并最终导致腹水、静脉曲张破裂出血和肝性脑病等并发症^[3]。然而,     

63例SARS中医症候群的动态分析

目的：观察严重急性呼吸综合征(SARS)患者的症候及舌象动态特征及与实验室检查的关系。方法：观察2003年3月11日--4月30日在我院感染科住院63例SARS患者的症候、舌象及实验室指标的动态变化。结果：(1)早期最常见的症状为发热(56例)、咳嗽(41例)、四肢乏力或困重(40例);中期(极期)最常见的症状为咳嗽(53例)、四肢乏力或困重(43例);恢复期患者临床症状多不典型,偶可见四肢乏力或困重(17例)、胸闷胸痛(13例)、低热(11例)、咳嗽(12例)、咳痰(11例)。(2)舌象：早期多舌淡红或舌尖红。舌苔薄白、白腻或黄腻;中期多舌质红,舌苔白腻或黄厚腻;恢复期多舌质淡红或舌尖红,偶有舌质暗紫,苔薄白或白腻,偶有苔黄腻。(3)SARS患者早期白细胞、血小板及CD4^+、CD8^+ T淋巴细胞均低于正常,至恢复期均显著升高,与早期比较,差异均有显著性(P<0．01)。结论：SARS不同病期的中医症状有其特点和变化规律,与实验室检查结果有一致性。     

不同感染途径艾滋病症、证分布规律的研究

运用中医学、临床流行病学、统计学的方法,在我国艾滋病流行的主要地区,选择不同感染途径(性传播878例,静脉吸毒527例,有偿供血652例)的HIV/AIDS患者,进行中医证候学调查,对不同感染途径艾滋病症、证分布规律进行为期1年的临床随访,初步总结出不同感染途径艾滋病的病性、病位和病机等特点.3种传播途径主要病性中虚证以气虚、阴虚和阳虚为主;实证中,血液传播以痰湿为主,性传播以气滞为主,静脉吸毒以热(火)毒为主.性传播者以肝肾阴虚、肝郁气滞证为主;静脉吸毒者以气阴两虚、湿热蕴结证为主;采供血者以肝胃不和、脾虚湿盛证为主.     

中医药对慢性肝病肠道微生态的影响研究现状

近年来,肠道微生态成为众多学者研究的热点,很多常见疾病与肠道菌群失调有关,如慢性肾脏病[1]、2型糖尿病[2]、心血管疾病[3]等。肠道菌群失调与慢性肝病互为因果的关系得到了众多学者的认可。目前通过调节肠道微生态治疗慢性肝病已逐渐成为研究的新方向。     

激活Notch1通路减轻高温高湿条件下H9C2心肌细胞缺氧/复氧损伤

目的明确Notch1通路在高温高湿条件下H9C2心肌细胞缺氧/复氧(Hypoxia/Reoxygenation,H/R)损伤中的作用及其潜在机制。方法常规培养H9C2心肌细胞并将其分6组即对照组;H/R组;高温高湿组;高温高湿+H/R组;高温高湿+Jagged1(Notch1激动剂)+H/R组;高温高湿+溶剂+H/R组。TUNEL法检测细胞凋亡,荧光探针JC-1检测线粒体膜电位,ATP检测试剂盒检测ATP含量,Western blot检测Notch1细胞内段(Notch1 intracellular domain,Notch1 ICD)、Hairy和分裂增强子(Hairy and enhancer of split,Hes1)、微管相关蛋白1轻链3(microtubuleassociated protein1 light chain 3,LC3)和p62的蛋白表达水平。结果与对照组相比,急性损伤H/R后,细胞凋亡增加(P0.05),线粒体膜电位降低(P0.05),ATP含量减少(P0.05),Notch1 ICD、Hes1、LC3-II/I(p62相应降低)表达升高(P0.05),而慢性损伤高温高湿后,细胞凋亡增加(P0.05),线粒体膜电位降低(P0.05),ATP含量减少(P0.05),Notch1 ICD、Hes1、LC3-II/I表达降低(p62相应升高)(P0.05);和H/R组或高温高湿组对比,高温高湿+H/R组中细胞凋亡进一步增加(P0.05),线粒体膜电位和ATP含量进一步降低(P0.05),Notch1ICD、Hes1、LC3-II/I表达进一步降低(p62进一步升高)(P0.05);和高温高湿+H/R组对比,加入Notch1激动剂Jagged1后,细胞凋亡减少(P0.05),线粒体膜电位和ATP含量增高(P0.05),Notch1 ICD、Hes1、LC3-II/I表达升高(p62相应降低)(P0.05)。结论激活Notch1通路通过促进自噬从而缓解高温高湿条件下H9C2心肌细胞缺氧/复氧损伤。     

中西医结合治疗85例艾滋病患者临床疗效观察

目的观察中医药改善艾滋病患者血CD4细胞水平变化。方法根据患者的治疗需求将85例患者分为中药组、中西药组和西药组三组,比较用药前和用药半年后患者血CD4细胞变化。结果CD4细胞在中药组治疗前为(203.3±223.8)个/mm3,治疗后为(263.3±261.3)个/mm3;中西药组治疗前为(233.4±180.0)个/mm3,治疗后为(330.4±223.4)个/mm3;西药组治疗前为(116.0±183.3)个/mm3,治疗后(140.1±177.3)个/mm3。结论中药组和中西药组都能明显提高患者CD4细胞水平,与西药组比较,有非常显著性差异。提示中医药或中西医结合治疗艾滋病能有效提高机体CD4细胞的水平。     

超声发现较大的以实性成分为主的腹膜假性黏液瘤1例报告

1 病例资料 患者，男，60岁。因腹胀、上腹部不适2个月就医。体格检查除上腹部及部分中腹部触诊稍硬，轻度不适外，余无阳性体征。于两家医院做了超声检查诊断不一，一家仅诊断：少量腹腔积液，另一家医院诊断：腹水，胃窦幽门端胃壁增厚性病变，胃周及大网膜内多发肿大淋巴结病变。怀疑胃癌，建议胃镜检查。而胃镜检查结果为慢性浅表性胃炎伴局部萎缩。CT诊断：肝多发小囊肿，腹水，大网膜增厚。