新型脊柱固定器械的研制与临床应用

自１９８９年以来，临床应用一种新型脊柱固定器械，共６８例，其中５２例为胸腰椎骨折，１６例为椎体滑脱。经临床观察和随访，治疗效果满意。这种新型固定器械，既可行胸腰椎骨折的固定，也可行椎体滑脱的复位。根据临床需要，该器械可行压缩、撑开、成角和中立位固定。作者强调，脊柱损伤只要有手术指征，手术时机甚为重要，应早期或立即手术，有利于脊柱骨折和椎管前方骨块的复位，早期也有利于神经功能的恢复。     

原钒酸钠对Ⅱ型糖尿病的降糖作用研究

目的　观察原钒酸钠对Ⅱ型糖尿病大鼠的降糖作用。方法　用高脂饲料灌胃正常大鼠 ,引起肥胖 ,测定血中游离脂肪酸浓度。同时应用正糖钳技术检测胰岛素抗性 ,对产生胰岛素抵抗的大鼠腹腔注射小剂量链脲菌素 (5 5mg·kg-1) ,然后筛选空腹血糖值大于 11 1mmol·L-1大鼠为糖尿病模型组。连续灌胃原钒酸钠 7d后 ,测定空腹血糖值。结果　①大鼠喂食高脂饲料后 ,正糖钳实验中维持血糖稳态所需胰岛素量增多 ,为 (0 5 4± 0 0 2 )U·min-1,高于正常组 (P <0 0 1) ;同时血中游离脂肪酸浓度增加 ,从正常 (0 4 6 9±0 0 4 7)mmol·L-1至 (1 5 32± 0 2 91)mmol·L-1(P <0 0 1) ;②原钒酸钠对正常大鼠的血糖值无影响 ,而对Ⅱ型糖尿病大鼠的空腹血糖值及糖耐量曲线下面积有降低作用 (P <0 0 5 )。结论　实验结果证明了原钒酸钠可以明显降低Ⅱ型糖尿病大鼠的空腹血糖值 ,并且对糖耐量具有保护作用     

术后恶心呕吐的危险因素分析及防治

恶心呕吐是术后常见的并发症，而且可引起切口裂开、吸入性肺炎、水电解质紊乱等严重后果。近年来，虽然对术后恶心呕吐(PONV)的发生机制进行了大量的研究，也出现了很多新型的抗呕吐药，但PONV发生率依然较高。PONV的治疗可分为非药物疗法和药物疗法，作者对药物疗法进行综述。     

Regulation of PTC phenotype and function by TGF-β1: implications for transdifferentiation

Introduction There is now increasing evidence that proximal tubular cells (PTCs) contribute to renal interstitial fibrosis by alteration of matrix turnover and by the generation of pro‐fibrotic cytokines such as TGF‐β1. Recent studies suggest that, through a process of transdifferentiation, the PTCs are one source of the interstitial myofibroblasts that directly drive the fibrotic process. The aim of this work was to examine the role and mechanism by which TGF‐β1 may regulate PTC phenotype and function. Methods Experiments were performed using both primary‐cultures of PTC and the human PTC cell line HK2. All experiments were performed on growth‐arrested cells in the absence of serum. Results TGF‐β1 altered cell phenotype, assessed by light microscopy, with cells appearing elongated and spindle‐shaped. This was associated with loss of cell–cell contact and rearrangement of the actin cytoskeleton, increased formation of stress fibres and focal adhesions. Disruption of the actin cytoskeleton with cytochalasin‐D prevented phenotypic alterations following addition of TGF‐β1. Transient transfection with Smad‐2/‐4 or Smad‐3/‐4 expression vectors did not alter cell phenotype. Previously, we have demonstrated β‐catenin translocation to PTC nuclei and its association with Smad proteins following addition of TGF‐β1, suggesting the possibility that TGF‐β1 may modulate Wnt signalling. Wnt‐responsive Xtwn‐reporter construct was, however, silent in response to TGF‐β1. Similarly, a second Wnt‐/LEF‐1‐regulated element Toplflash, which does not contain Smad‐binding sites, was insensitive to TGF‐β1 signalling. In contrast, phenotypic changes in response to TGF‐β1 were abrogated by inhibitors of the RhoA downstream target ROCK, which also prevented loss of cell–cell contact and adherens junction disassembly. Removal of TGF‐β1 and addition of 1% FCS, however, reverted cell phenotype to a typical cobblestone epitheliod appearance, suggesting that TGF‐β1 did not result in terminal PTC transdifferentiation. Cells grown on tissue culture dishes coated with either type‐I or type‐III collagen also acquired an elongated fibroblastic phenotype; this effect was exaggerated by the addition of TGF‐β1. In contrast to the cells stimulated with TGF‐β1 alone, following stimulation by both TGF‐β1 and exposure to interstitial collagens, cell phenotype was stable in that it was not reversed upon removal of TGF‐β1 and addition of FCS. Addition of TGF‐β1 to cells grown on type‐IV collagen had no greater effect than TGF‐β1 alone. Addition of TGF‐β1 alone had little effect on the expression of α‐SMA. In contrast, cells grown on either type‐I or type‐III collagen, following addition of TGF‐β1, demonstrated marked increased expression of α‐SMA, which appeared to be incorporated into the cell cytoskeleton. Similarly, the combination of interstitial collagen (either type‐I or type‐III) and TGF‐β1 had synergistic effect on the relocation and down‐regulation of the epithelial markers E‐cadherin and cytokeratin. Finally, the results demonstrated synergistic effects of coating with interstitial collagen (either type‐I or type‐III), on cell ‘fibroblastic’ cell function as assessed by cell migration and by the synthesis of type‐III and type‐IV collagen. Conclusion The results of these in vitro experiments suggest that terminal transdifferentiation of proximal tubular epithelial cells is the result of a combination of the effects of the pro‐fibrotic cytokine TGF‐β1 and exposure of the cells to components of the interstitial extra‐cellular matrix to which the cells are not exposed in the absence of damage to the tubular basement membrane.     

颞部-颌下联合进路切除咽旁颞下区巨大肿瘤(附2例报道)

[目的]探讨切除侵犯中颅窝的咽旁颞下区巨大肿瘤安全而彻底的手术进路.利用颞部切口可充分暴露中颅窝底和颞下窝以及颌下进路显露咽旁区解剖的特点,联合进路切除2例咽旁颞下区巨大肿瘤.2例侵犯中颅窝底的咽旁颞下区肿瘤顺利切除,患者术中组织损伤、出血量相对较少,术后无严重并发症.[结论]颞部-颌下联合进路适合于侵犯中颅窝底的咽旁颞下区肿瘤的手术切除.     

Protection of chickens against highly lethal H5N1 and H7N1 avian influenza viruses with a recombinant fowlpox virus co-expressing H5 haemagglutinin and N1 neuraminidase genes

Inactivated whole avian influenza virus (AIV) vaccine provides protection against homologous haemagglutinin (HA) subtype virus, but poor protection against a heterologous HA virus. Moreover, it induces chickens to produce antibodies to cross-reactive antigens, especially nucleoprotein, which is limits AIV serological surveillance. In this study, a recombinant fowlpox virus co-expressing HA (H5 subtype) and NA (N1 subtype) genes of AIV was evaluated for its ability to protect chickens against intramuscular challenge with a lethal dose of highly pathogenic (HP) AIV. Susceptible chickens were also vaccinated by wing-web puncture with the parent fowlpox vaccine virus. Following challenge 4 weeks later with HPAIV, all chickens vaccinated with recombinant virus were protected, while the chickens vaccinated with either the unaltered parent fowlpox vaccine virus or unvaccinated controls experienced 100% mortality following challenge. This protection was accompanied by the high levels of specific antibody to the respective components of the recombinant vaccine. The above results showed that rFPV-HA-NA could be a potential vaccine to replace current inactivated vaccines for preventing AI.     

经直肠超声引导前列腺穿刺活检203例临床分析

目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性，血清PSA〉4pg／L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果：良性前列腺增生（BPH）104例占51．24％，前列腺癌（PCa）95例占46．80％，前列腺结核及前列腺平滑肌肉瘤各2例，分别占0．98％。结论经直肠超声引导的前列腺穿刺活检其操作简单，病人痛苦小，并发症少，较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。     

学龄前儿童困难型气质影响因素的回归分析

目的 了解学龄前儿童困难型气质的影响因素。方法 对1150名学龄前儿童的气质类型进行评定，以筛选出的85例困难型气质儿童为研究对象，平易型气质儿童为对照，进行1：2病例对照研究，采用单因素和多因素条件logistic回归进行统计分析。结果 回归分析发现学龄前儿童困难型气质的影响因素主要有出生窒息（OR=8．93）、高热史（3岁前）（OR=2．85）、母亲打骂儿童情况（OR=5．266）、父母带儿童参加社会交往活动频率（OR=0．648）和长辈对儿童教育方式的一致性（OR=2．435）等。结论 学龄前儿童困难型气质受多种因素的影响，重视困难型气质儿童的早期发现，对其采取恰当的教养方式，做好围产期和儿童保健工作，有助于促进儿童健康成长。     

创伤输血的研究进展

现代创伤大多数伤情严重，失血量大。早期输血是救治危重患者的主要手段之一，尤其是失血性休克患者，尽快输血，改善组织微循环，可取得理想的救治效果。Schulman等报告美国每年创伤患者的数量庞大，仅1996年就有173900人死于创伤，2782400人因创伤而入院接受治疗，他们当中15％入院时即处于休克状态，为挽救其生命就需要输血。随着我国工业的快速发展，创伤患者逐年增多，输血在创伤救治中扮演着重要的角色。国内有关创伤输血的研究报道较少，为此，笔者对创伤患者输血相关的问题综述如下。     

Bax，Bcl-2在非小细胞肺癌中的表达相关性研究

目的 研究Bax，Bel-2在人类非小细胞肺癌中的表达及其相关性。方法 应用免疫组织化学（S—P法）检测80例非小细胞肺癌组织标本和40例肺良性病变组织中Bax，Bcl-2的表达水平。结果 ①非小细胞肺癌组织中Bax，Bel-2表达水平分别为63．8％，51．2％，二者表达均与组织学类型无关；②Bax，Bel-2在非小细胞肺癌中表达呈负相关。结论 Bax，Bel-2共同参与细胞凋亡，促进非小细胞肺癌的发生发展。