微创切取长屈肌腱重建慢性跟腱断裂

目的探讨微创切取长屈肌腱转移重建慢性跟腱断裂的临床效果。方法 2006年7月-2009年12月,收治22例22足慢性跟腱断裂患者。男16例,女6例;年龄28～65岁,中位年龄48岁。21例有患足用力蹬地史,1例无明显诱因。患者出现症状至手术时间为27～1 025 d,中位时间51 d。均有走路无力症状,Thompson试验呈阳性。根据美国矫形足踝协会(AOFAS)踝与后足疗效评价标准评分为(53.04±6.75)分。MRI示跟腱缺损长度为4.2～8.0 cm。术中作中足足底内侧切口和趾间关节跖侧平行横纹的小切口分步切取长屈肌腱,切取长度为超过跟骨结节10.5～13.5 cm,作3束反折编织缝合。界面螺钉或锚钉于跟骨后结节固定肌腱。结果术后患者切口均Ⅰ期愈合,无早期并发症发生。22例均获随访,随访时间12～42个月,平均16.7个月。术后12个月根据AOFAS踝与后足疗效评价标准评分为(92.98±5.72)分,与术前比较差异有统计学意义(t=—40.903,P=0.000);获优18例,良2例,可2例,优良率90.9%。随访期间均未见胫、腓肠神经损伤、跖底部痛性瘢痕、足底内外侧神经损伤。结论微创切取长屈肌腱转移重建慢性跟腱断裂具有切口小、术后恢复快、肌腱固定强度高以及并发症少的优点。     

Maslinic acid suppresses osteoclastogenesis and prevents ovariectomy‐induced bone loss by regulating RANKL‐mediated NF‐κB and MAPK signaling pathways

Activation of NF‐κB and MAPK/activator protein 1 (AP‐1) signaling pathways by receptor activator NF‐κB ligand (RANKL) is essential for osteoclast activity. Targeting NF‐κB and MAPK/AP‐1 signaling to modulate osteoclast activity has been a promising strategy for osteoclast‐related diseases. In this study we examined the effects of maslinic acid (MA), a pentacyclic triterpene acid that is widely present in dietary plants, on RANKL‐induced osteoclastogenesis, osteoclast function, and signaling pathways by in vitro and in vivo assay systems. In mouse bone marrow monocytes (BMMs) and RAW264.7 cells, MA inhibited RANKL‐induced osteoclastogenesis in a dose‐dependent manner within nongrowth inhibitory concentration, and MA decreased osteoclastogenesis‐related marker gene expression, including TRACP, MMP9, c‐Src, CTR, and cathepsin K. Specifically, MA suppressed osteoclastogenesis and actin ring formation at early stage. In ovariectomized mice, administration of MA prevented ovariectomy‐induced bone loss by inhibiting osteoclast activity. At molecular levels, MA abrogated the phosphorylation of MAPKs and AP‐1 activity, inhibited the IκBα phosphorylation and degradation, blocked NF‐κB/p65 phosphorylation, nuclear translocation, and DNA‐binding activity by downregulating RANK expression and blocking RANK interaction with TRAF6. Together our data demonstrate that MA suppresses RANKL‐induced osteoclastogenesis through NF‐κB and MAPK/AP‐1 signaling pathways and that MA is a promising agent in the treatment of osteoclast‐related diseases such as osteoporosis. © 2011 American Society for Bone and Mineral Research.     

重症监测治疗技术对重症手足口病患儿病情及预后的影响

目的：将重症监测治疗技术应用于重症手足口病患儿的救治,以探讨对病情及预后的影响。方法：选择自2009年1月1日-2009年9月6日24时入住我院手足口病重症病房的重症手足口病患儿492例．分析：①发病年龄．性别。（2）最高体温、皮疹、严重表现及并发症等。（3）机械通气患儿的带机时间。机械通气并发症。（4）WBC、血糖、血乳酸、心肌酶、肝功酶．胸片及病原学检查等辅助检查结果。应用重症监测治疗技术及脏器功能支持等。结果：83．7％患儿年龄在3岁以下：100％患儿发热;100％患儿口腔或手、足、臀部有皮疹。神经系统并发症表现为精神差．易惊、肢体抖动,嗜睡;呼吸系统表现为呼吸急促、浅慢,节律不规则;循环系统表现为心率增快、减慢．血压增高或降低、皮肤花斑、四肢皮温低;辅助检查：部分病例出现血WBC、AST．ALT、CK-MB和血糖、血乳酸升高,咽拭子EV71-PCR阳性率36．6％．肛拭EV71-PCR阳性率41．9％。胸片表现为肺纹理增粗。渗出或无明显异常。机械通气患儿147例。492例患儿治愈489例．死亡3例,死亡率0．61％。无1例患儿有机械通气并发症及神经系统后遗症。结论：在本次手足口病救治中。应用重症监测治疗技术对重症患儿各个脏器系统进行监测治疗,可降低死亡率．减少并发症,避免神经系统并发症。     

脓毒血症患者外周血Th17细胞与细胞因子表达的变化

目的：监测脓毒症患者外周血Th17细胞和细胞因子IL-17、IL-6的表达水平．探讨脓毒血症患者免疫功能变化的可能机制。方法：取2010年4月至11月住我院ICU病房的脓毒症患者62例。采用流式细胞术检测外周血Th17％（Th17／CD4＋T）。应用ELISA（酶联免疫吸附方法）检测血浆IL-17和IL-6的表达水平。同时选取来自我院查体中心的健康查体者30例作为对照组。结果：脓毒症患者外周血Th17％明显高于健康对照组[（6．94±1.95）比（1.91±0,32）％,P〈0．01];血浆IL-17,IL-6的表然亦最著高于对照组[（56．52±16．06）pg／ml比（19．59±1．98）pg／ml;（220,68±86．41）pg／ml比（24.39±0,87）Pg／ml]。患者血浆IL-17与IL-6表达水平里正相关（r=0．886．p〈0.01）。Th17的表达与IL-17、IL-6的表达亦呈正相关,（r1=20．846,r2=0．891．均P〈0．01）.结论：脓毒血症患者外周血中Th17％增加．血浆IL-17及IL-6表达水平亦升高．提示Th17可能参与脓毒症的发病机制。     

Salvage Surgery for Neck Residue or Recurrence of Nasopharyngeal Carcinoma: A 10-Year Experience

Background

To assess the outcome of and determine prognostic factors for neck residue or recurrence of nasopharyngeal carcinoma (NPC) in patients treated with a salvage neck dissection.

Materials and Methods

Over a 10-year period (from January 1998 through December 2007) in a tertiary hospital, we systematically reviewed the clinical charts of 355 patients with NPC who were diagnosed with neck residue or recurrence of nasopharyngeal carcinoma, after radical definitive radiotherapy with or without chemotherapy.

Results

The group with recurrent nodal disease consisted of 285 patients (80.3%), while the group with residual nodal disease included 70 patients (19.7%). There were no patients died of the surgery complications. Overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were 54.11, 35.01, and 55.59%, respectively, at 3-year, and 26.03, 22.65, and 27.84%, respectively, at 5-year. The local control rate in the neck was 70.92% at 3 years and 60.98% at 5 years. For all the 3 survival outcomes (OS, DFS, and DSS) and the local control rate of disease in the neck, there were significant differences between the “residue group” and “recurrence group.”

Conclusions

Radical neck dissection is proven to be safe and effective in the treatment of the neck failure. Our study has demonstrated that it may be possible to choose the selective lymph node dissection for patients of the residue group.     

Expression of CD19(+)CD5(+)B cells and IgA1-positive cells in tonsillar tissues of IgA nephropathy patients

The hallmark of IgA nephropathy (IgAN) is the mesangial deposits of polymeric IgA. However, the source of IgA1 and the mechanism of deposition of IgA1 in the mesangium remain unknown. To better understand its pathogenesis, we investigated the expression of CD19(+)CD5(+)B cells and IgA1-positive cells in the tonsils of IgAN patients. Immunofluorescence was used to visualize the locations of CD19(+)CD5(+)B cells and IgA1-positive cells in the tonsils. In this study, it was demonstrated that CD19(+)CD5(+)B cells are usually found in germinal centers and in the capsule covering the upper parts of the nodules of lymphoid tissue (cap of the nodule). The expression of IgA1-positive cells in tonsil tissue can be seen in the cap of the nodule and subepithelial tissue. There is a significant relationship between IgA1 and CD19(+)CD5(+)B cells. The level of CD19(+)CD5(+)B cells is positively correlated to the severity of renal pathological changes. These findings suggest that CD19(+)CD5(+)B cells in the tonsils could have an impact on the pathogenesis of IgAN.     

改良混合痔切除术的临床研究

为探讨改良混合痔切除术的临床疗效,本研究将40例重度混合痔患者随机分为两组,一组予改良混合痔切除术（治疗组）治疗,一组予传统外剥内扎术（对照组）治疗,对比分析两组患者疗效、术后并发症、创面愈合时间、药比、住院费用、住院时问及患者满意度。结果显示,两组疗效、创面愈合时间、药比及肛门狭窄和尿潴留方面差异均无统计学意义,P〉0．05;但在住院费用、住院时间、患者满意度及后遗皮赘、肛缘水肿、创面出血、术区疼痛方面差异有均统计学意义,P〈0．05,且治疗组优于对照组。结果表明,改良混合痔切除术治疗重度混合痔疗效确切,术后并发症少,不影响肛门功能和外观,患者满意度高,值得临床推广。     

基层医院腹腔镜、胆道镜联合治疗胆总管结石的临床体会(附20例报告)

目的:评价腹腔镜胆总管探查取石术的临床疗效.方法:回顾分析2009年3月至2010年12月为20例患者施行腹腔镜胆囊切除联合纤维胆道镜胆总管探查术的临床资料.结果:18例手术成功,2例中转开腹.术中均放置T管.无并发症发生,患者均痊愈出院.结论:腹腔镜、胆道镜联合治疗胆总管结石安全有效,值得推广应用.