复拇指畸形391例临床治疗分析

目的总结复拇指畸形的临床治疗体会。方法总结20年来经手术治疗的复拇指畸形391例病例，就其手术时机、治疗方法和术后继发畸形的原因进行回顾性分析。结果术后随访123例（137侧），随访时间为2-15年，参照Kawabata评分方法，优52例（58侧），良36例（40侧），差35例（39侧）。其中从生后6个月-1岁手术者随访到45例（51侧），优22例（24侧），良15例（17侧），差8例（10侧）。术后继发畸形进行二次手术治疗的患者有47例（55侧）。结论复拇指畸形的手术年龄应选择在生后6个月-3岁为宜，术前详细评估、术中正确处理和术后长期随访是复拇指畸形治疗的关键。     

青少年特发性胸椎侧凸患者的脊髓偏移及临床意义

[目的]揭示青少年胸椎特发性侧凸患者椎管内脊髓的偏移，明确其变化趋势，并探讨其可能的发生机制和临床意义。[方法]本研究包括39名以右胸弯为主弯的青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者。测量主胸弯节段内（T5-12）椎管内脊髓与凸凹侧椎弓根之间的距离，计算脊髓的偏移，揭示其变化趋势，并分析顶椎区脊髓偏移与主胸弯Cobb＇s角和顶椎相对偏移之间的相关性。[结果]在T5-12节段椎管内，脊髓与凸侧椎弓根之间的距离显著大于与凹侧椎弓根之间的距离（P〈0．05），即脊髓向凹侧椎弓根偏移，且以顶椎区最为显著，而逐渐向两侧端椎区递减。顶椎区脊髓偏移与主胸弯Cobb’s角和顶椎相对偏移存在显著的正相关（相关系数分别为0．631和0．546）。[结论]胸椎特发性脊柱侧凸患者存在侧凸节段椎管内脊髓偏移的现象，且以顶椎区最显著。研究结果提示脊髓偏移可能与脊椎偏移后凹侧脊神经的牵拉有关，而且凹侧置钉的风险高于凸侧。     

Body mass index, percent body fat, and bone mass in a cohort of Chinese twins aged 6 to 18 years

Introduction This report examines the relationship of body mass index (BMI), percent body fat (%BF), and bone mass in a cohort of male and female twins recruited from Anhui province, China, ages 6–18 years—577 male pairs (mean age = 11.4) and 478 female pairs (mean age = 11.6). Methods Whole body bone mineral content (WBMC) in (g), whole body bone area (WBA) in (cm²), and %BF were measured using DEXA (Lunar Prodigy, USA). Regression analysis of within-pair differences was used to assess the strength of the association, and the analysis was stratified by gender and age group, where age cut-offs were based on ages at spermarche or menarche estimated from large population based studies in China. Males were stratified at ages before 14 and age 14–18, and females at ages prior to 12 and age 12–18. Results Univariately, BMI and %BF were associated with WBMC and WBA in the younger males and females, and in older males; %BF was significant only in older females. Multivariate models included both BMI and %BF. Among the younger males, age < 14, BMI and %BF were significantly associated with WBMC and WBA. In the younger females, age < 12, %BF was only significant to WBA. In the older age group, only BMI was significant to WBMC and WBA in females, but in males, BMI was positively associated, and %BF was negatively associated with both bone measures. Discussion These findings show that association between BMI and %BF and bone mass differ across gender and developmental stages, and %BF appears to be beneficial at younger ages, but detrimental or non-beneficial at older ages of development.     

Bipedicle Orbicularis Oculi Flap in the Reconstruction of the Lower Eyelid Ectropion

Background Lower eyelid ectropion is conventionally reconstructed with a local flap or full-thickness skin graft. However, scar contracture and recurrence of ectropion often occur. This article describes an effective surgical technique for lower eyelid ectropion repair using a bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid. Methods This study prospectively analyzed collected data on the bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion between 1995 and 2004. The flap was used in 12 eyelid procedures for the correction of lower eyelid ectropion, in 10 cases with traumatic ectropion, and in 1 case with bilateral congenital ectropion. In these cases, a strip of orbicularis oculi muscle or a myocutaneous flap from the upper eyelid with two pedicles attached in the medial and lateral canthus was advanced to the lower eyelid to suspend the eyelid and repair the skin defect. Results No problem of flap viability was encountered in any of the patients, and all healed well. Deformities were corrected, and evaluation showed satisfactory function and appearance during 0.5 to 6 years (average, 2 years) of follow-up evaluation. Eyelid malposition and bulkiness of the lower eyelid occurred in the early stages, but disappeared gradually about 3 months after the operation. There was no flap contraction, recurrent deformity, or significant donor site morbidity in the follow-up period. The incision scars were almost invisible. Conclusions The application of bipedicle orbicularis oculi muscle or a myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion is effective and reduces postoperative morbidity.     

Quality of life in women with stress urinary incontinence

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity. Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from the National Institute of Child Health and Human Development and the Office of Research on Women’s Health, National Institutes of Health.     

White matter integrity of the whole brain is disrupted in first-episode schizophrenia

Diffusion tensor imaging studies in schizophrenia have demonstrated lower diffusion anisotropy within white matter that provides information about brain white matter integrity. We have examined whether white matter is abnormal in first-episode schizophrenia by using diffusion tensor imaging. Twenty-one schizophrenic patients and healthy controls underwent diffusion tensor imaging scans that analyzed by using a rigorous voxel-based approach. We found that fractional anisotropy in white matter of the patients was lower than that in controls at the cerebral peduncle, frontal regions, inferior temporal gyrus, medial parietal lobes, hippocampal gyrus, insula, right anterior cingulum bundle and right corona radiata. These results suggested that white matter integrity of the whole brain was disrupted in early illness onset of schizophrenia.     

Differentiation and neurological benefit of the mesenchymal stem cells transplanted into the rat brain following intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is often a fatal event. In a patient who survives the initial ictus, the resulting hematoma within brain parenchyma can trigger a series of events that lead to secondary insults and severe neurological deficits. Great efforts have been focused on searching for new approaches to help patients recover neurological function after ICH. Previous studies indicate that mesenchymal stem cells (MSCs) grafted into the ischemic rat brain can improve neurological function. However, there is no report regarding whether MSCs can be used in the same way to improve the neurological function after ICH. We generated the ICH model by injecting collagenase VII into rat brain. Subsequently, 5-bromo-2-deoxyuridine (BrdU)-labeled mesenchymal stem cells were delivered into the brain through carotid artery, cervical vein or lateral ventricle. The distribution and differentiation of MSCs were investigated by methods of immunohistochemistry. We found that MSCs were able to differentiate into neural cells in vitro as well as in the rat brain after ICH. The injected MSCs were able to migrate into hippocampus, blooding foci and ipsilateral cortex. In the hippocampus, MSCs differentiated into neurons; but in surrounding bleeding foci, they differentiated into neurons and astrocytes. In the ipsilateral cortex, MSCs differentiated into neurons, astrocytes and oligodendrocytes. Notably, the motor function of the rats in the carotid artery (CA) group and the lateral ventricle (LV) group improved significantly. Collectively, our study indicates that MSCs are able to differentiate into neural cells in the rat brain after ICH and can significantly improve motor function.     

Upregulation of type I interleukin−1 receptor after traumatic spinal cord injury in adult rats

Post-traumatic inflammation response has been implicated in secondary injury mechanisms after spinal cord injury (SCI). Interleukin-1 (IL-1) is a key inflammatory mediator that is increasingly expressed after SCI. The action of IL-1 is mediated through its functional receptor, type I interleukin-1 receptor (IL-1RI). However, whether this receptor is expressed after SCI remains to be elucidated. In the present study, the temporospatial expression of IL-1RI was detected in rats that received a moderate contusive SCI (a 10 g rod dropped at a height of 12.5 mm) at the ninth to tenth thoracic vertebral level using a widely used New York University impact device. Our study demonstrated that IL-1RI was slightly increased at 4 h post-injury compared to the normal or sham-operated controls, reached the peak at 8 h at mRNA level (4.44-fold, P<0.01) and 1 d at protein level (2.62-fold, P<0.01). IL-1RI remained at its elevated levels for a relatively long duration (4 h–7 days). Spatially, IL-1RI was observed throughout the entire length of a 10 mm-long cord segment containing the injury epicenter. Colocalization of IL-1RI was found in neurons, oligodendrocytes, astrocytes, and activated microglia. Our results suggest that the elevated expression of IL-1RI after SCI may contribute to posttraumatic inflammation responses of IL-1.     

早期大剂量纳络酮治疗重型颅脑损伤的临床观察

目的观察早期大剂量应用纳络酮治疗重型颅脑损伤的临床效果。方法将100例重型颅脑损伤患者分为治疗组及对照组,治疗组又分为伤后3h内用药组(A组)和3h后用药组(B组)。治疗组均在常规治疗的基础上采用大剂量持续给予纳络酮,对照组按照常规治疗方法进行治疗,观察病人生命体征、颅内压、头颅CT征变化和远期疗效等,并对数据进行统计学处理。结果纳络酮治疗组的A组和B组近、远期疗效均较对照组有显著改善(P<0.05),同时A组在清醒时间方面优于B组,呼吸异常的发生率低于B组(P<0.05)。结论早期大剂量应用纳络酮可以降低重型颅脑外伤病人颅内压的升高幅度,缩短昏迷时间,降低伤残率,促进病人神经功能恢复。     

坐位经幕下小脑上入路切除松果体区肿瘤的临床分析

目的研究松果体区肿瘤患者摆坐位经幕下小脑上入路手术治疗的临床适应证、相关问题和成功经验。方法对我科22例松果体区肿瘤采取坐位经幕下小脑上入路手术治疗的临床资料进行详细分析,并且与我们使用侧俯卧位和俯卧位经幕下小脑上入路手术治疗17例结果相比较。结果所有39例患者中,男性24例,女性15例;年龄7～52岁,平均22.6岁。病理性质:生殖细胞瘤17例,胚胎癌4例,内皮窦瘤2例,绒毛膜上皮癌1例,良性畸胎瘤8例,恶性畸胎瘤2例,松果体细胞瘤2例,脑膜瘤1例,皮样囊肿2例。所有39例肿瘤主体均位于直窦延长线以下,上界不超过此线1cm,且肿瘤主体也位于中线,两侧偏离中线均小于3cm,适合选用幕下小脑上入路。选择俯卧位和侧俯卧位17例,骨窗大小为7cm×8cm类圆形,结果全切除11例,次全切除2例,部分切除4例;术后脑室积血11例,小脑肿胀5例,昏迷3例,死亡3例。选择坐位手术22例,骨窗大小为4cm×5cm类椭圆形,结果全切21例,次全切1例;仅1例发生小脑肿胀,无脑室积血,无严重致残和无手术死亡,术后发生颅内积气2例;术中气栓1例,及时发现并经过适当处理得到缓解。术后存活患者根据病理性质选择放疗和(或)化疗。结论适合幕下小脑上入路的松果体区肿瘤选择坐位有明显的优势,体位摆放、辅助办法和麻醉措施得当可以明显减少静脉气栓发生或得到及时缓解,同时可达到缩小了骨窗减少创伤的目的。