乳腺手术患者胸椎旁神经阻滞与胸神经阻滞效果比较的Meta分析

目的 采用系统评价和Meta分析方法比较乳腺手术患者行胸椎旁神经阻滞（TPVB）和胸神经阻滞（Pecs阻滞）的镇痛效果。方法 检索PubMed、Web of Science、Embase、Ovid、Cochrane图书馆、CNKI、维普数据库、万方数据库和中国生物医学全文数据库,收集比较TPVB和PECS阻滞在乳腺手术麻醉镇痛效果的随机对照试验（RCT）。应用RevMan 5.2软件进行统计学分析。结果 获得符合标准的6个RCT研究,共计323例,其中PECS阻滞组161例,TPVB组162例。Meta分析结果显示：PECS阻滞组术后镇痛药物使用量少于TPVB组[MD=1.350,95% CI（-2.240,-0.460）],TPVB组术后疼痛评分高于PECS阻滞组[MD=1.350,95% CI（-2.110,-0.590）],两组术后恶心呕吐发生率差异无统计学意义[RlR=0.930,95% CI（0.560,1.320）]。结论 现有证据表明对于乳腺手术患者,PECS阻滞镇痛效果优于TPVB镇痛。     

钙化性肩袖肌腱炎的关节镜治疗

目的　探讨肩关节镜下治疗钙化性肩袖肌腱炎的适应证、手术技巧与疗效。方法　 18例的关节镜均自后方入路进入。术中发现 16例钙化灶位于冈上肌内 ,1例位于冈下肌内 ,1例同时涉及冈上肌与冈下肌。均行钙化灶清除术及肩峰成形术 ,其中 3例加行肩袖修补术。 18例在治疗前及最后 1次随访时进行ASES(Americanshoulder&elbowsurgeonscore ,ASES)评分、Constant Murley评分、以及SST(simpleshouldertest ,SST)问卷评估其疗效。结果　 18例术后平均随访 17 6个月。ASES评分 :治疗前平均为5 0 2 ,其中VAS疼痛评分为 8 4,肩关节平均前屈上举 86 4° ,外旋 14 7°。治疗后平均为 92 6,VAS疼痛评分为 1 7,肩关节平均前屈上举 14 0 1° ,外旋 3 8 8°。Constant Murley评分 :术前平均为 48 2 ,术后平均为90 7。SST问卷选择回答“是”的问题 :术前平均为 4.5个 ,术后平均为 10 2个。 3个评分治疗前后相比 ,差异有统计学意义 (P <0 0 1)。结论　在关节镜下作钙化灶清除及肩峰成形术 ,是治疗经保守治疗无效的钙化性肩袖肌腱炎的一种安全、有效的方法 ,并具有损伤小、恢复快等优点。     

γ刀照射三叉神经的剂量-效应关系研究

目的 探讨伽玛刀不同剂量照射大鼠三叉神经(感觉根)后对照射范围内三叉神经组织的损伤以及对周围临近脑干组织和脑桥的影响,为优化伽玛刀照射剂量提供理论依据。方法 选用成年雄性SD大鼠65只,分别以不同照射剂量(20、40、80、160 Gy)照射三叉神经,观察照射后1周、2周、4周大鼠行为学变化,取全脑组织进行HE、Nissl、MAPLC3B、53BP1、XRCC1染色观察细胞形态学和自噬以及DNA损伤和修复等变化。结果 所有剂量组照射大鼠均存活。20和40 Gy组均无行为学和病理学改变;80和160 Gy组均出现了照射部位毛发脱落;HE、Nissle、LC3B、53BP1及XRCC1染色发现,受照部位组织在80和160 Gy照射后,可见神经元细胞固缩、膨胀,神经元细胞发生自噬以及DNA损伤明显,160 Gy组DNA损伤明显加重。40 Gy照射后,神经元发生DNA损伤修复的程度较其他剂量增高。结论 伽玛刀照射三叉神经根对神经元有明显的剂量-效应关系。     

Microstructural brain abnormalities of children of idiopathic generalized epilepsy with generalized tonic‐clonic seizure: A voxel‐based diffusional kurtosis imaging study

The above article, published online on 3 May 2014 in Wiley Online Library ( wileyonlinelibrary.com ), has been retracted by agreement between the authors, the journal Editor in Chief, and Wiley Periodicals, Inc. The retraction has been agreed due to errors in the results of the published article. The authors stated in the Methods section that ‘. . . only clusters with a false discovery rate (FDR)‐corrected P‐value less than 0.05 were included.’ However, it was subsequently discovered that the FDG‐correction had not been performed correctly. Had this been carried out in the right way, the difference between the case group and the control group in most of the presented regions would have been insignificant. REFERENCE 1. Gao J, Feng S‐T, Wu B, Gong N, Lu M, Wu P‐M, Wang H, He X, and Huang B. Microstructural Brain Abnormalities of Children of Idiopathic Generalized Epilepsy With Generalized Tonic‐Clonic Seizure: A Voxel‐Based Diffusional Kurtosis Imaging Study J mag res. 2014 May 3. doi: 10.1002/jmri.24647 [epub ahead of print]     

附睾、睾丸精子卵浆内单精子注射治疗阻塞性无精症引起不育

为评价附睾或睾丸精子卵浆内单精子注射（ＩＣＳＩ）治疗阻塞性无精症引起不育的疗效，对３１例无精子男性不育患者配偶进行超排卵治疗３７个周期，获卵当日从患者附睾取精，其中２４例获得活动精子，７例失败，改用钳取睾丸曲细精管从中分离精子以供ＩＣＳＩ。结果：共获卵４５３个，附睾、睾丸精子ＩＣＳＩ受精率分别为５５７％、６１７％，平均每周期移植胚胎３７个，总妊娠率每周期２９７％。结论：只要获得活动精子ＩＣＳＩ，阻塞性无精症患者也有机会生育     

自身免疫性胰腺炎的CT和MRI诊断

_目的：探讨 CT 及 MRI 对自身免疫性胰腺炎（AIP）的诊断价值。方法：回顾性分析经实验室检查、穿刺活检、手术或临床激素治疗有效确诊的28例 AIP 患者的临床及影像学资料。21例行 CT 检查,其中17例行 CT 增强扫描;18例行 MRI 检查,其中11例行 MRI 增强扫描,12例行 MRCP 扫描;15例同时行 CT 及 MRI 扫描。结果：CT 与 MRI 可清楚显示胰腺实质及胰腺外脏器的形态、密度或信号改变。胰腺实质表现：胰腺弥漫性增大呈＂腊肠＂样改变,边缘呈＂香蕉皮＂样改变;局限性病变病灶呈＂假肿瘤＂样改变,增强扫描延迟期与正常胰腺实质密度、信号一致。胰腺外脏器表现：胆系改变表现为胆总管及肝内胆管扩张,管壁增厚,增强扫描呈明显强化;肾脏改变表现为 CT 增强扫描动脉期呈斑片状低密度,MRI 呈稍长 T1、稍长 T2信号,延迟期病灶与周围肾实质密度、信号一致;肺内改变表现为肺门区软组织肿块影。结论：自身免疫性胰腺炎 CT 及 MR 表现具有一定特征性,对于该病的诊断及治疗前后疗效的评估具有重要价值。     

Two-stage total knee arthroplasty for non-salvageable septic arthritis in diabetes mellitus patients

Pyogenic knee arthritis in a patient with advanced osteoarthritis is a serious medical problem. We have performed arthroscopic debridement in 136 patients with pyogenic knee arthritis from January 1999 to December 2001. Five of these patients were diabetic, they did not respond to the standard treatment protocol and they continued to have infection. For these patients, we performed open arthrotomy, with implantation of antibiotic cement as a spacer, and staged total knee arthroplasty. The clinical results were evaluated using the Hospital for Special Surgery (HSS) scoring system. At an average follow-up of 38 months (range: 29 to 46), the average pain score was 83 and the functional score was 73 with no patient having recurrence of the infection. This study shows that just as a 2-stage revision is now done for infected total knee arthroplasty, primary uncontrolled infected knees may be treated by a 2-stage arthroplasty as well.