手部创伤性骨关节缺损的处理

治疗手部骨关节缺损常采用植骨内固定、关节融合、关节成形及关节置换等方法．为总结经验，对１９８９年以来１０１例手部创伤性骨与关节缺损进行分析。单纯掌、指骨缺损３９例，行直接短缩对位，克氏针内固定６例，１例发主骨不连；对３３例缺损较大者用自体骨块植入克氏针交叉内固定，部分病例同时植人ＲＢＸ或异体骨粒，１０例发生延迟愈合，余全部正常愈合。骨与关节部分或完全缺损６２例，采用关节成形术４６例，其中以肋软骨移植效果最好，骨膜移植次之，筋膜衬垫或硅胶膜植入法较差；行关节融合术１１例．均达顺利融合；采用自体关节置换５例，均成活，术后关节活动度均＞７０°。我们认为：自体骨块植入克氏针交叉内固定，必要时植入ＲＢＸ骨粒．是治疗手部创伤性骨缺损的有效方法。关节缺损应按关节的重要性，分别采用关节融合术、关节成形术或关节置换术。     

Effects of posts on dentin stress distribution in pulpless teeth.

A finite element analysis was carried out to study the roles of posts in reducing dentin stress in pulpless teeth. Two-dimensional plane strain models of the midlabiolingual section of a human maxillary central incisor were first analyzed. The results showed that the gold alloy post reduced maximal dentin stress by as much as 30%. However, the integrity of the dentin was compromised and the effects of the post were likely to be exaggerated in such models. In an effort to correct for these problems, plane stress models with side plates and axisymmetric models were analyzed. Posts were found to reduce maximal dentin stress by only 3% to 8% when the teeth were subjected to masticatory and traumatic loadings in these latter models. Although posts reduced maximal dentin stress by as much as 20% when the teeth were loaded vertically, teeth such as incisors and canines normally are not subjected to vertical loadings. Thus the reinforcement effects of posts seem to be doubtful in these teeth.     

胶原酶溶解术治疗腰椎间盘突出症

采用国产胶原酶行腰椎间盘内注射治疗腰椎间盘突出症９０例。有效率为９３％，优良率为８４％。作者体会该方法创伤小，无出血，对椎管内无干扰。只要严格选择适应症，掌握正确的操作方法，无疑是一种有效的治疗方法。     

Laparoscopic nephrectomy in a porcine model.

Laparoscopic nephrectomy was performed in 15 male pigs, the procedure was successful in 14. Extraction of the intact kidney through a 5-cm lower abdomen incision was done in 7 animals; complete destruction and evacuation of the kidney was accomplished by a round-knife suction device through a 1-cm port in another 7 pigs. Grossly, the specimen consisted of sausage-like tubular renal tissue and a small amount of tissue debris. Pathology revealed that the glomerular and tubular structures were well preserved, no interstitial hematoma could be found. Four ports were usually used, one 1-cm umbilical camera port, one 0.5-cm port for ureter traction, and two 1-cm working ports along the midclavicular line. All the pigs recovered uneventfully. The average operation time was 3 h 20 min. The application of endo-GIA (United States Surgical Corporation) for renal hilum reduced the operative time to 2 h 20 min. Complications included renal vein tear during endoclip application and cutting in the first case, mild subcutaneous emphysema in 2 cases. This first pig received exploratory laparotomy for the repair and ligation of the renal vein. No more major complications occurred with increasing experience. From this porcine experiment, we conclude that the combination of laparoscopy, a tissue destroyer and an endobag for the entrapment of kidney seem to be a promising technique for clinical nephrectomy.     

Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia

PURPOSE: During clinical monitoring, vecuronium appeared to reduce the rapidly extracted auditory evoked potentials index (A-line ARX index or AAI) to some extent. A prospective and randomized study was designed to analyze this phenomenon. METHODS: Forty adult patients undergoing elective surgery were studied. After tracheal intubation, anesthesia was maintained with an end-tidal isoflurane concentration (F(ET)ISO) of 1.0% for 20 min, then a 10-mL dose of either vecuronium 0.05 mg*kg(-1), 0.1 mg*kg(-1), 0.2 mg*kg(-1) or saline was administered in a randomized, double-blind design. The AAI and bispectral index (BI(hx)) were monitored throughout the study and analyzed off-line. RESULTS: BI(hx) was unaltered after the administration of saline or vecuronium. The mean of the averaged (per patient) AAI values recorded from two minutes to ten minutes after the administration of saline or vecuronium 0.05 mg*kg(-1) did not differ significantly from the corresponding mean recorded from 15 min to 20 min after F(ET)ISO maintained 1.0% (P = 0.678, 0.169), however after the administration of vecuronium 0.1 mg*kg(-1) or 0.2 mg*kg(-1), AAI was reduced from 18.3, 18.0 to 14.8, 13.4 (P = 0.016, 0.017). CONCLUSIONS: Neuromuscular block with vecuronium reduces AAI in patients during steady state anesthesia without surgical stimuli, while BI(hx) is unaltered. The cut-off values of AAI for events should be determined according to the level of neuromuscular blockade when monitoring the depth of anesthesia/sedation.     

凋亡敏感基因在短暂性缺氧再复氧复注血清后的大鼠星形胶质细胞中的表达及其意义

目的研究一种新发现的抗氧化蛋白质--凋亡敏感基因(SAG)在短暂性缺氧再复氧复注血清诱导的细胞坏死和凋亡中的作用.方法用短暂性缺氧再复氧复注血清来诱导原代培养的大鼠大脑皮质星形胶质细胞损伤,用免疫细胞化学方法检测凋亡敏感基因的表达,并作图像分析;用流式细胞仪检测胶质细胞在短暂缺氧再复氧复注血清后不同时间点的凋亡率.结果凋亡敏感基因在缺氧15 min再复氧复注血清5 h后表达最高,在复氧复注血清16 h后恢复至对照组水平;细胞凋亡率在缺氧15 min再复氧复注血清1h时达到最高,而在再复氧复注血清5 h后降至对照组水平.结论凋亡敏感基因具有抗凋亡的作用,可减轻星形胶质细胞的缺血再灌注损伤.     

Visual completion processing in human face perception.

Subjects discriminated whether two sequentially presented human face pictures (S1 and S2) were identical while event-related potentials were recorded to explore the neural basis of visual completion for occluded objects. Four kinds of stimulus trials were employed: S2 and S1 were identical (match-complete); S2 and S1 were identical, but S2 was partially occluded (match-incomplete); S2 was a different face from S1 (mismatch-complete); S2 was different from S1, and was partially occluded (mismatch-incomplete). Incomplete faces enhanced the amplitude of N1 compared with complete faces. The peak latency of N2 elicited by incomplete faces was delayed about 20 ms compared with complete faces. The enhancement of N1 is related to visual completion processing that requires additional time.     

地塞米松缓释微粒在增生性玻璃体视网膜病变的应用

目的：观察含地塞米松（DEX）的缓释微粒治疗增生性玻璃体视网膜病变（PVR）的临床疗效。方法：9例（9只眼）视网膜脱离伴PVR患者进行常规玻璃体视网膜手术，并在玻璃体腔内植入1粒DEX微粒（含地塞米松1mg），观察术后反应及视力、PVR发展、DEX的位置及形状变化等。结果：术后炎症反应轻，7只眼视网膜复位，3只眼后极部视网膜前有增生；2只眼视网膜局限性脱离，最终3只眼玻璃腔内硅油填充。随访视力有8只眼较术前提高（P=0.015）。DEX未见对视网膜有不良影响，仅在随着处有少量色素吸附，4-6月后吸收。结论：DEX抑制PVR术后炎症反应及较远期作用是安全、有效的；对手术未完全清除的视网膜前增生有一定的抑制作用。     

氯化镉对小鼠免疫细胞增殖和凋亡的影响

[目的]观察镉在体内染毒条件下 ,对小鼠免疫细胞的功能和凋亡的影响。[方法]采用一次腹腔注射氯化镉0.34、1.38和5.50mg/kg后8h处死和一次腹腔注射氯化镉5.50mg/kg后4、8、12h处死动物以及连续灌胃0.3、0.6和1.2mg/(kg·d)氯化镉14d后处死动物 ,利用MTT颜色反应法观察淋巴细胞转化、用DNA凝胶电泳法和流式细胞仪法检测细胞凋亡。[结果]小鼠经一次腹腔注射CdCl25.50mg/kg后4或8h可见胸腺细胞凋亡率为24.91 %和32.45 % ,脾细胞凋亡率分别为22.64 %和16.67 % ,均高于对照组 ;注射后12h胸腺细胞凋亡仍高于对照组。同时注射氯化镉5.50mg/kg4h后 ,ConA刺激的淋巴细胞转化功能明显低于对照组 ,抑制率接近50 % ;而在注射8h后 ,除了T细胞在ConA刺激下的转化功能受到抑制外 ,未受刺激的脾细胞增殖转化功能也受到抑制 ,抑制率为47 %。连续14d灌胃给氯化镉对小鼠脾脏细胞和胸腺细胞凋亡及淋巴细胞转化均未见明显的影响。[结论]小鼠经一次腹腔注射CdCl25.50mg/kg ,在胸腺细胞和脾细胞凋亡增加 ,同时T淋巴细胞转化功能也受到抑制。连续14d灌胃0.3、0.6和1.2mg/(kg·d)氯化镉未见对小鼠脾脏淋巴细胞转化和脾脏细胞、胸腺细胞的细胞凋亡有所影响     

深圳南山0～2岁儿童营养状况及其影响因素的调查研究

目的 了解深圳南山0～2岁儿童营养状况及影响因素。方法 Z评分法、NCHS标准评价儿童营养,检测血红蛋白和血Cu、Fe、Zn、Ca、Mg、P,问卷调查有关社会环境因素。结果 深圳南山0～2岁儿童营养不良率为8.08％。常住儿童与暂住儿童营养不良率间差别有显著性意义(P<0.01)。营养不良的影响因素:儿童户籍是否常、暂住,膳食结构中谷类食物量,婴儿期是否母乳喂养。儿童年龄与贫血患病率间存在一定线性依从关系(P<0.01),暂住与常住儿童贫血患病率间差别有显著性意义(尸<0.05)。235名儿童的血Cu、Mg值均正常,而儿童缺Ca、Zn、P、Fe的发生率分别为71.06％、54.89％、22.12％和6.8％。结论 我区0～2岁儿童营养状况不容乐观,尤其暂住儿童更是高危人群。我们在重点营养干预同时,要注意改善整体儿童营养状况。