肺炎链球菌溶血素致脑损伤中细胞凋亡及凋亡诱导因子的变化及意义

目的 探讨肺炎链球菌溶血素(PLY)致感染性脑损伤中细胞凋亡及凋亡诱导因子(AIF)的表达及意义. 方法 SD大鼠80只按随机数字表法分为PLY组[颈内动脉注射0.2 mL(7μg) PLY]和生理盐水(NS)组(颈内动脉注射等体积NS),每组40只.每组按观察时间点分为6h、12h、24 h、48 h4个亚组,每亚组10只,其中5只注射髓,甲酰胺法测定脑组织EB含量判断血脑屏障(BBB)的破坏程度.5只不注射EB,取脑组织切片,应用免疫组化和TUNEL染色分别检测脑组织神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、AIF蛋白含量和细胞凋亡. 结果 与NS组比较,造模后各时间点PLY组大鼠脑组织EB、NSE、GFAP、AIF蛋白含量均较高,细胞凋亡较多,差异均有统计学意义(P＜0.05); PLY组大鼠脑组织凋亡细胞数与AIF蛋白的表达呈正相关关系(r=0.959,P=0.000). 结论 细胞凋亡参与了PLY诱导的脑损伤的发展过程,AIF可能介导了神经细胞的凋亡.     

经髂腹股沟和Kocher-Langenbeck联合入路治疗复杂移位髋臼骨折

 目的 探讨采用经髂腹股沟和 Kocher-Langenbeck(K-L)联合入路行切开复位内固定治 疗复杂移位髋臼骨折的疗效。方法 2004年 2月至 2009年 12月, 采用经髂腹股沟和 K-L联合入路治 疗 66例复杂移位髋臼骨折, 对其中获得随访的 45例患者进行分析, 男 27例, 女 18例;年龄 23~57岁, 平均 41.5岁;车祸伤 36例, 坠落伤 9例。按 Letournel分型: 野T冶形骨折 18例, 双柱骨折 17例, 前柱加后 半横行骨折 10例;骨折移位均在 3 mm以上。其中 15例合并股骨头中心性脱位, 21例合并股骨头后上 脱位。结果 45例患者手术时间 1.4~5.7澡, 平均 2.8澡;术中失血 530~2300 ml, 平均 1250 ml;骨折均愈 合, 愈合时间为 8~16周, 平均 10.4周。随访时间 8~45个月, 平均 26个月。根据 Matta评定标准, 优 33 例, 良 6例, 差 6例, 优良率 86.7%。按 Matta改良的 Merled爷Aubigne和 Postel的标准评价髋关节功能, 优 33例, 良 6例, 可 6例, 优良率 86.7%。异位骨化: 玉度 6例, 域度 3例。 6例发生坐骨神经牵拉伤, 其 中 3例于半年后恢复, 3例于 1年后恢复。 9例发生医原性股外侧皮神经损伤, 均于术后半年至 1年逐 渐减轻并恢复; 6例发生创伤性关节炎: 玉期 1例, 域期 2例, 芋~吁期各员例;3例玉、域期患者给予保 守治疗, 3例芋~吁期患者因疼痛及关节活动严重障碍而行全髋关节置换术。无一例患者发生股骨头缺 血性坏死、切口感染及骨折不愈合。结论 对复杂移位髋臼骨折, 采用经髂腹股沟和 K-L联合入路有利 于复位及内固定, 可最大限度恢复髋关节功能, 减少组织损伤及降低并发症发生率。     

经皮椎弓根螺钉内固定治疗胸腰椎骨折的生物力学及临床研究

 目的 通过生物力学测试及临床应用对经皮跨伤椎四钉内固定(万向钉固定)与开放手术四钉内固定(单向钉固定)进行比较。方法 取 12具新鲜冰冻小牛腰椎标本 L1~L5节段,随机分为单向钉固定组与万向钉固定组。制备腰椎前中柱损伤模型,比较两组在模型上的运动范围。分别应用 Sextant经皮跨伤椎四钉内固定与开放跨伤椎四钉内固定治疗无神经功能损伤的胸腰椎骨折 25例和 35例,观察其中随访超过 12个月的 11例和 18例的即时复位效果、矫正度丢失情况。结果 (1)生物力学试验院万向钉固定组在各个方向的运动范围均大于单向钉固定组,其中在前屈、后伸方向的差异有统计学意义; 单向钉固定组在前屈、后伸、侧屈方向上的稳定性较完整标本大,差异有统计学意义; 万向钉固定组在前屈、后伸方向上的稳定性与完整标本比较差异无统计学意义。(2)临床应用院两组术前、术后伤椎前缘高度、矢状位 Cobb角的组间差异均无统计学意义; 两组术后伤椎前缘高度、矢状面 Cobb角与术前比较差异均有统计学意义; 末次随访时经皮跨伤椎四钉内固定组伤椎前缘高度丢失(9.9%±5.1%)大于开放跨伤椎四钉内固定组(5.3%±6.8%)。结论 应用 Sextant系统经皮椎弓根螺钉内固定治疗无须神经减压的胸腰椎骨折较开放手术创伤小,但随访中伤椎前缘高度丢失明显。生物力学试验显示其在前屈、后伸运动方向上的强度较弱。     

姜黄消痤搽剂联合痤疮涂膜剂治疗寻常性痤疮疗效观察

目的：评价姜黄消痤搽剂联合痤疮涂膜剂治疗寻常性痤疮的疗效与安全性。方法：将150例痤疮患者随机分为三组：试验组：白天外用姜黄消痤搽剂,2次/天,晚上睡前外用痤疮涂膜剂,1次/天;对照Ⅰ组：白天外用姜黄消痤搽剂,2次/天;对照Ⅱ组：晚上睡前外用痤疮涂膜剂,1次/天。在治疗前、治疗第4周、8周时及停止治疗后2个月观察疗效。结果：治疗8周后,姜黄消痤搽剂和痤疮涂膜剂试验组有效率（83.33%）与姜黄消痤搽剂组（61.22%）及痤疮涂膜剂组（64.58%）相比,差异有统计学意义（均P〈0.05）,且不良反应少。结论：姜黄消痤搽剂联合痤疮涂膜剂治疗寻常性痤疮安全,疗效满意。     

128层螺旋CT的MPR和VR在胫骨平台骨折中的应用

目的：探讨螺旋CT MPR和三维重建（3D-CT）技术在胫骨平台骨折中的临床应用。方法：回顾性分析经128层螺旋CT的MPR和3D技术证实的60例胫骨平台骨折病例。结果：所有胫骨平台骨折经3D及MPR成像后均能立体显示骨折的部位、形态、类型、关节面碎裂及塌陷程度等空间信息,较平片优越,与手术中所见一致。结论：螺旋CT的MPR及3D技术能够更精确地显示胫骨平台的骨折情况,对骨折的分型判断及治疗方法的选择具有指导意义。     

Cerebrovascular atherosclerosis in type III hyperlipidemia is modulated by variation in the Apolipoprotein A5 gene

Objective

Type III Hyperlipoproteinemia is a rare lipid disorder with a frequency of 1-5 in 5000. It is characterized by the accumulation of triglyceride rich lipoproteins and patients are at increased risk of developping atherosclerosis. Type III HLP is strongly associated with the homozygous presence of the ε2 allele of the APOE gene.However only about 10% of subjects with APOE2/2 genotype develop hyperlipidemia and it is therefore assumed that further genetic and environmental factors are necessary for the expression of disease. It has recently been shown that variation in the APOA5 gene is one of these co-factors. The aim of this study is to investigate the development of cerebrovascular atherosclerosis in patients with Type III hyperlipoproteinemia (Type III HLP) and the role of variation in the APOA5 gene as a risk factor.

Methods

60 patients with type III hyperlipidemia and ApoE2/2 genotype were included in the study after informed consent. The presence of cerebrovascular atherosclerosis was investigated using B-mode ultra-sonography of the carotid artery. Serum lipid levels were measured by standard procedures. The APOE genotype and the 1131T > C and S19W SNPs in the APOA5 gene and the APOC3 sstI SNP were determined by restriction isotyping Allele frequencies were determined by gene counting and compared using Fisher''s exact test. Continuous variables were compared using the Mann Whitney test. A p value of 0.05 or below was considered statistically significant. Analysis was performed using Statistica 7 software.

Results

The incidence of the APOA5 SNPs, -1131T > C and S19W and the APOC3 sstI SNP were determined as a potential risk modifier. After correction for conventional risk factors, the C allele of the 1131T > C SNP in the APOA5 gene was associated with an increased risk for the development of carotid plaque in patients with Type III HLP with an odds ratio of 3.69. Evaluation of the genotype distribution was compatible with an independent effect of APOA5.

Conclusions

The development of atherosclerosis in patients with Type III HLP is modulated by variation in the APOA5 gene.     

碳酸氢钠注射液的质量研究

目的：验证新生产的碳酸氢钠注射液是否符合质量标准、达到上市销售要求。方法：按照碳酸氢钠注射液的质量标注,进行一系列的质量研究。结果：碳酸氢钠注射液的各项指标均达到要求。结论：新生产的碳酸氢钠注射液符合质量标准,允许上市销售。     

可变性红斑角化病1例

患者男,2岁。面部及腋下红斑1.5年。皮肤科情况:面部、颈部、双腋下及躯干部淡褐色角化过度性斑片,双手足角化过度,轻度脱屑。皮损组织病理示:表皮角化过度,棘层轻度肥厚,真皮浅层毛细血管周围少量以淋巴细胞为主的细胞浸润。诊断:可变性红斑角化症。     

Comparison of evoked arousability in breast and formula fed infants

Background: Currently, there is no consistent evidence that breast feeding reduces the risk for sudden infant death syndrome (SIDS). Arousal from sleep is believed to be an important survival mechanism that may be impaired in victims of SIDS. Previously it has been shown that arousability is impaired by the major risk factors for SIDS such as prone sleeping and maternal smoking. Aims: To establish whether arousability was altered by method of feeding, and whether breast fed infants would have lower arousal thresholds. Methods: Forty three healthy term infants were studied using daytime polysomnography on three occasions: 2–4 weeks post-term, 2–3 months post-term, and 5–6 months post-term. Multiple measurements of arousal threshold (cm H₂O) in response to nasal air jet stimulation applied alternately to the nares were made in both active sleep (AS) and quiet sleep (QS) while infants slept supine. Arousal thresholds and sleep period lengths were compared between formula fed and breast fed infants at each age. Results: Arousal thresholds were not different between breast fed and formula fed infants in QS. However, in AS breast fed infants were significantly more arousable than formula fed infants at 2–3 months of age. There was no difference between groups of infants when sleep period length was compared at any study. Conclusions: Breast fed infants are more easily aroused from AS at 2–3 months of age than formula fed infants. This age coincides with the peak incidence of SIDS.     

中耳胆脂瘤和慢性化脓性中耳炎手术临床分析

目的　探讨中耳胆脂瘤和慢性化脓性中耳炎术式选择及临床效果。方法　对110例中耳乳突病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据范围显微镜下实施完壁式或开放式乳突根治,部分同时鼓室成形术,随访术后干耳状况、并发症、复发情况以及术后听力改善程度等。结果　110例患者中66例中耳胆脂瘤、44例慢性化脓性中耳炎,出现颅内外并发症者7例。手术方式：51例（46.36%）行完壁式乳突根治术,46例（41.81%）同时行鼓室成形术,59例（53.64%）行开放式乳突根治术。完壁式乳突根治术后听 力提高＞25 dB 37例（33.64%）,＞15 dB 14例（12.72%）;开放式乳突根治术后听力提高＞15 dB 5例（4.55%）,听力减退4例（3.64%）,比较手术前后言语频率区平均听阈,差异有统计学意义（P＜0.05）。术后随访1年发现开放式和完壁式两组胆脂瘤复发共4例。结论　中耳胆脂瘤与慢性化脓性中耳炎通过选择恰当手术方式可获得较好的临床疗效。