应用OPA-K直丝弓矫治器双颌减数治疗安氏Ⅱ~1类错的临床研究

目的：评价OPA-K直丝弓矫治器双颌减数治疗安氏Ⅱ1类错的临床疗效,并探讨其机制和使用方法。方法：临床选择15～23岁安氏Ⅱ1类错患者22例,应用OPA-K直丝弓矫治器进行双颌减数治疗,并对治疗前后X线头影测量值的变化进行分析。结果：矢状方向上,U1-NA和U1-SN分别减小14.26°和10.32°,U1-NA（mm）减小4.16mm,U1-L1增加17.06°,以上差异均具有统计学意义（P〈0.05）,而SNA、SNB、ANB、L1-NB、L1-MP的变化均无显著性（P〉0.05）。垂直方向上,SN-MP和Y轴的变化均无显著性（P〉0.05）。结论：应用OPA-K直丝弓矫治器治疗安氏Ⅱ1类错可取得令人满意的临床效果。     

干细胞与骨质疏松症研究进展

干细胞是一类具有自我复制能力的多潜能细胞,在一定条件下可分化成多种功能细胞或组织器官,并且不表达组织相容性复合体(MHC),无免疫排斥反应,对许多疾病的治疗具有重要意义。本文对干细胞在骨质疏松症方面的基础研究进行综述,并对干细胞应用于重度骨质疏松症治疗提供理论依据。     

脊髓GABAA受体在异丙酚对内脏痛大鼠镇痛效应中的作用

目的 评价脊髓γ-氨基丁酸A(GABAA)受体在异丙酚对内脏痛大鼠镇痛效应中的作用.方法成年健康雌性SD大鼠,体重190～240 g,进行鞘内置管,并于直肠粘膜下注射10%福尔马林100 μl.取鞘内置管成功的大鼠32只,采用随机数字表法,将其随机分为4组(n=8):二甲基亚砜组(D组)、异丙酚组(P组)、荷包牡丹碱组(B组)和荷包牡丹碱+异丙酚组(BP组).D组、P组和B组分别鞘内注射二甲基亚砜5 μl、异丙酚10 μg、荷包牡丹碱2 μg;BP组先鞘内注射荷包牡丹碱2 μg,10min后鞘内注射异丙酚10 μg.注射福尔马林2 h时,取脊髓L5～S1节段,采用免疫组化法测定FOS蛋白表达水平.结果 与D组和B组比较,P组脊髓FOS蛋白表达下调(P＜0.05);D组和B组脊髓FOS蛋白表达差异无统计学意义(P＞0.05);与P组比较,BP组脊髓FOS蛋白表达上调(P＜0.05).结论 异丙酚可通过脊髓GABAA受体介导,对内脏痛大鼠产生镇痛效应.

Abstract：

Objective To evaluate the role of spinal cord CABAA receptors in the analgesic effect of propofol on visceral pain in rats. Methods Adult female SD rats, weighing 190-240 g, were used in this study.The animals were anesthetized with intraperitoneal ketamine 50-100 mg/kg. Intrathecal (IT) catheters were placed at L5-6 interspace according to the technique described by Storkson et al. Thirty-two animals in which IT catheters were successfully placed were randomly divided into 4 groups ( n = 8 each) : dimethyl sulphoxide (DMSO) group (group D), propofol group (group P), bicuculline group (group B) and bicuculline + propofol group (group B +P). Visceral pain was induced by injecting 10% formalin 100 μl underneath the mucous membrane of rectum.Groups D, P and B received IT DMSO 5 μl, propofol 10 μg and bicuculline 2 μg respectively. Group BP received IT bicuculline 2 μg and then IT propofol 10 μg 10 min later. The L5-S1 segment of the spinal cord was removed 2 h after formalin injection to determine FOS protein expression by hnmuno-histochemistry. Results Compared with groups D and B, FOS protein expression was significantly down-regulated in group P ( P ＜ 0.05 ) . There was no significant difference in FOS protein expression between groups D and B ( P ＞ 0.05) . FOS protein expression was significantly up-regulated in group BP compared with group P ( P ＜ 0.05) . Conclusion Propofol has analgesic effect on visceral pain in rats through spinal cord GABAA receptor action.     

经胸微创非体外循环下封堵室间隔缺损:多中心经验和近中期随访结果

目的 总结多中心应用食管超声引导、经胸微创小切口、非体外循环(CPB)下封堵室间隔缺损(VSD)的临床经验和近、中期随访结果.方法 432例病儿,男235例,女197例;年龄3个月～15岁,平均(3.2±1.9)岁;体重4.0～26.0 kg,平均(13.3±5.6)kg.膜周部VSD 351例,嵴上或嵴内型VSD 57例,肌部VSD 24例(17例多发VSD).VSD直径3～12 mm,平均(5.3±1.6)mm.膜周部VSD,经剑突下或胸骨下端3～4 cm小切口进胸;嵴内或嵴上VSD,经胸骨左缘第3肋间2～3 cm小横切口进胸.暴露右心室表面,在食管超声引导和实时监测下,穿刺右心室游离壁,导引钢丝经右心室腔穿过VSD到达左心室腔,沿导引钢丝导入输送鞘管建立轨道.通过输送鞘管直接将封堵器安放在VSD部位.经食管超声多切面反复评估封堵器的位置和与周边组织的关系,若无异常情况即可释放封堵器.结果 432例中417例封堵成功(96.5%),15例(3.5%)术中改为常规CPB手术.封堵成功者中,选用对称伞238例(57.1%),偏心伞179例(42.9%).13例(3.1%)发生新的微量至轻度三尖瓣反流,11例(2.6%)术后发生不完全右束支传导阻滞,3例(0.7%)术后发生一过性完全性房室传导阻滞.术后383例(91.8%)病儿在2 h内拔除气管插管,3～5天出院.术后416例(96.2%,416/432例)随访12～38个月,平均(19.3±11.6)个月,无近、中期死亡.1例术后6个月发生完全性房室传导阻滞.其余无明显异常.结论 应用食管超声引导、经胸微创非CPB下封堵VSD技术,是一种相对简单有效的治疗方法,近、中期临床结果满意,但远期结果需要进一步观察.

Abstract：

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.     

分子标记物预测直肠癌新辅助放化疗效果初步评价

目的：寻找预测直肠癌新辅助治疗效果的分子标志物。方法：对26例行新辅助治疗的进展期中低位直肠癌的治疗前活检标本的K-ras基因进行测序,同时通过免疫组织化学方法对分子标志物增殖细胞核抗体（Ki-67）、核转录因子（NF-KB）、细胞周期蛋白依赖性激酶1（CDK1）进行检测。对手术标本行病理分析和肿瘤消退分级评估。结果：本组病例新辅助治疗后获得病理完全缓解（pCR）的患者7例（26．9％）均为K-ras基因野生型,治疗后降期患者17例（65．4％）。K-ras基因是否突变同新辅助放化疗（CRT）能否达到pCR密切相关（P=0．048）。K-ras基因野生型患者的降期率和肿瘤消退率均为77．8％（14／18）,同突变型的降期率和肿瘤消退率比较P=0．063。结论：中低位直肠癌患者新辅助治疗前K-ras基因野生型可能预示着较好的新辅助治疗效果。     

冲击波与地塞米松对自体血清培养的骨髓间充质干细胞成骨分化的比较研究

[目的]观察冲击波(shock waves)与地塞米松对自体血清培养的人骨髓间充质干细胞(human mesenchyreal stem cells,hMSCs)体外成骨分化的影响比较.[方法]选择10名健康志愿者,每名健康志愿者抽取骨髓60 ml,抽取外周静脉血100 ml,然后分离出自体血清.把每名志愿者的骨髓分别...     

改良面神经额支的体表定位

目的:通过改良的方法对面神经的额支进行体表定位,为临床手术提供更加适用的寻找面神经额支的方法.方法:对20侧防腐成人头部标本进行大体和显微解剖,测量在耳轮上点与外眦上点的连线上和耳屏上切迹点与外眦点的连线上,面神经的额支所经过的相对位置.结果:额支在耳轮上点-外眦上点的连线后段(3/10～4/5)±1/10的范围内跨过,在耳屏上切迹点-外眦点的连线后段(1/5-1/2)±1/9的范围内跨过.结论:面神经额支在两条标志线的特定区域跨过,手术中,切口应避开该危险区域.     

肱骨干骨不连固定方法进展

骨不连是肱骨干骨折后常见并发症之一,发生率因治疗方法不同而异.固定不稳和骨折端分离可能是引起肱骨干骨不连的主要原因.手术是目前治疗肱骨干骨不连的首选方法.常用的固定方法如钢板、髓内钉和外固定支架在治疗肱骨干骨不连上何者更具优越性,尚存在争议.钢板固定治疗骨不连愈合率高,肩痛发生率低.髓内钉固定可减少软组织剥离,降低桡神经损伤和感染危险.对初次髓内钉固定失败患者,钢板更有优越性,单纯更换髓内钉治疗几乎没有效果.Ilizarov外固定技术可用于节段性骨缺损、感染、畸形和多次治疗失败的骨不连病例.必须依据个体化原则选择手术方案,尽可能避免潜在风险.     

保守治疗掌侧Barton骨折的临床探讨

目的：探讨保守治疗掌侧Barton骨折的指征和预后。方法：保守治疗23例掌侧Barton骨折患者,其中男8例,女15例;年龄16～84岁,平均52.2岁;骨折不伴桡腕关节掌侧半脱位7例,伴桡腕关节掌侧半脱位16例（Mehara Ⅰ型15例,Mehara Ⅲ型1例）。并对32具新鲜尸体标本进行实验,推断在掌侧Barton骨折的损伤机制中,桡腕关节背侧韧带损伤是产生桡腕关节向掌侧半脱位的重要原因。应用Pattee和Thompson的评价标准对治疗效果进行评价。结果：进行7～70个月随访,11例疗效满意（优1例、良10例）,12例不满意（中5例、差7例）。7例骨折不伴桡腕关节掌侧半脱位病例中,5例治疗结果满意;16例伴桡腕关节掌侧半脱位病例中,6例治疗结果满意。结论∶①复位结果影响掌侧Barton骨折的预后,复位后桡腕关节面移位应小于2mm。②不伴桡腕关节向掌侧半脱位,建议保守治疗。③伴有桡腕关节向掌侧半脱位,保守治疗预后欠佳,可试行手法整复、石膏外固定,如不能达到桡腕关节面移位小于2mm的标准,就应采取手术方法治疗。     

经皮氧分压监测在急性呼吸窘迫综合征治疗中的应用

目的 观察经皮氧分压(PtcO2)在急性呼吸窘迫综合征(ARDS)患者中的变化特点,了解其在ARDS治疗中的作用.方法 采用经皮氧分压监测仪对49例ARDS患者实施连续动态监测PtcO2,记录通气前和通气后4、8、16、24 hPtcO2值,同期抽取动脉血检测PaO2、SaO2,记录心率(HR)和平均动脉压(MAP).并比较存活组与死亡组不同时间PtcO2的差异.结果 SaO2、HR、MAP随时间变化的程度不明显(均P＞0.05),PtcO2和PaO2随时间变化显著(均P＜0.05);存活组(35例)与死亡组(14例)PtcO2比较,差异有显著性意义(P＜0.05).结论 PtcO2监测对ARDS治疗能提供连续、可靠的指导作用,PtcO2早期的变化对判断预后有一定帮助.