TLIF术式在布氏杆菌性脊柱炎病人中的临床疗效及安全性分析

目的 对比分析单纯后路内固定+一期经腰椎间孔病椎间病灶清除(TLIF)与经典的前后联合手术在布氏杆菌性脊柱炎患者中的临床疗效及安全性。 方法 对我院2015年1月至2017年12月收治的93例布病性脊柱炎患者的临床资料进行分析。按手术方式分为观察组(45例)和对照组(48例)。对两组患者的基础数据、临床指标、术前术后各项指标水平以及术后并发症、植骨治愈情况。 结果 观察组与对照组基础数据比较,差异无统计学意义(P>0.05)。观察组患者的手术时间、住院天数、术中出血量及术后下床时间均明显低于对照组(P<0.01)。两组患者术后3个月的ODI、VAS、CRP、ESR及Cobb角均明显低于术前(P<0.05);术后3个月,观察组患者的ODI、VAS、CRP、ESR及Cobb角均明显低于对照组(P<0.05)。观察组术后并发症发生率(4.4%)明显低于对照组(25.0%)(Χ²=7.674,P<0.01)。 结论 TLIF治疗布氏杆菌性脊柱炎患者的临床疗效突出,安全性较好,更有利于患者术后身体的恢复。     

Extracellular superoxide dismutase is important for hippocampal neurogenesis and preservation of cognitive functions after irradiation

Cranial irradiation is widely used in cancer therapy, but it often causes cognitive defects in cancer survivors. Oxidative stress is considered a major cause of tissue injury from irradiation. However, in an earlier study mice deficient in the antioxidant enzyme extracellular superoxide dismutase (EC-SOD KO) showed reduced sensitivity to radiation-induced defects in hippocampal functions. To further dissect the role of EC-SOD in neurogenesis and in response to irradiation, we generated a bigenic EC-SOD mouse model (OE mice) that expressed high levels of EC-SOD in mature neurons in an otherwise EC-SOD–deficient environment. EC-SOD deficiency was associated with reduced progenitor cell proliferation in the subgranular zone of dentate gyrus in KO and OE mice. However, high levels of EC-SOD in the granule cell layer supported normal maturation of newborn neurons in OE mice. Following irradiation, wild-type mice showed reduced hippocampal neurogenesis, reduced dendritic spine densities, and defects in cognitive functions. OE and KO mice, on the other hand, were largely unaffected, and the mice performed normally in neurocognitive tests. Although the resulting hippocampal-related functions were similar in OE and KO mice following cranial irradiation, molecular analyses suggested that they may be governed by different mechanisms: whereas neurotrophic factors may influence radiation responses in OE mice, dendritic maintenance may be important in the KO environment. Taken together, our data suggest that EC-SOD plays an important role in all stages of hippocampal neurogenesis and its associated cognitive functions, and that high-level EC-SOD may provide protection against irradiation-related defects in hippocampal functions.Cranial irradiation is widely used as a treatment modality for patients with primary or metastatic brain tumors (1–3), and is also used as a prophylactic treatment to prevent metastases of high-risk tumors to the nervous system (4). Although effective, cranial irradiation is associated with various complications or side effects in cancer survivors (1–3). One of the severe complications is neurocognitive impairment, which can include defects in executive functions and learning and memory (3). Neurocognitive impairments occur in both adults and children and are generally associated with higher doses and younger age (3). The pathogenesis of radiation-induced neurocognitive impairment is not completely understood, but recent studies suggest that suppressed hippocampal neurogenesis (5, 6), increased hippocampal neuronal apoptosis (7, 8), and reduced growth hormone secretion (9, 10) may be involved.The production of reactive oxygen species (ROS) is considered a major cause of radiation-induced tissue damage (11). Ionizing irradiation not only results in the acute generation of short-lived ROS, it also results in a persistent state of oxidative stress that extends up to several months or even years after irradiation (12, 13). Accordingly, animal and cell models with altered antioxidant capacities have been used to investigate the biochemical pathways involved in radiation-induced tissue and cell injuries, and experimental antioxidant-based therapies have been designed to protect normal tissues during radiation treatments (14).Hippocampal neurogenesis is important for hippocampal-dependent functions of learning and memory and the process is exquisitely sensitive to suppression by various stressors, including radiation and oxidative stress (5, 6, 15). To determine if altered redox balance in the hippocampal microenvironment affects hippocampal neurogenesis and the associated functions of learning and memory, we used a knockout mouse model (KO) deficient in the extracellular antioxidant enzyme, EC-superoxide dismutase (EC-SOD), in an earlier study with cranial irradiation (13, 16). When examined at 3–4 mo of age, EC-SOD deficiency was associated with a significant suppression of baseline neurogenesis and impaired hippocampal-dependent cognitive functions (13, 16). Unexpectedly, EC-SOD deficiency also rendered the process less sensitive to radiation-induced changes. The underlining mechanism for this paradoxical finding was not clear, but preliminary studies ruled out up-regulation of major antioxidant enzymes (13). The results suggested that the interaction between redox balance and irradiation and their effects on hippocampal functions can be complex, and understanding how these elements work in concert may be a key to identifying strategies for radioprotection.To manipulate redox balance in the hippocampus, we generated a mouse model with inducible EC-SOD transgenes (17). In the current study, we combined the inducible transgenes with EC-SOD KO and generated a bigenic mouse model, designated as the overexpressor (OE), with high levels of EC-SOD expressed only in Ca/calmodulin-dependent protein kinase- (CaMKII) positive neurons in an otherwise EC-SOD–deficient environment (17). Hippocampal neurogenesis generates new granule cells that are functionally integrated into the hippocampal network (18). Because granule cells are CaMKII-positive neurons and are the principal excitatory neurons in the dentate gyrus, the manipulation leads to an estimated four- to fivefold increase in EC-SOD activity in the hippocampal formation in OE mice (17). The OE mice were used to investigate the effects of altered EC-SOD levels at different stages of hippocampal neurogenesis and the functional consequences of learning and memory. Comparison between WT, OE, and KO mice revealed the importance of EC-SOD in progenitor cell proliferation, dendritic development, and long-term survival of newborn neurons. The study results also suggested that maintenance of the dendritic system following cranial irradiation was important for preservation of neurocognitive functions.     

以病人为中心的口腔科门诊数字化建设初探

目的：总结以病人为中心的口腔科门诊数字化建设的经验。方法：从诊疗手段、就医流程、医疗文书以及科室管理4个方面总结广州军区武汉总医院口腔科门诊数字化建设的概况。结果：2009年以来开始进行El腔科门诊的数字化建设,经过3年多的运行,科室工作流程优化明显,提高了工作效率和医疗服务质量。结论：科室的数字化建设有助于提高科室的工作效率和医疗服务质量,充分体现了”以病人为中心”这一理念。     

Dielectric properties of porcine cerebrospinal tissues at microwave frequencies: in vivo, in vitro and systematic variation with age

The dielectric properties of pig cerebrospinal tissues were measured in vivo and in vitro, in the frequency range of 50 MHz-20 GHz. The total combined measurement uncertainty was calculated at each frequency point and is reported over representative frequency regions. Comparisons were made for each tissue between the two sets of data and with the literature of the past decade. The in vitro study was extended to include tissue from pigs weighing approximately 10, 50 and 250 kg to re-visit the question of the variation of dielectric properties with age. White matter and spinal chord showed significant variation as function of animal age, no age-related variations were recorded for grey matter.     

Meta-analysis of retrojugular versus antejugular approach for carotid endarterectomy

Introduction

The retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high carotid lesions. Controversial opinion exists with regard to its safety and benefits over the conventional antejugular approach.

Methods

A systematic review of electronic information sources was conducted to identify studies comparing outcomes of CEA performed with the retrojugular and antejugular approach. Synthesis of summary statistics was undertaken and fixed or random effects models were applied to combine outcome data.

Findings

A total of 6 studies reporting on a total of 740 CEAs (retrojugular approach: 333 patients; antejugular approach: 407 patients) entered our meta-analysis models. The retrojugular approach was found to be associated with a higher incidence of laryngeal nerve damage (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 1.46–7.07). No significant differences in the incidence of hypoglossal or accessory nerve damage were identified between the retrojugular and antejugular approach groups (OR: 1.09 and 11.51, 95% CI: 0.31–3.80 and 0.59–225.43). Cranial nerve damage persisting during the follow-up period was similar between the groups (OR: 2.96, 95% CI: 0.79–11.13). Perioperative stroke and mortality rates did not differ in patients treated with the retrojugular or antejugular approach (OR: 1.26 and 1.28, 95% CI: 0.31–5.21 and 0.25–6.50).

Conclusions

Currently, there is no conclusive evidence to favour one approach over the other. Proof from a well designed randomised trial would help determine the role and benefits of the retrojugular approach in CEA.     

The application of tissue-engineered preputial matrix and fibrin sealant for urethral reconstruction in rabbit model

Background

To introduce the role of fibrin sealant and preputial acellular matrix (PAM) as a new source of inert collagen matrix for urethral reconstruction.

Methods

A ventral urethral segmental defect was created in 24 male rabbits divided into four groups. In group 1 (G1), urethrotomy was closed in layers. In group 2 (G2), closure was followed by applying fibrin sealant. In groups 3 (G3) and 4 (G4), urethroplasty was performed with a patch graft of PAM, and in G4, fibrin sealant was also applied. Serial urethrography was performed before and after the operation. Then, the animals were euthanized, and their urethra was excised 1, 3, and 9 months postoperatively for further electron microscopic examination, terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) technique, and immunohistochemical (IHC) staining with CD34, CD31, desmin, SMA, and α-actin.

Results

In G1 and G2, the fistula repair failed in all the time points. In G3 and G4, serial urethrography confirmed the maintenance of a wide urethral caliber without signs of strictures or extravasations. Satisfactory vascularity was observed in G3 and G4 during the whole study, which was more significant in G4 after 9 months of follow-up. The presence of a complete transitional cell layer was confirmed over the graft in G3 and G4 in all time points. IHC staining confirmed the effectiveness of fistula repair in G3 and G4, 3 months postoperatively.

Conclusion

This rabbit model showed that PAM combined with fibrin sealant may herald a reliable option for repairing segmental urethral defects.