后外侧融合对胸腰椎爆裂型骨折疗效的影响

目的 观察后外侧融合对预防胸腰椎爆裂型骨折短节段固定失败的作用及意义。方法 本组60例胸腰椎爆裂型骨折患者，A组30例均为我院收治患者，B组30例均为外院手术来我院复查的患者。A组行短节段内固定自体髂骨植骨、后外侧融合术；B组仅行短节段内固定，未植骨融合。平均随访16个月，在X线侧位片上测量Cobb角、伤椎后凸角及矢状面指数（SI），临床疗效评价采用下腰痛评分法（low back outcome score，LBOS）。结果 手术前、后两组间Cobb角、伤椎后凸角、SI比较，差异无统计学意义（P〉0．05），而末次随访时两组间Cobb角、伤椎后凸角、SI比较，差异有统计学意义（P〈0．01）。LBOS评分A组的优良率为73％（22／30），B组仅为43％（13／30）。结论 后外侧融合是降低内固定失败、减少纠正丢失等并发症的有效措施，只行内固定而不做植骨融合明显增高了并发症的发生率，是不恰当的手术方式。     

Simultaneous Bilateral Tibial Tuberosity Avulsions—Over 6-Year Follow-up

Abstract Simultaneous bilateral avulsions of the tibial tuberosity are rare injuries. The authors found only five reported cases in the orthopedic literature. We add a further case of bilateral avulsions of the tibial tuberosity with the longest reported follow-up.     

Messung der psychischen Belastung nach akutem Myokardinfarkt mit Hilfe der SCL-90-R

Zusammenfassung. Ziel: Die psychische Belastung bei Patienten mit akutem Herzinfarkt innerhalb der ersten 48 h auf der Intensivstation des Städtischen Krankenhauses Kiel wird mit Hilfe der Symptom-Checkliste (SCL-90-R) gemessen. Patienten und Methodik: 134 hauptsächlich wegen eines akuten Herzinfarkts aufgenommene Patienten wurden zwischen August 1996 und Juli 1999 randomisiert ausgewählt. Sie füllten einen der Intensivstation angepassten Fragebogen aus, der u. a. neben Fragen zu sozioökonomischen Daten die standardisierten SCL-90-R enthält. Ergebnisse: Erhöhte Mittelwerte zeigten sich vor allem für die Skalen Somatisierung, Ängstlichkeit, Depressivität und GSI (Global Severity Index) bei solchen Patienten, die wenig soziale Unterstützung bekamen und über ein niedriges Einkommen verfügten. Schlussfolgerung: Da für Patienten mit schlechtem sozialen Netzwerk, niedrigem sozialen Status, erhöhter Angst und Depressivität eine schlechtere Prognose hinsichtlich der Mortalität und Wiedereingliederung in den Beruf beschrieben wurde, ist es im prospektiven Verlauf dieser Studie notwendig, gerade diese Patienten hinsichtlich der Entwicklung ihrer Angst zu erfassen und zu behandeln. Abstract. Objective: 134 patients with acute myocardial infarction, who were treated in an intensive care unit (ICU) of a German hospital in Kiel between 1996 and 1999 were selected for the study to examine their psychologic symptoms. Patients and Methods: The patients were asked to fill in the self-report inventory, the Symptom Checklist-90-Revised (SCL-90-R) within the first 48 h after their arrival in the ICU. Results: Patients with a low social status were found to have elevated mean values of the following scales: somatization (0.93), depression (0.66), and anxiety (0.59). The Global Severity Index (GSI) as a global measure of psychologic distress was elevated as well (0.46). Conclusion: Since patients with a limited social network and low social status, increased anxiety and depressive scores have a poor prognosis as to their mortality and their professional reintegration, it it considered necessary for the prospective setting of this study to register particularly those patients in order to treat their anxiety.     

Functional correlates of Doppler flow study of the female urethral vasculature.

OBJECTIVES: To examine the effect of individual patient factors (age, parity, body mass index, menstrual cycle, menopause, hormone replacement therapy, bladder neck position and urethral mobility) on the appearance of Doppler flow in urethral vessels, to investigate the association between the Doppler flow parameters and intrinsic urethral function, storage and voiding, and to explore differences in the urethral vasculature between subjects with and without urodynamic stress incontinence (USI). METHODS: Over a 4-year period we prospectively performed imaging studies in 355 women, including 244 who denied any lower urinary tract symptoms within the previous 3 months (Group A) and 111 who had had lower urinary tract symptoms (Group B). Studies included morphologic assessment and Doppler flow investigation of the lower urinary tract. Vascular flow velocity and vessel density in the urethral vasculature were measured. For women in Group B, multichannel urodynamic studies were also performed. RESULTS: The urethral vasculature has five main branches of vessels. Their appearance was not affected by the menstrual cycle or menopause except for those of the anterior vaginal vessel and anterior branch of the middle urethral vessel. Other than that of the posterior urethral vessel, in which there was a correlation with parity, the resistance index (RI) was not affected by individual patient factors. However, there was a correlation between the vascular index (VI) and individual factors such as age (r = -0.336, P = 0.002), body mass index (r = -0.287, P = 0.028), menopause (r = -0.402, P < 0.001), and hormone replacement therapy (r = 0.392, P = 0.027). Only the VI and RI of the posterior urethral vessel correlated significantly with the urethral pressure profile. In subjects with lower urinary tract symptoms, the appearance of the urethral vasculature on power Doppler imaging and the corresponding RI and VI values were not correlated with objective evidence of USI. CONCLUSION: Patient factors may affect specific Doppler flow parameters of the urethral vasculature, which are related to intrinsic resting urethral closure. There is no difference in the appearance of the urethral vasculature in subjects with or without USI.     

Chemosensory event-related potentials in relation to side of stimulation, age, sex, and stimulus concentration.

OBJECTIVE: For chemosensory event-related potentials (ERP) significant effects of age and sex have been demonstrated. The aim of the present study was to assess the effects of stimulus concentration, side of stimulation, and sex on the topographical distribution of chemosensory ERP in a large group of subjects stratified for different age groups. In addition, psychophysical measures of both olfactory and trigeminal function should be assessed in greater detail compared to previous work. METHODS: A total of 95 healthy subjects participated in the study. Olfactory functions were tested using the 'Sniffin' Sticks' comprising tests of odor identification, odor discrimination, and odor threshold. Trigeminal sensitivity was assessed on a psychophysical level using a lateralization paradigm. ERP to the olfactory stimulant H2S and the trigeminal irritant CO2 were recorded; stimuli were presented in different concentrations to the left and right nostril. RESULTS: Olfactory thresholds exhibited an age-related increase while the outcome of psychophysical trigeminal tests was not significantly affected by age. In contrast, there was no significant main effect of the factor 'sex' for olfactory tests, while women scored higher than men in the trigeminal task. ERP to olfactory and trigeminal stimuli exhibited a relationship to stimulus concentration, age, and sex with youngest women showing largest amplitudes and shortest latencies. There was no significant main effect of left- or right-sided stimulation on ERP. Measures of olfactory function were found to correlate with parameters of olfactory ERP even when controlling for the subject's age. In addition, correlations between scores in the lateralization task and parameters of the trigeminal ERP were found. CONCLUSIONS: Based on electrophysiological data obtained in a large sample size the present results established an age-related loss of olfactory and trigeminal function, which appears to be almost linear. Further, the present results emphasize that responses to chemosensory stimuli are related to sex, while the side of stimulation does not play a major role in the presently used paradigm. Finally, these data establish the lateralization paradigm as a psychophysical tool to investigate intranasal trigeminal function. SIGNIFICANCE: The present results obtained in a representative group of healthy subjects establishes a comprehensive set of data, which will serve as reference for future work in this area of research.     

鹿鞭的药理研究与临床应用展望

综述了近年来传统中药鹿鞭的药理作用以及临床应用，资料表明鹿鞭具有抗衰老、抗疲劳、增强机体免疫、促进伤口愈合等药理作用，且临床疗效突出，是具有开发前景的中药材。     

Toxic effects of Fusarium mycotoxin butenolide on rat myocardium and primary culture of cardiac myocytes.

Mycotoxin toxicosis has been implicated in the etiopathogenesis of Keshan disease (KD), an endemic cardiomyopathy prevailing in some regions of China. Butenolide (4-acetamido-4-hydroxy-2-butenoic acid gamma-lactone, CAS No. 16275-44-8), a mycotoxin produced by several Fusarium species such as Fusarium tricinctum and Fusarium graminearum, is frequently detected from the cereals in the endemic areas of KD. The present study is undertaken to investigate whether this mycotoxin can induce myocardial damage. Exposure of primary culture of cardiac myocytes to butenolide resulted in significant cytotoxicity, manifested by changes in cell morphology and decreases in cell viability. Consistent with the in vitro findings, distinct myocardial toxicity in vivo was observed after administration of rats by gavage with butenolide (10 and 20 mg/kg/day) for 2 months, and the myocardial injuries were characterized by focal necrosis of myocardium and fragmentation of myofiber. Butenolide also induced significant oxidative damage to the myocardium in vitro evidenced by a concentration-dependent lipid peroxidation in the myocardial homogenates, whereas antioxidants superoxide dismutase (SOD), N-acetylcysteine (NAC) and glutathione (GSH) provided significant protections against this oxidative effect. Taken together, these results clearly reveal that butenolide possesses the potential to induce myocardial toxicity. The present findings may reinforce the hypothesis that toxicosis by mycotoxins is one of the etiological factors for KD.