短期睡眠剥夺对提高儿童听性脑干反应检测成功率的研究

探讨单独的睡眠剥夺或联合使用水合氯醛镇静在儿童听性脑干反应（ABR）检查中的可行性和有效性。方法 回顾性分析2012—2016年在西南医科大学附属医院进行ABR检查儿童的听力学资料。根据ABR测试前睡眠剥夺的时间和联合使用水合氯醛与否,将纳入的受试者分为4组（第1组：睡眠剥夺时间≥ 2?h+0镇静;第2组：睡眠剥夺时间≥2?h+水合氯醛镇静;第3组：睡眠剥夺时间<2?h+0镇静;第4组：睡眠剥夺时间<2?h+水合氯醛镇静）。对ABR检查准备时间、检查持续时间、被中断或被迫停止的患儿进行分析。结果 共纳入689例受试者,年龄3个月～11岁。440例（63.9%）单用睡眠剥夺获得自然睡眠,且检查成功率为95.5%（420/440）。第2组受试者检查成功率最高,为98.8%;最低为第4组,为90.4%。低于6个月龄的婴儿水合氯醛的使用率极低,仅为21.3%。结论 短期睡眠剥夺是一种安全有效的提高ABR测试成功率的方法,并且可以极大程度减少水合氯醛在ABR检查中的用量。     

双侧下颌角突出合并小颏畸形的治疗

目的 提高双侧下颌角突出伴有小颏畸形的手术治疗效果。方法 用口内入路行双侧下颌角连续弧线截骨术，同时行颏部水平骨前徒延长、小夹板坚强内固定、自体下颌角骨质断端间植骨术，不作咬肌部分切除手术。结果 1996－1999年共收治20例，术后下面部宽短畸形明显改善。咬肌虽未行部分切除，但术后随着咬肌附着点的上移、肌张力降低而发生部分萎缩，下颌角部曲线圆滑，形态自然。结论 双侧下颌角突出伴有严重小颏者，只有同时行双侧下颌角有和颏部水平截骨整形，才能达到全面矫治畸形的目的。下颌角连续弧线截骨术截骨设计灵活、向上可达下颌升支后缘、向下可延续至下颌体下缘，截骨量大；一次完成；截央后的下颌角更加圆滑自然；结合颏部截骨整 术，不仅提高了术后的整体效果，而且可利用截除的下颌角骨质充填于颏部水平截骨断端间，可以保证骨质的愈合，一举两得。     

Smad7 inhibits fibrotic effect of TGF-Beta on renal tubular epithelial cells by blocking Smad2 activation

It has been shown that transforming growth factor-beta (TGF-beta) is a potent mediator in renal fibrosis and that Smad proteins are critical intracellular mediators in TGF-beta signaling. It is here reported that TGF-beta mediates renal fibrogenesis in tubular epithelial cells (TEC) in association with the activation of Smad2 and that overexpression of Smad7 blocks this fibrotic process. Using a normal rat kidney tubular epithelial cell line (NRK52E), it was determined that TGF-beta1 induces Smad2 phosphorylation and nuclear localization in both a dose- and time-dependent manner. The activation of Smad2 was evident at 5 min (20%), peaked at 15 to 30 min (85%), and declined to baseline levels by 2 h (5 to 10%). This was associated with de novo expression of collagens I, III, and IV and the transformation of TEC into a "myofibroblast" phenotype with de novo expression of alpha-smooth muscle actin (alpha-SMA) and with the loss of E-cadherin (>50%). To investigate a negative regulatory role of Smad7 in renal fibrosis, the Smad 7 gene was stably transfected and its expression was tightly controlled by doxycycline into NRK52E cells. Overexpression of Smad7 induced by doxycycline results in marked inhibition of TGF-beta-induced Smad2 activation (90% downward arrow) with the prevention of collagen synthesis and myofibroblast transformation. Thus, Smad2 activation occurs in the fibrogenic response of TEC to TGF-beta, and this process is blocked by overexpression of Smad7. This indicates that Smad signaling is a key pathway of TGF-beta-mediated renal fibrosis and suggests that treatments targeting the inactivation of Smad2 by overexpression of Smad7 may provide a new therapeutic strategy for renal fibrosis.     

Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis

Methods for the treatment of tuberculous spondylitis still are controversial. The authors treated 32 consecutive patients with a two-stage surgical technique combined with antituberculous chemotherapy for 1 year. After anterior debridement, fusion with autogenous anterior iliac tricortical strut bone graft was done, and in a second stage, posterior instrumentation and fusion with autogenous posterior iliac corticocancellous bone graft was done 11 days (range, 4-22 days) later. Postoperatively, patients were encouraged to ambulate with brace protection as early as possible. Twenty-nine patients were followed up for a minimum of 2 years (median, 4.7 years; range, 2-10 years) of whom 28 patients achieved solid fusion (97%). All patients had improvement of back pain including the only patient with pseudarthrosis. Neurologic deficits completely recovered in 84% (16 of 19) of patients after 3 months. Kyphotic deformity improved in all 29 patients (34.6 degrees versus 17.3 degrees ) with the average correction angle of 17.3 degrees. Clinically, 27 patients had achieved a satisfactory outcome (93%). There were no evident surgical complications. The authors, therefore, recommend a two-stage surgical technique combined with antituberculous chemotherapy to treat patients with severe vertebral body destruction attributable to tuberculosis because of its high success rate and a low complication rate.     

足底内侧逆行岛状皮瓣修复前足底顽固性溃疡

目的　为临床前足底顽固性溃疡的修复提供一种方法。　方法　自 1 998年起 ,应用以足底内侧血管束远端为蒂的足底内侧逆行岛状皮瓣修复前足底顽固性溃疡 5例 ,同期矫正局部畸形 ,皮瓣切取范围 3.5～ 5.0 cm×4.0～ 5.5 cm,术后注意皮瓣区近期不负重 ,保持清洁干燥。　结果　皮瓣全部成活 ,随访 6～ 1 4个月 ,皮瓣质地好 ,可见较厚角化层 ,但皮瓣痛觉迟钝 ,患足可负重行走 ,溃疡无复发。　结论　以足底内侧动静脉为蒂的逆行岛状皮瓣血运好 ,适用于修复前足底顽固性溃疡     

Clinical and Imaging Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinomas

Background  

The goals of this study were to analyze clinical factors that affect cervical lymph node metastasis (LNM) in papillary thyroid cancer (PTC), and to evaluate the diagnostic accuracy of preoperative ultrasound (US) and computed tomography (CT) of the neck.     

Surveillance with serial serum carcinoembryonic levels detect colorectal cancer recurrences in patients who are initial nonsecretors

Serum carcinoembryonic antigen (CEA) levels, elevated in a subgroup of patients with colorectal cancer (CRC) at presentation, are serially followed as part of recommended surveillance after initial resection. The value of following serial CEA levels in patients who initially present with less than or normal levels of CEA (nonsecretors) is controversial. This study sought to determine the use of follow-up CEA levels in nonsecretors. A retrospective review was performed of patients with resected Stage I, II, and III CRC. We excluded patients who did not have a pretreatment CEA level, at least two follow-up CEA levels, or in whom CEA levels did not normalize after resection. The patients were grouped by initial CEA values: CEA 5 ng/mL or less (nonsecretors) and CEA 5 + ng/mL: (secretors). We identified 186 patients with CRC; 146 were initial nonsecretors. We identified 22 patients with recurrent colorectal cancer; 6 were secretors and 16 patients were nonsecretors. In the secretors group, CEA was elevated with recurrence in four (66%) of the patients. In the nonsecretors, CEA was elevated with recurrence in eight (50%) of the patients. In summary, many recurrences of CRC are marked by an elevation of CEA regardless of whether the patients initially presented as secretors or nonsecretors.     

第一、二鳃弓综合征颜面不对称的整形外科矫治

目的探讨第一、二鳃弓综合征面部不对称畸形的整形外科矫治方法。方法根据第一、二鳃弓综合征患者临床及X线所示面部双侧不对称情况,采用健侧下颌骨外板去除、颧骨截骨降低;患侧下颌体、颧骨应用健侧下颌骨外板贴附植骨或高密度多孔聚乙烯(Medpor)假体置入等术式,配合颏部水平截骨颏成形术,以缩小面部双侧宽度的差异,矫治颜面不对称畸形。结果共矫治23例,经6个月至3年的术后随访观察,双侧面部宽度差异明显缩小,正面观面部不对称明显改善。结论第一、二鳃弓综合征面部骨骼发育畸形是三维方向的,双侧面骨宽度的差异,是造成正面观面部不对称的重要因素,根据受术者的具体情况,采用以上术式的组合,扩充患侧或同时缩窄健侧骨骼,进行面部骨性支架重建,可以取得良好的矫治效果。     

咬肌与颅面形态的关系

目的探讨咬肌与颅面形态之间的关系，了解咬肌体积与邻近骨骼结构的大小及形态的相关性。方法对40例要求改变脸型者进行磁共振成像（MRI）测量，人体测量，头部正位、侧位和下颌骨曲面断层X线检查，测量并计算咬肌体积（MsV），测量头长（HL）、头宽（HB）、面长（FL）、面宽（FB）、下颌角间宽（IB）、下颌骨体长（CL）、下颌角切线长（MAL）、下颌角角度（JA），计算颜面形态指数FI（FL／FB）、头颅指数C（IHB／HL）。用SPSS11．5软件统计分析MsV与HI。HB、FL、FB、IB、CL、MAL、JA、FI、CI之间的相关性。结果MsV与JA呈明显负相关，与CL、MAL、IB、FB、HL呈明显正相关，与CL、FI、HB无明显相关性。结论咬肌肥大可能是方脸面型的成因之一，是影响面型的重要因素。