南京地区国人股骨头头颈直径比例的影像学测量

目的 通过X线片确定南京地区国人股骨头头颈直径比例的正常值.方法 选择468例无髋部症状的生活在南京及周边地区的成年中国人,男313名,女155名;年龄17～82岁,其中≤20岁13名,21～30岁88名,31～40岁123名,41～50岁104名,51～60岁102名,61～70岁24名,≥71岁14名,平均年龄42.4岁.摄标准骨盆正位X线片,应用Digimizer软件测量左、右侧股骨头最大直径与股骨颈最小纵径,并分别计算比值.将计算结果与西方人数据进行比较.结果 股骨头头颈直径比例1.33～1.69,平均1.48±0.09.≤20岁者1.46±0.09,21～30岁者1.48±0.09,31～40岁者1.47±0.10,41～50岁者1.46±0.09,51～60岁者1.49±0.10,61～70岁者1.48±0.08,≥71岁者1.49±0.10.不同性别、侧别及年龄组间差异均无统计学意义.南京地区国人股骨头头颈直径比例(左侧、右侧分别为1.48±0.09、1.48±0.10)与欧洲人数据(左侧、右侧分别为1.43±0.09、1.44±0.09)比较差异有统计学意义(P值均＜0.05).结论 南京地区国人股骨头头颈直径比例不存在性别、年龄及侧别差异.国人数据与欧洲人不同与种族的解剖差异有关.正常人群的股骨头头颈直径比例可能对某些髋关节疾病的诊断与治疗具有一定的参考意义.

Abstract：

Objective To measure the femoral head-neck ratio among Chinese adults in Nanjing to explore its clinical significance. Methods 468 Chinese without hip symptoms were chosen randomly. There were 313 males and 155 females. 13 cases were less than 20 years old, 88 cases were from 21 to 30 years old, 123 cases were from 31 to 40 years old, 104 cases were from 41 to 50 years old, 102 cases were from 51 to 60 years old, 24 cases were from 61 to 70 years old, 14 cases were more than 71 years old. The mean age was 42.4 years old (ranged from 17 to 82 years old). The maximum diameter of the femoral head and the minimum vertical diameter of femoral neck length on both sides were measured by Digimizer software in the standard anteroposterior pelvis film. The femoral head-neck ratio (FHNR) was calculated and compared with that of the western. Results The normal FHNR of Chinese in Nanjing was 1.48 ± 0.09 (1.33-1.69). FHNR was 1.46±0.09 in Chinese aged less than 20 years old. It was 1.48±0.09 in Chinese aged from 21 to 30 years, and 1.47±0.10 in those aged 31-40 years, 1.46±0.09 in 41-50 years, 1.49±0.10 in 51-60 years,1.48±0.08 in 61-70 years, 1.49±0.10 in those more than 71 years. There was no difference between male and female, the left and right side or the different age groups. There was no difference between the western and Chinese in Nanjing. Conclusion FHNR measurement has not variation with regard to sex, age and side. It may be useful to understand some kind of the hip diseases.     

女性青少年特发性脊柱侧凸支具治疗效果和影响因素评估

目的 评估女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者支具治疗效果及影响因素.方法 2003年7月至2009年7月,完成支具治疗或因侧凸进展而行手术治疗的女性AIS患者142例,初诊时平均年龄为(13.1±1.5)岁,平均主弯Cobb角29.6°±5.4°,平均Risser征为(2.0±1.5)级.定义侧凸畸形进展为末次随访Cobb角大于初诊6°以上或治疗期间建议行矫形手术(Cobb 角＞45°),其余为非进展.根据侧凸进展或需手术治疗的比率来评估支具治疗效果.运用卡方检验和Logistic回归分析探讨影响支具治疗效果的因素.结果 平均支具治疗时间为(2.5±1.0)年.按照侧凸进展的定义,进展组为27例(19%),非进展组115例(81%);手术组病例18例(13%),因支具治疗而避免手术病例124例(87%).卡方检验发现侧凸进展组和手术组中以初诊年龄10.0～12.9岁、月经初潮未至、Risser征0～1级、初诊Cobb角＞30°以及胸弯型居多.Logistic回归分析发现月经初潮未至(P=0.000)和胸弯型(P=0.012)是支具治疗后侧凸进展的独立预测因素,而初诊Cobb角＞30°(P=0.022)是支具治疗期间因侧凸进展而需手术治疗的另一独立预测因素.结论 支具治疗可有效控制多数AIS患者的侧凸进展,而生长发育状态、侧凸严重程度和侧凸类型是影响支具疗效的重要因素.

Abstract：

Objective To analyze the outcomes of bracing treatment for girls with adolescent idiopathic scoliosis (AIS), and to investigate the predictive factors of the protocol. Methods This study included 142 girls with AIS who finished standardized bracing treatment from July 2003 to July 2009. These patients had a mean age of 13.1±1.5 years, a mean main curve of 29.6°±5.4°, and a mean Risser grade of 2.0±1.5 before bracing treatment. Curve progression was defined that Cobb angle was greater than 6° compared to bracing initiation or was aggravated to more than 45° (indicative for surgery). The outcomes of bracing treatment were assessed based on the ratio of curves of progression or indicative for surgery. Chi-square and Logistic regression Analyses were performed to investigate the predictive factors of bracing treatment. Results The duration of bracing treatment averaged 2.5±1.0 years. Twenty-seven girls with curve progression (19%)and 115 girls (81%) with non-progression were found. Final curve which was greater than 45° was found in 18 girls (13%) who need a correction surgery, the remaining 124 girls (87%) had completed bracing treatment and avoided surgery. Chi-square analyses revealed that curve progression were more common in younger girls with lower Risser grade, with initial larger Cobb angle and with a main thoracic curve pattern.Logistic regression analyses found that premenarchal status and a main thoracic curve pattern were the independent risk factors of curve progression despite bracing. While initial Cobb angle which was greater than 30° was the additional independent risk factor of progression requiring surgery. Conclusion Bracing treatment could effectively prevent curve progression in most girls with AIS. The degree of growth maturity, the pattern and grade of curve are the influencing factor for bracing treatment.     

超声造影检查在肾肿瘤射频消融术后疗效评估中的应用价值

目的 探讨实时超声造影(CEUS)检查在肾肿瘤射频消融(RFA)术后疗效评估中的作用.方法 对47例肾肿瘤患者(肾癌40例,肾血管平滑肌脂肪瘤7例)49个病灶行RFA治疗,其中经腹腔镜下RFA 30例,开放手术RFA 17例.术后1周行常规超声及CEUS检查,观察造影剂在动脉相与实质相的灌注情况,评价病灶消融范围,并与增强CT结果比较.影像学上病灶无增强被认为是消融完全. 结果 49个病灶完全消融47个(95.9%).CEUS显示肾消融灶最大径为2.4～10.0 cm,平均(4.6±1.5)cm,其中消融灶大于原病灶者45个、与原病灶相同者3个、小于原病灶者1个.CEUS提示RFA术后原病灶有局部强化6例,其中2例经增强CT证实.以增强CT结果作为诊断标准,CEUS对RFA术后残留灶诊断的敏感性为100.0%,特异性为91.8%.术后平均随访11(4～21)个月,患者均存活. 结论 CEUS检查与CT结合对评价肾肿瘤RFA术后疗效具有实用价值.

Abstract：

Objective To discuss the utility of contrast-enhanced ultrasonography (CEUS) in the assessment of treatment efficacy of radiofrequency ablation (RFA) in patients with renal tumors.Methods Forty-seven patients (40 renal cell carcinomas and 7 angiomyolipomas of kidney) with 49 renal tumors were treated with RFA. Tumors were ablated by laparoscopy-assisted (n= 30) and open surgical (n= 17) RFA. The CEUS and contrast-enhanced CT were performed 1 week after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. Results Forty-seven (95. 9%) of 49 tumors were successfully ablated. The mean length of the major axis at the maximal necrotic area was 4. 6 cm. Compared with the lesions before RFA, the necrotic areas were bigger in 45 patients, identical in 3 patients, and smaller in 1 patient. Six lesions showed a residual enhancement at the portion adjacent to the normal renal parenchyma on follow-up CEUS, while 2 were confirmed by CT scans. The sensitivity and specificity of CEUS for detection of residual tumors were 100. 0% and 91.8%, respectively. All patients survived in the follow-up period ranging from 4 to 21 months. Conclusion CEUS combined with CT could be useful for evaluating treatment efficacy of RFA for renal tumors.     

双镜联合技术在胃间质瘤治疗中的应用

胃肠道间质瘤(GIST)是胃肠道最常见的间叶源性肿瘤.对于未发生转移的GIST,手术切除是首选的治疗措施.近年来随着腹腔镜外科、内镜外科等微创外科技术的不断发展和成熟,双镜联合技术(LECS)已逐渐发展为胃间质瘤治疗中一种较为成熟的微创手术方式.本文将就近年来双镜联合技术在胃间质瘤治疗中的应用做一综述.     

负载超顺磁性氧化铁的纳米囊泡标记人结肠腺癌细胞磁共振成像的初步研究

目的 探讨负载超顺磁性氧化铁（SPIO）纳米囊泡体外标记人结肠腺癌细胞株（Lovo）进行MR成像的可行性.方法 制备负载SPIO纳米囊泡,培养人Lovo细胞.分别取含有5×105、1×106的细胞量与含不同量（50μl和500μl）的负载SPIO纳米囊泡的培养液共同培养,经培养1、3和6 h后,分别取所培养的细胞进行电镜超微结构观察和MR T1WI、T2WI成像,未标记的Lovo细胞株为对照组.结果 Lovo细胞与负载SPIO纳米囊泡培养后6 h,电镜下见SPIO进入Lovo细胞的细胞质内.MR T1WI图像上,实验组各组间、实验组与对照组间的信号无明显差异.T2WI图像上,培养1 h后,实验各组、实验组与对照组间信号无明显差异 培养3 h后,500μl SPIO标记1×106 Lovo细胞组出现轻度信号下降 培养6 h后,实验各组的信号均出现明显下降.结论 负载SPIO纳米囊泡可以标记人Lovo细胞,应用MR可以对其进行监测.     

经鼻内镜脑脊液鼻漏修补术中漏口定位分析

目的探讨经鼻内镜脑脊液鼻漏修补术中准确寻找漏口的相关问题。方法回顾性研究12例漏口难以判断的脑脊液鼻漏患者,采用术前鼻内镜检查、核素扫描、术中影像导航系统定位以及椎管内注入生理盐水等方法判断漏口位置。结果12例患者术前核素扫描提示有脑脊液从鼻腔漏出,3例可疑蝶窦漏出,9例可疑筛窦漏出。蝶窦漏出的3例中,2例位于蝶窦侧壁,1例位于蝶窦后壁,其中2例经椎管内分别注入生理盐水15和20ml后发现漏口。9例可疑筛窦漏出的患者,在影像导航辅助下行筛窦轮廓化后,3例可见明确漏口(有清亮液体流出),另外6例于术中经椎管内分别注入生理盐水20~30ml后暴露漏口。结论经鼻内镜脑脊液鼻漏修补术中,对于漏口部位较难判断的患者,采用术前核素扫描、术中影像导航定位及椎管内注入适量生理盐水寻找漏口均为安全有效的方法,可为手术的成功奠定基础。     

人脑胶质瘤中β-catenin的表达与细胞增殖相关性研究

目的:探讨人脑胶质瘤中βcatenin的表达及与细胞增殖的相关性。方法:用免疫组化法观察了47例胶质瘤标本βcatenin、cyclinD1、增殖细胞核抗原(PCNA)的表达,并分析其相关性。结果:在胶质瘤中βcatenin、cyclinD1、PCNA均随肿瘤恶性程度增高而增高(P分别为0.017、0.017、0.027),相关分析发现βcatenin、cyclinD1、PCNA的表达两两相关(P<0.001,P<0.001和P=0.005)。结论:βcatenin表达水平的异常与胶质瘤细胞周期调节紊乱、增殖指数上升有关,因此可能是控制肿瘤细胞增殖活性的候选基因之一。     

纳洛酮对中重型颅脑损伤病人血浆C-反应蛋白的影响

目的评价纳洛酮对脑外伤的早期疗效及C-反应蛋白(CRP)检测在纳洛酮治疗脑外伤中的应用价值。方法将68例重型脑外伤病人随机分为治疗组30例和对照组38例,对照组给予常规治疗,治疗组在常规治疗的基础上,给予纳洛酮0.4mg·kg-·1d-1治疗。观察病人的GCS评分、颅内压及头颅CT所示脑水肿的变化,并测定治疗前后血清CRP浓度。结果治疗组在提高GCS评分、降低颅内压、控制脑水肿等方面均明显优于对照组(P<0.01)。两组治疗前CRP分别为(73.64±8.64)mg/L(、69.23±7.31)mg/L,差异无统计学意义(P>0.05);治疗后治疗组为(37.25±11.45)mg/L,对照组为(48.54±12.07)mg/L,治疗组明显低于对照组(P<0.01)。结论①纳洛酮综合治疗脑外伤效果明显。②CRP可作为颅脑外伤病情及纳洛酮治疗效果判断的参考指标。     

脑胶质瘤低氧诱导因子-1α的表达及其意义

目的 探讨低氧诱导因子-1α在脑胶质瘤中的表达及其意义。方法60例脑胶质瘤标本中Ⅰ级11例（毛细胞型星形细胞瘤8例、脉络丛乳头状瘤2例、黏液乳头状型室管膜瘤1例）；Ⅱ级20例（弥漫型星形细胞瘤11例、少突胶质细胞瘤5例、室管膜瘤2例、多形性黄色瘤型星形细胞瘤2例）；Ⅲ级21例（间变性星形细胞瘤12例、间变性少突胶质细胞瘤6例、间变性室管膜瘤3例）；Ⅳ级8例（均为胶质母细胞瘤）。采用免疫组织化学方法检测胶质瘤标本中低氧诱导因子-1α的表达变化，并与胶质瘤体积及患者年龄、性别进行统计学分析。结果（1）胶质瘤组织低氧诱导因子-1α表达呈阳性反应，主要位于细胞质和（或）细胞核，具有明显的异质性；肿瘤浸润边缘部的肿瘤细胞表达明显增强；而阴性对照标本和10例对照脑组织标本则无表达。胶质瘤组织中低氧诱导因子-1α阳性表达率为71．67％（43／60），其中Ⅰ级为27．27％（3／11），Ⅱ级70．00％（14／20），Ⅲ级85．71％（18／21），Ⅳ级100％（8／8）。高级别胶质瘤者低氧诱导因子-1α阳性表达率明显高于低级别者，不同级别间差异有高度统计学意义（X^2=15．907，P〈0．01）；表达强度与病理级别间呈高度正相关（rn=0．480，P〈0．01）。（2）低氧诱导因子-1α表达与患者年龄、性别及原发肿瘤体积的大小等均无相关性（均P〉0．05）。结论脑胶质瘤低氧诱导因子-1α的表达强弱与肿瘤病理分级相关。     

二氮嗪抑制Aβ1～42对U251细胞存活率、线粒体膜电位和细胞内活性氧水平的影响

目的探讨线粒体膜上ATP敏感的钾离子通道开放药物二氮嗪防治Aβ1～42细胞毒性作用及其分子学机制。方法采用不同浓度Aβ1～42和二氮嗪同时处理神经胶质细胞瘤U251细胞24h,以四唑盐比色法测定细胞存活率;四氯四乙基苯并咪唑基羰花青碘化物(JC-1)检测线粒体膜电位;2',7'-二氯荧光黄双乙酸盐(DCFH-DA)检测细胞内活性氧水平;膜联蛋白荧光素荧光染色检测U251细胞凋亡。结果(1)二氮嗪组神经胶质细胞瘤U251细胞在不同浓度Aβ1～42作用下,细胞存活率明显高于单纯Aβ1～42组(P<0.05)。(2)半定量分析显示,单纯Aβ1～42组(5μmol/L)U251细胞线粒体膜红/绿荧光强度比值(590/527nm)明显低于正常对照组(P<0.01);而二氮嗪组U251细胞红/绿荧光强度比值(590/527nm)明显高于单纯Aβ1～42组(P<0.01)。(3)流式细胞术检测显示,单纯Aβ1～42组(5μmol/L)U251细胞内的活性氧水平明显增高,与对照组相比差异有统计学意义(P<0.05);经二氮嗪(1mmol/L)预处理后U251细胞内的活性氧水平下降,与单纯Aβ1～42组相比差异有统计学意义(P<0.05)。(4)流式细胞荧光强度分析显示,无论Aβ1～42或Aβ42～1均不能引起U251细胞发生早期或晚期凋亡或坏死。结论Aβ1～42的细胞毒性作用明显早于其致细胞凋亡作用。提示尽早应用二氮嗪保护细胞线粒体功能状态,可预防长时间暴露于Aβ1～42导致细胞凋亡所引起的神经细胞数量的减少。