骶骨骨折的分型及手术治疗

骶骨是人体负重线上的轴心,与周围腰椎髂骨构成复杂韧带骨结构复合体。高能量损伤多见,应力骨折及骨质疏松性骨折等也有报道,骶骨骨折的分型从最早的Denis分型,侧重神经损害的Roy-Camille分型,侧重腰椎骶骨稳定性的ISSLE分型,侧重骨盆环稳定性的AO分型以及较新的引入韧带评价的LSICS评分,反映了临床医生对骶骨及其周围损伤的认识不断深化。骶骨骨折治疗重点是重建骨盆环稳定、重建脊柱骨盆稳定以及神经损伤治疗,微创化及坚强固定是主要的发展方向。同时本文也介绍了笔者单位对骶骨骨折的治疗情况。     

正常小肠血管与小肠腺癌血管对比研究

目的：建立正常小肠血管形态及小肠腺癌血管形态。材料与方法：对１０例正常小肠标本、１６例经病理证实的手术切除标本，其中８例术前已作肠系膜上动脉造影，分别采用血管铸型、血管造影、解剖镜观察及图像分析。结果：正常小肠血管的形态、分布与传统观点不尽相同。血管密度以十二指肠球部最低、在空、回肠呈由低增高，继而降低的变化规律。小肠腺癌术前血管造影确诊率较低（３／８）例，血管造影呈现：供血动脉增粗、杵状中断、狭窄，癌体内造影剂池，癌周血管增多、扭曲，肿块实质血管减少等特征。与正常组比，小肠腺癌血管面密度（目标总面积／统计场总面积）显著性减少（Ｐ＜０．０５）。结论：认识正常小肠血管分布规律，有助于小肠肿瘤的介入诊断和治疗。小肠腺癌癌周血管增多、变形，癌体内血管少、常见造影剂池征。     

A case of progressive multifocal leukoencephalopathy with hypogammaglobulinemia and a TCF3 mutation

Journal of NeuroVirology - Progressive multifocal leukoencephalopathy (PML) is a rare and potentially fatal demyelinating disease of the central nervous system (CNS) caused by JC virus; it was...     

Incidence,early case fatality and determinants of stroke in Iran: Golestan Cohort Study

Objectives: While few studies investigated the incidence of stroke in Iran, no Iranian cohort has estimated the standardized-incidence rate and early fatality of first-ever-stroke subtypes along with associated factors. Methods: Golestan Cohort Study is a prospective study launched in northeastern Iran in 2004, including 50,045 individuals aged 40-75 at baseline. Age-standardized incidence rate of first-ever-stroke was calculated per 100,000 person-years, according to World Standard Population. The 28-day case fatality was calculated by dividing the number of fatal first-ever-stroke during the first 28 days by total events. Cox proportional hazard models were conducted to assess incidence and fatality risk factors. We used Population Attributable Fractions to estimate the incidence and early fatality proportions reduced by ideal risk factor control. Results: 1,135 first-ever-strokes were observed during 8.6 (median) years follow-up. First-ever-stroke standardized incidence rate was estimated 185.2 (95% CI: 173.2-197.2) per 100,000 person-years. The 28-day case fatality was 44.1% (95% CI: 40.4-48.2). Hypertension and pre-stroke physical activity were the strongest risk factors associated with first-ever-stroke incidence (Hazard ratio: 2.83; 2.47-3.23) and 28-day case fatality (Hazard ratio: 0.59; 0.44-0.78), respectively. Remarkably, opium consumption was strongly associated with hemorrhagic stroke incidence (Hazard ratio: 1.52; 1.04-2.23) and ischemic stroke fatality (Hazard ratio: 1.44; 1.01-2.09). Overall, modifiable risk factors contributed to 83% and 61% of first-ever-stroke incidence and early fatality, respectively. Conclusion: Efficient risk factor control can considerably reduce stroke occurrence and fatality in our study. Establishing awareness campaigns and 24-hour stroke units seem necessary for improving the stroke management in this area.     

Use of cyproheptadine hydrochloride (HCl) to reduce neuromuscular hypertonicity in stroke survivors: A Randomized Trial: Reducing Hypertonicity in Stroke

ObjectivesThe goal of this study was to examine how the administration and dosing of the anti-serotonergic medication cyproheptadine hydrochloride (HCl) affects involuntary muscle hypertonicity of the spastic and paretic hands of stroke survivors.Materials and MethodsA randomized, double-blinded, placebo-controlled longitudinal intervention study was performed as a component of a larger clinical trial. 94 stroke survivors with chronic, severe hand impairment, rated as levels 2 or 3 on the Chedoke-McMaster Stroke Assessment Stage of Hand (CMSA-H), were block randomized to groups receiving doses of cyproheptadine HCl or matched doses of placebo. Doses were increased from 4 mg BID to 8 mg TID over 3 weeks. Outcomes were assessed at baseline and after each of the three weeks of intervention. Primary outcome measure was grip termination time; other measures included muscle strength, spasticity, coactivation of the long finger flexors, and recording of potential adverse effects such as sleepiness and depression.Results89 participants (receiving cyproheptadine HCl: 44, receiving placebo: 45) completed the study. The Cyproheptadine group displayed significant reduction in grip termination time, in comparison with the Placebo group (p<0.05). Significant change in the Cyproheptadine group (45% time reduction) was observed after only one week at the 4mg BID dosage. The effect was pronounced for those participants in the Cyproheptadine group with more severe hand impairment (CMSA-H level 2) at baseline. Conversely, no significant effect of Group * Session interaction was observed for spasticity (p=0.6) or coactivation (p=0.53). There were no significant changes in strength (p=0.234) or depression (p=0.441) during the trial.ConclusionsUse of cyproheptadine HCl was associated with a significant reduction in relaxation time of finger flexor muscles, without adversely affecting voluntary strength, although spasticity and coactivation were unchanged. Decreasing the duration of involuntary flexor activity can facilitate object release and repeated prehensile task performance.RegistrationClinical Trial number: NCT02418949     

胚肾发育过程中诱骗受体2表达与细胞衰老的关系

目的通过研究诱骗受体2(DcR2)在小鼠胚肾发育过程中的定位和表达,探讨DcR2在胚肾发育中与细胞衰老的关系。 方法分别选取胚龄为12.5 d、16.5 d、20.5 d和出生后8w小鼠的肾脏组织,使用过碘酸雪夫(PAS)染色观察肾组织形态,定量RT-PCR检测肾组织DcR2 mRNA表达水平,免疫组织化学染色观察DcR2的表达分布,免疫荧光共染检测DcR2与近端肾小管标志绒毛蛋白villin、远端肾小管标志水通道蛋白2(AQP-2)、衰老标志P16、胞核形态标志物核纤层蛋白B1(LaminB1)、增殖标志Ki-67和增殖细胞核抗原(PCNA)的共表达关系。 结果随着胚肾的发育,胚肾组织中DcR2 mRNA及蛋白表达逐渐增多,且明显高于成年肾脏;DcR2特异性表达于肾小管,且与villin共表达,但不与AQP-2共表达;DcR2阳性细胞高表达P16,却低表达LaminB1、Ki-67和PCNA。 结论DcR2特异性表达于胚肾近端肾小管细胞,且表达水平随胚龄增长而增多。此外,DcR2阳性细胞具有衰老相关表型,提示DcR2可能在胚肾发育过程中通过调控细胞衰老而具有重要作用。     

犬急性心肌缺血后左室功能变化与心肌细胞凋亡

目的观察犬急性心肌缺血后左心室壁动度、射血功能、细胞凋亡与心肌组织中caspase3活性的变化。方法犬30只随机分为实验组15只及对照组15只,实验组结扎左冠状动脉前降支近端,结扎时间分别为10min、30min、60min,每一时间点5只,对照组游离左冠状动脉前降支近端,不结扎。心肌组织行三苯四氮唑(TTC)染色,梗死区为黄白色,非梗死区为砖红色。超声心动图测定左室前壁增厚率及左心室射血分数,原位末端脱氧核苷酸转移酶介导的生物素脱氧尿嘧啶核苷酸缺口末端标记法(TUNEL)检测梗死区心肌组织凋亡细胞数,行caspase3活性测定。结果TTC染色示左室前壁及部分前间隔染色为黄白色,其余区域为砖红色。实验组冠脉结扎后10min,左室前壁增厚率降低,与对照组比较有显著性差异(P<0.05)。左心室射血分数未发生明显改变,与对照组比较无显著性差异(P>0.05)。冠脉结扎后30min至60min,前壁增厚率降低与左心室射血分数进一步下降,与对照组比较有非常显著性差异(P<0.01)。实验组冠脉结扎后10min,梗死区心肌TUNEL阳性细胞数与对照组比较无显著性差异;冠脉结扎后30min至60min,梗死区心肌TUNEL阳性细胞数明显增加,与对照组比较有非常显著性差异(P<0.01)。实验组冠脉结扎后10min,梗死区心肌caspase3荧光值升高,与对照组比较有显著性差异(P<0.05)。30min至60min梗死区心肌caspase3荧光值明显升高,与对照组比较有非常显著性差异(P<0.01)。结论急性心肌缺血后早期,促凋亡基因caspase3激活,缺血心肌细胞凋亡可能为急性心肌缺血的早期病理改变,并且与心肌室壁动度与左室收缩功能降低有一定关系。     

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Purpose: The intraorbital wooden foreign body is often misdiagnosed or missed on computed tomography (CT) scan, due to the invisible or unclear images. The residual foreign bodies often occur during surgical removal. The clinical manifestations, imaging features and treatment of intraorbital wooden foreign bodies were discussed in this study. Method: We retrospectively analyzed 14 cases of intraorbital wooden foreign bodies managed at our hospital between January 2007 and May 2015. All patients underwent orbital CT examination before surgery, and surgery was performed under general anesthesia with orbital wound debridement and suture, as well as exploration and removal of wooden foreign bodies. Results: At first, 11 cases underwent removal of foreign bodies, including 1 case with incomplete removal and then receiving a secondary surgery. Foreign bodies were not found in three cases with preoperative misdiagnosis and orbital MRI found residual foreign bodies in the orbit. Operations were performed via primary wound approach in eight cases, conjunctival approach in two cases, and anterior orbitotomy in four cases. Postoperatively, one case was complicated with eye injuries, three cases with ocular muscle injuries, eight cases with visual loss, and eight cases with orbital abscess. The length of foreign bodies ranged from 1.8 cm to 11.0 cm. The maximum of four foreign bodies were removed at the same time. Conclusion: Because the imaging of orbital wooden foreign bodies is complex and varied, MRI should be combined when they are invisible on CT scan. At the same time injuries trajectory and clinical manifestations of patients should be taken into account. Surgical exploration should be extensive and thorough, and foreign bodies and orbital abscess must be cleared.     

2006-2015年重庆市流行性乙型脑炎流行特征分析

目的 分析2006-2015年重庆市流行性乙型脑炎的流行特征,为控制乙脑流行提供有针对性和科学性的防治措施。 方法 采用描述性流行病学方法,利用SAS软件进行统计分析。 结果 2006-2015年重庆市共报告乙脑病例1 611例,发病率由2006年的0.72/10万降低到2015年的0.12/10万,发病率年均降低17.67%,年均发病率为0.49/10万;死亡31例,年均死亡率为0.009/10万,年均病死率为1.62%。男性发病率(0.57/10万)显著高于女性(0.40/10万)(P<0.05)。39个区县均有病例报告,发病呈散发,主要分布在大足区(129例,8.00%)、丰都县(123例,7.64%)、开县(114例,7.08%)、垫江县(97例,6.02%)。发病呈明显季节性,发病病例和死亡病例主要集中在7-8月(1 530例,94.97%);发病年龄以1~7岁为主,占73.43%,死亡以1~3岁为主,死亡中位年龄为2岁;职业分布以散居儿童为主,占55.62%。临床诊断病例698例(43.33%),实验室确诊病例913例(56.67%);病例以发热(89.63%),嗜睡(72.32%)等症状为主。病例中有疫苗接种史占18.37%,无疫苗接种史占26.88%,免疫史不详的占54.75%。 结论 重庆市乙脑发病逐年降低,今后应加强流行季节病例监测,在持续常规免疫的基础上,免疫重点应针对发病率相对较高地区的1~5岁散居儿童,同时提高个案调查质量和实验室诊断比例。     

2011-2016年重庆市江北区居民伤害死亡分析

目的 了解重庆市江北区2011-2016年伤害死亡变化特点,为针对性的开展伤害干预和控制提供依据。 方法 采用描述性统计方法对重庆市江北区2011-2016年居民伤害死亡资料进行流行病学分析。 结果 2011-2016年重庆市江北区居民伤害粗死亡率27.74/10万,标化死亡率为20.45/10万,伤害死亡人数占总死因的5.35%,其中男性标化死亡率26.13/10万,女性标化死亡率14.75/10万。江北区居民伤害死因排首位的为意外跌落,死亡率为8.39/10万,其中男性死亡率为10.52/10万,女性为6.18/10万。男性和女性伤害死亡排名前五位的原因相同,为意外跌落、机动车以外的运输事故、其他意外事故和有害效应、自杀、机动车辆交通事故。0~<5岁幼儿伤害首位死因为机动车辆交通事故,5~<15岁儿童伤害首位死因为其他意外事故和有害效应,15~<45岁青年伤害首位死因为机动车以外的运输事故,45~岁中老年人群伤害首位死因为意外跌落。 结论 伤害是2011-2016年重庆市江北区居民死亡的重要原因之一,应多部门协作,针对不同人群制定相应的干预措施,尤其应重点预防和控制居民意外跌落和机动车相关的事故,重点加强对老年人等重点人群的保护。