大鼠视神经钳伤后外侧膝状体细胞损伤的研究

目的　探讨大鼠视神经钳伤后 ,外侧膝状体 (lateralgeniculatebody,LGB)细胞的损伤情况。方法　用 4 0g视神经损伤钳 ,压迫Sprague Dawley(SD)大鼠双侧视神经 30s,制成视神经部分定量损伤的动物模型。对LGB连续梯度切片 ,7d后用末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法 (teriminaldeoxynucleotidyltransferase mediateddUTPnickend labeling ,TUNEL)对LGB细胞进行凋亡检测。 1个月后通过免疫组化染色技术 ,用兔抗鼠神经丝 (neurofilament,NF)单克隆抗体对LGB的神经元进行检测。同时经视觉中枢注入荧光染料颗粒蓝 ,对LGB细胞进行逆行荧光标记 ,在 70 0nm波长荧光显微镜下对连续切片的LGB标记细胞进行平均密度计数 ,并与对照组比较。结果　TUNEL法染色证实LGB细胞发生凋亡。对照组神经丝免疫组化染色呈清晰的条索状 ,而实验组明显减少。对照组LGB细胞密度均值为 (5 172± 2 4 8)个 /mm2 ,而损伤组LGB细胞密度均值为 (414 4± 6 1)个 /mm2 ,两组比较差异有非常显著意义 (t=8 995 ,P <0 0 1)。结论　在大鼠视神经钳伤后 ,LGB细胞受损 ,其损伤机制与凋亡有关     

3种保肝药物治疗艾滋病人的药物性肝损伤的成本—效果分析

目的:评价3种保肝药物治疗艾滋病人的药物性肝损伤的成本—效果。方法:166例患者随机分为3组,分别给予还原型谷胱甘肽(A组)、复方甘草酸苷(B组)、硫普罗宁(C组),治疗28d后观察(A、B、C组)3组治疗效果,并进行成本—效果分析。结果:A组疗效显著>B、C组(P<0.05),且A组成本/效果比为3组中最低。结论:还原型谷胱甘肽(A组)为艾滋病人的药物性肝损伤的较佳治疗药物。     

外伤相关黑素瘤87例临床病理特点与预后分析

目的:分析外伤相关黑素瘤的临床病理特点及其与患者预后间的关系。方法:回顾性分析2009—2020年第四军医大学西京皮肤医院87例外伤相关黑素瘤的临床病理特点,通过Mann-Whitney检验分析不同年龄、性别患者间肿瘤Breslow厚度的差异;通过Spearman秩相关分析外伤至发现皮疹的时间与Breslow厚度之间的...     

N-甲基-D-天门冬氨酸受体亚型NR1、NR2A在大鼠视网膜缺血再灌注损伤模型中的表达

目的:研究N-甲基-D-天门冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)功能亚单位NMDAR1、NM-DAR2A在Wister大鼠视网膜缺血再灌注模型中的表达情况。方法:18只健康成年Wister大鼠分成6组,每组3只,都取其右眼行视神经周围血管结扎手术制备视网膜缺血再灌注模型,左眼作为对照组不行手术。60分钟后去除结扎缝线恢复血流,分别于再灌注后即刻、3、12、24、72、168小时处死大鼠,摘除眼球,做冰冻切片。用免疫组织化学方法观察NR1、NR2A在视网膜缺血再灌注后不同时刻的变化并进行图象分析及统计学处理。结果:(1)各实验组和对照组间及各实验组间NMDAR1的表达无统计学意义。(2)除即刻组外各实验组和对照组间及各实验组间NMDAR2A的表达均有统计学意义,从再灌注后3小时至168小时NMDR2A表达缓慢上升。结论:(1)NMDAR1与视网膜缺血再灌注损伤无关,不参与谷氨酸的兴奋性毒性作用。(2)NMDAR2A与视网膜缺血再灌注损伤有关,参与谷氨酸兴奋性毒性作用。     

早期集束化急救策略救治严重多发伤临床评价

目的 探究采用早期集束化急救策略治疗严重多发伤的运用情况.方法 整群选择该院2013年2月—2015年2月收治的严重多发伤患者122例,分为观察组、对照组,各61例. 对照组采取一般监护治疗措施,观察组采取早期集束化急救策略. 对比两组在入院时、入院后1 h以及入院后24 h的乳酸(Lac)、血红蛋白(Hb)和血气指标,并且比较两组检查花费时间、平均住ICU时间、急诊手术率、漏诊率以及病死率情况. 结果 观察组在入院后1 h和24 h的Lac、Hb以及血气指标均显著优于对照组, 差异有统计学意义 (P<0.05). 观察组病死率为13.11%(8/61), 漏诊率为4.92%(3/61),均显著低于对照组的病死率31.15%(19/61),漏诊率为13.11%(8/61),差异有统计学意义(P<0.05);观察组急诊手术率为83.61%(51/61),显著高于对照的70.49%(43/61),差异有统计学意义(P<0.05);观察组检查花费时间和平均住ICU时间均显著低于对照组,差异有统计学意义(P<0.05). 结论 对于严重多发伤患者采取早期集束化急救策略可显著提高抢救率,降低死亡率,值得临床推广.     

医原性输尿管损伤18例临床分析

目的探讨医原性输尿管损伤的早期诊断和最佳治疗方案,提高手术成功率,减少合并症的发生。方法对1990至2005年18例19侧医原性输尿管损伤病例进行回顾性研究。分析治疗方法和预后及并发症之间的关系。结果15例早期发现患者中13例一期修复输尿管损伤;2例先行尿流改道,3个月后行修复手术成功。3例发现晚患者,3~10个月后手术,1例行肾切除,2例行一期修复手术。12例获得随访6~24个月,10例肾积水缓解。结论医原性输尿管损伤患者一般情况较好时,无论确诊时间早晚,均可考虑一期手术修复。     

马来西亚西部眼化学伤75例回顾分析

目的:探讨化学伤的致伤物质种类、最容易发生化学伤的职业,眼部化学伤的严重性和伤后的并发症和视力预后.方法:通过病例回顾性研究,包括伤者的性别、年龄、种族、职业,探讨化学伤的致伤物质种类,就诊时视力,眼部化学伤的严重性和伤后的并发症和视力预后.结果:在75例患者中,90.3%为男性,84% 在工作年龄范围(21-50岁);29.3% 是工厂工人;52% 碱烧伤:65.4% 为制造厂和建筑工人;57.3% 双眼受累;9.3% 就诊时受伤眼视力＜6/60;72% 为I级;19.5% 患者并发干眼症,角膜血管翳,角膜混浊,并发性白内障,继发性青光眼等;92%的伤眼最后视力是6/18或以上;6.2%伤眼失明.结论:虽然化学伤常常累及双眼,但多数患者伤情不严重,且视力预后较好.及时充分的冲洗可以缓解眼化学伤.适当的紧急处理可以减少长期的并发症和视力损害,但一些严重的化学伤可致盲.     

颅脑战伤非专科治疗标准化方案研究

目的明确并规范颅脑战伤非专科治疗方案,以指导颅脑战伤的时效救治。方法调研现代战争颅脑战伤的资料,参考国内外关于颅脑创伤的急救方案,结合我军战伤救治经验,分析颅脑战伤非专科治疗方案。结果提出颅脑战伤非专科治疗标准化方案、救治模式以及颅脑战伤处理程序图。结论此方案为颅脑战伤的时效救治及我军颅脑战伤救治手册的制定提供了依据。     

How to become Pediatric Orthopedic surgeon inEurope:a long journey offering a unique career,full of satisfactions

In most European countries,Pediatric Orthopedic (PO) surgeons graduated from an approved Orthopedic and Trauma surgery training program which lasts 5 or 6 years,depending on the country.Upon completion of the Orthopedic and Trauma surgery program,the future PO surgeon must complete an additional subspecialty training (one to two years,depending on the country) in PO surgery.The possibility to become a certified PO surgeon through the specialization in Pediatric Surgery (option Orthopedics) or through a dedicated PO surgery training program only exists in France and in Romania,respectively.Credit as active and fully responsible PO surgeon can only be claimed when the trainee has actively participated in all phases of treatment,from diagnosis to treatment,without forgetting the management of complications and the setting up of an adequate follow-up of children and adolescents with musculoskeletal disorders.     

Effect of the Affordable Care Act on healthcare utilization for Veterans with spinal cord injuries and disorders

Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.Setting: VA healthcare facilities.Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.Interventions: We assessed VA healthcare utilization before and after ACA implementation.Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions.Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001).Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.