岛状皮瓣转移修复小腿及足部骨外露创面

自1986年1月以来,我们使用5种岛状皮瓣为5例小腿及足部骨外露病人修复了创面,效果满意。笔者认为:岛状皮瓣转移术具有手术操作简单,安全可靠,血供丰富,抗感染能力强,术后处理容易等优点。本文还详细介绍了全部病例及手术注意事项。     

Pathogenesis of progressive muscular dystrophy: studies on free radical metabolism in an animal model

Evidence to suggest the presence of abnormal metabolism of oxygen free radicals in progressive muscular dystrophy is presented using an animal model. In the superficial pectoral muscles of dystrophic chickens, enzyme activities regulating the metabolism of oxygen free radicals, i.e., catalase, superoxide dismutases and glutathione peroxidase, were significantly elevated within 1 week of hatching. Activities of related enzymes, i.e., glutathione reductase, glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase were also elevated. In contrast, the specific activity of phosphofructokinase, the rate-limiting enzyme of the glycolytic pathway, was normal during the first 4-week period. These results suggest that there is an increased turnover of oxygen free radicals in the dystrophic muscle. This concept appears important in a further investigation of the pathogenesis and treatment of progressive muscular dystrophies.     

有机锗对大鼠实验性矽肺形成及脂质过氧化水平的影响

采用硫代巴比妥酸比色法和亚硝酸盐形成法，分别测定了实验性矽肺大鼠血清过氧化脂质（ＬＰＯ）及超氧化物歧化酶（ＳＯＤ）同工酶活力，同时观察了β羧乙基锗倍半氧化物（Ｇｅ－１３２）对实验性大鼠矽肺形成的阻断作用及对自由基代谢的影响。结果显示矽肺大鼠血清ＬＰＯ含量显著高于对照组，而血清总ＳＯＤ和ＣｕＺｎＳＯＤ活力显著下降。提示矽肺的发生可能与机体自由基代谢的失衡有关。使用Ｇｅ－１３２可显著提高大鼠机体的抗氧化能力，降低脂质过氧化作用，并可明显干预矽肺病变的形成。     

缺血－再灌注兔心肌肌浆网自由基的测定

应用电子自旋共振波谱仪（ＥＳＲ）直接检测了缺血－再灌注兔心肌肌浆网自由基的变化，以探讨肌质网系统与氧自由基的关系。实验中将２０只兔随机分为再灌注对照组、超氧化物歧化酶（ＳＯＤ）组、ＡＴＰ－氯化镁组和人参皂甙Ｒｅ组。实验结果，ｇ值２．００４６处为半醌自由基波谱，其相对浓度各组依次为７８．９４±２．１２６，１４．４６±２．８６，２０．６５±７．６５，１４．６６±３．６７（ｘ±ＳＤ），对照组与用药组均有显著性差异（Ｐ＜０．０５），表明缺血－再灌注兔心肌肌浆网产生大量的自由基，用ＥＳＲ可以直接检测到半醌自由基，外源性高能磷酸盐制剂ＡＴＰ－氯化镁及人参皂甙Ｒｅ与超氧化物歧化酶一样，发挥清除兔心肌肌浆网自由基的作用。     

The 21-aminosteroid antioxidant, U74389F, prevents estradiol-induced depletion of hypothalamic β-endorphin in adult female rats

A single intramuscular injection of 2 mg estradiol valerate (EV) results in neuronal degeneration and β-endorphin depletion in the hypothalamic arcuate nucleus of adult female rats. We have hypothesized that peroxidase-positive astrocytes in this brain region oxidize estrogens and catecholestrogens to semiquinone radicals which mediate oxidative neuronal injury. In the present study, dietary administration of the potent antioxidant 21-aminosteroid, U-74389F, completely blocked EV-induced β-endorphin depletion in the hypothalami of adult female rats. Neither EV nor 21-aminosteroid treatment had any effect on hypothalamic concentrations of neuropeptide Y and Met-enkephalin, confirming that the estradiol lesion is fairly selective for the β-endorphin cell population. The present findings support the hypothesis that the toxic effect of estradiol on hypothalamic β-endorphin neurons is mediated by free radicals.     

Serum Levels of Free Insulin-Like Growth Factor (IGF)-I in Normal Children

Serum levels of free insulin-like growth factor (IGF)-I were measured by immunoradiometric assay (IRMA) in fasting sera of 137 normal boys and 120 normal girls aged from 8 to 15 yr to study relationships between free IGF-I levels and ages, total IGF-I, IGF binding protein (IGFBP)-1, IGFBP-3, and acid-labile subunit (ALS) levels. In both sexes, serum free IGF-I levels and the ratios of free IGF-I to total IGF-I were significantly higher in the pubertal age groups than in the prepubertal age groups. Serum levels of free IGF-I showed a significant positive correlation with those of total IGF-I, IGFBP-3 and ALS, while they showed a significant negative correlation with those of IGFBP-1. These observations suggest that increase in serum free IGF-I levels during puberty is caused by a dramatic increase in total IGF-I, rather than IGFBP-3, and a decrease in IGFBP-1. Also, high free IGF-I levels may play an important role in pubertal growth spurt.     

依达拉奉防治缺血性脑损伤研究的新进展

近年来,依达拉奉脑保护作用的研究取得了很大进展,尤以对缺血性脑卒中和新生儿缺血缺氧性脑病的防治研究最为深入,而联合治疗策略也得到了广泛的重视.本文就近5年这些热点研究的新进展进行综述.     

Whole-heart cine MRI using real-time respiratory self-gating.

Two-dimensional (2D) breath-hold cine MRI is used to assess cardiac anatomy and function. However, this technique requires cooperation from the patient, and in some cases the scan planning is complicated. Isotropic nonangulated three-dimensional (3D) cardiac MR can overcome some of these problems because it requires minimal planning and can be reformatted in any plane. However, current methods, even those that use undersampling techniques, involve breath-holding for periods that are too long for many patients. Free-breathing respiratory gating sequences represent a possible solution for realizing 3D cine imaging. A real-time respiratory self-gating technique for whole-heart cine MRI is presented. The technique enables assessment of cardiac anatomy and function with minimum planning or patient cooperation. Nonangulated isotropic 3D data were acquired from five healthy volunteers and then reformatted into 2D clinical views. The respiratory self-gating technique is shown to improve image quality in free-breathing scanning. In addition, ventricular volumetric data obtained using the 3D approach were comparable to those acquired with the conventional multislice 2D approach.     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁

目的探讨经闭孔无张力尿道中段悬吊术(trans-obturator tension free vaginal tape,TVT-O)治疗女性压力性尿失禁(stress urinary incontinence,SUI)的临床疗效。方法2006年1月~2007年9月,对15例SUI行TVT-O,取阴道前壁纵行切口1cm,组织剪分离尿道旁阴道黏膜下间隙至闭孔膜,放入蝶形导引杆,将螺旋形穿刺针沿导引杆紧贴耻骨下支穿过闭孔膜,从大腿根部皮肤穿出,将吊带无张力放置于尿道中段下方。结果手术时间15~40min,平均30min。术中出血量10~40ml,平均20ml。术中无并发症。1例术后尿潴留,留置尿管5d后缓解。10例术后大腿根部疼痛,术后3~10d消失。15例随访2~19个月,平均8个月,均治愈,无复发。结论TVT-O操作简单、安全有效。     

The significance of involvement of a free serosal surface for recurrence and survival following resection of clinicopathological stage B and C rectal cancer

OBJECTIVE: To determine whether the presence of tumour at a free serosal surface was independently associated with pelvic recurrence or survival in patients who had a resection for clinicopathological stage B or stage C rectal cancer and who had not received adjuvant therapy. METHOD: Data were drawn from a comprehensive, prospective hospital registry of all resections for rectal cancer from January 1971 to December 1998 with follow up to December 2003. Statistical analysis employed the chi(2) test or Fisher's exact probability, Kaplan-Meier estimation and proportional hazards regression, with a significance level of < or =0.05 and 95% confidence intervals (CI). RESULTS: In 665 patients with stages B or C tumour, 35 (5.3%; CI 3.7-7.2%) had tumour at a free serosal surface. These comprised 6/332 (1.8%; CI 0.8-3.7%) patients with stage B tumour and 29/333 (8.7%; CI 6.1-12.2%) with stage C tumour. After adjustment for other relevant variables, involvement of a free serosal surface was significantly associated with pelvic recurrence [hazard ratio (HR) 2.7; CI 1.3-5.5] and diminished survival (HR 1.6; CI 1.1-2.4) but not with systemic (only) recurrence. CONCLUSION: This study has confirmed that direct tumour spread to a free serosal surface independently predicts pelvic recurrence and diminished survival after resection of clinicopathological stage B and C rectal cancer. This feature should always be sought by the pathologist and reported when present, and noted by the surgeon and oncologist. Serosal involvement should be evaluated further for its utility in selecting patients for adjuvant therapy.