240例社区内就诊的腰椎间盘突出症患者临床资料分析

目的：探讨社区内就诊椎间盘突出症病人的临床资料,以便更好地指导社区医疗临床。方法：对在广西南宁市五所社区门诊的240例非急性期腰椎间盘突出症患者的相关临床资料进行总结和分析。结果：本组240例患者中,女性发病率略高于男性,发病年龄多集中在40~59岁之间,职业以非体力劳动者为主,长期慢性积累性劳损、腰部外伤史是发病的主要因素,病程较短但容易复发。结论：社区内就诊椎间盘突出症病人有不同于住院椎间盘突出症病人的临床特征。     

应用根本原因分析法减少新生儿科高危药物外渗及损伤的实践

目的：探讨根本原因分析法（RCA）在减少新生儿科高危药物外渗及损伤中的作用。方法：对2011年2281例发生静脉输液高危药物外渗的案例进行根本原因分析,并制定改进措施;分析RCA实施前（2011年1-12月）与实施后（2012年1-12月）高危药物外渗发生率与程度。结果：RCA实施后高危药物外渗率及损伤率低于实施前,差异有统计学意义（P〈0.01）。结论：运用根本原因分析法能有效找到引起药物外渗及损伤的根本原因,采取相应的措施,提高新生儿科静脉输液的安全性。     

Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report

Abstract

Therapeutic neuroscience education (TNE) has been shown to be effective in the treatment of mainly chronic musculoskeletal pain conditions. This case study aims to describe the changes in brain activation on functional magnetic resonance imaging (fMRI) scanning, before and after the application of a newly-designed preoperative TNE program. A 30-year-old female with a current acute episode of low back pain (LBP) and radiculopathy participated in a single preoperative TNE session. She completed pre- and post-education measures including visual analog scale (VAS) for LBP and leg pain; Oswestry Disability Index (ODI); Fear Avoidance Beliefs Questionnaire (FABQ); Pain Catastrophizing Scale (PCS) and a series of Likert-scale questions regarding beliefs and attitudes to lumbar surgery (LS). After a 30-minute TNE session, ODI decreased by 10%, PCS decreased by 10 points and her beliefs and attitudes shifted positively regarding LS. Immediately following TNE straight leg raise increased by 7° and forward flexion by 8?cm. fMRI testing following TNE revealed 3 marked differences compared to pre-education scanning: (1) deactivation of the periaqueductal gray area; (2) deactivation of the cerebellum; and (3) increased activation of the motor cortex. The immediate positive fMRI, psychometric and physical movement changes may indicate a cortical mechanism of TNE for patients scheduled for LS.     

The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in orthopaedic applications

Preclinical proof-of-concept, feasibility and efficacy studies in lower animals resulted in the accumulation of data that served as a backbone for clinical trials with the recombinant, osteogenic bone morphogenetic protein-2 (BMP-2). Among the important observations was the dependence of dose and carrier on the outcome for osseous union in relation to the animal model used. Clinical outcome data for spinal applications indicate better overall results compared with traditional controls that utilised autogenous iliac crest bone graft for fusion. Parameters include less blood loss, less operating room time and costs, better fusion outcomes and increased patient satisfaction. At this juncture, the long journey from the identification of BMP-2 in demineralised bone fraction to FDA approval for use in a singular orthopaedic application has been completed. It has been demonstrated to be safe, efficacious and cost-effective, leading to increased patient satisfaction and improved clinical outcome.     

Small molecules for small minds? The case for biologic pharmaceuticals

Biologic pharmaceuticals are gaining in both market share and clinical utility compared with small molecule therapeutics. This market growth is, in part, reflective of a field of science entering its toddlerhood, where with increased maturity, both development timelines and costs of manufacturing for these complex molecules will decrease, further enhancing the profitability side of the equation. Although a firm understanding of the rules governing toxicity (especially antibody responses to therapeutic proteins) remains to be defined, it is clear that proteins are less prone to much of the idiosyncratic toxicity associated with small molecule drug candidates. Proteins are disadvantaged in that they are unlikely to find much use in targeting intercellular processes; however, they have clear strengths over small molecules in targeting protein–protein interactions and the specific targeting of surface features of particular cells (e.g., in oncology). As each aspect of protein pharmaceutical technology advances, it is clear that this will be the major area for growth in the industry over the next decade.     

牵引与后路枕颈复位固定治疗寰椎枕骨化并颅底凹陷症

目的评价术前牵引加后路多轴螺钉-棒系统枕颈复位固定治疗寰椎枕骨化合并颅底凹陷症的疗效.方法2004年1月～2006年2月共收治5例寰椎枕骨化合并颅底凹陷症患者,男3例,女2例,平均年龄34.8岁.患者均有明显神经功能损害症状,JOA评分平均9.4分.颈髓延髓角平均109.4°.4例合并难复性寰枢关节脱位.入院后均行颅骨牵引复位2～4周,当寰枢前后脱位复位达50%及齿状突垂直复位达4mm后行多轴螺钉-棒系统枕颈复位固定.术后均给予硬颈托固定3个月.结果齿状突均有较好的复位,术后颈髓延髓角平均增加32.4°,无术中、术后并发症.平均随访16个月,均固定满意并坚固融合,末次随访时所有患者神经功能恢复良好,JOA评分平均15.1分,改善率为75.0%.结论术前牵引加后路多轴螺钉-棒系统枕颈复位固定是治疗寰椎枕骨化合并颅底凹陷症的简单、安全、有效方法.     

三种术式治疗腰椎不稳症的临床疗效观察

目的 探讨3种术式治疗腰椎不稳症的疗效.方法 对86例腰椎不稳症分3组,用3种手术方式治疗,对治疗结果进行回顾性统计分析.结果 86例术后随访8～48个月,平均26个月.根据影像学检查,3组植骨融合率分别为78%、92.5%、95.5%.术后优良率分别为:1年82.5%,84.2%,85.5%;2年79.5%,84%,85.2%;3年75.8%,83.6%,85%.结论 单纯后路植骨远期疗效不如联合椎弓根螺钉内固定加椎间融合;应根据腰椎退变及硬膜囊神经根受压的程度选择合适的融合术式.     

Sema3A-Fc真核表达载体构建及诱导少突胶质细胞祖细胞迁移作用观察

目的 构建真核表达载体pIGSema3A-Fc,并观察Sema3A-Fc融合蛋白对少突胶质细胞祖细胞(OPCs)迁移的作用.方法 运用DNA重组技术自原核表达载体上将鸡来源的Sema3A基因克隆到真核表达载体pIGIsG1Fc上,并用双酶切、测序法进行鉴定.采用脂质体法转染非洲绿猴肾细胞株(COS-7)细胞进行融合蛋白表达,培养3天后提取上清液,经蛋白A亲和纯化,Western blotting进行鉴定.利用插入式细胞迁移小室(millicell-PCF)细胞迁移仓观察其对OPCs细胞迁移的诱导作用.结果 重组质粒双酶切产生了2.24kb目的 片段及5.7kb载体片段.测序证实构建的Sema3A膜外区与Sema3A-Fc cDNA阅读框完整,连接部位序列正确;Western blotting证实有Sema3A-Fc融合蛋白表达.迁移试验证明其对少突胶质细胞祖细胞迁移具有推斥作用.结论 成功构建了Sema3A-Fc真核表达载体,并使有生物学活性的Sema3A-Fc融合蛋白在COS-7细胞上获得了稳定表达,为进一步研究OPCs细胞定向迁移奠定了基础.     

临床路径用于腰椎间盘突出症患者健康教育的研究

目的探讨腰椎间盘突出症患者应用临床护理路径进行健康教育的效果。方法将160例患者分为观察组和对照组，每组各80例。观察组按制定好的临床护理路径对患者进行健康教育；对照组实施整体护理，观察两组的护理效果。结果观察组患者对疾病相关知识和健康教育内容的掌握程度及服务满意度明显高于对照组（P〈0．01；P〈0、005）。结论实行临床路径服务可以使医疗及护理工作进一步规范，能增强病人的自我护理能力，缩短住院时间，降低住院费用，促进护理人员与病人的沟通和互动，提高满意度。