SPECT、SPECT-CT与MRI对新鲜骨质疏松性椎体压缩骨折的诊断价值

目的:比较分析单光子发射计算机断层摄影术(SPECT)、单光子发射计算机断层摄影术联合同机CT扫描图像融合技术(SPECT-CT)与磁共振成像(MRI)对新鲜骨质疏松性椎体压缩骨折(OVCF)的诊断价值.方法:对201 1年10月～2012年4月因OVCF就诊而又同时接受了胸腰椎MRI、SPECT及SPECT-CT检查的20例老年患者进行回顾性分析,其中女12例,男8例,年龄60～80岁,平均73.5岁,平均病程21d.根据MRI表现确定最终诊断,MRI上出现骨髓水肿像的椎体定义为新鲜骨折椎体,椎体形态有压缩改变但MRI信号无异常者定义为陈旧骨折.由2位核医学医师分别评估SPECT及SPECT-CT检查,记录出现核素浓集的椎体,并给出疾病诊断意见.采用Kappa检验对比MRI与SPECT-CT判断新鲜骨折及陈旧骨折的一致性以及定性诊断能力.参考MRI发现,采用卡方检验分析SPECT与SPECT-CT定位病椎能力的异同.结果:根据MRI或SPECT-CT,20例患者均确诊为新鲜OVCF,其中MRI发现32个椎体存在新鲜OVCF,SPECT-CT发现34个椎体存在新鲜OVCF;根据SPECT诊断新鲜OVCF 12例,疑似新鲜OVCF但难以与肿瘤、感染相鉴别8例,共发现34个椎体存在核素浓集.MRI发现新鲜OVCF 32个椎体、陈旧OVCF 10个椎体,SPECT-CT发现新鲜OVCF 34个椎体、陈旧OVCF 8个椎体,两者之问具有良好的一致性(Kappa=0.0577,P＜0.05).在对病椎定位的准确性上,以MRI定位的病椎节段为参考,SPECT与MRI定位相同24个椎体,SPECT-CT与MRI定位相同30个椎体,SPECT-CT定位准确性优于SPECT(P＜0.05).SPECT-CT检查还发现了MRI未能显示的骨骼病损,其中骶尾椎骨折1例,肋骨骨折2例,骶髂关节炎1例,胸锁关节良性病变1例.结论:SPECT-CT在OVCF的定位、定性诊断上与MRI的价值相似,其准确定位病椎的性能优于传统SPECT检查;SPECT-CT还可以发现一些MRI未能显示的合并骨骼病损.SPECT-CT是患者不能接受MRI时的可靠选择.     

Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: a midterm follow-up study

Purpose

Our goal was to observe the midterm results of a case series of Denis type B thoracolumbar burst fracture treated with anterior decompression with single segmental spinal Interbody fusion.

Methods

Twenty patients with Denis type B thoracolumbar burst fractures underwent anterior decompression with single segmental spinal Interbody fusion. They underwent clinical and radiologic follow-up for at least three years after the surgery.

Results

The mean follow-up period lasted 57 months. To the last follow-up, there were no cases of internal fixation loosening, failure and other complications. Titanium mesh or interbody bone grafts were in good position. Spinal kyphosis was not observed. Interbody fusion was achieved for all cases. The average fusion time was 4.5 months. Based on visual analogue scale (VAS) pain scores, percentage of vertebral body height loss and Cobb angle, the difference was statistically significant between the preoperative period and postoperative one year or final follow-up (P < 0.05). Results at postoperative one year and final follow-up were better than the preoperative period. However, the difference was not significant between postoperative one year and final follow-up (P > 0.05).

Conclusions

Good midterm results on clinical and radiologic evaluation of anterior decompression with single segmental spinal Interbody fusion for suitable patients with Denis type B thoracolumbar burst fracture can be achieved. The incident rate of relative complications is low.     

单孔与多孔腹腔镜脾切除术比较的Meta分析

目的 系统评价单孔腹腔镜（ SILS ）与传统多孔腹腔镜脾切除术的临床安全及可行性.方法 计算机检索 PubMed、EMbase、MEDLINE、SCI、CNKI、WanFang Data 和 The cochrane Library,收集单孔与多孔腹腔镜脾切除术的随机或非随机同期对照试验,检索时限截止到 2012 年 12 月.由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用 RevMan 5.0 软件进行 Meta 分析.结果 纳入 4 个非随机对照试验,共 104 例患者.Meta 分析显示两组手术时间 （ MD = -1.08;95%CI = -37.24 to 35.07;P = 0.95 ）,术中出血量（ MD = -88.57;95% CI = -211.48 to 34.33;P = 0.16 ）,住院天数（ MD = -0.10;95% CI = -0.69 to 0.49;P = 0.73 ）均无统计学差异.结论 单孔腹腔镜脾切除术是安全、可行的.由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量 RCT 进一步验证.     

室内氡暴露居民外周血淋巴细胞DNA损伤及微核细胞发生率

目的：观察室内氡暴露居民外周血淋巴细胞DNA损伤及微核细胞发生率。方法：采用单核细胞凝胶电泳和微核检测两种方法。观察了我国甘肃省窑洞内氡暴露居民及对照居民外周血淋巴细胞DNA损伤及微核细胞发生率。结果：窑洞和普通住房居民（室内空气中氡浓度分别为200－350Bq.m^－3及37．5-77.1Bq.m^－3)的细胞迁移发生率分别为1．68％和1．43％，人发生细胞迁移百分别为57．1％和54．3％。50岁以上窑洞和普通住房居民细胞迁移和人发生细胞迁移率分别为2．14％、75．0％和2．00％、64．7％。窑洞和普通住房居民微核细胞发生率分别为1．07％和0．78％。结论：窑洞居民外周血淋巴细胞DNA损伤及微核细胞发生率略高于普通住房居民，P值接近0．05。     

汉族人群白介素17受体C基因单核苷酸多态性与青少年特发性脊柱侧凸的相关性

【摘要】　目的：探讨白介素17受体C（IL-17RC）基因单核苷酸多态性与中国汉族人群青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）易感性之间的相关性。方法：收集529例AIS女性患者及512例正常同龄女性青少年的静脉血标本,采用聚合酶链反应－限制性片段长度多态性（PCR-RFLP）方法鉴定和统计两组人群IL-17RC基因rs708567和rs279545多态性位点的基因型及等位基因分布频率;比较两组间不同多态性位点各基因型及等位基因分布频率的差异。结果：研究Power值（81%）大于80%,AIS患者组及正常对照组各多态性位点的基因型分布均符合Hardy-Weinberg遗传平衡定律。AIS组rs708567多态性位点GG基因型和G等位基因的分布频率显著高于对照组GG基因型（90.17% vs. 85.55%,P=0.023）和G等位基因（95.1% vs. 92.8%,P=0.028）的分布频率;携带GG基因型青少年中AIS的发病率约为携带AG基因型青少年的1.5倍（OR值=1.55;95% CI:1.45~3.11）。rs279545多态性位点各基因型及等位基因的分布频率在两组间均无统计学差异。结论：中国汉族人群中IL-17RC基因单核苷酸多态性与AIS的发生相关。     

GABAARG2基因C588T多态性与癫痫的相关性研究

目的探讨中国粤西地区汉族人群GABAARG2基因C588T的单核苷酸多态性与癫痫的关系。方法采用病例-对照研究方法,收集粤西地区汉族人群189例癫痫患者,100例健康人作为正常对照组,根据患者对抗癫痫药物的反应性分为耐药组(92例)和药物敏感组(97例),提取所有研究对象外周血基因组DNA,采用PCR扩增后基因测序鉴定GABAARG2基因C588T多态性,测定该位点基因型频率和等位基因频率,并进行统计学分析。结果耐药组与药物敏感组、正常对照组的CC、CT、TT基因型频率及C、T等位基因频率比较差异均无统计学意义;药物敏感组与正常对照组的CC、CT、TT基因型频率比较(χ~2=6.468,P=0.039)差异有统计学意义,CC与CT优势比为1.669(95%CI=0.842~3.306,P=0.141),CC与TT的优势比为2.652(95%CI=1.240~5.668,P=0.011);C、T等位基因频率比较(χ~2=7.411,P=0.006)差异有统计学意义,C等位基因与T等位基因优势比为1.737(95%CI=1.166~2.588,P=0.006)。结论 GABAARG2基因5号外显子的C588T多态性与癫痫的易感性相关,但与癫痫的耐药风险不相关。     

Do catecholamines directly modulate the delayed plateau potassium current in frog atrium?

An important electrophysiological action of catecholamines in the heart is the modulation of the second inward current (iCa). Catecholamine augmentation of iCa has been attributed to an increase in the number of functional channels, as well as an increase in the probability of channel opening [1, 4, 12]. Another important electrophysiological action of catecholamines in the heart is the modulation of time-dependent outward currents. In the Purkinje fibre, epinephrine has been shown to shift the voltage-dependence of the pacemaker current, iK2 [13]. The delayed outward current(s) which is activated over the plateau range of potentials (ix) is also augmented by catecholamines in Purkinje fibers [14] as well as frog atrium [3]. Several possible mechanisms for enhancement of the outward plateau current by catecholamines have been proposed [2]: (i) a direct increase in the maximal conductance of the channel; (ii) an indirect enhancement of outward current mediated by stimulation of Na+-K+ exchange (which may reduce potassium concentration in restricted extracellular spaces and hence produce an increase in the driving force for K+) or (iii) an indirect augmentation of outward current via enhancement of intracellular Ca2+ (calcium-activated potassium conductance) [10]. To distinguish between these possible mechanisms, the influence of epinephrine and isoproterenol on the delayed outward K+ current in single isolated bullfrog atrial cells was examined. Evidence is presented that in single frog atrial cells, concentrations of epinephrine or isoproterenol which produce large increases in the second inward current have no detectable effect upon the delayed plateau K+ current.     

Extended kinship analysis of historical remains using SNP capture

DNA-assisted identification of historical remains requires the genetic analysis of highly degraded DNA, along with a comparison to DNA from known relatives. This can be achieved by targeting single nucleotide polymorphisms (SNPs) using a hybridization capture and next-generation sequencing approach suitable for degraded skeletal samples. In the present study, two SNP capture panels were designed to target ~ 25,000 (25 K) and ~ 95,000 (95 K) nuclear SNPs, respectively, to enable distant kinship estimation (up to 4th degree relatives). Low-coverage SNP data were successfully recovered from 14 skeletal elements 75 years postmortem using an Illumina MiSeq benchtop sequencer. All samples contained degraded DNA but were of varying quality with mean fragment lengths ranging from 32 bp to 170 bp across the 14 samples. SNP comparison with DNA from known family references was performed in the Parabon Fx Forensic Analysis Platform, which utilizes a likelihood approach for kinship prediction that was optimized for low-coverage sequencing data with cytosine deamination. The 25 K panel produced 15,000 SNPs on average, which allowed for accurate kinship prediction with strong statistical support in 16 of the 21 pairwise comparisons. The 95 K panel increased the average SNPs to 42,000 and resulted in an additional accurate kinship prediction with strong statistical support (17 of 21 pairwise comparisons). This study demonstrates that SNP capture combined with massively parallel sequencing on a benchtop platform can yield sufficient SNP recovery from compromised samples, enabling accurate, extended kinship predictions.     

经脐单孔腹腔镜胆囊阑尾联合切除术16例报告

目的探讨经脐单孔腹腔镜胆囊阑尾联合切除术的临床应用价值。方法回顾性分析我院2010年7月～2012年1月16例经脐单孔腹腔镜胆囊阑尾联合切除术的临床资料。经脐置入多孔道trocar,曲线形腹腔镜器械先切除胆囊并使用推结器丝线打结结扎胆囊动脉及胆囊管,然后行阑尾切除,4例由脐孔行拖出式阑尾切除,12例应用常规腹腔镜器械切除阑尾并使用推结器丝线打结结扎阑尾动脉及阑尾根部。结果 16例均获成功,未放置引流。手术时间60～150 min,平均80.4 min,无并发症发生。结论使用专用器械行经脐单孔腹腔镜胆囊阑尾联合切除术安全、可行,但较传统腹腔镜手术操作困难,需要有一个学习曲线。     

经脐1cm单孔腹腔镜阑尾切除术式探讨

目的总结和交流经脐1 cm单孔腹腔镜阑尾切除术的经验。方法经脐1 cm单孔下通过两个特制穿刺器形成的双通道,术者一手扶镜、一手操作手术器械完成腹腔镜阑尾切除术37例。结果手术操作器械间冲突少,手术操作较顺利,手术时间15～45 min,平均30 min,患者术后当天可下床活动,进流质饮食,住院时间2～3 d,腹部未留下明显疤痕,37例患者无切口感染、切口疝、腹腔残余脓肿、肠粘连等并发症发生。结论在操作合理的情况下,大部分慢性阑尾炎、急性阑尾炎患者均可完成经脐1 cm单孔腹腔镜阑尾切除术。