副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症

 目的 探讨副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症的临床疗效。方法 2009年3月至2011年10月,采用副舟骨切除胫后肌腱止点重建跟骨内移截骨术治疗与副舟骨相关的平足症13例(16足),男4例,女9例;年龄18～64 岁,平均41.3岁。单足10例,双足3例;均有明显的跟骨外翻。术后以美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分评估后足功能,于X线片上测量足弓高度、跟骨倾斜角(CI)、距跟角(TC)、距骨-第一跖骨角(TMT)。结果 13例均获得随访,随访时间12~31个月,平均16.8个月。术后6个月时11例(13足)无任何疼痛,2例(3足)有长距离行走后足部疼痛。术后随访时AOFAS评分从术前(52.4±6.4)分提高至(88.1±2.8)分;负重侧位X线片上足弓高度从(3.8±0.3) mm提高至(12.0±1.1) mm,CI从9.5°±1.1°提高至20.1°±1.5°,TC从47.3°±2.5°改善至32.3°±2.5°,TMT从17.6°±1.6°改善至6.8°±1.0°;负重正位X线片上TC从39.5°±2.3°改善至26.2°±2.0°,TMT从15.2°±1.7°改善至6.3°±1.0°;轴位X线片上跟骨外翻角从11.3°±1.4°改善至4.2°±2.0°。结论 对与副舟骨相关的平足症的治疗,当存在后足外翻畸形时,副舟骨切除胫后肌腱止点重建跟骨内移截骨术可以明显缓解疼痛,有效矫正畸形,近期疗效良好。     

Melatonin-induced autophagy protects against human prion protein-mediated neurotoxicity

Melatonin has neuroprotective effects in the models of neurodegenerative disease including Alzheimer's and Parkinson's disease. Several studies have shown that melatonin prevents neurodegeneration by regulation of mitochondrial function. However, the protective action of melatonin has not been reported in prion disease. We investigated the influence of melatonin on prion-mediated neurotoxicity. Melatonin rescued neuronal cells from PrP(106-126)-induced neurotoxicity by prevention of mitochondrial dysfunction. Moreover, the protective effect of melatonin against mitochondrial dysfunction was related with autophagy activation. Melatonin-treated cells were dose-dependently increased in LC3-II, an autophagy marker. Melatonin-induced autophagy prevented a PrP(106-126)-induced reduction in mitochondrial potential and translocation of Bax to the mitochondria and cytochrome c release. On the other hand, downregulation of autophagy protein 5 with Atg5 siRNA or the autophagy blocker 3-methyladenine prevented the melatonin-mediated neuroprotective effects. This is the first report demonstrating that treatment with melatonin appears to protect against prion-mediated neurotoxicity and that the neuroprotection is induced by melatonin-mediated autophagy signals. The results of this study suggest that regulation of melatonin is a therapeutic strategy for prion peptide-induced apoptosis.     

Alcohol consumption and HIV/AIDS: the neglected interface

Many countries with heavy HIV and alcohol burdens do not fully recognize these epidemics as intrinsically interconnected. Missed opportunities for synergistic prevention and treatment of HIV and alcohol abound.Few HIV policies, services for HIV prevention or research projects adequately address alcohol-HIV harms or include alcohol use as an HIV risk factor.     

OxLDL/LOX-1系统及NF-κB通路在糖尿病血管内皮功能障碍中的作用机制

腹腔注射链脲佐菌素建立糖尿病大鼠模型(DM组),结果显示糖尿病大鼠2周时氧化低密度脂蛋白(oxLDL)水平已高于正常对照大鼠[(2.87±0.40对2.27±0.36)μg/dl,P＜0.05],血管舒张反应迟钝;6周时oxLDL水平更高[(4.32 ±0.66) μg/dl,P＜0.01],乙酰胆碱诱导的血管环舒张最大百分比(Rmax)明显降低(P＜0.01),糖尿病大鼠主动脉植物血凝素样氧化低密度脂蛋白受体1( LOX-1)、NF-kB、内皮细胞间黏附分子1(ICAM-1)蛋白及mRNA表达明显高于正常对照大鼠(P＜0.01),糖尿病大鼠LOX-1 mRNA表达水平与外周血oxLDL水平、NF-kBp65、ICAM-1 mRNA表达水平正相关,与Rmax呈负相关.提示OxLDL/LOX-1系统可能通过激活NF-kB,上调ICAM-1的表达,导致糖尿病早期内皮功能障碍.     

肿瘤坏死因子-α抗体对梗阻性黄疸大鼠肾脏IP3R表达的影响

目的研究肿瘤坏死因子-α(TNF-α)单克隆抗体对梗阻性黄疸大鼠肾功能的影响及机制。方法将60只雄性SD大鼠随机分成假手术组、模型组、干预组,采用胆总管结扎(CBDL)造梗黄模型,干预组于结扎后第2周开始腹腔注射TNF-α单克隆抗体[0.1 mg/(kg.2d)]。并于干预后1、2、3、4周麻醉动物,假手术组与5周模型组动物同批麻醉,留取肝和肾组织。采用HE染色确定模型建立情况,通过Western blot方法检测1,4,5-三磷酸肌醇受体(IP3R)的含量,免疫组织化学方法检测IP3R在肾组织的表达。结果 HE染色显示模型组和干预组肾间质有炎性细胞浸润,干预组较轻。免疫组化和Western blot显示模型组肾组织IP3R蛋白表达较多,干预组略下降,但均明显高于假手术组(P<0.05)。结论梗阻性黄疸时肾小球前小动脉平滑肌细胞内的IP3R蛋白的表达增强,而TNF-α单克隆抗体干预治疗可减轻IP3R表达增强的程度,部分减轻肾功能损害的发生。     

Medical treatment for sphincter of oddi dysfunction:Can it replace endoscopic sphincterotomy?

AIM:To report the results of a medical management of sphincter of oddi dysfunction(SOD) after an intermediate follow-up period.METHODS:A total of 59 patients with SOD(2 men and 57 women,mean age 51 years old) were included in this prospective study.After medical treatment for one year,the patients were clinically re-evaluated after an average period of 30 mo.RESULTS:The distribution of the patients according to the Milwaukee's classification was the following:11 patients were type 1,34 were type 2 and 14 were type 3.Fourteen patients underwent an endoscopic sphincterotomy(ES) after one year of medical treatment.The median intermediate follow-up period was 29.8 ± 3 mo(3-72 mo).The initial effectiveness of the medical treatment was complete,partial and poor among 50.8%,13.5% and 35%,respectively,of the patients.At the end of the follow-up period,37 patients(62.7%) showed more than 50% improvement.The rate of improvement in patients who required ES was not significantly different compared with the patients treated conservatively(64.2% vs 62.2%,respectively).CONCLUSION:Our study confirms that conservative medical treatment could be an alternative to endoscopic sphincterotomy because,after an intermediate follow-up period,the two treatments show the same success rates.