肺癌CT普查--疾病分期与肿瘤大小的关系

目的：肺癌分期与肿瘤直径的关系已被证实是一个预后指标,因此被纳入1986年肺癌分类的国际系统。近年来由于CT飞速发展,人们可以诊断出更小的肺癌,于是有人提倡对肺癌Ⅰ期进一步分期,即根据肿瘤直径小于还是大于30mm,将无确切远处淋巴结转移的病例（Ⅰ期病例）细分为Ⅰa和Ⅰb期。在诊断无症状（即潜伏）的肺癌时,CT普查的开展使人们考虑肿瘤大小的预后价值。在此我们对CT普查诊断的无症状潜伏型肺癌作了分期与大小关系的报道。     

转化生长因子β1在大鼠纤维化腹膜组织中的表达及作用

目的:检测转化生长因子β1在腹膜透析大鼠腹膜内表达,并探讨其在腹膜纤维化中的意义。方法:实验于2005-06/2006-03在中南大学湘雅二医院肾内科实验室完成。①实验材料:雄性SD大鼠,体质量180～240g,由中南大学湘雅二医院动物实验中心提供。②实验方法:将28只大鼠按随机数字表随机分为4组,每组7只。正常对照组不予任何干预;生理盐水组腹腔注射20mL生理盐水;低糖透析液组腹腔注射20mL1.5%葡萄糖透析液;高糖透析液组腹腔注射20mL4.25%葡萄糖透析液,均为1次/d。4周后,向大鼠腹腔注射4.25%葡萄糖腹膜透析液20mL,4h后于大鼠右下腹缓慢插入带有多个侧孔的10号静脉留置针,缓慢低位引流腹透液,量取引流液。③实验评估:取大鼠壁层腹膜组织,以苏木素-伊红染色,镜下测量腹膜厚度,采用免疫组织化学方法检测大鼠腹膜中转化生长因子β1及纤连蛋白。结果:28只大鼠均进入结果分析。①高糖透析液组、低糖透析液组超滤量均明显低于正常对照组与生理盐水组,并且高糖透析液组超滤量明显少于低糖透析液组(P均<0.05)。②高糖透析液组腹膜明显增厚,表面粗糙,间皮细胞肿胀,脱落,间皮下有大量血管生成以及胶原纤维沉积,还可见单核细胞等炎症细胞浸润,与其他组比较,腹膜厚度明显增加(P<0.05)。③高糖透析液组转化生长因子β1、纤连蛋白表达量均明显高于其他组;低糖透析液组转化生长因子β1、纤连蛋白表达量均明显高于正常对照组与生理盐水组(P<0.05)。④大鼠腹膜组织转化生长因子β1蛋白与纤连蛋白表达量、腹膜厚度之间呈明显的正相关(r=0.86,0.83,P<0.05)。结论:葡萄糖透析液可诱导腹膜组织转化生长因子β1明显上调,腹膜转化生长因子β1高表达与腹膜透析腹膜纤维化密切相关。     

Distribution and extent of involvement in brachial plexopathies caused by gunshot wounds, motor vehicle crashes, and other etiologies: a 10-year electromyography study

OBJECTIVE: To examine the differences in the extent and distribution of brachial plexopathy involvement caused by gunshot wounds (GSW), motor vehicle crashes (MVCs), and other etiologies, based on electrophysiologic data. DESIGN: Retrospective review of electrophysiologic data from 1993 to 2002. SETTING: A large urban county hospital. PARTICIPANTS: Sequential patients (N=109) with the diagnosis of brachial plexopathy established by electromyography testing. This included 35 patients with GSW, 25 involved in an MVC, and 49 with other etiologies. INTERVENTIONS: Not applicable.Main Outcome Measures The brachial plexus was divided into 9 regions: upper, middle, and lower root; upper, middle, and lower trunks; and lateral, posterior, and medial cords. Regions involved by needle study on electromyography were denoted as positive or negative. The total number of regions involved was also recorded. RESULTS: Injury was most common in the trunks (52%), cords (36%), and roots (12%) (Pearson chi(2), P<.000). Specifically, the "other" category had the greatest number of injuries to the trunks (54%) (Pearson chi(2), P<.000), whereas the trunks (46%) and cords (45%) were more evenly affected in GSW cases (Pearson chi(2), P=.585). In the MVC group, there was a trend toward more trunks (56%) being affected (Pearson chi(2), P=.076). CONCLUSIONS: Differences were noted in the distribution of injury when examining subtypes of traumatic brachial plexopathies.     

颈动脉损伤大鼠新生内膜增生与局部平滑肌细胞的增殖

目的:观察大鼠颈动脉损伤后高同型半胱氨酸血症对新生内膜形成和局部炎症因子单核细胞趋化因子1、细胞间黏附分子1表达及局部平滑肌细胞增殖的影响。方法:实验于2004-10/2005-02在北京大学第一临床医院心血管研究所完成。①Wistar雄性大鼠50只,采用随机数字法分为蛋氨酸组:1g/(kg·d)L-蛋氨酸灌胃;对照组:饮用水灌胃,每组25只。4周后检测两组血浆同型半胱氨酸浓度,并行左颈动脉球囊拉伤,分别于3,7,14,28d取材,检测血管损伤后新生内膜增生和局部单核细胞趋化因子1、细胞间黏附分子1表达情况。结果:①两组大鼠血浆同型半胱氨酸浓度:蛋氨酸组血浆同型半胱氨酸浓度明显高于对照组[(106.19±19.75),(4.90±0.10)μmol/L]。②两组大鼠血管组织形态学观察结果:苏木精-伊红染色血管损伤后7d可见内膜增生,14,28d蛋氨酸组新生内膜增生厚度比对照组增加36%,33%;新生内膜面积增加41%,30%;内膜面积/中膜面积增加36%,21%;管腔面积减少47%,61%;两组间比较差异均有显著性,但中膜面积无显著性差别。蛋氨酸组14d血管内膜和中膜平滑肌细胞中增殖细胞核抗原阳性颗粒百分比是对照组的1.7倍和2.3倍[(84.40±9.05)%比(49.00±4.51)%,P<0.01;(53.30±5.25)%比(23.70±6.17)%,P<0.01]。未损伤的右颈总动脉两组血管内膜及中膜增殖细胞核抗原阳性颗粒数小于0.1%。蛋氨酸组血管损伤局部单核细胞趋化因子1、细胞间黏附分子1表达增强,单核细胞趋化因子1主要分布在新生内膜和中膜,细胞间黏附分子1主要分布在内皮下和新生内膜,3d,7d明显,持续28d。结论:高同型半胱氨酸血症上调血管损伤局部炎症因子单核细胞趋化因子1、细胞间黏附分子1表达,促使局部平滑肌细胞增殖,使新生内膜增生。     

Lumbosacral plexopathy in gunshot wounds and motor vehicle accidents: comparison of electrophysiologic findings

OBJECTIVE: To characterize the differences between injuries to the lumbosacral (LS) plexus caused by gunshot wounds (GSW) and motor vehicle crashes (MVC) with regard to the location and extent of involvement. DESIGN: A retrospective review of electrophysiologic data from an electromyography laboratory of a county hospital. Nineteen patients with GSW and ten patients with MVC diagnosed by electromyography with an LS plexopathy were included in the study. Injuries were categorized by the number of anatomic quadrants of the LS plexus: upper anterior, upper posterior, lower anterior, and lower posterior. Comparison of upper vs. lower portions and bilaterality of LS plexus involvement was also made. Statistical analyses were performed with two-tailed Fisher's exact and general association tests. RESULTS: Lower portions of the plexus were involved more frequently in patients with MVC compared those observed in patients with GSW. Upper portions of the LS plexus were more involved compared with the lower portions in patients with GSW injuries. More sections of the plexus were involved in patients with MVC compared with those in patients with GSW. CONCLUSIONS: Compared with patients with MVC, patients with GSW had a greater chance of involvement of the upper portion of the plexus. The reverse was true for the lower portion. Hopefully this information will aid the electromyographer and rehabilitation team in the diagnosis and treatment of traumatic plexopathies caused by different etiologies.     

应用等离子体技术聚合制备-NH_2生物膜对大鼠卵巢细胞亲和性的影响

目的：以丙稀胺为单体,在RF脉冲等离子体条件下聚合制备含氨基的功能薄膜-NH2生物膜,观察应用等离子体技术进行材料表面改性后对卵巢细胞的细胞黏附、增殖及功能状态的影响。 方法：实验于2006-11/2007-04在首都医科大学生殖医学研究中心完成。①以丙稀胺为反应单体,利用等离子体处理仪器在盖玻片上聚合薄膜,制备-NH2生物膜基片。②覆有-NH2生物膜的基片为实验组;无覆膜的原始盖玻片为空白基片对照组。将P2代Wistar大鼠卵巢细胞分别接种于两组基片上,在37℃、体积分数为0.05的CO2培养箱中培养。③分别于培养12h和24h两个时间点取样检测。测量基片上细胞黏附面积,计算出百分率,反映细胞黏附率;利用MTT微量酶反应比色法测定MTT代谢率,反映细胞活性;采用放射免疫法检测培养液中雌二醇质量浓度,反映卵巢细胞分泌功能。 结果：①-NH2生物膜基片上卵巢细胞的黏附率12h和24h分别为61%,100%,明显高于空白基片上卵巢细胞细胞黏附率47%,78%。②-NH2生物膜基片上卵巢细胞MTT代谢率明显高于对照组（P〈0.01）。③-NH2生物膜基片培养液中雌二醇质量浓度也明显高于空白基片（P〈0.01）。 结论：应用等离子体技术进行表面改性后的-NH2生物膜在较短的时间内对体外培养的大鼠卵巢细胞的黏附、体外存活和分泌功能有明显的促进作用,对大鼠卵巢细胞具有细胞亲和性。     

基于椎弓根三维形态测量实施个体化置钉技术

目的:观察胸腰段椎弓根CT测量在椎弓根螺钉内固定中的作用,寻找一种个体化椎弓根螺钉置入的方法。方法:选择1999-02/2006-03河北工程大学附属医院收治的T12和/或L1段骨折患者59例,行螺旋CT检查及图像三维重建,重建结束后,得到胸腰段标本的三维图像,通过旋转和切割进行图像处理并测量,模拟出T11～L2的椎弓根形态,根据CT测量椎弓根的实际投照点进行调整,即横断面上椎弓根轴线与矢状位上椎弓根轴线的交点,在确定进钉点时选择下关节突为参照物,选用合适直径的螺钉进行植钉,植入螺钉后,连接棒或板系统。结果:262个椎弓根行植钉术,242个完全在椎弓根内,仅有20个螺钉穿透椎弓根皮质。术后平均随访16.1个月,均无临床并发症的发生,Frankel平均增加1.4级。术后有2例患者出现断钉(3枚),1例患者出现断棒,所植入的螺钉与机体生物相容性好,无不良反应的发生。结论:利用三维CT测量的数据辅助,严格按照个体化的椎弓根的轴线方向植钉,在置钉时应考虑到螺钉本身直径的因素,可以提高植钉的成功率。     

自体与异体移植重建膝关节前交叉韧带的关键技术

目的:探索膝关节前交叉韧带重建术的各个关键技术环节,为提高前交叉韧带修复的临床效果提供理论和实践依据。方法:通过分析与总结与前交叉韧带重建相关的文献资料,包括其手术方式、移植物的选择、骨道定位、髁间窝成形、移植物预张与张力、移植物固定等,同时结合作者的工作经验旨在进一步提高前交叉韧带重建技术。结果:①手术方式选择:膝关节镜下生物材料移植重建前交叉韧带取得比以往优良的临床效果,已得到广泛认可。多数采用单束重建,部分学者正在尝试双束重建以改善移植物生物力学性能。②移植材料的选择:包括自体和同种异体材料,其中自体骨-髌腱-骨与腘绳肌腱最为常用。骨-髌腱-骨由于两端带有骨块,固定牢靠,允许早期重返运动场,颇受年轻运动员青睐。腘绳肌腱取材切口小,术后很少出现膝前痛,但其稳定性不如骨-髌腱-骨,且术后相对容易出现骨隧道扩大。异体移植物在体内结合、重塑速度较自体移植慢,但若经过严格的供体筛选、合理的组织取材、消毒和保存,而不减弱移植物强度,仍可取得与自体移植相当的效果。③骨道位置:正确的骨道定位非常重要,骨道位置太靠前会造成髁间窝撞击和伸直受限。研究表明,术中采用骨性标志定位法要比采用软组织标志定位法准确,术中摄片有助于骨道位置的正确定位。④髁间窝成形术:髁间窝成形的目的是为了便于更清楚的观察髁间窝后侧,同时也是为了避免髁间窝撞击综合征的发生,由于髁间窝过度成形会增加关节出血、疼痛、肿胀以及骨赘生长,所以一般不主张广泛的髁间窝成形,除非术中确有必要时才进行。⑤移植物预张与张力:移植物初始张力不够会导致膝关节持续松弛,而张力过高会限制关节活动并加速关节退变。目前对于最佳的初始张力尚无确切说法。⑥固定:现在已经研制出许多不同类型的固定材料。对于骨-髌腱-骨而言,界面挤压螺钉单切口重建前交叉韧带时,股骨侧靠近关节腔侧固定,胫骨侧远离关节腔侧固定,双切口技术时胫骨侧靠近关节腔侧固定,股骨侧远离关节腔侧固定。股骨侧固定完毕后,膝关节取何角度对胫骨侧进行固定尚存争议。膝关节稍屈曲状态下固定不容易发生松弛,但正常的膝关节在前后方向上是允许有一定松弛度的。有些学者认为在膝关节完全伸直状态下固定可以避免屈曲挛缩畸形的发生并允许前后方向有轻度松弛。而有些学者认为在膝关节稍微屈曲状态下固定会更紧。结论:要真正做到解剖、生物力学、生理功能全方位重建,前交叉韧带重建技术,仍需不断完善,分子生物学、基因工程和组织工程技术的发展以及计算机辅助机器人手术的开展会使前交叉韧带重建技术日臻完善。