加味柴芍承气汤对重症急性胰腺炎肺损伤的作用

目的:探讨柴芍承气汤加味银杏叶对重症急性胰腺炎(SAP)肺损伤的防治作用及其机制.方法:SAP患者65例分为中药组(n=35)和对照组(n=30).分别观察2组患者低氧血症发生情况,腹痛缓解时间、肠鸣恢复时间、局部并发症及病死率,治疗72h后血中炎症介质血小板活化因子(PAF)、肿瘤坏死因子(TNF-α)、白介素-1(IL-1)的水平变化,并再次行上腹部螺旋CT扫描评估胰腺炎症进展情况.结果:中药组与对照组低氧血症的发生率分别为45.71%,73.33%(P<0.05);ARDS分别为8.57%,30%(P<0.05);治疗72h后中药组血中PAF(4.45±1.25vs2.83±1.64mg/L,P<0.01),TNF-α(32.96±4.33vs27.82±5.26ng/L,P<0.01),IL-1(3.46±1.07vs2.51±0.52ng/L,P<0.01)水平明显下降,而对照组血中PAF,TNF-α,IL-1水平无变化;中药组腹痛缓解时间、肠鸣恢复时间、CT扫描显示胰腺炎程度进展的比例明显低于对照组(P<0.05);2组局部并发症的发生率分别为2.86%,13.33%,病死率分别为0,10%.结论:柴芍承气汤加味银杏叶对SAP肺损伤有防治作用,抑制PAF,TNF-α,IL-1等炎症介质可能是该汤剂防治肺损伤的重要机制.     

家兔面神经机械性定量压迫损伤模型的建立

临床上面神经的损伤程度与预后直接相关，然而在实际工作中我们只能通过面神经电图（electro-neurogram，ENoG）等检查手段推测受损神经纤维数量，很难获得面神经的组织病理学观察结果，也无法判断髓鞘、轴突和柬膜等组织结构的损伤情况。因此有必要建立一种依据Sunderland组织病理学分级的动物模型，为将来能够把面神经的病理损伤情况与面神经电图等客观检查结果关联起来提供参考。我们于2006年7月至11月利用一种新型的压迫工具，对家兔面神经逐步施加可客观控制的挤压，将面神经所受的压力和时间精确量化，建立机械性定量压迫损伤模型。[第一段]     

海洛因依赖者人格特征分析及与首次吸毒年龄的关系

目的分析海洛因依赖者与正常人群的人格特征的不同特点,探讨人格特征与首次吸毒年龄的关系。方法采用气质性格问卷(Temperament and character inventory,TCl)分别对100例海洛因依赖者与88例正常对照者进行人格评定,比较TCI不同维度分在海洛因依赖组和正常对照组之间的差异,并分析首次吸毒年龄与TCI维度分的相关性。结果1)与正常对照组相比,海洛因依赖组的NS和HA得分高于对照组(P<0.05),而海洛因依赖组CO、SD维度得分均数低于对照组(P<0.01)。2)海洛因依赖者的TCI问卷不同维度的得分与首吸年龄无相关性(P>0.05)。结论1)寻求刺激、放荡不羁、冲动、探索、看事情悲观、害怕不确定、易疲劳等是海洛因依赖的易感人格特征,应对这部分人群进行早期干预。2)首次吸毒年龄与TCI的不同人格维度之间无相关性。     

Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw

Background

Iliac screw loosening has been a clinical problem in the lumbo-pelvic reconstruction. Although iliac screws are commonly inserted into either upper or lower iliac column, the biomechanical effects of the two fixations and their revision techniques with bone cement remain undetermined. The purpose of this study was to compare the anchoring strengths of the upper and lower iliac screws with and without cement augmentation.

Methods

5 pairs of formalin fixed cadaveric ilia with the bone mineral density values ranged from 0.82 to 0.97 g/cm² were adopted in this study. Using screws with 70-mm length and 7.5-mm diameter, 2 conventional iliac screw fixations and their revision techniques with cement augmentation were sequentially established and tested on the same ilium as follows: upper screw, upper cement screw, lower screw, and lower cement screw. Following 2000 cyclic compressive loading of − 300 N to −100 N to the screw on a material testing machine, the maximum pull-out strengths were measured and analyzed.

Findings

The average pull-out strengths of upper, upper cement, lower, and lower cement screws were 964 N, 1462 N, 1537 N, and 1964 N, respectively. The lower screw showed significantly higher pull-out strength than the upper one (P = 0.008). The cement augmentation notably increased the pull-out strengths of both upper and lower screws. The positive correlation between pull-out strength and bone mineral density value was obtained for the 4 fixations.

Interpretation

The lower iliac screw technique should be the preferred choice in lumbo-pelvic stabilization surgery; cement augmentation may serve as a useful salvage technique for iliac screw loosening; preoperative evaluation of bone quality is crucial for predicting fixation strength of iliac screw.     

The Role of Vitamin D in Blood Pressure,Endothelial and Renal Function in Postmenopausal Women

Background: Vitamin D is a pro-hormone that plays an essential role in the vasculature and in kidney function. Aims: To review the extra-skeletal effects of vitamin D on blood pressure, endothelial and renal function with emphasis on recent findings in postmenopausal women. Methods: Included in this review was a PubMed database search for English language articles through March 2013. This review discussed the physiology and definition of vitamin D deficiency, the recent evidence for the role vitamin D in blood pressure, vascular and renal function. Results: Experimental and epidemiological data suggest that vitamin D plays an important role in the vasculature and in kidney function. Low vitamin D concentrations appear to significantly associate with hypertension, endothelial and renal dysfunction. However, the results of clinical trials have generally been mixed. Studies specifically conducted among postmenopausal women are limited and findings are still inconsistent. Conclusions: Definitive studies are warranted to elucidate the effects of vitamin D supplementation on vascular and renal function and a more detailed work is needed to outline the route, duration and optimal dose of supplementation. It is premature to recommend vitamin D as a therapeutic option in the improvement of vascular and renal function at the current stage.     

长江南京段江滩鼠类日本血吸虫感染调查

目的了解鼠类在南京市阳性钉螺形成中的作用。方法用鼠夹法和鼠笼法捕获老鼠，调查南京市部分江滩的鼠类分布和鼠密度，对捕获鼠进行分类并解剖观察血吸虫感染情况。结果共放置鼠夹和鼠笼3865个，捕获鼠类8只，其中黑线姬鼠3只，沟鼠5只。经解剖均未发现有血吸虫寄生。结论鼠类在南京市阳性钉螺形成中的作用较小。     

表面处理对义齿基托修理弯曲强度的影响

目的：观察义齿基托树脂断面丙酮化学处理对树脂粘接修理后的弯曲强度的影响。方法：制作４８个６５ｍｍ×１０ｍｍ×２.５ｍｍＰＭＭＡ热凝树脂试样,进行上三点弯曲试验,将压断后的试样随机分为６组,断面经常规预备后采用三种表面处理 方法：无处理、ＭＭＡ单体涂刷３０ｓ、丙酮涂刷３０ｓ,分别用自凝和热凝树脂修理,然后在材料试验机上测定其弯曲强度。结果：丙酮处理热凝树脂修理组和自凝树脂修理组的弯曲强度高于同种树脂修理的无处理组和ＭＭＡ处理组（Ｐ＜０．０１）,丙酮处理热凝树脂修理组的弯曲强度最高,其强度恢复率为达９４．１４％;自凝和热凝树脂修理其弯曲强度无处理组和ＭＭＡ处理组无显著性差别（Ｐ＞０．０５）,其强度恢复率为原来的５０％～６０％。结论：丙酮化学处理树脂断面可提高义齿基托修理后的抗弯强度。     

一期经皮穿刺单个球囊多次扩张经皮椎体后凸成形术

目的探讨一期经皮穿刺单个球囊多次扩张经皮椎体后凸成形术（PKP）治疗骨质疏松性脊柱压缩骨折和椎体肿瘤的疗效和安全性。方法采用单个球囊一期多次扩张行PKP治疗多发性疼痛性椎体病变18例45椎,年龄平均68．77岁。其中骨质疏松性脊柱压缩骨折11例29椎,椎体转移肿瘤2例4椎,多发性骨髓瘤5例12椎。监测术中患者生命体征,分析患者术后疼痛缓解、日常生活功能恢复情况以及对手术满意程度等。比较手术前后椎体高度和后凸角（Cobb角）。结果患者均安全完成手术。手术时间55～127min,平均29．3min／椎。术中球囊扩张的压力为87～210Psi,平均为165Psi;扩张体积为1．5～4ml,平均3．25ml;扩张次数为2～5次,平均2．94次,1例球囊在第5次扩张时破裂,1例球囊在第3次扩张时破裂。骨水泥注射量为2～8．5ml,平均3．95ml／椎。1例1椎出现椎管内少量渗漏,1例2椎出现椎旁渗漏,均无症状。患者VAS由术前（8．00±0．97）分降低到术后的（3．28±0．75）分;ODI评分由术前平均的72．8％降低到29．5％。椎体前缘高度和中线高度明显恢复,Cobb角改善。术后随访6～18个月,平均12．3个月,受防患者的疼痛缓解效果均得到稳定的维持,日常生活能力改善,未见手术椎体再塌陷或手术临近椎体骨折发生。结论一期经皮穿刺单个球囊多次扩张经皮椎体后凸成形术治疗多发性骨质疏松性脊柱压缩骨折和多发性椎体肿瘤的经济、安全、有效。     

Pedunculated rectal carcinoid removed by endoscopic mucosal resection： A case report

Carcinoid tumors generally appear as yellow/gray or tan submucosal nodules. We experienced a case of pedunculated rectal carcinoid showing a mushroom-like appearance. The case was a forty years old woman who was admitted to our hospital due to rectal bleeding. Colonoscopy revealed a pedunculated polyp presenting a mushroom-shaped appearance measuring 13 mm in diameter in the rectum. The histological diagnosis of specimens obtained by biopsy was adenocarcinoma and transanal ultrasonography revealed the tumor localization within the submucosal layer in the rectum. Endoscopic mucosal resection (EMR) was performed. Histopathological examination established the diagnosis of carcinoid tumor in the rectum. Frequencies of the pedunculated type in rectal carcinoids were reported to be 2.4% to 7.1% in the literature. Because of its rarity, pedunculated configuration may confuse the endoscopic diagnosis of carcinoids. Treatment for carcinoids of 1 to 1.5 cm in size remains controversial. Although such tumors are technically respectable by EMR, careful attention must be paid in dealing with these tumors because there may be unexpected behaviors of the tumors.     

Biomechanical effects of the extent of sacrectomy on the stability of lumbo-iliac reconstruction using iliac screw techniques: What level of sacrectomy requires the bilateral dual iliac screw technique?

Background

Although both single and dual iliac screw techniques are used in spino-pelvic reconstruction following sacrectomy for treating sacral tumors, the basis for choosing between the two techniques for different instability types remains undetermined. The purpose of this study was to evaluate the effects of the extent of sacrectomy on the stability of the lumbo-iliac fixation construct using single and dual iliac screw techniques.

Methods

Nine human L2-pelvic specimens were tested for their intact condition simulated by L3–L5 pedicle screw fixation. Sequential partial sacrectomies and L3-iliac fixation using bilateral single and dual iliac screws were conducted on the same specimens as follows: under-S1 sacrectomy + single screw, under-½S1 sacrectomy + single screw, one-side sacroiliac joint resection + single screw, total sacrectomy + single screw, and total sacrectomy + dual screw. Biomechanical testing was performed on a material testing machine for evaluating the stiffness of the L3-iliac fixation construct in compression and torsion.

Findings

Single iliac screw technique was found to effectively restore the local stability in under-½S1 sacrectomy. However, it could not provide adequate stability for further resection of one-side sacroiliac joint in torsion and total sacrectomy in compression (P < 0.05). On the other hand, dual iliac screw technique could restore the stability to the intact condition after total sacrectomy in both compression and torsion.

Interpretation

The single iliac screw technique for L3-iliac fixation could effectively restore the local stability for under-½S1 sacrectomy. However, for instabilities of the under-½S1 sacrectomy with one-side sacroiliac joint resection or total sacrectomy, the dual iliac screw technique should be considered.