甲状旁腺激素对大鼠牵张成骨过程中O NC、OPN、C-FOS、COL1、VEGF、RUNX2、ALP基因表达的影响

目的：探讨甲状旁腺激素（PTH）对大鼠牵张成骨（DO）过程中ONC、OPN、C-FOS、COL1、VEGF、RUNX2、ALP基因表达的影响。方法30只雄性大鼠制备大鼠下颌骨DO模型。随机分5组，每组6只。第1组（只有牵张无PTH），术后8周取材，应用HE染色及微CT检测，以确定成骨情况。第2组（有牵张无PTH），第3组（有牵张有PTH），第4组（无牵张有PTH），第5组（对照组：无牵张无PTH）。2、3、4组及对照组术后1周取材，RT-PCR测定ONC、OPN、C-FOS、COL1、VEGF、RUNX2、ALP基因的表达。结果第1组，新骨形成，骨质充满牵张区，骨质连续，大鼠建模成功。RT-PCR检测结果显示，2、3、4组与对照组比较，OPN、COL1、RUNX2、ALP基因表达有明显提高（P＜0．05），其中第3组最为明显。ONC、C-FOS、VEGF基因2、3、4组与对照组比较差异无统计学意义（P＞0．05）。结论 PTH在 DO 过程中，间歇性给以 PTH的作用只有在牵张期发挥作用，其对 OPN、COL1、RUNX2、ALP基因表达能够获得理想的协同作用。     

牵张力对体外培养兔鼻软骨细胞影响的实验研究

目的：探讨牵张力对体外培养的不同年龄兔鼻软骨细胞增殖活性的影响及牵张力大小与兔鼻软骨细胞增殖活性改变的量效关系。方法：将第4代体外培养的新生及6周龄新西兰白兔兔鼻软骨细胞置于细胞膜式牵张力施加装置上培养，流式细胞仪检测不同的牵张力(5kPa、10kPa)在0-12h内对兔鼻软骨细胞增殖活性的影响。结果：0-10h内5kPa牵张力组软骨细胞增殖指数随着牵张力作用时间的延长不断上升，增殖指数峰值位于10h处；0～8h内10kPa牵张力组软骨细胞增殖指数随着牵张力作用时间的延长不断上升，增殖指数峰值位于8h处；5kPa较10kPa牵张力对体外培养兔鼻软骨细胞具有更大的促增殖作用；牵张力对体外培养的新生兔兔鼻软骨细胞具有更大的促增殖作用。结论：牵张力可促进体外培养的新生及六周龄新西兰白兔兔鼻软骨细胞增殖活性。提示我们鼻软骨牵张方法不仅适用于临床矫治新生儿唇腭裂伴发鼻畸形，而且有可能用于矫治1岁左右婴儿甚至更大年龄患儿的唇腭裂伴发鼻畸形。     

A daily process design study of attentional pain control strategies in the self-management of cancer pain.

This study investigated the use of attentional control strategies in the self-management of pain using daily process design methodology. Twenty six cancer patients with pain completed diaries 3 times daily for 10 days. Diaries incorporated measures of pain intensity, affect, coping, coping efficacy, and the novelty and predictability of pain, and participants completed a cross-sectional measure of catastrophizing. At the across-person level, focusing on pain was associated with increased negative affect, and the use of pain focusing strategies was positively correlated with experiencing pain that was novel in its location or quality. Distractions that were interesting, important and pleasant were positively correlated with positive affect, perceptions of control over pain and ability to decrease pain. Over-prediction of pain was positively correlated with catastrophizing, and negatively correlated with perceptions of control over and ability to decrease pain. The within-person analysis (ARIMA modelling) showed that catastrophizing moderated the effects of pain focusing strategies, novel pain and over-predictions of pain. Meta-analysis of the ARIMA models revealed that the within-person effects of using attentional strategies did not generalize across the sample. These findings indicated that the effects of distraction strategies are influenced by their motivational-affective significance rather than the frequency with which they are used, and provided further evidence that the threat value of pain influences the way in which people cope with their pain. Theoretical and clinical implications are discussed.     

唇腭裂患者上颌骨牵引成骨术后发音方式的变化

目的:通过对行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)唇腭裂患者治疗前后的错误发音数量变化、不同发音部位、不同发音方法以及不同类型错误发音发生特点及其变化评价,分析上颌骨RED对患者发音方式的影响。方法:1999年至2001年行上颌骨RED的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED前后进行语音测听并分类。治疗前后错误发音的差异性用非参数检验。结果:RED术后42.9%患者错误发音数较RED前增加,19.0%减少,38.1%无变化。从发音部位,舌尖前音错误发音发生率最高,其次为舌面音。从发音方法,错误发音多发于塞擦音。错误发音类型以咽喉摩擦/爆破音为主,其次为腭化构音和声门爆破音。上颌骨RED后腭化构音累及音节数减少,但咽喉摩擦/爆破音和声门爆破音反而增加,尤其是咽喉摩擦/爆破音。结论:唇腭裂患者经RED前移上颌骨后,会对患者发音方式产生影响,在行语音治疗前需考虑全面。     

Correction of camptodactyly with an external fixator

Camptodactyly is a flexion deformity of the proximal interphalangeal joint. Because of unsatisfactory results, treatment is not recommended for mild deformities, and in severe deformities surgery has been disappointing. A specially designed external fixator providing gradual distraction was used in a severe case. With this mildly aggressive method, an acceptable result was obtained. Received: 5 June 1997/Accepted: 2 February 1998     

Distraction vs remodeling surgery for craniosynostosis

Objects We designed several distraction devices and applied these instruments in 14 patients with varying types of craniosynostosis. The aim of this report is to clarify the advantages and disadvantages of these surgical methods and to discuss current concepts for the surgical strategy in the treatment of craniosynostosis. Methods From January 2000 to July 2005, 28 patients with craniosynostosis were retrospectively analyzed. Surgical treatment was performed on 14 patients using the distraction method with internal distraction devices that we designed, in which 5 patients had plagiocephaly, 3 brachycephaly, and 6 scaphocephaly. All patients underwent preoperative and postoperative evaluations, which included the patient’s neurological state, and three-dimensional CT. Results With distraction devices, the time required for the surgery could be shortened almost 3 1/3 h; the bleeding during the surgery was decreased with reduced requirement of more than 200 ml of blood transfusion as compared with remodeling surgery. Postoperatively achieved distraction distances varied from 30.0 to 47.5 mm (mean, 42.99 mm). The average increased volume percent of cranium in distraction surgery group was 20.9% (range, −11.5 to 58.9%) after full distraction. Conclusion With distraction surgery, satisfactory cranial volume expansion and aesthetically pleasing morphological states were achieved in all cases, and the efficacy was statistically significantly high as compared with remodeling method.     

撑开式椎板成形术治疗伴有马尾神经损害的腰椎间盘突出症

目的总结分析伴有马尾神经损害的腰椎间盘突出症的临床特点,并对手术方法进行探讨.方法对采用撑开式椎板成形术治疗的26例伴有马尾神经损害的腰椎间盘突出症患者的临床资料进行回顾性分析.结果获得随访资料26例平均随访6年5个月,根据Macnab疗效标准,优17例,良7例,可1例,差1例.优良率92.3%.结论伴有马尾神经损害的腰椎间盘突出症的临床症状重,手术治疗需要彻底减压方能取得优良效果.采用撑开式椎板成形术显露,除具有全椎板切除的优点,还不破坏腰椎后柱的稳定性,最大限度地保留了脊柱的完整性,减小了手术创伤,是行之有效的手术方法.