伴有麻木痛的脊髓损伤幻觉痛与其损伤性质,病程的关系

采用ＭｃＧｉｌｌ疼痛问卷对３８例脊髓伤（ＳＣＩ）带有麻木痛的幻觉患者进行了观察，结果发现：痛感觉成分、痛情绪成分、疼冯总分及痛强度的评分趋势为完全性ＳＣＩ〉不恶性循环 ＳＣＩ；痛感觉成分、疼痛测定指数总分、选词个数及痛强度的主分趋２ 性ＳＣＩ〉陈旧性ＳＣ〈而痛情绪成分为近发性ＳＣＩ〈陈旧性ＳＣＩ。提出麻木痛有可能是一种特征性的中枢性疼痛，陈旧性安全ＳＣＩ的有麻木痛觉与痛情绪成分的关系可能较为密切     

Congenital aortic stenosis secondary to dysplasia of congenital bicuspid aortic valves without commissural fusion

The hearts of nine children with clinical evidence of congenital valve stenosis and a congenital bicuspid aortic valve were reviewed. Aortic stenosis was diagnosed on the basis of cardiac catheterization data in four patients, operative findings in two and auscultatory findings in three. The patients were 1 month to 9 years old; six were male and three female. In each patient the two commissures of the valve were free to the aortic wall. The cusps were thickened, rolled and redundant; microscopic studies revealed that they consisted of Immature loose connective tissue consistent with a dysplastic or incompletely differentiated valve. The valve orifice was obstructed by the dysplastic cusps, and dysplastic changes rather than the commlssural fusion were responsible for the observed aortic stenosis. These valves do not appear amenable to valvotomy because obstruction Is due to the abnormal valve tissue. These findings may explain the occasional poor results of valvotomy in Infants and children with congenital aortic valve stenosis.     

Photodynamic therapy during second surgery for recurrent gliomas improves survival

BackgroundGlioma accounts for most central nervous system tumors, and the degree of invasion and malignancy are higher in the recurrent glioma. Photodynamic therapy (PDT) is an effective strategy in glioma. This study aimed to explore the risk factors for re-recurrence after a second glioma surgery and the effects of PDT on re-recurrence.MethodsThis was a retrospective study in the Second Affiliated Hospital of Harbin Medical University in China, and 43 patients that received the secondary surgery for recurrent glioma were included. The Kaplan-Meier test and Cox proportional hazard method were used to analyze.ResultsThe total re-recurrence rate after the second surgery for recurrent glioma was 48.84%. When the age increased by 1, the risk of re-recurrence increased 1.065 times (95% CI 1.000–1.134, P = 0.049). High matrix metalloproteinase (MMP) 2 expression was associated with a significantly higher risk of re-recurrence than low MMP2 expression (HR = 25.550, 95% CI 3.190–204.650, P = 0.002). Pathological grades IV and III were associated with a significantly higher risk of re-recurrence than pathological grade II (HR = 17.121, 95% CI 2.345–124.986, P = 0.005; HR = 2863.470, 95% CI 100.697–81,427.197, P < 0.001). PDT decreased the risk of re-recurrence (HR = 25.550, 95% CI 3.190–204.650, P = 0.002) and increased survival time (HR = 3.611, 95% CI 1.012–12.888, P = 0.048).ConclusionThe age, MMP2 expression, and pathological grade are independent risk factors for re-recurrence after a second surgery for recurrent glioma. PDT during the second surgery decreased the risk of re-recurrence and increased survival time.     

三七叶中低糖链皂苷的分离与鉴定

三七叶总苷经硅胶柱层析及反相RP-18柱层析分得6个低糖链皂苷成分,光谱分析及与标准品对照鉴定它们的结构分别为20(R)-人参皂苷-Rh_2、20(R)-人参皂苷-Rg_3、人参皂苷-Mc、人参皂苷-F_1、人参皂苷-rRh_1和胡萝卜苷。     

Molecular and functional basis of phenotypic convergence in white lizards at White Sands

There are many striking examples of phenotypic convergence in nature, in some cases associated with changes in the same genes. But even mutations in the same gene may have different biochemical properties and thus different evolutionary consequences. Here we dissect the molecular mechanism of convergent evolution in three lizard species with blanched coloration on the gypsum dunes of White Sands, New Mexico. These White Sands forms have rapidly evolved cryptic coloration in the last few thousand years, presumably to avoid predation. We use cell-based assays to demonstrate that independent mutations in the same gene underlie the convergent blanched phenotypes in two of the three species. Although the same gene contributes to light phenotypes in these White Sands populations, the specific molecular mechanisms leading to reduced melanin production are different. In one case, mutations affect receptor signaling and in the other, the ability of the receptor to integrate into the melanocyte membrane. These functional differences have important ramifications at the organismal level. Derived alleles in the two species show opposite dominance patterns, which in turn affect their visibility to selection and the spatial distribution of alleles across habitats. Our results demonstrate that even when the same gene is responsible for phenotypic convergence, differences in molecular mechanism can have dramatic consequences on trait expression and ultimately the adaptive trajectory.     

CT guided appendicectomy incision: A prospective case series

ObjectiveSeveral radiological studies have suggested that the base of the Appendix often does not correspond with Mc Burney’s point. The aim of our study is to assess the value of using CT localization of the appendicocaecal junction to guide placement of the appendicectomy incision.Design & Method32 consecutive patients, booked for open appendicectomy were prospectively included in this study. Coronal and axial CT scans with IV contrast were studied to assess site of the appendicocaecal junction. This information was used to guide placement of the incision.Results28 out of 32 patients studied, the appendicocaecal junctions were accurately identified. It was noted that the final incision sites were cephalad to Mc Burney's point in 8, at the point in 3 and caudal in 17. In 1 patient, it was necessary to extend the incision medially by 2 cm to retrieve the distal Appendix which had been detached through the site of rupture.ConclusionMc Burney’s point often does not correspond to the base of the appendix. We propose that using CT imaging to guide the appendicectomy incision is safe, facilitates locating the Appendix at surgery, minimizes incision size and decreases the need to extend it.     

Shikani可视喉镜与Mc Coy喉镜对气管插管应激反应影响的比较

目的探讨全身麻醉诱导后采用Shikani可视喉镜(SOS)和Mc Coy喉镜(MCL)进行气管插管时的应激反应。方法选择择期手术的患者191例,ASAⅠ或Ⅱ级,随机分为SOS组(S组,n=99)和MCL组(M组,n=92),每组中按声门暴露程度各分为三个亚组:S1组(n=34)、S2组(n=33)、S3组(n=32)和M1组(n=30)、M2组(n=30)、M3组(n=32)。静脉麻醉诱导后分别采用SOS(S组)和MCL(M组)实施经口气管插管操作。记录气管插管时间和麻醉诱导前(T0)、麻醉诱导后(T1)、插管后1min(T2)、3min(T3)、5min(T4)时的SBP、DBP、HR和Narcotrend指数(NI),记录插管过程中芬太尼用量,并于T0、T2、T4时检测血糖。结果 M3组芬太尼用量明显多于S3组(P0.05)。M2组1次插管成功率明显低于S2组,M3组1次插管成功率明显低于S3组(P0.05);T2、T4时M3组血糖明显高于T0时和S3组(P0.05)。T2~T4时M3组SBP、DBP明显高于,HR明显快于S3组(P0.05)。结论气管插管导致不同程度的应激反应,与MCL比较,SOS能有效减轻应激反应的程度,缩短插管时间,尤其在困难插管方面具有明显优势。     

Nuclear organization of cholinergic,catecholaminergic, serotonergic and orexinergic systems in the brain of the Tasmanian devil (Sarcophilus harrisii)

This study investigated the nuclear organization of four immunohistochemically identifiable neural systems (cholinergic, catecholaminergic, serotonergic and orexinergic) within the brains of three male Tasmanian devils (Sarcophilus harrisii), which had a mean brain mass of 11.6 g. We found that the nuclei generally observed for these systems in other mammalian brains were present in the brain of the Tasmanian devil. Despite this, specific differences in the nuclear organization of the cholinergic, catecholaminergic and serotonergic systems appear to carry a phylogenetic signal. In the cholinergic system, only the dorsal hypothalamic cholinergic nucleus could be observed, while an extra dorsal subdivision of the laterodorsal tegmental nucleus and cholinergic neurons within the gelatinous layer of the caudal spinal trigeminal nucleus were observed. Within the catecholaminergic system the A4 nucleus of the locus coeruleus complex was absent, as was the caudal ventrolateral serotonergic group of the serotonergic system. The organization of the orexinergic system was similar to that seen in many mammals previously studied. Overall, while showing strong similarities to the organization of these systems in other mammals, the specific differences observed in the Tasmanian devil reveal either order specific, or class specific, features of these systems. Further studies will reveal the extent of change in the nuclear organization of these systems in marsupials and how these potential changes may affect functionality.     

翼状胬肉的不同术式对创面上皮修复及复发率的影响

目的 :比较不同手术方法治疗原发性翼状胬肉对角膜创面上皮修复及其复发率的影响。方法 :对 78例 (82眼 )原发性翼状胬肉分别行显微切除联合角膜缘上皮移植术 (2 6例 2 8眼 )、羊膜移植术 (2 4例 2 6眼 ) ,和肉眼直视下的翼状胬肉结膜下转位移植术 (McReynoldtransplantation) (2 8例 ,2 8眼 )。术后用 1%荧光素钠染色法 ,观察角膜创面上皮修复速度 ,并随访 6～ 12个月 ,平均 8 5个月。结果 :显微切除联合角膜缘上皮移植、羊膜移植和肉眼直视下的结膜下转位移植术后 ,角膜创面平均上皮修复时间分别为 6 2 5、7 73和 8 5 0天 ,前者分别与后二者比较 ,差异有显著性 (P <0 0 5和 0 0 1)。随访观察 ,羊膜移植组和结膜下转位移植组分别有 2眼 (7 7% )和 5眼 (17 9% ) ,术后 2周角膜创面仍未完全上皮化 ,最后导致复发 ,而角膜缘上皮移植组无 1眼复发。结论 :显微切除联合角膜缘上皮移植或羊膜移植术治疗原发性翼状胬肉 ,可以显著促进角膜创面上皮修复 ,提高治疗效果 ,降低复发率 ,尤其以角膜缘上皮移植术疗效更佳。