神经生长因子基因转染联合强化铁营养防治豚鼠爆震性聋的实验研究

Objective To study the protective effects of adenovirus-mediated human beta-nerve growth factor gene (hNGFβ) transfer combined with iron fortified nutrition on blast hearing damage in guinea pigs. Methods Deafness was induced by blast (172dB SPL) in 35 healthy guinea pigs. Seven days after noise exposure, 10 guinea pigs were inoculated with adenovirus-mediated hNGFβ (Ad-hNGFβ) into the perilymphatic space (the gene group), another 10 guinea pigs were given hNGFβ combined with iron fortified nutritional diet (the combination group), still another 10 guinea pigs were inoculated with artificial perilymphatic fluid (APF), and 5 guinea pigs served as control, given neither medicine nor noise exposure. Auditory brainstem response (ABR) threshold shifts were monitored in the guinea pigs before blast exposure and after gene transfer. Changes in cochlear morphology were examined with immunohistochemical and HE staining. Results One week after successful inoculation of hNGFβ, it was noted that Ad-hNGFβ protein was expressed in each turn of the cochlea, and its intensity was almost equal. After gene transfer in the combination group and the gene group, ABR threshold shifts at week 1 and 4 were significantly smaller than those of the APF group. HE staining showed that the number of the spiral ganglion cells in the combination group and the Ad-hNGFβ group was significantly higher than that of the control group after 4 weeks (P<0.01). Conclusions Ad-hNGFβ combined with iron fortified nutritional diet was effective in the prevention and treatment of blast hearing damage of cochlear hair cells.     

慢性骨髓炎病灶清除术后冲洗疗法的护理

目的 探讨慢性骨髓炎病灶清除术后冲洗疗法的护理方法及应用.方法 对我院23例慢性骨髓炎病人行有效护理.结果 23例患者获得优良疗效,未出现并发症.结论 有效的护理可防止并发症的发生,促进健康.     

探讨腹腔镜联合胆道镜治疗胆结石合并肝外胆管结石效果及对免疫功能的影响

目的探讨腹腔镜联合胆道镜治疗胆结石合并肝外胆管结石的效果及对免疫功能的影响。方法回顾性分析2018年8月至2020年8月长治市第三人民医院普外科收治的105例胆结石合并肝外胆管结石患者的临床资料,男55例,女50例,年龄(60.25±2.65)岁,年龄范围为53~72岁。按照不同手术方法分为传统组(n=58)与双镜组(n=47),传统组给予传统开腹结石切除术治疗,双镜组给予腹腔镜联合胆道镜结石切除术治疗,比较两组患者的围术期指标、术前与术后免疫功能指标及术后并发症发生率。结果双镜组患者术中出血量[(43.58±5.17)ml]、手术时间[(104.22±16.50)min]、术后排气时间[(26.44±8.21)h]、切口长度[(2.45±1.04)cm]、术后住院时间[(6.54±1.46)d]均少于传统组[(71.02±6.14)ml、(128.75±20.57)min、(35.10±6.58)h、(9.26±1.58)cm、(11.56±1.82)d],差异有统计学意义(P<0.05)。传统组患者术后1 d的表面抗原分化簇4(CD4⁺)为[(30.15±1.08)%]、表面抗原分化簇8(CD8⁺)为[(24.54±1.60)%]、免疫球蛋白G(IgG)为[(10.28±1.63)g/L]、免疫球蛋白A(IgA)为[(2 556.43±62.89)mg/L]、免疫球蛋白M(IgM)为[(1 510.56±114.35)mg/L]水平均低于术前1 d[(35.62±1.17)%、(25.75±1.32)%、(11.59±1.62)g/L、(2 762.58±60.85)mg/L、(1 574.25±121.58)mg/L],差异有统计学意义(P<0.05)。双镜组患者术后1 d的CD4⁺[(30.24±1.17)%]、CD8⁺[(24.47±1.57)%]、IgG[(10.35±1.59)g/L]、IgA[(2 571.02±60.55)mg/L]及IgM[(1 507.74±109.88)mg/L]水平均低于术前1 d[(35.68±1.09)%、(25.64±1.26)%、(11.63±1.54)g/L、(2 751.42±61.74)mg/L、(1 580.96±115.47)mg/L],差异有统计学意义(P<0.05)。两组患者术后1 d的CD4⁺、CD8⁺、IgG、IgA及IgM水平比较,差异无统计学意义(P>0.05)。双镜组患者术后并发症发生率与传统组比较,差异无统计学意义(P>0.05)。结论腹腔镜联合胆道镜治疗胆结石合并肝外胆管结石的围术期指标更好,不会对免疫功能指标造成较大的影响,术后未增加并发症发生率,安全性较高。     

应用丙泊酚作替代的Wada试验临床分析

目的 探讨丙泊酚可否替代异戊巴比妥钠进行Wada试验,达到确定语言和记忆优势半球效果.方法 回顾性分析河北省人民医院功能神经外科42例以丙泊酚作替代的Wada试验,总结其成功率及安全性,分析其测定语言及记忆优势半球的有效性.记录患者从肌力消失到肌力恢复到3级(T3/5)和5级(Ts/s)的时间、在注药后出现言语功能障碍的时间(Tverb)和从注药至语言停止的时间(Tnverb),并根据患者性别、患侧或健侧、左右侧、语言及记忆优势半球或非优势半球进行对比分析.结果 42例(80侧)进行Wada试验,单侧丙泊酚的用量为7～24(13.8±3.6)mg.顺利完成38例,成功率为90.5％.在成功完成的38例76侧中,有11侧测试时患者出现了不同程度的不良反应,不良反应发生率为14.5％;37例确定语言优势半球,有效率为97.4％;27例确定记忆优势半球,有效率为71.1％.Tverb、Tnverb在左右侧、语言优势半球及非优势半球,记忆优势半球及非优势半球的差异均有统计学意义(P＜0.05).结论 应用丙泊酚进行Wada试验是相对安全、有效的,基本可以替代异戊巴比妥钠以达到确定语言和记忆优势半球效果.     

颅内胶质瘤继发癫痫患者的脑电图临床分析

目的探讨颅内胶质瘤继发癫痫患者脑电图(EEG)临床特征。方法对2010年4月—2014年6月我院收治的以继发癫痫发作为首发症状的51例胶质瘤的临床资料及24 h动态脑电图(24 h EEG)检查结果进行回顾性分析。结果本组头颅CT和(或)MRI检查示病灶位于额叶12例;颞叶26例,其中位于颞叶新皮层10例,前内侧颞叶7例,后内侧颞叶及颞-枕交界区5例,颞叶内外侧4例;顶叶9例;枕叶4例。24 h EEG检查正常13例,异常38例,其中轻度异常23例,中度异常11例,重度异常4例。术后病理检查示星形细胞瘤19例(Ⅱ级),少突-星形细胞瘤14例(Ⅱ级),神经节胶质细胞瘤9例(Ⅰ级),少突-胶质细胞瘤7例(Ⅱ级),室管膜瘤2例(Ⅱ级)。本组术后平均随访7.4个月。33例术后无明显癫痫发作,18例术后仍有癫痫发作。结论 EEG改变及影像学检查可帮助颅内胶质瘤的诊断与定位,手术是治疗颅内胶质瘤继发癫痫的重要措施。     

不同病理亚型FCD颞叶癫痫患者手术效果及预后比较

目的 比较不同病理亚型的颞叶局灶性皮层发育不良（FCD）颞叶癫痫患者的手术效果及预后.方法 对收治的68例行颞叶癫痫手术的FCD患者的临床资料进行回顾性分析,按照2011年国际抗癫痫联盟（ILAE）分型标准进行病理分型,参照Engel标准分级比较单纯型及结合型FCD的手术疗效.结果 病理结果示单纯型FCD24例,结合型FCD 44例.68例患者随访1～4年,按Engel标准评定,手术效果良好（Engel Ⅰ＋Ⅱ级）为53例,其中单纯型FCD 17例（70.8％）,结合型FCD 36例（81.8％）;手术效果不佳（EngelⅢ＋Ⅳ级）15例,其中单纯型FCD7例（29.2％）,结合型FCD 8例（19.2％）,单纯型FCD的手术效果良好率低于结合型FCD,结合型FCD的预后好于单纯型FCD.结论 按照2011年ILAE分型方法,结合型FCD的手术效果和预后优于单纯型FCD.     

蛛网膜下腔出血后迟发性脑血管痉挛的发病机制及治疗

蛛网膜下腔出血(SAH)是常见的脑血管意外,发病率高,可分为自发性蛛网膜下腔出血和外伤性蛛网膜下腔出血.自发性蛛网膜下腔出血多由于动脉瘤破裂造成的,可导致多种并发症,脑血管痉挛(CVS)是其最严重的并发症.蛛网膜下腔出血后脑血管痉挛是颅底动脉的一支或多支血管平滑肌的持续收缩,或血管损伤引起管腔形态学的变化,在动脉造影时表现出血管管腔狭窄,发生率高达30%～90%.早发性CVS出现于出血后,历时数分钟至数小时缓解,目前认为是SAH后流入脑脊液中的血液对脑血管的机械性刺激所致.暂时性或早发性CVS对脑血管功能影响不大.迟发性CVS发生于出血后4～15 d,7～10 d为高峰期,常引起严重的局部脑组织缺血或迟发性缺血性损伤,甚至导致脑梗死,成为致死和重残的主要原因.近年来随着发病机制研究的不断深入,治疗的种类和方法均有新的进展.     

神经生长因子基因转染联合强化铁营养防治豚鼠爆震性聋的实验研究

Objective To study the protective effects of adenovirus-mediated human beta-nerve growth factor gene (hNGFβ) transfer combined with iron fortified nutrition on blast hearing damage in guinea pigs. Methods Deafness was induced by blast (172dB SPL) in 35 healthy guinea pigs. Seven days after noise exposure, 10 guinea pigs were inoculated with adenovirus-mediated hNGFβ (Ad-hNGFβ) into the perilymphatic space (the gene group), another 10 guinea pigs were given hNGFβ combined with iron fortified nutritional diet (the combination group), still another 10 guinea pigs were inoculated with artificial perilymphatic fluid (APF), and 5 guinea pigs served as control, given neither medicine nor noise exposure. Auditory brainstem response (ABR) threshold shifts were monitored in the guinea pigs before blast exposure and after gene transfer. Changes in cochlear morphology were examined with immunohistochemical and HE staining. Results One week after successful inoculation of hNGFβ, it was noted that Ad-hNGFβ protein was expressed in each turn of the cochlea, and its intensity was almost equal. After gene transfer in the combination group and the gene group, ABR threshold shifts at week 1 and 4 were significantly smaller than those of the APF group. HE staining showed that the number of the spiral ganglion cells in the combination group and the Ad-hNGFβ group was significantly higher than that of the control group after 4 weeks (P<0.01). Conclusions Ad-hNGFβ combined with iron fortified nutritional diet was effective in the prevention and treatment of blast hearing damage of cochlear hair cells.     

青春期人类免疫缺陷病毒患者窗口期经输血传播给两例受血者

美国在对献血者进行病毒核酸检测（NAT）前，估计重复献血者通过输血传播艾滋病毒（HIV）的几率为1／4．5万～1／6．6万。采用NAT后，风险估计为1／213．5万；初次献血者传播HIV的风险为1／120万到1／180万。从1999年3月起，献血者除按标准检测HIV-1／2EIA和P24抗原外，还做NAT检查。NAT进一步缩短了HIV感染后的窗口期。虽然在献血人群中的HIV检测已经有了很大的进步，输血传播HIV的危险已经很小了，但风险终究不是零。对于HIV的传播，公共卫生机构必须进行有效和系统性调查以确定预防失误和紧急的流行趋势，并立即干预。本文报道2例经输血感染HIV，