阿奇霉素治疗脑梗死后不明原因长期发热的研究

目的研究阿奇霉素对脑梗死后不明原因长期发热的疗效。方法用免疫荧光法测定不明原因长期发热脑梗死患者112例的血清抗肺炎衣原体抗体,患者随机分为2组并分别给予阿奇霉素和新青霉素加入生理盐水中静脉滴注10d,每日观察比较2组患者的病情。结果所有病例抗肺炎衣原体IgM抗体滴度均≥1∶16;阿奇霉素组显效率为92.86%,高于新青霉素组的44.64%,差异有统计学意义(P<0.01)。结论长期发热的脑梗死患者肺炎衣原体的感染率高,用阿奇霉素治疗效果好。     

外伤性结肠破裂53例分析

目的,探讨外伤性结肠破裂的诊断及治疗方法.方法:分析53例外伤性结肠破裂病例诊断方法及治疗效果.结果:早期诊断及时正确治疗明显提高患者的治愈丰,减少并发症的发生.结论:早期诊断,及时手术是治疗成功的关键.     

超声引导下犬肝注射醋酸高渗氯化钠混合液对射频消融毁损体积的影响

目的探讨超声引导下活体犬肝注射不同剂量的醋酸高渗氯化钠液(acetic acid hypertonic saline solution,AHS)后行射频消融(RFA),观察犬肝一次性毁损体积的变化。方法使用LDRF-120S多极RFA系统联合AHS对活体犬肝行RFA。健康成年杂种犬30只,随机分为5组(n=6)。A组:注射2ml AHS后立即行RFA;B组:注射2ml AHS后延时5min行RFA;C组:注射4ml AHS后立即行RFA;D组:注射4ml AHS后延时5min行RFA;E组:注射6ml AHS后立即行RFA。结果5组间平均起始阻抗差异无统计学意义(P>0.05);5组间平均消融时间差异有统计学意义(F=83.831,P<0.001),LSD-t检验分析各组间两两比较差异有统计学意义(P<0.001),在观察范围内E组平均消融时间最长;5组间平均毁损直径差异有统计学意义(F=53.488,P<0.001),在观察范围内E组平均毁损直径最大,LSD-t检验分析除D与E组间差异无统计学意义(P>0.05)外,其余各组间两两比较差异有统计学意义(P<0.001);网状纤维染色显示凝固坏死区及其邻近的正常肝组织均可见血管内血栓形成;E组在AHS注射过程中出现不同程度的外溢;A、B、C及D组14d内无动物死亡,E组死亡4只。结论活体犬肝局部注射AHS4ml后延时5min行RFA即可达到较理想的毁损体积。     

脾切除治疗原发性骨髓纤维化适应证的探讨

目的：探讨脾切除治疗原发性骨髓纤维化的可行性及其效果。方法：回顾性分析我院2000年1月至2006年12月间收治的5例行脾切除治疗原发性骨髓纤维化的病人资料。结果：本组病人均行脾切除术，其中2例加行贲门周围血管离断术．术后发生脾窝积液1例，肺部感染1例。随访3月至5年，病人贫血状况、左上腹疼痛症状均得到缓解．生活质量得到改善。结论：脾切除对有适应证的原发性骨髓纤维化是可行的治疗手段，可明显改善病人的症状，提高生活质量。     

关节镜下治疗胫骨髁间隆起撕脱骨折

1999年7月～2005年7月,我科在关节镜下微创治疗19例胫骨髁间隆起撕脱骨折患者,取得满意的疗效.     

动脉血质子自旋标记与动态磁敏感对比MRI在急性脑缺血患者中的应用价值

目的对比研究动脉血质子自旋标记（ASL）与动态磁敏感对比（DSC）MRI在急性脑缺血诊断中的应用价值。方法27例发病3d内的急性脑卒中患者，均采用3．0TMR行脉冲式ASL和DSCMR检查。观察2种技术的灌注表现，包括灌注不足、正常灌注、延迟灌注、过度灌注等，采用Mann—Whitney检验做定性分析。在扩散加权成像显示的病变部位及对侧正常半球的镜像区域分别确定3个感兴趣区（ROI），测量信号强度并计算信号强度比（病侧／对照侧），并将结果做配对t检验。结果定性分析显示27例患者中，2l例2种技术检查结果一致（灌注不足14例，正常灌注5例，过度灌注2例）。6例2种技术不一致，其中4例ASL显示灌注不足而DSC显示延迟灌注，2例ASL显示正常灌注而DSC显示延迟灌注，两者间差异无统计学意义（P〉0．05）。定量分析示，2种技术的病侧与对照侧信号强度比值ASL为0．7l±0．46，DSC为0．73±0．42，两者间差异无统计学意义（P〉0．05）。结论无创性ASL技术在检测灌注异常时与DSCMRI有相似的敏感性；ASL可与常规MR检查相结合，为临床诊断急性缺血性卒中提供有价值的信息。     

三氧化二砷纳米微粒对抑制兔血管平滑肌细胞增殖作用的实验研究

目的 了解纳米微粒与普通剂型的三氧化二砷（As2O3）对抑制体外培养的兔血管平滑肌细胞（VSMC）增殖作用的差别。方法 对照组为不加药物的细胞，实验组为3μmol／L纳米微粒和普通剂型的As2O3，干预体外培养的兔VSMC细胞72h，进行四唑氮盐（MTT）染色测定细胞吸光度（A）值。用流式细胞仪检测细胞凋亡情况，提取细胞DNA，进行凝胶电泳分析，将3组的结果进行比较。结果 3μmol／L纳米剂型的As2O3，干预细胞，细胞数量随作用时间的延长逐渐减少，细胞生长明显受抑制，而普通剂型干预细胞，生长受抑制程度较纳米剂型弱。24h时，对照组、3μmol／L普通剂型组与纳米组，A值分别为0．68±0．10、0．58±0．12、0．33±0．12，48h时分别为0．79±0．11、0．48±0．14、0．28±0．11，72h时分别为0．96±0．13、0．34±0．15、0．20士0．06，差异均有统计学意义（Ⅳ值分别为10．934、15．039、15．539，P值均〈0．01）。流式细胞仪检测，纳米剂型As2O3、普通剂型As2O3干预及对照组的细胞干预48h，细胞增殖率分别为44．97％、58．54％、74．02％，早期凋亡率分别为16．89％、11．27％、11．20％，晚期凋亡率分别为26．56％、23．60％、12．46％，坏死细胞分别为11．58％、6．59％、2．32％。DNA电泳，As2O3干预细胞，可见凋亡梯形条带，部分细胞坏死，呈模糊的无间隔片状条带。纳米剂型药物作用的细胞DNA条带，梯形条带更多、更模糊。结论 As2O3，可以抑制体外培养的VSMC增殖，且纳米剂型As2O3较普通剂型的As2O3，对细胞抑制作用更强。     

Prospective randomized trial of direct endomyocardial implantation of bone marrow cells for treatment of severe coronary artery diseases (PROTECT-CAD trial).

AIMS: Experimental studies have demonstrated that bone marrow (BM) cells can induce angiogenesis in ischaemic myocardium. Recently, several non-randomized pilot studies have also suggested that direct BM cells implantation appears to be feasible and safe in patients with severe coronary artery diseases (CAD). METHODS AND RESULTS: We performed a randomized, blinded, and placebo-controlled trial in 28 CAD patients. After BM harvesting, we assigned patients to receive low dose (1 x 10(6) cells/0.1 mL, n = 9), high dose (2 x 10(6) cells/0.1 mL, n = 10) autologous BM cells or control (0.1 mL autologous plasma/injection, n = 9) catheter-based direct endomyocardial injection as guided by electromechanical mapping. Our primary endpoint was the increase in exercise treadmill time and our secondary endpoints were changes in Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) class, and myocardial perfusion and left ventricular ejection fraction (LVEF) assessed by single-photon emission computed tomography and magnetic resonance imaging, respectively. A total 422 injections (mean 14.6 +/- 0.7 per patient) were successfully performed at 41 targeted ischaemic regions without any acute complication. Baseline exercise treadmill time was 439 +/- 182 s in controls and 393 +/- 136 s in BM-treated patients, and changed after 6 months to 383 +/- 223s and 464 +/- 196 s [BM treatment effect +0.43 log seconds (+53%), 95% CI 0.11-0.74, P = 0.014]. Compared with placebo injection, BM implantation was associated with a significant increase in LVEF (BM treatment effect +5.4%, 95% CI 0.4-10.3, P = 0.044) and a lower NYHA class (odds ratio for treatment effect 0.12, 95% CI 0.02-0.73, P = 0.021) after 6 months, but CCS reduced similarly in both groups. We observed no acute or long-term complications, including ventricular arrhythmia, myocardial damage, or development of intramyocardial tumour or calcification associated with BM implantation. CONCLUSION: Direct endomyocardial implantation of autologous BM cells significantly improved exercise time, LVEF, and NYHA functional class in patients with severe CAD who failed conventional therapy.     

磷酸钙水泥填充固定桡骨远端骨折的抗旋转生物力学研究

目的对磷酸钙水泥(CPC)填充固定桡骨远端骨折的抗旋转应力进行评价,并与传统的克氏针固定方法进行比较。方法18根人桡骨标本制备桡骨远端骨折伴骨缺损模型,随机分为三组:克氏针固定组、CPC固定组和CPC 克氏针联合固定组。设定扭转速度为5°／min,最大扭转角度为10°时停止。记录扭转刚度、10°内的最大扭矩及所对应的最大扭角。结果在10°的扭转范围内,CPC固定组、CPC 克氏针联合固定组的扭转刚度、最大扭矩均比克氏针固定组大,差异有统计学意义(P< 0．01);最大扭转角度分别为4．3°和5．0°,均比克氏针组(9．6°)小,差异有统计学意义(P<0．01)。CPC固定组与CPC 克氏针联合固定组之间的扭转刚度、最大扭矩及最大扭角差异无统计学意义(P> 0．05)。结论在旋转角度小于4°范围内,CPC的抗旋转固定强度要比克氏针大,超过这个范围,骨水泥就会发生断裂,CPC的有效固定范围比克氏针要小。     

Disappearance of Tophi in Familial Juvenile Hyperuricemic Nephropathy after Kidney Transplantation

A 40-year-old man who had been on hemodialysis for 25 months due to familial juvenile hyperuricemic nephropathy (FJHN) received a kidney transplant. Biopsy of his native kidney had shown tubulo-interstitial nephropathy. Genetic analysis confirmed abnormal uromodulin expression due to a mutation in the exon 4 of the UMOD gene. He had multiple tophi on the day of transplantation, including some on his fingers. He received immunosuppressive treatment including polyclonal antilymphocyte antibodies, mycophenolate mofetil, steroids and cyclosporine and achieved excellent renal function, with serum creatinine at 13 mg/L on day 10 posttransplantation and 9.4 mg/L at 6 months. His uric acid excretion rate increased from 4.4% at day 2 posttransplantation to 7.7% 6 months after transplantation. The number and sizes of the tophi were reduced 3 months posttransplantation, and nearly disappeared at month 6. Serum uric acid level decreased slowly from 650 mumol/L before transplantation to 300 mumol/L. Reduction of tophi was probably due to the absence of the mutated UMOD gene in the transplanted kidney.