经皮椎体后凸骨水泥成形联合^125I放射粒子植入治疗脊柱转移瘤

背景：针对肿瘤破坏导致的椎体骨折,进而引起的神经功能障碍,单纯的放疗作用微小。近年来125I放射粒子已广泛应用于多种原发或继发肿瘤并取得良好效果。经皮球囊扩张椎体后凸成形可效恢复椎体高度,重建脊柱稳定性,缓解疼痛症状。 目的：观察经皮球囊扩张椎体后凸成形骨水泥注入联合125I放射粒子治疗脊柱转移瘤的疗效及安全性。 方法：回顾性分析2011年3月至2012年7月经皮球囊扩张椎体后凸成形注入骨水泥联合125I放射粒子治疗的30例脊柱转移瘤患者,收集患者的症状、体征、影像学资料,治疗前均有顽固性背痛,CT提示有椎体骨质破坏。采用目测类比评分、WHO疼痛缓解标准、功能障碍指数来评估治疗后临床症状转归及神经功能恢复情况,测量病椎高度变化。随访时间为治疗后1 d、1个月及6个月。 结果与结论：30例患者治疗过程顺利,治疗后24 h疼痛缓解,无神经损伤及压迫症状。治疗后目测类比评分、疼痛缓解情况、功能障碍指数、椎体高度均较治疗前显著改善（P 〈 0.05）。治疗后随访1个月及6个月,目测类比评分、功能障碍指数、椎体高度变化与治疗后24 h差异无显著性意义（P 〉 0.05）。骨水泥向椎间隙、前纵韧带下渗漏各2例无临床症状。提示经皮球囊扩张椎体后凸成形骨水泥注入联合125I放射粒子治疗脊柱转移瘤,能迅速缓解肿瘤所致的疼痛,有效恢复病椎高度,并发症少,显著提高患者生活质量。     

不同保存介质对脐带间充质干细胞活性的影响

背景：脐带间充质干细胞的临床应用面临移植前保存的问题,而临床保存介质对移植前细胞活性的影响直接关乎移植后疗效,目前却缺乏对临床介质保存效果的系统性研究。目的：评价临床常用保存介质对脐带间充质干细胞活性的影响。方法：在4℃与室温（25℃）条件下,将脐带间充质干细胞在临床常用保存液（0．9％氯化钠注射液,5％葡萄糖注射液和1％人血白蛋白溶液）中保存2,4,6h,观察上述保存介质对脐带间充质干细胞活性、凋亡,死亡率、多向分化能力及DNA损伤的影响。结果与结论：无论在4℃还是室温条件下,细胞在临床常用保存介质中的活性均在短期内呈时间依赖性下降。此外,不同保存介质引起细胞死亡而非凋亡,且死亡率呈时间依赖性增加;经不同介质保存后,细胞出现DNA损伤,但其增殖与多向分化能力未受明显影响,提示细胞核DNA损伤为细胞活性下降的关键因素。     

卵巢良性囊肿剥除不同术式效果比较及阴式途径的特点分析

目的：比较采用阴式途径、腹腔镜以及腹式不同术式行卵巢囊肿剥除术治疗卵巢良性囊肿的临床效果,总结阴式途径术式的特点。方法2006年1月至2012年12月来我院治疗的卵巢良性囊肿患者226例,其中75例行经阴道手术（阴式组）,77例行腹腔镜下手术（腹腔镜组）,74例行开腹手术（腹式组）。观察比较3组的手术时间、术中出血量、术后镇痛病例、术后排气时间和住院天数,以及术后病率。随访时间为术后1、3个月,进行临床疗效评定。结果术中手术时间和出血量阴式组[（41.71±16.92）min、（33.11±20.19）ml]与腹腔镜组[（50.73±18.71）min、（38.21±18.73）ml]和腹式组[（61.81±19.75）min、（107.29±41.27）ml]相比最少;术后排气时间（12.19±4.17）h 较腹腔镜组（15.43±4.31）h、腹式组（30.00±6.21）h 短;住院时间阴式组[（4.38±1.30）d 较腹腔镜组（5.60±0.50）d、腹式组（8.50±2.00）d]短,差异有统计学意义（P ＜0.05或 P ＜0.01）;术后病率阴式组1.33％、腹腔镜组1.30％较腹式组（4.05％）低,差异有统计学意义（P =0.036）。随访到3个月,3组有效率[阴式组94.7％（71/75）、腹腔镜组94.8％（73/77）、腹式组94.6％（70/74）]比较差异无统计学意义（P ＞0.05）。结论经阴道手术和腹腔镜手术治疗卵巢良性囊肿各有利弊,临床应用要准确掌握手术指征,以最小的创伤达到最佳治疗效果。     

简易日常生活功能训练方案在急性脑梗死偏瘫患者中的初步应用

目的对急性脑梗死偏瘫患者实施简易日常生活功能训练,观察其可行性、被接受度和患者依从性。方法 2015年9月,制定简易日常生活功能训练方案,便利抽样法选择急性期脑梗死偏瘫患者9例为研究对象,采用简易日常生活功能训练方案对其进行8周干预,并在干预前、干预后4周和8周进行功能评价,评价包括美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、患侧握力、"起立-行走"计时测试(timed up and go test,TUGT)和巴氏指数(Barthel index,BI)等。结果简易日常生活功能训练方案的执行过程和评价过程均顺利、安全完成,未出现任何意外、并发症或不良反应。从随访和训练日记中可见9例患者均有非常好的依从性。有3例在干预前握力为0。有4例在干预前测试时无法独自行走,将其结果定义为计时较多的60 s。干预后,患者神经功能缺损好转,上肢握力、动态平衡功能、步行能力和生活自理能力均改善。与干预前比较,在干预后4周和8周患者NIHSS评分、患侧上肢握力、TUGT和MBI均明显好转,差异均有统计学意义(均P0.05)。结论简易日常生活功能训练方案对偏瘫患者切实可行、安全有效,患者接受度和依从性高。     

Recombinant 56-kilodalton major outer membrane protein antigen of Orientia tsutsugamushi Shanxi and its antigenicity

The gene encoding the 56-kDa protein of Orientia tsutsugamushi Shanxi was amplified by a nested PCR and cloned into the expression vector pQE30. The 56-kDa protein of O. tsutsugamushi Shanxi (Sxh56) was expressed as a fusion protein with the His(6)-binding protein of Escherichia coli by deleting the signal peptide-encoding sequence from the 5' end of the open reading frame. The recombinant protein formed inclusion bodies when expressed in E. coli M15. The recombinant protein was examined for reactivity with mouse sera against three antigenic prototypes of O. tsutsugamushi by an immunoblot assay. The recombinant Sxh56 reacted only to polyclonal antiserum to O. tsutsugamushi Gilliam in an enzyme-linked immunosorbent assay (ELISA) and in an immunoblot assay. Recombinant Sxh56 was purified by Ni-nitrilotriacetic acid affinity chromatography and injected into mice to evaluate its ability to stimulate immune responses. High levels of immunoglobulin G and T-cell proliferation appeared in mice immunized with the recombinant protein. The recombinant Sxh56 was used in an ELISA to evaluate the ability of the method to detect antibodies to O. tsutsugamushi in human and animal sera. Thirty sera from mice infected with O. tsutsugamushi Gilliam or Shanxi and 55 sera from normal mice were detected in the ELISA with recombinant Sxh56, and the sensitivity and specificity were 96.67 and 100%, respectively. One hundred fifty-one positive sera and 412 negative sera to O. tsutsugamushi Gilliam were detected in an indirect immunofluorescence assay with the recombinant protein, and the sensitivity and specificity were 96.36 and 88.08%, respectively. These results strongly suggest that the recombinant Sxh56 is a suitable type-specific immunodiagnostic antigen and vaccine candidate.     

Nationwide survey of extended newborn screening by tandem mass spectrometry in Taiwan

In Taiwan, during the period March 2000 to June 2009, 1,495,132 neonates were screened for phenylketonuria (PKU) and homocystinuria (HCU), and 1,321,123 neonates were screened for maple syrup urine disease (MSUD), methylmalonic academia (MMA), medium-chain acyl-coenzyme A (CoA) dehydrogenase (MCAD) deficiency, isovaleric academia (IVA), and glutaric aciduria type 1 (GA-1) using tandem mass spectrometry (MS/MS). In a pilot study, 592,717 neonates were screened for citrullinemia, 3-methylcrotonyl-CoA carboxylase deficiency (3-MCC) and other fatty acid oxidation defects in the MS/MS newborn screening. A total of 170 newborns and four mothers were confirmed to have inborn errors of metabolism. The overall incidence was approximately 1/5,882 (1/6,219 without mothers). The most common inborn errors were defects of phenylalanine metabolism [five classic PKU, 20 mild PKU, 40 mild hyperphenylalaninemia (HPA), and 13 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency]. MSUD was the second most common amino acidopathy and, significantly, most MSUD patients (10/13) belonged to the Austronesian aboriginal tribes of southern Taiwan. The most frequently detected among organic acid disorders was 3-MCC deficiency (14 newborns and four mothers). GA-1 and MMA were the second most common organic acid disorders (13 and 13 newborns, respectively). In fatty acid disorders, five carnitine transport defect (CTD), five short-chain acyl-CoA dehydrogenase deficiency (SCAD), and two medium-chain acyl-CoA dehydrogenase (MCAD) deficiency were confirmed. This is the largest case of MS/MS newborn screening in an East-Asian population to date. We hereby report the incidences and outcomes of metabolic inborn error diseases found in our nationwide MS/MS newborn screening program.     

Specific primer amplification of the VP1 region directed by 5′ UTR sequence analysis: Enterovirus testing and identification in clinical samples from hand-foot-and-mouth disease patients

Many genotypes of the enterovirus (EV) pathogens can cause clinical hand-foot-and-mouth disease (HFMD). Therefore, rapid identification and monitoring of HFMD pathogens can be difficult, especially from the original clinical specimens. In this study, both universal pan-enterovirus and EV71/CA16 VP1-specific primer sets were designed and used to examine clinical specimens from HFMD patients. Based on the initial sequence analysis of the 5′-untanslated region (5′-UTR) and VP1 amplification products, additional primers for the VP1 region were redesigned for further genotyping of the remaining small portion non-EV71/non-CA16 specimens. With a known panel, it was possible to identify 15 out of 16 members using 5′-UTR sequence typing and VP1 typing, suggesting good detectability and genotyping of this method. One strain that was not typed by 5′-UTR was shown to be a recombinant virus. When this method was applied to examine clinical specimens from 44 suspected HFMD patients, 41 were detected as EV positive. In only one case, the VP1 sequence could not be identified. Four types of EVs, including CA16 (26/41, 63.4%), EV71-C4 (6/41, 14.6%), CA6 (5/41, 12.2%) and CA10 (3/41, 7.3%), were detected. In conclusion, 5′ UTR amplification sequencing and subsequent VP1 specific primer amplification ensures a high detection rate and good genotyping accuracy in the examination of clinical samples. This detection strategy can be used for routine evaluation and monitoring of HFMD to follow local trends of EV infection.     

Pathological Changes on Human Breast Cancer Specimens Ablated in vitro with High-Intensity Focused Ultrasound

The purpose of this study was to evaluate the pathologic changes of human breast cancer specimens ablated with high-intensity focused ultrasound (HIFU) in vitro. Twenty specimens of pathologically confirmed breast cancer tissue were ablated with ultrasound-guided HIFU. The evaluation methods include histopathologic observation using hematoxylin-eosin staining, electron microscopic imaging, enzyme histochemical and immunohistochemical examination on tumor antigens. Vacuole-like structures in cytoplasm were observed by histopathologic observation but there were no significant changes in cell morphology and nucleus karyotype. Typical phenomena related to coagulation necrosis were observed in electron microscopic studies; the contour of cell structure was still preserved but the structures of cell (all kinds of organelles and nucleus) were damaged or disappeared. Acid phosphatase and succinate dehydrogenase staining showed that tumor cells were inactivated. In immunohistochemical evaluations, estrogen receptor, progesterone receptor, cerbB-2 and P53 expression changed from 85%, 82%, 75% and 80% in nonablation tissue to no expression in ablated tumor tissue, respectively. We, therefore, conclude that breast cancer cells appear normal contour immediately after ablation with HIFU under light microscopic but they were evaluated to be dead by electron microscopic imaging, enzyme histochemical and immunohistochemical examinations. (E-mail:wangzbpaper@haifu.com.cn)     

桂西多民族地区脑卒中患者生活质量与自我效能水平的关系

目的 了解首发脑卒中患者生活质量与自我效能的关系,为实现两者的相互促进提供参考依据.方法 采用脑卒中影响量表(SIS)和慢性病自我效能量表对164例首发脑卒中患者进行调查,并分析其影响因素.结果 首发脑卒中患者生活质量总分为(143.77±27.33)分,自我效能平均得分为(6.81±2.34)分,患者的生活质量与自我效能水平多维度上呈显著相关,患者家庭经济状况、民族、自我效能、是否伴偏瘫、睡眠情况、医疗费用支付方式、康复训练为生活质量的主要影响因素.结论 临床工作中,应高度重视患者的康复训练和护理,全面了解患者的家庭经济状况和思想状况,以多种形式帮助患者争取最大的社会支持.同时,加强乡村医疗护理服务建设,提高服务能力,缩短患者住院天数,节省医疗费用,减轻经济负担,以最大限度提高患者的生活质量.     

子痫前期患者动态血压节律变化的调查分析与对策

目的调查子痫前期患者24h动态血压节律变化并提出相应的对策。方法对240例子痫前期患者进行24h动态血压监测(ambulatory blood pressure monitoring,ABPM),观察血压水平及昼夜变化规律。结果 240例子痫前期患者中,轻度子痫前期121例,重度子痫前期119例,两组间的24h昼夜均值、日间均值、夜间均值、夜间血压下降率比较,差异具有统计学意义(均P<0.05)。结论通过动态血压监测,护士可了解子痫前期患者不同血压变化曲线,科学监测患者降压治疗的效果,合理安排各项治疗护理操作,减少诱发子痫的因素,从而保证母婴的安全。