胫骨平台骨折合并内侧副韧带损伤的诊治体会

[目的]探讨胫骨平台骨折伴膝内侧副韧带损伤的诊断及治疗方法。[方法]回顾性分析本院1996年1月~2005年12月期间收治的52例胫骨平台骨折合并重度内侧副韧带损伤病例,并对有随访的49例(保守治疗21例,手术治疗28例)进行分析。[结果]随访10个月~9年(平均1.7年),按照Schatzker分型:Ⅱ型39例,Ⅲ型6例,Ⅵ型4例。骨折均切开复位内固定,对韧带损伤的治疗分为2组,保守治疗组21例,膝关节功能:优11例,良9例,差1例。手术治疗组28例,Ⅰ期修复19例:优17例,良2例。Ⅱ期修复9例:优5例,良3例,差1例。[结论]胫骨平台骨折合并内侧副韧带损伤Ⅰ期修复效果理想。     

与时俱进科学发展建设现代化和谐医院

吉林大学中日联谊医院是教育部直属高校--吉林大学所属、卫生部部管的一所集医疗、教学、科研、预防、保健、康复为一体的全民所有制现代化综合性三级甲等医院.     

环磷酸腺苷葡甲胺治疗婴幼儿急性毛细支气管炎的临床研究

目的探讨环磷酸腺苷葡甲胺注射液(心先安)在治疗婴幼儿急性毛细支气管炎中的临床疗效。方法112例急性毛细支气管炎患儿随机分为治疗组及对照组,在相同的基础治疗条件下,治疗组应用心先安每次2~5 mg/kg,加液静滴,每天2次。结果治疗组痊愈41例(73.2%),好转10例(17.9%),无效5例(8.9%),总有效91.1%。对照组痊愈34例(60.7%),好转8例(14.3%),无效14例(25%),总有效75%。两组相比,差异显著(P<0.05)。结论心先安治疗婴幼儿急性毛细支气管炎疗效确切,且安全、可靠。     

Pretreatment with Tongxinluo protects porcine myocardium from ischaemia/reperfusion injury through a nitric oxide related mechanism

Background The traditional Chinese medicine Tongxinluo can protect myocardium against ischaemia/reperfusion injury, but the mechanism of its action is not well documented. We examined the involvement of nitric oxide in the protective role of Tongxinluo. Methods Miniswine were randomized to four groups of seven: sham, control, Tongxinluo and Tongxinluo coadministration with a nitric oxide synthase inhibitor Nω-nitro-L-arginine (L-NNA, 10 mg/kg i.v.). Three hours after administration of Tongxinluo, the animals were anaesthetised and the left anterior descending coronary artery ligated and maintained in situ for 90 minutes followed by 3 hours of reperfusion before death. Area of no reflow and necrosis and risk region were determined pathologically by planimetry. The degree of neutrophil accumulation in myocardium was obtained by measuring myeloperoxidase activity and histological analysis. Myocardial endothelial nitric oxide synthase activity and vascular endothelial cadherin content were measured by colorimetric method and immunoblotting analysis respectively.Results Tongxinluo significantly increased the local blood flow and limited the infarct and size of no reflow. Tongxinluo also attenuated myeloperoxidase activity and neutrophil accumulation in histological sections and maintained the level of vascular endothelial cadherin and endothelial nitric oxide synthase activity in the reflow region when compared with control group. The protection of Tongxinluo was counteracted by coadministration with L-NNA. Conclusions Tongxinluo may limit myocardial ischaemia and protect the heart against reperfusion injury. Tongxinluo regulates synthesis of nitric oxide by altering activity of endothelial nitric oxide synthase.     

高原军人心理健康状况及其影响因素研究进展

结合国内外文献,综述了驻高原军人的心理健康状况,并探讨了可能影响驻高原军人心理健康状况的因素。多数研究以问卷或电话访谈的形式来评价高原军人的心理卫生状况,较一致的结论为:国内高原军人的SCL-90总分、总均分、阳性项目数等因子分均高于中国军人常模和中国成人常模,表明驻高原军人的心理健康状况较差;国外正服役的高原军人有明显的躯体活动受限、疼痛、慢性疲劳和休息不足等症状。高原低氧环境、个性特征、认知评价、应对方式、社会支持、生活事件的严重性和频度以及防御方式等对高原军人的心理健康有重要影响,进行心理干预和辅导,对提高高原军人心理健康干预模式的探讨具有重要现实意义。     

多序岩黄芪化学成分研究（Ⅳ）

目的研究多序岩黄芪(Hedysarum polybotrysHand.-M azz.)的化学成分。方法用柱色谱分离,用理化性质及波谱方法鉴定结构。结果从多序岩黄芪中分离鉴定了3个化合物:(1)白桦脂酸,(2)二十六碳酸,(3)蔗糖。结论化合物1和2为首次从该植物中分离得到。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

肝病患者血清诱导间充质干细胞表达肝细胞特异性标志物的实验研究

目的：观察重型肝病患者血清对人骨髓间充质干细胞（MSCs）的诱导分化作用，探讨人MSCs分离培养、体外扩增的条件和方法。方法：从肋骨分离、培养人骨髓MSCs、体外扩增培养、鉴定，并采用重型肝病患者血清诱导培养，分别在诱导培养0、7、14、21、28天时留取细胞，并采用免疫细胞化学方法检测肝特异性标志物（AFP、Alb、CK-18）、用PAS进行糖原染色实验。结果：诱导后5天、MSCs表现为肝细胞样细胞，随着诱导培养时间的延长，肝特异性标志物逐渐出现和成熟。AFP在7天时表达水平最高，培养14、21、28天时表达逐渐减弱；Alb、CK- 18和糖原随着诱导时间的延长，表达逐渐增强。结论：密度梯度离心，贴壁培养和消化时间控制相结合，是一种较为有效的分离纯化方法。重型肝病患者血清能诱导骨髓MSCs表达肝细胞的特异性标志物。     

快速眼动睡眠剥夺后大鼠脑内神经元骨架蛋白及超微结构的变化

目的探讨经历不同时间快速眼动（REM）睡眠剥夺对大鼠皮质及海马各区神经元形态结构的影响。方法选择微管相关蛋白（MAP2）和神经丝（NF）作为正常神经元结构的标识物，利用免疫组织化学法和Western blot技术观察REM睡眠剥夺1、3、5、7 d4个时间点大鼠皮质及海马MAP2和NF表达的时空变化规律。同时运用电镜技术观察睡眠剥夺后神经元超微结构的变化。我们的实验是用改良的多平台睡眠剥夺模型进行REM睡眠剥夺，结合免疫组织化学染色技术和蛋白质电泳以及电镜超微结构分析。结果REM睡眠剥夺后5d大鼠皮质、海马CA1及齿状回神经元结构蛋白MAP2和NF表达较对照组明显减少（P〈0．05）；电镜神经元核仁偏位，胞质中出现少量肿胀的线粒体和内质网；部分神经轴突的髓鞘溶解与浓集。环境对照组、REM睡眠剥夺5d和7d组，皮质中超微结构改变的神经元所占比例分别为1．2％、3．6％和5．8％。结论REM睡眠剥夺能够导致大鼠脑内神经元的超微结构发生异常变化。     

99Tcm-DMSA肾皮质显像诊断小儿肾发育不良

目的 探讨^99Tc^m—二巯基丁二酸(DMSA)肾皮质显像诊断小儿肾发育不良的价值。方法 疑为肾发育不良患儿29例，行常规^99Tc^m—DMSA肾皮质显像和腹部B超检查。图像分析：将发育不良肾分为0～4级。结果 ^99Tc^m—DMSA肾皮质显像示29例患儿中24例为单侧肾发育不良，其中11例1级，7例2级，6例3级，余5例患肾未显影为0级，结合其他：检查诊断为肾发育不良。患肾分肾功能为0～24．9％(平均6．3％)。29例患儿中24例患肾肾皮质显像诊断为肾发育不良，5例患肾未显影，由其他影像学方法确诊，诊断灵敏度为82．76％。29例中19例经手术治疗，病理检查证实为肾发育不良。结论 ^99Tc^m—DMSA肾皮质显像诊断肾发育不良灵敏度高、可靠，可确定发育不良肾部位和判断肾功能。