Ablation of Barrett's esophagus using the second-generation argon plasma coagulation

Objective To investigate the efficacy and safety of the second-generation argon plasma coagulation (VIO APC) in ablation of Barrett's esophagus. Methods Eighteen patients with Barrett's esophagus (12 males, median age of 55 years, median length of 2.1 cm,1 low-grade dysplasia, 13 cases of short segment Barrett's esophagus) received VIO APC, which was performed at a power setting of 40W and argon gas flow at 1. 5-2. 0 L/min, "forced" mode, in 1-3 sessions (mean 1.3). All the patients received treatment with high-dose proton pump inhibitors. The main complaints before ablation were upper abdominal pain in 12 patients (66%), sour regurgitation in 14 patients (77%), and dysphagia or odynophagia in 7 patients (38%). Two patients (11%) had esophageal hiatal hernia. Results The percentage of patients in whom ablation was endoscopically achieved proximal to the gastroesophageal junction was 77. 8%(14/18), and histologically achieved in 66. 7% (12/18). Berried glands were observed in 2 patients who had achieved endoscopic ablation, the areas of Barrett's mucosa were reduced by more than 60% in the other 4 patients. After treatment, 4 patients had transient retrosternal pain and 3 patients had mild epigastric discomfort. One patient had small amounts of hemorrhage during the process, and it ceased after norepinephrine and thrombosin were administered through endoscope biopsy channel. No esophageal stricture or other severe adverse events was observed. During 11.8 (4-15) months' follow-up, the patients who had achieved the complete ablation had no evidence of relapse of Barrett's esophagus. Conclusion VIO APC with a relatively low power setting can effectively ablate the Barrett's mucosa with special intestinal metaplasia when standard APC has been done. No severe adverse events were observed. Long-term follow-up is needed to assess cancer prevention and the durability of the neo-squamous epithelium.     

慢性肾功能衰竭患者血清对红系祖细胞的抑制及红细胞生成刺激素的疗效

本文探讨了慢性肾功能衰竭患者自身血清对骨髓红系祖细胞的抑制作用及红细胞生成刺激素(erythropoietin EPO)的临床疗效。自身血清加入培养体系与胎牛血清加入组比较,半数病例集落数减少,自身血清用活性炭吸附后,这种造血抑制作用被解除。EPO治疗后的血色素增加程度和自身血清的造血抑制活性呈相关性,可见,如果能设法有效地去除患者体液中的造血抑制因子,EPO的临床疗效就能进一步提高。     

Effectiveness of different orthoses on joint moments in patients with early knee osteoarthritis: Lateral wedge versus valgus knee bracing

The purpose of the study was to test the biomechanical differences between a lateral wedge and a valgus knee bracing on the knee joint moment during walking in patients with early stage of medial compartment knee osteoarthritis (OA). We conducted a crossover randomized design to compare gait parameters of 32 patients (with early stage medial compartment knee OA) in three different conditions during walking: with a custom-made lateral wedge of 5° (in standard shoes), with a valgus knee bracing (in standard shoes), and with control condition (in standard shoes). Both two-orthose conditions showed decreased loading patterns (knee adduction moment and knee adduction angular impulse) on the knee joint in dynamic condition (statistic probability P < 0.05). The decreased loading on OA knee in wedge condition was associated with a laterally shifted location of centre of pressure and increased ankle valgus degree and moment at the same foot (P < 0.05). It was not found significant differences in loading of the knee between these two-orthose conditions. These results indicated that, under dynamic condition, patients wearing lateral wedge and valgus knee bracing showed changes of moments on knee joints. Lateral wedge was as effective as valgus knee bracing in the treatment of early stage of knee OA.     

选择性应用陶瓷人工骨在椎体后凸成形中预防骨水泥渗漏的作用

目的在椎体后凸成形术中选择性使用陶瓷人工骨粒,观察其预防骨水泥渗漏的作用。方法选择西安交通大学医学院第一附属医院骨科自2009年6月～2011年5月116例椎体新鲜骨折患者,CT显示椎体前侧壁有不同程度的破裂,按随机原则分为两组:常规组采用传统的经皮球囊扩张椎体后凸成形术(PKP)方法,人工骨组在其基础上使用陶瓷人工骨粒,并记录人工骨粒填塞量、骨水泥注入量和渗漏发生率及后果;评估手术前后的疼痛程度(VAS法),测量椎体前缘高度压缩率(Lee法),测量椎体后凸角度(Cobb法),术后复查CT观察骨水泥渗漏情况。结果所有患者均顺利完成手术。人工骨组治疗58例,置入人工骨粒(2.83±1.67)g,骨水泥注射量为(3.74±0.66)mL,术中发现骨水泥渗漏2例,发生率为3.4%;手术前后VAS评分改善6.14±0.95,椎体前缘高度压缩率改善(21.74±1.99)%,椎体后凸角度改善23.72°±2.33°;术后CT可见椎体前侧方人工骨粒填充良好。常规组治疗58例,骨水泥注射量为(4.01±0.61)mL,术中发现骨水泥渗漏8例,发生率为13.8%;手术前后VAS评分改善6.00±0.94,椎体前缘高度压缩率改善(21.29±2.01)%,椎体后凸角度改善22.74°±2.00°。两组发生渗漏患者均无明显临床不适。SPSS17.0统计软件分析两组骨水泥注射量及骨水泥渗漏率差异有统计学意义(P<0.05),而VAS评分改善、椎体前缘高度压缩率改善及Cobb角改善情况两组间差异无统计学意义(P>0.05)。结论将陶瓷人工骨粒选择性应用于椎体后凸成形术中,在保证疗效的同时,能有效减少骨水泥的注入量,降低骨水泥渗漏的发生。     

吻合血管腓骨移植治疗股骨头缺血坏死

临床观察吻合血管腓骨移植治疗成人股骨头缺血坏死520例，其中有创伤史229例，服用激素药物史者228例，有酗酒史者34例，原因不明者29例。术后315例获得1～15年随访，结果提示，优良率为86．6％。手术切开说关节囊，在彻底清除股骨头内骨坏死囊变组织的同时，植入新鲜自体松质骨并在股骨头颈部前外侧植入吻合血管的腓骨。该手术增加了股骨头部血液供给，充分减轻了股骨头内压力，加之腓骨为坚质骨，来后不易吸收，对股骨头颈部起到了支撑作用，防止了股骨头进一步塌陷。     

CT导向胸内疑难病灶的经皮活检20例

报告CT导向胸内邻近大血管或直经小于3cm的病灶的经皮针吸活检术20例。这些疑难病灶的径皮活检术操作困难，危险性大，并发症多。本组正确诊断丰85％，其中恶性肿瘤为80％，良性病变为90％。术后小量气胸2例（1％），小量出血1例（5％）。CT扫描能精确确认病灶和穿刺针的位置，并能清楚显示心脏和大血管的轮廓，因此疑难病灶的经皮活检应该在CT导向下操作。     

CT导向胸内疑难病灶的经皮活检20例

报告CT导向胸内邻近大血管或直经小于3cm的病灶的经皮针吸活检术20例。这些疑难病灶的径皮活检术操作困难，危险性大，并发症多。本组正确诊断丰85％，其中恶性肿瘤为80％，良性病变为90％。术后小量气胸2例（1％），小量出血1例（5％）。CT扫描能精确确认病灶和穿刺针的位置，并能清楚显示心脏和大血管的轮廓，因此疑难病灶的经皮活检应该在CT导向下操作。     

Cyclin D_1反义寡核苷酸对人黑色素瘤细胞周期的影响及对细胞增殖抑制作用的研究

目的　探讨cyclinD1反义寡核苷酸对人黑色素瘤的潜在治疗作用。方法　合成针对cyclinD1翻译起始部位序列的 2 0bp硫代反义寡核苷酸 (AS ODN)。采用流式细胞仪检测细胞周期的分布 ,用台盼蓝计数、集落形成抑制试验体外观察AS ODN对人黑色素瘤细胞增殖的影响。结果　cyclinD1反义寡核苷酸能增加G1期细胞百分比 ,降低S期细胞百分比 ,且明显抑制人黑色素瘤细胞生长和集落形成。结论　CyclinD1反义寡核苷酸能有效抑制人黑色素瘤细胞的增殖。     

股骨头内松质骨移植观察

目的　了解股骨头内松质骨移植后的病理变化 ,为股骨头坏死治疗提供理论基础。方法　 80只日本白兔分实验组 (股骨头内骨质刮除 ,自体松质骨移植 )和对照组 (股骨颈骨折后原位内固定 ) ,进行病理组织学、X线和血管造影观察。结果　松质骨移植后股骨头可完全修复 ,且较对照组效果好。结论　髓腔血供可修复股骨头 ,故提供血管修复的环境很重要 ,而股骨头坏死治疗中血管植入可能只起加快修复作用     

中耳炎病理过程中的内通风引流阻塞

为探讨中耳炎病理过程中的中耳内通风引流阻塞的形成和病理影响 ,对2 90耳各型渗出性中耳炎颞骨连续切片进行光镜组织病理学观察研究。结果显示中耳内通风引流通道易被粘膜炎性水肿、粘连、包裹性积液和肉芽组织不同程度地阻塞 ,阻塞部位以上区域比前半中耳腔区域有更高的渗出液积存率和肉芽组织发生率 ,提示内通风引流阻塞是早期渗出性中耳炎向慢性发展的重要原因。     

陕西省黄陵县克山病病情8年连续观察

目的　观察陕西省黄陵县克山病 8年来病情及相关因素的变化。方法　选择黄陵县的 6个重病村设立监测点 ,该区居民列为监测对象。 1995年至 2 0 0 2年连续 8年对该监测点克山病的发病情况监测及 3～15岁儿童内环境硒水平进行监测。结果　①潜、慢型克山病的检出率 1995、1997、1999、2 0 0 0和 2 0 0 2年依次为 4 .3%、3.6 %、7.5 %、8.0 %和 8.5 % ;②潜在型克山病的新发生率 1995、1997、1999、2 0 0 0和 2 0 0 2年依次为 5 5 .6 /万、5 3.5 /万、19.5 /万、0 /万和 2 5 /万 ;③全县 8年慢型克山病死亡 2 2例 ,15例死于慢性充血性心力衰竭 (占 6 8.2 % ) ,7例死于猝死 (占 31.8% ) ;④病区 3～ 15岁儿童发硒含量 8年均达到非病区水平。结论　陕西省黄陵县克山病的发病呈平稳低发态势 ,但潜在型克山病仍有新发     

张口上仰位三相骨显像对颞颌关节紊乱综合征的诊断

研究放射性核素三相骨显像对颞颌关节紊乱综合征的早期诊断价值。方法　采用常规前位及张口上仰位对 2 2例颞颌关节综合征患者进行了三相骨显像。结果　常规前位及张口上仰位三相骨显像对颞颌关节紊乱综合征的阳性检出率分别为 70 .83%、87.50 %。张口上仰位三相骨显像患健侧颞颌关节放射性比值在血流相对峰值比为 1 .53± 0 .2 9,在延迟相时为 1 .57±0 .2 3,与常规前位采集均有显著性差异 ( P <0 .0 1 )。结论　张口上仰位三相骨显像能早期诊断颞颌关节紊乱综合征     

THE EVALUATION OF THE EFFECT OF MEBENDAZOLE ON TREATING ASCARIS LUMBRICOIDES AND TRICHURIS TRICHURA INFECTION WITH TWO KINDS

ＴＨＥＥＶＡＬＵＡＴＩＯＮＯＦＴＨＥＥＦＦＥＣＴＯＦＭＥＢＥＮＤＡＺＯＬＥＯＮＴＲＥＡＴＩＮＧＡＳＣＡＲＩＳＬＵＭＢＲＩＣＯＩＤＥＳＡＮＤＴＲＩＣＨＵＲＩＳＴＲＩＣＨＵＲＡＩＮＦＥＣＴＩＯＮＷＩＴＨＴＷＯＫＩＮＤＳＯＦＴＨＥＲＡＰＹＷｅｉＲｕｎｍｉｎ...     

雌激素对骨关节炎模型软骨基质蛋白多糖变化的影响

目的　观察雌激素对骨关节炎 (OA)模型软骨基质蛋白多糖变化的影响 ,探讨外源性雌激素治疗OA的作用机理。方法　以家兔制作OA动物模型 ,在雌激素干预治疗的基础上 ,获取病变早、中、晚期关节软骨 ,提取葡糖氨基聚糖 (GAG) ,用生化和放射免疫技术测定其中不同种类GAG及其功能基团的含量。结果　在病变的不同时期 ,对照组GAG的总量、透明质酸的含量均减少 ,硫酸软骨素与硫酸角质素的含量和比例增高 ;而雌激素干预组GAG的总量、透明质酸的含量、硫酸软骨素与硫酸角质素的含量和比例与正常组接近。结论　外源性雌激素通过抑制糖蛋白降解对OA提供保护作用。     

IL-1α和MMP-9在中耳胆脂瘤上皮中的表达

目的研究白介素-1α(interleukin-1α,IL-1α)和基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)的表达,探讨二者与胆脂瘤侵袭破坏能力的关系。方法采用免疫组织化学SP法检测了IL-1α、MMP-9在21例后天继发性胆脂瘤上皮与10例胆脂瘤患者外耳道皮肤表皮中的表达。结果IL-1α和MMP-9在胆脂瘤上皮的阳性表达率明显高于外耳道皮肤表皮,差异具显著性(P<0.01,P<0.01);胆脂瘤上皮IL-1α、MMP-9表达均与胆脂瘤的侵袭破坏程度正相关(P<0.05,P<0.05);胆脂瘤上皮中IL-1α、MMP-9表达存在正相关性。结论IL-1α、MMP-9是介导胆脂瘤侵袭破坏行为的重要细胞因子。在体内IL-1α可能对MMP-9表达具有上调作用。     

APACHEⅡ在胆道重症的应用

采用回顾方法对1992年6月～1997年1月期间胆道外科重症患者235例进行了急性生理学和慢性健康状况评分（APACHEⅡ）。APACHEⅡ评分统一在入监护室（SICU）第一个24h进行，所有病例随访至出院或死亡，记录转归；并与APACHEⅡ总分作相关性分析。结果：病死率高低与APACHEⅡ分值有密切关系，235例平均分值12．6分，最低7分，最高38分；199例存活病例平均分值10．4分；死亡36例（15．3％）平均分值为24．9分（P＜0．001）；风险病死率与实际病死率回归分析，r=0．895，P＜O．001。以ROC曲线发现，风险预测的准确性较高。     

关节内注射川芎嗪对兔膝关节软骨退变的影响

目的观察川芎嗪关节腔内注射对骨关节炎过程中软骨退变的保护作用,探讨川芎嗪关节腔注射治疗骨关节炎的应用前景。方法健康成熟新西兰大白兔26只,设立正常组、模型组、对照组和实验组。模型组、对照组及实验组建立骨关节炎模型。对照组与实验组分别关节腔注射地塞米松0.3 mL和川芎嗪0.3 mL。每周一次。在模型建立6周和9周时各组分别处死一半动物,去除关节炎模型,取材进行大体标本病理学观察,并经光镜和透射电镜观察膝关节软骨的病理变化。结果在6和9周时,实验组的大体标本软骨损伤分级明显优于其他3组;Mankin软骨组织学评分与上述两组相比,有非常显著性差异(P<0.01);电镜超微结构观察其病理改变明显轻于对照组和模型组。对照组大体标本软骨损伤分级与模型组基本相同;Mankin软骨组织学评分与模型组比较无显著性差异(P>0.05);电镜超微结构观察对照组与模型组在细胞形态、细胞内细胞器改变等方面相似。结论关节腔内注射川芎嗪能减轻兔膝关节炎模型的关节软骨退变程度,并可促进软骨的自身修复;激素关节腔内注射对损伤软骨的修复作用不明显。     

脑梗塞的磁共振成像与临床

本文讨论了80例脑梗塞磁共振成像与临床表现,其中20例有CT检查。多数病例磁共振成像显示为多发性脑梗塞(95%)。梗塞灶在T_1加权是低信号改变;T_2加权呈高信号改变,急性和慢性期特点一致。资料结果表明:磁共振成像定位准确(98.75%)。病灶检出T_2比T_1敏感,磁共振成像检出病灶多于CT。在诊断脑梗塞方面,磁共振成像优于CT。     

Accurate 3D reconstruction of subject-specific knee finite element model to simulate the articular cartilage defects

The biomechanical relationship between the articular cartilage defect and knee osteoarthritis (OA) has not been clearly defined. This study presents a 3D knee finite element model (FEM) to determine the effect of cartilage defects on the stress distribution around the defect rim. The complete knee FEM, which includes bones, articular cartilages, menisci and ligaments, is developed from computed tomography and magnetic resonance images. This FEM then is validated and used to simulate femoral cartilage defects. Based on the obtained results, it is confirmed that the 3D knee FEM is reconstructed with high-fidelity level and can faithfully predict the knee contact behavior. Cartilage defects drastically affect the stress distribution on articular cartilages. When the defect size was smaller than 1.00 cm², the stress elevation and redistribution were found undistinguishable. However, significant stress elevation and redistribution were detected due to the large defect sizes (⩾1.00 cm²). This alteration of stress distribution has important implications relating to the progression of cartilage defect to OA in the human knee joint.     

17例脊髓纵裂的CT结果分析

我院骨科自1978～1993年共收治先天性脊柱畸形427例,手术证实合并脊髓纵裂40例,其中17例术前经CT检查确诊。18个骨嵴中（1例为2个骨嵴）,16个为骨性嵴,2个分别为软骨性和纤维性嵴。CT特征:椎管中央的纵行骨嵴将脊髓或马尾分为两部分,多数骨嵴两侧蛛网膜下间隙及脊髓不均称;该部椎管扩大;椎体及附件结构紊乱。CT是一理想、可靠的诊断方法,不仅能准确诊断损害的平面,而且能显示椎管的自然状态和骨嵴的轮廓及种类。