根管低位断髓术治疗乳磨牙牙髓病临床探讨

目的 探讨乳磨牙牙髓病根管低位断髓术临床应用价值。方法 338例乳磨牙随机分为根管低位活髓切断术直接盖髓充填治疗 2 12例和FC半失活根管低位断髓术充填治疗 12 6例。结果 治疗后分别观察 6个月～ 3年。两组乳磨牙根管低位断髓术治疗的成功率分别为 82 0 8%和 83 33%。结论 乳磨牙有其生理的特殊性 ,对乳磨牙牙髓病作根管低位断髓应尽量去除病变的冠髓组织 ,严密充填根管口和覆盖封闭髓室底副根管 ,减少根分叉及根尖周病变的发生 。

断髓和电麻等引起牲畜各组织、脏器非病理性出血与病理性出血的鉴别

为使牲畜屠宰方便安全,常用断髓和麻电等方法,但这两种方法都能引起各组织,脏器的非病理性出血。麻电造成非病理性出血的原因是麻电器的电压过高,麻电时间过长,电流过大,破坏了血压调节中枢、致使动。静脉血压升高,流向心脏的血量减少,流入肌肉、皮肤、肺、肝、脾、肾等的血量增加,引起非病理性出血现象。

副神经移位恢复高位颈髓横断伤大鼠膈肌运动功能的初步研究

目的 :探讨副神经移位膈神经恢复膈肌运动功能的可行性。方法 :成年雄性SD大鼠 10 0只随机分成A、B2组。经颈前路显露两侧膈神经干 ,于C6水平切断。A组原位缝接 ;B组游离副神经 ,在其主干进入斜方肌前切断 ,并与膈神经干缝接。术前 ;术后 5min及第 1、2、4、6、8个月观察膈肌的位移 ,然后于C3～ 4 水平横断脊髓了解膈肌的位移变化。比较各时间点 2组膈肌位移的恢复率。结果 :高位颈髓横断伤前 2组膈肌位移恢复率无显著性差异 ,而高位颈髓横断伤后B组膈肌位移恢复率明显优于A组。结论 :副神经移位膈神经能有效地恢复高位颈髓横断伤大鼠的膈肌运动功能。

胸髓半横断引起腰髓前角钙网蛋白阳性中间神经元突触联系的变化

为检测大鼠胸髓半横断后后肢运动功能状况和腰髓前角中间神经元的突触联系的变化,并分析其相关关系,本实验通过BBB评分、钙网蛋白(CR)和突触囊泡素(SYN)免疫荧光双标记及相关分析方法进行了研究。结果显示:大鼠胸髓半横断后12 h时,后肢运动功能完全丧失,BBB分值下降,从第3 d开始后肢功能逐渐恢复,BBB分值逐渐增加,至第21 d基本恢复正常;同时观察到腰髓损伤侧12 h时CR免疫反应阳性(CR-IR)神经元周围的SYN-IR降低,第3 d时恢复至正常水平,至第21 d时升高;相关分析显示后肢运动功能BBB评分与CR-IR中间神经元周围的SYN表达水平呈正相关(r=0.45,P<0.05)。上述结果提示大鼠胸髓半横断后,与腰髓CR-IR中间神经元形成的突触联系出现可塑性改变,这种可塑性变化可能是后肢运动功能自发性恢复的形态学基础。

针刺不同神经节段穴位对高位颈髓横断模型大鼠胃内压的影响

目的比较和探讨不同神经节段腧穴对高位颈髓横断后模型大鼠胃内压的影响及其可能机制。方法通过在大鼠胃部安置球囊的方法记录胃内压,对大鼠C3颈髓节段进行横断脊髓的处理后,观察针刺其足三里、内关、胃俞三个不同神经节段腧穴后大鼠胃内压的变化。结果 (1)针刺前后比较:横断前针刺足三里穴组、内关穴组,胃内压均升高,差异有统计学意义(P<0.05),针刺胃俞穴组,胃内压降低,差异有统计学意义(P<0.05);高位颈髓横断后,针刺足三里组、内关组,胃内压无明显变化,差异无统计学意义(P>0.05),针刺胃俞组,胃内压降低,差异有统计意义(P<0.05)。(2)横断前后差值比较:针刺足三里组、内关组,与横断前相比,胃内压差值均降低,差异有统计学意义(P<0.05);针刺胃俞组,与横断前相比,胃内压差值无明显变化,差异无统计学意义(P>0.05)。结论高位颈髓及脊髓上中枢对不同神经节段腧穴调节胃内压可能具有不同的作用,这种差异可能与不同神经节段腧穴调节胃内压的神经传导途径不同有关。

颈髓横断致大鼠胃粘膜损伤机制

为了研究颈髓横断大鼠急性胃粘膜损伤的机制，我们在不同的时间点（３、５和７小时）测定大鼠胃粘膜非蛋白巯基（ＮＰＳＨ）、蛋白巯基（ＰＳＨ）和丙二醛（ＭＤＡ）含量。实验结果和对照组相比：ＮＰＳＨ分别减少１９．３２％（３小时）、２８．５０％（５小时）和４２．４９％（５小时）；ＰＳＨ分别下降２７．３３％（３小时）、２４．０９％（５小时）和２４．８９％（７小时）；ＭＤＡ含量增加１０２．００％（５小时）和１１１．４４％（７小时）。提示，颈髓横断后胃粘膜巯基含量减少引起胃粘膜清除自由基的能力下降而脂质过氧化加强，另外，ＰＳＨ的减少导致蛋白质结构和功能的改变。这些可能与急性胃粘膜损伤的发生有关。

Preparation and Identification of Anti-rabies Virus Monoclonal Antibodies

To provide a foundation for the development of rapid and specific methods for the diagnosis of rabies virus infection, anti-rabies virus monoclonal antibodies were prepared and rabies virus nucleoprotein and human rabies virus vaccine strain (PV strain) were used as immunogens to immunize 6-8 week old female BALB/c mice. Spleen cells and SP2/0 myeloma cells were fused according to conventional methods: the monoclonal cell strains obtained were selected using the indirect immunofluorescence test; this was followed by preparation of monoclonal antibody ascitic fluid; and finally, systematic identification of subclass, specificity and sensitivity was carried out. Two high potency and specific monoclonal antibodies against rabies virus were obtained and named 3B12 and 4A12, with ascitic fluid titers of 1:8000 and 1:10000, respectively. Both belonged to the IgG2a subclass. These strains secrete potent, stable and specific anti-rabies virus monoclonal antibodies, which makes them well suited for the development of rabies diagnosis reagents.

Syringomyelia after operation:diagnosis and its formational mechanism

Objective： To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods： Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years （range 2-10 months） by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results： All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid （CSF）. The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion： The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.

Clinical implication of FDG uptake of bone marrow on PET/CT in gastric cancer patients with surgical resection

AIM To determine the relationship between F-18 fluorodeoxyglucose(FDG) uptake of bone marrow(BM) on positron emission tomography/computed tomography(PET/CT) and clinical factors and to assess the prognostic value of FDG uptake of BM in gastric carcinoma.METHODS We retrospectively enrolled 309 gastric cancer patients who underwent staging FDG PET/CT and curative surgical resection. FDG uptake of primary tumor was visually classified as positive or negative FDG uptake. Mean FDG uptake of BM(BM SUV) and BM-to-liver uptake ratio(BLR) were measured. The relationships of BM SUV or BLR with clinical factors were evaluated. The prognostic values of BM SUV, BLR, and other clinical factors for predicting recurrence-free survival(RFS) and overall survival(OS) were assessed.RESULTS Of 309 patients, 38 patients(12.3%) experienced cancer recurrence and 18 patients(5.8%) died. Patients with advanced gastric cancer, positive FDG uptake, and recurrence had higher values of BM SUV and BLR than those with early gastric cancer, negative FDG uptake, and no recurrence(P < 0.05). BM SUV and BLR were significantly correlated with hemoglobin level, neutrophil-to-lymphocyte ratio, and platelet-tolymphocyte ratio(P < 0.05). On multivariate analysis, multiple tumors, T stage, lymph node metastasis, tumor involvement of resection margin, and BLR were significantly associated with RFS(P < 0.05). T stage, lymph node metastasis, hemoglobin level, and BLR were significantly associated with OS(P < 0.05). CONCLUSION BLR on PET/CT was an independent prognostic factor for RFS and OS in gastric cancer patients with curative surgical resection.

Work up for the clopidogrel hypersensitivity that led to recognising the undi- agnosed myelodysplastic syndrome

Antiplatelet therapy with clopidogrel is widely used as a preventive strategy in patients with acute coronary syn- drome, particularly after stent implantation.Diverse mani- festations of clopidogrel hypersensitivity reaction have been reported including cutaneous,and hematologic symp- toms[31 as well as fatal reactions including thrombotic throm- bocytopenic purpura （TTP）.

Evolving role of FDG-PET/CT in prognostic evaluation of resectable gastric cancer

Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical 18F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.

Spinal Monocytic Sarcoma Presenting as an Acute Cord Compression without Any Symptom of Leukemic Disease: One Case Report and Literatures Review

Introduction In this paper we present a case of monocytic sarcoma of the vertebral canal with a review of relevant literature references. According to the extensive morphological and immunohistochemical analyses, monocytic sarcoma is one type of myeloid sarcoma, and can be diagnosed from extensive morphological and immunohistochemical analysis. Most cases of myeloid sarcomas are associated with acute, or chronic leukemia, or myelo-proliferative disorders, as well as monocytic sarcoma. Rarely, the tumors may be identified before the diagnosis of any hematological malignancy and most of them predict portend existing, or pending acute myeloid leukemia （AML）. Myeloid sarcomas may occur in almost every part of the bodyt, but spinal monocytic sarcomas are relatively uncommon.

Acute myeloid leukemia in the era of precision medicine:recent advances in diagnostic classification and risk stratification

Acute myeloid leukemia(AML) is a genetically heterogeneous myeloid malignancy that occurs more commonly in adults, and has an increasing incidence, most likely due to increasing age. Precise diagnostic classification of AML requires clinical and pathologic information, the latter including morphologic, immunophenotypic, cytogenetic and molecular genetic analysis. Risk stratification in AML requires cytogenetics evaluation as the most important predictor, with genetic mutations providing additional necessary information. AML with normal cytogenetics comprises about 40%-50% of all AML, and has been intensively investigated. The currently used 2008 World Health Organization classification of hematopoietic neoplasms has been proposed to be updated in2016, also to include an update on the classification of AML, due to the continuously increasing application of genomic techniques that have led to major advances in our knowledge of the pathogenesis of AML. The purpose of this review is to describe some of these recent major advances in the diagnostic classification and risk stratification of AML.

Diagnosis and treatment of intramedullary hemangioblastoma of cervical spinal cord

OBJECTIVE: To investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord. METHODS: MR imaging and the methods and results of surgery were analyzed in 21 patients. RESULTS: The tumors were divided into three types on MR imaging. Syringeal type, where the tumor varied in size and was accompanied by syringobulbia and syringomyelia; Cystic type, where the tumor presented as a cyst with a small mural node; and Solid type, where the tumor was revealed as a huge solid mass. All tumors were totally removed and diagnosis was confirmed by histological study. Post-operative neurological status was improved in 20 patients and aggravated in 1. CONCLUSIONS: The localization and the nature diagnosis of the tumor can be made by cervical MR imaging. Operative methods vary with tumor types. It is the most important that the tumor is dissected along the right interface and removed after devascularization.

Failure of intramedullary femoral nail with segmental breakage of distal locking bolts： a case report and review of the literature

Breakage of locking bolts is an important cause of interlocking nail failure in femoral fractures. It usually occurs in the form of single breakage in one of the distal bolts of the nail or nail breakage around the distal locking hole. Here we report an unusual ease ofintramedullary femoral nail failure with segmental breakage of both the distal locking bolts. Such a scenario usually complicates further management. We successfully managed this casewith exchange nailing without bone grafting. Here we briefly reviewed the literature regarding such an unusual presentation and discussed in detail the possible etiology of such a presentation and the management options when facing such a complex situation.

电梯失控轿厢上缘挤压致人死亡1例

1案例资料1.1检验案情及现场勘验2013年某日,某写字楼电梯由22楼向下运行至3楼时,轿厢门正常打开,站在门口的王某某（女）边看手机边往电梯外走,刚探出上半身,轿厢突然在门开启状态下失控迅速下落,王某某的头颈部被下落的轿厢上缘与电梯间地面挤压,其坠落在下落的轿厢内,当场死亡。现场勘验见,电梯轿厢位于负一楼,厢门处于敞开状态,1具女性尸体头朝向轿厢内、脚朝向轿厢门,呈侧卧状态,右侧颌面部严重挫裂,

Imaging diagnosis of cervical spine and spinal cord injuries in children

Objective: To provide the experience in imaging diagnosis of cervical spine and spinal cord injuries in children. Methods: Imaging data of cervical spine and spinal cord injuries in 62 children were retrospectively reviewed. The routine radiography including the lateral, anteroposterior and open-mouth odontoid views were performed in all the patients. Tomography was available for 25 patients, and flexion-extension lateral views for 28 patients, CT scanning for 21 patients, MRI for 26 patients. Results: Of these patients, 46 patients were identified with injuries of upper cervical spine (9 with atlantal arch fracture, seven with axial fracture, 21 with odontoid fracture, 1 with atlantal arch fracture combining with odontoid fracture, and 1 with atlantal transverse ligament disruption); 7 patients sustained injuries of lower cervical spine (3 fractures of vertebral body, 2 dislocations and 6 fracture-dislocations); 2 patients had multiple noncontiguous cervical injuries; and 3 had cervical spinal cord injury without radiographic abnormalities (SCIWORA). Conclusions: Imaging assessment is of great importance in the diagnosis of cervical spine and spinal cord injuries in children. Whenever cervical spine and spinal cord injuries are suspected for children patients, and the three-views should be routinely indicated. MRI should be routinely performed in all children with cervical SCIWORA.

Undiagnosed Hoffa fracture of medial femoral condyle presenting as chronic pain in a post-polio limb

Isolated coronal fracture of medial femoral condyle with intact lateral femoral condyle is extremely rare. A high index of suspicion is necessary for early diagnosis especially in cases of undisplaced fractures. Here we report a case of medial Hoffa fracture in a post-polio limb presenting as chronic pain. Management of such fractures in limbs affected by late sequelae of poliomyelitis is particularly problematic in view of osteoporosis and osseous hypoplasia. The fracture was approached through medial parapatellar arthrotomy and fixation was done with cannulated cancellous screws in anteroposterior direction. Union was achieved at 16 weeks.

The role of circulating miRNAs in multiple myeloma

Multiple myeloma(MM) is a common malignant hematological disease. Dysregulation of micro RNAs(mi RNAs) in MM cells and bone marrow microenviroment has important impacts on the initiation and progression of MM and drug resistance in MM cells. Recently, it was reported that MM patient serum and plasma contained sufficiently stable mi RNA signatures, and circulating mi RNAs could be identified and measured accurately from body fluid. Compared to conventional diagnostic parameters, the circulating mi RNA profile is appropriate for the diagnosis of MM and estimates patient progression and therapeutic outcome with higher specificity and sensitivity. In this review, we mainly focus on the potential of circulating mi RNAs as diagnostic, prognostic, and predictive biomarkers for MM and summarize the general strategies and methodologies for identification and measurement of circulating mi RNAs in various cancers. Furthermore, we discuss the correlation between circulating mi RNAs and the cytogenetic abnormalities and biochemical parameters assessed in multiple myeloma.

Current status and perspective of diagnosis and treatment of thoracolumbar fracture in China

Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to various international communications benefited from the open policy. Therefore, it is essential to evaluate the current status and perspective of diagnosis and treatment of thoracolumbar fracture. There are several issues we would like to discuss here.