OBJECTIVE:The purpose of this study was to assess the effect of electroacupuncture stimulation (EAS) of the vagus nerve on the inflammatory response in rat models of spinal cord injury (SCI). METHODS:The T10 SCI model in adult male Sprague Dawley rats was established using the modified Allen's method. The EAS group was treated with the therapy on the vagus nerve of rat ear nails, while the SCI group did not receive any EAS treatment. The degree of inflammatory infiltration was reflected by hematoxylin-eosin staining. The inflammatory cytokines in spinal cord tissues, cerebrospinal fluid inflammation, and peripheral blood were detected by enzyme-linked immunosorbent assay. Changes in astrocytes and microglia were assessed using an immunofluorescence assay. RESULTS:Electroacupuncture stimulation treatment inhibited inflammatory infiltration, as well as the concentrations of interleukin-6, interleukin-1β, tumor necrosis factor-α, astrocytes, and microglia at 1, 6, and 24 hours after 1 EAS treatment. Multiple EAS treatments had an obvious effect on SCI inflammation. CONCLUSION:A single EAS treatment had a limited effect on inflammation, but multiple treatments had a significant inhibitory effect on inflammation.

背景:越来越多的证据显示,神经生长因子对神经元的存活、分化等有着重要的促进作用,但是神经生长因子半衰期短,稳定性较差,限制了它在临床上的广泛应用.目的:探讨大鼠骨髓间充质干细胞在可持续释放神经生长因子的壳聚糖/聚乳酸羟基乙酸/聚乳酸支架上向神经元细胞分化的可行性.方法:构建可持续释放神经生长因子的壳聚糖/聚乳酸羟基乙酸/聚乳酸支架和不含有神经生长因子的壳聚糖/聚乳酸羟基乙酸/聚乳酸支架,将大鼠骨髓间充质干细胞分别接种在两种支架表面,采用低糖DMEM完全培养基中加入碱性成纤维生长因子、脑源性神经营养因子以及N2和B27神经细胞生长添加剂的诱导方案进行成神经诱导分化.诱导18 d后,免疫荧光染色检测神经元标志物(微管相关蛋白2和巢蛋白)的表达,Western blot检测p-TrkA和p-ERK蛋白表达.结果 与结论:①经过连续18 d的诱导,免疫荧光检测显示微管相关蛋白2阳性细胞在空白支架组约为30％,可持续释放神经生长因子组约为70％,而巢蛋白阳性细胞在空白支架组为40％,可持续释放神经生长因子组约为60％,两组比较差异有显著性意义;②Western blot检测结果显示可持续释放神经生长因子组的p-TrkA和p-ERK蛋白表达量明显高于空白支架组,差异有显著性意义;③结果 表明,在持续性释放神经生长因子的壳聚糖/聚乳酸羟基乙酸/聚乳酸支架表面,骨髓间充质干细胞可以更好地向神经元细胞分化,其机制可能是通过TrkA/ERK通路来实现的.

The objective was to design a scaffold that could continuously deliver nerve growth factor (NGF) combined with neurally differentiated bone marrow mesenchymal stem cells (BMSCs) to promote better recovery of spinal cord injury (SCI) in rats. BMSCs were induced to differentiate into neurons for 6 days in vitro, and then seeded on a NGF persistent delivery scaffold, both were transplanted to SCI rats in combination. Relevant extensive tests were conducted 1, 4 and 8 weeks after transplantation. The results showed that the scaffold had a stable ability to continuously release NGF and that the BMSCs on the scaffold could successfully differentiate into nerve cells. The results of Bacco, Beattie and Bresnahan (BBB) scores, inclined plane tests and electrophysiological investigations revealed that the rats in the combined regimen had better locomotor functional recovery. The results of H&E/Nissl staining, Golgi staining and immunofluorescence showed that the rats in the combined regimen retained the most neurons and had the least cavities and more formations of dendritic spines. Similarly, the positive rate was high for MAP2, NeuN and MBP, and low for GFAP. The graft of the NGF persistent delivery scaffold seeded with neurally differentiated BMSCs significantly reduced the formation of cavities and glial scars at the SCI sites and promoted neuronal survival, axonal regeneration and locomotor function recovery. Compared with the single graft of NGF persistent delivery scaffold or the single graft of neurally differentiated BMSCs, this combined scheme had a better effect in promoting the recovery of SCI.

背景:干细胞具有多向分化潜能,组织工程支架可以为其提供支持,神经营养因子则可以促进干细胞的分化,3者联合移植治疗方案促进脊髓损伤功能恢复是当前研究热点之一.目的:综述近年来干细胞、组织工程支架、神经营养因子及其联合移植治疗脊髓损伤的研究进展.方法:作者检索PubMed、Sciencedirect、Medline、中国知网等数据库2000年1月至2019年10月的相关文章.英文检索词为"spinal cord injury,mesenchymal stem cells,issue engineering,neurotrophic factor",中文检索词为"脊髓损伤,间充质干细胞,组织工程,神经营养因子",检索文献类型为研究原著,初检文章712篇,再经过严格筛选后,对符合要求的79篇文献进行分类综述.结果与结论:单纯的干细胞移植并不能重建脊髓的复杂结构和稳定性,而单纯的生物材料、神经营养因子也不能替代脊髓损伤过程中的神经元丢失,因此联合移植是脊髓损伤治疗的研究方向.但是由于脊髓损伤的部位、损伤的组织及其修复时的营养需求各异,如何将干细胞、组织工程支架、神经营养因子联合的方案最优化仍是一个巨大的挑战.

A titanium mesh cage (TMC) is a common device used for interbody fusion in anterior cervical corpectomy and fusion (ACCF) surgery, with postoperative subsidence being a common complication. Among the many influencing factors, there is a paucity of research on the end-covers of the TMC. A total of 62 patients with cervical spondylotic myelopathy were treated with single-level ACCF. TMC without end-covers (group A), traditional TMC with end-covers (group B) and new TMC with end-covers (group C) were used as the fusion device. We evaluated the surgery time, intraoperative blood loss, postoperative drainage volume, postoperative fusion, falling height of the fused segment, cervical curvature and severe subsidence rate (the number of falling height of the fused segment > 3 mm/total surgical cases in the group). In addition, the Japanese Orthopaedic Association score was used for neurological status assessment and a 10-point Visual Analog Scale for postoperative neck pain. The results showed that the falling height of the fused segment in group A (1.9 ± 0.6 mm) was significantly greater than in group B (0.9 ± 0.2 mm) and group C (0.8 ± 0.3 mm). The area of the end-covers increased gradually in group A, group B and group C, while the severe subsidence rate of group A (8/20, 40%), group B (5/22, 23%) and group C (2/20, 10%) gradually decreased. The surgery time and blood loss in group B (116.4 ± 12.2 min, 183.5 ± 36.4 mL) were higher than those in group A (90.22 ± 5.60 min, 110.4 ± 20.8 mL) and group C (92.8 ± 8.47 min, 114 ± 24.0 mL). These results showed that there was a correlation between the postoperative subsidence and the end-covers of TMC. The larger the end-cover area was, the lower the severe postoperative subsidence rate was. In addition, the design of the end-covers extending inward was more conducive to the operation.

Objective To investigate the effect of vacuum sealing drainage (VSD) in the replantation of the avulsed skin and soft tissue of the extremities.Methods A retrospective study was performed in 192 patients with skin and soft tissue avulsion of the extremities who were hospitalized in our hospital from January 2012 to December 2014.All patients underwent debridement and replantation of skin and soft tissue,and then 87 patients (group A) received simple pressure dressing,while 105 patients (group B) received VSD.The following indices were compared between the two groups:survival rate of skin and soft tissue,treatment duration,and pain score,infection rate,and reoperation rate at 72 h after surgery.Results Compared with group A,group B had a significantly higher survival rate of skin and soft tissue (Z=8.146,P＜0.01) and a significantly shorter hospital stay ((12.4±2.3) d vs (23.1±3.1) d,t =6.121,P ＜0.05).And group B had significantly lower pain score,infection rate,and reoperation rate at 72 hours after surgery than group A (1.78±0.67 vs 8.32±1.05,t=5.332,P＜0.05;12.4％ vs 47.1％,x2=5.691,P＜ 0.05;18.1％ vs 44.8％,x2 =5.729,P＜0.05).Conclusion In the replantation of the avulsed skin and soft tissue of the extremities,compared with simple pressure dressing,VSD can shorten the treatment duration,relieve patients' pain,and reduce the reoperation rate and the burden of medical staff.

目的：比较微型铆钉和抽出钢丝法治疗锤状指的临床疗效。方法选取单纯伸肌腱止点撕脱导致的锤状指患者23例，11例采用微型铆钉修复，12例采用抽出钢丝法修复。23例患者术后均固定于近节指间关节屈曲、远节指间关节过伸位6周，6周后行手指功能锻炼。观察患者远节指间关节活动度。结果23例患者获7.2～12.3个月随访，微型铆钉修复患者远节指间关节活动度优6例，良4例，可1例；抽出钢丝法修复患者远节指间关节活动度优5例，良6例，差1例（由于功能锻炼过程中肌腱再撕脱）；两组比较差异无统计学意义（P＞0．05）。结论微型铆钉和抽出钢丝法治疗锤状指临床疗效均较好，但微型铆钉可有效防止肌腱再撕脱。

目的:研究比较股骨近端髓内钉(PFNA)和动力髋螺钉(DHS)治疗股骨转子间骨折的临床疗效.方法:选择2012年1月至2013年12月间因单侧股骨转子间骨折于我院住院行PFNA及DHS手术治疗的患者312例,其中192例采用PFNA内固定,120例采用DHS内固定,记录手术时间、术中出血量、术后3 d VAS评分、住院时间、Harris评分,并将所记录的结果进行统计分析.结果:PFNA和DHS两组的手术时间之间差异有统计学意义,而术后3d的VAS评分、住院时间及术后1年的Harris评分差异均无统计学意义,术中出血量的差异性仍需要进行进一步求证.结论:PFNA和DHS两种内固定方法治疗股骨转子间骨折时,手术时间PFNA优于DHS,而临床疗效两者无明显差异.

目的：探讨常规冲洗与脉冲冲洗在治疗GUSTILO-III型胫骨开放性骨折时的效果差异。方法：2013年1月-2015年5月本科收治的GUSTILO-III型胫骨开放性骨折的患者49例，23例采用常规冲洗，26例采用脉冲冲洗，对于受伤至冲洗的时间差、冲洗时间、冲洗量、伤口愈合时间、伤口愈合情况、感染率数据进行统计分析，并对冲洗前后的创面组织进行细菌培养。结果：两种冲洗方法在冲洗时间、冲洗量、伤口愈合时间、伤口愈合情况及感染率方面无明显统计学差异，与受伤至冲洗的时间差无统计学相关性。结论：常规冲洗与脉冲冲洗在治疗GUSTILO-III型胫骨开放性骨折均效果良好，而且两种方法效果无差异。

目的:总结50例危重症患者远距离转运过程中的风险因素,提出防范措施.方法:回顾性分析50例危重症患者从接诊至远距离转运送达目的地的全过程,归纳总结出较常见的风险因素,探讨防范这些风险因素的具体措施.结果:50例危重症患者中男27例,女23例;年龄最大82岁,最小19岁,平均58.7岁;放弃治疗8例,送回当地医院7例,转入南京市三级医院35例;格拉斯哥昏迷评分法≤8分者42例(84.00％),气管插管者26例(52.00％),转运成功45例,途中死亡5例.结论:患者病情非常危重、随车医护人员整体素质欠缺、转运前的准备工作不充分、对患者病情缺乏全面评估、医患沟通不足等是远距离转运过程中较常见的风险因素.

Objective To evaluate the long-term results of microendoscopic discectomy(MDE) in treatment of lumbar disc herniation and the factors to influence its prognosis.Methods A questionnaire survey was conducted in 515 patients underwent MED to investigate Oswestry disability index(ODI) and MacNab criteria.Prognostic factors including gender,age,course of disease,implicated segment,operation time and blood loss were evaluated by logistic regression analysis.Results A total of 312 patients(202 male and 110 female) obtained effective follow up with an average duration of 7 years.The mean ODI score was 7.5 and the excellent/good rate was 73.7% at the final follow-up.Outcomes based on MacNab criteria were good in 247 patients,fair in 62 and bad in 3 thereby indicating a significant symptomatic improvement in 79.2% of the patients.High correlation was obtained between ODI score and MacNab criteria(P0.01).Logistic regression analysis showed both ODI score and MacNab criteria were closely related to age,course of disease and multiple segment lesions.Conclusion MED shows the satisfactory long-term results for the treatment of lumbar disc herniation.Elder patient,long course of disease and multiple segment lesions are the main risk factors for predicting the long-term results of MDE.

目的探讨锁定加压钢板(LCP)内固定结合自体髂骨植骨治疗肱骨干骨折术后无菌性骨不连的疗效。方法应用LCP内固定结合自体髂骨植骨治疗45例肱骨干骨折术后无菌性骨不连。结果本组获随访7～38个月,骨不连均获治愈。肩关节功能优良率91.1%,肘关节功能优良率100%。结论 LCP内固定结合自体髂骨植骨可以显著提高骨愈合率,是治疗肱骨干骨折术后无菌性骨不连的有效方法之一。

Objective:To observe long-term clinical effect of microendoscopic discectomy for central type of lumbar disc herniation,to confirm the clinical value of microendoscopic discectomy in treatment of central type of lumbar disc herniation.Methods:23 cases with central type of lumbar disc herniation treated by microendoscopic discectomy were followed,the outcomes were estimated by ODI and the MacNab's criteria.Results:19 cases were followed up for 72.8 months(range 60-84 months),there were 14 males and 5 females,average ODI score was 4.6(range 0-14),efficient was 84.2%.According to MacNab's criteria,efficient was 94.7%.Conclusion:The effect of microendoscopic discectomy for central type of lumbar disc herniation is excellent.

When the input common-mode signals exceed or approach the supply voltage,shortcomings of traditional voltage comparators will emerge.It is necessary to design a new comparators to sense high common-mode signals.A commongate input stage was adopted,which largely extends the range of the input commonmode.Base on this input stage,two comparators were designed.The supply and Li-ion battery voltage in the Li-ion battery charge circuits were monitored by one,the other response speed is high.Simulation in CSMC0.6 μm CMOS process shows that the former can implement the input offset and hysteresis easily,and the quiescent current is only 1.2 μA.The input common-mode range of the latter is 1.3 to 15 V with a single supply voltages of 5 V.Its propagation delay is 11 ns with a 10 mV overdrive and quiescent current is 91 μA.