Background: Spinalfusion has shown satisfactory efficacy in the treatment of adult patients with low-grade isthmic spondylolisthesis (LGIS), however, the efficacy of direct repair (DR) for LGIS has not been established, and there is as yet a few reports on it. Objective: To assess the clinical efficacy of DR with the pedicle screw-rod-hook (PSRH) fixation and transforaminal lumbar interbody fusion (TLIF) in adult patients with symptomatic LGIS. Methods: A total of 140 adult patients with LGIS were enrolled from April 2009 to December 2018, of whom, 69 cases underwent DR using the PSRH system and 71 cases underwent TLIF, with clinical efficacy evaluated comparatively using clinical and radiological assessments. Results: The patients in both groups showed satisfactory pain relief efficacy and improvement in lumbar spine function. Bone fusion rate was 97.10% in the DR group vs. 100% in the TLIF group. The range of motion (ROM) of the surgical segment was significantly decreased from 13.72±6.73 preoperatively to 11.60±9.70 at the final follow-up (FFU) in the DR group and lost in the TLIF group, however, that of the upper intervertebral space (UIS)in each group or between groups before and after operation did not differ significantly. Conclusion: Both DR and TLIF are effective for adult patients with LGIS. As compared with TLIF, DR is more effective in preserving the ROM of the operative segment yet with less impact on adjacent segments.

Objective To investigate the clinical characteristics and identify risk factors of postoperative recurrence in thoracolumbar tuberculosis, aiming to assess clinical significance and propose management strategies. Methods Retrospective review of 69 patients' medical records with postoperative recurrence of thoracolumbar tuberculosis from 2006 to 2019, including demographics, clinical presentations, radiographic data, drug susceptibility, laboratory results, and recurrence patterns. Results The study included 40 males and 29 females, with a mean age of 36.1 ± 14.2 years at initial surgery and 37.5 ± 14.5 years at recurrence. Manifestations included pain (55.1%), sinus tracts (47.8%), and neurological deficits (37.7%). Radiographic assessments showed paravertebral (89.9%) and flowing abscesses (37.7%). Drug resistance was present in 41.5% of cases. Inflammatory markers were elevated in most patients, with anemia and hypoalbuminemia frequently observed. Most recurrences occurred within 24 months post-surgery, with a maximum interval of 84 months, and 37.7% had multiple recurrences. Conclusion Postoperative recurrence in thoracolumbar tuberculosis is multifactorial, linked to drug-resistant tuberculosis, inconsistent medication adherence, poor nutrition, inadequate immobilization, and systemic tuberculosis infections. Optimal postoperative surveillance and clinical management necessitate a focus on inflammatory markers, advanced imaging, diligent patient education, and rigorous follow-up to diminish recurrence rates and enhance patient outcomes.

Objective:To investigate the alleviating effect and potential mechanism of TRPC6 on renal ischemic reperfusion injury (RIRI).Methods:After establishing oxygen-glucose deprivation/reoxygenation, OGD/R HK-2 model cells and ischemia-reperfusion (I/R) model mice, the expression levels of IL-1β and IL-18 in model cells or mice were detected by using ELISA kits, whilst the expression of caspase-1 was examined by RT-qPCR, Western blot, and immunohistochemistry. And the cell viability and pyroptosis were determined by CCK-8 assay and flow cytometry. Moreover, the interaction between TRPC6 and miR-214 was identified by dual-luciferase reporter assay.Results:The expression of TRPC6 was observably increased in OGD/R HK-2 cells and I/R model mice. Meanwhile, down-regulation of caspase-1 enhanced the vitality of OGD/R HK-2 cells and inhibited inflammation and pyroptosis. Overexpression of TRPC6 could alleviate renal injury and down-regulate caspase-1 in I/R model mice. TRPC6 could down-regulate caspase-1 partly by regulating miR-214, thereby improving RIRI.Conclusion:TRPC6 alleviates RIRI by targeting miR-214 to down-regulate caspase-1 expression. The TRPC6/miR-214/caspase-1 regulatory pathway may provide key clues for the therapy of RIRI.

目的 探讨自体富血小板血浆凝胶(autologous platelet-rich plasma gel,APG)治疗难治性压力性损伤的效果.方法 选取2019年10月—2021年10月海军军医大学第一附属医院收治的难治性压力性损伤患者80例,随机分为两组各40例,对照组采用常规治疗,观察组采用APG治疗,比较两组治疗不同时间点溃疡面积、溃疡愈合时间、压力性损伤愈合评估量表得分、生长因子水平、临床疗效及生活质量.结果 观察组治疗6、9、15d溃疡面积(11.86±3.93)cm、(10.16±2.96)cm、(8.37±2.85)cm小于对照组(14.58±3.27)cm、(13.18±3.82)cm、(11.92±3.17)cm(t=3.365,P=0.001;t=3.952,P＜0.001;t=5.267,P＜0.001);观察组创面愈合时间(18.26±5.22)d短于对照组(25.57±5.38)d,压力性损伤愈合评估量表评分(3.97±1.27)低于对照组(6.46±1.65)(t=6.167、7.563,均P＜0.001);观察组临床有效率(95.00％)高于对照组(77.50％)(x2=5.165,P=0.023);观察组治疗6d VEGF(0.61±0.23)ng/mg、IGF-1(32.84±11.48)ng/mg、EGF(13.27±5.23)pg/mg、PDGF-BB(19.82±6.35)pg/mg、TGF-B1(0.45±0.14)ng/mg高于对照组(0.24±0.16)ng/mg、(19.24±9.76)ng/mg,(10.13±4.82)pg/mg、(13.48±5.38)pg/mg、(0.27±0.16)ng/mg(t=8.352,P＜0.001;t=5.708,P＜0.001;t=2.792,P=0.007;t=4.818,P＜0.001;t=5.355,P＜0.001);观察组治疗 15 d VEGF(0.47±0.22)ng/mg、IGF-1(26.92±8.62)ng/mg、EGF(13.72±4.64)pg/mg、PDGF-BB(16.53±5.92)pg/mg、TGF-B1(0.34±0.12)ng/mg 高于对照组(0.31±0.17)ng/mg、(16.26±6.83)ng/mg、(9.26±3.84)pg/mg、(11.74±6.28)pg/mg、(0.21±0.15)ng/mg(t=3.640、6.130、4.683、3.510、4.280,均P＜0.001);观察组治疗30d生活质量评分(78.17±6.29)高于对照组(68.21±5.93)(t=7.287,P＜0.001).结论 APG治疗难治性压力性损伤能够缩短创面愈合时间、提高临床疗效与生活质量.

In fire accidents, large-area burn patients are often accompanied by inhalation injury and have a high mortality rate; how to properly handle smoke inhalation resulting in acute lung injury(SI-ALI) has always been a huge challenge for burn apartment medical workers. By reading the published literature on SI-ALI, the author reviewed the current research progress in pathological mechanism and clinical manifestations, diagnostic methods, treatment measures of inhalation injury.

Background:Renal ischemic reperfusion injury (RIRI) is the most hackneyed cause of acute renal injury with high incidence. As a slit diaphragm (SD), TRPC6 (transient receptor potential channel 6) can maintain the structure and function of glomerular podocytes, and its activation has been reported to prominently alleviate ischemia reperfusion (I/R). However, the specific mechanism of TRPC6 in RIRI is uncertain.Methods:The TRPC6 specific shRNA or overexpressing plasmid was used to decrease or increase TRPC6 level in HK-2 cells, respectively. Subsequently, the OGD/R (oxygen-glucose deprivation and re-oxygenation) HK-2 cells and RIRI model rats was established to examine the effect of TRPC6 in RIRI in vitro. After processing, viability was confirmed with MTT; cell necrosis was analyzed with flow cytometry; necrosis and autophagy-related proteins were verified with Western blot; free Zn2+ was tested with an Zn2+ fluorescent probe; and cell autophagy was monitored with MDC (monodansylcadaverine) method. Furthermore, TRPC6 agonist (OGA) or TRPC6 inhibitor (SKF96365) were introduced to increase or inhibit the activity of TRPC6 in RIRI model rats, and the kidney injury was assessed with H&E staining and RIP1 and PARP-1 expressions were examined with IHC (immunohistochemistry) staining.Results:Our results verified TRPC6 could markedly enhance viability, Zn2+ influx, and autophagy, and suppressed necrosis in OGD/R HK-2 cells. In addition, increase of Zn2+ or autophagy activation produced similar results to TRPC6 overexpression in viability, autophagy, and necrosis of OGD/R HK-2 cells. Rescue experiment results also showed TRPC6 could prevent necrosis and facilitate Zn2+ influx and autophagy of OGD/R HK-2 cells by inducing Zn2+ influx and autophagy. Moreover, TRPC6 could ameliorate kidney injury, block necrosis, and enhance autophagy in RIRI model rats by promoting Zn2+ influx and autophagy.Conclusions:TRPC6 could prevent necrosis and induce autophagy to alleviate RIRI by accelerating Zn2+ influx and autophagy. This shows TRPC6/Zn2+ influx/autophagy might be a novel therapeutic strategy for RIRI.

Objective Type C fracture is a complete intra-articular fracture, and the mainstay of treatment remains open reduction and internal fixation. The purpose of the study is to observe the clinical effect of an anterior ankle C approach (ankle-C) combined with minimal invasive plate osteosystems (MIPO) for tibial pilon fractures (AO/OTA 43C, combined with fibula fractures). Methods A retrospective comparative analysis was performed on the clinical data of 33 patients with C-type pilon fractures (combined fibula fractures) admitted to our department from July 2018 to July 2021, including 12 cases treated with ankle-C (a-C) approach and 21 cases with conventional approach (including combined approach). All patients were followed up for over 6 months. Visual Analogue Scale (VAS), AOFAS Ankle-Hindfoot Scale (AOFAS-AHS), wound healing time, fracture healing time, and complications were used to evaluate the clinical efficacy. Results The scores of VAS and AOFAS in the a-C group scored better than the conventional group (P < 0.05), especially in the extent of limited range of motion (LROM) of ankle dorsiflexion-plantarflexion in 1 month after operation and at the last follow-up (P < 0.01). Bone healing was achieved in both groups 6 months after operation, with no implant exposure or infection. Among them, 4 cases in the conventional approach group had wound healing time exceeding 2 weeks. Conclusions For type C pilon fractures (combined with fibula fractures), ankle-C approach combined with MIPO technique has certain advantages in ankle function recovery and soft tissue repair, which provides an alternative for the treatment of type C pilon fractures.

目的 探讨脂肪间干细胞外泌体在通过调节细胞外基质重塑促进皮肤无疤痕修复的效果.方法 2020年3月—2020年6月选取40只小鼠为研究对象,随机分为观察组与对照组,每组各20只.建立小鼠背部创伤模型,实验组小鼠经尾部注射0.2 mg/mL的外泌体悬液100 μL,对照组小鼠则注射等剂量的PBS溶液.观察并对比两组小鼠残余创面面积、瘢痕横截面积、瘢痕抬高指数及瘢痕增生评分及基质金属蛋白酶1(MMP1)、基质金属蛋白酶3(MMP3)水平等指标.结果 治疗前两组小鼠残余创面面积无明显差异(P＞0.05),治疗后3 d、5 d及7 d观察组小鼠残余创面面积明显小于对照组,差异具有统计学意义(P＜0.05);观察组小鼠瘢痕横截面积明显小于对照组[(0.18±0.05)vs(0.37±0.09)],观察组小鼠瘢痕抬高指数低于对照组[(2.15±0.36)vs(4.27±0.39)],观察组小鼠瘢痕增生评分低于对照组[(5.12±1.07)vs(9.86±1.35)],差异均具有统计学意义(P＜0.05);观察组小鼠 MMP1、MMP3含量分别为(12.38±1.76)ng/mL、(13.72±2.16)mg/mL,对照组中小鼠 MMP1、MMP3含量分别为(20.52±2.85)ng/mL、(19.78±2.39)mg/mL,观察组中小鼠 MMP1、MMP3含量明显低于对照组,差异具有统计学意义(P＜0.05).结论 脂肪间干细胞外泌体可通过调节细胞外基质重塑促进皮肤无疤痕修复,能够调控相关基质金属蛋白酶的表达,促进细胞外基质的重建,进而有效抑制瘢痕的形成,提升皮肤修复质量,对皮肤伤口愈合具有一定的指导作用.

二加龙骨汤载于《小品方》,是桂枝加龙骨牡蛎汤的变方.原记载治疗"男子失精,女子梦交".临床依据症状反应,以先辨六经八纲继辨方证,求得方证对应,应用本方治疗男科、妇科及其他各科疾病归属于少阴阳明合病者,尤其治疗早泄疗效较好.该方愈病机制,依据胡冯经方医学体系,认为主在解少阴之表,同时清阳明里热,从而解除表虚不固,敛浮热止自汗、盗汗,而促使津血再生,同时强壮人体机能之沉衰.突破了既往"肾气不固"的传统观念,从而为辨治早泄提供了另一条辨证思路.

肾移植后TMA是肾移植后少见的严重并发症，移植肾和受者预后均不佳，国内报道甚少，陆军军医大学第一附属医院报道1例肾移植后出血并TMA，移植物丢失，随访18个月，受者情况良好。

Backgroud: A variety of extrapedicular puncture methods have been successfully used in percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Currently, there are no reviews on extrapedicular puncture. Authors reviewed the puncture methods in different extrapedicular approaches and recommend appropriate extrapedicular puncture methods for thoracolumbar PVP (PKP). Methods: All the published research available in English and Chinese up to January 2020 from Web of Science, PubMed, Embase, China National Knowledge Internet (CNKI), and the Wanfang Database were included. The subject areas included "percutaneous vertebroplasty, percutaneous kyphoplasty, vertebral augmentation" and "extrapedicular, parapedicular, bilateral, and unilateral". Articles met the selection criteria if they contained the details of the puncture method of the extrapedicular approach. Results: We searched 118 studies, and after careful reading, 9 studies introduced 10 types of extrapedicular punctures in detail: the transcostovertebral approach, extrapedicular approach, unilateral extrapedicular approach, far-lateral extrapedicular approach, parapedicular access, lumbar extrapedicular approach, thoracic infrapedicular approach, extrapedicular modified inferior endplate access, extrapedicular approach along the predetermined individualized puncture route, and Kambin triangle approach. Conclusions: In thoracic vertebrae, the extrapedicular approach could be a better puncture method. In the upper lumbar vertebrae, the unilateral extrapedicular and far-lateral extrapedicular approach are recommended as the extrapedicular puncture methods. In L4-5, extrapedicular puncture is not recommended because of the high risk of injury to the lumbar artery.

卫勤训练是指为提高卫勤保障能力所进行的训练,包括卫勤指挥训练、专业技术训练、自救互救训练等.该文结合部队卫勤训练转型,分别从院校及机关层次梳理分析了院校教育、任职培训、进修学习、集中训练等卫勤训练现状问题,从部队层次梳理分析了单人训练、班组训练、连训练等卫勤训练特点,并就部队卫勤训练提出了全员参训、狠抓教学、强化重点、夯实基础和利于实战等对策建议,旨在为提高部队卫勤训练质量提供参考.

军旅营体制队属医院组建培训基地,旨在提高部队卫生人员专业技术操作能力.目前,队属医院培训部队卫生人员还存在培训方法单一、重理论轻实践、内容趋向平时、模拟训练缺乏等问题.该文提出队属医院组建培训基地应在健全机构、强化教学、注重基础、加强协作等方面下功夫,并提出充分认清意义、提高办学起点、深入融合培养、强化服务管理等建议.

器官移植是终末期器官功能衰竭最有效的替代治疗手段,提高移植物及移植受者的长期生存率是器官移植学科的主要研究目标,免疫抑制剂是维持移植物存活的最关键环节.移植肾丢失率以每年约5％的速度递增,影响移植肾存活的很多关键因素都与免疫抑制剂有关.免疫抑制剂是对机体免疫反应具有抑制作用的药物,能影响移植免疫相关细胞(主要是T细胞和B细胞)的增殖及功能,降低免疫应答以达到维持移植物存活的目的.因此,优化的免疫抑制策略指针对免疫应答不同阶段、不同靶点联合使用免疫抑制剂,协同免疫抑制效果,与此同时可降低免疫抑制剂量,降低感染风险,减少移植相关并发症.

目的 探讨基于肾脏一体化+动漫视频融合教学平台在肾脏病学专业学位研究生教育中的应用效果.方法 选取陆军军医大学第一附属医院肾科2017～2020肾脏病学专业学位研究生70名为研究对象,并随机分为两组.其中,实验组学员35名,采用肾脏一体化+动漫视频融合教学平台进行教学;对照组学员35名,按照传统临床教学方法进行教学.比较两组学生在完成肾脏科学习后的出科测试成绩差异,并通过问卷了解实验组学生对新教学方法的反馈情况.结果 实验组学生理论考核成绩和实践技能实践考核成绩均高于对照组学生,且差异均具有统计学意义.经分析发现,两组之间的成绩差异主要来自作为既往教学短板的肾脏病理和肾脏移植亚专业的提高.实验组的调查问卷反馈结果显示学生认可新的教学方法能提高教学质量,弥补知识短板,提高职业自信.结论 基于肾脏一体化+动漫视频融合教学平台能调动学生自主学习的积极性,有效提高教学效率和质量,弥补传统的知识短板,使学生更自信地面对未来的肾脏病学执业生涯.

随着部队信息化、现代化建设的不断发展,军事化和非军事化斗争准备任务更加艰巨,对部队的实战化卫勤保障能力提出高要求.现代高技术战争中,高新技术武器的巨大杀伤效应,使得未来战争呈现武器杀伤强度大,致伤作用时间长,复合伤、多发伤增多,伤亡机制复杂,新伤类、新伤型增多,救治难度大等特点,对医务人员的救治能力提出了更高的要求.近年来,本单位将伤情驱动模式纳入在校学员卫勤演练,以伤情诱导为演练主线,提高演练各环节组织指挥、技术应用和保障手段实战运用能力,收到良好的教学和训练效果.

目的 通过前瞻性研究评估经后路椎弓根动态固定术与单纯髓核摘除术治疗单节段腰椎间盘突出症的中长期临床疗效.方法 选取陆军军医大学第一附属医院2012年7月至2014年8月收治的104例腰椎间盘突出症患者,其中19例因未能完成随访剔除本研究,最终85例纳入本研究.根据患者术式选择分为动态组44例和单摘组41例,术后随访5年以上.比较2组患者临床评估指标(VAS、ODI)、影像学评估指标(腰椎活动度、椎间隙高度)及并发症(手术节段腰椎间盘突出复发、腰椎不稳、螺钉松动及伤口感染)情况.结果 动态组在末次随访时VAS及ODI优于单摘组(P<0.05).末次随访时动态组椎间隙高度下降约12.75％,单摘组下降24.17％,2组比较差异有统计学意义(P<0.05).患者腰椎整体活动度术前与术后组内比较差异无统计学意义(P>0.05),2组间比较差异也无统计学意义(P>0.05);动态组手术节段末次随访时保留(4.05±0.79)°的活动度,约为术前活动度的45.30％,末次随访时邻近节段活动度与术前比较差异无统计学意义(P>0.05).动态组无腰椎间盘突出复发,单摘组复发5例,其中4例行保守治疗,1例再次手术.动态组未出现腰椎失稳病例,单摘组有3例失稳病例,其中1例因手术节段滑脱,出现腰痛及下肢神经症状再次手术,2例因无症状随访观察;2组均未出现螺钉松动及伤口感染病例.结论 经椎弓根动态固定术中长期临床疗效优于单纯髓核摘除术,能更好地维持椎间隙的高度,减少手术节段的复发和腰椎不稳的发生.

新体制对部队卫生士官队伍建设进行了全新定位,为顺利完成平战时卫勤保障任务、充分发挥卫生士官生力军作用奠定了重要基础.该文分析了当前卫生士官队伍现状,认为应将聚焦思想、强化管理、培养技能、岗位实践、全面锤炼作为卫生士官队伍建设重点,提出了新体制下部队卫生士官队伍建设的对策建议.

Objective To investigate the role of aquaporin-3 (AQP-3) in hyperosmolarity-induced apoptosis of cultured rat nucleus pulposus (NP) cells. Methods Rat NP cells were cultured under different osmotic pressures (330 and 550 mOsm/kg), and the proliferation and apoptotic rate of the cells were determined using CCK-8 assay and flow cytometry, respectively. Western blotting and real-time quantitative PCR were used to detect the expression levels of apoptosis-related molecules (Bcl-2, Bax, cleaved caspase 3/caspase 3), and immunocytochemistry, Western blotting and real-time quantitative PCR were used to detect the expression of AQP-3 in the cells. The effect of lentivirus-mediated AQP-3 overexpression on apoptosis of NP cells was investigated after hyperosmolar exposure. Results An osmotic pressure of 550 mOsm/kg, as compared with 330 mOsm/kg, significantly decreased NP cell proliferation, increased the cell apoptotic rate, upregulated the expression of the pro-apoptotic molecules Bax and cleaved caspase 3/caspase 3 (P < 0.05), and down-regulated the expression of the anti-apoptotic molecule Bcl-2 (P < 0.05). The cells with lentivirus-mediated AQP-3 overexpression showed an obviously lowered apoptotic rate following the hyperosmolar exposure and significantly reduced expression of Bax and cleaved caspase 3/caspase 3 (P < 0.05) with an enhanced expression of Bcl-2 (P < 0.05). Conclusion Hyperosmolar exposure significantly promotes apoptosis of NP cells and reduce the expression of AQP-3. AQP-3 overexpression can partly attenuate apoptosis of NP cells following a hyperosmolar exposure.