前臂骨间背侧动脉逆行岛状皮瓣在手外科的应用

<正> 解剖发现前臂骨间背侧动脉的末端在腕上与骨间掌侧动脉背侧支之间有恒定的吻合支,以此吻合支为蒂,可设计前臂骨间背侧动脉逆行岛状皮瓣,修复手部软组织缺损。     

骨间返血管为蒂前臂皮瓣的应用解剖

目的：为骨间返血管前臂皮瓣修复前臂近端、肘关节周围及臂下部的软组织缺损提供解剖学基础。方法：在３６侧灌注红色乳胶的成人上肢标本上，观测了骨间返动脉的起源、走行、分布和吻合。结果：骨间返动脉起始部距尺骨鹰咀最突出点为６．９±１．１ｃｍ，尺骨嵴外侧１．４±０．３ｃｍ，于尺骨鹰咀最突出点下方４．４±１．４ｃｍ，于肘肌与尺侧腕伸肌间发出皮支。骨间返动脉终末支至肘后部与桡侧返动脉、桡侧副动脉背侧支、中副动脉构成吻合。结论：以骨间返血管为蒂前臂背侧皮瓣顺行转位可修复前臂近端软组织缺损，如以吻合支为蒂逆行转位可修复肘关节周围及臂下部软组织缺损。     

腕背侧深层神经血管分布与腕背痛的解剖学研究

目的　对腕背侧深层神经血管来源、走行及分布进行解剖,探讨神经血管损伤与腕背痛的关系,为临床诊治腕背痛提供解剖学基础。 方法　在头戴式放大镜下,对10具尸体标本20侧上肢进行了腕背侧深层神经血管来源、走行及分布进行大体解剖并测量相关数据。 结果　腕背侧深层神经来源于骨间后神经终末支,经过第4骨纤维管道后分布至腕关节背侧;血管来源于骨间前动脉终末支,骨间前动脉在旋前方肌上缘穿前臂骨间膜至前臂后面,终末支最终分为桡侧和尺侧分支,分别经过第4和第5骨纤维管道分布至腕背侧深层,而桡侧分支在穿经第4骨纤维管道时与骨间后神经终末支伴行,尺侧分支单独穿过第5骨纤维管道。 结论　明确腕背侧深层神经血管分布、来源及走行,对腕背痛的预防、诊断、治疗具有重要临床意义。     

以骨间后血管及其返支为蒂串连皮瓣设计的解剖学基础

目的 :为以骨间后血管及其返支为蒂串连皮瓣设计提供解剖学基础。方法 :在 40侧上肢标本上观测了骨间后动脉及其返支的来源、走行、分支、分布及吻合情况。结果 :前臂背侧下 2 / 3区的皮瓣由骨间后动脉供血 ,而上 1/ 3区由骨间后动脉返支 (或骨间返动脉 )供血。骨间后动脉起点外径 1.5mm ,管蒂长可达 15cm ,骨间后动脉返支起点外径 1.1mm ,血管蒂长 5cm。结论 :以骨间后动脉及其返支为蒂截取的串连皮瓣 ,向下可修复手部大面积组织缺损 ;向上可修复肘关节周围及臂下部大面积组织缺损     

人体骶尾骨的动脉供应——骨外部分

本实验用解剖、透明、X线摄片和腐蚀铸型等方法研究了56例不同年龄新鲜尸体的骶尾骨骨外动脉的配布。骶骨的动脉供应主要来自骶外侧动脉、骶中动脉、髂腰动脉和腰最下动脉。骶中动脉、骶外侧动脉及其分支在骶骨腹侧面相互吻合形成骶前格子状动脉吻合网。椎管前支在椎间孔内侧分为升降二支,相邻升降支间在椎体背面相互吻合,两侧升降支间呈横形吻合。在骶椎椎体背侧形成菱形的骶管腹侧动脉网。椎管后支在椎板腹侧面亦分为升降二支,同侧及两侧升降支间在椎板腹侧形成梯状的骶管背侧吻合网。骶外侧动脉的背侧支出骶后孔即分为内侧支、肌支和外侧支。内侧支在骶中嵴两侧分为上下二支,相邻上下支之间形成骶中嵴动脉网。外侧支在骶骨外侧部分为升降二支,亦形成吻合。尾骨腹侧面的动脉来自骶中动脉和骶外侧动脉,背侧面主要由骶外侧动脉的终支供应。尾骨表面的动脉吻合稀少。     

骨间返动脉为蒂尺骨上段骨膜瓣移位的应用解剖

目的：为尺骨中上段和肱骨下段骨不连提供带血管蒂明膜瓣移位修复的解剖学基础，方法：在３６侧成人上肢标本上，观测了骨间返动脉的走行，分布和吻合，结果：骨间返动脉起始部距尺骨膺咀最突出点的长度为６．８９±１．１３ｃｍ，其动脉外径为１．３７±０．２９ｍｍ骨膜支外径为０．５４±０．２７ｍｍ，骨间返动脉母末支到肘后部与桡侧返动脉 ，桡别墅劝背侧支和中副动脉等构成吻合。结论：以骨间返动脉为蒂的尺骨上段骨膜瓣移闰     

尺侧返血管背侧支尺骨上段骨膜瓣移位术的应用解剖

目的 :为治疗肱骨干骨不连提供一种新的骨膜瓣供区。方法 :在 3 0侧成人上肢标本上解剖观察了尺侧返血管的起始、走行、分支、分布及其与尺侧下副动脉的吻合关系。结果 :尺侧返动脉始于尺动脉上段 ,距肱骨内上髁 (5 .3± 1.0 )cm ,外径 (1.9± 0 .3 )mm ,分出掌侧支和背侧支。背侧支位于尺神经深面 ,沿尺神经沟上行 ,沿途分出 4～ 8支外径在 0 .3～ 1.0mm的骨膜支 ,分布尺骨上段内侧骨面。结论 :以尺侧返血管背侧支为蒂的骨膜瓣逆行移位可修复肱骨中、下段骨不连。     

骨间后动脉前臂逆行皮瓣的解剖学研究

目的:通过对骨间后动脉的解剖观测,为骨间后动脉逆行皮瓣的临床应用提供解剖学依据。方法:用30侧成人上肢标本,对骨间后动脉及其皮支、吻合支的起始、走行、分布进行解剖观测。结果:骨间后动脉发自骨间总动脉,穿过骨间膜上缘至前臂背侧,经旋后肌和拇长展肌之间在前臂深浅两层伸肌之间下行,沿途发出7~12条皮支营养前臂背侧的皮肤,其终末支(96.7%)在尺骨茎突近端(2.5±0.5)cm处与骨间前动脉的背侧支有弧形吻合支相连接。其皮支分布可达动脉主干两侧6cm范围,近侧达肘平面,远端至腕平面。结论:以骨间后动脉为蒂,可在前臂背侧设计大面积(10cm×8cm)逆行岛状皮瓣,用以修复手部皮肤组织缺损、瘢痕挛缩切除术后创面。     

变异拇主要动脉吻合掌浅弓一例

在制作1成年男性右上肢血管神经标本时,发现变异拇主要动脉吻合掌浅弓1例.为积累国人解剖学资料,现报道如下.该标本中桡动脉在腕掌侧桡腕关节处未发出掌浅支,而是以单干斜向内下走行,在距桡骨茎突0.97 cm处入鼻烟窝并走行2.87 cm穿出,然后继续走行0.83 cm,至第1骨间背侧肌两头之间,穿人手掌参与构成掌深弓.其在穿人手掌前发出1分支称为变异支即拇主要动脉,其外径为1.56 mm,分支前后桡动脉外径分别为2.14 mm和1.90 mm.变异支在第1骨间背侧肌浅面走行5.02 cm至第1掌指关节内侧、第1骨间背侧肌下缘,发出示指桡侧固有动脉,其外径为0.94 mm,分支前后变异支外径分别为1.44 mm和1.40 mm.变异支绕向手掌走行0.86 cm至第1掌指关节手掌侧,发出拇指尺侧固有动脉,其外径为1.24 mm,分支前后变异支外径分别为1.30 mm和1.26 mm.     

肘后血管网与组织瓣设计的解剖学基础

目的：研究肘后血管网对肘后组织瓣的供血作用,为临床设计新的组织瓣提供解剖学基础。方法：通过6例新鲜上肢标本和2例上肢血管铸型标本的解剖,观察肘后血管网的形态学特点及其与肘后组织瓣的供血关系。结果：肘后血管网分为肘后内侧血管网和肘后外侧血管网,分别发出骨膜支和肌皮穿支到肘后相关组织瓣区,肘后内侧血管网吻合处外径在(1.8±0.3)mm;肘后外侧血管网吻合处外径在(0.9±　0.4)mm。肘后内、外侧血管网之间吻合处外径在0.3~0.9 mm。结论：根据肘后血管网吻合特点,可为临床设计出不带桡侧副动脉背侧支的外侧筋膜骨膜瓣、不带尺侧返动脉背侧支的内侧筋膜骨膜瓣和骨间返动脉骨膜支的鹰嘴骨膜皮瓣等组织瓣。     

Efficient, trans-complementing packaging systems for chimeric, pseudoinfectious dengue 2/yellow fever viruses

In our previous studies, we have stated to build a new strategy for developing defective, pseudoinfectious flaviviruses (PIVs) and applying them as a new type of vaccine candidates. PIVs combined the efficiency of live vaccines with the safety of inactivated or subunit vaccines. The results of the present work demonstrate further development of chimeric PIVs encoding dengue virus 2 (DEN2V) glycoproteins and yellow fever virus (YFV)-derived replicative machinery as potential vaccine candidates. The newly designed PIVs have synergistically functioning mutations in the prM and NS2A proteins, which abolish processing of the latter proteins and make the defective viruses capable of producing either only noninfectious, immature and/or subviral DEN2V particles. The PIV genomes can be packaged to high titers into infectious virions in vitro using the NS1-deficient YFV helper RNAs, and both PIVs and helpers can then be passaged as two-component genome viruses at an escalating scale.     

Biology of parainfluenza viruses.

Parainfluenza virus types 1 to 4 (PIV1 to PIV4) are important human pathogens that cause upper and lower respiratory tract infections, especially in infants and children. PIV1, PIV2, and PIV3 are second only to respiratory syncytial virus as a cause of croup in young children. Although some clinical symptoms are typical of PIVs, etiologic diagnosis always requires detection of infectious virus, viral components, or an antibody response. PIVs are typical paramyxoviruses, causing a syncytial cytopathic effect in cell cultures; virus growth can be confirmed either by hemadsorption or by using immunological reagents. Currently, PIV is most often diagnosed by demonstrating viral antigens in clinical specimens by rapid and highly sensitive immunoassays. More recently, PCR has been used for the detection of PIVs. Serological diagnosis is made by detecting a rising titer of immunoglobulin G or by demonstrating immunoglobulin M antibodies. PIVs infect species other than humans, and animal models are used to study the pathogenesis of PIV infections and to test candidate vaccines. Accumulating knowledge on the molecular structure and mechanisms of replication of PIVs has accelerated research on prevention and treatment. Several strategies for vaccine development, such as the use of live attenuated, inactivated, recombinant, and subunit vaccines, have been investigated, and it may become possible to prevent PIV infections in the near future.     

Production and characterization of vaccines based on flaviviruses defective in replication

To develop new vaccine candidates for flavivirus infections, we have engineered two flaviviruses, yellow fever virus (YFV) and West Nile virus (WNV), that are deficient in replication. These defective pseudoinfectious viruses (PIVs) lack a functional copy of the capsid (C) gene in their genomes and are incapable of causing spreading infection upon infection of cells both in vivo and in vitro. However, they produce extracellular E protein in form of secreted subviral particles (SVPs) that are known to be an effective immunogen. PIVs can be efficiently propagated in trans-complementing cell lines making high levels of C or all three viral structural proteins. PIVs derived from YFV and WNV, demonstrated very high safety and immunization produced high levels of neutralizing antibodies and protective immune response. Such defective flaviviruses can be produced in large scale under low biocontainment conditions and should be useful for diagnostic or vaccine applications.     

Prevalence of human respiratory viruses in adults with acute respiratory tract infections in Beijing, 2005–2007

To determine the aetiological role and epidemiological profile of common respiratory viruses in adults with acute respiratory tract infections (ARTIs), a 2-year study was conducted in Beijing, China, from May 2005 to July 2007. Nose and throat swab samples from 5808 ARTI patients were analysed by PCR methods for common respiratory viruses, including influenza viruses (IFVs) A, B, and C, parainfluenza viruses (PIVs) 1–4, enteroviruses (EVs), human rhinoviruses (HRVs), respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human coronaviruses (HCoVs) OC43, 229E, NL63, and HKU1, and adenoviruses (ADVs). Viral pathogens were detected in 34.6% of patient samples, and 1.6% of the patients tested positive for more than one virus. IFVs (19.3%) were the dominant agents detected, followed by HRVs (6.5%), PIVs (4.3%), EVs (3.2%), and HCoVs (1.1%). ADVs, RSV and HMPV were also detected (<1%). The viral detection rates differed significantly between infections of the lower and upper respiratory tracts in the sample population: PIVs, the second most commonly detected viral agents in lower acute respiratory tract infections (LRTIs), were more prevalent than in upper acute respiratory tract infections, indicating that the pathogenic role of PIVs in LRTIs should be investigated. Currently, this study is the largest-scale investigation of respiratory virus infections in China with multiple agent detection, providing baseline data for further studies of respiratory virus infections in adults with ARTIs.     

Reducing Bloodstream Infection Risk in Central and Peripheral Intravenous Lines: Initial Data on Passive Intravenous Connector Disinfection

BackgroundAlthough few facilities focus on it, bloodstream infection (BSI) risk from peripheral intravenous catheters (PIVs) may exceed central line-related risk. Over a 6-year period, Methodist Hospitals substantially reduced BSIs in patients with central lines but not in patients with PIVs. A practice audit revealed deficiencies in manual disinfection of intravenous connectors, thereby increasing BSI risk. Methodist thus sought an engineered approach to hub disinfection that would compensate for variations in scrubbing technique.MethodsOur institution involved bedside nurses in choosing new hub disinfection technology. They selected 2 devices to trial: a disinfection cap that passively disinfects hubs with isopropyl alcohol and a device that friction-scrubs with isopropyl alcohol. After trying both, nurses selected the cap for use in the facility's 3 intensive care units. After no BSIs occurred during a 3-month span, we implemented the cap throughout the hospital for use on central venous catheters; peripherally inserted central catheters; and peripheral lines, including tubing and Y-sites.ResultsComparing the postintervention period (December 2011-August 2013) to the preintervention span (September 2009-May 2011), the BSI rate dropped 43% for PIVs, 50% for central lines, and 45% overall (PIVs + central lines). The central line and overall results are statistically significant. The PIV BSI rate drop is attributable to cap use alone because the cap was the only new intervention during the postimplementation period. The other infection reductions appear to be at least partly due to cap use.ConclusionsOur institution achieved substantial BSI reductions, some statistically significant, by applying a disinfection cap to both PIVs and central lines.     

Clinical Evaluation of the Sorbaview SHIELD Securement Device Used on Peripheral Intravenous Catheters in the Acute Care Setting

Peripheral intravenous therapy (PIV) is probably the most common acute care invasive procedure, estimated at 90 percent for all inpatients. Current standards of practice recommend the use of a manufactured catheter stabilization device to secure PIVs. At FirstHealth Moore Regional Hospital (MRH), the PIV policy requires the use of a stabilization device to achieve a 96 hour dwell time for the PIV. The hospital does not utilize an intravenous therapy team; all nurses can insert PIVs and apply the dressing. In 2009, as a cost reduction measure, MRH changed securement devices from a two piece dressing and securement device to the Sorbaview SHIELD (SHIELD). A clinical evaluation of the SHIELD was conducted in January 2010, with 109 medical-surgical patients with PIVs, to demonstrate the expected cost savings associated with the SHIELD by maintaining the PIV for 96 hours and meeting patient and staff expectations. In 91.5% of the patients, the PIV stayed in for their length of stay (if less than 96 hours) or for 96 hours, only eight patients had unscheduled restarts. Eighty-six percent of nurses surveyed rated the device as excellent to good. Ninety-one percent of patients reported no discomfort of their PIV site. Changing to this device in 2009 has resulted in an average annual cost savings of $120,000 over the two piece device and has improved compliance by nursing.     

A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters

Background

Peripheral intravenous catheters (PIVs) have been considered as having lower risk of infection than central lines. However, research is limited regarding numbers of primary bloodstream infections related to peripheral lines and prevention of peripheral line-associated bloodstream infections (PLABSI).

Epidemiology of 11 respiratory RNA viruses in a cohort of hospitalized children in Riyadh,Saudi Arabia

Respiratory tract infections are a principal cause of illness and mortality in children worldwide and mostly caused by viruses. In this study, the epidemiology of 11 respiratory RNA viruses was investigated in a cohort of hospitalized children at a tertiary referral center in Riyadh from February 2008 to March 2009 using conventional and real‐time monoplex RT‐PCR assays. Among 174 nasopharyngeal aspirates, respiratory syncytial virus (RSV) was detected in 39 samples (22.41%), influenza A virus in 34 (19.54%), metapneumovirus (MPV) in 19 (10.92%), coronaviruses in 14 (8.05%), and parainfluenza viruses (PIVs) in 11 (6.32%). RSV, PIVs and coronaviruses were most prevalent in infants less than 6 months old, whereas MPV and influenza A virus were more prominent in children aged 7–24 and 25–60 months, respectively. The majority of the viruses were identified during winter with two peaks observed in March 2008 and January 2009. The presented data warrants further investigation to understand the epidemiology of respiratory viruses in Saudi Arabia on spatial and temporal basis. J. Med. Virol. 88:1086–1091, 2016 . © 2015 Wiley Periodicals, Inc.

     

Prospective study of human metapneumovirus infection in children less than 3 years of age

Most lower respiratory tract infections (LRTIs) in children under the age of 3 years are due to respiratory syncytial virus (RSV). Epidemiological, host, and viral factors eventually account for the severity of LRTIs, but they do not completely explain it. Human metapneumovirus (hMPV) was recently identified in children with LRTIs. In a population-based prospective multicenter study (the PRI.DE study, conducted in Germany over 2 years), we tested 3,369 nasopharyngeal secretions from children younger than 3 years of age with LRTIs for RSV A and B, influenza viruses (IVs) A and B, and parainfluenza viruses (PIVs) 1 to 3. Of the children requiring intensive care (n = 85), 18% had hMPV infections, and 60% of these children were infected with hMPV in combination with RSV. We did not detect hMPV in a randomly selected subset of RSV-positive nasopharyngeal secretions (n = 120) from children not requiring intensive care support. hMPV was detected in <1% of virus-negative samples from patients without intensive care support (n = 620). Our data support the hypothesis that coinfections with RSV and hMPV are more severe than infections with either RSV or hMPV alone, at least in children younger than 3 years of age.     

908例呼吸道感染患者病原体的IgM抗体检测结果分析

目的 检测本院908例呼吸道感染患者九项呼吸道病原体的IgM抗体,从而了解九种病原体的流行特征.方法 采用间接免疫荧光法对908例呼吸道感染患者血液中九项病原体的IgM抗体进行检测分析.结果 本研究呼吸道感染患者血清IgM抗体检测总阳性率为36.1％ (328/908),合并感染率为13.4％ (122/908),在阳性病例中占37.2％(122/328).INFB+ PIVS合并感染最为常见.春夏季以INFB流行为主,秋冬季以PIVS流行为主.不同季节病原体检测阳性率差异有统计学意义(P＜0.05).秋冬季的阳性率高于春夏季.≤25岁年龄组和≥65岁年龄组人群最易感染INFB,26～64岁年龄组人群最易感染LP1.3个年龄组的阳性率差异有统计学意义(P＜0.05).不同性别病原体检测阳性率之间差异没有统计学意义(P＞0.05).结论 重点季节预防相应病原体的流行和传播,持续监测病原体的IgM抗体有利于更好防控.