烧伤合并吸入性损伤并发急性呼吸窘迫综合征八例

1 临床资料 2004年10月-2007年5月,笔者单位收治特重度烧伤合并中重度吸入性损伤并发急性呼吸窘迫综合征(ARDS)患者8例,均为男性,年龄22～60岁.火焰烧伤3例、蒸气烫伤2例、热液烫伤2例(其中1例为癫痫发作后跌入热水池中烫伤)、瓦斯爆炸伤1例.烧伤总面积45%～100%,其中Ⅲ度25%～70%TBSA.8例患者伤后4～12 d并发ARDS.     

Bc1-6与弥漫性大B细胞淋巴瘤

弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma DLBCL)是一组在形态学、遗传学和临床表现上都具有异质性的肿瘤。在2001年WHO关于淋巴造血系统的最新分类中，DLBCL被定义为：B细胞起源的、有大的肿瘤细胞、具有侵袭性临床表现，需要高效力的化学治疗的一组恶性淋巴瘤。这类肿瘤发生于结内或结外，可原发或继发于其它低度恶性淋巴瘤的演进。DLBCL发病的具体机制不清，但Bc1-6基因与其关系较密切，可能与DLBCL发生、发展及预后相关，近年来一直成为研究的热点。     

雌激素受体基因多态性与上海市汉族女性月经初潮及绝经年龄的关系

目的探讨雌激素受体α(ER-α)基因XbaⅠ、PvuⅡ位点多态性与上海部分女性月经初潮及绝经年龄的关系。方法 401名无血缘关系的中青年女性,平均年龄(31.3±5.9)岁;571名绝经后女性,平均年龄(59.6±5.9)岁为研究对象,均为居住在上海30年的汉族人。采用双能X线测量仪测量腰椎、股骨颈骨密度(BMD),用PCR-RFLP方法分析受试者ER-α基因XbaⅠ、PvuⅡ位点多态性。采用Haploview及PLINK遗传分析软件对XbaⅠ、PvuⅡ位点连锁不平衡及单倍体进行分析。结果受试者的各基因型频率分布符合Hardy-weinberg平衡定律。携带XbaⅠ及PvuⅡ单个位点各基因型者间年龄、身高、体重、BMD和月经初潮及闭经年龄的差异均无统计学意义(均P0.05)。XbaⅠ及PvuⅡ单个位点各基因型与月经初潮及绝经年龄无相关关系。XbaⅠ、PvuⅡ2个位点之间具有较强的连锁不平衡,存在4种频率1%的单倍型PX、Px、px、pX。经校正身高、体重、体重指数(BMI)的影响后,协方差分析结果显示单倍型Px与绝经后女性闭经年龄相关(P=0.044),携带Px纯合子(PxPx)女性闭经年龄[(47.5±3.6)岁]早于携带Px杂合子者[(49.4±3.8)岁](P=0.040)及未携带单倍型人群[(49.8±3.9)岁](P=0.015)。结论 ER-α基因XbaⅠ、PvuⅡ位点多态性与中国汉族妇女绝经年龄相关,但与初潮年龄无明显相关。     

自体网状皮移植生物敷料覆盖术后体液渗出的对比研究

烧伤创面的处理贯穿在烧伤治疗的全过程,目前全国对创面外用覆盖物以及创面体液渗出做了大量的研究,其中异种猪皮生物敷料是目前临床应用广泛的一种创面覆盖物,是近几年来研制的一种通过人工技术原理,将猪皮制成的覆盖物,能为创面提供一个较好的环境,为后期创面愈合或再次手术提供条件,体液丢失的多少是指导术后补液的质和量的依据,而补液的欠缺往往不能纠正体内电解质紊乱或容量的作用[1],本试验就不同创面的覆盖物在不同时间段对体液丢失、抗菌作用、疼痛刺激的影响进行研究,以探究该情况下术后的治疗,报告如下.     

依托社会团体开展健康教育对2型糖尿病患者生存质量的影响

目的 探讨依托社会团体,建立会员制,开展健康教育,对2型糖尿病患者生存质量的影响.方法 随机选择加入社会团体成为会员的2型糖尿病患者110例为干预组,再随机选择非社会团体会员就诊的2型糖尿病患者113例为对照组.干预组患者接受健康家园团体组织的管理与教育,对照组进行常规的健康教育.采用SF-36生存质量量表进行生存质量评估,随访半年后再次评分.结果 干预前2组间各维度评分比较差异无统计学意义.半年后随访,对照组各维度评分与半年前比较无明显改善.干预组在总体健康、生命活力、情感职能、精神健康及社会功能等维度评分均有明显升高,差异有统计学意义.结论 成立社会团体,开展健康教育,可以提高2型糖尿病患者的生存质量.     

软骨细胞与骨髓基质细胞共培养体外构建软骨组织的实验研究

Objective To investigate the feasibility of chondrogenesis in vitro with bone marrow stromal cells (BMSCs) induced by the co-cultured chondrocytes. Methods The BMSCs and chondrocytes were separated from pig and cultured. The supernatant of chondrocytes was used as the inducing solution for BMSCs from the 2nd generation. 7 days later, samples were taken and underwent immunohistochemistry and RT-PCR for detection of the expression of specific type Ⅱ cartilage collagen,type Ⅱ collagen and aggrecan mRNA. The cultured BMSCs and chondrocytes were mixed at a ratio of 8:2(BMSC: cartilage cell) and were inoculated into a polyglycolic acid/polylactic acid (PGA/PLA) scaffold at the final concentration of 5.0 × 107/ml. The cartilage cells and BMSCs were also inoculated seperately at the same concentration as the positive and negative control. Pure cartilage cells at 20% of the abovementioned concentration (1.0 × 107/ml) were used as the low concentration cartilage cell control group. Samples were collected 8 weeks later. General observations, wet weight, glycosaminoglycans (GAGs) determination and histological and immunohistochemistry examinations were performed. Results The expression of type Ⅱ collagen, type Ⅱ collagen and aggrecan mRNA were positive in induced BMSCs.In the co-cultured group and the positive control group, pure mature cartilage was formed after 8 weeks of culture in vitro, and the size and shape of the scaffold were maintained. The newly formed cartilage in the two groups were almost the same in appearance and histological properties. The immunohistochemistry results indicated that the cartilage cells of the two groups all expressed ample cartilage-specific type Ⅱ collagen. The average wet weight and GAG content in the co-cultured group reached more than 70% of those in positive control group. Only an extremely small amount of immature cartilage tissues was formed in local regions in pure BMSC group, and the scaffold was obviously shrunk and deformed. Although the wet weight of newly generated cartilage tissue in the low concentration cartilage cell group reached 30% of that in positive control group, the scaffold was obviously shrunken and deformed. Only regional and discontinuous cartilage tissues were formed, and the amount of newly formed cartilage was obviously less than that in the co-culture group and the positive control group. Conclusions Chondrocytes can provide a micro-environment for the formation of cartilage, and also effectively induce BMSC to differentiate into chondrocytes and form tissue-engineered cartilage in vitro.     

烧伤后期残余创面处理

大面积深度烧伤患者治疗的后期常常会因为各种各样的原因而出现难以愈合的残余创面,创面的肉芽组织发生老化水肿,通过长时间换药难以愈合,更可能发生糜烂融合成片,增加患者的经济负担及痛苦,延长了创面愈合和患者住院时间,这种创面虽经各种措施处理,仍经久不愈,甚至导致一些后期并发症的出现,严重者可危及生命,即使愈合也会导致明显的瘢痕形成,影响外观及导致功能障碍。