胸腔镜钛夹夹闭胸交感神经干治疗头面部多汗10例报告

目的探讨电视胸腔镜胸交感神经干夹闭术治疗头面部多汗的可行性. 方法双腔气管插管全麻, 先左侧卧位,左侧单肺通气,腋中线第2～3肋间、腋后线4～5肋间置入7 mm与4.5 mm trocar,放置手术器械与胸腔镜光学视管,找到交感神经链,小号钛夹夹闭第2肋骨下缘处交感神经干.膨肺,缝合切口.将体位改为右侧卧位,改变体位行对侧手术. 结果手术时间55～130 min,平均110 min.术后头面部出汗全部消失,术后胸部、腹部、背部或腿脚部轻度代偿性多汗7例,10例对手术效果感到满意,术后第2～3天出院.术后无霍纳综合征等严重并发症发生.术后7～10 d后均能恢复正常学习工作和体育锻炼.10例术后随访1～9个月,平均6.3月,均无复发. 结论电视胸腔镜钛夹夹闭第2肋下缘胸交感神经干可以安全有效地治疗头面部多汗.     

心瓣膜疾病介入术中的慧眼——超声心动图的应用

经导管瓣膜治疗术如主动脉瓣置换术、二尖瓣钳夹术及三尖瓣置换术等已逐渐应用。超声心动图在心脏瓣膜病介入治疗前后能进行定性和定量诊断,具有重要价值。本文综述超声心动图技术在瓣膜病介入治疗中的应用现状与进展,以便指导临床实践。     

钛板重建修复下颌骨缺损的临床应用

目的：观察钛板在下颌骨缺损修复重建治疗中的应用效果,探索修复重建下颌骨缺损的理想材料。方法：对20例下颌骨肿瘤手术切除部分或全部下颌骨的病例行钛板或钛网的修复治疗。结果：20例病例中1例死于肿瘤转移,1例术后感染,去除钛板,其余均愈合良好,较好地恢复了颌骨的连续性及功能。结论：钛板在获得性下颌骨缺损的修复治疗中,治疗效果良好,有广阔的应用前景。     

新型大环配体—BDBPH合成及其晶体结构

目的　利用分子设计 ,合成新型大环多胺配体BDBPH ,研究其合成工艺及晶体结构。方法　2 ,6 二甲酰基对甲苯酚 ,二亚乙基三胺 ,Pb(SCN) 2 三种化合物在CHCl3溶液中 50～ 6 0℃反应 18h ,随后经NaBH4 还原、脱Pb2 等操作 ,得晶体产品BDBPH ,用1HNMR、FAB—MS、元素分析确定了其结构 ,用单晶X 射线衍射法测定其晶体结构。结果　1HNMR(D2 O) ,δ(ppm) :2 .13(s , CH3,6H) ,3.35(q ,ethylene ,16H) ,4 .2 1(s , CH2 ,8H) ,7.16 (s ,Ary1,4H) ;FAB MS :4 71(M H ) ;元素分析 ,计算值 (BDBPH·6HBr·4H2 O) :C 30 .35,H 5.4 4 ,N 8.17,实测值 :C 30 .2 2 ,H 5.4 6 ,N7.98。晶体属单斜晶系 ,P2 1/C空间群 ,晶体学参数 :a =14.4 4 1(5) ,b =11.4 82 (4 ) ,c =12 .0 90 (6 ) ,α =90 ,β =96 .92 (3) ,γ =90℃ ,V =1990 .0 (14) 3。大环分子采取椅式构型 ,6个Br- ,4个H2 O分子对称分布于大环两侧。结论　该大环配体合成工艺先进 ,晶体结构新颖 ,可用于多种金属配合物的研究 ,对进一步了解金属酶的结构及其催化作用机制具有重要意义。     

电感耦合等离子体-质谱法同时检测土壤8种金属元素

目的 建立酸消解 - 电感耦合等离子体 - 质谱法（ICP - MS）同时检测土壤中铅、镉、铬、汞、砷、镍、铜和锌。方法 土壤样品用硝酸 - 氢氟酸体系全自动石墨消解法消解,电感耦合等离子体 - 质谱法测定,内标法定量。结果 自动化的前处理方式增加了方法的安全性,缩短了前处理时间。方法回收率为88%～110%,精密度为0.4%～6.0%,方法检出限为0.007～0.99 mg/kg。使用GSS - 23、GSS - 14土壤标准物质进行质量控制,8种元素的结果均在标准值参考范围内。结论 本法操作安全、快速,灵敏、准确,适用于土壤中8种金属元素的检测。     

Biomechanical comparison of suture-button,bioabsorbable screw,and metal screw for ankle syndesmotic repair: A meta-analysis

BackgroundTo compare biomechanically metal screw fixation to suture-button or bioabsorbable screw fixation for ankle syndesmotic injuries.MethodsA literature search of the comparison studies in Pubmed and Google Scholar was conducted. The biomechanical outcomes of interest were syndesmotic stability in the coronal, sagittal, and axial planes as well as torque and rotation at failure.ResultsA total of 11 cadaveric studies were included. In the suture-button group, coronal displacement (MD 1.72 mm, p = 0.02) and sagittal displacement (MD 2.65 mm, p = 0.0003) were increased relative to the metal screw group. In contrast, no difference was found with axial rotation (MD 0.35 degrees, p = 0.57). Bioabsorbable screws exhibited equivalent failure torque (MD ?3.04 Nm, p = 0.53) and rotation at failure (MD 3.77 degrees, p = 0.48) in comparison to metal screws.ConclusionsSuture-button provide less rigidity when compared to metal screw fixation. They afford flexible syndesmotic micromotion which may more closely resemble a physiological state and be helpful for ligament healing. Bioabsorbable screws demonstrate similar mechanical strength properties to metal screws.     

Minimum 7‐year Follow‐up of A Porous Coated Trabecular Titanium Cup Manufactured with Electron Beam Melting Technique in Primary Total Hip Arthroplasty

ObjectivesTo investigate the cup survivorship, patient satisfaction level, clinical function, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) using electron beam melting (EBM)‐produced porous coated titanium cups at mid‐term follow up.MethodsA total of 32 patients (32 hips) from five hospitals in China who underwent primary THA using EBM‐produced trabecular titanium cups between May and December 2012 were retrospectively reviewed. The inclusion criteria were: (i) patients who underwent THA with the use of EBM‐produced cups with possible 7‐year follow up; and (ii) patients with follow‐up information, including the cup survivorship, patient satisfaction level, and clinical outcomes such as Harris hip score. The exclusion criteria were: (i) patients with neuropathic diseases; and (ii) patients who underwent THA due to neoplastic disease. Five (15.6%) patients were lost to follow up before the 7‐year follow‐up and, thus, were excluded; none of these patients died due to disease associated with the THA or had undergone removal of their cups as of our last evaluation. The mean age and body mass index of the patients were 59.37 (range: 38.00–69.00) years and 24.51 (range: 16.50–34.10) kg/m², respectively. Thirteen (48.1%) of the patients were female.ResultsThe average duration of follow‐up was 93.48 (range: 89.00–99.00) months. The median Harris hip score improved from 42.00 (interquartile range: 37.00–49.00) to 97.00 (interquartile range: 92.00–97.00) at the latest follow up (P < 0.001). A total of 18 (66.7%) patients rated their satisfaction level as very satisfied, 6 (22.2%) as satisfied, 2 (7.4%) as neutral and 1 (3.7%) as dissatisfied. No intraoperative or postoperative complications were identified. At the latest follow up, all cups were considered to have achieved osteointegration fixation, with three or more of the five signs evident in the most recent X‐ray. However, three cups revealed radiolucent lines with a width of less than 1 mm. The median vertical and horizontal distances between the latest postoperative center of rotation relative to the anatomic center of rotation were 2.50 (interquartile range: −3.10, 6.94) mm superiorly and 3.26 (interquartile range: −8.12, 2.38) mm medially, respectively, at the most recent postoperative follow up. Kaplan–Meier survivorship analysis of cups, with the endpoint defined as postoperative radiolucent lines of less than 1 mm in width in at least two zones, reveals that the 8.25‐year survival was 96.3% (95% confidence interval: 76.49%–99.47%).ConclusionThe mid‐term follow‐up of patients who underwent primary THA using EBM‐produced porous coated titanium cups demonstrated favorable patient satisfaction, good clinical function, excellent survivorship, and adequate biological fixation.     

两组方法检测耐碳青霉烯类肠杆菌碳青霉烯酶的临床价值

目的 研究EDTA协同碳青霉烯类灭活法（EDTA synergistic carbapenem inactivation method,eCIM)联合改良碳青霉烯类灭活法(modified carbapenem inactivation method,mCIM) 、简易EDTA协同碳青霉烯类灭活法（simple EDTA synergistic carbapenem inactivation method,esCIM)联合简易碳青霉烯类灭活法（simplified carbapenem inactivation method,sCIM）检测耐碳青霉烯类肠杆菌（Carbapenem-ResistantEnterobacteriaceae, CRE）丝氨酸碳青霉烯酶和金属β-内酰胺酶的临床价值。方法 收集临床分离的CRE菌株57株,以PCR结果为金标准,同时进行eCIM联合mCIM、esCIM联合sCIM检测丝氨酸碳青霉烯酶和金属β-内酰胺酶。结果 经PCR扩增后基因测序显示39株肺炎克雷伯菌中33株携带KPC-2基因,2株携带NDM-1基因,1株携带NDM-5基因,3株未检测出携带碳青霉烯酶基因;9株大肠埃希菌均携带NDM-5基因,9株阴沟肠杆菌均携带NDM-1基因。eCIM联合mCIM检测金属β-内酰胺酶的灵敏度95.2%（20/21）、特异度100%（33/33）,检测丝氨酸碳青霉烯酶灵敏度100%（33/33）、特异度95.8%（23/24）。esCIM联合sCIM检测金属β-内酰胺酶灵敏度90.5%（19/21）、特异度100%（33/33）,检测丝氨酸碳青霉烯酶灵敏度100%（33/33）、特异度91.7%（22/24）。结论 两组方法检测丝氨酸碳青霉烯酶和金属酶敏感度、特异度均高;esCIM联合sCIM操作更加简易、检测耗时更短,更适用于基层医院临床微生物实验室操作。     

镍钛形状记忆合金骨内植入生物安全度的深入研究

目的：观察表面处理和时间因素对镍钛形状记忆合金骨内植入后犬重要器官及组织中镍含量的影响。方法：将镍钛记忆合金牙科种植体植入犬股骨内,以表面是否复合氧化铝生物陶瓷分为复合组织和镍钛组,另设对照组,分别测定犬肝,肾,脾及鼻咽粘膜中镍的含量,并作组织病理学观察。结果;镍钛组镍含量有随时间增高的趋势,但各器官组织有所不同,复合组镍含量明显低于镍钛组６个月时,但仍高于对照组;两组组织病理学观察均未见明显异常