止血气雾剂对动脉破裂伤口的止血研究

目的 观测并评价止血气雾剂对肢体动脉破裂伤口的止血效果。方法 剪断30头猪的共30条股动脉,按照向伤口喷洒止血气雾剂前是否辅助其他止血方法分为指压止血+止血气雾剂、止血带止血+止血气雾剂和单纯喷止血气雾剂止血这3种方法制作动脉破裂止血模型,每种模型均制作10个,术后12h内观察止血效果。结果 止血带组的止血成功率为90%,指压法组的止血成功率30%,单纯喷止血气雾剂的止血成功率为10%。结论 对于肢体动脉破裂伤口,采用先扎止血带暂时止血,之后喷洒止血气雾剂,10min后放松止血带的止血方法成功率最高,是首选的止血方法。     

3D printing-assisted percutaneous balloon dilatation plasty for treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients北大核心CSCD

Objective To compare the clinical efficacy between 3D printing-assisted percutaneous balloon dilatation calcaneal plasty (3D-PCP) and conventional open reduction and internal fixation (ORIF) via the extended lateral L-shaped approach in the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients. Methods Retrospectively analyzed were the data of 36 elderly patients with osteoporotic calcaneal fracture of Sanders type Ⅱ or Ⅲ who had been surgically treated at Department of Orthopaedics, Yixing People's Hospital from June 2012 to June 2018. According to their treatment methods, the patients were divided into a 3D-PCP group [16 cases, 9 males and 7 females with an age of (73.0 ± 3.4) years] and an ORIF group [20 cases, 8 females and 12 females with an age of (71.4 ± 2.6) years]. The 2 groups were compared in terms of hospital stay, operation time, intraoperative fluoroscopy frequency, suture removal time, weight bearing time, fracture healing time, visual analogue scale (VAS) for the surgical site 2 days and one year after surgery, American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score, calcaneal imaging parameters (Böhler angle, Gissane angle, and length, width and height of the calcaneus axis) at 2 days and one year after surgery, and postoperative complications. Results There was no significant difference in the preoperative general data between the 2 groups, showing comparability (P > 0.05). All patients were followed up for 14 to 18 months (mean, 15.6 months). Compared with the ORIF group, the 3D-PCP group had significantly shorter hospital stay, significantly shorter operation time, significantly earlier suture removal, significantly earlier weight-bearing, significantly lower VAS scores at 2 days after surgery, significantly higher AOFAS ankle-hindfoot scores at one month after surgery, but significantly more times of intraoperative fluoroscopy (all P < 0.05). In all patients, the VAS scores at 2 days after surgery were significantly lower than those before surgery, and those at one year after surgery significantly lower than those at 2 days after surgery (P < 0.05). In all patients, the AOFAS ankle-hindfoot scores at one month after surgery were significantly higher than those before surgery (P < 0.001). In the ORIF group, the AOFAS ankle-hindfoot scores at one year after surgery were significantly higher than those at one month after surgery (P < 0.05), but in the 3D-PCP group there was no such a significant difference between one year and one month after surgery (P > 0.05). There was no significant difference in VAS score, AOFAS score, fracture healing time or postoperative imaging parameters between the 2 groups at one year after surgery (P > 0.05). There was no significant difference either in the incidence of complications between the 2 groups (P > 0.05). Conclusion In the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients, compared with conventional ORIF, 3D-PCP shows advantages of shorter operation time, minimal invasion, quicker incision healing, shorter hospital stay, earlier weight-bearing exercise, and better functional recovery but a disadvantage of increased times of intraoperative fluoroscopy. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

狼毒大戟中二萜类化合物DP抗白血病的作用机制研究

目的 探究狼毒大戟中二萜类化合物12-去氧佛波醇-13-棕榈酸酯（DP）能否通过磷脂酰肌醇3激酶（PI3K）/蛋白激酶B(Akt)信号通路发挥抗白血病的作用，为将其开发成抗白血病新药提供实验依据。方法 以LY294002(PI3K特异性抑制剂)为工具药，采用MTT、AnnexinⅤ-FITC/PI、AO-EB染色法观察并测定DP作用24 h后对人原髓细胞白血病细胞HL60增殖、凋亡的影响；采用ELISA法测定DP作用24 h后细胞培养液中乳酸脱氢酶（LDH）的释放量及细胞中胱天蛋白酶3(caspase-3)、caspase-9的活性。采用实时荧光定量-PCR法检测DP作用24 h后细胞中caspase-3、caspase-9、叉头框O3a(FoxO3a)、B细胞淋巴瘤2细胞死亡的相互作用介质（Bim）的m RNA转录水平；采用Western blot法检测细胞中磷酸化FoxO3a(p-FoxO3a)、磷酸化Akt(p-Akt)的蛋白表达水平，并采用免疫染色法在激光共聚焦显微镜下观察细胞中FoxO3a蛋白核转位情况。结果 10μmol/L DP和10μmol/L DP+LY294002对...     

高跟鞋与足部跖间应力关系的有限元分析

目的 研究穿着高跟鞋时前足跖间组织的应力变化，为跖间神经瘤诱发机制的定量分析和相应治疗方案提供参考。方法 通过已验证的足-踝-高跟鞋有限元模型平台，分析足部在0、2.54、5.08、7.62 cm［0、1、2、3″（英寸）］4种不同跟高高跟鞋平衡站立以及穿5.08 cm跟高高跟鞋行走时步态周期内的跖间组织应力大小及趋势。结果 随着鞋跟高度的增加，跖间组织应力明显增加，穿7.62 cm跟高高跟鞋时第3、4跖间组织受力是穿平跟鞋的312%。穿5.08 cm跟高高跟鞋行走时，在蹬地期第3、4跖间组织的受力最大，达到90 kPa，与临床最常见的跖间神经瘤发病部位相符。结论 穿着高跟鞋明显增加跖间组织的应力，鞋面横向挤压导致第3、4跖间组织受力最大，最容易导致跖间神经瘤的发生。     

卒中后情感障碍患者短期内PPPD发生的影响因素分析

目的 分析卒中后情感障碍患者短期内持续性姿势-感知性头晕(persistent posture-perceived dizziness, PPPD)发生的影响因素。方法 对2021年1月至2023年1月期间于我院治疗并确诊为卒中后焦虑、抑郁或共病的100例患者展开回顾性分析，所有患者均随访3个月，依据是否发生PPPD分为PPPD组(n=36)和对照组(n=64),单因素和Logistic多因素分析卒中后情感障碍患者短期内PPPD发生的影响因素。结果 PPPD组患者年龄>60岁、女性、高血压、血脂异常、医疗自费、家庭人均月收入<1 000元的占比高于对照组，差异统计学有意义(P<0.05)。PPPD组患者的入院BI、出院BI、甘油三酯、淋巴细胞水平均低于对照组，出院美国国立卫生研究院卒中量表(NIHSS)评分、汉密尔顿焦虑评分量表(HAMA)、中性粒细胞、中性粒细胞/淋巴细胞比值、糖化血红蛋白(HbA1c)≥8.5%、高同型半胱氨酸(Hcy)>15μmol/L、抗血小板聚集治疗占比均高于对照组，差异统计学有意义(P<0.05)。年龄>60岁、女性、医疗...     

医院膳食科对食品成本控制的管理

膳食科通过对食品成本有效控制,更好地为职工和住院患者提供安全卫生、价廉物美、营养均衡的膳食服务.因此对食品成本全程监管,不断完善食品成本控制制度,有效落实食品制作过程控制,坚持成本价格监督管理,才能有效地控制成本,增强抵御物价波动冲击的能力,充分发挥后勤保障管理部门应有的作用.     

矩阵针刺配合面部闪罐治疗脑卒中后吞咽障碍30例临床观察

目的 观察矩阵针刺配合面部闪罐治疗脑卒中后吞咽障碍的临床疗效。方法 将60例脑卒中后吞咽障碍患者采用随机数字表法分为治疗组和对照组，各30例。治疗组予矩阵针刺配合面部闪罐治疗，对照组采取吞咽功能训练治疗，2组均每日治疗1次，6次为1个疗程，疗程之间间隔1 d,治疗4个疗程后比较2组的临床疗效以及治疗前后的洼田饮水试验评分、吞咽障碍评价指数。结果 对照组总有效率为80.0%(24/30),治疗组为86.7%(26/30),2组比较差异有统计学意义(P<0.05);治疗后2组洼田饮水试验评分明显降低，吞咽障碍评价指数明显升高，与同组治疗前比较差异均有统计学意义(P<0.05),且治疗组改善更明显，与对照组治疗后比较差异均有统计学意义(P<0.05)。结论 矩阵针刺配合面部闪罐治疗脑卒中后吞咽障碍疗效确切，能明显改善患者的临床症状，值得临床推广应用。     

两种入路开放复位内固定Sanders Ⅱ～Ⅲ跟骨骨折

[目的]比较跗骨窦入路与外侧L形入路开放复位内固定SandersⅡ、Ⅲ型跟骨骨折的临床疗效。[方法]回顾性分析2018年7月—2021年8月手术治疗的SandersⅡ、Ⅲ型跟骨骨折患者40例（44足）的临术资料。根据术前医患沟通结果，21足采用跗骨窦入路结合埋头螺钉及微创锁定接骨板（跗骨窦组），23足采用传统外侧L形入路结合跟骨解剖锁定接骨板（L形组）。比较两组围手术期、随访及影像结果。[结果]跗骨窦组手术时间、切口长度、术中出血量以及住院时间均显著少于L形组（P<0.05）。两组患者术中透视次数及术后下地行走时间的差异无统计学意义（P>0.05）。40例患者随访12个月以上，两组术后完全负重活动时间的差异无统计学意义（P>0.05）。随术后时间推移，两组VAS评分显著减少（P<0.05）,AOFAS踝-后足评分、足内-外翻ROM均显著增加（P<0.05）。术后第1 d跗骨窦组VAS评分显著小于L形组（P<0.05）、术后6个月及末次随访时两组VAS评分的差异均无统计学意义（P>0.05），相应时间点，两组AOFAS踝-后足评分、足内-外翻RO...     

12-去氧佛波醇-13-棕榈酸酯通过Fas/FasL通路调控K562细胞凋亡

目的 探讨12-去氧佛波醇-13-棕榈酸酯(DP)诱导人白血病K562细胞凋亡及可能的分子机制。方法 Hoechst33342/PI染色后，荧光显微镜下观察不同浓度DP作用后的K562细胞形态学变化；DNA琼脂糖凝胶电泳法检测DP作用后的细胞DNA“梯带”;分光光度法检测半胱氨酸蛋白酶(caspase)3酶的活性；实时定量聚合酶链式反应(qRT-PCR)法检测caspase3、Fas、FasL mRNA表达；Western印迹检测procaspase3、Fas、FasL蛋白表达。结果 荧光显微镜下可见：DP作用的K562细胞形态学变化明显；DNA琼脂糖凝胶电泳可见清晰的梯带，随剂量的增加片段化更加明显；与control组比较，DP的作用使caspase3酶活明显增加(P<0.05,P<0.01);DP的作用使caspase3、Fas、FasL mRNA表达明显增加(P<0.05,P<0.01);DP能明显下调procaspase3蛋白表达，明显上调Fas、FasL蛋白表达(P<0.05,P<0.01)。结论 Fas/FasL通路参与DP诱导K562细...