血管化腓骨瓣修复涉及髁突下颌骨缺损的临床应用

目的:对累及髁突的不同类型下颌骨缺损采用游离腓骨瓣修复的方法、经验进行总结。方法:2001年10月-2004年10月,53例累及下颌升支上部的颌骨良性病损,行下颌骨切除后采用游离腓骨瓣进行下颌骨重建,分别采用了腓骨代替髁突法(30例)、游离髁突法(7例)及保留髁突法(16例)3种方法进行下颌骨缺损修复重建。分析总结临床方法经验,并对患者术后外形和功能进行临床评价。结果:本组血管化游离腓骨瓣移植成活率98.1%(52/53);41例患者术后随访,进行了临床检查及外形、功能评价,经Fisher检验,腓骨替代髁突组、游离髁突组及保留髁突组患者在术后外形和进食、语音功能上无显著差别。结论:3种不同髁突处理方法进行游离腓骨瓣下颌骨缺损重建,在临床上实用可行,可依据患者病损的具体情况选用。     

前臂桡侧游离皮瓣在口腔颌面外科的应用——附725例临床分析

目的详细阐述前臂桡侧游离皮瓣的应用解剖、制作技术、在口腔颌面外科的应用及新近研究进展。方法对我科自１９７９年以来，７２５例应用前臂桡侧游离皮瓣修复口腔颌面部各类缺损的病例，进行了临床分析。结果前臂桡侧游离皮瓣质地优良、血供可靠已及切取方便，总成功率达９６．６％；主要缺点是牺牲前臂的一条主供血管—桡动脉，供区疤痕明显，影响美观。结论前臂桡侧游离皮瓣是口腔颌面外科应用最多皮瓣，也是修复口腔颌面部软组织缺损的首选皮瓣。     

Strategies to improve quality of life in patients with head and neck cancer: microvascular surgery to nanotechnology

Educational Objectives: 1. Learn selection of microvascular free flaps to improve functional outcome.     

Evaluation of the surface free energy on root canal dentine walls treated with chelating agents and NaOCl

AIM: To evaluate ex vivo the effects of combined and single use of EDTA, RC-Prep and NaOCl on the surface free energy of canal wall dentine using the captive bubble technique. METHODOLOGY: Eighteen extracted human pre-molar teeth were sectioned at the crown and the apical third, the remaining mid-root portion were bisected longitudinally. Thereafter, the root halves were embedded in resin blocks that exposed the dentine surface of the canal wall. The specimens were randomly assigned to six experimental groups (n = 6) after polishing. The root dentine surfaces of the first two groups were treated with 17% EDTA or RC-Prep followed by 2.5% NaOCl irrigation. Groups 3, 4 and 5 were treated with either 17% EDTA, RC-Prep or 2.5% NaOCl alone. Control specimens were irrigated with saline solution. The surface free energies of experimental groups were calculated by measuring air and octane contact angles on the canal wall dentine. Statistical analysis was performed using the Mann-Whitney U and Bonferroni post-tests at P = 0.05. RESULTS: Compared with the control group; combined and single use of EDTA, RC-Prep and NaOCl irrigation significantly decreased the surface free energy of canal wall dentine surfaces (P < 0.05). Among all groups tested, the use of NaOCl as a final flush following RC-Prep treatment yielded increased wettability. Nevertheless, this value remained lower than that of the control group. CONCLUSION: Use of chelating agents alone or in combination with NaOCl decreased the wettability of root canal wall dentine.     

Establishment of cell free conversion system with biotin-labelled recombinant PrPsen expressed in E. coli

Objective To report a protocol using biotin-labelled PrP protein in cell free conversion assay instead of isotope. Methods A hamster PrP protein （HaPrP） was expressed in E. coli and purified with HIS-tag affinity chromatograph. After being labelled with biotin, HaPrP was mixed with PrP^sen preparation from scrapie strain 263K. Results Protease-resistant bands were detected after four-day incubation. Conclusion The new conversion model provides a reliable, easily handling, and environment-friendly method for studies of prion and transmissible spongiform encephalopathies.     

阿帕替尼联合化疗作为二线及以上方案治疗晚期胃癌或胃食管结合部腺癌的疗效观察

目的评估阿帕替尼联合化疗作为二线及以上治疗方案在晚期胃癌(GC)或胃食管结合部腺癌(AGEJ)患者中的疗效。方法分析行肿瘤介入治疗的129例晚期GC或AGEJ患者的临床资料,包括性别、年龄、ECOG分级、化疗方案、病理分级、原发病灶部位、既往是否行胃切除术、转移情况、转移灶个数、既往化疗及是否接受放疗,并记录无进展生存期(PFS)。按照治疗方法不同分为单独化疗组(77例,接受单独化疗)和联合化疗组(52例,接受阿帕替尼联合化疗),分析比较两组的临床资料。结果联合化疗组患者疾病控制率(DCR)高于单独化疗组(P＜0.05)。联合化疗组PFS显著长于单独化疗组患者(P＜0.05),转移灶个数≤2个患者的PFS显著长于转移灶个数＞2个的患者(P＜0.05)。多因素Cox回归分析结果显示,转移灶个数＞2个和阿帕替尼联合化疗方案是PFS的独立影响因素。结论与单独化疗比较,阿帕替尼联合化疗方案作为二线及以上方案,可以显著提高既往至少一线化疗失败的晚期GC或AGEJ患者疾病控制率,延长患者的无进展生存期,且不良反应可控。     

磁化准备真稳态进动快速成像序列在颅脑肿瘤增强中的应用

目的 评估二维磁化准备真稳态进动快速成像(2D-MP-TrueFISP)序列在颅脑肿瘤增强中的应用价值。方法 以60例行头部增强磁共振检查的颅脑患者为研究对象,在增强前后行2D-MP-TrueFISP/2D-SPGR扫描,比较病灶在2D-MP-TrueFISP和2D-SPGR增强后的评分,在2D-SPGR与2D-MP-TrueFISP同一层面分别测量病灶、白质、脑脊液增强前后的信号强度(SI),计算病灶的对比率(CR),比较病灶分别在2D-SPGR与2D-MP-TrueFISP增强前后的CR及在2D-SPGR与2D-MP-TrueFISP增强后的CR差异。结果 病灶在2D-MP-TrueFISP增强后的累积评分为9.0(9.0,9.0)分,明显高于2D-SPGR的7.0(6.0,7.0)分(Z=-6.86,P=0.00)。病灶在2D-SPGR和2D-MP-TrueFISP增强前后的CR差异均有统计学意义(P均<0.01)。病灶在2D-MP-TrueFISP 序列增强后的CR值,与白质比较和与脑脊液比较分别为1.58±0.46和8.50±2.47,均明显高于2D-SPGR的0.57±0.29(t=-17.38,P=0.00)和2.64±0.85(t=-19.71,P=0.00)。结论 相较于2D-SPGR,2D-MP-TrueFISP的增强程度及均匀性更好,轮廓更加清晰,且对病灶周围的水肿显示得更好。     

免费医学定向生专业承诺对职业成熟度的影响——情绪智力的中介作用

目的 探讨免费医学定向生专业承诺对职业成熟度的影响机制,为提升免费医学定向生的职业成熟度提供理论依据。方法 采用大学生专业承诺量表、情绪量表和大学生职业成熟度量表,对370名免费医学定向生进行调查。结果 免费医学定向生专业承诺与情绪智力、职业成熟度两两变量之间均呈正相关(P<0.05),情绪智力在免费医学定向生专业承诺与职业成熟度间起部分中介作用。结论 提高并践行免费医学定向生的专业承诺,注重其情绪智力的培养与教育,有利于提升免费医学定向生的职业成熟度。     

师范生顶岗实习前入职焦虑的调查研究

目的调查在湖南临湘、新晃、浏阳3地顶岗实习的某校175名学生的焦虑水平和担心事件,通过评估焦虑情绪的现状来确定职前培训的心理干预重点。方法以实习前担心情况调查表和人口学调查表作为测评工具,通过个别测试和团体施测相结合的方法在临湘、浏阳、新晃三个实习基地进行问卷调查。结果顶岗实习生的焦虑均分为(3.16±1.12),男、女生的焦虑水平存在显著的性别差异[(2.95±1.04)vs.(3.38±1.64),P0.001],三地实习生的焦虑水平差异有统计学意义[(3.21±1.25)、(3.12±1.59)、(3.09±1.72),P0.01]。结论顶岗实习生入职前的焦虑水平较高,且存在明显的性别差异和地方差异。     

维生素辅助治疗儿童癫痫56例疗效观察

目的:观察抗自由基药物(VE和VC)辅助治疗儿童癫痫的疗效。方法:癫痫患者56例,所有病例均符合国际抗癫痫联盟癫痫的诊断标准,随机分为传统抗癫痫药组(18例)、传统抗癫痫药+VE组(19例)、传统抗癫痫药+VC+VE组(19例),检测各组治疗前后静脉血中总抗氧化力(T-Aoc)及丙二醛(MDA)的平均水平。结果:(1)传统抗癫痫药+VE组静脉血中T-Aoc的平均水平较传统抗癫痫药组高,P<0.05;MDA的平均水平较传统抗癫痫药组低,P<0.05。(2)传统抗癫痫药+VC+VE组T-Aoc的平均水平较传统抗癫痫药+VE组高,但P>0.05,无统计学意义;MDA的平均水平较传统抗癫痫药+VE组低,P<0.05。(3)传统抗癫痫药+VC+VE组、传统抗癫痫药+VE组、传统抗癫痫药组治疗后的总有效率分别为68.4%、63.2%、55.6%。结论:对癫痫患儿加用抗自由基药物(VE和VC)作为辅助治疗,在血液指标与疗效方面可能优于未加者。VE、VC联合应用能起到协同效应,二者联合可能增强了抗氧化效果与抗癫痫作用。