钛合金表面介孔二氧化钛涂层的制备及表征

背景：介孔结构的二氧化钛涂层除了具有一般介孔材料的优点外,还具有很好的生物相容性和独特的抗菌性,并且在钛及钛合金表面很易形成。目的：对介孔诱导型二氧化钛涂层和普通的二氧化钛涂层进行形貌结构分析和比较,为钛合金表面介孔结构二氧化钛涂层在生物医学领域的应用提供实验和理论基础。方法：在Ti-6Al-4V合金表面采用模板法和非模板法制备介孔诱导型二氧化钛涂层和普通二氧化钛涂层,使用场发射扫描电子显微镜、快速比表面积/孔隙分析仪和X射线衍射仪对两种二氧化钛涂层的表面形貌结构进行比较分析。结果与结论：在Ti-6Al-4V合金表面制备的稳定介孔二氧化钛涂层,其平均介孔孔径、比表面积和孔容分别为6.6680nm、124.1906m^2/g和0.256470cm^3/g,具有介孔结构大比表面积和孔容的特点,适合对医用钛及钛合金改性。     

钛种植体基台与种植体上部结构合金的耐腐蚀性能

背景：国内有学者运用动电位极化技术测定常用牙科金属自腐蚀电位值来评价低贵金属的腐蚀性能,发现合金的贵金属含量是影响其耐腐蚀性能的主要原因。目的：评价TA2型商业纯钛、金合金、钴铬合金、钛合金及镍铬合金的体外耐腐蚀性能。方法：将TA2型商业纯钛、金合金、钴铬合金、钛合金及镍铬合金分别浸入人工唾液中,运用动电位极化技术测量5种材料在人工唾液中的自腐蚀电位和自腐蚀电流密度。结果与结论：5种合金的自腐蚀电位值由大到小排列顺序为金合金、商业纯钛、钛合金、钴铬合金、镍铬合金;金合金与纯钛电位较正,不易发生腐蚀;钛合金和钴铬合金居中,由于可以形成稳定氧化膜,具有较强的抗孔蚀和缝隙腐蚀能力;镍铬合金电位较负,则较容易发生溶解。5种合金的自腐蚀电流密度值排列顺序为金合金〈商业纯钛〈钛合金〈钴铬合金〈镍铬合金;金合金与纯钛电流密度值较小,达10-8,这表明金合金和纯钛的腐蚀速度较小,镍铬合金的腐蚀速度最大。结果说明金合金、纯钛是耐腐蚀性较好的材料,镍铬合金的腐蚀速度最大,应尽量避免用镍铬合金作为种植体上部结构。     

氧化锆陶瓷和钛合金表面粗糙度与细菌黏附的比较

实验于2006-03/06在山西医科大学微生物实验室完成。分别制作氧化锆陶瓷试件和Titan合金试件各6个。实验分为2组,氧化锆陶瓷抛光组：Cercaon氧化锆薄片磨光后,用EVE专用抛光轮高度抛光。钛合金抛光组：将钛合金原始铸件依次用粗砂纸、水砂纸（依次为200,600,800,1000,1200,1500,2000目）逐级磨光,再用抛光轮抛光。采用精密粗糙度测试仪检测各样本的表面粗糙度;然后将各样本置于变形链球菌的培养液中,在37℃条件下,静止培养状态下培养1h后,荧光显微镜下计数黏附细菌的数量,并通过扫描电子显微镜观察各样本的表面形貌。结果显示,两组间表面粗糙度无显著差异（P〉0.05）,但钛合金抛光组试件黏附细菌数多于氧化锆陶瓷抛光组试件黏附细菌数（P〈0.01）。扫描电镜显示,氧化锆陶瓷抛光组试件表面散在少量细小孔隙,而钛合金抛光组试件表面未见细小孔隙,但有较多裂隙和凹陷。     

医用钛合金在3种不同生理电解液中的耐腐蚀行为

背景:钛合金种植体已经广泛应用于临床,但作者所查对于牙种植体植入后的耐腐蚀性,尤其在不同生理电解溶液中耐腐蚀行为的对比报道很少.目的:对比观察医用钛合金在生理盐水,模拟人工唾液,模拟人工体液3种电解溶液中的耐腐蚀情况.设计、时间及地点:随机分组设计,对比观察实验,于2008-11/2009-03在兰州大学口腔医学院和中国科学院兰州化学物理研究所固体润滑实验室完成.材料:医用钛合金(Ti-6Al-4V)制备成10mm×10mm×1 mm板片,随机分为3组,每组10个.方法:利用电化学方法分析医用钛合金在生理盐水,模拟人工唾液,模拟人工体液中的腐蚀情况,扫面电镜观察腐蚀表面形貌,CA-A型接触角测试仪测试钛合金表面被腐蚀后接触角的变化.主要观察指标:医用钛合金在3种生理电解液中腐蚀4 d后的阳极极化曲线、表面形貌、接触角.结果:钛合金在3种生理电解液中的腐蚀情况依次是:模拟人工唾液>模拟人工体液>生理盐水.扫面电锖观察表明,医用钛合余绎生理盐水腐蚀后,表面出现了许多腐蚀孔,经模拟人体体液腐蚀后,表面变得粗糙不平整,腐蚀孔数目变化不大,钛合金经人工唾液腐蚀后,腐蚀孔数目增多,部分腐蚀孔孔径明显增大.经3种生理电解液腐蚀后,钛合金表面接触角都减小.结论:医用钛合金在人工唾液中的腐蚀最严重,在临床应用中应给予相应的防范措施.     

The development of novel bioactive porous titanium as a bone reconstruction material

Porous titanium fabricated by the resin-impregnated titanium substitute technique has good mechanical strength and osteoconduction. The alkali treatment of the titanium surface creates a bioactive surface. Alkali-treated porous titanium is expected to accelerate bone formation. The purpose of this study was to evaluate the bone reconstruction ability of alkali-treated porous titanium. Porous titanium (85% porosity) was treated with an alkali solution (5 N NaOH, 24 h). To assess material properties, we analyzed the surface structure by scanning electron microscopy (SEM) and mechanical strength testing. To assess bioactivity, each sample was soaked in a simulated body fluid (Hank''s solution) for 7 days. Surface observations, weight change ratio measurement (after/before being soaked in Hank''s solution) and surface elemental analysis were performed. We also designed an in vivo study with rabbit femurs. After 2 and 3 weeks of implantation, histological observations and histomorphometric bone formation ratio analysis were performed. All data were statistically analyzed using a Student''s t-test (P < 0.05) (this study was approved by the Hiroshima University animal experiment ethics committee: A11-5-5). Non-treated porous titanium (control) appeared to have a smooth surface and the alkali-treated porous titanium (ATPT) had a nano-sized needle-like rough surface. ATPT had similar mechanical strength to that of the control. After soaking into the Hank''s solution, we observed apatite-like crystals in the SEM image, weight gain, and high Ca and P contents in ATPT. There was significant bone formation at an early stage in ATPT compared with that in control. It was suggested that the alkali-treated porous titanium had a bioactive surface and induced bone reconstruction effectively. This novel bioactive porous titanium can be expected to be a good bone reconstruction material.

Porous titanium fabricated by the resin-impregnated titanium substitute technique has good mechanical strength and osteoconduction.     

清创技术的发展与临床应用现状

本文介绍了外科清创技术与理念的发展,叙述了机械性清创、自溶性清创、酶解清创、生物清创、电刀清创、水刀清创、超声清创等非手术和手术清创方法的特点及多种方法联合清创的优势,为临床清创方法的选择提供参考。并在TIME原则和"3P"治疗的基础上提出了"4P"创面治疗理念,建议使用联合清创,以确保清创效果安全有效,减少操作风险和并发症,为创面愈合创造良好条件。     

钛种植体表面改性的研究现状及应用进展

近年来,纯钛因其具有良好的生物相容性,而被应用于口腔种植领域,但其本身仍存在着许多问题.随着钛种植体广泛应用于临床,如何提高其种植的成功率引起了人们越来越多的关注.学者们研究了多种改善方法,其中钛种植体的表面处理对提高种植成功率起着重要作用,目前常用的表面处理方法主要包括:化学处理方法、物理方法,以及生物方法等,且不同处理方法都有其各自的优点.文章就目前国内外对钛种植体表面处理方法的研究现状及进展进行综述.     

镁合金在生物医用材料领域的应用及发展前景

镁及镁合金的降解行为使得它作为生物可降解植入材料有很大的吸引力,并且其具有合适的力学性能和良好的生物相容性.目前,镁及镁合金作为可降解医用材料的应用研究基本上集中于心血管支架、骨固定材料、多孔骨修复材料、牙种植材料、口腔修复材料等方面的研究.但是镁合金存在腐蚀速度过快的问题,因此,对镁及镁合金腐蚀本质的研究以及表面改性技术的完善成为其在生物材料领域应用的关键.     

镍钛合金表面改性后生物相容性及其持续动力压应力对骨折愈合的影响

背景:许多研究均特别强调镍离子在镍钛形状记忆合金腐蚀过程中的溶解作用,而这些离子可能对人体造成潜在的危害.应用各种表面处理措施可提高镍钛合金内植入材料的抗腐蚀能力.在现代医学的研究中,非常有必要对表面修饰后镍钛合金的特征进行分析.目的:观察表面改性及未改性的弹性镍钛合金内固定材料对骨折愈合的影响.同时设置髓内钉内固定材料做对照,比较弹性内固定材料在持续应压力下对骨折愈合的影响.设计、时间及地点:随机对照动物实验,于2004-09/2005-03在兰州大学第二医院骨科研究所组织工程实验室完成.材料:类金刚石镀膜镍钛合金环抱器和非镀膜镍钛合金环抱器(4H8-40型)由兰州西脉记忆合金股份有限公司提供,髓内针(ZQY-01型2X150)由天津市金兴达实业有限公司提供.方法:选择清洁级4～6月龄的青紫兰兔30只,按随机数字表法分为3组,类金刚石镀膜镍钛合金环抱器组、非镀膜镍钛合金环抱器组、髓内针内固定组,每组10只.每只兔1%戊巴比妥钠(25 mg/kg)麻醉后行股外侧切口,制成股骨中段横断骨折模型,分别用上述材料固定.主要观察指标:4周后取骨折局部骨痂,检测单位骨痂中无机物含量及碱性磷酸酶、骨钙素及肿瘤坏死因子的表达.并取局部肌肉组织、肝组织及脑组织测定镍离子含量.结果:①类金刚石镀膜镍钛合金环抱器组、非镀膜镍钛合金环抱器组骨痂中无机物含量,碱性磷酸酶、骨钙素及肿瘤坏死因子的表达均高于髓内针内固定组(P＜0.05).②类金刚石镀膜镍钛合金环抱器组和髓内针内固定组肝、脑、骨折周围肌肉组织内镍离子的含量低于非镀膜镍钛合金环抱器组(P＜0.05).结论:弹性内固定明显促进骨折愈合,类金刚石镀膜镍钛合金环抱器的组织相容性优于非镀膜镍钛合金环抱器.     

创伤协调护士的发展现状及启示

介绍创伤协调护士的产生背景、定义、任职资格、职责范畴,分析创伤协调护士发展面临的机遇和挑战,提出发展中国创伤协调护士的建议：认为中国应该借鉴创伤协调护士发展的成功经验,建立科学规范的培训模式和资格认证制度,完善岗位设置和运行机制,以提升创伤救治能力,应对创伤救治服务模式改革带来的挑战。     

国外开业护士的管理及启示

该文通过对国外开业护士的发展进行介绍,同时对开业护士的职责、资质要求、培训课程及处方权限等方 面进行综述,以期对国内开业护士的发展提供借鉴。     

护理工作环境量表的研制及信效度研究

目的 研制1 份适用于我国的护理工作环境量表。方法采用护理工作环境量表对804 名临床护士进行预测试,对1621 名临床护士进行正式测试,并采用 SPSS 和 AMOS 软件对问卷进行信效度分析。 结果 护理工作环境量表包含 7 个维度 26 个条目,解释了总变异量的69.057% ,总量表的 Cronbach蒺s α 系数为 0.946 ,分半信度为 0.894 ;护理工作环境量表一阶多因子模型的适配度指标分别是TLI 为0.919 , CFI 为 0.930 , GFI 为 0.900 , AGFI 为 0.875 , RMSEA 为 0.064 。结论 该护理工作环境量表具有较好的信效度,用此量表来测量我国护理工作环境是可靠的。     

Titanium anodizing in a choline dihydrogencitrate salt–oxalic acid deep eutectic solvent: a step towards green chemistry in surface finishing of titanium and its alloys

Deep Eutectic Solvents (DESs) are “green” competitors for some conventional plating baths and electrolytes used for surface modification. Their use allows a material to be obtained with a structure different from that observed in conventional plating or finishing technologies. In this work the titanium anodizing process was investigated in a bath based on a choline dihydrogencitrate salt and oxalic acid (1 : 1 molar ratio) green solvent. Titanium anodized at the lowest voltage applied (10 V) was a deep yellow color, which turned to deep blue at 30 V. The surface morphology and topography of titanium, both anodized and untreated, were monitored by optical, scanning electron (SEM and HR-SEM) and atomic force (AFM) microscopy. Anodizing at 10 V produced a fine granular morphology of the oxide layer, while anodizing at 30 V led to the formation of a probably thicker and quite uneven oxide layer, characterized by a distinct and coarse granular morphology. The average size of the micro-nodules was higher than those at 10 V and porous structures have been also identified. According to X-ray photoelectron spectroscopy (XPS) the stoichiometric TiO₂, regardless of the applied voltage during anodizing, was practically the only component of the oxide layer produced on titanium in the DES bath. At 10 V, the oxide layer was thicker (>10 nm) than the natural Ti passive layer (approx. 2.2 nm), which, apart from TiO₂, also contained oxides of titanium at lower oxidation states, i.e. +2 and +3. Moreover, the XPS technique was supported by electrochemical impedance spectroscopy (EIS), especially in the context of the structure of the oxide layer and its interaction with a corrosive environment. The corrosion resistance of anodized titanium was assessed in 0.05 mol dm⁻³ solution of NaCl by the linear polarization resistance (LPR) technique and polarization curves. During interpretation of the impedance spectra, the layers produced by the anodizing process were described using the two-layer model. It was assumed that the inner layer formed directly on the surface of metallic titanium was responsible for the barrier properties (resistance of 2.8 MΩ cm²). The porous outer layer formed on it has a much lower corrosion resistance, i.e. 800–1300 Ω cm².

Fabrication of nanometric color TiO₂ layers through polarization of titanium in a choline dihydrogencitrate–oxalic acid DES anodizing bath.     

急诊医学的发展与发展中的急诊医学

自1979年起,急诊医学正式成为医学专业领域的第23个专科。1983年,我国第一个急诊科在北京协和医院成立。目前我国急诊医学目前还处在发展中阶段。急诊医学服务体系（EMSS）涵盖了院前急救、灾害医学、院内急诊及加强治疗等领域。急诊医学在发展中体现出与其他二级学科不同的时间重要性、特殊的临床决策思路、与突发公共卫生事件的密切关系等特点。将来,急诊医生的工作任务应扩展到急诊医学教学和预防、急诊医学基础和临床研究、损伤预防、医学继续教育、灾害医学和（群体伤亡事件MCI）管理、中毒处理和中毒咨询、危险化学品和生物恐怖事件的处理、医院和EMS管理等。急诊科将来的发展需要政府及医院充分认识急诊医学在临床医学中的位置,从政策上给予支持,制定相关的准入制度、专科医师培养制度、福利待遇制度、风险分摊制度等,促进急诊医学在我国的发展。     

The Demoralization Scale: a report of its development and preliminary validation

The development and elaboration of a conceptualization of existential distress in patients with advanced disease is crucial in order to optimize our clinical response within palliative medicine. Demoralization is one expression of existential distress. Its empirical study will be greatly enhanced by a self-report measure that captures its dimensions and intensity. We report here on the development and testing of the Demoralization Scale in 100 patients with cancer. Factor analysis identified five relatively distinct dimensions: loss of meaning, dysphoria, disheartenment, helplessness, and sense of failure. These factors show high internal reliability, and convergent validity with the McGill Quality of Life Scale, Patient Health Questionnaire, Beck Depression Inventory, Beck Hopelessness Scale, Hunter Opinions and Personal Expectations Scale, and the Schedule of Attitudes toward Hastened Death. Its divergent validity is demonstrated through the differentiation of a subgroup of patients with high demoralization who do not meet DSM-IV categorization for a diagnosis of major depression. Confirmatory validation is needed for the scale to be used as a measure of change in interventions designed to treat demoralization.