复黄生肌愈创油膏对大鼠糖尿病创面中Ⅰ型和Ⅲ型胶原mRNA表达的动态影响

目的：动态观察复黄生肌愈创油膏对大鼠糖尿病创面新生肉芽组织中Ⅰ型和Ⅲ型胶原mRNA表达的动态影响。方法：36只雄性Wistar大鼠随机分为创面对照组、模型组、复黄膏组。采用荧光定量PCR技术,观察不同时段创面新生肉芽组织中Ⅰ型和Ⅲ型胶原mRNA表达的变化。结果：创面修复第11d,Ⅰ型胶原mRNA表达复黄膏组明显低于创面对照组（P〈0.05）,但和模型组比较无统计学差异;Ⅲ型胶原mRNA表达复黄膏组明显高于模型组（P〈0.05）,和创面对照组比较差异无统计学意义。结论：复黄生肌愈创油膏通过促进难愈性创面Ⅰ、Ⅲ型胶原增殖和平衡,从而起到促进创面愈合的作用。     

祛瘀生肌法促进肛瘘术后创面修复临床疗效研究

观察祛瘀生肌法促进肛瘘术后创面修复的临床疗效,为肛瘘术后创面修复寻找有效疗法。将60例肛瘘术后患者随机分为两组,每组各30例。治疗组口服生肌化恭方同时配合外用生肌散创面换药,每日2次,治疗3周;对照组单纯外用生肌散换药,每日2次,治疗3周。观察记录患者创面色泽、创面新生肉芽组织情况、创面大小、愈合率等临床指标。结果显示,生肌化瘀方配合生肌散治疗肛瘘术后创面愈合,具有改善创面色泽,促进新生肉芽生长,加快创面愈合,提高临床疗效的作用,明显优于对照组（P〈0．05）。结果表明,祛瘀生肌法是促进肛瘘术后创面愈合的有效方法。     

象皮生肌膏对糖尿病皮肤溃疡修复的效果及其机理探究

目的:研究象皮生肌膏对糖尿病模型大鼠皮肤溃疡的修复作用,初步探究象皮生肌膏的作用机理。方法:选取80只清洁级雄性SD大鼠,随机分成4组,正常组、模型组、贝复新组、象皮生肌膏组。各组分别在治疗7、14 d后观察各组皮肤溃疡的修复状况、检测皮肤溃疡组织中IL-6和TNF-α的表达情况。结果:象皮生肌膏组和贝复新组大鼠溃疡创面的修复率较模型组显著增加,差异有统计学意义(P<0.01),而且象皮生肌膏组修复率较贝复新组更高,差异有统计学意义(P<0.05)。与正常组相比,模型组内IL-6、TNF-α的含量显著增加(P<0.01)。与模型组相比,象皮生肌膏组及贝复新组创面组织匀浆中的IL-6、TNF-α的含量显著下降(P<0.01),且象皮生肌膏组较贝复新组各指标含量下降更明显(P<0.05)。结论:象皮生肌膏可以加快糖尿病皮肤溃疡的修复,其作用机理可能是调控创面炎性因子IL-6、TNF-α的含量,减少炎性细胞的聚集,加快皮肤溃疡创面的修复。     

磺胺嘧啶银联合生肌象皮膏治疗Ⅲ期压疮的效果观察

目的 探讨应用磺胺嘧啶银联合生肌象皮膏治疗Ⅲ期压疮的临床效果.方法 将125例Ⅲ期压疮患者按入院时间分为两组.对照组(59例)采用传统方法治疗,观察组(66例)采用磺胺嘧啶银与生肌象皮膏联合治疗.分别观察两组感染控制时间、肉芽组织形成时间及愈合时间.结果 观察组感染控制时间、肉芽组织形成时间及愈合时间显著短于对照组(均P＜0.01).结论 磺胺嘧啶银联合生肌象皮膏治疗Ⅲ期压疮,可祛腐生肌,有效控制感染创面,促进创面愈合.     

血竭生肌膏对糖尿病大鼠皮肤溃疡VEGF、PCNA表达的影响

目的:探讨血竭生肌膏对糖尿病大鼠皮肤溃疡的修复作用以及对创面组织中血管内皮生长因子(VEGF)和增殖细胞核抗原(PCNA)表达的影响。方法:建立糖尿病大鼠背部皮肤溃疡模型,随机分为正常对照组、模型组、中药治疗组和西药治疗组,后两组分别给予血竭生肌膏和重组人表皮生长因子(EGF)外涂创面,每日1次,共4周。结果:4周后,中药治疗组创面愈合明显优于西药治疗组及模型组,正常对照组创面基本愈合。模型组VEGF的表达为0.07367±0.010690,低于西药治疗组(0.07467±0.014264)和中药治疗组(0.07567±0.006532),且中药治疗组溃疡创面VEGF的表达明显高于西药治疗组(P0.01)。模型组PCNA的表达为0.08067±0.008262,低于西药治疗组(0.11583±0.010553)和中药治疗组(0.12167±0.009668),且中药治疗组溃疡创面PCNA的表达明显高于西药治疗组(P0.01)。结论:血竭生肌膏通过提高糖尿病大鼠溃疡创面VEGF的表达,促进新生血管形成,同时促进创面组织细胞增殖,加快糖尿病溃疡创面愈合。     

生肌膏加聚维酮碘软膏外敷治疗压疮效果观察

目的 探讨生肌膏加聚维酮碘软膏外敷治疗压疮的效果.方法 将82例院外压疮患者按入院时间分为观察组(42例)和对照组(40例).对照组在常规局部清创、消毒、红外线照射后,采用庆大霉素纱条湿敷创面;观察组采用消毒生肌膏加聚维酮碘软膏纱布外敷.现察两组患者的治疗效果及愈合时间.结果 观察组治疗效果显著优于对照组、愈合时间显著短于对照组(均P＜0.01).结论 生肌膏加聚维酮碘软膏可缩短压疮愈合时间,提高压疮治疗效果.     

芦荟生肌膏对大鼠直肠损伤模型的治疗机制

目的:探讨芦荟生肌膏对大鼠直肠损伤模型的治疗机制。方法:健康Wistar大鼠30只,随机分为正常对照组、模型组、芦荟生肌膏治疗组。连续治疗7d后,取各组大鼠直肠组织行蛋白质含量(考马斯亮蓝法)、髓过氧化物酶、成纤维细胞数及病理组织学检查。结果:芦荟生肌膏治疗组的直肠组织蛋白含量、成纤维细胞数明显高于模型组,而髓过氧化物酶的含量显著低于模型组(P0.01)。芦荟生肌膏治疗组的直肠病理组织学检查上皮基本完整,浆膜层基本正常。结论:芦荟生肌膏对大鼠直肠损伤模型有显著的治疗作用,其机制可能与减轻受损组织的炎性反应、促进成纤维细胞增生等有关。     

祛瘀生肌法对慢性下肢溃疡创面色泽及渗液量的影响

目的:探讨祛瘀生肌法对慢性下肢溃疡面创面色泽及渗液量的影响.方法:将50例慢性下肢溃疡患者按先后顺序分为两组,治疗组25例,口服生肌化瘀方同时配合外用生肌散创面换药.对照组25例,单纯外用生肌散换药,两组均1次/d.治疗4周,观察创面愈合率及创面色泽、渗液量情况.结果:生肌化瘀方合生肌散组治疗慢性下肢溃疡,可以提高创面愈合率,改善创面色泽和调节渗液量的作用,明显优于对照组(P＜0.05).结论:表明祛瘀生肌法是治疗慢性下肢溃疡的更佳方法.     

复方紫归膏促进大鼠创面愈合的实验研究

目的：探讨外用中药复方紫归膏（Compound-ZiGui Cream,CZGC）促进大鼠皮肤创面愈合的作用及机制。方法：取SD大鼠125只,建立大鼠创伤模型。实验分成A、B、C、D、E共5组,每组25只。A组为模型组,B组为京万红对照组,C、D、E组分别为复方紫归膏高、中、低药物浓度剂量组。分别于伤后3、7、10、14天时间点观测创面愈合率、HE常规染色显微镜下新生肉芽组织厚度及其形态学改变情况,最后观测创面平均愈合时间等。结果：B、C、D、E组第7、10、14天创面愈合率均优于A组（P〈0.01）,C、D组第7、10天创面愈合率优于B组（P〈0.05）;B组第7、14天创面愈合率较E组优（P〈0.01）;B、C、D、E创面愈合时间均优于A组（P〈0.01）;C、D组优于B组（P〈0.01）;B组和E组间创面愈合时间无差异（P〉0.05）。伤后第7、10天,B、C、D组肉芽组织厚度均较A组厚（P〈0.01）,E组第7、14天较A组厚（P〈0.05）,B组较E组厚（P〈0.01）。组织病理图像分析,伤后第7天,B、C、D、E组新生毛细血管数、毛细血管总面积、面密度、数密度和周密度较A组均有明显提高（P〈0.05或0.01）,且C、D组作用优于B组（P〈0.05或0.01）。B组优于E组（P〈0.05）。结论：外用中药复方紫归膏能促进皮肤创面愈合,其可能机制是促进新生毛细血管的增殖,促进肉芽组织生长。     

活血化瘀中药对糖尿病创面肉芽组织细胞周期变化的影响

目的:探讨活血化瘀中药对糖尿病创面肉芽组织中细胞周期的影响,探求辨证用药规律。方法:36只SD大鼠创面造模,随机分成糖尿病创面中药治疗组、糖尿病创面对照组和正常创面对照组。分别于创面修复3d、11d取材,流式细胞仪检测创面肉芽组织中细胞周期变化。结果:创伤后早期3d,糖尿病创面中药治疗组S期明显高于糖尿病创面对照组(P<0.05),但低于正常创面对照组(P<0.05)。创伤后11d比较,糖尿病创面中药治疗组新生肉芽组织中S期高于糖尿病创面对照组(P<0.05),与正常创面组无差异(P>0.05)。而G2~M期比较,3组无统计学差异(P>0.05)。结论:活血化瘀中药在创伤早期促使细胞增殖进入S、G2~M期,"祛瘀利于生肌",有利于创面修复。创面愈合晚期,活血化瘀中药虽能促使细胞DNA合成,但细胞增殖能力已减弱,对防止创面瘢痕过度生成有利。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.