除皱术的同时完成面部改形术

目的 探讨在行面部除皱术的同时完成面部改形术的临床效果及其注意事项.方法 采用SMAS-颈阔肌除皱技术,将SMAS-颈阔肌瓣分离后显露咬肌,水平方向钝性切开咬肌,显露大部分下颌角和下颌体,去除预计范嗣的下颌角和下颌体,洗净骨质、彻底止血后切除部分咬肌;于冠状切口时将显露的颧突-颧弓截断并上提固定,磨削颧突;于SMAS下分离并上提颊脂肪垫;用切除的SMAS-颈阔肌瓣或ePTFE填充颞部、额部、眉弓等凹陷部位.自1999年8月至2008年8月,采用该方法对132例求美者行面部美容与整形术.结果 132例求美者中,颞部填充感染者1例、面神经颧支损伤者1例、血肿者4例,经对症处理后均痊愈;余者均无并发症发生,但术区肿胀程度略重,较单纯除皱术的肿胀时间延长1～2 d.术后随访其中的28例求美者3个月至5年,面部外形对称、美观,均获得了面部年轻化及面型美的双重效果.结论 除皱术的同时完成截骨、填充的面部轮廓美容,如能准确掌握面部的解剖结构及熟练应用手术的操作技术,均可获得面部年轻化和面型美的双重效果.除肿胀程度较重外,能够避免其他较重并发症的发生.     

面部"S"形曲线在国人面部美容术中的意义

人类面部轮廓的立体感在人体美学中被描绘为“S”曲线。从斜面观察，“S”形曲线由：额部-眼窝-颧颊部(鼻尖）；眼窝-颧颊部(鼻尖)-鼻唇沟(上、下唇)；鼻唇沟(上、下唇)-唇颏沟-颏部3个半圆形组成；Little认为，由凸出和凹进的轨迹组成一条圆滑的“S”曲线(图1)。这一曲线的各个半圆的半径大小受面部软组织和骨组织的结构和形态的影响。     

肿胀法在面部除皱术中的应用

肿胀法在整形美容外科的应用较为广泛。该技术具有放大组织间隙、减少术中出血、组织损伤小等优点。自２０００年１月以来，笔者将肿胀法应用于面部除皱术，减少术中出血量，缩短手术时间，效果满意，现报道如下。１临床资料１．１一般资料：本组２０例，均为女性，年龄最小３６岁，最大５０岁，平均４２岁。５例额颞部除皱，９例全面部除皱，６例全面及颈部除皱，５例额颞部除皱采用局麻，其余１５例均采用全麻。１．２手术方法１．２．１肿胀液的配制：对于局麻患者，配制０．２５％利多卡因注射液１６０mL，另配１∶１０００肾上腺素盐…     

S形切口中面部除皱术的疗效观察

目的：探讨S形切口中面部除皱术的临床疗效。方法：2005年10月～2006年6月间共开展了65例S形切口中面部除皱术,均来自保加医疗美容上海和香港两诊所门诊病人。在颞部发际后和耳前上1/3区设计一S形切口,SMAS筋膜表面分离中面部区域,眼轮匝肌和耳前分离并形成肌瓣和筋膜瓣,向后上方提紧。术后随访6月,根据术者和患者的综合判断,评价该技术的疗效。结果：术后5～9天水肿和瘀血基本消退,患者可以恢复正常工作和生活。3月后完全恢复,面颊部皮肤收紧且富有弹性,眼角外侧皱纹基本消失,鼻唇沟变浅,下颌骨轮廓线清晰。无手术并发症发生。结论：S形切口中面部除皱术是一种切口隐蔽、创伤小、恢复快、疗效好的中面部除皱方法。     

小切口面部除皱术的优缺点

小切口面部除皱术对某些美容就医者来说，疗效非常满意，与传统的面部除皱术相比，具有并发症少、手术省时等优点。但是S．R．Waldman医师在2004年面部美容外科会议上说，小切口面部除皱术既不是一个“周末”手术，也不适合所有面、颈部下垂的美容就医者。     

三维面部除皱术

目的探索在面部除皱术中应用三维概念恢复年轻时的面部轮廓形态。方法全身麻醉下进行全面部除皱术，术中应用了面颊部软组织折叠，面部局部吸脂，移动或复位下移的面部脂肪袋、脂肪移植及组织代用品置入等手术方法。结果从2001年2月至2004年5月，完成手术18例，达到良好的除皱效果。结论通过以上手术方法，使面部除皱术中三维概念得到体现，不仅获得良好的除皱效果而且面部轮廓形态也得到明显改善。     

面部除皱术结合自体脂肪移植在面部年轻化中的应用

目的 探讨面部除皱术+自体脂肪移植用于面部年轻化手术中的效果。方法 选取2021年3月-2023年 11月呼和浩特五洲医院收治的60例面部年轻化手术患者,随机分为A组和B组,每组30例。B组予以面部除皱 术,A组予以面部除皱术+自体脂肪移植,比较两组临床疗效、面部定量指标、生存质量评分（SF-36）、 并发症发生情况。结果 A组总有效率为96.67%,高于B组的80.00%（P ＜0.05）;A组术后7 d双侧颧点间 距、ABC弧度、瞳孔点至鼻唇沟及瞳孔垂线交点距离均优于B组（P ＜0.05）;A组术后7 d 身体健康、 精神健康、生理职能、社会职能评分均高于B组（P ＜0.05）;A组并发症发生率为3.33%,低于B组的 20.00%（P ＜0.05）。结论 面部年轻化手术患者接受面部除皱术+自体脂肪移植的效果确切,可优化面部 定量指标,提升患者生存质量,降低整形术相关并发症发生几率。     

面部除皱术效果探讨

目的 根据面部老化的年龄特点,选择不同的切口和方法行面部除皱术,并比较术后效果.方法 采用额部冠状切口、颞部切口、耳前与耳后发际缘切口、眉上切口、下睑缘切口、发际内点状小切口,分别在帽状腱膜与骨膜之间、骨膜下、SMAS上下进行分离;以及采用点状切口行额、颞、颊"微创"性埋没悬吊提紧术.自1991年1月至2006年5月对138例面部老化患者行除皱术,其中行多切口多层次创伤性除皱者122例,点状小切口"微创"性埋没悬吊除皱者16例.结果 术后随访1～3年者133例,随访10年者5例.创伤性除皱效果维持时间较长,患者满意;小切口"微创"性除皱效果维持时间较短,1年后效果逐渐消失.结论 传统的多切口、多层次、多部位创伤性除皱术效果理想持久,而小切口"微创"性除皱术远期效果不理想.     

Anaesthesia suitable for prolonged bronchoscopic examination

A technique of combined general and topical anaesthesia is described involving spontaneous ventilation. Patients aged 46 to 76 were examined in this way for periods varying between 5 and 25 minutes. Carbon dioxide elimination was satisfactory in all but 2 of 18 patients, and these 2 are discussed in detail. Capillary oxygen tension was maintained at a level of over 75 mm. Hg throughout all 11 examinations where oxygen was introduced at the proximal end of the bronchoscope, but dangerous hypoxaemia occurred in 2 patients in whom oxygen was not administered in this way.     

Making stem cell lines suitable for transplantation

Human stem cells, progenitor cells, and cell lines have been derived from embryonic, fetal, and adult sources in the search for graft tissue suitable for the treatment of CNS disorders. An increasing number of experimental studies have shown that grafts from several sources survive, differentiate into distinct cell types, and exert positive functional effects in experimental animal models, but little attention has been given to developing cells under conditions of good manufacturing practice (GMP) that can be scaled up for mass treatment. The capacity for continued division of stem cells in culture offers the opportunity to expand their production to meet the widespread clinical demands posed by neurodegenerative diseases. However, maintaining stem cell division in culture long term, while ensuring differentiation after transplantation, requires genetic and/ or oncogenetic manipulations, which may affect the genetic stability and in vivo survival of cells. This review outlines the stages, selection criteria, problems, and ultimately the successes arising in the development of conditionally immortal clinical grade stem cell lines, which divide in vitro, differentiate in vivo, and exert positive functional effects. These processes are specifically exemplified by the murine MHP36 cell line, conditionally immortalized by a temperature-sensitive mutant of the SV40 large T antigen, and cell lines transfected with the c-myc protein fused with a mutated estrogen receptor (c-mycERTAM), regulated by a tamoxifen metabolite, but the issues raised are common to all routes for the development of effective clinical grade cells.     

适合中国人的抗磷脂酶A2受体抗体临界值的界定

目的分析中国原发性膜性肾病(PMN)患者抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体水平,及其与临床指标的相关性,探讨更适合中国人的诊断临界值。方法入选2018年1月至2018年8月期间北京大学人民医院所有接受肾活组织检查者为研究对象,按照原发病分为原发性膜性肾病(PMN)组(包括特发性膜性肾病及原因未明的不典型膜性肾病患者)和对照组(除PMN以外的其他病理类型,包括继发性膜性肾病患者),回顾性收集和分析患者临床及病理资料。用酶联免疫吸附法(ELISA)检测入选者血抗PLA2R抗体水平,比较两组患者血抗PLA2R抗体水平的差异。采用Spearman相关分析法分析PMN患者血抗PLA2R抗体水平与临床指标的相关性;用Logistic回归模型法分析鉴别患者发生PMN的相关因素;用ROC曲线分析诊断PMN的优化临界值。结果共354例患者入选本研究,其中PMN组114例,对照组240例。PMN组年龄(51.7±14.1)岁,男/女比例为2.2∶1。PMN组患者血抗PLA2R抗体水平显著高于对照组[16.87(1.88,57.26)RU/ml比1.43(1.20,1.62)RU/ml,P<0.001]。PMN患者血抗PLA2R抗体水平与24 h尿蛋白量(r=0.278,P=0.003)、尿红细胞(r=0.190,P=0.043)呈正相关,与血白蛋白(r=-0.149,P=0.114)、血肌酐(r=0.136,P=0.149)无相关。ROC曲线分析结果显示,当设定抗PLA2R抗体的临界值为2.28 RU/ml时,鉴别PMN与其他病理类型的灵敏度为69.3%(95%CI 60.3%~77.0%),特异度92.9%(95%CI 89.0%~95.5%),曲线下面积0.859(95%CI 0.813~0.905,明显优于临界值为20.00 RU/ml(灵敏度46.5%,特异度97.5%)及14.00 RU/ml(灵敏度53.5%,特异度97.1%)。结论下调PMN主要致病抗体抗PLA2R抗体临界值至2.28 RU/ml,可提高鉴别诊断PMN与其他病理类型的灵敏度而不显著降低特异度。     

Quality criteria for porcine islet cells suitable for xenotransplantation

Introduction: Intact functional pancreatic islets can be successfully isolated from various domestic pig breeds, including some minipig strains. Nevertheless, the technically demanding pig islet isolation procedure needs further improvements. Few efforts have been made to determine the underlying mechanisms for the greatly varying islet yields in many domestic pig breeds. This problem also relates to Landrace Pigs that are often used as donor animals to insert different human genes into the pig genome in order to overcome the various immunological reactions in response to transplantation of a porcine xenograft. Methods: To obtain a clearer picture on the efficiency of islet yields, we evaluated the number of islets, their morphology and intensity of insulin staining in pancreata of various brain‐dead pigs of crossbred and pure bred strains. We performed histochemistry with frozen tissue sections and anti‐pig‐insulin antibody and applied an evaluation procedure, based upon >1.600 microscopically screened pancreata, >800 isolations, and sub‐sequent functional in vivo and in vitro assays. Results: In first series 40 pancreata (tail end of the splenic lobe) of both sexes of the following donor animals were investigated: Piétrain [PI] × German Landrace Pig [GL] (n = 5), German Pure Bred Pig [GPB] x GL (n = 3), PI x GL/GPB (n = 9), GL (n = 12), GPB (n = 3), PI (n = 7), and Duroc (n = 1). Pigs were 6‐7 months old, and were fed and kept under identical conditions. Only three of 40 pancreata (7.5%) displayed islets of sufficient quality for subsequent isolation [data not shown], i.e. sufficient numbers of mostly rounded islets of ≥200 μm in diameter, displaying intensive and evenly distributed insulin staining. Each of the 3 “good” donor organs belonged to a different pig breed. This test was repeated a second time, using 50 pancreata from brain‐dead pigs (both sexes) collected in a Bavarian pig breeding institution: PI × GL (n = 16), PI × GL/GPB (n = 16), GL × GPB (n = 5), GL (n = 12), GPB (n = 2), PI (n = 1). Age, keeping and feeding conditions were identical with conditions of the first trial. Overall, four of 50 pancreata (8%) were determined to be suitable for subsequent islet isolation [not shown here], according to our microscopic evaluation criteria. Again, those four “good” pancreata belonged to four different pig breeds, i.e., a correlation between a particular pig breed and “good” islets could not be detected. In both tests, pancreata that displayed islets with large insulin‐free areas, pancreata with insufficient islet numbers, and islets that displayed very weak insulin staining, as compared to positive control islets, were determined as being unsuitable for islet isolation. Conclusions: Only 7.5–8% of domestic pig pancreata (n = 90) appear to be suitable for islet isolation; in previous years this number was 35–50%. The reasons for this continuous decline in suitable donor organs are presently unknown. None of the crossbreeds and pure breeds tested here displayed a genetic background that correlated with either “good” or “bad“ islets; sufficient animal numbers from pure bred pig strains could clarify this important point. A high versus low caloric diet could help to elucidate the possible influence of nutrients on islet development. From preliminary findings, we hypothesise that a certain amount of carbohydrate feeding may be beneficial in stimulating islet morphology and also islet function.