高原断肢（指）再植248例临床分析

我们于１９７８年至１９９４年，在高原环境条件下开展断肢（指）再植手术２４８例，成活率为９０．８％，文中着重分析了高寒、缺氧对断肢（指）再植的影响，并提出了处理方法。     

高氧液和高压氧对断肢再植后循环危象患者的疗效

断肢再植后出现的血液循环危象，是影响其成活的重要因素。我院自2001年以来，分别采用医用高氧液、高压氧配合治疗断肢再植后出现的血液循环危象，现报告如下：     

不同强度脉冲电磁场对大鼠颅骨成骨细胞增殖与分化的影响

目的：研究不同强度脉冲电磁场（PEMFs）对大鼠成骨细胞（ROB）增殖与分化的影响。方法：酶消化法分离获得大鼠颅骨成骨细胞,采用50 Hz,0.14、0.16和0.18 mT的PEMFs进行干预,测定细胞增殖率、ALP活性和BMP-2 mRNA的表达。结果：0.14 mT的PEMFs对ROB增殖和分化均无明显影响;0.16、0.18 mT的PEMFs可明显提高ALP活性,并上调BMP-2mRNA表达。结论：PEMFs对ROB的影响主要表现在促进其分化,且这种作用存在较为敏感的＂强度窗＂效应。     

脉冲电磁场、碱性成纤维细胞生长因子促进坐骨神经延长的实验研究

目的探讨减轻周围神经在缓慢牵拉过程中的损伤，增加神经延长率的方法。方法采用改良的组织扩张器，对大白兔坐骨神经行扩张延长的同时，辅以脉冲电磁场（ＰＥＭＦ）及碱性成纤维细胞生长因子（ｂＦＧＦ）处理。最后，测定神经延长率（ＮＥＲ）、运动传导速度（ＭＣＶ）及组织病理观察。结果ＮＥＲ在ＰＥＭＦ组及ｂＦＧＦ组均显著高于对照组，而ＭＣＶ的降低却显著较轻。组织病理显示，ＰＥＭＦ及ｂＦＧＦ组的神经变性轻，雪旺氏细胞增殖，新生毛细血管及髓鞘却较明显。结论ＰＥＭＦ及ｂＦＧＦ可减轻神经在扩张期间的损伤，增加延长率     

强脉冲声对听器损伤的实验观察

用强脉冲声作爆震源，观察大于１７０．０ｄＢ（ＳＰＬ）的强脉冲声对豚鼠听器的损伤。结果表明，１７０．０ｄＢ（ＳＰＬ）的脉冲声可引起暂时性听力下降，４８ｈ恢复正常。噪声强度大于１８０．０ｄＢ（ＳＰＬ），可造成豚鼠不同程度的听力损伤和中耳、内耳损伤，其病理改变主要为机械性损伤。采取有效的防护措施，对减少强脉冲声所致听器损伤，保护听力具有十分重要的意义。并为我军武器装备提供生物效应实验依据。     

骨断端吻合固定情况对断指再植的影响

近年来，随着断肢再植术的发展和显微外科技术的应用，断指再植已成为手外科的一门专项技术，并向纵深发展，取得瞩目成就。由于我国人口众多，因生活及工作意外造成手创伤的患者较多。手外科断指再植技术的进步，无疑对减少因伤致残起着非常积极的作用。过去许多文献对断指再植的研究侧重于血管、神经、肌腱和手部其他软组织吻合方面的探索，对骨断端吻合、固定情况对断植再植的效果影响评价较少。笔者从影像学、外科学、显微外科学的角度予以综合分析，旨在引起手外科医生对骨断端吻合、固定的重视，从而提高断指再植成活率，缩短康复时间。     

脉冲电磁场对去势大鼠腰椎局部细胞因子及骨组织学影响

目的：探讨脉冲电磁场对去势大鼠腰椎局部细胞因子及骨组织学的影响。方法：选用健康Wistar雌性大白鼠共18只,随机分为A组（双侧卵巢切除＋脉冲电磁场治疗组）,B组（双侧卵巢切除组）,C组（伪去势组）,每组6只。A组于术后3d置脉冲电磁场治疗,每天1次,1h／次,共治疗3个月,电磁场频率为2Hz。3个月后处死所有大鼠,取大鼠的全部腰椎和股骨,腰椎匀浆后取上清液,采用放射免疫法测定肿瘤坏死因子（TNF—α）和白细胞介素-6（IL-6）含量。股骨固定,脱钙,常规石蜡切片,HE染色观察骨组织学变化。结果：B组大鼠腰椎TNF—α含量显著高于A、C组（P〈0．01）。B组IL-6含量与A、C组比较显著增高（P〈0．01）。A组同C组比较TNF-α和IL-6含量无统计学差异。骨组织学观察：B组股骨与A、C组比较骨皮质变薄,骨髓腔扩大,骨小梁分布稀疏,骨小梁粗细不均,见断裂现象。A组与C组比较无明显差别。结论：去势大鼠腰椎TNF-α和IL-6含量显著高于正常对照组,大鼠去势后股骨骨小梁明显变细,数量减少,分布稀疏。脉冲电磁场能明显降低去势大鼠腰椎TNF—α和IL-6的含量和抑制骨吸收。     

高压氧对断肢(指、趾)再植血液循环危象的疗效

断肢 (指、趾 )再植后 ,由于各种原因 ,再植的肢 (指、趾 )体可能出现血液循环危象 ,严重影响其成活。为提高再植肢(指、趾 )体的成活率 ,我们自 1987年以来 ,采用高压氧(HBO)配合治疗再植断肢 (指、趾 )血液循环危象 18例 ,收到了较为满意的效果 ,报告如下。一、临床资料1.一般资料 :本组 18例中男 16例 ,女 2例 ;年龄 15～35岁 ,平均 2 8岁。共 2 0个肢 (指、趾 )体 ,包括左前臂、左腕部完全断离各 1个 ,手指完全断离 4个、不完全断离 6个 ,足趾完全断离 5个、不完全断离 3个 ;均于断肢 (指、趾 )再植术后出现血液循环危象 ,经常规处理…     

50 Hz 1 mT脉冲电磁场对脐带间充质干细胞免疫调节能力的影响及其安全性评价

目的探讨50 Hz 1 mT脉冲电磁场（PEMF）对脐带间充质干细胞（MSC）免疫调节能力的影响及其安全性。方法采用50 Hz 1 mT PEMF辐照脐带MSC,MTT法检测辐照后细胞活性的变化;实时荧光定量PCR法检测脐带MSC的环氧合酶2（COX2）、IL-10、吲哚胺-2,3-双加氧酶（IDO）、肝细胞生长因子（HGF）和转化生长因子β（TGF-β）等基因mRNA表达水平的改变;流式细胞仪检测PEMF对脐带MSC活性氧（ROS）水平、细胞凋亡和细胞周期的影响;单细胞凝胶电泳分析脐带MSC DNA损伤的情况。采用SPSS19.0软件,对各组间数据进行独立样本t检验分析。结果50 Hz 1 mT PEMF辐照可增强脐带MSC的细胞活性,其中每天辐照4 h组变化最为明显,差异有统计学意义（t=3.505,P < 0.05）。PEMF辐照可促进COX2、HGF、IDO和TGF-β等免疫调节因子mRNA的表达,但变化不明显,差异无统计学意义（t=0.982~2.376,均P>0.05）,对于干扰素γ（IFN-γ）激活的MSC,PEMF辐照可显著上调COX2、HGF、IDO和TGF-β的mRNA表达水平,差异有统计学意义（t=2.436~3.747,均P < 0.05）。50 Hz 1 mT PEMF辐照对脐带MSC的ROS水平、DNA损伤及细胞凋亡率、细胞周期无显著影响。结论对于IFN-γ激活的MSC,50 Hz 1 mT PEMF可显著上调COX2、HGF、IDO和TGF-β的mRNA表达水平,从而增强脐带MSC的免疫调节能力。50 Hz 1 mT PEMF对脐带MSC的ROS水平、细胞凋亡及DNA损伤无明显影响,此参数下的PEMF辐照对脐带MSC是安全的。     

483例断指再植的临床体会

目的 回顾性分析483例断指再植的临床研究疗效.方法 2007年3月～2010年6月我院采用臂丛麻醉或指根麻醉对483例601指进行断植再植手术,在手术显微镜下彻底清创、精确吻合血管,仔细修复肌腱及指神经.术后常规行"三抗"治疗与早期康复治疗.结果 再植601指成活581指,手术成功率为96.7%.术后经6个月～3年3...     

耳廓离断的显微再植与修复

目的探讨耳廓离断伤的显微外科再植和修复方法。方法回顾1990年以来8例耳廓离断伤,采用显微再植、寄养再植、皮瓣转移重建等方法进行修复。结果术后随访12～32个月,耳廓再植成活6例,原位再植及寄养再植各失活1例,后经皮瓣修复重建耳廓2例全部成活,所有病人均在术后7～10 d拆线,伤口一期愈合,耳廓皮肤感觉恢复,听力正常。结论对耳廓离断损伤患者,引入超显微外科技术,采用更为精细的血管吻合技术是最理想的修复方法。     

Effect of short exposure to radiofrequency electromagnetic fields on saliva biomarkers: a study on the electrohypersensitive individuals

Abstract

Context: Some individuals are reporting being sensitive to electromagnetic fields. They report some unspecific symptoms like headeache, sleep disruption, heart palpitations, itching, etc. The lack of scientific objective links between EHS symptoms and EMF exposure renders the diagnosis of EHS more complex.

Purpose: Our present work aimed to look for the effect of RF EMF exposure on saliva alpha amylase (AA) and other biological markers such as cortisol and IgA in EHS individuals.

Participants and methods: Ten EHS individuals participated in this double-blind provocation study. They were aged between 35 and 63?yr. Experiment consisted of two sessions (sham and real exposure). No external EMF sources were allowed, and the exposure consisted of a series of EMF signals emitted from a generator (Rhode & Schwarz) and a horn antenna (Schwarzbeck BBHA9120b). Consecutive RF signals were applied: GSM 900, GSM 1800, DECT, and Wi-Fi signals for 5?min each.

Results: Exposure to 4 consecutive radiofrequency signals did not show any significant modification (p?>?.05) on the saliva AA, cortisol or immunoglobulin A concentrations in the electrohypersensitive individuals.

Conclusions: Our study, under current conditions, do not presently allow us to propose an identification of marker for EHS.     

Biological effects of low frequency electromagnetic fields

Epidemiological studies since 1979 have raised some medical and much public concern that low frequency electromagnetic fields, such as those of power‐lines and in domestic and industrial electrical wiring, may have harmful biological effects. These studies are generally inconsistent, inconclusive, and difficult to replicate. Identifying biological mechanisms by which such harmful effects may occur has proved difficult, although there are several new and promising approaches. In epidemiological and laboratory studies’ much greater co‐ordination and standardization is needed if greater scientific knowledge of these phenomena, as opposed to mere diverse speculation, is to be achieved.     

The effects of microwave frequency electromagnetic fields on the development of Drosophila melanogaster

Purpose:?To investigate the effects of microwave frequency electromagnetic fields (EMF) on the development of Drosophila melanogaster.

Materials and methods:?Larvae of D. melanogaster were exposed to 10 GHz EMF continuously (3 h, 4 h and 5 h) and discontinuously (3 h exposure + 30 min interval + 3 h exposure). The percentages and times of transition from larvae to pupae and from pupae to adults were determined, and the mean offspring number was examined using the offspring of the females which had been exposed as larvae.

Results:?No differences were found in the transition percentages from larvae to pupae and from pupae to adults (p > 0.05). However, it was found that the mean pupation time was delayed linearly with an increasing electromagnetic field (EMF) exposure period (p < 0.05). In the 3 + 3-h exposed group (E3 + 3), the mean offspring number was significantly less than that of the control (p < 0.05).

Conclusions:?10 GHz EMF can cause developmental delay and decrease the number of offspring in D. melanogaster.     

四肢离断再植29例临床分析

目的探讨创伤后上下肢离断29例再植手术的临床疗效及治疗体会。方法选取2004年1月~2014年11月收治的29例四肢离断伤患者,男性23例,女性6例;年龄23~47岁,平均35岁。其中电锯伤9例,砍伤6例,旋转撕脱伤3例,挤压碾轧伤11例;离断平面:上肢损伤9例,包括手掌部离断1例,前臂离断5例,上臂离断3例;下肢损伤19例,包括足部离断3例,踝部离断8例,小腿离断7例,双踝部完全离断1例。结果 29例共离断30肢,其中5例术后因血管危象行血管探查修复,2例发生感染导致再植肢体坏死,进而截肢;9例术后一次性成功;18例术后伤口部分皮肤坏死,行创面换药及二次植皮手术伤口愈合,成活率93.1%。按照断肢再植术后功能评定标准:上肢:Ⅰ级3例,Ⅱ级4例,Ⅲ级1例,1例再植失败;下肢:Ⅰ级9例,Ⅱ级9例,Ⅲ级1例,1例再植失败。结论综合考虑患者的全身情况,选择再植的适应证,合理全面的清创固定,及时正确的修复血管、神经、肌肉、肌腱等组织,术后合理的康复锻炼及功能锻炼,是提高断肢再植成活率及功能康复的重要因素。     

静脉皮瓣在复杂断指再植中的应用

 目的 探讨静脉皮瓣在复杂断指再植中的应用。方法 复杂断指再植16例16指,先常规行断指再植手术,患指掌、背侧皮肤缺损处应用前臂掌侧静脉皮瓣游离移植修复,同期修复血管缺损。结果 15例断指、静脉皮瓣均成活,其中3例静脉皮瓣出现部分坏死,经换药或植皮后愈合。1例术后出现静脉危象导致断指、皮瓣坏死。16例获随诊3~23个月,末次随访皮瓣外形不臃肿、质地良好。皮瓣置于患指掌侧组、背侧组的优良率比较,差异无统计学意义(χ²=0.58,P>0.05)。结论 静脉皮瓣为合并血管、皮肤缺损的复杂断指再植提供了一种可行、有效的方法。     

Cellular effects of extremely low frequency (ELF) electromagnetic fields

Purpose: The major areas of research that have characterised investigation of the impact of extremely low frequency (ELF) electromagnetic fields on living systems in the past 50 years are discussed. In particular, selected studies examining the role of these fields in cancer, their effects on immune and nerve cells, and the positive influence of these ELF fields on bone and nerve cells, wound healing and ischemia/reperfusion injury are explored.

Conclusions: The literature indicates that there is still no general agreement on the exact biological detrimental effects of ELF fields, on the physical mechanisms that may be behind these effects or on the extent to which these effects may be harmful to humans. Nonetheless, the majority of the in vitro experimental results indicate that ELF fields induce numerous types of changes in cells. Whether or not the perturbations observed at the cellular level can be directly extrapolated to negative effects in humans is still unknown. However, the myriad of effects that ELF fields have on biological systems should not be ignored when evaluating risk to humans from these fields and, consequently, in passing appropriate legislation to safeguard both the general public and professionally-exposed workers. With regard to the positive effects of these fields, the possibility of testing further their efficacy in therapeutic protocols should also not be overlooked.