负压封闭引流并吸附材料治疗难治性创面40例★

选择广西医科大学第四附属医院骨一科2008-01/06救治的难治性创伤患者78例，单日入院40例患者进入治疗组，采用负压封闭引流技术治疗，即将负压封闭引流材料覆盖创面后外贴半透性薄膜接负压吸引；双日入院38例患者为对照组,采用普通换药方法治疗。两组患者最后均通过游离植皮、皮瓣转移或游离皮瓣移植修复。结果显示治疗组植皮及皮瓣修复创面成活率高，创面感染率低，患者住院时间短，提示负压封闭引流是临床治疗难愈性创面的一项较好的方法。     

RNPT设备及材料修复创伤性软组织缺损

背景：应用传统外科换药或负压封闭引流技术处理大面积难愈性伤口及创伤性软组织缺损可以促进创面愈合,但两项技术均存在明显不足。 目的：观察RNPT设备(Repairment of Negative Pressure Therapy,RNPT)及其材料在修复创伤性软组织缺损中的效果。 方法：60例创伤性软组织缺损病例随机平均分为2组,常规组行外科换药治疗;RNPT组应用RNPT治疗仪治疗。每例患者每次换药治疗时及疗程结束后(9 d)分别进行疗效评分。 结果与结论：同一类型创面,与常规组比较,使用RNPT治疗局部水肿消散时间、肉芽组织生成时间均提前。表明RNPT可明显促进损伤创面愈合、减轻局部水肿程度并刺激肉芽组织生成。     

应用人工真皮联合自体薄层皮片移植修复深度皮肤软组织缺损11例

背景：深度皮肤软组织缺损创面积极的治疗方法往往以皮瓣修复为主，但对患者身体状况要求较高，且代价较大。人工真皮是最早开发和成功应用于临床的组织工程化皮肤替代物，主要用于皮肤软组织缺损的修复。 目的：拟观察人工真皮联合自体薄层皮片移植对深度皮肤软组织缺损创面的修复效果。 设计、时间及地点：病例分析，于2006-01/2008-03在北京大学第三医院成形科、北京积水潭医院烧伤整形科完成。 对象：11例患者均存在由于手术或外伤导致不同程度和部位的皮肤软组织缺损创面，部分病例伴有骨质外露、骨膜缺损。 方法：手术中一期扩创，需要时凿骨，移植人工真皮，经2~4周创面被类真皮组织覆盖后，二期进行自体薄层皮片移植。 主要观察指标：观察创面愈合及植皮存活情况，供皮区有无明显瘢痕。 结果：11例创面均得到良好覆盖。创面愈合后1个月复查，植皮后愈合良好，供皮区均没有明显瘢痕。 结论：人工真皮联合自体薄层皮片移植对深度皮肤软组织缺损创面具有良好的修复效果，供区损伤小。人工真皮的应用为修复包含骨外露创面在内的深度皮肤软组织创面提供了一种新方法。     

人工真皮复合自体薄皮移植治疗皮肤软组织缺损

背景：修复皮肤软组织缺损自体或异体植皮治疗,往往需要多次植皮。而国内临床上应用人工真皮较少,应用经验亦不足。 目的：评价人工真皮治疗皮肤软组织缺损的疗效。 方法：收集因皮肤软组织缺损,行人工真皮结合自体薄皮移植修复创面的22例患者,其中骨外露6例,肌腱外露2例,表皮肿瘤切除3例,其他11例。一期清创移植人工真皮,2~4周后局部肉芽组织生长良好,外露肌腱、骨组织被类真皮组织覆盖,二期移植自体薄层皮片。观察取皮部位、损伤部位、操作性能、密封性、不良反应情况,结合评价临床效果及综合评价。 结果与结论：20例患者人工真皮结合二期自体薄皮移植全部存活,至二期植皮所需时间(18.50±4.27) d,其中1例患者因感染再次手术,2例患者行人工真皮后未行二期植皮,而自动上皮化;随访至3个月,21例损伤部位表皮生长性、外观性均良好、无瘢痕增生,1例因感染而致瘢痕增生严重、外观不良,但生长性良好;20例患者取皮部位无明显的色素沉着及色素脱出,无严重增生性瘢痕,上皮形成时间为(15.35±4.67) d。说明人工真皮结合自体薄皮移植修复皮肤软组织缺损,操作简便,创面愈合质量高,供皮区损伤轻微,至二期植皮时间较长,总体临床效果良好。     

Meek微型皮片移植修复大面积深度烧伤

背景：Meek植皮法是近5年来引进并陆续在国内多家医院采用的一项创面修复的新技术。 目的：观察Meek微型皮片移植修复在大面积深度烧伤患者皮肤缺损的效果。 方法：对16例大面积深度烧伤创面患者,采用早期切(削)痂后及晚期肉芽创面Meek植皮法植皮,其中6例选取Ⅲ度烧伤面积30%左右患者同一个体行相同面积Meek微型皮片植皮法,和自体小邮票植皮作为对照。 结果与结论：采用Meek微型皮片植皮法皮片成活率65%~95%,创面愈合时间21~65 d。Meek微型皮片与自体邮票植皮相比缩短了手术时间,节省了皮源,创面愈合后瘢痕平整,挛缩率低,关节功能恢复良好。     

人工真皮修复急性创伤后足背皮肤软组织缺损14例

背景：人工真皮具有硅胶膜和胶原海绵双层结构,是最早开发和应用于临床的组织工程化皮肤替代物,主要应用于皮肤软组织缺损修复。 目的：评价人工真皮在足背严重皮肤软组织缺损中的应用。 方法：选择北京积水潭医院烧伤科于2009-06/2010-12收治的14例急性外伤后足背严重皮肤软组织缺损患者,均有肌腱或骨外露。所有患者经清创后,以人工真皮移植,待人工真皮成活后以自体断层皮片移植,观察人工真皮和自体皮的成活情况。 结果与结论：所有植皮成活,创面愈合良好,供区未见明显瘢痕增生。提示人工真皮联合自体断层皮片移植可以有效修复足背严重皮肤缺损创面,减少供区损伤。     

皮肤软组织扩张修复头面部外伤性缺损的早期应用

目的：常规应用植皮或单纯的皮瓣修复头面部皮肤软组织缺损从美学角度讲存在一定的缺点。总结皮肤软组织扩张器在头面部外伤性缺损早期修复中的应用情况。 方法：①对象：选择2005-09/2007-10在解放军第四军医大学西京医院整形外科住院的部分外伤性头面部皮肤软组织缺损患者15例。其中男12例，女3例；年龄5~51岁。面部缺损4例，头皮缺损7例，面部并头皮缺损4例，缺损面积3 cm×5 cm~ 7 cm×11 cm。②方法：积极改善患者全身情况，加强局部创面处理，待全身情况稳定、创面肉芽组织新鲜的情况下，行清创、刃厚植皮术，覆盖除骨外露以外所有创面。同时或延期于缺损周围正常组织下埋置一至数枚容量不等（80~450 mL）的扩张器。皮片成活并稳定后，开始扩张器注水，约两三个月注水完成后行扩张器二期术，切除骨外露周围不稳定的瘢痕组织（包括早期植皮部分），用设计的扩张皮瓣覆盖缺损，完成修复。 结果：1例头皮扩张器在扩张后期出现了外露，及时进行二期手术修复缺损。所有患者头面部皮肤软组织缺损在短期内均得到了有效修复，2例患者在二期术后出现了轻度的器官移位，术后半年症状消失，所有病例无瘢痕性秃发发生。 结论：皮肤扩张可用于头面部外伤性缺损的早期修复，合理的选择、正确的应用可以获得满意的效果。     

猪后肢软组织爆炸伤后封闭负压引流组织修复效果与常规法的比较

背景：以往封闭式负压引流在外伤、切割伤等感染创面治疗上效果较为满意,但其对爆炸伤的治疗效果却少见报道。 目的：以猪后肢软组织爆炸伤为治疗模型,观察封闭式负压引流对爆炸伤的治疗效果。 方法：用雷管先后于4只活体健康白猪双后肢肌肉组织发达处行模拟爆炸,建立爆炸伤动物模型,并造成伤口污染后,一侧行封闭式负压引流治疗,对侧行常规治疗即每日用双氧水、新洁尔灭、生理盐水冲洗,油纱覆盖。实验动物于爆炸伤后第3,5,7 天分别进行细菌学检查,羟辅氨酸含量测定,苏木精-伊红染色,观察对比双侧各项指标的差异。 结果与结论：封闭式负压引流治疗3 d后,治疗侧细菌数量少于对照侧(P < 0.05)。封闭式负压引流治疗侧在治疗后第3,5,7 天羟辅氨酸含量明显高于对照侧(P < 0.05),相比对照侧,封闭式负压引流侧无明显炎症细胞渗出,碎裂区外侧可见大量肉芽组织形成。由此可见,封闭式负压引流能够加快爆炸伤创面愈合,可减少感染和各种并发症发生概率,治疗效果明显优于常规治疗。     

生肌液复合封闭负压引流对创面肉芽组织增殖的作用

背景：传统生肌中药促进创面愈合疗效独特，封闭负压引流技术是新兴的创面治疗方法。 目的：从组织学角度观察生肌液和封闭负压引流技术相结合对实验动物创面愈合的影响。 设计、时间及地点：随机对照动物实验，于2006-05/10在河南省正骨研究院生物工程实验室完成。 材料：100只SD大鼠随机分为模型组、麻油纱布组、生肌液纱布组、封闭负压引流组、生肌液复合封闭负压引流组，每组20只。生肌液和麻油煎剂均由本院制剂室规范制备。 方法：在每只大鼠背部制作2个皮肤切除伤创面模型。模型组等待创面自然愈合，麻油纱布组以两层麻油纱布敷于创面上，生肌液纱布组以两层生肌液纱布敷于创面上；封闭负压引流组给予创面封闭负压引流治疗。生肌液外用结合封闭负压引流组：给予创面封闭负压引流治疗，负压吸引间歇期从注药管注入生肌液。每组20只动物随机分4批各10个创面，第1，2，3个批次分别用于3，6，9天取材观察创面的愈合率和创面组织形态学变化。第4个批次观察创面愈合时间。 主要观察指标：①创面的愈合率。②创面愈合时间。③创面组织形态学变化。 结果：①各组创面第3天愈合率比较差异无显著性意义(P > 0.05)。3 d后封闭负压引流组及复合组愈合速度明显加快。第9天愈合率由高到低依次为复合组、封闭负压引流组、生肌液纱布组、麻油纱布组和模型组，组间比较差异有显著性意义(P < 0.05)。各组愈合时间由快到慢排序同上。②第3天封闭负压引流组毛细血管数略高于复合组(P > 0.05)；第6天复合组毛细血管数高于封闭负压引流组(P < 0.05)；第3天各组成纤维细胞数均维持在较低水平，组间比较差异无显著性意义(P > 0.05)第6天复合组成纤维细胞数高于封闭负压引流组(P < 0.05)。 结论：生肌液复合封闭负压引流技术可以更好地促进创面愈合。封闭负压引流技术在创面愈合的早期能明显促进组织细胞增殖；生肌液在中后期可以延续组织细胞的增殖趋势。     

股前外侧皮瓣移植修复四肢及口腔颌面软组织缺损

背景：高能量损伤所致四肢大面积软组织缺损及口腔颌面部肿瘤切除术后软组织缺损是临床常见的组织缺损,应用股前外侧皮瓣修复此类缺损不但能覆盖创面而且对供区影响小。 目的：总结分析游离股前外侧皮瓣在四肢及口腔颌面软组织缺损修复中的临床效果及治疗经验。 方法：收集41例四肢及口腔颌面创伤或肿瘤切除后软组织缺损应用游离股前外侧皮瓣修复的临床资料,软组织缺损面积为(12~25) cm×(5~11) cm,根据受区软组织缺损大小、形态切取股前外侧皮瓣,将皮瓣动静脉与受区动静脉吻合,覆盖创面。观察移植后股前外侧皮瓣成活、供区愈合情况,患者对手术的满意程度,受区的功能恢复情况。 结果与结论：所有皮瓣均完全成活,其中2例出现血管危象,均为移植后24~36 h出现皮瓣淤黑,予及时血管探查发现均为静脉栓塞,经手术取栓后皮瓣成活。病例随访4个月~3年,均得到覆盖创面的目的,2例患者移植后因皮瓣臃肿再次入院行削薄手术。游离股前外侧皮瓣血管恒定,血管口径大,可切取面积大,修复四肢及口腔颌面皮肤黏膜大面积软组织缺损安全可靠。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Necdin蛋白与神经元的生长分化

在神经系统,Necdin只在成熟神经元的细胞核中表达,可能与成熟神经元分裂静止状态的保持有关.近年的研究表明,Necdin是一种生长抑制蛋白,能与多种因子如SV40大T抗原,腺病毒E1A,转录因子E2F1以及肿瘤抑制蛋白p53等结合,在功能上类似于成视网膜瘤蛋白Rb.necdin基因缺陷时,会引起脑内,特别是下丘脑神经元分化障碍.人类necdin基因位于PWS综合征的基因缺失区,可能与PWS的一些症状有关.本文从Necdin蛋白的基本概况,生物功能以及Necdin与疾病三个方面进行了综述.     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Cortisol levels and depression in men and women using heroin and cocaine

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.     

相关性和一致性：这对相仿概念和测量方法的回顾与阐明

概述：一致性(agreement)和相关性(correlation)是两个广泛使用的概念,用来评估变量之间的关联。虽然二者相似且相关,但是它们代表关联完全不同的概念。评估变量之间的一致性假设变量测量的是相同的结构,而在变量测量完全不同的结构时也可以评估它们之间的相关性。这种概念上的差异就要求使用不同的统计方法,并且当评估一致性或相关性时,统计方法根据数据的分布和研究者的兴趣可能会有所不同。例如, Pearson相关性,作为评估连续变量之间相关性的一种普遍测量方法,只有用于符合线性关系的变量时才能提供有用的信息;当用于不符合线性关系的变量时就无法提供准确信息甚至会产生误导。同样地,内部相关性,作为一种评估连续变量之间一致性的常用方法,如果一致性不好的实质正好是研究兴趣所在,那么该测量就不能为研究者提供充分的信息。本报告回顾了一致性和相关性的概念,并讨论了几种常用方法在应用中的差异。