注射自体成纤维细胞除皱的临床应用

目的观察体外培养的自体成纤维细胞注射的面部除皱临床效果,探讨其在面部年轻化治疗中的意义。方法取10例睑袋及上睑松弛手术切除的皮肤行体外培养,细胞数量扩增至108后注射入面部不同治疗部位皮肤的真皮深层,共注射3次,每次间隔2周。结果10例随访6~12月,各例皱纹均得到明显改善,未出现免疫排斥、肉芽肿等并发症。结论应用培养的自体成纤维细胞注射去除面部浅表皱纹,治疗过程简便、创伤微小、安全、效果确实,是一种较好地填充除皱方法。由于尚缺乏更长期的随访结果,远期疗效还有待进一步观察。     

颈椎病合并下颈椎不稳的外科治疗策略

目的 探讨颈椎病合并下颈椎不稳的临床诊断、术式选择及手术疗效。方法 对手术治疗的32例颈椎病合并下颈椎不稳,分别摄术前及术后随访之颈椎正侧位、伸屈侧位X线片及颈椎MR检查。32例均经前路行减压、植骨融合、内固定手术治疗。以颈椎不稳节段与颈椎主要退变节段重合,并行减压内固定患者为A组,共7例;对25例颈椎不稳与颈椎病节段不重合,以其中仅处理颈椎病节段9例为B组;在处理颈椎病节段同时处理颈椎不稳节段16例为C组。以“40分”评分法分别对患者术前、术后随访情况予以评价,对数据分别行组间均值t检验及组内配对t检验。结果 经12～36个月随访（平均25个月）,所有患者均获骨性融合,平均改善率61．2％。A、B、C组间均值t检验：术前差异无显著性（P〉0．05）、术后差异亦无显著性（P〉0．05）。各组内配对t检验,术前、术后随访差异均有显著性（P〈0．05）。结论 在颈椎病合并下颈椎不稳的患者中,不稳节段与主要退变节段关系密切但往往并不重合。通过颈前路手术,在处理颈椎病节段同时处理相邻颈椎不稳节段,临床疗效满意。     

Major elective surgery for vascular disease in patients aged 80 or more: perioperative (30-day) outcomes

Although major vascular surgery is performed with increasing frequency in elderly people, the impact of age on outcomes is uncertain. We evaluated the perioperative (30-day) outcomes for patients who underwent major elective vascular operations under general or peripheral anesthesia in their eighties and nineties in a 14-year period. Data for all consecutive 3,060 patients (456 of them > or years old) who underwent 3,314 elective vascular surgery procedures were prospectively entered into a computerized vascular registry. Detailed information was collected on patients' preoperative status, type of procedure and anesthesia, perioperative outcomes, and predictors of perioperative outcomes. The end points of the study were perioperative death and main surgical complications. Perioperative all-cause mortality rates varied across operations and were higher in elderly than in younger patients (1.4% vs. 0.2%, P = 0.014) after abdominal surgery (2.4% vs. 0.1%, P = 0.006) and especially after abdominal aortic aneurysm repair (2.8% vs. 0%, P = 0.035). In the elderly cohort, the mortality rate was <1% for almost 60% of all operations. In logistic regression analysis, only preoperative hypertension (odds ratio [OR] = 72.5, 95% confidence interval [CI] 9.4-557.6), congestive heart failure (OR = 16.5, 95% CI 2.3-115.9), and perioperative cardiac (OR = 20.7, 95% CI 1.6-273.8) and pulmonary (OR = 41.7, 95% CI 7.9-218.9) complications were associated with a higher 30-day death risk. In this series, perioperative outcomes were not influenced by the type of elective surgical procedure. Though overall mortality after major vascular surgery was higher in patients > or 80 years old, age per se was not an independent factor of a higher perioperative mortality risk or fatal and nonfatal complications.     

A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma

OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (相似文献   

镍钛形状记忆合金蟹爪式聚髌器的研制及生物力学研究

目的　研究一种治疗髌骨骨折的新的内固定方法。　方法　根据国人髌骨的统计数据 ,采用镍钛形状记忆合金制做蟹爪式聚髌器 ,并进行生物力学研究。　结果　对髌骨横行骨折 ,蟹爪式聚髌器的固定作用明显优于改良张力带钢丝固定 (P <0 .0 0 1) ;对髌骨粉碎性骨折 ,聚髌器的固定作用亦明显优于环形钢丝固定 (P <0 .0 0 1)。　结论　蟹爪式聚髌器设计符合髌骨的解剖和生物力学特点 ,其对髌骨骨折的固定强度可满足临床应用之需要。     

hMLH1 and hMSH2 gene mutation in Brazilian families with suspected hereditary nonpolyposis colorectal cancer

Background The aim of this study was to search for mutations in the humanmutS homolog 2 (hMSH2) and humanmutL homolog 1 (hMLH1) genes in 25 unrelated Brazilian kindreds with suspected hereditary nonpolyposis colorectal cancer (HNPCC). Methods The families were grouped according to the following clinical criteria: Amsterdam I or II; familial colorectal cancer (CRC); an early age of onset of CRC in the proband only; or with at least one or two relatives who had HNPCC-related cancers; CRC in the proband only. All patients were studied with direct sequencing. Results Ten mutations were detected (10 of 25 [40%]); of nine different mutations, seven were novel. ThehMLH1 gene had a higher mutation detection rate thanhMSH2 (8 of 25 [32%] vs. 2 of 25 [8%]). Only 3 of these 10 families fulfilled the Amsterdam criteria. Two different polymorphisms were detected in thehMLH1 gene and four in thehMSH2 gene. Conclusions ThehMLH1 gene had a higher mutation detection rate thanhMSH2. The physician who deals with CRC must take into consideration the heredity issue with patients who present with an early age of onset or a familial history of CRC- or HNPCC-related cancers, including gastric cancer, even if they do not fulfill the former Amsterdam criteria.     

髌骨爪结合克氏针张力带治疗髌骨下极粉碎性骨折

目的探讨髌骨爪结合克氏针张力带治疗髌骨下极粉碎性骨折的临床疗效。 方法回顾分析中国人民解放军第184医院骨科2008年08月至2014年10月收治髌骨下极粉碎性骨折53例,排除髌骨体骨折病例。给予单纯克氏针张力带治疗(克氏针组)28例,克氏针张力带结合髌骨爪治疗(髌骨爪结合组)25例。记录克氏针组及髌骨爪组的愈合时间、术后并发症及其末次随访的膝关节功能比较,统计学方法采用SPSS 13.0统计软件进行数据分析,骨折愈合时间采用独立样本t检验,两组的术后并发症及其末次随访的膝关节功能采用χ²检验, 结果53例均获得随访,随访时间平均(12.5±2.9)个月,髌骨爪结合组愈合时间(9.7±0.9)周早于克氏针组愈合时间(10.3±0.9)周,组间的差异有统计学意义(t ＝ 2.393,P <0.05),根据美国纽约特种外科医院(HSS)评分标准进行评价,克氏针组优10例,良9例,可7例,差2例,优良率67.9%;髌骨爪结合组优13例,良10例,可1例,差1例,优良率92%;两组差异有显著性意义(χ²＝ 4.681 ,P <0.05),克氏针组中1例术后出现创伤性关节炎。3例出现内固定松动,4例关节僵硬,髌骨爪结合组中1例术后创伤性关节炎,未出现内固定松动,两组并发症发生率差异有显著性意义(χ²＝ 4.045 ,P <0.05)。 结论采用髌骨爪结合克氏针张力带治疗髌骨下极粉碎性骨折可以早期膝关节功能锻炼,避免关节僵硬,疗效满意。     

Ultrasound examination and localization of the sciatic nerve: a volunteer study

BACKGROUND: Few studies have examined the use of ultrasound for sciatic nerve localization. The authors evaluated the usefulness of low-frequency ultrasound in identifying the sciatic nerve at three locations in the lower extremity and in guiding needle advancement to target before nerve stimulation. METHODS: In this prospective observational study, 15 volunteers underwent sciatic nerve examination using a curved ultrasound probe in the range of 2-5 MHz and a Philips-ATL 5000 unit (ATL Ultrasound, Bothell, WA) in the gluteal, infragluteal, and proximal thigh regions. Thereafter, an insulated block needle was advanced inline with the ultrasound beam to reach the nerve target, which was further confirmed by electrical stimulation. The quality of sciatic nerve images, ease of needle to nerve contact, threshold stimulating current, and resultant motor response were recorded. RESULTS: The sciatic nerve was successfully identified in the transverse view as a solitary predominantly hyperechoic structure on ultrasound in all of the three regions examined. The target nerve was visualized easily in 87% and localized within two needle attempts in all patients. Nerve stimulation was successful in 100% after two attempts with a threshold current of 0.42 +/- 0.12 (mean +/- SD) eliciting foot plantarflexion or dorsiflexion. CONCLUSIONS: These preliminary data show that a curved 2- to 5-MHz ultrasound probe provides good quality sciatic nerve imaging in the gluteal, infragluteal, and proximal thigh locations. Ultrasound-assisted sciatic nerve localization is potentially valuable for clinical sciatic nerve blocks.     

肝癌高危人群AFP和影像学监测诊断小肝癌的研究

目的提高肝癌高危人群小肝癌的发现率,研究肝癌二级预防价值。方法1994-07～1999-07间,在AFP监测中,发现AFP大于20μg/ml,HBsAg阳性或有慢性肝炎史,首次B超无肝癌灶共427例,随机分为监测组278例,对照组149例,监测组每3个月复查AFP和B超,对照组不作定期检查,随访时间5年。结果监测组检出肝癌92例,检出率33.1%。对照组发生肝癌34例,发生率22.8%。AFP升高,肝癌发生率明显上升。监测组小肝癌的发现率为89.1%,明显高于对照组35.3%（P＜0.005)。监测组B超诊断肝癌准确率66.3%,B超结合CT或/和MRI诊断准确率为89.1%。监测组肝癌的手术切除率为43.5%,明显高于对照组20.6%（P＜0.025)。监测组的生存率分别为1年62.8%,3年45.9%,5年33.3%,高于对照组的38.7%、14.3%和12.3%。监测组中,手术治疗组的生存率高于非手术治疗组。结论①对AFP升高的肝癌高危人群定期监测,能明显提高小肝癌的发现率;②B超结合CT或/和MRI能有效提高小肝癌检出和定性能力;③发现肝癌病例应尽可能作手术切除才能体现二级预防价值。     

高交联玉米淀粉的非晶化特性

研究了以三氯氧磷为交联剂的高交联玉米淀粉的制备方法,报道了高交联玉米淀粉颗粒随反应取代度增加而逐渐非晶化的现象.采用偏光显微镜和广角X-射线衍射对其由多晶态向非晶态的渐变过程进行了研究,提出高交联玉米淀粉中存在不同于原淀粉多晶颗粒态的只含无定形结构的非晶颗粒态。对非晶颗粒态高交联玉米淀粉颗粒的粒度分布的进一步研究结果还表明,此时的淀粉颗粒发生了轻度的膨胀。