组配式桡骨头假体置换治疗MasonⅢ和Ⅳ型桡骨头骨折

目的：观察采用组配式桡骨头假体置换治疗MasonⅢ和Ⅳ型桡骨头骨折的早期疗效。方法：2009年1月至2012年3月,应用组配式桡骨头假体治疗16例MasonⅢ和Ⅳ型桡骨头骨折患者,男9例,女7例;年龄31～57岁,平均43岁。评价患者肘关节屈伸活动及前臂旋转活动范围,并根据Mayo肘关节功能评估评分（Mayo elbow perfor-mance score,MEPS）评价肘关节总体功能;对影像学进行测量,评价桡骨头假体高度及假体松动程度。结果：14例患者得到随访,时间12～33个月,平均23个月。关节活动范围与健侧比较,患侧肘关节屈伸度及前臂旋转活动度明显较差（P＜0．01）。MEPS评分90±16（45～100）;分级评定：优9例,良2例,可2例,差1例。按照Grewal分级,4例出现轻度的透亮线,1例中度透亮线。结论：组配式桡骨头假体置换治疗难以内固定可靠重建的MasonⅢ和Ⅳ型桡骨头骨折早期疗效满意,中、远期疗效仍有待于进一步研究。     

自选互动卡在手术室优质护理服务中的应用

目的探讨自选互动卡在手术室优质护理服务中的应用效果。方法将140例非全麻手术患者随机分为传统组与自选组各70例,传统组实施常规护理,自选组于术前访视时采用自制的自选互动卡予患者勾选,术中根据患者自选的要求尽量满足其需求。结果自选组患者术前焦虑、术中生命体征及患者满意度显著优于传统组(均P<0.05)。结论自选互动卡可提高手术室护理质量。     

跨理论模型应用于肥胖儿童体育锻炼的护理干预

目的探讨以跨理论模型为基础对肥胖儿童进行体育锻炼的干预效果。方法将肥胖儿童128人按学校分为干预组(65人)和对照组(63人)。研究人员未予对照组任何干预措施;干预组以跨理论模型为基础,针对肥胖儿童锻炼所处不同阶段给予匹配的为期6个月的体育锻炼行为干预。结果基线调查时65.6%肥胖儿童处于锻炼前意向/意向/准备阶段,34.4%处于行动/保持阶段;干预后不同时间干预组处于行动/保持阶段的比例及单次锻炼时间≥30min的次数显著高于对照组(P<0.05,P<0.01),但BMI变化不明显。结论跨理论模型干预模式对锻炼过程的变化呈良性改善,使肥胖儿童锻炼意愿增强,坚持锻炼次数增加,有利于提高其体质。     

1例滑动疝手术致膀胱损伤患者的护理

对1例滑动疝手术过程中误伤膀胱,立即进行膀胱修补。术后加强病情观察,做好体位、管道护理,充分镇痛解痉及心理疏导等,患者于术后15d痊愈出院。术后个性化的全方位护理有利于患者康复。     

髌骨骨折的规范化评估与治疗

髌骨骨折是临床常见的骨折之一,发生率约占全身骨折的1%[1]。随着社会的老龄化以及生产、生活方式的转变,髌骨骨折呈现发病率高、骨折粉碎严重,骨质疏松等特点[2]。张力带钢丝技术结合内外侧支持带修补是治疗髌骨骨折的经典方法[3],但随着该技术的推广与普     

不同置管方式用于股神经阻滞术后镇痛的效果

目的 采用连续刺激导管进行股神经置管,比较膝关节镜术后不同置管方法的镇痛效果.方法 选择择期行膝关节镜手术患者80例,随机均分为股神经刺激器引导置管组(RA组)和传统经验置管组(RT组).两组均采用1.73％碳酸利多卡因连续硬膜外维持术中麻醉,麻醉后置入连续股神经阻滞导管.两组术后经导管持续输注0.2％罗哌卡因5 ml/h.观察并记录术后2、6、24、48 h静息VAS评分、患者满意度、不良反应及伍用镇痛药情况.结果 术后2、6hRA组静息VAS评分明显低于RT组(P＜0.01).术后24 h和48 h两组静息VAS评分均低于3分,差异无统计学意义.两组患者术后均未出现头痛、恶心、呕吐、尿潴留等不良反应.结论 膝关节镜术后2、6 h神经刺激器引导置管较传统经验置管静息镇痛效果明显改善,但术后24、48 h镇痛效果无显著差别.     

中国湖南2?324例乳腺癌临床特征及分子亚型分析

目的：分析中国湖南乳腺癌的临床病理特征、分子亚型的分布特点及其与国内其他地区及国外的差异。 方法：回顾性分析湘雅医院2002年1月—2012年9月2?324例女性乳腺癌患者临床病理资料,根据雌激素受体（ER）,孕激素受体（PR）,Ki-67,表皮生长因子受体（Her-2）的状态,将乳腺癌分为4个分子亚型进行分析。 结果：湖南乳腺癌患者的平均年龄47.57岁,绝经前患者（64.5%）多于绝经后患者（35.5%）,以中期患者为主。分子亚型分布与国内不同地区及国外比较,差异均有统计学意义（均P<0.05）,其中luminal A型比例占59.6%,高于国内上海（52.8%）与广东人群（31.1%）及非裔美籍人群（55.5%）,但低于波兰人群（73.0%）与美国人群（66.1%）,Her-2型所占比例（5.6%）低于其他人群,而三阴型比例（22.0%）高于大多数其他人群。各分子亚型分布在年龄段、分期、绝经状态及新辅助化疗情况的分组间差异均有统计学意义（均P<0.05）。 结论：中国湖南乳腺癌平均发病年龄较轻,绝经前患者多,以luminal A型为主;分子亚型分布与年龄段、分期、绝经状态及新辅助化疗情况有关。     

功能部位皮肤软组织缺损创面治疗的新选择

目的：总结封闭式负压引流（vacuum-assisted closure, VAC）技术联合人工真皮（PELNAC）治疗功能部位皮肤软组织缺损创面的良好效果,推广该治疗方法的『陆床应用。方法：2008年3月-2011年12月,笔者应用VAC联合FELNAC治疗11例患者13处创面,其中车祸伤9例、自行车辐条搅伤1例、过山车滚轮碾压伤1例,所有创面均位于下肢,均为关节功能部位创面,9例有深部组织外露,伴有不同程度的关节功能障碍。围手术期行全身支持治疗,尽快扩创,行VAC治疗,创面肉芽组织生长新鲜后行PELNAC移植,PELNAC血管化后,行自体刃厚皮片移植。结果：所有创面经VAC治疗后,肉芽组织生长迅速,部分或完全覆盖深部外露组织,行PELNAC加自体刃厚皮片移植,12处创面一次性愈合,总治愈率为92．3％。随访半年-3年,创面愈合后无明显瘢痕增生,外观较好,功能佳。结论：VAC联合人工真皮治疗功能部深创面,明显缩短疗程,提高愈合质量,值得进一步推广使用。     

Monosodium iodoacetate induces apoptosis via the mitochondrial pathway involving ROS production and caspase activation in rat chondrocytes in vitro

Monosodium iodoacetate (MIA) is an inhibitor of glyceraldehyde‐3‐phosphate dehydrogenase activity, and causes dose‐dependent cartilage degradation resembling the pathological changes of human osteoarthritis (OA). In this study, we assessed the apoptosis induced by MIA and clarified the underlying mechanisms using the primary rat chondrocytes. The apoptosis of primary rat chondrocytes was analyzed by flow cytometry. The levels of mitochondrial membrane potential (ΔΨm) were evaluated using fluorescence spectrophotometer. The production of reactive oxygen species (ROS) was determined by fluorescence spectrophotometer. Apoptosis‐related protein cytochrome c and procaspase‐3 expressions were examined by Western blotting. We found that MIA treatment induces apoptosis in chondrocytes, as confirmed by increases in the percent of apoptotic cells, up‐regulation of cytochrome c and caspase‐3 protein levels. Treatment with MIA increases ROS production and decreases the levels of ΔΨm. The antioxidant, N‐acetylcysteine (NAC), significantly prevented the production of ROS, the reduction of ΔΨm, the release of cytochrome c and the activation of caspase‐3. Further, NAC completely protected the cells from MIA‐induced apoptosis. Together these observations suggest that the mechanisms of MIA‐induced apoptosis are primarily via ROS production and mitochondria‐mediated caspase‐3 activation in primary rat chondrocytes. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 364–369, 2013     

A quantitative assessment model of T‐cell immune function for predicting risks of infection and rejection during the early stage after liver transplantation

Although more and more clinical studies indicated that ImmuKnow assay could efficiently assess the immune status of recipients, it still has the challenge to predict the occurrence of clinical adverse events. This study aimed to establish a quantitative assessment model, which could more efficiently predict immune function of T lymphocytes after liver transplantation based on three indexes: CD4+ T lymphocyte count (C), CD4+/CD8+ ratio (R), and ImmuKnow adenosine triphosphate (ATP) value (A). We selected 194 recipients and measured the A, C, and R index every week, then obtained the Fisher linear discriminant functions by SPSS 16.0. Next, we divided the recipients into three groups: infection, stable, and rejection groups according to clinical status. After calculating, the discriminant function, 0.012A + 0.019C + 1.322R (simplified into T = 2A + 3C + 200R), was selected to represent the T‐cell‐mediated immune function. Based on the model, the optimal cutoff T values for infection and rejection were 1415 (sensitivity = 80%, specificity = 79.9%,AUC = 92.3%) and 1939.5 (sensitivity = 93.9%, specificity = 77.6%, AUC = 88.6%), relatively (p < 0.001). In conclusion, this model may be a more feasible way to evaluate the cellular immune function status in liver transplantation recipients.