指动脉背侧支皮瓣游离移植修复指端缺损的疗效评价

目的 应用指动脉背侧支皮瓣游离移植修复手指指端缺损的疗效评价.方法 对21例指端缺损的患者,采用指动脉背侧支皮瓣游离移植修复,将皮瓣内携带的指动脉指背侧支与受区指固有动脉吻合,皮瓣内指神经背侧支与受区指固有神经缝合,皮瓣内浅静脉与受区皮下静脉吻合.供区为患指或邻指的近节桡背或尺背侧,供区全部采用全厚皮片植皮.结果 术后21例皮瓣全部存活,随访时间为6～12个月,平均8个月,皮瓣质地、外形满意,手指功能恢复优良,皮瓣两点分辨觉为5～ 10 mm,皮瓣供区创面Ⅰ期愈合,远期随访植皮区耐磨,无破溃发生,供区指体活动未受影响.结论 指动脉背侧支皮瓣游离移植修复指端缺损,术后手指外形逼真,感觉功能恢复较好,是一种理想的手术方法.     

Reconstruction of infected and denuded scrotum and penis by combined application of negative pressure wound therapy and split‐thickness skin grafting

Trauma to the genital region and perineum can leave behind lifelong sequelae and pose significant challenges to surgeons in the restoration of functional ability and aesthetic status. Effective methods and techniques are indispensable during the treatment period. Negative pressure wound therapy (NPWT) is a widely accepted technique that is becoming a commonplace treatment in many clinical settings. The purpose of this case report was to introduce the efficacy of the concurrent usage of NPWT and split‐thickness skin grafting (STSG) in the reconstruction of genital injuries. A man suffered a traffic accident that caused necrosis of the scrotum and penis associated with a severe infection caused by Pseudomonas aeruginosa and Enterobacter cloacea. After debridement, we adopted NPWT during the postoperative dressing changes and the application of meshed STSG. The outcomes showed that combination of NPWT and split‐thickness skin grafts is safe, well‐tolerated and efficient in the reconstruction of penoscrotal defects. This could be a versatile tool for reconstruction after perineal and penoscrotal trauma.     

Transplantation of miRNA‐34a overexpressing adipose‐derived stem cell enhances rat nerve regeneration

Peripheral nerve injury is an ongoing challenge in reconstructive surgery. Adipose‐derived stem cell (ADSC) application is reported to improve nerve regeneration. In the present study, we evaluated the potential benefit of 34a‐ADSCs for never regeneration. Lentiviral vectors containing miRNA‐34a were constructed and ADSCs were transduced. The obtained 34a‐ADSCs were used to regenerate the sciatic nerve in surgically induced sciatic nerve injury rat model. Sprague–Dawley (SD) rats were randomly divided into two groups, a 34a‐ADSC group and an Lv‐ADSC group. Functional nerve recovery was assessed by walking track analysis at 12 weeks after surgery. In addition, histology, including light microscopy and transmission electron microscopy, and immunohistochemistry, was utilized to investigate the nerve repair effects of 34a‐ADSC. Results showed that reconstruction of the injured sciatic nerve had been significantly enhanced by restoration of nerve continuity and functional recovery in the 34a‐ADSC group compared with the Lv‐ADSC group. Furthermore, sciatic nerve conduction velocity and compound nerve action potential in the 34a‐ADSC group was much higher than that in the Lv‐ADSC group (30.72 ± 2.95 m/s vs. 22.73 ± 1.91 m/s, p< 0.0001; 11.93 ± 0.76 mV vs. 9.52 ± 0.53 mV, p = 0.0418). This study raises the possibility of using miRNA‐34a overexpressed ADSCs as a promising alternative for nerve regeneration.     

Endoscopic decompression of the optic canal for traumatic optic neuropathy

Purpose: Traumatic optic neuropathy (TON) is a serious complication of head trauma with the incidence rate of 0.5%e5%. The aim of this study was to investigate the therapeutic efficacy of endoscopic decompression of the optic canal for optic nerve injuries. Methods: In this study, 11 patients treated in our hospital from January 2009 to January 2015 with the visual loss resulting from TON were retrospectively reviewed for preoperative vision, visual evoked potential (VEP) scan, surgical approach, postoperative visual acuity, complications, and follow-up results. Results: All these patients received endoscopic decompression of the optic canal. At the 3-month followup, the visual acuity improvement rate of the 11 patients was 45.5%. The vision acuity of 2 cases improved from hand movement to 0.08 and 0.3 after operation. Another patient''s vision acuity returned to 0.05 compared to light sensation preoperatively. Two cases had finger counting before surgery but they had a vision acuity of 0.4 and light sensation respectively after surgery. However, the other 6 cases'' vision did not improve after surgery. Conclusion: Endoscopic decompression of the optic canal is an effective way to cure TON. VEP could be used as an important reference for preoperative and prognosis evaluation. Operative time after trauma is only a relative condition that may affect the therapeutic effect of optic canal decompression. Poor results of this procedure may be related to the severity of the optic nerve injury.     

腓骨近端截骨术治疗内侧间室膝骨关节炎的短期效果

目的观察分析腓骨近端截骨术与人工全膝关节置换术治疗内侧间室膝骨关节炎的短期效果差异。 方法回顾2018年1月至2019年12月间于赤峰宝山中医医院骨科接受腓骨近端截骨术(PFO)和人工全膝关节置换术(TKA)治疗的患者,符合内侧间室膝骨关节炎的诊断且Kellgren-Lawrence分级为Ⅲ、Ⅳ级,排除膝关节内畸形及其他影响关节功能的疾病,排除严重内科疾病及外翻畸形,临床资料完整者。其中接受PFO共55例,纳入观察组,同期接受TKA的55例纳入对照组,统计两组的手术时间、切口长度、术中出血量、住院时间、住院费用,采用t检验进行比较;统计术前及术后3个月的疼痛视觉模拟评分(VAS评分)、美国特种外科医院膝关节评分(HSS评分)、西安大略和麦克马斯特大学膝关节炎评分(WOMAC评分)、生活质量问卷评分(SF-36评分),组内及组间比较采用t检验。 结果观察组手术时间、切口长度、术中出血量、住院时间、住院费用均明显低于对照组,差异具有统计学意义(t＝8.712、9.251、9.435、8.987、9.296,均为P<0.01);两组患者术后3个月的VAS、HSS、WOMAC、SF-36评分较术前明显改善,差异具有统计学意义(观察组：t＝7.692、7.802、8.453、7.622,均为P<0.01;对照组：t＝7.639、7.787、8.441、7.619,均为P<0.01),各评分组间比较差异均无统计学意义(t＝0.258、0.401、0.250、0.542,均为P>0.05)。 结论腓骨近端截骨术与人工全膝关节置换术治疗内侧间室膝骨关节炎,均可获得较好的早期效果;前者手术简单、创伤小、费用低,临床中可以选择性使用。     

三种术式治疗肝细胞癌的近期临床疗效比较

目的比较腹腔镜切除术(LR)、开腹切除术(OR)与超声定位下的射频消融术(RFA)治疗肝细胞癌的近期临床疗效。 方法回顾性分析2010年6月至2018年6月接受手术治疗的152例肝细胞癌患者的病例资料,71例患者纳入LR组,52例患者纳入OR组,29例患者纳入RFA组。采用SPSS 25.0软件分析数据,手术相关指标、VAS评分等计量资料以( ±s)描述,行f检验;近期疗效、并发症等计数资料行χ²检验,P<0.05为差异有统计学意义。 结果三组患者术后3个月治疗总有效率比较,LR组(76.1%)>OR组(73.1%)>RFA组(72.4%),差异无统计学意义(P>0.05)。三组手术时间、术中总出血量及住院时间相比,OR组>LR组>RFA组(P<0.05);术后24 h及1周后VAS评分比较,OR组>LR组>RFA组(P<0.05);OR组并发症总发生率(36.5%)>LR组(29.6%)>RFA组(6.7%),差异有统计学意义(P<0.05);术后随访3个月的复发率比较,OR组(7.7%)0.05)。 结论对分期早且肿瘤小的肝细胞癌患者分别采用LR术、OR术与RFA术治疗,患者近期疗效相当,但RFA术具有损伤小、术后恢复快等优点,可减轻患者术后疼痛程度,安全性更高。但对于瘤体较大且靠近重要血管胆管的肝细胞癌患者,还需进行个体化治疗。     

14种市售抗菌药对金黄色葡萄球菌标准菌株的体外抑菌作用

目的：通过测定我院使用的14种市售抗菌药对金黄色葡萄球菌标准菌株的体外抑菌浓度与美国临床和实验室标准协会（CLSI）标准比较,了解市售抗菌药抑菌作用的达标情况。方法：采用试管倍比稀释法测定药物的最低抑菌浓度。结果：有12种达标,2种超范围,其中克林霉素测定值为3.13μg/mL ,与 CLSI允许抑菌浓度范围（0.06～0.25μg/mL）比较存在较大差距;磺苄西林测定值为12.5μg/mL ,远高于同类抗菌药测定值。结论：此法可以作为市售抗菌药抑菌作用是否达标的监测方法。     

Decreased expression of Gab2 in patients with temporal lobe epilepsy and pilocarpine‐induced rat model

Growth factor receptor bound protein‐2 associated binding protein‐2 (Gab2) is widely expressed in the central nervous system, and participates in multiple signaling pathways. Recent studies showed that Gab2 was involved in the pathogenesis of Alzheimer's disease (AD). Gab2 reduces tau phosphorylation levels and is associated with cellular apoptosis and differentiation. However, whether Gab2 was also involved in the pathogenesis of epilepsy, remains unknown. This study aimed to investigate the expression pattern of Gab2 protein in brains with temporal lobe epilepsy (TLE) and in pilocarpine‐induced rat model of TLE. Western blot, immunohistochemistry, and immunofluorescence were used to assess the location and the expression level of Gab2 in the neocortex of the temporal lobe in patients with TLE and in rat model of epilepsy. Results showed that Gab2 protein was expressed mainly in the membranes and cytoplasm of neurons in the cortex and hippocampus. Gab2 protein expression was remarkably reduced in temporal neocortex of TLE patients. In hippocampus and adjacent cortex in rat epilepsy model, Gab2 expression was decreased at different time points after kindling compared with the controls, and the lowest level of Gab2 expression occurred at 1 week. Thus, significant reductions of Gab2 protein in both TLE patients and epilepsy rats suggest that Gab2 may play an important role in the pathogenesis of TLE. Synapse 68:168–177, 2014. © 2013 Wiley Periodicals, Inc.