多方位教学形式在美容医学教学中的应用

随着医疗美容行业领域的快速发展,人们的美容需求得到满足,同时也对美容医学提出来更高要求。近年来,我国医疗美容工作人才需求也在逐渐增大,因此需重视美容医学教学工作,不拘泥于传统的教育教学模式,采取多方位的教学形式,全面提升美容医学教学质量,输出更高水平的专业人才资源,从而促使美容医学领域得到良好发展。本文就针对多方位教学形式在美容医学教学中的应用进行分析,以期提升美容医学教学水平。多方位教学;教学形式;美容医学     

丙泊酚复合艾司氯胺酮用于全麻的镇静效果

目的 探讨丙泊酚复合艾司氯胺酮用于全麻的镇静效果。方法 选择择期手术全身麻醉患者150例,男63例,女87例,年龄18～64岁,BMI 18～30 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组：丙泊酚组(P组)、艾司氯胺酮组(E组)和丙泊酚复合艾司氯胺酮组(S组),每组50例。每组再随机分为五个亚组,每个亚组10例。在麻醉诱导前,P1组、P2组、P3组、P4组和P5组分别予丙泊酚0.80、1.00、1.25、1.56和1.95 mg/kg, E1组、E2组、E3组、E4组和E5组分别予艾司氯胺酮0.11、0.18、0.30、0.50和0.84 mg/kg, S1组、S2组、S3组、S4组和S5组按照4∶1剂量比分别予丙泊酚/艾司氯胺酮0.38/0.10、0.48/0.12、0.60/0.15、0.75/0.19和0.94/0.24 mg/kg。记录给药5 min内呼吸抑制、高血压、低血压等不良反应发生情况。采用点斜法测定两药及复合用药的半数有效剂量(ED₅₀)和95%可信区间(CI),并用等辐射分析法分析两药复合使用时镇静效应的...     

内镜支架减压对比肠造口减压对梗阻性结直肠癌择期手术近远期疗效影响的Meta分析

目的 比较急诊造口减压和内镜支架减压后择期手术切除治疗梗阻性结直肠癌的近远期效果。方法 检索PubMed、Embase、Cochrane Library、中国知网、万方数据库已公开发表的有关造口减压对比内镜支架减压后序贯择期手术切除的梗阻性结直肠癌近远期效果的文献,提取的数据采用RevMan 5.3软件进行Meta分析。结果 共10篇回顾性病例对照研究纳入汇总分析,Newcastle-Ottawa Scale评分范围为6～8分,其中高质量文献6篇。总样本量为1 807例,包括造口组939例,支架组868例。汇总分析结果提示,支架组两次手术间隔时间短于造口组（WMD=13.37,95%CI:7.88～18.86,P<0.000 01）,但造口组择期手术一期吻合率高于支架组（OR=1.58,95%CI:1.10～2.26,P=0.01）,3年总生存率也高于支架组（HR=0.77,95%CI:0.61～0.97,P=0.02）。两组在择期手术入路方式、永久性造口率、总体并发症和围手术期死亡率方面比较,差异均无统计学意义。结论 肠造口减压和内镜支架减压对梗阻性结直肠癌患者后续择期行结直肠...     

3D打印经皮导板辅助经皮后凸成形术治疗骨质疏松椎体压缩性骨折

目的:验证3D打印经皮导板辅助经皮后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松椎体压缩性骨折(osteoporosis vertebral compression fractures,OVCFs)的安全性。方法:对2020年11月至2021年8月,采用PKP治疗的60例OVCFs患者进行回顾性分析,男24例,女36例,年龄72～86(76.5±7.9)岁,其中30例采用常规PKP治疗(常规组),30例采用3D打印经皮导板辅助PKP治疗(导板组)。观察术中椎弓根穿刺时间(穿刺针到椎体后缘)及透视次数,手术总时间,总透视次数,骨水泥注入量,并发症(椎管型骨水泥渗漏),比较两组患者术前和术后3 d的视觉模拟评分(visual analogue scale,VAS)及伤椎前缘压缩率。结果:60例患者均成功实施手术,无椎管型骨水泥渗漏并发症发生。导板组椎弓根穿刺时间(10.23±3.15) min,透视次数(4.77±1.07)次,手术总时间(33.83±4.21) min,总透视次数为(12.27±2.61)次;常规组椎弓根穿刺时间(22.83±3.09)...     

颈后路椎弓根钉棒短节段内固定治疗寰枢椎骨折脱位

目的:探讨颈后路椎弓根钉棒短节段内固定治疗寰枢椎骨折脱位的临床疗效。方法:对2015年1月至2018年1月手术治疗的60例寰枢椎骨折脱位患者进行回顾性分析,根据手术方法的不同分为研究组和对照组,其中研究组30例,男13例,女17例;年龄(39.32±2.85)岁;行颈后路椎弓根钉棒短节段内固定术。对照组30例,男12例,女18例;年龄(39.57±2.90)岁;行寰椎后路椎板夹内固定。记录两组患者手术时间、术中出血量、术后下床活动时间和住院时间以及并发症,观察两组患者疼痛视觉模拟评分(visual analogue scale,VAS),神经功能日本骨科协会(Japanese Orthopedic Association,JOA)评分及融合情况。结果:两组患者均获得至少12个月随访。研究组手术时间、术中出血量、术后下床活动时间及住院时间均优于对照组(P=0.000)。研究组发生呼吸道损伤1例;对照组发生切口感染2例,呼吸道损伤3例,相邻节段关节退变3例;研究组并发症发生率低于对照组(χ²=4.705,P=0.030)。术后1、3、7 d,研究组VAS低于对照组(P=0.000);术后1、3个月时,研究组JOA评分高于对照组(P=0.000)。术后12个月研究组患者均获得骨性融合;对照组出现3例骨性融合不佳,3例内固定断裂,发生率为20.00%(6/30);两组差异有统计学意义(χ²=4.629,P=0.031)。结论:颈后路椎弓根钉棒短节段内固定治疗寰枢椎骨折脱位具有创伤小、手术时间短、并发症少、疼痛程度轻等优势,且可促使神经功能尽快恢复。     

小鼠髓核细胞体外衰老模型的建立及评价

【摘要】 目的：建立并评价小鼠髓核细胞（nucleus pulposus cells,NPCs）体外衰老模型。方法：取8周龄C57BL/6雄性小鼠,体外分离培养小鼠NPCs,并采用细胞免疫荧光（immunofluorescence,IF）检测NPCs标志蛋白聚集蛋白聚糖（aggrecan）的表达进行细胞鉴定。取不同浓度（0μmol/L、50μmol/L、100μmol/L、200μmol/L、300μmol/L、400μmol/L、500μmol/L）的叔丁基过氧化氢（tert-Butyl hydroperoxide,TBHP）干预NPCs,采用CCK8法检测干预2h、4h后的细胞活性,筛选TBHP的最佳干预浓度及时间。应用最佳干预浓度TBHP、最佳干预时间干预P1代NPCs后换成完全培养基继续培养24h、48h、72h,采用衰老相关β半乳糖苷酶染色（senescence-associated β-galactosidase staining,SA-β-gal）检测各时间点的衰老NPCs阳性率,观察不同时间点NPCs的衰老变化。将P2代NPCs分为对照组和模型组,对照组在完全培养基中培养,模型组加入最佳干预浓度TBHP干预最佳时间干预后换成完全培养基培养,采用实时荧光定量PCR（real-time quantitative PCR,RT-qPCR）检测两组细胞衰老相关基因p53、p21、p16以及Aggrecan、Ⅱ型胶原蛋白（collagen Ⅱ）、含Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶-5（a disintegrin and metalloproteinase with thrombospondin motifs-5,ADAMTS-5）、基质金属蛋白酶-3（matrix metalloproteinase-3,MMP-3）、基质金属蛋白酶-13（matrix metalloproteinase-13,MMP-13）mRNA表达,免疫印迹法（Western blot,WB）检测Aggrecan、Collagen Ⅱ、MMP-3、MMP-13、p53、p21蛋白表达水平。结果：分离培养的细胞高表达Aggrecan,为NPCs。TBHP最佳干预浓度为100μmol/L,最佳干预时间为4h。在100μmol/L TBHP干预4h后培养24h、48h、72h,NPCs的SA-β-gal染色阳性率均显著性增加（P＜0.05）,三个时间点间无统计学差异（P＞0.05）,后续模型组加入最佳干预浓度TBHP干预最佳时间干预后换成完全培养基培养24h,对照组培养相同时间。RT-qPCR检测模型组p53、p21、p16、MMP-3、MMP-13、ADAMTS-5 mRNA表达较对照组显著性升高（P＜0.05）,Aggrecan、Collagen Ⅱ mRNA表达较对照组显著性降低（P＜0.05）;WB检测模型组MMP-3、MMP-13、p53、p21蛋白表达较对照组显著性升高（P＜0.05）,Aggrecan、Collagen Ⅱ蛋白表达较对照组显著性降低（P＜0.05）。结论：采用TBHP诱导能成功构建小鼠NPCs体外衰老模型,可为椎间盘退行性变的发病机制研究提供良好的研究样本。     

Implant Materials for Anterior Column Reconstruction of Cervical Spine Tumor

The spine is the most common site of bone metastases. Many cancer patients will ultimately develop spinal metastatic disease with symptomatic epidural spinal cord compression. At present, the main treatment for cervical spine tumors is surgical resection combined with postoperative radiotherapy. Implant materials for cervical spine anterior column reconstruction need to meet amounts of different properties, such as biocompatibility, bioactivity and the ability to maintain long-term mechanical strength. The selection of different materials determines the surgical efficacy and prognosis of patients to a certain extent. This article provides an overview of a variety of implant materials used for anterior column reconstruction after cervical spine tumor resection, introduces and analyzes their properties, advantages, disadvantages, derivatives, and applications in clinical practice, and looks forward to the future development of implant materials.     

Antibiotic-loaded bone substitutes therapy in the management of the moderate to severe diabetic foot infection: A meta-analysis

In recent years, local antibiotic-loaded bone substitutes (ALBS) have been used increasingly in the treatment of diabetic foot infection (DFI). The meta-analysis aimed to analyse the efficacy of ALBS on patients with moderate to severe DFI (with or without osteomyelitis). With an appropriate search strategy, 7 studies were selected for analysis (2 RCTs and 5 cohort studies). The result showed that the application of ALBS effectively reduced the length of hospital stay (WMD −5.55; 95% CI: −9.85 to −1.26; P = 0.01), the recurrence rates (RR 0.33; 95% CI: 0.15 to 0.69; P = 0.003) and the mortality rates (RR 0.22; 95% CI: 0.06 to 0.82; P = 0.02). Compared to the control groups , however, there was no difference in healing rates (RR 1.06; 95% CI: 0.96 to 1.18; P = 0.26), healing time (WMD −1.44; 95% CI: −3.37 to −0.49; P = 0.14), the number of debridement (WMD −1.98; 95% CI: −4.08 to 0.12; P = 0.06) and major amputation rates (RR 0.76; 95% CI: 0.35 to 1.61; P = 0.47). The ALBS appears to have some beneficial effects as an adjunct to standard surgery in the treatment of DFI with or without osteomyelitis, as it reduces recurrence rates, mortality rates, and length of hospital stay, but there was no statistically significant difference in enhancing wound healing.     

The Effect of the Hip Flexion Angle in Osteonecrosis of the Femoral Head Based on China‐Japan Friendship Hospital Classification ‐ A Finite Element Study

Objective

The alteration in the mechanical environment of the necrotic area is the primary cause of the collapse observed in osteonecrosis of the femoral head (ONFH). This study aims to evaluate the biomechanical implications of the China-Japan Friendship Hospital (CJFH) classification system and hip flexion angles on the necrotic area in ONFH using finite element analysis (FEA). The goal is to provide valuable guidance for hip preservation treatments and serve as a reference for clinical diagnosis and therapeutic interventions.

Methods

Hip tomography CT scan data from a healthy volunteer was used to create a 3D model of the left hip. The model was preprocessed and imported into Solidworks 2018, based on the CJFH classification. Material parameters and boundary conditions were applied to each fractal model in ANSYS 21.0. Von Mises stresses were calculated, and maximum deformation values were obtained to evaluate the biomechanical effects of the load on the necrotic area and post-necrotic femur, as well as assess each fractal model's collapse risk.

Results

(1) At the same hip flexion angle, maximum deformation followed this order: M Type < C Type < L Type. The L3 type necrotic area experienced the most significant deformation at 0, 60, and 110° angles (1.121, 1.7913, and 1.8239 mm respectively). (2) Under the same CJFH classification, maximum deformation values increased with hip flexion angle (0 < 60 < 110°), suggesting a higher risk of collapse at larger angles. (3) Von Mises stress results showed that the maximum stress was not located in the necrotic area but near the inner and outer edge of the femoral neck, indicating decreased stiffness and strength of the subchondral bone after osteonecrosis.

Conclusion

The study found that femoral head collapse risk was higher when the necrotic area was located in the lateral column under the same stress load and flexion angle. Mechanical properties of the necrotic area changed, resulting in decreased bone strength and stiffness. Large-angle hip flexion is more likely to cause excessive deformation of the necrotic area; thus, ONFH patients should reduce or avoid large-angle hip flexion during weight-bearing training in rehabilitation activities.     

腹壁竖切口美容缝合在妇科手术中的应用效果

目的 分析在妇科手术中应用腹壁竖切口美容缝合的临床效果。方法 选取2021年2月-2022年2月于淄博市中心医院行妇科手术的140例患者为研究对象,随机分为对照组和观察组,每组70例。对照组采用常规缝合,观察组采用腹壁竖切口美容缝合,比较两组缝合时间、出血量、切口愈合情况及满意度。结果 观察组缝合时间、出血量及切口愈合情况均优于对照组（P＜0.05）;观察组对瘢痕外观、疼痛程度、牵拉感的满意度均优于对照组（P＜0.05）。结论 腹壁竖切口美容缝合在妇科手术中的应用效果确切,能够有效缩短缝合时间,减少出血量,促进切口愈合,对于提升术后切口美观度具有积极意义,且患者对缝合效果的满意度较高,值得临床应用。