改良法(足母)甲皮瓣移植拇指远端缺损再造术

目的 分析改良(足母)甲皮瓣移植再造拇指远端缺损的方法,评价手术的安全性和对足部功能的影响.方法 对18例拇指远端缺损的患者,应用改良的(足母)甲皮瓣移植术进行拇指再造.其中Ⅰ类A区缺损5例,Ⅰ类B区缺损8例,Ⅱ类A区缺损5例.手术对躅甲皮瓣设计、骨骼处理等方面进行改进,针对跖背动脉的分型,采用不同的血管吻合方式.术后随访观察再造拇指的外观、感觉、关节活动度、握力和拇、示指捏力及满意度.根据足功能评定分析行走及弹跳功能,评价手术对足部功能的影响.结果 术后18例再造拇指全部存活,成功率达100%.术后随访8～26个月,再造拇指外观良好,接近健侧拇指.部分患者再造拇指指间关节保留良好的活动功能,手指捏力和握力达健侧的60%～90%.改良的手术方法对足部功能和外观的不良影响明显减小.足部并发症少,没有明显疼痛,外观、行走功能均良好.足功能评定显示:静止站立时足负重区、重心没有明显变化,站立负重区主要为躅趾趾腹、前足掌部及足跟;供足单足站立时重心轻度外移或不变,前后摆动身体重心位于两足之间,或轻度偏向健足.结论 改良的(足母)甲皮瓣移植术是一种安全的拇指再造方法,对供足功能影响更小.根据拇指缺损程度和血管情况的差异,选择不同的处理方法,可以进一步减少创伤,简化手术,增加手术的安全性.     

脑外伤记忆康复的新途径——内隐记忆

目的：本研究探讨脑外伤患内隐记忆和外显记忆，为心理康复训练提供理论依据。方法：用1：1配对法对25例脑外伤患及相应的正常人进行模糊图辨认和再认的记忆测验。结果：与正常对照组相比，脑外伤患再认成绩明显下降．模糊图辨认成绩无显差异。结论：脑外伤患外显记忆受损．内隐记忆存在。     

与月骨缺血性坏死有关的骨骼因素

月骨缺血性坏死的发生与许多因素有关。其中骨骼因素，如尺骨负变异、桡骨远端关节面尺偏角，是文献中最常提及的，尺骨延长、桡骨短缩或楔形截骨等手术的流行与之不无关系。但新近一些研究结果却与传统观点相对立，应当引起我们的注意。     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.     

消化道大出血行胃大部切除术后再出血原因分析

目的 :总结如何提高上消化道大出血的诊断水平 ,改善处理对策 ,避免误诊误治。方法 :回顾性分析 1988～ 2 0 0 3年 16例上消化道大出血行胃大部切除术后再出血的临床资料。结果 :16例均于胃大部切除术后 72小时内再出血 ,11例急诊胃镜检查或再次剖腹探查确诊 ,5例再次手术中联合胃镜检查明确诊断。发生再出血后 ,3例保守治疗 ,13例再次手术治疗 ,死亡3例 ,病死率 18.75 % ( 3 /16)。结论 :上消化道大出血病因较复杂 ,常易误诊误治。选择手术或非手术治疗有赖正确的诊断 ,因此强调术前胃镜检查或术中联合胃镜检查的重要性 ,避免手术盲目性 ,审慎行胃大部切除术     

复杂坠落伤28例诊断与治疗体会

坠落伤多为复合伤,患者入院时多有不同程度的休克和昏迷,伤情复杂,患者病史叙述不清,查体难以合作,诊治不当易造成死亡。我院2002年1月~2004年12月收治坠落伤28例,重度多发伤比例高,我们严格按照Crashplan或VIPCO程序进行,遵循边抢救边诊断的原则,治愈20例、好转6例,取得满意疗     

2016年7月全国突发公共卫生事件及需关注的传染病风险评估

目的 评估2016年7月国内外突发公共卫生事件及需要关注传染病的风险。方法 根据国内外突发公共卫生事件报告及重点传染病监测等各种资料和部门通报信息,采用专家会商法,并通过视频会议形式邀请省（直辖市、自治区）疾病预防控制中心专家参与评估。结果 根据近期传染病和突发公共卫生事件监测数据,结合既往突发公共卫生事件发生情况及传染病流行特点分析,预计7月全国总报告事件数和病例数较6月将有所减少。近期我国仍有可能出现寨卡病毒病、黄热病、登革热、基孔肯雅热等蚊媒传播传染病的输入性病例,随着盛夏季节来临,登革热等虫媒传染病及霍乱等肠道传染病的流行强度会逐渐增强,部分省份可能出现本地暴发疫情。人感染禽流感疫情仍可能呈散发态势。同时,需继续关注中东地区中东呼吸综合征的疫情动态和输入风险。各地应密切关注灾害可能导致的次生、衍生公共卫生风险。此外,高温中暑、食物中毒事件也将有所增加。结论 2016年7月我国的突发公共卫生事件及传染病疫情发生态势与往年相似,较6月将有所减少;需关注寨卡病毒病、黄热病、登革热、基孔肯雅热等媒介伊蚊传染病、人感染禽流感等传染病疫情以及气象及自然灾害、高温中暑、食物中毒引发的公共卫生风险。     

拉曼光谱法快速鉴别人血白蛋白

目的:建立快速鉴别人血白蛋白的拉曼光谱法。方法:采集不同产家不同批次人血白蛋白的拉曼光谱图,建立人血白蛋白的特征拉曼光谱图,将采集的样品拉曼光谱图与特征拉曼光谱图进行比对分析,结合拉曼光谱峰位移频率和峰强度的相似度计算结果,以判断人血白蛋白样品的真假伪劣。结果:从市场监督抽取的人血白蛋白注射剂中,采集到与标准光谱图不一样的样品拉曼光谱,判断其为假人血白蛋白,此法所得的结果与采用中国药典2010年版三部中方法得到的结果一致。结论:结果表明拉曼光谱法可作快速鉴别真假人血白蛋白的有效方法。     

胆舒软胶囊的振动光谱分析

目的:建立鉴别中药材及其制剂中组分的分子振动光谱方法.方法:采用拉曼光谱法和红外光谱法鉴别胆舒软胶囊及对照品,测定胆舒胶囊中的薄荷素油的量,结果与气相法进行比较.结果:无论红外光谱还是拉曼光谱,胆舒软胶囊所呈现的峰均比对照品峰为多,但不干扰薄荷素油峰的鉴别,比较胆舒软胶囊和薄荷素油光谱,可快速鉴别胆舒软胶囊真伪.结论:建立的鉴别方法简便、快速、专属性强,灵敏度高.     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

Objective To investigate the differentiation of rat bone marrow mesenchymal stem cells (MSCs) to renal tubular epithelial-like cells under different conditions. Methods MSCs were obtained from rat marrow. MSCs were isolated by gradient density centrifugation and plastic adherence and then purified. Surface markers were identified with flow cytometry after amplification in vitro. The purified MSCs of the third passage were cultured respectively as follows: (1) control group: DMEM medium with fetal bovine serum(FBS). (2) all-trans retinoic acid (ATRA) group: DMEM medium with FBS, ATRA and ischemic reperfusion-injured kidney tissue homogenate. (3)combination group: DMEM medium with FBS, ATRA, ischemic reperfusion-injured kidney tissue homogenate, epidermal growth factor (EGF) and bone morphogenetic protein 7 (BMP-7). After 7 days, the MSCs were collected for alkaline phosphatase (AKP) staining, cytokeratin-18 and E-cadherin immunocytochemical analysis. Results The positive rates of the third passage MSCs in CD44, CD90 and CD29 were 97.8%±0.9%, 96.8%±1.4% and 97.6%±2.4%,respectively, but in CD11b/c and CD34 were only 13.2%±0.6% and 1.2%±0.5%. The MSCs in control group were spindle. The MSCs in ATRA group were round and elliptic. The MSCs in combination group became cobblestone-like cells after 7 days. AKP staining showed that tubular epithelial-like cells from MSCs in control group were negative, some above cells in ATRA group were positive and number of above cells increased in combination group. Compared with negative control group, the ratios of cytokeratin-18 positive cells in ATRA group and combination group were respectively increassed by 29.47%±1.08% and 47.52%±2.13% (all P<0.05), the ratios of E-cadherin positive cells in ATRA group and combination group were respectively increased by 14.88%±2.46% and 36.15%±1.13% (all P<0.05). Conclusion MSCs may differentiate by renal tubular epithelial-like cells under the induction of ischemic reperfusion-injured kidney tissue homogenate and ATRA in vitro, which are further differentiated under the combined induction of EGF and BMP-7.