脊柱术后切口内异物残留原因分析及对策

0　引言　手术切口内异物残留有多种原因 ,包括伤口内异物没有被发现和没有取净 ,或者无法取出 .无菌手术切口内异物残留很少发生 ,常见于腹腔及四肢深部手术 ,多系医务人员粗心而遗漏 ,常见的有手术器械、敷料、引流管等 .脊柱后路手术因切口小 ,较浅 ,切口内异物残留更少见 .我科 1989- 0 6 /2 0 0 1- 0 5收治了 3例脊柱后路手术后切口内异物残留患者 ,报道如下 .1　临床资料　例 1:男 ,2 2岁 ,因腰部砸伤后部分截瘫以L5 S1 外伤性滑脱 度 ,腰骶部皮下巨大血肿急诊住院 ,曾行L5 S1 牵引复位 ,皮下血肿切开 ,硅胶管引流术 ,术后换药治疗…     

双歧杆菌定量分析技术研究进展

传统细菌培养计数法是依据细菌表型特征来对双歧杆菌进行鉴别计数的,MTPY和BSM培养基是经常使用的双歧杆菌培养基．近年来包括点杂交、荧光原位杂交、荧光原位杂交结合流式细胞计数和荧光实时定量PCR技术在内的以核糖体及其编码基因核酸序列为鉴别基础的分子生物学技术被广泛用于双歧杆菌的定量定性分析,其中荧光原位杂交结合流式细胞计数和荧光实时定量PCR技术是目前较为理想的方法．     

Analysis of the Mixing of Filler and Base Materials in Arc-Welded Single-Bead Surface Welds Using an EDXS Method

This article deals with an analysis of mixing and determines the admixing rate of a base S355 steel plate in single-bead surface welds by measuring the chemical composition using a plane-scan energy dispersive X-ray spectroscopy (EDXS) on metallographic cross-sections. The results show that obtaining a larger number of EDXS measurements does not necessarily lead to obtaining a more accurate admixing rate. Due to the ever-present segregations that are generally near the base material, the disadvantage of this method is the subjective influence of the SEM operator on the estimated admixing rate. To obtain relevant results, a sufficiently wide area of well-mixed melt, including segregations, must be analyzed. This study showed that by using a sufficiently large number of appropriately selected sites with a sufficiently large surface area, it is possible to estimate the admixing rate from the chemical composition with an accuracy of ≥96% for the geometrically determined admixing rate D = 30%. From several equations, the best result showed an equation which is the arithmetic mean of the two different arithmetic means and in which the artificial influencing factor of the segregations of the base material is taken into account. With this equation, the same value of admixing rate, D = 30%, was obtained using the comparative geometric method.     

超声促进4,4-二取代-2-苯基-2-噁唑啉-5-酮的水解

目的碱性水解4,4-二取代-2-苯基-2-     

Evidence that platelet density depends on the alpha-granule content in platelets

The relation between platelet buoyant density and beta-thromboglobulin (beta-TG), a marker for platelet alpha-granule content, was assessed by three independent approaches. (1) Platelets were separated on iso- osmolar discontinuous Stractan density gradients into five fractions, ranging in density from 1.061 g/ml to 1.091 g/ml (20 degrees C). The beta-TG content (mean +/- SD, n = 17) increased with the platelet density from 27.8 +/- 8.6 micrograms beta-TG/10(9) cells (20% less- dense platelets) up to 65.6 +/- 15.5 micrograms beta-TG/10(9) cells (15% most-dense platelets). (2) Activation of platelets in platelet- rich plasma with thrombin, adenosine diphosphate, collagen, or epinephrine resulted in a decreased density of the platelets. This was only seen when there was simultaneous secretion of beta-TG. (3) The less-dense and the more-dense platelet fractions, after isolation by density gradient centrifugation, were separately treated with thrombin. After complete degranulation, the density distribution of the originally less-dense and more-dense platelets were identical and were much narrower than the density distribution of resting platelets.     

Characterization of 25 monoclonal antibodies to factor VIII-von Willebrand factor: relationship between ristocetin-induced platelet aggregation and platelet adherence to subendothelium

We have studied the role of factor VIII-von Willebrand factor (FVIII- vWF) in both platelet adherence to subendothelium and ristocetin- induced platelet aggregation using monoclonal antibodies to human FVIII- vWF. Twenty-five monoclonal antibodies were obtained, two of which were directed to the factor VIII moiety of FVIII-vWF; one of these two completely inhibited the procoagulant activity (FVIII:C). The remaining 23 monoclonal antibodies were directed to the von Willebrand factor moiety of FVIII-vWF. The ability of the latter monoclonal antibodies to inhibit platelet adherence to arterial subendothelium was investigated with a perfusion model. According to the number of platelets adhering to the subendothelium, three groups of monoclonal antibodies could be discerned: (A) antibodies not affecting platelet adherence; (B) antibodies that inhibited platelet adherence to the level as observed when von Willebrand's disease plasma was tested; and (C) antibodies that completely inhibited both platelet adherence to subendothelium and ristocetin-induced platelet aggregation. The two antibodies present in group C competed for the same or closely related epitope(s) present on FVIII-vWF. These results demonstrate that a domain is present on the FVIII-vWF molecule that is associated both with ristocetin-induced aggregation and with the ability of FVIII-vWF to support platelet adherence to the subendothelium. Based on these observations, it is concluded that ristocetin-induced binding of FVIII-vWF to platelets reflects, at least in part, a physiologic mechanism regulating the function of FVIII-vWF in primary hemostasis.     

Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

Introduction

Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection.

Methods

The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19–9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed.

Results

Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19–9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging.

Conclusions

In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.     

Biphasic effects of transforming growth factor β on bone morphogenetic protein–induced osteoblast differentiation

Bone morphogenetic proteins (BMPs) exert an important role in skeletal development, adult bone homeostasis, and fracture healing and have demonstrated clinical utility for bone regeneration. However, BMPs fall short as regenerative agents because high doses need to be used to obtain therapeutic effects. Determining the molecular mechanisms controlling BMP‐induced bone formation may lead to the development of more effective BMP‐based therapies. To identify kinases mediating BMP‐induced osteoblast differentiation, we performed an siRNA screen to find kinases modulating BMP‐6‐induced alkaline phosphatase (ALP) activity. Surprisingly, although transforming growth factor β (TGF‐β) generally is considered to antagonize BMP‐induced osteoblast differentiation, C2C12 cells transfected with siRNAs targeting TGF‐β receptors displayed reduced BMP‐6‐induced ALP activity. Furthermore, pharmacologic inhibitors blocking the TGF‐β type I receptor impaired BMP‐induced ALP activity in KS483 and C2C12 cells and mineralization of KS483 cells. Consistently, costimulation with BMPs and TGF‐β further increased expression of osteoblast‐specific genes, ALP activity, and mineralization of KS483 cells and primary mesenchymal stem cells compared with BMPs alone. The stimulatory and inhibitory effects of TGF‐β were found to depend on timing and duration of the costimulation. TGF‐β inhibited BMP‐induced activation of a BMP‐Smad‐dependent luciferase reporter, suggesting that the stimulatory effect of TGF‐β is not due to increased BMP‐Smad activity. TGF‐β also inhibited the BMP‐induced expression of the BMP antagonist noggin and prolonged BMP activity. In conclusion, TGF‐β, besides acting as an inhibitor, also can, by dampening the noggin‐mediated negative‐feedback loop, enhance BMP‐induced osteoblast differentiation, which might be beneficial in fracture healing. © 2011 American Society for Bone and Mineral Research.     

Coil holder and marker system for MR imaging of the total spine

To improve the efficiency of magnetic resonance imaging of the total spine, the authors developed a coil holder and marker system to accurately localize the level of the spine imaged. The patient's external auditory canal and the alignment light on the imager are lined up with marks on the coil holder. The spine is then imaged in three segments by using a 24-cm field of view. The device has been successful in 20 of the 23 patients in whom it was used. The three failures were due to technical problems.