肝外伤157例临床治疗分析

目的 提高对不同类型肝外伤的诊断和治疗水平。方法 回顾性总结1990年9月至2002年1月我中心收治的157例肝外伤患者，包括非手术治疗32例，手术治疗125例。结果 非手术治疗32例，完全治愈28例，4例死亡。手术治疗125例，完全治愈107例，死亡18例，总治愈率85．9％(135／157)，病死率14．1％(22／157)，其中9例死于多发性创伤合并多器官功能衰竭(MOF)，8例死于肝内大血管损伤引起的出血，5例死于术后并发症。结论肝外伤病情危重，临床表现复杂，早期正确诊断、及时和合理的手术治疗是减少死亡率提高救治水平的关键，积极抗休克，实行重症监护和防治并发症等非常重要。血流动力学稳定的患者可行非手术治疗。     

三种内固定治疗上肢长骨干骨折的临床比较研究

目的观察天鹅记忆接骨器(swan-likememoryconnector,SMC)治疗上肢长骨干骨折的疗效,并与加压接骨板(dynamiccompressiveplate,DCP)和带锁髓内针(lockedintramedullarynail,LIN)进行临床对比研究。方法随机选择1997年8月～2001年8月入院的新鲜上肢长骨干骨折148例,分别采用SMC(49例)与DCP(50例)、LIN(49例)进行内固定治疗,术后常规抗炎治疗1周,定期拍片并随访患肢功能恢复情况。结果SMC组的手术时间明显低于LIN组与DCP组(P<0.05),三组伤口感染率无差异。SMC组骨愈合时间和骨不连发生率显著短于DCP组和LIN组(P<0.05),而术后功能优良率高于DCP组和LIN组。在SMC固定下,骨折愈合直接由解剖型或类解剖型的骨样骨板状直接替代连接,固定段无应力遮挡和骨质疏松。结论SMC是治疗上肢长骨干骨折的有效方法,优于DCP和LIN。SMC的几何构形和力学特性有利于骨折愈合。在本器固定下,可能存在一种新的尚未被认知的骨折愈合方式。     

体外大鼠骨髓间充质干细胞多向分化潜能的研究

目的研究体外大鼠骨髓间充质干细胞向神经细胞等不同组织细胞多向分化的潜能。方法从SD大鼠股骨骨髓中获得间充质干细胞,原代培养后1∶2传代,传至第5代后分为普通传代培养组、神经细胞诱导组、成骨细胞诱导组和脂肪细胞诱导组。倒置相差显微镜下观察各组细胞生长情况、形态变化以及矿化结节和脂肪细胞的形成;流式细胞检测第5代大鼠骨髓间充质干细胞表面抗原CD29、CD44、CD90、CD31、CD34、CD45;免疫组织化学检测普通传代培养组和神经细胞诱导组细胞巢蛋白、微管相关蛋白-2、胶质纤维酸性蛋白和神经元特异性烯醇化酶等神经细胞相关蛋白的表达情况。结果大鼠骨髓间充质干细胞呈贴壁生长,细胞扩增至第5代时形态趋于一致,呈梭形。大鼠骨髓间充质干细胞表面抗原CD29(99.83%)、CD44(99.77%)、CD90(99.86%)均呈阳性表达,CD31(0.83%)、CD34(1.78%)、CD45(2.90%)无表达。在体外,普通传代培养细胞仅巢蛋白呈阳性表达;由神经细胞诱导的细胞巢蛋白、微管相关蛋白-2、胶质纤维酸性蛋白和神经元特异性烯醇化酶均呈阳性表达,且形态类似神经细胞;由成骨细胞诱导的细胞质内可见矿化结节形成;由脂肪细胞诱导的细胞质内出现多个猩红色呈簇状的脂肪滴。结论大鼠骨髓间充质干细胞易于提取、纯化和扩增,可于体外自发表达神经干细胞标志蛋白,并可通过诱导向神经细胞、成骨细胞及脂肪细胞分化。提示骨髓间充质干细胞不仅具有多向分化潜能,而且可能具有自发向神经干细胞分化的特性。     

腹腔镜筋膜内子宫切除和开腹子宫全切除临床对照研究

目的 :探讨腹腔镜筋膜内子宫切除术 (CISH)的手术方法和临床效果。方法 :选择CISH患者 6 0例 (腹腔镜组 )与开腹子宫全切除术 6 0例 (开腹组 )为研究对象。术前B超检测两组子宫大小无明显差异 ,术后两组的病理诊断均为良性。结果 :腹腔镜组 6 0例均获成功 ,与开腹组相比 ,腹腔镜组术中出血少 ,术后最高体温低 ,术后用药少 ,患者痛苦小 ,住院时间短 ,术后发热率低 ,术后并发症发生率低。结论 :CISH具有很多微创手术的优点 ,适合良性子宫病变患者。     

Effects of basic fibroblast growth factor on biological characteristics of osteoblasts

Objective: To elucidate the effects of exogenous basic fibroblast growth factor ( bFGF ) on biological characteristics of rat osteoblasts cultured in vitro. Methods: The osteoblasts isolated from a Sprague-Dawley rat and cultured in vitro were treated with different concentrations of bFGF ( 5-50 ng/ml) respectively. At 24 hours after treatment, the proliferating cell nuclear antigen was measured with immunocytochemistry, alkaline phosphatase (ALP) activity was determined and the expression of transforming growth factor beta 1 ( TGF-β1 )was detected to observe the effects of bFGF on growth and differentiation of osteoblasts. Resu/ts: bFGF ( 5-50 ng/ml ) could obviously promote the growth of osteoblasts. The intracellular expression of TGF-β1 mRNA increased significantly, but the intracellular ALP content decreased. Conclusions: bFGF can obviously stimulate the proliferation of osteoblasts and promote the synthesis of TGF-β1, but cannot promote the differentiation of osteoblasts.     

康广盛教授治疗胆石病的经验

康广盛教授在40余年的中医临床实践中，积累了丰富的经验，笔者总结了康教授对胆石病病因病机的认识及辨病辨证相结合的治疗方法，并列举出典型病案，简述个人的体会及见解。     

芪月降脂片中黄芪甲苷的含量测定

[目的 ]研究芪月降脂片中黄芪甲苷的含量测定方法 .[方法 ]用甲醇提取、水饱和正丁醇萃取、大孔吸附树脂处理供试品后 ,以双波长薄层扫描法测定黄芪甲苷的含量 .[结果 ]黄芪甲苷的平均回收率为 10 4 18% ,RSD为 3 2 5% .[结论 ]双波长薄层扫描法较为简便、经济且重现性较好 ,可用于制剂中黄芪甲苷的质量控制     

接触性热痛诱发电位检测方法的建立

目的 建立接触性热痛诱发电位(CHEP)的检测方法,估测介导此诱发电位的外周神经传导速度.方法 受试者取卧位,应用CHEP刺激器,于两个强度水平(49.5℃和54.5℃)应用可调节脉冲,刺激部位为鱼际肌、手背、前臂的掌侧面.受试者在每次刺激后,按照视觉模拟评分标准对刺激强度分级.以Keypoint仪器记录,记录点为Cz和Pz.测定刺激强度和疼痛分级的关系、诱发电位的主要成分及外周神经传导速度.结果 刺激强度和疼痛分级的关系为:49.5℃和54.5℃刺激鱼际肌皮肤,疼痛分级分别为(3.2±0.3)、(4.4±0.5)级;54.5℃刺激手背和前臂掌侧面皮肤,疼痛分级分别为(6.3±0.8)、(7.2±0.5)级.于记录点记录到3个主要成分:Cz/N550、Cz/P750和Pz/P1000.介导此诱发电位的外周神经传导速度分别为(12.9±7.5)、(1.7±0.4)m/s,分别与Aδ纤维和C纤维的传导速度相对应.结论 CHEP能较为稳定、可靠地引出,介导此诱发电位的外周神经为Aδ纤维和C纤维.     

Subcutaneously administered recombinant human β-interferon in the treatment of chronic hepatitis B virus infection

Background: Treatment of chronic replicative hepatitis B virus (HBV) infection is aimed at stopping viral replication and preventing the development of chronic liver disease. β-Interferon treatment has been less well studied than α-interferon. Methods: The efficacy and tolerability of a 6-month course of subcutaneously administered human recombinant β-interferon (rINF-β_ser) was studied and the results of a low-dose regime compared with a high-dose regime. Twenty patients (17 men and three women), aged 24–54 years, with chronic hepatitis B virus infection (all hepatitis B surface antigen-positive with detectable HBV-DNA in their sera for at least 3 months prior to therapy) were randomized into two treatment groups of 10 patients each. The low-dose group received 6×10⁶ U/dose and the high-dose group received 30×10⁶ U/dose, both groups receiving their respective doses three times a week initially for 1 month and continuing for a total of 6 months. Results: The treatment was well tolerated in both groups. None of the patients required dosage reduction or cessation of treatment because of side-effects. HBV-DNA decreased in all patients during treatment, demonstrating the anti-viral efficacy of rINF-β_ser, and was undetectable in 20 and 40% of patients receiving low-dose and high-dose regimes, respectively, at the end of 6 months treatment (P=N.S.). One year after completion of treatment, HBV-DNA was undetectable in 50 and 30% of patients in the low-dose and high-dose groups, respectively (P=N.S.). However, only one patient achieved seroconversion with loss of the hepatitis B surface antigen and appearance of an anti-hepatitis B ‘e’ antigen at the end of 18 months. Conclusion: This study shows that subcutaneously administered rINF-β_ser is well tolerated, but the optimal dose and duration of treatment still needs to be defined by further studies.     

无创心输出量监测在暴发性心肌炎患儿中的应用

目的 探讨无创心输出量监测系统(non-invasive cardiac system, NICaS)在暴发性心肌炎(fulminant myocarditis, FM)患儿中的应用价值。方法 纳入FM患儿39例作为试验组,同期住院的肺炎患儿47例作为对照组。2组均行NICaS和经胸超声心动图(transthoracic echocardiography, TTE)检查,监测心脏指数(cardiac index, CI)、△CI、格兰夫-高尔指数(Granov Goor index, GGI)及左心室射血分数(left ventricular ejection fraction, LVEF)等参数,比较试验组患儿NICaS和TTE参数的差异及相关性;试验组随机分为A1组(n=21,参照NICaS制定治疗方案)和A2组(n=18,参照TTE制定治疗方案),比较2组预后。结果 试验组TTE和NICaS测得的CI均小于对照组,试验组NICaS测得的CI小于TTE,差异有统计学意义(P<0.05)。Pearson相关性分析显示,试验组和对照组NICaS与TTE测得的CI呈显著正相关(r=...