Wedge-Shaped Excision and Modified Vertical Mattress Suture Fully Buried in a Multilayered and Tensioned Wound Closure

Background  A successful deep multilayered wound suture should provide a firm tension-relieving closure, good wound-edge eversion, hemostasis, and minimal intradermal extraneous materials. However, this is not always achieved with a single standard technique. The authors describe their modification of a wound closure method that can rapidly and reliably achieve these results. Methods  A wedge-shaped excision was adopted to obtain a trapezoid pattern transect, after which a modified fully buried vertical mattress suture technique was used to close the wound. These techniques were compared with the standard excision and suture techniques used for the same patient at different times after surgery. Results  The wedge-shaped excision can facilitate good wound-edge eversion, and the modified fully buried vertical mattress suture can provide firm tension relief and optimal apposition. Compared with conventional excision and suture techniques, the described techniques brought about a better outcome in terms of hypertrophic scar prevention. Conclusion  The described modified technique seems to be more efficient than conventional procedures used to prevent hypertrophic scar formation.     

微信课堂在绝经相关疾病诊治培训中的运用及效果评价

目的评价微信课堂在妇科医师绝经相关疾病诊治培训中的运用效果。方法选取2017年3月自愿参与北京世纪坛医院线下继续医学教育项目"绝经相关疾病诊治培训"的47位妇科医师作为对照组(传统教学),自愿参与线上微信课堂培训的52位妇科医师作为实验组(微信课堂教学)。通过比较培训前后妇科医师对绝经相关疾病知识的掌握情况及课程满意度,以评价教学效果。采用SPSS 20.0对组间数据行t检验或卡方检验。结果所有妇科医师均完成了研究,培训前后的测评问卷回收率均为100%。培训前实验组学员绝经相关疾病知识平均得分(63.65±21.42)、知识考核通过率为65.4%,与对照组[(60.85±24.83)分,63.8%]相比,差异无统计学意义(P>0.05)。两组学员培训后的绝经相关疾病知识得分和考核通过率均高于培训前,且差异有统计学意义(P<0.05)。培训后,实验组学员平均得分为(77.50±16.19)分、考核通过率为90.1%,优于对照组[(78.72±16.89)分,87.2%],但两组差异无统计学意义(P>0.05)。实验组学员对培训的满意度相较对照组更高,但两组差异无统计学意义(P>0.05)。结论微信课堂用于妇科医师绝经相关疾病诊治培训,具有与传统教学相同的效果且培训满意度更高,可进一步运用于妇科其他亚专业培训及向其他专科推广。     

Role of serum angiopoietin-2 level in screening for esophageal squamous cell cancer and its precursors

Background Angiopoietin-2 (Ang-2) is one of the critical regulators of tumor angiogenesis. Studies have shown a significant correlation of Ang-2 expression to tumor invasion and metastasis in various human cancers, but little is known about the serum Ang-2 (sAng-2) levels in esophageal squamous cell cancer (ESCC) and its precursors. In this study, we aimed to investigate its role in screening for ESCC and its precursors.Methods We carried out a free endoscopic screening in Feicheng City, a high ESCC incidence area in Shandong Province of China. Serum samples were collected as follows: 91 from normal subjects, 44 from patients with esophagitis, 85 from patients with hyperplasia, and 13 from patients with early ESCC. In addition, 28 serum samples were obtained from patients with invasive ESCC undergoing surgery in People’s Hospital of Feicheng City. All the subjects of the five groups were diagnosed by histopathology. The sAng-2 levels were tested and compared, and the diagnostic power in early or/and invasive ESCC was calculated in terms of sensitivity and other parameters.Results The sAng-2 levels were (22.0±5.5), (21.3±3.2), (20.5±3.3), (24.0±5.0), and (29.8±5.0) U/ml in normal, esophagitis, hyperplasia, early ESCC, and invasive ESCC groups respectively. It was significantly higher in early ESCC than inhyperplasia group (P=0.009). The invasive ESCC group showed the highest Ang-2 level among all groups (all P=0.000). The sensitivities of sAng-2 to early and invasive ESCC were 23.1% and 78.6% respectively.Conclusion sAng-2 level is related to carcinogenesis and progression of ESCC, but it can not be used to screen for early ESCC.     

Smad7对转化生长因子β1诱导的肺泡上皮细胞向间质细胞转变的影响

目的检测转化生长因子（TGF）β1能否在体外诱导肺泡Ⅱ型上皮细胞向间质细胞转变（EMT）,以及Smad7基因转染能否阻止此种转变及相关信号转导机制。方法采用脂质体法转染Smad7基因到大鼠肺泡Ⅱ型上皮（RLE-6TN）;实时荧光PCR及免疫印迹法检测转染前后上皮细胞标志物（E—cadherin,CK19）、间质细胞标志物（FN、Vimentin及α—SMA）及Smad信号通路相关蛋白表达变化;相差显微镜观察TGFβ1诱导的肺泡上皮细胞形态改变,其超微结构改变采用透射电镜观察。结果成功转染Smad7到RLE-6TN;转染前,在TGFβ1作用下,RLE-6TN间质标志物的表达在mRNA和蛋白水平上调,而上皮标志物表达下调;转染后,其间质标志物下调的同时上皮标志物上调;转染前RLE-6TN在TGFβ1作用下p-Smad2／3表达上调,转染后其表达无明显改变;形态学上,TGFβ1能诱导肺泡上皮发生EMT,Smad7转染则能阻止EMT;超微结构上,TGFβ1能诱导肺泡上皮特有板层小体变性、肿胀并随其时间延长最终完全消失。结论TGFβ1能在体外诱导肺泡Ⅱ型上皮向间质细胞转变,其机制部分与Smad信号转导途径相关,Smad7转染能在一定程度上阻止该转变。     

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective　To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods　Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results　All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion　Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle.     

动态血糖监测联合心理干预对糖尿病患者的改善分析

目的：探讨分析动态血糖监测系统监测糖尿病患者血糖变化的精确性以及给予心理护理干预的作用。方法：选取我院从2014年2月至2016年4月收治的190例糖尿病患者选取为此次研究对象,应用数字随机法将其分为对照组（n=95）与研究组（n=95）,对照组患者应用血糖监测仪监测血糖变化并给予患者常规护理,研究组患者采用动态血糖监测系统（continuous glucose monitoring system,CGMS）,在此基础上加以心理护理干预,对比2组患者血糖变化监测的准确性,分析不同护理干预模式对患者的影响作用。结果：研究组患者监测准确率高于对照组患者,即Clarke EGA指标分析结果显示A/B点位占比95.8%,高于对照组83.2%（?字2=8.047,P=0.005）;研究组患者血糖水平控制效果优于对照组且SAS评分[（20.4±5.8）分]、SDS评分[（19.3±1.5）分]均明显低于对照组患者SAS评分[（51.2±10.4）分]、SDS评分[（55.7±3.6）分]（t=25.210,P=0.000;t=90.970,P=0.000）,组间数据比较差异均有统计学意义（P<0.05）。结论：CGMS对于糖尿病患者的血糖变化检测准确性更高,心理护理干预能够消除患者负性情绪,对于血糖控制有一定的积极作用。     

开放性问题在妇产科教学中的应用研究

文章从我国医学教育以问题为基础的学习（problem-based learning,PBL）应用现状展开,分析了PBL在我国医学教育的局限性,并运用建构主义理论简述了开放性问题教学的必要性。以教材中的妇产科学开放性问题对三个年级进行教学实施,结果显示,开放性问题是提高学生发现问题和自主学习能力的有效方法,也是实现意义建构的有效途径。     

乌司他丁对老年患者直肠癌根治术后认知功能障碍的影响

目的 观察乌司他丁对老年患者腹腔镜直肠癌根治术后认知功能障碍（POCD）的影响。方法 拟行腹腔镜直肠癌根治术的老年患者60 例,随机分为对照组（C 组）和实验组（U 组）,每组30 例。U 组麻醉诱导前静脉注射乌司他丁20 万u,然后以10 万u/h 的速度持续静脉泵注射至患者离室,C 组给予等剂量的生理盐水。测定患者手术前1 天（T0）、手术结束时（T1）、手术后第1 天（T2）和手术后第3 天（T3）血浆IL-6、TNF-α 和S100β 的浓度,并在T0、T2 和T3 时点完成简易精神状态检查量表（MMSE）评分,记录POCD 发生率。结果 两组T1 时点IL-6、TNF-α 和S100β 水平高于其他时点（P <0.05）,C 组T2 时点IL-6 和TNF-α 水平高于T0 和T3 时点（P <0.05）;U 组T1 时点IL-6、TNF-α 和S100β 水平低于C组（P <0.05）,T2 时点IL-6 和TNF-α 水平低于C 组（P <0.05）。C 组术后T2 时点MMSE 评分低于T0 和T3 时点（P <0.05）,U 组T2 时点MMSE 评分高于C 组（P <0.05）,U 组POCD 发生率低于C 组（P <0.05）。结论 乌司他丁可降低腹腔镜直肠癌根治术老年患者术后IL-6、TNF-α 和S100β 水平,减轻全身炎症反应和中枢神经系统细胞损伤,减少POCD 的发生。     

椎管内肿瘤26例围手术期的护理

0　引言　手术切除椎管内肿瘤是唯一有效的治疗方法 .由于病变部位的特殊性 ,手术难度大、危险性大 ,术后易出现神经损伤、脊髓缺血、水肿 ,发生呼吸障碍、高热、消化道出血、四肢瘫痪或截瘫等严重并发症 .其护理工作也具有一定的复杂性和特殊性 .1　临床资料　我院 2 0 0 0 - 0 5 / 11收治椎管内肿瘤患者 2 6 (男19,女 7)例 ,年龄 9～ 6 1岁 .颈椎段 14例 ,胸椎段 6例 ,腰椎段 5例 ,骶管内 1例 . 7例为转移瘤 ,2例为原发性胶质瘤 ,其余均为良性肿瘤 .本组患者以颈段椎管内肿瘤居多 (5 4% ) .2　讨论　为使患者安全渡过围手术期 ,术前健康教…     

脑梗死患者血清IL-6和TNF检测的临床意义

目的探讨白细胞介素-6（IL-6）和肿瘤坏死因子（TNF）在脑梗死过程中所起的作用和临床意义。方法采用ELISA方法测定42例脑梗死患者和40例同龄健康体检者血清IL-6和TNF含量,并分析它们与梗死体积的关系。结果急性脑梗死患者血清IL-6和TNF明显高于对照组,它们与脑梗死体积存在明显相关性。结论IL-6和TNF参与了急性脑梗死的发生发展。