我省医学临床教学基地建设的现状与思考

对我省医学临床教学基地评审结果进行分析，就大部分基地教学意识不强、教学设施不完善、教学条件有待改善、师资队伍素质水平不高等问题进行了阐述，并针对存在的问题提出建议和思考，从建章立制规范管理、加强建设、提供保障、重视培训、提高素质、强化管理、创新机制等方面进行探索，希望能使我省医学临床教学基地质量得以提高、完善，为我省培养一流的医学专业人才奠定基础．     

Tagawa髋臼旋转截骨术治疗髋臼发育不良的评价

目的　评价Tagawa髋臼旋转截骨术治疗髋臼发育不良的临床效果。方法　采用Tagawa髋臼旋转截骨术治疗髋臼发育不良 ,用Harris评分和测量X线髋臼指数来评估手术的临床效果和髋臼 股骨头解剖关系的变化。结果　Harris评分从术前的平均 ( 80± 7.7)分提高到 ( 95± 1.8)分 ,主要表现为疼痛明显改善。X线显示髋臼CE角、AC角、AHI获得明显改善 ,但HLI没有变化。所有病例没有重大并发症发生。结论　Tagawa髋臼旋转截骨术治疗髋臼发育不良能较好地重建髋臼和股骨头的解剖关系 ,可以明显改善患者髋部疼痛症状 ,延迟髋关节骨关节病的发生     

中药泡洗治疗糖尿病足90例疗效分析

目的为了观察中药泡洗对糖尿病足的疗效。方法对90例糖尿病足患者用中药（方剂组成：桃仁、红花、桂枝、没药、乳香、花椒、川芎等各10g）水煎制后分为2袋各300ml配合足浴仪泡洗，2次，d，30min／次，10d为1疗程。结果全组90例患者显效66例，有效24例，总有效率100％。结论中药泡洗治疗糖尿病足疗效确切。     

大鼠脂肪干细胞复合胶原-壳聚糖-硫酸软骨素三维支架构建组织工程软骨

Objective To evaluate the character of the collagen-chitosan-chondroitin sulfate scaffold seeded with rat adipose tissue-derived stromal cells. Methods A dipose tissue were harvested from 6 weeks old Wistar rats and the stromal cells were harvested by type Ⅰ collagenase and then cultured in vitro. Type Ⅰ collagen was fully mixed with chitosan, freeze-dried and cross-linked with chondroitin sulfate, then freeze-dried again and sterilized by ethylene oxide. The pore diameter, water content, porosity of the scaffold were tested. The adipose tissue-derived stromal cells were digested, seeded into the plates, scaffold, and cen-trifuged into pellet, and then induced into cartilage. MTT detection for cell proliferation was done. After 3 weeks, the cell morphology, and cell proliferation and adhesion were observed, and chondrngenic differenti-ation was also analyzed. Results The pore diameter, water content, porosity tested for the scaffold showed an appropriate form. Cell proliferation showed faster in the scaffold and pellet culture system after 5 day, there was still cell proliferation in the scaffold system after 14 days but no obvious changes in the pellet cul-ture system; ceils on the scaffold proliferated densely showed by histological staining, but there was a scaf-fold structure residues in the inner layer. The finding of type Ⅱ immunohistochemistry stain showed that cells express strong positive for type Ⅱ collagen in the scaffold and pellet culture system whereas it was weakly positive in the plate culture system; the specific mRNA for cartilage, type Ⅱ collagen, aggrecan and SOX-9 were expressed in all three systems showed by RT-PCR, but type X collagen was expressed continu-ously in the plate culture system and expressed after 21 days in the pellet culture system, whereas it was not detected in the collagen-chitosan-chondroitin sulfate scaffold system. Conclusion The parameters of the collagen-chitosan-chondroitin sulfate scaffold were suitable in our study. The results suggested that it can promote the adipose tissue-derived stromal cells proliferation and chondrogenic differentiation better than the plate and pellet culture systems and maintain the phenotype of chondrocytes well; it is the optimal choice for cartilage tissue engineering in the future.     

精子洗涤对精液中HBV DNA含量的影响

目的：检查HBV感染者精液是否存在乙型肝炎病毒（HBV），探讨精子洗涤是否能去除其中的HBV DNA。方法：用实时荧光定量PCR（FQ-PCR）法检测57名血清HBsAg阳性患者精液中HBV DNA，采用Percoll非连续梯度离心及上游法分离其中21份精液，并对洗涤后标本进行HBV DNA检测。结果：62份精液标本中有15份HBV DNA阳性，阳性率为24.19%;21份用于洗涤的精液标本中有，有7份HBV DNA阳性，洗涤后仍有6份标本阳性。结论：部分HBV感染者精液具有传染性，精子洗涤不能完全去除精液中的乙肝病毒。将HBV感染者的精液用于人工授精或体外受精应慎重。     

内镜鼻胆管引流术在腹腔镜和开腹胆总管探查术中的应用

目的　评价内镜鼻胆管引流术 (Endoscopicnasobiliarydrainage ,ENBD)配合腹腔镜和常规开腹手术治疗胆总管结石的疗效。　方法　回顾分析 1997年 1月～ 2 0 0 1年 7月应用ENBD配合完成腹腔镜胆总管探查、I期缝合术 4 4例及开腹胆总管探查、I期缝合术 34例。　结果　 78例均手术成功 ,术后无胆漏、胆道出血、胆管炎等并发症。术中结石取净率 10 0 % (78 78)。术后住院时间 :腹腔镜组为 (6 2±1 3)d ,开腹组为 (7 4± 2 1)d。随访 5 7例 ,时间 (1～ 4 5 )年 ,平均 2 6年 ,腹部彩色B超检查无胆管狭窄及结石复发。　结论　ENBD配合腹腔镜和开腹胆总管探查取石、胆总管I期缝合术安全、可靠。     

Cre recombinase-mediated site-specific recombination between plant chromosomes.

We report the use of the bacteriophage P1 Cre-loxsystem for generating conservative site-specific recombination between tobaccochromosomes. Two constructs, one containing a promoterless hygromycin-resistancegene preceded by a lox site (lox-hpt) and the other containing a cauliflowermosaic virus 35S promoter linked to a lox sequence and the cre coding region(35S-lox-cre), were introduced separately into tobacco plants. Crosses betweenplants harboring either construct produced plants with the two constructssituated on different chromosomes. Plants with recombination events wereidentified by selecting for hygromycin resistance, a phenotype expressed uponrecombination. Molecular analysis showed that these recombination eventsoccurred specifically at the lox sites and resulted in the reciprocal exchangeof flanking host DNA. Progenies of these plants showed 67-100% cotransmission ofthe new transgenes, 35S-lox-hpt and lox-cre, consistent with the preferentialcosegregation of translocated chromosomes. These results illustrate thatsite-specific recombination systems can be useful tools for the large-scalemanipulation of eukaryotic chromosomes in vivo.     

Influence of mild hypothermia on vascular endothelial growth factor and infarct volume in brain tissues after cerebral ischemia in rats

BACKGROUND: It has been demonstrated that mild hypothermia has obvious protective effect on both whole and local cerebral ischemia. However, the definite mechanism is still unclear for the brain protection of mild hypothermia on cerebral edema, inhibiting inflammatory reaction, stabilizing blood brain barrier, etc. OBJECTIVE: To investigate the effect of mild hypothermia on the expression of vascular endothelial growth factor and the infarct volume after cerebral ischemia in rats, and analyze the brain protective mechanism of mild hypothermia. DESIGN: A randomized grouping and controlled animal trial. SETTING: Department of Neurology, People's Hospital of Yunyang Medical College. MATERIALS: Twenty adult male SD rats of clean degree, weighing (250±30) g, were provided by the animal experimental center, School of Medicine, Wuhan University. The kits for SP immunohistochemistry were purchased from Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd. METHODS: The experiments were carried out in the laboratory of Department of Neurology, Renmen Hospital of Wuhan University from May to July 2005. ① The 20 rats were divided randomly into normal temperature group (n =10) and mild hypothermia group (n =10). Models of permanent middle cerebral artery occlusion were established with modified nylon suture embolization. The rats were assessed with the Longa standards: 0 point for without nerve dysfunction; 1 for mild neurological deficit (fore claws could no extend completely); 2 for moderate neurological deficit (circling towards the affected side); 3 for severe neurological deficit (tilting towards the affected side); 4 for coma and unconscious; 1-3 points represented that models were successfully established. The rats of the normal temperature group were fed at room temperature, and those in the mild hypothermia group were induced by hypothermia from 2 hours postoperatively, and the rectal temperature was kept at 34-35 ℃ for 72 hours. ② Measurement of infarct volume: All the rats were anesthetized by intraperitoneal injection overdose sodium pentobarbital 7 days postoperatively, and then the heads were cut down to harvest brain. The brain tissues were placed into -20 ℃ refrigerator for 20 minutes, coronal sections of 2 mm were prepared. The infarct sites were not stained, whereas normal brain tissues were stained as red. The infarct volumes were calculated by using MPLAS-500 multimedia color pathological image&&word analytical system. ③ Counting positive cells of vascular endothelial growth factor protein: The brains were harvested by cutting heads, then coronal sections of 2 mm were prepared. Routine dehydration, hyalinization, wax immersion and embedding were performed, then the detected with SP immunohistochemistry, the kits were purchased from Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd. The cells whose cytoplasm was yellow-brown were positive ones, a single sample as a unit, peri-ischemic site and ischemic core were selected, and the corresponding sites in controlateral hemisphere were taken as controls. Five visual fields were selected from each site to be observed under microscope, the cells were counted, and the average number of positive cells was calculated in each group. The numbers of positive cells were determined with the image analytical apparatus. MAIN OUTCOME MEASURES: Number of the positive cells of vascular endothelial growth factor protein; Infarct volume of rat brain tissue. RESULTS: All the 20 rats were involved in the analysis of results. ① Number of positive cells of vascular endothelial growth factor protein in brain tissue: It was obviously lower in the mild hypothermia group than in the normal temperature group [(24.02±5.05), (36.07±2.69) cells/high power visual field, P < 0.01]. ② Comparison of infarct volume of brain tissue: After MCAO, it was obviously smaller in the mild hypothermia group than in the normal temperature group [(153.25±23.14), (253.45±36.21) mm3, P < 0.01]. CONCLUSION: Mild hypothermia can inhibit the expression of vascular endothelial growth factor and decrease the volume of cerebral infarction. The inhibition of mild hypothermia on the expression of vascular endothelial growth factor may be one of the brain protective mechanisms.     

解释——护理过程中应重视的一个环节

在护理过程中护士和患者进行频繁接触和互动,护士主要应从以下几点做好解释工作,达到消除患者各种顾虑,改善和融洽医患关系,增强与患者的配合能力,使护理工作顺利进行,杜绝护理差错事故的发生,使患者心情愉快,早日康复.①解释环节对护士的素质要求,护士有高尚的职业道德水准,有扎实的基础知识和丰富的临床实践经验.②解释前,对患者的情况做全面了解.③整个护理操作前解释、操作中指导和操作后嘱咐的内容和要求.④鼓励患者及家属积极提出问题,并能全面、科学地做知识解答.笔者旨在通过撰写此文,引起护理同仁对解释环节的重视,不断提高解释水平的护理质量.     

冷冻异体手指复合组织移植后的骨关节病变观察

目的 研究自体Mu甲皮瓣游离移植包裹冷冻异体手指骨－关节－肌腱－腱鞘复合组织再造Mu，手指后，异体指骨关节病变发生的特点。方法 应用X线片和病理活检方法，对16例植入11个月－15年6个月，平均4年5个月的病变异体骨关节进行观察和评价。结果 异体骨关节病变过程可分早期（＜2年），中期（2－10年）和晚期（＞10年）。X线摄片分别显示软骨下骨虫蛀样缺损，骨关节吸收脱位和毁损。所有的病变骨关节中未见炎性细胞浸润，异体肌腱内见肌腱样细胞生长。结论 异体指骨关节病变严重程度与病程有关，其表现类似于失神经关节病变（Charcot关节病）。异体肌腱可长期存活。