脂膜微泡结合凝血酶原复合物的制备

目的:制备结合凝血酶原复合物(PCC)的阴离子脂膜微泡,评价微泡的理化性质。材料和方法:采用机械振荡直接连接法,分两组(于机械振荡之前或之后加入),制备结合PCC的阴离子脂膜微泡,观察并检测洗涤前后微泡的理化性质。结果:微泡与PCC的结合率及Ⅸ因子活性:两组间比较无明显差异(P>0.05),但洗涤后结合率由洗涤前的95%降为80%,活性由90%降为19%。结论:直接连接法可制备结合PCC的阴离子脂膜微泡,微泡与PCC结合率较高,且洗涤前能保持Ⅸ因子较高的活性。     

关节镜下人工韧带重建前交叉韧带的临床初步体会

目的探讨关节镜下应用LARS人工韧带重建前交叉韧带的可行性及近期疗效. 方法用法国产LARS人工韧带对16例前交叉韧带(anterior cruciate ligament,ACL)损伤行关节镜下ACL重建术.等距点钻胫骨、股骨骨道,将肌腱拉入骨道,韧带游离部分位于关节腔内,拉紧后2枚螺钉固定韧带,合并损伤同期处理. 结果手术时间51～86 min,平均64 min.术后无滑膜炎、韧带断裂、活动明显受限等并发症.16例均随访1.5～6个月,平均3.8月.按照IKDC评分标准:术前C级6例,D级10例;术后A级6例,B级9例, C级1例(χ2=6.264,P<0.05).Lysholm膝关节功能评分术前36～76分,(63.7±7.3)分;术后86～97分,(94.8±9.6)分(t=10.356,P<0.05). 结论关节镜下LARS人工韧带重建ACL,操作简便,可使膝关节获得即时稳定性,早期康复锻炼,最大限度的防止关节功能受限,近期疗效满意.     

Protein adsorption on ex vivo catheters and polymers exposed to peritoneal dialysis effluent.

BACKGROUND: Deposition of proteins on surfaces of medical devices has been recognized to putatively relate to the process of regulation of biomaterial-associated complications by attachment of fibrin clots, eukaryotic cells, and microbes. The molecules adsorb to a varying extent, depending not only on the physicochemical properties of the biomaterial, but also on the composition of the host fluid. OBJECTIVE: Adsorption of proteins on catheters exposed both ex vivo and in vitro to dialysate of patients on peritoneal dialysis (PD) was studied. METHODS: Peritoneal dialysis effluent was collected from 5 patients with end-stage renal disease on continuous ambulatory PD. Tenckhoff catheters were obtained from 16 patients. Deposition of proteins on excised Tenckhoff catheters and tubing of different materials exposed to PD effluent in vitro was studied using 125iodine-labeled antibodies. Adhesion of Staphylococcus aureus and Staphylococcus epidermidis strains was quantified on tubing exposed to PD effluent in vitro. RESULTS: The presence of albumin, transferrin, immunoglobulin G, fibrinogen, fibronectin, von Willebrand factor, vitronectin, and thrombospondin was determined at various concentrations in PD effluent. All proteins analyzed were detected on PD catheters removed from patients. The extent of protein deposition on Tenckhoff catheters exposed to PD effluent, in vitro, rapidly reached a plateau and remained constant, as it did on polyvinyl chloride and polyethylene tubing. Adhesion of staphylococci was enhanced on Tenckhoff catheters exposed to PD effluent compared to unused PD solution. CONCLUSIONS: The data identify surface exposed proteins that may serve as adhesion sites for microbes on peritoneal catheters indwelled in patients undergoing PD.     

颅内假性动脉瘤的手术治疗

目的探讨颅内假性动脉瘤的诊断和手术方法。方法回顾性分析16例手术治疗的颅内假性动脉瘤病人的临床及影像学特点．其中创伤性9例，感染性7例。结果出院时临床状况优良11例，轻残3例，死亡2例（其中1例为创伤性，术后发生脑梗死）。对12例行3个月。5年门诊随访，均未发生再出血。结论颅内假性动脉瘤是颅内动脉瘤中特殊且较复杂的类型，其诊断和处理策略与一般动脉瘤不同。提高对颅内假性动脉瘤的认识，以及有效应用神经外科技术，可以降低假性动脉瘤的手术风险，改善预后。     

Immunology and genetics

Medical and Surgical Dermatology -     

派罗欣治疗慢性乙型病毒性肝炎的观察与护理

目的探讨乳腺癌术后胸部气压固定带的制作及临床应用价值。方法将64例乳腺癌术后患者随机分为观察组和对照组各32例,对照组采用传统的绷带加压包扎,观察组采用自行设计并制作的胸部气压固定带加压包扎。观察两组术后引流量、拔管时间及并发症的发生情况。结果观察组皮下积液发生率显著低于对照组（P〈0.05）,术后24h引流量、置管时间显著少于/短于对照组（均P〈0.01）。结论乳腺癌术后使用胸部气压固定带加压固定可减少渗出,缩短置管时间,降低皮下积液发生率。     

MED术中应用自制器械处理后纵韧带钙化及骨赘增生

目的探讨脊柱后路显微内镜(microendoscopic disectomy,MED)手术治疗腰椎间盘突出症合并后纵韧带钙化及椎体后缘骨赘增生的方法. 方法 MED手术中应用自制弧形纤维环刀和L形打入器治疗115例该类患者. 结果全组随访12～30个月,平均22个月,按MacNab标准:优、良109例,可5例,差1例,优良率94.8(109/115).未出现硬脊膜破裂及神经孙上,未发生椎间隙感染,无中转开放手术. 结论正确运用MED技术,配合采用自制器械及相应的改良方法,能较好地处理合并后纵韧带钙化及椎体后缘骨赘增生的难题,进一步扩大了手术适应证范围,提高了疗效及安全性.     

计算机导航在骨科手术中的应用

目的将计算机导航技术应用于骨科手术,并对其进行初步分析。方法2004年2～12月,计算机导航系统辅助下共行134枚椎弓根螺钉固定,51枚股骨颈骨折空心钉内固定,58枚交锁髓内钉远端交锁螺钉固定。结果所有病例全部在导航下完成手术,术中明显减少C型臂X线机透视次数,未发生血管和神经损伤并发症。结论计算机导航手术安全有效,更有利于微创手术的开展。     

Fabrication of porous hollow silica nanoparticles and their applications in drug release control.

Preparation and characterization of porous hollow silica nanoparticles (PHSN) for controlled release applications were investigated. Through orthogonally designed experiments, the optimal synthesis conditions for the preparation of PHSN were obtained and the produced PHSN were characterized by BET, SEM, TEM and IR. Scanning and transmission electron microscopy images revealed their hollow shell-core structure and also demonstrated that the size and shape of PHSN are determined by the templating CaCO3 nanoparticles. The produced PHSN were applied as a carrier to study the controlled release behaviors of Brilliant Blue F (BB), which was used as a model drug. Being loaded into the inner core and on the surfaces of the nanoparticles, BB was released slowly into a bulk solution for about 1140 min as compared to only 10 min for the normal SiO2 nanoparticles, thus exhibited a typical sustained release pattern without any burst effect. In addition, higher BET of the carriers, lower pH value and lower temperature prolonged BB release from PHSN, while stirring speed showed little influence on the release behavior. It showed that PHSN have a promising future in controlled drug delivery applications.     

护理业务流程再造现状分析及对策

目的了解护士对护理业务流程再造的知晓度及需求,找出流程再造存在的问题,针对存在问题提出相应的对策。方法采用问卷调查方法,调查广东省16所县级以上医院287名护士对护理业务流程再造的认识情况。结果护士对护理流程再造的知晓现状与临床状况不尽人意;护士认为进行护理流程优化再造是必要的和重要的;现有的护理流程存在的问题是流程流于形式、不完善及实用性不强。结论要进行护理流程再造,必须转变观念,加强在职培训,设计精简、方便、实用的护理流程。