SOX-9和转化生长因子-β1共同诱导大鼠脂肪干细胞向软骨细胞分化

目的探讨应用SOX-9和TGF-β1基因转染大鼠ADSCs(Adipose stromal cells,ADSCs)后,目的基因分泌情况及向软骨细胞的分化效果,为构建新型的组织工程软骨种子细胞提供思路。方法6周龄健康雄性Wistar大鼠2只,体重约150g。扩增、提取质粒pcDNA3.1-TGF-β1、pcDNA3.1-SOX-9。分离、纯化Wistar大鼠ADSCs,倒置相差显微镜观察原代和传代ADSCs形态学改变,免疫荧光法检测细胞表面标志。将SOX-9和TGF-β1基因单独或共转染第3代ADSCs,按转染情况分为5组:对照组、转染空载体组、转染SOX-9组、转染TGF-β1组、SOX-9与TGF-β1共转染组。对转染后细胞进行筛选,MTT法测定筛选后细胞的增殖活性,RT-PCR和Westernblot法检测筛选后细胞的表达。结果免疫荧光法检测ADSCs的CD29、CD44呈阳性反应,CD34、CD106呈阴性反应。MTT法测定各组细胞在490nm波长处的吸光度(A)值,未转染组、空载体组与SOX-9组、TGF-β1组、SOX-9与TGF-β1共转染组间差异显著(P<0.01)。RT-PCR和Western blot检测目的基因和蛋白的表达量,SOX-9表达以转染SOX-9组最多;TGF-β1表达以SOX-9与TGF-β1共转染组组最多;II型胶原表达以SOX-9与TGF-β1共转染组最多。结论SOX-9和TGF-β1基因共同转染ADSCs修复软骨缺损是一个较有前景的发展方向,对组织工程软骨应用于临床具有重要意义。     

创伤合并海水浸泡后愈合过程的病理学观察

目的观察创伤合并海水浸泡后对伤口愈合时间的影响及愈合过程中的病理学改变。方法以大鼠为实验动物,建立背部双侧圆形创伤模型,创后随机分为对照组和实验组,每组50只,实验组创后置海水中浸泡30min。观察2组创面的愈合生长状况。观察伤口局部愈合过程中的病理学改变,应用免疫组化方法观察愈合过程中伤口修复细胞增殖指数及微血管密度变化。结果对照组平均愈合时间为（12.0&#177;1.0）d,而实验组的平均愈合时间为（14.3&#177;0.8）d;两组在肉芽组织形成时间上以及修复细胞增殖能力上存在差异。结论创伤合并海水浸泡可导致伤口愈合时间延迟,加重创伤局部的炎症反应、延缓肉芽组织形成时间。     

妊娠合并极重度血小板减少26例临床分析

Objective To investigate the etiology and perinatal outcome of pregnancies complicated with extremely severe thrombocytopenia [ at least two times of platelets count (PLT) < 10 × 109/L during pregnancy]. Methods Clinical data, including basic information, etiology, management and outcomes of pregnant women with extremely severe thrombocytopenia, admitted to Peking University People's Hospital from January 2004 to March 2009, were retrospectively collected. The management of these cases varied according to different etiology and the symptoms: (1) PLT were maitained > 20 × 109/L and hemoglobulin> 70 g/L in those women without spontaneous bleeding; (2) PLT transfusion would be required when PLT< 10 × 109/L or bleeding occur and RBC would be supplied when hematocrit <25% and hemoglobulin <70g/L; (3) Hemoglobulin should be > 70 g/L and PLT >30 × 109/L before cesarean section or delivery;(4) Predinisone and/or intravenous immunoglobulin G (IVIG) would be given in women complicated with idiopathic thrombocytopenic purpura (ITP) when PLT < (20-30) × 109/L or bleeding. PLT would be given if all the above management were failed, or PLT < 10 × 109/L, or bleeding. Women without bleeding would be closely monitored and delivery would be planned. Results (1) Twenty-six cases were identified among 9302 deliveries during the study period (0.28%), with an average of maternal age of 29. Seventeen were diagnosed before conception and 9 during pregnancy. Among the 26 women, half received regular prenatal check in our hospital and the average gestations at diagnosis was 24 weeks and the other half without regular prenatal visits and the average gestations at diagnosis was 32 weeks. Etiology was identified in 24 out of the 26 women, including 14(54%) ITP, 5 myelodysplastic syndrome (MDS), 4 chronic aplastic anaemia(CAA) and 1 systemic lupus erythematosus (SLE). (2) Management: All of the 26 women received blood products. Among the 14 ITP cases, 6 received predinisone and IVIG and 8 only took predinisone. Nine of the 26 patients (35%) had pregnant complications, among which 6 (6/9) were preeclampsia. The overall average gestation at delivery was 36 weeks. Only 2 delivered vaginally with the average blood loss of 83 ml and 23 cesarean sections were performed with the average blood loss of 410 ml. (3) Perinatal outcomes:There were 26 perinatal babies, among which 1 died intrauterine and 25 were born alive (12 preterm infants). The average birth weight was 2877 g. Neonatal severe thrombocytopenia presented in 2 newborns whose mother complicated with ITP. Conclusions The main cause of extremely severe thrombocytopenia during pregnancy is ITP, managed mainly by predinisone and IVIG, followed by CAA and MDS, which may require supportive treatment. Pregnancy complicated with extremely severe thrombocytopenia is not an indication of termination. Better maternal and fetal outcomes can be achieved through proper treatment based on the etiology, intensive care in prevention and management of complications and cesarean section.     

药物涂层球囊扩张成形术对颈动脉支架内再狭窄患者术后再狭窄及炎症因子水平的影响

目的 探讨药物涂层球囊扩张成形术对颈动脉支架内再狭窄患者术后再狭窄及炎症因子表达水平的影响。方法 选取2020年1月至2022年1月华北理工大学附属医院收治的73例颈动脉支架内再狭窄患者，按处理方式的不同分为观察组（31例，采用药物涂层球囊扩张成形术治疗）和对照组（42例，采用普通球囊扩张成形术治疗）。比较两组术后6个月的再狭窄率，术前及术后3d的C反应蛋白（C-reactive protein,CRP）、白介素-6(interleukin-6,IL-6)水平及活化部分凝血酶原时间（activated partial prothrombin time,APTT）、凝血酶原时间（prothrombin time,PT）、纤维蛋白原（fibrinogen,FIB）、凝血酶时间（thrombin time,TT）等凝血功能指标的变化。结果 术后6个月观察组再狭窄率为6.45%，明显低于对照组（30.95%），差异有显著性（P=0.034）。术前两组CRP及IL-6水平比较差异无显著性（P>0.05）；术后两组CRP及IL-6水平均明显低于术前，且观察组明显低于对照组，差异有显著性（P&...     

距下关节牵伸骨块植入融合术治疗跟骨陈旧骨折12例分析

跟骨骨折在临床上是较常见的骨折，但在基层医院，由于没有专业的骨科医生，容易漏诊，从而产生很多的跟骨畸形愈合的病例。畸形愈合常导致疼痛及活动受限等严重后果，影响患者的日常生活和工作。笔者在2004～2009年间对跟骨陈旧骨折畸形愈合，行距下关节牵伸骨块植入融合术治疗12例，效果满意，现报道如下。     

大鼠腹部开放伤后海水浸泡对肠道细菌的影响

目的 探讨大鼠腹部开放伤合并海水浸泡对肠道细菌的影响. 方法将50只成年健康Wistar大鼠随机分为5组,每组10只.A组为正常对照组,B组为单纯腹部开放伤组,C组为单纯腹部海水浸泡组,D组为腹部开放伤合并生理盐水浸泡组,E组为腹部开放伤合并海水浸泡组.建立大鼠腹部开放伤合并海水浸泡创伤模型,每组大鼠取全血、肝脏和肠系膜淋巴结,分别制备成血浆、肝和肠系膜淋巴结匀浆进行细菌培养并计数菌落数. 结果大鼠血浆、肝脏和肠系膜淋巴结匀浆上清液细菌培养结果显示,正常对照组和单纯腹部海水浸泡组均无细菌生长;腹部开放伤合并海水浸泡组均有细菌生长,且菌落数显著高于正常对照组或腹部开放伤合并生理盐水浸泡组(P＜0.01). 结论大鼠腹部开放伤合并海水浸袍后肠黏膜屏障功能受损,肠道细菌发生易位.     

急性颈椎损伤的呼吸管理原理

急性颈椎损伤在骨科是常见损伤，据报道呼吸衰竭是患者死亡最常见的原因，发生率15％～40％。伴随对脊髓损伤产生的呼吸功能改变的研究进一步深入，有关呼吸的全方位的治疗已经开始进行，虽然脊髓损伤伴四肢瘫引起与呼吸有关的并发症和死亡率已显著下降，但是肺部并发症引起的死     

天麻加前列腺素E治疗糖尿病周围神经病变68例疗效分析

糖尿病周围神经病变DNP为糖尿病(DM)的常见并发症，随着病程延长发生率越高，并严重影响患者的生活质量，而单独应用西药治疗效果不够理想。笔者采用天麻加前列腺素E(PGE1)联合治疗DNP．取得了满意效果，现报告如下。     

培美曲塞维持治疗与延迟治疗晚期非鳞状NSCLC的临床疗效

目的对比晚期非鳞状非小细胞肺癌(NSCLC)患者应用培美曲塞维持治疗与延迟治疗的临床疗效。方法选取该院收集的非鳞状NSCLC患者,随机分至培美曲塞维持治疗与延迟治疗组中,对比观察两组患者的症状恶化时间、药物的安全性与毒性、总生存期(OS)和无进展生存期(PFS),并进行统计学分析。结果培美曲塞维持治疗和延迟治疗两组患者的中值疾病PFS分别为4.2和2.9个月,培美曲塞维持治疗能使患者的疾病进展风险减少35%(风险比=0.63,P=0.000 53)。维持组患者中位OS(17.5个月)较延迟组(12.3个月)长,两组的OS及生存曲线比较有统计学意义(χ2=6.252,P=0.018)。维持组患者报告的贫血、白细胞减少、天门冬氨酸氨基转移酶高、疲劳较延迟组例数多,且具有显著性差异(P=0.000 2,0.005,0.031,0.002),其他不良反应及毒副作用两组患者无显著性差异(P0.05)。症状恶化时间中接受培美曲塞维持治疗组患者的疼痛时间比延迟治疗组患者长(P=0.041),但在治疗过程中,维持治疗组患者需要镇痛药的剂量和次数较维持组显著减少,且维持组的患者往往需要更强的止痛药。在需要4个周期疗程的患者中,培美曲塞维持治疗组120例(92%)患者在和延迟治疗组34例(90%)没有使用镇痛药物或非甾体抗炎药;对治疗之后患者症状恶化程度跟踪随访,发现约10%的病人咯血症状恶化(维持组15例,延迟组5例),且延迟组患者症状恶化时间显著较长(P=0.038)。两组患者在食欲不振、疲劳、咳嗽、呼吸困难、症状困扰、活动困难和整体生活质量之间没有显著差异(P0.05)。结论本研究初步证明培美曲塞维持治疗能有效延长患者OS及无疾病进展期,但在药物的安全性与毒性上仍具有部分副作用,如可能令患者贫血、白细胞减少、天门冬氨酸氨基转移酶高、疲劳等。     

尺侧指固有动脉与桡动脉腕背支桥接的断拇再植

目的:介绍一种治疗近端动脉严重损伤的拇指离断再植术的方法,并评价其疗效。方法:2007年2月至2009年3月,采用前臂掌侧静脉移植,桥接鼻咽窝处桡动脉腕背支与尺侧指固有动脉的远侧断端,治疗13例近端动脉严重损伤的拇指离断。男11例,女2例;年龄16～50岁,平均34.5岁。左侧7例,右侧6例。完全离断8例,不全离断5例。急诊再植10例,按常规步骤再植术后动脉危象探查修复3例。结果:13例拇指全部成活。所有患者获得随访,时间8～17个月,平均11个月。再植拇指外形满意,根据中华医学会手外科学会断指再植功能评定试用标准:优9指,良3指,差1指。指腹两点辨别觉58mm,平均6.5mm。结论:静脉移植桥接鼻咽窝桡动脉腕背支与尺侧指固有动脉远端的方法修复拇指动脉,行复杂拇指离断再植,手术体位舒适,不影响手部血供,扩大了再植适应证,提高了再植成功率。