纽扣钢板悬吊固定自体胴绳肌肌腱前交叉韧带重建术后远端骨隧道填充磷酸三钙人工骨的临床分析

目的：判断微孔磷酸三钙（ mp-TCP）临床上是否可以有效促进腱骨愈合,提高膝关节稳定性,减少胫骨隧道的扩大,恢复关节功能。方法本研究对2007年6月至2008年10月,120例进行前交叉韧带（ ACL）自体腘绳肌肌腱重建手术的患者进行研究,随机填充mp-TCP,符合实验标准共105例患者。术后随访1年,进行临床、影像学指标统计分析。结果 TCP填充组及TCP非填充组两组在术后12个月的临床指标中,膝关节活动度（ ROM）、单腿跳跃检查、大腿周径差别、Lachman试验和轴移试验结果均无统计学差异;Tegner评分,Lysholm评分和IKDC主观功能量化评分统计学上也均无统计学差异（P＜0.05）;但是双侧膝关节前向松弛度差异（SSD）上则有统计学差异。重建术后影像学指标统计分析示骨隧道填充TCP可以有效减少术后骨隧道扩大的程度。结论前交叉韧带自体腘绳肌肌腱重建手术骨隧道填充TCP可以有效减少术后骨隧道扩大的程度。     

局部麻醉下腹股沟疝无张力修补术临床路径及其应用

目的：探讨局部麻醉下腹股沟疝无张力修补术的临床路径及其应用。方法观察局部麻醉下腹股沟疝无张力修补术临床路径的56例患者住院时间、住院各项费用及并发症情况。结果进入临床路径56例患者中,54例完成临床路径,2例退出,完成率为96．4％;纳入临床路径的患者住院时间明显缩短,各项费用显著降低;有14例患者出现术后近期并发症,无复发。结论局部麻醉下腹股沟疝无张力修补术临床路径操作简单,能明显缩短住院时间、降低住院医疗成本,减轻患者和社会负担,值得推广。     

2-(1-Hydroxypentyl)-benzoate increases cerebral blood flow and reduces infarct volume in rats model of transient focal cerebral ischemia

2-(1-Hydroxypentyl)-benzoate (dl-PHPB), a derivate of 3-n-butylphthalide (dl-NBP), is a novel drug candidate used for treatment of cerebral ischemia. The goal of the present study was to investigate the effects of dl-PHPB on infarct volume, neurological function, and cerebral blood flow (CBF) in transient focal cerebral ischemia. Therefore, an animal model of 2-h middle cerebral artery occlusion (MCAO) followed by 24-h reperfusion was used. Rats received dl-PHPB (1.3, 3.9, or 12.9 mg/kg) intravenously 10 min after the onset of MCAO. Compared with the vehicle control group (37.4%), infarct volume in dl-PHPB-treated groups was reduced significantly and dose-dependently to 25.4, 17.4, and 13.7%, respectively. The changes in neurological deficient were also observed in neurobehavioral test in a dose-dependent manner, and the neuronal score was improved significantly from the vehicle control of 3.2 to 2.7, 2.1, and 1.8, respectively. At the highest dose, the potency of dl-PHPB was similar to those of dl-NBP. CBF was quantified by using laser-Doppler flowmetry. During the ischemia, the regional CBF values of dl-PHPB groups were significantly higher than that of vehicle group. In addition, our study showed that dl-PHPB converted into dl-NBP very quickly in blood in vitro. Approximately 70% of dl-PHPB converted into dl-NBP in 5 min when dl-PHPB was added into plasma at final concentrations of 6, 30, and 60 mug/ml. This result demonstrated that the neuronal protection effects of dl-PHPB were mainly induced by dl-NBP, an active compound converted from its precursor, dl-PHPB. In conclusion, dl-PHPB can reduce infarct volume and improve neurobehavioral deficits in a rat model of transient MCAO. Those effects may partially be due to an increase in CBF by the active metabolite (dl-NBP) of dl-PHPB. Therefore, our results suggest that dl-PHPB may be useful for treatment of ischemia stroke.     

1例静脉注射古拉定致过敏反应病人的护理

古拉定为维持细胞生物功能有重要作用,加速自由基的排泄,有助于减轻化疗、放疗的毒副反应,很少致过敏反应,现就1例我院静脉注射古拉定致过敏反应的病人介绍如下。1病例介绍病人,女,44岁,因“间断浮肿6年,加重20d”于2006年3月9日入院治疗。入院诊断:肾病综合征,肾性高血压。既往无过敏史。查体:体温36.5℃,脉搏86/min,呼吸18/min,血压20.88/13.03kPa(157/98mmHg)入院后给予5%葡萄糖溶液150mL+20mL+古拉定1.8g,当输古拉定液体滴入约100mL时病人突然主诉咽部痰多,胸闷,观察病人面色通红,呼吸费力,呼吸26/min血氧饱和度88%考虑为古拉定所致的…     

胶原-壳聚糖复合材料的制备及生物安全性检测

目的:制备胶原-壳聚糖复合细胞载体,并对该载体进行系统的生物学性能检测。方法:实验于2003-07/2006-06在天津市医药科学研究所完成。将胶原溶液和壳聚糖溶液按照一定比例(9∶1)混匀,交联后真空冷冻干燥,制成胶原-壳聚糖复合载体,对该载体进行复合材料性状及理化性能检测。并采用急性全身毒性试验、皮内刺激试验、皮肤致敏试验、溶血试验、细胞毒性试验和致突变试验进行生物学性能检测。结果:①胶原-壳聚糖复合材料具有三维立体多孔结构,适合细胞的三维生长,能为新生组织提供良好的支架。②急性全身毒性试验、皮内刺激试验均阴性,致敏率仅为6.25%,细胞毒性为0级,无诱变能力。结论:从仿生学角度出发,制备出可生物降解的胶原-壳聚糖复合材料,经过系统的生物学评价发现,胶原-壳聚糖复合材料具有良好的生物安全性,对机体无毒,不致突变,对细胞有较强的亲和作用,利于细胞生长和分化。     

Evaluation of severe transplant renal artery stenosis with Doppler sonography

PURPOSE: To evaluate and determine Doppler criteria for predicting a severe transplant renal artery stenosis (80%-99% diameter reduction) and to compare the Doppler findings in patients with end-to-end and end-to-side anastomosis. METHODS: We performed Doppler sonography on 16 consecutive patients with transplant renal artery stenosis (TRAS) confirmed by digital subtraction arteriography (DSA). Fourteen patients had end-to-end anastomosis, and 2 had end-to-side anastomosis. Eleven patients were re-evaluated with color Doppler sonography within 4 days after intervention. Seven Doppler parameters, including the peak systolic velocity (PSV) in the renal, iliac and interlobar artery, Pre-PSV ratio (the ratio of the PSV in the renal artery to that in the iliac artery), Post-PSV ratio (the ratio of the PSV in the renal artery to that in the interlobar arteries, acceleration time and resistance index, were measured. In the patients with severe TRAS the measurements of these parameters were compared before and after successful intervention. RESULTS: In the 16 patients with a single transplanted kidney, arteriography demonstrated 14 main renal arteries with severe stenosis, and 3 renal arteries with moderate stenosis. When using the cutoff values of Post-PSV ratio >13, renal artery PSV >4 m/sec, acceleration time >0.06 second, and resistance index <0.5 for the detection of all 14 severe stenoses, the sensitivities were 100%, 71%, 93%, and 50%, respectively. For assessing all 14 severe stenoses and 12 severe stenoses of end-to-end anastomosis, the cutoff value of Pre-PSV ratio >5 had sensitivities of 86% and 100%, respectively. Pre-PSV ratios in severe stenoses of end-to-end anastomosis (range, 5.1-11.5) were significantly greater than those recorded in severe stenoses of end-to-side anastomosis (range, 2.8-3.1). Statistically significant differences before and after successful intervention were found for all 7 Doppler parameters in the 7 patients with severe stenosis. CONCLUSIONS: An 80%-99% diameter reduction of the renal artery can be diagnosed based on a Post-PSV ratio >13 for patients with either end-to-end or end-to-side anastomosis. A Pre-PSV ratio >5 for patients with end-to-end anastomosis and acceleration time >0.06 second are helpful in the diagnosis of severe TRAS.     

Characterization and gene transfer in mesenchymal stem cells derived from human umbilical-cord blood

It has been shown that the stromal-cell population found in bone marrow can be expanded and differentiated into cells with the phenotypes of bone, cartilage, muscle, neural, and fat cells. However, whether mesenchymal stem cells (MSCs) are present in human umbilical-cord blood (UCB) has been the subject of ongoing debate. In this study, we report on a population of fibroblastlike cells derived from the mononuclear fraction of human UCB with osteogenic and adipogenic potential, as well as the presence of a subset of cells that have been maintained in continuous culture for more than 6 months. These cells were found to express CD29, CD44, CD90, CD95, CD105, CD166, and MHC class, but not CD14, CD34, CD40, CD45, CD80, CD86, CD117, CD152, or MHC class II. We also compared gene expression after gene transfer using lenti- and adenoviral vectors carrying the green fluorescence protein to the MSCs derived from UCB because a reliable gene-delivery system is required to transfer target genes into MSCs, which have attracted attention as potential platforms for the systemic delivery of therapeutic genes. The lentiviral vectors can transduce these cells more efficiently than can adenoviral vectors, and we maintained transgene expression for at least 5 weeks. This is the first report showing that UCB-derived MSCs can express exogenous genes by way of a lentivirus vector. These results demonstrate that human UCB is a source of mesenchymal progenitors and may be used in cell transplantation and a wide range of gene-therapy treatments.     

开设产前护理门诊对提高孕产妇孕产期健康认知行为依从性的研究

[目的]探讨提高孕产妇孕产期健康认知行为依从性的健康教育模式。[方法]参加产前护理门诊的100例孕妇为观察组,采用小讲座、沙龙、技能培训、一对一咨询指导等多形式相结合的方法,并根据孕期各阶段特点予以系统、规范、连续性、适时、个体化的教育、咨询和指导。同期参加常规孕妇学校接受健康教育100例孕妇作为对照组。评估对比两组产前检查次数、孕期体重增加幅度等孕期依从性,临产心理准备、产程检查处置配合、缓解分娩疼痛技巧的应用、社会因素导致的剖宫产率等产时依从性,产褥期自我护理技巧、母乳喂养知识与技巧、新生儿护理技巧等依从性。[结果]观察组孕期、产时、产褥期依从性明显高于对照组,差异有统计学意义（P〈0.01）。[结论]产前护理门诊是一种有效提高孕产妇孕期自我保健、促进产时、产褥期依从性,保证母婴健康的有效方法。