第一掌骨背侧-大鱼际联合逆行皮瓣在修复拇指末节皮肤缺损中的应用

目的 探讨应用第一掌骨背侧-大鱼际联合逆行皮瓣修复拇指较大面积缺损的效果.方法 2018年1月—2019年12月哈尔滨市第五医院手外科收治5例拇指末节皮肤缺损患者,男性3例,女性2例,年龄22～50岁,平均36.8岁.其中末节脱套伤2例,末节离断伤2例,末节掌侧撕脱伤1例,缺损面积为7.0cmx5.0cm～4.0cmx5.0cm.采用第一掌骨桡背侧筋膜蒂皮瓣联合切取鱼际区逆行皮瓣修复,观察皮瓣外观、质地,供区瘢痕情况及感觉恢复、指腹胼胝体形成情况.结果 患者均随访6～12个月,平均9.6个月.患者均皮瓣外观良好,质地接近正常皮肤,无破溃发生.拇指末节皮肤可见皮纹,尺掌侧均可见少许胼胝体形成.其中供瓣区3例直接缝合,2例行中厚断层皮片移植,供瓣区均恢复良好.修复效果按中华医学会手外科学会上肢部分功能评定试用标准评定:优4例,良1例.按英国医师协会感觉评分,感觉恢复至S3 2例,S4 3例.结论 将第一掌骨背侧逆行皮瓣与大鱼际区逆行皮瓣联合切取,手术操作简单,在同一麻醉下、同一术区内即可完成,桡背侧修复拇指背侧,鱼际区修复尺掌侧,修复后的拇指可获得背侧的保护性感觉及掌侧的耐磨性角质皮肤,是一种理想的适合拇指较大面积组织缺损修复的方式.     

Cranial base in craniofacial development: Developmental features,influence on facial growth,anomaly, and molecular basis

The cranial base is of crucial importance in integrated craniofacial development. As distinct from facial bones, it is formed through endochondral ossification. The posterior and anterior cranial bases are derived from distinct embryologic origins and grow independently — the anterior cranial base solely from the neural crest, the posterior cranial base from the paraxial mesoderm. The anterior cranial base has more prolonged and active growth and exerts more influence on facial growth than does the posterior cranial base. Cranial base angulation is a unique feature in modern human beings. Cranial base anomalies have been identified in many genetic and developmental disorders. The molecular basis of cranial base development and growth is being clarified. In this review, these aspects of cranial base are discussed in detail, with a focus on developmental features, roles in craniofacial growth, anomalies, and the genetic basis of development.     

Confocal Comparison of Corneal Nerve Regeneration and Keratocyte Reaction between FS-LASIK, OUP-SBK, and Conventional LASIK

Purpose. We compared the regeneration characteristics of injured corneal subbasal nerve fibers (CSNFs) and keratocyte reaction following LASIK with a femtosecond laser (FS-LASIK), One Use-Plus Sub-Bowman's keratomileusis (OUP-SBK), and M2 90 microkeratome to provide a more suitable treatment strategy. Methods. A total of 22 eyes that underwent FS-LASIK, 32 eyes that underwent OUP-SBK, and 26 eyes that underwent conventional LASIK were analyzed by confocal microscopy. Morphologic modifications of corneal architecture were evaluated postsurgically at 1, 3, and 6 months, and comparisons were made by ANOVA analysis. Results. The density of stromal keratocytes in the FS-LASIK group was higher than that of OUP-SBK and conventional LASIK groups at 1 month postsurgery (P < 0.05), while in the OUP-SBK group it was higher than that of the FS-LASIK and conventional LASIK groups at 3 months postsurgery (P < 0.05). Regeneration of CSNFs was detected in 90% of eyes in all three groups around 3 mm of the peripheral flap at 1 month postoperation. CSNFs in 6.3% of the eyes in the OUP-SBK group were even observed around the peripheral flap at 6 mm 3 months after surgery, CSNFs were found in 62.5% of eyes (conventional LASIK), 72% of eyes (OUP-SBK), and 64.3% of eyes (FS-LASIK) around 3 mm near the center of the flap. While at 6 months, CSNFs were found in 100% of the eyes in all three groups. Conclusions. Keratocyte reactions after FS-LASIK and OUP-SBK were a little more severe than that after conventional LASIK. The repairing velocity of subbasal nerve fibers in the OUP-SBK group was a little faster than that of the FS and conventional LASIK groups.     

对苯醌与磺胺二甲嘧啶荷移反应研究

本文研究了对苯醌与磺胺二甲嘧啶荷移反应的条件、络合物的组成,初步探讨了对苯醌与磺胺二甲嘧啶反应的动力学性质。在醇酸性介质中,对苯醌与磺胺二甲嘧啶形成1:1的橙红色络合物,其ε=4.9×10~3l·mol~(-1),λ=490nm。     

DMSO对脑损伤后细胞凋亡影响的实验研究

目的 :探讨二甲基亚砜 (DMSO)对颅脑损伤后细胞凋亡的影响。方法 :采用自由落体撞击脑损伤模型造成中度颅脑损伤 ,治疗组伤后经尾静脉给予DMSO 5 0mg/kg。损伤对照组、治疗组分别于损伤后 6h、1 2h、2 4h、48h、72h和 1 6 8h随机点杀动物 6只 ,空白对照组于 6h一次处死。HE染色和TUNEL末端标记法观察并检测细胞凋亡数。结果 :HE染色发现损伤对照组较治疗组凋亡细胞明显密集。神经细胞凋亡检测结果发现 ,DMSO治疗组TUNEL阳性细胞数减少 ,与损伤对照组对应时相相比P <0 .0 5。结论 :DMSO的应用可以减轻颅脑损伤后神经细胞的凋亡。从而对颅脑损伤后继发性脑损伤具有保护作用     

中脑导水管周围灰质内神经降压素对大鼠痛阈的影响

以钾离子透入法引起大鼠甩尾反应的电流强度为痛反应指标，测定动物的痛阈。观察到水脑导水管周围灰质注射神经主素后，大鼠痛阈明显增加；注射抗神经降压素血清后，痛阈明显降低；纳洛酮后神经降压的镇痛作用明显削弱。提示中脑导水管周围灰质内生理水平的神经降压素在痛觉调制中发挥作用，其部分作用可能是由内源性阿片肽系统中介的。     

N-myc在大鼠急性痫性发作模型中的表达及其意义

目的 探讨在氯化锂-匹罗卡品诱导大鼠急性痫性发作模型中N-myc表达及其意义。方法健康Wistar雄性大鼠45只，随机分为生理盐水对照组、地西泮干预组和致痫1h～9d组(根据致痫后的不同时点分7个组)，共9组，每组5只。采用氯化锂-匹罗卡品联合腹腔注射急性致痫大鼠模型，常规脏染色观察实验大鼠脑组织的形态学改变，免疫组化染色法观察脑内N—myc表达产物分布及其含量变化。结果 致痫1d～9d组尤其致痫6d和9d两组可见到脑组织损伤性改变，海马区重于皮质区。生理盐水对照组N—myc几乎无表达，地西泮干预组低表达，致痫组表达增多，尤其以致痫1d组和致痫3d组最为明显。结论 急性痫性发作或癫痫持续状态可导致脑组织损伤性改变，以海马结构等易损区为明显。N—myc表达及其表达量可能与急性痫性发作后脑损伤及其受累部位有关。     

重组人生长激素对大面积烧伤患者免疫功能的影响

目的探讨重组人生长激素(rhGH)对大面积烧伤患者细胞和体液免疫功能的影响.方法将24例大面积烧伤患者,随机分为rhGH治疗组和对照组.于切、削痂手术后1d(伤后7～10d)开始每天皮下注射rhGH 0.2 IU/kg;对照组注入0.9%氯化钠注射液2ml.两组患者疗程均为15d.动态滥测患者伤后第3、7、14、21、28d的血清免疫球蛋白IgG、IgA、IgM水平及CD4 、CD8 和淋巴细胞计数.结果IgA、CD4 和CD4 CD8 值在伤后14、21和28d,治疗组明显高于对照组(P＜0.05或0.01),而IgG、IgM、CD8 与淋巴细胞计数的差别无显著性意义(P＞0.05).结论治疗大面积烧伤病人时辅助使用rhGH,能增强机体的免疫功能.     

氟性肘关节炎109例X线分析

本文报告109例氟性肘关节炎的常见 X 线征象:关节面硬化、不规则和中断,关节间隙狭窄,关节面下骨纹粗大,骨小梁呈粗疏或致密状改变伴囊状透光区。作者首次提出:滑车外侧骨赘形成,出现双侧韧带骨化是氟性肘关节炎的特征性 X 线征象。     

咽旁间隙肿瘤

本文对我院收治的89例咽旁肿瘤作了回顾分析。术前32例病人作了针吸活检，50例作了CT检查；全部病人均行手术治疗，大多数病人经腮腺和经颈部入路手术。结果在32例针吸活检病人中27例诊断正确，50例CT检查中36例可准确判断肿瘤的位置，组织学见良性肿瘤72例（81％），恶性肿瘤17例（19％），咽旁肿瘤中以混合瘤最为多见，共37例（42％）；术后良性肿瘤复发10例（14％），恶性肿瘤12例（74％）。结果显示针吸活检和CT对咽旁肿瘤的术前诊断和评估十分必要和关键，经腮腺入路和经颈部入路是最常用的手术进路，咽旁肿瘤的术后复发率高。