局部减压法辅助治疗早产儿静脉输注脂肪乳外渗

目的 探寻早产儿脂肪乳外渗后的治疗方法和护理措施.方法 将静脉输注脂肪乳外渗的早产儿38例随机分为观察组和对照组各19例.观察组局部减压后再采用50%硫酸镁湿敷,对照组只采用50%硫酸镁湿敷.结果 观察组脂肪乳外渗部位肿胀消退时间较对照组显著缩短（P＜0.05）.观察组外渗局部皮肤有2例出现淤斑,对照组有9例出现淤斑、水疱、破溃或硬结等,两组比较,差异有统计学意义（P＜0.05）.结论 局部减压后再使用50%硫酸镁湿敷治疗早产儿脂肪乳外渗效果良好,局部并发症少,操作简便.     

Traditional Chinese medicine for pressure ulcer: a meta‐analysis

To assess the effect of Traditional Chinese Medicine (TCM) [Chinese herbal medicine ointment (CHMO), acupuncture and moxibustion] on pressure ulcer. In this study, we searched MEDLINE, EMBASE, CENTER, CBM, CNKI, WAN FANG and VIP for articles published from database inception up to 4 April 2011. We included randomised controlled trials (RCTs), which compared the effects of TCM with other interventions. We assessed the methodological quality of these trials using Cochrane risk of bias criteria. Ten of 565 potentially relevant trails that enrolled a total of 893 patients met our inclusion criteria. All the included RCTs only used CHMO intervention, because acupuncture and moxibustion trials failed to meet the inclusive criteria. A meta‐analysis showed beneficial effects of CHMO for pressure ulcer compared with other treatments on the total effective rate [risk ratio (RR): 1·28; 95% confidence interval (CI): 1·20–1·36; P = 0·53; I² = 0%), curative ratio (RR: 2·02; 95% CI: 1·73–2·35; P = 0·11; I² = 37%) and inefficiency rate (RR: 0·16; 95% CI: 0·02–0·80; P = 0·84; I² = 0%). However, the funnel plot indicated that there was publication bias in this study. The evidence that CHMO is effective for pressure ulcer is encouraging, but due to several caveats, not conclusive. Therefore, more rigorous studies seem warranted.     

Pathogenic alteration in severe burn wounds

The present study aims to define the trend of time related changes with local bacterial alteration of bacterial resistance in severe burns in our burn center during a 12-year period. Retrospective analysis of microbiological results on severely burned wounds between 1998 and 2009 was carried out. A study of 3615 microbial isolates was performed. Staphylococcus aureus was the most commonly isolated pathogen (38.2%) followed by A. baumannii (16.2%), Streptococcus viridans (11.4%), Pseudomonas aeruginosa (10.4%), coagulase-negative staphylococci (CNS, 9.2%). The species ratios of S. aureus and A. baumannii increased significantly from 1st to 8th week of hospitalization, while those of Streptococcus viridans, P. aeruginosa and coagulase-negative staphylococci decreased during the same period. Bacterial resistance rates were compared between the periods 1998-2003 and 2004-2009. Vancomycin remained as the most sensitive antibiotic in S. aureus including methicillin-resistant S. aureus (MRSA). It was very likely that the majority of infections caused by Streptococcus viridans, P. aeruginosa and coagulase-negative staphylococci occurred in the early stage of burn course and the majority of infections caused by A. baumannii occurred 4 weeks after admission. The use of different antibiotics was probably the major contributor to these trends.     

Preparation of gentamicin-loaded electrospun coating on titanium implants and a study of their properties in vitro

Purpose

Implant-related infections are disastrous complications in the clinic, and there are no effective therapies. In this preliminary study, gentamicin-loaded coating on titanium implants was prepared using the electrospinning technique, and some properties of the coating titanium implants were studied.

Methods

We adopted the electrospinning technique to prepare gentamicin-coated titanium implants. The surface structure of the coating implants was observed using scanning electron microscope. An elution study was performed to determine the release behavior of the gentamicin from the coating. The antibacterial efficacy and quantitative analysis of the bacterial adhesion of Staphylococcus aureus were evaluated in vitro, and the cytotoxicity of the coated titanium implants on osteoblasts was investigated in vitro.

Results

The morphology of the gentamicin-coated titanium implants exhibited nanofibers, and the release of gentamicin showed an initial gentamicin burst followed by a slow release. The gentamicin-coated titanium implants had a persistent antibacterial efficacy for 1 week and significantly reduced the adhesion of the Staphylococcus aureus compared with bare titanium implants in vitro. There was no cytotoxicity observed in vitro for the gentamicin-coated implants.

Conclusion

The gentamicin-coated titanium implants, which were prepared using an electrospinning technique, present many advantages and may be considered to prevent and treat the implant-related infections.     

1例多器官功能衰竭体外膜肺联合连续性血液净化治疗的护理

对1例肺、肾功能衰竭患者行组合式体外膜肺联合连续性血液净化治疗,结果患者病情得到控制并最终康复出院.提出多器官功能衰竭患者病情发展迅速,预后极差,在临床上除行体外膜肺联合连续性血液净化治疗的护理外,还应注意预防感染、出血等严重并发症,以积极改善预后,提高患者生活质量.     

在体阻断软骨下营养对关节软骨影响的实验研究

背景：关节软骨无血管分布,其营养来自关节液和软骨下骨,哪条营养通路对关节软骨更为重要是学者们争论的焦点。目的：研究软骨下营养对关节软骨的影响,并探讨软骨下营养与骨关节炎的关系。方法：45只5个月龄雄性新西兰大白兔,建立股骨滑车骨软骨缺损的动物模型,并随机分为3组：自体骨软骨块移植组（Control组,n=15）;假手术组（Sham组,n=15）,用环钻在股骨滑车钻取骨软骨块,将其置入管状PVC内,原位回植;阻断软骨下营养组（DNBM组,n=15）,取出骨软骨后,将其置入帽状PVC内,原位回植。术后4周、8周、12周,每组5只（10膝）,取出膝关节进行大体评分、组织学评分、软骨厚度测量、凋亡染色（TUNEL染色）。结果：与Control组相比,大体评分结果提示,DNBM组软骨无明显退变;组织学评分结果提示,术后12周时DNBM组软骨明显退变（P〈0.005）;软骨厚度测量结果提示,术后8周、12周时DNBM组软骨厚度明显变小（P=0.00）;TUNEL染色结果提示,术后8周、12周时DNBM组关节软骨细胞凋亡明显增加（P〈0.01）。结论：软骨下营养是软骨的重要营养来源,失去软骨下营养,软骨会逐渐发生退变。     

Evaluation of thymosin β4 in the regulation of epithelial-mesenchymal transformation in urothelial carcinoma

ObjectivesTo study the underlying alteration in the expression of epithelial markers involved in epithelial-mesenchymal transition (EMT), and elucidate the potential mechanism(s) for Tβ4-induced EMT-like phenotypic changes in bladder cancer cells.Materials and methodsAll tissue samples in this study were obtained from clinical patients of the Union Hospital of Tongji Medical College, and were confirmed by surgery and pathology. Of these, normal bladder tissues (control), primary urothelial carcinoma of different grades (Stage pTa, Stage pT3), bladder paracancerous tissues, accompanied with 2 bladder cancer cell lines (BIU-87 and T24), were divided into 6 groups. Quantitative RT-PCR, Western blotting, and immunohistochemical study of adhesion molecules Tβ4, ILK, E-cadherin, and β-catenin involved in EMT were carried out. A lentiviral gene transferring vector containing the RNA polymerase III-dependent U6 promoter to express short hairpin RNA (shRNA) directed against Tβ4 was also applied. In the present study, all agents were evaluated using commercial kits.ResultsA strong correlation between the expression levels of Tβ4, ILK, E-cadherin, and β-catenin was found in the bladder transitional cell carcinoma (TCC) patients. In the BIU-87 and T24 bladder cancer cells overexpressing Tβ4, which were accompanied by a loss of E-cadherin as well as a cytosolic accumulation of β-catenin, up-regulation of ILK was also revealed. The inhibition of the Tβ4 expression with lentiviral shRNA vector could raise EMT-like phenotypic changes, significantly depressed motility, and subsequent invasiveness of bladder cancer cells.ConclusionsOur results imply that the Tβ4 is likely to play a crucial role in EMT progression, and that inhibition of the Tβ4 expression or interactions with other genes should be novel therapeutic targets for bladder cancers with high invasive and metastatic potential.     

体位改良预防头颈部肿瘤患者PICC颈内静脉异位

目的寻找合适PICC置管体位,以预防或减少头颈部肿瘤患者导管颈内静脉异位的发生。方法将92例需行PICC置管的头颈部肿瘤患者按置管顺序单双号分为观察组和对照组各46例,对照组取常规体位,即患者平卧,置管侧上肢外展90°,穿刺成功送管,至导管末端到达肩关节位置时,嘱患者将头偏向穿刺侧,下颌紧贴锁骨,继续送管至预测长度。观察组取改良体位,即患者平卧,头枕5cm高枕头,置管侧上肢外展45°～90°,穿刺成功送管至导管末端到达肩关节位置时,患者配合抬高穿刺侧上肢,操作者继续送管至预测长度。结果观察组导管颈内静脉异位发生率为2.17%,对照组为23.91%,两组比较,差异有统计学意义(P<0.01)。结论体位改良能有效降低头颈部肿瘤患者PICC颈内静脉异位的发生。     

小切口经前路腹膜后人工髓核置换术治疗退行性腰椎间盘疾患

目的：评价应用小切口技术进行人工髓核假体置换治疗退行性腰椎间盘疾患的临床初步疗效。方法：2003年6月～2004年9月共施行人工髓核（PDN）置换术12例，男4例，女8例，平均年龄28．5岁。其中腰椎间盘突出症10例，椎间盘源性腰痛2例。包容型腰椎间盘突出症和椎间盘源性腰痛采用前路PDN置换，脱出游离型椎间盘突出症采用后路椎间盘摘除、前路PDN置换；术后评价内容包括临床和影像学结果。结果：平均前路切口长度4．2cm，前路平均手术时间80min，平均术中出血量110ml。PDN置入部位均为L4／5，共置入PR925型假体12枚。所有患者术后腰痛症状得到改善。术后平均随访6．5个月，影像学检查未见假体移位和脱出。结论：应用前路腹膜后小切口进行PDN置换在减少手术创伤的同时，可以有效防止髓核脱入椎管。近期效果肯定，但长期疗效有待进一步观察。