应用生物补片行疝修补术后并发症防治

生物补片因为其独特的内源性再生特点,植入机体后不引起强烈的炎性反应,且可吸收、可降解,具有耐受感染的能力,但血清肿、发热等并发症发生率较高,成为限制其使用的因素。在选择生物补片时,更小的生物补片所引起的术后血清肿更轻微。术区加压包扎可在一定程度上减少血清肿的发生。生物补片诱导机体再生的腹壁组织强度可超过生物补片本身的强度,足以抵抗腹腔压力,术后疝复发及腹壁膨出主要是由于生物补片未能完全覆盖腹壁缺损或薄弱区,导致术后出现腹壁膨出。另外,生物补片虽有较强耐受感染的能力,但并不抗感染,不推荐使用在污染较重的创面。生物补片是未来疝修补材料的发展趋势,但现阶段不能完全替代合成材料。     

术后切口脂肪液化30例诊疗体会

近年来随着经济快速发展，人民生活水平的日益提高，手术患者中肥胖、高龄人群比例的增加及高频电刀的广泛使用，腹部切口脂肪液化的发生有增多趋势。一旦发生此并发症势必增加病人的精神和经济负担，严重者继发切口感染、切口裂开，影响病人术后的康复。现将近10年来我院外科发生术后切口脂肪液化病例30例报告如下。     

脑氧饱和度监测用于指导巨大腹膜后肿瘤切除术患脑保护的研究

目的 探讨围术期局部脑氧饱和度(regional cerebral oxygen saturation,rScO2)监测用于指导脑氧供需平衡在巨大腹膜后肿瘤切除术患者脑保护中的意义.方法 选择37例巨大腹膜后肿瘤手术患者,围术期监测rScO2、动脉血气分析、桡动脉压和心输出量等,以rScO2为主要观察指标进行临床干预,改善和维护患者术中脑氧供需平衡.结果 肿瘤切除过程中rScO2较切除前明显下降,差异有统计学意义(P＜0.05);经过有效的临床干预,肿瘤切除后rScO2与切除中比较显著提高(P＜0.05);2例患者循环波动大,rScO2监测数值低于50％,术后出现苏醒延迟和癫痫发作.结论 术中rScO2监测对患者围术期脑氧供需平衡的管理具有重要指导意义,全面监测与有效调控是患者良好转归的基础.     

雌激素对蛛网膜下腔出血后P2X7受体及神经炎症反应的影响北大核心CSCD

目的:观察雌激素对蛛网膜下腔出血(Subarachnoid hemorrhage,SAH)大鼠皮层P2X7受体(P2X7 receptor,P2X7R)表达及神经炎症反应的影响。方法:采用改良血管内穿刺法建立SAH大鼠模型。将60只成年雄性SD大鼠随机分为假手术组(Sham组)、模型组(SAH组)、雌激素治疗组。通过激光多普勒血流仪检测大鼠局部脑血流量;采用ELISA法检测大鼠脑皮层TNF-α、IL-6的表达水平;免疫组织化学及Western blot法检测大鼠脑皮层中P2X7R的表达。结果:与Sham组相比,SAH后大鼠局部脑血流量显著降低(P<0.05);各时间点大鼠皮层内炎症因子TNF-α、IL-6的含量明显增多(P<0.05),且于24 h达高峰;P2X7R蛋白表达量于6、12、24 h显著上调(P<0.05),且于12 h达峰值。与SAH组相比,雌激素组大鼠局部脑血流量明显升高(P<0.05);TNF-α、IL-6的含量及P2X7R蛋白量显著降低(P<0.05)。结论:雌激素可以减轻蛛网膜下腔出血后脑皮层的神经炎症反应,其机制可能与下调P2X7R蛋白相关。     

透明质酸修护生物膜辅助治疗干燥性湿疹的多中心对照研究北大核心CSCD

目的探讨透明质酸修护生物膜辅助治疗干燥性湿疹的结果。方法5家医院82例干燥性湿疹分为试验组和对照组。试验组外搽糠酸莫米松乳膏和透明质酸修护生物膜,对照组仅外搽糠酸莫米松乳膏,每天2次,14d后停用糠酸莫米松乳膏,试验组继续外搽透明质酸修护生物膜,分别于首诊、治疗后7、14、28、42、56d随访。比较两组皮损SCORAD评分、总改善率、受试者自评、复发率、经皮水分丢失（TEwL）值及角质层含水量。结果①试验组比对照组皮损SCORAD评分显著改善,42d时SCORAD评分,试验组（4．42±2．64）、对照组（6．03±4．02）,56d时试验组（3．49±2．78）,对照组（6．06±4．28）,两组比较,差异有统计学意义（P均〈0．05）;②试验组改善率高于对照组,停用糠酸莫米松乳膏后,试验观察56d时,差异有统计学意义（均P〈0．05）;③停用糠酸莫米松乳膏后,观察28、42、56d时试验组均无复发,对照组复发率分别为11.4％、11．4％、20％,两组比较,差异有统计学意义（均P〈0．05）;④试验组TEWL下降低于对照组,56d时,试验组TEWL（10．35±2．02）与对照组TEWL（17．28±4．06）比较,差异有统计学意义（P〈0．05）;试验组角质层含水量高于对照组,42d时试验组角质层含水量（29．10±5．39）、对照组（23．12±4．76）,56d时,试验组角质层含水量（31．79±4．09）、对照组（22．87±4．85）,两组比较,差异有统计学意义（均P〈0．05）。试验组未发生不良反应。结论透明质酸修护生物膜可以辅助治疗干燥性湿疹,降低复发率,促进皮肤屏障功能的恢复,安全性高。     

社区老年妇女COPD患者营养状况对生活质量评分的影响

目的 了解社区老年慢性阻塞性肺部疾病(COPD)女性患者生活质量,研究营养状况对生活质量评分的影响.方法 选取2014年1月至2017年1月经内蒙古医科大学附属医院诊断的314例社区COPD老年妇女以微型营养评定法(MNA)行营养评定并进行分组,营养良好组164例,营养一般组73例,营养缺乏组77例,比较三组肺功能分级、6min步行及圣乔治问卷生活质量评分差异.结果 不同营养COPD患者FEV1/FVC、FEV1比较有显著性差异(F值分别为34.144、43.646,均P<0.05),进一步每两组之间比较发现,营养良好组患者FEV1/FVC、FEV1均显著高于营养一般组、营养缺乏组(t值分别为3.457、4.021、5.236、5.897,均P<0.05),营养一般组患者FEV1/FVC、FEV1均显著高于营养缺乏组(t值分别为3.034、2.908,均P<0.05).不同营养COPD患者肺功能分级有显著性差异(χ2=70.244,P<0.05),随着营养状况的下降,肺功能分级也处于下降趋势.不同营养COPD患者Borg评分、mMRC评分、步行距离比较有显著性差异(F值分别为7.929、4.198、8.386,均P<0.05),随着营养状况的下降,Borg评分、mMRC评分呈上升趋势,而步行距离呈下降趋势.不同营养COPD患者生活质量中症状评分、活动评分、心理社会评分、总评分比较有显著性差异(F值分别为11.677、6.757、9.240、8.862,均P<0.05),随着营养状况的下降,各评分项目均呈上升趋势.结论 慢性阻塞性肺部疾病患者的营养状况与患者的生活质量关系密切.     

Experimental study on the effect of moxibustion at Shenque (CV 8) for long-term exercise-induced fatigue

Objective

To investigate the effect of moxibustion at Shenque (CV 8) on fatigue in rats with chronic exercise-induced exhaustion.

Methods

Thirty male Sprague-Dawley (SD) rats were randomly divided into a blank group, a model group and a moxibustion group, 10 rats in each group. Except rats in the blank group, the remaining rats were subjected to create long-term exhaustion models by repeated swimming. After successful modeling, rats in the moxibustion group received mild moxibustion at Shenque (CV 8) for 15 min, once every other day with a total of 10 times. Rats in the model group and the blank group did not receive moxibustion. At the end of the treatment, the exhausted times, and the body weight of rats before and after the experiment were compared among groups. The levels of blood malondialdehyde (MDA) and urea nitrogen (BUN), as well as the activities of aspartate transarninase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were also measured by the automatic biochemical analyzer, 24 h after the exhausting excise.

Results

The 10th swimming time was significantly longer in the moxibustion group than that in the model group (P<0.01). The increase rate of the body weight was lower in the rats of the moxibustion group than that in the model group before the 7th and the 10th exhausting excise (P<0.05, P<0.01). The levels of serum MDA and BUN, as well as the activities of AST, ALT and LDH in the model group were higher than those in the blank group (all P<0.01). The levels of serum MDA and BUN, as well as the activities of AST, ALT and LDH in the moxibustion group were lower than those in the model group (P<0.01).

Conclusion

Moxibustion at Shenque (CV 8) can decrease the serum levels of MDA and BUN, as well as activities of AST, ALT and LDH in the long-term fatigue rats, thus to improve the symptoms of fatigue.

     

中医药基于核因子κB信号通路调控破骨细胞分化的研究进展

中医药治疗骨相关疾病疗效显著,其分子生物学机制研究也成为热点,破骨细胞分化异常导致一系列骨相关疾病发生,中医药通过核因子κB(NF-κB)信号通路调控破骨细胞分化的研究取得不少进展。本文对中医药基于NF-κB信号通路的调控破骨细胞分化的研究现状进行归纳总结,阐明分子生物学机制,指出目前研究不足及未来研究方向,为中医药治疗骨相关疾病拓展思维。     

胰岛移植现状

<正> 随着全胰或胰片段移植的开展,一些学者又进行了胰岛移植的研究。一、胰岛的分离与提纯最初获取胰岛是用手工进行分离,这种方法费工而且效率低。Moskalewski利用胶元酶(collagenase)破坏豚鼠胰腺的纤维结构。1967年Lacy和Kostianovsky把胶元酶消化技术用于大鼠,并成功地应用蔗糖梯度离心使胰岛组织与胰的腺泡组织进一步分     

硬膜外血肿增大的回顾性分析

目的 研究硬膜外血肿增大的临床规律.方法 回顾性地总结硬膜外血肿增大的发生率、对病情变化及近期疗效的影响,分析硬膜外血肿增大的预测因素.结果 24例(20 3%)患者发生血肿增大.血肿增大的患者病情加重及最终需要手术治疗的比例均明显高于无血肿增大的患者,两组患者出院时的治疗结果差异无统计学意义.血肿增大患者受伤到首次CT检查的时间、首次CT血肿量、入院时的血凝检查结果异常及饮酒嗜好者的比例均与无血肿增大患者存在明显差异.结论 急性硬膜外血肿增大的发生率较高,血肿增大对患者病情可造成不利影响,但不影响近期疗效,血肿增大预测因素有受伤到首次CT检查的时间、首次CT血肿量、血凝检查结果异常及饮酒嗜好.

Abstract：

Objective To study the clinical issues of progressive epidural hematoma ( PEDH ) .Method The incidence, impacts on clinical course and short-term outcomes and predictors of PEDH were retrospectively studied.Results PEDH occurred in 20.3% of the patients.The rates of neurological deterioration and surgical treatment due to the deterioration in patients with PEDH were significantly higher than those in patients without PEDH.There was not a significantly difference in short-term outcome between patients with and without PEDH.There was a significantly difference in the timing from injury to first CT scanning,volume of the hematoma on the first CT,rate of other intracranial injuries, hypocoagulability and heavy alcohol consumption between patients with and without PEDH.Conclusions The incidence of PEDH is 20.3% or more.PEDH is associated with neurological deterioration.But there is not a association between hematoma growth and poor clinical outcome.The time interval between injury and first CT scanning, volume of the hematoma on the first CT, hypocoagulability, heavy alcohol consumption appear to be independent predictors of hematoma growth.