PICC脱出的预防研究进展

对近年来国内外关于PICC脱出的预防及护理方法进行综述,认为发生导管脱出的原因主要有固定不牢、健康教育不到位、患者依从性差;护理对策包括专职护理人员置管及维护、掌握正确的皮肤消毒方法,选择敷贴,应用适宜的导管固定方法,掌握敷贴更换方法及做好健康教育等。提出PICC脱出的护理重点在于预防,只有控制可能引起PICC脱出的每个环节,才能真正做到防患于未然,将导管脱出发生率降至最低。     

Reamed intramedullary nailing versus unreamed intramedullary nailing for shaft fracture of femur: a systematic literature review

Introduction  

Fractures of femoral fracture are among the most common fractures encountered in orthopedic practice. Intramedullary nailing is the treatment choice for femoral shaft fractures in adults. The objective of this article is to determine the effects of reamed intramedullary nailing versus unreamed intramedullary nailing for fracture of femoral shaft in adults.     

人重组TNF相关凋亡诱导配体联合塞来昔布诱导胆囊癌细胞凋亡的作用研究

目的于体外实验观察人重组肿瘤坏死因子相关凋亡诱导配体(rhTRAIL)联合环氧化酶-2选择性抑制剂塞来昔布对胆囊癌的疗效,初步探讨产生疗效的机制.方法用western-blot法检测塞来昔布作用于胆囊癌细胞株后,抗凋亡蛋白c-FLIP和死亡受体DR4、DR5表达状况.rhTRAIL联合塞来昔布作用于胆囊癌细胞株SGC-996后,采用3种方法检测细胞凋亡状况:(1)细胞的相差显微镜观察;(2)caspase 3、7活性检测;(3)Annexin染色后凋亡细胞流式细胞仪检测.结果塞来昔布可下调SGC-996细胞c-FLIPs的表达,上调DR5的表达,且呈浓度、时间依赖性.rhTRAIL联合塞来昔布作用于胆囊癌细胞后,细胞凋亡水平明显高于单独用药组和对照组.结论塞来昔布可通过下调c-FLIPs表达和上调DR5表达,显著增强rhTRAIL诱导胆囊癌SGC-996细胞凋亡的作用.     

Hemi-arthroplasty performed in a 109-year-old patient with intertrochantericfracture: A case report

The mortality of conservative treatment and the risk resulting from operation for elderly patients with femoral intertrochanteric fractures are high. Safety in the perioperative period and quicker recovery should be placed at the top priority for elderly patients with hip fractures. We reported a case of 109-year-old female patient with intertrochanteric fracture who has undergone the hemiarthroplasty in our center recently. With sciatic nerve and lateral cutaneous nerve block anesthesia, she was offered the artificial femoral head replacement in the lumbar plexus block after sufficient preoperative preparation. The surgery went well with minimally invasive cut, and the patient''s recovery was satisfactory.     

粉刺净胶囊剂质量控制研究

采用薄层色谱法对制剂中的大黄、赤芍进行了定性鉴别 ;用消化—配位滴定法对硫酸锌进行了含量测定 ,方法简便 ,专属性及重现性好 ,可作为该制剂的质量控制指标。     

Characterization of EGFP-labeled mesenchymal stem cells and redistribution of allogeneic cells after subcutaneous implantation

INTRODUCTION: Bone marrow mesenchymal stem cells (MSCs) are ideal target cells for cell transplantation and tissue engineering. We investigated their biological characteristics and differentiation mediated by different methods. It is important to study the short-term fate of labeled allogeneic MSCs after subcutaneous implantation in rabbits in order to provide insights into the application of allogeneic MSCs for tissue regeneration. MATERIALS AND METHODS: Mesenchymal stem cells were labeled by two different methods in vitro and then were incubated with gelatin sponge. Autologous MSCs-Gelatin constructs and allogeneic MSCs-Gelatin constructs were subcutaneously implanted into 32 rabbits. The constructs were analyzed for the survival and migration of labeled MSCs at day 3, week 1, 3, and 5 post-implantation. RESULTS: EGFP was successfully expressed following transfection of MSCs with the retroviral vector pLEGFP-N1. In addition, EGFP-MSCs can be functionally induced into osteocytes, chondrocytes, and adipocytes in conditioned media. By weeks 3 after implantation, the labeled cells distributed extensively on the surface of gelatin sponge and gradually integrated into host tissues. EGFP-labeled MSCs were observed under fluorescence microscopy and BrdU-expressing cells were detected with immunohistochemical stain in allogeneic or autologous MSCs-Gelatin constructs during the initial five weeks after implantation. CONCLUSIONS: It is a simple and reliable way to trace the changes of MSCs in vivo by EGFP in cell transplantation and gene therapy. Allogeneic rabbit MSCs can survive for at least 5 weeks after subcutaneous implantation and maintain a strong ability of migration, indicating that allogeneic MSCs are of certain value in clinical application for temporary replacement.     

原发性胆囊癌的影像学诊断分析

目的:探讨B超、CT等影像学检查在诊断原发性胆囊癌中的作用 。方法:对原发性胆囊癌63例的术中所见、病理检查及手术前影像学检查结果,进行回顾总结并作比较分析 。结果:术前诊断为胆囊癌37例,术前诊断率为58.7%(37/63),B超及CT术前确诊率分别为64.8%(35/54)和62.9%（22/35） 。结论:B超和CT是诊断原发性胆囊癌的主要辅助诊断方法,值得推广。     

Monocyte Infiltration and Kidney Allograft Dysfunction During Acute Rejection

Multiple cell types infiltrate acutely rejecting renal allografts. Typically, monocytes and T cells predominate. Although T cells are known to be required for acute rejection, the degree to which monocytes influence this process remains incompletely defined. Specifically, it has not been established to what degree monocytes impact the clinical phenotype of rejection or how their influence compares to that of T cells. We therefore investigated the relative impact of T cells and monocytes by correlating their presence as measured by immunohistochemical staining with the magnitude of the acute change in renal function at the time of biopsy in 78 consecutive patients with histological acute rejection. We found that functional impairment was strongly associated with the degree of overall cellular infiltration as scored using Banff criteria. However, when cell types were considered, monocyte infiltration was quantitatively associated with renal dysfunction while T-cell infiltration was not. Similarly, renal tubular stress, as indicated by HLA-DR expression, increased with monocyte but not T-cell infiltration. These data suggest that acute allograft dysfunction is most closely related to monocyte infiltration and that isolated T-cell infiltration has less acute functional impact. This relationship may be useful in assigning acute clinical relevance to biopsy findings.     

关节镜下应用微骨折方法修复关节软骨缺损的实验研究及临床初步应用

目的探讨应用微骨折技术对全层关节软骨缺损修复的效果。方法20只大白兔随机分为两组,在其右股骨内髁先建立全层软骨缺损模型,实验组进行微骨折处理,对照组则不予特殊处理。分别在4周和8周各处死10只实验兔,作大体观察、病理学检查和修复组织厚度测量。临床上对68例全层关节软骨缺损进行随机分组：实验组35例,关节清理后应用微骨折技术进行处理;对照组33例,仅作关节清理术。结果对照组只有肉芽组织和瘢痕组织生长,仅边缘有少量软骨组织生长,实验组在4周时大部分为软骨组织生长,8周已全部被软骨组织修复。术后平均随访8．6个月,Lysholm评分实验组明显优于对照组。结论微骨折技术是一种有效的修复全层关节软骨缺损方法。     

Anti-apoptotic effect of insulin in the control of cell death and neurologic deficit after acute spinal cord injury in rats

Recent studies confirmed that the new cell survival signal pathway of Insulin-PI3K-Akt exerted cyto-protective actions involving anti-apoptosis. This study was undertaken to investigate the potential neuroprotective effects of insulin in the pathogenesis of spinal cord injury (SCI) and evaluate its therapeutic effects in adult rats. SCI was produced by extradural compression using modified Allen's stall with damage energy of 40 g-cm force. One group of rats was subjected to SCI in combination with the administration of recombinant human insulin dissolved in 50% glucose solution at the dose of 1 IU/kg day, for 7 days. At the same time, another group of rats was subjected to SCI in combination with the administration of an equal volume of sterile saline solution. Functional recovery was evaluated using open-field walking, inclined plane tests, and motor evoked potentials (MEPs) during the first 14 days post-trauma. Levels of protein for B-cell lymphoma/leukemia-2 gene (Bcl-2), Caspase-3, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) were quantified in the injured spinal cord by Western blot analysis. Neuronal apoptosis was detected by TUNEL, and spinal cord blood flow (SCBF) was measured by laser-Doppler flowmetry (LDF). Ultimately, the data established the effectiveness of insulin treatment in improving neurologic recovery, increasing the expression of anti-apoptotic bcl-2 proteins, inhibiting caspase-3 expression decreasing neuronal apoptosis, reducing the expression of proinflammatory cytokines iNOS and COX-2, and ameliorating microcirculation of injured spinal cord after moderate contusive SCI in rats. In sum, this study reported the beneficial effects of insulin in the treatment of SCI, with the suggestion that insulin should be considered as a potential therapeutic agent.