Panfacial fractures: analysis of 33 cases treated late.

PURPOSE: The aim of this retrospective study was to analyze the characteristics of delayed panfacial fractures and evaluate treatment results. PATIENTS AND METHODS: Thirty-three patients with delayed panfacial fractures were treated in the Maxillofacial Trauma Center of Peking University, School and Hospital of Stomatology between 1998 and 2004. Each patient was examined by computed tomography (CT) scans before operation. For those who had no severe opening restriction, dental impressions were taken to fabricate dental casts. For those with severely comminuted fractures, 3-dimensional (3D) models of the facial skeleton were used. Re-establishing the continuity of the mandible was the first step and then used as a platform to reconstruct the maxillary fractures via maxillomandibular fixation after Le Fort I osteotomy. The third step was to restore the mid- and upper-facial width and projection by coronal approach to expose the zygomatic complex and frontal bone/sinus and/or naso-orbito-ethmoid (NOE) fractures. RESULTS: There were 3 types of mandibular fractures that affected the treatment plan: 1) type I, mandibular body/symphysis fracture(s) (17/33, 51.52%); 2) type II, mandibular angle and/or condylar fracture(s) (6/33, 18.18%); and 3) type III, both mandibular body/symphysis and angle/condylar fractures (10/33, 30.30%). Fourteen cases were associated with NOE fractures (42.42%) and 3 cases had frontal sinus fractures (9.1%). Twelve cases had enophthalmos (36.36%) and 3 lost 1 eyeball. The order of treatment was dependent on the mandibular fracture type. For type I fractures, reconstructing the mandibular arch was the first step. For type II fractures, repairing the angle, ascending rami, and condylar areas was the first step. For type III fractures, when both mandibular height and arch were disrupted, freeing the malunited angle or condyle was the first step before restoring the mandibular arch form. Reconstruction of the mandibular height and projection was then carried out. For all 3 types, the second step was to restore the mid- and upper facial width and projection by reducing the zygomatic complex and frontal bone/sinus or NOE fractures. Maxillary fixation across the Le Fort I level was the last step. Le Fort I osteotomy was used for all 33 cases. Bone grafts and soft tissue suspension also were used. Twenty-one cases (63.64%) had good results, 7 (21.21%) cases were acceptable, and 5 (15.15%) were not good. There were 7 cases (21.21%) that still had soft tissue problems that needed secondary operations. CONCLUSIONS: Reconstruction of the mandible first with Le Fort I osteotomy is a good way to treat delayed panfacial fractures. Computed tomography and 3D CT, model surgery, and occasionally 3D models are necessary aids for diagnosis and treatment. Soft tissue problems, including lacerations and asymmetries, were often the factors that caused an unfavorable outcome.     

Pyruvate-modified perfadex improves lung function after long-term hypothermic storage.

BACKGROUND: Lungs harvested for transplantation are stored while inflated with oxygen, which can serve to support oxidative metabolism. However, strategies aimed at increasing graft metabolism during storage have received little attention. In this study, we added pyruvate to the preservation solution Perfadex and measured the effects on oxidative metabolism and reperfusion lung function. METHODS: Rat lungs were stored for 6 and 24 hours in low-potassium dextran solution at 10 degrees C containing either 5 mmol/liter uniformly carbon-13 (U-(13)C) labeled glucose (Perfadex), 32 mmol/liter 3-(13)C pyruvate (pyruvate), or both (combined). Oxidation of exogenous substrates was measured as the incorporation of (13)C into tricarboxylic acid cycle intermediates by magnetic resonance spectroscopy. Additional groups of lungs with each substrate modification were preserved for 6 or 24 hours and then reperfused. RESULTS: Enrichment of tricarboxylic acid cycle intermediates was low in the Perfadex group (9% at 6 hours and 32% at 24 hours of storage, respectively). In contrast, enrichment was significantly increased in both the pyruvate group (50% and 59%, respectively) and combined group (39% and 54%, respectively) compared with the Perfadex group (p<0.01). Graft function was excellent after 6-hour storage in all groups. All lungs stored for 24 hours exhibited inferior lung function, but oxygenation, pulmonary artery pressures, and airway pressures in the combined group were significantly improved compared with the Perfadex group (p<0.05). CONCLUSIONS: Preservation solution substrate composition influences graft metabolism during storage. The addition of pyruvate to Perfadex increases metabolism during storage and improves reperfusion lung function.     

Study of pathological morphology in chronic sinusitis]

OBJECTIVE: To study the pathological characteristics and regularity of chronic sinusitis (CS) in different clinical types, tc estimate the reliability and feasibility of CS classification on the pathologic basis. METHODS: HE, Van Gieson's, alcian blue-periodic acid-schiff(AB-PAS) staining was used to observe the changes of epithelium, to measure the thickness of basement membrane and the area of mucous glands. The ultrastructural changes of pseudostratified ciliated columnar epithelium were observed under transmission electron microscope (TEM) and scanning electron microscope (SEM). RESULTS: The epithelial fiber tissue was increased, the basement membrane was thickened, and the mucous glands were obviously increased in CS under the light microscope. Subepithelial fibrosis and thickened basement membrane were most obviously seen in type III of CS and the hyperplasia of mucous glands was most distinct in type II. Under the TEM, abnormal structure of cilia, decrease of ciliated cells, increase of goblet cells were detected in all three CS types. Under the SEM, the cilia of every types showed the ingravescenced process of pathological changes from slight cilium disorder, disorientation, to desquamation of most cilia and replacement of microvilli. CONCLUSION: There is significant distinction of mucous membrane structure among three types. The Chinese classification of CS has pathological basis, it represents the occurrence, development and regularity of CS, and it can be used as basis in further study, communication and evaluation for surgical effect of CS.     

根据桂枝汤的效应消除半衰期和表观消除半衰期制订给药方案的探讨

为探讨药效法估测的效应消除半衰期和效量法估测的表观半衰期对合理制订给药方案的意义和作用,以桂枝汤解热和抗炎的药物动力学实验中所得的相应参数值设计了给药方案,观察了它们在提高药效上的作用。结果表明在给药总剂量相等、首次给药同时开始的情况下,以半衰期设计的给药方案组的药效均明显高于习惯的一次给药组;而以效应消除半衰期设计给药方案组药效增强率又高于以表观半衰期设计的方案组。提示效应消除半衰期比表观半衰期似更有实践意义。     

北京市东城区和平里社区居民慢性病防治探讨

为探索慢性病的防治方法，我们于１９８９￣１９９４年社区居民中开展了以高血压为主的循环系统慢性病防治课题，经过５年的干预，观察组与对照组居民及接受管理的高血压病人在减少吸烟，饮酒，控制食盐摄入，掌握慢性病防治知识等方面有显著性差异，取得了满意的结果，从而为今后全面开展慢性病防治积累了经验。     

大白鼠肾上腺的血管构筑

本实验采用血管铸型扫描电镜,注射明胶卡红组织切片显微镜下观察和注射铅丹乳胶追踪血管来源三种方法对14只健康大白鼠肾上腺血管构筑进行了研究。大白鼠肾上腺动脉发自腹主动脉和肾动脉。它们在行程中发出分支至腺体表面,再次分支穿入囊内,逐级分支至毛细血管。皮质动脉发自囊内血管,它们在皮质中分支分布。球状带的毛细血管与囊的毛细血管相连,毛细血管在球状带围绕细胞团形成网眼状;在束状带呈放射状排列;在网状带吻合增多形成网状。髓质动脉亦发自囊的血管,它们在皮质中不发分支直抵髓质,在髓质分成毛细血管。网状带的毛细血管越向髓质口径越粗,它们在皮髓交界处互相吻合形成更粗的静脉,这些静脉逐级吻合,最后形成一主干——中央静脉,它穿出皮质出现于肾上腺门处。左侧的中央静脉注入在肾静脉,右侧的注入下腔静脉。     

甘利欣联合654-2治疗慢性乙型肝炎60例疗效观察

目的观察甘利欣联合654-2治疗慢性乙型肝炎的临床疗效。方法采用甘利欣联合654-2治疗慢性乙型肝炎患者60例。治疗4w和8w时,分别观察临床症状、体征及肝功能(包括ALT和TB)的变化。结果ALT、TB恢复程度以治疗组为高,与对照组比较有统计学差异(P<0.05)。采用甘利欣联合654-2治疗8w后,总有效率为96.6%。结论甘利欣联合654-2治疗慢性乙型肝炎的治疗较疗效满意。     

组织多肽特异性抗原在乳腺癌中的临床研究

OBJECTIVE: To investigate the expression of serum tissue polypeptide-specific antigen (TPS) in breast cancer patients and its clinical value in such cases. METHODS: Altogether 160 subjects (90 patients with breast cancer, 40 with benign breast lesions, and 30 healthy subjects) were enrolled in this study. The serum TPS and CA153 levels were measured by ELISA in all the subjects. RESULTS: The levels and positivity rate of serum TPS and CA153 in breast cancer group were significantly higher than those in the normal subjects group and benign lesion group (P<0.01), and became even higher as the malignancy progressed. High serum TPS level was detected in the cancer patients in stage I. Serum TPS level was the most sensitive to bone metastasis of the malignancy, but its highest levels occurred in cases of lymphoid node metastasis (P<0.05). In patients who responded favorably to the treatment, serum TPS and CA153 levels were significantly reduced (P<0.05), but the reduction in TPS levels tended to be more obvious (P<0.05). CONCLUSION: Serum TPS can be used as a very useful and sensitive tumor marker in the diagnosis of breast cancer, especially in case of bone metastasis, and may be of great value in clinical decision-making and assessment of therapeutic effect.     

Optical Pretargeting of Tumor with Fluorescent MORF Oligomers

Objective Pretargeting with radioactivity has significantly improved tumor to normal tissue radioactivity ratios over conventional antibody imaging in both animal studies and clinical trials. This laboratory is investigating DNA analogues such as phosphorodiamidate morpholinos (MORFs) for pretargeting using technetium-99m (^99mTc) for detection. However, the unique properties of fluorescence activation and quenching combined with oligomers with their unique properties of hybridization may be particularly useful when used together for pretargeting with optical detection. The use of linear fluorophore-conjugated oligomer duplexes have been little used in animals, and to our knowledge, have not previously been considered for pretargeting applications. Methods A MORF/cDNA pair was selected such that when hybridized, the fluorescence of the Cy5.5-conjugated 25 mer MORF (Cy5.5–MORF25) is inhibited with a BHQ3-conjugated 18 mer complementary DNA (BHQ3–cDNA18). The short BHQ3–cDNA18 was selected to dissociate in the presence of a long cMORF25 in the pretargeted tumor, thus releasing the inhibitor from the Cy5.5 emitter. In this manner, the Cy5.5 fluorescence will be inhibited everywhere but in the target. The dissociation was first examined in vitro by adding the duplex to the cMORF25 both in solution and immobilized on polystyrene microspheres and by surface plasmon resonance (SPR). Thereafter, biotinylated cMORF25 immobilized on streptavidin polystyrene microspheres were administered intramuscularly in one thigh of hairless SKH-1 mice as target while an identical weight of the identical microspheres but without the cMORF25 was administered in the contralateral thigh as control. The animals then received IV the Cy5.5–MORF25/BHQ3–cDNA18 duplex or equal molar dosage of single-chain Cy5.5–MORF25 and were imaged. Results The SPR studies showed that the immobilized cDNA18 rapidly captured the flowing MORF25 to provide a duplex with a slow dissociation rate constant. Furthermore, when cMORF25 was next allowed to flow over the now immobilized duplex, the cDNA18 was unable to prevent dissociation of the heteroduplex and the formation and release of the cMORF25-MORF25 homoduplex. Images of animals obtained soon after receiving the Cy5.5–MORF25 singlet showed intense whole body fluorescence obscuring the target thigh. However, only 5 minutes after receiving the Cy5.5–MORF25/BHQ3–cDNA18 duplex, the target thigh was clearly visible along with only the kidneys. Conclusions This first study of optical pretargeting provides a proof of concept that oligomer pretargeting found to be useful with radioactivity detection is applicable with fluorescent detection as well. In addition, our results demonstrate that by using linear oligomers for optical pretargeting, chain lengths (and base sequences) may be manipulated to provide duplexes with stabilities and fluorescence inhibition optimized for pretargeting and other in vivo applications of optical imaging.     

肾移植2,3,5年患者的免疫抑制用药分析

目的：分析肾移植后免疫抑制剂对长期存活的影响，寻找移植后不同时间合适的免疫抑制用药方案及其用药剂量。 方法：对肾移植一年以上、肾功能正常的４９７例患者进行５年连续随访。根据移植后２、３、５年的不同免疫抑制用药将患者分为三联、二联、传统二联治疗三组。统计各组的排异发生率，排异和无排异患者免疫抑制用药的种类、剂量及ＣｓＡ浓度，对排异患者追踪排异发生前１２个月内的药物更动情况。 结果：肾移植后２、３、５