Wound healing in hemophilia B mice and low tissue factor mice

Wound healing involves a number of physiologic mechanisms including coagulation, inflammation, formation of granulation tissue, and tissue remodeling. Coagulation with robust thrombin generation leading to fibrin formation is necessary for wound healing. It is less clear if there is a requirement for ongoing coagulation to support tissue remodeling. We have studied wound healing in mice with defects in both the initiation (low tissue factor) and propagation (hemophilia B) phases. In hemophilia B mice, dermal wound healing is delayed; this delay is associated with bleeding into the granulation tissue. Mice can be treated with replacement therapy (factor IX) or bypassing agents (factor VIIa) to restore thrombin generation. If treated just prior to wound placement, mice will have normal hemostasis in the first day of wound healing. As the therapeutic agents clear, the mice will revert to hemophilic state. If the primary role of coagulation in wound healing is to provide a stable platelet/fibrin plug that is loaded with thrombin, then treating hemophilic animals just prior to wound placement should restore normal wound healing. The results from this study did not support that hypothesis. Instead the results show that restoring thrombin generation only at the time of wound placement did not improve the delayed wound healing. In preliminary studies on low tissue factor mice, there also appears to be a delay in wound healing with evidence of bleeding into the granulation tissue. The current data suggests that ongoing coagulation function needs to be maintained to support a normal wound healing process.     

Stereotactic Aspiration and Thrombolysis of Spontaneous Intracerebellar Hemorrhage

Objective: Spontaneous intracerebellar hemorrhage (SCH) accouts for 10% of intracerebral hemorrhages. The unpredictability of clinical deterioration and the bad prognosis once deterioration starts, make SCH a surgical emergency. Up to now stereotactic aspiration and thrombolysis of SCH was less reported. Methods: Eighteen patients with SCH were treated by stereotactic aspiration and thrombolysis and reviewed in this report. The 3-mm axial stereotactic computer tomography slices throughout the hematoma were obtained. Those images were then transferred to the workstation. The trajectory of catheter was designed to go through the main axis of the hematoma. Under local anesthesia a catheter was directed stereotactically into the hematoma through a burr hole. Hematoma thrombolysis and clot drainage was followed by instillation of urokinase (10 000 IU) every 12 hours. The catheter was removed when the majority of hematoma was evacuated. Results: Mean age was 64.3 years. Median initial GCS was 12.6. Mean initial hematoma volume was 17.4 mL. Initial SCH volume was reduced by an average of 86.2% and the average final hematoma volume was 2.8 mL. At 3 months’ follow-up, 13 patients (72.2%) had achieved good recovery. At 6 months’ follow-up, 12 patients (66.6%) had achieved good recovery. Conclusions: Stereotactic aspiration and thrombolysis of SCH was a simple, feasible, and effective method to treat moderate and some benign SCH that less respond to medical treatment. The timing of the procdure should be over 7 hours from the onset.     

替罗非班对心肌梗死急诊介入术中无复流的影响

目的观察替罗非班对急性ST段抬高心肌梗死急诊冠状动脉介入无复流现象的治疗效果。方法冠状动脉介入术中出现无复流现象45例,依次给予硝酸甘油、维拉帕米和替罗非班,观察靶血管前向血流的TIMI分级。结果替罗非班可以明显改善PCI术中无复流现象,替罗非班组与硝酸甘油组或维拉帕米组比较差异有显著性,硝酸甘油组与维拉帕米组比较差异无统计学意义。术中即刻效果不理想者,持续应用替罗非班,24h再次造影均改善了无复流。结论替罗非班可以明显改善急性ST段抬高心肌梗死急诊冠状动脉介入无复流现象。     

渐进多焦点眼镜对缓解视屏终端操作者视疲劳症状临床观察

目的:了解渐进多焦点眼镜缓解视屏终端(visual display terminal,VDT)操作者视疲劳的效果。方法:有视疲劳症状且屈光不正的VDT操作者98例,按自愿原则分为2组,其中一组配戴普通单光眼镜,共52例;另一组配戴渐进多焦点眼镜,共46例,经1a随访,分析两组屈光状态及其缓解视疲劳的效果。结果:所有98例患者中,44例存在未矫正、屈光矫正不足和过矫正;视物不能持久、眼部酸胀2种症状在两组中的差异有极显著性统计学意义(P<0.01),眼痛、眼干和眼睑沉重3项在两组中无统计学意义。结论:渐进多焦点眼镜对缓解轻中度近视VDT操作者视疲劳有效。     

比较TACE+微波消融+程序性死亡受体-1与TACE+微波消融治疗原发性肝癌

目的 比较TACE+微波消融（MWA）+程序性死亡受体-1（PD-1）与TACE+MWA治疗原发性肝癌（PHC）的价值。方法 回顾性纳入接受TACE+MWA+PD-1（观察组）或TACE+MWA治疗（对照组）的PHC患者各40例,比较组间基线资料、疗效和并发症。结果 2组患者基线资料差异均无统计学意义（P均>0.05）。观察组与对照组客观缓解率（ORR）分别为90.00%和72.50%,疾病控制率（DCR）分别为97.50%和95.00%;组间差异均无统计学意义（P均>0.05）。观察组与对照组中位总生存期（OS）分别为30.80个月和15.70个月,中位无进展生存期（PFS）分别为23.35个月和6.80个月;观察组OS和PFS均长于对照组（P均<0.05）。组间并发症发生率差异均无统计学意义（P均>0.05）,且均经相关对症治疗后好转。结论 TACE+MWA+PD-1联合治疗PHC效果优于TACE+MWA。     

胰头癌扩大根治术研究进展

胰腺癌是全世界范围内发病率和死亡率不断上升的致命恶性肿瘤。胰头是胰腺癌发生的主要部位,由于其解剖位置特殊,早期症状常不明显,发现时多属晚期,预后极差。目前,外科手术可能是胰头癌有限的治疗方法中唯一有效的治愈方法,患者的术后远期疗效也随着外科技术及手术方式的不断发展在一定程度上得以提高。手术方式的选择由最初的标准切除术逐步演变为更加接近根治性切除的扩大根治术,包括联合血管切除、扩大淋巴结清扫及联合脏器的切除,但其治疗效果在某些方面仍存在诸多争议。     

急性脑梗死患者溶栓治疗前后血浆基质金属蛋白酶-9含量的变化及意义

目的 探讨血浆基质金属蛋白酶-9(MMP-9)在急性脑梗死患者溶栓治疗后的变化及临床意义.方法 测定34例急性脑梗死患者溶栓前后血浆MMP-9水平,并与健康对照组(34例)比较.结果 急性脑梗死患者溶栓前MMP-9水平较健康对照组无明显升高[(13.47±3.09)ng/L比(12.89±10.22)ng/L,P＞0.05],溶栓后MMP-9水平[(22.06±12.53)ng/L]较健康对照组和溶栓前均显著升高(均P＜0.05).溶栓后发生出血患者(发生率26.5%,9/34)MMP-9水平较溶栓前显著增加[(24.02±15.41)ng/L比(14.28±2.33)ng/L,P＜0.05];与无出血患者[(20.42±9.57)ng/L]相比有增高趋势,但差异无统计学意义(P＞0.05).溶栓后完全再通患者(再通率58.8%,20/34)MMP-9水平较溶栓前明显升高[(19.26±7.94)ng/L比(13.63±3.02)ng/L,P＜0.05];与不完全再通患者[(18.97±4.23)ng/L]相比有增高趋势,但差异无统计学意义(P＞0.05).结论 溶栓后激活了MMP-9,MMP-9增加溶栓后出血的风险并参与了溶栓后出血的机制.     

64排容积扫描多向调整多平面重组在内耳结构全程显示中的评价

目的：探讨多向调整多平面重组技术同平面全程显示内耳精细结构的方位和方法。材料和方法：运用64排螺旋CT对76例内耳行高分辨率容积扫描后行多向调整MPR后处理,确定耳蜗、半规管结构的基础显示方位、重组基线旋转中心点解剖标志,测量旋转角度。按全程显示程度对内耳轴、冠、矢图像及MPR图像进行分级统计,进行Ridit分析和χ2检验。结果：多向调整MPR耳蜗底周,外、上、后半规管的同层全程显示率均为100%,明显高于轴面、冠状面、矢状面显示率,差异有统计学意义（P<0.01）。64排螺旋CT颞骨容积扫描只需一次扫描,后经多次MPR处理,就可取代内耳多次多方位扫描。结论：各向同性扫描技术上的多向调整多平面重组可以取代多次多方位扫描,可提供具有诊断意义的内耳精细解剖结构全程显示方法,具有重要的临床应用价值。     

射频消融后残余肿瘤模型的制作及病理观察

目的 观察兔VX2射频消融后残余肿瘤模型不同时间段病理形态学变化.方法 超声引导经皮穿刺48只新西兰白兔接种VX2肿瘤,并开腹射频消融制作残余肿瘤模型.将模型随机分成6组,每组8只,分别于射频消融术(RFA)之前、术后1天、3天、1周、2周及3周观察病理学变化.结果 残余肿瘤组织射频消融术后MVD、VEGF及PCNA表达即明显减低,一直维持较低水平至射频消融后2周;RFA后2周至第3周,MVD、VEGF及PCNA表达再次增加.结论 射频消融治疗后残余肿瘤短期内受到抑制,仍需要进一步治疗.