低强度超声在下颌埋伏智牙拔除术中的应用

目的:观察埋伏阻生牙拔除术后应用低强度超声照射对缓解疼痛、肿胀、干槽症和促进骨愈合的效果。方法:在门诊患者中,依据曲面断层X线片选择两侧埋伏阻生程度相近者为研究对象,一侧创口术后照射低强度超声,另一侧进行常规处理。应用SPSS10.0软件对患者手术后疼痛、肿胀、干槽症和创口完全骨愈合的情况进行统计学分析。结果:实验组和对照组比较,实验组疼痛4例,对照组16例(P<0.05);实验组肿胀11例,对照组13例(P>0.05);实验组发生干槽症患者0例,对照组4例(P<0.05);实验组创口完全骨愈合35例,对照组21例(P<0.01)。结论:埋伏阻生牙拔除术后应用低强度超声,可以显著缓解术后疼痛,降低干槽症发生率,并促进创口骨愈合,但是对术后肿胀的治疗效果不明显。     

Recurrent pilonidal sinus treated with epilation using a ruby laser

BACKGROUND : Surgical treatment of pilonidal sinus disease of the natal cleft has a significant failure rate. Reported here is the case of a 33-year-old man who first presented at the age of 18 with a pilonidal sinus. METHOD : The patient's scar was treated with a ruby laser using a pulse length of 2 ms and energy densities of 6.0-7.2 J/cm 2 . Treatment was performed five times at 6-week intervals. RESULT : The sinus healed and has not recurred to date, 6 months after the last treatment. CONCLUSION : It is felt that there may be a future for this treatment, either as primary treatment or as an adjunct to surgery in refractive cases. It could also be useful in preventing the growth of hairs into wounds that have been left open and allowed to granulate.     

Impairment of wound healing after operative treatment of mandibular fractures,and the influence of dexamethasone

Our aim was to clarify the incidence of impaired wound healing after open reduction and ostheosynthesis of mandibular fractures, and to find out whether the use of dexamethasone during the operation increased the risk. Patients were drawn from a larger group of healthy adult dentate patients who had participated in a single-blind, randomised study, the aim of which was to clarify the benefits of operative dexamethasone after treatment of facial fractures. The present analysis comprised 41 patients who had had open reduction and fixation of mandibular fractures with titanium miniplates and monocortical screws through one or 2 intraoral approaches. The outcome variable was impaired healing of the wound. The primary predictive variable was the perioperative use of dexamethasone; other potential predictive variables were age, sex, smoking habit, type of fracture, delay in treatment, and duration of operation. Wound healing was impaired in 13/41 patients (32%) (13/53 of all fractures). The incidence among patients who were given dexamethasone and those who were not did not differ significantly. Only age over 25 was significantly associated with delayed healing (p = 0.02). The use of dexamethasone 30 mg perioperatively did not significantly increase the risk of impaired wound healing in healthy patients with clinically uninfected mandibular fractures fixed with titanium miniplates through an intraoral approach. Older age is a significant predictor of impaired healing, which emphasises the importance of thorough anti-infective care in these patients during and after the operation.     

美宝（MEBO）联合碱性成纤维细胞生长因子（bFGF）在小儿深Ⅱ°烧伤创面的应用

目的探讨美宝联合碱性成纤维细胞生长因子治疗小儿深Ⅱ°烧伤创面的临床疗效。方法选择我科2008年9月至2011年4月135例因热开水烫伤四肢皮肤致深Ⅱ°烧伤的小儿患者,按创面处理方法分为A组和B组。A组（66例）采用美宝联合碱性成纤维细胞生长因子治疗,B组（69例）单独采用美宝进行治疗。对两组创面的愈合时间及愈合后瘢痕形成等情况进行比较。结果 A组平均愈合时间（14.8±2.7）天,愈后瘢痕少;B组平均愈合时间（16.2±2.7）天,愈后瘢痕少。两组愈合时间有显著性差异（P〈0.01）。结论联合应用美宝和碱性成纤维细胞生长因子治疗小儿深Ⅱ°烧伤创面,可加速创面愈合,愈后瘢痕形成无明显差异。     

细胞凋亡在骨折愈合中的作用

目的 探讨骨折愈合过程中细胞凋亡的发生及意义。方法 建立颌骨骨折模型,利用末脱氧核苷酸酶（TdT)介导的dUTP－X切口末端标记（TUNEL）法,原位观察骨折愈合不同时期细胞凋亡的发生情况。结果 在整个愈合过程中,均可见凋亡细胞,而膜内骨化膜(第5d）和软骨形成期（第11d) 凋亡细胞明显增多。结论 骨折愈合过程伴随凋亡的发生,通过凋亡机控制控制细胞的数量和清除无用的细胞,以利于组织的正常修复。     

注射用脱氧核苷酸钠对烧伤创面愈合的临床观察

目的评估脱氧核苷酸钠注射液钠对烧伤患者的愈合时间效果和副作用情况。方法选择烧伤患者82例,按住院号末尾数的奇偶随机平分为观察组和对照组,前者静脉点滴脱氧核苷酸钠,后者静脉点滴鹿瓜多肽。结果脱氧核苷酸钠注射液治疗组较鹿瓜多肽对照组平均愈合时间明显缩短(P<0.05),不良反应发生率为0。结论脱氧核苷酸钠注射液对烧伤患者能明显缩短烧伤创面的愈合时间,减少不良反应的发生,是治疗中小面积烧伤创面愈合的较好药物。     

Physicians Contracting with Managed Care

It has been observed that enrollees in managed care systems such as HMOs and PPOs have lower expenditures and utilization rates than those in conventional insurance plans. Few studies have investigated this issue by examining providers. This paper studies whether physicians with low costs are more likely to sign contracts with HMOs and PPOs in order to help explain the observation of lower expenditures and utilization rates by HMO and PPO enrollees. A logistic regression is applied to the data from the 198401985 Physician Practice Costs and Income Survey. The results do not show strong evidence that a physician's likelihood of contracting with HMOs and PPOs is related to the physician's practice costs and utilization decision of contracting with managed care systems are the physician's socio-demographics, the physician's practice region, and the market conditions.     

The Healing Forest Metaphor Revisited: The Seen and “Unseen World” of Drug Use

There is one world we live in. Its geographical and spatial boundaries tell us this. We see it on maps, we see it on television, and we see it when we walk out of the door. Children, adults, and people of all races and creeds live in this one world. The world we live in is viewed differently by these many individuals. Some see it as hostile, some see it as peaceful, and some go about their daily business and do not see it at all. This is the seen world. The one we can see with our eyes. The seen world is not the only one that exists, however, because there is also another world behind our eyes. When we close our eyes, it is in there. We have an imagination to tell us what it could be like, we have thoughts to tell us what we want it to be like, and we have dreams to tell us what we want it to be. Where is this unseen world? We carry it around with us every nanosecond of every day that we are alive. While we live in the seen world, the unseen world is alive in us. What could the unseen world be like for substance users? This is the topic of the current article.     

培养条件下肌腱中心区域腱细胞的增殖能力

目的　研究肌腱损伤后腱中心区域组织的愈合能力。方法　选用 8只白色纯种来亨鸡 ,在无菌条件下切取双侧最长趾 区趾深屈肌腱 ,切成 4 mm长的肌腱段 ,分为两组 ,每组 12条。实验组 :切除腱外膜和外膜下腱组织的肌腱中心区域组织 ;对照组 :仅剥除腱外膜组织的肌腱段。将两组肌腱组织进行体外培养 ,于培养第 9、18及 2 7天取标本进行大体观察及组织学检查。另取 4条肌腱作正常对照组 ,直接进行大体观察和组织学检查。结果　各时间点的腱细胞数 ,对照组均明显少于实验组及培养前 ,有统计学意义 (P<0 .0 1) ;实验组比培养前均明显增多 ,有统计学意义 (P<0 .0 1) ;但培养第 18天和 2 7天时 ,实验组腱细胞数较培养第 9天少 (P<0 .0 1)。结论　屈肌腱损伤后腱中心区域组织有良好的愈合能力。