游离串联皮瓣修复小腿大面积软组织缺损的临床应用

伴受区血管受限小腿大面积软组织缺损的较好方法.     

Cost‐effectiveness of treating vascular leg ulcers with UrgoStart® and UrgoCell® Contact

Although chronic wounds have a high socio‐economic impact, data on comparative effectiveness of treatments are rare. UrgoStart^® is a hydroactive dressing containing a nano‐oligosaccharide factor (NOSF). This study aimed at evaluating the cost‐effectiveness of this NOSF‐containing wound dressing in vascular leg ulcers compared with a similar neutral foam dressing (UrgoCell^® Contact) without NOSF. Cost‐effectiveness analysis from the perspective of the German statutory health care system was performed using a decision tree model for a period of 8 weeks. Cost and outcome data were derived from the clinical study ‘Challenge’ suggesting a response rate (≥40% wound size reduction) of UrgoStart^® of 65·6% versus 39·4% for the comparator. In the treatment model, effect‐adjusted costs of €849·86 were generated after 8 weeks for treatment with UrgoStart^® versus €1335·51 for the comparator resulting in an effect‐adjusted cost advantage of €485·64 for UrgoStart^®. In linear sensitivity analyses, the outcomes were stable for varying assumptions on prices and response rates. In an 8‐week period of treatment for vascular leg ulcers, UrgoStart^® shows superior cost‐effectiveness when compared with the similar neutral foam dressing without any active component (NOSF). As demonstrated within a randomised, double‐blind clinical trial, UrgoStart^® is also more effective in wound area reduction than the neutral foam dressing. Wound healing was not addressed in this clinical trial. Follow‐up data of 12 months to allow for reulceration assessment were not generated.     

Quality of life psychosocial characteristics in Greek patients with leg ulcers: a case control study

Chronic leg ulcers are a public health problem that can have a significant impact on the patient's physical, socioeconomic and psychological status. The aim of this study is to evaluate the quality of life, anxiety and depression, self‐esteem and loneliness in patients suffering from leg ulcers. A total of 102 patients were enrolled in the study. The quality of life, anxiety and depression, self‐esteem and loneliness of the patient were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's Self‐esteem Scale (RSES) and the UCLA Loneliness Scale (UCLA‐Version 3), respectively. The mean DLQI score was 13·38 ± 2·59, suggesting a serious effect on the quality of life of patients. Those with leg ulcers had statistically significant higher scores according to the HADS‐total scale (P = 0·031) and HADS‐anxiety subscale (P = 0·015) compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA‐scale (P = 0·029). Female patients presented with a higher score of anxiety (P = 0·027) and social isolation (P = 0·048), and worse quality of life (P = 0·018) than male patients. A severe quality of life impairment was documented, reflecting a significant psychosocial impact on patients with leg ulcers.     

Unusual cause of lower extremity wounds: Cobb syndrome

Cobb syndrome (Cutaneomeningospinal Angiomatosis) is a rare segmental neurocutaneous syndrome associated with metameric cutaneous and spinal cord arteriovenous malformations (AVMs). In this syndrome, capillary malformation or angiokeratoma‐like lesions are formed in a dermatomal distribution, with an AVM in the corresponding segment of the spinal cord. The spinal cord lesions can cause neurological disorder and paraplegia, which typically develop during young adulthood. We report a 32‐year‐old male with the Cobb syndrome associated with lower extremity painful wounds and acute‐onset paraplegia due to metameric vascular malformations.     

死后小鼠肾组织细胞核DNA变化规律的研究

目的:研究DNA降解变化与死亡时间的关系,为法医学推断死亡时间提供一种比较准确可靠的新方法。方法:应用单细胞凝胶电泳(SCGE)技术结合荧光显微镜和专业的计算机图像分析技术,测定111只小鼠在死后72h内不同时间点小鼠肾组织细胞核头半径、尾长度、头DNA含量比例、尾DNA含量比例、尾矩、Olive矩、头面积、尾面积8项参数的变化值。结果:在个体死亡72h内,测定的8项参数指标中尾DNA含量比例、彗星尾长、尾矩、Olive矩、尾面积都呈增加趋势,头半径、头DNA含量比例、头面积均呈下降趋势。上述参数均与死亡时间具有高度的相关性。并将每个参数的测量值进行了多项式运算,获得了更能体现DNA降解趋势的二项式回归方程和多元回归方程,均具有高度的统计学意义(P均<0.01)。结论:应用本研究提供的72h内肾组织组织DNA变化与死亡时间之间呈线性关系的各组回归方程,为法医学推断死后经过时间提供了一种新的、客观的、精确的方法和参考依据。     

1401例超长住院日患者分布与影响因素分析

目的分析超长住院患者分布及影响因素,探讨减少超长住院日的措施。方法从江苏省某三甲医院病案管理系统中调取2020年1月1日-2020年12月31日134 016例出院患者的住院病案首页资料,对住院时间≥30天的1401例超长住院患者的分布特征进行统计描述,采用Logistic回归模型分析超长住院日的影响因素。结果 2020年全院平均住院日为7.13天,其中超长住院患者平均住院日为41.85天。超长住院患者以60岁以上年龄组最多(39.61%);出院科室主要分布在血液科(42.18%)、普通外科(11.85%)、骨科(7.49%)等;疾病类别主要为肿瘤(47.32%)、影响健康状态和与保健机构接触的因素(10.56%)、循环系统疾病(7.07%)等;多因素Logistic回归结果显示,男性(OR=1.188)、离院方式为非医嘱离院或其他(OR=2.046)和死亡病例(OR=3.362)是超长住院的危险因素。结论控制超长住院日对平均住院日影响显著,医院应加强重点人群、重点科室和重点病种管理提高诊疗管理水平,缩短平均住院日。     

亚甲基四氢叶酸还原酶基因多态性与脑血管疾病的研究

目的　探讨N 亚甲基四氢叶酸还原酶 (MTHFR)基因多态性与脑血管疾病的关系。方法　利用聚合酶链反应和限制性片段长度多态性 (PCR RFLP)方法 ,检测了 72名健康人和 71名脑血管疾病患者MTHFR基因的6 77碱基多态性突变C→T情况 ,并加以对照分析。结果　脑血管疾病患者MTHFR基因突变型V6 77基因的频率 ,与正常健康人对比差异无显著意义 (P >0 .0 5 )。结论　MTHFR基因突变型V6 77基因可能是脑血管疾病的又一个遗传风险因子 ,但本研究结果显示与脑血管疾病的发病无关 ,是否为脑血管病的遗传风险因素有待进一步研究。     

围产期缺氧对早产儿脑干功能的影响

目的用最大长度序列(MLS)脑干听觉诱发电位技术检测有围产期缺氧早产儿生后早期的脑干功能,研究不同程度缺氧对脑干功能的影响,并比较MLS脑干听觉诱发电位是否较常规法对异常的检出具有优越性。方法胎龄29~33+6周的早产儿,重度缺氧组51例,轻度缺氧组36例,对照组为相对正常早产儿41例。MLS脑干诱发电位的声刺激速率为91、227和455次/秒,选常规法21次/秒作为对照,观察指标为Ⅰ、Ⅲ、Ⅴ波潜伏期和振幅,Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ峰间期。结果随着缺氧程度加重,缺氧组早产儿V波潜伏期、Ⅲ-Ⅴ和Ⅰ-Ⅴ峰间期较正常对照组逐渐延长,V波振幅逐渐降低;通过MLS提高刺激速率后,缺氧早产儿Ⅲ波的潜伏期、Ⅰ-Ⅲ峰间期也表现出明显延长,Ⅲ波振幅也逐渐降低,并且随刺激速率逐渐增高,统计学差异逐渐明显。轻度缺氧组常规21次/秒时各参数与正常早产儿组无明显差异,但在MLS227及455次/秒时,Ⅲ、Ⅴ波潜伏期,各个峰间期也显示出延长[455次/秒时,轻度缺氧组Ⅲ波潜伏期为(6.55±0.53)ms,Ⅴ波潜伏期为(10.13±0.86)ms,Ⅰ-Ⅲ峰间期为(3.60±0.34)ms,Ⅲ-Ⅴ峰间期为(3.58±0.57)ms,Ⅰ-Ⅴ峰间期为(7.18±0.73)ms],同时部分振幅降低;重度缺氧组与轻度缺氧组的差异主要为Ⅴ波潜伏期、Ⅲ-Ⅴ和Ⅰ-Ⅴ峰间期延长及Ⅴ波振幅降低,而与正常早产儿组比较不仅上述差异更加显著,同时Ⅲ波的潜伏期及振幅、Ⅰ-Ⅲ峰间期也都显示出异常[455次/秒时,重度缺氧组Ⅴ波潜伏期为(10.57±0.93)ms,Ⅲ-Ⅴ峰间期为(3.93±0.53)ms,Ⅰ-Ⅴ峰间期为(7.60±0.73)ms,Ⅴ波振幅为(0.02±0.02)μV]。结论围产期缺氧会对早产儿生后早期的脑干功能造成损伤,且随缺氧程度加重诱发电位的变化也更加明显。MLS脑干听觉诱发电位通过提高刺激速率,加大神经元负荷,对脑损伤有更高的诊断价值。     

不同性别原发性高血压患者血清叶酸甘油三酯与水平MTHFR C677T位点的相关性

目的探讨不同性别原发性高血压患者中血清叶酸水平与甘油三酯水平及亚甲基四氢叶酸还原酶(MTHFR)C677T多态性位点的相关性。方法从哈尔滨、沈阳、北京、西安、上海、南京6城市收集的480例28~75岁轻中度原发性高血压患者,测定其血清叶酸和血脂水平及MTHFRC677T位点基因型及其他健康指标,对其中资料完整者445例(男性196例,女性249例)的MTHFRC677T位点、血清甘油三酯与叶酸水平的关系进行统计分析。结果①女性血清叶酸水平显著高于男性(P<0.05);②不同性别MTHFRC677T基因型中TT基因型人群的叶酸水平均显著低于CC或CT基因型(P<0.05),但CT基因型与CC基因型间叶酸水平差异无显著性;③调整年龄、MTHFRC677T基因型、地区等混杂因素后,男性中甘油三酯异常组血清叶酸水平显著低于正常组,女性中不显著。结论原发性高血压患者中血清叶酸水平与性别、MTHFRC677T基因多态性存在相关性,另外也发现男性叶酸水平与甘油三酯呈明显的负相关关系。     

5,10-亚甲基四氢叶酸还酶基因多态性与砷甲基化代谢的关系

目的:探讨5,10-亚甲基四氢叶酸还原酶(5,10-methylenetetrahydrofolate reductase, MTHFR)基因多态性及其与叶酸联合作用对砷甲基化代谢的影响.方法:在砷中毒流行区选择饮水史清楚、饮水砷含量高于0.05 mg/L的43名居民,采集空腹静脉血并收集晨尿,以聚合酶链反应-限制性长度多态性方法分析MTHFR基因C677T位点多态性,采用高效液相色谱-氢化物发生-原子荧光法检测尿中各种形态的砷,采用微生物法测定血清中叶酸水平.比较不同MTHFR基因型及其和叶酸联合作用与尿中砷化物百分构成的关系.结果:和MTHFR原型基因个体相比,MTHFR基因677位突变个体(包括杂合突变和纯合突变)尿中As3+构成增加(r=27.17,P=0.029),而二甲基胂酸百分含量下降(r=26.57,P=0.033);MTHFR C677T基因型和叶酸联合作用未对尿中不同砷化物百分构成产生影响(P＞0.05).结论:MTHFR基因C677T位点多态性可能影响个体砷代谢能力,且这种作用独立于血清叶酸水平.