心脏不停跳心内直视术后护理体会

目的:探讨浅低温体外循环心脏不停跳心内直视手术(简称不停跳术)后的护理体会。方法:对32例不停跳术和30例阻断升主动脉中低温体外循环心内直视术(简称停跳术),在术后的相关并发症和血管活性药物等护理方面进行比较分析。结果:停跳术在肺部并发症、血管活性药物、ICU入住时间均优于不停跳术,在血红蛋白尿并发症方面有待于提高和改进。结论:不停跳术由于术中对心肌保护更加充分,术后心功能恢复较快,呼吸道并发症、血管活性药物用药均明显减少,ICU入住时间、住院日数缩短,减轻了病人的经济负担,术后随访3~12个月均恢复良好。     

Photoreduction of Copper Ions Using Silica–Surfactant Hybrid and Titanium (IV) Oxide under Sulfuric Acid Conditions

Photoreduction of Cu²⁺ ions to Cu metal by titanium(IV) oxide (TiO₂) was conducted in the presence of a silica–surfactant hybrid under sulfuric acid conditions. After irradiation, a dark-red color, reflections due to Cu metal in the X-ray diffraction pattern, and peaks due to Cu 2p_1/2 and 2p_3/2 in the X-ray photoelectron spectrum indicated the precipitation of Cu metal in the product. In addition, an increase in the Brunauer–Emmett–Teller specific surface area from 36 and 45 m²/g for the silica–surfactant and TiO₂, respectively, to 591 m²/g for the product, and a decrease in the intensity of the C-H stretching band in the Fourier–transform infra-red spectra implied the removal of surfactant during the reaction. These characteristics were never observed when TiO₂ was used solely. Therefore, this study indicated that the photoreduction of Cu²⁺ ions to Cu metal by TiO₂ was facilitated under the sulfuric acid medium, where the surfactants extracted from silica–surfactant hybrids by protons in the acidic condition were successfully photo-oxidized by TiO₂. Thus, this study presents a new application of the conversion of a silica–surfactant hybrid into mesoporous silicas.     

A Novel Alveolar Distractor Incorporating Nickel–Titanium Alloy Springs: A Preliminary In Vitro Study

A new design of an alveolar distractor using nickel–titanium (NiTi) open-coil springs was developed and investigated to produce distraction forces against the tensile forces of porcine attached gingiva to simulate human gingiva. We subjected 15 mm long NiTi open-coil springs (Highland and ORMCO) with three levels of forces (light, medium and heavy) to mechanical testing in a 37 ± 1 °C water bath. Ten strips of porcine mandibular attached gingiva were subjected to tensile tests to determine the resistance force. The forces from the springs were compared with the tensile forces from the porcine attached gingiva. Data between groups were analyzed with independent-samples T-tests (p-value < 0.05). The tensile strength and the Young modulus were greater in buccal compared to lingual porcine attached gingiva. Compared to other spring dimensions and companies, forces generated from 0.014 × 0.036″ ORMCO springs were the highest and could overcome the tensile resistance from porcine attached gingiva over the longest distraction range of 1.6 mm. This preliminary in vitro study introduced a new design of an alveolar distractor incorporated with NiTi open-coil springs that could generate light and continuous forces to overcome the resistance from porcine attached gingiva.     

羟基磷灰石表面修饰人工角膜钛支架的生物相容性：电镜观察

背景：人工角膜是双眼角膜盲患者复明的希望,提高人工角膜材料的生物相容性使人工角膜与宿主角膜达到生物愈合是目前人工角膜的研究方向。 目的：扫描电子显微镜观察经羟基磷灰石表面修饰能否增加人工角膜纯钛支架的生物相容性。 方法：采用酸碱两步预处理法在人工角膜钛支架表面快速沉积羟基磷灰石涂层。将第4~6代兔角膜基质成纤维细胞直接接种于羟基磷灰石修饰的钛支架、纯钛支架及玻璃表面,3,24,48,72 h后,扫描电子显微镜观察材料表面的细胞黏附,伸展及增殖情况;将18只正常新西兰白兔随机分为2组,于右眼角膜基质层内分别植入羟基磷灰石修饰的钛支架、纯钛支架,术后6,12周取出人工角膜支架,扫描电子显微镜观察材料表面角膜组织贴附生长状态。 结果与结论：体外实验显示,细胞接种3 h和24 h后,细胞扩展面积及细胞张力丝长度：羟基磷灰石修饰的钛支架>玻璃>纯钛表面,羟基磷灰石修饰的钛支架表面的活细胞数多于其他材料表面(P < 0.05)。72 h后,羟基磷灰石修饰的钛支架表面完全被胶原覆盖。体内实验显示,扫描电子显微镜观察羟基磷灰石修饰的钛支架表面细胞外基质生长良好,与羟基磷灰石贴附紧密。而纯钛支架仅为角膜组织简单包裹。说明人工角膜纯钛支架经羟基磷灰石表面修饰后,其生物相容性增加。 关键词：人工角膜;羟基磷灰石;钛;表面改性;生物相容性;扫描电子显微镜 doi:10.3969/j.issn.1673-8225.2010.29.007     

钛表面双层纳米管制备及生物活性的测定

采用电化学两步阳极氧化法在钛表面制备纳米管,光滑纯钛作为对照组,通过场发射电镜、X射线能量色散谱和原子力显微镜观察分析试件表面微观形貌、元素组成和三维形貌并计算粗糙度。体外培养小鼠骨髓间质干细胞( BM-SCs)进行生物活性的测定。结果显示在钛表面制备出有序的双层蜂窝状二氧化钛纳米管阵列,纳米管的表面由钛和氧元素组成,纳米管组粗糙度值大于光滑组,两组间比较差异有统计学意义(P<0.05),纳米管组试件促进了BMSCs的黏附、增殖和分化。     

钢板内固定治疗肱骨近端骨折63例疗效分析

目的：探讨钢板内固定治疗肱骨近端骨折的临床疗效。方法：选取我院2004年6月-2010年8月收治的63例肱骨近端骨折患者的临床资料,所有患者均经过钢板内固定治疗,将其分为肱骨近端解剖钛板组（43例）、三叶草钛板组（8例）及肱骨近端锁定钛板组（12例）,随访6～24个月,依照Neer百分功能评分标准,观察三组术后并发症及临床疗效。结果：所有患者均为骨性愈合,平均愈合时间为7．2周,三叶草固定术后并发外展功能受限较多,锁定钛板能保证颈干角不丢失,疗效满意。结论：微创锁定钢板治疗肱骨近端骨折,术后并发症少,疗效满意,值得在临床推广。     

内镜下金属钛夹治疗上消化道出血的效果比较

目的 观察内镜下金属钛夹治疗上消化道出血的临床效果及安全性.方法 将2010年1月～2013年4月天门市第一人民医院消化内科治疗的95例内镜下急性消化道出血患者随机分成两组,48例进行金属钛夹止血治疗（治疗组）,47例进行内镜下注射药物止血（对照组）,比较两组患者的疗效.结果 治疗组症状消失时间明显短于对照组,治疗组患者的住院时间[（7.6±1.3）d]也短于对照组[（9.8±1.2）d],治疗组总有效率[100.0％ （48/48）]高于对照组总有效率[95.7％（45/47）],差异均有统计学意义（P＜0.05）.所有病例无穿孔及其他术后并发症.结论 经内镜下金属钛夹比注射止血治疗上消化道出血安全有效.     

EOLP不同椎板固定方法对颈椎曲度及轴性症状的影响

目的 探讨颈椎后路单开门椎管成形术(EOLP)不同椎板固定方法对颈椎曲度及轴性症状的影响.方法 回顾性分析天津市人民医院2009年1月至2012年1月因多节段脊髓型颈椎病(CSM)行EOLP的101例患者临床资料.其中32例采用传统缝线悬吊“门轴”(A组),35例患者采用锚钉法进行“门轴”固定(B组),34例患者采用微型钛板Centerpiece固定法(C组).对3组患者手术前、后日本骨科学会(JOA)评分,颈椎曲度变化及轴性症状评分进行分析.结果 3组患者平均随访时间为(31.83±5.10)个月,JOA评分改善率A、B、C组分别为(61.53±24.00)％、(60.72±19.82)％、(65.17±21.13)％,3组比较差异无统计学意义(F=0.41,P=0.67);颈椎曲度丢失A、B、C组分别为(3.38±1.51)％、(3.12±1.91)％、(2.24±1.30)％,3组比较差异有统计学意义(F=4.67,P=0.01);术后24个月轴性症状评分A、B、C组分别为(9.13±0.66)、(10.77±0.49)、(11.11±0.77)分,3组差异有统计学意义(F=88.30,P=0.00).JOA评分改善率与轴性症状评分无相关性(r=0.07,P＞0.05),颈椎曲度丢失与轴性症状评分呈负相关(r=-0.21,P=0.03).结论 EOLP传统缝线悬吊“门轴”法、锚钉固定“门轴”法、微型钛板centerpiece固定法均是开门法“门轴”固定的有效方法,但微型钛板内固定法可有效地减少术后颈椎曲度的丢失,降低轴性症状的发生率.     

新型抗肿瘤药物双（β-二酮）钛（Ⅳ）配合物的合成

目的开发新型抗肿瘤药物。方法以苯甲酰丙酮、二硫化碳、1,2-二溴乙烷为起始原料,设计合成了两个新型含硫杂环双（β-二酮）配体（Ⅰa-Ⅰb）及其钛配合物（Ⅱa-Ⅱb）。结果合成得到的新型含硫杂环双（β-二酮）配体（Ⅰa-Ⅰb）及其钛配合物（Ⅱa-Ⅱb）通过元素分析、红外光谱1、HNMR、MS等手段对其进行了结构表征。结论此合成路线完全可行。     

Effect of Surface Tooling Techniques of Medical Titanium Implants on Bacterial Biofilm Formation In Vitro

The aim of this study was to assess the biofilm formation of Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Escherichia coli on titanium implants with CAD-CAM tooling techniques. Twenty specimens of titanium were studied: Titanium grade 2 tooled with a Planmeca CAD-CAM milling device (TiGrade 2), Ti₆Al₄V grade 5 as it comes from CAD-DMLS device (computer aided design-direct metal laser sintering device) (TiGrade 5), Ti₆Al₄V grade 23 as it comes from a CAD-CAM milling device (TiGrade 23), and CAD-DMLS TiGrade 5 polished with an abrasive disc (TiGrade 5 polished). Bacterial adhesion on the implants was completed with and without saliva treatment to mimic both extraoral and intraoral surgical methods of implant placement. Five specimens/implant types were used in the bacterial adhesion experiments. Autoclaved implant specimens were placed in petri plates and immersed in saliva solution for 30 min at room temperature and then washed 3× with 1× PBS. Bacterial suspensions of each strain were made and added to the specimens after saliva treatment. Biofilm was allowed to form for 24 h at 37 °C and the adhered bacteria was calculated. Tooling techniques had an insignificant effect on the bacterial adhesion by all the bacterial strains studied. However, there was a significant difference in biofilm formation between the saliva-treated and non-saliva-treated implants. Saliva contamination enhanced S. mutans, S. aureus, and E. faecalis adhesion in all material types studied. S. aureus was found to be the most adherent strain in the saliva-treated group, whereas E. coli was the most adherent strain in the non-saliva-treated group. In conclusion, CAD-CAM tooling techniques have little effect on bacterial adhesion. Saliva coating enhances the biofilm formation; therefore, saliva contamination of the implant must be minimized during implant placement. Further extensive studies are needed to evaluate the effects of surface treatments of the titanium implant on soft tissue response and to prevent the factors causing implant infection and failure.