成人创伤后肘内翻畸形的矫形及双柱固定

目的探讨肱骨髁上截骨双钢板固定治疗成人创伤后肘内翻的方法及疗效。方法回顾性分析2007年6月-2010年12月手术治疗22例成人创伤后肘内翻畸形患者的临床资料。其中男16例,女6例;年龄18～29岁,平均21岁。既往均有肱骨髁上骨折病史;初次骨折后3个月～1年,平均6个月出现肘内翻畸形;出现畸形后4～17年,平均8年入院手术。术前患侧肘关节提携角为肘内翻16～25°,平均20.6°。肘关节功能采用Flynn评分均为差。术中行肱骨外侧闭合楔形截骨,以2块重建钢板塑形后分别置于肱骨内外侧柱以固定截骨断端。术后无需外固定,早期行功能锻炼。结果术后切口均Ⅰ期愈合。22例均获随访,随访时间6～24个月,平均13个月。末次随访时患侧肘关节提携角为肘外翻0～10°,平均7.5°。患者截骨处均骨性愈合,愈合时间8～13周,平均10周。术后无感染,神经、血管损伤,内固定物松动、断裂等并发症发生,无肘内翻复发。末次随访时Flynn评分优17例,良3例,中2例,优良率91%。结论采用肱骨髁上截骨加双钢板固定治疗成人创伤后肘内翻畸形,固定坚强,骨折愈合率高,术后能早期功能锻炼,肘关节功能恢复满意。     

成人先天性胆管囊状扩张症的临床分析

目的:探讨成人先天性胆管囊状扩张症的诊断及治疗。方法:回顾性分析1996年1月—2012年5月收治的53例成人先天性胆管囊状扩张症患者的临床资料。结果:53例患者均行手术治疗,Ia,Ib,Ic型39例和II型4例行囊肿完整切除、肝总管空肠Roux-en-Y吻合术,另3例Ia型行囊肿大部分切除、肝总管空肠Roux-en-Y吻合术;IVa型1例行肝左外叶切除、囊肿完整切除、胆管成形、肝总管空肠Roux-en-Y吻合术,另1例行囊肿完整切除、肝总管空肠Roux-en-Y吻合术;V型1例行左肝内胆管囊肿切除术;2例癌变患者,其中1例行癌变囊肿切除、局部转移淋巴结清扫术,1例行囊肿切除、左肝内胆管肿瘤切除术。53例手术患者中获随访42例,随访时间为6个月至3年,良性患者情况良好;2例癌变患者,1例术后生存26个月,死于肿瘤复发,多系统器官功能衰竭,1例术后26个月肿瘤复发,肝转移,再次手术行左半肝切除、S5(第V段肝脏)切除、肝肠吻合术,术后2个月出现肿瘤进展,死于多系统器官功能衰竭。结论:成人先天性胆管囊状扩张症的手术方式选择与治疗效果密切相关,不同的临床分型应选择不同的手术方式。     

2019年 NICE《成人原发性高血压管理指南》解读

高血压是脑卒中、心脏病、慢性肾衰竭等疾病的主要危险因素,高血压的及时治疗和综合管理具有重要意义。2019年8月英国国家卫生与临床优化研究所（NICE）发布了成人高血压诊断和管理指南,这是距2004年NICE高血压诊断和管理指南发布后的第３次更新,既沿用了以往的一些理念,又补充了许多新的内容,新版高血压管理指南在血压测量、高血压诊断、心血管风险、靶器官损害评估、降压治疗、血压监测及哪些患者需要专科医生诊治等方面均进行了全面而详细的阐述,尤其在高血压药物治疗的启动时机、治疗方案的选择及综合管理的治疗理念方面,值得临床医生借鉴与学习。     

高频振荡通气在成年人急性呼吸窘迫综合征的临床应用

背景 高频振荡通气(high-frequency oscillatory ventilation,HFOV)作为一种新的通气模式,具有高频率、小潮气量、高平均气道压的特点,近年来被成功应用于成年人急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的治疗.研究表明,HFOV在改善氧合、减少呼吸机相关性肺损伤(ventilator associated lung injury,VILI)方面较常规机械通气(conventional mechanical ventilation,CMV)具有优势.但其对ARDS病死率的影响尚不明确. 目的 通过归纳HFOV在成年人ARDS中的临床应用揭示HFOV的优势和缺陷. 内容 HFOV能够高效改善氧合、减少VILI,但不能减少ARDS的病死率.HFOV技术的最适患者的筛选、最佳使用时机、最佳参数的设定以及与其他治疗手段联用等问题有待进一步探索. 趋向 HFOV应用于ARDS的治疗需要更加深入的研究和探索.     

The effects of human keratinocyte coculture on human adipose‐derived stem cells

The potential for adipose‐derived stem cells to differentiate into keratinocyte‐like cells has recently been receiving attention, stemming from the hypothesis that a bioengineered skin may be manufactured from these readily available mesenchymal stem cells. This study was conducted to evaluate the influence of human keratinocyte non‐contact coculture on hADSCs. Human epidermal keratinocytes and hADSCs obtained by lipoaspiration were cultured in keratinogenic growth media, which were divided into the following groups: human adipose‐derived stem cell (hADSC) monoculture, non‐contact coculture of hADSCs and human keratinocytes and keratinocyte monoculture. Cell proliferation was assessed, and keratogenicity was analysed through immunocytochemistry and polymerase chain reaction of early, intermediate and late keratogenic markers. hADSCs cocultured with keratinocytes displayed enhanced proliferation compared with the monoculture group. After a 7‐day coculture period, immunohistochemistry and polymerase chain reaction findings revealed the presence of specific keratinocyte markers in the coculture group. This study demonstrates that hADSCs cocultured with keratinocytes have the capacity to transdifferentiate into keratinocyte lineage cells, and suggests that adipose tissue may be a source of keratinocytes that may further be used in structuring the bioengineered skin.     

口腔正畸联合修复治疗成人错颌畸形的临床效果

探究口腔正畸联合修复治疗成人错颌畸形的临床效果。方法 选取2019年5月-2023年1月南通市通州区平潮中心卫生院口腔科收治的50例成年错颌畸形患者为研究对象,随机分为对照组和观察组,各25例。对照组给予常规治疗,观察组给予口腔正畸联合修复治疗,比较两组口腔功能、协调美观度、临床疗效及治疗满意度。结果 观察组治疗后语言功能、咀嚼功能、协调美观度评分均优于对照组（P＜0.05）;观察组临床治疗总有效率为96.00%,优于对照组的56.00%（P＜0.05）;观察组治疗满意度为92.00%,优于对照组的52.00%（P ＜0.05）。结论 采用口腔矫正与修复相结合的方式对成年错颌畸形进行矫治,可有效提高患者口腔功能及协调美观度,加速其牙齿的修复,患者满意度高,值得临床应用。     

应用新的治疗满意度量表来评估ED患者及其性伴侣对伐地那非治疗的满意度

治疗满意度量表(TSS)是为评估男性勃起功能障碍(ED)患者及其性伴侣对ED治疗的满意度而制订的一个新量表。该自我报告式的调查问卷由四大部分组成:未治疗期的患者,治疗期的患者,未治疗期患者的性伴侣,以及治疗期患者的性伴侣。对以下6个方面进行评估:自信心、勃起的容易度、对勃起功能的满意度、性快感、对性高潮的满意度以及治疗满意度。TSS量表已经过多国有效性检验和心理学测验,被证明能可靠评价患者及其伴侣对ED治疗的满意度。在最近完成的一项双盲、多中心、平行组、灵活剂量的临床试验中,应用这个新的TSS量表比较了ED患者及其伴侣对伐地那非和安慰剂治疗的满意度。结果发现,伐地那非能显着改善勃起功能以及ED患者和伴侣的自信心、感知到的勃起容易度、性快感、对勃起功能、高潮和药物治疗的满意度。     

成人骨髓基质干细胞体外定向诱导分化为软骨细胞的实验研究

目的 建立临床成人骨髓基质干细胞(MSCs)体外培养、定向诱导分化为软骨细胞的途径。方法抽取成人骨髓，Percol密度梯度离心法进行体外培养，贴壁细胞传代，取第3代细胞在培养基中添加软骨分化诱导剂地塞米松、维生素C和不同剂量转化生长因子-β(TGF-β)，培养16d后,在倒置显微镜观察细胞形态，甲苯胺蓝染色蛋白多糖，逆转录一聚合酶链反应(RT-PCR)、免疫细胞化学(SABC法)检测Ⅱ型胶原表达，诱导后MSCs与新型材料聚乳酸和羟基乙醇共聚物(PL-GA)复合。结果 Percoll密度梯度离心法培养可获得均一的。MSCs；5、10ng TGF-β诱导分化的MSCs生长迅速。呈典型的软骨细胞形态，甲苯胺蓝染色阳性，Ⅱ型胶原表达阳性，MSCs对材料PL-GA黏附力强。结论 可以从成人骨髓中培养出MSCs，并可定向诱导分化为软骨细胞，5～10ng TGF-β为最佳诱导剂量，成人MSCs可用作临床自体软骨组织工程种子细胞。     

Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis

There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4–8) in the L5 group and 6.09 (range 4–9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7° before surgery to 6.8° after surgery in the L5 group, and from 22.8° to 7.7° in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration.