替罗非班联合替格瑞洛和阿司匹林在老年急性心肌梗死急诊经皮冠状动脉介入治疗中的临床疗效

目的 观察对于老年急性心肌梗死（AMI）患者采取急诊经皮冠状动脉介入（PCI）治疗中采用替罗非班联合替格瑞洛和阿司匹林治疗的临床疗效分析。方法 选取2016年1月-2017年12月在郑州市第一人民医院急诊科确诊为急性心肌梗死行急诊PCI治疗的老年患者138例,根据PCI围术期治疗药物不同将患者分为观察组69例和对照组69例,对照组患者术前均给予负荷量阿司匹林300 mg及替格瑞洛180 mg嚼服,观察组在此基础上加用替罗非班术前以0.4 U/（kg· min）速度静脉泵入30 min,术后以0.1 U/（kg· min）的速度持续泵入24~36 h,术后两组均常规口服阿司匹林和替格瑞洛,至术后12个月。对比两组患者临床治疗效果、安全性及心肌酶标志物与超声检查。结果 观察组患者无复流、慢血流、主要不良心脏事件（MACE）发生率明显少于对照组,TIMI3及ST段回落几率高于对照组,观察组心肌酶标志物酸激酶同工酶（CK-MB）浓度峰值时间、左室射血分数（LVEF）及左室舒张末内径（LVEDd）结果明显优于对照组,差异均具有统计学意义（P<0.001）。治疗后两组血清超敏C-反应蛋白（hs-CRP）和白介素-6（IL-6）水平均显著降低（P<0.05）;且治疗后观察组hs-CRP、IL-6均显著低于对照组（P<0.05）。两组均未出现严重出血,两组出血发生率比较差异无统计学意义;两组非心源性呼吸困难发生率比较差异无统计学意义,入组患者均未因上述不良反应而停用抗血小板药物。结论 对于老年AMI患者采取急诊PCI术时,应用替罗非班联合替格瑞洛和阿司匹林治疗,可有效减少无复流或慢血流的发生几率,改善心肌灌注功能,不增加出血风险,减少主要不良心脏事件发生。     

Static reconstruction of malar region in facial paralysis: A new alternative technique for plasty of symmetric mouth appearance

Abstract

Static suspension using fascia lata graft is used as a reconstructive procedure against drooping of the mouth corner for treating longstanding facial paralysis. Although it achieves symmetry at rest, movement of the mouth corner at mouth opening is restricted to some extent because it is fixed with fascia lata to the immovable temporal fascia, the parotid fascia, or bones. This was overcome by suspending the mouth corner to the mandibular coronoid process with fascia lata, which enabled a shift of the mouth corner with mouth opening and closure. The nine patients discussed in this study were operated on since 1994 for longstanding facial paralysis and followed-up for over 1.5 years. As in conventional static suspension, the fascia lata was harvested and split into two bands. Next, one semi-oval fascial loop was inserted around the paralysed part of the mouth and tied with another fascial band at the mouth corner, which was looped to the mandibular coronoid process. The suspended fascia lata graft was relaxed with anteroinferior movement of the coronoid process at mouth opening, enabling the mouth corner to shift inferiorly. The mouth corner returned to its original position at mouth closure, and the nasolabial fold deepened during mastication. No limitation in mouth opening was observed. Suspension of the mouth corner to the mandibular coronoid process provided a dynamic element, thereby restoring a near-normal shift. The procedure is considered as an alternative for reconstructing the malar region of patients with facial paralysis and in whom dynamic reconstruction is not indicated.     

Early postnatal motor experience shapes the motor properties of C57BL/6J adult mice

This study aimed to evaluate the long‐term consequences of early motor training on the muscle phenotype and motor output of middle‐aged C57BL/6J mice. Neonatal mice were subjected to a variety of motor training procedures, for 3 weeks during the period of acquisition of locomotion. These procedures are widely used for motor training in adults; they include enriched environment, forced treadmill, chronic centrifugation, and hindlimb suspension. At 9 months, the mice reared in the enriched environment showed a slower type of fibre in slow muscles and a faster type in fast muscles, improved performance in motor tests, and a modified gait and body posture while walking. The proportion of fibres in the postural muscles of centrifuged mice did not change, but these mice showed improved resistance to fatigue. The suspended mice showed increased persistence of immature hybrid fibres in the tibialis, with a slower shift in the load‐bearing soleus, without any behavioural changes. The forced treadmill was very stressful for the mice, but had limited effects on motor output, although a slower profile was observed in the tibialis. These results support the hypothesis that motor experience during a critical period of motor development shapes muscle phenotype and motor output. The different impacts of the various training procedures suggest that motor performance in adults can be optimized by appropriate training during a defined period of motor development.     

Skin substitutes with noncultured autologous skin cell suspension heal porcine full-thickness wounds in a one-stage procedure

Clinical application of skin substitute is typically a two-stage procedure with application of skin substitute matrix to the wound followed by engraftment of a split-thickness skin graft (STSG). This two-stage procedure requires multiple interventions, increasing the time until the wound is epithelialised. In this study, the feasibility of a one-stage procedure by combining bioengineered collagen-chondroitin-6-sulfate (DS1) or decellularised fetal bovine skin substitute (DS2) with autologous skin cell suspension (ASCS) in a porcine full-thickness wound healing model was evaluated. Twelve full-thickness excisional wounds on the backs of pigs received one of six different treatments: empty; ASCS; DS1 with or without ASCS; DS2 with or without ASCS. The ASCS was prepared using a point-of-care device and was seeded onto the bottom side of DS1, DS2, and empty wounds at 80 000 cells/cm². Wound measurements and photographs were taken on days 0, 9, 14, 21, 28, 35, and 42 post-wounding. Histological analysis was performed on samples obtained on days 9, 14, 28, and 42. Wounds in the empty group or with ASCS alone showed increased wound contraction, fibrosis, and myofibroblast density compared with other treatment groups. The addition of ASCS to DS1 or DS2 resulted in a marked increase in re-epithelialisation of wounds at 14 days, from 15 ± 11% to 71 ± 20% (DS1 vs DS1 + ASCS) or 28 ± 14% to 77 ± 26 (DS2 vs DS2 + ASCS) despite different mechanisms of tissue regeneration employed by the DS used. These results suggest that this approach may be a viable one-stage treatment in clinical practice.     

猪肺表面活性物质联合布地奈德混悬液气管内滴入治疗新生儿胎粪吸入综合征的疗效观察

目的探讨猪肺表面活性物质(PS)联合布地奈德混悬液气管内滴入治疗新生儿胎粪吸入综合征(MAS)的临床效果。方法采用前瞻性研究法,将70例MAS新生儿随机分成治疗组与对照组(n=35)。对照组常规给予气管内滴入PS(100 mg/kg)治疗,治疗组在此基础上加用布地奈德(0.25 mg/kg)治疗。结果治疗组在治疗后12 h需重复使用PS的比例明显低于对照组(P0.05)。治疗组在治疗后6 h、12 h、24 h动脉氧分压与吸入氧浓度比值(Pa O_2/Fi O_2)、经皮血氧饱和度(Tc Sa O_2)、动脉血氧分压(Pa O_2)、动脉血二氧化碳分压(Pa CO_2)的改善情况明显优于对照组(P0.05)。治疗后48 h胸片显示治疗组肺部炎症吸收明显优于对照组(P0.05);治疗组并发症的发生率明显低于对照组(P0.05),平均住院时间也较对照组明显缩短(P0.01)。结论与单用PS比较,PS联合布地奈德混悬液气管内滴入治疗新生儿MAS能更好改善血气指标和临床症状,缩短住院时间,减少并发症。     

广藿香悬浮细胞原生质体的分离与纯化研究

目的 探讨广藿香悬浮细胞原生质体分离与纯化过程中的影响因素.方法 以广藿香悬浮细胞为材料,采用酶解法分离原生质体,结合过滤法和离心沉降法进行纯化,测定原生质体产量和活力,考察酶液组合、酶解时间、渗透压调节剂甘露醇浓度、悬浮细胞继代培养时间、不同孔径滤网和离心条件的影响.结果 将继代培养9～14d的悬浮细胞在质量浓度分别为1.5％纤维素酶、0.8％果胶酶、0.5％半纤维素酶,渗透压调节剂甘露醇浓度为0.4 mol/L条件下,避光振荡酶解12h,可分离出大量原生质体,依次经40→100→200目滤网过滤,600 r/min离心5 min,得到杂质少、形态正常的广藿香悬浮细胞原生质体,产量为13.05x 105个/g,活力达到80.98％.结论 建立了广藿香悬浮细胞原生质体的分离及纯化方法,获得高产量高活力的原生质体,可用于培养、原生质体融合等进一步研究.     

临时卵巢悬吊术减少子宫内膜异位症手术后粘连的Meta分析

目的：通过Meta分析综合评价临时卵巢悬吊术是否能减少子宫内膜异位症（EMs）患者腹腔镜术后的卵巢粘连。方法：检索PUBMED、MEDLINE、EMBASE、the ISI Web of Science、Ovid、Cochrane Library、中国知网（CNKI）、万方全文数据库、维普中文科技期刊数据库、中国生物医学文献数据库、中国期刊全文数据库和Google学术搜索等,并辅以手工检索。检索时间截至2017年12月,收集关于临时卵巢悬吊术预防腹腔镜手术治疗EMs术后卵巢粘连的随机对照试验（RCT）。由2名研究者按Cochrane系统评价方法提取数据进行Meta分析。结果：共纳入4篇RCT,共计302例患者。结果显示：临时卵巢悬吊术能降低EMs患者腹腔镜治疗后卵巢粘连的发生（RR＝0.75,95%CI：0.64～0.87）,可能有效缓解EMs患者腹腔镜术后大便困难（RR=－0.30,95%CI：－0.58～ －0.02）,但并不一定能缓解患者痛经（RR=－0.75,95%CI：－1.92～0.41）、慢性盆腔疼痛（RR=－0.77,95%CI：－1.88～ 0.35）、性交困难（RR=1.25,95%CI：－0.86～3.37）及尿痛（RR=－1.51,95%CI：－4.22～1.20）。结论：运用临时卵巢悬吊术能减少腹腔镜治疗EMs患者术后卵巢粘连的发生,改善患者大便困难的症状,一定程度提高患者生活质量。     

HPLC法测定磺胺嘧啶混悬液中的有关物质

摘 要 目的：建立HPLC法测定磺胺嘧啶混悬液中有关物质的检查方法。方法: 采用Capcell PAK MGⅡ C18 (250 mm×4.6 mm,5 μm)色谱柱,流动相A为0.3%乙酸铵溶液,流动相B为乙腈,梯度洗脱,流速为1.0 ml·min-1,检测波长为260 nm,柱温为30℃。结果: 磺胺嘧啶在0.155 1～15.510 0 mg·ml-1浓度范围内线性关系良好（r=0.999 8）,各杂质峰与主峰均能完全分离。杂质A、B、C、D的平均加样回收率分别为101.2%、99.9%、100.8%、103.7%,RSD分别为1.6%、0.8%、0.8%、0.6%（n=9）。结论: 本方法专属性强,准确度高,重现性良好,可用于磺胺嘧啶混悬液的质量控制。     

尾悬吊模拟失重大鼠肺组织一氧化氮合酶的变化

目的 :研究尾悬吊模拟失重大鼠肺组织一氧化氮合酶 (NOS)的变化。方法 :采用尾悬吊模拟失重 ,分为悬吊 7日和 2 1日及相应对照 4个组 ,每组 10只健康雄性 SD大鼠 ,共 4 0只大鼠。并采用免疫组织化学技术检测肺组织 NOS的表达情况。结果 :同正常对照组相比 ,7日尾悬吊模拟失重大鼠肺组织诱导型一氧化氮合酶(i NOS)的表达水平明显增高 (P<0 .0 5 ) ;2 1日的表达水平仍显著增高 (P<0 .0 5 ) ,同时可见血管内皮细胞随着时间延长阳性数目显著增多 (P<0 .0 1)。结论 :在模拟失重条件下肺组织 i NOS的表达水平增高     

A pilot multi‐centre prospective randomised controlled trial of RECELL for the treatment of venous leg ulcers

Venous leg ulcers (VLUs) have a significant impact on approximately 3% of the adult population worldwide, with a mean NHS wound care cost of £7600 per VLU over 12 months. The standard care for VLUs is compression therapy, with a significant number of ulcers failing to heal with this treatment, especially with wound size being a risk factor for non‐healing. This multicentre, prospective, randomised trial evaluated the safety and effectiveness of autologous skin cell suspension (ASCS) combined with compression therapy compared with standard compression alone (Control) for the treatment of VLUs. Incidence of complete wound closure at 14 weeks, donor site closure, pain, Health‐Related Quality of Life (HRQoL), satisfaction, and safety were assessed in 52 patients. At Week 14, VLUs treated with ASCS + compression had a statistically greater decrease in ulcer area compared with the Control (8.94 cm² versus 1.23 cm², P = .0143). This finding was largely driven by ulcers >10 to 80 cm² in size, as these ulcers had a higher mean percentage of reepithelialization at 14 weeks (ASCS + compression: 69.97% and Control: 11.07%, P = .0480). Additionally, subjects treated with ASCS + compression experienced a decrease in pain and an increase in HRQoL compared with the Control. This study indicates that application of ASCS + compression accelerates healing in large venous ulcers.