皮肤扩张术修复头皮合并颅骨缺损

目的探讨头皮合并颅骨缺损的修复方法。方法对2000年至2007年治疗的6例头皮合并颅骨缺损患者，采用皮肤扩张术修复头皮，钛网修补颅骨缺损。结果6例患者中，1例患者出现皮瓣下积液，经抽吸、加压包扎后愈合；其余病例未出现感染、血肿及皮瓣坏死等并发症，外观满意。结论皮肤扩张术和钛网联合应用是修复头皮合并颅骨缺损的较好方法。     

Human temperature regulation during cycling with moderate leg ischaemia

The effect of graded ischaemia in the legs on the regulation of body temperature during steady-state exercise was investigated in seven healthy males. It was hypothesised that graded ischaemia in the working muscles increases heat storage within the muscles, which in turn potentiates sweat secretion during exercise. Blood perfusion in the working muscles was reduced by applying a supra-atmospheric pressure (+6.6 kPa) around the legs, which reduced maximal working capacity by 29%. Each subject conducted three separate test trials comprising 30 min of steady-state cycling in a supine position. Exercise with unrestricted blood flow (Control trial) was compared to ischaemic exercise conducted at an identical relative work rate (Relative trial), as well as at an identical absolute work rate (Absolute trial); the latter corresponding to a 20% increase in relative workload. The average (SD) increases in both the rectal and oesophageal temperatures during steady-state cycling was 0.3 (0.2)°C and did not significantly differ between the three trials. The increase in muscle temperature was similar in the Control (2.7 (0.3)°C) and Absolute (2.4 (0.7)°C) trials, but was substantially lower (P<0.01) in the Relative trial (1.4 (0.8)°C). Ischaemia potentiated (P<0.01) sweating on the forehead in the Absolute trial (24.2 (7.3) g m^–2 min^–1) compared to the Control trial (13.4 (6.2) g m^–2 min^–1), concomitant with an attenuated (P<0.05) vasodilatation in the skin during exercise. It is concluded that graded ischaemia in working muscles potentiates the exercise sweating response and attenuates vasodilatation in the skin initiated by increased core temperature, effects which may be attributed to an augmented muscle metaboreflex.     

Prediction of the average skin temperature in warm and hot environments

The prediction of the mean skin temperature used for the Required Sweat Rate index was criticised for not being valid in conditions with high radiation and high humidity. Based on a large database provided by 9 institutes, 1999 data points obtained using steady-state conditions, from 1399 experiments and involving 377 male subjects, were used for the development of a new prediction model. The observed mean skin temperatures ranged from 30.7 °C to 38.6 °C. Experimental conditions included air temperatures (T _a) between 20 and 55 °C, mean radiant temperatures (T _r) up to 145 °C, partial vapour pressures (P _a) from 0.2 to 5.3 kPa, air velocities (v _a) between 0.1 and 2 m/s, and metabolic rates (M) from 102 to 620 W. Rectal temperature (T _re) was included in the models to increase the accuracy of prediction. Separate models were derived for nude (clothing insulation, I_cl, ≤0.2 clo, where 1 clo=0.155 m² · °C · W⁻¹, which is equivalent to the thermal insulation of clothing necessary to maintain a resting subject in comfort in a normally ventilated room, air movement=10 cm/s, at a temperature of 21 °C and a humidity of less than 50%) and clothed (0.6 ≤ I_cl ≤ 1.0 clo) subjects using a multiple linear regression technique with re-sampling (non-parametric bootstrap). The following expressions were obtained for nude and clothed subjects, respectively: T _sk=7.19 + 0.064T _a + 0.061T _r + 0.198P _a− 0.348v _a + 0.616T _re and T _sk=12.17 + 0.020T _a + 0.044T _r + 0.194P _a − 0.253v _a + 0.0029M + 0.513T _re. For the nude and clothed subjects, 83.3% and 81.8%, respectively, of the predicted skin temperatures were within the range of ±1 °C of the observed skin temperatures. It is concluded that the proposed models for the prediction of the mean skin temperature are valid for a wide range of warm and hot ambient conditions in steady-state conditions, including those of high radiation and high humidity. Accepted: 7 February 2000     

负压封闭吸引对糖尿病溃疡愈合的促进作用

目的 在"创而床准备(WBP)"理论指导下,观察负压封闭吸引局部处理糖尿病溃疡的疗效.方法 收集2000年1月至2005年1月间收治的27例糖尿病溃疡患者作对照组,2005年1月至2007年6月的8例糖尿病溃疡患者为试验组.两组患者均经常规系统的治疗,试验组在创面的黑、黄期采用清创后负压吸引治疗.观察两组创而各分期间的演进情况.比较两组手术Ⅰ期修复率、入院首次及实施负压治疗后1、2、3周创面细菌学检查结果 .观察各期创面组织标本的HE染色和黄、红两期Ⅰ、Ⅲ型胶原纤维苦味酸-天狼猩红染色结果 及对其含量进行图像分析.结果 试验组患者创面各分期的演进速度、于术Ⅰ期修复率均优于以照组(100%比46%,P<0.05).治疗2周后试验组创面末检出致病菌,对照组检出率为66.7%(P<0.05).HE染色显示试验组各期间的演进类似于急性创面愈合过程,且试验组黄期Ⅰ、m型胶原总含量为12.28%,对照组为24.77%(P<0.01).结论 基于WBP方案的负压吸引治疗能促进糖尿病溃疡的创面愈合过程.     

雌激素处理DCs在诱导小鼠同种皮肤移植免疫耐受中的作用

目的：研究雌二醇（17β-estradiol, E₂）处理的供体骨髓来源树突细胞（dendritic cells, DCs）在诱导小鼠同种异基因皮肤移植免疫耐受中的作用。方法：体外培养小鼠骨髓来源DCs，然后用E₂处理。受体小鼠在皮肤移植前经尾静脉分别输注经E₂处理的供体小鼠DCs、供体小鼠成熟DCs以及不成熟DCs，输注PBS为对照组。1周后对受体小鼠进行同种异基因皮肤移植，手术后观察皮肤存活情况，应用流式细胞术检测手术前后受体小鼠外周血中CD4+CD25+调节性T细胞百分率的变化。结果：在同种异基因皮肤移植中，受体小鼠尾静脉输注经E2处理的DCs组与对照组和不成熟DCs组比较，移植皮肤存活时间显著延长，较不成熟DCs组存活时间平均延长10.6 d（P<0.01）；与对照组和不成熟DCs组比较，E₂处理组外周血中CD4+CD25+ 调节性T细胞百分率明显升高（P<0.01）。结论：在同种异基因小鼠皮肤移植模型中，E₂处理的供体小鼠DCs可以延长移植皮肤存活时间。     

Physiological Detection of Deception: Measurement of Responses to Questions and Answers During Countermeasure Maneuvers

Physiological detection of deception (“lie detection”) procedures were evaluated with 24 actors, half of whom were “guilty” of a mock-crime and half were “innocent.” All subjects were trained in the Stanislavsky method of acting and were instructed to use this method to appear innocent on the polygraph test. Two versions of the control question detection of deception test were employed: one in which subjects verbally answered immediately following each question and the other in which they delayed their verbal answer for 8 sec following each question. The delayed answer technique allowed the separate measurement of physiological responses to the questions and the answers. Skin resistance responses, cardiovascular changes, and respiration were recorded and analyzed. Excluding inconclusive results, the overall accuracy of the decisions varied between 78% and 91% depending on the test employed. The principal results were: 1) attempts by guilty subjects to appear innocent were totally ineffective, 2) physiological responses elicited by the questions were more valid indicators of deception and nondeception than were the responses elicited by the verbal answers, and 3) errors occurred more frequently with innocent subjects (between 17% and 25% depending on the measure used) than with guilty subjects (0% with each measure). Variables which may affect the generalizability of these results to the field situation are discussed and suggestions for increasing the generalizability of laboratory findings are made.     

供体骨髓细胞输注促进小鼠皮肤移植耐受及其机理的研究

目的　探索“细胞 +环磷酰胺 (cyclophosphamide ,CP)”系统联合抗H 2 b 单克隆抗体、供体骨髓细胞输注诱导移植耐受的作用及其机制。方法　第 0天 ,经尾静脉给C5 7BL/ 6 (H 2 b,B6 )小鼠注入 10 8BALB/c(H 2 d,B/c)来源的脾细胞 ,第 2天 ,腹腔注射环磷酰胺 2 0 0mg/kg ,第 3、5天 ,分别经尾静脉注入抗H 2 b 单抗 ,剂量为 40 0 μg/ 0 .5ml,第 8天进行皮肤移植。皮肤移植后 1周 (第 15天 ) ,输入 2× 10 7供体BALB/c来源的骨髓细胞。观察皮肤移植物存活时间 ,并于第 30天对耐受B6小鼠作混合淋巴细胞反应 (mixedlymphocytereaction ,MLR) ,迟发型超敏反应 (delayedtypehypersensitivity ,DTH)等确定耐受的状态。并通过过继转移实验、嵌合体检查及脾细胞中细胞因子mRNA的表达情况 ,进一步探讨耐受形成的机制。结果　采用此诱导方案 ,B6小鼠对BALB/c小鼠的皮肤移植物长期存活。耐受可以被过继转移 ;耐受小鼠胸腺内的嵌合程度与耐受的维持密切相关 ;TH1型细胞因子在耐受小鼠中明显降低 ,而TH2型细胞因子明显升高。结论　“细胞 +CP”系统联合H 2 b 单克隆抗体、供体骨髓细胞输注能够诱导异基因小鼠皮肤移植耐受。耐受机制与胸腺嵌合体的存在密切相关。克隆无能 (aner gy)、抑制细胞和TH1/TH2偏移在耐受中也     

Dynamic Thermography: Analysis of Hand Temperature During Exercise

Exercise has a noted effect on skin blood flow and temperature. We aimed to characterize the normal skin temperature response to exercise by thermographic imaging. A study was conducted on ten healthy and active subjects (age=25.8 ± 0.7 years) who were exposed to graded exercise for determination of maximal oxygen consumption (VO₂ max), and subsequently to constant loads corresponding to 50%, 70%, and 90% of VO₂ max. The skin temperature response during 20 min of constant load exercise is characterized by an initial descending limb, an ascending limb and a quasi-steady-state period. For 50% VO₂ the temperature decrease rate was --0.0075±0.001°C/s during a time interval of 390 ±47 s and the temperature increase rate was 0.0055 ± 0.0031 °C/s during a time interval of 484 ±99 s. The level of load did not influence the temperature decrease and increase rates. In contrast, during graded load exercise, a continuous temperature decrease of --0.0049 ± 0.0032 °C/s was observed throughout the test. In summary, the thermographic skin response to exercise is characterized by a specific pattern which reflects the dynamic balance between hemodynamic and thermoregulatory processes. © 1998 Biomedical Engineering Society. PAC98: 8722Pg, 8759Wc, 8745Dr, 0180+b, 8745Hw     

Relationship between core temperature and skin blood flux in lower limbs during prolonged arm exercise in persons with spinal cord injury

The purposes of the present study were to examine the response of the skin blood flux (SBF) in the paralyzed lower limbs of persons with spinal cord injury (PSCI) and to clarify the relationship between the SBF and core temperature during prolonged arm exercise. Eight male PSCI with lesions from T6 to L5 and six male control subjects (CS) participated in this study. The subjects rested for 60 min and then performed arm-cranking exercise at 20 W for 30 min at 25 °C. The tympanic membrane temperature (T _ty) and SBF in the anterior thigh (SBFT) and in the posterior calf (SBFC) were continuously measured throughout the experiment. The SBFC did not change in either PSCI or CS during the experiment. The SBFT in four PSCI with high lesions (T6 to T12), remained unchanged during exercise. The SBFT in the other four PSCI with low lesions (T12 to L5, SBFT+) began to elevate markedly when the T t, exceeded a threshold temperature of 36.69 °C. The pattern of increase of SBFT in SBFT+ was similar to that in CS, although onset of the increase in SBFT was delayed and the peak of SBFT during exercise was significantly lower in comparison with the CS. We consider that these differences between the SBFT+ and CS were largely attributable to the lowerT _ty in the former group, which took a prolonged time to reach the threshold of 36.69 °C.     

Design of a multichannel solid-state recorder and its application to temperature measurement

The development of a multichannel unconstrained memory system for monitoring physiological information is described. The system comprises a portable recorder, worn by the subject, to detect and store data in memory and a readout unit for transferring the data to a microcomputer. Using the microcomputer, the physiological data are displayed, retrieved and analysed. The portable recorder consists of a memory control unit, an instrumentation unit, an LCD timer and batteries. In the memory-control unit the data are transferred to EPROM (erasable programmable read-only memory), which is a nonvolatile memory. This memory, removed from the protable recorder, can be delivered to the laboratory and its contents analysed without interrupting the field experiment. In connection with the instrumentation unit, an 8-channel skin thermometer was designed and tested. It was accurate to within ±0.08°C compared with a standard thermometer.