手部创伤性骨关节缺损的处理

治疗手部骨关节缺损常采用植骨内固定、关节融合、关节成形及关节置换等方法．为总结经验，对１９８９年以来１０１例手部创伤性骨与关节缺损进行分析。单纯掌、指骨缺损３９例，行直接短缩对位，克氏针内固定６例，１例发主骨不连；对３３例缺损较大者用自体骨块植入克氏针交叉内固定，部分病例同时植人ＲＢＸ或异体骨粒，１０例发生延迟愈合，余全部正常愈合。骨与关节部分或完全缺损６２例，采用关节成形术４６例，其中以肋软骨移植效果最好，骨膜移植次之，筋膜衬垫或硅胶膜植入法较差；行关节融合术１１例．均达顺利融合；采用自体关节置换５例，均成活，术后关节活动度均＞７０°。我们认为：自体骨块植入克氏针交叉内固定，必要时植入ＲＢＸ骨粒．是治疗手部创伤性骨缺损的有效方法。关节缺损应按关节的重要性，分别采用关节融合术、关节成形术或关节置换术。     

嗅觉诱发电位的实验研究

目的：观察电刺激家兔嗅区黏膜记录的诱发电位的波形及其稳定性，探讨一种可以客观评价嗅觉功能的方法。方法：将双极刺激电极经家兔前鼻孔置于嗅区黏膜，给予电刺激，在颅顶记录嗅觉诱发电位(OEPs)；改变刺激参数和部位，观察对电位潜伏期、阈值和波形的影响。结果：在颅顶前方近嗅球处记录到一组波形稳定的N1-P1-N23相复合波。潜伏期为：N1波20．6ms，P1波33．5ms，N2波58．3ms；改变刺激强度对各波无明显影响；改变刺激频率对各波影响较大，频率过高．波形分化较差。结论：正常OEPs是一组波形稳定的负-正-负3相复合波，波形稳定、重复性好，各参量可作为评价嗅觉功能变化的有用指标。     

老年人自评状况和社会支持与老年抑郁症患病率

目的 探讨老年人抑郁症患病率与自评状况及社会支持的关系。方法 就调查的1736名老年人的自评状况以及社会支持分别进行单因素的患病率分析，再进行多因素Logistic回归分析。结果 自评健康状况差、患有老年慢性支气管炎和癌症、健康恶化都可以增加老年抑郁症的患病率。     

老年人躯体疾病与老年抑郁症患病率

目的 探讨老年人躯体疾病与抑郁症患病率的关系。方法 就调查的1736名老年人的自评健康情况、躯体患病情况以及健康恶化情况分别进行单因素的患病率分析，再进行多因素Logistic回归分析。结果 自评健康差、患有老年慢性支气管炎和癌症、健康恶化都可以提高老年抑郁症的患病率。     

Role of Bile Acids in Liver Injury and Regeneration following Acetaminophen Overdose

Bile acids play a critical role in liver injury and regeneration, but their role in acetaminophen (APAP)–induced liver injury is not known. We tested the effect of bile acid modulation on APAP hepatotoxicity using C57BL/6 mice, which were fed a normal diet, a 2% cholestyramine (CSA)–containing diet for bile acid depletion, or a 0.2% cholic acid (CA)–containing diet for 1 week before treatment with 400 mg/kg APAP. CSA-mediated bile acid depletion resulted in significantly higher liver injury and delayed regeneration after APAP treatment. In contrast, 0.2% CA supplementation in the diet resulted in a moderate delay in progression of liver injury and significantly higher liver regeneration after APAP treatment. Either CSA-mediated bile acid depletion or CA supplementation did not affect hepatic CYP2E1 levels or glutathione depletion after APAP treatment. CSA-fed mice exhibited significantly higher activation of c-Jun N-terminal protein kinases and a significant decrease in intestinal fibroblast growth factor 15 mRNA after APAP treatment. In contrast, mice fed a 0.2% CA diet had significantly lower c-Jun N-terminal protein kinase activation and 12-fold higher fibroblast growth factor 15 mRNA in the intestines. Liver regeneration after APAP treatment was significantly faster in CA diet–fed mice after APAP administration secondary to rapid cyclin D1 induction. Taken together, these data indicate that bile acids play a critical role in both initiation and recovery of APAP-induced liver injury.Bile acids are versatile biological molecules that regulate energy homeostasis, activate nuclear receptors and cell signaling pathways, and control cell proliferation and inflammatory processes in the liver and gastrointestinal tract.^1,2 Bile acids maintain their own homeostasis by activating a complex signaling network involving hepatic and intestinal farnesoid X receptor (FXR), small heterodimer partner, and intestinal fibroblast growth factor (FGF) 15 (FGF19 in human) expression, culminating in inhibition of the primary bile acid–synthesizing enzyme, CYP7A1.^3–6 Although bile acids are potent signaling molecules at pathophysiological concentrations, they cause apoptosis, necrosis, and oxidative stress.^3,7–10 Bile acids have also been implicated in stimulation of liver regeneration.^11–14 Studies in recent years indicate that the bile acid–mediated gut-liver signaling axis may play a critical role in regulation of liver homeostasis.^6,15,16Acetaminophen (APAP) is the most commonly used analgesic and antipyretic agent.¹⁷ An overdose of APAP is the major cause of acute liver failure in the United States.^18,19 The mechanisms of APAP-induced liver injury and subsequent liver regeneration are the focus of intense investigation.^20–22 In an overdose situation, excess APAP is mainly metabolized by CYP2E1 to a reactive metabolite, N-acetyl-p-benzoquinone imine (NAPQI). In hepatocytes, conjugation of NAPQI to GSH is the key mechanism for detoxification of NAPQI. Once the GSH is depleted, NAPQI attacks cellular proteins, especially mitochondrial proteins, to form protein adducts. This triggers a cascade of intracellular signaling events involving c-Jun N-terminal protein kinase (JNK) activation and mitochondrial permeability transition, finally culminating in necrotic cell death.²⁰ Liver injury is followed by compensatory liver regeneration, which is a critical determinant of final outcome of liver injury.²³ Despite decades of research, how these intracellular events are affected by extracellular signaling is not known.The current study was designed to explore the role of bile acids in initiation of liver injury and stimulation of liver regeneration after APAP overdose. These studies are highly significant because the data reveal a novel role of bile acids in cellular protection and liver regeneration after APAP overdose, and these studies investigate the effect of resin-mediated bile acid depletion, a commonly used therapy, on APAP toxicity.     

医疗美容技术专业教学模式改革调查问卷分析

针对2010~2012级医疗美容技术专业160名学生的问卷调查,了解不同级段学生对该专业教学模式改革的认识以及分析调查出现的问题,提出一些合理化的建议和意见.     

m5C甲基化相关基因预测肾透明细胞癌的预后

目的：利用肿瘤基因组图谱(the Cancer Genome Atlas,TCGA)数据库中的数据,构建m5C甲基化相关基因组成的生存预后模型,分析与肾透明细胞癌生存有关的独立预后影响因素以预测肾透明细胞癌患者的预后。方法：从TCGA数据库下载肾透明细胞癌患者资料,从已发表的文献中获取m5C甲基化相关基因并分析其在肿瘤组和对照组间的表达差异。对这些基因进行共识聚类分析以揭示m5C甲基化相关基因与肾透明细胞癌预后之间的关系。通过单变量Cox分析和Lasso?Cox回归分析构建出生存预后模型并分析与肾透明细胞癌相关的预后影响因素,GO和KEGG富集分析进一步探索生物功能和潜在的信号通路。通过qRT?PCR验证m5C甲基化相关基因在肾透明细胞癌细胞系及组织和正常肾细胞系及组织之间的差异表达。 结果：m5C甲基化相关基因在肾透明细胞癌肿瘤组和正常组之间存在差异性表达。共识聚类分析结果显示亚群1的肾透明细胞癌患者预后优于亚群2。构建的生存预后模型将肾透明细胞癌分为高风险组和低风险组,单变量和多变量Cox分析显示分级和分期可能是肾透明细胞癌的独立预后因素,而GO和KEGG分析显示m5C?RNA甲基化修饰可影响肾透明细胞癌的进展。 此外,qRT?PCR实验也证实m5C甲基化相关基因在肾透明细胞癌肿瘤组和正常组之间表达存在差异。结论：本文构建的m5C 甲基化相关基因的生存预后模型可以预测肾透明细胞癌患者的预后。     

中国消除新生儿破伤风现场认证调查

目的 现场调查认证中国是否消除新生儿破伤风（NT）。方法 采用批质量保证-群抽样（LQA-CS）方法,现场人户调查中国NT发病风险最高的广东省江门市和广西壮族自治区河池市各随机抽取的96个调查点、每个点调查12名符合条件（调查前一年内出生）活产儿的NT发病情况。结果 江门市共调查23465户家庭、1153名合格活产儿,河池市共调查21623户家庭、1152名合格活产儿。现场认证调查所设立的各项质控指标均符合要求。调查中两市均未发现因NT引起的死亡或者住院病例,已达到消除NT的标准,结合现场调查各项可靠质控指标,也证实调查点已消除NT。结论 在中国2个NT发生最高危的地区已调查证实消除了NT,据此可以推断其他地区也应消除了NT。按照WHO认证程序,中国已实现消除NT,建议此后工作重点应转为维持消除NT状态。     

经右前外侧肋间小切口心脏多瓣膜手术154例中期疗效随访的回顾性队列研究

目的 分析经右前外侧肋间小切口心脏多瓣膜手术的早期疗效中期随访结果,探讨手术的安全性、有效性与外科医生学习曲线.方法 回顾性分析2015～2019年空军军医大学第一附属医院心血管外科完成的154例经右前外侧肋间小切口多瓣膜手术的临床资料.男103例,女51例,年龄23 ～ 68岁,全部手术经股动、静脉建立闭式体外循环,...