对比剂注射方式对CT门静脉成像质量的影响

目的 :探讨对比剂注射方式对CT门静脉成像质量的影响。方法 :选取行双源CT门静脉血管成像,且符合纳入标准的116例患者进行研究,通过抽签法分为研究组(n=63)与对照组(n=53)。研究组先以4.0 mL/s的流率注射碘佛醇(370 mg I/mL)60 mL,后以2.0 mL/s的流率注射碘佛醇30 mL,再用30 mL生理盐水以3.0 mL/s的流率冲管;对照组先以3.0 mL/s的流率注射碘佛醇(370 mg I/mL)90 mL,再用30 mL生理盐水以3.0 mL/s的流率冲管。由2位有经验的技师对2组图像质量进行评分,并测出门静脉主干、门静脉左右支主干、脾静脉和门静脉主干-肝实质CT值,对比2组所测CT值。对2位技师的CTV图像质量评分的一致性行Kappa检验;2组测量图像质量评分及CT值数据比较采用两独立样本t检验。结果:2位技师对2组图像质量评分一致性好(K=0.839)。2组门静脉主干、门静脉左右支主干、脾静脉、门静脉主干-肝实质的CT值和图像质量评分比较,差异均有统计学意义(均P0.05)。结论:对比剂以不同流率相结合的注射方式能够提高门静脉成像质量,减少其他血管的干扰。     

吸入性损伤患者早期气管切开拔管时机及后期并发症分析

Objective To investigate the appropriate extubation time and treatment of late complications after early tracheotomy in patients with moderate or severe inhalation injury. Methods One hundred and fifty patients ( 105 males and 45 females) with inhalation injury were admitted to our hospital from January 2000 to January 2009. Among them, 109 out of 129 cases with moderate inhalation injury received early tracheotomy, and all 21 cases with severe inhalation injury received early tracheotomy. Data were collected for analysis as follows: ( 1 ) incidence of re-intubation due to suffocation and pneumonia incidence after extubation within 2 weeks or after 2 weeks post inhalation injury (PⅡ), and mortality rate within the first week after injury were recorded. (2) Conservative treatments including expectorant, oral antibiotics, and absolute bedrest were recommended for patients who had severe cough, hoarseness or poor pulmonary function after late extubation and closure of tracheostomy wound. Fiberoptic bronchoscopy findings ( tracheostenosis degree, granuloma formation rate, vocal cord paralysis rate) and pulmonary function index ( FEV1 ) data were collected and analyzed in 30 cases with moderate inhalation injury and 10 cases with severe inhalation injury within 3 months after injury for follow-up. Data were processed with t test or chi-square test. Results There was no obvious difference in the rate of re-intubation after extubation in patients with moderate inhalation injury between those done within 2 weeks PⅡ ( 15/70, 21.4% ) and those done after 2 weeks PⅡ (2/25, 8.0% ) ( x 2 = 1.52, P ＞ 0.05 ). Pneumonia incidence in patients of moderate inhalation injury with extubation within 2 weeks PⅡ (21/70, 30.0% ) was lower than those with extubation after 2 weeks PⅡ (15/25, 60.0% ) (x 2= 7.04, P ＜ 0.05). Levels of above-mentioned indexes in patients with severe inhalation injury extubated in diffferent stages were similar to those of patients with moderate inhalation injury.Within the first week after injury, mortality rate of patients with severe inhalation injury was higher than that of patients with moderate inhalation injury ( x 2 = 11.90, P ＜ 0.05 ). During follow-up, tracheostenosis rate in patients with moderate or severe inhalation injury was 100.0%; granuloma formation rate and vocal cord paralysis rate in patients with severe inhalation injury were higher than those of patients with moderate inhalation injury ( with x 2 value respectively 4.59, 13.47, P values all below 0.05 ). The FEV1 value of patients with moderate inhalation injury in the 1st, 2nd, 3rd month after injury was respectively higher than that of patients with severe inhalation injury ( with t value respectively 5.48, 12. 10, 6.25, P values all below 0.05). The values recovered to normal level in the 3rd month after injury. Conclusions Extubation time of tracheotomy for patients with moderate or severe inhalation injury within 2 weeks or after 2 weeks PⅡ has its own advantage and disadvantage, and it should be performed according to specific conditions of each patient. Conservative treatment is optional for late complications of respiratory system.     

会阴部Paget's病的外科治疗

目的总结会阴部Paget's病外科手术治疗方法及疗效。方法1998年1月～2004年9月,对20例会阴部Paget's病患者行手术治疗,均为男性,年龄47～80岁。病程1～9年,平均4.7年。单纯累及阴囊14例,阴囊及阴茎同时受累5例,阴囊、阴茎及下腹部受累1例。15例术前病理检查确诊为Paget's病,均未发现转移。结果19例患者术后伤口期愈合;1例植皮区部分坏死,经换药后期愈合。20例均获随访2～5年,阴囊及阴茎外形满意。2例分别于术后6个月及1年复发,再次手术切除后好转。2例于术后6个月因阴茎腹侧瘢痕挛缩致勃起时出现下弯畸形,经局麻下皮瓣移位调整后好转;余患者术后阴茎勃起功能正常。结论会阴部经久不愈的湿疹样病损应高度怀疑Paget's病,尽早行病理活检可明确诊断;广泛彻底切除是唯一有效的治疗方法;肿瘤切除后创面应尽量采用阴囊皮瓣修复,也可联合阴茎及下腹皮瓣移位或结合游离植皮修复创面;同时术后应密切随访。     

皮肤软组织扩张术治疗头皮良性肿瘤术后缺损16例

目的 总结皮肤软组织扩张术治疗头皮良性肿瘤的疗效。方法 2000年1月～2005年9月，对16例头皮良性肿瘤患者，采用皮肤软组织扩张术治疗术后头皮缺损。其中男10例，女6例；年龄6～35岁。病程6～35年，平均21年。神经纤维瘤6例，血管瘤5例，头皮巨大黑色素细胞痣4例，毛细淋巴管瘤1例。14例接受1次软组织扩张术治疗，2例因病变巨大接受2次软组织扩张术治疗。扩张头皮瓣7．5cm×10．5cm～17cm×25cm。结果经1次皮肤软组织扩张术的患者，13例完全修复病变切除后残留创面，1例修复大部分创面，残留小部分非头发生长区，经植皮修复；经2次皮肤软组织扩张术的2例患者术后完全修复病变切除后残留创面。术后获随访6～12个月，无肿瘤复发，头发生长良好。结论 皮肤软组织扩张术是修复头皮巨大良性肿瘤切除后残留创面的主要方法之一。     

头皮扩张器扩张头皮治疗秃发的手术配合

使用头皮扩张器扩张头皮治疗秃发是上世纪末国内外美容整形外科的一项新进展[1]。这项技术的应用,使得患者的秃发区得以被正常头皮完全或部分覆盖,改善了患者形象,增强了患者信心。1995年1月-2005年12月,我科利用扩张术修复头部秃发患者57例,取得了比较满意的效果,现报道如下。     

中药对HIV患者肠道菌群结构及免疫影响的研究

目的：基于16SrRNA高通量测序,研究中医药对HIV患者肠道菌群丰度、多样性及免疫的影响。方法：纳入HIV患者36例,采用多中心、双盲、随机、安慰剂对照研究方法,分为试验组(Treat组)和对照组(Control组),其中试验组16例、对照组20例。试验组给予单纯中药,对照组给予相应中药安慰剂,连续治疗72周。利用16SrRNA高通量测序观察上述干预措施对HIV患者肠道菌群丰度和多样性的影响并检测治疗前后两组患者T淋巴细胞计数以观察患者免疫情况。结果：对比两组患者肠道菌群菌落结构及组成发现,对照组的梭菌在门、纲、目、科、属水平丰度均偏高(P<0.05);试验组瘤胃球菌属、塞内加尔厌氧菌属丰度偏高(P<0.05)。治疗前,两组患者CD4+T细胞计数、CD8+T细胞计数、CD4+/CD8+未见明显差异(P>0.05);经72周治疗,两组患者CD4+T细胞计数、CD4+/CD8+较治疗前均增加,CD8+T细胞计数较治疗前均减少,组间未见明显差异(P>0.05),组内前后比较中仅对照组CD4+/CD8+存在显著差异(P<0.05)。结论：两组HIV患者肠道菌群的...     

N-乙酰半胱氨酸对烫伤大鼠炎症反应的影响

目的:探讨N-乙酰半胱氨酸对烫伤大鼠炎症反应的影响。方法:48只Wistar大鼠随机分为实验组和对照组,制作烫伤休克模型,伤后1小时腹腔注射生理盐水40ml/kg抗休克,实验组于抗休克盐水中加入N-乙酰半胱氨酸160mg/kg,其后足量饮水。分别于烫伤前、烫伤后8小时、16小时及24小时,处死每组各6只大鼠并立即心脏取血,采用ELISA法检测大鼠血清中TNF-a含量,于创周近头侧0.5cm处取皮肤全层组织,在显微镜下进行中性粒细胞计数。结果:两组大鼠血清TNF-a含量伤后显著升高,8小时达到高峰,其后逐渐下降,两组各时点比较有显著差异(P<0.05);创周组织中性粒细胞计数于伤后随时间延长逐渐增多,两组比较有显著性差异(P<0.05)。结论:N-乙酰半胱氨酸有助于降低烫伤大鼠血浆中TNF-a含量及创周组织中的中性粒细胞计数量,减轻烫伤大鼠的全身及局部炎症反应。     

重睑成形术后不对称的原因及修复前后比较

目的:探讨重睑成形术后重睑不对称的发生原因、修复策略及修复后的效果。方法:2013年7月至2018年6月,四川大学华西医院整形外科/烧伤科收集各类重睑术后出现双侧重睑不对称患者73例,男14例,女59例,年龄18~42岁,中位年龄27岁。术前重新设计重睑线,术中彻底松解上睑皮下组织纤维粘连、修整下唇眼轮匝肌、调整提上睑...     

XRCC1参与修复鼠尾草酚诱导的DNA损伤

目的 研究鼠尾草酚(carnosol,CAR)诱导的DNA损伤修复机制.方法 采用CCK-8试验检测CAR对TK6细胞(人类淋巴母细胞)增殖的影响;利用染色体畸变试验和免疫荧光分析试验分析CAR对TK6细胞的损伤作用和修复机制;采用流式细胞术检测细胞凋亡情况.结果 CAR对TK6细胞呈剂量依赖性抑制,且与野生型(wid...