逆行岛状皮瓣修复手部软组织缺损

目的报道手部软组织缺损逆行岛状皮瓣修复方式的选择及临床效果。方法根据手部软组织缺损的不同部位，应用六种不同的手与前臂逆行岛状皮瓣进行修复。结果本组57块皮瓣中，除4块皮瓣远端部分坏死外，其余皮瓣成活良好，外观满意，弹性、质地良好，两点辨别觉6～12mm。结论手与前臂逆行岛状皮瓣切取简便，创伤小。根据手部软组织缺损不同部位，选择不同的逆行岛状皮瓣进行修复，可获得满意的临床效果。     

菲立磁标记兔BMSCs自体移植脊髓后的核磁共振活体示踪及形态学研究

目的通过观察菲立磁标记兔骨髓源性神经干细胞(BMSCs)自体移植脊髓后的核磁共振活体示踪及形态,期待找到一种应用非侵袭性方法来识别、跟踪BMSCs的存活状态及与宿主组织整合情况的方法。方法无菌条件下股骨取骨髓,梯度密度离心法分离获取兔骨髓基质细胞;使用“Feridex-多聚赖氨酸复合物(FE-PLL)”标记骨髓基质细胞,采用普鲁士兰染色和台盼蓝排除实验等方法鉴定FE-PLL标记兔骨髓基质细胞的效率和细胞的活力;体外标记的细胞自体脊髓移植,磁共振、免疫组织化学染色和透射电镜检查。结果普鲁士蓝染色显示FE-PLL标记骨髓基质细胞胞质内出现细小的蓝色铁颗粒;与正常未标记的细胞相比较,FE-PLL标记对骨髓基质细胞的活力、增殖和分化等能力没有明显的影响;经菲立磁标记的兔BMSCs自体脊髓移植后,可在核磁共振上活体示踪。结论菲立磁与核磁共振联合可无创性活体标记检测移植的神经干细胞基本的存在部位、存在方式及其一些生物学特性,可以用来活体示踪移植的BMSCs。     

带血管骨膜瓣移植修复烧伤坏死管状骨的实验研究

目的探讨带血管骨膜瓣移植修复烧伤坏死管状骨的可行性，试图为临床修复烧伤坏死骨提供一种有效的方法。方法8月龄成年新西兰家兔20只，设一侧肢体的桡骨为实验组，另一侧为对照组，采用同体对照法。实验组保留带血管的骨膜瓣，从桡骨中下段离断1．2cm桡骨，置沸水中煮沸30min冷却后原位回植，再行骨膜瓣移植包绕、固定。对照组按上述方法处理后不移植骨膜瓣。分别于术后2、4、6、8～10、12周摄X线平片，同时分别处死4～5只兔并取两侧桡骨行组织学切片检查。结果实验组：术后2～4周在骨坏死区见到明显的骨膜增生影像；术后6～8周见骨折断端连接征象，新生骨小梁形成并逐渐改建；术后8—10周可见网织骨普遍融合重建，形成板层，新的哈佛系统形成；术后12周新生骨结构更加成熟，骨折愈合。对照组：术后2周仍为死骨，骨坏死区无骨膜增生现象；术后4、6周未见骨折愈合征象；8周可见骨缺损；12周坏死骨完全溶解、吸收，骨缺损区清晰可见，骨缺损区被少许纤维组织充填。结论带血供的骨膜瓣能不断形成新生骨并爬行替代原坏死骨，使坏死骨获得再生，能很好地修复烧伤坏死的管状骨。     

Isochronic transplantation of neonatal grafts in the visual cortex of cats: responsiveness,ocular dominance and specificity of cortical cells to visual stimulation

Summary The visual cortex of adult cats was studied physiologically following neonatal isochronic transplantation of grafts from areas 17,18, which were placed homotopically, in order to reveal their functional integration and thus possible repairing of damaged cortical neuronal circuits. Three homograft cats, in which transplantation was carried out between siblings (228 cortical cells) were compared to 4 animals receiving reimplanted autografts of the equivalent size (131 cells) as well as 3 animals with analogous sectioning of the visual cortex (162 cells) (pseudograft controls). The location of the boundaries between the transplant region and the host were determined using the Nissl's method for staining histological cross sections. Extracellular unit recording revealed typical waveform of the action potentials in the transplanted region and in the surrounding host tissue of all groups of cats. Visual responsiveness in the homograft cats was 17.5% in the transplanted region and 80.4% in the unoperated hemisphere; the corresponding results were 40.3% for the transplanted region and 82.2% for the unoperated hemisphere in the autografts and 23.1% and 73.4% in the pseudografts. The specificity of the cells to visual stimulation as expressed by their orientation and direction specificity, indicated preservation of these properties in the transplanted cats. While all responsive cells in the transplanted region of the homografts were orientation specific, their proportion was 60% in the autografts and 55.5% in the analogous region in the pseudograft controls. As to the direction specific cells, their performance in the grafted region of the grafted cats was even much higher than that of the pseudograft controls. The ocular dominance distribution of the cells showed preservation of binocularity in the transplanted region (90.0% binocular cells) of the homografts; it was however smaller in the equivalent region of the autografts (65.0%) and remarkably reduced (20.0%) in the pseudografts. It was concluded that despite the deafferentation induced during the transplantation procedure, a remarkable visual responsiveness was found in the transplanted region, indicating postoperative recovery. However, the cells there were mainly affected in their activity and less in their specificity to visual stimulation.     

肝移植术后血管并发症的病因学分析

目的 探讨肝移植术后血管并发症的病因。方法 对1993年4月～2002年4月所完成的160例原住肝移植临床资料进行回顾性分析。结果 肝动脉并发症发生率为5％，与肝动脉并发症相关的死亡率为3．13％；门静脉并发症发生率为3．75％，与门静脉并发症相关死亡率为0；肝后下腔静脉狭窄并发症发生率为3．75％。结论 肝移植术后早期魂脉并发症主要与手术技术和肝动脉病变有关，改进吻合技术，术前评估肝动脉病变能降低早期肝动脉并发症发生率；术前有门脉高压症手术治疗史、移植术前门静脉血栓、门静脉手术史以及严重感染病史等是门静脉并发症的高危因素；手术技术是导致下腔静脉狭窄的重要原因，腔静脉整形的改良背驮式肝移植能避免该并发症的发生。     

高敏受者肾移植术前行血浆置换的临床探讨

目的 :探讨高敏受者肾移植术前行血浆置换 (PE)的效果。方法 :12例高敏受者在肾移植术前进行PE治疗 ,37例高敏受者未行PE治疗 ,观察两组肾移植病人排斥反应发生率的差异。结果 :PE组置换前PRA值71.0 %± 19.1% ,置换后 34.3%± 17.9% ,两者有显著性差异 (P <0 .0 1)。术后发生超排 2例 ,急性排斥 2例 ;未行PE组发生超排 2例 ,急性排斥 8例 ,两组间超排和急性排斥的发生率均无显著性差异。结论 :PE对预防超排和降低急性排斥的发生率均无明显作用。PE治疗的主要适应症为PRA大于 80 %的受者 ,能快速降低PRA值 ,有助于HLA抗体特异性分析和HLA配型。     

腺苷A1受体诱导预处理延迟效应对供心保存的影响及机制探讨

目的　探讨腺苷A1受体激动剂预处理延迟效应对保存大鼠心脏的影响及其机制。方法　Wistar大鼠随机分为 8组 ,A、C组以高选择性腺苷A1受体激动剂 (CCPA)预处理 ;D、E、F组在CCPA预处理前分别注射锰 超氧化物歧化酶 (Mn SOD)反义、有意义、错配寡核苷酸 (ODN) ;B、G组注射生理盐水 ,H组只注射反义寡核苷酸。 2 4h后 ,A、B组用 4℃St.Thomas液保存 4h ,复灌 1h ,而另 6组采取低温缺血 3h ,复灌 1h。观测心功能、磷酸肌酸激酶 (CK mb)、三磷酸腺苷 (ATP)含量等。结果　A组左室内压上升与下降最大速率恢复率 (±dp/dtmax,% )为 6 2 .83± 17.2 7,6 6 .81± 18.99,心肌ATP含量 (10 3 μmol/g)为3.6 7± 1.4 2 ;而B组分别为 4 0 .4 1± 18.2 9,4 4 .70± 2 5 .14 ,1.4 6± 0 .5 4 ;A组均明显高于B组 ,差异均有显著性 (P <0 .0 1orP <0 .0 5 )。C组±dp/dtmax恢复率、ATP、Mn SOD活性均明显高于D、G、H组 (P <0 .0 1orP <0 .0 5 ) ,而与E、F组比较 ,差异无显著性。结论　腺苷A1受体激动剂能诱导预处理的延迟效应 ,改善离体大鼠心脏的保存效果 ,而该效应与Mn SOD的高表达有关。     

外周血及移植肾内嗜酸性粒细胞变化的临床意义

为了解移植肾在急性排斥时外周血和移植肾内嗜酸性粒细胞（ＥＯ）变化的意义，动态观察３１例同种异体肾脏移植病人的外周血和移植肾内ＥＯ的变化。结果发现在急性排斥反应时，移植肾内ＥＯ数＞２％者占８０．９％，明显高于肾功能稳定时，Ｐ＜０．０１；重度排斥中血ＥＯ数＞４％者占８２．６％，明显高于肾功能稳定时和中度以下排斥者，Ｐ＜０．０１。结果认为，测定移植肾内的ＥＯ变化可以做为监测急性排斥反应的可靠指标，外周血中的ＥＯ明显增多常提示排斥反应较为严重。     

Transplantation of embryonic noradrenergic neurons in two models of adult rat spinal cord injury: ultrastructural immunocytochemical study

The synaptic connections established by grafted noradrenergic (NA) neurons into the lesioned adult rat spinal cord were analysed using immunocytochemistry at the electron microscopic level. An embryonic cell suspension of the locus coeruleus region from E-13 rat embryos was transplanted into the spinal cord following either: (1) spinal cord transection or (2), partial selective denervation by 6-hydroxy dopamine (6-OH DA). One month after grafting, the NA-neurons established, in the two models, an innervation pattern similar to that found in the intact spinal cord. In both models, the transplanted NA-immunoreactive neurons formed extensive synaptic contacts with dendrites, spines and perikarya. The proportion of axodendritic and axospinous contacts was inverse in the two models. The first model thus reproduced more closely the normal synaptic pattern prefering dendritic targets, which could correspond to a better integration of the graft. In the second model, a partially NA-denervated spinal cord, there existed a competition between residual intrinsic and grafted neuron-derived fibres, which presumably affects synaptogenesis. In conclusion, the present study illustrate the complexity of cell interations conducting to the formation of a specific circuitry. Recognition phenomenon are likely modulated by space constraints, which ultimately shape-up the geometry of synaptic contacts.     

胚胎脊髓细胞悬液植入急性成年大鼠损伤脊髓

目的：建立胚胎脊髓细胞悬液移植于脊髓损伤模型，以评价其治疗脊髓损伤的可能性。方法：４２只Ｗｉｓｔａｒ大鼠以改良Ａｌｅｎ法（５０ｇｃｍ）打击脊髓，３天后将孕１４天（Ｅ１４）ＦＳＣＳ２０μｌ植入损伤空腔，移植后２、４、６、８、１０、１２周，以光、电镜、免疫组织化学观察移植物存活、分化及其与宿主之间关系。结果：移植细胞逐渐长大。充满不规则空腔，宿主ＮＦ、５－ＨＴ、ＣＧＲＰ纤维分别出现于移植物，ＧＦＡＰ纤维于宿主移植物交界处适量存在。移植成神经细胞、成少突胶质细胞、成星形细胞的细胞器日渐完善，细胞功能活跃。复杂及多样突触与细胞连接，将上述细胞与神经纤维、胶质纤维、毛细血管网在三维空间内连接成一体，并与宿主紧密嵌合。结论：（１）成年大鼠脊髓损伤３天后植入ＦＳＣＳ可以存活。（２）移植物进入宿主后，出现再分布，继而器官样分化。（３）长、短传导束进入移植物，显示了移植物的桥作用。（４）成少突胶质细胞的神经营救作用。（５）移植区内出现多种突触，提示移植物中继作用的可能性。