开放性胫腓骨骨折支架外固定术后的自我护理指导

目的探讨开放性胫腓骨骨折支架外固定术后对患者及其照顾者进行自我护理相关知识及操作技能培训的模式。方法将127例开放性胫腓骨骨折患者按入院时段分为对照组(62例)和观察组(65例),均于手术室复位。住院期间对照组行常规健康教育和自护技能指导,观察组成立自护指导小组,开展分阶段、多种形式的自护技能指导。结果观察组骨折愈合时间、骨折肢体功能恢复及针道感染3项指标显著优于对照组(P<0.05,P<0.01)。结论系统的综合自我护理指导可有效提高胫腓骨骨折支架外固定术后患者的康复进程。     

用于老年基础医学研究与临床辅助诊断的神经肽Y及其受体Y1-6检测方法的初步设想

神经肽Y（NPY）作为机体内一种主要的神经递质和能量调控因子，广泛参与机体各种生理功能的调节，是维持机体内环境稳态的重要物质之一。随着对其研究的不断深入，人们发现它可通过与特定靶细胞膜上不同NPY受体Y1-6的特异性结合而启动并激活相应细胞信号传导通路，从而参与对机体生理功能和靶细胞增殖分化的调控，且NPY及其受体在体内的表达水平又可影响机体的正常生理功能、细胞代谢活动、以及这种改变所诱导或促进或参与的某些老年性疾病的发生、发展及转归，并对相关药物的防治带来明显影响。因此，对NPY及其受体含量的检测项目已成为相关老年性疾病与合并症的发病机制分析、疾病进程观察、治疗效果评价、疾病痊愈判断及预后跟踪随访的重要辅助诊断指标之一。为此，本文通过对可用于老年基础医学研究与临床辅助诊断的NPY及其受体检测的酶联免疫吸附法、放射免疫测定法、荧光免疫检测法、化学发光免疫分析法、免疫组织化学法、压电石英晶片免疫传感器法、免疫印迹法、斑点免疫层析及胶体金法、受体放射配基结合分析法、放射自显影法、液体芯片技术、微粒子酶免分析法等进行NPY及其受体检测方法的综述，并提出前瞻性设想和设计，希望这些用于检测NPY及其受体指标的方法能为未来老年医学的研究和临床应用奠定基础。     

Percutaneous endoscopic laser annuloplasty for discogenic low back pain

BackgroundLaser-assisted spinal endoscopy (LASE) kit has been used for percutaneous intradiscal decompression to evaporate and shrink the posterior and central nucleus for improvement of leg and radicular pain due to contained disc herniation. Percutaneous endoscopic laser annuloplasty (PELA), a new minimally invasive technique, uses LASE to directly coagulate the inflamed disc granulation tissue associated with annular tears. The small diameter of the endoscope including Ho:YAG laser, irrigation, and light, plus the extreme posterolateral approach into the posterior annulus, enables one to minimize damage to normal nuclear tissue. The authors sought to demonstrate the safety and efficacy of PELA for controlling discogenic low back pain (DLBP) due to abnormal disc tissues, new vessels, and nerves in the central torn posterior annulus.MethodsClinical outcomes of PELA were investigated in patients having DLBP with an annulus-torn degenerative disc or contained disc herniation. Thirty patients treated at a single level and achieving a mean follow-up of 9.7 months were analyzed. Outcomes were assessed using the visual analog scale (VAS) for back pain, the Korean Oswestry Disability Index (KODI), and the modified Macnab's criteria.ResultsThe mean back pain VAS score improved from 8.0 to 2.4, and the mean KODI score improved from 79.0 to 22.4 (P < .001). Results by the modified Macnab's criteria also showed a good outcome, with a success rate of 90.0%. There were no serious complications observed during follow-up.ConclusionsPercutaneous endoscopic laser annuloplasty using the Ho:YAG laser provides favorable outcomes for carefully selected groups of patients with DLBP.     

Transurethral injection of bulking agent for treatment of failed mid-urethral sling procedures

Introduction and hypothesis  

We evaluated the efficacy of transurethral injection (TUI) for the treatment of recurrent or persistent stress urinary incontinence after mid-urethral sling (MUS) procedures.     

人脂肪间充质干细胞的分离培养及其遗传稳定性

背景:研究发现脂肪间充质干细胞核型具有不稳定性,且干细胞移植后长期安全评价等问题尚未从根本上得到解决.目的:观察体外分离培养的人脂肪间充质干细胞传代培养的遗传稳定性.设计、时间及地点:细胞学体外观察,于2008-03/11在解放军兰州军区兰州总医院骨科研究中心完成.材料:成人腹部大网膜脂肪组织来源于单纯性阑尾炎患者,由解放军兰州军区兰州总医院普通外科提供.方法:胶原酶消化法体外分离培养人脂肪间充质干细胞,加入含体积分数为10%胎牛血清的HG-DMEM培养基吹打细胞沉淀,过滤后于37℃、体积分数为5%的CO2饱和湿度条件下培养,待细胞生长至70%～80%融合时消化传代.分别取第3,25,30代脂肪间充质干细胞进行相关指标检测.主要观察指标:脂肪间充质干细胞表面标志表达、细胞增殖、核型分析、超微结构电镜观察、恶性肿瘤特异性生长因子的表达.结果:第3代脂肪间充质干细胞CD13,CD44,CD59均呈阳性表达,而造血干细胞表面标志CD34及成纤维细胞表面标志HLA-DR均呈阴性表达:染色体的形态、结构和数目均未见异常,呈二倍体结构;镜下可见完整的高尔基复合体,数量较多的粗面内质网,部分糖元颗粒分布在胞浆中.第25代脂肪间充质干细胞分裂增殖作用强于第3代脂肪间充质干细胞;多条染色体出现断裂畸变,并且染色体数目出现异常,呈亚二倍体或超二倍体核型;核仁增大,异染色质及线粒体数量增多,内质网数量少,细胞较为幼稚.第3,25,30代脂肪间充质干细胞恶性肿瘤特异性生长因子的表达吸光度值无明显差异(P>0.05).结论:分离获得的人脂肪间充质干细胞长期体外培养具有遗传不稳定性,有向肿瘤细胞突变的倾向.     

护理硕士研究生学习风格的调查研究

[目的]了解护理硕士研究生学习风格,以期为护理教育提供参考,提高教学质量.[方法]采用柯勃编制的学习风格量表对4所大学护理硕士研究生进行问卷调查,并用SPSS13.0统计软件包统计分析.[结果]护理硕士研究生学习风格处于不平衡状态,主要表现在主动实践阶段,其均分落在20%的区间;不同地区学习风格4个阶段得分差异无统计学意义;不同年级间学习风格在具体经验阶段差异有统计学意义(F=3.79,P=0.027),并且随着年级的增长而提高;其他3个环节在不同年级间差异无统计学意义.[结论]护理教学中,要注意引导学生平衡自己的学习风格,特别要加强实践能力和与人合作能力的培养,同时要强化信息教学信念,以拓展学生获取和加工信息的渠道,从而培养和提高学生荻取和加工信息的能力,适应信息社会对人才的需求.     

Enhanced Percolation and Gene Expression in Tumor Hypoxia by PEGylated Polyplex Micelles

In regard to gene vectors for cancer gene therapy, their percolation into the tumor tissue should be essential for successful outcome. Here, we studied the tumor penetrability of nonviral vectors (polyplexes) after incubation with the multicellular tumor spheroid (MCTS) models and intratumoral (i.t.) injection into subcutaneous tumors. As a result, polyethylene glycolated (PEGylated), core–shell type polyplexes (polyplex micelles) showed facilitated percolation and improved transfection inside the tumor tissue, whereas conventional polyplexes from cationic polymers exhibited limited percolation and localized transfection. Furthermore, the transfection of hypoxia-responsive plasmid demonstrated that polyplex micelles allowed the transfection to the hypoxic region of the tumor tissue in both in vitro and in vivo experiments. To the best of our knowledge, our results demonstrated for the first time that polyplex micelles might show improved tumor penetrability over cationic polyplexes, thereby achieving transfection into the inside of the tumor tissue.