鼻烟窝皮瓣修复拇指大面积皮肤缺损的临床应用

探讨鼻烟窝皮瓣在修复拇指大面积皮肤缺损中的方法和治疗效果。从2008年1月～2013年10月间应用桡动脉在解剖鼻烟窝穿支为血管蒂的鼻烟窝皮瓣,逆行修复拇指大面积皮肤缺损26例,年龄17岁～55岁。术后平均随访时间25个月,皮瓣全部成活。皮瓣色泽及质地与健侧拇指背侧皮肤相近,拇指活动度基本正常。因此,鼻烟窝皮瓣是一种简便经济、效果理想、患者易于接受的术式,适合应用于拇指大面积皮肤缺损的治疗。     

治疗感染性骨不连伴大段骨缺损的探讨与思考

感染性骨不连伴大段骨缺损是目前临床骨科较为常见、多发、治疗极为棘手的病种之一,治疗方法多种多样,但疗效却不理想,且缺乏统一的诊治与疗效判断标准,总结、分析几种临床上主要治疗方法的利弊,为该病探寻一条微创、安全、并发症少及疗效确切的可靠治疗方法.随着对Ilizarov技术的基础与临床研究的不断深入,该技术在治疗传统方法难以治愈的疾病如四肢关节严重畸形、感染性骨不连或伴有骨缺损、皮肤软组织缺损等方面显示出自身的优势,为治疗疑难骨科疾病开辟了一条新的有效途径.     

Interfacial defects in YBa2Cu3O7-δ/SrTiO3(0 0 1) heterostructures studied by aberration-corrected ultrahigh-resolution electron microscopy

The microstructure of interfacial defects in YBa₂Cu₃O_7-δ/SrTiO₃(0?0?1) heterostructures has been investigated by aberration-corrected ultrahigh-resolution electron microscopy. We determine that c-axis-oriented YBa₂Cu₃O_7-δ thin films epitaxially grow on SrTiO₃(0?0?1) with two types of interface structure. The coalescence of nucleation sites with different types of interface structure leads to the formation of antiphase domain boundaries in YBa₂Cu₃O_7-δ thin films, which terminate at planar faults with different configurations near the interface. Stand-off misfit dislocations are observed and the dislocation core structure is explored. Based on the interface structure and interfacial defects, the initial growth mode of YBa₂Cu₃O_7-δ thin films on SrTiO₃(0?0?1) is discussed.     

Quantitative defect evolution of nanocrystalline nickel during cold rolling

The defect evolution of cold-rolled nanocrystalline nickel is quantitatively investigated. We report that the density of dislocations (or stacking faults) first increases and then decreases after an equivalent strain of ～0.30. The density of stacking faults decreases more significantly than that of dislocations when the grain size increases above 35?nm. This is attributed to the grain size dependence of dislocation activity. The roles of texture and deformation twins are also considered to help understanding of the decreasing density of dislocations (or stacking faults).     

示中环指指尖缺损的鱼际皮瓣修复

探讨应用鱼际皮瓣修复示中环指指尖缺损的方法和效果.自2010年8月～2013年3月,应用鱼际皮瓣修复示中环指指尖缺损28例,术后评价皮瓣外观及供区愈合情况.结果术后28例皮瓣全部存活,随访时间为2个月～8个月.患指指尖皮瓣质地柔软,外形饱满,颜色与周围一致,指端无压痛,供区直接缝合,未发现刀口疲痕挛缩影响拇指及虎口功能.鱼际皮瓣修复示中环指指尖缺损手术操作简单,修复后患指指尖外观满意、供区损伤小.患者顺从性好,易于为临床医生所接受.     

肿瘤是限铁机制的体现,其功能是防卫细菌——解读肿瘤之谜

通过哲学思辨质疑肿瘤是异己的判断.列举肿瘤的特征,探索肿瘤的实质.通过对限铁机制和铁致癌机理的研究,对铁致癌以及铁是癌细胞营养素的假设提出质疑.经过辩证思考推断,肿瘤是对坏血酸遗传缺陷的代偿性补救措施,是限铁机制的体现,是进化适应的特征,它的功能是聚集游离铁,不让细菌获得铁,以降低细菌感染的风险.同时提供证据,证明肿瘤确有降低细菌感染风险的功效.继而提出细胞癌变的可能机理,并据此解释肿瘤何以转移,何以避免免疫摧毁.最后提出对肿瘤发病机制的定义,并提出预防肿瘤的关键措施.     

Response expectancy versus response hope in predicting birth‐related emotional distress and pain

Response expectancies and response hopes have been shown to be two distinct constructs with important implications for nonvolitional outcomes. More specifically, studies show that response expectancies: (1) are sufficient to cause nonvolitional outcomes, (2) are not mediated by other psychological variables, and (3) are self‐confirming while seemingly automatic. A new programmatic research line has differentiated between people's response expectancies and their response hopes regarding nonvolitional outcomes and showed that even if response hope and response expectancy are separate constructs, they are not unrelated. These concepts have not yet been studied in pregnant women. Moreover, determining the causal factors that best explain the variance of emotional distress and pain in pregnancy is of great importance. Thus, the aim of this study was to investigate the interrelations between response expectancy and response hope in pregnant women with respect to (1) emotional distress prior to giving birth and (2) pain during giving birth. Additionally, self‐reported labor hours were analyzed as a secondary outcome. Results show that response expectancy for pain directly predicts pain, and that the discrepancy between response hopes and response expectancies is a strong predictor of investigated outcomes. Thus, our results support the idea that preventive psychological interventions for pregnant women should emphasize adjusting response expectancies and response hopes regarding the pain and emotional distress associated with giving birth. We believe that the results have both theoretical and practical implications and the topic deserves further investigation.     

What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’

Evidence suggests between 1% and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth. ‘Hotspots’ are moments of extreme distress during traumatising events that are implicated in symptoms of PTSD. This cross-sectional internet survey of hotspots examined (1) the content of intrapartum hotspots and (2) whether particular events, cognitions or emotions during hotspots are related to PTSD. Women (N?=?675) who experienced a difficult or traumatic birth completed a questionnaire composed of a validated measure of PTSD, questions concerning the existence of hotspots, and a newly developed measure of emotions and cognitions during hotspots. The majority of women (67.4%) reported at least one hotspot during birth and 52.9% had re-experiencing symptoms of these hotspots. Women were more likely to have PTSD if hotspots involved fear and lack of control (odds ratio (OR) 1.30, 95% CI 1.17–1.43) or intrapartum dissociation (OR 1.12, 95% CI 1.05–1.19). Risk of PTSD was higher if hotspots concerned interpersonal difficulties (OR 4.34, 95% CI 2.15–8.77) or obstetric complications (OR 3.35, 95% CI 1.64–6.87) compared to complications with the baby.     

Brain Activity and Cognitive Transition during Childhood: A Longitudinal Event-Related Brain Potential Study

This study examined the relation between brain activation and cognitive development using event-related brain potentials (ERPs) and a longitudinal design. Five-year-old girls performed a visual recognition (‘oddball’) task and an experimental analogue of the Piagetian conservation of liquid quantity task at three experimental sessions, with one year between consecutive sessions. The data revealed age-related changes in neurocognitive mechanisms common to both tasks. In comparing children before and after a Piagetian transition on a traditional clinical conservation test the data revealed a major shift in performance and ERPs to the experimental analogue of the liquid quantity task. These findings are consistent with a previously performed cross-sectional study and provide strong support for the hypothesis that cognitive transition is related to new neurocognitive mechanisms emerging during childhood. Possible implications of these findings for child neuropsychology are discussed.     

Very Low Birth Weight and Attention Deficit/Hyperactivity Disorder

It is well recognized that reaction time performance of term-born children with a normal birth weight (NBW > 2500 g) who fulfill the DSM-IV criteria for attention deficit/hyperactivity disorder (ADHD) in the primary school age is sensitive for the presentation rate of stimuli. They have been found to perform more poorly in conditions of relatively slow event rates as compared with fast event rates. The purpose of the current study was to explore whether reaction time performance of children with very low birth weight (VLBW < 1500 g) with or without ADHD showed the same sensitivity for the factor presentation rate of stimuli compared to children with a normal birth weight plus ADHD. To this end, reaction time performance of four groups of children was compared on a Go/No-Go test with a fast presentation rate of 1 second and a slow presentation rate of 6 seconds. Groups were: children with VLBW plus ADHD, children with VLBW only, children born full term with normal birth weight (NBW >2500 g) plus ADHD, and children born full term without ADHD (the control group). Findings indicated that, compared to the non-ADHD groups, the groups with ADHD (NBW and VLBW) showed a more dramatic decline in their reaction time performance in the slow condition: a state regulation deficit. In addition, both groups showed a response inhibition deficit. No difference was found in reaction time performance between the groups of children with VLBW only and the control group.