Objective:To investigate the effect of repeated transcranial stimulation ( rTMS) on the improvement of depression in patients with cerebral infarction and the change of FTHUE-HK ( FTHUE-HK) rat-ing in patients with hemiplegia. Methods:96 patients with cerebral infarction who were treated in our hospital from September 2015 to August 2016 were selected and divided into three groups:0. 5Hz group, 1Hz group and 2Hz group , Each group of 32 cases. Three groups were using the basic drug therapy and rehabilitation training, on the basis of this group with the corresponding frequency rTMS for treatment. The improvement of depression in the three groups before and after treatment was evaluated by the Depression Self-Rating Scale ( SDS) . The changes of FTHUE-HK were observed before and after treatment. Results:There was no signifi-cant difference in SDS scores between the two groups before treatment ( P> 0.05) . However, after treatment, the scores of SDS in the three groups were significantly decreased, but the 0.5Hz group and the 2Hz group all dropped below the cut- (P <0.05), but there was no significant difference between the two groups (P <0. 05), but there was no significant difference between the two groups (P <0.05). There was no significant difference in FTHUE-HK between the two groups before treatment, and there was no significant difference be-tween the two groups and the 2Hz group ( P <0.05) . Conclusion:The use of different frequencies of rTMS in the treatment of cerebral infarction patients can improve the patient's depressive symptoms and hemiplegia up-per limb function, but in contrast, high frequency and low frequency rTMS treatment of cerebral infarction is more significant.

Objective To investigate the clinical effect of low frequency repetitive transcranial magnetic stimu-lation(rTMS)in the treatment of anxiety and depression of elderly patients with acute cerebral infarction.Methods 80 cases of elderly patients with anxiety and depression after acute cerebral infarction were selected and randomly divided into rTMS group and the conventional group.The two groups were both given conventional drug therapy and rTMS group was added with rTMS treatment at the same time.After 8 weeks of treatment,the treatment effects of the two groups of patients were compared.Results After treatment,Hamilton Depression Scale[[(9.86 ±2.04)points],Hamilton Anxiety Scale[(10.24 ±1.75)points]and Chinese brain stroke scale[16.39 ±2.27)points]in rTMS group were lower than those in the conventional group[(11.18 ±2.23)points,(12.05 ±2.11)points and(19.15 ±2.50) points,respectively],P<0.05.The serum level of brain-derived neurotrophic factor[(28.14 ± 4.42)μg· L-1· mL-1)]in rTMS group was higher than that in the conventional group[(25.26 ±4.25)μg· L-1· mL-1],P<0.05.Conclusion RTMS assisted drug in the treatment of anxiety and depression in elderly patients with acute cerebral infarction has better effect than the single drug treatment.

Objective To analyze the effect of high flow humidification oxygen therapy on pulmonary infection in elderly patients with cerebral infarction and the effect on oxygen saturation and pneumonia in patients with cerebral infarction. Methods A retrospective study was conducted on 70 elderly patients with pulmonary infarction who were hospitalized in geriatrics department of Affiliated Hospital of Chengde Medical College from May 2015 to January 2017. The patients were divided into control group and experimental group according to different oxygen feeding methods.The control group was treated with traditional nasal catheter oxygen mask,the experimental group were treated with high respiratory flow humidified oxygen. The heart rate,respiratory frequency,blood pressure,blood gas index change,change the expectoration ability of patients,the hospital infection rate and patients,the incidence of drug-resistant bacteria,antibiotic use time were observed in the two groups. Results There was no difference of blood pressure before and after treatment in two groups(P> 0.05). 1H,4H two groups,24h heart rate,respiratory rate,PaO2,PaCO2,SaO2,PH and oxygen index levels were improved dramatically after treatment than before treatment in two groups(P< 0.05),and these treatment index were better in experimental group than in control group after treatment(P < 0.05). Two groups of patients after treatment of sputum viscosity grade was improved too after treatment in the two groups(P < 0.05),and the sputum characters was better in experimental group than control group after treatment(P< 0.05). The rate of internal infection and the incidence of drug-resistant bacteria in experimental group were lower than those of the control group,and the time of antibiotics use was shorter in experimental group than that in control group(P<0.05).Conclusion High flow humidification oxygen therapy can improve the blood gas index and respiratory function of pulmonary infection in elderly patients with bedridden cerebral infarction,and improve the comfort of patients,and reduce the incidence of nosocomial infection and the incidence of drug-resistant bacteria.

目的 探究老年高血压患者的血管弹性状态、内皮功能、虚弱指数的研究.方法 选取承德医学院附属医院2017年2月 ～2018年2月收治并进行血管相关功能检测的老年高血压患者50例(高血压组),同期住院进行健康体检者50例作为健康对照组,通过肱动脉二维超声显像,并测定肱动脉内径及反应性充血变化.结果 反应性充血引起肱动脉内径的变化在高血压组减弱,高血压组的反应性充血舒张百分比较对照组低,比较差异有显著统计学意义(P<0.01).老年高血压患者的非内皮依赖性血管扩张能指标与健康对照组比较差异无统计学意义(P>0.05);内皮依赖性血管扩张功能指标明显低于健康对照组,差异有统计学意义(P<0.01).高血压组患者由于高血压、饮食、服药及年龄的原因造成了身体不健康指数的增高,其虚弱指数显著高于健康对照组,差异有统计学意义(P<0.01).结论 老年高血压患者的血管弹性状态和内皮功能受高血压影响,由于疾病相关因素导致虚弱指数上升,应在临床诊断治疗中予以关注.

Objective To investigate the effect of high flow oxygen therapy system on the incidence of hospital acquired pneumonia in patients with tracheotomy.Methods 70 patients who separated from the ventilator of tracheoto-my were randomly divided into treatment group (humidified oxygen humidified high flow)and conventional group (tra-ditional artificial humidification oxygen mask)35 cases,arterial oxygen partial pressure (PaO2 ),arterial partial pressure of carbon dioxide (PaCO2 ),oxygen saturation (SaO2 ),the incidence of airway humidification effect of pH value,satis-faction rate and complication were compared between two groups.Results Before the treatment,humidified oxygen ther-apy group and normal group of PaO2 ,PaCO2 ,SaO2 ,pH value of the difference was not statistically significant (P >0.05);4 h treatment,after the treatment of 24h,PaO2 ,SaO2 humidification oxygen therapy group were higher than that in control group (P <0.05 ),there was no significant difference between PaCO2 and the conventional group (P >0.05);after 1 2 h treatment,the two groups of patients with airway humidification was evaluated,humidification oxygen therapy group airway humidification satisfaction was 80% higher than the conventional group 54.29% (P <0.05);hu-midification oxygen therapy group excessive airway humidification of 0% lower than the conventional group 1 1 .43%(P <0.05);the treatment process,oxygen humidification treatment group,the complication rate was 1 1 .43% lower than the conventional group 40 (P <0.05),humidification oxygen therapy group occurs in hospital acquired pneumonia in 6 cases (1 7.1 4%)of 1 4 cases lower than the conventional group (40%),the difference was statistically significant (P <0.05).Conclusion High flow humidification oxygen therapy system can effectively reduce the incidence of hospital ac-quired pneumonia in patients with tracheotomy and maintain stable blood gas levels.

Objective To investigate the characteristics and quality of life of patients with pulmonary infections after tracheotomy.Methods Betweem November 2012 and November 2016,200 ICU cases of patients with tracheal tubes after tracheotomy were studied and divided into the infection group (126 cases) and non-infection group (74 cases) according to the occurrence of pulmonary infections.The characteristics of patients with urinary tract infections were statistically analyzed,and the quality of life was compared between the two groups.Results Among the 200 cases with tracheal tubes,126 suffered from pulmonary infections.From respiratory secretions were detected 268 strains of pathogens,including 170 strains of gram-negative bacilli (63.43％),59 strains of gram positive cocci (22.01％),and 39 strains of fungi (14.55％).The scores of mental function,physical function,social functioning and quality of life in the infection group were lower than in the non-infection group,and the difference was statistically significant (P＜0.05).Conclusion The incidence of pulmonary infections in patients with tracheal incision is high,which is mainly caused by gram-negative bacilli,and pulmonary infections can seriously affect the quality of life of patients.

Objective To study the effect of mitomycin C(MMC) on transforming growth factor(TGF)-β/Smad signal passage in keloid fibroblasts(KFB) and its mechanism.Methods The different concentrations of MMC were acted on in vitro cultured KFB and their influence on the expression of KFB TGF-β1 mRNA was detected by the RT-PCR method.The Western blot technology was used to detect the expression of Smad2/3,Smad4 and Smad7 protein in the in vitro cultured KFB under MMC action.Results The RT-PCR results showed that TGF-β1 mRNA related expression quantity in the MMC intervention group was significantly lower than that in the normal control group,showing statistical differences starting from 12.5 μg/L MMC(P<0.05).With the MMC concentration increase,the related expression quantity of TGF-β1 mRNA in the MMC intervention group showed the gradually decreasing trend.The Western blot detection displayed that 12.5 μg/L MMC started to show the enhancing effect on Smad7 protein expression in KFB(P<0.05),50 μg/L MMC started the weakening effect on the expression of Smad2/3 protein(P<0.05),but had no effect on the Smad4 protein expression.Conclusion MMC has obviously decreasing effect on expression of TGF-β1 mRNA.The different concentrations of MMC can obviously increase the expression of Smad7 protein,decrease the expression of Smad2/3 protein in KFB and has no effect on the expression on Smad4 protein.

皮瓣是具有自带血液供应的一块皮肤和皮下组织,用于修复有肌腱、骨、关节、大血管、神经干等组织裸露的新鲜创面,或陈旧性创伤及有深部组织缺损的创面,还可用于器官再造以及洞穿性缺损的修复等.皮瓣可分为任意型皮瓣和轴型皮瓣,游离皮瓣是轴型皮瓣的一种.游离皮瓣是将岛状皮瓣的血管蒂由近端切断,完全与供区分离,通过显微外科技术与受区的血管进行吻合,重新建立血液循环,一次完成远位转移.游离皮瓣手术的成功除了精湛的外科技巧外,严密的围手术期护理极为重要.

<正>皮瓣是具有自带血液供应的一块皮肤和皮下组织,用于修复有肌腱、骨、关节、大血管、神经干等组织裸露的新鲜创面,或陈旧性创伤及有深部组织缺损的创面,还可用于器官再造以及洞穿性缺损的修复等。皮瓣可分为任意型皮瓣和轴型皮瓣,游离皮瓣是轴型皮瓣的一种。

BACKGROUND: Mitomycin C has been gradually used in hyperplastic scar therapy. But the molecular mechanism underlying the effects of mitomycin C on hyperplastic scar via cell apoptosis is reported few. OBJECTIVE: To explore the effects of mitomycin C on fibroblasts apoptosis in hypertrophic scar. METHODS: Hypertrophic scar fibroblasts were cultured in vitro with five different concentrations of mitomycin C (2.5, 12.5, 50, 100, 200 mg/L). Cell cycle distribution and apoptosis of fibroblasts were detected by Annexin V-PI, and the protein expression levels of Bax and Bcl-2 in fibroblasts were detected with Western blotting. RESULTS AND CONCLUSION: Mitomycin C blocked the growth of hyperplastic scar fibroblasts in G0/G1 period, and induced apoptosis of hyperplastic scar fibroblasts in an obvious concentration-dependent manner. Bax protein expression levels increased and Bcl-2 protein expression levels decreased in hyperplastic scar fibroblasts after treated with 2.5-200 mg/L mitomycin C for 24 hours (P < 0.05). These findings indicate that mitomycin C has the possibility to promote fibroblasts apoptosis through increasing Bax expression and decreasing Bcl-2 expression in hyperplastic scar fibroblasts.

负压封闭引流(vaccum sealing drainage VSD)是用内含引流管的聚乙烯酒精水化海藻盐泡沫敷料覆盖或填充皮肤或缺损软组织创面,再用生物半透膜对之进行封闭,使其成为密闭空间,通过连接负压源,利用可控制的负压促进创面愈合的治疗方法,现已广泛应用于临床。我科自2010年8月至2012年2月共计应用VSD技术治疗难愈性创面20例,其中慢性溃疡12例,热压伤2例,压疮6例。患者手术平均次数为1-2次,可保持有效引流5-7天,患者均痊愈出院。

目的:探讨负压封闭引流技术治疗难愈性创面围手术期的护理.方法:术前做好心理护理及常规准备、调试负压装置,术后严密观察患者生命体征、观察引流液的性状、注意无菌操作并应用抗生素预防感染、注意保证负压引流通畅.结果:20例患者均痊愈出院,未发生术后感染等并发症.结论:围手术期病情的密切观察及有效护理、及时发现和解决出现的问题是负压封闭引流技术能够取得良好疗效的关键.

目的探讨丝裂霉素C(MMC)对增生性瘢痕成纤维细胞(FB)增殖的影响及机制,为增生性瘢痕的治疗提供理论依据。方法用组织块法体外培养人增生性瘢痕FB,应用MTT方法、Western blot技术结合光密度扫描分析,观察MMC对增生性瘢痕FB增殖活性的影响及Smad7蛋白的表达情况。结果在24、48、72 h这3个时间段内,随着培养时间的增加,细胞生长抑制率呈现明显的上升趋势,并且MMC浓度为2.5～200μg/mL时,对细胞生长有明显的抑制效应,与对照组比较存在统计学差异(P<0.05),显示明显的时间剂量依赖关系。经2.5～200μg/mL不同浓度的MMC作用增生性瘢痕FB 24 h,Smad7蛋白表达量增加。结论 MMC对增生性瘢痕FB的增殖起到抑制作用,同时诱导Smad7蛋白的表达。

Objective To study the influence of mitomycin C(MMC) on cell proliferation and Smad2/3 expression of keloid fibroblasts.Methods People scar fibroblasts were cultivated by tissue block method.The influence of different concentrations of MMC on cell proliferation activity was observed by MTT.Smad2/3 protein expression was measured by Western blot.Results Different concentrations of MMC restrained fibroblasts proliferation active with time and dose dependence.12.5 μg/ml MMC began to decrease Smad2/3 protein expression(P<0.05).Conclusions MMC inhibits keloid formation by inhibiting fibroblasts proliferation and decreasing Smad2/3 protein expression.