目的 探讨改良皮肤牵张器联合负压封闭引流(VSD)技术治疗四肢大面积皮肤缺损的效果.方法 选取2018年10月至2021年10月我院收治的90例四肢大面积皮肤缺损患者,分为两组各45例.对照组采用VSD治疗,观察组采用改良皮肤牵张器联合VSD治疗.比较两组的创面愈合效果.结果 治疗后,观察组的创面细菌计数少于对照组,透明质酸(HA)、血管内皮生长因子(VEGF)水平均高于对照组(P<0.05).观察组的创面色泽、血管分布、厚度、柔软度评分均高于对照组(P<0.05).结论 改良皮肤牵张器联合VSD治疗四肢大面积皮肤缺损患者可减少创面细菌,刺激HA及VEGF的分泌,促进创面皮肤恢复.

Objective:To investigate and analyze the effect of ubiquitin-editing protein A20 on monocytes activity in patients with ventilator-associated pneumonia (VAP).Methods:Twenty-four VAP patients (VAP group) and twelve healthy controls (control group) were included from the First Affiliated Hospital of Zhengzhou University between February 2019 and September 2019. Peripheral blood mononuclear cells (PBMCs) and bronchial alveolar lavage fluid (BALF) (both infection site and non-infection site) were collected from VAP patients, while PBMCs were collected from healthy controls. A20 level in CD14 + monocytes were measured. CD14 + monocytes and CD4 + T cells were purified from VAP patients. CD14 + monocytes were transfected by A20 siRNA. Transfected CD14 + monocytes were directly/indirectly co-cultured with autologous CD4 + T cells. The secretion of interferon-γ (IFN-γ) and interleukin-17 (IL-17) by CD4 + T cells was investigated. Transfected CD14 + monocytes were directly/indirectly co-cultured with NCI-H889 cells. Cytotoxicity, and cytokines/granzyme B level, and tumor necrosis factor-related apoptosis inducing ligand (TRAIL)/Fas ligand (FasL) level was assessed. Student t test or SNK-q test was used for comparison. Results:VAP group had elevated percentage of circulating CD14 +A20 + cells than control group [(66.14±19.62)% vs. (52.52±13.71)%, P<0.05], and also had increased A20 mean fluorescence intensity (MFI) than control group [(268.0±72.56) vs. (197.4±60.01), P<0.05]. The percentage of CD14 +A20 + cells in BALF from infection site was higher than from non-infection site in VAP group [(66.14±19.62)% vs. (52.52±13.71)%, P<0.05], while A20 MFI in infection site was also up-regulated compared with non-infection site [(268.0±72.56) vs. (197.4±60.01), P<0.05]. In direct contact co-culture, A20 siRNA transfected CD14 + monocytes, which were purified from peripheral blood and BALF of VAP patients, induced elevated percentage of IFN-γ and IL-17 secreting CD4 + T cells than un-transfection or control siRNA transfection ( P<0.05). However, there were no significant differences of CD4 +IFN-γ + or CD4 +IL-17 + percentages among un-transfection, control siRNA transfection, and A20 siRNA transfection ( P>0.05). A20 siRNA transfected CD14 + monocytes, which were purified from peripheral blood and BALF of VAP patients, induced increased target cell death in both direct and indirect contact co-culture than un-transfection or control siRNA transfection ( P<0.05). Tumor necrosis factor-α, IL-6, granzyme B level and TRAIL MFI was also up-regulated ( P<0.05). There was no remarkable difference of target cell death between direct and indirect contact co-culture ( P>0.05). Conclusions:A20 was increasingly expressed in monocytes of VAP patients, and might dampen the activity of monocytes.

脊髓损伤(spinal cord injury,SCI)是一种严重的神经系统疾病,其特点为损伤部位神经元功能的永久丧失及胶质瘢痕形成,导致相应支配区域的感觉和运动功能障碍.SCI可能会引起一系列严重后果,例如感觉障碍和肢体瘫痪;另外,由于失去了神经的营养作用,骨质疏松和肌肉萎缩也是其常见的并发症[1].SCI不仅给患者及家庭带来沉重的生理和心理负担,而且给社会造成巨大的经济损失,故而其预防、治疗和康复已成为医学领域的重要问题.SCI的发病机制复杂,涉及原发性和继发性损伤两个阶段.在骨折、压迫等原发性损伤发生后,炎症反应、组织缺氧、神经元坏死和凋亡、局部微环境抑制等一系列继发性损伤进一步加重了脊髓损伤,导致严重的感觉和运动功能丧失.临床上,即使患者能得到及时的救治,但仍有相当一部分SCI患者终生忍受着瘫痪的折磨[2].因此,寻找能够有效治疗该疾病的新的分子靶标至关重要.

Objective To investigate the application of autologous blood transfusion in posterior correction of scoliosis in adolescents. Methods A retrospective analysis was made on the clinical data of 87 patients who underwent posterior scoliosis surgery in the First Affiliated Hospital of Zhengzhou University from August 2017 to August 2018. Eighty-seven patients were divided into group A and group B. Routine drainage devices were used in group A and autologous blood transfusion devices were used in group B. The basic data and operative data of the two groups were compared. The hemoglobin levels before operation and 0 h, 24 h and 72 h after operation, the drainage volume 24 hours after operation and the blood transfusion volume after operation were also compared between the two groups. Results There was no significant difference in the basic data ( age, sex, body mass, Cobb angle) or operative data (number of fusion vertebrae, screw, duration of operation, intraoperative blood loss, length of skin incision) between the two groups (P > 0. 05). There was no significant difference in hemoglobin levels between the two groups before operation, 0 h, 24 h and 72 h after operation (P > 0. 05). The proportion of allogeneic blood transfusion and 24 h actual drainage volume in group B were lower than those in group A (P < 0. 05). Postoperative reinfusion volume was significantly correlated with the number of fusion vertebrae and body mass, but not with other factors. Conclusions In posterior correction of adolescent idiopathic scoliosis, the use of autologous blood transfusion after surgery can significantly reduce the postoperative drainage and the proportion of allogeneic blood transfusion. The amount of reinfusion is significantly correlated with the number of fusion vertebrae and body mass.

Objective To compare the relative factors of cervical spinal nerve 5 palsy ( C5 P ) after laminoplasty ( LP ) and anterior cervical decompression and fusion ( ACDF ) in the treatment of multilevel cervical myelopathy ( MCSM ) . Methods A retrospective analysis was performed on 376 patients with cervical spondylotic myelopathy who underwent cervical decompression surgery in the First Affiliated Hospital of Zhengzhou University from January 2010 to June 2016 . All patients were followed up for at least 2 years. According to surgical methods, they were divided into two groups: LP group (n=215), ACDF group(n =161). Results A total of 34 cases of C5P occurred postoperatively, including 26 cases in LP group (12. 1％, 26/215) and 8 cases in ACDF group (5. 0％, 8/161), with statistically significant differences. At the last follow-up, the improvement rate of Japanese Orthopaedic Association score and neck disability index in ACDF group was significantly better than that in LP group, and cervical curvature index in ACDF group was better than that in LP group, with statistically significant differences (P<0. 05). In the univariate logistic analysis, age were statistically correlated with C5P both in the LP group(P=0. 012) and in the ACDF group (P=0. 034). According to a multivariate logistic analysis, age was also significantly correlated in both groups (P =0. 003, P =0. 041). Prophylactic C4/C5 foraminotomy performed were statistically correlated with C5 P in ACDF group according to univariate logistic regression ( P = 0. 023 ) and a multivariate logistic regression ( P = 0. 037 ) . Conclusions LP and ACDF are the two main surgical techniques for the treatment of MCSM. ACDF is superior to LP in maintaining the physiological curvature of the cervical spine. Prophylactic C4/5 foraminotomy can effectively reduce the occurrence of C5P after ACDF. Elderly patients after cervical decompression should be more alert to the occurrence of C5P.

目的:探究3D打印的个性化椎弓根置钉导向器对于重度脊柱畸形患者(主弯Cobb角≥90°)矫形手术中辅助置钉的安全性和有效性.方法:回顾我院2017年1月～2017年9月采用椎弓根置钉导向器辅助置钉的13例(9女4男)重度脊柱畸形患者,平均手术年龄12.9±3.1岁(10～19岁),随访时间13.8±1.9个月(12～18个月).术后2周CT测量椎弓根螺钉突破椎弓根皮质的程度,并将其分成0级(未突破椎弓根皮质)、1级(突破＜2mm)、2级(突破2～4mm)、3级(突破＞4mm),其中0级和1级认定为螺钉置入准确.测量并比较术前、术后2周、末次随访的主弯Cobb角、后凸角、冠状面平衡、脊柱矢状位轴,记录置钉相关并发症.结果:13例重度脊柱畸形患者术中在119枚椎弓根置钉导向器(238个椎弓根导向孔)的辅助下,成功置入232枚椎弓根螺钉,辅助置钉成功率97.5％(232/238).依据CT测量分级,0级、1级、2级和3级螺钉数依次为111枚、84枚、33枚和4枚,置钉准确率为84.1％(195/232).术后2周,主弯Cobb角由术前的110.6°±15.2°纠正至52.3°±16.2°(P＜0.05);后凸角由术前的58.3°±20.6°纠正至35.7°±10.4°(P＜0.05);冠状面平衡由术前的2.8±1.7cm纠正至1.7±0.5cm(P＜0.05);脊柱矢状位轴由术前的3.1±1.8cm纠正至1.4±0.4cm (P＜0.05).末次随访与术后2周比较,无统计学差异(P＞0.05).至末次随访时,未发生严重的置钉相关并发症.结论:椎弓根置钉导向器可为重度脊柱畸形患者提供准确性较高的辅助导航.

例1 男 ,3岁 ,因左侧阴囊空虚入院 ,初诊为"左侧隐睾".体格检查时于左侧阴囊及腹股沟区未触及睾丸组织.超声检查示 :左侧阴囊空虚并左侧腹腔髂血管旁类睾丸样回声 ,左侧腹股沟杂乱回声(考虑腹股沟疝).实验室检查示性激素在正常参考值范围内.入院后拟行"左侧睾丸下降固定术+疝囊高位结扎术".术中于左侧睾丸引带处见一类睾丸样肿物(图1) ,大小约10 mm × 6 mm × 5 mm ,质软 ,包膜完整 ,表面光滑 ,肿物与同侧主睾丸、附睾及输精管分离 ,同侧主睾丸、附睾无明显异常 ,给予切除肿物 ,同时下拉固定左侧主睾丸 ,结扎疝囊.术后病理检查报告 :镜下见生精小管基底膜增厚 ,生精细胞及支持细胞减少 ,部分小管内生精细胞缺如 ,仅见少许支持细胞 ,睾丸间质增生 ,间质细胞减少 ,符合睾丸发育不良(图2).患儿术后3 d出院 ,术后1个月复诊双侧睾丸、附睾未见明显异常.

Objective To explore the application of ultrasound-guided bladder biopsy in the diagnosis of pediatric eosinophilic cystitis (EC).Methods The clinical data were retrospectively reviewed for 7 children diagnosed as EC by bladder biopsy under a guidance of color Doppler ultrasound from January 2014 to October 2017.The diagnostic value was analyzed with the relevant literatures.There were 5 boys and 2 girls with an average age of 8.1 years and the course of disease for 3-20 days.The major clinical manifestations were irritative bladder symptoms and lower abdominal pain.Among them,5 children had additional ultrasound-guided bladder biopsy under local (n =1) and general (n=4) anesthesia when the diagnosis was unclear by initial cystoscopic biopsy under general anesthesia.Two children underwent ultrasound-guided bladder biopsy under local (n =1) and general (n=1) anesthesia.The diagnostic results of five children undergoing cystoscopic biopsy and additional ultrasound-guided bladder biopsy were matched and compared.SPSS 24.0 software was used for conducting hypothesis test and comparative analysis with α =0.1 as a standard.Results All children undergoing ultrasound-guided bladder biopsy had satisfactory biopsy results and no significant complications occurred.Initial biopsy in 5 cases of cystoscopic biopsy failed to confirm the diagnosis and then ultrasound-guided biopsy established the diagnosis of EC.Two children undergoing ultrasound-guided biopsy were directly diagnosed as EC during the first biopsy.As shown by the result of hypothesis test,if suspected diagnoses were not treated as misdiagnoses,there was not statistically significant difference in misdiagnostic rate of EC (x2 =1.33 ＜ 2.7,P＞ 0.1).However,if suspected diagnoses were treated as undetermined diagnoses,then no statistically significant difference existed in accuracy rate (x2 =3.2 ＞ 2.7,P ＜ 0.1).Conclusions Bladder biopsy guided by color Doppler ultrasound has the advantages of high accuracy rate,safety and easy handling.Furthermore,local anesthesia is sufficient for elder children so that cystoscopy and risk of general anesthesia are avoided.So it is a preferred method of diagnosing pediatric EC.

Objective To investigate the effect of local application of vancomycin powder in preventing deep infection in posterior spinal instrumentation surgery. Methods A total of 675 patients who underwent posterior spinal instru-mentation surgery were divided into two groups according to admission date. In the control group, 320 patients under-went intravenous application of cefuroxime sodium 2. 0 g at preoperative 0.5 h, and superadded once very 3 h in the operation. In the observation group, besides the usual application of cefuroxime sodium, 355 patients were applieated vancomycin powder 1.0 g in the field of local surgical site before closing the surgical incision. The deep infection rate evaluated by using the etiologic diagnosis standard was compared between the two groups. Results After surgery, the deep infection happened in 17 cases(2.52%), including 13 cases(4.06%) in the control group and 4 cases (1.13%) in the observation group. There was statistically significant in deep infection rate between the two groups (P=0.015), but there was no statistical difference among cervical, thoracic and lumbar region(P＞0.05). Con-clusions The local application of vancomycin powder can reduce the deep infection rate of posterior spinal instru-mentation surgery.

Objective To explore the treatment effect of pedicled myocutaneous island flap of anterolateral thigh muscle on the suprapubic defect caused by bladder exstrophy in children. Methods The clinical data of 3 adolescents with bladder exstrophy were analyzed. All 3 cases underwent one-stage Kelly procedure and received the treatment using pedicled myocutaneous island flap of anterolateral thigh muscle to repair the suprapubic defect. The bladder expansion was performed with ileal sarcoplasmic layer graft, and the Cohen ureteral reimplantation was performed as well, for 1 case 1, 1 year after the first operation. The others 2 patients didn′t receive the second operation. Results All operations were successful. The femoral donor regions were directly closed. Postoperative follow-up period was 1-7 years. The myocutaneous island flaps were survived and grew well. All incisions of the femoral donor region were primary healing without scar hypertrophy. Urinary continence was achieved in 2 cases, and partially achieved in 1 case. Recurrent urinary tract infection, recurrent fever or abdominal pain were not observed in all patients. Conclusions The pedicled anterolateral thigh myocutaneous island flap is an alternative way to repair suprapubic defect caused by bladder exstrophy.

Objective To investigate the appropriate treatment protocol for children with urinary calculi complicated with acute renal failure caused by improper use of drugs .Methods Clinical data of 55 cases of pediatric urolithiasis complicated with acute renal failure caused by improper use of drugs treated in the First Affiliated Hospital of Zhengzhou University from December 2010 to December 2015 were collected . Ultrasound showed that the volume of both kidneys increased and diffuse lesions occurred;multiple stones and flocculent material emerged in the urinary tract; 27 cases had bilateral lesions , 28 cases had unilateral lesions;and the X-ray images did not display any stones .Antispasmodic and alkalized urine treatment were implemented to all the patients , of which 16 children were given hemodialysis at the same time .Results Thirty-nine children restored urination within 24 hours after simple antispasmodic , urine alkalization and correction of internal environment disorders . Sixteen children gradually restored urination after once hemodialysis treatment . One week after treatment , patients were reexamined by color ultrasound after urine became stable , and results showed that the stones were radically disappeared in 51 cases; stones were significantly reduced in 4 cases of children , and renal parenchymal echo returned to normal , areas of water accumulation disappeared for all cases accompanied by kidney or ureteral water . In the three-month follow-up outside the hospital , the electrolyte, renal function and urinary color ultrasound results were normal in all 55 cases. Conclusions The children with urolithiasis complicated with acute renal failure due to improper use of drugs should be treated as early as possible .For the pediatric utolithiasis patients , antispasmodic , alkaline urine therapy , liquid treatment to maintain the internal environment , combined with hemodialysis treatment if necessary , has ideal therapeutic effects .At the same time, we should pay more attention to pediatric medication .

Objective To investigate the diagnosis of multi-cystic lymphangioma of head and neck in children,and to evaluate the clinical effect of pingyangmycin tumor injection on children with multi-cystic lymphangioma of head and neck.Methods Thirty-three cases of multi-cystic lymphangioma of the head and neck were selected.The diagnosis of multi-locular cystic lymphoma was carried out before treatment with color Doppler ultrasound,CT and paracentesis.In the treatment,multi-point parallel needle tumor injection of pingyangmycin were used,and the children were followed up for more than 1 year after drug injection to observe the clinical efficacy.Results Among the 33 cases,21 cases of tumors disappeared completely(the cure rate was 63.6％),9 cases of tumors reduced significantly(the significant improvement rate was 27.3％),the disappearance of tumors in 3 cases were not obvious (improvement rate was 9.1％),the total effective rate was 100％.Conclusions Color Doppler ultrasound,CT and paracentesis can provide a reliable basis for the diagnosis of multi-cystic lymphangioma of head and neck in children.Multi-point parallel needle injection of pingyangmycin has good clinical effect on children with head and neck multi-cystic lymphangioma.

Objective To study the therapeutic effects of solifenacin combined with behavior training in the treatment of children with primary monosymptomatic nocturnal enuresis.Methods One hundred children with primary monosymptomatic nocturnal enuresis in the First Affiliated Hospital of Zhengzhou University from March of 2014 to March of 2015 were selected as the research population.There were 47 males, with an average age of (7.4±2.2) years old.There were 47 females, with an average age of (7.7±2.6) years old.These children were randomly divided into control group and observation group, 50 cases in each group.The two groups were treated with behavior training, while the observation group was treated with oral solifenacin.Two groups were treated continuously for 12 weeks and were followed up for 8 weeks.Voiding diary was continuously collected in children with primary monosymptomatic nocturnal enuresis from 8 weeks before treatment, until after follow-up for eight weeks.Bladder function was detected by urodynamic instrument before and after treatment, and also after follow-up.The treatment effect was compared between the two groups.Results The curative effect of observation group was obviously better than the control group, and the difference was statistically significant (P<0.05).The improvement of bladder function after treatment of observation group was obviously better than the control group, and the difference was statistically significant (P<0.05).The recurrence rate of observation group was lower than the control group, and the difference was statistically significant (P<0.05).Conclusion Solifenacin combined with behavior training can effectively improve the bladder function of primary monosymptomatic enuresis in children, reduce the number of nocturnal enuresis, improve the quality of life of patients, with less adverse reactions, and it is worthy of popularizing.