低弹性模量接骨板对骨改建的影响

３０只成年新西兰家兔分成两大组，采用金属板和碳素板Ⅰ型、碳素板Ⅱ型３种不同弹性模量的接骨板于双侧胫骨中段作末截骨内固定。术后６月截取接骨板下皮质骨通过生物力学测定，显示高弹性模量的金属板固定区域骨的力学性能差。组织学研究显示金属钢板固定后皮质骨出现大量的骨吸收腔，碳素板固定区仅有少量骨吸收腔，皮质骨较厚。表明高弹性模量接骨板有较高的应力保护作用。     

接骨板固定及取出后局部骨量骨结构和骨强度的变化

接骨板固定及取出后局部骨量骨结构和骨强度的变化朱振安戴克戎裘世静陈永强作者单位：２０００１１上海第二医科大学附属第九人民医院骨科附表接骨板固定及取出后骨弯曲极限强度和弹性模量（％，ｘ±ｓ）类别取钢板后时间（月）０１２３４内固定后６个月弯曲极限强度５６...     

β－焦磷酸钙人工骨的应用及其病理变化的实验研究

观察了β－焦磷酸钙人工骨嵌入骨缺损部位的病理变化。实验用家兔３６只，随机分为６组，其中一组作为对照，分别于第４周、６周、８周、１０周、１２周各处死６只。切取组织用１０％福尔马林固定，普通石蜡包埋，ＨＥ染色，光镜检查。结果表明，第４周以后渐出现新生骨小梁，８周以后新生骨与受骨融合，骨连接较为坚实，提示β－焦磷酸钙人工骨是一种较好的骨移植替代材料     

磷酸三钙植骨治疗跟骨骨折的疗效和组织学观察

目的：观察多孔磷酸三钙治疗跟骨骨折的疗效及骨细胞生长情况。方法：85例跟骨骨折患者中,采取传统切口钢板内固定57例,小切口空心钉内固定28例,其中75例使用磷酸三钙植骨治疗,观察临床疗效。骨折愈合后二次手术取内固定,并在原植骨区取极少量骨组织标本再次行组织学观察,比较骨细胞的生长情况。结果：传统切口钢板内固定和小切口内固定植骨患者临床疗效明显优于小切口内固定未植骨患者（P〈0.01）。植骨后新生骨组织中成骨细胞增生活跃,骨细胞分化成熟,密度增大,骨小梁密度增宽,骨小梁间纤维组织增生伴毛细血管增生。结论：多孔磷酸三钙具有良好的生物相容性、生物力学强度和骨传导作用,其降解效应与骨组织的改建塑形基本同步,降解速度适中,骨愈合后接近与正常骨组织,性能稳定,组织学照片显示新骨生成良好,与原骨组织相似。     

家兔经皮自体骨髓移植在骨缺损瘢痕组织内成骨的组织学观察

目的：观察家兔自体骨髓移植在骨缺损瘢痕组织内成骨的组织学改变。方法：选择健康家兔１８只，建立双侧桡骨骨缺损模型。６周后，于右侧桡骨骨缺损瘢痕组织内注射自体骨髓２ｍｌ，左侧骨缺损区注射自身外周血２ｍｌ。于注射前及注射后１周２周３周４周和８周行组织学检查。结果：骨髓注射组在注射１周后骨缺损区内有软骨组织形成，２周可见软骨组织内有骨小梁及骨髓组织，至注射后８周，骨缺损大部分为正常骨组织充填，而外周血组无成骨现象。结论：经皮自体骨髓移植在骨缺损瘢痕组织内可以成骨，外周血注射无成骨作用     

矩形钉、记忆骑缝钉加植骨治疗肱骨中下段骨不连

肱骨中下段骨不连的治疗比较困难，利用记忆骑缝钉热缩冷涨的特性，我们１９９２年２月～１９９８年８月，共收治肱骨中下段骨不连４２例，均采用矩形钉、记忆骑缝钉加植骨治疗，经术后随访１０～２４个月，取得满意效果。１ 临床资料１. １ 一般资料 本组４２例，男３２例，女１０例，年龄２５～６８岁，平均３８．６岁。术前：钢板固定２８例，矩形钉固定６例，钢丝固定４例，螺丝钉固定２例，外固定架２例；第１次术后活动开始时间２周～２个月。２次手术时间间隔８～１８个月，骨不连分型：膨大型３５例，萎缩型７例。并发有挠神经损伤…     

多孔面钛合金植入物骨长入生物固定的实验研究

本文对国产多孔面钛合金植入物骨长入生物固定进行了实验观察。植入柱形假体(多孔面孔径200～600 μm,孔隙率44％)于成年家兔股骨下端。设骨水泥对照组,实验组在12周内分组观察。荧光、偏光显微镜和电子探针微区分析等切片观察表明,假体植入两周后多孔内就有骨组织长入,8～12周多孔内被骨充盈。力学测试表明,多孔面假体植入后两周即可达到与骨水泥相当的剪切固定强度,但产生一定的抗张固定强度则需要4～6周时间;多孔面骨界面具有与骨质相似的力学特性,有利于应力传递。结果证实国产钛合金多孔面骨长入生物固定在假体固定中的可行性。     

H形脱钙骨在脊柱后路手术中的临床应用

目的 观察H形脱钙骨在促进脊柱后路融合和防粘连中的作用，探讨其在脊柱后路手术中的应用价值。方法 对23例严重椎管狭窄和31例椎管内肿瘤患者，行全椎板切除减压，对肿瘤患者同时行椎管内探查，肿瘤摘除术后，再行脊柱后侧及后外侧H形脱钙骨植骨融合术。最后，根据患者经济情况，行内固定或石膏外固定术一，平均随访21个月(18～31个月)。结果 所有患者在术后8个月内获相应节段骨融合．43例术后症状明显缓解，且无再加重现象。11例肿瘤患者术后症状明显缓解，1年后出现再加重现象。结论 H形脱钙骨在脊柱后路手术中有重要应用价值。     

诱导成骨修复家兔桡骨缺损的实验研究

定性、定量地了骨基质明胶和脱钙骨基质与自体红骨髓复合植入物修复家兔桡骨损的过程。结果表明两者均有诱导成骨作用，骨基质明胶的诱导成骨能力优于钙骨基质。术后６周，骨基质明胶组的骨缺损已完全愈合，而脱钙骨基质组接近愈合。作者认为含有骨形态发生蛋白的骨基持明胶和脱钙骨基质具有诱导成骨能力，而自体红骨髓为骨形态发生白提供诱导成骨的靶细胞。     

等离子喷涂硅酸二钙涂层与骨组织相容性的形态学研究

目的观察硅酸二钙喷涂的钛合金植入动物体骨组织后局部组织的反应,研究硅酸二钙涂层与骨的组织相容性。方法应用等离子喷涂技术于钛合金基体表面喷涂硅酸二钙涂层,将该种植体植入动物股骨髁内,分别于1月、2月和3月处死实验动物,截取含有种植体的股骨髁,作HE染色、甲苯胺蓝染色和四环素荧光标记,分别行光镜和荧光显微镜观察。结果植入硅酸二钙涂层的钛合金后,涂层周围骨组织的修复属于正常的骨修复过程,种植体-骨界面直接发生骨整合,无纤维包囊形成。结论等离子喷涂硅酸二钙涂层的钛合金与骨组织具有良好的组织相容性。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.