HBsAg阳性患者中HBV-DNA(PCR)与其它HBV复制标志物的关系

本文应用聚合酶链反应(PCR)对125例乙型肝炎病毒患者血清进行了HBV-DNA检测,根据其检测结果与乙型肝炎病毒的其它复制标志物HBcAg(检测125例)、HBeAg(检测115例)、PreS_2Ag(检测92例)、PHSA-R(检测114例)、Anti—HBclgM(检测118例)进行比较。HBV-DNA阳性血清中HBcAg、HBeAg、PreS_2Ag、PHSA-R、Anti-HBcIgM的检出率分别为83.75％(67/80)、62.34％(48/77)、61.02％(39/59)、74.03％(57/77)、72.97％(54/74)。经统计学处理,显示五项复制标志物与HBV-DNA的相关关系应是:HBcAg>PHSA-R>Anti-HB-cIgM>HBeAg>PreS_2Ag。在HBV-DNA(PCR)阳性血清中,HBcAg的检出率为最高。提示在除HBV-DNA(PCR)外,上述五项标志物中,HBcAg可能是HBV-DBA复制的最佳指标。HBeAg在HBV复制过程中的地位仍有待今后进一步探讨。     

模特征对伴单侧坐骨神经痛的腰椎间盘突出症的诊断价值

目的：介绍与验证一种反映腰椎间盘突出伴单侧坐骨神经痛的体征——模特征。方法：选取72例经腰椎MRI证实有腰椎间盘突出（L4，532例，L5／S1 40例）并伴单侧坐骨神经痛的患者，男49例，女23例，年龄32～68岁，平均50．7岁。每例患者人院当日由两位医师间隔2h分别检查，患者背对检查者，嘱其取最能缓解坐骨神经痛的站立姿势，若患者出现患侧屈髋屈膝、骨盆倾向患侧的姿势，记为“模特征阳性”，否则记为“模特征阴性”。同时行直腿抬高试验（SLR），阳性患者记录诱发下肢放射痛的最小角度。结果：70例患者两检查者结果完全相同，其中阳性60例，阴性10例，敏感性为85．7％；仅2例患者两检查者结果不一致，重复性97．2％。SLR均为阳性。结论：模特征是诊断伴单侧坐骨神经痛腰椎间盘突出症的简单、敏感的临床体征。     

Chameleon voices: Interpreting for deaf parents

As interpreters for their deaf parents, hearing children are a cultural link between two often separate worlds: the Deaf and the Hearing. Data from a 4 year study of adult hearing children throughout the United States indicate significant differences between hearing daughters and hearing sons. Not only were daughters more likely than sons (regardless of birth order or age differences) to interpret for their parents, but daughters were also far more likely to be bilingual: fluent in both spoken English and American Sign Language. A similar gender bias has been observed among the general hearing public: women are far more likely to attend sign language classes and to work as interpreters for the deaf. This paper explores the social mechanisms and cultural values which determine the gender of the way we communicate with one another. Informants' narratives suggest that sign language and the practice of interpreting often touched upon a larger pattern of socialization and status differences between women and men. The discussion then turns to consider how these differences affect the cultural identity of hearing sons versus hearing daughters.     

大骨节病儿童手部X线征与年龄的关系

本文分析了2800例4～13岁大骨节病儿童掌指骨X线病变与年龄的关系,结果表明手部掌指骨干骺端X线征随年龄增加而趋于下降,骨端、骨骺、腕骨X线征的类型与检出率则随年龄而呈上升趋势,反映出大骨节病关节病变的范围有随年龄增长而扩大和增重的趋势。     

ERK1/2信号转导途径在低切应力上调人脐静脉内皮细胞IL-8基因表达中的作用

血管内皮细胞位于血流和血管壁之间,除受化学因素的调节外还受力学因素的影响。切应力可通过刺激相应的力学感受系统来调节内皮细胞某些基因的表达,其中包括诱导内皮细胞表达IL- 8。为了阐明MAPK信号途径中的ERK1/ 2信号通路是否参与调控低切应力上调人脐静脉内皮细胞IL- 8基因表达,采用Western blot分析了低切应力(4.2 0 dyne/ cm2 )处理不同时间内皮细胞ERK1/ 2的磷酸化水平及TPK抑制剂Genistein,MEK抑制剂PD980 5 9对其磷酸化的影响;采用定量RT- PCR检测内皮细胞经低切应力刺激或给予阻断剂后再行切应力刺激等处理后IL- 8基因的表达。结果显示:(1)低切应力处理可引起内皮细胞ERK1/ 2蛋白磷酸化水平上调,其磷酸化水平与切应力作用时间有关,具有快速、双向性的特点(在刺激10 min时达到高峰,2 h左右降至未刺激水平) ,阻断剂Genistein和PD980 5 9处理后,ERK1/ 2磷酸化水平与低切应力刺激10 min比较明显降低;(2 )阻断剂Genistein,PD980 5 9可显著抑制低切应力所致的内皮细胞IL- 8m RNA上调。结果表明低切应力可通过ERK1/ 2信号途径上调人脐静脉内皮细胞IL- 8基因的表达。     

Prevalence of Risk Factors for Adverse Spinopelvic Mobility Among Patients Undergoing Total Hip Arthroplasty

BackgroundPatients with adverse spinopelvic mobility have higher complication rates following total hip arthroplasty (THA). Risk factors include a stiff lumbar spine, standing posterior pelvic tilt ≤ ?10°, and a severe sagittal spinal deformity (pelvic incidence minus lumbar lordosis mismatch ≥20°). The purpose of this study is to define the spinopelvic risk factors and quantify the prevalence of risk factors for pathologic spinopelvic mobility.MethodsA retrospective cohort analysis from January 2014 to February 2020 was performed on a multicenter series of 9414 primary THAs by 168 surgeons, all with preoperative spinopelvic measurements in the supine, standing, and flex-seated positions. All patients were included. The prevalence of adverse spinopelvic mobility and frequency of each spinopelvic risk factor was calculated.ResultsThe cohort was 52% female, 48% male, with an average age of 65 years. Thirteen percent of patients exhibited adverse spinopelvic mobility and 17% had one or more of the 3 risk factors. Adverse mobility was found in 35% of patients with at least 1 risk factor, 47% with at least 2 risk factors, and 57% with all 3 risk factors.ConclusionForty-six percent of patients had spinopelvic pathology driven by one or more of the risk factors. Number of risk factors present and risk of adverse spinopelvic mobility were positively correlated, with 57% of patients with all 3 risk factors exhibiting adverse spinopelvic mobility. Although this study defines the prevalence of these risk factors in this highly selected cohort, it does not report incidence in a general THA population.Level of EvidencePrognostic Level IV.     

Association of feces sign with prognosis of non-emergency adhesive small bowel obstruction

Background/Objective: The feces sign has been reported as a possible predictive factor for non-operative treatment of small bowel obstruction. However, its relationship with prognosis of non-emergency adhesive small bowel obstruction remains unclear. This study aimed to clarify the relationship between the feces sign and prognosis of non-emergency adhesive small bowel obstruction.MethodsNinety-two patients with non-emergency adhesive small bowel obstruction with the transitional zone visible on computed tomography were included. Patients were categorized into two groups: feces sign positive (n = 40) and negative (n = 52). Clinical features and prognosis were compared between the two groups. Cox proportional hazards regression models incorporating the feces sign were used to analyze odds of diet resumption and discharge.ResultsPatients with feces sign were younger (p = 0.015), had a higher body mass index (p = 0.027), and a lower white blood cell count (p = 0.019) on admission. More patients with feces sign were successfully treated with fasting and/or nasogastric tube placement (p < 0.001), and no patient with feces sign suffered from recurrent obstruction after diet resumption. Kaplan–Meier analysis showed that patients with feces sign took less time for diet resumption (p = 0.007) and discharge (p = 0.004) than those without it. Using Cox proportional hazards regression model, the feces sign was reported as an independent predictor of diet resumption (odds ratio 1.685, p = 0.018) and discharge (odds ratio 1.861, p = 0.007).ConclusionsThe feces sign is associated with improved odds for diet resumption and discharge.     

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

PurposeThe purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method.MethodsThe panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached.ResultsConsensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade.ConclusionThis study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP.Level of evidenceV