钽棒植入与骨瓣移植治疗成年人早期股骨头坏死的近期疗效对比

目的:比较髓芯减压联合金属钽棒植入术与带血管蒂髂骨瓣转移术治疗成年早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的近期临床疗效.方法:回顾性收集本院2012年1月至2015年2月间收治的83例(97髋)非创伤性ONFH患者病历资料,A组43例52髋行髓芯减压并钽棒植入术,B组40例47髋,行自身带血管蒂髂骨瓣转移术,术后随访1年,比较两组手术参数指标、术后1年Harris髋关节功能评分及手术疗效.结果:A组手术时间(40.7±10.3) min、术中失血量(88.0±27.1) mL、术后镇痛泵应用时间(1.68±0.32)d、拆线天数(12.8±1.5)d均显著低于B组[(82.5±17.2) min,(239.4±45.2) mL,(2.15±0.48)d,(14.2±1.9)d;P＜0.05].两组术后12个月Harris总评分及各项目评分均较术前显著提高(P＜0.0s),A组术后Harris总评分(88.4±5.9)及关节功能评分(41.5±4.8)均显著高于B组[(83.6±5.3),(37.5±6.1);P＜0.05].两组术后12个月髋关节功能优良率均较术前显著提高(P＜0.05),A组术后12个月优良率(92.3％)显著高于B组(76.6％,P＜0.05).B组有1例出现髓塌陷,A组无髓塌陷病例.结论:髓芯减压联合金属钽棒植入术较带血管蒂髂骨瓣转移术治疗早期ONFH手术操作相对简单,近期疗效更为明显.     

Myr-RKEFAK肽选择性调控血小板外向内信号转导相关功能

目的:研究踝蛋白杆部整合素结合位点2与整合素β3相互作用对于血小板信号转导的影响。方法:设计合成模拟整合素β3胞浆近膜端α螺旋上6个氨基酸序列(R724KEFAK729)的寡肽,并通过十四烷酰化修饰以使其具有穿细胞膜性(myr-RKEFAK肽)。观察myr-RKEFAK肽对经典血小板外向内信号转导事件(固相纤维蛋白原上的稳定黏附和伸展、二相聚集、纤维蛋白凝块回缩),以及内向外信号转导事件(一相聚集、游离纤维蛋白原的结合)的影响。结果:myr-RKEFAK肽可以浓度依赖性地抑制血小板固相化纤维蛋白原上稳定黏附和伸展、二相聚集以及纤维蛋白凝块回缩等外向内信号转导功能;但不影响游离纤维蛋白原结合和一相聚集等内向外信号转导功能。结论:穿膜肽myr-RKEFAK对血小板的外向内信号转导相应功能产生抑制,但不影响血小板内向外信号转导相关功能。     

聚醚醚酮棒脊柱动态内固定系统在腰椎退行性疾病中的临床对比研究

目的对比研究聚醚醚酮（PEEK）棒脊柱动态内固定系统与传统刚性内固定在治疗腰椎退行性病变中的临床疗效。 方法回顾性分析2014年6月至2017年6月47例腰椎退行性病变患者的临床资料。根据内固定材料的不同,将47例患者分为PEEK棒组（21例）和钛棒组（26例）。比较两组病例的手术时间、术中出血量、住院时间、下床活动时间、手术并发症及Oswestry功能障碍指数（ODI）评分、疼痛视觉模拟评分（VAS）等的差异。 结果患者术后获得18~36个月［（24.4±6.5）个月］随访。PEEK棒组与钛棒组在手术时间、术中出血量、下床活动时间、住院时间差异无统计学意义（P>0.05）。术后1、3个月ODI评分、VAS差异无统计学意义（P>0.05）,但末次随访ODI评分、VAS评分PEEK棒组优于钛棒组,差异具有统计学意义［ODI评分：（14.3±2.4）分vs（21.8±5.2）分,t=2.45,P<0.05;VAS评分：（6.32±0.81）分vs （5.15±1.02）分,t=3.43,P=0.021］。并发症方面,PEEK棒组随访期间未出现邻近节段退变,钛棒组出现2例患者3个节段退变,伴有轻度坐骨神经痛症状,予以保守治疗,部分缓解。2组患者在随访期间均无内固定断裂、松动发生。 结论PEEK棒动态内固定系统治疗腰椎退行性病变可获得较好的临床疗效,并发症少。     

The effects of sex,skeletal age,and sagittal skeletal pattern on pharyngeal airway dimensions and related structures in growing Thai orthodontic patients

Purpose

To evaluate the effects of sex, skeletal age, sagittal skeletal pattern, and the interaction among these three factors on the pharyngeal airway widths and areas, and the positions and dimensions of surrounding structures.

Treatment changes of hypo- and hyperdivergent Class II Herbst patients

Objectives:To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients.Materials and Methods:The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo- or hyperdivergent based on their MPAs. Pre- and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures.Results:The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a “headgear effect.” Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo- and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients.Conclusions:Hypo- and hyperdivergent patients benefit from the Herbst''s headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.     

后路椎管减压钉棒系统内固定术治疗胸腰椎爆裂性骨折的术后护理

目的探讨后路椎板开窗减压并钉棒系统内固定治疗胸腰椎爆裂性骨折的护理方法。方法采用后路椎管减压钉棒系统内固定术治疗胸腰椎爆裂性骨折患者87例,并评估神经功能恢复情况。实施一系列护理措施,并定期随访。结果本组87例患者治疗转归:术后随访10-24个月,平均15个月,均无术后并发症发生。10-12个月再次住院行内固定取出术2例,达到了重新行走、生活及工作的能力。结论经后路椎管减压钉棒系统内固定治疗胸腰椎爆裂性骨折,围术期系统的护理措施及健康教育能够保证该项技术的顺利实施。能有效改善患者术后的生活质量。     

Bone disorders in experimentally induced liver disease in growing rats

AIM: To investigate the change of bone parameters in a new model of experimentally induced liver cirrhosis and hepatocellular carcinoma (HCC) in growing rats. METHODS: Fischer-344 rats (n=55) were used. Carbon tetrachloride (CCl4), phenobarbital (PB), and a single diethylnitrosamine (DEN) injection were used. Animals were killed at wk 8 and 16. Bone mineral content, femoral length, cortical index (quotient of cortical thickness and whole diameter) and ultimate bending load (Fmax) of the femora were determined. The results in animals treated with DEN+PB+CCl4(DPC, n = 21) were compared to those in untreated animals (UNT, n = 14) and in control group treated only with DEN+PB (DP, n = 20). RESULTS: Fatty liver and cirrhosis developed in each DPC-treated rat at wk 8 and HCC was presented at wk 16. No skeletal changes were found in this group at wk 8, but each parameter was lower (P<0.05 for each) at wk 16 in comparison to the control group. Neither fatty liver nor cirrhosis was observed in DP-treated animals at any time point. Femoral length and Fmax values were higher (P<0.05 for both) in DP-treated animals at wk 8 compared to the UNT controls. However, no difference was found at wk 16. CONCLUSION: Experimental liver cirrhosis and HCC are accompanied with inhibited skeletal growth, reduced bone mass, and decreased mechanical resistance in growing rats. Our results are in concordance with the data of other studies using different animal models. A novel finding is the transiently accelerated skeletal growth and bone strength after a 8-wk long phenobarbital treatment following diethylnitrosamine injection.     

优美特宫颈扩张棒用于扩张宫颈口的临床研究

目的探讨优美特宫颈扩张棒（以下称优美特）的有效性、安全性及使用方法。方法选择门诊收治的置、取宫内节育器（intrauterine device,IUD）、妊娠10周内负压吸引人工流产术术前需扩张宫颈口的受术者221例,随机分为两组,分别使用优美特和宫术宁胶棒（以下称宫术宁）,术后20 d进行随访。结果优美特组扩张有效率高于宫术宁组（P〈0.05）;扩张后宫颈口松弛度和扩张前、后宫颈口松弛度差值,优美特组均优于宫术宁组（P〈0.05）;置入时疼痛率优美特组低于宫术宁组（P〈0.05）;两组均无宫颈损伤等不良反应,术后随访无与使用扩张宫颈口产品关联的不良事件。结论优美特扩张宫颈口效果良好、安全可靠、不良反应少,对不同时期妇女扩张宫颈口均有效;产品操作简便,适用于基层医院。     

Large-scale determinants of intestinal schistosomiasis and intermediate host snail distribution across Africa: does climate matter?

The geographical ranges of most species, including many infectious disease agents and their vectors and intermediate hosts, are assumed to be constrained by climatic tolerances, mainly temperature. It has been suggested that global warming will cause an expansion of the areas potentially suitable for infectious disease transmission. However, the transmission of infectious diseases is governed by a myriad of ecological, economic, evolutionary and social factors. Hence, a deeper understanding of the total disease system (pathogens, vectors and hosts) and its drivers is important for predicting responses to climate change. Here, we combine a growing degree day model for Schistosoma mansoni with species distribution models for the intermediate host snail (Biomphalaria spp.) to investigate large-scale environmental determinants of the distribution of the African S. mansoni-Biomphalaria system and potential impacts of climatic changes. Snail species distribution models included several combinations of climatic and habitat-related predictors; the latter divided into “natural” and “human-impacted” habitat variables to measure anthropogenic influence. The predictive performance of the combined snail–parasite model was evaluated against a comprehensive compilation of historical S. mansoni parasitological survey records, and then examined for two climate change scenarios of increasing severity for 2080. Future projections indicate that while the potential S. mansoni transmission area expands, the snail ranges are more likely to contract and/or move into cooler areas in the south and east. Importantly, we also note that even though climate per se matters, the impact of humans on habitat play a crucial role in determining the distribution of the intermediate host snails in Africa. Thus, a future contraction in the geographical range size of the intermediate host snails caused by climatic changes does not necessarily translate into a decrease or zero-sum change in human schistosomiasis prevalence.     

Luque棒生理负荷下的实验应力分析

Luque棒断裂、旋转和错动导致治疗失败,已引起临床专家的重视,目前尚缺乏有关的生物力学实验和分析。本实验应用8具新鲜猪脊柱,分4级载荷(100N,200N,300N,400N)测试Luque棒的应力分布及其影响因素。结果表明:生理负荷下,Luque棒中段承力最大,应力随负荷增加而增大,在400N负荷下,应力接近316L不锈钢材料的疲劳限度。钢丝固定的松紧度影响Luque棒受力的均衡。根据研究结果,作者找出了Luque棒生理轴压下的应力分布及其影响因素。作者同时还指出:新型脊柱内固定结构的研究,应考虑固定结构受力后的应力分布情况,依据力学原理,使固定物应力分布均衡。同时,强调Luque系统的规范化操作是保障脊柱固定可靠和固定物力学稳定的重要环节。