改良眶隔法和传统睑板法切开重睑术的术后重睑形态、瘢痕发生率、角膜暴露率比较研究

目的 比较改良眶隔法和传统睑板法切开重睑术中的应用效果及对术后重睑形态、瘢痕发生率、角膜暴露率的影响。方法 选取2020年3月-2021年3月首都医疗爱育华医院收治的80例单睑患者，采用随机数字表法将其分对照组和观察组，各40例。对照组接受传统睑板法切开重睑术，观察组接受改良眶隔法切开重睑术，比较两组术后重睑形态、瘢痕发生率、角膜暴露率、并发症发生率。结果 观察组总有效率高于对照组，差异有统计学意义（P＜0.05）；观察组GAIS评分高于对照组，VAS评分低于对照组，差异有统计学意义（P＜0.05）；观察组右侧角膜暴露率增加值、左侧角膜暴露率增加值高于对照组，差异有统计学意义（P＜0.05）；观察组并发症发生率为5.00%，低于对照组的22.50%，差异有统计学意义（P＜0.05）。结论 相比于传统睑板法切开重睑术，改良眶隔法切开重睑术不会过度增加术后角膜暴露率，术后瘢痕发生率更低，重睑形态更理想，患者接受度更高。     

Role of site-directed mutagenesis and adjuvants in the stability and potency of anthrax protective antigen

Anthrax is a zoonotic infection caused by the gram-positive, aerobic, spore-forming bacterium Bacillus anthracis. Depending on the origin of the infection, serious health problems or mortality is possible. The virulence of B. anthracis is reliant on three pathogenic factors, which are secreted upon infection: protective antigen (PA), lethal factor (LF), and edema factor (EF). Systemic illness results from LF and EF entering cells through the formation of a complex with the heptameric form of PA, bound to the membrane of infected cells through its receptor. The currently available anthrax vaccines have multiple drawbacks, and recombinant PA is considered a promising second-generation vaccine candidate. However, the inherent chemical instability of PA through Asn deamidation at multiple sites prevents its use after long-term storage owing to loss of potency. Moreover, there is a distinct possibility of B. anthracis being used as a bioweapon; thus, the developed vaccine should remain efficacious and stable over the long-term. Second-generation anthrax vaccines with appropriate adjuvant formulations for enhanced immunogenicity and safety are desired. In this article, using protein engineering approaches, we have reviewed the stabilization of anthrax vaccine candidates that are currently licensed or under preclinical and clinical trials. We have also proposed a formulation to enhance recombinant PA vaccine potency via adjuvant formulation.     

Enhancing adherence and management in patients with hypertension: Impact of form and frequency of knowledge intervention

BackgroundThe alarming rise in prevalence of hypertension warrants psychosocial methods supplementing pharmacotherapy for better management and prevention of cardiac emergencies. The objective of the study was to assess the differential impact of the form and frequency of knowledge intervention on management of primary hypertension.Materials and methodThe study was conducted on 256 hypertensive patients recruited through purposive sampling at health centers in Hyderabad, India. Pretest post-test control group quasi-experimental design was adopted for the study. There were two forms of the knowledge intervention, namely ‘Direct Interaction’ and ‘Audio-Visual’. Each form was presented in two frequencies namely ‘single exposure’ and ‘double exposure’. The four groups were labelled as Direct Intervention Single (DIS), Direct Intervention Double (DID), Audio-Visual Single (AVS) and Audio-Visual Double (AVD). Adherence and management of hypertension were assessed at baseline and six weeks post experiment. Analysis of Covariance (ANCOVA) was applied using IBM SPSS Statistics version 20.ResultsANCOVA followed by Bonferroni Multiple Group Comparison Test revealed significant differences between the four intervention groups and control group on adherence (p< .001). In case of hypertension management significant differences were observed between Control group and DIS, DID (p < .001), Control and AVS (p < .01). Control group did not differ from AVD.ConclusionThere was a positive impact of Knowledge Intervention on adherence and management of hypertension. Double exposure in audio visual form was counterproductive in hypertension management.     

The safety and feasibility of minimal invasive plate osteosynthesis (MIPO) of the posterior aspect of the humerus: A cadaveric study

The aim of this study was to determine the feasibility of applying MIPO of the humerus via the posterior approach and to observe the tension of the radial nerve in different elbow positions. Two separate incisions were made on the posterior aspect of the humerus in ten fresh cadavers (20 humeri). The radial nerve was identified at the proximal incision and the distances through which the nerve could be elevated from the bone with the elbow in flexion and extension were measured. A 10‐hole extra‐articular distal humeral locking compression plate was inserted and fixed through the submuscular tunnel. The tunnel was then explored to identify any entrapment of the radial nerve and to observe the anatomical relationship of the radial nerve to the plate and bone. There was no entrapment of the radial nerve or its branches. The distances through which the radial nerve could be elevated were greater with the elbow in extension than in flexion (P < 0.01). The radial nerve crossed the medial and lateral borders of the posterior surface of the humerus at 80.1–132 mm (average 104.7 mm) and 116.6–175.5 mm (average 142.7 mm) of its total length, respectively. The axillary nerve was located at 38.7–61.7 mm (average 47.9 mm) of total humeral length. MIPO of the humerus using the posterior approach is an alternative option for treating distal humeral shaft fracture. The risk of radial nerve injury can be minimized by careful dissection in the proximal incision. Clin. Anat. 32:176–182, 2019. © 2018 Wiley Periodicals, Inc.     

锁骨钩钢板内固定术后钢板钩与肩峰匹配性影像学研究

目的通过测量锁骨钩钢板内固定术后患者影像学资料，分析发生肩峰骨侵蚀的原因是否与钢板钩-肩峰匹配度相关。 方法回顾性分析2015年8月1日至2018年8月31日期间在上海市浦东医院骨科就诊的210例患者的影像学资料，210例患者均因肩锁关节脱位或锁骨远端骨折行锁骨钩钢板内固定治疗，其中男110例、女100例；年龄24~76岁，平均（44.60±8.75）岁；肩锁关节脱位70例，锁骨远端骨折140例。测量术后及终末随访患者肩锁关节正位X线片相关数据，按锁骨钩钢板术后是否发生肩峰骨侵蚀，将纳入患者分为3组：无骨侵蚀组（A组）、伴钢板钩移位骨侵蚀组（B组）、不伴移位的骨侵蚀组（C组），分别测量钢板钩-肩峰的匹配度（β），统计分析术后发生肩峰骨侵蚀与钢板钩-肩峰匹配度之间的关系。 结果纳入研究的210例患者术后随访24~64周，平均（32.0±6.5）周。A组患者115例，B组患者54例，C组患者41例。A组匹配度β（3.72±0.48）mm与B组β¹（6.91±0.84）mm比较差异有统计学意义（P<0.05）；A组匹配度β（3.72±0.48）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）；B组匹配度β¹（6.91±0.84）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）。 结论锁骨钩钢板内固定术后是否发生肩峰骨侵蚀与钢板钩-肩峰匹配度β存在明显相关性，钢板钩与肩峰之间的匹配度越好，β值越小，发生肩峰骨侵蚀的可能性更小。     

Risk factors for postoperative graft laxity without re-injury after double-bundle anterior cruciate ligament reconstruction in recreational athletes

BackgroundAlthough high activity is a risk factor for graft failure after anterior cruciate ligament (ACL) reconstruction, the risk factors for postoperative laxity after ACL reconstruction in recreational athletes are unknown.MethodsWe enrolled 91 patients (40 males, 51 females; mean age 29.2 years; mean follow-up 4.3 years) who scored ≤ 6 on the Tegner activity scale, underwent double-bundle ACL reconstruction between 2010 and 2018, and did not experience re-injury. In the stable group (75 patients, <3.0 mm side-to-side difference (SSD) in anterior translation, grade 0 or 1 pivot shift 1 year after surgery) and unstable group (16 patients, ≥3.0 mm SSD, ≥grade 2 pivot shift), multivariate logistic regression analyses adjusted for factors showing P ≤ 0.3 on univariate analysis assessed risk factors for graft laxity. Lysholm score and graft intensity on MRI (Howell grade) were compared at final follow-up.ResultsMean SSD in anterior translation was 0.7 mm (stable group) and 3.3 mm (unstable group). Pivot shift grades were 0 (88%) and 1 (12%) in the stable group, and 0 (12.5%), 1 (50%), and 2 (37.5%) in the unstable group. Multivariate regression analyses showed that younger age and knee hyperextension were significant risk factors for graft laxity (P = 0.018 and 0.0016; cutoffs 18 years old and 8°, respectively). Lysholm scores in both groups were comparable, but graft intensity on MRI demonstrated significantly worse Howell grade in the unstable group (P = 0.002).ConclusionYounger age and knee hyperextension were risk factors for postoperative graft laxity without re-injury in recreational athletes.