Comparison between tension band and cerclage with X-Plate and lag screws in treatment of comminuted patellar fractures

BackgroundComminuted patellar fractures are not rare, and the ideal treatment method remains controversial. The present study was conducted to evaluate effects and compare complications of two different methods used to treat comminuted patellar fractures.MethodsFrom March 2010 to August 2016, 102 cases of 34-C2 or 34-C3 comminuted patellar fractures were treated at our hospital, wherein patients received two different treatments: titanium cable tension band with cerclage method (group A) and intrafragmentary screws with X-shaped plating technique (group B). At follow-ups, articular step-off, range of motion (ROM), Lysholm scores, time of union, and complications were recorded and analyzed. Radiographic and clinical data as well as rate of complications were statistically analyzed.ResultsIn total, 87 patients were included in the final analysis (n = 47 in group A and n = 40 in group B). No significant differences were noted in terms of cost of implant, age, gender, rate of 34-C3 fractures, rate of layered inferior pole fractures, postoperative articular step-off and union time. At 2-year follow-up, average Lysholm scores, ROM and rate of complications were (89.0 ± 4.5), (122°±12°) and (27.7%) in group A and (90.2 ± 3.9), (124°±11°) and (17.5%) in group B, respectively, with no significant differences (p > 0.05). The mean time of surgery in group B was shorter than that in group A with significant difference (p < 0.05).ConclusionsTreatment using the intrafragmentary screws and plate method for amenable comminuted patellar fractures achieved similar complication rate and favorable functional outcomes at the 2-year follow-up, which was comparable to the titanium cable tension band with cerclage method. Thus, the intrafragmentary screws and plate method is effective, safe and convenient for 34-C2/C3 comminuted patellar fractures, especially appropriate for patients with layered fragments.     

基于“祛邪为第一要义”从清热化湿论治新型冠状病毒肺炎

结合验案分析,基于"祛邪为第一要义"探讨新型冠状病毒肺炎从清热化湿论治的思路与方法。认为新型冠状病毒肺炎主要是属于"湿热"性质的疫病,治疗应强调清热化湿,以"祛邪为第一要义",辅以扶正。在中医祛邪与扶正理论指导下,通过宣肺平喘、通腑泻热、芳香化湿等治法,祛邪为主,肺肠合治,可以使发热减轻或消退,使大便通畅,从而截断病情进展,避免或减少危重症的发生及死亡的风险;通过清热化湿、疏肝健脾、凉血化瘀等治法,祛邪兼以扶正,肺与肝、脾合调,可以改善肝功能损伤,减少病情加重的风险;通过补气健脾等扶正治法,可以改善患者的精神和体力,促使病毒更快转阴,缩短病程,促进患者早日康复。     

CD2AP inhibits metastasis in gastric cancer by promoting cellular adhesion and cytoskeleton assembly

Diffuse gastric cancer (DGC) is a lethal malignancy lacking effective systemic therapy. Among the most provocative recent results in DGC has been that the alter of the cellular cytoskeleton and intercellular adhesion. CD2-associated protein (CD2AP) is one of the critical proteins regulating cytoskeleton assembly and intercellular adhesion. However, no study has investigated the expression and biological significance of CD2AP in gastric cancer (GC) to date. Therefore, the aim of our study was to explore if the expression of CD2AP is associated with any clinical features of GC and to elucidate the underlying mechanism. Immunohistochemistry of 620 patient tissue samples indicated that the expression of CD2AP is downregulated in DGC. Moreover, a low CD2AP level was indicative of poor patient prognosis. In vitro, forced expression of CD2AP caused a significant decrease in the migration and invasion of GC cells, whereas depletion of CD2AP had the opposite effect. Immunofluorescence analysis indicated that CD2AP promoted cellular adhesion and influenced cell cytoskeleton assembly via interaction with the F-actin capping protein CAPZA1. Overall, the upregulation of CD2AP could attenuate GC metastasis, suggesting CD2AP as a novel biomarker for the prognosis and treatment of patients with GC.     

解建国治疗癌症常用药对经验述要

解建国教授是国家级名老中医、辽宁省首届名中医,从事中医药治疗疑难顽怪病的临床及科研工作40余载。临床用药喜用药对,擅用药对。文章介绍解建国教授运用药对治疗癌症的经验。解老师临床治疗癌症,整体上以扶正缩瘤药对为基础,结合病变脏腑功能不同,以各脏腑药对为辅,同时结合病变症状表现不同,佐以对症效药药对。其所用药对之性味归经、剂量配比皆有深意,是充分考虑癌病及其病机特点,精研药物功效配伍,并通过长期临床实践所成的宝贵经验。特色鲜明,疗效确切,故加以总结整理,以飨同道。     

A network pharmacology-based strategy for predicting anti-inflammatory targets of ephedra in treating asthma

Asthma, the most common chronic respiratory disease in the world, is involved in a sustained inflammatory response caused by a variety of immune cells. Ephedra with multi-target, multi-pathway functions is an effective treatment for asthma. However, the ingredients and anti-inflammatory targets of ephedra in treating asthma are unclear. Therefore, there is a need for further research. Ephedra-related and anti-inflammatory targets were found and then combined to get intersection, which represented potential anti-inflammatory targets of ephedra. Moreover, compound-anti-inflammatory target and asthma-target protein-protein interaction network were merged to get the protein-protein interaction network intersection and core genes in asthma-target protein-protein interaction network. For the anti-inflammatory targets of ephedra in treating asthma, Gene Ontology and pathway analysis were executed to confirm gene functions of ephedra in antagonizing inflammation of asthma. Finally, molecular docking, qRT-PCR, WB and ELISA were performed to assess the binding activities between the compounds and anti-inflammatory targets of ephedra in treating asthma. Critical compounds and anti-inflammatory targets of ephedra in treating asthma were identified, including quercetin, luteolin, kempferol, naringenin, beta-sitosterol, SELE, IL-2 and CXCL10. The biological processes of anti-inflammatory targets of ephedra in treating asthma were involved in immune response, inflammatory response, cell-cell signaling and response to lipopolysaccharide. Moreover, 22 pathways were obtained and we proved that critical compounds inhabited the expression of SELE, IL-2 and CXCL10 at mRNA and protein levels.     

基于子宫内膜异位症与恶性肿瘤的相关性探析补肾化瘀法作用机制及中医理论依据

子宫内膜异位症其异位内膜组织虽然在形态学上呈良性表现，却具有类似恶性肿瘤的生物学特性。中医学一般认为，“正虚伏邪”为恶性肿瘤的病机特点；那么，肾虚血瘀既属于“正虚伏邪”的范畴，又体现了EMs发病学和疾病发生、发展过程中的主要特点。在“病证相应”的中医治则之下，补肾化瘀法的临床疗效主要表现为：缓解痛经症状、提高受孕率，以及调整月经周期。本文基于EMs与恶性肿瘤的相关性，通过分析补肾化瘀法治疗EMs的理论依据及其抑制异位内膜侵袭的调控机制，主要包括解除免疫抑制、阻断局部微血管新生等，旨在阐明其疗效显著的原因，为临床推广提供可靠的基础研究证据。     

化湿利水泄浊法对自发性高血压大鼠主动脉血管结构的影响

为观察化湿利水泄浊法(DTM)对自发性高血压大鼠(SHR)主动脉血管结构的影响。27只12周龄SHR，随机分为模型组(B)、化湿利水泄浊组(C)、依那普利组(D)，另选同周龄大鼠9只作为正常对照组(A)，灌胃给药8周。测量清醒状态下尾动脉收缩压，及血浆内皮素(ET)、降钙基因相关肽(CGRP)。血管壁厚度／管外径(WT／LD)、管壁面积／管面积(MA／WA）、管腔面积／管面积(LA／WA）。主动脉血管平滑肌细胞增殖核抗原(PCNA)的表达。结果：与A组比较，收缩压B组明显升高，C组明显下降；B组ET浓度升高，C组下降；B组主动脉超微结构见中膜纤维化改变，细胞间隙增宽，平滑肌细胞排列紊乱等改变；C、D组动脉超微结构改变较轻；B组平滑肌细胞PCNA表达明显增强，C、D组降低。提示化湿利水泄浊法能部分逆转SHR主动脉的超微结构改变，抑制平滑肌细胞增殖可能是其发挥作用的机制之一。     

基于SP的CBL联合TBL教学在重症医学科临床教学中的应用

目的　研究在重症医学科临床教学中应用基于标准化病人（standardized patient,SP）的以案例教学法（case-based learning,CBL）联合以团队为基础（team-based learning,TBL）教学的教学效果。方法　将60名在重症医学科临床学习的医学生分为两组,各30名,分别接受以授课为基础的教学（lecture-based learning,LBL）和基于SP的CBL联合TBL教学。通过对两组学生的临床综合能力进行测评,以及学生对两种教学方法的满意度调查,对教学效果进行评价。采用SPSS 19.0进行卡方检验和t检验。结果　与LBL教学相比,接受基于SP的CBL联合TBL教学的学生的临床综合能力更优（P<0.05）,主要体现在临床思维能力[（4.18±0.55）vs. (3.66±0.47）]、临床技能能力[（4.03±0.61）vs. （3.59±0.52）]及与患者的沟通交流能力[（4.11±0.58）vs. (3.74±0.50）]方面;而且观察组学生对教学方法的满意度也更高（P<0.05）,主要体现在学习兴趣[（4.38±0.72）vs.（3.65±0.56）]、自主学习能力[（4.24±0.71）vs.（3.91±0.52）]、临床思维能力[（4.09±0.66）vs.（3.22±0.54）]、沟通交流能力[（4.42±0.60）vs.（3.67±0.48）]及团队合作精神[（4.15±0.58）vs.（3.78±0.51）]方面。结论　基于SP的CBL联合TBL教学在重症医学科的临床教学中切实可行,具有良好的教学效果。