新生血管特异性结合肽GX1二聚体抑制胃癌新生血管生成的实验研究

目的:探讨新生血管特异性结合肽GX1二聚体对胃癌新生血管生成的影响。方法:化学合成GX1二聚体、GX1单体、对照肽二聚体，CCK-8实验、管状结构形成实验、迁移实验研究GX1二聚体对胃癌血管内皮细胞（co-HUVEC）增殖、微管形成、迁移能力的影响，流式细胞学技术分析其对细胞周期分布和凋亡的影响。结果:CCK-8结果显示，GX1二聚体与对照肽二聚体及PBS对照组相比，100~200 μmol/L可抑制co-HUVEC增殖，具有统计学差异（P<0.05），并呈剂量依赖性，GX1二聚体较单体抑制作用增强，并有统计学差异（P<0.05）。管状结构形成实验、细胞损伤迁移实验结果显示，与对照肽二聚体及对照组PBS 相比，GX1二聚体及GX1单体，均可抑制胃癌内皮细胞管状结构的形成及迁移，且二聚体抑制作用强于单体；对照肽二聚体仅有轻微的抑制胃癌内皮细胞管状结构的形成及迁移。流式细胞术分析显示，与对照肽二聚体及PBS对照组相比，GX1二聚体及GX1单体均可诱导细胞凋亡（P<0.05），且GX1二聚体的诱导作用强于GX1单体（P<0.05），而对细胞周期分布则无明显影响。结论:GX1二聚体和GX1单体均可抑制胃癌新生血管内皮细胞增殖、微管形成、迁移能力及诱导凋亡，且GX1二聚体较GX1单体作用增强。GX1二聚体有望代替单体成为胃癌新生血管靶向治疗小肽类药物。     

2009-2019年西安市肺结核流行特征及治疗转归分析

目的 了解2009-2019年西安市肺结核的流行特征及治疗转归情况，为完善西安市肺结核防治策略提供依据。方法 收集2009-2019年《传染病信息管理系统》中登记的肺结核患者病案信息数据，通过描述性研究方法对肺结核流行病学特征和治疗转归情况进行分析。结果 2009-2019年间西安市肺结核年平均发病率为49.06/10万。郊县、郊区、城区肺结核年平均发病率分别为54.13/10万、47.46/10万和46.19/10万；男性发病率是女性的1.85倍。职业分布排在前5位的为农民（47.48%），家政、家务及待业（14.65%），离退人员（9.55%），学生（8.63%）和工人（5.23%）。利福平敏感或耐药性未知患者的成功治疗率平均为98.03%，利福平耐药患者治疗成功率为51.47%。结论 西安市近年来肺结核发病率和治疗率呈增长趋势，利福平耐药患者治疗成功率较低，要加强对重点人群的健康促进工作，加大肺结核发现力度及患者治疗管理工作。     

Three-dimensional finite element analysis of intramedullary nail with different materials in the treatment of intertrochanteric fractures

Intramedullary nails are the common treatment options for femoral intertrochanteric fractures. However, aseptic loosening is considered to be one of the primary forms of failure that can be caused by the stress shielding between the bone and implants. The matching in mechanical properties of implant and bone is a key issue to prevent this failure. Polyetheretherketone (PEEK) and Function-graded (FG) materials are widely used in clinical because of their excellent mechanical properties. In this study, to investigate the biomechanical behaviors of intramedullary nails made of Ti-6Al-4V alloy, Stainless Steel (SS), PEEK and two FG materials, three-dimensional finite element models of intertrochanteric fracture femur with intramedullary nail were constructed with ABAQUS. The maximum von Mises stress on the femoral fracture surface fixed by PEEK intramedullary nail was the largest, followed by FG intramedullary nail, which help stimulate bone growth and subsequently reduce fracture healing time. Compared with traditional metal intramedullary nails, PEEK and FG implants might increase von Mises stress along the same path in the proximal femur. The results showed that PEEK and FG intramedullary nails obviously changed the stress distributions in the bone and reduced stress shielding. This finding indicated that PEEK and FG intramedullary nails have the potential to become alternatives to the conventional metal intramedullary nails.     

Incidence,risk factors and clinical implications of postoperative urinary tract infection in geriatric hip fractures

IntroductionPostoperative urinary tract infection (UTI) is common in geriatric patients; however, little is known about the impact of UTI in orthopedic trauma. The present study was designed to determine the risk factors and clinical impact of postoperative urinary tract infection (UTI) in acute geriatric hip fractures.Patients and methodsGeriatric patients (≥65 years of age) undergoing hip fracture surgery were identified within the American College of Surgeons National Surgical Quality Improvement Program between 2016 and 2019. Patients presenting with UTI at the time of surgery were excluded. Baseline characteristics and outcomes were compared between patients with and without postoperative UTI. Multivariate logistic regression was performed, controlling for potential confounders.ResultsA total of 46,263 patients included in the study. Overall, 1,397 (3.02%) patients had postoperative UTI. Patients who developed postoperative UTI had higher rates of pneumonia (6.44% vs. 3.76%, p < 0.001), DVT (2.22% vs. 1.04%, p < 0.001), sepsis (7.73% vs. 0.62%, p < 0.001), and more frequently experienced postoperative hospital lengths of stay exceeding 6 days (37.94% vs. 20.33%, p < 0.001). Hospital readmission occurred more frequently in patients with postoperative UTI (24.55% vs. 7.85%, p < 0.001), but surprisingly, these patients had a lower mortality rate (1.36% vs. 2.2%, p < 0.001). Adjusted analysis demonstrated the following variables associated with postoperative UTI: age ≥ 85 (OR = 1.37, 95%CI = 1.08 - 1.73), ASA class ≥ 3 (OR = 1.59, 95%CI = 1.21 – 2.08,), chronic steroid use (OR = 1.451, 95%CI = 1.05 - 1.89), blood transfusion (OR = 1.24, 95%CI = 1.05 - 1.48), and >2 days delay from admission to operation (OR = 1.37, 95%CI = 1.05 - 1.79). Postoperative UTI was significantly associated with sepsis (OR = 7.65, 95%CI = 5.72 – 10.21), postoperative length of stay >2 days (OR = 1.83, 95%CI = 1.07 – 3.13), and readmission (OR = 3, 95%CI = 2.54 – 3.55).ConclusionsIn our study, postoperative UTI was found in 3% of geriatric hip fracture patients. Predictors of postoperative UTI were age ≥ 85, ASA class ≥ 3, chronic steroid use, blood transfusion, and time to operation > 2 days from admission. Results showed that postoperative UTI is independently associated with sepsis, postoperative length of stay beyond 2 days, and hospital readmission. To diminish the risk of UTI and its consequences, we recommend operating geriatric hip fractures in 24–48 hours after admission.     

踇甲皮瓣联合腓动脉穿支皮瓣游离移植再造拇指并修复足部供区 15 例

目的总结应用踇甲皮瓣再造拇指及腓动脉穿支皮瓣游离移植修复足部供区的手术方法及临床效果。方法2016 年 6 月—2018 年 5 月，应用踇甲皮瓣联合腓动脉穿支皮瓣游离移植再造拇指并修复足部供区 15 例。男 10 例，女 5 例；年龄 21～48 岁，平均 34.6 岁。致伤原因：重物压砸伤 7 例，机器绞伤 5 例，电锯切割伤 3 例。Ⅰ度缺损 9 例，Ⅱ度缺损 6 例。入院至皮瓣手术时间 4～7 d，平均 5.2 d。结果术后踇甲皮瓣及腓动脉穿支皮瓣全部成活，切口均Ⅰ期愈合。患者均获随访，随访时间 8～24 个月，平均 16.4 个月。末次随访时，再造拇指指甲生长平整，有光泽，指腹饱满；足部皮瓣外形良好，颜色及质地接近受区。根据中华医学会手外科学会拇手指再造功能评定标准，获优 9 例、良 6 例；根据 Maryland 足功能评分标准，获优 10 例、良 5 例。患者行走步态正常，无跛行及疼痛不适。结论踇甲皮瓣修复拇指Ⅰ、Ⅱ度缺损，再造拇指可获得良好外观及功能；腓动脉穿支皮瓣具有血供可靠、血管恒定、易切取等优点，可有效修复足部供区。     

Cervifix在陈旧性寰枢椎脱位并高位颈髓压迫症中的应用

目的:探讨Cervifix内固定系统治疗陈旧性寰枢椎脱位并脊髓不全损伤的价值。方法:36例陈旧性寰枢椎脱位并脊髓不全损伤行后路融合、Cervifix内固定。男23例、女13例,年龄15～62岁,平均38.3岁。陈旧性外伤21例,先天性畸形9例,类风湿性关节炎伴寰椎前脱位6例。结果:随访8～42个月,平均19个月。术后脊髓功能按JOA17分法评定,改善率为71.4％。全部患者均获骨性融合,内置物无松动、断裂及脊髓损伤加重等并发症。结论:Cervifix内固定可提供坚强有效的节段性固定,提高融合率。同时,可预防单纯减压融合术后早期失稳导致的高位脊髓损伤加重。     

单中心18726例腹腔镜胆囊切除术并发症分析及预防处理对策探讨

目的 分析腹腔镜胆囊切除术(LC)的并发症及其影响因素，探讨并发症防治策略。方法 采用回顾性分析法，对自1992年3月至2001年7月在我腹腔镜中心行LC的18726例病人，术中、术后并发症及其发生因素进行分析。结果 术中胆总管损害28例(0.15％)，术后胆漏62例(0．33％)，腹腔出血6例(0．03％)，术后腹腔内脓肿及切口疝7例(0．03％)，总计103例，并发症发生率为0．55％。分析其原因与比适应证选择不当及术者对胆道解剖变异等缺乏足够认识等因素有关。结论 胆漏以及胆管损伤是比的主要并发症，精确操作可避免其损伤，术中及时发现和处理，一般预后是良好的。     

额颞除皱术辅以隆额隆颞术

对既有面部老化，又有因局部发育不良，面骨体积缩小，畸形等伴有“额小颞窄”和“两侧不对称”等症状的患者，采用额颞除皱术辅以隆额隆颞手术的方法，既可使额颞部皱纹消除，又可达到整形的目的。本组共４８例，其中应用硅橡胶隆颞２８例，额肌瓣隆额１０例，额肌瓣隆额加颞筋膜瓣隆颞６例，额肌瓣隆额加硅橡胶隆颞４例。随访最长５个月，疗效满意。因此，对伴有额颞部外形不满意及面部老化的患者，应以此术为首选方法。     

以骨间前血管为蒂前臂骨膜骨瓣的临床应用

应用骨间前血管为蒂.桡、尺骨骨膜骨瓣移位治疗上肢骨不连或骨缺损38例,均获得成功。该术式与以桡、尺动脉为蒂的桡、尺骨骨膜骨瓣移位相比较,有不损伤前臂主要血管干、移位范围大、适应症较广和操作简便易推广等特点.