定制人工膝关节假体在骨肉瘤保肢治疗中的应用

目的探讨定制人工膝关节假体在骨肉瘤保肢术中应用价值。方法采用定制的人工膝关节假体治疗在本科住院的膝关节周围(股骨下段、胫骨上段)骨肉瘤患者6例,4例为股骨下段骨肉瘤,2例为胫骨上段骨肉瘤,6例均采用定制的人工膝关节假体进行关节重建,对其中2例胫骨近端骨肉瘤患者同时行腓肠肌、比目鱼肌肌瓣移植。结果 6例患者术后随访12～48个月(平均为30个月),按Enneking法评定功能,≥23分4例,15～22分1例,<15分1例,优良率达到83.33%。膝关节平均活动度为伸0°、屈85°～135°。1例肿瘤复发而截肢,1例1年后出现肺部转移而死亡。结论定制的人工膝关节假体是治疗骨肉瘤较好的保肢方法,能减少患者致残率,改善生活质量,术后关节功能、疗效满意。     

定制人工膝关节假体治疗膝关节周围恶性骨肿瘤

目的 :探讨定制人工膝关节假体在膝关节周围恶性骨肿瘤保肢治疗中的临床效果。方法 :对19例股骨远端或胫骨近端恶性骨肿瘤行瘤段骨广泛切除、定制人工膝关节假体置换术。结果 :随访 1年 5个月～ 5年 ,膝关节活动度为伸 0° ,屈 90°～ 10 5°。 19例患者中发生假体周围积液和行走后踝关节痛各 1例 ,无感染、假体松动及断裂 ,无肿瘤复发。 1例发生肺转移 ,带瘤存活 ,2例因肺及其他部位转移死亡。结论 :定制人工膝关节假体治疗膝关节周围恶性骨肿瘤能尽早及较好地恢复膝关节功能 ,尤其适合于骨破坏严重 ,骨支架作用基本丧失者。     

人工假体置换在膝关节周围恶性骨肿瘤中的临床应用

目的 探讨人工假体在膝关节周围恶性骨肿瘤保肢术中的临床应用效果.方法 膝关节周围骨肿瘤患者22例.对化疗敏感的,由肿瘤内科行正规静脉化疗,术前72小时内常规行血管造影及瘤体动脉栓塞,行骨肿瘤广泛切除或根治性切除后,采用人工膝关节假体置换重建.结果 22例患者术后随访12-60个月,其中17例患者无局部复发或远处转移, 4例出现复发.膝关节活动 0°-110°,根据Insall评分标准治疗后效果优15例,良3例,可4例,优良率85%.结论 人工假体是一种治疗膝关节周围恶性骨肿瘤较好的保肢方法,能降低局部并发症及提高临床疗效.     

腓肠肌及比目鱼肌瓣在胫骨近端恶性骨肿瘤保肢术的应用

目的　探讨带血管蒂腓肠肌、比目鱼肌肌瓣移植在胫骨近端恶性骨肿瘤保肢术中的应用价值。方法　行胫骨近端恶性骨肿瘤保肢术患者共 2 6例 ,其中行腓肠肌、比目鱼肌肌瓣移植 16例 ,未行肌瓣移植 10例。结果　肌瓣移植者中有 1例发生肌瓣坏死及骨筋膜室综合征 ;非移植者中有 2例发生切缘皮瓣坏死深部感染 ,3例切口脂肪液化浅表感染。 19例术后平均随访 38个月 ,按Enneking法评定功能 ,≥ 2 3分 6例 ,15～ 2 2分 8例 ,<15分 5例 ,优良率为 73.7%。结论　胫骨近端骨恶性肿瘤保肢术中采用带血管蒂腓肠肌、比目鱼肌肌瓣移植可重建软组织缺损、降低局部并发症及提高临床疗效。     

人工假体置换在膝周恶性骨肿瘤中的临床应用

目的 探讨人工假体在膝关节周围恶性骨肿瘤保肢术中的临床效果.方法 28例膝关节周围恶性骨肿瘤瘤段广泛切除后,采用人工膝关节假体置换重建.结果 28例患者术后根据Enneking评分标准评定疗效优18例,良6例,可4例,优良率85%.随访4～48个月,其中20例患者无局部复发或远处转移,8例复发或转移.结论 人工假体置换重建膝关节周围骨肿瘤手术可改善膝部恶性骨肿瘤患者的早期生活质量,减少致残率,严重并发症少,患者术后关节功能、效果较满意.     

旋转铰链型膝关节置换术在膝部骨肿瘤中应用的临床研究

目的探讨旋转铰链型人工膝关节置换术在膝部骨肿瘤中应用的疗效。方法选择2009年7月～2012年6月湖北医药学院附属襄阳医院行手术治疗的膝部良恶性骨肿瘤患者32例,其中股骨远端18例,胫骨近端14例,分别是骨肉瘤17例,骨巨细胞瘤12例,骨巨细胞瘤合并动脉瘤样骨囊肿3例。骨肉瘤患者术前均接受1～2个疗程新辅助化疗,术后继续3-4个疗程正规化疗。观察术后Enneking肢体功能评分、影像学评价。结果所有患者均得到随访,随访12～36个月（平均24个月）;未见肿瘤复发、假体松动;1例术后出现肢端麻木：1例术后出现感染;股骨下端组Enneking肢体功能评分平均24．7分;胫骨上端组平均24．1分。结论旋转铰链型膝关节置换术是治疗膝部良恶性骨肿瘤较理想的保肢方法。     

人工膝关节置换在膝周恶性骨肿瘤保肢术中的应用

目的 探讨在膝关节周围恶性肿瘤行瘤段切除和肿瘤型铰链式人工膝关节置换术的临床效果.方法 回顾19例膝关节周围恶性骨肿瘤采用瘤段切除及肿瘤型铰链式人工膝关节置换来修复和替代切除的股骨远端或胫骨近端.结果 随访8～76个月,平均21.3个月,19例中存活17例.假体置换后功能评定优良率达89%.结论 肿瘤型铰链式人工膝关节置换是膝关节周围恶性骨肿瘤保肢重建的一种疗效可靠的方法 .     

人工肩关节置换治疗肱骨上段恶性骨肿瘤

目的 探讨用特制的人工肩关节置换治疗肱骨上段恶性骨肿瘤的临床应用效果。方法对9例单侧肱骨上段恶性骨肿瘤患者均使用定制的人工肩关节假体置换行保肢术，患者平均年龄37．0岁，术后平均随访3．7年（11～96个月）。结果术后肩关节功能按国际保肢学会（ISOLS）的评估标准评分，优5例，良2例，可1例，差1例，优良率为77．8％，术后未出现明显假体松动。结论临床应用特制的人工肩关节置换治疗肱骨上段恶性骨肿瘤，可达到保肢的目的，是一种疗效较好的方法，不仅保留了患肢的形态，也保留了上肢的大部分功能。     

腓肠肌内侧头肌瓣在胫骨上端骨肿瘤保肢术中的应用研究

目的 探讨带血管蒂腓肠肌肌瓣移植在胫骨近端骨肿瘤保肢术中的应用价值.方法 行胫骨近端骨肿瘤保肢术患者共38例,出院后所有患者完成随访.结果 肌瓣移植者中有1例发生肌瓣坏死及骨筋膜室综合征;3例切口浅表感染.38例术后全部做到随访,平均随访时间40个月.结论 胫骨近端骨骨肿瘤保肢术中采用带血管蒂腓肠肌肌瓣移植可重建软组织缺损、降低局部并发症及提高临床疗效.     

特制型人工假体在肱骨近端恶性肿瘤保肢治疗中的应用

目的肱骨近端恶性骨肿瘤的保肢治疗方法很多,但都面临同样的难题,即满足安全外科边界切除肿瘤的前提下尽量保留肢体功能,同时降低并发症的发生率.本研究探讨特制型人工假体置换在肱骨近段恶性骨肿瘤保肢治疗中的临床疗效.方法应用自行设计的定制型人工假体对2000年2月至2009年2月间的16例肱骨近端恶性肿瘤患者行保肢术.男性10例,女性6例.年龄14～56岁,平均（27±3）岁.病理证实：骨肉瘤10例,恶性纤维组织细胞瘤1例,尤文肉瘤1例,骨巨细胞瘤4例.骨巨细胞瘤按Campanicci分级：4例为Ⅲ级.其它12例患者以Enneking分期：Ⅱa期2例,Ⅱb期10例.除骨巨细胞瘤外均辅予术前、术后化疗.结果平均随访32个月（6～84个月）,置入假体无感染、松动及断裂等并发症.人工肩关节不完全脱位2例（12.5%,2/16）.术后肩关节功能按国际保肢学会（ISOLS）标准评分,优良率81.3%（13/16,评分≥24分）.结论应用特殊定制的人工假体置换能够降低术后并发症,获得较为满意的肩关节功能.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.