病理性瘢痕中脂质过氧化产物和铜锌超氧化物歧化酶的变化

目的了解病理性瘢痕（增生性瘢痕与瘢痕疙瘩）中脂质过氧化产物和铜锌超氧化物歧化酶（copper，zinc-superoxide dismutase，CuZn-SOD）的变化。方法取2005年5月-2005年8月收治患者自愿捐献的标本。瘢痕疙瘩组10例，年龄16～35岁，平均病程2．2年；增生性瘢痕组10例，年龄17～32岁，平均病程8个月；正常皮肤组8例，年龄16～34岁。应用化学比色法测定3组标本中CuZn．SOD活力和丙二醛（malonaldehyde，MDA）含量，采用免疫组织化学方法观察CuZn-SOD蛋白在病理性瘢痕中的表达，并对其进行评分。结果正常皮肤组、增生性瘢痕组及瘢痕疙瘩组MDA含量分别为（0．8213±0．0864）、（1．1390±0．1067）、（1．1900±0．0748）nmol／mg prot；CuZn-SOD活力分别为（20．60±5．56）、（31．65±2．21）、（34．36±5．01）U／mg prot。增生性瘢痕组和瘢痕疙瘩组MDA含量与CuZn-SOD活力同正常皮肤组比较，差异均有统计学意义（P〈0．05）；增生性瘢痕组及瘢痕疙瘩组间比较，差异无统计学意义（P〉0．05）。免疫组织化学染色观察：3组表皮角质形成细胞和真皮成纤维细胞均有CuZn．SOD蛋白阳性表达。正常皮肤组、增生性瘢痕组及瘢痕疙瘩组在表皮角质形成细胞中免疫组织化学评分分别为（2．20±0．45）、（4．14±0．90）、（4．43±0．79）分；在真皮成纤维细胞中评分分别为（1．60±0．89）、（4．00±0．82）、（4．43±0．53）分。增生性瘢痕组和瘢痕疙瘩组CuZn-SOD蛋白表达与正常皮肤组比较，差异有统计学意义（P〈0．05）；增生性瘢痕组及瘢痕疙瘩组间比较，差异无统计学意义（P〉0．05）。结论病理性瘢痕中脂质过氧化产物MDA含量增加，CuZn-SOD活力升高、表达增强。     

自制多器官保存液对肾皮质能量代谢的影响

目的寻找理想的器官保存液，以提高器官移植的长期疗效。方法应用高效液相系统（HPLC），检测自制多器官保存液（SMO液）和对照组（HC-A液和UW液）对犬肾低温保存中皮质腺苷酸含量改变的影响。取皮质标本匀浆、沉淀蛋白、离心，HPLC检测上清中腺苷酸含量，根据标准曲线方程和加样回收率计算ATP、ADP、AMP含量、比值和能荷（EC）。结果随保存时间延长，各组皮质腺苷酸含量下降；保存12、36、72h后SMO组皮质ATP含量（3．7±0．5、3．1±0．3、2．3±0．5nmol／mg蛋白）高于HC—A组（2．8±0．2、2．0±0．2、1．5±0．2nmol／mg蛋白），P〈0．05，SMO组EC（0．38±0．04、0．37±0．05、0．35±0．04）高于HCfA组（0．32±0．03、0．30±0．04、0．28±0．03），P〈0．05，在多数保存时点SMO组ADP、ATP／AMP高于HC—A组（P〈0．05），但2组间AMP、ATP／ADP比值差异无统计学意义（P〉0．05）；犬肾保存期间SMO组腺苷酸含量及EC与UW组比较差异无统计学意义（P〉0．05）。结论低温保存期间SMO液能够维持皮质内较高的ATP和EC水平，减轻肾脏低温缺血损伤。     

整合素β3在人皮肤血管瘤中的表达及意义

目的：探讨整合素β3在血管瘤发生、发展及退化过程中的表达状况及意义。方法：采用RT—PCR技术,检测人血管瘤增生期、消退期及正常皮肤组织中整合素β3的表达,利用SPSS软件进行数据分析,增生期血管瘤标本中整合素β3的表达明显高于消退期及正常皮肤组织,差异有显著性意义（P〈0．05）;消退期标本与正常皮肤组织中β3的表达无显著性差异（P〉O．05）。结论：整合素β3在血管瘤的发生发展中起到重要的作用。     

合成短肽S247对呼吸机所致肺损伤中肺上皮细胞凋亡的影响

目的 研究合成短肽S247对呼吸机相关性肺损伤凋亡的影响，探索其在肺损伤中的防护作用。方法 30只清洁级雄性SD大鼠随机分为3组：对照组（C组）、肺损伤组（Ⅰ组）和S247治疗组（S组），每组10只，大潮气量损伤性通气4h建立呼吸机相关性肺损伤模型（呼吸参数：Vt=40ml／kg体重，呼吸频率=80次／min，FiO2=21％），光镜下观察肺病理改变，测定肺湿／干比；收集肺泡灌洗液（BALF），考马思亮兰法测BALF中总蛋白含量，光境下行WBC计数，免疫组织化学检查肺组织Fas、Caspase-3蛋白的表达水平，TUNEL法检测肺组织细胞凋亡情况。结果 Ⅰ组肺病理改变明显，各组肺湿／干比、BALF中总蛋白含量、WBC计数差异都有统计学意义（P〈0．05或P〈0．01），Ⅰ组Fas、Caspase-3蛋白的表达水平（0．359±0．055；0．152±0．007）显著增高（P〈0．01），凋亡指数（60．000±7．461）明显增加（P〈0．01）；在用S247后，Fas、Caspase-3蛋白的表达水平（0．240±0．062；0．146±0．004）显著下降（P〈0．05），凋亡指数（47．857±3．716）有所减少（P〈0．05）。结论 S247能通过抑制细胞凋亡，有效降低呼吸机相关性肺损伤的程度。     

Caspase-3、Bcl-2与Bax在血管瘤组织中的表达及其意义

目的：探讨半胱氨酸天冬氨酸蛋白酶-3（Caspase-3）、Bcl-2与Bax的表达及其与血管瘤消退的关系。方法：采用免疫组化sP法检测Caspase-3、Bcl-2与Bax在34例血管瘤和6例正常皮肤组织中的表达。结果：Caspase-3、Bcl-2与Bax在34例血管瘤组织中的阳性表达率，增生期分别为31．3％、81．3％、37．5％，消退期分别为72．2％、38．9％、77．8％，而在正常皮肤均不表达，其中，Bcl-2在增生期中表达高于消退期，差异有统计有统计学意义（P〈0．05），Caspase-3及Bax在消退期中的表达高于增生期，差异有统计学意义（P〈0．05）。结论：Caspase-3、Bcl-2与Bax参与了血管瘤由增殖期转变为消退期的病理发生过程，Caspase-3的活化及Bcl-2与Bax的平衡诱导了细胞凋亡的发生，这可能是血管瘤自发消退的主要因素之一。     

肝癌及癌旁组织中β-葡萄糖醛酸酶蛋白及mRNA的表达及意义

目的探讨肝细胞癌及癌旁组织中β-葡萄糖醛酸酶（β-G）蛋白及β-G mRNA的表达和临床意义。方法采用逆转录-聚合酶链反应（RT-PCR）方法和免疫组织化学方法，对25例原发性肝细胞癌及其癌旁组织和10例正常肝脏组织进行检测，并分析其与临床病理特点之间的关系。结果半定量分析显示β-G mRNA的表达在肝脏癌组织（3．71±0．32）与癌旁肝组织（1.83±0.22）以及正常肝脏组织（1．71±0．32）间差异比较，均有统计学意义（均为P〈0．01），而癌旁肝组织和正常肝组织间比较，差异无统计学意义（P〉0．05）；从正常肝组织、癌旁组织到肝癌组织β-G蛋白的阳性细胞表达率分别为（48．2％±5．5％）、（56．8％±6．2％）和（83．8％±9．1％），呈递增趋势（χ^2=42．33，P〈0．01）；β-G蛋白的表达与肝癌病人的门脉癌栓以及淋巴结转移等临床因素有关（P〈0．01），而与肿瘤大小、AFP水平无关。结论β-G与肝细胞的癌变过程密切相关，可能在肝癌的侵袭和转移过程中也起一定的作用。     

胆固醇结石患者肝脏核受体基因表达的研究

目的研究胆囊胆固醇结石患者肝脏的核受体基因：肝脏X受体α（liver Xreceptor α，LXRα、法尼醇受体（farnesoid X receptor，FXR）、人类固醇异生物受体（steroid xenobiotic receptor，SXR）及肝受体同类物1（liver receptor homolog 1，LRH-1）的表达，探讨胆固醇结石病的发病机理。方法27例胆囊胆固醇结石患者（胆石组），男6例，女21例，平均年龄（52．44±1．92）岁。10例无胆石症的胆囊息肉患者为对照（对照组），男6例，女4例，平均年龄（47．10±2．73）岁。测定胆石胆固醇成分及血清脂类成分：总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-ch）、载脂蛋白（Apo）B和ApoA1和胆汁脂类成分（胆固醇、磷脂和胆汁酸），并计算胆汁总脂和胆汁胆固醇饱和指数。实时定量PCR法测定肝脏LRH-1、FXR、SXR及LXRα基因的表达量。结果胆石组血清中HDL—ch浓度明显低于对照组[（0．93±0．05）mmol／L vs（1．33±0．09）mmol／LD，P〈0．001；ApoA1浓度也低于对照组[（1．19±0．05）g／L vs（1．36±0．06）g／L]，P〈0．05；血清ApoB、TC和TG2组比较差异均无统计学意义（P〉0．05）。胆石组胆汁呈胆固醇过饱和（胆固醇过饱和指数：1．17±0．02 vs 0．79±0．10，P〈0．001）；胆汁胆固醇摩尔百分比浓度较对照组升高[（7．96±0．39）mol％vs （5．26±0．89）mol％]，P〈0．01；胆汁总脂较对照组明显下降[（104．72±10．51）g／L vs （154．24±14．20）g／L]，P〈0．05；胆汁中胆汁酸和磷脂成分2组比较差异均无统计学意义（P〉0．05）。胆石组LRH-1表达高于对照组（14．18±1．80 vs 7．22±2．22），P〈0．05，LXRα、FXR和SXR表达2组差异无统计学意义（P〉0．05）。结论人类肝脏LRH-1的表达增高与胆囊胆固醇结石形成有关。     

大鼠肝移植后早期血清一氧化氮的变化及其意义

目的探讨大鼠肝移植后早期血清一氧化氮（NO）的变化情况及其意义。方法将SD大鼠随机分成A、B、C三组，进行肝移植．供、受者均为SD大鼠。A组于移植肝恢复血流2h、B组于移植肝恢复血流4h、C组于移植肝恢复血流6h时采取受者的下腔静脉血和左肝叶组织．测定血清丙氨酸转氨酶（ALT）和NO含量．免疫组化法测定移植肝组织中核因子．κB p65亚单位（NF-κB p65）的表达，并观察肝组织病理学变化；每组均于移植肝恢复血流时收集5min的胆汁，测量5min胆汁分泌量。结果A组的5min胆汁分泌量为（3．73±1．11）μl．明显高于B组的（2．35±0．92）μ和C组的（2．23±0．81）μl（P〈0．05）。A组血清ALT含量为（468±36）IU／L．B组为（619±49）IU／L．C组为（820±65）IU／L，A组明显低于B、C组（P〈0．05），B组明显低于C组（P〈0．05）。A组血清NO含量为（14．2±1．5）μmol／L，明显高于B组的（10．5±1．2）μmol／L和C组的（10．3±1．1）μmol／L（P〈0．05）。A组肝组织中NF-κB p65表达阳性细胞百分率为（23．5±1．9）％．B组为（43．8±3．8）％，C组为（48．6±5．1）％．A组明显低于B、C组（P〈0．05）。病理学观察显示．随着移植肝脏再灌注时间的延长，肝组织损伤呈进行性加重。Pearson相关性分析提示．NO与血清ALT水平及NF-κB p65表达呈明显的负相关（r值分别为-0．74和-0．77，P〈0．01）。结论移植肝脏再灌注早期．血清NO下降，NF-κB的活性逐渐增强．移植肝脏的功能和组织损伤呈加重趋势。     

食管鳞状细胞癌bFGF,TSP-1的表达与微血管密度的关系

目的探讨食管鳞状细胞癌组织中碱性成纤维细胞生长因子（bFGF）、凝血酶敏感蛋白-1（TSP-1）和微血管密度（UVD）表达及其意义。方法采用免疫组化方法对46例病人食管鳞状细胞癌组织常规石蜡包埋切片分别检测bFGF、TSP-1和MVD。结果食管鳞状细胞癌组织bFGF、TSP-1阳性率分别为60．9％（28／46）和37．0％（17146），MVD定量（56．59±28．97）／mm^2。T3期肿瘤组织bFGF阳性表达率明显高于T2期者。bFGF阳性表达的肿瘤组织MVD明显少于bFGF阴性表达的肿瘤组织[（49．51±24．73）／mm^2对（67．61±32．23）／mm^2，P〈0．05）]，T3期、TNMⅢ期肿瘤组织TSP-1阳性表达率明显高于T2期及TNMⅡ期者。肿瘤细胞分化Ⅲ级者MVD明显高于Ⅰ、Ⅱ级者[（85．38±37．88）／mm^2对（41．35±20．32）／mm^2，P〈0．01；（85．38±37．88）／mm^2对（54．28±23．43）／mm^2，P〈0．01]，伴有区域淋巴结转移组MVD明显高于无淋巴结转移组[（65．38±32．33）／mm^2对（47．00±21．66）／mm^2，P〈0．05]。结论bFGF、TSP-1表达以及MVD计数与食管鳞状细胞癌组织的生物学行为有密切关系，bFGF是调节食管鳞状细胞癌组织血管生成的重要因子。     

血清蛋白质标记物检测在小儿肾母细胞瘤预后监测中的价值

目的 探索肾母细胞瘤患儿预后监测的新方法。方法 应用表面增强激光解析电离飞行时间质谱（SELDI—TOF—MS）技术检测肾母细胞瘤患儿术前后血清蛋白质标记物的表达差异。肾母细胞瘤患儿血清标本100例，其中术前30例、术后2周24例、术后3个月和6个月各23例，正常儿童血清标本20例，以生物信息学方法支持向量机分析质谱数据。结果 肾母细胞瘤患儿手术（包括根治术和姑息性切除术）前后血清蛋白质标记物有明显差异。筛选出2个质荷比（m／z）位于6984．0、6455．0处的蛋白质标记物：术前30例标本2种蛋白质标记物表达强度分别为299．8±134．6、1037．0±375．9，与正常对照组（表达强度分别为1110．6±213．8、2268．7±1058．0）比较差异有统计学意义（P〈0．01）；19例根治术患儿术后2周2种蛋白质标记物表达强度分别为1101．2±221．8、2065．2±660．5，与术前组比较差异有统计学意义（P〈0．01），与正常对照组比较差异无统计学意义（P〉0．05）。2例根治术和3例姑息性切除患儿术后2周2种蛋白质标记物表达强度分别为358．1±213．3、1307．9±402．2，与术前组比较差异无统计学意义（P〉0．05）。术后3、6个月复查发现，持续高表达者均无复发转移征象，持续低表达者为瘤体未切净或已有远处潜在转移者。结论 血清蛋白质标记物检测为肾母细胞瘤术后患者预后判断提供了一种可能的新方法。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.