胫骨远端骨折应用交锁髓内钉固定时远端不同锁定钉状态的有限元分析

目的 探究胫骨远端骨折应用交锁髓内钉固定时远端不同锁定钉状态的稳定性及其生物力学特性。方法 选择一名健康成年男性的胫骨CT Dicom数据,应用mimics、geomagic和solidworks软件构建胫骨、髓内钉、锁定钉的3D模型,然后按照髓内钉远端不同锁定状态分为试验组（两枚横向锁定钉和一枚纵向锁定钉）和对照组（两枚横向锁定钉）,分别给予轴向、侧向和扭转方向的不同大小的载荷,以模拟正常人体胫骨和内固定系统在不同受力情况下的应力和位移分布情况。结果 试验组和对照组的应力分布没有明显差异,二者都集中在骨-螺钉结合部位,但试验组在轴向、侧向和扭转方向的不同大小的载荷下的最大等效应力均略低于对照组,在轴向300、600、900 N载荷下,试验组的最大等效应力为24.84、49.68、74.52 MPa,对照组的为27.80、55.51、83.27 MPa;在扭转2、4、6 N/m的载荷下,试验组的最大等效应力为144.87、290.92、431.80 MPa,对照组为146.01、292.03、434.80 MPa;在侧向300、600、900 N载荷下,试验组的最大等效应力为209.79、419.58、629.37 MPa,对照组为210.47、420.94、631.41 MPa。在形变位移方面,两组的内固定系统都没有发生明显形变,且试验组的最大位移均略小于对照组。在轴向300、600、900 N载荷下,试验组的最大位移为0.022 9、0.045 8、0.068 7 mm,对照组的为0.024 1、0.048 1、0.072 3 mm;在扭转2、4、6 N/m的载荷下,试验组的最大位移为0.217 8、0.428 8、0.597 8 mm,对照组为0.218 5、0.436 9、0.607 2 mm;在侧向300、600、900 N载荷下,试验组的最大位移为0.949 2、1.898 5、2.847 7 mm,对照组为0.952 5、1.905 0、2.857 6 mm。结论 通过应力和位移对比分析,在使用髓内钉固定胫骨远端骨折时,髓内钉远端固定两枚横向锁定钉已经提供了足够的稳定性,与使用三枚锁定钉相比,两枚锁定钉能减少额外的手术时间和不必要的辐射暴露。在实际情况中还需要手术医生结合临床的具体情况为病人选择最合适的手术方案。     

糖尿病合并骨质疏松的中医研究进展

随着全球老龄化进程，糖尿病合并骨质疏松在慢性疾病中发病率显著升高，其最常见的并发症之一骨折严重降低患者生活质量。现代医学治疗具有经济负担重、缺少前瞻性研究的缺点，而中医药治疗具有不良反应小、依从性高及价格适中等优点，具有临床多途径、多靶点治疗糖尿病合并骨质疏松的独特优势。近年来中医药有关其研究越来越多，在治疗上注重滋补肝肾，重视补阴药及活血药的运用，许多研究者结合现代医学的检验、检查指标证明了中药的疗效，而从单味药、药对或是复方着手的许多实验研究又证明其疗效通路机制，除此之外，针灸推拿等中医特色治疗也有改善糖代谢及骨代谢的作用。笔者从糖尿病合并骨质疏松的病因病机、辩证分析、治法、实验研究、临床研究及中医特色疗法等方面进行综合论述，深入认识糖尿病合并骨质疏松，能为其治疗提供一定的理论依据及临床参考。     

双能X线骨密度仪精密度和准确度的研究

目的：通过测量长、短期精密度和短期准确度对双能X线吸收法（ dual－energy X－ray absorptiometry ,DXA）骨密度仪进行质量控制。方法①长期精密度：对质量保证（Quality Assurance,QA）模块连续1年的测试数据进行统计分析,分别计算其高、中、低骨密度、均值骨密度、骨矿盐含量、投影面积的变异系数（ coefficient of variation ,CV）;②短期精密度：取连续25天的QA模块测试数据,计算高、中、低骨密度平均值和标准差（standard deviation,SD）,制作Shewhart质控图。另外选取30名志愿者,分别测量L1－4椎体,双侧股骨颈、大粗隆、Ward＇s三角、全髋关节的骨密度（bone mineral density,BMD）值,计算均方根变异系数（ root mean square of the CV ,RMS－CV）;③短期准确度：取连续25天的QA模块测试数据,计算高、中、低骨密度的准确度。结果①长期精密度：QA模块测量高、中、低骨密度、均值骨密度、骨矿盐含量、投影面积的CV分别为0．37％、0．37％、0．41％、0．43％、0．47％、0．12％;②短期精密度：连续25天QA模块测试数据均符合Shewhart 法则;30例受试者L1－4椎体,双侧股骨颈、大粗隆、Ward＇s 三角、全髋关节各测量部位的RMS－CV 分别为1．3％、0．8％、0．9％、1．2％、1．3％、1．5％、1．6％、0．6％、0．6％;③短期准确度：连续25天QA模块测试数据的高、中、低骨密度的准确度分别为－0．07％、0．10％、0．60％。结论进行长、短期精密度和准确度测试能反映双能X线吸收骨密度仪的一致性和可靠性,可有效提高骨质疏松的流行病学研究、诊断、治疗、药物试验研究的可信度。     

影响神经源性膀胱排尿报警装置的主要因素

目的研究神经源性膀胱排尿报警装置的主要影响因素，为产品设计及临床应用提供参考。方法采用厚3mm／n、直径10mm／n的铁氧体永磁铁和直径分别为10、15、20mm／n的钕铁硼永磁铁，模拟腹壁厚度为2、3、4、5、6、7、8、9cm，永磁铁位置设定为0、1、2、3、4、5、6、7、8、9、10、11、12cm，测试腹壁厚度、永磁铁位置及其类型对神经源性膀胱排尿报警装置的影响。模拟腹壁厚度为2、3、4、5cm，永磁铁位置为2、3、4、5、6、7、8、9、10cm，测试地磁场对神经源性膀胱排尿报警装置的影响。结果报警仪指针角度与铁氧体永磁铁位置仅在腹壁厚度为2cm时成正相关（r=0．632，P〈0．05），而在3～9cm时无相关性（P〉0．05）。报警仪指针角度与钕铁硼永磁铁位置成正相关（r〉0．622，P〈0，05），且随永磁铁直径增大而增强，随腹壁增厚而减弱。地磁场的影响与人体朝向、永磁铁位置和腹壁厚度相关。结论影响神经源性膀胱排尿报警装置的主要因素包括永磁铁磁性和位置、腹壁厚度和地磁场，这些主要影响因素的合理配置可优化装置性能。     

Endovascular restorative neurosurgery: a novel concept for molecular and cellular therapy of the nervous system

The amalgam of molecular biology and neurosurgery offers immense promise for neurorestoration and the management of neurodegenerative deficiencies, developmental disorders, neoplasms, stroke, and trauma. This article summarizes present strategies for and impediments to gene therapy and stem cell therapy of the central nervous system and advances the concept of a potential new approach, namely endovascular restorative neurosurgery. The objectives of gene transfer to the central nervous system are efficient transfection of host cells, selective sustained expression of the transgene, and lack of toxicity or immune excitation. The requisite elements of this process are the identification of candidate diseases, the construction of vehicles for gene transfer, regulated expression, and physical delivery. In the selection of target disorders, the underlying genetic events to be overcome, as well as their spatial and temporal distributions, must be considered. These factors determine the requirements for the physical dispersal of the transgene, the duration of transgene expression, and the quantity of transgene product needed to abrogate the disease phenotype. Vehicles for conveying the transgene to the central nervous system include viral vectors (retroviruses, lentiviruses, adenoviruses, adeno-associated viruses, and herpes simplex virus), liposomes, and genetically engineered cells, including neural stem cells. Delivery of the transgene into the brain presents several challenges, including limited and potentially risky access through the cranium, sensitivity to volumetric changes, restricted diffusion, and the blood-brain barrier. Genetic or cellular therapeutic agents may be injected directly into the brain parenchyma (via stereotaxy or craniotomy), into the cerebrospinal fluid (in the ventricles or cisterns), or into the bloodstream (intravenously or intra-arterially). The advantages of the endovascular route include the potential for widespread distribution, the ability to deliver large volumes, limited perturbation of neural tissue, and the feasibility of repeated administration.     

The brain: functional divisions

The incompletely separated cerebral hemispheres consist of a thin outer folded cortex of grey matter containing organized neuronal cell bodies and interneurons. Some of the surface convolutions subserve particular sensory or motor functions. Incoming afferent and projected efferent fibres constitute the underlying white matter, which connects different parts of each hemisphere, the hemispheres to each other and (as the corona radiata) to subcortical nuclei, especially components of the deeply-embedded diencephalon and the basal ganglia, and continuing between the latter as the internal capsule to and from the cerebellum and brainstem. Divisions of the diencephalon, the deeper part of the embryonic forebrain, include the epithalamus (pineal gland), the thalamus (connected extensively with the cortex), the subthalamus and the hypothalamus (involved in the autonomic nervous system, limbic system and neuro-endocrine system). The brainstem, consisting of the midbrain, pons and medulla, allows passage of many ascending and descending nerve fibre tracts between the brain and spinal cord, carrying sensory information from and allowing movement of the limbs and trunk. It is also the site of many of the cranial nerve nuclei, through which the brain innervates the head region. It houses the centres controlling vital aspects related to respiration, cardiovascular function and consciousness levels. The cerebellum also has a cortex of grey matter, tightly convoluted into folia, and containing layered neuronal cell bodies projecting laterally and, as underlying white matter, to a collection of deep nuclei. Fibres run to and from the cerebellar nuclei in a series of peduncles to the midbrain, pons and medulla, and allow the cerebellum to coordinate movement at an unconscious level.     

调髓法论治血友病性骨质疏松症

“肾主骨生髓”是中医藏象理论的重要认知，认为肾藏功能紊乱是中医骨病发生发展的根本原因。浙派中医骨伤学家基于临床经验，在此理论基础上，结合古代文献及现代研究，创新性地将奇恒之腑“髓”对骨科疾病的影响作为一个独立的研究专题提出；系统构建出“髓系骨病”的理论体系；并创立对应的“调髓”治法。血友病性骨质疏松症属此类病症之一，其主要病机为先天之精功能异常，致血溢脉外，引发髓的藏泻失调，继而骨稳态失衡，发为骨痿。其治疗原则应为标本同治，内外调髓，恢复骨稳态。笔者以精、骨、髓、血的关系为立足点，对血友病性骨质疏松症的祖国医学与现代医学认识进行阐述，探讨运用“调髓法”对其进行治疗的思路。     

基于文献计量学分析太极拳防治骨质疏松研究现状

目的 探究太极拳防治骨质疏松的现状及未来发展趋势,从而为进一步研究提供参考依据.方法 检索所有公开发表的关于太极拳防治骨质疏松的文献,分析文献年代分布、文献类型和语言、期刊分布、核心机构、高频关键词、疗效指标等特点.结果 纳入文献共210篇,近10年共发表136篇论文,占全部论文量的64.76％,是太极拳防治骨质疏松研...     

医美科研课题查新与查新人员素质提升策略研究

医学美容科研查新及查新人员素质在医美行业中的地位日益提升，受到了广泛关注。随着科研 信息量的快速增长，查新工作越来越复杂，挑战明显增加，同时查新人员的素质直接影响到查新结果的质 量和效率。本文主要探讨医美科研查新质量以及查新人员素质的提升策略。为提高查新质量，提出了建立 医学美容查新体系和标准，包括规范查新流程、加强查新技术、确保查新结果的权威性和准确性。同时， 对于查新人员素质的提升，强调了文献检索、有效沟通和外语翻译能力的培养，以及服务意识、责任感、 成就导向意识和安全保密意识的重要性。本研究旨在为提升医美科研查新质量和查新人员素质提供理论 依据和实践建议，从而推动医美行业的持续发展。     

Neural and vascular anatomy of the menisci of the human knee

STUDY DESIGN: Review of literature. OBJECTIVES: To review the general anatomy, vascular anatomy, healing potential, neural anatomy, and sensory functions of the menisci of the human knee. BACKGROUND: Recent research has revealed important roles and functions of the menisci of the human knee. METHODS AND MEASURES: A Medline search was performed using the following title and key words: menisci, meniscus, meniscal, vascular, blood, neural, nerve, anatomy, healing, sensory, mechanoreceptors, proprioception, nociceptors, surgery, meniscectomy, repair, and rehabilitation. The references from each article obtained were then reviewed in order to find additional articles not already located through the Medline search. RESULTS: In adults, the blood supply to the menisci of the knee reaches the outer 10% to 33% of the body of the menisci. This portion of the menisci is capable of inflammation, repair, and remodeling. Neural innervation with nociceptors and type I, II, and III mechanoreceptors reaches the outer 66% of the body of the menisci. The anterior and posterior horns of the menisci have a rich supply of both blood vessels and nerves. CONCLUSIONS: The menisci of the human knee are an important source of proprioceptive information regarding the position, direction, velocity, and acceleration and deceleration of the knee. Rehabilitation following injury or surgery to the menisci of the knee should, therefore, incorporate a proprioceptive retraining program that respects both the abilities and inabilities of different portions of the menisci to follow through with repair and remodeling.     

从“治痿独取阳明”论治脾肾两虚型老年性骨质疏松症

老年性骨质疏松症(senile osteoporosis,SOP)是一种以骨量减少和骨微结构破坏为特征的老年全身退化性骨病,以致骨的强度降低,骨脆性增加,骨折发生风险较高。SOP属于祖国医学中"骨痿"、"痿证"、"骨枯"等范畴,该病以肝、脾、肾三脏虚损为本,脾肾两虚证是SOP较为常见的证型。目前关于脾肾两虚型SOP是以肾虚为主要病机,补肾健骨成为主要治法,而从脾胃方面论治本病的相关研究较少。本文首次从"治痿独取阳明"角度论治脾肾两虚型SOP,补益中焦脾胃以益肾,并滋养脏腑,改善机体营养状况,为防治本病提供新的思路。     

Electroconvulsive therapy--1987

The noncontroversial fact regarding ECT seems to be that controversy exists in almost every area of its use, its art, and its science. The nature of the treatment itself, its history of abuse, unfavorable media presentations, special attention by the legal system, uneven distribution of use among facilities and practitioners, and lack of certified standards for psychiatric training in ECT have tended, in the past 2 decades, to swing the pendulum towards the use of tricyclic and other antidepressant agents for the treatment of severe depression. Despite recommendations for continual review of data and of clinical and research experience, few pertinent reports by anesthesiologists have appeared. Guidelines for the anesthesiologist have not been established. Due to the pervading presence in earlier studies of hypoxia, hypercarbia, and acidosis, it is futile to compare findings of unmodified ECT to modified ECT. More recent studies relating especially to cardiovascular abnormalities have also been difficult to evaluate because of widely varying formats, use of different agents and dosages, continuance or discontinuance of psychotropic drugs, and variability of ventilation and concentrations of oxygen. ECT is a modality that has not outlived its usefulness. With proper pretreatment, selection and evaluation of patients, use of appropriate modification techniques, and careful clinical management and monitoring during treatment, ECT can be both safe and effective, even in relatively high-risk patients. ECT provides an exciting challenge for concerned physicians to explore the role of brain function and behavior, and the effects of seizures on neuroendocrine mechanisms, neurohumoral mechanisms, cerebral metabolism, the blood-brain barrier, and ion transport systems. It may lead to further understanding of the action of general anesthetics, CNS depressant drugs, and the effects of stimulation of the central autonomic nervous system and the endocrine systems. A close interaction between basic and clinically oriented researchers holds the key to designing studies that can answer these critical questions, rather than continuation of studies that merely generate more data.     

From the lumen to the laparoscope

Throughout the ages, the issues that have defined the management of disease processes have been particularly exemplified in the gastrointestinal tract. The use of gas lamps and candles with reflectors by Bozzini, Segalas, Cruise, and Fisher (19th century) allowed for some ingress into both the upper and lower gastrointestinal tract. Von Mikulicz, Leiter, Nitze, Kelling, and Jacobaeus contributed to the development of rigid instruments that could be used endoscopically or laparoscopically. Endoscopic efforts were amplified and extended by Rosenheim, Sternberg, Wolf, and, finally, Schindler, who not only introduced novel lens systems but also for the most part overcame the problems of flexibility and illumination. Bernheim, Ruddock, Veress, and Palmer made significant technical and clinical contributions to abdominal cavity exploration. The subsequent application of Hopkins and Kapany's work on optics, and the development by Hirschowitz and Curtiss of the flexible fiber optic endoscope, enabled the design of instruments that would allow the appropriate illumination and vision of both the farthest reaches of the bowel as well as the interior of the abdomen. Thus, the same endoscopic instruments coupled with a surgical interest in diagnostic laparotomy allowed for the evolution of minimally invasive surgery along a similar timescale. The cycle whereby diagnostic laparotomy in the early part of the century was supplanted by endoscopy and laparoscopy has now attained full circle whereby laparoscopy has evolved from a diagnostic procedure into one with major therapeutic applications and is perceived as the state-of-the-art technique for a wide variety of operations, including appendectomy, cholecystectomy, hernia repair, fundoplication, splenectomy, colectomy, and gastrointestinal anastomoses.     

肠道菌群与胆石症病因的研究进展

胆石症是最常见的胆道外科疾病,临床症状主要取决于结石的部位、胆道梗阻、胆道感染等因素,具体可表现为腹痛、发热、恶心、呕吐、黄疸等症状。随着人口的老龄化、膳食结构的改变,其发病率呈逐渐上升趋势。目前虽然诊断及治疗技术已相对成熟,但胆道结石形成的具体病因及发病机制尚未完全阐明。代谢综合征相关疾病可能与胆石症的形成与发展存在密切关系。肠道菌群失调可能会引起代谢变化,导致代谢相关疾病的发生发展,因此胆石症的发生与肠道微生态失衡存在密切的关系,但有关肠道微生态失衡与胆石症发生的关系研究相对较少,其作用机制也不甚清楚。笔者综述肠道菌群在胆石症形成的发病机制中的作用,探讨未来的研究方向。     

Anatomic exposures for vascular injuries.

The exposure of vascular injuries is contingent on knowledge of anatomy and the limitations and boundaries for proximal and distal control of each artery. In this article, these are conveniently organized into arteries of the neck, of the chest, of the abdomen, and of the extremities. In addition, the interface between the neck and chest, and the chest and the abdomen provide particular challenges because of the need to expose two body regions frequently. The anatomy, the points of proximal and distal control, the details of exposure, and the key maneuvers required to expose particular arteries are reviewed.     

异体手移植的手术设计与操作

目的 探讨异体手移植的手术设计与技术操作要点。方法 2例右手缺失病人行异体手移植,参照自体断腕再植的基本程序,依次受区准备、供手准备、移植手组织重建。骨骼再接平面位于桡尺骨离桡骨关节面2.5cm～3cm处,桡骨阶梯状截骨、螺钉固定,尺骨平面截骨、三棱针或钢板内固定;先缝合屈侧深肌腱,吻合尺、桡动脉后静脉放血,再吻合头、贵要静脉,缝合屈侧浅肌腱及伸侧肌腱,吻合神经,缝合皮肤。术后抗免疫排斥、抗感染、抗凝、抗血管痉挛。结果 手术时间分别为7h52min、9h10min,供手缺血时间6h、ah 19min。病例一移植手血循环良好;病例二术后3小时静脉危象,经手术恢复血循环。现术后8个月移植手存活良好,无免疫排斥反应发生,手握持功能及手部感觉已恢复,手内在肌功能部分恢复。结论 异体手移植的手术设计重点依据手缺失残端位置确定受一供体手移植平面,组织重建的顺序为骨骼、深肌腱、动脉、静脉、浅肌腱、神经和皮肤。     

Health Content Analysis of Organ Donation and Transplantation News on Turkish Television Channels and in Turkish Print Media

The media affects individuals' behaviors, especially by means of news and advertisements. In this study, we evaluated health content of organ donation and transplantation news in the printed media and on television programs for a 1-year period in Turkey. We examined 2449 news items in 230 newspapers and magazines; 1179 news programs on 45 television channels, all concerning organ donation and transplantation. The news obtained from the Media Pursuit Center were transferred to an electronic file to evaluate the format and content of the news. Nine variables were examined about the scope and the formal characteristics of the news: the publication name, its type, the province, the date, the headline, the title length, the presence of a photograph, or its kind, the news size, and the page number. In the content analysis of the news, we also examined 9 variables: the topic, the message of the headline, the property of the words in the title, the identification of photographs in the news, the age, gender of actors in the news, as well as donor or recipient. In a summary, print media and television channels, failed to show sufficient information about organ donation and transplantation. The percentage of news about organ donation and transplantation was small and mostly negative items in the media. On television channels, sufficient place was not given to organ donation and transplantation. The news in printed media and on television channels was not about motivated or altruistic behavior. The pattern of organ donation and transplantation news is important in terms of perception and comment by the public. Furthermore it directly affects the perception of the news by the reader.     

The haemodynamics of human septic shock

In the time it has taken medicine to develop the techniques to describe the circulatory changes of severe infections, both pattern and process have been profoundly influenced by the use of intravenous fluids, vasopressors, antibiotics, steroids, mechanical ventilation and haemoflltration. Constant features of severe sepsis include a reduction in peripheral vascular tone on both the arterial and venous sides of the circulation, a defect in oxygen utilisation resulting in lactic acidosis, and varying degrees of myocardial dysfunction. These events have a temporal progression, the precise pattern observed depending on the tempo of the infection, the influence of therapeutic manoeuvres, the age and comorbidities of the patient, and the time the observations are made in the course of events. Early sepsis is accompanied by a decrease in systemic vascular resistance and a metabolic acidosis. The clinical picture includes fever, tachycardia, tachypnoea, respiratory alkalosis and an increased cardiac output with warm, dry peripheries and a bounding pulse. Advanced sepsis involves varying degrees of venous and myocardial contractile failure, and is characterised by progressive acidaemia, respiratory failure and marked sympathetic adrenergic activation. In the absence of vigorous fluid resuscitation, the cardiac output is decreased and the patients are cold, clammy peripherally shut down, and frequently confused, obtunded or comatose. In infections with a silent primary focus (predominantly involving Gram-negative organisms), this stage is frequently the first to attract the attention of attending staff. Late sepsis is characterised by profound acidaemia, vascular hypo-responsiveness, multiple organ failure and death.