透明质酸钠在关节疾病中的应用

目的：综述透明质酸钠在关节内的生理功能以及在关节疾病中的临床应用。方法：广泛查阅相关文献资料，分析透明质酸钠治疗关节疾病的机制及应用前景。结果：外源性透明质酸钠通过参与改善关节滑液、保护关节软骨、抑制炎症发生等，在膝骨关节炎、类风湿性关节炎、颞下颌关节炎等疾病中均可发挥作用。结论：透明质酸钠对关节疾病具有很好的治疗作用，应用前景广阔。     

应用关节镜清理和透明质酸钠注射治疗膝关节骨关节炎

目的：比较2例治疗膝关节骨关节炎方法的效果。方法：2组病人分别采用关节镜清理和透明质酸钠注射治疗膝关节骨关节炎，结果：术后随访2年以上，根据关节疼痛，积液肿胀，关节活动度，行走功能四个项目及综合评价。关节镜组随访结果，半年－1年，优良率为96．2％，1－2年，优良率84．6％，2年以上优良率为73％，透明质酸钠组随访结果：半年－1年，优良率为94．9％，1－2年，优良率86．4％，2年以上优良率为74．6％，。结论：关节镜清理和透明质酸钠注射治疗膝关节炎2种方法都有一定的效果，2组之间无明显差别。     

柱前衍生化HPLC法测定人血清中丙戊酸钠的浓度

目的:建立测定人血清中丙戊酸钠浓度的方法.方法:采用2-溴-对硝基苯乙酮为衍生化试剂,以高效液相色谱法进行测定.色谱柱为大连依利特Hypersil ODS2色谱柱(4.6mm×150mm,5μm),流动相为甲醇-水(80:20),流速为1mL.min-i,检测波长为265nm,柱温为30℃,内标为环己烷羧酸.结果:丙戊酸钠血药浓度在8.96～134.4mg.L-1范围内线性关系良好(r=0.9992,n=6),最低检测浓度为2 mg.L-1;平均回收率为99.8％～102.4％,日内与日间RSD均＜6.7％(n=5).结论:本方法快速、简便、准确,适用于临床丙戊酸钠的血药浓度监测.     

透明质酸钠在下泪小管断裂吻合术中的应用

目的探讨透明质酸钠在下泪小管断裂吻合术中寻找泪小管断端的应用价值。方法鼻腔用油沙条填塞后，从上泪小点注入透明质酸钠，寻找下泪小管鼻侧断端；从下泪小点注入透明质酸钠，寻找泪小管颠侧断端，行泪小管吻合术。结果本组患者16例(16只眼)，泪小管鼻侧断端经透明质酸钠标记明显，寻找断端的成功率100％，吻合手术顺利。术后随访6～12个月，14例患者治愈(87．5％)，2例未愈(12．5％)。结论注入透明质酸钠，寻找泪小管断端．简便易行．应作为寻找泪小管断端的首选方法．     

几丁聚糖和透明质酸钠对成纤维细胞增殖影响的实验研究

目的：比较几丁聚糖和透明质酸钠对成纤维细胞增殖的影响。方法：用含不同浓度的几丁聚糖和透明质酸钠的培养液培养成纤维细胞，以四唑盐比色法测细胞增殖，并用流式细胞仪测细胞周期。结果：几丁聚糖在≥0.1mg/ml时即对成纤维细胞的增殖有抑制作用，透明质酸钠的抑制浓度为1mg/ml，透明质酸钠和几丁聚糖都可使细胞周期中G1期比例增加。结论：几丁聚糖和透明质酸钠均抑制成纤维细胞的增殖，但几丁聚糖的抑制作用较强。     

应用透明质酸钠治疗踝关节骨折

目的：透明质酸钠在治疗踝关节骨折中的作用。方法：66名踝关节骨折切开复位内固定的患者随机分成2组，一组给予踝关节内注射透明质酸钠，另一组作为对照组，定期随诊，根据Mazur踝关节评分系统评分，进行前瞻、对照、双盲研究。结果：在6周时，透明质酸组踝关节评分为63分，对照组为58分，P＜0．05，在12周，透明质酸组踝关节评分为83分，对照组76分，P＜0．05，在26周时，透明质酸组踝关节评分为88分，对照组为82分，P＜0．05，在52周时，透明透明质酸组踝关节评分为93分，对照组为86分，P＜0．05。结论：在踝关节骨折术后关节内注射透明质酸钠可改善踝关节功能，减少创伤性骨关节炎的发生。     

全麻药对中枢神经系统电压门控性钠通道的影响

电压门控怀钠通道是可兴奋细胞动作电位一产生和传播的关键因素，它在神经元的联系和信息整合中发挥着核心作用，钠通道是否全麻药作用的靶位，尚未成定论。本文介绍了钠通道的分。钠通道的药理学、分子生物学及电生理学特征，并就全麻药一中枢神经系统钠通道影响的近年进展作一综述。     

对比头孢曲松钠、头孢唑肟钠、头孢吡肟钠治疗下呼吸道感染的疗效

目的:比较头孢曲松钠、头孢唑肟钠、头孢吡肟钠在治疗下呼吸道感染中的疗效。方法:确诊为下呼吸道感染的病患191的资料,分为1、2、3组,分别为63例、66例、62例,1组用头孢曲松钠进行治疗,2组用头孢唑肟钠,3组用头孢吡肟钠,比较治疗后效果及不良反应的发生情况。结果:用头孢吡肟钠的3组患者总见效率明显高于1、2组,不良发应发生情况显著少于1、2组,差异具有显著性,P<0.05。结论:头孢吡肟钠在下呼吸道感染的治疗上效果明显好于头孢曲松钠及头孢唑肟钠,且不良反应发生较少。     

可调钠透析防治高危血液透析患者低血压研究

目的：观察可调钠透析（PHD）在高危人群（高龄、糖尿病肾病及心功能不稳定）血液透析中防治低血压的作用。方法：选择30例维持性血液透析中的高危患者透析，治疗分两阶段进行，第1月行普通透析（CHD）为A组，透析液钠浓度138mmol／L，第2月行可调钠透析（PHD）为B组，透析液钠离子浓度由148mmol／L，线性下降到135mmol／L，透析时间均4．5h，患者自身交叉对照，两者血流速相等，脱水量恒定，透析过程中监测透析前后血清钠浓度，监测透析过程中低血压发生率。结果：CHD组与PHI）组相比，透析前后血清钠浓度无明显差异（P〉0．05）。CHD组与PHD组相比，PHD组低血压发生率较CHD组明显降低（p〈0．01）。与CHD相比，PHD的作用以不增加患者的钠负荷为代价，不造成透析间期体重增长过多。结论：PHD组可明显减少维持血液透析中高危人群的低血压的发生率。     

透明质酸钠治疗膝骨关节炎临床疗效观察

目的观察透明质酸钠注射液治疗膝骨关节炎的临床疗效。方法对143例156侧膝骨关节炎患者关节腔内注射透明质酸钠，每周1支，5支1疗程，治疗期间不用其他治疗关节炎的药物，并嘱患者在治疗期间多注意休息，减少活动量。结果143例患者156侧肢体随访3～9个月，疗效为优91侧（55．29％），良32侧（21．76％），可16侧（14．13％），差17侧（8．82％）。优良率77．05％，有效率89．10％，未见明显毒副作用。结论透明质酸钠对轻、中度膝骨关节炎具有良好的疗效，是一种安全、有效的理想药物。     

Plantar pressures in the forefoot after lateral column lengthening: a cadaver study comparing the Evans osteotomy and calcaneocuboid fusion

BACKGROUND: Excessive varus alignment of the forefoot after lateral column lengthening has been reported to lead to overloading of the lateral foot. The purpose of this study was to investigate whether there is a difference between the Evans opening wedge calcaneal osteotomy (Evans) and the calcaneocuboid distraction arthrodesis (CCDA) with respect to lateral forefoot loading. METHODS: In each of 12 matched pairs of cadaver feet, plantar pressure measurements of the intact specimens were obtained during simulated foot-flat and early heel-rise phases of gait and again after randomly performing the Evans procedure on one foot and the CCDA on the other foot. Cervical plate fixation was used for immediate stability. RESULTS: Both procedures resulted in statistically significant increased loading of the lateral forefoot and decreased loading of the medial forefoot compared with the preoperative status. The relative increase in lateral pressures was statistically greater with the CCDA than with the Evans. The average increase in pressure under the fifth metatarsal head in the foot-flat phase was 46% +/- 42% (range-4% to 141%) with the Evans and 104% +/- 58% (range 9% to 216%) with the CCDA (p = 0.003). In the early heel-rise phase, the increase in pressure was 50% +/- 43% (range 2% to 108%) and 96% +/- 65% (range 12% to 263%), respectively (p = 0.02). CONCLUSION: The experimental data suggest that lateral column overload may be more likely with the CCDA than with the Evans. Physicians should be aware of the likelihood of increasing lateral column loads with both the CCDA and the Evans procedure. It may be possible to avoid this problem by using less lateral column lengthening than the 1 cm used in this study or by considering a medial column arthrodesis or plantarflexion osteotomy to balance forefoot loading.     

Effects of icariin on cGMP—specific PDE5 and cAMP—specific PDE4 activities

Aim:To clarify the mechanism of the therapeutic action of icariin on erectlile dysfunction(ED).Methods:PDE5 was isolated from the human platelet and PDE4 form the rat liver tissue using the FPLC system (Pharmacia,Milton Keynes,UK)and the Mono Q column.The inhibitory effects of icariin on PDE5 and PDE4 activities were investigated by the two-step radioisotope procedure with [^3H]-c GMP/[^3H]-cAMP.Papaverine served as the control drug.Results:Icariin and papaverine showed dose-dependent inhibitory effects on PDE5 and PDE4 activities.The IC50 of Icariin and papaverine on PDE5 were 0.432μ mol/L and 0.680μmol/L,respectively and those on PDE4,73.50μmol/L and 3.07μmol/L,respectively.The potencies of selectivity of icariin and papaverine on PDE5(PDE4/PDE5 of IC50)were 167.67 times and 4.54 times,respectively.Conclusion:Icariin is a cGMP-specific PDE5 inhibitor that may be developed into an oral effective agent for the treatment of ED.     

Pharmacokinetic evaluation of pamidronate after oral administration: A study on dose proportionality,absolute bioavailability,and effect of repeated administration

Summary To evaluate dose proportionality and absolute bioavailability of a new enteric-coated pellet formulation of pamidronate disodium (AREDIA), nine females (aged 52–66 years) were given three different single peroral doses of pamidronate disodium (75, 150, and 300 mg) and an i.v. infusion of 15 mg over 30 minutes at constant infusion rate. Repeated peroral doses (75 and 150 mg) were administered to 12 females (aged 51–70 years) for 10 consecutive days. Urinary excretion of pamidronate after peroral and i.v. administration was used for estimation of pamidronate absorption. Renal excretion of pamidronate ranged from 0.01% to 0.35% of dose, with mean values of 0.11, 0.16, and 0.18% for 75, 150, and 300 mg, respectively. After i.v. infusion, the renal excretion of pamidronate was 26–53% of the dose, lower than for other bisphosphonates. The absolute bioavailability was 0.31% (range 0.08–0.7%) after 75 mg, 0.43% (0.01–1.20%) after the 150-mg dose, and 0.48% (0.07–1.06%) following 300 mg of pamidronate disodium. Urinary excretion after the 10th intake showed a significant increase (difference 0.07% (range -0.003-0.29%),P < 0.02) when compared with the first dose. In conclusion, intestinal uptake of pamidronate was low with high intraindividual variation, like other bisphosphonates.     

The use of eidronate disodium in the prevention of heterotopic ossification in burn patients

Heterotopic ossification (HO) is a well-known complication of moderate and severe burn injuries. The development and progression of HO in burn patients are poorly understood phenomena at this time. Numerous measures aimed at preventing or minimizing HO have been described, but no definitive prophylactic modality has been found. Biphosphonate compounds are known to inhibit calcification, but previous studies are equivocal regarding their effectiveness in preventing HO in burn patients. We retrospectively reviewed the effect of etidronate disodium (EDHP), a bisphosphonate, on the development of HO in severely burned patients. We found that not only was EDHP ineffective in preventing HO, the group of patients treated with EDHP demonstrated an increased incidence of HO over that seen in a comparison group. This was true after controlling for age, sex, and %TBSA burned. Based on the results of this study, the routine use of etidronate disodium to prevent HO in burn patients cannot be recommended.     

1,25二羟维生素D3与5-氟尿嘧啶对乳腺癌细胞生长及凋亡的影响

目的研究1，25二羟维生素D3[1，25(OH)2D3]与5-氟尿嘧啶(5-Fu)对人乳腺癌细胞株MCF-7生长及凋亡的影响。方法采用噻唑蓝(MTT)比色法分析细胞生长抑制作用，流式细胞术测定细胞周期和凋亡率，免疫组织化学法检测bcl-2蛋白表达。结果1，25(OH)2D3与5-Fu均可抑制MCF-7细胞生长、1，25(OH)2D3阻滞细胞周期于G0／G1期，5-Fu阻滞细胞周期于S期，并可诱导细胞凋亡；当两药联合应用时，上述作用得到显著加强，凋亡率明显上升。两药均可下调bcl-2蛋白表达，当两药联合应用时，bcl-2蛋白几乎不表达。结论1，25(OH)2D3与5-Fu联合应用对乳腺癌细胞具有协同抑制生长和诱导凋亡作用。     

帕米膦酸二钠对人骨髓间充质干细胞增殖和成骨分化的影响

目的观察帕米膦酸二钠对人骨髓间充质干细胞(Mesenchymal stem cells,MSC)生物学特性的影响,以探索双磷酸盐导致骨组织损伤的机制。方法人骨髓MSC培养体系中加入不同浓度的帕米膦酸二钠,培养72 h后,MTT法测定490 nm光密度值,观察细胞增殖情况;培养1周后,流式细胞技术检测细胞表面分子表达。体外诱导MSC成骨分化,体系中加入1μg/mL帕米膦酸二钠,1周后PCR法测定细胞Runx-2表达水平,2周后组织化学法测定细胞内碱性磷酸酶活性,以细胞总蛋白量为参照,观察MSC成骨分化的差异。结果 MTT结果显示,在0.1~10μg/mL浓度范围内,帕米膦酸二钠抑制人骨髓MSC增殖,作用呈浓度依赖性,最低作用浓度为1μg/mL,72 h OD490显著低于对照组(P<0.01)。流式细胞检测显示,帕米膦酸二钠处理后,细胞仍均一表达CD44和CD73,不表达CD31和CD45。PCR及细胞化学结果显示,帕米膦酸二钠无促进MSC成骨分化作用,也未提高成骨诱导体系促分化效果。结论帕米膦酸二钠可抑制MSC增殖,不促进其体外成骨能力,可能是长期使用双磷酸盐导致骨损伤的机制之一。     

GDF-5在小鼠肢体骨骼发育中的表达及对肢芽细胞影响的研究

目的 :初步观察并探讨生长分化因子 5 (GDF 5 )在小鼠肢体发育过程中的表达及对肢芽细胞软骨分化的影响。方法 :RT PCR法检测小鼠肢体发育过程中GDF 5表达的变化情况 ;MTT法测定不同浓度GDF 5对体外微团培养肢芽细胞增殖率的影响 ;Alcian染色在倒置相差显微镜下观察不同浓度GDF 5对肢芽细胞软骨分化的影响 ,探讨GDF 5影响骨骼系统发育的机理。结果 :RT PCR结果提示GDF 5在胚胎发育的第 12、 13d高表达 ,骨骼系统基本形成之后在孕 14、 15d表达渐下降稳定于一较低水平 ;不同浓度GDF 5对肢芽细胞增殖率影响不同 ,5 0ng/ml浓度组促肢芽细胞增殖作用最强 ;Alcian染色结果显示GDF 5促进肢芽细胞软骨分化的作用呈剂量依赖效应 ,以12 0ng/ml组软骨分化最快 ,软骨结节体积最大 ,10 0ng/ml组软骨结节的数量最多。结论 :GDF 5在肢体发育的不同阶段表达水平不同 ,在骨骼系统形成早期及关节系统形成阶段表达最强 ,主要通过影响肢芽细胞增殖及软骨分化而发挥作用。     

5-Aza-CdR调控胃癌细胞系RASSF1A基因表达及对细胞生长的抑制作用

目的观察去甲基化制剂5-Aza-CdR对体外培养的胃癌细胞SGC7901RASSF1A基因的去甲基化和表达调控及生长抑制作用。方法5-Aza-CdR处理SGC7901细胞后,应用MTT法、流式细胞术、AnnexinV．FITC染色法检测细胞增殖活性、细胞周期分布及细胞凋亡率;应用MSP、RT-PCR及Westem印迹法检测RASSF1A基因的甲基化状态、mRNA及蛋白表达。结果5-Aza-CdR处理后,胃癌细胞SGC7901生长受到抑制（P〈0．05）,细胞周期呈现G1期阻滞,细胞凋亡率显著增加（P〈0．05）。RASSF1A基因在SGC7901中呈异常甲基化状态,在mRNA及蛋白水平表达阴性：5-Aza-CdR处理后RASSF1A基因呈去甲基化状态,在mRNA及蛋白水平重新表达。结论去甲基化制剂5-Aza-CdR调控胃癌细胞SGC7901RASSF1A基因去甲基化及重新表达．对SGC7901细胞具有生长抑制作用。     

Comparison of Extraosseous Talotarsal Stabilization Implants in a Stage II Adult-Acquired Flatfoot Model: A Finite Element Analysis

Subtalar arthroereisis has been proved to be an efficient method for correcting flexible adult flatfoot. However, the optimal sinus tarsi implant is still debated and yet to be determined. In the present study, we compared the biomechanical effects of type I and II sinus tarsi implants in stage II adult-acquired flatfoot deformity (AAFD). First, a finite element model of stage II AAFD was established in which virtual surgery of subtalar arthroereisis was simulated. The indexes of plantar stress distribution, peak von Mises of the medial and lateral columns, strain of the medial ligaments and plantar fascia, arch height, talo-first metatarsal angle, calcaneus pitch angle, talonavicular coverage angle, and hindfoot valgus angle were all compared and analyzed. The results of the present study have validated the stage II AAFD finite element model by comparing the simulation results with the same parameters measured from weightbearing radiographs in the midstance phase. All the indexes showed that both types of arthroereisis can lower the plantar pressure and the strain of the medial ligaments that support the medial longitudinal arch and can shift the load of the medial column to the lateral column. They can also help to correct the deformity and restore the arch. However, the type II sinus tarsi implant design exhibited a more obvious effect than that of type I.     

Are Damage Modes Related to Microstructure and Material Loss in Severely Damaged CoCrMo Femoral Heads?

BackgroundFretting and corrosion in metal-on-polyethylene total hip arthoplasty (THA) modular junctions can cause adverse tissue reactions that are responsible for 2% to 5% of revision surgeries. Damage within cobalt-chromium-molybdenum (CoCrMo) alloy femoral heads can progress chemically and mechanically, leading to damage modes such as column damage, imprinting, and uniform fretting damage. At present, it is unclear which of these damage modes are most detrimental and how they may be linked to implant alloy metallurgy. The alloy microstructure exhibits microstructural features such as grain boundaries, hard phases, and segregation bands, which may enable different damage modes, higher material loss, and the potential risk of adverse local tissue reactions.Questions/purposesIn this study, we asked: (1) How prevalent is chemically dominated column damage compared with mechanically dominated damage modes in severely damaged metal-on-polyethylene THA femoral heads made from wrought CoCrMo alloy? (2) Is material loss greater in femoral heads that underwent column damage? (3) Do material loss and the presence of column damage depend on alloy microstructure as characterized by grain size, hard phase content, and/or banding?MethodsSurgically retrieved wrought CoCrMo modular femoral heads removed between June 2004 and June 2019 were scored using a modified version of the Goldberg visually based scoring system. Of the total 1002 heads retrieved over this period, 19% (190 of 1002) were identified as severely damaged, exhibiting large areas of fretting scars, black debris, pits, and/or etch marks. Of these, 43% (81 of 190) were excluded for metal-on-metal articulations, alternate designs (such as bipolar, dual-mobility, hemiarthroplasty, metal adaptor sleeves), or previous sectioning of the implant for past studies. One sample was excluded retroactively as metallurgical analysis revealed that it was made of cast alloy, yielding a total of 108 for further analysis. Information on patient age (57 ± 11 years) and sex (56% [61 of 108] were males), reason for removal, implant time in situ (99 ± 78 months), implant manufacturer, head size, and the CoCrMo or titanium-based stem alloy pairing were collected. Damage modes and volumetric material loss within the head tapers were identified using an optical coordinate measuring machine. Samples were categorized by damage mode groups by column damage, imprinting, a combination of column damage and imprinting, or uniform fretting. Metallurgical samples were processed to identify microstructural characteristics of grain size, hard phase content, and banding. Nonparametric Mann-Whitney U and Kruskal-Wallis statistical tests were used to examine volumetric material loss compared with damage mode and microstructural features, and linear regression was performed to correlate patient- and manufacturer-specific factors with volumetric material loss.ResultsChemically driven column damage was seen in 48% (52 of 108) of femoral heads, with 34% (37 of 108) exhibiting a combination of column damage and imprinting, 12% (13 of 108) of heads displaying column damage and uniform fretting, and 2% (2 of 108) exhibiting such widespread column damage that potentially underlying mechanical damage modes could not be verified. Implants with column damage showed greater material loss than those with mechanically driven damage alone, with median (range) values of 1.2 mm³ (0.2 to 11.7) versus 0.6 mm³ (0 to 20.7; p = 0.03). Median (range) volume loss across all femoral heads was 0.9 mm³ (0 to 20.7). Time in situ, contact area, patient age, sex, head size, manufacturer, and stem alloy type were not associated with volumetric material loss. Banding of the alloy microstructure, with a median (range) material loss of 1.1 mm³ (0 to 20.7), was associated with five times higher material loss compared with those with a homogeneous microstructure, which had a volume loss of 0.2 mm³ (0 to 4.1; p = 0.02). Hard phase content and grain size showed no correlation with material loss.ConclusionChemically dominated column damage was a clear indicator of greater volume loss in this study sample of 108 severely damaged heads. Volumetric material loss strongly depended on banding (microstructural segregations) within the alloy. Banding of the wrought CoCrMo microstructure should be avoided during the manufacturing process to reduce volumetric material loss and the release of corrosion products to the periprosthetic tissue.Clinical RelevanceApproximately 30% of THAs rely on wrought CoCrMo femoral heads. Most femoral heads in this study exhibited a banded microstructure that was associated with larger material loss and the occurrence of chemically dominated column damage. This study suggests that elimination of banding from the alloy could substantially reduce the release of implant debris in vivo, which could potentially also reduce the risk of adverse local tissue reactions to implant debris.