全关节镜下微创复位固定术治疗SandersⅡ、Ⅲ型跟骨关节内骨折的疗效分析

目的 探讨全关节镜下微创复位固定术治疗SandersⅡ、Ⅲ型跟骨关节内骨折的临床疗效。方法 前瞻性随机对照研究。纳入2017年3月—2020年12月徐州仁慈医院足踝外科Sanders Ⅱ、Ⅲ型跟骨骨折患者40例,其中男36例、女4例,年龄18~58（39.6±10.8）岁,左侧22例、右侧18例,Sanders Ⅱ型16例、Ⅲ型24例。40例患者数字表法随机分为关节镜组（采用关节镜下跟骨关节内骨折微创复位、经皮螺钉固定术治疗）、大“L”形切口组（采用传统的大“L”形切口跟骨骨折复位钢板内固定术治疗）,每组20例。观察指标：（1）比较2组患者性别、年龄、体质量指数（BMI）、骨折类型、术前美国足踝外科学协会（AOFAS）踝-后足功能评分等基线资料差异;（2）比较2组患者手术切口长度、手术时间、术中出血量、住院时间、术后切口愈合情况等围术期资料差异;（3）术后观察局部有无麻木感、是否钢板外露、切口皮肤坏死、术后1年是否有创伤性关节炎等手术并发症情况;（4）对比分析2组患者末次随访时AOFAS踝-后足功能评分、Gissnae角和Bohler角。结果 （1）2组患者性别、年龄、BMI、骨折类型、术前AOFAS踝-后足功能评分等基线资料比较,差异均无统计学意义（P值均>0.05）。（2）关节镜组患者的切口长度（0.94±0.08）cm、术中出血量（7.20±1.98）mL、手术时间（41.45±9.96）min、住院时间（8.45±2.01）d,大“L”形切口组患者的切口长度（14.35±1.63）cm、术中出血量（27.35±10.35）mL、手术时间（90.65±12.08）min、住院时间（17.15±6.72）d,关节镜组优于大“L”形切口组,差异均有统计学意义（t=-36.70、-8.54、-14.04、-5.54,P值均<0.001）。（3）术后平均随访12.3个月。术后关节镜组切口均甲级愈合,无创伤性关节炎、足背皮肤麻木。大“L”形切口组20例中,18例患者切口甲级愈合,2例患者切口皮缘坏死、钢板外露,予腓肠神经营养逆行岛状皮瓣修复后伤口愈合;有4例患者术后感足背外侧麻木,经治疗分别于术后8~14个月痊愈。（4）末次随访时AOFAS踝-后足功能评分关节镜组为（92.10±3.16）分、大“L”形切口组为（91.3±2.45）分,术后2组患者跟骨的Gissnae角和Bohler角均在正常范围内,组间比较差异均无统计学意义（P值均>0.05）。结论 与传统的切开复位内固定术相比较,全关节镜下微创手术治疗Sanders Ⅱ、Ⅲ型跟骨关节内骨折,具有手术切口小、手术时间短、内固定牢固、切口愈合好、疗程短、术后瘢痕不明显、功能恢复快等优势。     

Regulation of Toll-like receptor-mediated inflammatory response by microRNA-152-3p-mediated demethylation of MyD88 in systemic lupus erythematosus

Objective

microRNAs (miRNAs) play critical roles in embryogenesis, cell differentiation and the pathogenesis of several human diseases, including systemic lupus erythematosus (SLE). Toll-like receptors (TLRs) are also known to exert crucial functions in the immune response activation occurring in the pathogenesis of autoimmune diseases like SLE. Herein, the current study aimed to explore the potential role of miR-152-3p in TLR-mediated inflammatory response in SLE.

Methods

We determined the miR-152-3p expression profiles in CD4⁺ T cells and peripheral blood mononuclear cells (PBMCs) harvested from patients with SLE and healthy controls, and analyzed the correlation between miR-152-3p expression and clinicopathological parameters. CD70 and CD40L expression patterns in CD4⁺ T cells were assessed by RT-qPCR and flow cytometry. ChIP was adopted to determine the enrichment of DNA methyltransferase 1 (DNMT1) in the promoter region of myeloid differentiation factor 88 (MyD88).

Results

The obtained findings revealed that miR-152-3p was highly-expressed in CD4⁺ T cells and PBMCs of patients with SLE, and this high expression was associated with facial erythema, joint pain, double-stranded DNA, and IgG antibody. DNMT1 could be enriched in the MyD88 promoter, and miR-152-3p inhibited the methylation of MyD88 by targeting DNMT1. We also found that silencing miR-152-3p inhibited MyD88 expression not only to repress the autoreactivity of CD4⁺ T cells and but also to restrain their cellular inflammation, which were also validated in vivo.

Conclusion

Our study suggests that miR-152-3p promotes TLR-mediated inflammatory response in CD4⁺ T cells by regulating the DNMT1/MyD88 signaling pathway, which highlights novel anti-inflammatory target for SLE treatment.

     

p15蛋白在低分化鼻咽癌中的表达

目的:探讨p15蛋白在低分化鼻咽癌(NPC)的发生发展过程中的作用。方法:用免疫组化技术检测低分化NPC组织中p15蛋白的表达。结果:p15蛋白在鼻咽部正常组织和低分化NPC中表达阳性率分别为100％,70.91％,两组间差异有显著性意义(P<0.05)。低分化NPC中p15蛋白表达阳性率与局部浸润程度、临床分期有关(P<0.05),与有无颈淋巴结转移和5年生存率无关(P>0.05)。结论:p15蛋白丢失在低分化NPC发生发展过程中有重要意义,p15蛋白表达可能与低分化NPC的预后无关。     

从原创思维看中医学的传承与发展

中医药之所以能够长期存在并经久不衰,在于其防治疾病的有效性。中医的的理论思维都源于中国古代哲学思维,当时占统治地位的哲学思想如精气学说、阴阳学说和五行学说都很好地融入中医的原创思维中。中医药工作者应在继承优良经验的基础上,运用现代科学技术诠释之,从而达到新的认识,创建出新的理论为现代临床服务,这样也许对中医能有科学性的认识,从而使得中医踏上可持续的发展之路。     

医患沟通的叙事转向与医学生医学叙事能力的培养

生物－心理－社会医学模式下有效的医疗实务需要医生具备叙事和沟通能力。叙事逐步应用于医学实践和研究,促成了叙事研究方法与医学的结合。“叙事医学”推动了医患沟通研究的叙事转向,也为医学人文教育提供了新的视角。在医患沟通过程中,医生叙事能力的合理运用,有助于实现医患之间的有效沟通,构建和谐医患关系。在医学教育中,应通过课堂教学和临床见习带教两种途径相结合的教学策略培养和提高医学生的医学叙事能力。     

血清Cystatin C对早期肾小球滤过功能受损的诊断价值

目的　评价CystatinC在反映早期肾小球滤过功能受损时的价值。方法　对 65例确诊有肾小球疾病患者同时测定血清CystatinC、β2 微球蛋白、BUN、Scr共 115例次 ,对其升高程度构成、浓度相关性、相对敏感性进行分析。结果　CystatinC浓度与BUN、Scr升高程度构成比较差异非常显著 (P <0 .0 1) ;CystatinC与 β2 微球蛋白、BUN、Scr浓度是正相关 (r 分别为 0 .90 7、0 .612、0 .419) ,并有显著意义 (P <0 .0 1) ,与CystatinC比较 ,β2 微球蛋白、BUN、Scr的相对敏感性分别为 95 %、43 %、3 1%。结论　血清CystatinC浓度可反映肾小球滤过功能受损的程度 ,可作为诊断早期肾小球滤过功能受损的敏感指标     

论中医的核心内容——和

中医在辨证用药运用发散的思维方式,同时大道至简地可用＂和＂这一字概况,认为以＂和＂的理念灵活运用临床实践和基础理论研究中,能获得较好的临床疗效和学术见地。     

Topically administered Risedronate shows powerful anti-osteoporosis effect in ovariectomized mouse model

We investigated the therapeutic effect of topical Risedronate (RIS) on a mouse model of estrogen-deficient osteoporosis. Fourteen-week-old female mice were ovariectomized and assigned to 4 groups: SHAM-operated (SHAM), OVX mice treated with vehicle (OVX-V), OVX mice treated with 0.2% RIS (OVX-0.2% RIS), and OVX-mice treated with 0.02% RIS (OVX-0.02% RIS). Topical samples containing RIS were prepared in 10% (w/w) polyethylene glycol (PEG, MW 400) and 80 μg of sample was spread on the mice's mid-backs every 3 days for 5 weeks. Micro-CT analysis of femora demonstrated that OVX-0.2% RIS exhibited a 29% greater bone mineral density and 24% greater bone volume fraction than that of OVX-V group. Investigation of the trabecular bone in OVX-0.2% RIS revealed a 24% higher bone volume (BV/TV), 51% higher trabecular number (Tb.N), and 40% lower trabecular separation (Tb.Sp) compared to OVX-V mice. Additionally, bone phenotypes of tibiae were further confirmed by histological analysis. OVX-0.2% RIS group exhibited a 494% greater BV/TV, 464% less Tb.Sp, 81% greater active osteoclast surface (Oc.S/BS) and 26% less osteoclast number (N.Oc/BS) than that of OVX-V group. Collectively, these results indicated that topical delivery of RIS has powerful pharmaceutical effects on the prevention of osteoporosis and bone turnover.