不同结构松质骨填充植入股骨头负重区缺损的有限元分析

目的:应用三维有限元分析法比较松质骨粒和结构性松质骨块植骨重建股骨头负重区缺损对股骨近段应力分布的影响。方法:实验于2005-06/2006-03在解放军总医院骨科研究所完成。采用Taddei的基于连续CT断层构建的人股骨三维有限元模型,在ANSYS5.7分析软件中划分52350个四面体单元,模拟单腿站立时髋臼在股骨头表面负重区施加的面载荷,合力指向股骨头形心,与股骨干长轴的夹角成25°,大小2100N,分别在正常状态时、股骨头负重区缺损时及原位松质骨植入、异位松质骨植入和松质骨粒植入时计算股骨近段的应力分布。结果:①正常股骨近段的应力峰值集中在股骨颈上下方,股骨头表面的应力峰值为2.12MPa,深部应力高于表面应力峰值为6.37MPa。②负重区缺损模型下,股骨头表面应力增高,峰值达10.39MPa,股骨头内部应力低于表面。③在松质骨粒植入后,表面应力有所下降,但仍然高于内部,应力峰值达8.55MPa。④异位结构性松质骨植入后表面应力峰值为2.43MPa,与正常时差别不大;而原位松质骨块植入后的应力曲线几乎与正常应力曲线重合。结论:结构性松质骨块的植入对恢复股骨头表面及内部的应力水平要优于松质骨粒。     

补肾方药归经与实验性骨质疏松靶器官信号转导分子Smad4的表达

目的:观察补肾方药归经与实验性骨质疏松靶器官信号转导分子Smad4的基因表达,从基因水平研究中医归经理论,为靶向给药提供依据。方法:实验于2004-06/2007-05在河北医科大学中西医结合基础实验室完成。①实验分组:选择3月龄健康雌性SD大鼠(未曾交配)70只,体质量(300±20)g。常规喂养1周后,随机数字表法分成7组:正常对照组、病理模型组、补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组、非经非穴位外贴组,每组10只。②实验处理:除正常对照组喂正常饲料,自由饮水外,其余各组均喂食低钙饲料,饮用蒸馏水,每周2次在大鼠大腿内侧肌肉注射地塞米松1mg/kg体质量,5周后建立骨质疏松模型。造模后,补肾方药口服组将补肾方药总成分按8g/kg体质量灌喂给药;依普拉封口服组按10mg/kg体质量灌喂给药;正常对照组、模型组每天灌胃等体积的生理盐水,每天上午给药;膀胱经外贴组大鼠在膀胱经取肾俞、飞扬穴;肾经外贴组大鼠在肾经选太溪、大钟穴;非经非穴位外贴组大鼠在大腿内侧肌肉丰厚处选非经非穴位;于脱毛区贴上相应的膏剂,左右交替进行,1次/d。③实验评估:检测连续给药16周后的血清钙、磷、碱性磷酸酶、雌二醇、睾酮,以双能X线骨密度仪检测腰椎骨密度,采用反转录-聚合酶链反应、蛋白免疫印迹杂交方法分别检测Smad4的mRNA、蛋白表达。结果:70只大鼠均进入结果分析。①血清碱性磷酸酶、雌二醇、睾酮、骨密度:给药16周后,与病理模型组比较,补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组的血清碱性磷酸酶、雌二醇、睾酮、骨密度明显增加(P均<0.01)。②Smad4mRNA和Smad4蛋白的表达:应用补肾中药防治16周后,与病理模型组比较,补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组Smad4mRNA的表达明显上调(P<0.01);Smad4蛋白表达亦明显增强,差异有显著性(P<0.01)。结论:①补肾方药通过口服和外贴穴位两种不同途径给药均发挥"归经"作用,使靶器官骨组织上调Smad4的表达而有效改善骨密度。②Smad4mRNA表达及蛋白水平的下调可能是原发性骨质疏松症发生的重要机制之一。     

High platelet count associated with venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)

Summary.  Background:  In cancer patients, laboratory parameters that predict venous thromboembolism (VTE) are scarce. Increased platelet count has been found to be a risk factor for VTE in cancer patients receiving chemotherapy (CHT). We have assessed high platelet count as a risk predictor for VTE in patients with cancer undergoing discriminative anti-cancer treatments and investigated whether platelet count correlates with thrombopoietin (TPO) levels. Design and methods:  The Cancer and Thrombosis Study (CATS) is an ongoing prospective observational study of patients with newly diagnosed cancer or progression of disease, which started in October 2003. Occurrence of VTE and information on the patients' anti-cancer treatment during follow-up were recorded. Results: Between October 2003 and February 2008, 665 patients with solid tumors were included (314 female/351 male, mean age 62 years). VTE occurred in 44 patients (18 female/26 male, mean age 62 years). The cumulative probability of VTE after 1 year was 34.3% in patients with a platelet count (PC) above the 95th percentile representing 443 × 10⁹/L compared with 5.9% in those below 443 × 10⁹/L. High platelet count [hazard ratio (HR): 3.50, 95% confidence interval (CI): 1.52–8.06, P  = 0.0032], soluble P-selectin [HR: 2.66, 95% CI: 1.42–4.96, P  = 0.0021] and surgery [HR: 4.05, 95% CI: 1.74–9.46, P  = 0.0012] were statistically significant risk factors for VTE in multivariable analysis along with leucocyte count, age, gender, radio- and CHT. We found no correlation between platelet count and TPO levels. Conclusions:  High PC is a clinically important, independent risk predictor for VTE in cancer patients. PC was not found to be associated with TPO levels.     

Dangers of injections overuse in developing countries with a high HIV/AIDS prevalence: a review on HIV risk hazards,traumatic effects and other blood borne infections

Use of injections is commonly practiced in both developed and developing countries. However, in developing countries like Tanzania, both public and private health care providers prescribe and administer injections to clients/patients. The private sector in developing countries is on the leading side for several reasons and becomes the main one being economic or financial gains through charging patients who demand or request or need an injection. Injections in Tanzania are believed by clients/patients or consumers to work fast or better or more effective than oral medications/tablets. This belief is based on the pharmacological advantage of the pharmacokinetics and pharmacodynamics of injectables versus oral medications/tablets. Despite the curative advantage injections have in a human body, these injections must be administered by qualified personnel in our health facilities applying both aseptic and sterile techniques in order to minimize/prevent trauma which may lead to paralysis after damaging sciatic nerve to gluteal muscle, nerve to deltoid muscle, continuous bleeding in individuals with bleeding disorders such as haemophilia, or thrombocytopenia, and spread of infections such as HIV, hepatitis B, C, poliomyelitis, osteomyelitis and other abscesses. Thus, there is a need to institute educational interventions targeting all the three levels i.e. health care providers (clinicians and nurses) in public and private facilities, clients/patients or consumers of care who attend in these facilities and not forgetting injection drug users and traditional healers/practitioners from the informal health sector in our society.     

Intermediate and high peri-operative cardiac enzyme release following isolated coronary artery bypass surgery are independently associated with higher one-year mortality

Background  

The relationship between cardiac enzyme (CE) release following coronary artery bypass surgery (CABG) and medium term outcome is unclear. We sought to determine the relationship between post-operative CE release and one-year survival following isolated CABG.     

钙结合蛋白D28k在小鼠肾脏发育中的表达

目的:观察钙结合蛋白D28k在小鼠肾脏发育中表达规律及定位,探讨钙结合蛋白D28k在小鼠肾脏发育中的作用。方法:实验于2006-03/09在辽宁医学院组织胚胎学实验室完成。选取25～30g健康成年昆明小白鼠,采用检查阴道栓脱落的方法确定其受孕后,选取胚龄10,12,14,16,18d的胎鼠和生后日龄1,3,7,14,21,40d的仔鼠,每组取8只鼠。将各胚(日)龄小鼠剖腹取出肾脏,应用免疫荧光技术对各组小鼠肾脏钙结合蛋白D28k表达进行定性观察;应用蛋白印迹技术(Western blotting)对不同发育阶段的小鼠远端肾单位钙结合蛋白D28k的表达进行定量的测定。结果:①免疫荧光结果:钙结合蛋白D28k在胚龄10d胎鼠肾脏未见表达,胚龄12d在输尿管芽微量表达,胚龄14d在输尿管芽Y型分支表达,表达量增加,胚龄16d在输尿管芽壶腹表达强烈,且在肾单位与输尿管芽壶腹连接部有少量表达。胚龄18d到生后7d,钙结合蛋白D28k表达量逐渐增加,并定位于远曲小管、连接小管、皮质集合管。生后7d到生后40d,钙结合蛋白D28k在远曲小管、连接小管、皮质集合管表达丰富,在髓质集合管表达下降。钙结合蛋白D28k表达部位在输尿管芽或远曲小管、连接小管、皮质集合管上皮细胞胞浆内。②Western blotting检测结果:胚龄12d钙结合蛋白D28k表达量极低,无法检测。胚龄14d到胚龄16d,钙结合蛋白D28k表达量增加[(12.0994±0.6911),(13.2383±0.1729),P<0.01]。胚龄16d与胚龄18d钙结合蛋白D28k表达量无显著性差异。胚龄18d到生后7d钙结合蛋白D28k表达量明显增加[(13.8447±0.2385),(15.2718±0.2019),(16.3208±0.2839),(19.3383±0.4044),P<0.01]。生后7d到生后14d,钙结合蛋白D28k表达量减弱,差异有显著性意义[(19.3383±0.4044),(15.8915±1.0185),P<0.01]。生后14d到生后40d钙结合蛋白D28k表达量差异无显著性。结论:在小鼠肾脏发育中,钙结合蛋白D28k在胚龄12d胎鼠肾脏输尿管芽微弱表达,随胚(日)龄增加其表达逐渐增加,生后7d达最大水平,并定位于远曲小管、连接小管和皮质集合管。此后表达减弱并趋于平稳。钙结合蛋白D28k表达部位在输尿管芽或远曲小管、连接小管、皮质集合管上皮细胞胞浆内。     

Lack of association between leptin G2548A gene polymorphism and Behçet''s disease

Background Behçet's disease is a chronic, multisystem, inflammatory disease characterized by the predominance of T‐helper 1 cytokines. The disease is also characterized by infiltration of lymphocytes and neutrophils into the affected tissues. Because cytokines are involved in the regulation of lymphocyte and phagocyte functions, they may play an important role in the pathogenesis of Behçet's disease. Leptin, a member of the gp 130 family of cytokines, induces a strong T‐helper 1 response and is regarded as a proinflammatory inducer. Recent studies have shown that serum leptin concentration was increased in patients with Behçet's disease and correlated with disease activity. Objectives We aimed to investigate the role of G2548A polymorphism of leptin gene in patients with Behçet's disease and compare the results with healthy controls. Patients and methods A total of 93 subjects with Behçet's disease and 125 healthy controls were included in this study. Analyses of G‐2548A polymorphism of the LEP gene were performed using the PCR‐restriction fragment length polymorphism technique. The genotypes (GG, GA, and AA of leptin G2548A) and alleles (G and A of leptin 2548) were scored and the frequency was estimated. The frequencies of the alleles and genotypes in patients and controls were compared. We analysed the correlation between leptin gene polymorphism and the clinical features of BD. Results Both genotype and allele frequencies were not significantly different between controls and Behçet's disease patients [OR = 0.67, 95% CI (0.35–1.29), P = 0.197 and OR = 0.77, 95% CI (0.52–1.15), P = 0.184]. We did not find any significant relationship between leptin gene polymorphism and the clinical features of BD (P > 0.05). Conclusion In the present case‐control study, we found no evidence of an association between the G‐2548A variant of the leptin gene and BD among Turks. Further studies are needed to investigate serum leptin level to explain the mechanisms behind the lack of association between leptin G2548A gene polymorphism and BD.     

静脉留置针输液中静脉炎7例的处理

0　引言　封闭式静脉留置套管针进行静脉输液的广泛应用,对改善患者生活质量,提高医护人员工作效率发挥了重要作用.我科1998年开始普及使用,但同时存在一些不足之处,在长期使用中,我们发现一些患者出现了局部渗漏、红、肿、痛等情况,现就96例套管针使用者,7例患者不同程度地出现静脉炎后的护理观察、处理体会报告如下.1　临床资料　本组96(男40,女56)例患者,年龄1～67岁,应用套管针时间1～5d,7例不同程度出现局部红、肿、热、痛现象.1例应用可达龙24h内出现机械性静脉炎,2例48h出现化学性静脉炎,2例同时应用多巴胺、多巴酚丁胺3～6μg.收稿…     

高效液相法测定排毒养颜胶囊中大黄素的含量

目的：建立排毒养颜胶囊中大黄素含量测定方法。方法：用高效液相法测定,选定YWG－C18分析柱（4．6mm*250mm,5um),流动相：甲醇－0．25％磷酸（80：20）,检测波长：436nm,流速：1．1ml/min,柱温：室温。结果：本法简便,灵敏,准确,生理性好,线性范围0．36－1．80ug(r=0.9999),平均回收率99．14％,RSD．0．81％,结论：建立的定量可用于排毒养颜胶囊的质量控制标准。