Metatarsal fracture management

Metatarsal fractures represent a significant proportion of all foot injuries. Patients present with pain and difficulty with ambulation either after a traumatic insult or an increase in activity level. Diagnosis requires a foot X-ray series and tarsometatarsal injuries may need to be excluded with a CT. Management is determined by patient factors and fracture pattern. The aim of treatment is to preserve the longitudinal and transverse arches of the forefoot and restore the alignment of the metatarsals to achieve normal weight distribution. Open fractures, fractures with sagittal plane displacement more than 10° or with 3–4 mm displacement in any other plane may benefit from surgical intervention. The majority are minimally displaced and can be treated with a walking boot or hard-soled shoe with arch support or non-weight bearing in a short leg cast for 6–8 weeks. Any suggestion of instability or displacement for the first metatatarsal will require surgical treatment. Proximal fifth metatarsal fractures have differing treatments depending on the location of the fracture.     

转基因小鼠胰岛β细胞株胰岛素样生长因子1受体和胰岛素受体表达与小檗碱的干预效应

目的:观察小檗碱对转基因小鼠胰岛β细胞株胰岛素受体和胰岛素样生长因子1受体mRNA表达的影响。方法:实验于2005-09/2006-10在华中科技大学同济医学院附属同济医院中西医结合研究所完成。①实验材料:培养NIT-1细胞,在低糖(5.5mmol/L)和高糖(11.1mmol/L)环境下,分别加入0,1,3,10,30μmol/L的小檗碱和1μmol/L的格列苯脲,0μmol/L小檗碱组为空白对照组。②实验评估:培养24h后,采用四甲基偶氮唑盐法检测小檗碱NIT-1细胞增殖抑制作用;逆转录-聚合酶链反应测定NIT-1细胞胰岛素受体和胰岛素样生长因子1受体mRNA表达。结果:①四甲基偶氮唑盐法检测发现,不同浓度小檗碱(1～30μmol/L)与NIT-1细胞作用24h后,小檗碱组吸光度值比空白对照组低,随着小檗碱浓度的增加,吸光度值逐渐从0.356±0.061降低至0.162±0.014,而且在各组之间有显著性差异。②在低糖及高糖环境下,与空白对照组相比,小檗碱能促进NIT-1细胞胰岛素受体mRNA的表达(低糖环境:0.27±0.04,0.49±0.02;高糖环境:0.22±0.04,0.42±0.03;P<0.01),但仍低于格列苯脲组(低糖环境:0.75±0.22;高糖环境:0.78±0.01;P<0.01);而且随着小檗碱浓度的升高,NIT-1细胞胰岛素受体mRNA表达的增加更为明显,分别从0.49±0.02增高至0.68±0.44及从0.42±0.03增高至0.71±0.01。与空白对照组相比,小檗碱组胰岛素样生长因子1受体mRNA的表达无明显改变。结论:小檗碱促进胰岛素分泌,其作用机制可能与促进胰岛β细胞胰岛素受体mRNA表达有关。     

Low risk of viral infection after administration of vapor-heated factor VII concentrate or factor IX complex in first-time recipients of blood components. International Factor Safety Study Group

BACKGROUND: Vapor-heated human factor VII concentrate and human factor IX complex are both obtained from prothrombin complex, undergo similar methods of manufacture, and are subjected to an identical two-step vapor-heating process for virus inactivation. STUDY DESIGN AND METHODS: Intermediate-purity vapor-heated human factor VII concentrate and vapor- heated human factor IX complex were monitored for safety with regard to viral infection in the context of an International Factor Safety Study, a prospective study that follows the revised recommendations from the International Congress of Thrombosis and Hemostasis (ICTH). Because the rarity of the respective hereditary deficiencies would have made separate analyses unrealizable, the results were combined for the final analysis. Entry required that patients have no history of transfusion with any blood derivative. After the first infusion of the study drug, patients were monitored for 6 months for the development of non-A, non- B hepatitis (NANBH) and infection with hepatitis B virus (HBV) and for 15 months for infection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV). An event was defined as a positive result on any test for any infection. An alanine aminotransferase level more than 2.5 times the upper limit of normal on two consecutive occasions was defined as an event for NANBH. HBV infection was monitored with tests for three different HBV markers: the HBV surface antigen, antibody against the HBV surface antigen, and antibody against HBV core antigen. HCV and HIV infection were monitored with tests for HCV and HIV antibodies. RESULTS: The 25 patients who completed the study (1 has not completed the study and 1 dropped out) received a total of 434 infusions comprising 17 different production lots of the concentrates. Twenty patients were analyzable for NANBH and 25 for HCV and HIV infection. Since most patients had been given HBV vaccination, only 4 patients were analyzable for this end point. None of the patients showed evidence of having developed an event. These data satisfy ICTH criteria when the products are considered together, but vapor-heated factor VII concentrate does not qualify alone because there were only five patients in this group. CONCLUSION: Vapor-heated factor VII concentrate and vapor-heated factor IX complex are associated with a low risk of viral infection. Preliminary results are also presented, indicating that the concentrates are safe with regard to inhibitor development.     

Prevalence and horizontal propagation of gonococcal infections among Nigerian children

The prevalence and mode of spread of gonococcal infections was studied among prepubertal children in Nigeria. Of 16 children with symptoms suggestive of sexually transmissible diseases (STD), 9 (56%) had gonorrhoea, while no causative organism was found in 7. The majority (7; 78%) of the gonococcal isolates produced penicillinase. Three of the cases were by child-to-child transmission, with female peers as the initiators. Prepubertal children should no longer be ignored as propagators of STD.     

Paramyosin: a candidate vaccine antigen against Schistosoma japonicum

Paramyosin, a 97 kDa myofibrillar protein, is a candidate vaccine antigen for prevention of infection with the human parasite Schistosoma mansoni . To determine if paramyosin would also induce protection against Schistosoma japonicum , paramyosin was biochemically purified from S. japonicum adult worms. SDS-PAGE demonstrated a single protein with a molecular weight of 97 kDa. In four separate experiments, vaccination of mice with S. japonicum paramyosin without adjuvant induced significant resistance (62%–86%, P < 0.001) against cercarial challenge as compared to controls. These data suggest that S. japonicum paramyosin may represent a candidate vaccine for immunization against schistosomiasis japonica.