不同的内固定方式对骨折愈合影响的研究

生物力学是影响骨折愈合的重要因素之一,随着生物力学学科的发展,生物力学因素对骨折的影响越来越受到临床关注。探讨内固定相关的AO（国际内固定研究学会依据骨折治疗的基础和临床研究,形成骨折内固定治疗的基本理念和理论体系）、BO（骨折稳固和软组织完整之间的平衡治疗理念）、CO（中西结合、骨折治疗与功能恢复并重理念）、EO（弹性接骨术,elastic osteosynthesis）理念。AO原则是骨折解剖复位,坚强内固定;BO注重功能复位达到二期愈合,注重保护骨骼的血运,强调骨折愈合的基础;CO坚持中西结合理念;EO强调骨折生长愈合的全程弹性固定。文章介绍了依据EO理念设计锁骨、股骨弹性带锁髓内钉,从生物力学方面提出骨折断端间断的适量的旋转、弯曲、剪式应力能够促进骨折的愈合这一观点,并分析了促进骨折愈合的生物力学原理,为临床骨折治疗供新思路。     

医疗器械物理学特性引发的生物学危害评价探讨

目的：阐述医疗器械物理学特性引发的生物学危害、对该危害的评价方法，并尝试建立系统性评价框架。方法：分析梳理国内外监管机构发布的监管文件、指南、指导性文件，以及相关领域的标准、文献等。结果与结论：当前对于医疗器械化学及生物性能引起的生物学危害的评价研究较多，对于医疗器械物理性能引发的生物学危害的评价研究较少，且医疗器械生物学评价系列标准对此要求讨论不多也不系统。本文概述了医疗器械物理学特性引发的生物学危害及其评价方式，希望能供相关机构及研发人员参考使用，并能在一定程度上推动相关标准的完善及评价体系的科学化。     

健康妊娠妇女不同孕期血清补体因子的变化及其参考区间的建立

目的 探讨健康妊娠妇女血清补体C1q、B因子、H因子以及C3、C4在不同孕期的变化，并建立其参考区间。方法 选择398例健康妊娠妇女，按照孕周将其分为孕早期、孕中期和孕晚期，并选取120例健康非妊娠妇女作为健康未孕组。采用免疫透射比浊法测定血清C3、C4、H因子、B因子、补体C1q的水平。比较各组之间补体因子的差异，依据美国临床和实验室标准化协会(CLSI)EP28-A3c要求，以非参数法建立不同孕期血清C1q等补体因子的95%参考区间。结果 血清补体C1q和C4水平在各孕期之间差异无统计学意义，妊娠期血清C1q的参考区间为135～254 mg/L,补体C4为131～387 mg/L。妊娠早期、中期及晚期其他补体因子参考区间：B因子分别为255～397 mg/L、294～493 mg/L、312～615 mg/L,H因子分别为228～433 mg/L、276～446 mg/L、299～466 mg/L,补体C3分别是889～1 557 mg/L、1 081～1 664 mg/L、1 139～1 822 mg/L。结论 相比健康非妊娠妇女，健康妊娠妇女的血清补体C1q水平无显著变化，而B...     

子痫前期预测模型的研究进展

摘要:子痫前期(PE)是妊娠期一种严重的并发症,全世界发病率为2%~4%,是导致不良妊娠结局与围产儿死亡的主要原因之一。研究表明,在妊娠16周前开始服用低剂量阿司匹林可显著降低早产PE的发生率。因此,在妊娠16周前对PE进行预 测有着非常重要的意义。迄今,已建立多种预测模型,纳入了包括母体因素、生物标志物、生物物理参数等多种指标。该文将聚焦孕早期预测模型进行总结归纳,以期为未来的研究指明方向。     

妊娠合并感染性心内膜炎1例

Infective endocarditis in pregnancy is extremely rare in clinical practice. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. Due to increased blood volume and hemodynamic changes in late pregnancy, endocardial neoplasms are easy to fall off and cause systemic or pulmonary embolism, respiratory, cardiac arrest and sudden death may occur in pregnant women, the fetus can suffer from intrauterine distress and stillbirth at any time, leading to adverse outcomes for pregnant women and fetuses. The disease is dangerous and difficult to treat, which seriously threatens the lives of mothers and babies. Early diagnosis and reasonable treatment can effectively improve the prognosis of patients. The most important method for the treatment of infective endocarditis requires early, adequate, long-term and combined antibiotic therapy. Moreover, surgical controversies regarding indication and timing of treatment exist, especially in pregnancy. In terms of the timing of termination of pregnancy, the timing of cardiac surgery, and the method of surgery, individualized programs must be adopted. A pregnant woman with 30⁺⁵ weeks of gestation is reported. She was admitted to hospital due to intermittent chest tightness, suffocation and fever, with grade Ⅲ cardiac insufficiency. Imaging revealed large mitral valve vegetation, 22.0 mm×4.1 mm and 22.0 mm×5.1 mm, respectively, and severe valve regurgitation. Mitral valve perforation was more likely, blood culture suggested Staphylococcus epidermidis infection, after antibiotic conservative treatment, the effect was poor. After the joint consultation including cardiology, neonatology, interventional vascular surgery, anesthesiology, and obstetrics, the combined operation of obstetrics and cardiac surgery was performed in time. The heart was blocked for 60 minutes, the bleeding was 1 200 mL, the newborn was mildly asphyxiated after birth, and the birth weight was 1 890 g. Nine days after the operation, the patient was discharged from the hospital, and the newborn was discharged with the weight of 2 020 g. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child. An optimal outcome in a challenging case like this greatly depends on effective interdisciplinary communication, informed consent of the patient, and concerted action among the specialists involved.     

外周血细胞因子白细胞介素-33在学龄前儿童反复喘息发作中的作用

目的 探讨外周血细胞因子白细胞介素-33(interleukin-33)在学龄前儿童反复喘息发作中的作用。方法 选择2018年2—7月于本院住院治疗的80例学龄前反复喘息患儿(喘息组)以及40名健康儿童(对照组)作为研究对象，采用流式细胞仪检测外周血CD4⁺CD25⁺CD127^lowTreg细胞百分比，采用ELISA法检测各组外周血血清IL-33、IL-17、IL-10、转化生长因子-β1(Transforming growth factor-β1)水平，并进行比较分析。结果 喘息组患儿外周血Treg细胞百分比及IL-10、TGF-β1水平较对照组均降低(P<0.05),IL-33及IL-17水平较对照组均升高(P<0.05);在喘息组中，血清IL-33水平与外周血调节性T细胞(T regulatory cells)比例及血清IL-10、TGF-β₁水平呈负相关(r=-0.2721,r=-0.2586,r=-2898,P<0.05),与IL-17水平呈正相关(r=0.3779,P&...