跟骨关节内骨折钛钢板内固定手术治疗临床分析

目的:探讨钛钢板内固定手术治疗跟骨关节内骨折的临床效果.方法:自2005年3月～2011年9月,采用切开复位钛钢板内固定治疗跟骨关节内骨折42例48足.其中Sander分型II型16足,III型19足,IV型13足.采用美国足踝外科学会(AOFAS)评分系统从疼痛、功能、力线三方面评价手术疗效.结果:33例35足获得随访,随访时间3～28个月,平均17个月.所有骨折均愈合,愈合时间为8～12周.术中术后患者均未发生神经、血管损伤或出现骨折移位或内固定失败等情况.术前AOFAS评分为(16.37±9.21)分,术后3个月和6个月分别为(74.51±5.46)分和(77.63±13.29)分.结论:切开复位钛钢板内固定治疗跟骨关节内骨折,复位满意,固定可靠,利于患者的功能恢复.钛钢板内固定是治疗跟骨关节内骨折的有效方法.     

RNA versus DNA (NucliSENS EasyQ HIV-1 v1.2 versus Amplicor HIV-1 DNA test v1.5) for early diagnosis of HIV-1 infection in infants in Senegal

The objective of this study was to compare the performance of the NucliSENS EasyQ HIV-1 v1.2 platform (bioMérieux, France) to the Amplicor HIV-1 DNA test v1.5 (Roche Molecular Systems, Switzerland) in detecting HIV-1 infection in infants using venipuncture-derived whole blood in tubes and dried blood spots. A total of 149 dried blood spots and 43 EDTA-anticoagulated peripheral blood samples were collected throughout Dakar and other areas in Senegal from infants and children aged 3 weeks to 24 months who were born to HIV-1-infected mothers. Samples were tested using the NucliSENS and Amplicor technologies. The NucliSENS and Amplicor results were 100% concordant using either EDTA-anticoagulated peripheral blood or dried blood spots. Compared to Amplicor, the sensitivity and specificity of the NucliSENS test were 100%. The NucliSENS EasyQ HIV-1 RNA assay performed as well as the Amplicor HIV-1 DNA test in detecting HIV-1 infection in infants. In addition, this platform can give an indication of the viral load baseline. The NucliSENS EasyQ platform is a good alternative for early infant diagnosis of HIV-1 infection.     

Age-related progression of tau pathology in brains of baboons

Recently, cytoskeletal changes associated with abnormally phosphorylated tau protein were demonstrated in neurons and glial cells of two aged baboons (Papio). The present study examines the effects of age on the development of tau pathology in baboons. Brains of 50 baboons ranging in age from 1 to 30 years were categorized into four age groups: Group I: 1–10 years [n = 9], group II: 11–20 years [n = 13], group III: 21–25 years [n = 17], group IV: 26–30 years [n = 11]). Whole hemisphere sections (100 μm) were examined using phosphorylation-dependent anti-tau antibodies. Cytoskeletal changes were completely absent in animals of group I. In group II four animals (31%) exhibited cytoskeletal changes which were rated as mild or moderate. In group III abnormal tau was found in 12 brains (71%) ranging in severity from mild to severe. Finally, in group IV 10 out of 11 animals (91%) exhibited some degree of tau pathology which was rated as severe in 4 animals (36%). A statistically significant relationship was found between advancing age and progression of tau pathology in baboons. In conclusion, the present findings underline the value of the baboon as a potential nonhuman primate model for age-related tau pathology afflicting the human brain.     

大鼠股骨缺损模型中BBP增强BMP-2的骨诱导作用*

目的验证在大鼠节段性骨缺损模型中骨形态发生蛋白结合肽（BMP Binding Peptide,BBP）对于重组人骨形态发生蛋白-2（recombinent human bone morphogenetic protein-2,rhBMP-2）骨诱导作用的影响。方法 70只缺损大鼠分别分成7组,每组不同剂量的rhBMP-2＋/-1000 gBBP,4w和8w后分别摄片,动物8w后处死,股骨样本分别手工评估,采用uCT测量骨容积,随后分别采用组织学和生物力学分析。结果高剂量（10 g）rhBMP-2组术后8w可见骨愈合,骨缺损处骨完全覆盖和桥接,但低剂量（5 g和2 g）rhBMP-2组术后8w骨愈合欠佳。与单独应用rhBMP-2相比,使用低剂量的rhBMP-2复合一定量的BBP可以取得更满意的骨形成量。BBP增强rhBMP-2的骨形成活性发生于4~8w时,而在术后早期并无明显作用。单纯应用BBP仅可见骨缺损处局部的钙化,未见骨愈合。结论 BBP能显著增强rhBMP-2的骨形成活性,这种增强作用需要一定时间来产生效果;其活性发生于术后4~8w时,在术后早期并无明显作用。而且BBP本身并没有骨诱导潜力,仅仅能增强rhBMP-2的骨形成活性。BBP起到缓释作用,与rhBMP-2紧密结合后,让rhBMP-2缓慢而持久的释放。     

重度阻塞性睡眠呼吸暂停患儿临床预测模型研究

目的　建立习惯性打鼾患儿中重度阻塞性睡眠呼吸暂停（OSA）的临床预测模型,为临床诊疗提供依据。方法　选择2019年1月至12月就诊于首都医科大学附属北京儿童医院睡眠中心的3～12岁习惯性打鼾患儿。所有患儿完成一般资料收集、OSA-18问卷、PSQ-SRBD量表及多导睡眠监测。应用决策树方法构建重度OSA患儿的临床预测模型。结果　共纳入受试患儿1441例,根据PSG结果,重度OSA 1152例,非重度OSA 289例。重度OSA组年龄、男性比例、体重指数（BMI）、颈围/身高比、腹围/臀围比、SRBD量表呼吸维度、其他维度及总分均高于非重度OSA组（P均<0.01）。OSA-18问卷各个维度得分及总分在两组患儿间比较,差异无统计学意义（P均>0.05）。基于决策树构建的重度OSA患儿预测模型,对非重度OSA患儿预测精确率为90%,召回率76%,F1得分82%,对重度OSA患儿的预测精确率32%,召回率58%,F1得分41%,整体准确率为73%。 结论　该研究构建的重度OSA患儿临床预测模型整体准确率73%,有一定的预测价值,能为临床排除重度OSA患儿提供一定的依据,指导临床决策,但仍需更多的临床资料进一步优化模型。     

全身型幼年特发性关节炎患儿合并巨噬细胞活化综合征早期预警量表建立的研究

目的　总结全身型幼年特发性关节炎（sJIA）合并巨噬细胞活化综合征（MAS）的早期临床特征、实验室及辅助检查特点,筛选对诊断MAS有预警作用的检测指标,并量化形成量表,以达到快速对疾病“早识别,早治疗,降低病死率”的目的。方法　回顾性分析2006年1月至2016年1月,北京儿童医院风湿免疫科收治sJIA合并MAS患儿的病例资料,在临床及辅助检查观测指标中筛选出对早期诊断MAS有评估意义的候选指标;通过ROC曲线的方法选择最佳的诊断界限值（Cut-off值）;采用多因素Logistic回归分析MAS独立危险因素,效果以优势比（OR）表示,计算95％置信区间;经过同行评议对上述因素进行权重分值量化并最终形成积分表。结果　390例sJIA患儿,其中141例合并MAS。临床表现全部患儿均有高热、肝脾和（或）淋巴结进行性增大、血液系统受累,中枢神经系统受累患儿19例。单因素Logistic回归及ROC曲线分析结果显示,MAS组和重症sJIA组比较,10个变量存在显著差异（P<0.05）。Logistic回归分析结果显示,Fib ≤3.11g/L、WBC≤11.0×109/L、SF/ESR≥99.4及PLT≤260×109/L为MAS的独立危险因素。绘制模型ROC曲线,灵敏度和特异度分别为92.42%、81.20%。经过30位同行专家评议并投票,分别对上述患儿进行MAS诊断,并对各项临床表现及检验检查项目进行权重值评分,形成早期预警量表。结论　临床表现结合辅助检查结果,利用积分量表的形式,快速判断重症sJIA是否合并早期MAS,对诊断窗口提前,提高MAS诊断率,降低漏诊及前瞻性研究提供参考。     

股骨颈骨折内固定物临床及生物力学特点比较

目的：探讨股骨颈骨折内固定植入物的生物力学特点,为治疗股骨颈骨折选择内固定植入物提供生物力学依据。方法：应用计算机检索PubMed数据库1996年1月-2008年8月关于股骨颈骨折的内固定器械方面的文章,比较股骨颈骨折不同内固定植入物的生物力学特点。结果：MCS的抗剪切作用较弱,抗扭转作用与DHS相当,固定骨质疏松及不稳定的骨折不如DHS和LPFP,但有较好的动力加压作用。DHS／DCS的抗剪切作用较强,也有较强的抗扭转作用和动力加压作用,治疗骨质较疏松的骨折也有较好的固定作用。LPFP各方面的强度都最高,固定不稳定骨折及骨质疏松的骨折也最为稳定,但缺乏动力加压作用。结论：不同的内固定材料有不同的生物力学特性,股骨颈骨折的内固定选择要综合多方面因素,根据医师的经验、患者的病情和年龄作出最合理的选择。     

B cell apoptosis accelerates the onset of murine lupus

To investigate whether the increased rate of lymphocyte apoptosis in systemic lupus erythematosus is involved in the onset of the disease, apoptotic or necrotic T or B lymphocytes from various cell lines were injected intraperitoneally into pre-autoimmune (NZBxNZW)F1 mice (BW) and non-autoimmune BALB/c mice. The intraperitoneal production of cytokines and chemokines, the specific T cell response in the spleen, and the production of anti-histone and anti-dsDNA Ab were investigated. The onset of the disease was characterized by creatinine levels and evaluation of glomerular IgG deposits. In BW, but not in BALB/c mice, injection of apoptotic and not necrotic cells up-regulated IL-6 and IL-10 in resident macrophages. Administration of apoptotic cells augmented the number of Th2 and B lymphocytes recruited in the peritoneal cavity. Only the treatment with apoptotic B cells promoted a systemic Th2 autoimmune response to H2 histones, associated with earlier occurrence of high levels of anti-dsDNA autoantibodies, higher creatinine levels and more numerous glomerular IgG deposits than in BW controls not injected with apoptotic B cells. In genetically susceptible mice exposure to apoptotic of B, but not T, lymphocytes can elicit a Th2 response to H2 histones that helps B cell production of anti-dsDNA Ab and finally triggers the onset of lupus.     

严重烧伤患者血清IL-18、sFas和sFasL水平的变化规律及其相关性研究

目的 :探讨严重烧伤患者血清IL 18、sFas和sFasL水平间的变化及其与病情的关系。方法 :选择烧伤总面积(TBSA)≥ 30 %的严重烧伤患者 30例 ,其中死亡 3例 ;正常对照组 4 5例。采用ELISA法对不同时相点 (伤后 1、3、5、7、14、2 1、2 8和 35天 )患者血中IL 18、sFas和sFasL水平进行检测。结果 :与正常对照组比较 ,患者血清IL 18、sFas和sFasL水平均呈显著性上升 (P <0 0 1～ 0 0 5 ) ,并分别持续至伤后 2 8,2 1和 2 1天 ;感染组患者血清IL 18、sFas和sFasL水平均显著地高于非感染组 (P <0 0 1～ 0 0 5 ) ;死亡组患者血清IL 18水平下降 ,而sFasL水平则升高。患者血清IL 18和sFasL水平与烧伤面积相关 ;患者血清IL 18、sFas和sFasL之间也呈显著正相关 (P <0 0 1)。结论 :患者血清IL 18、sFas和sFasL水平与烧伤严重程度及伤后感染密切相关 ,在烧伤后免疫功能及凋亡调控中可能起一定作用。