闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素分析

目的回顾性分析闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素。 方法对2009年1月至2017年3月293例采用加压空心螺钉治疗股骨颈骨折的患者进行回顾性分析，其中获得随访的患者247例。应用SPSS20.0软件进行统计学分析，并对影响股骨头坏死的各项因素进行Logistic回归分析。 结果247例患者获得平均58个月（24~80个月）随访，32例出现股骨头坏死，发生率12.9%，随访时髋关节Harris评分平均81.4±3.9分（54~98分）。影响股骨颈骨折术后股骨头坏死的因素和顺序依次为复位质量（OR=9.854，P=0.012），空心钉排列方式（OR=7.965，P=0.017），骨折分型（OR=6.453，P=0.021），空心钉取出与否（OR=5.364，P=0.027），术前是否牵引（OR=2.561，P=0.042）。 结论复位质量是影响股骨颈骨折预后最为关键的因素。空心螺钉正三角形排列、空心螺钉取出以及未及时术前牵引均可能加重股骨头坏死。     

PDCA教学模式在完全中间入路腹腔镜右半结肠CME术中的应用价值

目的探讨PDCA教学模式在完全中间入路腹腔镜右半结肠CME术中的应用价值。方法以2017年1月1日—8月1日时间段随机选取23例于我院行完全中间入路腹腔镜右半结肠癌CME术的患者,依据建档顺序作为对照组,以及2018年1月1日—8月1日时间段随机选取23例我科在施行PDCA教学模式后行相同术式,相同入路,依据建档顺序作为研究组。通过比较实施PDCA学习模式前后,两组手术的手术时间、术中出血量、淋巴结清扫情况、术后恢复时间及住院时间等疗效指标。结果应用PDCA教学模式后,淋巴结清扫更彻底、手术时间缩短、术中出血量减少(P<0.05)。而肠功能恢复时间和术后住院时间上差异无统计学意义(P>0.05)。结论应用PDCA教学模式后,在进行完全中间入路腹腔镜下右半结肠CME手术过程中,熟练度及手术质量有提高,效果显著。     

Modeling the pharyngeal anatomical effects on breathing resistance and aerodynamically generated sound

The objective of this study was to systematically assess the effects of pharyngeal anatomical details on breathing resistance and acoustic characteristics by means of computational modeling. A physiologically realistic nose-throat airway was reconstructed from medical images. Individual airway anatomy such as the uvula, pharynx, and larynx was then isolated for examination by gradually simplifying this image-based model geometry. Large eddy simulations with the FW-H acoustics model were used to simulate airflows and acoustic sound generation with constant flow inhalations in rigid-walled airway geometries. Results showed that pharyngeal anatomical details exerted a significant impact on breathing resistance and energy distribution of acoustic sound. The uvula constriction induced considerably increased levels of pressure drop and acoustic power in the pharynx, which could start and worsen snoring symptoms. Each source anatomy was observed to generate a unique spectrum with signature peak frequencies and energy distribution. Moreover, severe pharyngeal airway narrowing led to an upward shift of sound energy in the high-frequency range. Results indicated that computational aeroacoustic modeling appeared to be a practical tool to study breathing-related disorders. Specifically, high-frequency acoustic signals might disclose additional clues to the mechanism of apneic snoring and should be included in future acoustic studies.     

Conserved residues in yeast initiator tRNA calibrate initiation accuracy by regulating preinitiation complex stability at the start codon

Eukaryotic initiator tRNA (tRNA_i) contains several highly conserved unique sequence features, but their importance in accurate start codon selection was unknown. Here we show that conserved bases throughout tRNA_i, from the anticodon stem to acceptor stem, play key roles in ensuring the fidelity of start codon recognition in yeast cells. Substituting the conserved G31:C39 base pair in the anticodon stem with different pairs reduces accuracy (the Sui⁻ [suppressor of initiation codon] phenotype), whereas eliminating base pairing increases accuracy (the Ssu⁻ [suppressor of Sui⁻] phenotype). The latter defect is fully suppressed by a Sui⁻ substitution of T-loop residue A54. These genetic data are paralleled by opposing effects of Sui⁻ and Ssu⁻ substitutions on the stability of methionylated tRNA_i (Met-tRNA_i) binding (in the ternary complex [TC] with eIF2-GTP) to reconstituted preinitiation complexes (PICs). Disrupting the C3:G70 base pair in the acceptor stem produces a Sui⁻ phenotype and also reduces the rate of TC binding to 40S subunits in vitro and in vivo. Both defects are suppressed by an Ssu⁻ substitution in eIF1A that stabilizes the open/P_OUT conformation of the PIC that exists prior to start codon recognition. Our data indicate that these signature sequences of tRNA_i regulate accuracy by distinct mechanisms, promoting the open/P_OUT conformation of the PIC (for C3:G70) or destabilizing the closed/P_IN state (for G31:C39 and A54) that is critical for start codon recognition.     

Associations between serum amino acids and incident type 2 diabetes in Chinese rural adults

Background and aimsSome amino acids (AAs) may be associated with type 2 diabetes (T2DM). This study aimed to determine the associations of individual AAs with the development of T2DM in rural Chinese adults.Methods and resultsA cohort study of 1199 individuals aged 18 years or older was conducted from 2006 to 2008 in a rural community of Deqing, China, a repeated survey was done in 2015 and data linkage with the electronic health records system was performed each year for identifying new T2DM cases. A high-performance liquid chromatography approach was used to measure the baseline serum concentrations of 15 AAs. Cox proportional hazards models were used to examine the associations between AAs and the risk of incident T2DM. A total of 98 new T2DM cases were identified during the follow-up of 12 years on average. Among 15 AAs, proline was associated with an increased risk of incident T2DM after adjusted for age, sex, body mass index, fasting plasma glucose, family history of T2DM, smoking status, alcohol use, and history of hypertension, the adjusted hazard ratio for 1-standard deviation increment was 1.20 (95% confidence interval: 1.00, 1.43). The association tended to be more marked in subjects younger than 60 years and overweight/obese subjects. Among participants without hypertension, proline and phenylalanine were associated with an increased risk of incident T2DM, while aspartic acid was associated with a decreased risk.ConclusionSerum proline was associated with the risk of incident T2DM in rural Chinese adults and might be a potential predictor.