提踵运动对中老年人骨质改善程度的研究

目的 研究提踵运动对中老年人骨密度的改善情况。方法 以中老年人为研究对象,采用提踵运动对受试者的足跟给予应力剌激干预,以跟骨骨密度为主要参考指标,结合受试者的主观感受,经过3个周期的训练,对提踵试验组与对照组受试者的跟骨骨密度测试结果进行对比分析。结果 应力剌激对改善中老年男性的跟骨骨密度有一定帮助,提踵运动对于中老年男性跟骨骨密度的改善有较好的效果。女性对于应力剌激的阈值低于男性。结论 适宜负荷强度和频率的应力剌激,对改善处于骨质疏松情况下的中老年人跟骨骨密度有显著效果。     

Postoperative Acute Pulmonary Embolism Following Pulmonary Resections

Postoperative acute pulmonary embolism after pulmonary resections is highly fatal complication. Many literatures have documented cancer to be the highest risk factor for acute pulmonary embolism after pulmonary resections. Early diagnosis of acute pulmonary embolism is highly recommended and computed tomographic pulmonary angiography is the gold standard in diagnosis of acute pulmonary embolism. Anticoagulants and thrombolytic therapy have shown a great success in treatment of acute pulmonary embolism. Surgical therapies (embolectomy and inferior vena cava filter replacement) proved to be lifesaving but many literatures favored medical therapy as the first choice. Prophylaxis pre and post operation is highly recommended, because there were statistical significant results in different studies which supported the use of prophylaxis in prevention of acute pulmonary embolism.Having reviewed satisfactory number of literatures, it is suggested that thoroughly preoperative assessment of patient conditions, determining their risk factors complicating to pulmonary embolism and the use of appropriate prophylaxis measures are the key options to the successful minimization or eradication of acute pulmonary embolism after lung resections.     

针刺抗炎研究进展

背景 创伤、烧伤、手术等容易导致机体发生全身炎性反应综合征、脓毒症、多器官功能不全综合征(multiple organ disfunction syndrome,MODS),甚至死亡.调控过度的炎症反应是防治脓毒症和MODS的重要手段之一. 目的 阐释针刺抗炎的作用及机制. 内容 针刺对多种炎性疾病有良好的治疗作用,对脓毒症和MODS亦有一定的防治作用.针刺可通过对免疫细胞、免疫球蛋白、神经递质和细胞因子等的调节,发挥抗炎作用.此外,下丘脑-垂体-肾上腺轴、胆碱能抗炎通路和内源性大麻素系统参与了针刺的抗炎机制. 趋向 针刺抗炎的确切机制尚不清楚,是否还有其他机制参与针刺的抗炎作用还有待阐明.     

Anatomy,Definition, and Treatment of the “Terrible Triad of the Elbow” and Contemplation of the Rationality of this Designation

In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. The adjective terrible is bestowed on an elbow triad that comprises three coexisting complicated traumas; namely, radial head and ulnar coronoid process fractures and posterior dislocation of the elbow joint. In this review, the classification, treatment principles and prognosis for different forms of management of the radial head and ulnar coronoid process fractures and the ligaments lesions are introduced sequentially and various surgical procedures and their efficacy are discussed. This triad has long given orthopedic surgeons headaches. Nonetheless, in recent years a series of anatomical mechanical studies on the elbow joint have been published and there have been several breakthroughs in surgical techniques for managing this elbow triad. This review examines some memorable millstones and unveils trends in the current clinical norm for this triad. The accomplishments achieved recently have reportedly resulted in enhanced prognoses in the last two or three years compared with previous years. It is therefore high time to revise our thoughts about the justice and accuracy of defining this triad of the elbow as terrible. Lastly, we may safely conclude that the terrible triad of the elbow is much less terrible than previously, provided the commonly approved clinical approaches are undertaken.     

Eaf2基因调控microRNA抑制白内障发生的机制研究

目的探讨Eaf2基因敲除小鼠中micro RNA的表达情况,以及Eaf2基因对人晶状体上皮细胞凋亡及晶状体内micro RNA表达的影响。方法利用Lipofectamine 2000瞬时转染p EGFP-C1-Eaf2质粒过表达Eaf2基因,利用流式细胞仪检测细胞凋亡率的变化,利用Real time q-PCR方法检测人晶状体上皮细胞中micro RNA的表达情况;利用Real time q-PCR方法检测Eaf2基因敲除小鼠micro RNA的表达情况。结果 p EGFP-C1-Eaf2质粒转染组细胞凋亡率显著低于对照组,mi R-125b、let-7a的表达显著高于对照组,而mi R-204的表达显著低于对照组;Eaf2基因敲除小鼠mi R-125b、let-7a的表达显著低于对照组,而mi R-204的表达显著高于对照组,差异均有统计学意义(P<0.01)。结论 Eaf2基因可能通过调控micro RNA的表达抑制人晶状体上皮细胞凋亡,从而在白内障发生中发挥晶状体保护作用。     

Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

Background:The goal of total knee arthroplasty (TKA) is to restore knee kinematics.Knee prosthesis design plays a very important role in successful restoration.Here,kinematics models of normal and pros...     

Coronal Diffusion-weighted Magnetic Resonance Imaging of the Kidney: Agreement with Axial Diffusion-weighted Magnetic Imaging in Terms of Apparent Diffusion Coefficient Values

Background:

Coronal diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) values have gradually become applied (following conventional axial DW-MRI) in the renal analysis. To explore whether data obtained using coronal DW-MRI are comparable with those derived using axial DW-MRI, this preliminary study sought to assess the agreement in renal ADC values between coronal DW-MRI and axial DW-MRI.

Methods:

Thirty-four healthy volunteers were enrolled in the study; written consents were obtained. All subjects underwent respiratory-triggered axial and coronal DW-MRI using a 1.5-MR system with b values of 0 and 800 s/mm². The signal-to-noise ratios (SNRs) of the two DW-MRI sequences were measured and statistically compared using the paired t-test. The extent of agreement of ADC values of the upper pole, mid-pole, and lower pole of the kidney; the mean ADC values of the left kidney and right kidney; and the mean ADC values of the bilateral kidneys were evaluated via calculation of intraclass correlation coefficients (ICCs) or Bland–Altman method between the two DW-MRI sequences.

Results:

The SNR of coronal DW-MR images was statistically inferior to that of axial DW-MR images (P < 0.001). The ICCs of the ADC values of each region of interest, and the mean ADC values of bilateral kidneys, between the two sequences, were greater than 0.5, and the mean ADCs of the bilateral kidneys demonstrated the highest ICC (0.869; 95% confidence interval: 0.739–0.935). In addition, 94.1% (32/34), 94.1% (32/34), and 97.1% (31/34) of the ADC bias was inside the limits of agreement in terms of the mean ADC values of the left kidneys, right kidneys, and bilateral kidneys when coronal and axial DWI-MRI were compared.

Conclusions:

ADC values derived using coronal DW-MRI exhibited moderate-to-good agreement to those of axial DW-MRI, rendering the former an additional useful DW-MRI method, and causing the ADC values derived using the two types of DW-MRI to be comparable.     

Importance of Sample Size for the Estimation of Repeater F Waves in Amyotrophic Lateral Sclerosis

Background:

In amyotrophic lateral sclerosis (ALS), repeater F waves are increased. Accurate assessment of repeater F waves requires an adequate sample size.

Methods:

We studied the F waves of left ulnar nerves in ALS patients. Based on the presence or absence of pyramidal signs in the left upper limb, the ALS patients were divided into two groups: One group with pyramidal signs designated as P group and the other without pyramidal signs designated as NP group. The Index repeating neurons (RN) and Index repeater F waves (Freps) were compared among the P, NP and control groups following 20 and 100 stimuli respectively. For each group, the Index RN and Index Freps obtained from 20 and 100 stimuli were compared.

Results:

In the P group, the Index RN (P = 0.004) and Index Freps (P = 0.001) obtained from 100 stimuli were significantly higher than from 20 stimuli. For F waves obtained from 20 stimuli, no significant differences were identified between the P and NP groups for Index RN (P = 0.052) and Index Freps (P = 0.079); The Index RN (P < 0.001) and Index Freps (P < 0.001) of the P group were significantly higher than the control group; The Index RN (P = 0.002) of the NP group was significantly higher than the control group. For F waves obtained from 100 stimuli, the Index RN (P < 0.001) and Index Freps (P < 0.001) of the P group were significantly higher than the NP group; The Index RN (P < 0.001) and Index Freps (P < 0.001) of the P and NP groups were significantly higher than the control group.

Conclusions:

Increased repeater F waves reflect increased excitability of motor neuron pool and indicate upper motor neuron dysfunction in ALS. For an accurate evaluation of repeater F waves in ALS patients especially those with moderate to severe muscle atrophy, 100 stimuli would be required.     

Depression of the Thoracolumbar Posterior Vertebral Body on the Estimation of Cement Leakage in Vertebroplasty and Kyphoplasty Operations

Background:

The cross-section of thoracolumbar vertebral body is kidney-shaped with depressed posterior boundary. The anterior wall of the vertebral canal is separated from the posterior wall of the vertebral body on the lateral X-ray image. This study was designed to determine the sagittal distance between the anterior border of the vertebral canal and the posterior border of the vertebral body (DBCV) and to analyze the potential role of DBCV in the estimation of cement leakage during percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).

Methods:

We retrospectively recruited 233 patients who had osteoporotic vertebral compression fractures and were treated with PVP or PKP. Computed tomography images of T11–L2 normal vertebrae were measured to obtain DBCV. The distance from cement to the posterior wall of the vertebral body (DCPW) of thoracolumbar vertebrae was measured from C-arm images. The selected vertebrae were divided into two groups according to DCPW, with the fracture levels, fracture grades and leakage rates of the two groups compared. A relative operating characteristic (ROC) curve was applied to determine whether the DCPW difference can be used to estimate the degree of cement leakage. The data were processed by statistical software SPSS version 21.0 using independent sample t-test and Chi-square tests.

Results:

The maximum DBCV was 6.40 mm and the average DBCV was 3.74 ± 0.95 mm. DBCV appeared to be longer in males than in females, but the difference was not statistically significant. The average DCPW of type-B leakage vertebrae (2.59 ± 1.20 mm) was shorter than that of other vertebrae (7.83 ± 2.38 mm, P < 0.001). The leakage rate of group DCPW ≤6.40 mm was lower than that of group DCPW >6.40 mm for type-C and type-S, but much higher for type-B. ROC curve revealed that DCPW only has a predictive value for type-B leakage (area under the curve: 0.98, 95% confidence interval: 0.95–0.99, P < 0.001), and when the cut-off value was 4.05 mm, the diagnostic sensitivity and the specificity were 94.87% and 93.02%, respectively.

Conclusions:

Depression of the thoracolumbar posterior vertebral body may be informative for the estimation of cement location on C-arm images. To reduce type-B leakage, DCPW should be made longer than DBCV on C-arm images for safety during PVP or PKP.