膝关节周围骨折伴腘动脉损伤救治的临床研究

目的观察膝关节周围骨折伴腘动脉损伤的保肢治疗过程及功能恢复情况,探讨保肢手术的治疗方案。方法对27例膝关节周围骨折伴腘动脉损伤患者,急诊行骨折固定、腘动、静脉探查修复术,2例行大腿下段1例行膝关节水平截肢术,其余患者的肢体经3~5次(平均4次)手术治疗,肢体得以保留。3例患者的肢体软组织缺损经行背阔肌皮瓣游离移植,其余患者的软组织缺损经行腓肠肌内侧头肌皮瓣或局部直接随意筋膜皮瓣转移修复。术后随访12~24(16±2.39)个月。参照Puno等的标准对康复后肢体功能进行评定。结果患者无死亡,3例患者行患肢截肢,24例患者肢体得以保留,其中4例患者存在明显的足下垂、垂趾等畸形,功能评定为差。结论膝关节周围骨折伴腘动脉损伤的治疗,关键在于早诊断及早治疗,疑有腘动脉损伤者尽早探查;对伴有足踝部软组织及踝关节损伤,或足底难以恢复保护性感觉,估计小腿肌肉会发生广泛的坏死和感染者,应考虑一期行截肢术。     

Effects of low‐frequency pulsed electromagnetic fields on plateau frostbite healing in rats

Plateau frostbite (PF) treatments have remained a clinical challenge because this condition injures tissues in deep layers and affected tissues exhibit unique pathological characteristics. For instance, low‐frequency pulsed electromagnetic field (PEMF) can affect tissue restoration and penetrate tissues. Therefore, the effect of PEMF on PF healing should be investigated. This study aimed to evaluate the effects of low‐frequency PEMF on PF healing systematically. Ninety‐six Sprague‐Dawley rats were randomly and equally divided into three groups: normal control, partial thickness plateau frostbite (PTPF), and PTPF with low‐frequency PEMF exposure (PTPF + PEMF). PTPF wounds were induced in the dorsum of the rats. The PTPF + PEMF group was exposed to low‐frequency PEMF daily. During PF healing, wound microcirculation in each group was monitored through contrast ultrasonography. Wound appearance, histological observation, and wound tensile strength were also evaluated. Results showed that the rate of the microcirculation restoration of the PTPF + PEMF group was nearly 25% faster than that of the PTPF group, and wound appearance suggested that the healing of the PTPF group was slower than that of the PTPF + PEMF group. Histological observation revealed that PEMF accelerated the growth of different deep tissues, as confirmed by tensile strength examination. Low‐frequency PEMF could penetrate PF tissues, promote their restoration, and provide a beneficial effect on PF healing. Therefore, this technique may be a potential alternative to treat PF.     

短视频在父亲支持母乳喂养健康教育中的应用

目的 探讨基于短视频的健康教育在父亲支持母乳喂养中的应用效果。方法 选取103对住院分娩的初产妇及其配偶按照住院时间顺序分组。对照组52对,给予常规健康教育;干预组51对,在常规健康教育的基础上增加基于短视频的健康教育。结果 干预组产后42 d父亲支持母乳喂养自我效能评分、初产妇对配偶参与母乳喂养满意度评分、产后3 d及42 d纯母乳喂养率显著优于对照组（均P<0.05）。结论 基于短视频的健康教育能够提高父亲支持母乳喂养自我效能,提升产妇对配偶参与母乳喂养的满意度,进而促进纯母乳喂养。     

Sclerostin Antibody Treatment Increases Bone Formation,Bone Mass,and Bone Strength in a Rat Model of Postmenopausal Osteoporosis

The development of bone‐rebuilding anabolic agents for potential use in the treatment of bone loss conditions, such as osteoporosis, has been a long‐standing goal. Genetic studies in humans and mice have shown that the secreted protein sclerostin is a key negative regulator of bone formation, although the magnitude and extent of sclerostin's role in the control of bone formation in the aging skeleton is still unclear. To study this unexplored area of sclerostin biology and to assess the pharmacologic effects of sclerostin inhibition, we used a cell culture model of bone formation to identify a sclerostin neutralizing monoclonal antibody (Scl‐AbII) for testing in an aged ovariectomized rat model of postmenopausal osteoporosis. Six‐month‐old female rats were ovariectomized and left untreated for 1 yr to allow for significant estrogen deficiency‐induced bone loss, at which point Scl‐AbII was administered for 5 wk. Scl‐AbII treatment in these animals had robust anabolic effects, with marked increases in bone formation on trabecular, periosteal, endocortical, and intracortical surfaces. This not only resulted in complete reversal, at several skeletal sites, of the 1 yr of estrogen deficiency‐induced bone loss, but also further increased bone mass and bone strength to levels greater than those found in non‐ovariectomized control rats. Taken together, these preclinical results establish sclerostin's role as a pivotal negative regulator of bone formation in the aging skeleton and, furthermore, suggest that antibody‐mediated inhibition of sclerostin represents a promising new therapeutic approach for the anabolic treatment of bone‐related disorders, such as postmenopausal osteoporosis.     

SSX2基因mRNA在泌尿系统肿瘤组织中的表达

目的探讨肿瘤特异性SSX2基因mRNA在肾细胞癌及尿路移行细胞癌组织中的表达.方法采用逆转录聚合酶链反应方法,检测26例肾细胞癌患者、27例尿路移行细胞癌患者的癌组织,及15例患者相应的癌旁组织中SSX2基因mRNA的表达.结果 26例肾癌患者癌组织中,18例(69%)SSX2 基因mRNA表达阳性;27例尿路移行细胞癌组织中,22例(81%)SSX2 基因mRNA表达阳性.癌旁组织均不表达.在肿瘤不同分期之间及不同分级之间SSX2 基因mRNA的表达差异均无统计学意义(P均＞0.05).结论 SSX2基因mRNA在肾癌及尿路移行细胞癌组织中高表达.     

A new osteonecrosis animal model of the femoral head induced by microwave heating and repaired with tissue engineered bone

The objective of this research was to induce a new animal model of osteonecrosis of the femoral head (ONFH) by microwave heating and then repair with tissue engineered bone. The bilateral femoral heads of 84 rabbits were heated by microwave at various temperatures. Tissue engineered bone was used to repair the osteonecrosis of femoral heads induced by microwave heating. The roentgenographic and histological examinations were used to evaluate the results. The femoral heads heated at 55 degrees C for ten minutes showed low density and cystic changes in X-ray photographs, osteonecrosis and repair occurred simultaneously in histology at four and eight weeks, and 69% femoral heads collapsed at 12 weeks. The ability of tissue engineered bone to repair the osteonecrosis was close to that of cancellous bone autograft. The new animal model of ONFH could be induced by microwave heating, and the tissue engineering technique will provide an effective treatment.     

Increased RANK ligand in bone marrow of orchiectomized rats and prevention of their bone loss by the RANK ligand inhibitor osteoprotegerin

Orchiectomized (ORX) rats were used to examine the extent to which their increased bone resorption and decreased bone density might relate to increases in RANKL, an essential cytokine for bone resorption.Serum testosterone declined by > 95% in ORX rats 1 and 2 weeks after surgery (p < 0.05 versus sham controls), with no observed changes in serum RANKL. In contrast, RANKL in bone marrow plasma and bone marrow cell extracts was significantly increased (by  100%) 1 and 2 weeks after ORX. Regression analyses of ORX and sham controls revealed a significant inverse correlation between testosterone and RANKL levels measured in marrow cell extracts (R = − 0.58), while marrow plasma RANKL correlated positively with marrow plasma TRACP-5b, an osteoclast marker (R = 0.63). The effects of RANKL inhibition were then studied by treating ORX rats for 6 weeks with OPG-Fc (10 mg/kg, twice/week SC) or with PBS, beginning immediately after surgery. Sham controls were treated with PBS. Vehicle-treated ORX rats showed significant deficits in BMD of the femur/tibia and lower trabecular bone volume in the distal femur (p < 0.05 versus sham). OPG-Fc treatment of ORX rats increased femur/tibia BMD and trabecular bone volume to levels that significantly exceeded values for ORX or sham controls. OPG-Fc reduced trabecular osteoclast surfaces in ORX rats by 99%, and OPG-Fc also prevented ORX-related increases in endocortical eroded surface and ORX-related reductions in periosteal bone formation rate. Micro-CT of lumbar vertebrae from OPG-Fc-treated ORX rats demonstrated significantly greater cortical and trabecular bone volume and density versus ORX-vehicle controls. In summary, ORX rats exhibited increased RANKL protein in bone marrow plasma and in bone marrow cells, with no changes in serum RANKL. Data from regression analyses were consistent with a potential role for testosterone in suppressing RANKL production in bone marrow, and also suggested that soluble RANKL in bone marrow might promote bone resorption. RANKL inhibition prevented ORX-related deficits in trabecular BMD, trabecular architecture, and periosteal bone formation while increasing cortical and trabecular bone volume and density. These results support the investigation of RANKL inhibition as a strategy for preventing bone loss associated with androgen ablation or deficiency.     

Cytokine responses following laparoscopic or open pyeloplasty in children

Background

The present study evaluated the cytokine response in children following laparoscopic pyeloplasty (LP) or open pyeloplasty (OP). A series of cytokines were measured postoperatively, including interkin1-β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP).

Methods

A total of 31 patients, with an average age of 9.1 ± 3.0 years (range 2.5–14 years) were studied. Fourteen patients underwent LP and 17 underwent OP. Blood serum concentrations of IL-1β, IL-6, IL-8, IL-10, TNF-α, and CRP were measured via enzyme-linked immunosorbent assay (ELISA) before surgery as well as 4, 24, and 48 h following the operation. In addition, the procedure duration, hospital stay, incidence of wound infection, and the recurrence rate of stenosis in both groups were compared.

Results

Serum IL-6 and CRP concentrations were significantly elevated in both groups at 4, 24, and 48 h relative to preoperative levels. However, the rise in IL-6 and CRP in OP group was significantly more robust than in LP group. No significant changes were observed in serum levels of IL-1β, IL-8, IL-10, or TNF-α in either group. The procedure duration was significantly longer for LP (193.6 ± 74.7 min, range 120–360 min) versus OP (120.1 ± 27.5 min, range 90–165 min, p < 0.05), but the hospital stay following LP was shorter (LP group: 5.3 ± 1.1 days versus OP group: 9.3 ± 2.1 days, p < 0.05). No severe complications were noted in either group, however, one child experienced wound infection following OP procedure. An incident of recurrent stenosis following the operation occurred in both groups. There was no postoperative morbidity or severe implications at 12 month follow-up in either group.

Conclusions

Both OP and LP are safe and effective procedures for the treatment of ureteropelvic junction obstruction in the pediatric population. However, the shorter hospital stay and decreased cytokine response following LP indicates potential benefits over traditional invasive procedures.     

肾交感神经消融术临床研究进展

近期,肾交感神经消融术(catheter-based renal sympathetic denervation,RDN)的研究成果引起了介入放射学家、血管外科医师的兴趣,亦引起了学术界对肾交感神经在多种疾病发生发展中的用机制亦的重视.此技术不仅为多种以交感神经过度活化为特点的疾病提供了新的治疗方法,也为进一步了解此类疾病的病理生理学研究提供了机会.本文对该技术的研究现状、临床应用、禁忌证、操作步骤、疗效及并发症作一论述.     

Sensory neuronopathy involves the spinal cord and brachial plexus: a quantitative study employing multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM)

Introduction

Sensory neuronopathy (SNN) is a distinctive subtype of peripheral neuropathies, specifically targeting dorsal root ganglion (DRG). We utilized MRI to demonstrate the imaging characteristics of DRG, spinal cord (SC), and brachial plexus at C7 level in SNN.

Methods

We attempted multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM) methods in nine patients with sensory neuronopathy and compared with those in 16 disease controls and 20 healthy volunteers. All participants underwent MRI for the measurement of DRG, posterior column (PC), lateral column, and spinal cord area (SCA) at C7 level. DRG diameters were obtained through its largest cross section, standardized by dividing sagittal diameter of mid-C7 vertebral canal. We also made comparisons of standardized anteroposterior diameter (APD) and left–right diameters of SC and PC in these groups. Signal intensity and diameter of C7 spinal nerve were assessed on TIRM.

Results

Compared to control groups, signal intensities of DRG and PC were higher in SNN patients when using MEDIC, but the standardized diameters were shorter in either DRG or PC. Abnormal PC signal intensities were identified in eight out of nine SNN patients (89 %) with MEDIC and five out of nine (56 %) with T2-weighted images. SCA, assessed with MEDIC, was smaller in SNN patients than in the other groups, with significant reduction of its standardized APD. C7 nerve root diameters, assessed with TIRM, were decreased in SNN patients.

Conclusion

MEDIC and TIRM sequences demonstrate increased signal intensities and decreased area of DRG and PC, and decreased diameter of nerve roots in patients with SNN, which can play a significant role in early diagnosis.