Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

Alleviation of hypoxic pulmonary vascular structural remodeling by L-arginine

目的探讨L-精氨酸(L-Arg)对低氧性肺血管结构重建的干预作用及其可能机制.方法将18只Wistar大鼠配伍后随机分为对照组、低氧组和低氧+L-Arg组(共6个配伍组).以右心导管法测定肺动脉压力,并对大鼠肺组织标本进行显微结构观测和超微结构观察,同时以分光光度法测定血浆一氧化氮(NO)含量,并对肺组织以内皮素-1(ET-1) cRNA探针进行原位杂交,研究肺动脉内皮细胞ET-1 mRNA的表达.结果低氧组大鼠肺动脉平均压明显高于对照组(20.33±2.18?mm?Hg vs 15.38±1.05?mm?Hg, P<0.05).低氧后大鼠肺血管显微及超微结构发生明显改变,肺血管结构重建形成.同时低氧组大鼠血浆NO间接含量明显低于对照组 (P<0.05 ).低氧后肺动脉内皮细胞ET-1 mRNA表达明显增强.然而,低氧+L-Arg组大鼠PAMP较低氧组明显降低(16.73±1.35?mm?Hg vs 20.33±2.18?mm?Hg, P<0.05).L-Arg缓解了低氧性肺血管结构重建的形成.同时低氧+L-Arg组大鼠血浆NO间接含量明显高于低氧组(P<0.05).L-Arg使低氧大鼠肺动脉内皮细胞ET-1 mRNA表达明显受抑制.结论 L-Arg对低氧性肺血管结构重建以及低氧性肺动脉高压的形成有重要的调节作用,其机制可能与通过促进低氧大鼠体内NO生成,从而抑制肺动脉内皮细胞ET-1 mRNA表达有一定的关系.     

Stable clonal expansion of the T-cell receptor Vβ6， Vβ17 and Vβ19 T cells in a cGVHD case using genescan analysis

Objective To investigate the distribution and clonality of the T-cell receptor (TCR) Vβ repertoire in chronic graft versus host disease (cGVHD).Methods The complementarity determining region 3 (CDR3) of the TCRβ gene with 24 variab le regions was amplified in peripheral blood mononuclear cells drawn from one cG VHD patient after allogenic bone marrow transplantation (allo-BMT) 35, 39, 43 o r 45 months respectively, using RT-PCR, to observe the expression of TCR Vβ re pertoire T cells.The PCR products were further analyzed by genescan to evaluat e clonality of T cells.Results Fourteen or 16 TCR Vβ subfamily T cells were detected in each sample of cGVHD c ase. Oligoclonal T cells were identified in TCR Vβ 6, 16, 17, 19 and 21 subfamili es.The stable clonal T cells in all samples were identified in Vβ6, Vβ17 and Vβ21 subfamilies. Conclusion Skewing distribution and stable clonal expansion of T cells can be found in cG VHD cases and it may be related to the initiation of cGVHD.     

Autologous peripheral blood stem cell transplantation in the patients with hematologic malignancies and solid tumors

Objective To evaluate the long-term therapeutic effects of autologous peripheral blood st em cell transplantation (auto-PBSCT) on the treatment of hematological and soli d tumors. Methods Fifty-one patients were recruited in this auto-PBSCT study, in which several p otentially important parameters were studied including the optimal time for stem cell co llection, the dose of stem cell reinfusion, the time of hematopoietic reconsti tution, the disease free survival (DFS) and overall survival (OS), complication s related to transplantation, and maintenance chemotherapy after auto-PBSCT. Results After APBSCT, 3-year and 5-year survival rates of NHL were 83.3%; those of AM L were 74.7%; those of MM were 37.9% and 19%; those of ALL were 40% and 0% res pectively. Hematopoietic reconstitution was greatly promoted by granulocyte col ony stimulating factor (G-CSF). The mean time for patients’ neutrophil to reco ver up to &gt;0.5×10(9) /L after APBSCT was 11.14 days in the group of the patien ts receiving G-CSF in contrast to 17.6 days in the group receiving no G-CSF. The most common complications of transplantation were fever, liver dysfunction and hypokalaemia, which were curable. No death was due to transplantation related complications.Conclusion Comparing with conventional chemotherapy, our study suggests that auto-PBSCT i s a very important therapeutic option that can significantly improve the prognos is in the patients with hematological and solid tumors, especially in the patien ts with AML and NHL.     

cGMP对大鼠心肌细胞葡萄糖摄取的抑制作用

目的：观察大鼠心脏两种负荷状况时环化鸟苷一磷酸（cGMP）对心肌细胞摄取葡萄糖的影响。方法：应用cGMP类似物8-BrcGMP、一氧化氮合酶（NOS）抑制剂L-NAME和NO供体SNAP灌注Wistar大鼠心脏,并用放免法测定组织内cGMP浓度。根据2-^3H标记率计算葡萄糖摄取量。结果：低负荷状况时8-BrcGMP使冠脉血流增加,细胞内糖原浓度升高。高负荷状况时8-BrcGMP使心排出量减少,心肌细胞对葡萄糖摄取减少和使糖原浓度降低。L-NAME降低心肌细胞cGMP逍度,并刺激葡萄糖摄取,而SNAP作用则相反。结论：心肌细胞内cGMP浓度升高,可抑制葡萄糖摄取;而NOS抑制剂L-NAME则能降低cGMP浓度,使心肌细胞葡萄糖摄取增加,糖原分解减少,使缺血心肌功能受到保护。     

不同方法使用东莨菪碱脱毒效果的比较

目的：观察东莨菪碱（scopolamine,Spm)和氯丙嗪（chloprmazine,Clo)对吗啡戒断反应的影响。方法：采用吗啡依赖大鼠模型,不同剂量单多次皮下注射（sc)东莨菪碱及合并使用氯丙嗪处理动物后,腹腔注射（ip)纳洛酮5mg/kg诱发戒断反应,观察戒断症状。结果：单次sc东莨菪碱1.0mg/kg及多次sc东莨菪碱0.5mg/kg可明显抑制吗啡依赖大鼠的身体戒断反应,合并注射氯丙嗪20.0mg/kg时的效果更好.结论:东莨菪碱通过Ach受体可以抑制吗啡戒断反应,氯丙嗪则可能通过作用于蓝斑墙 枢部位α2受体与东莨菪碱起到协同作用.     

血清总胆汁酸测定及相关生化指标在肝脏疾病变化分析

目的　用血清胆汁酸及相关指标评价不同肝病特异性 ,敏感性及临床意义。方法　使用酶终点法及速率法测定肝脏疾病患者血清总胆汁酸及相关生化指标AST、ALT、AKP、γ -GT ,并对各种肝病TBA及相关生化指标进行比较分析。结果　餐前胆汁酸在慢性肝炎、肝硬化、肝癌灵敏度高达 78.4% ,98.0 % ,82 .7% ,其升高幅度依次为急性肝炎 >肝癌 >肝硬化 >胆汁淤积性肝病 >慢性肝炎 >脂肪肝。胆汁酸、γ -GT持续升高 ,ALT/AST长期倒置 ,与肝病的慢性化有关。结论　胆汁酸及相关指标测定可以客观地对各种肝病作较全面的分析     

冠心病经皮冠状动脉内成形术的临床应用

目的：观察心绞痛、心肌梗死经皮冠状动脉内成形术（PTCA）的安全性和有效性。方法：不稳定型心绞痛3例,急性心肌梗死2例。其中病变血管6支,回旋支远端狭窄1例,左前降支完全闭塞1例,左前降支近端狭窄3例（其中1例合并右冠状动脉中段狭窄）。分别行PTCA或PTCA加支架术。结果：PTCA成功4例,失败1例。PTCA后有3例发现内膜撕裂和血管壁塌陷,随即行支架植入。术前急性心肌梗死溶栓治疗临床试验（TIMI）血流0－1级,术后均恢复TIMI血流3级。术后随访1－3个月,患者均无心绞痛发作。结论：PTCA和支架植入,是冠状血管再通安全而有效的方法。     

妊娠合并心脏病76例分析

目的：探讨妊娠合并心脏病的产科处理原则。方法：对我院1990～1999年产科分娩的7776名孕妇及其中76例合并心脏病的临床资料进行回顾性分析。结果：妊娠合并心脏病的发生率为0.98%,风湿性心脏病与先天性心脏病之比为1.86:1。本组共发生心力衰竭17例,孕产妇死亡1例,孕前已行外科手术纠正者11例,心脏手术后妊娠和分娩者无1例发生心力衰竭。结论：妊娠合并心脏病者产前定期检查可预防合并症,改善母婴预后;对心功能不全患者应剖宫产终止妊娠。     

功能性消化不良患者胃排空功能与症状分型的关系

目的　通过 99m Tc植酸钠固体餐检测胃排空 ,了解功能性消化不良 (functional dyspepsia,FD)患者各临床亚型胃运动的情况 .方法　 99m Tc植酸钠标记固体餐 ,对 30例 FD患者 (其中溃疡样型 10例 ,动力障碍型 10例 ,非特异型 10例 )及 10名健康对照者进行了核素检测分析 .结果　运动障碍样型及非特异型 FD患者胃半排空时间延迟 (87± 2 8min,89± 2 6 min vs6 1± 9min,P<0 .0 5 ) ,2 h胃排空率明显减少(6 3.0± 11.5 % ,5 7.7± 15 .5 % vs87.0± 10 .3% ,P<0 .0 1) ,而溃疡样型 FD与正常人比无差异 (P>0 .0 5 ) .结论　胃排空延迟在运动障碍样型及非特异型 FD病因中占重要地位 ,FD三个临床亚型之间发病机制既相同又略有不同 ;FD患者中有症状与胃排空之间存在不一致现象 ,所以核素胃排空检查在 FD胃运动功能的判定及指导治疗上有重要意义 .