开放复位可塑形钛板内固定治疗跟骨骨折33例

目的 评价开放复位可塑形钛板内固定治疗跟骨骨折的疗效。方法 对33例(37足)以后关节突移位为主的跟骨骨折,行跟骨外侧入路、开放性复位可塑形钛板螺钉内固定,必要时行植骨术(18例)。结果 平均随访11.5个月,参照Mary—land food score评分,对患足是否疼痛、步态、距下关节及踝关节活动度、是否支架辅助、术后X线摄片等加以评估,19足疗效为优,17足为良,1足可。其中钛板断裂1例,手术切口皮缘坏死1例,换药后自愈。结论 跟骨外侧入路开放复位可塑形钛板螺钉内固定,必要时植骨术是治疗跟骨骨折的有效方法。     

适应建设研究型医院要求努力创新人才工作机制

着眼创建研究型医院对人才工作提出的新要求,紧紧抓住培养、考核、使用、激励4个人才建设的关键环节,介绍了医院近年在人才工作中的一些创新性举措,对于盘活人才资源,激发人才活力,提高人才队伍整体素质,推动研究型医院建设,起到了积极的促进作用.     

电脑比配色仪与比色板之间的相近性分析

目的：通过对比色记录的分析，比较Vita比色板、松风Vintage Halo比色板和电脑比配色仪之间的相近性和差异性。方法：随机抽取100名年龄在21～24岁的本地在校大学生，由男女两位测试者使用电脑比配色仪、Vita比色板和松风Vintage Halo比色板对被测试者的左上中切牙进行比色分析。结果：三种比色方法均以A色调最为集中，占总数的55％以上。其次是D色调占总数20％以上。男女测试者的选色在A、R、VR．系列中无明显差异。结论：电脑比配色仪、Vita比色板、松风Vintage Halo比色板均不能完全覆盖本地区青年天然中切牙的色度特征，只在A色调系列中重复率较高。     

凹槽交锁髓内钉治疗股骨多段骨折(附18例报告)

目的探讨一种新型交锁髓内钉-凹槽交锁股骨髓内钉(Biorigid nail femur，简称BNF)治疗股骨多段骨折的方法。方法自2002年3月～2003年10月应用德国aap公司生产的BNF治疗骨折多段骨折18例。结果本组经过3～18个月、平均9个月的随访。骨折均愈合，膝、髋关节恢复良好。结论BNF具有设计独特、内固定可靠、主钉全程均可交锁的特点，能满足自股骨转子下到股骨髁之间一处或多处骨折内固定需要。     

Enhanced chondrogenesis and Wnt signaling in PTH-treated fractures.

Studies have shown that systemic PTH treatment enhanced the rate of bone repair in rodent models. However, the mechanisms through which PTH affects bone repair have not been elucidated. In these studies we show that PTH primarily enhanced the earliest stages of endochondral bone repair by increasing chondrocyte recruitment and rate of differentiation. In coordination with these cellular events, we observed an increased level of canonical Wnt-signaling in PTH-treated bones at multiple time-points across the time-course of fracture repair, supporting the conclusion that PTH responses are at least in part mediated through Wnt signaling. INTRODUCTION: Since FDA approval of PTH [PTH(1-34); Forteo] as a treatment for osteoporosis, there has been interest in its use in other musculoskeletal conditions. Fracture repair is one area in which PTH may have a significant clinical impact. Multiple animal studies have shown that systemic PTH treatment of healing fractures increased both callus volume and return of mechanical competence in models of fracture healing. Whereas the potential for PTH has been established, the mechanism(s) by which PTH produces these effects remain elusive. MATERIALS AND METHODS: Closed femoral fractures were generated in 8-wk-old male C57Bl/6 mice followed by daily systemic injections of either saline (control) or 30 microg/kg PTH(1-34) for 14 days after fracture. Bones were harvested at days 2, 3, 5, 7, 10, 14, 21, and 28 after fracture and analyzed at the tissue level by radiography and histomorphometry and at the molecular and biochemical levels level by RNase protection assay (RPA), real-time PCR, and Western blot analysis. RESULTS: Quantitative muCT analysis showed that PTH treatment induced a larger callus cross-sectional area, length, and total volume compared with controls. Molecular analysis of the expression of extracellular matrix genes associated with chondrogenesis and osteogenesis showed that PTH treated fractures displayed a 3-fold greater increase in chondrogenesis relative to osteogenesis over the course of the repair process. In addition, chondrocyte hypertrophy occurred earlier in the PTH-treated callus tissues. Analysis of the expression of potential mediators of PTH actions showed that PTH treatment significantly induced the expression of Wnts 4, 5a, 5b, and 10b and increased levels of unphosphorylated, nuclear localized beta-catenin protein, a central feature of canonical Wnt signaling. CONCLUSIONS: These results showed that the PTH-mediated enhancement of fracture repair is primarily associated with an amplification of chondrocyte recruitment and maturation in the early fracture callus. Associated with these cellular effects, we observed an increase in canonical Wnt signaling supporting the conclusion that PTH effects on bone repair are mediated at least in part through the activation of Wnt-signaling pathways.     

Pretransplant survival is shorter in HIV-positive than HIV-negative subjects with end-stage liver disease.

Despite improved survival after liver transplantation (OLTX) in HIV-positive individuals treated with highly active antiretroviral therapy (HAART), some transplant candidates do not survive to OLTX. To determine if pretransplant outcome is related to severity of liver disease and/or HIV infection, we prospectively evaluated 58 consecutive HIV-positive candidates seen at a single center from 1997-2002. Of the 58, 15 (25.9%) were transplanted, whereas 21 (36.2%) died before OLTX, a median one month of evaluation, with more than half of those (12 of 21, 57.1%) dying from infection. By contrast, of 1,359 HIV-negative candidates, 860 (63.3%) were transplanted, whereas 211 (15.5%) died before OLTX (P < 0.001). The cumulative survival following initial evaluation was significantly shorter among HIV-positive than HIV-negative candidates (880 vs. 1,427 days, P = 0.035, Breslow) but was not related to the initial pretransplant MELD score (16 vs. 15), INR (1.5 vs. 1.5), creatinine (1.3 vs. 1.3 mg/dL), or total bilirubin (6.6 vs. 5.7 mg/dL), respectively, all P > 0.05. Among untransplanted HIV-positive candidates, the 21 who died did not differ from the 22 surviving in initial MELD (15 vs. 13), CD4 (230 vs. 327/microL), HIV load (both < 400 copies/mL), HAART intolerance (10/21, 47.6% vs. 10/22, 45.4%), or HCV infection (16/21, 76.2% vs. 16/22, 72.3%), all P > 0.05. Further, the 21 did not differ from the 15 transplanted in pre-OLTX CD4, HIV load, or MELD score, all P > 0.05. In conclusion, pretransplant survival appears shorter in HIV-positive OLTX candidates and is unrelated to severity of liver or HIV disease. Further study is warranted to determine risk factors for poorer pretransplant outcomes.     

Toxic effects of Fusarium mycotoxin butenolide on rat myocardium and primary culture of cardiac myocytes.

Mycotoxin toxicosis has been implicated in the etiopathogenesis of Keshan disease (KD), an endemic cardiomyopathy prevailing in some regions of China. Butenolide (4-acetamido-4-hydroxy-2-butenoic acid gamma-lactone, CAS No. 16275-44-8), a mycotoxin produced by several Fusarium species such as Fusarium tricinctum and Fusarium graminearum, is frequently detected from the cereals in the endemic areas of KD. The present study is undertaken to investigate whether this mycotoxin can induce myocardial damage. Exposure of primary culture of cardiac myocytes to butenolide resulted in significant cytotoxicity, manifested by changes in cell morphology and decreases in cell viability. Consistent with the in vitro findings, distinct myocardial toxicity in vivo was observed after administration of rats by gavage with butenolide (10 and 20 mg/kg/day) for 2 months, and the myocardial injuries were characterized by focal necrosis of myocardium and fragmentation of myofiber. Butenolide also induced significant oxidative damage to the myocardium in vitro evidenced by a concentration-dependent lipid peroxidation in the myocardial homogenates, whereas antioxidants superoxide dismutase (SOD), N-acetylcysteine (NAC) and glutathione (GSH) provided significant protections against this oxidative effect. Taken together, these results clearly reveal that butenolide possesses the potential to induce myocardial toxicity. The present findings may reinforce the hypothesis that toxicosis by mycotoxins is one of the etiological factors for KD.     

CT结合内镜检查诊断胃肠道间质瘤的价值

目的：探讨CT结合内镜检查诊断胃肠道间质瘤(GIST)的价值。方法：回顾分析18例均经手术病理检验证实为GIST病人的CT及内镜检查资料。结果：(1)18例GIST的CT表现为类圆形或分叶状肿瘤，边界清楚，13例平扫及增强密度均匀，强化明显，5例瘤灶内有坏死液化区；肿瘤周围肠管不同程度受压移位或粘连。(2)15例源于胃、十二指肠及结肠的间质瘤均行内镜检查，4例瘤侧胃壁镜下所见黏膜呈外压性改变者未行咬检；11例伴有溃疡形成，溃疡处咬检获取病理组织。(3)18例均行手术后光镜观察及免疫组化检查，18例CD-117均为阳性，13例CD-34阳性，10例Vimentin阳性。结论：CT与内镜相结合检查，能提高胃、十二指肠及结肠GIST定位、定性的准确性。     

管状膨体聚四氟乙烯用于组织工程支架材料的动物实验研究

目的：研究膨体聚四氟乙烯(ePTFE)植入动物体内后与机体的关系。方法：管状膨体聚四氟乙烯两端闭合，内充DMEM培养液，埋入家兔皮下，观察宿主生命情况，于术后1、2、4、6周取出标本，行大体及光镜下观察。结果：家兔在植入膨体聚四氟乙烯材料及DMEM培养液后存活情况良好，DMEM培养液在1周时即已完全无色透明；4周时膨体聚四氟乙烯与周围组织有粘连，6周时粘连紧密；光镜下观察，各时间点材料间隙均可见着色，1周时可见少量淋巴细胞浸润，无血管及组织细胞。材料内壁未见细胞附着。结论：植入膨体聚四氟乙烯材料及少量DMEM培养液对宿主动物存活无影响；管内外液体可相互交通，管状膨体聚四氟乙烯可作为组织工程化尿道的支架材料。