颈动脉粥样硬化斑块中COX-2、mPGES-1表达及塞来昔布对其的影响作用

目的探讨兔颈动脉粥样硬化斑块中环氧化物酶-2（COX-2）、诱导型前列腺素合成酶-1（mPGES-1）的表达机制及塞来昔布对其表达的影响。方法采用32只雄性新西兰大白兔．其中正常对照组8只（A组），另24只将特制的硅橡胶圈置于兔右侧颈动脉。术后给予1％高胆固醇喂养14d，建立兔颈动脉粥样硬化性狭窄动物模型，将模型兔随机分为颈动脉狭窄无干预组（B组1、小剂量塞来昔布治疗组（15mg／kg，C组），大剂量塞来昔布治疗组（35mg／kg，D组），每组各8只。治疗4周后取双侧颈动脉并分为平等2段，分别行半定量逆转录聚合酶链反应（RT—PCR）及Western blot法测定颈动脉斑块干预后COX-2及mPGES-1的表达。结果与A组比较,B、C、D组颈动脉粥样硬化模型兔的斑块中COX-2及mPGES．1表达增高，差异具有显著性（P〈0．05）；与B组比较，C、D组颈动脉斑块的C0X-2及mPGES．1表达显著下调，差异有显著性（P〈0．051。结论在颈动脉粥样硬化斑块的病理过程中炎症反应可能起着主导作用。塞来昔布干预可抑制COX-2及mPGES—1的表达，减缓颈动脉粥样硬化的进展。     

关节镜辅助下的同种异体半月板移植(附4例术后20个月以上随访报告)

目的:介绍同种异体半月板移植并总结4例关节镜辅助下的同种异体半月板移植的初步临床效果。材料和方法:2005年6月～7月,4例半月板切除术后的患者接受关节镜辅助的同种异体半月板移植手术,其中男性3例、女性1例,平均年龄30.78±7.71岁(21.5～38.5岁)。3例内侧半月板移植,1例外侧半月板移植。随访采用症状询问,体征检查,IKDC、Lysholm和Tegner评分及KT2000测量关节稳定性的方法。4例患者均每半年进行一次X线片及MRI检查,分别观察膝关节的关节间隙改变及移植半月板状态。对所得结果,因病例只有4例,故只进行数据描述,不进行统计学分析。结果:对4例患者均进行了平均21.80±0.81(20～22)个月的随访。所有患者随访时关节活动度均正常,均无明显的膝关节疼痛和肿胀,原来长时间活动后被切除半月板的间室不适完全消失。患者可以胜任日常活动和体育锻炼,无并发症出现。IKDC、Lysholm、Tegner评分均较术前明显提高。KT2000测量发现术后膝关节的稳定性有所改善。X线片检查提示术后患者关节间隙无明显变化。每半年一次的MRI检查提示移植半月板术后1年时替代存活已经很好。结论:关节镜辅助下的同种异体半月板移植安全可行,半月板移植可缓解半月板切除后出现的关节疼痛、肿胀等症状,促进关节功能恢复并使膝关节的稳定性有所改善。     

蜂胶提取物对小鼠胸腺肽合成的影响

目的：研究蜂胶乙醇提取物黄酮（EEP）对小白鼠衰老过程中胸腺肽合成量的影响。方法：垂直板电泳法。结果：EEP可增加小鼠胸腺肽的合成量。结论：EEP可增强小鼠的免疫力。具有抗衰老作用。     

Calcification and ossification of chronic encapsulated intracerebral haematoma: case report.

We report a case of calcified chronic encapsulated intracerebral haematoma (ICH) in a 29-year-old female who presented with progressive left sided weakness and intermittent seizures since childhood. The preoperative magnetic resonance (MR) imaging of the head initially suggested that a partially thrombosed aneurysm or vascular malformation was present. However, no vascular stain was found on the digital subtraction angiography (DSA) of both the carotid and vertebral arteries. The excised mass was histologically diagnosed as a chronic ICH. We traced the patient's medical history and found that at the age of one she sustained a head injury after a fall. So far, to our knowledge, no case of epilepsy secondary to a calcified chronic encapsulated ICH occurring 28 years after head injury has been reported. Calcified chronic encapsulated ICH concomitant with new bone formation within is even rarer. The possible pathogenesis of this case is discussed.     

Outcome after traumatic frontal intracerebral haemorrhage: a comparison of unilateral and bilateral haematomas

Frontal intracerebral haemorrhage (ICH) is a common result of cranial trauma. Outcome differences between bilateral and unilateral frontal ICH are not well studied but would be valuable to predict prognosis in clinical practice. Two aims are proposed in this study: first to compare the risk of developing delayed ICH after bilateral or unilateral frontal ICH, and second to determine the variables helpful to predict outcome according to the Glasgow Outcome Scale (GOS). Between January 1993 and December 1997, 694 consecutive patients with traumatic ICH were admitted to the Chang Gung Medical Center within 24 h of the trauma. Patients with ICH in sites other than the frontal lobes were excluded. A total of 161 cases (mean age 46.3+/-20.3 years), including 57 bilateral (mean age 52.5+/-18.7 years) and 104 unilateral (mean age 42.9+/-20.5 years) traumatic frontal ICH were studied. Twenty-eight of 57 patients (49%) with bifrontal ICH versus 17 of 104 patients (16%) with unilateral frontal ICH had a further, delayed ICH. In 42 of 45 patients (93%) with delayed ICH, this occurred within 5 days of the initial trauma. Multivariate logistic regression was used to select significant predictors of outcome. We found that delayed ICH (p<0.001), age (p=0.004) and mechanism of injury (p=0.001) explained the worse outcome in patients with bifrontal ICH. The best-fitting logistic regression model included three variables: delayed ICH (p=0.011), initial GCS (p=0.023), and a sum score of clinical and radiological variables (p=0.003). Bifrontal ICH tended to occur in older patients after a fall and was associated with a higher risk of developing delayed ICH or brain stem compression compared to unilateral ICH damage. Using these three variables - delayed ICH, initial GCS, and the sum score - in a logistical regression model is useful to predict outcome in patients with traumatic frontal ICH and may aid patient management.     

Skeletal unloading induces resistance to insulin-like growth factor-I (IGF-I) by inhibiting activation of the IGF-I signaling pathways.

We showed that unloading markedly diminished the effects of IGF-I to activate its signaling pathways, and the disintegrin echistatin showed a similar block in osteoprogenitor cells. Furthermore, unloading decreased alphaVbeta3 integrin expression. These results show that skeletal unloading induces resistance to IGF-I by inhibiting activation of the IGF-I signaling pathways at least in part through downregulation of integrin signaling. INTRODUCTION: We have previously reported that skeletal unloading induces resistance to insulin-like growth factor-I (IGF-I) with respect to bone formation. However, the underlying mechanism remains unclear. The aim of this study was to clarify how skeletal unloading induces resistance to the effects of IGF-I administration in vivo and in vitro with respect to bone formation. MATERIALS AND METHODS: We first determined the response of bone to IGF-I administration in vivo during skeletal unloading. We then evaluated the response of osteoprogenitor cells isolated from unloaded bones to IGF-I treatment in vitro with respect to activation of the IGF-I signaling pathways. Finally we examined the potential role of integrins in mediating the responsiveness of osteoprogenitor cells to IGF-I. RESULTS: IGF-I administration in vivo significantly increased proliferation of osteoblasts. Unloading markedly decreased proliferation and blocked the ability of IGF-I to increase proliferation. On a cellular level, IGF-I treatment in vitro stimulated the activation of its receptor, Ras, ERK1/2 (p44/42 MAPK), and Akt in cultured osteoprogenitor cells from normally loaded bones, but these effects were markedly diminished in cells from unloaded bones. These results were not caused by altered phosphatase activity or changes in receptor binding to IGF-I. Inhibition of the Ras/MAPK pathway was more impacted by unloading than that of Akt. The disintegrin echistatin (an antagonist of the alphaVbeta3 integrin) blocked the ability of IGF-I to stimulate its receptor phosphorylation and osteoblast proliferation, similar to that seen in cells from unloaded bone. Furthermore, unloading significantly decreased the mRNA levels both of alphaV and beta3 integrin subunits in osteoprogenitor cells. CONCLUSION: These results indicate that skeletal unloading induces resistance to IGF-I by inhibiting the activation of IGF-I signaling pathways, at least in part, through downregulation of integrin signaling, resulting in decreased proliferation of osteoblasts and their precursors.     

新型胫骨髓内钉的研制与生物力学研究

目的　研制新型胫骨串孔型髓内钉并对其进行生物力学研究。方法　用TAMZ合金制造远端锁孔由一个三个同样直径的串孔所替代的 9根新型胫骨髓内钉。将髓内钉安装在自行设计的夹具中 ,先将 3根新钉进行静态垂直压缩实验 ,根据静态实验结果 ,分别测试 6根新钉的动态疲劳强度。结果　新钉的静态压缩破坏载荷为 2 1 33N ,是人平均体重的 3倍多 ;通过 5 0万次压缩循环的条件疲劳强度为 1 2 0 0N ,约是人体重的 2倍。结论　新钉不仅能够方便临床使用 ,而且拥有较好的力学特性     

Antegrade interlocking nailing of humeral shaft fractures

The results of 39 humeral shaft fractures (37 patients) treated with antegrade locked nailing using a Russell–Taylor nail were reviewed. There were 30 acute fractures, 6 fractures malaligned in a hanging cast or brace, and 3 pathological fractures. Patient age ranged from 26 to 80 years (average, 59.7 years) and average follow-up was 25.7 months (range, 6–48 months). Fracture union was achieved in 92.3% of our cases, while shoulder function was excellent or good in 87.2% of cases. Antegrade locked nailing offers a dependable solution for the treatment of humeral shaft fractures, especially in polytrauma patients and cases of segmental or pathological fractures. Far less satisfactory results were obtained in comminuted fractures of the proximal third in the humerus, especially in osteoporotic patients, and we therefore advocate caution with the use of intramedullary nailing in this type of fracture. Certain technical aspects such as avoiding nailing the fracture in distraction, properly countersinking the tip of the nail, and achieving adequate fixation stability have been found to be of paramount importance to reduce the incidence of delayed union/non-union rate and to obtain better functional results from the shoulder joint.