动力髋结合转子稳定钢板与Gamma钉内固定治疗股骨转子间骨折的比较

背景：股骨转子间骨折患者在早期积极有效的内固定治疗可以获得良好的疗效。目的：探讨动力髋螺钉＋转子稳定钢板与Gamma钉置入内固定治疗Evans ⅢB型、IV型股骨转子间骨折的比较。方法：选取上海交通大学医学院附属新华医院崇明分院2009年2月至2012年11月收治的67例Evans ⅢB型、IV型股骨转子间骨折患者,其中动力髋螺钉＋转子稳定钢板治疗28例,Gamma钉治疗39例。所有患者治疗后常规使用抗生素和功能锻炼。回顾性分析两组患者治疗时间、治疗中出血量、骨折愈合时间以及Harris髋关节功能评分。结果与结论：所有患者随访6—45个月,平均随访21个月。①动力髋螺钉＋转子稳定钢板组出现感染1例,经换药半年后拔除内固定治愈,Gamma钉1例肥胖患者治疗后3周下床活动时再次受伤,出现远端锁钉处骨折,经更换长Gamma钉后愈合,Gamma钉组有4例患者因大转子固定欠稳定,卧床时间超过6周出现重症肺炎,经转内科治疗后治愈。②动力髋螺钉＋转子稳定钢板组治疗后出现髋内翻畸形2例,Gamma钉组3例,所有患者骨折均愈合。③动力髋螺钉＋转子稳定钢板组较Gamma钉组治疗时间更长,治疗中出血量明显增多（P〈0．05）,骨折愈合时间及Harris髋关节功能评分,两组比较差异无显著性意义（P〉0．05）。动力髋螺钉＋转子稳定钢板和Gamma钉均是治疗Evans ⅢB型、IV型股骨转子间骨折的有效方法,选择合适的内固定物要根据骨折的稳定性、骨折愈合状况、骨质疏松程度等综合分析。     

Imaging Integrin αvβ3 and NRP-1 Positive Gliomas with a Novel Fluorine-18 Labeled RGD-ATWLPPR Heterodimeric Peptide Probe

Purpose

Radiolabeled Arg-Gly-Asp (RGD) and Ala-Thr-Trp-Leu-Pro-Pro-Arg (ATWLPPR) peptide analogs have received interests for their capability to serve as radiopharmaceuticals for imaging integrin α_vβ₃ and Neuropilin-1 (NRP-1) positive tumors, respectively. In this study, we developed a RGD-ATWLPPR heterodimeric peptide which contained both RGD and ATWLPPR motifs in one molecular probe. The aim of this study was to investigate the dual receptor-targeting property and tumor diagnostic value of RGD-ATWLPPR heterodimeric peptide labeled with fluorine-18 (F-18).

Procedures

A RGD-ATWLPPR heterodimer was synthesized from c(RGDyK) and ATWLPPR through a glutamate linker. The peptide was radiolabeled by reacting the [¹⁸F]fluoride–aluminum complex with the cyclic chelator, 1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA). The receptor-binding characteristics and tumor-targeting efficacy of [¹⁸F]FAl-NOTA-RGD-ATWLPPR were tested in vitro and in vivo.

Results

RGD-ATWLPPR had affinity for both integrin α_vβ₃ and NRP-1 in vitro. [¹⁸F]FAl-NOTA-RGD-ATWLPPR displayed significantly higher tumor uptake than [¹⁸F]FAl-NOTA-RGD and [¹⁸F]FAl-NOTA-ATWLPPR, both in vitro and in vivo. The uptake of the F-18 labeled heterodimer by an U87MG tumor was inhibited only partially in the presence of an excess amount of unlabeled RGD or ATWLPPR but was blocked completely in the presence of both RGD and ATWLPPR. Compared with the monomeric RGD and ATWLPPR peptides, [¹⁸F]FAl-NOTA-RGD-ATWLPPR showed improved in vivo pharmacokinetics, resulting in a more preferable imaging quality.

Conclusions

[¹⁸F]FAl-NOTA-RGD-ATWLPPR exhibited significantly improved receptor-targeting properties both in vitro and in vivo compared with the F-18 labeled RGD or ATWLPPR monomers. The improved targeting and localization exhibited by the RGD-ATWLPPR heterodimer provide a foundation for further investigations of its applicability in clinical tumor imaging.     

生理剂量的雌激素对雌、雄性大鼠肝纤维化形成的影响

目的 探讨生理剂量的β-Est对雌、雄性大鼠肝纤维化形成的影响.方法 采用皮下注射CCl4制作大鼠肝纤维化模型,观察β-Est(0.02 mg·kg-1·d-1)对完整或去势雌、雄性大鼠肝纤维化形成的影响.6周后收集肝组织和血清标本,以标准酶法、ELISA、RIA分别测定血清肝功能、ECM及性激素水平;VG染色观察肝脏组织学改变,结合图像分析计算胶原面积.结果 在相同剂量CCl4作用下雄性大鼠肝纤维化反应较雌性大鼠强烈;补充生理剂量β-Est能改善雌性、去势肝纤维化大鼠肝功能,降低其ECM分泌及肝组织纤维化程度;去势加重雌性大鼠肝纤维化反应;而生理剂量β-Est或去势对雄性大鼠肝纤维化形成无影响.结论 内源性雌激素能抑制CCl4诱导的大鼠肝纤维化,而不同性别对雌激素反应各不相同,这可能是导致肝纤维化形成具有性别差异性的原因之一.     

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??Sepsis is one of important reasons for the death of children in intensive care unit. Although anti-infection and active symptomatic treatment are the key to treatment??whether nutrition support is rational and effective or not can also affect clinical prognosis. Sepsis children are in stress status??so nutrition support needs to meet the demand for energy??protein and other nutrients without increasing the burden of organs. Although intestinal function is damaged because of systemic infection??enteral nutrition??EN?? is still the first choice by actively creating conditions. If the EN is not enough??supplemental parenteral nutrition??PN?? should be given. In the process of nutrition support??immune nutrients can be added to regulate immune function and attenuate inflammation.     

Therapeutic perspectives on uricases for gout

Available recombinant uricases (rasburicase, pegloticase) are potent hypouricaemic agents for tophaceous gout, but their long-term use is in question. We have performed a literature review on uricases, using Scirus, PubMed, Science Direct, and several other search engines. We have also consulted the records of drug regulatory authorities and patents on uricases. Rasburicase (Fasturtec^®) was approved in Europe for tumour lysis syndrome induced by chemotherapy, in a single daily infusion dose for a maximum of 7 days. A retrospective study (n = 10) conducted in patients with gout and three clinical cases have shown that infusions spaced over time, over several months, ensure the control of serum uric acid and help to eliminate or significantly reduce the size of tophi. However, repeated gout attacks (despite colchicine) and hypersensitivity reactions (despite corticosteroids) have dampened enthusiasm for its use in gout. Pegloticase was recently approved by the Food and Drug Administration (FDA) for patients with chronic gout, refractory or intolerant to conventional hypouricaemic therapy. A 6 month study versus placebo showed that pegloticase (infused at 8 mg every 2 weeks), induced a significant decrease in plasma uric acid in about 40% of patients (associated with a tendency for tophi dissolution). However, the remaining patients were non-responders, which correlated with the formation of pegloticase antibodies and infusion reactions. Research efforts are needed to develop less immunogenic uricases. In conclusion, some uricases could have an important role in the treatment of gout, for instance as a first-line treatment and over a short period of several months in patients with severe and tophaceous gout to allow rapid tophi dissolution.     

智力发育落后与遗传性疾病

智力发育落后是高度异质性疾病,具有复杂的遗传学病因。拷贝数变异和单基因疾病是导致智力发育落后发生的主要病理性遗传改变。而染色体微阵列技术和外显组测序技术的临床应用则显著提高了智力发育落后患儿的病因诊断率。     

A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China

Background

Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care.

Objective

To prospectively determine PICU CAP admission features and outcomes.

Methods

A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics.

Results

Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co‐morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3–27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings.

Conclusions

Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. Pediatr Pulmonol. 2013; 48:390–397. © 2012 Wiley Periodicals, Inc.