全髋关节置换术后关节不稳的处理策略

正对于晚期关节炎,全髋关节置换可明显减少疼痛,提高患者的功能,具有较高的满意度和较低的手术并发症[1-2]。全髋关节置换的目标是无痛,活动时关节稳定,获得最大限度的活动范围,没有撞击和下肢长度尽量相等[3]。术后一个重要的并发症就是关节不稳,这是引起关节翻修的原因之一。     

Effect of tet methylcytosine dioxygenase 2 on the regulation of transforming growth factor-β1 expression in mesangial cells induced by high glucose

Objective To investigate the role of tet methylcytosine dioxygenase 2 (TET2) in the regulation of transforming growth factor-β1 (TGF-β1) expression in human glomerular mesangial cells induced by high glucose. Methods Cultured human glomerular mesangial cells were divided into normal control group (5.5 mmol/L glucose) and high glucose group (30.0 mmol/L glucose) which was cultured for 12 h to 72 h. The gene expression of TET2 in mesangial cells were inhibited by small molecule chemical called SC1, and which were divided into high glucose group (30.0 mmol/L glucose+DMEM), DMSO group (30.0 mmol/L glucose+0.1%DMSO) and SC1 group (30.0 mmol/L glucose+3 μmol/L SC1). The mRNA and protein expression of TGF-β1, TET1 to 3 and α-smooth muscle actin (α-SMA) was detected by quantitative real-time PCR and Western blotting. Methylation of CpG islands in the regulation region of TGF-β1 was detected by bisulfite sequencing PCR (BSP). The activity of mesangial cell proliferation was assessed by colorimetry of thiazolyl blue (MTT). Results Compared with normal control group, the mRNA and protein expression of TET2 in mesangial cells induced by high glucose was increased significantly in a time-dependent manner (all P＜0.05), but the expression of TET1 and TET3 was not affected. Meanwhile methylation rate of 4 CG sites from 24 h to 72 h were decreased in the first exon of TGF-β1 (P＜0.01), but not in the promoter. Compared with high glucose group, when the expression of TET2 was inhibited by SC1, the methylation rate of TGF-β1 was recovered evidently (P＜0.05), the mRNA and protein expression of TGF-β1 and α-SMA was suppressed, and the proliferation of mesangial cells was decreased (all P＜0.05). Conclusions Demethylation of the CpG island mediated by TET2 may play an important role in the expression of TGF-β1 and mesangial cell phenotype transformation induced by high glucose.     

电刺激小脑顶核对持续局灶性脑缺血时钙蛋白酶活性的影响

目的观察电刺激小脑顶核(FN)对持续局灶性脑缺血钙蛋白酶活性的影响,以阐明其神经保护作用机制。方法健康雄性Wistar大鼠,随机分为假手术组(PO)、FN刺激假手术组(PO-FN)、持续缺血组(PI)及持续缺血-FN刺激组(PI-FN),后两组又分为缺血1,3,6,12及24h组。建立大鼠电刺激FN及持续局灶性脑缺血模型,应用Western印迹半定量各组缺血核心区Mr=150000FBDP含量(表示钙蛋白酶活性),并应用尼氏体染色对缺血核心区神经元数量及形态进行分级评分。结果PO组及PO-FN组钙蛋白酶活性相似(P>0.05),处于低水平。PI组钙蛋白酶活性从缺血1h犤(3670±600)A/μg总蛋白犦开始即显著增高(t=6.338,P<0.001),以后随着缺血时间延长,钙蛋白酶活性不断增高,直至缺血24h犤(9180±360)A/μg总蛋白犦仍有持续增高趋势(缺血12,24h,t=14.673,16.632,P<0.001)。PI-FN组随着缺血时间的延长,钙蛋白酶活性从缺血1h犤(2510±460)A/μg总蛋白犦也开始增高,以后随着缺血时间延长,钙蛋白酶活性不断增高,但各时点组与其相应PI组相比,其增高程度明显减低,差别具有显著意义(缺血1,24h,t=1.875,2.134,P<0.05)。PO组及PO-FN组神经元形态及数量正常,评分均为0分。PI组从缺血1h(0.8±0.3)开始,神经元形态、数量即出现轻度改变,其评分增高(z=2.443,P<0.01),以     

Timing of surgical fixation in traumatic spinal fractures: A systematic review

BackgroundThe optimal timing of fracture fixation following spinal injury is controversial. Many spinal fractures occur as part of polytrauma requiring a complex management strategy. Whilst the decision to stabilize unstable spinal column injuries is without debate, the duration between injury and definitive fixation can impact on the incidence of post-operative complications. This study was designed to systemically summarize and compare the complication profile of early vs late stabilization of spinal injuries, in an attempt to unveil an appropriate treatment protocol for traumatic spinal fractures.MethodsA comprehensive search strategy was performed on the PubMed, Cochrane, and Google Scholar databases using key words. The search strategy provided 1120 results. Forty-six articles were reviewed for full-text. Reference lists were analysed for potential additional texts.ResultsSixteen articles met the inclusion criteria and were included for systematic review. Studies were controversial and the overall result was inconclusive. Several studies favour early stabilisation to reduce post-surgical complication rates, especially in cases of patients with high Injury Severity Scale (ISS) scores. However, this is challenged by a small number of studies reporting a higher mortality rate in the early-stabilisation cohort.ConclusionDue to limited studies and a small overall cohort, the authors would cautiously recommend the early surgical fixation of unstable spine fractures in the stable trauma patient. For severely injured patients, the discordance among literature warrants the need for further investigation.     

Subtalar Arthroereisis Implantation in Acquired Neuropathic Pes Planus: A Preliminary Report Detailing a Minimally Invasive Approach to Healing Medial Column Ulcerations

Ulcerations under the medial column in patients with acquired neuropathic pes planus may be intractable to conservative techniques such as regular debridement, offloading, bracing, and accommodative shoes. When surgery becomes necessary for these patients, the foot and ankle surgeon has the option of exostectomy, medial column beaming, medial column fusion, and external fixation, among others. In the case of a flexible midfoot collapse, the option of arthroereisis for indirect medial column support may be warranted. In this preliminary report, the authors detail a technique of Achilles tendon lengthening, arthroereisis implantation, and advanced cellular tissue product application in an attempt at wound coverage and prevention of recurrence. Three patients presenting with intractable medial column ulcerations of ∼1 year's duration underwent this procedure, and within 7 weeks (range 5 to 7), all medial column ulcerations healed. These patients remained healed at last follow-up (average 29 months; range 8 to 44). This preliminary report provides evidence for a minimally invasive procedure aimed at offloading, healing, and preventing recurrence of medial column ulcerations in patients with flexible neuropathic pes planus.     

骨盆骨折后血流动力学的变化

目的：探讨骨盆骨折后血流动力学的变化特点。方法：对进入急救部的18例严重骨盆骨折的患者经颈内静脉置入Swan-Ganz导管进行了动态的血流动力学监测，对死亡者和存活者血流动力学的变化特点进行了分析。结果：死亡者和存活者的血流动力学变化有明显的不同，死亡者7例均于入院后24h内死亡，经液体复苏后4～8h，职显著降低，MAP、CI显著升高，但10h之后MAP、CI又降低非常显著，MPAP、PCWP显著升高，CVP升高非常显著。存活者11例，经液体复苏后血流动力学逐渐平稳，复苏4～6h后职降低非常显著，MAP、CVP、MPAP、PCWP、CI均升高非常显著，16～24h之后血流动力学参数趋于稳定并逐渐回到正常范围。结论：经液体复苏后血流动力学难以稳定者死亡率高。     

不同年龄大鼠坐骨神经损伤后脊髓中神经生长导向因子Slit-1及Robo-2受体的表达变化

目的观察不同年龄大鼠坐骨神经损伤后,轴突导向因子Slit-1及其Robo-2受体在脊髓中的表达,以探讨不同年龄大鼠外周神经损伤后再生神经具有靶向性差异的可能机制。方法老年、成年和幼年大鼠各20只,建立左侧坐骨神经横断、硅胶管桥接模型。通过免疫荧光染色观察Slit-1蛋白和Robo-2受体在腰段脊髓中表达的变化,计算其荧光强度值,并进行统计学分析。结果伤后2周和4周,3组大鼠脊髓前角Slit蛋白均有较高表达,但各组间无显著差异。伤后2周和4周各组Robo-2受体表达均升高,其中老年鼠脊髓前角Robo-2受体表达明显高于成年和幼年组,差异有统计学意义(P0.05)。结论大鼠坐骨神经损伤后能刺激脊髓前角Slit-1高表达,不同年龄大鼠脊髓组织中Robo-2受体表达的差异可能决定了Slit-1在再生神经中的靶向性调节作用。     

依托咪酯与丙泊酚分别复合瑞芬太尼应用于无痛胃镜检查中的效果比较

目的探索和比较依托咪酯和丙泊酚复合瑞芬太尼应用于无痛胃镜检查中的效果和安全性。方法对2014年2-4月第三军医大学大坪医院消化科收治的328例行无痛胃镜检查的患者资料进行回顾性分析,比较依托咪酯组和丙泊酚组患者检查前、检查中、检查后的动脉血压、心率、氧饱和度及不良反应。结果依托咪酯组患者在检查前、检查中及检查后的血压稳定,效果明显优于丙泊酚组;依托咪酯组低血压发生率低于丙泊酚组;丙泊酚组患者苏醒程度相对依托咪酯组更加彻底。结论依托咪酯复合瑞芬太尼麻醉应用于无痛胃镜的检查,具有安全性高、起效快,对血压影响较小的特点,值得在临床推广。     

基于1H-MRS联合DTI定量检测2型糖尿病患者后扣带回损伤及其与认知功能的相关性

目的 联合运用¹H-MRS和DTI技术检测和评估2型糖尿病（T2DM）患者后扣带回（PCC）脑微结构损伤及脑代谢物异常改变,探讨其与认知功能障碍的相关性。方法 对43例T2DM患者[21例伴认知功能障碍（T2DM+CD组）、22例不伴认知功能障碍（T2DM组）]和23名健康志愿者（HC组）PCC进行单体素MRS及DTI检查,计算各代谢物波峰曲线下面积比值及各向异性分数（FA）、平均弥散率（MD）,并与认知功能指标进行相关性分析。结果 T2DM+CD组PCC脑区肌醇/肌酸（mI/Cr）值高于T2DM和HC组,谷氨酸复合物/肌酸（Glx/Cr）低于T2DM和HC组（P均<0.05）;Glx/Cr与蒙特利尔认知评估量表（MoCA）评分呈正相关（r=0.59,P<0.01）。T2DM+CD组全脑及PCC脑区FA值低于T2DM和HC组,MD值高于T2DM和HC组（P均<0.05）;FA值与MoCA评分呈正相关（r=0.57,P=0.01）。结论 以PCC为兴趣区联合采用¹H-MRS与DTI技术可定量反映T2DM引起认知功能损伤的神经病理学基础,有望成为早期预警的临床指标。     

解除颈动脉狭窄治疗轻度认知功能障碍的实验研究

目的:探讨不同程度颈动脉狭窄后能否导致认知功能障碍,解除颈动脉狭窄是否能减轻轻度认知功能障碍并与药物治疗进行比较。方法:62只SD大鼠制作不同程度的颈动脉狭窄模型,分别给予不同的治疗措施,4周后进行水迷宫行为学评价和事件相关电位P300检测,同时对各组颈动脉管腔横截面积狭窄率进行比较。结果:颈动脉狭窄组P300潜伏期、水迷宫实验潜伏期较假手术组显著延长(P<0·01)。狭窄解除4周后,狭窄解除组颈动脉管腔横截面积狭窄率显著低于相应狭窄对照组(P<0·01),P300潜伏期和水迷宫实验潜伏期也显著缩短(P<0·01)。重度狭窄解除组认识功能改善明显优于药物治疗组(P<0·01)。结论:颈动脉狭窄可导致认知功能障碍,解除颈动脉狭窄对轻度认知功能障碍有显著的治疗作用,且对重度狭窄的治疗作用优于药物治疗。