维生素C对TNF-α及血清剥夺诱导的人髓核细胞凋亡的作用

目的探讨维生素C(Vitamin C,Vit C)在TNF-α及血清剥夺诱导人椎间盘髓核细胞凋亡中的作用及机制。方法取脊柱矫形手术患者的髓核组织,消化法获得正常髓核细胞,取第3代细胞按不同处理因素分为Vit C作用组(A组)、TNF-α诱导组(B组)和血清剥夺组(C组),每组再分为以下亚组:A组分为A1组(基础培养液)、A2组(100μg/m L Vit C)、A3组(200μg/m L Vit C);B组分为B0组(对照组)、B1组(100 ng/m L TNF-α)、B2组(100μg/m L Vit C+100 ng/m L TNF-α)、B3组(200μg/m L Vit C+100 ng/m L TNF-α);C组分为C0组(对照组)、C1组(FBS浓度由8%降低为2%)、C2组(2%FBS+100μg/m L Vit C)、C3组(2%FBS+200μg/m L Vit C)。各组作用24 h后,采用流式细胞术检测各组膜联蛋白V、碘化丙啶双染后髓核细胞凋亡率;实时荧光定量PCR检测p53(基因编码相对分子质量为53×103的蛋白质)、脂肪酸合成酶(fatty acid synthase,FAS)、半胱氨酸天冬氨酸蛋白酶3(Caspase3)、Ⅰ型胶原、Ⅱ型胶原、Sox9和糖胺多糖(Aggrecan)m RNA表达。结果 A组:与A1组比较,A2、A3组的Vit C均能降低髓核细胞凋亡及p53、FAS、Caspase 3 m RNA表达(P0.05),但A2、A3组间比较差异无统计学意义(P0.05);A2、A3组的Vit C可促进髓核细胞Ⅰ型胶原、Ⅱ型胶原、Aggrecan、Sox9 m RNA表达,且A3组促进作用显著大于A2组(P0.05)。B组:与B0组比较,B1组TNF-α促进了髓核细胞凋亡,增加了髓核细胞p53、FAS、Caspase 3 m RNA表达(P0.05);与B1组比较,B3组的Vit C能降低髓核细胞凋亡及p53、FAS、Caspase 3 m RNA表达,而B2组的Vit C则增加其凋亡及p53、FAS、Caspase 3 m RNA表达,差异均有统计学意义(P0.05)。C组:与C0组比较,C1组2%FBS能诱导髓核细胞凋亡,但降低了髓核细胞p53、FAS、Caspase 3 m RNA表达(P0.05);与C1组比较,C3组的Vit C能降低髓核细胞凋亡及p53、FAS、Caspase 3 m RNA表达,而C2组的Vit C则增加其凋亡及p53、FAS m RNA表达,差异有统计学意义(P0.05)。结论 Vit C能延缓或降低髓核细胞凋亡、促进细胞外基质合成与分泌,200μg/m L Vit C可延缓或降低100 ng/m L TNF-α和2%FBS诱导的凋亡,而100μg/m L Vit C则促进其诱导的凋亡。     

关节镜下半月板成形缝合术治疗盘状半月板损伤的近期疗效研究

目的评价关节镜下半月板成形缝合术治疗盘状半月板损伤的近期疗效。方法回顾性研究本组行单侧膝关节镜下半月板成形缝合术的盘状半月板患者,47例随访超过12个月,评价半月板撕裂类型和稳定性,其中稳定型34例、不稳型13例,根据撕裂、不稳部位使用Fas T-Fix、MM-Ⅱ缝合器缝合,比较术前、术后和稳定型、不稳型盘状半月板的膝关节活动度、Lysholm评分和IKDC评分。结果盘状半月板损伤关节镜下半月板成形缝合术患者膝关节活动度由术前(121±11)°提高到术后(133±7)°,Lysholm评分由术前(72±7)分提高到术后(93±4)分、IKDC评分由术前(65±5)分提高到术后(86±7)分,稳定型和不稳型的术后活动度、Lysholm评分、IKDC评分无统计学差异。结论关节镜下半月板成形缝合术能够有效治疗盘状半月板损伤,取得满意的近期疗效;合理缝合治疗不稳型盘状半月板早期临床效果与稳定型盘状半月板相同。     

不稳定性肩胛骨骨折的手术治疗与入路选择分析

目的探讨不稳定性肩胛骨骨折的手术治疗及手术入路选择。方法2004年7月-2009年7月治疗不稳定性肩胛骨骨折患者25例,其中开放性骨折取原伤口入路,闭合性骨折分别取肩关节前侧、肩胛骨后侧、肩胛骨外侧缘入路,骨折复位后运用重建钢板、螺钉、钢丝等进行固定。结果所有患者均获随访,随访时间3～20个月,平均11个月。术后复查x线片显示复位满意。根据Hardegger功能评定标准,优18例,良6例,可1例,优良率为96％。结论对不稳定性肩胛骨骨折选择合适的手术入路和固定方法,辅以早期功能锻炼,疗效满意。     

Serial Monitoring of Co-stimulating Signals in Double Hand Allograft: A Case Report

Aims

The aim of this study was to evaluate the clinical significance of serial monitoring of co-stimulating signals in double hand transplantation.

Methods

From September 2001 to December 2001, a patient who had double hand transplantation in our hospital was the subject of the experiment. Before the operation, a blood sample was collected before giving an immunodepressant and twice after giving the immunodepressant. A blood sample was also collected before arteriovenous connection during the operation, as well as once a day during the first week after the operation, once every other day in the second week, twice a week in the third and fourth week, followed by once a week for 2 months. The first week after operation was taken as the induction period with the other samples as the maintenance period. Then 2 mL peripheral venous blood collected from a healthy adult was anti-coagulated using EDTA of mass scores of 20 g/L. Flow cytometry was used for serial monitoring of T-cell surface co-stimulating molecules (CD28, CD54, and CD11a).

Results

The changes in the 3 co-stimulating molecules—CD28, CD54, and CD11a—were consistent with each other after double hand transplantation, displaying a decrement during induction compared with preoperatively: 9.84 ± 5.28%, 55.50 ± 3.62%; 71.03 ± 5.33% versus 95.10 ± 1.26%; 9.40 ± 9.17%, 29.70 ± 3.23% with low levels during maintenance 22.54 ± 6.56%, 91.28 ± 8.12%, 11.22 ± 4.08%.

Conclusion

The serial monitoring of the co-stimulating signals in the peripheral blood of limb allograft patients may be beneficial to evaluate postoperative immunologic reactions to guide immunosuppression as well as predict and diagnose postoperative immune rejection.     

瘦素对体外培养软骨细胞分泌NO和MMP-13的影响

目的:观察瘦素对体外培养兔关节软骨细胞分泌一氧化氮(NO)和基质金属蛋白酶-13(MMP-13)的影响。方法:获取2月龄兔原代软骨细胞,培养、鉴定、传代。将第3代软骨细胞按实验要求种板培养,饥饿12 h后,以不同浓度瘦素单独或与 TNF-&agr;联合干预48或96 h,测定各组细胞上清液中NO及MMP-13的浓度。结果:不同浓度瘦素(5,10,15和20 μg/mL)组NO浓度与空白对照组差异无统计学意义(P>0.05);而不同浓度的瘦素与TNF-&agr;(10 ng/mL)联合应用后,与TNF-&agr;组差异有统计学意义(P<0.05)。空白对照组并未测出MMP-13的存在,不同瘦素浓度(10,50和100 ng/mL)组测得MMP-13浓度在剂量主效应和时间主效应均有统计学意义(P<0.05)。结论:瘦素在体外能协同TNF-&agr;促进兔关节软骨细胞分泌NO和MMP-13。     

胸椎经横突-椎体固定术在脊柱侧凸治疗中的应用

目的：探讨胸椎经横突-椎体固定术治疗脊柱侧凸的临床价值.方法：对53例脊柱侧凸患者行术前CT扫描,观测椎弓根形态变化及椎体旋转程度,对过窄或变形严重的胸椎椎弓根行经横突-椎体内固定术,并观察其手术疗效.结果：53例脊柱侧凸患者共86个胸椎弓根过窄或严重变形不适合经椎弓根内固定,其中椎弓根窄细39个、椎弓根风吹样变28个、椎弓根不规则变形19个.均行经横突-椎体内固定术,侧凸畸形矫正良好,无神经并发症发生.术后3个月、6个月及1年随访,未见明显矫正度丢失,未见断钉断棒及螺钉松动.结论：应用经横突-椎体内固定技术治疗脊柱侧凸,手术操作简单安全、固定牢固可靠,尤其适用于胸椎椎弓根过窄或变形严重的侧凸患者.     

Prognostic factors for unfavorable outcome after mild traumatic brain injury. A review of literature

BackgroundUnfavorable outcomes occur in 15–20% of patients with mild traumatic brain injury (mTBI). Early identification of patients at risk of unfavorable outcome is crucial for suitable management to be initiated, increasing the chances of full recovery. Many studies have been published on prognostic factors, but are not of a high level of evidence and certainty. A number of factors have been proposed and predictive models have been constructed that, although attractive, have not yet been externally validated.ObjectivesA review of literature (systematic search of PubMed and Google Scholar) assembled relevant available information about prognostic factors for unfavorable outcome after mTBI. We discuss the consistency of these findings, and the possibility and difficulty of using these factors in a daily practice.ResultsIt appears that the strongest and most consistent predictors are the number, severity and duration of symptoms present in the first few days after the trauma.     

老年髋部骨折患者术后髋关节功能恢复的影响因素及股骨颈强度指数和骨髓脂质分数的预测价值

目的 研究老年髋部骨折患者术后髋关节功能恢复的影响因素及股骨颈强度指数（FSI）和骨髓脂质分数（LF）的预测价值。方法 选取2016年10月—2019年2月河北省沧州中西医结合医院176例老年髋部骨折手术患者,参考Harris髋关节评分标准,分为恢复良好组90例,恢复不佳组86例。采用回顾性研究方法观察术后两组患者相关资料,监测FSI和LF变化,采用Logistic回归分析老年髋部骨折患者术后髋关节功能恢复的影响因素;绘制受试者工作特征（ROC）曲线,明确FSI和LF变化对老年髋部骨折患者术后髋关节功能恢复的早期预测价值。结果 恢复良好组患者年龄、骨折部位、基础疾病、巴塞尔评定、术后并发症、术后关节康复训练与恢复不佳组患者比较,差异有统计学意义（P <0.05）。恢复良好组患者术后3个月与术前的FSI和LF差值均大于恢复不佳组患者（P <0.05）。多因素Logistic回归分析结果显示：基础疾病■、巴塞尔评定■、术后并发症■,以及术后3个月的FSI■是影响老年髋部骨折患者术后髋关节功能恢复的风险因素（P <0.05）,术后关节康复训练■是其保护因素（P <0....