骨形态发生蛋白2基因治疗与缓释载体修复骨缺损的比较研究

[目的]比较骨形态发生蛋白2（BMP-2）基因治疗与生长因子缓释方法修复节段性骨缺损效果。[方法]于兔双侧桡骨中段造成1．5cm骨缺损，采用4种方法修复：A组植入转基因骨髓间质干细胞（MSCs）与PLA／PCL（聚乳酸／聚己内酯）支架的复合物；B组植入单纯MSCs与含重组BMP-2的PLA／PCL缓释载体的复合物；C组植入单纯MSCs与PLA／PCL复合物；D组植入单纯PLA／PCL。术后4、8、12周行X线、组织学、生物力学和骨密度等检测，[结果]A组体内植入4周后，成骨细胞和间质细胞呈BMP-2强阳性表达；其成骨速度及成骨质量均明显优于B组，12周时骨缺损完全修复、C组成骨能力较弱，而D组则无新骨形成，残留骨缺损。[结论]BMP-2基因治疗是修复节段性骨缺损的好方法。     

手术治疗臀肌挛缩症48例临床分析

目的 介绍应用手术治疗臀肌挛缩症的经验，并对治疗结果进行评估。方法 取臀部后外侧纵切口，彻底松解挛缩增厚的臀肌，术后6d开始进行功能锻炼，循序渐进。结果 48例中，优28例，良10例，可2例，差8例，优良率为79．17％；随访时间6个月～4年(平均17个月)。其中2例松解过度，8例刀口感染。结论 臀肌挛缩症患需手术治疗，手术对挛缩的臀肌进行彻底的松解，术后适时适度的进行功能锻炼，可达到较理想的疗效。     

琥珀酸美托洛尔缓释片在高龄合并快速永久性心房颤动治疗中的有效性和安全性分析

目的分析琥珀酸美托洛尔缓释片在高龄合并快速永久性心房颤动治疗中的有效性和安全性。方法选取70岁以上伴有快速永久性心房颤动40例。在基础治疗上加用小剂量酒石酸美托洛尔片逐渐达到靶剂量,2周后按照1∶1更换为琥珀酸美托洛尔缓释片,继续观察2周。分别记录患者症状、清晨静息心率,检查B型尿钠肽、动态心电图及动态血压并进行分析。结果琥珀酸美托洛尔缓释片的治疗靶剂量为（66.25±18.75） mg。患者在琥珀酸美托洛尔缓释片治疗后症状、24 h平均心率、清晨静息心率、24 h平均血压、B型尿钠肽均较用药前明显改善,差异有统计学意义(P<0.05)。琥珀酸美托洛尔缓释片当使用到靶剂量时最长R-R间期无明显延长,患者未出现不适症状。结论在高龄合并快速永久性心房颤动治疗中,琥珀酸美托洛尔缓释片有着良好的临床疗效和安全性,值得临床应用。     

LCPT once‐daily extended‐release tacrolimus tablets versus twice‐daily capsules: a pooled analysis of two phase 3 trials in important de novo and stable kidney transplant recipient subgroups

African‐American and elderly kidney transplant recipients (KTR) have increased risk for poor clinical outcomes post‐transplant. Management of immunosuppression may be challenging in these patients and contribute to worse outcomes. A novel once‐daily formulation of tacrolimus (LCPT) has demonstrated noninferiority, similar safety, improved bioavailability, a consistent concentration time profile, and less peak and peak‐trough fluctuations vs. tacrolimus twice‐daily (Tac BID). This pooled analysis of two phase 3 randomized, controlled trials, including 861 (LCPT N = 428; Tac BID N = 433; 38% of patients were stable KTR, and 62% were de novo KTR) patients, examined the efficacy of LCPT in KTR subgroups (blacks, females, and age ≥65). Overall, treatment failure [death, graft failure, centrally read biopsy‐proven acute rejection (BPAR), or lost to follow‐up] at 12 months was as follows: LCPT: 11.9%, BID Tac: 13.4% [?1.48% (?5.95%, 2.99%)]. BPAR rates were as follows: LCPT: 8.2%, Tac BID: 9.5% [?1.29% (?5.14%, 2.55%)]. Numerically, fewer treatment failure events with LCPT were found in the majority of subgroups, with significantly less treatment failure associated with LCPT among black KTR [?13.82% (?27.22%, ?0.31%)] and KTR ≥65 [?13.46% (?25.27%, ?0.78%)]. This pooled analysis suggests numerically lower efficacy failure rates associated with LCPT among high‐risk subgroups, in particular black KTR and KTR ≥65 years old.     

3D打印载PaMZ/BMP-2的nHA抗结核人工骨在体内成骨效果及药物缓释性能研究

【摘要】 目的：评估3D打印的载普托马尼（Pa）、莫西沙星（M）、吡嗪酰胺（Z）组合抗结核药物（PaMZ）和骨形态发生蛋白-2（bone morphogenetic protein-2,BMP-2）的纳米羟基磷灰石（nano-Hydroxyapatite,nHA）抗结核人工骨在体内的成骨效果及药物缓释性能。方法：取40只新西兰兔,随机分为4组,每组10只,构建脊柱骨缺损模型。其中A组植入载PaMZ/BMP-2的nHA人工骨（实验组）;B组植入空白nHA人工骨（阴性对照组）;C组植入自体髂骨（阳性对照组）;D组不植骨（空白组）。观察动物一般情况,监测体温、体重、肝肾功能;术后4、8、12周行螺旋CT三维重建观察骨缺损修复情况,并进行CT-Hedberg评分;术后8、12周行组织大体观察及植入物-骨缺损界面组织病理学观察。取SD大鼠100只,随机分为2组,实验组植入载PaMZ/BMP-2的nHA人工骨,对照组植入空白nHA人工骨,采用高效液相色谱法分别检测材料周围肌肉组织和血浆中术后不同时间点的药物浓度。结果：所有动物模型构建成功,无切口感染、死亡等情况发生。兔模型中各组动物的体温、体重及肝肾功能指标正常,组间比较均无统计学差异（P＞0.05）;CT-Hedberg评分显示在术后4、8、12周时,A组与C组相比均无统计学差异（P＞0.05）,其余各组间在不同时间点相比均存在统计学差异（P<0.05）。大体标本显示12周时A组人工骨完全被新骨包埋或替代,但B组仍有部分人工骨裸露。对植入物-骨缺损界面的骨小梁总面积定量分析显示在术后8、12周时,A组和C组相比无统计学差异（P＞0.05）,其余各组间相比均有统计学差异（P＜0.05）。SD大鼠模型对照组未测出药物成分,实验组Pa、M、Z三种药物在局部组织中均能缓释至少84d,血药浓度在植入载药人工骨后的初始时间点未测出,随后测得结果远低于局部组织药物浓度,二者具有正相关关系。结论：载PaMZ/BMP-2的nHA人工骨在体内具有良好的成骨性能,修复脊柱骨缺损的效果与自体髂骨相当,优于单纯的nHA人工骨支架;其在体内的缓释性能满意,血药浓度远低于局部组织药物浓度。     

End-of-Skin Grafts in Syndactyly Release: Description of a New Flap for Web Space Resurfacing and Primary Closure of Finger Defects

Treatment of syndactyly necessitates creation of neo-web space and separation of fingers. Traditionally, this has been done by use of flaps taken from the dorsum; the resultant raw areas thus created have been managed by use of skin grafts. The classical teaching has been that the separated fingers will need skin graft as primary closure is not possible. The skin grafts have a tendency to contract and lead to finger flexion contractures and “creep” of the web space. We describe a flap based upon subcutaneous tissue in the web that is moved in a V–Y fashion to resurface the neo-web. The flap donor site can easily be closed primarily. The fingers are then separated; the subcutaneous fat is carefully removed from the finger flaps under magnification to allow primary closure of the finger defects. It has been possible to primarily close the donor site and fingers in all the patients. The procedure has been used in seven patients with 14 web releases. The age varied between 10 months to 3 years. The V–Y advancement flap based upon the subcutaneous pedicle in the region of the web allows adequate creation of a new web space. The careful de-fattening of skin flaps allows the separated fingers to be closed primarily.     

The use of peripheral nerve blocks at the elbow for carpal tunnel release

This case report illustrates that median, radial, and ulnar nerve blocks at the elbow provides anesthesia for ambulatory carpal tunnel release surgery. This report discusses 3 patients with medical conditions, including vascular access problems and morbid obesity, which made nerve blocks at the elbow advantageous compared with other anesthetic techniques. Peripheral nerve blocks at the elbow were done before surgery in a block room, so the patients spent less time in the operating room. Nerve blocks at the elbow are effective anesthesia for hand procedures with no patient requiring further local anesthetic injection and opioids for pain or expressing any discomfort during surgery. The blocks are easy to perform and set up quickly, and using long-acting local anesthetics, elbow blocks provide postoperative pain control for approximately 10 hours. The nerve blocks at the elbow facilitate the perioperative process by being done out of the operating room and providing prolonged pain control without the need for opioids, so nausea may be avoided.     

Lateral retinacular release during primary total knee arthroplasty: effect on outcomes and complications

Intraoperative lateral retinacular release performed during primary total knee arthroplasty (TKA) can improve patellar tracking. This study compares the outcomes of patients who did and did not have lateral retinacular release during primary TKA. One thousand one hundred eight consecutive primary TKAs were reviewed. Lateral release was performed on 314 patients; 794 patients did not undergo release. Comparisons of range of motion, Knee Society Score, and postoperative complications were made between the 2 groups. At an average follow-up of 4.7 years, no statistically significant difference in range of motion, Knee Society Score, or postoperative complications of patella fracture, subluxation, postoperative manipulation, or wound complications was demonstrated. Lateral retinacular release to achieve improved patellar tracking does not compromise the clinical outcomes or complication rate of primary TKA.     

齐墩果酸-纳米碳酸钙固体分散体的制备及评价研究

目的?制备齐墩果酸-纳米碳酸钙固体分散体,以期提高齐墩果酸的溶出度。方法?以纳米级碳酸钙为载体,采用溶剂法制备齐墩果酸固体分散体,采用扫描电镜分析(SEM)、差示量热扫描分析(DSC)和X-射线衍射分析对固体分散体进行物相表征,并对其体外溶出行为进行考察。结果?分析显示齐墩果酸在固体分散体中以无定形态存在,体外溶出结果表明,齐墩果酸-纳米碳酸钙（1∶2,w/w）60?min的累积溶出度达到83.30%,显著高于齐墩果酸原料药。结论?将纳米碳酸钙作为齐墩果酸固体分散体的载体,能显著提高齐墩果酸的体外溶出度。      

iRGD靶向声学脂质体在类风湿关节炎诊疗中的作用

目的 制备集治疗与成像为一体的载甲氨喋呤(MTX)和吲哚菁绿(ICG)iRGD靶向载药声学脂质体(iRGD-MTX-ICG-ELIP),观察其靶向性及联合低频超声体外抑制滑膜细胞(MH7A)增殖的效果.方法 采用薄膜水化法和冷冻冻干法制备iRGD-MTX-ICG-ELIP,检测其一般特性及声学响应性,通过细胞摄取实验验证iRGD-MTX-ICG-ELIP的体外靶向结合性能,构建类风湿关节炎小鼠模型,通过靶组织的药物荧光强度验证iRGD-MTX-ICG-ELIP的体内靶向性;CCK8法检测iRGD-MTX-ICG-ELIP联合超声体外抑制MH7A增殖的效果.结果 制备的iRGD-MTX-ICG-ELIP粒径为134.4±17.6 nm,电位为-10.07± 4.28 mv,iRGD-MTX-ICG-ELIP中MTX和ICG的包封率分别为(62.56±0.77)%和(95.13±0.82)%;其联合低频超声控释药物发现,随超声作用强度增加和作用时间的延长,MTX与ICG释放均增多.细胞摄取实验表明血管内皮细胞HUVECs对iRGD-MTX-ICG-ELIP的摄取效率比对MTX-ICG-ELIP摄取效率高1.89倍,差异有统计学意义(P<0.05),活体成像实验显示iRGD-MTX-ICG-ELIP在RA发病关节的荧光强度明显强于非靶向组;CCK8检测结果显示,iRGD-MTX-ICG-ELIP联合超声组的MH7A存活率为(32.49±3.04)%,与未联合超声组比较差异有统计学意义(P<0.05).结论 本研究制备的iRGD-MTX-ICG-ELIP粒径小、均一性好,对HUVECs和RA病变关节组织具有较好的靶向性.较佳的药物包封率和声学响应性增强了iRGD-MTX-ICG-ELIP联合超声抑制MH7A的增殖作用,为后续更精准有效的治疗类风湿关节炎提供前期基础.