夹板与石膏管型外固定物治疗儿童前臂远端隆突样骨折的系统评价

背景：儿童前臂远端隆突样骨折一般无继发移位风险,文献报道可通过石膏管型、掌侧托、夹板、支具以及绷带等外固定物治疗获得满意疗效。但是不同外固定物治疗对患儿功能恢复及生活能力的影响并不明确。 目的：评价夹板与石膏管型外固定物治疗儿童前臂远端隆突样骨折的疗效和安全性。 方法：计算机检索Medline、Embase、Cochrane 图书馆(2011年第3期)及中国生物医学数据库、中国期刊全文数据库,检索时限为建库至2011年4月;手工检索相关会议论文;在线检索重要临床试验注册中心,文献检索无语种限制。收集随机对照及半随机对照试验,行质量评价并采用Revman 5.1行Meta分析。 结果与结论：纳入2项研究,包括314例患者,1项随机对照试验评价为B级,1项半随机对照试验评价为C级。结果表明,夹板与石膏管型外固定物治疗后均无骨折、骨折不愈合以及再骨折,患肢疼痛以及书写、绘画、自理饮食、洗漱4方面生活能力差异无显著性意义;而固定后患儿洗澡能力夹板组早期优于石膏管型组,后期差异无显著性意义。参加规律运动方面亦为夹板固定组优于石膏管型固定组。两种固定方法不良事件发生率比较差异无显著性意义。提示夹板与石膏管型外固定物治疗儿童前臂远端隆突样骨折后患肢疼痛无明显改善,但夹板固定有利于维持洗澡能力及参加规律运动,且安全性良好。但仍需设计良好、实施完善的大样本、多中心随机对照试验验证。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Occupational asthma related to low levels of airborne methylene diphenyl diisocyanate (MDI) in orthopedic casting work

Orthopedic plaster casts contain methylene diphenyl diisocyanate (MDI). A few case reports have suggested occupational asthma to MDI in casting work. However, the knowledge of the exposure levels related to the occupational asthma cases is lacking. We report on two occupational asthma cases due to MDI in nurses irregularly applying orthopedic plaster casts, verified with placebo controlled specific inhalation challenge. The levels of MDI in the air were measured in the exposure chamber during the specific inhalation challenges with a quantitative method including filter collection and subsequent liquid chromatography-mass spectrometry (LC-MS) analysis of the isocyanate groups. In order to estimate the level of airborne MDI in casting work, measurements were conducted also in two hospitals during the application and removal of synthetic plaster casts using the same method. The concentrations were well below the occupational exposure limit in both specific inhalation challenge and hospital measurements. Based on our findings, even minor exposure to airborne MDI in casting work can cause an asthmatic reaction in some patients.     

Accuracy of 3D Tooth Movements in the Fabrication of Manual Setup Models for Aligner Therapy

Background: The clinical outcome of aligner therapy is closely related to the precision of its setup, which can be manually or digitally fabricated. The aim of the study is to investigate the suitability of manual setups made for aligner therapy in terms of the precision of tooth movements. Methods: Six dental technicians were instructed to adjust each of eleven duplicate plaster casts of a patient models as follows: a 1 mm pure vestibular translation of tooth 11 and a 15° pure mesial rotation of tooth 23. The processed setup models were 3D scanned and matched with the reference model. The one-sample Wilcoxon signed-rank test (p < 0.05) was used for evaluation. Results: The overall precision of the translational movement covers a wide range of values from 0.25 to 2.26 mm (median: 1.09 mm). The target value for the rotation of tooth 23 was achieved with a median rotation of 9.76° in the apical-occlusal direction. Unwanted movements in the other planes also accompanied the rotation. Conclusions: A manual setup can only be fabricated with limited precision. Besides the very high variability between technicians, additional unwanted movements in other spatial planes occurred. Manually fabricated setups should not be favored for aligner therapy due to limited precision.     

距骨骨折治疗方法的选择及疗效分析

目的：探讨距骨骨折治疗方法的选择并分析其疗效。方法：1998年10月至2009年10月,共治疗距骨骨折患者44例,其中38例获得随访,男28例,女10例;年龄19-65岁,平均33．5岁。采用石膏外固定10例、切开复位内固定22例、I期Blair胫-距-跟融合术6例。按Matti—Weber分型：I型3例,Ⅱ型15例,Ⅲ型16例,Ⅳ型4例。采用Hawkins评定标准通过疼痛、关节活动度、有无跛行等方面进行疗效评估。结果：38例患者的平均随访时间为4．8年（1～11年）。按Hawkins标准,石膏外固定10例中,优4例,良2例,可3例,差1例。切开复位内固定22例中,优2例,良6例。可6例,差8例。其中结果为差的8例,术后3～5年,均实行了Ⅱ期关节融合术,1例术后患肢短缩3em,跛行,患者拒绝进一步治疗,评价为差,余7例效果均为可。I期Blair胫-距-跟融合术6例中,良1例,可4例,差1例。随访期内发现距骨缺血性坏死12例,创伤性关节炎13例。结论：距骨骨折并发症多见且预后欠佳。骨折损伤程度与预后相关。距骨骨折移位小于2mm宜石膏外固定;手法复位后骨折移位大于2mm应切开复位内固定;骨折合并距骨体全脱位或者关节面不能修复的粉碎骨折宜采用Blair胫-距-跟融合术。     

Assessment of the amount of tooth wear on dental casts and intra‐oral photographs

Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Many grading scales are available to assess the amount of tooth wear, one of which is the tooth wear evaluation system (TWES). A grading scale can be used chairside, on casts and on photographs. The aim was to test whether the grading scales of the TWES, used on casts and on photographs, resulted in comparable scores. In addition, it was tested whether these scales can be used to assess tooth wear reliably on photographs. Of 75 tooth wear patients, sets of casts and series of photographs were obtained and graded. Comparison of the grading on casts and on photographs revealed equal median values and percentiles for both occlusal/incisal grading and non‐occlusal/non‐incisal grading. The grading on casts and on photographs showed a high correlation for the occlusal/incisal grading and a low correlation for the non‐occlusal/non‐incisal grading (Spearman's rho = 0·74 and rho = 0·47; P < 0·001). Concerning the grading on photographs, the interexaminer reliability was fair‐to‐good (ICC = 0·41 to ICC = 0·55) while the intra‐examiner reliability was fair‐to‐good to excellent (ICC = 0·68 to ICC = 0·86) for the occlusal/incisal grading. For the non‐occlusal/non‐incisal grading, the interexaminer reliability was poor to fair‐to‐good (ICC = 0·22 to ICC = 0·59), while the intra‐examiner reliability was fair‐to‐good to excellent (ICC = 0·64 to ICC = 0·82). It was concluded that the scores obtained with the grading scales of the TWES on casts and on photographs are comparable. The grading scales can be used in a reliable way on photographs, which is especially the case for occlusal/incisal grading.     

Three-dimensional organization of the elastic fibres in the rat lung

Background: The elastic framework of the distal lung has been studied by light microscopy (LM) and transmission electron microscopy (TEM). The preservation of the elastic fibres, for the three-dimensional observation in their relative positions, is difficult because they lack support when the normal methods of tissue processing are used. The goal of the present study was to understand the three-dimensional ultrastructure and organization of the elastic fibres of the lung preserved in their relative positions. Methods: A combination of intravascular resin injection and formic acid digestion was used. The resin cast of the microvasculature acted as a scaffold to preserve the in vivo arrangement of the elastic fibres that are, otherwise, easily collapsible. Scanning electron microscopy (SEM) samples were further processed for TEM in order to confirm that the fibres were indeed components of the elastic system. Results: SEM demonstrated a fine framework of elastic fibres, representing remnants of the alveolar walls, with the casted capillaries interwoven with the network of elastin. Each individual elastic fibre is composed of a small bundle of discrete fibrils. Some of these fibrils emerge from the fibre and join other fibres, producing an anastomosing appearance. Several elastic fibres link the walls of the intrapulmonary conducting airways, the vessels walls and the alveolar network, thus establishing an interrelated and interlaced framework. Conclusions: The method we have applied to visualize the elastic fibres of the lung is a unique approach to define the spatial organization of the pulmonary elastic fibres. We have demonstrated here the close relationship between the elastic fibres and the capillaries of the septal alveoli. The arrangement of the interwoven network of elastin and its relationship with the capillaries offers the structural setting for the distending capacity of the alveolar wall. © 1995 Wiley-Liss, Inc.     

家兔卵巢血管立体构筑扫描电镜研究——甲基丙烯酸甲酯注射腐蚀铸型法

本文采用甲基丙烯酸甲酯注射腐蚀铸型方法研究了10只杂种雌性家兔卵巢微血管的立体构筑。从中看到间质、卵泡及黄体铸型的微血管是非常丰富的,营养卵巢的大血管从卵巢门穿入实质。而卵泡和黄体周围的毛细血管网从表面看卵泡和黄体整体都呈球状,并耒自卵巢内血管。卵泡和黄体毛细血管球周围的间隙内具有丰富弥漫的毛细血管网。初级卵泡壁的毛细血管球,起初为单层,随着生长发育成次级卵泡,其壁内的毛细血管球则迅速成为双层;内层为繁密的毛细血管网,外层为微动脉和毛细血管前动脉和微静脉。黄体体积较大,血管球表层仍为微动脉、毛细血管前动脉和微静脉。小动脉并深入到黄体内部构成致密的毛细血管网。     

Cotrel Traction, Exercises, Casting in the Treatment of Idiopathic Scoliosis: A Pilot Study and Prospective Randomized Controlled Clinical Trial

A pilot study of ten individuals with adolescent-onset idiopathic scoliosis demonstrated that a week of Cotrel traction and exercises did not improve curve correction obtained by the application of an elongation, derotation, flexion (EDF) cast. There was, however, a significant improvement in lateral bending correction during this period. A prospective, randomized, controlled clinical trial showed that the exercise programme and not the traction was responsible for rendering the spine less rigid.     

Peculiar structures of the blood vessels forming the secondary ossification center in the rat femoral heads

To investigate the development of the blood vessels forming the secondary ossification center in the femoral heads of growing rats, we observed the specimens of the proximal femurs having vascular casts using both an optical and a scanning electron microscopy (SEM). Histologically, the vascular invasion occurred from the lateral part of the cartilaginous epiphysis, prior to the appearance of the ossification center. The vascular casts were prominent within the cellular spaces consisting of a few hypertrophic chondrocytes. The SEM study suggested that the vascular buds had peculiar structures and invaded the cartilaginous epithysis by breaking through the cellular spaces. The blood vessels budded out from the arch of the lateral epiphyseal vessels toward the femoral heads. The sizes of the large-caliber vascular buds of about 50 m in diameter were similar to those of the cellular spaces, and they penetrated into the epiphysis by repeated merging and branching. Many deep impressions were noted on the surface of the vascular buds, and the tips showed the peculiar shape similar to a suction cup.     

Macroscopic Anatomy of the Saimaa Ringed Seal (Phoca hispida saimensis) Lower Respiratory Tract

We studied the macroscopic anatomy of the lower respiratory tract of the endangered Saimaa ringed seal (Phoca hispida saimensis). Examination of one adult and one young individual found dead showed that trachea had 85 and 86 complete cartilage rings. The adjacent cartilages exhibited very few random anastomoses. There was variation in the confirmation of the trachea between the cranial and caudal part of the trachea. The right lung was divided by partly incomplete inter‐lobar fissures into cranial, middle, caudal, and accessory lobes. The left lung consisted of cranial, middle, and caudal lobes. The lungs were characterized by a high amount of interlobular connective tissue. Silicone casts were prepared of the two specimens to visualize the tracheobronchial branching which was similar to that of marine ringed seals but in the Saimaa ringed seal the right middle lobar bronchus originated at the same level as the accessory lobar bronchus. Anat Rec, 299:538–543, 2016. © 2016 Wiley Periodicals, Inc.