地震挤压伤对肢体骨折术后伤口愈合影响的临床观察

目的：观察地震挤压伤对术后伤口愈合影响。方法：肢体在地震时曾被挤压而接受骨折内固定手术的患者28例为观察组；以地震时肢体未被挤压接受骨折内固定手术的患者27例为对照Ⅰ组，以同期本地骨折内固定手术的患者30例为对照Ⅱ组。分别检查尿常规、肌酸激酶、观察伤口并发症及伤口愈合情况。结果：各组尿颜色、尿常规、肌酸激酶没有明显差异，而观察组的伤口并发症、伤口愈合率与两个对照组均有差异。结论：地震挤压伤对术后伤口愈合有影响。     

Time-to-event analysis with artificial neural networks: An integrated analytical and rule-based study for breast cancer

This paper presents an analysis of censored survival data for breast cancer specific mortality and disease-free survival. There are three stages to the process, namely time-to-event modelling, risk stratification by predicted outcome and model interpretation using rule extraction. Model selection was carried out using the benchmark linear model, Cox regression but risk staging was derived with Cox regression and with Partial Logistic Regression Artificial Neural Networks regularised with Automatic Relevance Determination (PLANN-ARD). This analysis compares the two approaches showing the benefit of using the neural network framework especially for patients at high risk. The neural network model also has results in a smooth model of the hazard without the need for limiting assumptions of proportionality. The model predictions were verified using out-of-sample testing with the mortality model also compared with two other prognostic models called TNG and the NPI rule model. Further verification was carried out by comparing marginal estimates of the predicted and actual cumulative hazards. It was also observed that doctors seem to treat mortality and disease-free models as equivalent, so a further analysis was performed to observe if this was the case. The analysis was extended with automatic rule generation using Orthogonal Search Rule Extraction (OSRE). This methodology translates analytical risk scores into the language of the clinical domain, enabling direct validation of the operation of the Cox or neural network model. This paper extends the existing OSRE methodology to data sets that include continuous-valued variables.     

Clinician's perspectives on the treatment of venous leg ulceration

Treatment of venous leg ulcers (VLU) represents a considerable challenge to the health care professional and to the patient alike. Much of the current literature regarding VLU focuses on either wound pathophysiology and treatment of chronic venous insufficiency or the patients' experience of the condition. We present two studies that examine more closely the clinicians' experience of treating VLU and reflect upon how that understanding may further enhance better outcomes for patients in the future. The first of these studies is a qualitative investigation of 49 clinicians treating VLU in the UK and USA. The second is a quantitative, online survey of 304 clinicians' beliefs, attitudes and practices in the UK, Germany and USA. Findings show that the clinicians' experience of treating VLU is often accompanied by frustration and dissatisfaction with treatment challenges and uncertain outcomes. Practices and treatment choices were found to vary widely and differ by countries. We conclude that a key aspect in improving VLU treatment is in listening to the frustrations of the clinician when considering new approaches to therapy.     

愈痹丸质量标准的研究

目的 :为控制愈痹丸的质量 ,建立了阿魏酸的HPLC方法及有关药材鉴别方法。方法 :色谱条件为 :YMG -C184.6× 2 5 0mm ,以乙腈 - 0 .0 0 32mol/L四丁基氢氧化铵 (TBAH) (15 :85 )用 10 %磷酸调pH =2 .3为流动相 ,流速 1.0ml/min ;检测波长为 32 0nm。结果 :平均回收率 98.8% ,RSD =2 .10 %。结论 :此方法简便、灵敏、准确、重现性好 ,其它组分对测定无干扰 ,可用于该制剂的质量评价和质量控制     

Explorations on artificial time perception

In the field of biologically inspired cognitive systems, time perception, a fundamental aspect of natural cognition is not sufficiently explored. The majority of existing works ignore the importance of experiencing the flow of time, and the implemented agents are rarely furnished with time processing capacities. The current work aims at shedding light on this largely unexplored issue, focusing on the perception of temporal duration. Specifically, we investigate a rule switching task that consists of repeating trials with dynamic temporal lengths. An evolutionary process is employed to search for neuronal mechanisms that accomplish the underlying task and self-organize time-processing dynamics. Our repeated simulation experiments showed that the capacity of perceiving duration biases the functionality of neural mechanisms with other cognitive responsibilities and additionally that time perception and ordinary cognitive processes may share the same neural resources in the cognitive system. The obtained results are related with previous brain imaging studies on time perception, and they are used to formulate suggestions for the cortical representation of time in biological agents.     

Factors affecting healing after arthroscopic rotator cuff repair

Rotator cuff repair has been shown to have good long-term results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.     

弹性髓内钉与钢板置入修复儿童肱骨骨折的Meta分析

背景：对于弹性髓内钉和钢板内固定,选择何种方法修复儿童肱骨骨折疗效满意,目前尚未达成共识,且当前的研究仅限于小样本研究,很难做到大样本多中心治疗观察分析。 目的：用Meta分析的方法评价弹性髓内钉与钢板置入内固定车修复儿童肱骨骨折的疗效及安全性。 方法：计算机检索PubMed、EMbase、CBM、CNKI、VIP和万方数据库,并手工检索相关领域杂志,时间从建库至2014年8月。搜集关于弹性髓内钉与钢板置入内固定修复儿童肱骨骨折的对照研究,由2名评价员独立选择试验、提取资料,并进行质量评价。 结果与结论：最终纳入2项随机对照试验,3项回顾性队列研究试验。Meta分析结果显示,弹性髓内钉组内固定后功能恢复Constant肩关节评分高于钢板组(P < 0.01)。在骨折愈合时间、手术时间、瘢痕长度、术中出血量及住院时间等方面弹性髓内钉组少于或小于钢板组(P < 0.01)。在并发症发生率方面,骨不连发生率、切口感染和骨折延迟愈合等方面两组差异无显著性意义(P > 0.05)。现有证据表明,弹性髓内钉置入内固定修复儿童肱骨骨折疗效优于钢板内固定,在并发症发生率方面两种方法差异无显著性意义,但由于研究文献均为小样本和高偏倚风险的原始研究,建议今后开展样本量充足、设计合理、执行严格的临床试验进一步评价。 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：     

腓骨内固定修复胫骨干远端1/3骨折：可明显改善胫骨外翻畸形及踝关节功能

背景：胫腓骨干骨折是四肢骨干骨折中最常见的骨折类型,对于腓骨固定在胫骨干远端骨折的临床意义,一直存在争论,各研究报道也不尽相同。 目的：探讨腓骨内固定在胫骨干远端1/3骨折修复中的临床意义。 方法：回顾性分析2006年1月至2010年3月于海洋石油总医院骨科治疗的64例胫骨干远端1/3骨折患者的临床资料,根据是否固定腓骨分为两组,其中腓骨固定组36例,腓骨非固定组28例。比较两组患者的骨折愈合率、骨折愈合时间及胫骨外翻角,根据Merchant-Dietz标准评估对比两组的踝关节活动度及踝关节功能评分。 结果与结论：两组患者的骨折愈合率、骨折愈合时间、踝关节活动度差异无显著性意义;腓骨固定组的胫骨外翻角(5.42±1.16)°小于腓骨非固定组(7.54±1.90)°,差异有显著性意义(P=0.006);腓骨固定组踝关节功能评分(93.58±0.97)分高于腓骨非固定组(90.57±3.92)分,差异有显著性意义(P=0.000)。腓骨固定组中3例伤口浅部感染,抗炎换药后愈合良好。提示在胫骨干远端1/3骨折治疗中,腓骨内固定可明显缩小胫骨外翻角,改善踝关节功能。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     

不同置钉方式修复中青年移位型股骨颈骨折：复位质量及股骨头坏死率对比

背景：股骨颈骨折闭合复位与切开复位的关键区别就在于是否切开关节囊,对于这个问题国内外学者抱有不同的意见,目前尚无统一结论。 目的：比较切开复位与闭合复位置钉内固定修复中青年移位型股骨颈骨折的复位质量及股骨头坏死率。 方法：分析2008年6月至2014年6月在贵州省骨科医院创伤科就诊且获得完整随访的102例中青年股骨颈骨折患者的临床资料,根据复位方式分为两组,切开复位组39例,闭合复位组63例。对比两组患者的一般资料、治疗后骨折愈合情况、股骨头坏死率及复位质量。 结果与结论：两组患者的一般资料、治疗前后血红蛋白差值、骨折愈合时间及骨折不愈合率相比,差异均无显著性意义(P > 0.05)。切开复位组的股骨头坏死率低于闭合复位组,复位质量高于闭合复位组,差异有显著性意义(P < 0.05)。提示切开复位置钉内固定修复中青年移位型股骨颈骨折的股骨头坏死率较低,复位质量好。尽管表明切开复位有一定优势,但病例数量以及病例研究仍有一定限制,应根据患者病情选择合适的复位修复方式。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