Unreamed femoral nail with spiral blade in subtrochanteric fractures: experience of 55 cases

OBJECTIVE: To evaluate the use of the unreamed femoral nail with spiral blade (UFN-SB) in the treatment of subtrochanteric femoral fractures. DESIGN: A retrospective review of a consecutive series of 55 fractures. Fourteen patients had metastatic disease (four had prophylactic nailing). RESULTS: In five fractures, the UFN-SB failed: there was migration in three cases and breakage of the spiral blade in two cases, with breakage of the nail in two cases. Revision surgery was necessary in four cases. Five out of seven complications related to the spiral blade were seen in patients with a Seinsheimer fracture Type IIC or V. All other fractures healed within 1 year including those that needed revision surgery. In two cases the end result was THR. CONCLUSIONS: No complication was observed in pathological fractures, which may be because of a high mortality in the first 4 months after surgery due to co morbidity. The main advantage of the nail seems to be its ease of use. It can be inserted through a small incision. The options in spiral blade angle insertion make it a very versatile implant. The implant should probably not be used in Type IIC or V (Seinsheimer) fractures.     

Maternal stress differently alters nociceptive behaviors in the formalin test in adult female and male rats

The long-term effects of restraint stress in Wistar rats during the last week of gestation were investigated on the acute and tonic phases of the specific biphasic nociceptive behavioral response in the formalin test in offspring, females and males, at 90 days. Prenatal stress produced significant changes in formalin-induced pain, which was more pronounced in females as compared to males. The distorted response in females was more at the supraspinal level with an increased intensity of the licking response in both phases as well as with an increased their duration. Results concerning changes of the interphase length indicate the impairments of inhibitory mechanisms in the central nervous system. Furthermore, profound difference in the effects of prenatal stress on the first phase but similarity in these effects on the second phase in females and males are indirect strong support of the view that the second phase in the formalin test can not be mediated by central sensitization alone but greatly depends on signals ongoing from nociceptive primary afferents. Finally, the results obtained in males are important argument in favor of assumption about different mechanisms of acute and tonic pain. Taken together, these studies show that prenatal stress alters nociceptive behaviors in the formalin test in rats at 90 days in a sex-specific manner.     

Visualization of proliferating cells in the adult mammalian brain with the aid of ribonucleotide reductase

Proliferating cells are hardly detectable in the adult mammalian brain by microscopy of stained sections, but after pre-labeling with radioactive thymidine or 5'-bromo-2-deoxyuridine (BrdU), either marks the nucleus, as do mitosis-related proteins such as Ki67 and PCNA. Engineered virus may also be used to mark proliferating cells. One alternative approach is to use the enzyme ribonucleotide reductase (RNR), expressed by proliferating cells, but not by quiescent ones. A monoclonal antibody against the M1 subunit of RNR was used to visualize proliferating cells in the brains of adult normal rats, rabbits, pigs and sheep. Stem cells were distinctly outlined. In the subgranular layer in the hippocampal dentate gyrus, most RNR immunoreactive cells were bipolar to multipolar, and had a large cell body and long processes. Two different populations of RNR expressing cells were visualized in the subventricular zone in the forebrain, one dominated by small, bipolar cells extending into the rostral migratory stream, while the other was formed by large multipolar cells, adjacent to the ependyma, with processes extending to the lateral ventricle. Furthermore, rare RNR-expressing cells were recognized throughout the brain. The RNR immunoreactive cells were immature, as they did not express any marker characterizing differentiated neurons and glial cells, except for a fraction that co-expressed the gliofibrillary acidic protein. BrdU and RNR were co-localized in proliferating cells in animals pretreated with BrdU. We conclude that RNR immunohistochemistry can accurately visualize proliferating cells, including stem cells, in adult mammalian brains. The occurrence of processes at cell proliferation is elucidated. Further, the advocated approach does not require any pre-labeling, and can be carried out on fixed tissues.     

成人药学教育中教学质量标准及课程体系的构建

通过对成人药学教育质量标准的分析，从投入、过程、效果三个方面入手，确立成人药学教育质量标准。在质量标准的指导下，分析成人药学教育课程体系现状，探讨成人药学教育课程体系的构建原则，构建具有学校特色和成人特色的药学课程体系。     

深圳市原住居民和户籍移民病残子女病种差异和成因研究

目的了解深圳市原住居民与户籍移民病残子女病种差异，并探寻形成差异的原因和干预措施。方法将深圳市人口计生局病残儿医学鉴定小组过去五年鉴定的病残儿分父母均为原住居民（双原住）、父母中一方为原住居民，另一方为广东省内外户籍移民（单原住）、父母均为广东省外户籍移民（双省外）、父母均为广东省内户籍移民（双省内）、父母中一方为广东省内，另一方为省外户籍移民（单省内）共五组。对五组患儿遗传病及7类非遗传病构成比进行比较，并通过调查表或电话咨询收集与致残原因有关的数据进行分析。结果2003年1月～2007年12月，深圳全市病残儿鉴定总数566例，其中遗传病29例，七成为地中海贫血症；非遗传病537例，例数最多的是神经系统、畸形／变形和精神行为障碍类疾病。五组的遗传病与非遗传病构成比无显著差异（x2=7．655，P=0．105）。非遗传病中，双原组的畸形／变形类疾病构成比排位领先于其他组，该组母亲文化程度低，孕保健意识较弱。双省外组的精神行为障碍类疾病构成比排位领先于其他组，且患儿多数由父母单独抚养。结论努力提高深圳市原住居民育龄夫妇的文化素质，普及优生知识，提倡适龄生育，孩子出生后父母应尽早与其接触交流，妇幼保健机构要重视提高从事产前诊断超声医师的诊断水平，有利于减少某些出生缺陷的发生。     

四川省城市居民卫生需求影响因素分析

目的：对影响四川省城市居民卫生需求的因素进行研究；方法：采用多元logjstic回归分析法对四川省城市卫生服务调查数据进行相关分析；结果：影响四川省城市居民住院需求的因素为人均收入、年龄、职业、慢性病患病情况、两周患病；影响四川省城市居民门诊需求的因素有年龄、性别、职业、商业保险、慢性病患病情况、两周患病情况；并在此基础上建立了住院需求和门诊需求预测模型。     

预诱导提高成年动物肝细胞胆红素代谢活性

目的 探讨经苯巴比妥钠(phenobarbital sodium,PBS)体内预诱导的成年动物肝细胞(adult animal hepatocytes,AAH)在体外时能否提高对胆红素的代谢活性,为体外生物人工肝支持系统(extracorporeal bioartificial liver support system,EBLSS)寻求更佳的生物材料.方法 12只成年雄性小白鼠平均体重34g,随机分为预诱导组与对照组各6只,预诱导组每日1次腹腔内注射PBS 45mg/kg,共5次,对照组注射NS,末次给药的24h后取肝脏;从同组的每只实验鼠中各取湿重肝0.5g混合,合并研制为混悬液加入96孔培养板每孔30μl,各孔再加入黄疸血清50μl,最后加培养液20μl,使各孔终体积为100μl,每组设6孔,共两组12孔;同时设无肝细胞的黄疸血清孔做两组的对照,共同在37℃、95%湿度、5%CO2培养箱中静置培养3h后离心,取上清用贝克曼生化分析仪检测两组的胆红素变化.结果 与对照血清比较,预诱导组总胆红素、间接胆红素各下降60%、71.42%,直接胆红素无显著变化;对照组总胆红素、间接胆红素各下降34.78%、54.87%,直接胆红素亦无显著变化;两组总胆红素变化比较P＜0.05(t=2.899),间接胆红素变化比较P＞0.05(t=1.571).结论 体内PBS预诱导可增强AAH在体外对胆红素的代谢活性,预诱导的AAH可能是EBLSS更佳的生物材料.     

广东省汕尾市区健康成人血清尿酸浓度检测分析

目的分析汕尾市区健康成人血清尿酸浓度与年龄、性别之间的关系,建立血清尿酸参考值范围。方法采用尿酸酶-过氧化物酶偶联法对789例健康成人血标本进行检测。结果血尿酸浓度男性为(341±70)μmol/L,女性为(282±61)μmol/L,已接近欧美国家水平。同年龄段男女相比较,差异均有统计学意义(P<0.001)。结论血清尿酸浓度男女之间差异有统计学意义,各年龄段也有差别,建议各地实验室建立自己的血清尿酸参考值范围,以便能够更好诊断引起尿酸浓度改变的各种疾病。     

用ELES模型分析城镇居民药品需求弹性

目的:定量研究我国城镇居民药品需求弹性。方法:运用扩展的线性支出系统模型分析2003年我国城镇居民各项消费支出及可支配收入的截面数据,计算边际消费倾向值、需求收入弹性值和需求价格弹性值。结果与结论:药品价格的变化对药品需求影响较小,城镇居民的药品消费属于生活必需品消费。     

Train the trainers!

With the introduction of training programmes and logbooks for basic postgraduate training and subspecialty training, the European Board and College of Obstetrics and Gynaecology has given impulses to harmonise training in obstetrics and gynecology in the European Union. Current changes in the practice of medicine, among which the European Working Time Directive, numbers of surgical procedures decreasing, more demanding patients and a change in work ethos, challenge both trainers and trainees to optimise postgraduate training. For training to be effective and efficient, it is necessary to clearly define learning goals and outcomes and to create a stimulating educational environment. This requires trainers who (a) have knowledge of adult learning and educational theory and (b) will act as facilitators of the learning process of postgraduate trainees. Most of the doctors involved in postgraduate training have not had any formal formation to be a trainer. Teacher professionalisation offers the medical professional a framework to increase efficiency as a trainer. In this article, an introduction to educational practice for the medical professional is given. Several aspects of adult learning, such as the learning cycle, appraisal and assessment, and giving feedback, are discussed.