股骨转子间骨折髓内固定物治疗的优劣评说

背景：随着股骨转子间骨折发生率的不断上升,它的治疗方法也不断更新,当前治疗股骨转子间骨折的方法很多,就生物力学而言,髓内固定较髓外固定更加具有优势。 目的：综述股骨转子间骨折髓内固定治疗方法的发展及现状,分析各种方法的利弊,展望股骨转子间骨折髓内固定治疗的发展。 方法：以Intertrochanteric fracture,Intramedullary nail,Gamma nail,Proximal femoral nail, InterTan为英文检索词检索Pubmed数据库,以转子间骨折,髓内固定,伽马钉,股骨近端髓内钉,联合拉力交锁髓内钉为中文检索词检索CNKI数据库和中国知网数据库中2001至2012年发表的相关文献,纳入有关股骨转子间骨折髓内固定治疗的文献和有关治疗股骨转子间骨折内固定物的文献。共检索到115篇文献,排除无关重复的文献,保留54篇进行综述。 结果与结论：对于不稳定型转子间骨折,髓内固定系统在生物力学上具有优势,更靠近重心,力臂较短,髓内钉能更可靠的对抗沿股骨距传导的应力,并可防止股骨干内移。Gamma钉、股骨近端髓内钉、股骨近端抗旋髓内钉、可膨胀股骨近端髓内钉、微创短重建钉、联合接力交锁髓内钉在临床应用上可以达到骨折复位满意、坚强内固定的要求。而人工髋关节置换可应用于一些骨折不稳定、高龄老年人并且合并内科疾病及严重骨质疏松的患者。随着学者们对生物力学的研究和重新认识,内固定物的变革更新,手术技术的进一步发展,治疗股骨转子间骨折的方法和疗效会有更大的提高。     

射野区域的剂量验证研究

目的:实现射野区域剂量分布Gamma（[γ]）通过率的计算,对治疗传输的准确性进行评估。方法:从Oncentra Masterplan治疗计划系统中随机提取6位完全匿名患者的调强放射治疗验证计划,导出DICOM格式的验证计划并利用Matlab软件重建多叶准直器区域和剂量。然后将验证计划移植到MatriXX模体并测量剂量分布。用Matlab代码对验证计划剂量分布和模体测量的绝对剂量分布进行分析。结果:传统方法[γ]通过率受计算区域选择影响较大,而以射野区域作为计算区域则避免了这个问题,两种方法计算得到的[γ]通过率有统计学差异（[P]<0.05）。结论:射野区域的剂量验证避免了[Dn]值对[γ]通过率的影响,而且对射野区域利用剂量面积直方图分析其剂量特性,有利于评估治疗计划系统临床治疗的准确性和指导临床工作。     

基于ArcCHECK模体的VMAT计划验证及摆位误差对剂量验证的影响

目的:探究ArcCHECK模体在旋转容积调强技术（VMAT）计划验证中的应用,并利用软件模拟摆位误差对剂量验证的影响。方法:随机收集45例VMAT计划,分别选取胸部肿瘤、乳腺癌和宫颈癌各15例,将ArcCHECK模体实测的剂量分布与计划系统计算的结果进行对比分析,分别探究在阈值10%下,3%/3 mm和2%/2 mm时,Gamma分析与DTA分析下相对剂量（RD）与绝对剂量（AD）的通过率。利用SUNnuclear公司Sunpatient软件将计划系统计算的剂量分布与实际测量的剂量分布进行对比,并利用软件模拟旋转误差,分别旋转±0.5°、±1°、±1.5°、±2°,将旋转后的剂量分布与计划系统计算剂量分布对比,得到旋转误差下的计划验证通过率;同样利用软件模拟平移误差,分别向X、Y方向平移±1、±2、±3、±5 mm后进行剂量分布对比,得到平移误差下的计划验证通过率。结果:当阈值选择10%、3%/3 mm时,Gamma分析时,RD与AD下各部位的通过率基本达到95%及以上,DTA分析时,RD和AD下各部位的通过率基本达到90%及以上。当阈值选择10%、2%/2 mm时,各部位肿瘤VMAT计划的验证通过率无论在Gamma还是DTA分析时,RD和AD的平均通过率只有80%左右。存在误差时,旋转误差大于等于1°时,各部位肿瘤VMAT计划验证在两种分析方法下通过率的单因素方差分析结果显示P<0.05;X方向和Y方向平移误差大于等于3 mm时,单因素方差分析结果显示P<0.05。结论:ArcCHECK模体能很好地应用于VMAT计划的验证,阈值选择10%、3%/3 mm时,胸部肿瘤、乳腺癌和宫颈癌验证通过率均能达到95%及以上;阈值选择10%、2%/2 mm时通过率均有大幅度下降,仅有80%左右。旋转误差大于等于1°时对计划验证通过率有显著影响,差异具有统计学意义,同样X方向或Y方向平移误差大于等于3 mm时,两种分析方法下的计划验证通过率均有显著差异。     

Multisensory processing and oscillatory activity: analyzing non-linear electrophysiological measures in humans and simians

Stimulus-related oscillations are known to be closely linked to integrative processing in the brain. One research domain within which there has been tremendous interest in oscillatory mechanisms is in the integration of inputs across the widely separated sensory systems. Under the standard approach of assessing multisensory interactions in electrophysiological datasets, the event-related response to a multisensory stimulus is directly compared with the sum of the responses to its unisensory constituents when presented alone. When using methods like wavelet transformation or fast Fourier transformation to derive induced oscillatory signals, however, such linear operations are not appropriate. Here we introduce a simple bootstrapping procedure wherein the linear summation of single unisensory trials forms a distribution against which multisensory trials may be statistically compared, an approach that circumvents the issue of non-linearity when combining unisensory oscillatory responses. To test this approach we applied it to datasets from intracranial recordings in non-human primates and human scalp-recorded EEG, both derived from a simple audio-visual integration paradigm. Significant multisensory interactions were revealed in oscillatory activity centered at 15 and 20 Hz (the so-called beta band). Simulations of different levels of background noise further validated the results obtained by this method. By demonstrating super- and sub-additive effects, our analyses showed that this approach is a valuable metric for studying multisensory interactions reflected in induced oscillatory responses.     

p38丝裂原活化蛋白激酶信号转导通路在紫外线诱导表皮细胞凋亡中的作用

大量流行病学调查及分子生物学实验研究表明：紫外线可通过诱导活性氧及细胞因子产生DNA损伤和基因表达的改变导致细胞凋亡,这个过程非常复杂,有多个信号转导途径参与.由于细胞凋亡与皮肤癌的发生密切相关,近年来UVB诱导表皮细胞凋亡引起了人们广泛的关注.p38丝裂原活化蛋白激酶（p38MAPK）是细胞内重要的信号传导系统之一,参与细胞生长、发育、分化和凋亡等一系列生理、病理过程.p38MAPK可被紫外线激活,并在紫外线诱发的细胞应答过程中发挥重要的作用.     

Voronoi Polyhedra Analysis of Optimized Arterial Tree Models

Topological and metric properties of Voronoi polyhedra (VP) generated by the distal end points of terminal segments in arterial tree models grown by the method of constrained constructive optimization (CCO) are analyzed with the aim to characterize the spatial distribution of their supply sites relative to randomly distributed points as a reference model. The distributions of the number N _f of Voronoi cell faces, cell volume V, surface area S, area A of individual cell faces, and asphericity parameter of the CCO models are all significantly different from the ones of random points, whereas the distributions of V, S, and are also significantly different among CCO models optimized for minimum intravascular volume and minimum segment length (p < 0.0001). The distributions of N _f , V, and S of the CCO models are reasonably well approximated by two-parameter gamma distributions. We study scaling of intravascular blood volume and arterial cross-sectional area with the volume of supplied tissue, the latter being represented by the VP of the respective terminal segments. We observe scaling exponents from 1.20 ± 0.007 to 1.08 ± 0.005 for intravascular blood volume and 0.77 ± 0.01 for arterial cross-sectional area. Setting terminal flows proportional to the associated VP volumes during tree construction yields a relative dispersion of terminal flows of 37% and a coefficient of skewness of 1.12. © 2003 Biomedical Engineering Society. PAC2003: 8719Uv, 8710+e, 4720Ky, 0260Pn, 0230Oz     

小鼠γ—干扰素真核表达质粒的构建和鉴定

目的 克隆小鼠γ-干扰素(γ-IFN)基因，构建并鉴定小鼠γ-干扰素真核表达质粒。方法 从BALB／c小鼠脾脏提取总RNA，用RT—PCR方法扩增出小鼠γ-干扰素基因，分别用EcoR Ⅰ、BamH Ⅰ双酶切扩增片段和pcDNA3.1(-)，定向克隆到真核表达质粒pcDNA3．1(-)，构建成真核表达质粒pcDNA3．1(-)γ-IFN，转化产物通过PCR扩增筛选，双酶切鉴定；阳性克隆进行序列分析。结果 RT—PCR产物电泳可见一约500bp大小目的片段，PCR和双酶切电泳结果均证实已插入约500bp的γ-IFN基因片段；阳性克隆测序结果表明克隆的小鼠γ-干扰素基因完全正确。结论 成功构建了小鼠γ-干扰素真核表达质粒，为进一步气道内实施哮喘小鼠基因治疗打下了坚实基础。     

Novel Fluorinated Polymer by Radiation‐Induced Polyaddition of Bisperfluoroisopropenyl Terephthalate with 1,4‐Dioxane

Radical polyaddition of bis(α‐trifluoromethyl‐β,β‐difluorovinyl) terephthalate [CF₂?C(CF₃)OCOC₆H₄COOC(CF₃)?CF₂] (BFP) with 1,4‐dioxane (DOX) was investigated under γ‐rays radiation from a ⁶⁰Co source to produce higher molecular weight polymers compared to those yielded by benzoyl peroxide initiation. Prior to polyaddition, the addition reactions of 2‐benzoxypentafluoropropene [CF₂?C(CF₃)OCOC₆H₅] (BPFP) with tetrahydrofuran (THF) and DOX, and BFP with THF were examined in order to develop probable polyaddition reaction conditions. The polymer bearing 1.5 × 10⁴ as a molecular weight was obtained under the feed molar ratio of DOX/BFP = 16 with an irradiation dose of 2 000 kGy at 40 °C, which is a much higher molecular weight compared to that yielded by benzoyl peroxide.

     

放射损伤细胞中高尔基体弥散现象及香兰素衍生物的防护作用

目的：通过观察辐射对高尔基体形态的影响,确定香兰素衍生物VND3207对受照细胞高尔基体的防护作用。方法采用免疫荧光技术检测放射损伤细胞中高尔基体弥散现象并统计弥散面积,检测细胞周期变化,分析细胞存活率,同时对高尔基体蛋白的表达水平进行检测。结果免疫荧光检测结果显示,照射后高尔基体的弥散面积增加,具有一定的剂量效应和时间效应;VND3207能减轻γ射线对高尔基体的损伤,其表现为与未加药组相比,在抑制不同剂量照射后可使高尔基体弥散面积增加;细胞周期测定结果显示,4 Gy γ线照射后G2／M期阻滞峰值约出现在12 h后;免疫印迹结果显示DNA损伤引起的G2／M期阻滞也在12 h后解除;而高尔基体弥散在细胞周期阻滞解除后12和24 h仍然存在;平板克隆结果显示,VND3207促进了受照细胞的存活。结论放射损伤能引起剂量依赖性高尔基体弥散效应,且这种弥散与DNA损伤诱导的周期阻滞无关,VND3207对放射损伤引起的高尔基体弥散有一定的抑制作用,可能与受照细胞受到保护有关。     

斜发沸石对亚急性辐射损伤小鼠的保护作用研究

目的 研究斜发沸石(Cp)对亚急性辐射损伤小鼠的防护作用.方法 48只雄性BALB/c小鼠随机分为空白对照组(给予蒸馏水,不照射)、辐照模型组(给予蒸馏水,照射)、300mg/kg 523组(照射前24h给予尼尔雌醇200mg/kg,照射后4h给予尼尔雌醇100mg/kg,其余天数给予蒸馏水灌胃,照射)、56mg/kg沸石组(给予56mg/kg沸石水溶液,照射)、167mg/kg沸石组(给予167mg/kg沸石水溶液,照射)和500mg/kg沸石组(给予500mg/kg沸石水溶液,照射).以灌胃方式连续给药7d,采用137Csγ射线对小鼠进行一次性全身照射,剂量率为0.75Gy/min,总剂量为4.0Gy.照射后继续灌胃给药14d.用血细胞分析仪测定外周血象;测定脏器指数、骨髓DNA含量;检测小鼠血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量及谷胱甘肽过氧化物酶(GSH-Px)活性;流式细胞仪检测骨髓造血干细胞含量.结果 经137Csγ射线照射后10d,与辐照模型组相比,56mg/kg沸石组与167mg/kg沸石组红细胞数量明显升高(P＜0.05,P＜0.01),56mg/kg沸石组与500mg/kg沸石组白细胞数量明显升高(P＜0.01);照射后14d,与辐照模型组相比,沸石各给药组小鼠血清中SOD活性显著升高(P＜0.05,P＜0.01),167mg/kg沸石组与500mg/kg沸石组GSH-Px活性明显升高(P＜0.01),56mg/kg沸石组与500mg/kg沸石组骨髓细胞DNA含量明显升高(P＜0.05,P＜0.01),沸石各给药组骨髓造血干细胞含量明显升高(P＜0.01).结论 斜发沸石对亚急性辐射损伤小鼠具有一定保护作用.