Protective and Risk Factors for Humerus Head Necrosis After Proximal Humerus Fracture Treated with Internal Locking Plate

BackgroundProximal humerus fractures (PHF) are common and lead to post-traumatic humerus head necrosis (HHN) in 3–35% after ORIF with an internal locking plate. Few studies focus on this condition and risk factors remain a discussion topic. Hertel’s criteria for initial head ischemia right after fracture (fracture complexity, medial hinge displacement and short metaphyseal head extension) have recently been correlated to HHN, but there is still a clear lack of evidence on the topic. Due to its anatomical similarities to the proximal femur, some authors argue that PHF may as well benefit from early surgery to avoid head necrosis.MethodsIn this 10-year retrospective study, we assessed 305 patients from a single center. All cases were treated with a PHILOS plate through a deltopectoral approach. The mean follow-up time was 467 days. The primary endpoint was HHN.ResultsHHN was diagnosed in 12 patients (4%), 10 of which were diagnosed within the first year and one case 4 years after surgery. A positive correlation (p < 0.04) was found between HHN and fracture type (both in AO and Neer’s classification), initial neck-shaft-angle (NSA) and metaphyseal head extension (MHE). Medial hinge displacement (MHD) occurred in all HHN cases. Achieving perfect reduction (< 2 mm dislocation) was relevant to avoiding HHN (p = 0.035). Although HHN developed in 32% of the high risk cases (four-part fractures with a short MHE), it was completely avoided (0%) when perfect reduction was achieved. Time until surgery after admission was neither a protective nor a risk factor for HHN.ConclusionWe conclude that fracture complexity (four-part and C-fractures) as well as disruption of the medial hinge with a metaphyseal head extension smaller than 8 mm are relevant risk factors for humerus head necrosis. A combination of these criteria generated an high risk pattern with a 32% rate of HHN. Though often difficult to achieve, perfect reduction was a clear protective factor and reduced HHN to 0%. Perfect reduction may be key to inosculation and, therefore, salvage of the humerus head, especially in high risk cases. Surgery timing did not correlate with HHN.Level of EvidenceLevel 3, retrospective cohort study.     

Male Sexual Function After Pediatric Kidney Transplantation—A Cross-sectional Nationwide Study

BackgroundData on adult sexual functioning after kidney transplantation (KTx) during childhood or adolescence are scarce.AimTo assess the long-term sexual and psychosocial quality of life after pediatric KTx.Methods29 young men (median age 27.1 years) were examined 18.7 years (median) after KTx. 56 age-matched healthy men (median age 30.0 years) served as controls.OutcomeWe studied the influence of sociodemographics, previous renal replacement therapy, current reproductive hormonal serum levels, testicular size, and data on several validated mental and physical questionnaires on participants' Derogatis Interview for Sexual Functioning self-report scores.ResultsThe KTx recipients had significantly poorer sexual functioning than their healthy peers. KTx men had less frequent sexual activity with a partner (P = .03) and poorer orgasms (P = .002) than the controls but no erectile dysfunction (P = .5).Clinical implicationsDepressive symptoms, relationship status, and longer dialysis duration predicted poor adult sexual functioning in KTx recipients, whereas age at transplantation or at the time of the study did not.Strengths & LimitationsThis study contributes extended follow-up data to the very scarce literature on adult sexual functioning in pediatric KTx recipients. Relatively small population and low participation rate limit the comprehensive data interpretation in a population-based cohort of male KTx recipients.ConclusionSexual functioning is often impaired in young men after pediatric KTx, emphasizing the need for long-term monitoring of sexual health and sexuality as important dimensions of quality of life.Tainio J, Jahnukainen T, Jalanko H, et al. Male Sexual Function After Pediatric Kidney Transplantation—A Cross-sectional Nationwide Study. J Sex Med 2020;17:2104–2107.     

新冠肺炎危重型患者气管切开术初步经验与体会(附1例报告)

新型冠状病毒肺炎(新冠肺炎,COVID-19)是指由2019新型冠状病毒(新冠病毒,2019-nCoV)感染导致的肺炎。新冠病毒传播途径主要为呼吸道飞沫传播和接触传播,并存在气溶胶传播可能。由于肺部严重感染易导致急性呼吸窘迫综合征,新冠肺炎危重型患者气管切开术可作为一种救治手段,但术中可能会产生大量的病毒飞沫通过气道扩散在空气中形成气溶胶,增加院内感染风险。本文根据国家卫健委新冠肺炎相关诊疗方案和措施,结合我院的1例危重型患者在重症监护隔离病区行气管切开术的经验,探讨危重型新冠肺炎患者气管切开的必要性、手术方式、术前准备、术中操作、术后护理及医护防护措施等相关问题。     

禽巴氏杆菌OmpH外膜蛋白DNA疫苗的免疫效果

目的:研究禽多杀性巴氏杆菌omph DNA疫苗在小鼠体内诱导的免疫保护效果。方法:利用PCR技术扩增出禽多杀性巴氏杆菌的omph基因片段,克隆到pMD18-T上,再亚克隆到真核载体pcDNA3.1(+)上,构建重组质粒pOMPH,体外转染SP2/0细胞,RT-PCR、间接免疫荧光试验、Western blot检测其转录及表达情况。然后进行动物免疫,实验动物分为三组即:pOMPH组、pCDNA3.1(+)空载体组和PBS对照组,每组16只BALB/c小鼠,pOMPH组和pCDNA3.1(+)组以100μg/只的剂量肌注免疫,PBS组每只小鼠肌注100μl1×PBS,各组均进行了三次免疫,每次间隔两周。间接ELISA检测免疫后小鼠血清特异性抗体水平,MTT法检测免疫小鼠脾淋巴细胞增殖情况,三免两周后检测脾淋巴细胞IFN-γ分泌情况。强毒攻击,计算小鼠存活数目及保护率。结果:间接免疫荧光试验、Western blot和RT-PCR检测结果均表明pOMPH可在体外培养的SP2/0细胞中表达目的蛋白。动物免疫后,pOMPH组免疫小鼠血清抗体水平持续上升,与pCDNA3.1(+)组和PBS组相比差异极显著(P0.01)。经提取的外膜蛋白(Omps)刺激后,pOMPH组的刺激值(SI值)与pCDNA3.1(+)组及PBS免疫组相比均差异显著(P0.05)。免疫小鼠脾细胞产生的IFN-γ极显著高于两对照组产生的IFN-γ(P0.01)。攻毒后pOMPH组保护率明显高于两对照组,可达70%。结论:成功构建了禽多杀性巴氏杆菌omph DNA疫苗,该疫苗可诱导免疫小鼠产生较强的体液和细胞免疫应答及较好的保护效果。     

激光针灸镇痛效应与穴区肥大细胞功能的关系

目的:观察低强度复合和单激光照射急性佐剂性关节炎大鼠"足三里"穴的镇痛效应及其与肥大细胞脱颗粒效应的关系.方法:采用清洁级SD大鼠66只,随机分为空白组、模型组、假照射组、10.6μm激光组、650 nm激光组和复合激光组,治疗时除空白、模型组外各组照射"足三里"穴30 min.除了空白组,其他5组通过左踝关节腔内注射完全弗式佐剂0.05 mL建立急性佐剂性关节炎模型.采用辐射热缩爪反射的方法,以大鼠缩爪反射的潜伏期为观察指标,比较各组的镇痛效果;通过穴位组织切片和甲苯胺蓝染色,离体对照激光照射前后穴位处局部肥大细胞脱颗粒率的变化.结果:激光照射后,650 nm激光组和复合激光组的痛阈显著高于模型组和假照射组(P＜0.01),650 nm激光组与复合激光组的肥大细胞脱颗粒率也显著高于模型组和假照射组(P＜0.001).10.6μm激光组的痛阈和肥大细胞脱颗粒率与模型组、假照射组比无显著差异.肥大细胞脱颗粒率与缩爪潜伏期的线性相关系数为0.737(P＜0.001).结论:低强度复合650 nm+10.6μm激光和单650 nm激光照射急性佐剂性关节炎大鼠"足三里"穴有显著镇痛效应;穴区中的肥大细胞脱颗粒率与镇痛效应呈正相关,在激光针灸镇痛效应的产生过程中起着重要作用.     

甲状腺肿瘤217例手术治疗

目的探讨颌面外科医生手术治疗甲状腺肿瘤疾病的疗效。方法回顾收治并行手术切除的217例甲状腺包块的患者,对甲状腺手术治疗的风险、治疗效果和并发症进行分析。结果本组患者中有58例行甲状腺部分切除术,146例行甲状腺次全切术,13例行一侧腺叶切除＋峡部切除术。217例患者中术后有3例出现暂时性喉返神经损伤症状,1例伤口感染,2例甲状腺癌术后两年复发,其余病例均未出现喉返神经、喉上神经损伤、甲状腺、甲状旁腺功能低下等症状。结论颌面外科医生可以有效治疗不同甲状腺疾病。     

保护导丝对冠脉分支闭塞率的影响

目的观察冠心病介入治疗使用保护导丝对冠脉分支闭塞率的影响。方法选择冠状动脉分叉病变患者98例,分为观察组（有保护导丝）50例和对照组（无保护导丝）48例,观察两组患者分支血管闭塞率差别。结果观察组分支闭塞率明显低于对照组（P〈0．05）。结论冠心病介入治疗使用保护导丝可以显著降低分支闭塞率。     

贾文魁教授治疗肺癌经验探析

在2013年10月召开的第22届亚太抗癌大会上,中国工程院院士郝希山说:"亚太地区癌症新增病例占到全球癌症新增病例的45%,死亡人数约占全球癌症死亡人数的一半,肺癌、胃癌和肝癌是亚洲国家最常见的3种癌症。目前,肺癌是亚洲国家面临的最主要癌症。"肺癌属于疑难病,挖掘有效的治疗方法已是医学界热门的研究课题。贾文魁教授对肺癌的中医治疗有着丰富的临床经验,从临床角度提出"温阳散结化癌瘤、肺癌重在虚和痰、一扶三保贯始终"等一系列治疗方法和思想,在肺癌的临床治疗中取得了满意的效果。