Simultaneous bilateral versus unilateral tibial tubercle fractures

PurposeTibial tubercle/tuberosity fractures are rare injuries in young patients accounting for less than one percent of physeal fractures. Bilateral simultaneous fractures are even rarer, with only a few case reports in literature. The purpose of our study was to describe the largest case series of bilateral simultaneous tibial tuberosity avulsion fractures and compare it with unilateral fractures. We also wanted to compare our bilateral fractures case series with all the cases reported in the last 65 years.MethodsIRB approved retrospective study involving patients under age 18 years with tibial tuberosity avulsion fractures. Bilateral simultaneous fractures were compared to a unilateral group including demographic data, mechanism of injury, clinical exam findings, complication rates, and outcomes including return to function. Statistical analysis was performed using Mann-Whitney and Fisher Exact tests to compare the different groups.Results138 patients (131 males, 7 females) from a tertiary children’s hospital between 2012 and 2019 with tibial tuberosity avulsion fractures were included. 11 bilateral simultaneous fractures (BL Group) were identified and compared to age matched cohort from the 127 unilateral fracture patients (UL group). There was no significant difference found in BMI, height, weight, age, sex, mechanism of injury, return to functional range of motion, and return to sports between the groups. 7/11 (63%) of the patients in the BL group who sustained simultaneous fractures had to be home bound and could not attend school for an average of 8.3 weeks. There was a higher rate of complications in the BL group (63.3%) compared to the UL group (21.1%), which was statistically significant. The most common complications in the bilateral group were hardware removal and wound dehiscence.ConclusionThis first case series comparing unilateral versus bilateral simultaneous tibial tuberosity avulsion fractures suggests that the final outcomes of the two groups are similar, however it shows a significantly higher complication rate and hardware removal rate in the BL group. This study is also the first to highlight the significant initial morbidity in the BL fracture group with issues with regards to early mobility and loss of school-days. Keeping in mind the profound initial impact the bilateral injury poses to the patient; surgeons can possibly plan for rigid fixation for early mobilization to better prepare bilateral fracture patients for the early post-operative recovery process.     

Fifty years of the mitochondrial pyruvate carrier: New insights into its structure,function, and inhibition

The mitochondrial pyruvate carrier (MPC) resides in the mitochondrial inner membrane, where it links cytosolic and mitochondrial metabolism by transporting pyruvate produced in glycolysis into the mitochondrial matrix. Due to its central metabolic role, it has been proposed as a potential drug target for diabetes, non-alcoholic fatty liver disease, neurodegeneration, and cancers relying on mitochondrial metabolism. Little is known about the structure and mechanism of MPC, as the proteins involved were only identified a decade ago and technical difficulties concerning their purification and stability have hindered progress in functional and structural analyses. The functional unit of MPC is a hetero-dimer comprising two small homologous membrane proteins, MPC1/MPC2 in humans, with the alternative complex MPC1L/MPC2 forming in the testis, but MPC proteins are found throughout the tree of life. The predicted topology of each protomer consists of an amphipathic helix followed by three transmembrane helices. An increasing number of inhibitors are being identified, expanding MPC pharmacology and providing insights into the inhibitory mechanism. Here, we provide critical insights on the composition, structure, and function of the complex and we summarize the different classes of small molecule inhibitors and their potential in therapeutics.     

甲状腺肿的专家诊断与咨询系统

本文通过对１７４８３例甲状腺肿大中五种甲状腺病病例的收集、分析、整理、统计与提炼，确定了诊断原则，建立了知识库、病例库和正反双向混合推理机制，完成了用Ｔｕｒｂｏ－Ｐｒｏｌｏｇ语言编制。采用适用于表示医学产生式知识表示方法所开发的专家诊断与咨询系统，为教学、临床工作及家庭保健提供了有价值的软件。经临床病例验证，该软件准确、可靠、有很强的实用价值，对人工智能的研究、临床及教学的现代化，提高人们的保健水     

《内经》非药物疗法的防病治病机理初探

非药物疗法是中医治疗学中的一个重要组成部分.<内经>中的非药物疗法,通过协调阴阳平衡、调和气血运行、调节神志活动、调整脏腑功能等作用,对防病治病、养生益寿有重要意义.     

The effect of accident mechanisms and initial findings on the long-term course of whiplash injury

The aim of this study was to assess the relationships between accident mechanisms as well as initial findings and the long-term course of whiplash injury. A representative sample of 117 consecutive patients referred by primary care physicians was followed-up over 12 months. Fractures or dislocations of the cervical spine, head trauma and pre-existing neurological disorders were exclusion criteria. The interval between the accident and the baseline examination was 7.4 days (SD 4.2 days). Assessment included accident features (e.g. passenger position in the car, head restraint, head position, type of collision), initial symptoms (e.g. intensity and onset of pain, symptoms of neurological dysfunction, multiple symptom score), and signs (restricted neck movement, neurological deficits). At the 1-year examination, patients were divided into an asymptomatic and a symptomatic group and were compared with respect to accident features and baseline findings. Twenty-four percent of patients were still symptomatic after 1 year. Analysing accident mechanisms separately, rotated or inclined head position was the primary feature related to symptom persistence (P=0.005). The symptomatic group scored higher at baseline on the multiple symptom rating (P=0.004) and had a higher incidence of initial headache (P=0.004) and neurological symptoms (P=0.008) together with a higher intensity of headache (P=0.0002) and neck pain (P=0.0009). The following set of initial variables predicted persistence of symptoms at 1 year (logistic regression): intensity of neck pain (P=0.001) and headache (P=0.009), rotated or inclined head position (P=0.02), unpreparedness at the time of impact (P=0.01) and car stationary when hit (P=0.01). In conclusion, accident mechanisms and initial findings suggestive of more severe injury were significantly related to long-term persistence of symptoms after whiplash injury.This study was supported by the Swiss National Science Foundation (project number: 3.883-0.88) and the Swiss Accident Insurance Company (Schweizerische Unfallversicherungsanstalt), Berne     

从中医理论探索方药的作用机理

主要以所承担过的科研课题的研究思路及研究结果为依据,论述从传统中医理论探索方药作用机理的重要性。文中从养阴生津方药治疗热瘀证的作用、血分证中运用活血化瘀法的作用、辛开苦降法的作用及解表法的作用等方面论述从中医的特有理论出发,可以在探索方药作用机理时提供思路、开拓新的研究领域。同时,中医传统证治理论也要不断发展、提高,在运用传统证治理论研究方药作用机理时,不能完全被其所束缚,随着对证治理论认识的发展,对方药作用机理的认识也必然会出现一个飞跃。     

Proposal of a new electromechanical total artificial heart: the TAH Serpentina

A new type of energy converter for an electro-mechanical total artificial heart (TAH) based on the principle of a unidirectional moving motor is described. Named the TAH Serpentina, the concept consists of 2 major parts, a pendulum shaped movable element fixed on one side using a joint bearing and a special shaped drum cam. Pusher plates are mounted flexibly to the crossbar of the pendulum. A motor drives the special shaped drum cam linked to the pendulum through a ball bearing. The circular motion of the unidirectional moving brushless DC motor is transferred into the linear motion of the pendulum to drive the pusher plates. Using a crossbar with a variable length, the stroke of the pendulum and therefore the displaced blood volume is alterable. To achieve a variable length, an electric driven screw thread or a hydraulic system is possible. Comparable to the natural heart, cardiac output would be determined by frequency and stroke volume.     

Possible role of dopamine in central effects of cocaine as measured by apomorphine gnawing test in mice

Apomorphine (10 mg/kg, s.c.) does not induce in mice a compulsion to gnaw, but pretreatment with cocaine (10–40 mg/kg, i.p.) caused gnawing activity. This effect of cocaine was inhibited by pretreatment with -methyl-p-tyrosine, haloperidol, and physostigmine, but not with FLA-63, phenoxybenzamine and tetrabenazine. These findings would suggest that dopaminergic mechanism plays a significant role in the potentiation of apomorphine gnawing activity by cocaine and also support the view that inhibition of dopamine uptake is responsible for the stimulatory action of cocaine.     

针灸治疗单纯性肥胖症及机理研究探讨

单纯性肥胖症是当今社会常见病、多发病之一。近年来 ,针灸治疗单纯性肥胖症无论在临床方面还是在实验机理研究方面 ,均取得较大进展。但针灸减肥的机理研究大多局限在中枢神经核团神经递质含量的研究 ,没有新的突破 ,在临床方面有待于更多、更科学、更规范的临床研究报道。