基于AO分型的数字化分型在浮膝损伤中的应用

目的建立一种基于AO分型的浮膝损伤数字化分型体系。方法回顾性分析2005年3月至2020年12月滨州医学院附属医院收治100例成年浮膝损伤患者的资料。其中, 男74例, 女26例;平均年龄43.7岁;左膝54例(54.0%)、右膝43例(43.0%)、双膝3例(3.0%)。新的数字化分型按照AO分型将股骨及胫骨各分成三部分, 按照部位组合后共重新编排成六种分型。通过应用该分型对所纳入病例的影像学结果进行分析, 以总结该分型在浮膝损伤中的使用范围及分型分布规律。计数资料采用χ2检验。结果Ⅰ～Ⅵ型损伤比例分别为Ⅰ型42.7%(44/103)、Ⅱ型18.4%(19/103)、Ⅲ型9.7%(10/103)、Ⅳ型10.7%(11/103)、Ⅴ型11.7%(12/103)、Ⅵ型6.8%(7/103)。不同损伤分型患者在性别(χ2=6.068, P>0.05)、受伤侧别(χ2=0.658, P>0.05)方面差异均无统计学意义。结论基于AO分型的浮膝损伤数字化分型体系能够对大部分浮膝损伤以及合并开放伤病例进行分类, 能有效地为手术治疗方案的选择提供参考, 更有利于评估预后及学术交流。     

Reliability of the classification of proximal femur fractures: Does clinical experience matter?

BackgroundRadiographic fracture classification helps with research on prognosis and treatment. AO/OTA classification into fracture type has shown to be reliable, but further classification of fractures into subgroups reduces the interobserver agreement and takes a considerable amount of practice and experience in order to master.Questions/purposesWe assessed: (1) differences between more and less experienced trauma surgeons based on hip fractures treated per year, years of experience, and the percentage of their time dedicated to trauma, (2) differences in the interobserver agreement between classification into fracture type, group, and subgroup, and (3) differences in the interobserver agreement when assessing fracture stability compared to classifying fractures into type, group and subgroup.MethodsThis study used the Science of Variation Group to measure factors associated with variation in interobserver agreement on classification of proximal femur fractures according to the AO/OTA classification on radiographs. We selected 30 anteroposterior radiographs from 1061 patients aged 55 years or older with an isolated fracture of the proximal femur, with a spectrum of fracture types proportional to the full database. To measure the interobserver agreement the Fleiss’ kappa was determined and bootstrapping (resamples = 1000) was used to calculate the standard error, z statistic, and 95% confidence intervals. We compared the Kappa values of surgeons with more experience to less experienced surgeons.ResultsThere were no statistically significant differences in the Kappa values on each classification level (type, group, subgroup) between more and less experienced surgeons. When all surgeons were combined into one group, the interobserver reliability was the greatest for classifying the fractures into type (kappa, 0.90; 95% CI, 0.83 to 0.97; p < 0.001), reflecting almost perfect agreement. When comparing the kappa values between classes (type, group, subgroup), we found statistically significant differences between each class. Substantial agreement was found in the clinically relevant groups stable/unstable trochanteric, displaced/non-displaced femoral neck, and femoral head fractures (kappa, 0.60; 95% CI, 0.53 to 0.67, p < 0.001).ConclusionsThis study adds to a growing body of evidence that relatively simple distinctions are more reliable and that this is independent of surgeon experience.     

复杂Pilon骨折的手术治疗体会

目的：评价切开复位内固定对Pilon骨折的治疗效果。方法；分析手术治疗Ⅱ、Ⅲ型Pilon骨折32例的临床资料，应用AO原则，根据伤情特点，把握手术时机行切开复位钢板内固定，术后早期进行不负重功能锻炼。结果：32例平均随访1．8年，疗效优17例，良8例，可6例，差1例，优良率为78％。早期以皮肤软组织坏死为主，晚期并发症主要是创伤性关节炎，踝关节功能障碍。结论：Ⅱ、Ⅲ型Pilon骨折治疗难度大，其并发症发生率高，若合理应用手术原则，把握手术时机，将有助于降低其病残率。     

热疗联合化疗对K562/AO2细胞体外作用的实验研究

本研究观察热疗联合阿霉素对耐药慢性髓系白血病细胞系K562/AO2体外增殖的抑制作用、诱导凋亡及对Bcl-2及P-gp表达的影响。以MTT法确定阿霉素的工作浓度进行化疗,以40、41和42℃体外加热K562/AO2。加热前及加热后48小时采用台盼蓝拒染法检测肿瘤细胞的存活率,MTT检测肿瘤细胞增殖的抑制作用,流式细胞术检测肿瘤细胞凋亡、Bcl-2及P-gp表达,观察热疗联合阿霉素的抗肿瘤效果。作用48小时的IC50值作为实验的工作浓度。结果表明：与单纯培养相比,40、41和42℃热疗60分钟对K562/AO2细胞有明显地抑制作用（p〈0.01）,并随温度增高而增强;热疗＋化疗组在40、41和42℃时,K562/AO2增殖抑制明显（p〈0.01）,随着温度的增高而增强。热疗组、化疗组及热疗＋化疗组的细胞凋亡率均较对照组显著升高,各组之间均有显著性差异（p〈0.01）;Bcl-2蛋白及P-gp的表达均下降,各组之间也有显著性差异（p〈0.01）。结论：热疗联合阿霉素能增强对K562/AO2细胞的体外抑制作用,提高肿瘤细胞的凋亡率,下调Bcl-2及P-gp的表达。     

Inhibition of cathepsin S induces autophagy and apoptosis in human glioblastoma cell lines through ROS-mediated PI3K/AKT/mTOR/p70S6K and JNK signaling pathways

Cathepsin S is a lysosomal cysteine protease that is overexpressed in various cancer models and plays important role in tumorigenesis, however the mechanisms are unclear. In the present study, we found that inhibition of cathepsin S induced autophagy and mitochondrial apoptosis in human glioblastoma cells. Blockade of autophagy by either a chemical inhibitor or RNA interference attenuated cathespin S inhibition-induced apoptosis. Furthermore, autophagy and apoptosis induction was dependent on the suppression of phosphatidylinositide 3-kinases/protein kinase B/mammalian target of rapamycin/p70S6 kinase (PI3K/AKT/mTOR/p70S6K) signaling pathway and activation of c-Jun N-terminal kinase (JNK) signaling pathway. In addition, reactive oxygen species (ROS) served as an upstream of PI3K/AKT/mTOR/p70S6K and JNK signaling pathways. In conclusion, the current study revealed that cathepsin S played an important role in the regulation of autophagy and apoptosis in human glioblastoma cells.     

AO微型钢板内固定、微型外固定架和克氏针内固定治疗掌指骨骨折的疗效分析

目的 比较3种固定材料治疗掌指骨骨折的临床效果.方法 连续入选我科经手术治疗的掌指骨骨折患者129例(158处),随机分为AO微型钢板内固定组、微型外固定架组和克氏针内固定组,术后随访6～12个月,平均(8.2±1.8)个月.按照TAFS的评级标准对各组指间及掌指关节功能、感染情况和骨折愈合等情况进行评定.结果 AO微...     

三种胸腰段骨折分类法的可信度和可重复性研究

目的:探讨并比较AO分型、Denis分类、TLICS评分分类系统在胸腰段骨折诊断中的可信度和可重复性。方法:选择临床及影像学资料(X线片、CT、MRI)完整的31例胸腰段骨折患者,将该31例患者的资料提供给6名骨科医生,分别采用AO分型、Denis分类、TLICS评分分类三种方法进行脊柱骨折分类。3个月后进行重复分类。采用加权Cohen′s Kappa系数评价观察者间可信度和观察者内可重复性。结果:AO分型、Denis分类、TLICS评分分类的观察者间平均Kappa系数分别为0.517、0.639、0.713;三种分类方法的观察者内平均Kappa系数分别为0.766、0.832、0.804。结论:三种胸腰段骨折分类方法比较,TLICS评分分类方法的可信度和可重复性较高,Denis分类方法次之,AO分型方法较差,前者更具临床实用价值。     

AO锁骨钩钢板治疗TossyⅢ型肩锁关节脱位

目的观察AO锁骨钩钢板对TossyⅢ型的肩锁关节脱位切开内固定的治疗效果。方法采用AO锁骨钩钢板内固定治疗22例急性TossyⅢ型肩锁关节脱位患者,术后3天指导患者患肩功能锻炼,平均于术后10个月（8～12个月）取出锁骨钩钢板。结果随访时间6～12个月,采用Karlsson标准评定,A级17例,B级5例。术后6周均完全恢复日常生活和工作能力。结论AO锁骨钩钢板治疗TossyⅢ型肩锁关节脱位固定牢靠,有利于早期功能锻炼,疗效满意,手术合并症少,是一种较好的治疗方法。     

Dihydroartemisinin induces autophagy by suppressing NF-κB activation

Nuclear factor-kappa B (NF-κB) and autophagy are two major regulators involved in both tumor initiation and progression. However, the association between these two signaling pathways still remains obscure. In this work, we demonstrate that dihydroartemisinin (DHA) stimulates the induction of autophagy in several cancer cell lines through repression of NF-κB activity. We also show that inhibiting NF-κB results in an accumulation of reactive oxygen species (ROS), which participate in the stimulation of autophagy. These findings present a pathway by which DHA promotes autophagy in cancer cells and provide evidence for the DHA-induced sensitization effect of some chemotherapeutics.