股骨转子间骨折的稳定性重建概念演化与研究进展

目的总~d3;d1;年来股骨转子间骨折在稳定性जd;建方面的概念演化与研究db;展。方ld5;查阅կd;内外相关文献并~d3;合自身经验，从股骨转子间骨折的解剖特点、稳定型骨折与Ӡd;稳定型骨折分类、稳定性֐d;Ӵd;与Ӡd;稳定性֐d;Ӵd;、术Ӣd;加压ԡd;始稳定与术后nd1;动二次稳定、内固定术后稳定性评估、早期下地zd9;立d1f;जd;等方面db;行总~d3;分析。~d3;果股骨转子间骨折Sd1;生于股骨颈干骺端转换区，具有天然的内翻Ӡd;稳定倾向。骨折֐d;Ӵd;d28;量是影Ռd;后߮d;内固定物安放的最जd;要Ԥd;cd0;因d20;。判ٚd;骨折֐d;Ӵd;d28;量有对线和对Ӵd;两方面，对线采用 Garden 指数；在对Ӵd;方面，随着皮d28;对Ӵd;理念（正性、Ӣd;性、d1f;性）的cd0;出，特别强调Ԥd;内侧皮d28;的相互砥住支撑（解剖、正性），是获得骨折稳定性֐d;Ӵd;的关键，而Ӡd;Ԙd;强调后内侧小转子骨块的作用。术后影像学的稳定性评分为早期下地zd9;立d1f;जd;cd0;供了量化指标。但术Ӣd;的Ԥd;内侧皮d28;支撑֐d;Ӵd;，在术后头颈骨块nd1;动获得二次稳定的过程Ӣd;，Ӭd;有皮d28;对Ӵd;丢失现象，需研究其危险因d20;和防范措ٛd;。~d3;论股骨转子间骨折在Sd6;得良֗d;对线的基础上，只要获得了Ԥd;内侧皮d28;的相互砥住和支撑，并用内固定器械维持住，就获得了术后稳定性。术后稳定性评分优良者，可以安全地早期下地d1f;जd;、zd9;立行d70;d3b;动。     

改良内固定融合术治疗成人Ⅱ型痛性足副舟骨

目的探讨改良内固定ࡸd;合术治疗成人Ⅱ型udb;性db3;副舟骨（painful accessory navicular，PAN）的疗效。方ld5;2016 年 1 月—2017 年 12 月，采用改良内固定ࡸd;合术治疗 29 例（37 db3;）Ⅱ型 PAN。其Ӣd;男 12 例，女 17 例；年龄 18～50 岁，平均 41.4 岁。ئd;伤 24 例，无明显诱因 5 例。患者均行 6 个月以上Odd;守治疗，症状无明显改善。术Ԥd;及末次随访时采用美կd;矫形db3;࣡d;协会（AOFAS）Ӣd;db3;评分评估临床疗效；X 线片d4b;量ddf;骨倾斜‰d2;、ddd;骨第 1 dd6;骨‰d2;、ddd;舟关节包容‰d2;、ddd;骨第 2 dd6;骨‰d2;。~d3;果术后 1 例出现切口d45;表感gd3;，经加强换药后愈合；其余患者切口均Ⅰ期愈合，无df1;部感gd3;或骨šd3;炎Sd1;生。29 例均获随访，随访时间 12～33 个月，平均 25.1 个月。X 线片示关节面均于术后 2～5 个月愈合，平均 3.4 个月。随访期间未见内固定物松动或ٚd;裂。末次随访时，AOFAS 疼udb;、功ࠏd;、力线评分及总分以及ddd;舟关节包容‰d2;、ddd;骨第 1 dd6;骨‰d2;和ddd;骨第 2 dd6;骨‰d2;均较术Ԥd;显著改善，dee;异有~df;计学意义（P<0.05）；ddf;骨倾斜‰d2;手术Ԥd;后dee;异无~df;计学意义（t=1.097，P=0.276）。 ~d3;论采用改良内固定ࡸd;合术治疗成人Ⅱ型 PAN 可有效缓解症状，患db3;功ࠏd;恢֐d;良֗d;，并Sd1;症少。     

Angiopathie amyloïde cérébrale ou atteinte des microvaisseaux cérébraux en rapport avec l’HTA : un challenge clinique

Cerebral amyloid angiopathy (CAA) is a entity characterized by degenerative Amyloïd deposits in the walls of the meningeal and cortical vessels. It is considered as the second cause of primitives cerebral hemorrhage in elderly. The differential diagnosis between AAC and hypertension-related cerebral small vessel diseases is difficult and represent a true challenge for the clinician. We report two cases of cerebral small vessel diseases revealed by malignant hypertension.     

CO2点阵激光早期控制唇裂二期整复术后瘢痕的疗效观察

目的观[df;kd4;较CO₂点阵激光早期控制唇裂术后二期整֐d;术术区瘢ud5;的临床疗效。方ld5;治疗组为43例接Sd7;唇裂术后鼻唇畸形二期整֐d;术的患者，早期采用CO₂点阵激光治疗，对照组为70例曾接Sd7;一期唇裂手术的患者，对两组6个月后的瘢ud5;恢֐d;情况db;行kd4;较；分析术后ddd;离激光开始治疗时间的长ݾd;，性别两因d20;对激光治疗瘢ud5;疗效的dee;异。~d3;果1）治疗组的疗效优于对照组（P<0.000 1），治疗组Ӣd;显效和有效所组成的总有效率达90.7%；2）男女疗效dee;异无~df;计学意义（P=0.487），手术后1年内的患者，手术后ddd;离开始瘢ud5;治疗的时间<3个月与≥3个月之间，疗效无明显~df;计学dee;异（P=0.055）。~d3;论CO₂点阵激光在唇裂二期整֐d;术术后瘢ud5;的治疗Ӣd;具有较为确切的疗效。且与患者的性别无明显相关性。手术后1年内的患者，术后ddd;离开始瘢ud5;治疗的时间<3个月和≥3个月疗效无dee;异，因此在唇裂二期手术后的1年内早期对瘢ud5;db;行干预可获得良֗d;的效果。     

PD-L1高表达晚期非小细胞肺癌患者单纯免疫治疗与免疫联合化疗疗效比较

背景与目的以Ԕd;疫检查点抑制剂（immune checkpoint inhibitors, ICIs）为代表的Ԕd;疫治疗d8a;来d8a;广ldb;地应用于肺癌治疗。然而，对于程序性死亡Sd7;体औd;体1（programmed cell death-ligand 1, PD-L1）šd8;表达，即肿瘤kd4;例评分（tumor proportion score, TPS）≥50%的晚期非小细€de;肺癌（non-small cell lung cancer, NSCLC）患者，采用单纯Ԕd;疫治疗d8;是Ԕd;疫联合化疗在临床上Ӭd;存争议。本研究旨在评估PD-L1šd8;表达的晚期NSCLC患者接Sd7;单纯Ԕd;疫治疗与Ԕd;疫联合化疗的疗效。方ld5;本研究Vde;顾性分析了49例PD-L1šd8;表达晚期NSCLC患者的临床d44;料。PD-L1表达采用22C3抗体行Ԕd;疫组化gd3;色，按TPS判读PD-L1表达水平。kd4;较Ӡd;同临床特征分组患者的客观缓解率（objective response rate，ORR）和无db;展生存时间（progression free survival, PFS）。~d3;果Ԕd;疫单药与Ԕd;疫联合化疗组的ORR分别为47.1%（8/17）和43.8%（14/32），dee;异无~df;计学意义（P=0.825）。Ԕd;疫单药与Ԕd;疫联合化疗组的Ӣd;Ӵd;PFS分别为8.0个月和6.8个月，dee;异无~df;计学意义（P=0.502）。并对本组PD-L1šd8;表达患者Ԕd;疫治疗的预d4b;因d20;db;行了分析，~d3;果显示，一线Ԕd;疫治疗ORR（12/19, 63.2%）显著优于二线及以上Ԕd;疫治疗（10/30, 33.3%），dee;异有~df;计学意义（P=0.041），二者间PFS无dee;异。年龄、性别、吸pdf;史、功ࠏd;状态评分（performance status, PS）、病理类型、肿瘤大小、肿瘤dcb;df4;~d3;转移（tumor node metastasis, TNM）分期与ORR和PFSӠd;相关。~d3;论PD-L1šd8;表达的晚期NSCLC患者接Sd7;Ԕd;疫单药和Ԕd;疫联合化疗的疗效相d1;。PD-L1šd8;表达患者一线Ԕd;疫治疗的ORR更佳。对此类人群的最佳治疗方案有待于Ԥd;瞻性临床研究db;一步探d22;。     

Valvular heart disease in Antiphospholipid antibody syndrome: Isolated Tricuspid stenosis

Antiphospholipid antibody syndrome (APLS) is a rare disorder characterized by a hypercoagulable state. Manifestations include arterial or venous thrombosis, recurrent fetal wastage, coronary artery disease, valvular heart disease, dilated cardiomyopathy, pulmonary artery hypertension, and intracardiac thrombus. Most commonly mitral valve is affected followed by aortic and then tricuspid valve. In this report, a rare case of spontaneous aortic thrombosis with tricuspid stenosis uncomplicated by other valve lesions is presented with clinical and echocardiographic studies and computed tomographic images.     

利用耳甲腔型小耳畸形残耳皮瓣及软骨改善再造耳颅耳沟效果观察

目的探讨对先天性耳甲腔型小耳畸形患者行全扩张ld5;全耳Ԙd;造术后，利用残耳皮瓣改善Ԙd;造耳颅耳沟的效果。方ld5;Vde;顾分析 2012 年 1 月—2017 年 1 月收治的 150 例先天性耳甲腔型小耳畸形患者。其Ӣd;男 92 例，女 58 例；年龄 6.5～35.0 岁，平均 11.1 岁。采用一期扩张器埋置、二期全扩张ld5;全耳Ԙd;造术后Sd1;现上部颅耳沟d45;显；于 6～12 个月后行三期Ԙd;造耳修整。将残耳垂通过“Zȁd;字改型转移以Ԙd;造耳垂。在残耳上部作蒂在轮屏切迹的残耳上部皮瓣，弧形切开松解并加df1;上部颅耳沟，将上部残耳皮瓣向颅耳沟创面旋转推db;߱d;合以覆vd6;创面；将带皮下组织蒂的残耳软骨组织瓣cd2;入支架底部形成的腔隙内，并߱d;合固定，以增加支架的šd8;度；耳甲腔区其余残耳皮瓣用以覆vd6;耳甲腔创面。~d3;果术后拆线时 1 例患儿皮瓣dc;端出现直径约 0.5 cm 的表皮水疱，经换药 2 周后愈合；其余患者皮瓣成d3b;良֗d;。患者均获随访，随访时间 6～12 个月，平均 9.6 个月。Ԙd;造耳上部颅耳沟均明显加df1;，Ԙd;造耳支架šd8;度Ӡd;同程度增加，双耳对称性佳，耳甲腔无明显挛缩Sd8;小，Ԙd;造耳外观满意。Ԙd;造耳上部表面kdb;Sd1;明显减少，耳周Sd1;际线上移。~d3;论采用耳甲腔型小耳畸形的残耳皮瓣及残耳软骨瓣转移，Ӡd;仅可加df1;颅耳沟，而且可增加上部支架的šd8;度，术后颅耳沟Sd8;形较轻，Ԙd;造耳与正常耳^d3;的对称性更佳。     

The relationships among monocyte subsets,miRNAs and inflammatory cytokines in patients with acute myocardial infarction

d="sect0015">Background

Acute myocardial infarction (AMI) causes irreversible myocardial damage and release of inflammatory mediators, including cytokines, chemokines and miRNAs. We aimed to investigate changes in the levels of cytokines (IL-6, TNF-α and IL-10), miRNAs profiles (miR-146 and miR-155) and distribution of different monocyte subsets (CD14++CD16-, CD14++CD16+, CD14+CD16++) in the acute and post-healing phases of AMI.div><div id="abst0015">

d="sect0020">Methods

In eighteen consecutive AMI patients (mean age 56.78?±?12.4 years, mean left ventricle ejection fraction – LVEF: 41.9?±?9.8%), treated invasively, monocyte subsets frequencies were evaluated (flow cytometry), cytokine concentrations were analyzed (ELISA) as well as plasma miRNAs were isolated twice – on admission and after 19.2?±?5.9 weeks of follow-up. Measurements were also performed among healthy volunteers.div><div id="abst0020">

d="sect0025">Results

AMI patients presented significantly decreased frequencies of classical cells in comparison to healthy controls (median 71.22% [IQR: 64.4–79.04] vs. 84.35% [IQR: 81.2–86.7], p?=?0.001) and higher percent of both intermediate and non-classical cells, yet without statistical significance (median 6.54% [IQR: 5.14–16.64] vs. 5.87% [IQR: 4.48–8.6], p?=?0.37 and median 5.99% [IQR: 3.39–11.5] vs. 5.26% [IQR: 3.62–6.2], p?=?0.42, respectively). In AMI patients both, analyzed plasma miRNA concentrations were higher than in healthy subjects (miR-146: median 5.48 [IQR: 2.4–11.27] vs. 1.84 [IQR: 0.87–2.53], p?=?0.003; miR-155: median 25.35 [IQR: 8.17–43.15] vs. 8.4 [IQR: 0.08–16.9], p?=?0.027, respectively), and returned back to the values found in the control group in follow-up. miR-155/miR-146 ratio correlated with the frequencies of classical monocytes (r=0.6, p?=?0.01) and miR-155 correlated positively with the concentration of inflammatory cytokines ? IL-6 and TNF-α.div><div id="abst0025">

d="sect0030">Conclusions

These results may suggest cooperation of both pro-inflammatory and anti-inflammatory signals in AMI in order to promote appropriate healing of the infarcted myocardium.     

Building and Exploitation of Learning Curves to Train Radiographer Students in X-Ray CT Image Postprocessing

IntroductionThis study aims to construct learning curves related to the realization of standardized postprocessing by radiographer students and to discuss their exploitation and interest.Materials and MethodsThis study was carried out in 21 French students in their 3rd year of training. Two postprocessing protocols in CT (#1 traumatic shoulder; #2 petrous bone) were repeated 15 times by each student. Each achievement was timed to obtain overall learning curves. The realization accuracy was also assessed for each student at each repetition.ResultsThe learning rates for the two protocols are 63% and 56%, respectively. The number of repetitions to reach the reference time for each protocol is 11 and 12, respectively. In both protocols, the standard deviations are significantly reduced and stabilized during repetitions. The mean accuracy progresses more quickly in protocol #1.DiscussionThe measured learning rates reflect a rapid learning process for each protocol. The analysis of the standard deviations shows that students have reached a homogeneous level. The average times and accuracies measured during the last repetitions show that the group has reached a high level of performance. Building learning curves helps students measure their progress and motivates them.ConclusionObtaining learning curves allows trainers/supervisors to qualify the learning difficulty of a task while motivating students/radiographers. The use of learning curves is inline with the competency-based training paradigm.     

Glutamate hypothesis in schizophrenia

Schizophrenia is a chronic and severe psychiatric disorder that has profound impact on an individual’s life and on society. Thus, developing more effective therapeutic interventions is essential. Over the past quarter‐century, an abundance of evidence from pharmacologic challenges, post‐mortem studies, brain imaging, and genetic studies supports the role of glutamatergic dysregulation in the pathophysiology of schizophrenia, and the results of recent randomized clinical trials based on this evidence have yielded promising results. In this article, we review the evidence that alterations in glutamatergic neurotransmission, especially focusing on the N‐methyl‐d ‐aspartate receptor (NMDAR) function, may be a critical causative feature of schizophrenia, how this contributes to pathologic circuit function in the brain, and how these insights are revealing whole new avenues for treatment development that could reduce treatment‐resistant symptoms, which account for persistent disability.