下肢复杂骨折交锁髓内钉治疗粉碎骨折螺钉辅助固定的意义

[目的]探索在交锁髓内钉治疗下肢复杂骨折中粉碎骨折块辅助固定的意义。[方法]下肢复杂骨折78例根据AO分型均为C型骨折，通过交锁髓内钉内固定，辅以拉力螺钉固定。[结果]术后摄片骨折及骨折块达解剖或功能复位，随诊6～24个月，优良率为94．88％（74／78例）。[结论]四肢复杂骨折治疗中，粉碎骨折块的螺钉辅助固定能够加强交锁髓内钉的稳定性，减少断钉、断棒现象，有利于骨折愈合。     

透明质酸钠与带蒂筋膜脂肪片预防椎管粘连157例临床观察

目的:讨透明脂酸钠与带蒂筋膜脂肪片联合应用预防椎管粘连的可行性。方法:板切除减压,病灶摘除后,将透明脂酸钠2～4ml注入硬膜周围,后用带蒂筋膜脂肪片覆盖椎版缺损处。结果:57例术后随访6～64个月,优良率98%。结论:明脂酸钠与带蒂筋膜脂肪片联合应用为预防椎管粘连的有效方法。     

Is endoscopic one‐piece mucosal resection essential for early gastric cancer?

Background: Endoscopic mucosal resection (EMR) is widely accepted as a minimally invasive treatment for early gastric cancer (EGC) in Japan. However, the criteria for EMR must be strictly adhered to otherwise patients will miss the chance for additional therapy. We assess the important factor in expanding the indication of EMR. Methods: We investigated 1101 EGCs that had been resected by EMR at the National Cancer Center Hospital (NCCH), Tokyo, Japan, according to the indication recommended by Japanese Gastric Cancer Association (JGCA) and the expanded indication proposed by NCCH. Curability and local recurrence of the EMRs were assessed related to the applied indication and the number of resected specimens. Results: The recurrence rate of non‐evaluable resection was higher than that of evaluable resection (P < 0.0001). Eighty‐three lesions among 772 lesions in the JGCA group were non‐evaluable. Thirty‐seven leisons among 329 lesions in the NCCH group were non‐evaluable. There was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.8329). However, the rate of curative resection was lower in the NCCH group than in the JGCA group (P = 0.0009). In piecemeal resection, there was no difference in the rate of non‐evaluable resection between JGCA and NCCH groups (P = 0.0527). In one‐piece resection, the rate of non‐evaluable resection was lower in the NCCH group than the JGCA group (P = 0.0137). Conclusion: Based on our series of cases, we propose one‐piece resection as a gold standard for EMR because it enables accurate histological evaluation, even in the EMR, according to the expanded indication.     

Effect of various diuretics on membrane voltage of macula densa cells. Whole-cell patch-clamp experiments

The tubuloglomerular feedback mechanism is inhibited by diuretics such as furosemide. For the macula densa (MD) cells similar transport systems, as present in thick ascending limb (TAL) cells, have been suggested. To examine this further, membrane voltages (V _m) of MD cells were recorded with the fast or slow wholecell patch-clamp method. The effects of diuretics on voltages and the conductance properties of these cells were examined. V _m of MD cells measured with the whole-cell patch-clamp method were as high as those in TAL cells: –72±1 mV (n=21). An increase in the extracellular K⁺ concentration by 15 mmol/l depolarized V _m of MD cells by 11±1 mV (n=18). Ba²⁺ (1 mmol/ l) reversibly depolarized MD cells by 10±2 mV (n= 10). Thus, MD cells possess a K⁺ conductance that could allow for the recycling of K⁺ taken up by the Na⁺-2 Cl^–-K⁺ cotransporter. MD cells hyperpolarized reversibly upon addition of the loop diuretics furosemide, piretanide and torasemide, whereas muzolimine and hydrochlorothiazide, neither one acting on this cotransport system in other preparations including the TAL, had no effect on V _m. MD cells most likely possess the same cotransport system as the TAL cells, which drives NaCl reabsorption in the TAL and serves as sensor for the tubular NaCl concentration in MD cells.     

Immediate rehabilitation of a rheumatoid arthritis patient with single-piece implants

Introduction and importanceThe aim of this article is to report the long-term outcome of full mouth rehabilitation with single piece, smooth surface implants following immediate loading protocol on a patient suffering with RA and severe unilateral condylar resorption.Case presentationHere, we present a challenging case of a patient suffering from Rheumatoid Arthritis who was stabilized and completed successfully with a 4 year follow-up period. Prosthetic management optimized the inter-occlusal relationship to maintain both function and esthetic integrity. Single piece implants are designed to engage and take support from the cortical bone low in metabolic activities thus promoting the force transmission through apical threads that are engaged in the cortical bone.DiscussionRheumatoid Arthritis [RA] is an auto-immune inflammatory condition in which the inflamed and hypertrophic synovial membrane grows into the articulation surfaces. The Temporomandibular Joints [TM] are frequently involved in rheumatoid arthritis. According to the literature on RA, due to frequent periodontitis, decreased salivary secretion, medication, as well as decrease in bone regenerative potential, RA is often considered as a relative contraindication in the use of implants. Atrophic jaws and cases with comorbidities like osteoporosis, diabetes, rheumatoid arthritis, periodontally infected cases are restored with high success by single piece smooth surface.ConclusionTo the best of our knowledge, this may be the first case of immediate functional loading by bi-cortical single piece implants.     

前牙缺失中种植基桩数目对种植固定桥适合性影响的实验研究

为探讨前牙321缺失中不同种植基桩数目对Ni-Cr合金种植固定桥桥支架适合性的影响,采用三维坐标测量法,对3组分别含有1、2、3个种植基桩的五单位双端固定桥试件进行测量.结果显示选择不同的种植基桩数目对同一长度的铸件的精度有差别,含2个基桩的试件精度最高.固位体的理论边缘间隙值在50～150μm,理论浮升量在100～250μm.     

10%盐水冰袋的研制及临床应用

目的　探讨有效实用的临床物理降温方法。方法　选内、外科发热病人及五官科术后病人 10 0例随机分为对照组和观察组各 5 0例 ,对照组采用传统的冰块冰袋 ,观察组用自行研制的 10 %盐水冰袋 (冰霜状 )进行物理降温。结果　 10 %盐水冰袋低温持续时间长 ,冰袋松软 ,接触体表充分 ,易于固定 ,病人自觉舒适 ,降温、止血、止痛效果明显优于传统的清水冰袋 (P <0 0 5 )。结论　 10 %盐水冰袋制作简单、操作方便 ,在临床、社区、家庭护理中可广泛推广使用。     

软肝化纤丸治疗慢性乙型肝炎合并早期肝硬化40例临床分析

目的探讨软肝化纤丸治疗慢性乙型肝炎（CHB）合并早期肝硬化患者的临床疗效。方法将慢性乙型肝炎合并早期肝硬化患者81例随机分为治疗组（40例）与对照组（41例）。治疗组给予软肝化纤丸治疗；对照组用鳖甲软肝片、利加隆（水飞蓟素胶囊），疗程3个月。观察治疗前后肝功（ALT、AST、ALB、TBiL）和肝纤维化（HA、IV-C、LN）等指标的变化情况。结果疗程结束后，治疗组患脾大、门静脉增宽、肝纤维化指标明显好转，与对照组比较差异有显著性（P〈0．05或P〈0．01）。结论软肝化纤丸治疗慢性乙型肝炎合并早期肝硬化疗效优于鳖甲软肝片，利加隆。     

脑血栓片治疗脑梗死的疗效分析

脑梗塞是常见缺血性脑血管疾病,发病率逐年增高,其致死率、致残率高的特性严重危害着患者身体健康及生活质量。近年已成为医学和社会重点关注的课题,如何进一步提高对脑梗塞的治疗效果,降低致残率,提高患者的生活质量同时做好二级预防,降低复发率,是我们目前需要解决的一个重要问题。各种围绕治疗卒中的药物有很多,具体疗效各有不同,我们对脑血栓片治疗脑梗塞的疗效进行了观察。