手术治疗跟骨骨折对预防与减少距下关节炎发生的临床观察

目的探讨跟骨骨折的手术治疗与非手术治疗对跟骨骨折远期距下关节炎发生的影响。方法我院自1998—2010年共收治各型跟骨骨折95例,手术治疗75例,非手术治疗及翘拨复位20例。结果手术组术后4～6个月据骨折愈合情况完全负重行走。非手术治疗患者伤后2个月拆除克氏针及石膏,下地行走。手术治疗患者术后X线及CT检查,钢板、螺钉位置满意,Bohler’s角及Gissane角均得到恢复。随访患者85例。随访年限9个月～12年,平均6年。按Maryland足部评分系统评价,并以每足为基数,分数85～90分。手术治疗组全组优良率95%,非手术治疗组分数40～60分,优良率为30%。非手术治疗的患者中有10例出现行走疼痛,无法长距离行走,5例二期行距下关节融合术。结论恢复距下关节面及跟骰关节面平整,维持正常足弓形态和跟骨宽度是治疗的重点,钢板内固定治疗跟骨骨折对减少距下关节炎的发生是一种较理想的方法。     

AO钛钢板内固定治疗累及跟距关节的跟骨骨折分析

目的探讨切开复位AO钛钢板内固定治疗累及跟距关节的骨跟骨折的效果。方法行切开复位AO钛钢板内固定治疗累及跟距关节的跟骨骨折36例38侧,比较手术前后Bolder角和Gissane角。平均随访11．2个月。结果所有患者均恢复正常行走,Bohler角手术前平均-7．20°,手术后平均22．31°;Gis-sane角手术前平均158．70°,手术后平均113．30°。结论对于累及跟距关节的跟骨骨折行切开复位AO钛钢板内固定,可以恢复跟距关节,达到解剖复位,患者能够早期进行功能锻炼。     

切开复位解剖钢板内固定治疗跟骨关节内骨折疗效观察

目的评价切开复位解剖钢板内固定治疗跟骨关节内骨折的疗效。方法将18例22足关节面移位的跟骨骨折患者，经可延长的外侧L形入路切开复位解剖钢板内固定，自体髂骨植骨。术中使后跟距关节面解剖复位，恢复跟骨结节关节角（Bohler角）和跟骨交叉角（Gissane角）。结果术后患者获6～24个月（平均16个月）随访。按马里兰（Maryland）足部评分标准评价手术效果：优8足，良12足，可2足，优良率91％。结论切开复位解剖钢板内固定治疗跟骨关节内骨折可以取得满意的效果。     

切开复位钢板内固定治疗跟骨关节内骨折

目的观察和分析切开复位钢板内固定治疗跟骨关节内骨折的疗效。方法2001年10月至2006年12月对48例53侧跟骨关节内骨折,经跟骨外侧L形切口进行切开复位内固定。结果全部患者经8个月-3年随访,患者主观症状满意率77.4%,踝关节活动优75.5%,Bohler角优75.5%,足部外形优90.6%,总体优良率96.7%。术后跟骨长度、高度、宽度、距下后关节面复位、Bohler角、Gissane角均得到良好的恢复。结论切开复位钢板内固定治疗跟骨关节内骨折,复位良好,固定牢固,允许术后早期功能练习,能最大限度的减少骨折后的并发症,是治疗跟骨关节内骨折的一种理想方法。     

波及距下关节的跟骨骨折40例手术疗效评价

目的 观察波及距下关节的跟骨骨折的临床疗效.方法 40例跟骨骨折均波及跟距关节面,行切开复位内固定、植骨治疗,其中26例用跟骨钢板固定;18例患者为大块的骨折块,用一到两枚直径为2.5mm的克氏针自跟骨结节钻入至跟骨,维持复位的跟距关节面后,术后配合石膏固定.结果 所有患者骨折均于3月内愈合,参照有关评定标准,优31例,良8例,差1例,优良率97.5%.结论 波及距下关节的跟骨骨折,切开复位内固定是一种较好的治疗方法.     

可塑性钛钢板内固定治疗跟骨关节内骨折的疗效分析

目的 探讨可塑性钛钢板内固定治疗跟骨关节内骨折疗效及安全性.方法 选取跟骨关节内骨折患者42例,采用跟骨外侧改良“L”形切口,矫正跟骨短缩和内、外翻畸形.斯氏针从跟骨结节骨折块的后下沿跟骨轴向钻入直达塌陷的后关节面下方,恢复Bohler角、Gissane角和跟骨长度、高度,将外侧骨折片复位.用可塑形重建钛板固定,X线透视检查骨折复位.结果 本组42例患者,骨折愈合时间为(11.4±0.6)周.骨折对位对线良好,跟距关节面平整,跟骨Bohler、Gissane角均恢复至正常范围.Maryland评分优良率为90.5％.未发现手术原因引起的钢板断裂及螺钉断裂.结论 内固定切开复位及可塑性钛钢板内固定治疗跟骨关节内骨折,疗效显著,安全性高,值得临床推广.     

AO跟骨钢板治疗跟骨骨折35例疗效分析

目的:评价AO跟骨解剖钢板治疗跟骨关节内骨折的疗效。方法:将35例37足跟骨关节内骨折患者按Sanders分型,采用AO解剖钢板进行复位有限坚强内固定通过手术将后跟距关节面解剖复位,同时恢复Bhler′S角、Gissane角及跟骨高度,必要时植骨。结果:本组病例随访6～36个月,平均随访时间18个月。按Maryland足部评分标准评价,优15足,良17足,中3足,差2足,优良率86.5%。结论:本方法治疗跟骨骨折复位满意,固定牢靠,术中自体髂骨植骨,术后早期关节功能锻炼,疗效肯定,是一种目前治疗跟骨骨折的较好方法。     

跟骨骨折手术并发症的分析及预防策略

跟骨骨折是临床常见骨折之一,由于近75%的跟骨骨折累及距下关节,因此追求解剖复位并可靠固定是治疗的目的.以恢复跟骨的结构和解剖关系,避免创伤性关节炎的发生.由于距下关节形态复杂、显露困难,无论是撬拨复位石膏外固定,还是切开复位钢板内固定,常难达到解剖复位和牢靠固定,并发症多见.常见近期并发症有切口皮肤坏死、感染、甚至慢性骨髓炎,腓骨长短肌腱断裂,腓肠神经损伤.     

跟骨钢板治疗跟骨骨折63例体会

目的 探讨跟骨钢板治疗跟骨骨折体会.方法 跟骨关节内骨折51人63例,全部采用外侧切口,跟骨钢板内固定.结果 随访一年,63例跟骨骨折均达到骨性愈合,出现2例钢板外露,4例局部皮肤麻木,无感染、内固定折断及距下关节创伤性关节炎及跟痛症.结论 跟骨关节内骨折如要获得好的功能,应该解剖复位跟骨关节面及跟骨外形,跟骨钢板治疗跟骨骨折目前是最佳选择.     

跟骨结节牵引辅助复位下异型钢板固定治疗跟骨骨折23例效果观察

目的探讨跟骨结节牵引辅助复位下异型钢板固定治疗跟骨骨折的疗效。方法对23例跟骨骨折患者行切开复位异型钢板固定,术中采用跟骨结节牵引辅助复位,术后定期复查X线,记录骨折愈合后的Bohler角、Gissane角;术后1年采用Maryland足部评分系统评价术后足部功能。结果骨折愈合时间为2~6个月,平均(3.2±0.5)个月。术后Bohler角、Gissane角均恢复正常;Maryland足部评分优良率91.3%。结论跟骨结节牵引辅助复位下异型钢板固定治疗跟骨骨折效果良好,能够使跟骨关节面获得良好的解剖复位,使足部功能恢复正常,是治疗跟骨骨折的有效方法 。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.