奥美拉唑加羟氨苄青霉素治疗幽门螺杆菌阳性消化性溃疡60例疗效分析

对108例幽门螺杆菌阳性消化性溃疡随机分为两组：治疗组60例用奥美拉唑联用羟氨苄青霉素，对照组48例单用奥美拉唑治疗．结果，治疗组溃疡愈合率、幽门螺杆菌根除率、活动性胃炎消失率分别为95％、93．3％、95％显著优于对照组；12个月复查溃疡复发率、幽门螺杆菌检出率治疗组分别为13．3％和35％，显著低于对照组．说明，奥美拉唑联用羟氨苄青霉素治疗幽门螺杆菌阳性消化性溃疡的疗效明显优于单用奥美拉唑．     

Evans手术对跟骰关节压力影响的生物力学研究

目的　研究Evans手术矫正平足畸形对跟骰关节压力的影响以及该术式的足外侧柱最佳撑开宽度,为临床提供借鉴与参考。 方法　6例正常成人新鲜足标本,根据不同工况分为正常对照组、平足模型组、Evans手术外侧柱延长的LCL*4 mm、LCL*6 mm、LCL*8 mm、LCL*10 mm及LCL*12 mm组。实验标本逐级加载至350 N,利用K-ScanTM骨关节接触面测量系统的K-Scan6900#压敏片分别测量7组跟骰关节压力变化。 结果　在350 N垂直载荷下跟骰关节的峰值压强分别为（kg/cm2）：对照组(9.21±　1.60)、平足组(24.90±2.45)、LCL*4 mm组(21.68±2.21)、LCL*6 mm组(15.95±2.59)、LCL*8 mm组(11.04±　1.15)、LCL*10 mm组(15.20±2.35)、LCL*12 mm组(21.55±2.03)。平足组跟骰关节峰值压强较对照组显著增高（P＜0.05）;Evans术后的所有组跟骰关节峰值压强较平足组有明显降低（P＜0.05）;LCL*8 mm组与正常对照组跟骰关节峰值压强接近（P=0.143）;LCL*8mm组跟骰关节峰值压强较其他外侧柱延长组小（P＜0.05）。 结论　 Evans手术治疗获得性平足,其术后对跟骰关节压力在一定范围内较平足术前有所减小,呈先减小后增大的趋势;而撑开长度在8 mm时跟骰关节压力最小,且最接近正常状态。     

股骨转子间骨折经皮加压钢板固定与髋螺钉固定的比较

Summary Evidence from four randomized controlled trials suggests a 60％ reduction in 1 year mortality for percutaneous compression plating(PCCP)compared with hip screw(HS)for treatment of pertrochanteric hip fractures.Other outcomes favoring PCCP include lower mean blood transfusion requirements and slightly lower postoperative pain.Both PCCP and HS are associated with low rates of implant failure,however,in the PCCP group implant failure and unplanned reoperations may be more common.Additional randomized controlled trials are recommended to verify these results.4项随机对照研究的证据提示,与髋螺钉(HS)治疗股骨转子间骨折相比,经皮加压钢板固定(PCCP)术后1年的死亡率可以降低60％.另外,PCCP治疗还可以降低输血量,术后疼痛相对轻微.虽然PCCP与HS治疗发生内固定失败的几率均较低,但是相比较而言,PCCP的内固定失败率和再次手术率更高.因此,需要开展大样本随机对照研究(RCT)来进一步明确这些研究结果.     

急性早幼粒细胞性白血病误诊病例的骨髓细胞形态学鉴别诊断作用探讨

目的：探究急性早幼粒细胞白血病的误诊病例骨髓细胞形态学的鉴别诊断价值。方法资料回顾性选取急性早幼粒细胞白血病6例误诊患者资料,均行骨髓细胞形态学的鉴别诊断,分析其鉴别的诊断结果情况。结果行骨髓检查误诊为AML-M5的3例患儿,经再次行骨髓鉴别诊断1例AML-M3a、2例AML-M3b,3例误诊为APL,再次诊断确诊为2例AML-M2a、1例AML-M2;予病例针对性干预,症状有效缓解。结论对于急性早幼粒细胞白血病行骨髓细胞形态学检查,可发生误诊病例,临床诊断时需要严格、认真检查显示结果,可提高鉴别诊断准确性。     

胫骨下段粉碎性骨折的手术治疗

[目的]探讨胫骨下段粉碎性骨折的治疗方法和临床疗效：[方法]回顾本院自2004年5月～2005年2月，对30例胫骨下段粉碎性骨折的患者进行手术治疗。选择合适的手术时机，延期切开复位应用胫骨远端内侧解剖型钢板内固定，并对所有患者进行预防性植骨。[结果]术后随访8～17个月，平均13．9个月，伤口均一期愈合，所有病例获得骨性愈合，平均愈合时间12．7周（9～16周）。按Mazur评分标准：优22例，良6例，可2例，差0例，优良率93．3％，所有患者无严重并发症。[结论]胫骨远端内侧解剖型钢板是治疗胫骨下段骨折的理想内固定物，选择合适的手术时机、预防性植骨是取得满意疗效的保证。     

IRAK-4在大鼠缺血性脑损伤早期的表达及意义

目的 探讨白细胞介素-1受体相关激酶-4(interleukin-1 receptor-associated kinases,IRAK-4)在大鼠大脑缺血性损伤早期的表达及意义.方法 应用大脑中动脉线栓法(MCAO)建立大鼠局灶永久性脑梗死模型,随机分为正常对照组、假手术组、缺血组、干预组.采用RT-PCR、Western blot、免疫荧光、神经功能5分评定及TTC染色等方法,检测大鼠额顶叶皮层组织IRAK-4在脑缺血性损伤早期的mRNA及蛋白表达变化、神经功能缺损程度及脑梗死体积变化,并统计各组死亡率.结果 大鼠大脑缺血性损伤早期额顶叶皮层组织IRAK-4 mRNA表达:3 h开始增加,12 h达到高峰,24 h仍维持在较高水平;IRAK-4蛋白表达:3 h开始增加,6 h达到高峰,12 h仍维持在较高水平,24 h下降与正常对照组无统计学意义;IRAK-4抑制能明显缩小脑梗死体积、改善神经功能、降低死亡率.结论 大鼠额顶叶皮层组织IRAK-4在脑缺血性损伤早期表达迅速上调,可能参与了脑缺血后炎性反应的调控,早期抑制其功能可以发挥显著脑保护作用.

Abstract：

Objective To investigate the expression and significance of Interleukin - 1 ReceptorAssociated Kinases 4( IRAK -4) in rat ischemic brain injury. Method Models of focal cerebral infarct were established by occlusion of middle cerebral artery ( MCAO ). Rats were randomly divided into normal control group, sham surgery group, ischemic group, treated group. The mRNA and protein expressions of IRAK-4 in cerebral cortex were detected by RT- PCR method, Western blot analysis and laser scanning confocal microscope(LSCM). The neurological deficits were evaluated in 0 ～ 4 scales. The infarct size was measured by TTC staining. The mortality of each group was also calculated. Results The mRNA and protein expressions of IRAK -4 in cerebral cortex increased after ischemic injury 3 hours and decreased gradually after reaching the highest level at 12 h or 6 h( P ＜0.01 ) ,after 24 h the concentration of protein showed no significant differences compared with normal control group ( P ＞ 0.05 ), but mRNA is still at a high level ( P ＜ 0.05 ) ;the inhibition of IRAK -4 could induce the cerebral infarct, neurological deficits and mortality rate. Conclusions Brain ischemic injury increased the expression of IRAK - 4 in cerebral cortex,and inhibition of neuronal IRAK-4 by IRAK- 1/4 inhibitor at the early stage could effectively protect the neuron against death. The mechanism may be related with down - regulation of the inflammation response resulted from stroke.     

儿童肱骨髁上骨折内外侧交叉克氏针固定与单纯外侧克氏针固定的比较(UPDATE to December 2007 report)

3项小样本随机对照研究显示内外侧交叉克氏针固定与外侧克氏针固定治疗儿童肱骨髁上骨折疗效相当.根据总体研究结果分析,两治疗组间Baumann角和提携角的丢失、关节活动度、功能障碍、医源性神经损伤及感染的发生率等监测指标差异均无统计学意义.虽然感染(其中2项研究)和尺神经损伤(其中1项研究)在内外侧克氏针固定组更为常见,但是差异并无统计学意义.因此,为明确两种治疗方法的远期有效性和安全性,还需开展大样本随机对照研究,并进一步增加病例的随访时间.     

两种第二趾切取游离移植对供足足底应力影响的生物力学研究

目的 探讨第2足趾切取游离移植对供足足底应力的影响.方法 取6具正常成人新鲜尸体足标本,根据不同状态分3组:完整组(A组)、第2趾截除(保留跖骨头)组(B组)及带部分跖骨的第2趾截除(跖骨远l/3处)组(C组).应用电子万能试验机以2 mm/min的速度从胫骨远端施加轴向压载,加载载荷分别为0、600、1200 N.通过F-Scan足底压力测量系统检测足底应力变化,并对数据进行统计学分析.结果 足底应力随轴向压载的增加而增大.A组(足母)指及5个跖骨头的峰值压强以第2跖骨头最大,600 N垂直载荷时为(37.33±7.34)kPa,1200 N垂直载荷时为(112.33±10.33)kPa.同一载荷下,A组与B组的(足母)指及5个跖骨头的峰值压强差异均无统计学意义(P>0.05).同一载荷下,A组、B组分别与C组比较,(足母)指及5个跖骨头的峰值压强差异均有统计学意义(P<0.05).结论 第2跖骨的完整对足底应力正常分布及维持足弓具有重要意义.保留跖骨头的第2趾切取对供足足底应力分布影响较小,带部分跖骨的第2趾切取可导致供足足底应力的异常分配.     

髋部骨折负重与非负重锻炼对促进功能恢复的影响

The results from two recent RCTs indicate little additional efficacy of weight-bearing exercise compared with nonweight-bearing exercise on measures of strength, balance, gait, and functional performance. Although one study found significant improvements in some balance and functional performance measures at the 4-month follow-up, the other study found no significant between-group differences at 2-weeks follow-up. There was a discrepancy in the timing of the exercises following fracture that may have affected the results: exercises were commenced at a mean of 156 days in one study and 18 days in the other. Methodologically rigorous randomized controlled trials with larger populations are necessary to establish the superiority of weight-bearing exercise following hip fractures.