简介：摘要目的探讨钛制弹性髓内针（TEN）应用于儿童股骨干骨折治疗中的疗效。方法选取2017年3月—2018年3月我院收治的40例股骨干骨折患儿，均采用闭合或者小切口复位弹性髓内针固定进行治疗，对患儿术中、术后各指标及恢复情况进行统计分析。结果40例患儿手术时间为（35±10.5）min，术中出血量（20±11.0）ml，引流量为0，住院（4.5±1.5）d，术后骨折愈合时间（11±2.4）周；所有患儿均未出现并发症且恢复良好。结论钛制弹性髓内针疗效显著，创伤小，恢复快，愈合佳，值得临床用于儿童股骨干骨折的治疗。

简介：Ｔｈｅｓｙｎｔｈｅｓｉｓｏｆｐｏｒｐｈｙｒｉｎｎｉｔｒｏｇｅｎｍｕｓｔａｒｄｓｆｒｏｍｄｅｕｔｅｒｏｐｏｒｐｈｙｒｉｎａｎｄ３，８ｄｉａｌｋｙｌｏｘｙｈｅｍａｔｏｐｏｒｐｈｙｒｉｎｍｅｔｈｙｌｅｓｔｅｒｓｔｈｒｏｕｇｈｒｅｄｕｃｔｉｏｎ，ｂｒｏ...

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简介：摘要目的分析弹性钛制髓内钉（TEN）在儿童下肢长骨干骨折中的应用效果。方法回顾性分析2010年1月～2013年1月我院外科应用弹性钛制髓内钉内固定技术的38例下肢长骨干骨折的儿童患者的临床资料和治疗效果。结果全部病例均获随访，随访时间8.6~15.4个月，平均12.0个月。优13例，良22例，可1例，差2例，优良率为92.1%。结论弹性钛制髓内钉内固定技术具有损伤小、感染率低、骨折愈合率高等优点，是治疗儿童下肢长骨干骨折的有效方法。

简介：摘要目的制备同时携带IR780碘化物和硫酸长春新碱（VCR）的聚乳酸-羟基乙酸（PLGA）靶向纳米粒（IR780-VPN），并观察其在体外对肾母细胞瘤（SK-NEP1）的靶向作用及抗肾母细胞瘤增殖效率。方法制备IR780-VPN，检测其基本理化特性，培养SK-NEP1细胞作为体外肿瘤细胞模型，研究IR780-VPN的体外靶向性，观察以下6组的体外抗SK-NEP1细胞增殖效率：A组，PBS（对照组）；B组，游离VCR；C组，空白纳米粒（PN）；D组，载VCR纳米粒（VPN）；E组，载IR780纳米粒（IR780-PN）；F组，IR780-VPN。结果制备出的IR780-VPN平均粒径为（290.82±3.22）nm，粒径的分散指数（PDI）为0.024，平均Zeta电位为（1.16±0.87）mV。用细胞膜绿色荧光探针染色后于倒置荧光显微镜下观察，IR780-VPN大小均匀、形态规则，无聚集、粘连；透射电镜下观察IR780-VPN为球形或类球形，表面光滑，粒径分布均匀。其平均包封率为72.80%，平均载药量为2.80%，平均连靶率为91.30%。体外寻靶实验中可见SK-NEP1细胞表面有大量的IR780-VPN聚集。体外抗SK-NEP1细胞增殖实验证实，在相同药物质量浓度条件下，IR780-VPN组较VCR、VPN组的体外抗肿瘤细胞增殖效率高（P均<0.001），且游离VCR、VPN、IR780-VPN对SK-NEP1细胞增殖的抑制率具有浓度依赖性，药物质量浓度越大，对细胞的抑制作用越强（F=13254.105、54354.510、1370.059，P均<0.001）；而随着药物质量浓度增加，PN、IR780-PN组的细胞增殖抑制率差异均无统计学意义（P均>0.05），PBS（对照组）对SK-NEP1细胞增殖的抑制率为（2.83±0.32）%。结论本实验成功制备了性质稳定的靶向IR780-VPN，对肾母细胞瘤细胞有良好的的靶向性，并提高了体外抗肾母细胞瘤增殖效率，为体内的肿瘤分子靶向研究提供了实验基础。

简介：AbstractSchatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane, consequent to valgus impaction caused by low velocity of trauma. However, a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau. We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents. The fracture pattern and severity of injury deviate from the original description of Schatzker type 1; in view of dual plane split, there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury. The patients were initially treated with knee spanning external fixator and after a latency of 5 days, definitive fracture specific fixation was done, combined with repair of grade-III medial collateral ligament injury. At the 6 months follow-up both the patients achieved satisfactory knee functions (knee society score case 1:100 and case 2: 92) and returned to their jobs. The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury. Because of timely diagnosis, early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury. To prompt the description of injury pattern we coined the name "dual split and dislocation" of lateral tibial plateau, as a complex injury variant of split fracture of lateral tibial plateau fracture.

简介：Objective:Toinvestigatetheinfluenceofdifferentrightventricular(RV)pacingsitesonQRSwidth,andtoprovideapotentialreferencesiteforpermanentrightventricularpacinginpatientsimplantedwithpermanentpacemakers.PacingatthesitewiththeshortestQRSdurationmayreducethedeleteriouseffectsofRVpacingonLVfunction,andthushavingbeneficialeffectsonpatient’soutcome.Methods:AllconsecutivepatientswhowereplannedtohavepermanentpacemakerimplantationforaClassIorIIaindicationatourdepartmentfromOctober2010toJuly2012werescreenedfortheparticipationinthisprospective,singlecenter,non-randomizedstudy.ThebaselinesurfaceECGwasanalyzedforQRSwidthandmorphology,respectively.DuringtheimplantationprocedurepatientsweretransientlypacedatdifferentRVlocations(rightventricularapex,rightventricularinflowtract[RVIT],midseptum,highseptumandrightventricularoutflowtract[RVOT])beforetheleadwasplacedatitsfinalposition.Duringpacingatthedifferentpositionsthesurface12-leadsECGwasrecorded.BasedonthesurfaceofECGQRSdurationandmorphologyofthedifferentrightventricularpacingsiteswereanalyzedandcomparedwithbaselineandtoeachother.Results:Atotalof216patients(39%female,meanage69±13years,higherdegreeAVblock30.5%)wasenrolledinthestudy.PacedQRSdurationwassignificantlydifferentbetweenallrightventricularpacingsitescomparedwiththebaselineECG(baseline:106ms±21ms;meanpaced:158ms±16ms;p<0.001).RVApacingshowedthewidestQRS(168ms±16ms).QRSdurationwithRVITpacingwas166ms±15ms,andthatwithRVOTpacingwas165ms±15ms,respectively.QRSdurationwasnotsignificantlydifferentbetweenthesethreepositions.Mid-septalpacingshowedthenarrowestQRS(139ms±19ms)comparedtoallotherpacingsites(p<0.001).Pacingatthehigh-septumshowedabroaderQRS(153ms±14ms)thanthatpacingatthemid-septum.Comparedtootherrightventricularpacingsites

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简介：摘要目的探讨丙氨酸氨基转移酶(ALT)水平对原发性肝癌(以下简称肝癌)发病风险的预测价值。方法采用回顾性队列研究方法。收集2006年7月至2007年12月在华北理工大学附属开滦总医院(26 980例)、开滦林西医院(18 306例)、开滦赵各庄医院(14 469例)、开滦唐家庄医院(4 389例)、开滦范各庄医院(4 561例)、开滦荆各庄医院(7 623例)、开滦吕家坨医院(4 249例)、开滦林南仓医院(3 136例)、开滦钱家营医院(6 356例)、开滦马家沟医院(2 319例)、开滦医院分院(3 392例)行健康体检的95 780例受试者的体检资料，其中男76 491例，女19 289例；年龄为(51±11)岁，年龄范围为18～98岁。依据ALT三分位水平将受试者分为3组：T1组31 859例(ALT<14.7 U/L)，T2组30 627例(14.7 U/L≤ALT<22.0 U/L)，T3组33 294例(ALT≥22.0 U/L)。由固定医师团队于2006、2008、2010、2012、2014年在相同地点按相同健康体检顺序对受试者进行体检，收集流行病学调查内容、人体测量学及实验室检查指标。观察指标：(1)3组受试者的临床特征比较。(2)受试者随访和肝癌的发病情况。(3)影响受试者新发肝癌的危险因素分析。(4)ALT对肝癌模型预测价值的比较。采用健康体检的方式进行随访，随访内容为肝癌新发病情况和患者生存情况。以2006年首次健康体检时间作为随访起始时间，随访终止事件为发生肝癌、失访、死亡。随访时间截至2018年12月31日。正态分布的计量资料以±s表示，多组间比较采用单因素方差分析。偏态分布的计量资料以M(范围)表示，多组间比较采用Kruskal-Wallis秩和检验。计数资料以绝对数和(或)百分比表示，组间比较采用χ2检验。采用Kaplan-Meier法计算累积发病率，累积发病率的组间比较采用Log-rank进行检验。使用限制性立方样条曲线(RCS)计算连续变化的ALT和肝癌发病风险的剂量反应关系。而后采用COX比例风险模型分析不同ALT水平分组影响肝癌发病的风险比(HR)和95%可信区间。使用似然比检验和赤池信息量准则(AIC)计算ALT对于肝癌预测模型拟合情况的影响。使用C-统计量计算不同模型的预测能力。结果(1)3组受试者的临床特征比较：T1组受试者男性、年龄、收缩压、舒张压、腰围、体质量指数、总胆固醇、甘油三酯、空腹血糖、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、乙型肝炎表面抗原(HBsAg)阳性、高血压病、糖尿病、肝硬化、脂肪肝、恶性肿瘤家族史、吸烟、饮酒、体育锻炼分别为23 516例、(53±14)岁、(130±21)mmHg(1 mmHg＝0.133 kPa)、(82±12)mmHg、(85±10)cm、(24±3)kg/m2、(4.9±1.1)mmol/L、1.11mmol/L(0.79～1.63 mmol/L)、(5.4±1.6)mmol/L、(1.5±0.4)mmol/L、(2.3±1.0)mmol/L、478例、12 758例、2 482例、15例、5 899例、1 071例、9 553例、5 434例、5 210例；T2组受试者上述指标分别为24 886例、(52±12)岁、(132±21)mmHg、(84±12)mmHg、(87±10)cm、(25±3)kg/m2、(4.9±1.2)mmol/L、1.27 mmol/L(0.91～1.90 mmol/L)、(5.5±1.7)mmol/L、(1.6±0.4)mmol/L、(2.4±0.9)mmol/L、744例、13 884例、2 677例、13例、9 365例、981例、8 935例、5 216例、5 023例；T3组受试者上述指标分别为28 089例、(50±12)岁、(132±21)mmHg、(85±12)mmHg、(89±10)cm、(26±3)kg/m2、(5.0±1.2)mmol/L、1.45 mmol/L(1.02～2.28 mmol/L)、(5.6±1.8)mmol/L、(1.6±0.4)mmol/L、(2.3±0.9)mmol/L、1 416例、15 471例、3 583例、70例、15 277例、1 350例、10 514例、6 184例、4 447例；3组受试者上述指标比较，差异均有统计学意义(χ2＝1 181.88，F＝350.52、148.39、417.75、948.63、1 917.20、111.60, χ2＝3 747.25，F＝133.78、18.17、14.45, χ2＝478.33、306.60、181.38、58.19、5 649.18、38.82、45.69、35.11、152.64，P<0.05)。(2)受试者随访和肝癌的发病情况：95 780例受试者随访时间为9.05年(8.75～9.22年)，共有新发肝癌351例，肝癌总发病密度为3.39/10 000人年，女性肝癌发病率为1.11/10 000人年，男性肝癌发病率为3.97/10 000人年。T1组、T2组、T3组肝癌的发病密度分别为2.09/10 000人年、2.54/10 000人年和5.42/10 000人年。T1组、T2组、T3组受试者的肝癌累积发病率分别为2.47‰、3.10‰和6.11‰，3组比较，差异有统计学意义(χ2＝63.50，P<0.05)。(3)影响受试者新发肝癌的危险因素分析。COX比例风险模型分析结果显示：校正性别、年龄、体质量指数、总胆固醇、空腹血糖、HBsAg阳性、高血压病、糖尿病、肝硬化、脂肪肝、恶性肿瘤家族史、吸烟、饮酒、体育锻炼后，与T1组比较，T3组新发肝癌的风险增加(HR＝1.87，95%可信区间为1.40～2.49，P<0.05)。RCS结果显示：ALT与肝癌的发病风险呈非线性相关，且曲线呈上升趋势(RCS_S1_χ2＝7.21，P<0.05)。(4)ALT对肝癌模型预测价值的比较：建立多因素模型，将性别、年龄、体质量指数、总胆固醇、空腹血糖、HBsAg阳性、高血压病、糖尿病、肝硬化、脂肪肝、恶性肿瘤家族史、吸烟、饮酒、体育锻炼因素共同带入模型中，计算此模型的C统计量、-2Log L值和AIC值，分别为0.791、6 313.30和6 345.30。将ALT三分位数分组带入模型中，以T1组为对照组计算此时模型的C统计量、-2Log L值和AIC值，分别为0.792、6 300.48和6 328.48。多因素＋Fbg模型的C统计量和AIC数值降低，与多因素模型的-2Log L值的差值为12.82，差异有统计学意义(χ2＝12.82，P<0.05)。结论ALT是肝癌的独立危险因素。在建立肝癌预测模型或评估肝癌发病风险时，ALT可作为重要的参考指标。

简介：AbstractVaporized hydrogen peroxide (VHP) is a highly active disinfectant, and VHP decontamination systems have been widely applied in hospitals, microbiological laboratories, and pharmaceutical industries. However, the decomposition of VHP into non-toxic by-products is essential. Evaluation of the disinfection efficacy of VHP is crucial to ensuring the reliability of VHP disinfection and controlling microbial contamination. In this study, a rapid and sensitive strategy is proposed to evaluate the efficacy of VHP in surface disinfection by detecting the survived and killed bacteria from VHP-exposed biological indicators (BIs). A dual-channel solid-phase cytometer is designed, and fluorescent dyes are used as indicators to automatically and accurately distinguish live cells from dead cells in the mixtures of bacteria. To verify the availability and effectiveness of the laser scanning cytometry, experiments on its application in estimating the efficacy of VHP disinfection practice have been carried out in this study, and its estimation effect compared with that of the traditional plate counting method. Results show that the proposed assay might distinctly identify live or killed cells labeled by green and red fluorescent dyes and examined the disinfection efficacy in 30 min by calculating the bactericidal rate. Compared with the plate counting method, the proposed approach is accurate and practical, with an average detection efficiency of 98.47% ± 1.55%. Moreover, an excellent correlation between the concentrations of B. subtilis var niger (ATCC 9372) measured by the proposed detection system and by the plate counting method is noticed (R2= 0.9971), indicating that this approach had advantages in the detection of trace microorganisms. To summarize, the proposed strategy appears practical and significant in many fields in which microbial counting and identification are required.

简介：摘要目的探讨单根钛制弹性髓内针(TEN)治疗幼儿(１－２)岁股骨骨折的应用疗效.方法分析２０１１年６月~２０１４年０６月期间我科对收治２４例幼儿股骨干骨折,应用单根钛制弹性髓内针(TEN)手术治疗的患儿临床资料.结果患儿骨折全部愈合,功能恢复良好,平均住院天数５．３天,骨折愈合时间４~６周,术后３~５个月拔除髓内针,平均６~７周下地完全负重,未发生明显肢体短缩、过度生长、感染、断针等并发症,无内固定失败、不愈合、延迟愈合,膝关节活动正常.结论应用单根钛制弹性髓内针(TEN)固定技术具有操作方便、固定可靠、骨折愈合快、并发症少等优点,是目前治幼儿股骨骨折值得推广的方法.关键词单根肽制弹性髓内针;股骨骨折;幼儿中图分类号R６８７文献标识码B文章编号１００８－６３１５(２０１５)１０－０４１８－０２

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简介：本文研究了双波长差示一阶导数分光光度法运用于作为对照品的一氧化碳（ＣＯ）饱和水浓度标定及定性与定量测定微粒体代谢中生成的一氧化碳的方法。本法的优点在于能显著消除试样本底干扰，大大提高了定量准确性及灵敏度。在ＣＯ浓度２～１０μｍｏｌ·Ｌ１范围内与导数光谱峰（４１５ｎｍ）和谷（４２６ｎｍ）之间距离（Ｄ）呈良好线性关系，ｒ＝０．９９９９（ｎ＝５），回归方程Ｃ（ｍｍｏｌ·Ｌ１）＝１７．６Ｄ０．４。最低检测浓度低于０．１μｍｏｌ·Ｌ１ＣＯ。系统回收率和加样回收率（Ｘ±ＲＳＤ）分别为１０２．１±２．９％（ｎ＝７）和７９．７±６．８％（ｎ＝１２）；日内、日间精密度（ＲＳＤ）分别为４．４％（ｎ＝１８）和６．１％（ｎ＝１６）。将本法用于４个三卤苯胺和一个三卤苯的体外代谢测定，结果表明，仅２，４，５三氟苯胺在体外能被大鼠肝微粒体、ＮＡＤＰＨ和分子氧代谢生成一氧化碳。苯巴比妥和地塞米松等肝药酶诱导剂能显著提高一氧化碳的代谢转化速率，它们分别为空白对照组的３或８倍。

简介：AbstractBackground:High-dose dual therapy (HDDT) with proton pump inhibitors (PPIs) and amoxicillin has attracted widespread attention due to its favorable efficacy in eradicating Helicobacter pylori (H. pylori). This study aimed to compare the efficacy and safety of high-dose PPI–amoxicillin dual therapy and bismuth-containing quadruple therapy for H. pylori rescue treatment.Methods:This was a prospective, randomized, multicenter, non-inferiority trial. Patients recruited from eight centers who had failed previous treatment were randomly (1:1) allocated to two eradication groups: HDDT (esomeprazole 40 mg and amoxicillin 1000 mg three times daily; the HDDT group) and bismuth-containing quadruple therapy (esomeprazole 40 mg, bismuth potassium citrate 220 mg, and furazolidone 100 mg twice daily, combined with tetracycline 500 mg three times daily; the tetracycline, furazolidone, esomeprazole, and bismuth [TFEB] group) for 14 days. The primary endpoint was the H. pylori eradication rate. The secondary endpoints were adverse effects, symptom improvement rates, and patient compliance.Results:A total of 658 patients who met the criteria were enrolled in this study. The HDDT group achieved eradication rates of 75.4% (248/329), 81.0% (248/306), and 81.3% (248/305) asdetermined by the intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses, respectively. The eradication rates were similar to those in the TFEB group: 78.1% (257/329), 84.2% (257/305), and 85.1% (257/302). The lower 95% confidence interval boundary (–9.19% in the ITT analysis, –9.21% in the MITT analysis, and –9.73% in the PP analysis) was greater than the predefined non-inferiority margin of –10%, establishing a non-inferiority of the HDDT group vs. the TFEB group. The incidence of adverse events in the HDDT group was significantly lower than that in the TFEB group (11.1% vs. 26.8%, P < 0.001). Symptom improvement rates and patients’ compliance were similar between the two groups.Conclusions:Fourteen-day HDDT is non-inferior to bismuth-containing quadruple therapy, with fewer adverse effects and good treatment compliance, suggesting HDDT as an alternative for H. pylori rescue treatment in the local region.Trial registration:Clinicaltrials.gov, NCT04678492.

简介：摘要目的探讨钛制弹性髓内钉治疗小儿四肢长干骨骨折术中及术后可能出现并发症。方法选取于2013年1月～2014年2月来院治疗的小儿四肢长干骨折患儿86例作为研究对象，均采取钛制弹性髓内钉治疗，随访5～12个月，观察所有患儿术中、术后并发症发生情况及治疗效果。结果本组病例均达到骨性愈合，骨折愈合时间为（5.45±1.23）周，术中2例出现髓内钉进入骺板，2例骨皮质劈裂，1例骨折愈合时间延长，5例取钉困难，2例患肢缩短；治疗效果优67例，良15例，可4例，优良率为95.35%。结论钛制弹性髓内钉治疗小儿四肢骨折具有一定的优势，但也会出现一些并发症，具有创伤小、切口小、固定可靠、并发症少等优点，是一种安全、可行的方法。

简介：摘要目的探索Dual刀预切开在困难经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)中价值。方法选取2016年1月—2019年3月于复旦大学附属中山医院内镜中心就诊行ERCP治疗的40例患者，对插管困难的患者行Dual刀预切开，再行插管，评估该种方法对插管成功率及并发症的影响。结果40例患者中胆管结石21例，胰腺或胆管肿瘤15例，良性乳头或胆管狭窄4例。39例Dual刀切开后插管成功，成功率为97.5%(39/40)；l例未成功病例为胰腺肿瘤广泛侵犯胆管。术后发生血淀粉酶升高共11例，其中高淀粉酶血症2例，无出血、穿孔、ERCP术后胰腺炎、感染及死亡病例。结论Dual刀预切开在增加插管成功率的同时，降低了切开过程中的出血、穿孔及ERCP术后胰腺炎风险，提高了困难ERCP的成功率。