【摘要】 目的 探讨骨形成蛋白-2（bone morphogenetic protein-2，BMP-2）对室管膜前下区（anterior subventricular zone，SVZa）神经干细胞DLX5表达的影响。 方法 体外培养SVZa神经干细胞，用BMP-2及其拮抗剂Noggin诱导SVZa神经干细胞，分别用免疫荧光染色和逆转录-聚合酶链反应（RT-PCR）检测DLX5表达变化。 结果 BMP-2组SVZa神经干细胞DLX5蛋白表达和DLX5mRNA表达水平明显高于对照组（Plt;0.05），且该效应能被其拮抗剂Noggin特异性地抑制。 结论 BMP-2是DLX5上游调节基因，可促进SVZa神经干细胞DLX5的表达。【Abstract】 Objective To investigate the effect of bone morphogenetic protein-2 (BMP-2)on expression of DLX5 of neural stem cells in anterior subventricular zone (SVZa). Methods The neural stem cells of SVZa were separated and cultured in vitro, which were induced by BMP-2 and Noggin.Immunofluorescence staining and RT-PCR were employed to assay the expression of DLX5. Results The percentages of expression of DLX5 protein and DLX5 mRNA in BMP-2 group were much higher than those in the control group (Plt;0.05). And this induction could be specifically blocked by Noggin. Conclusion BMP-2 is an upstream gene of DLX5; BMP-2 can promote the expression of DLX5 of the neural stem cells of SVZa.
Objective To evaluate the physiological function and the anatomic structure of the first metatarsophalangeal joint for the patient withhallux valgus after a remodeling operation with the Keller’s method. Methods From April 2004 to November 2006, the first metatarsophalangeal joints in 11 patients (22 feet) with hallux valgus were remodeled with the Keller’s operation. There were 3 males and 8 females, aged 5173 years. Accordingto the Piggot typing standard, there were 17 feet of type Ⅱ (deflexion) and 5 feet of type Ⅲ (semiluxation). The hallux valgus angles(HVAs) were 2449° (average, 37°). The intermetatarsal angles (IMAs) were 90135° (average, 115°). The curative effect and the anatomic structure were evaluated by the followup and the Xray examination. Results All the cases werefollowed up for 6 to 30 months after operation (average, 14 months). According to the standard of ZHU Li Hua, et al, the results were excellent in 18 feet,good in 3 feet, and poor in 1 foot. The Xray films showed that the first meta tarsophalangeal joint of 14 feet developed mortarlike false articulation, and 8 feet developed partial false articulation. HVAs were 716° (average, 11°).IMAs were 90135° (average, 11.5°). According to the Piggot typing standard, there were 12 feet of typeⅠ(fitter) and 10 feet of type Ⅱ (deflexion). Conclusion For the patients with hallux valgus, the remodeling ofthe first metatarsophalangeal joint by the Keller’s operation can rectify HVA, improve the stability of the joints, and prevent occurrence of the insufficient muscle strength after operation.
OBJECTIVE: To investigate a cryophylactic agent (CPA) to protect tissue engineered tendon (TET) in deep low temperature. METHODS: Sixty-four BALB/C inbred nude mice were chosen, which included 4 as blank control group, left sides of 60 as experimental group and their right sides as control group. Transformed human embryonic tendon cells of the 54th passage and artificial materials of carbon fiber (CF) and polyglycolic acid (PGA) were co-cultured in vitro to construct TET. TET was frozen in liquid nitrogen with four kinds of CPA (groups A, B, C, and D) for 2 months. They were thawed quickly and transplanted into hind limbs of nude mice to repair the defects of Achilles tendon, which was 5 mm in length and 65.7% of total Achilles tendon. In control group, no cryopreservation treatment was taken. The morphological, histological, ultrastructure, and immunohistochemistry examinations were made and short tandem repeat loci were detected 2, 4, 6, 8, and 12 weeks later. RESULTS: In the experimental group, the morphological properties of tendon cells resumed gradually and the capability of synthesizing collagen enhanced by degrees. Tendon cells survived and could secret type I collagen and there was less difference between experimental and control groups 12 weeks after transplantation. In group A, vacuole in mitochondrion of tendon cell decreased, tendon cell arranged in order and abundant collagen fibers were found and linked. CONCLUSION: The cryopreservation agent in group A can protect TET in deep low temperature.
Objective To analyze retrospectively the overall situation of medical rescue in the Third People’s Hospital of Chengdu after the Wenchuan earthquake, so as to provide references for the emergency preparedness for the disaster of earthquake. Methods The analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the Hospital up to 8 a.m. of July 12. The software of Microsoft EXCEL was used for data input, and SPSS 11.5 was used for statistical analysis. Results Up to July 12, 563 cases from the disaster area had been treated in the hospital, of whom 249 were admitted into the outpatient department and 314 into the inpatient department, including 287 men and 276 women, with a median age of 42 years (28, 57) in the outpatient department and a median age of 46 years (33, 65) in the inpatient department. The inpatients’ age was older than the outpatients’s (P=0.003). Most outpatients were sent to the hospital within the first 3 days after the quake (73.50%), while less than half of the inpatients were sent to the hospital during this period of time. The wounded were mainly from Dujiangyan, Aba Prefecture and Pengzhou, which was correlated with the transportation distance, the casualty and the condition of the local hospitals. The wounded were mainly admitted into the Departments of Orthopaedics (69.3%), Neurosurgery (15.6%) and General Surgery (3.7%). The total cost in the Department of Orthopaedics was the highest, followed by the Intensive Care Unit (ICU) and the Department of Neurosurgery. However, the median cost in the ICU was the highest, followed by the Department of Neurosurgery and the Department of Nephrology. Only 9 out of the 563 patients died, including 5 outpatients and 4 inpatients, of whom 8 deaths were due to craniocerebral injury and 1 died of crush syndrome. Conclusion Based on the data, it is of vital importance to develop an emergent plan for the medical rescue after an earthquake disaster, and to strengthen the reserve of medical supplies, personnel training, scientific field triage as well as the construction of information platforms.
Objective To investigate the orthopaedic inpatients’ disease and cost constitution of the Third People’s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic department of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases (ICD-10). Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn’t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitalization cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient’s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient’s own expense reduced generally. Conclusion a) The total number of inpatients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b) The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe. c) The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d) Among all payment modes of hospitalization cost, the constituent ratio of patient’s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.
【摘要】 目的 探讨2型糖尿病合并下肢血管病变血管内介入治疗的临床意义。 方法 2009年1-5月对4例2型糖尿病合并下肢血管病变患者，根据血管狭窄情况选择不同介入治疗方式，行下肢动脉造影及动脉球囊扩张或支架成形术。 结果 4例患者均有表现静息痛及间歇性跛行，下肢血管超声显示糖尿病下肢动脉有不同程度的斑块、狭窄与血栓形成，病变累及下肢股动脉、髂动脉及胫前、足背动脉。介入治疗后患者下肢血管灌注得到明显改善，静息痛及间歇性跛行明显改善，皮温改善，需要截肢患者截肢平面显著降低。 结论 通过下肢血管DSA造影检查，准确了解糖尿病患者下肢血管的阻塞部位及程度，在保守治疗基础上选择不同方式的介入治疗，有助于下肢血管病变的明显改善。【Abstract】 Objective To investigate the clinical significance of intervention therapy for patients with type 2 diabetes combined with vascular lesions of lower extremities. Methods From January to May, 2009, four diabetic patients with vascular lesions of lower extremities were examined by Doppler ultrasonography and digital subtration angiography (DSA). All patients were treated by percutaneous transluminal angioplasty (PTA) or stenting therapy. Results Stenoses and obstruction of lower extremity blood vessels were observed in all patients. After intervention therapy, vascular perfusion of lower extremities was improved and signs of rest pain and intermittent claudication were relieved; the skin temperature was improved, and the amputation level was apparently decreased. Conclusion It suggests that DSA is effective in judging extend and location of blood vessel stenosis,and the interventional treatment could lead to a satisfying prognosis.
Objective To explore the clinical effects of emergency transcatheter aortic replacement (TAVR) on the treatment of patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis during hospitalization. Methods The study selected 44 patients from 8 heart valve centers from January 2018 to January 2021. All patients received emergency TAVR treatment. The patients’ baseline clinical data, cardiac ultrasound indicators, and postoperative hospital stay were collected. Paired t-test and McNemar test were used to compare and analyze the preoperative and postoperative cardiac ultrasound indexes, moderate to severe aortic stenosis, and cardiac function. Results The average age of the patients was (72.0±7.9) years. Valve displacement occurred in one patient during the operation, and the surgical success rate was 97.7%. Four cases died during hospitalization, and the mortality rate was 9.1%. The median length of hospital stay was 11.5 d. The postoperative aortic valve area was significantly higher than that before surgery [(0.5±0.2) vs. (3.8±1.6) mm2, P<0.05], the mean transvalvular pressure of the aortic valve was significantly lower than that before operation [(64.0±24.9) vs. (11.3±4.6) mm Hg (1 mm Hg=0.133 kPa), P<0.05], the peak aortic flow velocity was significantly lower than that before operation [(4.5±0.7) vs. (1.9±0.7) m/s, P<0.05], the left ventricular end diastolic inner diameter was lower than that before operation [(59.0±7.2) vs. (56.1±7.3) mm, P<0.05], the left ventricular ejection fraction increased significantly compared with that before operation [(30.1±10.4)% vs. (40.9±11.0)%, P<0.05], and the cardiac function improved significantly compared with that before operation (P<0.05). During the operation, 2 cases (4.5%) underwent valve-in-valve implantation, 11 cases (25.0%) underwent percutaneous coronary intervention during the same period. During the postoperative hospital stay, 1 case (2.3%) developed stroke, 3 cases (6.8%) experienced severe bleeding, 5 cases (11.4%) had severe vascular complications, 2 cases (4.5%) experienced acute myocardial infarction, 30 cases (68.2%) had small or trace paravalvular regurgitation, 3 cases (6.8%) received permanent pacemaker implantation, and 5 cases (11.4%) developed acute kidney injury. Conclustion Emergency TAVR is an effective and feasible treatment plan for patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis.