简介：TheeffectofstressdistributionduetothechangesofthedistalscrewalignmentinrelationtotheGammanailandthefemoralshaftisthoroughlystudiedinthispaper.FailureoftheGammanailcompositeoccursthroughthecranialapertureofthedistalscrewsandtheinsertionholeforthelagscrewduetononunion,delayed-unionandcontinuedweight-bearing.Athree-dimensionalfiniteelementmodelwasusedtostudythefracturedfemur,theGammanail,thelagscrewandthedistallockingscrews.ThefirstandtheseconddistalscrewswereinsertedintotheGammanailinfourdifferentconfigurations.WefoundthatthestressoftheGammanailcompositewassubstantiallyreducedwiththetwoscrewsconfiguredintheanteriortoposteriordirection.Thisalignmentcanbeargreaterloadinginthemoredemandingfracturetypes.Inthesubtrochantericfractureorthecomminutedfracturesattheproximalfemur,theoptimalalignmentofthetwodistalscrewswasintheanteriortoposteriordirection.

简介：客观；在脚关节关节上学习远侧的tibiofibularsyndesmosis的分离的影响并且比较各种各样的起作用的方法以便为分开的远侧的tibiofibular韧带联合发现合适的稳定。方法：从1997年7月到2002年7月，我们对待87个病人(64男性和23女性，变老18-54年)与distaltibiofibular韧带联合的分离，在谁之中，79与踝的骨折被相结合。Manipulativereduction，有cancellous螺丝钉的内部固定和有灰浆支持的外部固定在37个病人，有为腓骨的骨折的板和螺丝钉的固定和固定上被执行为34个病人上的远侧的tibiofibular韧带联合的withcancellous螺丝钉，和有peroneus的腱的distaltibiofibular系带的修理渴望我们，分开的distaltibiofibular韧带联合的减小，和有16个病人上的cancellous螺丝钉的固定。当远侧的tibiofibular韧带联合与cancellous螺丝钉被修理时，脚关节关节是为30°的dorsiflexed。并且cancellous螺丝钉在操作以后在8-10星期被拿出。结果：这些病人被跟随在上面为至少二年。药品效果根据病人的抱怨被估计，脚关节的轮廓，功能和无线电报连接；优秀in55病人(63%)，在14个病人(16%)在18个病人(21%)好、公平。distaltibiofibular韧带联合的分离在为长与peroneus的腱修理远侧的tibiofibular系带经历了一个手术的2个病人复发了我们并且恢复。一个cancellous螺丝钉被折断。没有坏死在脚关节榫眼的前面的皮肤发展了。结论:远侧的tibiofibular韧带联合的分离能与各种各样的合理操作被对待。长与peroneus的腱修理我们能为远侧的tibiofibular韧带联合的完全的分离得到优秀结果。

简介：Schwannomasareneurogenictumorsthatarisefromtheneuralsheathsofperipheralnerves.Thesetumorscanbelocatedinanyareaofthehumanbody;themostcommonlocationsarethehead,neck,trunkandextremities.Pancreaticschwannomasareveryrare.Overthepast40years,only67casesofpancreaticschwannomashavebeenreportedintheEnglishliterature.Herewepresentacaseofpancreaticschwannomaina62-year-oldmale.Thetumorwasrevealedbyultrasoundandcomputedtomographyintheneckandbodyofthepancreas.Anaccuratediagnosiswasdifficulttoobtainpreoperatively.Thepatientconsentedtotheperformanceofalaparotomy,andthemasswasfoundintheneckandbodyofthepancreasandsuccessfullytreatedusingaspleenpreservingdistalpancreatectomywithsplenicarteryandveinpreservation.Theprocedurehasonlybeenreportedinoneothercaseofpancreaticschwannoma;herewepresentthesecondreportedcase.Macroscopically,thetumorwaswellcircumscribed,gray-whiteincolorand3.3cm×2.8cminsize.Microscopically,thetumorcellswerespindle-shapedandhadapalisadingarrangementwithnoatypia,whichareresultscompatiblewithabenigntumor.Bothhypercellularandhypocellularareaswerevisible.Immunohistochemically,thetumorcellswerestronglypositiveforS-100protein.Thetumorwasdefinitivelydiagnosedasaschwannomaofthepancreaticneckandbody.Thepatientwasfollowedfor72moandhasbeendoingwellwithoutanycomplications.

简介：AbstractImportance:A nasogastric tube is used commonly to decompress the stomach and provide enteral feeding in surgical and medical practice. Sometimes this safe and innocent-looking tube may lead to unexpected complications. We focus here on the possibility of spontaneous 'lariat loop’ knotting of the nasogastric tube when some resistance is felt on tube retrieval and describe a method of safe tube removal.Case presentation:We present a case of self-knotting of a nasogastric tube that was placed to decompress the stomach during the postoperative period after surgical repair of anorectal malformation in a 4-month-old boy.Conclusion:Self-knotting of the distal end of nasogastric tube is an unusual complication with catastrophic sequelae if not addressed properly. If any resistance is felt during nasogastric tube retrieval, self-knotting of the tube must be suspected.

简介：Objective:　Toanalyzethecausesofdistalfemoralnonunionanddelayedunionandassesstheoutcomeofthecorrespondingtreatment,retrogradeintramedullaryinterlockingnail(RIIN).　　Methods:　FromJune1995toDecember1998,15patients(9malesand6females)withdistalfemoralnonunionanddelayedunionweretreatedwithRIIN.Theaverageageofthepatientswas34.5years(23-46years).Bonegraftingwasperformedin10patients,closedreamingwasdoneintheother5patients.Correctionosteotomywasperformedin2patients,andintra-articularreleaseofkneeadhesionin11patients.X-rayexaminationandkneesocietyclinicalratingsystem(KSS)wereusedtoevaluatetheresults.　　Results:　Allfractureswerefollowedupforatleast9monthswithaveragefollow-updurationof14.5months(9-33months).Solidunionwasdocumentedinallpatientsat6.4monthsonaverage.Therewerenoinfectionsormalunionsinthisseries.Basedonthefinalfollow-updata,acceptablefunctionalrangeofmotion(ROM)ofover90°wasachievedinmostpatients.TheaverageROMwas93.5°withsignificantimprovementof28°(42.7%,P＜0.05)comparedwiththepreoperativeROM.Theaveragekneescorewas96.ExcellentROMemergedin13patients.Thekneefunctionscorewas90.5onaverage.　　Conclusions:　Themaincausesofdistalfemoralnonunionanddelayedunionareimproperindicationsandimproperuseoftheimplants.RIINisaneffectivealternativefortreatmentofdistalfemoralnonunionanddelayedunionbecauseitcanprovideastableandreliablefixationwhichisbeneficialforearlyfunctionalexerciseofknee.Bonegrafting,closedreamingandintra-articularreleaseofkneeadhesionshouldbeconsideredinordertoenhancethebonehealingandimproveROMandthekneefunction.

简介：ObjectivesToevaluatethefeasibilityandsafetyofdistalprotectiondevice(PercuSurge)duringpercutaneouscoronaryintervention(PCI)inpatientswithacutecoronarysyndrome.MethodsFromOctober2004toAugust2007,40patientswithhighriskacutecoronarysyndromewhoreceivedprimarycoronaryinterventionwereincludedinthisstudy.PatientsweredividedintotwogroupsaccordingtowhetherPercuSurgewasattemptedduringPCI.Thebasicclinicalcharacteristics,angiographicresults,andfollow-updatabeforedischargewerecompared.Coronaryarteriesbloodflowthrombolysisinmyocardialinfarction(TIMI)grade,TIMImyocardialperfusion(TMP)gradeandtherateofno-reflowwereperformedinallcasesafterPCI.ResultsTherewasnosignificantdifferencebetweenthetwogroupsinbasicclinicalcharacteristicsandangiographybeforePCI(P>0.05).AllpatientsunderwentPCIsuccessfullyinbothgroups.InthePercuSurgegroup,PCIwithPercuSurgeguardwireprotectionwasperformedsuccessfullyin18patients.TherewassignificantdifferencebetweenthetwogroupsinTIMI3flowsgainedintargetvesselsafterPCI.BetterpercentageofTMPgrade3oftargetvesselswasachievedinPercuSurgegroup.Lessno-reflowwerefoundinPercuSurgegroup.TherewerelowerpeaktroponinIandserumMBisoenzymeofcreatinekinaselevels,higherleftventricularejectionfractionandsmallerleftventricularend-diastolicdimensioninthePercuSurgegroupafterPCIatthedatebeforedischarge(P<0.05).TherewasnomajoradversecardiaceventsinPercuSurgegroup,onlyonepatientdiedinthecontrolgroup.ConclusionsThisstudydemonstratesthatusingthePercuSurgeGuardwiresystemduringPCIinhighriskacutecoronarysyndromepatientstopreventno-reflowisfeasibilityandsafety.

简介：瞄准：为了在Sprague-Dawley的远侧的食管分析microbiota移动，老鼠喂了一本高脂肪的食谱。方法：二十只Sprague-Dawley老鼠各被划分成高脂肪的饮食和10只老鼠的正常控制组。在从远侧的食管的mucosa的microbiota的作文基于选择文化被分析。许多乳杆菌种类被分子的生物技术识别。从乳杆菌殖民地的细菌的DNA被提取，并且16SrDNA被PCR用细菌的通用教材放大。放大16SrDNA产品被使中毒分开坡度胶化电气泳动(DGGE)。每个单身的乐队从胶化被净化并且送了被定序。结果：在远侧的食管把细菌的culturing基于mucosal，葡萄球菌aureus不在、全部厌氧微生物和乳杆菌种类与正常控制组相比在高脂肪的食谱组显著地被减少(P<0.01)。在远侧的食管的乳杆菌种类的作文上的详细DGGE分析揭示了那乳杆菌crispatus，乳杆菌gasseri(L。gasseri)并且乳杆菌reuteri(L。reuteri)在高脂肪的食谱组包括了乳杆菌种类，当在正常控制组的乳杆菌种类的作文由L组成了时。gasseri，乳杆菌jensenii和L。reuteri。结论：高脂肪的饮食在老鼠在远侧的食管导致了mucosalmicroflora移动，特别乳杆菌种类的作文。

简介：AbstractPurpose:The purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO.Methods:Patients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation.Results:Eighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6-36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old).Conclusion:BTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.

简介：远侧更少(Dll)基因是在大多数後生动物并且在所有调查节肢动物组的代表是在场的homeodomain抄写因素。在果蝇，最好学习了昆虫，Dll处于良好的竟技状态腿，天线和analia的proximodistal轴起一个必要作用，并且在指定antennal身份。在在果蝇胚胎的中间侧面的区域的房间的簇的Dll表示的开始代表手足的最早基因的标记。Dll基因涉及外部神经系统和敏感机关的发展，并且他们也在一些昆虫系作为黑色素沉着的主人管理者工作。这里，我们分析六只昆虫，线虫Caenorhabditiselegans和人的完全的染色体在数据库可得到的现代人，以及多重的Dll序列以便检验这些基因的结构和蛋白质特征。我们也在昆虫和蜘蛛上与强调考察节肢动物Dll基因的函数，表达式，规定和进化。

简介：以前的调查后退幸存由神经生长因素(NGF)和另外的neurotrophins发信号支持了多样的机制，但是所有建议机制有在普通retrogradely传给neuronal细胞身体的幸存信号的产生。我们报导在轴突发现被本地NGF发信号压制一个retrogradeapoptotic信号。从远侧的轴突的NGF退却独自是足够的激活pro-apoptotic抄写因素，c-jun，在房间身体。直接提供NGF给房间身体，从而恢复导致NGF的幸存的来源发信号，不能阻止NGF退却从远侧的轴突引起的c-jun激活。这是c-jun没在房间身体由于幸存信号的损失被激活的证据。而且，与用番红花作原料而制成的植物盐基堵住axonal运输禁止了建议retrogradely搬运的幸存的一个retrogradely搬运的pro-apoptotic信号，而非损失发信号的NGF剥夺引起的c-jun激活，引起的c-jun激活。另外的实验证明c-jun，pro-caspase-3劈开，和apoptosis的激活被蛋白质kinaseC禁止者，rottlerin和chelerythrine堵住，仅仅当适用于建议他们堵住轴突特定的pro-apoptotic信号的远侧的轴突时。rottlerin敏感的机制被发现调整肝糖synthasekinase3(GSK3)活动。siRNA的效果击倒，并且GSK3的药理学抑制建议GSK3为NGF剥夺引起的apoptosis被要求并且可以作为轴突apoptotic信号的一个retrograde搬运人工作。在被neurotrophins压制的轴突表明系统的retrograde死亡的存在为neurodevelopment并且为为neurodegenerative疾病和neurotrauma发现治疗有宽广含意。

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简介：AbstractPost-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.

简介：骨头接枝可以被需要用metaphyseal在老病人填满骨头缺点弄碎的远侧的半径骨折。在这回顾，nonrandomized，单个外科医生的学习，我们评估了与使矿物化的骨胶原(MC)使用两块背面的锁住板与或没有扩大的临床、放射线学的结果为老病人与的骨头接枝背面地，metaphyseal弄碎半径破裂。在组1的病人(n=12)在组2用MC骨头接枝申请与背面的锁住的盘子被对待进metaphyseal骨头缺点，和那些(n=12)仅仅与背面的锁住的盘子。临床、放射线学的参数在外科以后在三和12个月被决定。在最后的后续，没有重要差别在2个组之间被注意以手掌倾斜并且光线的倾斜(p=0.80)；然而，尺骨的变化在没有扩大，2与背面的锁住的盘子对待的组显著地增加了(p<0.05)。机能上地，这些组之间没有重要差别。我们的初步的学习建议骨头接枝代用品和背面的锁住盘子可以是的MC的那联合一为有metaphyseal的老病人有用地其他弄碎的远侧的半径骨折。

简介：AbstractPurpose:Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.Methods:This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).Results:Average malunion (degrees) in the MIPPO group was 5 (3—7) ± 1.41 vs. 10.22 (8—14) ± 2.04 in the IMIL group (p= 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p= 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p= 0.001).Conclusion:Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

简介：AbstractPurpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment. This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation.Methods:A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups: volar plate group and external fixator group. These patients aged between 18 and 60 years had unilateral fractures, and agreed to be included in the study. Patients with a history of fracture, bilateral fracture, associated other injuries, delayed injury for more than 2 weeks, open fracture, pre-existing arthrosis or disability, psychiatric illness and pathological fracture were excluded. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The assessment of pain, functional activity, range of motion and grip strength was done at each stage of follow-up. The pain and functional activities were assessed by patient rated wrist evaluation (PRWE) score and disabilities of the arm, shoulder and hand (DASH) score.Results:Patients in volar plate group had superior PRWE score and DASH score at each stage of follow-up. At 1 year follow-up, the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group; while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group. They had better flexion and extension range of movement. They also had better pronation and supination range of motion at initial follow-up, however the difference get attenuated by 1 year. Volar plate group had significantly better grip strength than external fixator group. Complication rates were higher in external fixation group.Conclusion:Fixation with variable angle volar plate results in early wrist mobilization, better range of movement, less pain and disability and early return of function.

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简介：客观：为胫骨的intramedullarynails.Methods的远侧的锁住评估帮助thecomputer的汽车框架航行系统的临床的可行性和效果：系统的硬件部件与一个监视器包括了一台PC计算机，汽车机械立体声战术的定位立方的框架，脚持有者和起作用的本地化仪器。特殊航行软件能被用于X光检查fluoroscopic图象和工具的real-timecontrolling航行的登记。近胫骨、腓骨的破裂的21个案例被对待，关上的intramedullary钉其6在中间第三包含了，12在里面中间、更低第三，3在里面降低第三。涉及锁住的过程的C手臂排列和登记时间，fluoroscopic时间和钻的时间被记录。unreamed或铰大的胫骨的钉子的尺寸从8/300-11/330。结果：除了1的所有远侧的洞成功地被锁。在41个锁的洞(21.95%)中的9个里，练习小点摸了没有钉子和临床的后果的损坏，锁洞的运河。荧光检查时间每一些螺丝钉是2.23s±0.31s。结论:为远侧的锁住的帮助计算机的汽车框架航行系统很好被设计，对容易操作并且不在过程期间需要另外的仪器。发达系统使医生能精确用就一些校准计算机的X光线照相术的图象在整个解剖遨游外科的仪器。X光暴露的全部的时间能显著地每过程被减少。

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简介：BACKGROUND:Amyotrophiclateralsclerosis(ALS)isthemostcommonofallthemotorneurondiseasesandtheabsenceofabiologicmarkerhasmadebothdiagnosisandtrackingevolutionofthediseasedifficult.Electrodiagnostictestsplayafundamentalroleinquantifyingpathologicalchangesinthemotorunitpool.OBJECTIVE:Weassesseddistal-proximalMotorUnit(MU)lossandchangesusingthemethodofmotorunitnumberestimation(MUNE).DESIGN,TIMEANDSETTING:Acase-controlstudywasperformedattheDepartmentofNeuroscience,PisaUniversityMedicalSchool,ItalyfromDecember1999toNovember2009.PARTICIPANTS:Atotalof50ALSpatientswererecruited,30males:meanage(59.6±13.3)years20females:meanage(63.9±11.7)years;range(30-82)years;allpatientshadprobableordefiniteALS.Thirtyhealthyvolunteerswererecruitedfromdepartmentstaffs,including20malesand10females;meanage(57.7±13.8)yearsservedascontrols.METHODS:MUNEwasperformedforboththebicepsbrachiiandabductordigitiminimimusclesothesameside.Thetechniqueusedrelayedsubstantiallyonmanualincrementalstimulationofthemotornerve,knownastheMcComastechnique(50mssweepduration,againof2mV/DivforMwave,0.5mV/Divforeachstep;filters10-20kHz).MAINOUTCOMEMEASURES:MUNEresultsweremeasured.RESULTS:FunctioningMUnumbers,measuredbyMUNE,decreasedinthebicepsbrachiiandabductordigitiminimimusclesovertheentireone-yearfollow-upperiod(oneassessmenteverythreemonths)comparedwithbaselinedetermination,therateofMUdecreasewassimilarinbothmuscles,butsteeperdistally.CONCLUSION:MUNEisafeasiblemethodforALSpatientsbothproximallyanddistallytotrackchangesovertimeinmuscleMUsduringthedisease'sevolution.

简介：AbstractBackground:The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture.Methods:The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications.Results:Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI:-2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach.Conclusions:This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.