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Objective:To study the effect of simulated case base on the training of resident’s post competency in the department of emergency.Methods:The study selected 63 residents who had the standardized training in the Department of Emergency, Xuanwu Hospital of Capital Medical University from June 2018 to October 2019, and they were randomly divided into observation group ( n=32) and control group ( n=31). The observation group was trained by emergency simulated case base, while the control group was trained by routine training methods such as theoretical lecturing and single skill training. The differences between the two training methods in the abilities of diagnosis and treatment, medical knowledge, interpersonal communication, practice-based learning and improvement of post competencies were compared by means of theoretical and operational assessments. Two groups were investigated with questionnaires, self-evaluation and satisfaction degree of post competency, and the differences between the two groups were compared. SPSS 19.0 software was used for t test and chi-square test. Results:There was no significant difference in the scores of medical knowledge and skill operation between the observation group [(43.53± 9.26) points and (7.32±1.03) points] and the control group [(42.47±8.64) points and (7.24±1.12) points] ( P>0.05). However, the scores of clinical diagnosis and treatment ability, professional accomplishment, interpersonal communication ability and practice-based learning and improvement were all significantly higher in the observation group than those in the control group ( P<0.05). The questionnaire self-assessment showed that there was no significant difference in scores of medical knowledge and skill operation between the observation group [(4.23±0.46) points and (4.05±0.52) points] and the control group [(4.14±0.38) points and (3.98±0.69) points] ( P>0.05), and the self-evaluation scores of professional accomplishment, interpersonal communication ability, clinical diagnosis and treatment ability, practice-based learning and improvement ability were higher than those in the control group ( P<0.05). The satisfaction with teaching method in the observation group was also higher than that in the control group ( P=0.020). Conclusion:The application of simulated case base can improve post competency in the standardized training of residents in the department of emergency, with good training effect.
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Objective To detect the influence of miRNA-34a (miR-34a) on the proliferation of osteosarcoma and the mechanisms responsible for miR-34a regulation.Methods The osteoblastic cell line MG-63 and Saos-2,human osteoblastic cell line hFOB 1.19,10 osteosarcoma tissues and 10 normal bone tissues were selected.The expression of miRNA-34a in osteosarcoma cells and tissues was detected by quantitative real-time polymerase chain reaction (qPCR).Next,a eukaryotic expression vector named pcDNA/miR-34a was constructed.Then,osteosarcoma cells were transfected with this eukaryotic expression vector and the effects of miR-34a overexpression on the proliferation and growth of osteosarcoma were measured using CCK-8,colony formation and xenograft model of nude mice.Finally,Western blot analysis was used to detect the expression of ether-à-go-go 1 (Eag1) gene in osteosarcoma cells after transfected with pcDNA/miR-34a or a miR-34a inhibitor miR-34a-2'-O-Methyl antisense oligoribonucleotide (miR-34a-2'-O-Me).Results Compared with normal bone tissues and osteoblastic cell line,miR-34a was down-regulated in osteosarcoma cell lines and tissues.Compared with the blank group and the control group,the cell survival rates of miR-34a group of the two cell lines were significantly lower [MG-63 72 h:blank group (40.05±4.82) ％,control group (36.88± 4.66) ％,miRNA-34a group (26.24±6.22) ％;MG-63 96 h:blank group (83.55±5.95) ％,control group (80.13± 4.48) ％,miRNA-34a group (30.21±7.26) ％;Saos-2 72 h:blank group (46.45±8.15) ％,control group (43.33± 6.89) ％,miRNA-34a group (26.81±3.17) ％;Saos-2 96 h:blank group (84.79±4.10) ％,control group (80.14± 3.11) ％,miRNA-34a group (31.77±5.17) ％].The similar results were obtained from colony formation assay (MG-63:blank group 83.40±3.29,control group 80.00±3.06,miR-34a group 24.40±2.71;Saos-2:blank group 85.00±3.32,control group 80.60±3.29,miR-34a group 30.40±4.94).The tumor volumes of osteosarcoma xenograft in the miR-34a group was significantly smaller than that in the blank group and control group after 21 days treatment (all P ＜ 0.001).Overexpression of miR-34a could decrease Eag1 expression in osteosarcoma cell lines while inhibition of miR-34a induced the of expression Eag1 (P ＜ 0.001).Conclusion MiR-34a plays a tumor suppressor role in osteosarcoma and could suppress the proliferation and growth of osteosarcoma through the regulation of Eag1.Moreover,it may be a novel target for osteosarcoma therapy.
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Objective To evaluate our noval rod-screw construct in anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures.Methods From February 2007 through May 2010,we treated 28 patients with Denis type B burst fracture.They were aged from 18 to 52 years (average,37.4 years).The fractures were located at T1 1 in 3 cases,at T12 in 10,L1 in 12,and L2 in 3.Of them,7 were complicated with unilateral pedicle fracture and 3 with bilateral pedicle fractures.According to the American Spinal Injury Association (ASIA) scale,the neurological deficits were rated as grade B in 11 cases,as grade C in 9,and grade B in 8.All the patients received anterior single-segmental decompression,titanium mesh and autogenous bone graft,and fixation with our noval rod-screw construct.The therapeutic efficacy was evaluated in terms of visual analogue scale (VAS),cobb angle,and spinal canal encroachment.Results The mean follow-up time was 26 months (range,from 17 to 33 months).The average length of surgery was 144 minutes(range,from 90 to 176 min);the mean blood loss was 580 mL (range,from 300 to 1 100 mL).The mean VAS score,cobb angle and spinal canal encroachment were improved from 8.2 ± 1.5,17.4° ± 4.3° and 53％ ± 16％ preoperatively to 2.7 ± 2.4,9.4° ± 5.8° and 4％ ±2％ at the final follow-up,respectively(P ＜ 0.05).None of the patients exhibited neurological deterioration.Conclusion Our noval rod-screw construct is a safe and effective device that can be used in the anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures.
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<p><b>OBJECTIVE</b>To design a kind of internal fixation device to treat the syndesmosis injury.</p><p><b>METHODS</b>The elastic syndesmosis hook plate is made of medical stainless steel alloy, which is consisted of locking or common screw fixing hole of the tibial side for the head, tridentate fork like arc anatomical fibula side plate for the tail and serpentine elastic connecting body. By reduction of the joint of the lower tibia and fibula, the steel plate tail is fixed at the side of the fibula and the head is fixed at the side of the tibia for fixing the symphysis.</p><p><b>RESULTS</b>The design of elastic syndesmosis hook plate is reasonable, and the operation is convenient. There is no need to penetrate the substantia ossea and the plate has elastic micro-movement feature, the problem of internal fixation breakage and loosening is avoid in huge degree, so it is safe and reliable.</p><p><b>CONCLUSION</b>The elastic syndesmosis hook plate is a new type medical apparatus of internal fixation of the symphysis, which is worthy of clinical popularization and application.</p>
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Humanos , Traumatismos do Tornozelo , Placas Ósseas , Parafusos Ósseos , Fíbula , Fixação Interna de Fraturas , Aço Inoxidável , TíbiaRESUMO
Objective To evaluate the safety and efficacy of the newly combined anterior platerod system in treatment of acute thoracolumbar burst fracture combined with neurologic deficit.Methods A retrospective study was carried out on 84 consecutive patients with acute thoracolumbar burst fracture combined with neurologic deficits treated by anterior surgery,bone fusion,and internal fixation with the new plate-rod system.There were 61 males and 23 females with a mean age of 31.4 years (range,19-53 years).Primary pathogenesis was high falls in 67 patients,traffic accidents in 13 patients and others in 4 patients.Fractured segments included T11 in 19 patients,T12 in 22,L1 in 25,and L2 in 18.Visual analogue scale (VAS),spinal canal encroachment,and loss of kyphosis correction were measured for all patients to evaluate radiologic and neurological outcomes.Results Bony union occurred in all patients at the 3-5 months of follow-up.There was no pseudarthrosis or vascular complications related to the fixation device.Percentage of canal encroachment decreased from preoperative 70％ to postoperative 2％.Mean segmental kyphotic angle measured 27.9 ° before operation and 7.4 ° after operation,with a mean correction of 20.5°.All patients demonstrated at least one grade of neurological improvement at final follow-up.Mean VAS was improved significantly from preoperative 7.3 points to postoperative 2.9 points.Conclusion The new anterior plate-rod system is safe and effective in treatment of acute thoracolumbar burst fracture combined with neurologic deficit.
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A new production method of spraying dextran-based polyurethane external splints is introduced in this paper. The main raw material components are polymethylene polyisocyanate (PAPI), mixed with surfactants, acetone, soluble starch, catalyst, and so on. The splint is used for temporary fixing after fracture, with small size, light weight, easy portability, fine air perviousness, completely transparent to the X-ray. It also needs a shorter fixed operating time. It can not only fix quickly and effectively the vertebral column and limbs, but also significantly shorten the time of pre-hospital care.
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Dextranos , Desenho de Equipamento , Fixadores Externos , Primeiros Socorros , Fixação de Fratura , Fraturas Ósseas , Cirurgia Geral , Poliuretanos , ContençõesRESUMO
Objectlve To explore the effect of platelet-rich plasma (PRP) on cellular proliferation and intracytoplasm calcium ion concentration of osteoblasts and tenocytes during the process of tendon-bone healing. Methods We established a kind of indirect co-culture system using transwell chambers to co-culture osteoblasts and tenocytes.The cellular proliferation was carried out in following manners:single culture of osteoblasts versus single culture of osteoblasts plus PRP and co-culture of osteoblasts versus co-culture of osteoblasts plus PRP; single culture of tenocytes versus single culture of tenocytes plus PRP and co-culture of tenocytes versus co-culture of tenocytes plus PRP.The cellular proliferation rates were measured by CCK-8 test.The intracytoplasm calcium ion concentration of was measured by laser confocal microscopy and fluo-3/AM. Results The proliferation rates and fluorescence intensities in the co-culture groups without PRP were significantly lower than other groups ( P ＜ 0.05).The proliferation rates and fluorescence intensities in the single culture groups without PRP were significantly higher than in the co-culture groups without PRP but significantly lower than in the groups with PRP ( P ＜ 0.05).The proliferation rates and fluorescence intensities in the groups with PRP were significantly higher than other groups ( P ＜ 0.05) but there was no significant difference between groups of the same cells ( P ＞ 0.05).The intracytoplasm calcium ion concentrations were proportional to the proliferation rates. Conclusions During the process of tendon-bone healing,PRP has a potential not only to wipe off the depression effect of osteoblasts and tenocytes co-cultured indirectly but also to enhance the cellular proliferation rate to a higher level.At the same time the calcium ion concentrations will be elevated.
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BACKGROUND: Autologous bone graft was always applied to repair bony cavity defect produced by benign bone tumor.OBJECTIVE: Taking autogenous bone graft for repairing bony cavity defect caused by bone tumor or tumor-like pathological change as control standard, to observe transplantation of deproteined bovine cancellous bone combined with autogenous red marrow in occluding the residual cavity and the density of newly formed bone.DESIGN: A randomized grouping design, controlled observation SETTING: Department of Orthopaedics, the 175 Hospital of Chinese PLA PARTICIPANTS:We recruited 175 cases of bony cavity defect who received treatment in the Department of Orthopaedics, the 175 Hospital of Chinese PLA from July 1993 to July 1998. They were randomly assigned into two groups: experimental group and control group. There were 63 cases treated in the experimental group. The average disease-suffering time was (6.2±2.1) months and bone defect was (136±30) mm3. There were 62 cases treated in the control group. The average disease-suffering time was (6.1±2.3)months, and bone defect was (133±37) mm3.METHODS: Deproteined bovine cancellous bone combined with autogenous red marrow was transplanted in the experimental group and autologous bone graft was applied in the control group. We curetted tumor completely, cauterized the wound with alcohol of 0.95 volume fraction, then curetted the area of cauterization to make it bled. Bone graft was applied.The quantity of implanted bone should be abundant, and disposed compactly. The X-ray films of the first week after operation were used as a standard for density of new bone growth. X-ray films were taken at the 3rd,6th and 8th months postoperatively, and the X-ray films of the eighth months after operation were used as a standard.MAIN OUTCOME MEASURES: To compare the bone union in two groups with a standard of residual cavity occluding and density of bone growth.RESULTS: All patients were followed up for an average of 20 months.One case was lost six months after operation. And two cases were lost eighteen months after operation respectively in the experimental group and control group. After 8 months of operation, residual cavities of bone defect of 44 cases in experimental group and 46 cases in control group were disappeared. Palingenetic bone fused with left bone organization. Its density was the same as or higher than normal bone organization. Residual cavities of 12 cases in experimental group and 10 cases in control group were disappeared basically. The density of palingenetic bone was approximate to normal bone organization. To compare with autologous bone graft, deproteined bovine cancellous bone and an autogenous red marrow had an identical effect for repairing bony cavity defect.CONCLUSION: Bony cavity defect produced by benign bone tumor is often repaired by bone transplantation. To explore the substitutable grafting materials of autogenous bone in this study, a composite material composed of deproteined bovine cancellous bone and an autogenous red marrow (DBCAM) is applied to repair the bony cavity defect.
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Objective To investigate the effect of deproteinated bone(DPB)-bone morphogenetic protein(BMP) complex on bone tunnel enlargement after anterior cruciate ligament reconstruction in rabbits.Methods A total of 96 adult New Zealand white rabbits were used in this study,and divided into 4 groups.In each group,we reconstructed the anterior cruciate ligaments of the animals using semitendinosus autograft.After the operation,DPB-BMP complex,DPB,or BMP was implanted into the femoral bone tunnel of the rabbits in three of the 4 groups.Another group that received neither DPB nor BMP served as a control.In 4,8,12,or 16 weeks after the implantation(6 rabbits in each group at each time point),we killed the animals to obtain the specimens of the femoral bone tunnel.Then the width of the tunnel was measured,and the percentage of its enlargement was calculated.Results In the DPB+BMP,DPB,BMP,and control groups,the bone tunnel was enlarged by(23.52?0.43)%,(34.83?0.52)%,(51.57?0.76)%,and(56.90?0.81)% in 4 weeks,(22.21?0.34)%,(35.35?0.46)%,(60.97?0.63)%,and(67.18?0.70)% in 8 weeks,(21.94?0.37)%,(33.01?0.41)%,(50.56?0.54)%,and(54.61?0.55)% in 12 weeks,and(20.96?0.35)%,(32.11?0.50)%,(49.29?0.66)%,and(53.31?0.59)% in 16 weeks,respectively.The rates of bone tunnel enlargement in the DPB+BMP group was the lowest at each time point(DPB+BMP group
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BACKGROUND: After internal fixation is applied to femoral shaft fracture with medial cortical defect, the fixation device is often bended and broken due to the stress on it. So far, reliable methods have not been found to solve this problem in clinic.OBJECTIVE: To evaluate the biomechanical stability of the allograft bone plate after a bony defect of the medial cortex is reconstructed with allograft bone plate.DESIGN: A randomized controlled experimental study.SETTING: This trial was conducted in the Department of Orthopaedics, the 175 Hospital of Chinese PLA, and Laboratory of Biomechanics, First Military Medical University of Chinese PLA.PARTICIPANTS: This trial was conducted in Laboratory of Medical Biomechanics, First Military Medical University. MTS858 Biomix biomaterial testing machine was used to simulate model of femoral shaft fracture on 3male adult femurs donated voluntarily by their relatives, aged 23, 24 and 28years old.INTERVENTIONS: The fracture model of medial cortical defect was made in the femurs. Different kinds of fixation were applied and the results were compared between fixated femurs and the normal ones. The fixations included steel plate fixation(fixation for group 1 ), steel plate with allograft bone plate fixation(fixation for group 2), steel plate with allograft bone plate fixation and reduction of the medial cortical fragment(fixation for group 3).MAIN OUTCOME MEASURES: The vertical compression displacement under 500 N load, three-point bending strength under 10 N and anti-torsional angle under 300 N load are all measured.RESULTS: The vertical compression displacement and three-point bending strength of the control group were insignificantly different from those of the fixation group 3 ( P ＞ 0.05), but significantly different from those of the fixation group 1 and 2 ( P ＜ 0.05). The anti-torsional angle of the control group was significantly different from that of the three fixation groups( P ＜ 0. 05) . The result of fixation in fixation group 1 was the worst, better in fixation group 2and the best in fixation group 3.CONCLUSION: When there is a medial cortical defect in the femur, reconstruction with a bone plate can recover the integrity of the femoral medial cortex, and the successful rate of the plate internal fixation is increased.
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Objective To investigate the effects of surgical management for upper thoracic tuberculosis with neurological deficits using primary bone grafting and internal fixation through right anterior intrapleural approach. Methods In this study, 6 cases of upper thoracic tuberculosis were admitted to our hospital from January 1999 to June 2002, of which 3 cases were male and 3 female. The age ranged from 26 to 48 years, and the period from the onset of the symptom to hospitalization was 12 months to 24 months. Clinical features included thoracic and back pain, kyphosis and neurological deficits. The kyphosis angle ranged from 15 to 30 degrees. One case involved T3 to T5, 4 cases involved T4,5, and 1 case involved T3 to T6. Neurological deficits were evaluated by ASIA score system. The results showed that there were 5 cases in C grade, and 1 case in D grade. MRI showed compression of dura in all cases, and abscess inside the vertebral canal in 2 cases and outer abscess in 4 cases. All were treated with primary debridement, decompression, interbody autografting and internal fixation of "K" shape plate or Ventrofix by right anterior intrapleural approach. The antituberculous treatment and nutritional supplement were also performed routinely during the perioperative period. Results During the follow-up period of an average 21 months, all cases healed without any recurrence and complications such as infection, respiratory failure and so on. The thoracic and back pain disappeared and erythrocyte sedimentation rate (ESR) decreased to a normal level. All neurological deficits recovered within 3 months, 4 cases of which recovered at 4 weeks after operation. Spinal fusion occurred after 3 to 8 months after operation, and sixteen degrees of kyphosis correction was achieved. Conclusion It is a safe and effective method to use right anterior intropleural approach, primary autografting and internal fixation in the management of upper thoracic tuberculosis associated with neurological deficits.
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Objective To investigate the characteristics of looped ankle injury caused by cord strangulation, seek proper treatment to decrease amputation rate, and restore limb function as much as possible. Methods Among the nine patients with looped strangulation ankle injury, 7 had both their anterior and posterior tibia arteries involved, while the other 2 patients had only their posterior tibial artery involved. There were 4 patinets suffered from combined open tibia and fibula fractures, 2 patients from close tibia and fibula fractures; and another 2 patients from external malleolus fracture. The interval from injury to treatment varied from 6 to 27 hours(average 12 hours). All patients were treated with surgical procedures as soon as possible, blood vesseles and nerve injuries were detected and anastomosis had been done if necessary. All fractures were fixed externally. Results The limbs of all 9 patients were salvaged successfully. Most function of the injured limbs were restored. Only one external malleolus fracture malunited and was treated successfully by subsequent osteotomy. Conclusion Emergent intervention is of great importance to looped ankle injury caused by cord strangulation. Once blood vessel or nerve injuries are suspected, surgical detection or anstomosis if neccessary, should be done as soon as possible. All the associated fractures should better be fixed externally, and in order to avoid "tourniquet effect"the injured skin should be incised as early as well. With proper limb salvage procedure, good or excellent result may be achieved even in the patient with a delayed diagnosis.