Objective To investigate the impact of long non-coding RNA (lncRNA) FGD5-AS1 on the osteogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBM-MSCs) through regulation of the microRNA miR-93-5p/bone morphogenetic protein-2(BMP2) axis. Methods hBM-MSCs in logarithmic growth phase were taken, and the expression levels of lncRNA FGD5-AS1, miR-93-5p and BMP2 mRNA were detected before and after osteogenic differentiation; The cells were transfected or co-transfected with pcDNA FGD5-AS1, miR-93-5p inhibitor, miR-93-5p mimics and corresponding negative controls, respectively, then divided into pcDNA NC group, pcDNA FGD5-AS1 group, inhibitor NC group, miR-93-5p inhibitor group, pcDNA FGD5-AS1+mimics NC group, or pcDNA FGD5-AS1+miR-93-5p mimics group and non-transfected cells were taken as blank group. CCK-8 assay was applied to detect cell proliferation ability of each group; Alkaline phosphatase (ALP) kit was applied to detect its activity; Alizarin red staining was applied to identify cellular mineralized nodule formation; Western blot was applied to detect the levels of BMP2, osteogenesis-related markers-osteocalcin (OCN), osteopontin (OPN), and osterix(OSX); Dual-luciferase experiment was applied to verify the targeting relationship of miR-93-5p with FGD5-AS1 and BMP2, respectively. Results lncRNA FGD5-AS1 and BMP2 were found to be targets of miR-93-5p. After osteogenic differentiation, the expression of FGD5-AS1 and BMP2 was increased and the expression of miR-93-5p was decreased (P＜0.05). Compared with pcDNA NC group, the expression of FGD5-AS1 in pcDNA FGD5-AS1 group was significantly increased(P＜0.05), indicating successful transfection; Mineralized nodules, cell proliferation, ALP activity and the expression of BMP2, OCN, OPN and OSX were obviously higher (P＜0.05) in pcDNA FGD5-AS1 group. Compared with the inhibitor NC group, the expression of miR-93-5p in miR-93-5p inhibitor group was significantly decreased (P＜0.05), indicating successful transfection; Mineralized nodules, cell proliferation, ALP activity and the expression of BMP2, OCN, OPN and OSX were obviously improved (P＜0.05) in miR-93-5p inhibitor group. Over-expression of miR-93-5p inhibited the promoting effect of FGD5-AS1 on the osteogenic differentiation of hBM-MSCs(P＜0.05). Conclusions Up-regulation of FGD-AS1 promotes the osteogenic differentiation of hBM-MSCs, which might be related to the miR-93-5p/BMP2 axis.

目的 探讨芹菜素介导磷酸肌醇3激酶(PI3K)/蛋白激酶(Akt)通路调节绝经后骨质疏松症大鼠骨吸收与骨形成稳态的作用.方法 取60只3月龄雌性SD大鼠随机分为假手术组(n=9)和建模组,后者采用切除双侧卵巢法构建绝经后骨质疏松症模型.建模成功后随机分为模型组(n=9)、雌二醇组(n=10)、芹菜素低剂量组(n=10)、芹菜素中剂量组(n=10)、芹菜素高剂量组(n=10),雌二醇组予以0.18 mg/(kg·d)戊酸雌二醇灌胃,芹菜素低、中、高剂量组分别予以40、80、160mg/(kg·d)芹菜素灌胃,假手术组和模型组仅予以等量生理盐水灌胃,1次/d,给药14周.给药结束24 h后,苏木素伊红(HE)染色观察股骨组织病理变化;计算机微断层扫描仪(Micro-CT)检测股骨组织微结构及计量学指标;抗酒石酸碱性磷酸酶(TRAP)染色观察股骨组织破骨细胞染色情况;碱性磷酸酶(ALP)染色观察股骨组织成骨细胞染色情况;酶联免疫吸附实验(ELISA)检测血清骨源性碱性磷酸酶(BALP)、I型胶原氨基末端前肽(PINP)、Ⅰ型胶原羧基末端肽(CTX-1)、TRAP5b水平;实时-定量聚合酶链反应检测骨组织PI3K、Akt、矮小相关转录因子2(Runx2)、骨钙素(OCN)、骨保护素(OPG)、细胞核因子-κB受体活化因子(RANKL)mRNA 表达;免疫印迹法检测骨组织 PI3K、Akt、Runx2、OCN、OPG、RANKL 蛋白表达及 p-PI3K、p-Akt水平.结果 假手术组大鼠骨小梁分布均匀致密,结构完整,骨髓腔较小;模型组骨小梁断裂,连续性差,骨髓腔明显增大;雌二醇组以及芹菜素低、中、高剂量组骨小梁病理结构逐渐改善;与假手术组比较,模型组大鼠骨组织骨密度(BMD)、骨体积分数(BV/TV)、骨小梁数目(Tb.N)、骨小梁厚度(Tb.Th)降低[(0.11±0.02)g/cm3vs.(0.39± 0.05)g/cm3、(0.14±0.02)％vs.(0.56±0.09)％、(2.67±0.41)mm-1vs.(7.56±1.12)mm-1、(0.04±0.01)mm vs.(0.12±0.02)mm],骨小梁分离度(Tb.Sp)、骨小梁模式因子(Tb.Pf)上升[(0.35±0.06)mm vs.(0.06±0.01)mm、(10.91±1.97)mm-1 vs.(3.72±0.65)mm-1],差异均有统计学意义(P均＜0.05);与模型组比较,雌二醇组以及芹菜素低、中、高剂量组BMD、BV/TV、Tb.N、Tb.Th上升,Tb.Sp、Tb.Pf降低,差异均有统计学意义(P均＜0.05),上述指标在雌二醇组和芹菜素中剂量组间比较差异均无统计学意义(P均＞0.05),芹菜素低、中、高剂量组呈剂量依赖性.与假手术组比较,模型组被染红破骨细胞数量明显增多、成骨细胞ALP染色明显减少;与模型组比较,雌二醇组和芹菜素低、中、高剂量组被染红破骨细胞数量逐渐减少、成骨细胞ALP染色逐渐增加.与假手术组比较,模型组大鼠血清BALP、PINP水平降低[(6.91±1.15)μg/L vs.(18.43±3.08)μg/L、(15.28±2.68)μg/L vs.(32.64±6.11)μg/L],CTX-1、TRAP5b 水平上升[(15.72±2.82)μg/L vs.(6.18±1.05)μg/L、(85.49±16.08)μg/L vs.(23.67±4.43)μg/L],差异均有统计学意义(P均＜0.05);与模型组比较,雌二醇组以及芹菜素低、中、高剂量组大鼠血清BALP、PINP水平上升,CTX-1、TRAP5b水平降低,差异均有统计学意义(P均＜0.05);上述指标在雌二醇组和芹菜素中剂量组间比较差异均无统计学意义(P均＞0.05),芹菜素低、中、高剂量组呈剂量依赖性.与假手术组比较,模型组大鼠骨组织PI3K、Akt、Runx2、OCN、OPG mRNA 以及 p-PI3K、p-PI3K/PI3K、p-Akt、p-Akt/Akt 水平降低[(0.31±0.04)vs.(0.98±0.12)、(0.19±0.03)vs.(1.03± 0.15)、(0.38±0.05)vs.(0.91±0.14)、(0.26±0.04)vs.(0.96±0.14)、(0.23±0.03)vs.(0.95±0.14)、(0.29±0.03)vs.(0.71± 0.11)、(0.27±0.04)vs.(0.68±0.12)、(0.21±0.03)vs.(0.76±0.10)、(0.21±0.03)vs.(0.79±0.12)],RANKL mRNA表达上升[(2.43±0.36)vs.(0.87±0.13)],差异均有统计学意义(P均＜0.05);与模型组比较,雌二醇组以及芹菜素低、中、高剂量组大鼠骨组织PI3K、Akt、Runx2、OCN、OPG mRNA 以及p-PI3K、p-PI3K/PI3K、p-Akt、p-Akt/Akt水平上升,RANKL mRNA表达降低,差异均有统计学意义(P均＜0.05);上述指标在雌二醇组和芹菜素中剂量组间比较差异均无统计学意义(P均＞0.05),芹菜素低、中、高剂量组呈剂量依赖性.与假手术组比较,模型组大鼠骨组织Runx2、OCN、OPG 蛋白表达降低[(0.43±0.06)vs.(1.02±0.15)、(0.33±0.04)vs.(1.06±0.16)、(0.29±0.03)vs.(0.98±0.14)],RANKL蛋白表达上升[(1.62±0.24)vs.(0.68±0.09)],差异均有统计学意义(P均＜0.05);与模型组比较,雌二醇组以及芹菜素低、中、高剂量组大鼠骨组织Runx2、OCN、OPG蛋白表达上升,RANKL蛋白表达降低,差异均有统计学意义(P均＜0.05);上述指标在雌二醇组和芹菜素中剂量组间比较差异均无统计学意义(P均＞0.05),芹菜素低、中、高剂量组呈剂量依赖性.结论 芹菜素可抑制绝经后骨质疏松症骨吸收,促进骨形成,可能与激活PI3K/Akt通路,促进Runx2、OCN、OPG表达,抑制RANKL表达,上调BALP、PINP水平上升,下调CTX-1、TRAP5b水平相关.

目的:探讨积雪草酸对大鼠绝经后骨质疏松症(OP)的治疗作用及相关机制.方法:采用一次性手术摘除双侧卵巢方式构建绝经后 OP大鼠模型,分为模型组(9 只)、雌二醇组(10 只)、积雪草酸低剂量组(10 只)、积雪草酸中剂量组(10 只)和积雪草酸高剂量组(10 只).另取 9 只大鼠作为假手术组.观察骨组织病理改变、骨密度及微结构,以及血清骨代谢指标、骨代谢相关基因及蛋白表达.结果:雌二醇组和积雪草酸低、中、高剂量组均可减轻骨组织病理改变,增加骨密度,改善骨微结构.与假手术组比较,模型组大鼠股骨骨密度(BMD)、骨体积分数(BV/TV)、骨小梁数目(Tb.N)、骨小梁厚度(Tb.Th)下降,结构模式指数(SMI)和骨小梁分离度(Tb.Sp)上升,血清骨碱性磷酸酶(BALP)水平下降,Ⅰ型胶原交联氨基端肽(NTX-Ⅰ)和抗酒石酸酸性磷酸酶(TRAP)水平上升,骨组织音猬因子(SH H)、细胞表面跨膜蛋白Patched1(Ptc1)、7 次跨膜蛋白(Smo)、Gli家族锌指蛋白-1(Gli1)、矮小相关转录因子2(Runx2)、骨保护素(OPG)、成骨细胞特异性转录因子(Osx)mRNA 和蛋白表达下降,细胞核因子-κB受体活化因子(RANKL)mRNA和蛋白表达上升(均P<0.05).与模型组比较,雌二醇组和积雪草酸低、中、高剂量组大鼠股骨BMD、BV/TV、Tb.N、Tb.Th上升,SMI和Tb.Sp下降,血清BALP水平上升,NTX-Ⅰ和TRAP水平下降,骨组织 SHH、Ptc1、Smo、Gli1、Runx2、OPG、Osx mRNA 和蛋白表达上升,RANKL mRNA 和蛋白表达下降(均 P<0.05).雌二醇组和积雪草酸低剂量组上述指标比较差异无统计学意义(均P>0.05).积雪草酸低、中、高剂量组上述指标呈剂量依赖性(均P<0.05).结论:积雪草酸可治疗绝经后 OP,可能与激活 Hedgehog信号通路相关.

骨质疏松性椎体压缩性骨折(Osteoporotic Vertebral Compression Fractures,OVCF) 是骨质疏松常见并发症 , 经皮穿刺椎体后凸成形术(percutaneous kyphoplasty,PKP)是近些年发展起来的微创技术, 因其创伤小,疗效显著, 受到许多医师普遍认可[1].本研究采用 PKP 治疗 OVCF 患者获得了满意效果,现报道如下.

目的:研究三参生血颗粒对60Co照射所致C57BL/6小鼠造血及免疫系统不良反应的治疗作用.方法:50只C57BL/6雄性小鼠随机分为正常组、模型组、高剂量组、中剂量组及低剂量组.采用60Co照射对模型组、高剂量组、中剂量组及低剂量组小鼠进行造模,照射完成后,对各组小鼠进行给药处理,其中高剂量组、中剂量组及低剂量组小鼠分别灌胃给予6.15 g/kg、3.075 g/kg及1.5375 g/kg的三参生血颗粒,空白组及模型组则给予等量生理盐水,连续给药15 d.末次给药后24 h采血,检测其中血象指标含量[红细胞计数(RBC)、白细胞计数(WBC)、血小板计数(PL T)及血红蛋白(Hgb)],氧化应激指标含量[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)及过氧化氢酶(CAT)],免疫功能指标含量[CD3+、CD4+、IgG、IgA及IgM].取血完成后,取小鼠胸腺和脾脏,计算胸腺和脾脏指数.同时取小鼠胸骨及股骨,检测骨髓嗜多染红细胞微核率及有核细胞数.结果:与模型组比,高剂量组、中剂量组及低剂量组小鼠RBC、WBC、PL T及Hgb含量均显著降低(P<0.05),CD3+、CD4+、IgG、IgA及IgM含量均显著增高(P<0.05),且胸腺和脾脏指数均显著增高(P<0.05).与模型组比,高剂量组、中剂量组及低剂量组小鼠骨髓嗜多染红细胞微核率均显著降低,而有核细胞数均显著增高(P<0.05).与模型组比,高剂量组、中剂量组及低剂量组小鼠MDA均显著降低,而SOD、GSH-PX及CAT均显著增高(P<0.05).结论:三参生血颗粒对60Co照射所致C57BL/6小鼠造血及免疫系统不良反应具有较好的治疗作用.

Objective:To investigate the correlation between circulating miR-29a and miR-150 and delivered dose during thoracic radiation therapy(RT)for non-small cell lung cancer(NSCLC).Methods:56 cases of NSCLC patients who received radiotherapy in our hospital were collected from January,2014 to December,2015.miRNA profi-ling of plasma samples obtained from 5 NSCLC patients(miRNA array group)at 0,20,40,60 Gy each during radical thoracic RT by miRNA array.Candidate miRNAs were then assessed in samples from a separate cohort of 51 NSCLC patients(validation group)at 0,20,40 Gy each during receiving radical thoracic RT by qRT-PCR.qRT-PCR were used to identify cellular source of circulating miR-29a and miR-150 within intracellularly and secreted exosomes in A549 and MRC5 cells which received radiation treatment with 2 Gy/d for successive 3 days. Results:10 miRNA (miR-29a,miR-150,miR-142,miR-342,miR-125b,miR-101,miR-425,miR-338,miR-126,miR-15b) were screened out with the increase of RT dose in NSCLC patients.The results showed that there exists significant difference of the expression of circulating miR-29a and miR-150 in the validation group under 0,20,40 Gy radia-tion,respectively(P<0.05).The circulating miR-29a and miR-150 expression of the validation group were nega-tively correlated with V5,V20,mean lung dose(MLD),mean esophagus dose,respectively.The expression of miR-29a and miR-150 were increased significantly(P<0.05)after 3 days irradiation of A549 and MRC5 cells,mean-while,decreased significantly(P<0.05)in secreted exosomes of A549 and MRC5 cells with radiation.Conclusion:Circulating miR-29a and miR-150 were correlated with NSCLC RT dose.

目的 探讨影响椎体成形术(PVP)后骨水泥椎体内弥散的影响因素.方法 回顾性分析就诊于延安大学附属医院关节外科的80例行PVP的骨质疏松性椎体压缩性骨折(OVCF)患者的临床资料,根据患者术后CT检测骨水泥弥散情况将患者分为骨水泥弥散充分组(观察组)和骨水泥弥散不佳组(对照组),每组40例,同时根据骨水泥注射量、骨折至手术时间、椎体压缩程度分为各亚组,观察比较2组患者骨水泥分布情况、骨水泥灌注量、骨水泥弥散体积和骨水泥弥散系数,同时比较不同因素下各亚组骨水泥弥散系数变化情况.结果 2组患者在入口侧达到上下终板、在中心平面过椎体中线、弥散特征及骨水泥形状方面差异具有统计学意义(P<0.05).2组患者在骨水泥灌注量比较差异无统计学意义(P>0.05),而在骨水泥弥散体积和骨水泥弥散系数比较差异显著(P<0.05).随着骨水泥灌注量增加,骨折时间延长及椎体压缩程度增加,患者骨水泥弥散系数逐渐降低,对比2组之间的骨水泥弥散系数表明,差异无统计学意义(P>0.05).结论 骨水泥灌注量、骨折时间及椎体压缩程度均为PVP术后骨水泥椎体内弥散的影响因素.

目的 :研究骨肉瘤组织中miR-494、miR-130b的表达量并探究下游靶基因.方法 :收集在延安大学附属医院手术切除的骨肉瘤组织,另取同期关节置换术后的正常骨组织作为对照;抽提miRNA后测定miR-494、miR-130b的表达量,抽提RNA后测定增殖基因 、侵袭基因的mRNA表达量,抽提蛋白后测定血管新生分子的蛋白含量.结果 :骨肉瘤组织中miR-494、Runx3、ELL2、p16、RECK、TIMP1的表达量以及TSSC3的蛋白含量显著低于正常骨组织,miR-130b、β-catenin、CyclinD1、Sox9、AD-AM TS18、CatD、STMN1的表达量以及CEACAM6、VEGF、Ang-2的蛋白含量显著高于正常骨组织;骨肉瘤组织中miR-494与Runx3、ELL2、p16、RECK、TIMP1、TSSC3呈正相关,与 β-catenin、Cy-clinD1、Sox9、ADAM TS18、CatD、STM N1、CEACAM6、VEGF、Ang-2呈负相关,miR-130b与Runx3、ELL2、p16、RECK、TIMP1、TSSC3呈负相关,与 β-catenin、CyclinD1、Sox9、ADAM TS18、CatD、ST-MN1、CEACAM6、VEGF、Ang-2呈正相关.结论 :骨肉瘤组织中miR-494的低表达以及miR-130b的高表达能够调控增殖 、侵袭基因的表达及血管新生分子的生成.

目的 探讨胃肠间质瘤经腹腔镜与开腹手术治疗对患者术中出血量、术后恢复及T淋巴细胞水平的影响.方法 选取2017年6月至2018年6月延安大学附属医院收治的胃肠间质瘤患者80例,随机分为治疗组与对照组,各40例.对照组行常规开腹手术治疗,治疗组在腹腔镜下行肿瘤切除术治疗.观察两组患者术中出血量、术后恢复及T淋巴细胞水平等情况.结果 两组分别实施不同手术治疗,治疗组的术中出血量显著少于对照组(P<0.001),进食时间、排气时间及恢复活动时间均明显早于对照组(P<0.001).术前,两组患者T淋巴细胞CD3+、CD4+、CD8+、CD4+/CD8+水平无显著性差异(P>0.05);术后1个月,治疗组的CD3+、CD4+、CD4+/CD8+水平显著高于对照组,CD8+水平显著低于对照组(P<0.01).术前,两组外周血凝血功能(APTT、PT、D-二聚体、FIB、INR)指标比较均无统计学意义(P>0.05);术后,治疗组APTT、INR指标与术前及对照组术后比较无统计学意义(P>0.05),而治疗组PT显著低于对照组,D-二聚体、FIB指标显著高于对照组(P均<0.001).结论 胃肠间质瘤患者经腹腔镜切除肿瘤具有出血量少、术后恢复快、对免疫功能影响小及降低患者发生血栓性疾病的风险,可作为临床治疗胃肠间质瘤的常用手段.

目的 探讨神经生长因子(NGF)对胫骨骨折患者内固定术后骨折愈合及增加骨密度的效果.方法 回顾性分析了延安大学附属医院自2012年1月至2016年7月行切开复位内固定术的50例患者的临床资料,根据术后治疗方法不同分为常规组(n=25)与联合组(n=25).常规组给予常规抗生素治疗,并配合抬高患肢、辅助功能锻炼,联合组在常规组基础上予以NGF联合治疗.记录并比较两组患者治疗效果及骨折愈合效果,并于术前、术后检测骨折区骨密度变化情况.结果 联合组患者优良率为88.0％(22/25),高于常规组的68.0％(17/25),但差异无统计学意义(P>0.05).与常规组比较,联合组骨折愈合时间、疼痛消失时间显著缩短,差异均有统计学意义(P<0.05).两组患者术后6个月骨密度均显著升高,与术前比较,差异均有统计学意义(P<0.05);联合组术后12个月骨密度较术后6个月显著升高(P<0.05),而常规组术后12个月骨密度较术后6个月升高不明显(P>0.05);且联合组术后6个月、12个月骨折区骨密度均显著高于常规组(P<0.05).结论 胫骨骨折患者切开复位内固定术后给予NGF治疗,可有效促进骨折愈合,尽快消除疼痛及增加骨折区骨密度,从而促进功能恢复.

Objective:To study the effect of proximal femoral nail antirotation (PFNA) internal fixation in the treatment of senile intertrochanteric fracture and its effect on the function of hip joint.Methods:The subjects were 86 cases elderly intertrochanteric fractures patients in our hospital from August 2012 to May 2015, randomly divided into control group and observation group, 43 cases in each group.The control group received dynamic hip screw (DHS) internal fixation treatment, observation group patients were treated with PFNA internal fixation.compared the operative effect and complication rate between two groups, and postoperative follow-up, compared two groups of patients with hip the score of joint function and the level of expression of inflammatory cytokines.Results:The observation group of the operation time, intraoperative blood loss, recovery time and fracture healing time was significantly lower than the control group (P＜0.01);the incidence of complications in the observation group (4.66％) was significantly lower than the control group (20.94％) (x2=5.11, P=0.02);postoperative follow-up of 6 months, Harris the hip function of two groups was no significant difference between the score excellent rate (P＞0.05).After operation, the levels of IL-6, IL-10 and TNF-αin the observation group were significantly lower than those in the control group (P＜0.01).Conclusion:PFNA treatment of intertrochanteric fracture in the elderly has significant effect, less surgical trauma, bleeding, and fewer complications and postoperative functional restoration of hip joint The effect is good, worthy of clinical promotion.

目的 探讨锁定接骨板治疗股骨远端骨折术后骨不愈合的近远期疗效及对其下肢功能的影响.方法 回顾性分析2015年1月～2017年7月于我院行锁定接骨板内固定治疗的股骨远端骨折内固定术后骨折不愈合的29例患者的病例资料,所有患者均行自体骨移植加锁定接骨板内固定术.统计所有患者术后骨折愈合率及愈合时间,比较患者术后1月、6月及1年时疗效、疼痛评分、下肢活动度评分、膝关节活动度评分.结果 患者术后骨折临床愈合率为89.6％,平均愈合时间为(5.49±1.35)月;患者术后6月及术后1年疗效优良率显著高于术后1月(P<0.05),但患者术后6月及术后1年疗效优良率无显著差异(P>0.05);患者术后6月及术后1年疼痛评分、下肢活动度评分优良率及膝关节活动度优良率无显著差异(P>0.05),其余时间点比较患者疼痛评分、下肢活动度评分优良率及膝关节活动度优良率有显著差异(P<0.05).结论 锁定接骨板治疗股骨远端骨折术后骨不愈合近远期疗效较好,且能有效恢复患者下肢功能及膝关节活动度.

目的 探讨全膝关节置换术配合渐进式功能锻炼治疗重度膝骨关节炎合并帕金森病患者的疗效,并作对比分析.方法 回顾性分析2015年6月至2016年12月收治的28例重度膝骨关节炎(knees osteoarthritis,KOA)合并帕金森(parkinson disease,PD)患者,均给予全膝关节置换术(total knee arthroplasty,TKA)配合渐进式康复运动锻炼,采用美国特种外科医院膝关节评分表(hospital for special surgery,HSS)、Berg平衡量表(the Berg balancescale,BBS)、Fugl-Meyer平衡功能量表(the Fugl-Meyer balance scale,FM-B)观察术前、术后6个月、术后1年评分,进行临床疗效对比,并观察术后1年并发症情况.结果 28例患者均获得随访,术后1年,1例患者因不慎摔跤,再次损伤膝关节;2例患者因PD病情加重,需手扶拐杖下行走;术后HSS评分总分由术前(23.56±3.64)分提升至术后6个月(78.49±12.65)分、术后1年随访时(87.421±15.34)分,与术前比较差异均有统计学意义(P<0.05);术后BBS评分总分由术前(32.58±6.77)分提升至术后6个月(47.72±8.24)分、术后1年随访时(50.13±9.17)分;术后FM-B评分总分由术前(36.57±5.17)分提升至术后6个月(43.58±7.19)分、术后1年随访时(50.13±9.17)分,与术前比较差异有统计学意义(P<0.05);术后6个月、术后1年有效率分别为86.71％、96.4％,两组有效率经秩和检验Z=-1.975,P=0.048.结论 全膝关节置换术配合渐进式功能锻炼在重度KOA合并PD患者中的应用是一种有效安全的治疗方案,具有并发症少、膝关节功能恢复快、依存性高等优势,为临床研究提供可靠的理论和循证医学依据.

目的 探讨利伐沙班联合疏血通预防老年全膝关节置换术(TKR)后下肢深静脉血栓(DVT)的治疗成本/效果比分析.方法 选取行TKR老年患者51例,按入院时间段分为对照组26例、观察组25例,对照组在术后6h给予利伐沙班,观察组在对照组的基础上加用疏血通注射液.比较两组术前和术后24 h、7d和14d的内皮素(ET)和血栓素B2(TXB2)水平、治疗后DVT发生率和治疗成本/效果比.结果 两组ET和TXB2水平均在术后24h显著升高,此后开始回落,到术后14 d时恢复到术前水平.在术前和术后14d,两组ET和TXB2水平无明显差异(P＞0.05),但在术后24 h和术后7d,对照组明显高于观察组(P＜0.05);术后1个月内,观察组DVT发生率显著低于对照组(P＜0.05);但观察组治疗成本/效果比高于对照组(P＜0.05).结论 利伐沙班联合疏血通注射液可显著降低TKA后患者发生DVT的风险,可能与降低ET和TXB2水平有关.但联合用药的治疗成本/效果比较高,在基层医院的应用需考虑患者的经济承受能力.

目的 探讨塞来昔布联合仙灵骨葆胶囊对膝关节骨性关节炎的治疗效果.方法 将85例膝关节骨性关节炎患者分为对照组(43例)和观察组(42例).对照组单纯口服塞来昔布治疗,观察组联合服用塞来昔布与仙灵骨葆胶囊治疗,比较两组临床疗效.结果 观察组的有效率为88.09％,明显高于对照组的67.44％(P＜ 0.05);治疗后,两组的白介素-6、肿瘤坏死因子-α、白介素-23、疼痛VAS评分和Lequesne评分均显著降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 塞来昔布联合仙灵骨葆胶囊治疗膝关节骨性关节炎的效果明显优于单用塞来昔布,可以更有效控制炎性状态,缓解疼痛程度,改善膝关节功能,且具有较高的安全性.

Objective To investigate the effect of imatinib mesylate on radiation-induced lung injury mice and its influence on the oxidative stress and transforming growth factor-βl (TGF-β 1) expression in mice.Methods Forty-five C57BL/6 mice were divided into a treatment group,a control group and a model group.The treatment group and model group were given radiation of 18 Gy delivered in the thorax.After 4 h daily of the radiation,the treatment group received imatinib mesylate of 0.081 g/kg,while the other groups were given normal saline solution.The experiments were continued for 30 days.After the experiments,the lungs of mice were divided into 4 parts.The haematoxylin and eosin and immunohistochemical stain were prepared to observe the situation of pathology and TGF-β 1.The lung homogenate was prepared and the levels of superoxide dismutase (SOD),malondialdehyde (MDA),total antioxidant capacity (T-Aoc) and glutathione peroxidase (GSH-PX) were detected.Results The levels of GSH-PX,T-Aoc and SOD were (173.15±12.21) U,(119.33±11.06) U/mgprot and (1.73±0.33) nmol/mgprot in the treatment group,significantly higher than the control group,while the levels of MDA was (0.68±0.08) nmol/mgprot,significantly lower than the control group (P＜0.05).The HE and immunohistochemical stain showed that there were mild alveolar inflammatory changes in the treatment group while such changes were serious in the model group.The scores of HE and immunohistochemical were 1.26±0.12 and 0.31±0.12 in the treatment group,significantly lower than those in the control group (P＜0.05).Conclusion The imatinib mesylate can effectively ameliorate the oxidative stress and inhibite TGF-β 1 expression in radiation-induced lung injury mice.

Objective To investigate the mobility of replaced segments after Bryan artificial disc replacement and the factors that influence mobility.Methods Forty-eight patients with single-segment Bryan cervical disc arthroplasty underwent orthopedic surgery in our department between January 2015 and May 2016.The clinical data was analyzed retrospectively.All the patients were followed up.The preoperative and postoperative radiographic data of all the patients was analyzed.The height of different intervertebral spaces,different degrees of mobility,the ratio of spine functional units to the height of the upper vertebral body and the different functional segments of the spine were compared.The relationships between mobility and the above-mentioned variables were analyzed.Results (1) All the patients had significantly greater postoperative mobility.Pateints with a postoperative intervertebral space height ratio＞ 0.80 had a greater mobility than those with a ratio ≤ 0.80.Patients with a preoperative replaced segment mobility ＞ 6 ° had an increased postoperative mobility compared with those with mobility ＜6 ° (P＜0.05).Patients whose ratio of FSU to the height of the superior vertebral body (preoperative/postoperative) was above 0.05 had significantly a greater mobility than those with a ratio ≥0.05.The difference was statistically significant (P＜0.05).However,there was no significant difference in the postoperative range of FSU (P＞ 0.05) at different angles (postoperative/preoperative).(2)A ratio of intervertebral space to height ＞ 0.80,a range of postoperative mobility ＞ 6 °,and a ratio of FSU to the height of the superior vertebral body ＜0.05 (preoperative/postoperative) were independent factors that influenced the mobility of replaced segments after Bryan disc replacement.Conclusion Bryan artificial disc replacement can significantly improve the mobility of replaced segments.The ratio of the intervertebral space to height,the preoperative mobility of replaced segments and the ratio of FSU to the height of the superior vertebral body are factors that influence the postoperative range of motion.

Objective To compare the efficacy and influence on the immune function of oxaliplatin combined with tegafur gimeracil oteracil potassium capsule and mFOLFOX6 method in the treatment of gastric cancer with liver metastasis.Methods One hundred and thirty-four gastric cancer with liver metastasis patients who underwent treatment from Jan.2014 to Jan.2016 in Yulin First Hospital were selected as the participants and randomly divided observation group (67 cases) and control group (67 cases).The control group was treated by mFOLFOX6 method,while the observation group was treated by oxaliplatin combined with tegafur gimeracil oteracil potassium capsule.After treatment,the curative effects were evaluated.The life quality in each group as performed by KPS method before the treatment and in every period of treatment.Before and after the treatment,the levels of CD3 +,CD4 +,CD8 + and CD19 + were detected in two groups and the toxicity was compared.The SPSS 22.0 software was used to analyze relevant data,the measurement data was described by (x ± s) and using t-test,the enumeration data was described by percentage,using the Chi-square test.Results The total effective rate was 52.2％ in the observation group,higher than the 38.8％ in the control group (P ＜ 0.05).After the third and fourth course of treatment,the karnofsky perfomance status score were (81.3 ± 9.7) and (83.2 ± 9.9),were significantly higher in the observation group than which in the control group (P ＜ 0.05).After the treatment,the levels of CD3 +,CD4+,CD8+ andCD19+ were (54.21 ±6.38)％,(24.11 ±2.41) ％,(21.33±3.16) ％ and (7.18 ±1.13) ％ in the observation group,and higher than the control group (P ＜ 0.05).During the treatment,there were no serious toxicity occurs in the patients and the rates of toxicity were significantly lower in the observation group than which in the control group (P ＜ 0.05).Conclusion Oxaliplatin combined with tegafur gimeracil oteracil potassium capsule has a better effect and safety for therapy in the treatment of gastric cancer with liver metastasis than mFOLFOX6.

Objective Comparing the difference in postoperative recurrence,complications,quality of life and cosmetic results between patients receiving radical mnastectomy and breast conserving surgery,provides an evidence of breast conserving surgery superior to radical mastectomy.Methods A retrospective analysis of 477 breast cancer patients cases in Department of General Surgery,Third People's Hospital of Baoji City from January 2009 to January 2012.These patients were divided into two groups:the control group 229 cases (48％) underwent conservative surgery treatment and the observation group 248 patients (52％) underwent radical surgery.Using SPSS15.0 statistical software analysis and compare with recurrence,postoperative complications,breast cosmetic effect and quality of life for these two groups of patients.Results In breast-conserving group compared with radical mastectomy group,the one and two year recurrence or metastasis rate were not statistically different between the two groups (P ＞ 0.05),the incidence of postoperative complications was significantly decreased (P ＜ 0.05).The scores for quality of life between the breast-conserving group and radical mastectomy group were all significantly different (P ＜ 0.05).Excellent cosmetic results in breast-conserving group was 78.52％,which was significantly higher than that in the radical mastectomy group (61.34％),the difference was statistically significant (x2 =5.86,P ＜ 0.05),The two groups are not significant in overall survival time (x2 =3.154,P ＞ 0.05) and progression free survival (x2 =4.243,P ＞ 0.05) as two indicator of long-term efficacy.Conclusions Conservative surgery compared with radical mastectomyhave less clinical complications,more breast cosmetic effect,better survival quality,and both of them share the same recurrence or metastasis and survival rate,so conservative surgery should be preferable in the clinical application.

Objective To investigate the role of metastatic lymph node ratio (MLR) in the evaluation of prognosis of patients with gastric cancer (GC) at different lymph node numbers examined. Methods Clinical data were reviewed retrospectively in a total 535 patients who underwent surgery for GC. Spearman correlation analysis between MLR or number of metastatic lymph nodes (N) and examined lymph node numbers, Kaplan-Meier method was used for comparison survival rates of N stage and MLR stage. A receiver operating characteristic (ROC) curve was used to evaluate the role of N stage and MLR stage in the prognosis of GC patients. Results Metastatic lymph node ratio and number of metastatic lymph nodes correlated with the examined lymph node numbers (r=0.146, r=0.378, P 10(P 10 (P<0.001). Conclusions MLR was less influenced by lymph node number examined than N . MLR stage has potential superiority to that the N stage in assessing prognosis of GC patients, especially for patients with more than 6 lymph nodes examined. Key words: Stomach neoplasms; Lymph nodes; Neoplasm staging; Prognosis