骨质疏松症(OP)归属于中医"骨痿"的范畴.骨髓间充质干细胞(BMSCs)作为成骨细胞和脂肪细胞共有的前体细胞,其成骨/成脂向分化的动态平衡与OP的发生密切相关.细胞外信号调节激酶5(ERK5)在BMSCs成骨/成脂向分化中扮演着重要的角色.这一动态过程与中医阴阳学说内涵高度一致.本文试运用肾阴阳自和理论探讨ERK5介导BMSCs成骨/成脂分化平衡在OP的作用,深化OP发病的中西医结合机制的认识,为OP的防治提供新的启发.

目的 探讨单次及两次静脉滴注氨甲环酸对老年股骨转子间骨折患者围术期隐性失血和凝血功能的影响.方法 老年股骨转子间骨折患者100例根据随机数字表法分为研究组和对照组,两组在术前静脉滴注氨甲环酸;研究组术后7 h再次给药.比较两组手术时间、切口长度、住院时间、失血情况、凝血功能及双下肢深静脉血栓的发生率.结果 两组手术时间、切口长度、住院时间无明显差异(P>0.05),研究组总失血量、隐性出血量及输血率均显著低于对照组(P<0.05);术前、术后3 d,两组凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)水平无明显差异(P>0.05),两组双下肢深静脉血栓发生率无明显差异(P>0.05).结论 术前及术后7 h两次静脉滴注氨甲环酸可更有效减少老年股骨转子间骨折患者隐性失血量,且不会对患者的凝血功能造成明显影响.

目的 评价采用微信通信教育法在本科临床教学的成效.方法 将2015年6月—2018年6月临床本科学生共80人按2组随机划分,每组40人,分别应用微信通信教育法(观察组)及跟师学习教学方法(对照组)开展实习教学,通过对2组实习生教学考核成绩、满意度调查问卷对比,分析2组教学方法在临床实践中的应用效果.评价方法:评价方法有两种:一种将考核成绩分为4个等级,以等级成绩的数量及平均分为依据;一种以实习生调查问卷评分表的反馈为依据.结果 观察组出科考核得分明显超过对照组,观察组每项反馈评分均超过对照组,差异均具有统计学意义,P<0.05.结论 微信通信教育法在临床本科教学运用可以提高教学满意度和学习成绩,收到了良好的教学效果.

Purpose: To evaluate the repairing effects of glucosamine sulfate combined with etoricoxib on articular cartilages of patients with knee osteoarthritis (KOA). Methods: A total of 106 KOA patients were randomly divided into control (n=40) and experimental groups (n=66), and treated with etoricoxib alone and glucosamine sulfate plus etoricoxib respectively. Changes in WOMAC score and clinical efficacy were observed. The synovial fluid was extracted. Bone metabolism indices, growth factors, inflammatory factors, matrix metalloproteinases (MMPs) and NO-induced apoptosis-related factors were measured by ELISA. JNK and Wnt5a mRNA levels were determined using RT-PCR. Results: After treatment, the total WOMAC scores of both groups significantly declined (P<0.05), being lower in experimental group. The total effective rate of experimental group was higher (P<0.05). BGP and OPG levels rose, especially in experimental group (P<0.05). CTX-II, COMP and RANKL levels decreased, particularly in experimental group (P<0.05). TGF-β, IGF-1 and FGF-2 levels increased, especially in experimental group (P<0.05). Both groups, particularly experimental group, had decreased levels of IL-1β, IL-17, IL-18, TNF-α, MMP-3, MMP-9 and MMP-13 (P<0.05). JNK and Wnt5a mRNA levels of both groups dropped, which were lower in experimental group (P<0.05). NO and LPO levels reduced, being lower in experimental group. SOD level rose, especially in experimental group (P<0.05). Conclusion: Glucosamine sulfate plus etoricoxib can repair the articular cartilages of KOA patients. Probably, JNK and Wnt5a are down-regulated to inhibit the secretion of MMPs through lowering the levels of inflammatory factors, thereby delaying cartilage matrix degradation. NO-induced chondrocyte apoptosis may be suppressed via the SOD pathway.

目的 研究采用改良空心钉内固定方式治疗青中年股骨颈骨折的疗效.方法 将自2015-01-2018-03收治的青中年股骨颈骨折45例分为传统组(24例)及改良组(21例),传统组取3枚7.5 mm空心加压钉呈倒三角形固定;改良组取2枚7.5 mm空心加压钉和1枚直径6.5 mm无头全螺纹空心钉呈倒三角形固定,2组置入的方法及位置均相同.结果 传统组19例获得完整随访,随访时间6～21个月,平均17.5个月;改良组15例获得完整随访,随访时间7～19个月,平均16.8个月.传统组和改良组在股骨颈短缩率、内固定失败率上有显著的差别,在骨折不愈合及股骨头坏死率上无明显差异.结论 采用改良空心钉内固定方式治疗青中年股骨颈骨折,近期疗效显著,降低术后短缩率及内固定失败率,不增加其他并发症的发生率.