MutS homolog 2 (MSH2) is a crucial participant in human DNA repair, and lots of the studies functionally associated with it were begun with hereditary nonpolyposis colorectal cancer (HNPCC). MSH2 has also been reported to take part in the progresses of various tumors' formation. With the help of GTEx, CCLE, and TCGA pan-cancer databases, the analysis of MSH2 gene distribution in both tumor tissues and normal control tissues was carried out. Kaplan-Meyer survival plots and COX regression analysis were conducted for the assessment into the MSH2's impact on tumor patients' clinical prognosis. In an investigation to the association of MSH2 expression with immune infiltration level of various tumors and a similar study on tumor immune neoantigens, microsatellite instability was subsequently taken. It was found that high expression of MSH2 is prevalent in most cancers. MSH2's efficacy on clinical prognosis as well as immune infiltration in tumor patients revealed a fact that expression of MSH2 in prostate adenocarcinoma (PRAD), brain lower-grade glioma (LGG), breast-invasive carcinoma (BRCA), and head and neck squamous cell carcinoma (HNSC) posed a significant correlation with the immune cell infiltration level of patients. Likewise as above, MSH2's expression comes in a similar trend with tumor immune neoantigens and microsatellite instability. MSH2's expression in the majority of tumors is a direct factor to the activation of tumor-associated pathways as well as immune-associated pathways. MSH2's early screening or even therapeutic target role for sarcoma (SARC) diagnosis is contributing to the efficiency of early screening and overall survival in SARC patients.

目的 探讨双侧矢状面交叉穿刺经皮穿刺椎体成形术(PVP)治疗Kümmell病的疗效.方法 2015年6月至2017年9月重庆大学附属中心医院骨科收治的78例Kümmell病病人实施该手术.观察指标包括骨水泥渗漏、椎体内骨水泥分布、伤椎前缘高度、矢状面Cobb角、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI).结果 78例病人均获得24个月随访.1例病人出现骨水泥渗漏,无严重并发症发生.骨水泥在椎体内分布均匀,同时接触上、下终板.伤椎前缘高度、Cobb角、VAS、ODI评分术后2 d[(21.5±2.4)mm、(12.7±2.3)°、(2.3±0.6)分、(25.1±4.1)％]、1月[(20.7±2.5)mm、(13.1±2.0)°、(2.1±0.5)分、(22.1±3.5)％]、12月[(20.4±2.2)mm、(13.3±2.1)°、(1.9±0.4)分、(21.1±3.1)％]、24月[(20.1±1.6)mm、(14.1±1.5)°、(2.2±0.1)分、(24.1±2.5)％]较术前[(14.1±2.1)mm、(21.1±3.0)°、(7.7±0.9)分、(73.9±3.3)％]显著改善(P<0.05),术后1月、12月、24月与术后2 d相比较差异无统计学意义(P>0.05).随访24个月,病人无骨水泥松动、移位及手术椎体再骨折发生.结论 双侧矢状面交叉穿刺PVP治疗Kümmell病疗效确切,安全可靠.此技术能使骨水泥同时接触上、下终板,全椎体强化,降低手术椎体再骨折风险.

[目的]探讨非植骨融合单纯经皮短节段椎弓根螺钉固定治疗伴有后方韧带复合体损伤的屈曲-牵张型(AO分类B型)不稳定胸腰段脊柱骨折的临床疗效.[方法]回顾性分析2015年1月～2018年10月本院采用非植骨融合单纯经皮短节段椎弓根螺钉固定治疗的39例伴后方韧带复合体损伤的屈曲-牵张型不稳定胸腰椎骨折患者,总结围手术期、随访和影像资料.[结果]所有患者手术顺利完成,术中未发生脊髓神经根、血管损伤;手术时间(85.52±6.10) min,术中出血量(60.34±23.12) ml,支具保护下地行走时间(2.61±0.35)d,住院天数(9.47±1.61)d.所有患者随访(14.22±1.16)个月,随时间推移,39例患者的VAS和ODI评分均显著减少(P＜0.05).影像方面,与术前相比,术后39例患者椎体前缘高度显著增加(P＜0.05),而矢状面Cobb角显著减少(P＜0.05).术后椎体前缘高度和矢状面Cobb角无显著改变(P＞0.05).至末次随访时,未出现内固定断裂或松动.[结论]非植骨融合单纯经皮微创后路短节段椎弓根螺钉固定治疗无神经功能损害的伴有后方韧带复合体损伤的屈曲-牵张型不稳定胸腰段脊柱骨折安全有效.

少数病例报告描述了与急性髌骨脱位有关的股骨髁骨软骨骨折[1-3].其发生率并不十分确切.如果骨软骨块几乎全部是软骨性的,而骨性很小,则可能无法通过普通X线影像诊断.这种损伤的发病机理尚不清楚.髌骨与股骨滑车之间的高速低能量剪切力会导致软骨或骨软骨骨折[4],这与引起髌骨脱位的机制相似,这类骨折可以发生在股骨髁的多个部位.通常情况,轻度屈膝状态下的髌骨脱位,骨折部位好发于股骨前外侧髁的非承重部分和髌骨下内缘[5-6].创伤性骨软骨碎块通常仅作为关节内游离体,在手术清创时切除[7-9].骨折部位通过形成纤维软骨样组织愈合,最终导致膝关节疼痛、早期退行性关节炎.

目的 对比采用多功能经颅骨颅内穿刺针持续颅内压(ICP)监测对不同全身麻醉(全麻)诱导方式行的指导.方法 对颅脑创伤手术患者术前行快速ICP监测,其中男39例,女33例,随机数字表法分为常规诱导组(丙泊酚)和依托咪酯组,根据动态监测脑灌注压(CPP)和ICP观察两种诱导药物使用后的变化,以调整诱导药物使用.术前利用多功能经颅骨颅内穿刺针监测ICP、CPP;比较两组患者麻醉前(T0)、诱导中(T1)、插管前(T2)、插管时(T3)、插管后(T4)患者平均动脉压(MAP)、ICP、CPP、心率(HR)的变化.结果 在麻醉诱导前两组ICP、MAP、CPP、HR、血氧饱和度(SpO2)指数均差异无统计学意义(P＞0.05).麻醉诱导后两组各指标均出现不同程度的变化,MAP、CPP下降程度更显著(P＜0.05).两组ICP、MAP及CPP在不同时间点(T1、T2、T3)变化差异有统计学意义(P＜0.05).结论 运用多功能经颅骨颅内穿刺针ICP传感器置入在颅脑创伤手术中可有效地监测ICP、CPP变化,并能指导调整全麻诱导期药物的使用.

Objective To guide the dose of propofol for anesthesia in craniocerebral trauma patients by self-designed multifunctional transcranial puncture for intracranial pressure monitoring.Methods A prospective randomized controlled study was designed on 68 patients with craniocerebral trauma.They were randomly divided into the conventional group and the experimental group (n =34),with cerebral perfusion pressure (CPP) and intracranial pressure (ICP) to guide the dose of propofol before operation.The changes of ICP,CPP,systolic blood pressure (SBP),diastolic blood pressure (DBP),and mean arterial pressure (MAP) before anesthesia (T0),in induction (T1),1 h after operation (T2),2 h after operation (T3),and 10 min before the end of surgery (T4) were measured and compared between the 2 groups.Results There were no significant differences in SBP,DBP,MAP,ICP and CPP between the 2 groups before anesthesia induction (P ＞ 0.05).At T2 and T3,SBP,DBP,MAP,ICP and CPP were declined more significantly in the conventional group than the experimental group (P ＜ 0.05).Conclusion Our designed multifunctional transcranial puncture can effectively monitor ICP and CPP and guide the dose of propofol for craniocerebral trauma patients.It is worthy of further clinical promotion.