明清之际的学者王船山,基于对明亡教训与时代问题的反省,借由深入诠释《论语》“子贡问政”章,指出社会生养需求的满足、基于内外安全需要而保持充足的武力,以及通过教化养成民众的诚信之德,乃为政治得以维系的三项重要功能要素.其中又以百姓诚信之德的养成,为政治建构与维系的核心基础.因此,船山认为政治建构,应以道德教化为起点与导向,再次第达至足食、足兵之目标.此外,船山针对最新的时代状况,对于《论语》本章所关涉的治道问题,提出了诸多极具现实性的应对举措.

Objective To investigate the histopathological features,immunohistochemical expression and prognostic factors of gas-trointestinal stromal tumor(GIST). Methods Clinical and pathological data were collected from 67 patients with gastrointestinal stromal tumors. All patients underwent routine pathological and immunohistochemical examination of CD117,while CD34,S-100,dog-100, desmin staining characteristics were also analyzed. Life-table method was used to estimate overall survival and survival plot curves. COX proportional hazards model was used to analyze the prognostic factors of GSIT. Results Of all the 67 cases,41 were located at stomach,17 were in bowel,and the other 9 were in the gastrointestinal tract. The most common seen histological type were fusiform common in 52 cases,followed by 12 cases of epithelial cell type,3 cases of mixed cell type. Immunohistochemistry results:61 were CD117-positive,52 were CD34-positive,65 weredog-1-positive,28 were S-100-positive and 23 were desmin-positive. The expression of CD117,CD34,dog-1 were higher in the digestive tract than the other that are not (P<0.05). Multivariate analysis showed that GIST prognosis was associated with distant metastasis,Gleevec treatment and risk classification (P<0.05),but not associated with sex,age, tumor location,tumor size,and CD117 expression (P>0.05). Conclusions The most common type of GIST was spindle cells and stomach is the most common occurrence site,followed by intestine. CD117,CD34,dog-1 were highly expressed in the GIST. Risk classification,metastasis and Gleevec treatment were independent prognostic factors of GIST.

《尚书·洪范》之作,相传为周武王克商后访问箕子并请教治国临民之道,箕子演说"九畴"大法以为治道之要.后代儒者对《洪范》极为重视,常借诠释《洪范》以论述治道之主张.朱子即曾言《洪范》"此是个大纲目,天下之事,其大者大概备于此矣".(《朱子语类》卷七十九)明清之际的学者王船山,由天人关系问题着眼,对于《洪范》所蕴含的政治思想进行深入发掘,特别是他经由详细分析与诠释"五行"与"皇极"两畴之内涵,从而对王政之要、为政之德与成德之学等问题做出了深刻的阐发.

[目的]评价后路脊柱双平面截骨矫形,病灶清除植骨融合,椎弓根钉固定术治疗脊柱结核伴严重后凸畸形的临床效果和并发症.[方法]回顾性分析2009年1月～2010年1月9例严重脊柱侧后凸患者的临床资料.男5例,女4例；年龄20～72岁,平均47.89岁.胸椎结核(T5～T12)5例,胸腰段结核(T12L1)1例,腰椎结核3例.病程3～15个月,平均8个月.MRI发现均存在超过3个以上脊柱节段的脊柱畸形,术前Cobb角＜30°者1例,＞30°者8例.ASIA功能评定A级0例,B级1例,C级5例,D级2例,E级1例.观测指标包括窦道及切口愈合情况、并发症情况、复发率、植骨融合率、神经症状恢复等.[结果]手术时间120～150 min,平均135 min；术中出血量400～1400 ml,平均900ml.术后无神经功能障碍加重.2例脑脊液漏,1例行修补,1例未行,均顺利愈合.1例术后伤口不愈,形成窦道,经抗痨加局部换药治疗后痊愈,其余患者术后伤口均Ⅰ期愈合.9例均获得随访,随访时间24～28个月,平均26个月.随访期内未见结核复发.所有患者均显示骨性融合,末次随访后凸畸形平均矫正18.05°±10.19°,所有病例病理检测确诊脊柱结核,植骨全部融合,融合时间5～14个月,平均8.5个月.[结论]后路脊椎双平面截骨矫形,病灶清除植骨融合,椎弓根钉固定术治疗脊柱结核伴严重后凸畸形配合正确的抗痨治疗、手术技巧及术后处理可取得优良的临床疗效.

Objectives: To investigate the results of a simple anterior surgical treatment for thoracic and lumbar tuberculosis with huge abscess with debridement,bone grafting and internal fixation.Methods: A total of 9 cases suffering from thoracic and lumbar tuberculosis with huge abscess involvement between January 2009 and January 2010 underwent a simple anterior surgical treatment with debridement,bone grafting and internal fixation.The destruction lession range involving 2 vertebral bodies in 6 cases(T9,T10 1 case,T10,T11 2 cases,T12,L1 1 case,L2,L3 2 cases),involving 3 vertebral bodies in 3 cases(T10-T12 1 case,T7-T9 1 case,L2-L4 1 case).All cases were involved more than 3 vertebral abscesses.Spinal function assessment of ASIA grade B in 1 case,C in 5 cases,D in 2 cases,E in 1 case.The preoperative average Cobb angle of kyphosis was 28.3°±13.5°(range,5°-45°);average VAS score was 6.0±1.2 points(range,3 to 8 points);average ODI was(68.6±17.6)%(range,50% to 95%).All cases underwent anterior debridement with autograft of ilium bone graft fusion and internal fixation.1 case not completely paralyzed received emergency operation.4 cases acquired poor effect of preoperative oral isoniazid(H),rifampicin(R),pyrazinamide(Z),ethambutol(E)(HRZE) drug antituberculous therapy for 1 week and then were treated with operation.4 patients with preoperative HRZE antituberculous therapy for 2 weeks before undergoing operation treatment continued to HRZE postoperative antituberculous therapy for 12 months.The clinical manifestations were observed,the X ray and CT or MRI were received after 1 month,6 months and 12 months postoperatively,observing the incision healing,complications,bone graft fusion rate,neural symptom recovery.Wear of thoracic and lumbar spine brace for 3 months.Results: The average sugrical time was 135min(range,120-150min),an average loss of blood was 900ml(range,400-1400ml).There was no neurological handicaps,two cases suffered from cerebrospinal fluid leakage,1 case accepted routine repair and the other one who did not healed itself.2 cases of postoperative wound healed occurs sinus Ⅱ,the rest were stage Ⅰ healing.1 case of the injury of left L3,L4 nerve root,the strength of left femoral head four muscle was 3 level until 1 week postoperation.With the application nervous nutrition drugs and acupuncture,physiotherapy and symptomatic treatment,the muscle strength level was 4 level after 12-month follow-up.All cases were followed up for an average of 17 months(ranges,12-20 months).The time of the abscess completely absorption was an average of 4.5 months(3-6 months).The average time of fusion was 8.5 months(range,5-14 months).At the last follow-up,the kyphosis Cobb angle was an average of 10.3° ±3.3°(5°-15°).ASIA evaluation of spinal cord function in 1 case of grade B preoperatively returned to grade D,8 cases recovered to level E.ODI was 1%-3%,average(2.8%±0.9%).VAS to 0-1,average 0.6 ±0.5 point.During the follow-up period,all patients were without internal fixation loosening and fracture.At the last follow-up,all patients were clinically cured.Conclusions: Based on the regular antituberculosis drug therapy,it is reliable in the treatment of thoracolumbar spinal tuberculosis with huge abscess to use anterior debridement with autologous iliac bone graft and internal fixation.

Objective To clarify the safety limitation of abduction angles of puncture of unilateral percutaneous vertebroplasty(PVP) for thoracic and lumbar vertebrae when puncture needle end point being determined.Methods CT scan images of thoracic and lumbar vertebrae of elderly patients with osteoporotic vertebral compression fracture(OVCF) from January 2011 to January 2012 were collected,All 520 pictures of CT scan including 320 thoracic vertebral and 200 lumbar vertebral pictures of each were selected randomly,with 40 cases of thoracic fracture and 40 cases of lumbar fracture(half male and half female).Data of the abductionangles on vertebral body cross-section were measured by DICOM Medical Image Viewer Ver 1.01 software.First step was to determine the end point at anterocentral 1/3 of the vertebral midline as puncture end point.Included angles between midline and line of transpedicular outer wall,inner wall to puncture end point were determined as puncture maximum and minimum angles respectively,and angles of transpedicular axial line to midline as puncture axial angles.Results Maximum and minimum angles as well as axial angles of thoracic puncture angle from T5-T12 were 28.3°-37.4°,17.2°-23.1°and 19.2°-29.9°,and those of lumbar puncture angle were 31.9°-44.8°,14.2°-26.5° and 23.5°-35.4°respectively.Maximum and minimum angles as well as axial angles in male patients were 28.3°-44.5°,14.2°-25.7°and 19.2°-35.4°,and the parameters in female patients were 29.3°-44.8°,17.2°-26.5° and 23.2°-35.9° respectively,the difference between male and female patients had no statistical significance(P > 0.05).Conclusions For OVCF patients,abduction puncture angles of unilateral PVP should be kept about 30° after the puncture end point being determined at anterocentral 1/3 of the vertebral midline,so as to ensure the surgical safety and good therapeutic effects.

目的:探讨前路病灶清除、植骨及内固定术治疗胸腰椎结核伴发多节段,多部位巨大脓肿患者的安全及疗效性.方法:2009年1月至2010年1月手术治疗9例伴发多节段,多部位巨大脓肿胸腰椎结核患者,病变累及2个椎体8例,3个及以上者1例,累及胸椎5例,腰椎3例,胸腰椎者1例.单纯椎旁脓肿7例,合并盆腔脓肿2例,距椎体最远距离(5.11±3.14)cm.Cobb角5～450°,平均(28.3 ±13.47)°.VAS评分6±1.22;ODI指数45.5±13.90,术前均采用口服异烟肼(H)、利福平(R)、乙胺丁醇(E)、比嗪酰胺(Z)四联方案(HBZE)抗结核治疗后行前路病灶清除取自体髂骨植骨内固定术,内固定方式包括前路金属接骨板系统及前路钉棒系统,术后继续HRZE抗结核治疗12个月.佩戴胸腰椎支具3个月.结果术中出血量400～1400mL,平均900 mL.术后无神经功能障碍加重,2例脑脊液漏,1例行修补,1例未行,均顺利愈合,2例术后切口出现窦道Ⅱ期愈合,其余均I期愈合,9例均获随访,随访时间8～12个月,平均10个月,脊柱后凸Cobb角恢复至5～15°,平均(10.25±3.28)°.脓肿完全吸收时间平均为3个月,ASIA功能评定A、B、C级0例,D级2例,E级7例,VAS降至0.56±0.53;ODI指数降至术后3.78±2.64;植骨全部融合,融合时间5～14个月,平均8.5个月.随访期间内固定无松动及断裂.末次随访时所有患者均获临床治愈.结论:在正规抗结核药物治疗基础上,单纯前路病灶清除植骨内固定辅助胸腰椎支具固定及外科综合治疗可有效治愈多发巨大脓肿胸腰椎结核,疗效满意.

BACKGROUND: It is effective in the application of posterior incision debridement, bone graft and fixation on the patients with spinal tuberculosis deformity angle more than 40°, spinal cord or cauda equina, nerve root compression and unstable. OBJECTIVE: To analyze clinical results and biomechanical characteristics of the posterior spine dual-plane osteotomy, debridement and fusion, pedicle screw fixation for the patients of spinal tuberculosis with severe kyphosis. METHODS: From January 2009 to January 2010, the clinical information of nine patients who accepted a bilateral posterior spinal osteotomy, debridement and fusion with pedicle screw fixation for the treatment of spinal tuberculosis with severe kyphosis was analyzed retrospectively. RESULTS AND CONCLUSION: All the patients were safe in the perioperative period, the term of followed up was 12 (8-16) months, without the cases recurrence of tuberculosis and were all bone fusion, Cobb angle of the last follow-up and visual analogue scale score compared with preoperative score improved significantly (P < 0.01), fusion time was 8.5 (5-14) months. The clinical outcomes illustrated that the correct anti-tuberculosis treatment with the posterior spine dual-plane osteotomy, debridement and fusion, pedicle screw fixation for the treatment of spinal tuberculosis with severe kyphosis has better clinical and biomechanical effectiveness.

Objective To investigate the influence of bone cement leakage into spinal canal on clinical effects of vertebroplasty. Methods From October 2009 to December 2011, 260 patients (337 vertebral bodies) with osteoporotic compression fracture (OVCF) were treated with percutaneous vertebroplasty (PVP, 238 patients) or percutaneous kyphoplasty (PKP, 22 patients) at Liuzhou Worker's Hospital. Bone cement leakage into spinal canal was investigated by X-rays and CT scans. The bone cement area of spinal canal were calculated. The clinical effects were evaluated according to visual analogue scale (VAS) and Oswestry disability questionnaire. The clinical neurological symptoms were observed. Results X-rays and CT scans showed bone cement leakage into spinal canal occured in 48 patients (56 vertebral bodies) and 84 patients (93 vertebral bodies) respectively in which 37 patients (44 vertebral bodies) were included according to the evaluation criteria. The difference between VAS and ODI at preoperation and postoperation had statistical significance (P <0.05); the results of 37 patients (44 vertebral bodies) compared to the others were no statistically different at postoperation, 3 patients (5 vertebral bodies) had nerve root pain, numbness symptoms, while the others showed negative symptoms. Conclusion Bone cement leakage into cpinal canal has no significant impact on the clinical effect of vertebroplasty although the incidence is high. Strengthened monitoring, strict surgical indications control and good surgical technique can reduce the incidence of bone cement leakage into spinal cannal.

BACKGROUND:Bone cement has some traits of liquidity due to a higher proportion of leakage in the treatment of percutaneous vertebroplasty(PVP).How to minimize the probability of bone cement leakage in clinical work and prevent serious complications are hot issues of concern to scholars.OBJECTIVE:To review bone cement leakage after percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture,and to summarize prevention and cure measures of bone cement leakage.METHODS:Osteoporosis vertebral compression fractures in 131 centrums of 102 cases were treated with PVP.Injured centrum was located under the X-ray machine perspective,through the unilateral pedicle of vertebral arch to centrum 1/3 of before and middle was injected with bone cement to fill,diffusion satisfaction 3-5 minutes,the transfixion pin was pulled out.The degree of pain relief and bone cement leakage in patients were observed.RESULTS AND CONCLUSION:A total of 90 cases with the pain completely disappeared,8 cases with the pain significantly reduced,4 cases with the pain reduced,without patients with exacerbation of pain.A total of 22 cases with bone cement leakage in surgery,including 3 cases of leakage in the spinal canal,without symptoms of acute spinal cord compression.5 cases exhibited leakage under and around the anterior longitudinal ligament,without significant symptoms of major vascular erosion.4 cases exhibit leakage around the nerve root canal,with irritative symptoms of unilateral nerve root and radioactive pain of unilateral lower limb.Patients were treated with dehydration,dexamethasone,and nerve nutrition,and then were relieved after the treatment of bed rest.6 cases of leakage to peripheral vertebral,there was no neurological symptom.1 case showed pulmonary punctate cement leakage,with no significant respiratory symptoms.3 cases of leakage along the paravertebral vein spread from around the first and lower vertebral,there was no neurological symptom.There was no rejection in polymethacrylic acid bone cement in vivo.The results showed that PVP treatment of osteoporosis vertebral compression fractures has good effect,but with a higher incidences of cement leakage,surgical indications are need to be strictly controlled to reduce the incidences of bone cement leakage.

Objective To evaluate the effectiveness and safety of external xation(EF) and open reduction and internal xation(ORIF) for unstable distal radius fractures in adults.Methods We searched MEDLINE(1966 to Sep-tember 2008),Cochrane Central register of controlled Trials(The Cochrane Library,Issue 3,2008),EMbase(1974 to Sep-tember 2008),CBM,CNKI,and collected randomized controlled trials(RCTs) of EF and ORIF for unstable distal radius fractures in adults.The quality of the included studies was critically assessed and data analyses were performed with the Cochrane Collaboration’s RevMan 5.0 software.Results Seven RCTs involving 634 patients were included,of which 269 were in EF group,and 293 were in ORIF group.Only 1 study had relative high quality,all the others had some limitation in randomization,blinding,and allocation concealment.The results of meta-analyses showed that,1) about the effective-ness: according to the Gartland and Werley grade standard,the ORIF group was better than the EF group with statistic difference(RR=1.50,95%CI 1.11 to 2.03,P=0.008);because of the original studies did not offer the detailed data including pad strength,grip strength,exion-extension,radial deviation,and ulnar deviation,we only processed a descriptive analy-sis;and 2) about complications: the infection rate of the pin track was higher in the EF group than that in the ORIF group with statistic difference(RR=0.24,95%CI 0.08 to 0.76,P=0.02);but there were no differences between the two groups in reffex sympathetic dystrophy(RSD)(RR=0.88,95%CI 0.30 to 2.56,P=0.82),extensor tendon rupture(RR=3.93,95%CI 0.45 to 34.62,P=0.22),and compartment syndrome(RR=3.13,95%CI 0.51 to 19.09,P=0.22).Conclusions Compared with EF,ORIF is much better based on Gartland and Werley grade standard,and causes much less infection.Because of the limited quality and quantity of the included studies,more proofs are required from more RCTs with large sample.

Iron is an essential nutrient with crucial biological function although too much iron is harmful to cells and tissues..Patients with viral hepatitis often has abnormal iron metabolism,and even serious intrahepatic iron accumulation,which not only accelerate liver injury,but also maybe interfere the response of interferon.This article reviews research progresses about iron metabolism abnormality in viral hepatitis in recent years.

Adiponectin,the first down regulating fat cell cytokine,is the only down-regulation hormone in all fat cell cytokines,which has anti-diabetic,insulin-sensitizing,anti-inflammatory and anti-atherogenic effects,these effects must be mediated by its receptors including AdipoRl and AdipoR2.Further researching of adiponectin and its receptors may offer a new alternative of related diseases in their prevention and cure.

The optimal fermentation medium by Serratia marcesens L15-2 produceing chitinase highly,was composed of 1% chitin,0.3% K_2HPO_4,0.3% KH_2PO_4,0.05% MgSO_4,0.05% CaCl_2,0.001% FeSO_4.After fermentation for 4 days at 37 ℃ and purification,the obtained chitinase was purified and tested by SDS-PAGE.The optimal temperature was 50 ℃ and pH was 6.6 for catalysis by the obtained enzyme.The enzyme was stable below 60 ℃ and under pH 4～10.The enzyme activity was effected on by different metal ions.Its actiaity was enhanced by Ba~(2+),Mn~(2+) and Ca~(2+) and inhibited by Fe~(2+) and Zn~(2+).The chitinase also has an obvious effect on restraining the growth of epiphyte.