动力髋螺钉与股骨近端髓内钉内固定治疗股骨粗隆间骨折患者的疗效及安全性和关节功能对比观察

目的:比较动力髋螺钉(DHS)与股骨近端髓内钉(PFNA)内固定治疗股骨粗隆间骨折患者的疗效及安全性和关节功能。方法:选取滁州市第一人民医院于2013年3月～2018年4月期间收治的160例股骨粗隆间骨折患者,根据内固定方式的不同将患者分为DHS组(n=80,采用DHS内固定)和PFNA组(n=80,采用PFNA内固定),比较两组临床疗效,采用髋关节功能Harris评分评价所有患者关节功能恢复情况,比较两组患者术前及术后相关指标,并观察患者术后并发症发生情况。结果:PFNA组患者临床总有效率为90.00%,高于DHS组患者的68.75%(P0.05)。两组患者Harris评分的优良率比较差异无统计学意义(P0.05)。PFNA组患者手术时间、卧床时间、骨折愈合时间、切口长度均短于DHS组(P0.05),术中出血量、术后引流量均少于DHS组(P0.05)。两组患者术后并发症总发生率比较无统计学差异(P0.05)。结论:DHS与PFNA内固定治疗股骨粗隆间骨折在术后关节功能恢复、安全性方面效果相当,但与DHS内固定治疗比较,PFNA内固定治疗的临床疗效更佳,手术时间更短,出血量更少,患者术后恢复更快,是治疗股骨粗隆间骨折较理想的手术方式。     

两种内固定方法治疗老年骨盆后环骨折的疗效对比及对血清应激因子和疼痛相关生化指标的影响

摘要 目的：对比3D导航下经皮骶髂关节螺钉内固定、后路微创重建钢板内固定两种内固定方法治疗老年骨盆后环骨折的疗效及对血清应激因子和疼痛相关生化指标的影响。方法：回顾性分析2016年7月~2020年9月期间我院收治的100例老年骨盆后环骨折患者的临床资料。根据手术方式的不同将患者分为A组（n=50,后路微创重建钢板内固定）和B组（n=50,3D导航下经皮骶髂关节螺钉内固定）。对比两组手术相关指标、疼痛情况、Majeed功能评分、血清应激因子和疼痛相关生化指标变化情况。结果：B组术后3 d、术后1个月、术后3个月、术后1年视觉疼痛模拟评分（VAS）评分低于A组（P<0.05）。B组术中出血量少于A组,住院时间、手术时间、手术切口长度短于A组,但X线暴露时间长于A组（P<0.05）。B组术后1年Majeed功能评分高于A组（P<0.05）。B组术后7 d促甲状腺激素（TSH）水平高于A组,皮质醇（Cor） 、肾上腺素（E）水平低于A组（P<0.05）。B组术后7 d 5-羟色胺（5-HT）、P物质（SP）、前列腺素E2（PGE2）水平低于A组（P<0.05）。A组、B组的并发症发生率组间对比无显著性差异（P>0.05）。结论：与后路微创重建钢板内固定治疗老年骨盆后环骨折患者相比,3D导航下经皮骶髂关节螺钉内固定具有创伤小、手术时间短、术中出血量少、疼痛减轻、应激反应轻等诸多优势,可促进患者术后恢复。     

Molecular movement of the voltage sensor in a K channel

The X-ray crystallographic structure of KvAP, a voltage-gated bacterial K channel, was recently published. However, the position and the molecular movement of the voltage sensor, S4, are still controversial. For example, in the crystallographic structure, S4 is located far away (>30 A) from the pore domain, whereas electrostatic experiments have suggested that S4 is located close (<8 A) to the pore domain in open channels. To test the proposed location and motion of S4 relative to the pore domain, we induced disulphide bonds between pairs of introduced cysteines: one in S4 and one in the pore domain. Several residues in S4 formed a state-dependent disulphide bond with a residue in the pore domain. Our data suggest that S4 is located close to the pore domain in a neighboring subunit. Our data also place constraints on possible models for S4 movement and are not compatible with a recently proposed KvAP model.     

经皮椎弓根空心螺钉微创椎体间融合治疗腰椎间盘突出的临床效果分析

目的：探究经皮椎弓根空心螺钉微创椎体间融合治疗腰椎间盘突出的临床效果及安全性。方法：病例来源于我院2009 年12 月~2013 年12 月收治的确诊为腰椎间盘突出症的病患174 例,依据随机数字表法将其均分为观察组与对照组,每组87 例。其 中,观察组施行Quadrant微创通道经皮椎弓根空心螺钉椎间融合术,对照组施行经后入路开放性椎间融合术。评估和比较两组病 患术前和随访结束时的视觉模拟评分系统(VAS)疼痛评分与Oswestry 功能障碍指数(ODI)的变化及术后并发症的发生情况。结 果：观察组治疗前、出院时及随访一年时的VAS 评分与ODI指数与对照组比较差异均不显著(P>0.05)。观察组手术切口长度、术 后住院时间及术中出血量均明显优于对照组(P<0.01),而其手术所需时间明显长于对照组(P<0.01)。对照组患者术后出现20 例神 经根损伤(22.99%),3 例椎间隙感染(3.45%),其并发症总发生率为(26.44%),而观察组患者术后仅出现3 例神经根损伤,发生率为 3.45%,显著低于对照组(P<0.01)。结论：经皮椎弓根空心螺钉微创椎体间融合治疗的临床效果肯定,能减少对病患的创伤,控制术 后并发症的发生,具有较高的临床应用价值。     

vGNM: a better model for understanding the dynamics of proteins in crystals

The dynamics of proteins are important for understanding their functions. In recent years, the simple coarse-grained Gaussian Network Model (GNM) has been fairly successful in interpreting crystallographic B-factors. However, the model clearly ignores the contribution of the rigid body motions and the effect of crystal packing. The model cannot explain the fact that the same protein may have significantly different B-factors under different crystal packing conditions. In this work, we propose a new GNM, called vGNM, which takes into account both the contribution of the rigid body motions and the effect of crystal packing, by allowing the amplitude of the internal modes to be variables. It hypothesizes that the effect of crystal packing should cause some modes to be amplified and others to become less important. In doing so, vGNM is able to resolve the apparent discrepancy in experimental B-factors among structures of the same protein but with different crystal packing conditions, which GNM cannot explain. With a small number of parameters, vGNM is able to reproduce experimental B-factors for a large set of proteins with significantly better correlations (having a mean value of 0.81 as compared to 0.59 by GNM). The results of applying vGNM also show that the rigid body motions account for nearly 60% of the total fluctuations, in good agreement with previous findings.     

Structural comparison of fucosylated and nonfucosylated Fc fragments of human immunoglobulin G1

Removal of the fucose residue from the oligosaccharides attached to Asn297 of human immunoglobulin G1 (IgG1) results in a significant enhancement of antibody-dependent cellular cytotoxicity (ADCC) via improved IgG1 binding to Fcgamma receptor IIIa. To provide structural insight into the mechanisms of affinity enhancement, we determined the crystal structure of the nonfucosylated Fc fragment and compared it with that of fucosylated Fc. The overall conformations of the fucosylated and nonfucosylated Fc fragments were similar except for hydration mode around Tyr296. Stable-isotope-assisted NMR analyses confirmed the similarity of the overall structures between fucosylated and nonfucosylated Fc fragments in solution. These data suggest that the glycoform-dependent ADCC enhancement is attributed to a subtle conformational alteration in a limited region of IgG1-Fc. Furthermore, the electron density maps revealed that the traces between Asp280 and Asn297 of our fucosylated and nonfucosylated Fc crystals were both different from that in previously reported isomorphous Fc crystals.     

Bold 螺钉治疗内踝骨折的疗效分析

目的:对比Bold螺钉和普通空心螺钉内固定治疗单纯内踝骨折的疗效。方法:空心螺钉治疗单纯内踝撕脱骨折57例,分为A组Bold螺钉内固定治疗内踝骨折25例,B组使用普通空心螺钉内固定32例。结果:两组57例均获得随访,两组病例远期均能得到较坚强的固定和良好的功能恢复,但Bold螺钉组相对普通螺钉组愈合时间更快(P<0.05),下床活动时间更早(P<0.05),早期踝关节功能评分高(P<0.05),但六个月后没有明显差异。结论:Bold螺钉内固定有助于内踝骨折早期愈合和早期功能锻炼,是一种比较好的内固定材料,值得推广。     

Osteoblast viability and differentiation with Me2SO as cryoprotectant compared to osteoblasts from fresh human iliac cancellous bone

The aim of this study was to compare the viability of human osteoblasts cryopreserved with Me2SO to that of fresh human iliac cancellous bone using cell culture techniques. Osteoblasts were obtained by spontaneous outgrowth of human iliac cancellous bone specimens in experiment I. In experiment II, human iliac cancellous bone was frozen with 10% Me2SO at -80 degrees C for 2 weeks and osteoblasts grew spontaneously after thawing at 37 degrees C by removing Me2SO with sucrose. The cells were grown in culture flasks containing DMEM as a culture medium, supplemented with 10% fetal calf serum. They were kept at 37 degrees C in a humidified atmosphere of 95% air and 5% CO2. Cells from the second passage were plated at a density of 5 times 10(3) cells/cm2 in 24-well plates. For detection of viability and differentiation, WST-1 assay, determination of alkaline phosphatase activity, concentration of procollagen I peptide, concentration of osteocalcin, and indirect immunofluorescence for osteopontin, collagen type I, integrin beta1, and fibronectin were applied. Experiments were conducted at four stages of confluence (days 4, 7, 14, and 21 after plating the cells). Based on the results of this study, we conclude that osteoblast-like cells survived cryopreservation and synthesized a range of markers that were consistent with this cell type.     

H-Bonding and Positive Charge at the N(5)/O(4) Locus Are Critical for Covalent Flavin Attachment in Trametes Pyranose 2-Oxidase

Flavoenzymes perform a wide range of redox reactions in nature, and a subclass of flavoenzymes carry covalently bound cofactor. The enzyme-flavin bond helps to increase the flavin's redox potential to facilitate substrate oxidation in several oxidases. The formation of the enzyme-flavin covalent bond—the flavinylation reaction—has been studied for the past 40 years. For the most advocated mechanism of autocatalytic flavinylation, the quinone methide mechanism, appropriate stabilization of developing negative charges at the flavin N(1) and N(5) loci is crucial. Whereas the structural basis for stabilization at N(1) is relatively well studied, the structural requisites for charge stabilization at N(5) remain less clear. Here, we show that flavinylation of histidine 167 of pyranose 2-oxidase from Trametes multicolor requires hydrogen bonding at the flavin N(5)/O(4) locus, which is offered by the side chain of Thr169 when the enzyme is in its closed, but not open, state. Moreover, our data show that additional stabilization at N(5) by histidine 548 is required to ensure high occupancy of the histidyl-flavin bond. The combination of structural and spectral data on pyranose 2-oxidase mutants supports the quinone methide mechanism. Our results demonstrate an elaborate structural fine-tuning of the active site to complete its own formation that couples efficient holoenzyme synthesis to conformational substates of the substrate-recognition loop and concerted movements of side chains near the flavinylation ligand.     

A putative alpha-helical porin from Corynebacterium glutamicum

The cell wall of Corynebacterium glutamicum contains a mycolic acid layer, which is a protective nonpolar barrier similar to the outer membrane of Gram-negative bacteria. The exchange of material across this barrier requires porins. Porin B (PorB) is one of them. Recombinant PorB has been produced in Escherichia coli, purified, crystallized and analyzed by X-ray diffraction, yielding 16 independent molecular structures in four different crystal forms at resolutions up to 1.8 Å. All 16 molecules have the same globular core, which consists of 70 residues forming four α-helices tied together by a disulfide bridge. The 16 structures vary greatly with respect to the 29 residues in the N- and C-terminal extensions. Since corynebacteria belong to the group of mycolata that includes some prominent human pathogens, the observed structure may be of medical relevance. Due to the clearly established solid structure of the core, the native porin has to be oligomeric, and the reported structure is one of the subunits. An α-helical porin in a bacterial outer envelope is surprising because all presently known structures of such porins consist of β-barrels. Since none of the four crystal packing arrangements was compatible with an oligomeric membrane channel, we constructed a model of such an oligomer that was consistent with all available data of native PorB. The proposed model is based on the required polar interior and nonpolar exterior of the porin, on a recurring crystal packing contact around a 2-fold axis, on the assumption of a simple C_n symmetry (a symmetric arrangement around an n-fold axis), on the experimentally established electric conductivity and anion selectivity and on the generally observed shape of porin channels.