关节镜联合富血小板血浆对膝关节半月板损伤患者膝关节功能和生活质量的影响

目的:探讨关节镜联合富血小板血浆对膝关节半月板损伤患者膝关节功能和生活质量的影响。方法:选取2017年12月-2019年9月期间我院收治的膝关节半月板损伤患者80例,根据随机数字表法分为对照组(n=40)和研究组(n=40),对照组予以关节镜下修整手术治疗,研究组在对照组基础上联合富血小板血浆治疗,比较两组患者优良率、生活质量及视觉模拟评分量表(VAS)、Lysholm评分量表、美国西安大略和麦克马斯特大学关节炎指数(WOMAC)评分。记录两组治疗期间不良反应情况。结果:研究组治疗后3个月的膝关节功能优良率高于对照组(P0.05)。两组治疗前、治疗后1个月、治疗后3个月VAS、WOMAC评分均逐步降低,Lysholm评分逐步升高(P0.05);研究组治疗后1个月、治疗后3个月VAS、WOMAC评分低于对照组,Lysholm评分高于对照组(P0.05)。两组治疗后3个月SF-36各维度评分均较治疗前升高,且研究组高于对照组(P0.05)。两组不良反应发生率对比未见统计学差异(P0.05)。结论:关节镜联合富血小板血浆治疗膝关节半月板损伤患者,可促进膝关节功能的恢复,可有效缓解手术治疗后的疼痛症状,改善患者生活质量,具有较好的临床应用价值。     

髓内固定对老年股骨转子间骨折患者关节功能的影响

摘要 目的：研究髓内固定对老年股骨转子间骨折患者关节功能的影响。方法：选取2016年9月~2019年9月我院收治的股骨转子间骨折的老年患者80例为研究对象,采用随机数字表法将其分为两组,每组各40例。对照组患者采用Gamma钉进行治疗,观察组患者采用股骨近端防旋髓内钉固定治疗。比较两组患者的围术期相关指标、骨折愈合时间、Harris评分、临床治疗效果及并发症的发生情况。结果：观察组患者的手术时间、切口长度、术中出血量、术后引流量、住院时间及骨折愈合时间均显著少于或短于对照组(P＜0.05)。术前,两组患者的Harris评分比较无统计学差异(P＞0.05);术后6个月及术后12个月,两组患者的Harris评分均较术前显著升高,且观察组显著高于对照组(P＜0.05)。观察组患者的治疗优良率为92.50 %,显著高于对照组(75.00 %,P＜0.05)。两组患者深静脉血栓、感染、褥疮、固定松动、股骨头坏死及严重疼痛的发生率比较无统计学差异(P＞0.05)。结论：股骨近端防旋髓内钉固定治疗老年股骨转子间骨折效果明显优于Gamma钉治疗,可有效缩短骨折愈合时间,提高髋关节功能。     

Symbiont community diversity is more variable in corals that respond poorly to stress

Coral reefs are declining globally as climate change and local water quality press environmental conditions beyond the physiological tolerances of holobionts—the collective of the host and its microbial symbionts. To assess the relationship between symbiont composition and holobiont stress tolerance, community diversity metrics were quantified for dinoflagellate endosymbionts (Family: Symbiodiniaceae) from eight Acropora millepora genets that thrived under or responded poorly to various stressors. These eight selected genets represent the upper and lower tails of the response distribution of 40 coral genets that were exposed to four stress treatments (and control conditions) in a 10‐day experiment. Specifically, four ‘best performer’ coral genets were analyzed at the end of the experiment because they survived high temperature, high pCO₂, bacterial exposure, or combined stressors, whereas four ‘worst performer’ genets were characterized because they experienced substantial mortality under these stressors. At the end of the experiment, seven of eight coral genets mainly hosted Cladocopium symbionts, whereas the eighth genet was dominated by both Cladocopium and Durusdinium symbionts. Symbiodiniaceae alpha and beta diversity were higher in worst performing genets than in best performing genets. Symbiont communities in worst performers also differed more after stress exposure relative to their controls (based on normalized proportional differences in beta diversity), than did best performers. A generalized joint attribute model estimated the influence of host genet and treatment on Symbiodiniaceae community composition and identified strong associations among particular symbionts and host genet performance, as well as weaker associations with treatment. Although dominant symbiont physiology and function contribute to host performance, these findings emphasize the importance of symbiont community diversity and stochasticity as components of host performance. Our findings also suggest that symbiont community diversity metrics may function as indicators of resilience and have potential applications in diverse disciplines from climate change adaptation to agriculture and medicine.     

Complementary strengths of spatially-explicit and multi-species distribution models

Species distribution models (SDMs) project the outcome of community assembly processes – dispersal, the abiotic environment and biotic interactions – onto geographic space. Recent advances in SDMs account for these processes by simultaneously modeling the species that comprise a community in a multivariate statistical framework or by incorporating residual spatial autocorrelation in SDMs. However, the effects of combining both multivariate and spatially-explicit model structures on the ecological inferences and the predictive abilities of a model are largely unknown. We used data on eastern hemlock Tsuga canadensis and five additional co-occurring overstory tree species in 35 569 forest stands across Michigan, USA to evaluate how the choice of model structure, including spatial and non-spatial forms of univariate and multivariate models, affects ecological inference about the processes that shape community composition as well as model predictive ability. Incorporating residual spatial autocorrelation via spatial random effects did not improve out-of-sample prediction for the six tree species, although in-sample model fit was higher in the spatial models. Spatial models attributed less variation in occurrence probability to environmental covariates than the non-spatial models for all six tree species, and estimated higher (more positive) residual co-occurrence values for most species pairs. The non-spatial multivariate model was better suited for evaluating habitat suitability and hypotheses about the processes that shape community composition. Environmental correlations and residual correlations among species pairs were positively related, perhaps indicating that residual correlations were due to shared responses to unmeasured environmental covariates. This work highlights the importance of choosing a non-spatial model formulation to address research questions about the species–environment relationship or residual co-occurrence patterns, and a spatial model formulation when within-sample prediction accuracy is the main goal.     

污染场地土壤生态风险评估研究进展

随着我国快速城市化以及产业结构的调整,遗留下了大量的污染场地,发展和实施污染场地土壤生态风险评估是进行大规模污染场地修复行动的必要条件。本文围绕污染场地土壤生态风险评估的科学原理、框架构建及技术方法等方面的关键问题: 1)评估框架的场地实际针对性;2)概念模型的不确定性;3)土壤复合污染毒性机制;4)评估终点筛选;5)评估方法和框架构建等展开讨论,指出土壤复合污染的制毒机制,即污染物生物有效性和联合效应是污染场地土壤生态风险评估的关键科学问题。耦合美国环保局四步法和欧盟层级法的“证据-权重法”评估框架适用于野外复杂环境条件下的土壤污染生态风险评估。建议今后重点开展以下5个方面的工作: 1)污染场地土壤生态风险评估技术框架与风险管控技术框架之间的联合;2)概念模型研究;3)基于过程的场地土壤污染物反应运移模型研究;4)场地土壤复合污染生态毒理学机制研究;5)生态系统高水平生态风险评估终点研究。旨在为形成我国本土污染场地土壤生态风险评估技术指南提供理论基础和构架。     

Shared ancestral polymorphisms and chromosomal rearrangements as potential drivers of local adaptation in a marine fish

Gene flow has tremendous importance for local adaptation, by influencing the fate of de novo mutations, maintaining standing genetic variation and driving adaptive introgression. Furthermore, structural variation as chromosomal rearrangements may facilitate adaptation despite high gene flow. However, our understanding of the evolutionary mechanisms impending or favouring local adaptation in the presence of gene flow is still limited to a restricted number of study systems. In this study, we examined how demographic history, shared ancestral polymorphism, and gene flow among glacial lineages contribute to local adaptation to sea conditions in a marine fish, the capelin (Mallotus villosus). We first assembled a 490‐Mbp draft genome of M. villosus to map our RAD sequence reads. Then, we used a large data set of genome‐wide single nucleotide polymorphisms (25,904 filtered SNPs) genotyped in 1,310 individuals collected from 31 spawning sites in the northwest Atlantic. We reconstructed the history of divergence among three glacial lineages and showed that they probably diverged from 3.8 to 1.8 million years ago and experienced secondary contacts. Within each lineage, our analyses provided evidence for large N_e and high gene flow among spawning sites. Within the Northwest Atlantic lineage, we detected a polymorphic chromosomal rearrangement leading to the occurrence of three haplogroups. Genotype–environment associations revealed molecular signatures of local adaptation to environmental conditions prevailing at spawning sites. Our study also suggests that both shared polymorphisms among lineages, resulting from standing genetic variation or introgression, and chromosomal rearrangements may contribute to local adaptation in the presence of high gene flow.     

Exploiting nonsystematic covariate monitoring to broaden the scope of evidence about the causal effects of adaptive treatment strategies

In studies based on electronic health records (EHR), the frequency of covariate monitoring can vary by covariate type, across patients, and over time, which can limit the generalizability of inferences about the effects of adaptive treatment strategies. In addition, monitoring is a health intervention in itself with costs and benefits, and stakeholders may be interested in the effect of monitoring when adopting adaptive treatment strategies. This paper demonstrates how to exploit nonsystematic covariate monitoring in EHR‐based studies to both improve the generalizability of causal inferences and to evaluate the health impact of monitoring when evaluating adaptive treatment strategies. Using a real world, EHR‐based, comparative effectiveness research (CER) study of patients with type II diabetes mellitus, we illustrate how the evaluation of joint dynamic treatment and static monitoring interventions can improve CER evidence and describe two alternate estimation approaches based on inverse probability weighting (IPW). First, we demonstrate the poor performance of the standard estimator of the effects of joint treatment‐monitoring interventions, due to a large decrease in data support and concerns over finite‐sample bias from near‐violations of the positivity assumption (PA) for the monitoring process. Second, we detail an alternate IPW estimator using a no direct effect assumption. We demonstrate that this estimator can improve efficiency but at the potential cost of increase in bias from violations of the PA for the treatment process.     

神经肌肉关节促进训练对脑性瘫痪患儿智力及肢体功能的影响

摘要 目的：探讨神经肌肉关节促进训练对脑性瘫痪(cerebral palsy,CP,脑瘫)患儿智力及肢体功能的影响。方法：2016年12月到2018年12月选择在本院儿保科门诊就诊的脑瘫患儿134例,根据治疗方法分为观察组与对照组,各67例。对照组给予常规康复训练,观察组在对照组给予神经肌肉关节促进训练,两组康复观察3个月,记录智力及肢体功能变化情况。结果：观察组的总有效率为98.5 %,高于对照组的83.6 %(P<0.05)。两组康复后的粗大运动功能测试量表(gross motor function measure, GMFM)评分都高于康复前(P<0.05),观察组高于对照组(P<0.05)。两组康复后的适应与语言行为评分都高于康复前(P<0.05),观察组也高于对照组(P<0.05)。两组康复后的F波振幅高于康复前(P<0.05),阈值低于康复前(P<0.05),康复后观察组与对照组对比差异也都有统计学意义(P<0.05)。结论：神经肌肉关节促进训练在脑瘫患儿的应用能促进改善智力及肢体功能,重建患儿的肌电功能,从而提高治疗效果。     

切开与闭合复位空心钉内固定对移位股骨颈骨折患者骨折复位质量和髋关节功能的影响

摘要 目的：探讨切开与闭合复位空心钉内固定对移位股骨颈骨折患者骨折复位质量和髋关节功能的影响。方法：本研究为回顾性研究,选取98例移位股骨颈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,切开复位）和B组（n=48,闭合复位）,比较两组患者优良率、骨折复位质量、髋关节功能、围术期指标、术后并发症发生率和二次手术发生率。结果：A组患者术后6个月的优良率为78.00%（39/50）,高于B组的58.33%（28/48）（P<0.05）。两组术后负重下地时间、术中透视时间比较无差异（P>0.05）;B组手术时间、住院时间短于A组,术中出血量少于A组（P<0.05）。两组患者术后1个月、术后3个月、术后6个月髋关节功能Harris评分均较术前升高,且A组高于B组（P<0.05）。两组二次手术及并发症发生率比较无差异（P>0.05）。A组Ⅰ型、Ⅱ型的例数均多于B组,Ⅲ型例数少于B组（P<0.05）。结论：与闭合复位空心钉内固定相比,切开复位空心钉内固定虽损伤较大,但其术后骨折复位质量和髋关节功能改善效果更佳,且不增加并发症发生率和二次手术发生率。