锁定接骨板治疗肱骨近端骨折

目的：探讨锁定钢板治疗肱骨近端骨折的临床疗效。方法：2005年3月-2010年3月应用锁定钢板（包括肱骨近端锁定钢板或肱骨近端锁定内固定系统）治疗肱骨近端骨折43例,按Neer分型2部分骨折20例,3部分骨折19例,4部分骨折4例。随访评定包括X线片、Neer肩关节功能评分标准。结果：43例患者获得平均14．2个月（9-21个月）临床随访,骨折全部愈合,愈合平均时间10．4周（8～12周）。根据Neer肩关节功能评分标准：优19例,良19例,可5例,优良率88．4％。结论：锁定钢板治疗肱骨近端骨折具有手术创伤小、操作方便、固定可靠的优点,允许早期功能锻炼,疗效满意。     

The roles of aromaticity in the structure of DNA and its intercalation complexes with quinones

The X-ray crystallographic coordinate data of a 56 DNA double helical oligomers were examined, using the molecular modeling program STR3DI32.EXE, in order to ascertain the aromatic statuses of the Watson-Crick hydrogen bonded base pairs. Several oligomers that were intercalated with anthraquinoid molecules (like the daunomycin and nogalamycin aglycones) were also included in the study in order to evaluate the aromatic statuses of the intercalated entities. This study revealed that the base pairs were aromatic in their Watson-Crick hydrogen bonded double helices, whereas they are known to be non-aromatic in situations in which they are not involved in Watson-Crick hydrogen bonding. The resonance energy gained by the aromatization of these bases, while engaged in Watson-Crick hydrogen bonding, must contribute to the stability of these DNA double helices. The anthraquinoid intercalates were revealed to be in their radical anion form, having received an electron from one of the bases between which these intercalates were sited. These anthraquinoid intercalates are therefore "held" in position by ionic - charge transfer - interactions, as well as hydrogen bonding due to their glycosidic entities. These observations are also relevant to investigations of the electrical conductivity of DNA double helices that are similarly intercalated.     

The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study

Introduction

We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population.

Methods

We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions.

Results

We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year.

Conclusions

The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies.     

Intramedullary Nail versus Dynamic Compression Plate Fixation in Treating Humeral Shaft Fractures: Grading the Evidence through a Meta-Analysis

There is a debate regarding the choice of operative intervention in humeral shaft fractures that require surgical intervention. The choices for operative interventions include intramedullary nailing (IMN) and dynamic compression plate (DCP). This meta-analysis was performed to compare fracture union, functional outcomes, and complication rates in patients treated with IMN or DCP for humeral shaft fractures and to develop GRADE (Grading of Recommendations, Assessment, Development, and Evaluation)-based recommendations for using the procedures to treat humeral shaft fractures. A systematic search of all the studies published through December 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and Cochrane Central databases. The randomized controlled trials (RCTs) and quasi-RCTs that compared IMN with DCP in treating adult patients with humeral shaft fractures and provided data regarding the safety and clinical effects were identified. The demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Ten studies that included a total of 448 patients met the inclusion criteria. The results of a meta-analysis indicated that both IMN and DCP can achieve similar fracture union with a similar incidence of radial nerve injury and infection. IMN was associated with an increased risk of shoulder impingement, more restriction of shoulder movement, an increased risk of intraoperative fracture comminution, a higher incidence of implant failure, and an increased risk of re-operation. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DCP may be superior to IMN in the treatment of humeral shaft fractures. Because of the low quality evidence currently available, high-quality RCTs are required.     

Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy

Background

Radial nerve palsy associated with fractures of the shaft of the humerus is the most common nerve lesion complicating fractures of long bones. However, the management of radial nerve injuries associated with humeral fractures is debatable. There was no consensus between observation and early exploration.

Methods and Findings

The PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, CINAHL, International Bibliography of the Social Sciences, and Social Sciences Citation Index were searched. Two authors independently searched for relevant studies in any language from 1966 to Jan 2013. Thirty studies with 2952 humeral fractures participants were identified. Thirteen studies favored conservative strategy. No significant difference between early exploration and no exploration groups (OR, 1.03, 95% CI 0.61, 1.72; I² = 0.0%, p = 0.918 n.s.). Three studies recommend early radial nerve exploration in patients with open fractures of humerus with radial nerve injury. Five studies proposed early exploration was performed in high-energy humeral shaft fractures with radial nerve injury.

Conclusions

The conservative strategy was a good choice for patients with low-energy closed fractures of humerus with radial nerve injury. We recommend early radial nerve exploration (within the first 2 weeks) in patients with open fractures or high-energy closed fractures of humerus with radial nerve injury.     

桡骨远端骨折治疗的选择

目的：探讨不同类型的桡骨远端骨折的有效治疗方法。方法：分析106例桡骨远端骨折,分别采用闭合手法复位,切开复位或有限切开复位内固定方法,分别对骨折复位比较及功能评分。结果：完整随访106例桡骨远端骨折病例,随访时间3～21个月。对保守治疗组与手术治疗组进行骨折复位测定及改良Garland和Werley评分,A,B型骨折无显著性差异;C型骨折中,手术组明显优于保守治疗组。结论：对于C型骨折,建议行切开复位内固定治疗;对于A,B型需根据实际情况选择治疗方式。     

桡骨远端骨折治疗的选择

目的:探讨不同类型的桡骨远端骨折的有效治疗方法。方法:分析106例桡骨远端骨折,分别采用闭合手法复位,切开复位或有限切开复位内固定方法,分别对骨折复位比较及功能评分。结果:完整随访106例桡骨远端骨折病例,随访时间3～21个月。对保守治疗组与手术治疗组进行骨折复位测定及改良Garland和Werley评分,A,B型骨折无显著性差异;C型骨折中,手术组明显优于保守治疗组。结论:对于C型骨折,建议行切开复位内固定治疗;对于A,B型需根据实际情况选择治疗方式。     

Atomic resolution analysis of a 2:1 complex of CpG and acridine orange.

Cytidylyl-3', 5'-guanosine and acridine orange crystallize in a highly-ordered triclinic lattice which diffracts X-rays to 0.85 angstrom resolution. The crystal structure has been solved and refined to a residual factor of 9.5%. The two dinucleoside phosphate molecules form an antiparallel double helix with the acridine orange intercalated between them. The two base pairs of the double helical fragment have a twist angle of 10 degrees and it is found to have a C3' endo-(3', 5')-C2' endo mixed sugar puckering along the nucleotide backbone as has been observed for other simple intercalator complexes. Twenty-five water molecules have been located in the lattice together with a sodium ion. The intercalator double helical fragments form sheets which are held together by van der Waals interactions in one direction and hydrogen bonding interactions in the other. The crystal lattice contains aqueous channels in which sixteen water molecules are hydrogen bonded to the nucleotide, none to the intercalator, five water molecules are coordinated about the sodium ion and four water molecules bind solely to other water molecules. The bases in the base pairs have a dihedral angle of 7 to 8 degrees between them.     

The use of virtual screening and differential scanning fluorimetry for the rapid identification of fragments active against MEK1

We report the analysis of an in-house fragment screening campaign for the oncology target MEK1. The application of virtual screening (VS) as a primary fragment screening approach, followed by biophysical validation using differential screening fluorimetry (DSF), with resultant binding mode determination by X-ray crystallography (X-ray), is presented as the most time and cost-effective combination of in silico and in vitro methods to identify fragments. We demonstrate the effectiveness of the VS–DSF workflow for the early identification of fragments to both ‘jump-start’ the drug discovery project and to complement biochemical screening data.     

Additional materials of Myanmarpithecus yarshensis (Amphipithecidae, Primates) from the middle Eocene Pondaung Formation

Myanmarpithecus yarshensis is an amphipithecid primate from the middle Eocene Pondaung Formation in Myanmar. It was previously known based on maxillary fragments with P⁴–M³ and mandibular fragments with C–P₃ and M_2–3. This study reports new materials for the genus, including a humeral head fragment, a lingual fragment of the right M², a lingual fragment of the right M³, and a left I¹. These new materials were collected from approximately the same point, and likely belonged to the same individual. The upper molar morphology and size of the new materials show similarity to those of the type specimen, indicating that the new materials can be assigned to M. yarshensis. The humeral head is the first postcranial element that is associated with dental materials for amphipithecids. The morphological similarity between the previously reported larger humerus and this specimen confirms the assignment of the former specimen to Amphipithecidae and suggests common locomotor adaptations in the family. The upper central incisor is large relative to the molar fragments, but is within the variation among extant platyrrhines. The tooth is spatulate-shaped and high crowned, and lacks the mesial process, indicating similarity to I¹ of haplorhines and clear differences from that of adapoids. It has been suggested that amphipithecids, including Myanmarpithecus, have affinities with notharctine adapoids, but the morphology of I¹ does not support the notharctine hypothesis of the Amphipithecidae.     

The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

Background

The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures.

Methods

Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed.

Results

Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001). When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P≤0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture.

Conclusions

Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.     

Identification and extraction of proteins that compose the triad junction of skeletal muscle

Treatment of both transverse tubules and terminal cisternae with a combination of Triton X-100 and hypertonic K cacodylate causes dissolution of nonjunctional proteins and selective retention of membrane fragments which are capable of junction formation. Treatment of vesicles with Triton X-100 and either KCl or K gluconate causes complete dissolution of all components. Therefore K cacodylate exerts a specific preservative action on the junctional material. The membrane fragment from treatment of transverse tubules with Triton X-100 + cacodylate contains a protein of Mr = 80,000 in SDS gel electrophoresis as the predominant protein while lipid composition is enriched in cholesterol. The membrane fragment retains in electron microscopy the trilaminar appearance of the intact vesicles. Freeze fracture of transverse tubule fragments reveals a high density of low-profile, intercalated particles, which frequently form strings or occasional small arrays. The fragments from Triton X-100 plus cacodylate treatment of terminal cisternae include the protein of Mr = 80,000 as well as the spanning protein of the triad, calsequestrin, and some minor proteins. The fragments are almost devoid of lipid and display an amorphous morphology suggesting membrane disruption. The ability of the transverse tubular fragment, which contains predominantly the Mr = 80,000 protein, to form junctions with terminal cisternae fragments suggests that it plays a role in anchoring the membrane to the junctional processes of the triad. The junctional proteins may be solubilized in a combination of nonionic detergent and hypertonic NaCl. Subsequent molecular sieve chromatography gives an enriched preparation of the spanning protein. This protein has subunits of Mr = 300,000, 270,000 and 140,000 and migrates in the gel as a protein of Mr = 1.2 X 10(6) indicating a polymeric structure.     

经皮钢板内固定术治疗肱骨骨折的临床应用研究

目的:观察经皮钢板内固定术对肱骨骨折的临床疗效。方法:选取2005年1月至2013年12月我院骨科收治的肱骨骨折患者172例,随机分为两组,其中对照组86例,予传统切开复位钢板内固定治疗;实验组86例,采用经皮钢板内固定术治疗。治疗结束后,对比两组患者手术时间、出血量、骨折临床愈合时间、术后并发症及临床疗效。结果:实验组手术时间、骨折临床愈合时间及出血量明显少于对照组,差异有统计学意义(P0.05);实验组术后并发症明显少于对照组,差异有统计学意义(P0.05);两组治疗结束后比较临床疗效,实验组临床疗效明显优于对照组,差异有统计学意义(P0.05)。结论:经皮钢板内固定术能够明显改善肱骨骨折术后并发症,提高肱骨骨折特别是粉碎性骨折的临床疗效,对临床具有指导意义,值得临床推广。     

Microstructural Features of Non-Union of Human Humeral Shaft Fracture

Microstructures of non-unions of human humeral shaft fractures were investigated by using scanning electron microscopy, transmission electron microscopy, and X-ray microdiffraction. The non-union has a trabeculae structural framework similar to woven bone. Among the trabeculae are cavities that are subdivided into small chambers by thin plates of collagen fibrils. Some chambers are filled with variously shaped mineralized particles several micrometers in size. The collagen fibrils in both the trabeculae and the thin plates were only slightly mineralized by hydroxyapatite. Vesicles loaded with noncrystalline calcium phosphate (NCP) were observed in most mineralized particles, and brushite crystals with special morphology were seen to be embedded in some particles in irregular shapes. X-ray microdiffraction results indicated that the mineral phases in the non-unions were mainly NCP in addition to small amounts of hydroxyapatite and brushite. NCP deposition and insufficient mineralization of the collagen fibrils may be two important microstructural features of the non-unions of human humeral shaft fractures different from normally repaired bone callus.     

采用同种异体腓骨植骨重建肱骨近端内侧柱的临床应用及疗效

目的:探讨同种异体腓骨移植重建肱骨近端内侧柱联合锁定钢板治疗肱骨近端骨折的临床疗效。方法:回顾性分析2011年3月至2013年9月于我院行同种异体腓骨移植联合锁定钢板治疗肱骨近端骨折患者38例。根据Neer分型:三部分骨折26例,四部分骨折12例;随访期间测量肱骨头内翻角度、肱骨头高度;患肩功能评分采用Constant肩关节评分标准、美国肩肘协会评分系统(ASES)及加州大学肩关节评分系统(UCLA),同时记录患者并发症。结果:患者随访时间平均15.5±1.8个月;末次随访Constant肩关节评分平均89.0±3.2分;美国肩肘协会评分系统(ASES)评分为平均81.2±14.5分;加州大学肩关节评分系统(UCLA)平均27.6±5.3;根据UCLA评分系统,患者术后优良率为89.4%。患侧肩关节前屈、外展、外旋及内旋运动范围分别是143±20°、138±9°、44±12°、42±9°。影像学结果显示:末次随访肱骨头高度平均丢失1.9 mm,颈干角度平均为128±16°。根据Paavolainen方法,末次随访优30例、良7例、差1例。结论:同种异体腓骨移植重建肱骨近端骨折内侧柱,术中联合肱骨近端锁定钢板能有效支撑肱骨头,预防肱骨头塌陷及螺钉穿出,短期临床疗效满意。     

改良肩关节前上方入路结合锁定接骨板治疗肱骨近端骨折

目的:评价改良肩关节前上方入路结合肱骨近端锁定接骨板治疗肱骨近端骨折的优越性。方法:分别采取改良肩前上方入路(A组)、肩峰下外侧入路(B组)和肩关节前内侧入路(C组)结合锁定近端肱骨接骨板固定治疗72例肱骨近端骨折患者。比较各组患者手术时间、术中出血量及术后引流量,术后1周疼痛视觉模拟评分(Visual analogue scale,VAS),术后3月Constan-Murley评分和骨折愈合率之间的差异。结果:A组和B组手术时间无差异(P0.05),二者均大于C组(P0.05);A组和B组术中出血量、术后引流量及术后1周VAS评分无差异(P0.05),二者均小于C组(P0.05);术后3月,A组和B组Constan-Murley评分、骨折愈合率无差异(P0.05;P0.0125),二者均大于C组(P0.05;P0.0125)。结论:改良肩前上方入路治疗肱骨近端骨折具有创伤小的特点,同时具备术中改变切口扩大显露的灵活性,是一种治疗肱骨近端骨折安全有效的手术入路。     

Cloning a promoter that puts the expression of tetracycline resistance under the control of the regulatory elements of the mer operon

We have sub-cloned from the Eco RI-H fragments of the IncFII plasmid R100 a 260-bp EcoRI fragment, using the promoter-cloning vehicle, pBRH4, (The Inc FII plasmid codes for the mer operon, and pBRH4 expresses tetracycline resistance only when the deleted tet promoter has been replaced by another sequence that can serve as a promotor). With the 260-bp fragment inserted, the derivative plasmid, pFB4, directs the expression of tetracycline resistance only if there is a second plasmid in the strain that carries the merR-positive regulatory element. Under these conditions, the level of tetracycline resistance is directly proportional to the concentration of Hg2+ present in the medium. The 260-bp fragment also allows low-level constitutive expression of tet resistance when transactivated with merR mutants that have a "micro-constitutive" phenotype. The 260-bp mer promoter fragment contains a single HincII site; there is also but one HincII site in the EcoRI-H fragment of R100 from which the promoter fragment was derived. Restriction analysis of purified Eco RI-H DNA shows that the single HincII site is at 550 bp from the "right"terminus of the IS1b element, which is also present in the EcoRI-H fragment. Because of its biological activity and its location within the "H" fragment, this promoter is very likely a promoter for the structural genes of the operon.     

The Domain Structure of ICAM-1 and the Kinetics of Binding to Rhinovirus

Fragments of intercellular adhesion molecule 1 (ICAM-1) containing only the two most N terminal of its five immunoglobulin SF domains bind to rhinovirus 3 with the same affinity and kinetics as a fragment with the entire extracellular domain. The fully active two-domain fragments contain 5 or 14 more residues than a previously described fragment that is only partially active. Comparison of X-ray crystal structures show differences at the bottom of domain 2. Four different glycoforms of ICAM-1 bind with identical kinetics.     

Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central fragment in classification and treatment

The medial canthal tendon and the fragment of bone on which it inserts ("central" fragment) are the critical factors in the diagnosis and treatment of nasoethmoid orbital fractures. The status of the tendon, the tendon-bearing bone segment, and the fracture pattern define a clinically useful classification system. Three patterns of fracture are appreciated: type I--single-segment central fragment; type II--comminuted central fragment with fractures remaining external to the medial canthal tendon insertion; and type III--comminuted central fragment with fractures extending into bone bearing the canthal insertion. Injuries are further classified as unilateral and bilateral and by their extension into other anatomic areas. The fracture pattern determines exposure and fixation. Inferior approaches alone are advised for unilateral single-segment injuries that are nondisplaced superiorly. Superior and inferior approaches are required for displaced unilateral single-segment injuries, for bilateral single-segment injuries, and for all comminuted fractures. Complete interfragment wiring of all segments is stabilized by junctional rigid fixation. All comminuted fractures require transnasal wiring of the bones of the medial orbital rim (medial canthal tendon-bearing or "central" bone fragment). If the fracture does not extend through the canthal insertion, the canthus should not be detached to accomplish the reduction.     

Shifts in the abundance and distribution of shallow water fish fauna on the southeastern Brazilian coast: a response to climate change

Myriophyllum aquaticum is a semi-submerged exotic macrophyte that was introduced to China for many years. This species may be found in an emergent form in aquatic environments or in an amphibious form under drained conditions. Nuisance growth of this species has often been attributed to excessive amounts of nutrients. Therefore, we tested the following hypotheses: (1) high nutrient availability facilitates the establishment of M. aquaticum and (2) fragment type interacts with nutrient availability to determine the colonization and regeneration capacities of M. aquaticum. Two types of fragments were grown in water solutions with two levels of phosphorous. After 3 weeks, the survival rates showed no significant difference between the phosphorous treatments. However, emergent fragments showed higher RGR in the low and high phosphorous treatments than amphibious fragments. In addition, emergent fragments also showed higher regeneration capacities, indicating higher invasiveness in emergent fragments compared to amphibious fragments. Moreover, the high phosphorous concentration caused emergent fragments to produce more branches, indicating that nutrient availability may increase M. aquaticum propagule pressure. Our study highlights that nutrient supply increased emergent fragment establishment and shaped the invasion dynamics of macrophytes, which could help predict the spread and potential impact of exotic macrophytes in natural aquatic ecosystems.