中医“高骨”的解剖学研究

目的:证实中医“高骨”的存在及它与相关结构的关系,为临床应用提供解剖学依据。方法:选择２０例小儿、２０例青年及８０例成人的桡骨标本,结合活体、尸体解剖、桡骨剖开和桡骨的Ｘ光片,对“高骨”及相关结构进行了形态学观测。结果:“高骨”是桡骨茎突上方向前突出的纵形骨嵴,长度为(１６．２５±１．９４)ｍｍ;“高骨”上端平面之下的桡骨下端略向前、向内弯曲,在此平面的骨质亦显著变薄;小儿、青年的“高骨”隆起处有骺板经过,在成人２８．７５%的人有明显骺线经过;“高骨”的内侧有桡动脉经过;桡骨茎突是向下的锥形突,长度为(９．６４±１．２) ｍｍ。结论:“高骨”存在;“高骨”与桡骨茎突是不同的结构;“高骨”是确定桡动脉的标记;“高骨”上端平面和“高骨”是桡骨下端的两个薄弱区域。

对桡骨茎突和中医“高骨”的形态观测

为把长期混淆的“高骨”与桡骨茎突辨别清楚，本文选择了挠骨Ｘ光片一张，桡骨标本４０例进行了形态观测。结果发现；“高骨”是在茎突上方的向外侧的纵形嵴，长为１１．１０±０．８８ｍｍ；桡骨茎突是向下的锥形突，长为 １１． ８０± ０． ５０ｍｍ；高骨与桡骨茎突的间距为６．００±０．５７ｍｍ。结论：“高骨”与桡骨茎突是两个不同的结构，为临床应用提供了解剖学依据。

Portal hypertension secondary to myelofibrosis with myeloid metaplasia:A study of 13 cases

AIM:To describe the clinical presentation and complications of portal hypertension (PH) secondary to myelofibrosis with myeloid metaplasia (MMM).METHODS: Medical records for 123 patients with MMM were reviewed.RESULTS: Thirteen patients with PH secondary to MMM were identified. Median ages at time of MMM and PH diagnosis were 61 and 66 years, respectively. The interval from MMM diagnosis to presentation with one of the PH features ranged from 1 to 11 years. Variceal bleeding and ascites were the most common presentations. Of the eight patients who presented with variceal bleeding, six patients underwent endoscopic variceal ligation (EVL) with no variceal recurrence or hematological worsening during a 12-mo follow up period.CONCLUSION: Patients with MMM might develop PH. Exact mechanisms leading to PH in MMM are still controversial. As in other etiologies, variceal bleeding and ascites are the most common presentations. Anemia may correlate with, and/or predict, the severity of the PH presentation in these patients. EVL can successfully control variceal bleeding in MMM. Further clinical studies are required.

Multiple esophageal variceal ruptures with massive ascites due to myelofibrosis-induced portal hypertension

A 75-year old man had been diagnosed at 42 years of age as having polycythemia vera and had been monitored at another hospital. Progression of anemia had been recognized at about age 70 years, and the patient was thus referred to our center in 2008 where secondary myelofibrosis was diagnosed based on bone marrow biopsy findings. Hematemesis due to rupture of esophageal varices occurred in January and February of 2011. The bleeding was stopped by endoscopic variceal ligation. Furthermore, in March of the same year, hematemesis recurred and the patient was transported to our center. He was in irreversible hemorrhagic shock and died. The autopsy showed severe bone marrow fibrosis with mainly argyrophilic fibers, an observation consistent with myelofibrosis. The liver weighed 1856 g the spleen 1572 g, indicating marked hepatosplenomegaly. The liver and spleen both showed extramedullary hemopoiesis. Myelofibrosis is often complicated by portal hypertension and is occasionally associated with gastrointestinal hemorrhage due to esophageal varices. A patient diagnosed as having myelofibrosis needs to be screened for esophageal/gastric varices. Myelofibrosis has a poor prognosis. Therefore, it is necessary to carefully decide the therapeutic strategy in consideration of the patient's concomitant conditions, treatment invasiveness and quality of life.

Incidence and survival of stomach cancer in a high-risk population of Chile

AIM:To study the incidence and survival rate of stomach cancer(SC)and its associated factors in a high risk population in Chile. METHODS:The population-based cancer registry of Valdivia,included in the International Agency for Research on Cancer system,covers 356 396 residents of Valdivia Province,Southern Chile.We studied all SC cases entered in this Registry during 1998-2002 (529 cases).Population data came from the Chilean census(2002).Standardized incidence rates per 100 000 inhabitants(SIR)using the world population, cumulative risk of developing cancer before age 75, and rate ratios by sex,age,ethnicity and social factors were estimated.Relative survival(EdererⅡmethod) and age-standardized estimates(Brenner method) were calculated.Specific survival rates(Kaplan-Meier) were measured at 3 and 5 years and survival curves were analyzed with the Logrank and Breslow tests. Survival was studied in relation to demographics, clinical presentation,laboratory results and medical management of the cases.Those variables significantly associated with survival were later included in a Cox multivariate model. RESULTS:Between 1998 and 2002,529 primary gastric cancers occurred in Valdivia(crude incidence rate 29.2 per 100000 inhabitants).Most cases were male(69.0%), residents of urban areas(57.5%)and Hispanic(83.2%), with a low education level(84.5%<8 school years). SC SIR was higher in men than women(40.8 and 14.8 respectively,P<0.001),risk factors were low education RR 4.4(95%CI:2.9-6.8)and 1.6,(95%CI:1.1-2.1) for women and men respectively and Mapuche ethnicity only significant for women(RR 2.2,95%CI:1.2-3.7).Of all cases,76.4%were histologically confirmed,11.5% had a death certificate only(DCO),56.1%were TNM stageⅣ;445 cases(84.1%)were eligible for survival analysis,all completed five years follow-up;42 remained alive,392 died of SC and 11 died from other causes. Specific 5-year survival,excluding cases with DCO,was 10.6%(95%CI:7.7-13.5);5-year relative survival rate was 12.3%(95%CI:9.1-16.1),men 10.9%(95%CI: 7.4-15.2)and women 16.1%(95%CI:9.5-24.5).Fiveyear specific survival was higher for patients aged<55 years(17.3%),with intestinal type of cancer(14.6%), without metastasis(22.2%),tumor size<4 cm(60.0%), without lymphatic invasion(77.1%),only involvement of the mucous membrane(100%).Statistically significant independent prognostic factors were:TNM staging, diffuse type,metastasis,supraclavicular adenopathy, palpable tumor,and hepatitis or ascites. CONCLUSION:Social determinants are the main risk factors for SC,but not for survival.An advanced clinical stage at consultation is the main cause of poor SC survival.

Sulfuric Acid Resistance of Concrete with Blast Furnace Slag Fine Aggregate

The deterioration of concrete by sulfuric acid attack in sewage environments has become a serious problem for many existing sewage structures. In this study, the properties of concrete using the blast furnace slag have been examined. It was shown that by using the blast furnace slag fine aggregate and blast furnace slag fine powder, it is possible to enhance the resistance of mortar and concrete to sulfuric acid. The resistance to sulfuric acid of mortar and concrete can be improved by using a blast-furnace slag fine aggregate in the total amount of fine aggregate. When mortar or concrete reacts to sulfuric acid, dihydrated gypsum film is formed around the particulate of the fine aggregate. This dihydrated gypsum film could retard the penetration of sulfuric acid, thus, improving the resistance to sulfuric acid. Furthermore, it has been proved that the relationship between the erosion depth by sulfuric acid attack and the product of immersion period and concentration of sulfuric acid can be expressed linearly. However, this relationship is dependent on the type of materials of concrete.

Early Prevention of Exercise-induced Tibia Periostitis for Long-Distance Runners in China＇ s Regular Universities

Exercise-induced tibia periostitis is one of the most common sports injuries in the sports training of athletics in regular institutions of higher learning. It often occurs. When it is serious, periosteal proliferation would occur, It will result in fatigue fi^cture sometimes. This is relevant to tibialis anterior muscle restrained contraction in the events in the sports process. If measures are not adopted, early prevention should be strengthened. This would not only affect seriously the sports achievement of long-distance runners, but also affects their future ordinary lives. Through analysis and summaries, the main reasons for the occurrence of tibia periostitis for long-distance runners are shown. From the perspectives of reasonably arranging the exercise load, strengthening the field management and strengthening the self-protection and so on, the prevention of tibia periostitis for long-distance runners has been explored. It also helps the long-distance runners to train scientifically, which can effectively avoid and lessen the occurrence of tibia periostitis and the adverse effect it brings.

EFFECTS OF ACUPUNCTURE AT FENGCHI POINT (GB 20) ON CEREBRAL BLOOD FLOW

Blood velocity in the vertebral artery and the basilar artery was observed before and after acupuncture at Fengchi point (GB 20) in 97 patients by transcranial Doppler ultrasonic detecting. The results showed that the blood velocity in patients with either high or low blood flow had significant changes after acupuncture (P

Studies on HUFA Biosynthesis in a Marine Teleost Siganus Canaliculatus

Marine fish are incapable or have a deft- cient capacity to synthesize highly unsaturated fatty acids （HUFA） from C18 precursors, and thus fish meal and fish oil （FO） are needed in their formulated diets.

The Knee Wear Prediction of UHMWPE Tibial Insert Using VIPRO Platform

The failure mechanism was postulated as a combination of the high level of loading during normal activities and a non-conforming contact mechanism between the femoral condyles and the tibial insert. The question that arises is： could be this phenomenon evaluated quantitatively a priori, e.g., could be the failure due to delamination wear predicted？ In order to do some finite element simulations were performed to dynamically determinate the contact area and contact pressure for three different activities. The results obtained using VIPRO platform lead to the conclusion that many clinically reported failures of the tibial tray are caused by the adhesive and fatigue wear.

Rheological Properties of Recycled Aggregate Concrete Using Superplasticizers

The mechanical properties of recycled aggregates concrete from demolition have been studied for several years. It has been documented that rheological properties of these concrete are generally affected by use of recycled aggregates. They could present mechanical properties less affected by the presence of recycled aggregates if the initial concrete were of good quality. However, manufacturing problems, mainly attributed to the angular character of these aggregates and to the granulometry of recycled sand, limit their industrial use. The worth point of this study consists in the optimization of the concrete formulation using specific admixture, adapted to this aggregates in order to facilitate its manufacturing. It shows that the new generation of superplasticizers containing some copolymer polycarboxylate makes it possible to significantly improve the fluidity of the recycled aggregates concrete in its fresh state. The aim of this research is to control rheologica] properties of fresh recycled aggregates concrete with fine and coarse recycled aggregates to limit the negative influence of aggregates on mechanical properties of concrete.

Photodegradation of Methylene Blue in Natural Seawater

This paper reports the photochemical degradation of Methylene Blue(MB)in natural seawater(NSW).The photode-gradation reaction conformed to the first-order reaction kinetics with the rate constant 0.0158 min-1.MB was photochemically de-gradated faster under high-pressure mercury lamp(HPML)than under sunlight.When MB was in lower concentrations,salinitycould inhibit the photoreaction whereas MB in higher concentration,salinity could accelerate the photoreaction.Humid acid couldalso inhibit the photoreactions.Toxicity tests with marine phytoplankton Skeletonema costatum(Sk)and Heterosigma akashiwo Hada(Ha)showed decreased acute toxicity after photodegradation.

Mandibular Reconstruction with Autogenous Fragment of Previous Iliac Crest Associated to Hyperbaric Oxygen Therapy： Case Report

Early efforts at mandibular reconstruction are described from ancient China and the Etruscans to even Hippocrates, involving wooden, terracotta and metal prostheses attached to bone or teeth. Since then, modem surgery has developed more effective techniques, including no vascularized bone grafts, better alloplastic materials, vascularized loco regional grafts, soft and hard tissue compounds, bone fixation and stretching materials, and mechanisms for study models. These components have become indispensable in the surgeon＇s arsenal with regard to reconstructive surgery. A gold standard for mandibular bone reconstruction is the use of autogenous grafts. The objective of this study was to describe a clinical case of mandibular reconstruction with autogenous graft associated with adjuvant hyperbaric oxygen therapy. The clinical case presented shows the treatment performed for after-effects correction due to the non-consolidation of sagittal mandibular osteotomy performed for correction of standard III dentofacial deformity, resulting in a pseudoarthrosis with bite deviation and facial asymmetry. As a treatment plan, mandibular reconstruction was instituted with autogenous graft of anterior iliac crest associated with the use prototyping biomodel and hyperbaric oxygen therapy. After a control of 1 year and 6 months, no signs of recurrence were identified and the radiographic image showed excellent positioning, good volume and maintenance of the mandibular contour.

Experimental investigation of three-dimensional mixed-mode fracture of a titanium alloy at room and elevated temperatures

Damage tolerance of titanium alloy structures is very important for the safety of modern aircraft under complex loading and environmental conditions. However, there is no available systematic knowledge about the effect of alloy thickness under mixed-mode loading at elevated temperatures. In the present study, a newly developed fracture experimental technique based on high-temperature moiré interferometry was employed to investigate experimentally I-II mixed-mode fracture in titanium alloy TC11 of various thicknesses at room and elevated temperatures. Compact shear specimens with thickness ranging from 1.8 to 7.1 mm were tested. The effects of temperature, thickness, and loading angle on the load capacity and crack initiation angle were investigated systematically. The TC11 alloy was shown to possess varied fracture performance at elevated tem-perature, and an opposite thickness effect at room temperature. Increasing temperature would enhance the fracture load capacity of thick specimens but reduce the fracture load capacity of thin specimens. Crack initiation angles under I-II mixed-mode loading showed the thickness-temperature coupling effects. These complex effects call for new development in three-dimensional mixed-mode fracture theory and technologies for damage tolerance assessment.

An unclassified tibial plateau fracture： Reverse Schatzker type Ⅳ

The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unusual and previously undescribed fracture patterns being recognized. We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation. We highlight the challenges confronted and present the management and the outcomes of his injury. A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level I major trauma centre emergency department. His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation. The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system. The patient received a spanning external fixator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode. A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively. At the 6 months follow up, the patient walks without aids and with no limp. Examination revealed a stable joint and full range of motion. Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable. High energy injuries can lead to more complicated fracture patterns, which challenge the orthopaedic surgeons in their management. It is crucial to understand the individual fracture pattern and the possible challenges that may occur. This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker IV type fracture.

Effect of BMI on outcomes of surgical treatment for tibial plateau fractures： A comparative retrospective case series study

Purpose： Tibia plateau fracture （TPF） treatment aims at achieving a stable, aligned, mobile, painless knee and preventing post-traumatic osteoarthritis. To achieve this goal, surgeons consider criteria such as patients＇ characteristics, severity, risk of complications, fracture displacementJdepression, degree of soft tissue injury. However, body mass index （BMI） is not considered as a risk factor in literature. Our study was conducted to find out any possible correlation between BMI and functional scores or radiological score separately. Methods： Retrospective analysis of case series between 2011 and 2014 was done on the database of a tertiary hospital in Istanbul. There were 67 TPF patients （54 males, 13 females） in the study. Relationship between BM1 and functional knee scores or radiological score was compared statistically. Closed fractures with both high-energy and low-energy injury were included in the study. Patients with open fracture, multi-trauma presence, meniscus and/or ligamentous injury, increased co-morbidity, inadequate records （25 cases in all） were excluded. Surgery type, Schatzker classification, injury side, trauma energy, and gender were considered as possible risk factors. Binary regression analysis was done for possible factors affecting functional knee scores and radiologic score. Results： Model summary calculations were done as Nagelkerke R2 test for Knee Society score, Lysholm knee score, and Ahlback and Rydberg radiologic scores, which were 0.648, 0.831, and 0.327 respec- tively. Homer-Lemeshow test values were 0.976, 0.998, and 0.362, respectively. There is negative correlation between BMI and both knee function scores. There is no correlation between BMI and radiologic score. Conclusion： An increase in BMI has a negative effect on functional knee scores after surgical treatment of TPFs. Therefore, BMI should be considered as a risk factor for surgical treatment of TPFs.

Complications in the management of closed high-energy proximal tibial plateau fractures

Purpose： To report complications in the management of complex closed proximal tibial fractures. Method： A retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 20tl and March 2014. Sixty two patients were included in the study. The mean patient age was （43.16 ±11.59） years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted. Results： The overall complication rate was 30.65% （19 out of 62）. Infectious complications were noted in 20.97% cases （13162）. In majority of the cases （8113）, superficial infection was seen which managed with regular dressing and antibiotic administration. The patients （5/13） who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention. Conclusion： Proximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

Triple plating of tibia in a complex bicondylar tibial plateau fracture

High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons. Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics. Anatomic reconstruction of the proximal tibial articular surfaces, restoration of the limb axis （limb alignment） and stable fixation permitting early joint motion are the goals of the treatment. In cases of complex bicondylar tibial plateau fractures, isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions. However sometimes a complex type of bicondylar tibialplateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane. In such fractures it is imperative to fix the medial plateau with buttressing in both planes. One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury, surgical approach and management.

A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis

Objective: To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees. Methods: A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996. Results: One hundred and sixty-one knees (144 patients) were followed up for (1.5)-12 years with an average of (7.5) years and their data were reviewed. The proportion of excellent outcome were (97.3)%, (93.6)% and (78.2)% two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was (11.8)% (19 knees retreated with TKA for HTO failure). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of (98.7%), (95.0%) and (84.1)% 2, 5 and 10 years after HTO, respectively. There were (5.6)% complications (12 /161), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees) missed follow-up, among them 10 patients (11 knees) died.Conclusions: HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.

Observations on Curative Effect of High-frequency Electric Sparkle and Point-injection Therapy on Knee Osteoarthritis

Objective: To observe the curative effect of high-frequency electric sparkle and point-injection therapy (HESPT) on knee osteoarthritis (KOA). Methods: Two hundred and five patients were randomly divided into a warming needle moxibustion group (68 cases), a HESPT group (68 cases) and a point-injection group (69 cases). In the warming needle moxibustion group, the main points of Xuehai (SP 10), Neixiyan (EX-LE4), Waixiyan (EX-LE5), Dubi (ST 35), Zusanli (ST 36) and Yanglingquan (GB 34), and the adjunct points of Yinlingquan (SP 9) and Sanyinjiao (SP 6), on the affected side, were chosen for stimulation. In the HESPT group, tenderness points, the main points of Liangqiu (ST 34), Xuehai (SP 10), Neixiyan (EX-LE4), Waixiyan (EX-LE5) and Zusanli (ST 36), and the adjunct points of Yinlingquan (SP 9), Weizhong (BL 40) and Chengshan (BL 57), were chosen. After proper manipulation, Corydalis decumbens Pers. liquid was injected into the points and a high-frequency electric sparkle was applied to stimulate the needles for 30 seconds. In the point-injection group, point injection was performed with the same method, but the patients did not receive electric stimulation. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Lysholm Knee Score Scale (LKSS) and the ROM (Range of Motion) scale were used to evaluate the severity of KOA and the function of knee joints before treatment and 4 weeks after treatment. Finally, the Nimodipine method was used to assess the total curative effect. Results: After HESPT treatment, the scores for pain, morning stiffness and swelling were significantly lower (P<0.01) and LKSS index and ROM were much higher (P<0.01 and P<0.05 respectively) compared to the two other groups. The obviously effective rate and total effective rate were also significantly higher in the HESPT group than in the two other groups (P<0.01 or P<0.05). Conclusion: HESPT can improve joint function in KOA patients, and the curative effect is better than for warming needle moxibustion or point-injection only.