ObjectiveTo explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation (OAT) in treatment of large area (4-6 cm2) cartilage injury of the femoral condyle of knee.MethodsBetween March 2016 and June 2017, 22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT. There were 16 males and 6 females with an average age of 22-60 years (mean, 38.6 years). The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases. The disease duration was 1-6 months (mean, 3.4 months). There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries. The area of cartilage defect was 4-6 cm2 (mean, 4.98 cm2). According to the International Cartilage Repair Society (ICRS) classification, 9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ. Eighteen cases were combined with meniscus injuries. Preoperative visual analogue scale (VAS) score was 6.36±1.25 and Lysholm score was 36.00±7.77.ResultsAll incisions healed by first intention. All patients were followed up 2-3 years with an average of 2.3 years. At 2 years after operation, the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21, which were significantly improved when compared with those before operation (t=16.595, P=0.000; t=21.895, P=0.000). At 2 years after operation, MRI showed that the cartilage defect was repaired well.ConclusionArthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee, and the good early effectiveness can be obtained.
ObjectiveTo compare the osteogenic effect of bone marrow mesenchymal stem cells (BMSCs) transfected by adenovirus-bone morphogenetic protein 2-internal ribosome entry site-hypoxia inducible factor 1αmu (Ad-BMP-2-IRES-HIF-1αmu) and by Ad-cytomegalovirus (CMV)-BMP-2-IRES-human renilla reniformis green fluorescent protein 1 (hrGFP-1) single gene so as to optimize the source of osteoblasts. MethodsBMSCs were separated and cultured from 1-month-old New Zealand white rabbit. The BMSCs at passage 3 were transfected by virus. The experiment was divided into 4 groups (groups A, B, C, and D) according to different virus: BMSCs were transfected by Ad-BMP-2-IRES-HIF-1αmu in group A, by Ad-CMV-BMP-2-IRES-hrGFP-1 in group B, by Ad-CMV-IRES-hrGFP-1 in group C, and BMSCs were not transfected in group D. The optimum multiplicity of infection (MOI) (50, 100, 150, and 200) was calculated and then the cells were transfected by the optimum MOI, respectively. The expression of BMP-2 gene was detected by immunohistochemistry staining after transfected, the expressions of BMP-2 protein and HIF-1α protein were detected by Western blot method. The osteogenic differentiation potential was detected by alkaline phosphatase (ALP) activity and Alizarin red staining. ResultsThe optimum MOI of groups A, B, and C was 200, 150, and 100, respectively. The expression of BMP-2 was positive in groups A and B, and was negative in groups C and D by immunohistochemistry staining; the number of positive cells in group A was more than that in group B (P ﹤ 0.05). The expression of BMP-2 protein in groups A and B was significantly higher than that in groups C and D (P ﹤ 0.05), group A was higher than group B (P ﹤ 0.05). The expression of HIF-1α protein in group A was significantly higher than those in the other 3 groups (P ﹤ 0.05), no significant difference was found among the other 3 groups (P ﹥ 0.05). ALP activity in groups A and B was significantly higher than that in groups C and D (P ﹤ 0.05), group A was higher than group B (P ﹤ 0.05). Calcium nodules could be seen in groups A and B, but not in groups C and D; the number of calcium nodules in group A was higher than that in group B (P ﹤ 0.05). ConclusionThe expression of BMP-2 and osteogenic effect of BMSCs transfected by Ad-BMP-2-IRES-HIF-1αmu (double genes in single carrier) are higher than those of BMSCs transfected by Ad-CMV-BMP-2-IRES-hrGFP-1 (one gene in single carrier).
Objective To know the training status and expectation of village doctors in remote and poor areas of Sichuan province and to provide the preferences for developing a viable and efficient training model. Methods The cluster sampling method, combined with questionnaire surveys and qualitative interviews, was used. A total of 463 village doctors of 302 village clinics in Pengzhou and Baoxing of Sichuan province were interviewed. Results The “three-side” phenomenon including the doctor being old, poor academic background and lack of female doctor in remote and poor areas of Sichuan was serious. In-service village doctors’ knowledge on public health and Chinese medicine increased through training. There were differences between the training village doctors participated and that they had expected. The cost of the training was somewhat high for rural doctors. The training system has not been established yet in remote areas. Conclusions Both quantity and quality should be considered in in-service village doctor training in remote areas of Sichuan Province, which should also consider local conditions and farmers’ needs . The in-service training system should be developed as soon as possible. It is suggested that the treatment of village doctors should be improved. Cultivating more young village doctors should be based on the stability of the medical team.
【摘要】 目的 了解四川省医护人员工作倦怠状况，分析其影响因素，为卫生行政管理部门进行有效的预防和干预提供依据。 方法 2008年8月采用分层随机抽样方法，对2 588名医护人员进行调查。 结果 有明显工作倦怠感的医护人员占被调查人员总数的1/4，其年龄、性别、文化程度、职称、专业类别与专业工作年数、行政业务管理职务与医疗机构级别等是影响工作倦怠的主要因素。 结论 优化医院人员配置，营造良好的工作环境和条件，重视和加强对医护人员专业知识、技能培训，对医护人员的工作付出及时予以积极评价等，是避免和降低医护人员工作倦怠的有效措施。【Abstract】 Objective To understand the situation of job burnout and its influential factors among doctors and nurses of Sichuan province and so as to provide evidences for relative departments to prevent job burnout. Methods Stratified random sampling was adopted to investigate 2588 doctors and nurses in August, 2008. Results The percentage of doctors and nurses with evident job burnout in Sichuan province was about 25%. And it was mainly affected by sex, age, education level, job title, job specialty, work experience, administration duty and level of medical institution. Conclusion Relative departments should emphasize on optimizing personnel combination, constructing favorable work condition, reinforcing professional knowledge and skill training, commending work achievement in time in order to avoid and reduce job burnout of doctors and nurses effectively.
【Abstract】 Objective To produce a new bone tissue engineered carrier through combination of xenograft bone (X)and sodium alginate (A) and to investigate the biological character of the cells in the carrier and the abil ity of bone-forming in vivo, so as to provide experimental evidence for a more effective carrier. Methods BMSCs were extracted from 2-week-old New Zealand rabbits and the BMSCs were induced by rhBMP-2 (1 × 10-8mol/L). The second generation of the induced BMSCs was combined with 1% (V/W) A by final concentration of 1 × 105/mL. After 4-day culture, cells in gel were investigated by HE staining. The second generation of the induced BMSCs was divided into the DMEM gel group and the DMEM containing 1% A group. They were seeded into 48 well-cultivated cell clusters by final concentration of 1 × 105/mL. Seven days later, the BMP-2 expressions of BMSCs in A and in commonly-cultivated cells were compared. The second generation of the induced BMSCs was mixed with 2% A DMEM at a final concentration of 1 × 1010/mL. Then it was compounded with the no antigen X under negativepressure. After 4 days, cells growth was observed under SEM. Twenty-four nude mice were randomly divided into 2 group s (n=12).The compound of BMSCs-A-X (experimental group) and BMSCs-X (control group) with BMSCs whose final concentrat ion was 1 × 1010/mL was implanted in muscles of nude mice. Bone formation of the compound was histologically evaluated by Image Analysis System 2 and 4 weeks after the operation, respectively. Results Cells suspended in A and grew plump. Cell division and nuclear fission were found. Under the microscope, normal prol iferation, many forming processes, larger nucleus, clear nucleolus and more nuclear fission could be seen. BMP-2 expression in the DMEM gel group was 44.10% ± 3.02% and in the DMEM containing 1% A group was 42.40% ± 4.83%. There was no statistically significant difference between the two groups (P gt; 0.05). A was compounded evenly in the micropore of X and cells suspended in A 3-dimensionally with matrix secretion. At 2 weeks after the implantation, according to Image Analysis System, the compound of BMSCs-A-X was 5.26% ± 0.24% of the totalarea and the cartilage-l ike tissue was 7.31% ± 0.32% in the experimental group; the compound of BMSCs-X was 2.16% ± 0.22% of the total area and the cartilage-l ike tissue was 2.31% ± 0.21% in the control group. There was statistically significant difference between the two groups (P lt; 0.05). At 4 weeks after the operation, the compound of BMSCs-A-X was 7.26% ± 0.26% of the total area and the cartilage-l ike tissue was 9.31% ± 0.31% in the experimental group; the compound of BMSCs-X was 2.26% ± 0.28% of the total area and the cartilage-l ike tissue was 3.31% ± 0.26% in the control group. There was statistically significant difference between the two groups (P lt; 0.05). Conclusion The new carrier compounding A and no antigen X conforms to the superstructural principle of tissue engineering, with maximum cells load. BMSCs behave well in the compound carrier with efficient bone formation in vivo.
【摘要】 目的 了解四川省基层医疗卫生机构基本医疗功能开展情况，以便有针对性地采取措施，提高基层医疗卫生机构的服务能力。 方法 2008年8月采用自填式问卷调查的方法，对基层医疗卫生机构开展的基本医疗功能情况进行调查。 结果 基层医疗卫生机构提供的三类基本医疗功能（基本检查项目、常见病诊疗、家庭诊疗及转诊）总体情况不甚理想，基本检查项目开展情况社区卫生服务中心好于乡镇/街道卫生院。一级项目中除社区卫生服务中心转出服务开展比例达100%外，大部分医疗卫生机构一级、二级项目开展不全，社区卫生服务中心与乡镇/街道卫生院X线检查开展比例均在50%左右，常见病诊疗部分一级项目开展机构的比例不到30%。家庭诊疗及转诊二级项目两类机构开展比例均较低。 结论 基层医疗卫生机构提供的基本医疗功能特别是常见病诊疗项目有待加强。【Abstract】 Objective To understand the situation of basic medical services in primary medical institutions of Sichuan province so as to take related measures to improve the medical services in primary medical institutions. Methods We used self-administered questionnaires to investigate the basic medical services in primary medical institutions in August, 2008. Results The general situation of the three types of basic medical services (basic examination items, common disease diagnosis and treatment, family diagnosis and treatment and referrals) was not very good, but the development of basic examination items in the community health service center was better than that in villages and town hospitals or street service center. Among all kinds of first-grade medical health services, except for that the referral service in community health service center accounted for 100%, most of the first and second-grade medical health services were not fully developed. The proportion of X ray detection in community health service center and villages and town hospitals or street service center was about 50%, and the development of common disease diagnosis and treatment among the first grade medical health services accounted for only 30%. The proportion of family diagnosis and treatment and referrals was low. Conclusion The basic medial services in primary medical institutions should be strengthened, especially for the common disease diagnosis and treatment.