全麻对手术病人血浆尾加压素Ⅱ和肾素、血管紧张素活性的影响

目的：研究全麻诱导地患者血浆加压素Ⅱ和肾素、血管紧张素活性的影响。方法：20例全麻手术患者，于麻醉诱导前20分钟和诱导后10分钟分别抽取静脉血测定血浆尾加压素Ⅱ和肾素、血管紧张素活性。结果：与麻醉前比较，麻醉后尾加压素Ⅱ的浓度明显下降（P＜0．01）；肾素活性及血管加压素Ⅱ含量均明显升高（P＜0．01）。结论：全麻后，血浆尾加压素Ⅱ与肾素、血管紧张素含量呈反向变化。     

全身热疗对血浆肾素血管紧张素Ⅱ和β2-微球蛋白浓度的影响

目的 观察晚期肿瘤患者行全身热疗对血浆肾素-血管紧张素系统(RAAS)和肾功能的影响.方法 择期晚期肿瘤患者行全身热疗20例,随机均分为全麻插管组(A组)和静脉麻醉组(B组),分别在加温前、加温至41.8℃维持60 min时(加温后)、复温至38℃(复温后)用放射免疫法测肾素活性(RA)、血管紧张素Ⅱ(AⅡ)和β2-微球蛋白(β2-MG)的浓度.结果 A组血浆RA浓度在加温后比加温前增高(P＜0.05),而AⅡ、β2-MG浓度稍有下降;B组血浆RA、AⅡ、β2-MG浓度在加温后均比加温前明显增高(P＜0.05),B组加温后RA、AⅡ、β2-MG浓度均高于A组(P＜0.05).结论 全麻插管能够抑制全身热疗高温刺激所致的RAAS反应.     

丙泊酚对高龄高血压大鼠血液动力学肾素-血管紧张素系统的影响

目的 探讨丙泊酚对高龄高血压大鼠血液动力学和肾素-血管紧张素系统的影响。方法48只高龄高血压大鼠随机分为对照组(A组)、小剂量丙泊酚组(B组)和大剂量丙泊酚组(C组)，观察输注期间平均动脉压和心率变化，并于30min时处死大鼠，测定血浆肾素活性、血浆、心肌和主动脉血管紧张素Ⅱ浓度。结果 B、C组血压、心率随着丙泊酚输注进行性下降；B、C组肾素活性显著低于A组；B、C组血液、心肌及主动脉血管紧张素Ⅱ浓度显著低于A组。结论 丙泊酚麻醉对高龄高血压大鼠循环有与剂量及时间有关的抑制；丙泊酚抑制肾素-血管紧张素系统可能是其对血液动力学抑制的机制之一。     

依托咪酯复合舒芬太尼麻醉诱导对患者血流动力学及应激反应的影响

目的观察依托咪酯复合舒芬太尼麻醉诱导对患者血流动力学及应激反应的影响。方法将60例气管插管全麻下腹部手术患者,随机分为异丙酚组(A组)和依托咪酯组(B组),各30例,ASAⅠ~Ⅱ级。比较麻醉诱导各时段的血流动力学、血浆皮质醇(Cor)浓度和血糖(Glu)的变化。结果于麻醉诱导前(T0)、插管前即刻(T1)、插管后1 min(T2)、5 min(T3),测量每组患者的平均动脉压(MAP)、心率(HR),在各时点抽取动脉血监测Cor浓度和Glu。与T0比较,2组患者T1时点MAP、HR均明显下降(P0.05),差异有统计学意义。MAP、HR在T2、T3时点A组较B组低(P0.05),差异有统计学意义。A组插管后各时间点Cor浓度和Glu与B组比较差异无统计学意义(P0.05)。结论依托咪酯复合舒芬太尼麻醉诱导对患者血流动力学影响较小,更适于全麻手术患者的麻醉诱导。     

不同麻醉法对血浆肾素,血管紧张素II,醛固酮,皮质醇水平的…

观察全麻复合硬膜外阻滞和全麻两种麻醉时血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇变化。２５例择期上腹部手术患者，随机分两组：Ａ组为全麻复合硬膜外阻滞１２例，Ｂ组为全麻１３例。分别于麻醉前、麻醉插管后２分钟、进腹探查时、术中２小时、拔管后即刻抽取中心静脉血测肾素、血管紧张素Ⅱ、醛固酮、皮质醇的浓度。结果示Ａ组麻醉前后无明显变化（Ｐ〉０．０５）；Ｂ组术中肾素活性和皮质醇显著增高（Ｐ〈０．０１）。此外，手术     

不同全麻诱导药对高血压病人围诱导期血浆R-A-A-S系统的影响

在全身动脉血压的调节中,肾素-血管紧张素-醛固酮系统（Renin-angiotensin-aldosterone system,R-A-A-S）具有非常关键性的作用,围手术期对血浆肾素活性（Plasmarenin activity,PRA）、血管紧张素 Ⅱ（angiotensin Ⅱ,A Ⅱ）和醛固酮（aldosterone,Ald）系统的研究较多[1,2],本研究旨在观察不同全麻诱导药对原发性高血压病人围诱导期血     

丙泊酚对不同抗高血压治疗后高血压大鼠血流动力学和血管紧张素Ⅱ的影响

目的 探讨丙泊酚对不同抗高血压治疗后自发性高血压大鼠(SHR)血流动力学和血浆、心肌及主动脉中血管紧张素Ⅱ浓度的影响.方法 32只SHR随机分为四个抗高血压治疗组:卡托普利组(A组)、普荼洛尔组(B组)、双氧克尿塞组(C组)和非洛地平组(D组),每组8只.在抗高血压治疗12周后,大鼠以丙泊酚5 mg/kg诱导,继之以丙泊酚60 mg·kg-1·h-1持续输注30 min,观察输注期间MAP和HR变化,并于结束时处死大鼠,测定血浆、心肌及主动脉中血管紧张素Ⅱ浓度.结果 各组MAP、HR随着丙泊酚输注进行性下降和减慢,其中血流动力学抑制在A组最为明显.且A组各部位的血管紧张素Ⅱ浓度显著低于其它组(P<0.05).结论 丙泊酚麻醉对不同抗高血压治疗后高血压大鼠血流动力学有抑制作用,卡托普利治疗后抑制最明显;丙泊酚对血流动力学 抑制与体内血管紧张素Ⅱ浓度降低可能有关.     

不同麻醉法对血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇水平的影响

观察全麻复合硬膜外阻滞和全麻两种麻醉时血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇变化。２５例择期上腹部手术患者，随机分两组：Ａ组为全麻复合硬膜外阻滞１２例，Ｂ组为全麻１３例。分别于麻醉前、麻醉插管后２分钟、进腹探查时、术中２小时、拔管后即刻抽取中心静脉血测肾素、血管紧张素Ⅱ、醛固酮、皮质醇的浓度。结果示Ａ组麻醉前后无明显变化（Ｐ＞０．０５）；Ｂ组术中肾素活性和皮质醇显著增高（Ｐ＜０．０１）。此外，手术期间Ａ组比Ｂ组心率慢，血压低（Ｐ＜０．０１）。表明全麻复合硬膜外阻滞是一种应激反应较轻的麻醉方法。     

卡托普利在异氟醚控制性降压期间对肾素活性‘血管紧张素的影响

２４例控制性降压的择期颅脑手术患者随机分为二组，Ｉ组为单纯异氟醚降压组（ｎ＝１２），Ⅱ组为异氟醚加卡托普利降压组（ｎ＝１２）。两组患者的平均动脉压比降压前降低３０％左右。结果显示，Ｉ组患者血浆血管紧张素（Ａ）Ⅱ浓度较降压前增加２６０％（Ｐ＜０．０１）；Ⅱ组患者血浆ＡⅡ浓度较降压前稍有下降。Ｉ组患者诱导及维持降压的异氟醚呼气末浓度均分别高于Ⅱ组。结论认为，静注卡托普利可减弱降压期间的肾素活性及血管紧张素Ⅱ的浓度，与异氟醚合用于较长时间的控制性降压可能有其优点。     

Narcotrend监测下丙泊酚靶控输注技术在肾移植患者全麻诱导期的应用

目的探讨Narcotrend监测下丙泊酚靶控输注(TCI)技术在肾移植患者全麻诱导期的应用对心血管及应激反应的影响。方法选择择期行亲属活体肾移植手术的尿毒症患者40例,男25例,女15例,年龄21~38岁,ASAⅢ或Ⅳ级,随机分为A、B两组,每组20例。A组在Narcotrend监测下采用Diprifusor TCI输注泵输注丙泊酚,B组人工推注丙泊酚。记录麻醉诱导前(T_0)、气管插管前(T_1)、气管插管后1 min(T_2)、3 min(T_3)、5 min(T_4)的HR、MAP、Narcotrend指数(NTI)及血糖(Glu)、血浆皮质醇(Cor)浓度。结果与T0时比较,T1时两组患者HR明显减慢,MAP明显下降(P0.05),且B组明显低于A组(P0.05);T_2、T_3时B组HR明显增快,MAP明显升高(P0.05),且B组明显高于A组(P0.05)。与T_0时比较,T2~T4时A组Glu、Cor略有升高,但差异无统计学意义;T_2~T_4时B组Glu、Cor浓度明显升高(P0.05),且B组明显高于A组(P0.05)。结论 Narcotrend监测下丙泊酚TCI用于肾移植患者全麻诱导时,麻醉深度可控性强,能有效减轻气管插管引起的机体应激反应,维持血流动力学平稳。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020