老年股骨粗隆间骨折PFNA治疗围手术期隐性失血分析

目的探讨老年股骨粗隆间骨折应用闭合复位股骨近端防旋髓内钉(PFNA)治疗隐性失血的特点及相关危险因素。方法回顾性分析自2010-04—2015-04采用PFNA治疗73例老年(≥65岁)股骨粗隆间骨折,计算其隐性失血量,比较并分析年龄差别(≥80岁、80岁)、性别、有无合并基础疾病等情况下隐性失血量的情况及影响因素。结果 PFNA术后失血总量平均为877 ml,隐性失血量为(753±88)ml,显性失血量为(122±14)ml。隐性失血是围手术期失血主要因素。年龄分层、有无合并基础疾病的PFNA围手术期隐性失血量差异有统计学意义(t=2.249,P=0.014;t=2.330,P=0.011),而不同性别间的差异无统计学意义(t=0.728,P=0.230)。结论老年股骨粗隆间骨折PFNA治疗其围手术期隐性失血是术后贫血的主要因素。高龄及合并基础疾病者更易出现大量隐性失血,需加以重视。     

髓内、外内固定方式治疗高龄股骨粗隆间骨折患者失血量及相关因素分析

目的分析高龄股骨粗隆间骨折运用髓内髓外固定方式治疗时的失血量差异并探讨相关因素的影响。方法回顾性分析自2011-01—2015-01诊治的157例高龄股骨粗隆间骨折,患者分别采用股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)内固定治疗,分析2组显性失血量、隐性失血量及总失血量的差异,以及年龄、性别和体重指数对2种术式中隐性失血量的影响。建立隐性失血量与术后第3天血红蛋白之间的线性方程式。结果 PFNA组显性出血量(140.3±31.6)ml,隐性出血量(409.7±191.3)ml,总出血量(550.0±192.5)ml,DHS组显性出血量(174.3±39.0)ml,隐性出血量(295.0±134.3)ml,总出血量(469.3±144.1)ml,2组显性失血量(t=6.01,P0.001)、隐性失血量(t=-4.33,P0.001)、总失血量(t=-2.96,P=0.036)比较差异有统计学意义。PFNA组中高龄组与超高龄组中隐性出血量比较差异有统计学意义(P0.05);性别(F=0.97,P=0.326)与BMI(F=0.00,P=0.976)对2组的隐性出血量差异无统计学意义。手术方案、术后3 d Hb及隐性出血量三者之间呈线性关系。结论髓内固定方式治疗高龄股骨粗隆间骨折的隐性出血量显著大于髓外固定方式,但显性出血量相反;年龄是影响隐性出血量的因素;隐性失血量与术后血红蛋白水平呈负相关。     

股骨粗隆间骨折应用Intertan固定后隐性失血的初步分析

目的探讨Intertan治疗股骨粗隆间骨折术后隐性失血的特点和相关影响因素。方法回顾性分析2009年9月-2012年9月应用Intertan治疗股骨粗隆间骨折患者107例,其中男46例,女61例,平均年龄73．08岁。骨折依照OTA／AO分型：A1型41例,A2型66例。均为初次单侧新鲜股骨粗隆间骨折,术后24h补液总量不超过2000ml。通过Gross方程计算隐性失血量。结果本组手术时间平均（65．9±5．6）min,围手术期失血总量平均（1072．0±36．0）ml,其中显性失血量平均（182．0±13．6）ml,隐性失血量平均（917．0±16．3）ml。男女组间隐性失血量比较无统计学差异（P〉0．05）,但是在AO／OTA31A1和AO／OTA31A2组间隐性失血量和总失血量存在统计学差异（P〈0．05）。结论Intertan手术虽为微创手术,术中显性失血量较少,但隐性失血量较多,在临床工作中应当注意患者术后的生命体征变化,及时复查血常规和给予相应治疗。     

动力髋螺钉与股骨近端防旋髓内钉治疗老年股骨粗隆间不稳定骨折的病例对照研究

目的：回顾对比应用动力髋螺钉（dynamic hip screw,DHS）和股骨近端防旋髓内钉（proximal femoral nail anti-rotation,PFNA）内固定治疗老年股骨粗隆间不稳定骨折疗效优劣。方法：2004年8月至2012年8月,采用DHS和PFNA内固定治疗股骨粗隆间不稳定骨折92例,其中DHS组50例,男27例,女23例,平均年龄（72．5±5．3）岁;PFNA组42例,男22例,女20例,平均年龄（72．8±5．8）岁。对两组手术时间、失血量（包括隐性失血和显性失血）、卧床时间、下地负重时间、术后并发症及髋关节评分等进行比较。结果：术后随访10～18个月,平均13．5个月。PFNA组较DHS组手术时间和显性失血少,隐性失血多。PFNA组并发症发生率低于DHS组,疗效优于DHS组。髋关节Harris评分PFNA组高于DHS组。结论：治疗高龄股骨粗隆间不稳定骨折,在髋关节功能恢复和减少并发症方面,PFNA效果更好;对于Ⅱa、IIb、Ⅲ型骨折采用DHS可获取良好疗效,在减少围手术期失血方面具有优势。     

PFNA治疗高龄股骨粗隆间骨折隐性失血的发生机制及影响因素初步分析

[目的]探讨采用闭合复位股骨近端防旋髓内钉(PFNA)治疗高龄股骨粗隆间骨折患者术后隐性失血的发生机制及其危险因素。[方法]对本院2008年5月²012年5月所有PFNA病例中抽取的87例高龄股骨粗隆间骨折患者(≥80岁)进行回顾性分析,通过Gross方程计算隐性失血量。记录不同年龄(以80周岁为界),性别,肥胖(BMI 30 kg/m2为界),有无心脑内科疾病(高血压病、冠心病、脑中风偏瘫后遗症)等情况下围手术期隐性失血量,分析讨论围手术期隐性失血的发生机制和危险因素。[结果]PFNA围手术期失血总量平均为899 ml,隐性失血平均为749 ml,占失血总量的83.3%。年龄、有无心脑内科疾病在PFNA手术中隐性失血的量方面差异有统计学意义,而不同性别之间、是否肥胖在PFNA手术中隐性失血的量方面差异无统计学意义。[结论]隐性失血是闭合复位PFNA治疗股骨粗隆间骨折围手术期失血的主要因素。高龄患者、有心脑内科疾病者是隐性失血的危险因素,对高龄患者更应特别重视隐性失血的及时处理,进一步提高PFNA治疗高龄股骨粗隆间骨折的效果。     

应用髓外和髓内固定物治疗股骨转子间骨折显性和隐性失血量的比较

背景：股骨转子间骨折的微创治疗已广泛应用于临床,但隐性失血尚未得到广泛重视,对其研究较少。目的：比较应用髓外固定物动力髋螺钉（DHS）和髓内固定物（PFNA、InterTan）治疗股骨转子间骨折围手术期的显性和隐性失血量,分析隐性失血的影响因素,为内固定物的选择提供临床依据。方法：回顾性分析2010年1月至2011年12月应用DHS或PFNA、InterTan治疗的股骨转子间骨折患者89例,记录患者年龄、性别、身高、体重,记录术中及术后显性失血量,手术时间,手术前后的血红蛋白（Hb）和红细胞压积（Hct）。应用Gross方程计算总失血量和隐性失血量,对统计数据进行比较分析。结果：应用DHS 24例,总失血量平均为832 ml,其中显性失血量为187 m（l22.5%）,隐性失血量为645m（l77.5%）;应用PFNA 38例,总失血量平均为210 ml,其中显性失血量为123 m（l58.5%）,隐性失血量为87 m（l41.4%）;应用InterTan 27例,总失血量平均为1054 ml,其中显性失血量为153m（l14.5%）,隐性失血量为901 m（l85.5%）。结论：股骨转子间骨折患者常存在严重的隐性失血,极易引起术后贫血,需严密监控患者的失血量。髓外和髓内固定方法的出血量基本一致,髓内固定方法具有更强的力学稳定性,髓内固定物PFNA的操作简单,出血量相对较少,可作为治疗股骨转子间骨折的首选方法。     

股骨粗隆间骨折PFNA内固定股骨髓腔直径与髓内钉直径比值对失血量的影响

目的探讨股骨髓腔直径与髓内钉直径比值对股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定手术失血量的影响。方法回顾性分析自2016-01—2018-12采用PFNA内固定手术治疗的249例股骨粗隆间骨折,根据术后正侧位X线片测量并计算漏斗起始部、漏斗终止部、股骨干峡部股骨髓腔直径与髓内钉直径的比值。通过Pearson相关分析不同层面股骨髓腔直径和髓内钉直径比值与失血量的相关性,通过多元线性回归分析确定影响隐性失血量的危险因素。结果本组总失血量为(694.2±159.3)mL,术中显性失血量为(198.5±54.9)mL,隐性失血量为(495.7±79.5)m L。股骨髓腔直径与髓内钉直径比值:漏斗起始部为1.39±0.27,漏斗终止部为1.61±0.25,股骨干峡部为1.44±0.25。Pearson相关分析结果显示,漏斗起始部、漏斗终止部和股骨干峡部股骨髓腔直径与髓内钉直径比值与总失血量、隐性失血量呈正相关(P 0.05),与术中显性失血量无相关性(P0.05)。多元线性回归分析结果显示,体重指数、漏斗起始部和漏斗终止部股骨髓腔直径与髓内钉直径比值是影响隐性失血量的危险因素。结论股骨粗隆间骨折PFNA内固定术中股骨髓腔直径与髓内钉直径比值越小,患者的隐性失血量与总失血量越少。     

PFNA治疗老年股骨转子间骨折围手术期隐性失血量分析

背景：股骨近端防旋髓内钉（PFNA）治疗老年股骨转子间骨折术后,会产生严重的隐匿性失血,如何预防以及治疗是临床工作中不可回避的问题。目的：探讨PFNA治疗老年股骨转子间骨折时围手术期失血量的特点。方法方法：回顾性分析2010年1月至2012年1月,采用PFNA内固定治疗的36例股骨转子间骨折患者的临床资料。男22例,女14例;年龄65-89岁,平均77.97岁。通过术前,术后1 d、3 d、5 d、7 d血常规,以及术中、术后出血的变化,使用Gross方程计算失血量,应用重复测量研究对不同组别间（年龄、性别、体重）进行统计学分析。结果：36例患者平均总失血量为（956.82±207.61）ml,平均显性失血为（88.08±16.28）ml,占总失血量的9.88%;平均隐性失血为（820.96±164.34）ml,占总失血量的90.23%。不同年龄、性别患者的失血量无显著统计学差异。与非肥胖患者相比,肥胖患者的围手术期出血量及隐性出血量显著增加。结论：在PFNA治疗老年股骨转子间骨折的患者中,隐性失血是主要的失血方式,应给予重视并且及时补充血容量,减少并发症的发生。     

PHILOS钢板和Multiloc髓内钉治疗老年肱骨近端骨折的显性失血和隐性失血分析

目的分析PHILOS钢板和Multiloc髓内钉治疗老年肱骨近端骨折的显性失血和隐性失血的临床特点。 方法回顾性分析2016年1月至2019年12月分别采用PHILOS钢板治疗（45例）和Multiloc髓内钉治疗（37例）的老年肱骨近端骨折患者的临床资料，比较手术时间、显性失血量和隐性失血量，对患者围手术期失血情况进行评估和分析。 结果PHILOS钢板组平均手术时间（141.78±36.18）min，总失血量674.68（592.87,979.65）ml，显性失血量320.00（220.00,430.00）ml；Multiloc髓内钉组平均手术时间（102.70±22.10）min，总失血量589.23（430.80,714.82）ml，显性失血量100.00（100.00,125.00）ml，两组间差异具有统计学意义（P<0.05）。两组围手术期隐性失血量为383.55（253.17,575.48）ml和460.98（309.87,610.25）ml，差异无统计学意义（P>0.05），分别占总失血量56.85%和78.23%。 结论与PHILOS钢板比较，Multiloc髓内钉内固定治疗此类骨折患者的平均手术时间短，总失血量和显性失血量少。两种内固定治疗方式的隐性失血量无明显差异，但隐性失血量在总失血量中所占比重较大，临床上应该时刻重视，积极干预，改善患者预后。     

PFNA治疗老年股骨粗隆间骨折130例效果分析

目的探讨防旋股骨近端髓内钉（PFNA）治疗老年股骨粗隆间骨折的临床效果。方法 130例老年股骨粗隆间骨折患者均为闭合性骨折,在伤后3～7天,C型臂X线机透视下闭合复位,PFNA内固定治疗。结果术后随访6～12个月,本组患者平均手术时间53分钟;失血量平均160ml;骨折全部愈合。术后髋关节功能优良率为92.31%。结论 PFNA治疗老年股骨粗隆间骨折操作简单、创伤小、固定可靠、手术时间短、术后并发症少。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre

BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.