保留股骨颈型人工全髋关节置换的中期疗效

目的探讨保留股骨颈(collum femoris preserving,CFP)型人工全髋关节置换(total hip arthroplasty,THA)的中期疗效。方法 2004年1月-2007年2月,对45例髋关节疾病患者行CFP型THA。男29例(31髋),女16例(17髋);年龄38～60岁,平均48.8岁。左侧20髋,右侧22髋,双侧3髋。其中骨关节炎20例,股骨头缺血性坏死13例,髋关节发育不良致创伤性关节炎4例,类风湿性关节炎3例,髋臼骨折后创伤性关节炎2例,强直性脊柱炎患者2例,Perths病1例。病程2～13年,平均6.1年。手术前后摄X线片,行Harris评分及疼痛视觉模拟评分(VAS),测量关节活动度;术后评估患者步态,应用SF-36简明健康状况调查量表对患者生活质量进行评估。结果 45例均获随访,随访时间5～8年,平均6.4年。术后切口均Ⅰ期愈合,无感染、髋关节脱位、神经损伤及深静脉血栓形成等并发症发生。6例(13.3%)患者术中发生假体远端股骨外侧皮质劈裂骨折,未作特殊处理,均于术后8个月骨折愈合。4例(8.9%)患者出现轻度异位骨化,无特殊不适;5例(11.1%)发生股骨近端骨密度降低。末次随访时臼杯和假体柄生存率均为100%。术后1年及末次随访时髋关节Harris评分、VAS评分、关节活动度均显著优于术前(P<0.05);术后1年与末次随访时比较除Harris评分差异有统计学意义(P<0.05)外,其余各指标比较差异均无统计学意义(P>0.05)。末次随访时Harris功能评价获优31髋、良11髋、中6髋,优良率达87.5%。末次随访时SF-36评分结果除了生理职能、躯体疼痛和总体健康得分较四川省城市男性的参考值低(P<0.05)外,其余各项得分与参考值比较差异均无统计学意义(P>0.05)。结论 CFP型THA中期疗效满意,是股骨颈完整、无骨质疏松年轻患者行THA的一种良好选择。     

Minimally-invasive versus conventional aortic valve replacement – perioperative course and mid-term results

Objective: We performed a case-control-study to compare perioperative and mid-term results of minimally invasive with conventional aortic valve replacement. Methods: Between 8/96 and 7/97, 113 patients underwent isolated aortic valve replacement (minimally invasive: 29, conventional: 84) in our Department. Diagnosis, ejection fraction, pressure gradient/regurgitation fraction, age, gender and body-mass-index were used as matching criteria for the case-control-study. For qualitative data correspondence was requested, for quantitative data deviations up to 10% were accepted. With these criteria 25 patients of the minimally invasive group were matched to 25 patients of conventional group. All patients were reexplored 1 year after aortic valve replacement. Statistical analysis was done by the Fisher's exact test for qualitative data and the Mann–Whitney test for quantitative data. Results: We implanted 15 (20) bioprosthesis’ and 10 (five) mechanical prosthesis’ in the minimally invasive, respectively, conventional group. There were no statistically significant differences between both groups with respect to the perioperative course, only duration of surgery (mean 201.6 vs. 143.9 min, P<0.01) and extracorporeal circulation (mean 116.1 vs. 71.3 min, P<0.01) as well as aortic-cross-clamp-time (mean 77.9 vs. 46.9 min, P<0.01) were significantly longer in the minimally invasive group. Postoperative complications occurred in one patient of the minimally invasive group (dissection of the right coronary artery) and four patients of the conventional group (third degree AV block, pneumothorax, grand mal convulsion, cardiopulmonary resuscitation). Two patients, one of each group, died during follow-up for unknown reasons. Follow-up revealed no significant differences with respect to clinical and echocardiographic data, but the shorter skin incision was cosmetically more accepted by patients of the minimally invasive group. Minor paravalvular leaks occurred in four patients of the minimally invasive and three patients of the conventional group as diagnosed by transthoracic echocardiography. Conclusions: Both surgical techniques may be performed with comparable perioperative and mid-term results, but the better cosmetic result in the minimally invasive group is paid by a longer duration of surgery.     

Induction of Mid-term Abortion by Ricin A Chain in Mice

Ricin A chain, the potent inhibitor of protein synthesis, was evaluated for abortifacient activity using pregnant mice at mid-gestation. In a preliminary experiment, the intraperitoneal dose 50 µg per mouse killed all pregnant mice within 24 h with signs of vaginal bleeding and abortion. In subsequent experiments, pregnant mice given 100 ng each resulted in a decrease in maternal weight gain (48%, P&lt;.05), while fetal weight showed a dose-related decrease of 19 and 22% in mice which received 50 or 100 ng respectively. In another experiment, the ricin A chain, administered as two successive doses (100 ng or 200 ng) on days 12 and 13 gestation, induced abortion in 16 to 67% of mice. At the same time 3 mice out of six, that received a dose of 100 ng/mouse lost w eight, whereas of those that received 200 ng. Four mice out of six lost weight and one died. Furthermore, laparotomized mice exhibited dead fetuses, separation of placenta and blood clots. These observations clearly indicate that the ricin A chain exhibits abortifacient effect, maternal and fetal toxicity in pregnant mice at mid-term.     

宁波市“全国亿万农民健康促进行动”示范村建设中期督导报告

目的通过对宁波市“行动”示范村建设的中期督导评估,总结经验和不足,为进一步做好“行动”示范村工作提供参考和指导。方法采用现场考察、小组访谈、档案查阅和问卷调查等4种形式,分别对4个宁波市“行动”示范村的村容村貌、健康教育场所、组织建设、健康教育活动、健康教育资料发放、村民满意程度和健康知信行情况、档案资料收集和整理情况等进行了考核。结果取得了政府领导重视、注重交流合作、加强环境建设、健康教育活动多样、健康教育资料充裕等经验。同时,也发现了如健康教育专兼职人员缺乏培训、健康教育场所设置单一、讲座不够经常化和规范化、工作主动性不够等问题。结论项目基本按照进度实施,今后应重点加强兼职人员培训和提高项目村工作主动性。     

Lactate vulnerability of remitted panic patients

Sodium lactate precipitates panic in 70-100% of clinically ill patients with panic disorders. The lactate vulnerability of remitted patients is unknown. In this study, 13 panic patients completed three sequential sodium lactate infusions: one before treatment, a second when panic free on tricyclic antidepressants (TCA), and a third when in remission and unmedicated for 1 to 6 months. Three out of 13 patients panicked at the third infusion as compared to 0/13 infused on TCA and 7/12 at pretreatment infusion. This result (1) indicates that lactate vulnerability can exist in clinically well, unmedicated patients, and (2) raises the possibility that lactate vulnerability may be a trait characteristic. Further studies are needed before definite conclusions can be drawn.     

法洛四联症术后右室限制性生理临床转归的研究

目的 研究法洛四联症(tetralogy of Fallot,TOF)术后右室限制性生理临床转归,探讨TOF术后右室限制性生理发生的危险因素、评估指标和转归情况.方法 2011年10月至2012年5月在上海儿童医学中心行TOF根治术的80例患儿随机入选本次研究,通过床边心脏彩超明确30例患儿发生了右室限制性生理.统计患儿围手术期的临床资料,记录患儿最后一次超声随访的结果,比较患儿的右室流出道梗阻情况、肺主动脉梗阻情况、肺动脉分支狭窄情况和肺动脉反流情况.结果 右室限制性生理组患儿比非右室限制性生理组的年龄更小,体外循环时间、主动脉阻断时间、机械通气时间、重症监护时间和住院时间更长(P均<0.01).Logistic多元回归分析表明,术前年龄小(OR=0.48,P=0.01)、术中体外循环时间长(OR=1.7,P=0.04)是患儿发生右室限制性生理的危险因素.术后1周内,右室限制性生理组静脉血氧饱和度的上升和氧摄取分数的下降程度均小于非右室限制性生理组(P均<0.05).右室限制性生理组乳酸水平高于非右室限制性生理组(P=0.03).C-反应蛋白在术后2d内先上升,3~7d内下降,且右室限制性生理组下降的速度要慢于非右室限制性生理组(P=0.08).右室限制性生理组氨基末端脑钠肽(N-terminal pro-BNP,NT-proBNP)术后1周内显著升高, NT-proBNP≥4750pg/ml 提示患儿发生了右室限制性生理.中期随访结果表明两组患儿右室流出道梗阻、肺主动脉梗阻、肺动脉分支狭窄的发生率无明显差别,肺动脉反流程度也无明显差别(P均>0.05).结论 TOF术后发生右室限制性生理与手术年龄和体外循环时间相关,NT-proBNP可作为评估TOF术后患儿发生右室限制性生理的指标.术后早期右室限制性生理的发生在一定程度上会影响患儿转归,然而随访数据表明右室限制性生理对患儿中期转归无明显影响.     

河南省消除疟疾行动计划中期评估报告

中国消除疟疾行动计划启动以来,河南省采取在一类县加强传染源控制与媒介防制,二类县清除疟疾传染源,三类县加强监测和输入病例处置等策略措施。2010—2015年6月30日,共血检"三热"病人547万余人次,发现并规范治疗疟疾病例1 880例,所有病例均在24h内进行网络疫情报告。2012年以来所有病例均为实验室确诊病例,3 d内进行流行病学个案调查和7d内疫点处置。随着消除疟疾各项措施的全面落实,本地感染疟疾病例数逐步下降,全省已提前实现《行动计划》确定的阶段目标。2012年首次实现无本地感染疟疾病例的历史性突破,提前4年实现国家"到2015年无本地感染疟疾病例"的规划目标,并连续4年保持无本地感染疟疾病例。2014年全省69个三类县100%通过了消除疟疾考核评估,提前1年实现国家"到2015年所有三类县实现消除疟疾"的规划目标。     

Short-term and mid-term results of lateral condyle sliding osteotomy in the treatment of valgus total knee arthroplasty: A successful therapy option in Grade 2 valgus total knee arthroplasty

Background

Different methods exist for deformity correction and ligament balancing in total knee arthroplasty (TKA) of valgus knees, the sliding osteotomy being one of them. The objective of the current study was to analyze the clinical and radiological short-term and mid-term results of this technique in a larger series.

三种中期引产方法临床效果比较

目的 比较米非司酮配伍米索前列醇、利凡诺配伍米非司酮及单纯使用利凡诺在中期引产中的效果.方法 235例12～28周要求终止妊娠孕妇,随机分成3组:观察1组、观察2组和观察3组.观察1组80例,米非司酮50 mg空腹或饭后2 h口服,12 h 1次,连用3 d,第4天米索前列醇阴道上药,剂量200～1000 μg;观察2组78例,利凡诺羊膜腔注射,剂量70～100 mg,同时米非司酮75 mg空腹或饭后2 h口服,12 h 1次,共1 d;观察3组77例,仅用利凡诺羊膜腔注射,剂量70～100 mg.结果 观察1组、观察2组和观察3组完全流产率分别为88.75%(71/80)、65.38%(51/78)、38.96%(30/77),成功率分别为98.75%(79/80)、71.79%(56/78)、76.62%(59/77).开始宫缩至胎儿胎盘娩出时间分别为(6.85±3.68)、(8.87±3.58)、(14.67±3.50)h,产时至产后2 h阴道出血量分别为(80.86±40.28)、(94.70±42.35)、(120.68±43.30)ml.观察1组完全流产率、成功率高于观察2组和观察3组,而且产程短、出血少,差异有统计学意义(P均<0.01).观察2组完全流产率高于观察3组,且产程缩短,差异有统计学意义(P<0.01).结论 米非司酮配伍米索前列醇引产具有完全流产率高、成功率高、产程短、出血少等优点,特别适用于孕20周以下中期引产;利凡诺配伍米非司酮引产能够提高完全流产率,缩短产程,减少出血,适合于孕周16周以上引产;单纯利凡诺引产产程长,疼痛较重,不全流产率较高.