Metal Articulations as a Source of Total Hip Arthroplasty Pain

The consensus systematic risk stratification algorithm from the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society summarizes clinical challenges in evaluation and treatment of metal-on-polyethylene total hip arthroplasty (THA) patients with adverse local tissue reaction (ALTR) due to mechanically assisted crevice corrosion (MACC), reviews up-to-date evidence, and identifies the areas for future research in order to provide a useful resource for orthopedic surgeons providing care to these patients. A painful THA has various intrinsic and extrinsic causes. ALTR is one of the intrinsic causes in patients with painful THA. The occurrence of ALTR due to MACC at modular junctions is likely to be multifactorial, including implant, surgical, and patient factors. Therefore, a systematic evaluation needs to involve a focused clinical history, detailed physical examination, laboratory tests, and imaging in order to identify potential differential diagnoses. There should be a low threshold to perform a systematic evaluation of patients with painful non–metal-on-metal THA, including patients with metal-on-polyethylene THA, and modular dual-mobility THA with the CoCr metal acetabular insert, as early recognition and diagnosis of ALTR due to MACC will facilitate initiation of appropriate treatment prior to significant adverse biological reactions. Specialized tests such as blood metal analysis and metal artifact reduction sequence magnetic resonance imaging are important modalities in evaluation and management of ALTR in patients with painful THA.     

New Evaluation and Management Code Level Selection Trends in Hip and Knee Osteoarthritis Patients

BackgroundOn January 1, 2021, the American Medical Association implemented changes regarding the outpatient Evaluation and Management (E/M) criteria dictating Current Procedural Terminology code level selection to help diminish administrative burden and emphasize medical decision-making as the primary determinant in E/M level of service (EML). The goal of this study was to describe EML coding trends in outpatient visits for hip and knee osteoarthritis after the 2021 Centers for Medicare and Medicaid Services changes to the E/M system.MethodsAll outpatient visits for primary hip and knee osteoarthritis within the divisions of Joint Replacement, Operative Sports Medicine, and Nonoperative Sports Medicine at a single orthopaedic practice were retrospectively analyzed during 2 separate 10-month timeframes in 2019 and 2021. The primary endpoint was the visit EML (1 through 5) based on Current Procedural Terminology E/M codes.ResultsIn 2019, 7.8% of all visits were billed as level 2, 85.8% of all visits were billed as level 3, and 6.3% of all visits were billed as level 4. In 2021, 2.8% of visits were billed as level 2, 54% of visits were billed as level 3, and 41.3% of visits were billed as level 4. Level 1 and Level 5 visits did not exceed 2% in either year. Across all 3 divisions, level 2 and 3 visits decreased significantly (P < .05), while level 4 visits increased significantly (P < .05).ConclusionSince the E/M coding criteria overhaul in 2021, there has been a significant trend towards higher level of service code selection across multiple divisions in our orthopaedic practice.     

成人造血干细胞移植患者饮食与营养教育效果评价指标的构建

目的 构建成人造血干细胞移植患者饮食与营养教育效果评价指标,以评价其教育效果。 方法 以“知信行”理论为框架,系统检索国内外文献,拟定评价指标各级条目;通过2轮专家（28人）咨询及层次分析法确定最终评价指标。 结果 构建的评价指标包括营养管理知识、营养管理信念和营养管理行为3项一级指标、9项二级指标和25项三级指标。专家函询问卷有效回收率分别为93.55%、96.55%,权威系数为0.862、0.869,肯德尔和谐系数为0.114、0.268（均P＜0.05）。 结论 评价指标可用于评价患者饮食与营养知信行情况,了解教育效果,指导临床实践。     

老年痴呆病人的护理进展

老年痴呆是一种慢性进行性大脑功能衰退综合征,随着病程的进展,病人逐渐出现记忆障碍、思维能力和判断力下降、情感障碍、人格改变以及行为的严重异常。现从老年痴呆的评估工具、护理理念、照护场所、护理4方面进行综述。     

中药品质传递过程评价技术与方法研究进展

中药品质的优劣直接关系着中药临床的疗效,是保证中药有效性、安全性、可控性的基础。中药从种植开始形成高品质药材到临床能否发挥应有疗效,品质传递过程是重要保障,而其过程有无完整传递,需要符合中药自身特点的科学评价方法。目前中药评价方法多以化学成分含量作为评价指标,且大多是针对中药材、中药饮片、中药提取物、中药制剂等某单个环节进行质量评价,对中药在生产全产业链的各环节传递过程中的品质整体性变化缺乏关注,对中药品质从药材到制剂直至临床传递过程中的整体性评价方法还未有系统论述。针对中药品质传递过程的规律和特点,对可用于中药品质传递过程的评价技术和方法进行综述,为中药品质传递过程评价及制定符合中药本身特色的质量标准提供参考。     

冬虫夏草中砷及其安全性评价研究进展

传统名贵中药冬虫夏草Cordyceps sinensis中砷超标及其安全性问题近年来备受关注,针对冬虫夏草中砷的研究逐渐增加并不断深入。在文献查阅的基础上,从冬虫夏草砷及砷形态的分析方法,砷的含量、分布、存在形态,安全性评价,以及野生和人工仿生繁育冬虫夏草中砷含量等方面进行归纳总结,并对冬虫夏草中砷的认知及研究进行展望,以期为冬虫夏草安全性评价的深入研究提供参考。     

桂花果实HPLC指纹图谱及9种化学成分含量测定研究

目的建立桂花Osmanthus fragrans果实HPLC指纹图谱及9种化学成分的含量测定方法,为桂花果实的质量控制提供科学依据。方法采用YMC-Pack ODS-A色谱柱(250 mm×4.6 mm,5μm),以乙腈-水(含0.1%磷酸)溶液为流动相进行梯度洗脱,体积流量1.0 mL/min,柱温25℃,进样量10μL,检测波长210 nm,对不同产地桂花果实样品进样分析;采用国家药典委员会"中药色谱指纹图谱相似度评价系统"(2012版),建立桂花果实的指纹图谱,同时测定其中9种化学成分含量。结果对不同产地20批桂花果实样品进行指纹图谱研究,共标定了24个峰,指认出其中9个色谱峰。含量测定结果表明,女贞苷G13、特女贞苷、新女贞苷及红景天苷为桂花果实中主要化学成分。经方法学考察,测定方法的精密度和重复性良好,样品在24 h内稳定;红景天苷、毛蕊花糖苷、新女贞苷、特女贞苷、异麦角甾苷、女贞苷G13、槲皮素、芹菜素、山柰酚在一定质量浓度范围内线性良好,加样回收率均在95%～105%。结论建立的桂花果实HPLC指纹图谱及9种化学成分的含量分析方法稳定、可靠,可为桂花果实的质量控制及综合开发提供参考。     

基于UPLC指纹图谱结合化学计量学评价不同产地盾叶薯蓣药材质量

目的建立盾叶薯蓣Dioscorea zingiberensis的UPLC指纹图谱,分析不同产地盾叶薯蓣质量特征的共有性和差异性,为盾叶薯蓣药材的质量评价提供科学依据。方法采用色谱柱Infinity Lab Poroshell 120 EC-C_(18)(150mm×2.1mm,2.7μm),以乙腈(B)-水(A)为流动相梯度洗脱,体积流量0.3mL/min,检测波长203nm,柱温30℃,建立65批不同产地盾叶薯蓣药材的UPLC指纹图谱;利用SPSS19.0和SIMCA14.1软件对不同产地的盾叶薯蓣药材进行质量评价及差异性分析。结果盾叶薯蓣药材UPLC指纹图谱共标定31个共有峰,指认出的5种皂苷类成分和其他未知成分均作为主要信息参与了盾叶薯蓣的质量表达,主成分载荷值的综合得分表明不同产地盾叶薯蓣药材的综合质量差异较大,主成分分析(PCA)结果显示不同产地盾叶薯蓣的化学质量特征存在差异,且各自聚为一类,其中湖北丹江口地区盾叶薯蓣与其他产地样品均存在较大差异;偏最小二乘法分析(PLS-DA)模型筛选出的5、28、11、12、29、18、16、31、13号色谱峰所代表的成分是造成盾叶薯蓣样品间差异的主要标志性物质,其中28、29号峰分别为盾叶新苷和三角叶薯蓣皂苷。结论本研究建立的盾叶薯蓣UPLC指纹图谱可以较为全面地表征其化学质量特征,指纹图谱的化学计量学分析结果为盾叶薯蓣质量标志物的筛选及质量标准的制定提供科学依据。     

基于偏头痛药效优化青花椒超临界提取物热熔压敏胶贴剂的成型工艺及其安全性评价

目的基于偏头痛药效研究优化青花椒超临界提取部位热熔压敏胶贴剂成形工艺,并对贴剂安全性进行评价。方法以均匀性、涂展性、渗布程度、皮肤追随性、剥离性、反复揭贴性、残留量等感官评价及初黏力、持黏力、剥离强度为指标,采用单因素试验与Box-Behnken设计-响应面法对热熔压敏胶基质配比进行筛选;采用在体动物评价法,以硝酸甘油型偏头痛大鼠挠头次数为指标筛选贴剂载药量;另外采用小鼠急性毒性试验、家兔皮肤刺激性试验及豚鼠皮肤过敏性试验评价青花椒超临界提取部位热熔压敏胶贴剂的安全性。结果热熔压敏胶贴剂的最佳基质处方为苯乙烯-异戊二烯-苯乙烯(SIS)弹性体-氢化石油树脂-液体石蜡4∶2∶5;青花椒超临界提取部位贴剂可明显减少硝酸甘油型偏头痛大鼠的挠头次数,70 mg/贴载药量组在30～60 min可将大鼠挠头次数降低81.75%,优选为最佳载药量;该贴剂对小鼠无急性毒性,对新西兰兔完整皮肤和破损皮肤有轻微刺激性,6 h内自行消除,对豚鼠无过敏性。结论该工艺制备的青花椒超临界提取部位热熔压敏胶贴剂感官性能好,黏附力强,且安全有效。     

基于临床病症特点的慢性脑缺血动物模型分析

慢性脑缺血是临床常见病、多发病,也是血管性痴呆、阿尔茨海默病等多种神经系统疾病共同的病理基础。本文基于慢性脑缺血的中西医临床病症特点,对现有的慢性脑缺血动物模型进行归纳与总结,并对动物模型与临床病症特点的吻合度具体评价,分析其优缺点及应用前景。目前关于慢性脑缺血模型建模方法主要有血管闭塞法、动静脉瘘及控制血管直径法,其中属血管闭塞法中的双侧颈总动脉结扎模型是慢性脑缺血最常用的模型。由于每一种模型均存在一定的优势和局限性,因此构建一种理想的慢性脑缺血动物模型,对于本病的病理机制研究和临床治疗及其并发症的防治均具有重大意义。