Alignment in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty: The Limb Has a Leg Up on the Component

BackgroundTo assess how implant alignment affects unicompartmental knee arthroplasty (UKA) outcome, we compared tibial component alignment of well-functioning UKAs against 2 groups of failed UKAs, revised for progression of lateral compartment arthritis (“Progression”) and aseptic loosening (“Loosening”).MethodsWe identified 37 revisions for Progression and 61 revisions for Loosening from our prospective institutional database of 3351 medial fixed-bearing UKAs performed since 2000. Revision cohorts were matched on age, gender, body mass index, and postoperative range of motion with “Successful” unrevised UKAs with minimum 10-year follow-up and Knee Society Score ≥70. Tibial component coronal (TCA) and sagittal (TSA) plane alignment was measured on postoperative radiographs. Limb alignment was quantified by hip-knee-ankle (HKA) angle on long-leg radiographs. In addition to directly comparing groups, a multivariate logistic regression examined how limb and component alignments were associated with UKA revision.ResultsIn the Progression group, component alignment was similar to the matched successes (TCA 3.6° ± 3.5° varus vs 5.1° ± 3.5° varus, P = .07; TSA 8.4° ± 4.4° vs 8.8° ± 3.6°, P = .67), whereas HKA angle was significantly more valgus (0.3° ± 3.6° valgus vs 4.4° ± 2.6° varus, P < .001). Loosening group component alignment was also similar to the matched successes (TCA 6.1° ± 3.7° varus vs 5.9° ± 3.1° varus, P = .72; TSA 8.4° ± 4.6° vs 8.1° ± 3.9°, P = .68), and HKA was significantly more varus (6.1° ± 3.1° varus vs 4.0° ± 2.7° varus, P < .001). Using a multivariate logistic regression, HKA angle was the most significant factor associated with revision (P < .001).ConclusionIn this population of revised UKAs and long-term successes, limb alignment was a more important determinant of outcome than tibial component alignment.Level of EvidenceLevel III case-control study.     

右美托咪定与丙泊酚对外科术后机械通气患者镇静效果及血流动力学的影响

目的 探究右美托咪定与丙泊酚对外科术后机械通气患者镇静效果及血流动力学的影响。方法 将我院60例外科手术后机械通气患者作为研究对象,电脑随机将其分成右美托咪定组和丙泊酚组,各30例。右美托咪定组给予右美托咪定治疗,丙泊酚组给予丙泊酚治疗,比较两种方法的镇静效果及对血流动力学的影响。结果 镇静30 min后,两组的Ramsay镇静评分对比差异无统计学意义(Z=1.23,P>0.05);右美托咪定组心动过缓(6.67%)、低血压(13.33%)、低血压合并心动过缓(3.33%)发生率分别低于丙泊酚组(30.00%、36.67%、26.67%),两组间对比差异有统计学意义(χ2分别为5.45、4.36、6.41,P均<0.05)。结论 给予外科术后机械通气患者右美托咪定或丙泊酚,均有更好的镇静效果,但右美托咪定对于血流动力学的影响较小,更适用于机械通气患者。     

高龄重度急性左心衰竭并呼吸衰竭患者的机械通气治疗

目的　总结在高龄重度急性左心衰竭（ALVF）合并急性呼吸衰竭（ARF）患者应用机械通气治疗的临床经验。方法　回顾性总结10年间102例高龄重度ALVF并ARF患者应用机械通气治疗的方式、好转率、病死率和合并症,并将合并Ⅰ型ARF（ARF-Ⅰ）（42例）和Ⅱ型ARF（ARF-Ⅱ）（60例）两组患者资料进行比较。结果　102例115次机械通气途径经鼻面罩给氧18次,经鼻插管68次,经口插管29次;通气方式容量控制115次,压力控制25次,稳定气道正压(CPAP)26次,呼气终末加压(PEEP)45次。病情好转率在全部病人、ARF-Ⅰ和ARF-Ⅱ组分别是60.8%,69.0%和55.0%（两组比较P<0.05）;病死率分别是39.2%,30.9%,45.0%（两组比较P<0.05）。用呼吸机过程中的主要合并症在全部病人为心律失常37.3%,低血压35.3%,肺感染34.3%,消化道出血31.4%,酸碱失衡20.6%,张力性气胸2.9%。两组比较显示ARF-Ⅱ组病情重,病死率高,合并症多。结论　高龄重度ALVF并ARF患者机械通气治疗难度大,风险高,但只要严格掌握适应征及合适的通气方式,注意防治合并症,仍可以取得良好疗效,挽救大部分患者的生命。     

肝素钠软膏对多巴胺诱发兔静脉及其周围组织损伤治疗的实验研究

目的：笔者观察了肝素钠软膏、５０％硫酸镁、透明质酸酶对多巴胺诱发兔静脉及其周围组织损伤的治疗作用。方法：兔耳静脉连续注身大剂量的多巴胺和静脉周围组织注射多巴胺诱发静脉炎。结果：５０％硫酸镁加肝素钠软膏对多巴胺诱发的静脉炎治疗效果最好,其次为肝素钠软膏和５０％硫酸镁,透明质酸酶无治疗作用。     

Gabapentin (neurontin) and S-(+)-3-isobutylgaba represent a novel class of selective antihyperalgesic agents

1. Gabapentin (neurontin) is a novel antiepileptic agent that binds to the α₂δ subunit of voltage-dependent calcium channels. The only other compound known to possess affinity for this recognition site is the (S)-(+)-enantiomer of 3-isobutylgaba. However, the corresponding (R)-(−)-enantiomer is 10 fold weaker. The present study evaluates the activity of gabapentin and the two enantiomers of 3-isobutylgaba in formalin and carrageenan-induced inflammatory pain models.
2. In the rat formalin test, S-(+)-3-isobutylgaba (1–100 mg kg⁻¹) and gabapentin (10–300 mg kg⁻¹) dose-dependently inhibited the late phase of the nociceptive response with respective minimum effective doses (MED) of 10 and 30 mg kg⁻¹, s.c. This antihyperalgesic action of gabapentin was insensitive to naloxone (0.1–10.0 mg kg⁻¹, s.c.). In contrast, the R-(−)-enantiomer of 3-isobutylgaba (1–100 mg kg⁻¹) produced a modest inhibition of the late phase at the highest dose of 100 mg kg⁻¹. However, none of the compounds showed any effect during the early phase of the response.
3. The s.c. administration of either S-(+)-3-isobutylgaba (1–30 mg kg⁻¹) or gabapentin (10–100 mg kg⁻¹), after the development of peak carrageenan-induced thermal hyperalgesia, dose-dependently antagonized the maintenance of this response with MED of 3 and 30 mg kg⁻¹, respectively. Similar administration of the two compounds also blocked maintenance of carrageenan-induced mechanical hyperalgesia with MED of 3 and 10 mg kg⁻¹, respectively. In contrast, R-(−)-3-isobutylgaba failed to show any effect in the two hyperalgesia models.
4. The intrathecal administration of gabapentin dose-dependently (1–100 μg/animal) blocked carrageenan-induced mechanical hyperalgesia. In contrast, administration of similar doses of gabapentin into the inflamed paw was ineffective at blocking this response.
5. Unlike morphine, the repeated administration of gabapentin (100 mg kg⁻¹ at start and culminating to 400 mg kg⁻¹) over 6 days did not lead to the induction of tolerance to its antihyperalgesic action in the formalin test. Furthermore, the morphine tolerance did not cross generalize to gabapentin. The s.c. administration of gabapentin (10–300 mg kg⁻¹), R-(−) (3–100 mg kg⁻¹) or S-(+)-3-isobutylgaba (3–100 mg kg⁻¹) failed to inhibit gastrointestinal motility, as measured by the charcoal meal test in the rat. Moreover, the three compounds (1–100 mg kg⁻¹, s.c.) did not generalize to the morphine discriminative stimulus. Gabapentin (30–300 mg kg⁻¹) and S-(+)-isobutylgaba (1–100 mg kg⁻¹) showed sedative/ataxic properties only at the highest dose tested in the rota-rod apparatus.
6. Gabapentin (30–300 mg kg⁻¹, s.c.) failed to show an antinociceptive action in transient pain models. It is concluded that gabapentin represents a novel class of antihyperalgesic agents.

     

不同通气方式对机械通气引起急性肺损伤兔模型的影响

目的：通过表面活性物质缺乏的兔肺模型,评估传统通气模式（ｃｏｎｖｅｎｔｉｏｎａｌ ｍｅｃｈａｎｉｃａｌ ｖｅｎｔｉｌａｔｉｏｎ,ＣＭＶ）与允许性高碳酸血症加最佳ＰＥＥＰ（ｐｅｒｍｉｓｓｉｖｅ ｈｙｐｅｒｃａｐｎｉａａｓｓｏｃｉａｔｅｄ ｗｉｔｈｉｄｅａｌＰＥＥＰｖｅｎｔｉｌａｔｉｏｎ,ＰＨＹ＋ ＰＥＥＰｉ）的通气模式对肺损伤的影响,了解肿瘤坏死因子α（ｔｕｍｏｒ ｎｅｃｒｏｓｉｓｆａｃｔｏｒα,ＴＮＦα） 与机械通气引起肺损伤（ｖｅｎｔｉｌａｔｏｒｉｎｄｕｃｅｄｌｕｎｇｉｎｊｕｒｙ,ＶＩＬＩ） 的关系。方法：１２ 只成年兔,以反复肺灌洗法制备表面活性物质缺乏兔肺模型。以ＣＭＶ（Ｃ组） 或ＰＨＹ＋ ＰＥＥＰｉ （Ｐ 组） 通气４ ｈ 后,测定通气前、后的支气管肺泡灌洗液（ｂｒｏｎｃｈｏａｌｖｅｏｌａｒ ｌａｖａｇｅ ｆｌｕｉｄ,ＢＡＬＦ）中ＴＮＦα含量和白细胞分类计数,测定肺水量,进行动脉血气分析和病理检查。结果：ＣＭＶ 组表现为明显的低氧血症,ＢＡＬＦ中较多的中性粒细胞数,总肺水量及血管外肺水量明显增多,肺内病理改变为较明显透明膜形成及炎性细胞聚集;而ＰＨＹ＋ ＰＥＥＰｉ 组引起较少的上述病理、生理变化。且ＣＭＶ 组ＢＡＬ     

动态硫化PP／EPDM强化增韧机理的动态力学研究

采用动态力学试验方法,研究了不同ＥＰＤＭ含量的动态硫化和简单共混两种ＰＰ／ＥＰＤＭ材料动态力学响应的差异及其特征。结果显示：与简单共混ＰＰ／ＥＰＤＭ相比,动态硫化ＰＰ／ＥＰＤＭ具有ΔＴｇ小,内耗峰扩宽程度大,低温和室温内耗峰强度高,所处温度低,６０－７０℃时内耗峰强度发生高低变位,在ＥＰＤＭ相的α转变以下还显示β和γ次级转变等特性。     

高晶体-高胶体渗透压溶液对受机械性损伤的海马神经细胞容积的影响

观察机械性损伤的海马神经细胞在不同浓度高晶体－ 高胶体渗透压溶液中容积的变化。取原代培养大白鼠胚胎的海马神经细胞,用超声波机械损伤细胞后暴露于含０．５ ｇ／Ｌ、１ ｇ／Ｌ和２．５ ｇ／Ｌ氯化钠的细胞培养基中１５ ｍ ｉｎ。结果显示机械性损伤的细胞明显肿胀（Ｐ＜ ０．０５）。当细胞暴露于不同浓度的高晶体－ 高胶体溶液１５ ｍ ｉｎ 后, 细胞容积与同一实验时间的对照值相比明显下降, 并保持至第７ ｄ （Ｐ＜ ０．０５）。表明受到机械性损伤的海马神经细胞在高晶体－ 高胶体渗透压环境中的容积调节功能丧失或减弱。     

慢性阻塞性肺疾病继发急性呼吸衰竭机械通气治疗10例分析

目的：探讨慢性阻塞性肺疾病（ＣＯＰＤ）所致急性呼吸衰竭行机械通气（ＭＶ）治疗的转归及其影响因素。方法：通过对１０例ＣＯＰＤ所致急性呼吸衰竭患者的资料分析,评价ＭＶ治疗的临床疗效。结果：９例２￣４２天内撤机并拔管存活。结论：适宜的ＭＶ参数调节,良好的呼吸道管理,预防感染和营养支持对尽早撤机非常重要,其预后较好。     

材料力学性能对人颞下颌关节力三维非线性模拟的影响

比较分析骨性结构和关节盘的材料力学性能对在活性基础上建立的人颞下颌关节（Ｔｅｍｐｏｒｏ－ｍａｎｄｉｂｕｌａｒｊｏｉｎｔ,ＴＭＪ）三维非线性有限元模型模拟ＴＭＪ力的影响。方法利用Ａｕｔｏ－ＣＡＤ软件及螺旋ＣＴ扫描技术与有限元应力分析方法的相结合在活性基础上建立ＴＭＪ三维非线性有元模拟型并比较下颌骨,关节窝和关节盘选用不同材料力学性能时关节内应力的变化。结果骨组织的各种向同性和各向异性特征使组成ＴＭＪ