臭茉莉叶总黄酮提取工艺优化及月周期变化研究

目的:采用超声辅助正交试验法优化臭茉莉叶总黄酮的提取工艺,并进一步研究臭茉莉叶中总黄酮1年内每月含量变化趋势,探讨臭茉莉叶最佳采收时间。方法:以提取液中总黄酮含量为指标,选择乙醇浓度(%)、超声时间(min)、料液比、提取温度(℃)等为考察因素,采用正交试验法L9(34)确定臭茉莉叶提取液中总黄酮的最优工艺。结果:臭茉莉叶所含总黄酮最优提取工艺条件:乙醇浓度70%、超声时间60min、料液比1∶25、提取温度50℃。3月份总黄酮/药材量是0.0235mg·g-1为最高。结论:该提取工艺快捷以及操作简便,适用于臭茉莉叶总黄酮的提取。结合总黄酮月周期变化规律,可以确定1年中5月份和7月份为最佳采摘期。     

妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素分析

目的探讨妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素。方法该研究为病例对照研究。回顾性纳入山东大学齐鲁医院、山东第一医科大学附属省立医院、山东省千佛山医院和青岛大学附属医院2010年5月至2020年5月妊娠合并肺动脉高压患者。根据是否发生剖宫产围产期并发症分为并发症组和对照组。收集患者的一般临床资料和辅助检查结果, 记录患者发生围产期并发症的情况。围产期并发症包括心功能恶化、新发心律失常、心脏骤停、术后42 d内全因死亡、产后出血及血栓事件。采用多因素logistic回归模型分析妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素。结果研究纳入患者167例, 年龄28(24, 32)岁, 其中并发症组47例, 对照组120例。两组患者年龄, 孕周, 初产妇、存在心内分流及接受靶向药物治疗者比例, 左、右心室舒张末期内径差异均无统计学意义(P均>0.05)。与对照组比较, 并发症组患者特发性肺动脉高压者比例较高(P=0.001)、接受全身麻醉的比例较高(P=0.001)、超声心动图估测的肺动脉收缩压较高(P<0.001)、术前世界卫生组织(WHO)功能Ⅲ/Ⅳ级者比例较高(...     

Body mass index is a predictor of discharge to a postacute care facility following total shoulder arthroplasty

BackgroundThe purpose of this study is to evaluate the effect of body mass index (BMI) on discharge to a postacute care (PAC) facility following elective total shoulder arthroplasty (TSA).MethodsThe National Surgical Quality Improvement Program database was queried to identify adult patients (>18 years old) who underwent inpatient TSA for primary osteoarthritis between 2005 and 2018. Hemiarthroplasty, revision TSA, trauma indications, and outpatient procedures were excluded. Patient and perioperative data were identified. Univariate analysis and multivariate logistic regression were used to assess the relationship between BMI and discharge to PAC facilities.ResultsA total of 10,198 patients with a primary TSA were identified. The majority (93%) of patients were discharged home vs. 7% to PAC facilities. Patients discharged to PAC had significantly higher mean BMI (P = .006). After controlling for demographic and comorbid factors, BMI was the only modifiable risk factor that was independently associated with an increased risk of discharge to a PAC. For every increase in BMI point, there was an increased risk of discharge to a PAC by 2.9% (odds ratio [OR] 1.029, confidence interval [CI] 1.016-1.041, P < .001). Additional covariates associated with PAC discharge were older age (OR 1.113, CI 1.099-1.127, P < .001), female gender (OR 3.037, CI 2.489-3.705, P < .001), and dependent functional status (OR 8.322, CI 5.544-12.492, P < .001).ConclusionMost patients undergoing TSA were discharged home following surgery. While age, sex, and functional status also affect disposition, elevated BMI is the only modifiable risk factor that independently predicts PAC discharge. Consideration of patient BMI prior to elective TSA may greatly improve discharge planning and management of patient expectations.     

结直肠癌肝转移患者行全腹腔镜与腹腔镜辅助同期切除手术的疗效观察

目的探讨结直肠癌肝转移(CRLM)患者采用全腹腔镜与腹腔镜辅助同期切除术治疗的临床疗效比较。方法选取2010年2月至2015年4月间大连大学附属新华医院收治的68例CRLM同期切除患者,采用随机数表法分为辅助组和全镜组,每组34例。辅助组患者采用腹腔镜结直肠癌(CRC)根治术联合开腹CRLM切除术治疗,全镜组患者采用全腹腔镜切除术治疗,比较两组患者术中术后指标、术后并发症发生率及生存时间。结果两组患者手术时间和术中出血量比较,差异无统计学意义(P> 0.05)。两组患者术后排便时间和住院时间比较,差异无统计学意义(P>0.05)。辅助组患者并发症发生率为44.1%,全镜组为32.4%,差异无统计学意义(P> 0.05)。两组患者无病生存时间和总生存时间比较,差异无统计学意义(P> 0.05)。结论全腹腔镜与腹腔镜辅助同期切除术治疗CRLM患者的安全性及有效性结果接近,临床可根据患者病情合理选择手术方式。     

渐进式平衡训练方案在全髋关节置换术后患者中的应用

目的研究渐进式平衡训练方案在全髋关节置换术（THA）后患者干预过程中的应用。方法将2017年5月至2020年5月于深圳市宝安区石岩人民医院接受THA治疗的89例患者纳入研究，按照随机数字表法分作A组44例和B组45例。B组开展常规干预，A组则于常规干预基础上增用渐进式平衡训练。分析两组干预前后患者平衡能力、活动状态以及心理状态变化情况的差异。结果干预2周、4周、8周后，A组的Berg平衡量表评分均高于B组（均P＜0.05）；A组的站立行走测试结果短于B组（均P＜0.05）。在干预8周后，A组的SAS、SDS评分低于B组（均P＜0.05）。结论渐进式平衡训练方案的实施可显著改善THA患者的平衡能力，同时有助于减轻患者心理不良情绪，促进活动能力的提升。     

Unicompartmental knee arthroplasty is associated with lower proportions of surgical site infection compared with total knee arthroplasty: A retrospective nationwide database study

BackgroundThis study aimed to clarify the association between types of knee arthroplasty (KA) (total knee arthroplasty (TKA) or unicompatmental knee arthroplasty (UKA)) and surgical site infection (SSI) with adjustment for various factors, using a Japanese national database.MethodsData on 181,608 patients who underwent unilateral primary KA for osteoarthritis from 2010 to 2017 were obtained from the Japanese Diagnosis Procedure Combination database. SSI was identified based on International Classification of Diseases 10th Revision codes. Deep SSI (i.e. periprosthetic joint infection (PJI)) was identified as SSI treated with surgical procedures. Multivariable logistic regression analyses for SSI and PJI were performed, in which dependent variables included types of KA, patient backgrounds (sex, age, body mass index (BMI), smoking status, comorbidities), and seasonality.ResultsEight percent of analyzed patients underwent UKA, while 92% underwent TKA. The proportions of SSI and PJI after UKA were 0.9% and 0.3%, respectively, both of which were lower than those after TKA (1.9% and 0.6%) (P < 0.001). Multivariable analyses showed lower proportions of SSI for UKA (adjusted odds ratio, 0.47; 95% confidence interval, 0.37–0.60; P < 0.001) and PJI (adjusted odds ratio, 0.47; 95% confidence interval, 0.34–0.65; P < 0.001) than TKA. Other factors associated with both SSI and PJI included male sex, BMI >30 kg/m², renal dysfunction and summer season.ConclusionUKA was associated with lower proportions of SSI and PJI than TKA. Surgeons should carefully consider the indication of UKA before performing TKA, especially in patients with knee unicompartmental osteoarthritis who are at a high risk for SSI or PJI.     

Early tibial loosening of the cemented ATTUNE knee arthroplasty – Just a question of design?

BackgroundTotal knee arthroplasty is a very successful standard treatment for severe osteoarthritis. Nevertheless, the literature reports tibial debonding between implant and bone cement as well as radiolucent lines related to the tibial components of different knee systems. Regardless of cementing techniques and the influences during surgery, we examined the design of a newly developed knee system and its predecessors (Attune, Attune S+, P.F.C. Sigma, P.F.C. Sigma RP/M.B.T., all DePuy).MethodsWe investigated the dimensions of the tibial components and the fit between them and their bone bed after instrumentation in a foam material.ResultsOur results showed considerable differences for the used knee prostheses as well as their tibial instrumentation options with a corresponding risk for incomplete seating.ConclusionThe orthopedic surgeons need to be aware of these design features and the resulting increased seating resistance especially in hard and sclerotic bone.Article focusComparison of the tibial instruments and the different design options of the Attune knee system and its predecessor knee prostheses.Key messagesThe Attune implant showed incomplete seating because of too much press fit and an uneven bone quality or sclerosis can result in tilting of the tibial component.Strengths and limitationsThis is the first study investigating the Attune knee and its predecessor in terms of implant seating and press fit. The foam material is a limitation.     

Patellar resurfacing has minimal impact on in vitro tibiofemoral kinematics during deep knee flexion in total knee arthroplasty

BackgroundWhile patellar resurfacing can affect patellofemoral kinematics, the effect on tibiofemoral kinematics is unknown. We hypothesized that patellar resurfacing would affect tibiofemoral kinematics during deep knee flexion due to biomechanical alteration of the extensor mechanism.MethodsWe performed cruciate-retaining TKA in fresh-frozen human cadaveric knees (N = 5) and recorded fluoroscopic kinematics during deep knee flexion before and after the patellar resurfacing. To simulate deep knee flexion, cadaver knees were tested on a dynamic, quadriceps-driven, closed-kinetic chain simulator based on the Oxford knee rig design under loads equivalent to stair climbing. To measure knee kinematics, a 2-dimensional to 3-dimensional fluoroscopic registration technique was used. Component rotation, varus-valgus angle, and anteroposterior translation of medial and lateral contact points of the femoral component relative to the tibial component were calculated over the range of flexion.ResultsThere were no significant differences in femoral component external rotation (before patellar resurfacing: 6.6 ± 2.3°, after patellar resurfacing: 7.2 ± 1.8°, p = 0.36), and less than 1° difference in femorotibial varus-valgus angle between patellar resurfacing and non-resurfacing (p = 0.01). For both conditions, the medial and lateral femorotibial contact points moved posteriorly from 0° to 30° of flexion, but not beyond 30° of flexion. At 10° of flexion, after patellar resurfacing, the medial contact point was more anteriorly located than before patellar resurfacing.ConclusionDespite the potential for alteration of the knee extensor biomechanics, patellar resurfacing had minimal effect on tibiofemoral kinematics. Patellar resurfacing, if performed adequately, is unlikely to affect postoperative knee function.     

Effect of gap balancing and measured resection techniques on implant migration and contact kinematics of a cementless total knee arthroplasty

BackgroundThe purpose of this study was to compare implant migration and tibiofemoral contact kinematics of a cementless primary total knee arthroplasty (TKA) implanted using either a gap balancing (GB) or measured resection (MR) surgical technique.MethodsThirty-nine patients underwent TKA via a GB (n = 19) or a MR (n = 20) surgical technique. Patients received an identical fixed-bearing, cruciate-retaining cementless implant. Patients underwent a baseline radiostereometric analysis (RSA) exam at two weeks post-operation, with follow-up visits at six weeks, three months, six months, and one year post-operation. Migration including maximum total point motion (MTPM) of the femoral and tibial components was calculated over time. At the one year visit patients also underwent a kinematic exam via RSA.ResultsMean MTPM of the tibial component at one year post-operation was not different (mean difference = 0.09 mm, p = 0.980) between the GB group (0.85 ± 0.37 mm) and the MR group (0.94 ± 0.41 mm). Femoral component MTPM at one year post-operation was also not different (mean difference = 0.27 mm, p = 0.463) between the GB group (0.62 ± 0.34 mm) and the MR group (0.89 ± 0.44 mm). Both groups displayed similar kinematic patterns.ConclusionsThere was no difference in implant migration and kinematics of a single-radius, cruciate retaining cementless TKA performed using a GB or MR surgical technique. The magnitude of migration suggests there is low risk of early loosening. The results provide support for using the cementless implant with either a GB or MR technique.