Ultrasound-Guided Periprosthetic Biopsy in Failed Total Hip Arthroplasty: A Novel Approach to Test Infection in Patients With Dry Joints

BackgroundTo diagnose periprosthetic joint infection (PJI) preoperatively, ultrasound-guided joint aspiration (US-JA) may not be performed when effusion is minimal or absent. We aimed to report and investigate the diagnostic performance of ultrasound-guided periprosthetic biopsy (US-PB) of synovial tissue to obtain joint samples in patients without fluid around the implants.MethodsOne-hundred nine patients (55 men; mean age: 68 ± 13 years) with failed total hip arthroplasty (THA) who underwent revision surgery performed preoperative US-JA or US-PB to rule out PJI.ResultsSixty-nine of 109 patients had joint effusion and underwent US-JA, while the remaining 40 with dry joint required US-PB. Thirty-five of 109 patients (32.1%) had PJI, while 74/109 (67.9%) had aseptic THA failure. No immediate complications were observed in both groups. Technical success of US-PB was 100%, as the procedure was carried on as planned in all cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-JA were 52.2%, 97.8%, 92.3%, 80.3%, and 82.6%, while for US-PB, they were 41.7%, 100%, 100%, 80%, and 82.5%, respectively, with no significant difference (P = .779). Using the final diagnosis as reference standard, we observed a moderate agreement with both US-JA (k = 0.56) and US-PB (k = 0.50).ConclusionWe present a novel US-guided technique to biopsy periprosthetic synovial tissue of failed THA to rule out PJI. We found similar diagnostic performance as compared with traditional US-JA. This supports future larger studies on this procedure that might be applied in patients without joint effusion.     

水提干法制粒的中药配方颗粒溶化性与粉体物理属性相关性研究

目的 为加快实现中药生产过程中对中药配方颗粒的质量控制,从粉体物料属性出发,探究其对水提工艺下干法制粒的中药配方颗粒溶化性影响机制。方法 以60种中药配方颗粒及中间体混合粉为研究对象,通过对各品种混合粉粉体属性进行测定,建立粉体物性参数与颗粒溶化性关联模型。采用二维矩阵热点图对各品种间及物性指标间相似性进行分析,结合系统聚类分析对其进行归类,并运用多元统计方法初步筛选影响水提工艺下中药配方颗粒溶化性的关键因素。结果 各品种间粉体物性参数相关系数在-0.951～1.000,并按照各品种物理属性大致可以分为5类,结合变量投影响应值（variable importance for the projection,VIP）、自变量回归系数与方差膨胀因子（variance inflation factor,VIF）分析,最终筛选出其休止角（α）、含水量（HR）、吸湿性（H）与比表面积（SSA）4个指标为影响中药配方颗粒溶化性的关键物料属性（critical material attributes,CMAs）。结论 基于中药粉体物料属性与数据分析初步探寻影响水提条件下干法制粒的中药配方颗粒的溶化性机...     

布地奈德联合福莫特罗干粉剂在急诊治疗重症支气管哮喘患者中的应用效果评价

目的 观察布地奈德联合福莫特罗干粉剂在急诊治疗重症支气管哮喘患者中的应用效果。方法 参照随机数字表法,将2017年7月—2019年6月在某医院接受急诊治疗的40例重症支气管哮喘患者分为两组,每组各20例。对照组患者采用布地奈德治疗,观察组在对照组基础上联合福莫特罗干粉剂治疗。两组患者均治疗1个月,观察两组C反应蛋白(CRP)、血常规水平及肺功能指标[第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FCV)比值(FEV1/FCV)和最大呼气流量(PEF)]。结果 治疗期间对照组患者夜间睡眠时憋醒次数为(13.55±3.25)次,观察组患者夜间睡眠时憋醒次数为(5.25±0.95)次;组间相比,差异有统计学意义(t=10.962,P<0.05);治疗后,观察组CRP、白细胞计数、嗜酸性粒细胞比率、淋巴细胞比率分别为:(12.36±1.43)mg/L、(6.31±1.05)×109/L、(4.82±2.03)%、(20.06±2.48)%,均低于对照组的(15.98±1.95)mg/L、(8.59±1.34)×109/L、(6.79±2.68)%、(25.09±3.12)%,(t值分别为6.695、5.990、2.621、5.644,P值均<0.05);治疗后,观察组FEV1、PEF及FEV1/FCV水平分别为:(2.51±0.70)L、(3.28±0.75)L/s、(75.38±8.49)%,均高于对照组(2.02±0.52)L、(2.76±0.66)L/s、(62.63±6.89)%,(t 值分别为2.513、2.328、5.215,P值均<0.05)。结论 布地奈德联合福莫特罗干粉剂在急诊重症支气管哮喘患者的治疗中效果较好,能有效改善CRP及血常规水平,提高肺功能。     

串联质谱分析干血滤纸片中酰基肉碱质控

目的：串联质谱技术是近几年应用于临床检验的新技术，具有特异性强、灵敏度高，一次试验可检测数十种物质的优点。本文通过对近4年的质控结果进行分析，探讨影响检测结果的因素及应对措施。方法：美国CDC每年提供4批酰基肉碱质控干血滤纸片，酰基肉碱检测方法为取直径为3mm的质控干血滤纸片放入96孔聚丙烯板，经含酰基肉碱内标的甲醇萃取，盐酸正丁醇衍生后，进行串联质谱检测。分析本实验室质控结果与美国CDC检测结果的偏差及其他实验室质控结果（169个实验室的均值）与美国CDC检测结果的偏差之间的差异。结果：本实验室每次质控结果所有酰基肉碱均在美国CDC检测结果95％可信区间内，且每一批结果的临床评价与美国CDC质控临床评价完全一致。本实验室质控结果与美国CDC检测结果的偏差与其他实验室质控结果与美国CDC检测结果的偏差比较，无显著差异，丙酰基肉碱差异显著（Z=-2．638，P〈0．005），戊二酰基肉碱差异亦显著（Z=-2．482，P〈0．005）。结论：本实验室酰基肉碱质控结果，达到美国CDC的质控要求，丙酰基肉碱检测值偏高，其阳性判断切割值设定也相应增高，而戊二酰基肉碱检测值偏低，其阳性判断切割值设定也相应降低。     

胆汁泡蛋白ELISA检测法的建立与初步临床应用

目的 建立胆汁泡蛋白快速检测法,筛选有效的胆石症防治手段。方法 获取３３．５ｋｄ胆汁泡蛋白,通过微量抗原免疫法获得高效价抗体,建立ＥＬＩＳＡ标准曲线;并应用ＥＬＩＳＡ法测定正常人、胆石症患者胆汁和血清中泡蛋白含量,同时观察不同溶石防药和利胆冲剂、胆酸钠等对泡蛋白的影响。结果 建立了ＥＬＩＳＡ标准曲线,其曲线方程为Ｙ＝０．０３５Ｘ（ｒ＝０．９９）;正常人胆汁和血清中３３．５ｋｄ泡蛋白含量都明显较胆固     

Comparison of autonomic function using Valsalva ratio and 30:15 postural ratio prior to and after haemodialysis treatment

In published studies of chronic haemodialysis patients, the frequency of autonomic dysfunction varies widely. One reason for the variation may be the time of testing with respect to time of dialysis. The current study tests the hypothesis that autonomic function — as measured by heart rate responses to the Valsalva manoeuvre (Valsalva ratio) and 30:15 electrocardiogram (ECG) R—R interval to upright posture (postural ratio) — is different when patients are above dry weight (predialysis) than when they are at or below dry weight (postdialysis). The study also reviews available literature to analyze other factors that may affect the results of autonomic testing in this population. A total of 25 chronic haemodialysis patients underwent standard Valsalva and 30:15 R—R interval postural autonomic testing prior to and after haemodialysis. In addition, pre- and postdialysis orthostatic responses were measured and compared with a control population. The 30:15 ratio increased after dialysis (p = 0.001). The Valsalva ratio did not change with dialysis. Out of 25 subjects, seven had an abnormal 30:15 ratio prior to dialysis decreasing to two out of 25 patients postdialysis (p < 0.03). Orthostatic responses predialysis did not differ from those in the control group. Review of the literature shows great variability in definition of normal Valsalva and postural (30:15 R—R interval) ratios. Diabetic patients in the current and prior studies were more likely to have abnormal responses. In conclusion, the prevalence of autonomic dysfunction in chronic dialysis patients as determined by Valsalva and 30:15 ECG postural ratios may be influenced by the following factors: when subjects are studied with respect to their dialysis treatment; the number of subjects with diabetes; and the cut-off point used to define abnormal test results. Abnormal Valsalva ratios are less frequent when measured postdialysis.     

15kg负重沙漠干热应激行军速度和时间对人体GSH和SOD的影响

目的　探讨沙漠干热负重应激行军人体ＧＳＨ 和ＳＯＤ 作用机制。方法　对７４ 名１５ ｋｇ 负重在沙漠干热环境以不同速度和时间行军战士和对照人群血浆的变化进行了研究。结果　１５ ｋｇ 负重,３－５ｋｍ／ｈ 和５ ｋｍ／ｈ 行军者ＧＳＨ 在应激的最初１ 小时内迅速上升,约１ 小时达到高峰,之后迅速下降;随着行军速度的增加,机体抗氧化作用所消耗的ＳＯＤ 量增加,血浆ＳＯＤ 浓度亦随之下降。结论　从行军时间来看,在应激的最初１ 小时内,因应激诱导的ＧＳＨ 的合成和ＳＯＤ 的量增加,故沙漠干热环境负荷应激行军以１５ ｋｇ、３－５ ｋｍ／ｈ 为宜。     

沙漠干热环境徒手应激行军对人体热休克蛋白27的影响

为探讨沙漠干热徒手应激行军人体内热休克蛋白２７（ＨＳＰ２７）的变化规律,对在沙漠干热环境中以不同速度和时间徒手行军的５９名战士和１４名对照组的ＨＳＰ２７进行了研究。结果发现,不论是以３．５还是５．０ｋｍ／ｈ徒手应激行军,各不同行军时间组ＨＳＰ２７明显增高（Ｐ＜０．０１）,相同行军时间不同行军速度组和同速度不同时间组之间的ＨＳＰ２７均无显著性差异（Ｐ＞０．０５）。随行军速度（应激强度）增加,同一行军时间者血浆ＨＳＰ２７均略增高,行军小时１小时ＨＳＰ２７最高,之后略下降,２小时后变化不大,行军３小时与行军２小时基本处于同一水平。     

干眼症结膜印迹细胞学研究

目的 :探讨结膜印迹细胞学检查 (CIC)在干眼诊断中的作用。方法 :对 45人 90眼正常组和 80人16 0眼实验组除采用泪液分泌实验I(S -I-T)、泪膜破裂时间 (BUT)、虎红染色 (RBS)及荧光素染色 (FLS)计分等常用眼表泪功能检查外 ,重点采用CIC ,通过观察结膜上皮细胞情况及杯状细胞数来了解正常眼、干眼的泪膜粘液层的情况。结果 :印迹细胞学分级及杯状细胞数组间均有显著的差异 ,正常组分级主要集中于 0级 ;非SS干眼组的分级主要集中于 1级和 2级 ;SS干眼组的分级主要集中于 2级及 3级。杯状细胞与虎红色计分呈负相关。结论 :结膜印迹细胞学检查通过分级、观察杯状细胞数变化 ,了解泪膜粘液层的情况可用于区分正常人与干眼症患者并可了解干眼的病程变化     

鲑降钙素吸入粉雾剂的制备及其药剂学性质研究鲑降钙素吸入粉雾剂的制备及其药剂学性质研究

目的喷雾干燥法制备鲑降钙素吸入粉雾剂,考察其主要药剂学特性。方法按中国药典2000年版方法测定鲑降钙素吸入粉雾剂排空率及有效部位沉积量,扫描电镜观察粉粒的形态,激光粒度测定仪测定粉粒的粒径大小及分布,差热分析及X射线粉末衍射考察吸入粉雾剂载体的晶型。结果有效部位鲑降钙素沉积量均在10%以上,排空率均在90%以上;相对湿度在52%以下,粉粒呈圆整的分散状态;当RH=75%时粉粒发生较多的粘连和聚集;粉体平均粒径为1.67 μm;差热分析结果显示:吸入粉雾剂中L-亮氨酸的熔融热较单一组分在喷雾干燥后显著下降;X射线粉末衍射图谱中,吸入粉雾剂载体的衍射峰强度较喷雾干燥前显著下降。结论在鲑降钙素吸入粉雾剂载体系统中加入甘露醇,粉粒圆整,加入L-亮氨酸可形成超低密度载体;扫描电镜的结果提示,应严格控制吸入粉雾剂贮存时环境的湿度;喷雾干燥复合载体更有助于无定形的形成。