侧卧位直接前方入路全髋关节置换的可行性和效果

目的探讨侧卧位直接前方入路(DAA)全髋关节置换术的可行性和临床效果。方法对307例患者(332髋)行侧卧位DAA全髋关节置换术,评估临床功能,观察影像学结果和并发症。结果单侧髋关节置换手术时间41~73(52.0±5.6)min,术中失血量60~210(94.0±37.4)ml。患者均随访1年。髋关节Harris评分术后1、3、12个月均较术前明显改善(F=237.2,P<0.001)。术后第2天,髋臼假体前倾角为7°~22°(14.4°±6.0°),外展角为26°~57°(43.8°±4.4°)。双下肢长度的差异由术前0~2.5 cm纠正为术后0~1.5 cm(Z=-14.71,P<0.001)。18髋发生股外侧皮神经损伤,3髋发生术中股骨近端骨折,2髋术后早期出现髋关节脱位,1髋髋臼杯未完全打入臼窝,该24例经对症治疗后均愈合、复位良好。术后1年未发生假体周围骨折,无菌性假体松动。结论侧卧位DAA全髋关节置换术安全可行,临床效果良好。     

Fetal bisphenol A and ethinylestradiol exposure alters male rat urogenital tract morphology at birth: Confirmation of prior low-dose findings in CLARITY-BPA

Bisphenol A (BPA) is a contaminant in virtually all Americans. To examine BPA’s adverse effects, the FDA-NCTR, NIEHS, and 14 groups of academic scientists formed a consortium: CLARITY-BPA. The purpose of our study was to investigate the effects of a wide range of doses of BPA on fetal development of the NCTR CD-SD male rat urogenital sinus (UGS). Pregnant rats were administered BPA or positive control ethinylestradiol (EE2) daily, via oral gavage, from gestational day 6 through parturition. Tissues were collected on postnatal day 1 and the UGS was analyzed using computer-assisted 3-D reconstruction. Importantly, only low doses of BPA, as well as EE2, significantly changed birth weight and UGS morphology, including an increased size of the colliculus and decreased size of the urethra, consistent with prior reported BPA and EE2 effects. Our findings provide further evidence that BPA mediates nonmonotonic developmental effects on the fetal urogenital sinus.     

Fecal Incontinence: A Stepwise Approach to Primary Care Management

Fecal incontinence can adversely affect quality of life, leading to embarrassment and social isolation. It occurs more often in older adults and is a common reason for nursing home referrals. Numerous treatments are available, but most patents self-treat and often do not report their symptoms. Advanced practice nurses providing primary care develop a rapport with the patient, allowing him or her to elicit important information about this sensitive subject. Interventions are designed to relieve symptoms and decrease incontinence episodes, ultimately improving quality of life. Management follows a stepwise approach beginning with conservative methods and newer technologies when indicated.     

Nobel clinician软件引导上颌窦内提升术在磨牙缺失修复中的应用研究

目的:研究Nobelclinician软件引导上颌窦内提升术在磨牙缺失的应用效果,为临床应用提供指导。方法:选择2016年10月-2018年10月在笔者医院进行手术的86例上颌磨牙缺失患者为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组:采用常规上颔窦内提升术;观察组:在Nobelclinician软件引导下进行上颌窦内提升术,两组均使用nobelreplace种植体种植。比较两组患者的种植体存留率及种植体周围组织情况[包括术前上颌窦底距牙槽嵴骨高度(Bone height of the maxillary sinus floor from the alveolar ridge,RBH)、术后6个月新骨获得量、术后1年垂直骨丧失、牙周探诊深度(Periodontal probing depth,PPD)];比较两组患者治疗后的X片检查结果及治疗满意度。结果:观察组的RBH、PPD及术后1年垂直骨丧失均显著小于对照组,术后6个月新骨获得量显著大于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后随访6个月,观察组的种植体存留率(100.00%)与对照组(94.55%)相比,差异不具有统计学意义(P>0.05),X片检查结果显示,两组患者的种植体及周围骨组织均结合良好,术后1年均已生成新的上颌窦底壁。观察组患者的满意度(100.00%)显著高于对照组(90.70%),差异具有统计学意义(P<0.05)。结论:Nobelclinician软件引导上颌窦内提升术能够降低垂直骨丧失量,增加新骨获得量,有助于提高磨牙缺失修复的美学效果,提高患者满意度。     

Efficacy of Oral Anticoagulation in Stroke Prevention among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction after Cryoablation

The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients.This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke.The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke.Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.