关节镜下半月板部分切除术的临床效果评价

目的探究关节镜下半月板部分切除术治疗膝关节半月板损伤的临床效果。 方法选取2017年11月至2018年11月南通大学第四附属医院骨科收治的膝关节半月板损伤患者98例,其中采用关节镜下半月板部分切除者纳入研究组(n＝49),应用小切口半月板部分切除者纳入对照组(n＝49)。采用t检验对比分析两组患者的手术时间、手术费用、术前术后的疼痛视觉模拟评分(VAS评分),术前术后膝关节Lysholm功能评分,采用卡方检验对比两组的临床治疗效果。 结果研究组的治疗效果明显优于对照组(χ²＝5.124,P<0.05)、两组患者术前Lysholm评分差异无统计学意义(t＝1.562,P>0.05),研究组术后3 d(t＝14.154,P<0.05)及术后1年(t＝15.685,P<0.05)的Lysholm评分都显著高于对照组。两组患者术前疼痛评分无差异(P>0.05),术后3 d研究组患者的静息痛评分(t＝13.974,P<0.05)和行走痛评分(t＝13.976,P<0.05)均低于对照组,术后1年研究组患者的静息痛评分(t＝14.258,P<0.05)和行走痛评分(t＝14.859,P<0.05)亦显著低于对照组。对照组的手术时间短于研究组(t＝8.568,P<0.05),且手术费用更低(t＝3.405,P<0.05)。 结论关节镜下半月板部分切除治疗膝关节半月板损伤的临床效果较好,且有创伤小,疼痛轻等优点,小切口半月板部分切除术的技术难度较低,亦可在临床中选择性采用。     

新型冠状病毒肺炎疫情期间骨科急症处理原则的专家共识

自2019年12月以来,湖北省武汉市部分医院相继收治多个有华南海鲜市场暴露史的不明原因肺炎病例[1]。患者症状多为发热、乏力、干咳并逐渐出现呼吸困难,部分重症患者出现了急性呼吸窘迫综合征或脓毒症休克、甚至病死。2020年1月7日,我国研究人员首次从患者标本中检测出一种新型冠状病毒[2]。2020年1月20日,中华人民共和国国家卫生健康委员会发布2020年1号公告,将新型冠状病毒感染的肺炎纳入乙类传染病,并按照甲类传染病进行防疫、控制[3]。世界卫生组织将新型冠状病毒肺炎命名为"COVID-19"[4]。     

Mechanical and hypoxia stress can cause chondrocytes apoptosis through over-activation of endoplasmic reticulum stress

ObjectiveTo examine the role of mechanical force and hypoxia on chondrocytes apoptosis and osteoarthritis (OA)-liked pathological change on mandibular cartilage through over-activation of endoplasmic reticulum stress (ERS).MethodsWe used two in vitro models to examine the effect of mechanical force and hypoxia on chondrocytes apoptosis separately. The mandibular condylar chondrocytes were obtained from three-week-old male Sprague–Dawley rats. Flexcell 5000T apparatus was used to produce mechanical forces (12%, 0.5 Hz, 24 h vs 20%, 0.5 Hz, 24 h) on chondrocytes. For hypoxia experiment, the concentration of O₂ was down regulated to 5% or 1%. Cell apoptosis rates were quantified by annexin V and propidium iodide (PI) double staining and FACS analysis. Quantitative real-time PCR and western blot were performed to evaluate the activation of ERS and cellular hypoxia. Then we used a mechanical stress loading rat model to verify the involvement of ERS in OA-liked mandibular cartilage pathological change. Histological changes in mandibular condylar cartilage were assessed via hematoxylin & eosin (HE) staining. Immunohistochemistry of GRP78, GRP94, HIF-1α, and HIF-2α were performed to evaluate activation of the ERS and existence of hypoxia. Apoptotic cells were detected by the TUNEL method.ResultsTunicamycin, 20% mechanical forces and hypoxia (1% O₂) all significantly increased chondrocytes apoptosis rates and expression of ERS markers (GRP78, GRP94 and Caspase 12). However, 12% mechanical forces can only increase the apoptotic sensitivity of chondrocytes. Mechanical stress resulted in OA-liked pathological change on rat mandibular condylar cartilage which included thinning cartilage and bone erosion. The number of apoptotic cells increased. ERS and hypoxia markers expressions were also enhanced. Salubrinal, an ERS inhibitor, can reverse these effects in vitro and in vivo through the down-regulation of ERS markers and hypoxia markers.ConclusionWe confirmed that mechanical stress and local hypoxia both contributed to the chondrocytes apoptosis. Mechanical stress can cause OA-like pathological change in rat mandibular condylar cartilage via ERS activation and hypoxia existed in the meantime. Both mechanical forces and hypoxia can induce ERS and cause chondrocytes apoptosis only if the stimulate was in higher level. Salubrinal can protect chondrocytes from apoptosis, and relieve OA-liked pathological change on mandibular condylar cartilage under mechanical stress stimulation.     

Tolerance-inducing effect and properties of innate immune stimulation on chronic stress-induced behavioral abnormalities in mice

Over-activation of the innate immune system constitutes a risk factor for the development of nervous system disorders but may reduce the severity of these disorders by inducing tolerance effect. Here, we studied the tolerance-inducing effect and properties of innate immune stimulation on chronic social defeat stress (CSDS)-induced behavioral abnormalities in mice. A single injection of the innate immune enhancer lipopolysaccharide (LPS) one day before stress exposure prevented CSDS-induced impairment in social interaction and increased immobility time in the tail suspension test and forced swimming test. This effect was observed at varying doses (100, 500, and 1000 μg/kg) and peaked at 100 μg/kg. A single LPS injection (100 μg/kg) either one or five but not ten days before stress exposure prevented CSDS-induced behavioral abnormalities. A second LPS injection ten days after the first LPS injection, or a 2 × or 4 × LPS injections ten days before stress exposure also induced tolerance against stress-induced behavioral abnormalities. Our results furthermore showed that a single LPS injection one day before stress exposure skewed the neuroinflammatory response in the hippocampus and prefrontal cortex of CSDS-exposed mice toward an anti-inflammatory phenotype. Inhibiting the central innate immune response by pretreatment with minocycline or PLX3397 abrogated the tolerance-inducing effect of LPS preconditioning on CSDS-induced behavioral abnormalities and neuroinflammatory responses in the brain. These results provide evidence for a prophylactic effect of innate immune stimulation on stress-induced behavioral abnormalities via changes in microglial activation, which may help develop novel strategies for the prevention of stress-induced psychological disorders.     

急性胰腺炎并发肝损害的临床研究

目的:探讨和分析急性胰腺炎(AP)并发肝损害的临床特点及对预后的影响。方法:对106例AP患者的临床资料进行分析,了解肝损害的发生率,肝损害的程度对病程的影响。结果:106例AP患者中有63例合并肝损害,其中重症胰腺炎(SAP)35例,轻症胰腺炎(MAP)28例;胆源性胰腺炎(BAP)54例,非胆源性胰腺炎(NBAP)9例。SAP较MAP肝损害发生率高(分别为100%和39.4%),BAP比NBAP肝损害发生率高(分别为80.6%和23.1%)。SAP肝功能损害较MAP重,差异有显著性(P<0.05)。SAP合并肝功能损害的患者,其腹痛缓解时间,血淀粉酶复常时间及住院天数均较MAP合并肝功能损害的患者明显延长(P<0.05)。结论:急性胰腺炎并发肝损害可影响病情的发展及预后。     

超声弹性成像定性诊断甲状腺结节

目的评价超声弹性成像技术定性诊断甲状腺结节的价值。方法对68例甲状腺结节患者的90个甲状腺结节进行常规超声和超声弹性成像检查,并进行硬度分级,计算病灶弹性成像图与灰阶声像图面积比值,将诊断结果与手术后病理结果进行对比。结果甲状腺恶性结节弹性成像硬度评分高于良性结节,恶性结节弹性成像图与灰阶声像图的面积比值高于良性病灶（P均〈0.05）。若以硬度分级≥4级、病灶弹性成像图与灰阶声像图面积比值≥1.48作为诊断恶性结节的标准,则弹性成像硬度分级联合面积比值诊断甲状腺恶性结节的敏感度、特异度、准确率分别为94.44%（17/18）、88.89%（64/72）、90.00%（81/90）。结论超声弹性成像硬度分级能判断甲状腺结节的相对硬度,结合结节弹性成像图与灰阶声像图面积比值有助于鉴别诊断甲状腺结节的良恶性。     

Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: A Meta‐Analysis of Randomized Controlled Trials

This study aimed to analyze the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension. Randomized controlled trials (RCTs) that evaluated the effect of CPAP on BP in patients with OSA and resistant hypertension, indexed in MEDLINE, Embase, and the Cochrane Library from inception until March 20, 2015, were included in the meta‐analysis. A total of five RCTs were identified to meet the inclusion criteria. The pooled changes after CPAP treatment for 24‐hour ambulatory systolic BP and diastolic BP (DBP) were −4.78 mm Hg (95% confidence interval [CI], −7.95 to −1.61) and −2.95 mm Hg (95% CI, −5.37 to −0.53) in favor of the CPAP group. CPAP was also associated with reduction in nocturnal DBP (mean difference, −1.53 mm Hg, 95% CI, −3.07 to 0). The results indicated a favorable reduction in BP with CPAP treatment in patients with OSA and resistant hypertension.     

超声在剖宫产切口瘢痕妊娠早期诊断及介入治疗中的应用

目的探讨彩色多普勒超声在子宫下段剖宫产切口瘢痕妊娠早期诊断及介入治疗中的应用。方法对本院收治的15例子宫下段剖宫产切口瘢痕妊娠患者进行彩色多普勒超声检查,确诊后行经阴道超声引导下孕囊穿刺注射甲氨蝶呤治疗,术后动态观察孕囊变化。结果 15例子宫下段剖宫产切口瘢痕妊娠均为胎囊型,孕囊形态结构完整,孕囊前有子宫壁肌层完整覆盖,彩色多普勒示孕囊周边呈较丰富环状血流信号;15例确诊后行经阴道超声引导下孕囊穿刺注射甲氨蝶呤均一次性成功,治愈率为100%;穿刺治疗后孕囊逐渐变小,随后脱落或被吸收,血β-HCG逐渐下降至正常。结论经阴道彩色多普勒超声能早期确诊子宫下段剖宫产切口瘢痕妊娠,还可行超声引导下孕囊穿刺治疗及术后动态观察,值得临床推广应用。     

The association between blood oxygen saturation and baroreflex sensitivity in adults with type 1 diabetes with and without albuminuria

BackgroundLow baroreflex sensitivity is an indicator of early cardiovascular autonomic neuropathy. We explored the association between baroreflex sensivity and blood oxygen saturation (SpO₂) in type 1 diabetes and various degrees of microvascular disease.MethodsIn this Danish-Finnish cross-sectional multicentre study, baroreflex sensivity and SpO₂ (pulse oximetry) were examined in persons with type 1 diabetes and normoalbuminuria (n = 98), microalbuminuria (n = 28), or macroalbuminuria (n = 43), and in non-diabetic controls (n = 54). Associations and differences between groups were analysed using regression models and adjustment included age, sex, smoking, HbA_1c, blood haemoglobin, urine albumin creatinine ratio, body mass index, and estimated glomerular filtration rate.ResultsIn type 1 diabetes, higher baroreflex sensitivity was associated with higher SpO₂ before adjustment (% increase per one % increase in SpO₂ = 20 % (95%CI: 11–30); p < 0.001) and the association remained significant after adjustment (p = 0.02). Baroreflex sensitivity was not different between non-diabetic controls and persons with type 1 diabetes and normoalbuminuria (p = 0.052). Compared with type 1 diabetes and normoalbuminuria, baroreflex sensitivity was lower in micro- (p < 0.001) and macroalbuminuria (p < 0.001). SpO₂ was lower in persons with type 1 diabetes and normoalbuminuria compared with non-diabetic controls (p < 0.01). Within the participants with type 1 diabetes, SpO₂ was not different in micro- or macroalbuminuria compared with normoalbuminuria (p-values > 0.05), but lower in macro-compared with microalbuminuria (p < 0.01).ConclusionsLower baroreflex sensitivity was associated with lower SpO₂ in type 1 diabetes. The present study support the hypothesis that hypoxia could be a therapeutic target in persons with type 1 diabetes.