CPM加中药熏洗在膝部手术后关节功能康复的效果观察与护理

目的:总结与评价膝部手术后使用下肢持续被动运动机(CPM)加中药熏洗对患者膝关节功能康复的影响与护理要点。方法:膝部术后患者48例,随机分为A、B两组。A组24例,术后早期常规接受CPM锻炼;B组24例,除术后早期常规接受CPM锻炼外,伤口拆线后即加用中药熏洗。术后6周对A、B两组进行疗效评估。结果:术后6周B组膝关节屈伸角度显著高于A组(P<0.01);WOMAC评分中膝关节疼痛、功能积分和WOMAC总分均低于A组(P<0.05),膝关节僵硬积分与A组相比有显著性差异(P<0.01)。结论:CPM加中药熏洗比单纯使用CPM在改善膝关节的活动度、关节僵硬、关节功能及减轻疼痛更有效。     

CPM在髌骨骨折张力带内固定术后的应用

目的 探讨CPM在髌骨骨折改良张力带内固定术后的应用效果。方法 早期应用CPM治疗髌骨骨折行改良张力带内固定术后病人156例。结果 所有病例均得到随访，临床疗效优良率为98％。结论 在髌骨骨折行改良张力带内固定术后早期应用CMP，可显著利于膝关节功能恢复，提高治愈率。     

兔膝关节持续被动活动对前交叉韧带重建术后切口局部组织血氧饱和度的影响

目的 探讨膝关节持续被动活动（continuous passive motion, CPM）对兔前交叉韧带重建术后切口局部组织血氧饱和度的影响. 方法 20 只八月龄雄性新西兰大白兔右侧后肢膝关节行自体双股半腱肌腱移植重建前交叉韧带手术,术后随机分为2组：自由活动组（n＝10）和CPM组（n＝10）.自由活动组笼内自由活动;CPM组应用兔膝关节持续被动活动器运动.术后第2天,近红外光技术装置ODISseyTM 局部组织血氧监护仪测量每一来回（屈曲30°～110°）不同CPM速度（分别为2.35°/s、3.2°/s 、8°/s）时的切口局部组织血氧饱和度（tissue oxygen saturation ,StO2）变化,选择最好的CPM范围和速度.分别在术前和术后第2、4、6、8、10、14天观察膝关节CPM不同角度时切口局部组织StO2的变化. 结果 与自由活动组相比,3种速度的CPM在不同屈曲角度下均保持较高的StO2,且有显著性差异（P＜0.05）,不同CPM速度之间StO2有显著性差异（P＜0.05）.每一来回（屈曲30°～110°）运动速度为3.2°/s时保持最高的StO2.在术前和术后第2、4、6、8、10、14天等各时间点,膝关节屈曲30°、60°、90°、110°时StO2均无显著性差异（P＞0.05）,不同的时间点（术前和术后第2、4、6、8、10、14天）切口的StO2差别均有显著统计学意义（P＜0.05）.术后第2～4天最低,然后逐渐上升.术后第2周拆线后,切口愈合良好,没有感染、血肿和切口裂开. 结论 兔膝前交叉韧带重建术后第2天开始进行膝关节CPM（屈曲30°～110°）,可增加切口局部组织血氧饱和度,以3.2°/s的CPM速度最佳.     

CPM在膝关节镜术后康复中的效果观察与分析

目的 探讨早期应用下肢关节康复器(CPM)进行功能锻炼以治疗膝关节镜术后的临床疗效及应用价值.方法 采用不同病例对照研究,对照组沿用传统的康复方法,而实验组早期使用CPM进行肢体功能康复训练.结果 随访1～3个月,实验组56例患者关节活动度均达正常,恢复正常生活时间为20～62d(平均28.6d),较之对照组有明显差异.结论 膝关节镜术后早期应用CPM进行功能锻炼在预后及康复时间上均有明显优势,有利于功能恢复,缩短康复时间.     

Analysis of depressed cell-mediated immunity in asbestos workers

To explore the mechanisms of asbestos-related perturbations of the immune system, we evaluated the in vitro cell-mediated immunity of five asymptomatic asbestos workers with hypergammaglobulinemia and decreased T-cell numbers. These results were compared with those in 10 matched controls. Analysis of T-lymphocyte populations revealed decreased absolute numbers of OKT4+ (helper/inducer) T cells in the peripheral blood and phytohemagglutinin (PHA)-stimulated mononuclear cell cultures of the workers. When chrysotile asbestos was added to PHA cultures, expansion of OKT4+ cell populations was disproportionately inhibited in workers' cultures. Furthermore, control proliferative responses to PHA became indistinguishable from initial worker responses. These effects were incompletely explained by the cytotoxic effects of asbestos on cultured lymphocytes. We conclude that both in vivo and in vitro exposure of mononuclear cell populations to asbestos may lead to a diminution of helper-inducer T-cell numbers. In asbestos-exposed individuals, this latter lymphocyte subpopulation appears to be especially sensitive to in vitro asbestos exposure. Although the clinical implications of these findings are unclear, we hypothesize that many of the immunologic abnormalities that occur in asbestos workers could be explained by direct asbestos effects on the OKT4+ immunoregulatory population.     

Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons’ communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences.     

目前下肢被动运动装置存在的问题和改进原则

本文分析了目前下肢ＣＰＭ装置存在的问题,指出在ＣＰＭ每一运动周期,人体下肢与ＣＰＭ支架之间都将产生有害的相对位移和交替牵拉应力,影响关节功能顺利康复。提出下肢ＣＰＭ的正确使用方法和设计原则。     

膝关节手术后中药熏洗疗法效果观察

熏洗疗法是借温度、机械和药物的作用对机体发挥治疗效能的.当利用药汤乘热在皮肤或患部熏洗时,由于温热刺激,引起皮肤和患部的血管扩张,能促进局部和周身的血液循环及淋巴循环,使新陈代谢旺盛,改善局部组织营养和全身机能;并且能疏通经络,调和气血,促进经络的调节活动功能.     

Cytogenetic confirmation of a positive NIPT result: evidence-based choice between chorionic villus sampling and amniocentesis depending on chromosome aberration

It has been shown that in non-invasive prenatal testing (NIPT) there is a small chance of a false-positive or false-negative result. This is partly due to the fact that the fetal cell-free DNA present in maternal plasma is derived from the cytotrophoblast of chorionic villi (CV), which is not always representative for the fetal karyotype due to chromosomal mosaicism. Therefore, a positive NIPT result should always be confirmed with invasive testing, preferably amniocentesis, in order to investigate the fetal karyotype. However, since this invasive test can only be safely performed after 15.5 weeks of gestation while NIPT can be done from the 10^th week of gestation, this potentially means an unacceptable long waiting time for the prospective parents to receive a definitive result. Based on our experience with cytogenetic investigations in CV and the literature, we determined whether CV sampling may be appropriate for confirmation of an abnormal NIPT result.     

基质刚度调节细胞-细胞外基质间黏附对肿瘤细胞迁移影响的模型研究

目的研究细胞外基质(extracellular matrix,ECM)刚度对细胞和ECM间黏附及肿瘤迁移的影响。方法建立基于网状波茨模型(cellular Potts model,CPM),模拟肿瘤细胞生长与细胞间免疫反馈过程,观察细胞力学行为改变对细胞-ECM黏附的影响状况,分析不同ECM下肿瘤细胞迁移的变化。结果 ECM刚度变化会影响肿瘤细胞的迁移速度。ECM刚度改变调节细胞与ECM的黏附力,黏附力改变影响细胞的迁移速度。结论细胞的迁移和分布模式与ECM黏附性以及刚度密切相关。基质刚度增加促进肿瘤细胞在较低刚度下迁移,而基质刚度进一步增加抑制肿瘤细胞迁移。研究结果可进一步揭示ECM动态变化、黏附大小及肿瘤细胞迁移的力学表现。