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1.
BackgroundIn shoulder arthroplasty, bone resorption around the stem can lead to stem loosening and makes surgery difficult at the time of revision. Proximal bone resorption after reverse shoulder arthroplasty can cause instability because of a decrease of deltoid wrapping effect. As factors of the stem itself, such as stem coating, shape, length, and use of bone cement, may also affect bone resorption, a single-stem model should be used to compare bone resorptions between different pathologies and surgical procedures. However, to date, a few reports have compared these differences in detail using a single-stem model. Therefore, we investigated the prevalence and location of humeral bone resorption in a single-stem model.MethodsThe study included 100 shoulders that underwent anatomical total shoulder arthroplasty (TSA) or humeral head replacement (HHR) with a single uncemented humeral stem from 2008 to 2018. The patients were 31 men and 69 women. The mean age at surgery was 72.9 years (range, 41-86 years). The patients were divided into three groups: especially, 25, 61, and 14 shoulders received TSA for primary osteoarthritis without rotator cuff tears (TSA group), HHR using an anatomical head with rotator cuff repair for cuff tear arthropathy (CTA) (HHR group), and HHR using a CTA head without rotator cuff repair (CTA group), respectively. Patients were monitored for a mean of 56 months (range, 12-98 months). The location of bone resorption was divided into seven zones as follows: zone 1, greater tuberosity; zone 2, lateral diaphysis; zone 3, lateral diaphysis beyond the deltoid tuberosity; zone 4, tip of the stem; zone 5, medial diaphysis beyond the deltoid tuberosity; zone 6, medial diaphysis; and zone 7, calcar region. The degree of bone resorption was classified from grade 0 to 4.ResultsBone resorption of grade 3 or higher was significantly more frequent at the greater tuberosity in the HHR and CTA groups (P < .001 and P < .001, respectively) than that in the TSA group. Grade 4 bone resorption was significantly more frequent in the CTA than that in the TSA and HHR groups in zone 1 (P = .016 and P = .041, respectively).ConclusionThe state of attachment of the rotator cuff to the greater tuberosity might affect bone resorption at the greater tuberosity, such as the greater tuberosity after shoulder arthroplasty. In cases of shoulder arthroplasty for arthropathy with rotator cuff tear, performing rotator cuff repair might prevent bone resorption.Level of evidenceLevel IV; Prognosis Study  相似文献   
2.
IntroductionEmergency nurses experience occupational stressors resulting from exposures to critical clinical events. The purpose of this study was to identify the critical clinical events for emergency nurses serving 3 patient populations (general, adult, pediatric) and whether the resilience of these nurses differed by the patient population served.MethodsThis study used a cross-sectional survey design. A total of 48 emergency nurses were recruited from 3 trauma hospital-based emergency departments (general, adult, pediatric). Clinical Events Questionnaire, Connor-Davidson Resilience scale, and an investigator-developed demographic questionnaire were used to collect data from respondents.ResultsAll respondents were female (n = 48, 100%), and most were White (n = 46, 96%). The average age of participants was 39.6 years, the average number of years as a registered nurse was 12.7 years, and the average number of years as an emergency nurse was 8.8 years. Clinical events considered most critical were providing care to a sexually abused child, experiencing the death of a coworker, and lack of responsiveness by a colleague during a serious situation. The least stress-provoking event was incidents with excessive media coverage. Nurses were less affected by the critical events they experienced more frequently at work. Nurses in the 3 trauma settings had high level of resilience, with no statistically significant differences between groups.DiscussionThe occupational stress from exposure to significant clinical events varied with the patient population served by emergency nurses. It is important that interventions be adopted to alleviate the effect of work-related stressors and promote the psychological health of emergency nurses.  相似文献   
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ObjectivesBurnout is increasingly a concerning problem in US Healthcare systems. Although the causes of burnout are not predominantly due to individual factors, mindfulness instruction is an evidence-based approach to counteracting burnout. Our health system initiated a multi-pronged approach to mindfulness instruction for our employees and community. We aimed to assess the impact of these varied programs.MethodsSeveral mindfulness courses of different lengths were employed. Validated survey instruments were administered to participants before and after the courses to assess stress, mindfulness and burnout. Pre-course and post-course results were compared for each intervention. Free-text responses were also captured and analyzed in a qualitative fashion.ResultsParticipants in MBIs demonstrated statistically significant improvement in burnout and perceived stress on post-course survey results. Several mindfulness domains also showed statistically significant improvement (awareness, non-react and observe). There was no difference in the observed results between the mindfulness interventions. Qualitative analysis yielded three themes: seeking help, symptoms, and changes in mindfulness practice.ConclusionsMBIs designed for employees of an academic medical center were associated with positive quantitative and qualitative results. All MBI participants achieved improvement in perceived stress and mindfulness as well as reduction in burnout, regardless of course length.  相似文献   
5.
目的研究右美托咪啶在静脉吸入复合全身麻醉方案中对患者苏醒期应激反应及寒战发生率的影响。方法选取2019年3月至2020年6月于我院进行外科手术并使用静吸复合全身麻醉方案的152例符合标准的患者纳入研究,采用随机数字法将患者分为试验组(76例)与对照组(76例),试验组给予静脉持续泵入右美托咪啶辅助静吸复合全身麻醉方案,对照组给予静脉持续泵入0.9%氯化钠注射液辅助静吸复合全身麻醉方案,对2组患者术前一般资料及拔管时、拔管5 min后及拔管30min后的肌肉活动评分法(MAAS评分)、心率、呼吸频率、平均动脉压与寒战的发生率,对比气管插管至拔管后2h之间不良反应的发生率,分析右美托咪啶用于静吸复合全身麻醉方案中对患者苏醒期应激反应及寒战发生率的影响。结果试验组拔管时与拔管后30min的心率、平均动脉压、呼吸频率及MAAS评分均小于对照组,差异有统计学意义(P<0.05);试验组寒战发生率与不良反应发生率均小于对照组,差异有统计学意义(P<0.05)。结论右美托咪啶应用于静吸复合全身麻醉方案中可以减少患者苏醒期应激反应及寒战发生率,降低不良反应的发生,值得在临床外科手术中推广。  相似文献   
6.
目的:探讨高中生童年期创伤、压力知觉与抑郁之间的关系,为预防和识别高中生抑郁提供参考依据。方法:采用童年期创伤问卷、中文版压力知觉量表和流调中心用抑郁量表对安徽省滁州市2310名高中生进行调查。结果:(1)女生的压力知觉总分和抑郁总分显著高于男生,有留守经历学生的压力知觉总分和抑郁总分显著高于无留守经历的学生。(2)童年期创伤总分与压力知觉总分、抑郁总分均呈显著正相关。(3)中介作用检验结果表明,压力知觉在高中生童年期创伤与抑郁间中介作用显著,中介效应占总效应的比例为65.22%。结论:压力知觉在童年期创伤与抑郁间起部分中介作用,童年期创伤能直接或间接增加高中生患抑郁的风险。  相似文献   
7.
This clinical trial investigated the effect of an Emotional Freedom Techniques (EFT) intervention on brain activation in chronic pain sufferers using functional magnetic resonance imaging (fMRI). EFT is a brief stress reduction technique which combines stating a cognitive statement with somatic tapping on acupressure points. Twenty-four adults were allocated to a six-week online group EFT treatment and underwent resting-state fMRI pre and post the intervention. A repeated measures MANOVA indicated significant differences in the levels of pain severity (−21%), pain interference (−26%), quality of life (+7%), somatic symptoms (−28%), depression (−13.5%), anxiety (−37.1%), happiness (+17%), and satisfaction with life (+8.8%) from pre-to post-test. Cohen's effect sizes ranged from small (0.2) to large (0.75) values suggesting significance for the intervention. fMRI analysis showed post-EFT treatment significantly decreased connectivity between the medial prefrontal cortex (a pain modulating area) and bilateral grey matter areas in the posterior cingulate cortex and thalamus, both areas being related to modulating and catastrophizing of pain. There were no brain areas that showed significantly increased connectivity post-EFT treatment. Coupled with the psychological measures the findings support the effects of the EFT intervention in reducing chronic pain and its impacts. Recommendations for future research are discussed.  相似文献   
8.
BackgroundFull-thickness bone resorption around the humeral stem in shoulder arthroplasty is an increasingly recognized phenomenon, but the impact on outcomes remains unclear. This study aims to investigate prevalence of bone resorption in patients with the Zimmer-Biomet Comprehensive reverse shoulder arthroplasty and the impact on the functional outcomes.MethodsA retrospective analysis was carried out on 65 consecutive patients with primary reverse total shoulder arthroplasty using the Comprehensive Shoulder System from 2014 to 2020, with a minimum of 12-month follow-up. The prevalence of humeral bone resorption was graded from 0 to 4, and risk factors for these changes and their impact on functional outcomes were further investigated.ResultsThe majority of patients (75%) were female with an average age of 75 years (53-93), with an overall average follow-up of 26 months (12-60). Bone resorption occurred in 53 patients (82%), and full-thickness bone resorption occurred in only 8 patients (12%). Metaphyseal bone (zones 1 and 7) is mostly at the risk of high-grade resorption. There was no difference in the final Oxford Shoulder Score between patients who had differential resorption grades from 0 to 4 (P = .5742). None of the risk factors from the previous literature including age, sex, indication for surgery, rotator cuff tear and repair, and intramedullary occupation ratio of the implant showed any impact on the rate of resorption.ConclusionFull-thickness humeral bone resorption occurred in approximately 12% of patients when using the Comprehensive reverse shoulder arthroplasty, but it has no impact on the functional outcomes or revision rate in the short-to-medium term.  相似文献   
9.
目的 探讨右美托咪定持续输注对择期行肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗术(HIPEC)腹膜癌患者围术期应激反应、乳酸(Lac)清除率和术后康复的影响。 方法 收集60例全身麻醉下行CRS联合HIPEC腹膜癌患者的临床资料,筛选后剔除4例患者,分为对照组(常规麻醉)27例和右美托咪定组29例。所有患者常规全身麻醉,右美托咪定组患者同时给予右美托咪定;术中监测有创动脉压(ABP)和中心静脉压(CVP),测定心脏指数(CI),计算心率血压乘积(RPP),术中以每搏变异度(SVV)指导补液。记录手术前(T0)、HIPEC开始前(T1)、HIPEC结束后(T2)和手术结束后(T3)时平均动脉压(MAP)、心率(HR)、RPP、CVP及CI和血中Lac、碱剩余(BE)、血糖(Glu)和皮质醇水平,计算Lac清除率;记录2组患者术后3 d内并发症发生情况。 结果 循环相关指标,在T0时2组患者MAP、HR、RPP、CVP和CI比较差异无统计学意义(P>0.05);在T1时,与对照组比较,右美托咪定组患者RPP减少(P<0.05);在T2时,与对照组比较,右美托咪定组患者HR和CVP均明显降低(P<0.05),RPP减少(P<0.05);在T3时,与对照组比较,右美托咪定组患者HR、MAP和CVP明显降低(P<0.05),RPP减少(P<0.05),2组患者CI比较差异无统计学意义(P>0.05)。血气及应激相关指标,在T0时,2组患者血中Lac、BE、Glu和皮质醇水平比较差异无统计学意义(P>0.05);在T1和T2时,与对照组比较,右美托咪定组患者血中Lac、Glu和皮质醇水平降低(P<0.05),BE负值减少(P<0.05)。术后Lac水平和肝肾功能,在术后12 h(T4)、术后24 h(T5)、术后48 h(T6)和术后72 h(T7)时,与对照组比较,右美托咪定组患者Lac水平降低(P<0.05),Lac清除率明显升高(P<0.05);T5和T7时右美托咪定组患者丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)水平明显降低(P<0.05)。术后并发症发生情况,与对照组比较,术后3 d内右美托咪定组患者术后低血压、恶心呕吐、腹胀、寒战和睡眠障碍发生例数明显减少(P<0.05)。 结论 术中右美托咪定持续输注可降低腹膜癌患者围术期应激反应和Lac水平,减少术后并发症发生,促进患者术后康复。  相似文献   
10.
【摘要】 目的:利用有限元技术探究颈椎关节突关节矢状角不对称对颈椎间盘纤维环和关节突关节的应力影响。方法:选择一名26岁健康女性志愿者的颈椎CT扫描数据构建颈椎有限元模型。首先,构建C3-C7的颈椎正常模型,该模型通过先前发表的研究数据进行了验证。其次,提取C5-C6的数据,并改变C5-C6关节突关节矢状角的角度以重新构建实验模型。重新构建成三个模型,包括对称模型(左右两侧矢状角均为90°),中度颈椎关节突关节矢状角不对称(facet tropism,FT)模型(左侧矢状角100°,右侧90°),重度颈椎FT模型(左侧矢状角110°,右侧90°)。在每个模型中,分别施加四种纯扭矩和复合扭矩以研究FT对椎间盘纤维环应力和关节突关节压力的影响。结果:在前屈、后伸、左右侧屈、左旋和前屈结合左旋的扭矩下,三个模型的椎间盘纤维环纤维应力和关节突关节压力差异无显著性。但在右旋和前屈结合右旋的扭矩下,三个模型的椎间盘纤维环纤维应力和关节突关节压力有显著差异,与颈椎关节突关节对称模型相比,中度颈椎FT模型和重度颈椎FT模型的纤维环纤维应力呈增加趋势(右旋扭矩下分别增加16.65%和35.16%;前屈结合右旋扭矩下分别增加了19.47%和54.39%),且重度颈椎FT模型增加更明显;关节突关节压力呈减少趋势(右旋扭矩下分别减少了3.31%和5.95%;前屈结合右旋扭矩下分别减少了7.19%和15.52%),且重度颈椎FT模型减少更明显。结论:颈椎关节突关节矢状角不对称会增加椎间盘纤维环的应力,并且不对称程度越大,应力增加越明显,可能是颈椎间盘退变或突出的病理解剖学因素之一。  相似文献   
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