Anesthetic considerations for scoliosis surgery in a patient with recessive severe/lethal form of osteogenesis imperfecta

Osteogenesis imperfecta is a heterogeneous genetic disorder characterized by bone fragility, with disease ranging from mild fractures to death in utero. We describe a child with autosomal recessive osteogenesis imperfecta type VIII (severe or lethal phenotype), who successfully underwent posterior spinal fusion, was extubated on postoperative day 1 and discharged home 25 days later. Recently identified recessive forms of osteogenesis imperfecta are associated with severe/lethal phenotype. Special consideration is needed in scoliosis surgery, with challenges arising from prone positioning, neurophysiology monitoring, and blood loss.     

Intraoperative Right Ventricular Myocardial Infarction in a Geriatric Patient with Hip Fracture: a Case Report

HIP fracture is becoming a global public health issue due to increased longevity and the in-creased incidence of osteoporosis.1,2 Patients who underwent surgery experience high rates of mortality and disability, with approximately 5% death rate before discharge and 10% death rate within 30 days after discharge.3,4Intraoperative cardiac arrest (IOCA) complicates up to 43 per 100,000 surgeries.5Even with resuscitation by eligible professionals in a well-equipped operating room,IOCA is still associated with 35% imme-diate mortality and 65.5% in-hospital mortality.6,7Themain causes may be related to patient conditions, preoperative complications, anesthesia or surgical procedures.7,8 Age- associated changes in cardiovascular and other systems especially increase the risk of IOCA, which may explains why geriatric patients are the majority who experience asystole during surgery.     

利福平联合左氧氟沙星治疗骨科术后耐甲氧西林金黄色葡萄球菌感染的临床分析

目的 探讨利福平联合左氧氟沙星治疗骨科手术后耐甲氧耐西林金黄色葡萄球菌的临床疗效及安全性.方法 70例骨科手术后甲氧西林耐药葡萄球菌感染患者分别予以万古霉素(对照组)和利福平联合左氧氟沙星(观察组)治疗.治疗2周后,对比两组的总有效率、细菌清除率及不良反应,并测定患者治疗前后的相关炎性因子水平.结果 治疗后,观察组总有效率(94.29%)高于对照组(80.00%)、细菌清除率(88.57%)高于对照组(68.57%),差异均有统计学意义(P<0.05);两组均未见严重不良反应.观察组治疗后的炎性因子IL-1β、IL-6 及TNF-α水平显著低于对照组同期(P<0.05).结论 利福平联合左氧氟沙星治疗骨科术后耐甲氧西林金黄色葡萄球菌感染的效果显著、安全性高,可明显降低患者血清炎性因子水平.     

阿司匹林预防骨科大手术后静脉血栓栓塞症的系统评价

目的 系统评价阿司匹林预防骨科大手术后静脉血栓栓塞症的有效性及安全性。方法 检索PubMed，Embase和Cochrane图书馆，收集阿司匹林预防围手术期静脉血栓栓塞症的随机对照研究（RCT）及队列研究，提取资料并评价质量后，采用RevMan 5.3软件进行Meta分析。结果 共纳入7项RCT和5项回顾性队列研究。与空白对照组相比，阿司匹林能降低术后深静脉血栓形成率[RR=0.69，95%CI（0.54，0.89），P=0.004]及肺栓塞发生率[RR=0.60，95%CI（0.43，0.84），P=0.003]。与低分子肝素□LMWH□相比，阿司匹林的术后深静脉血栓形成率、肺栓塞发生率、血红蛋白下降量分别为[RR=1.06，95%CI（0.96，1.17），P=0.22]，[RR=1.04，95%CI（0.93，1.18），P=0.48]以及[MD=-7.61，95%CI（-11.73，-3.49），P=0.000 3]。结论 与空白对照组相比，阿司匹林能降低骨科大手术后静脉血栓栓塞症的发生率；与LMWH相比，在术后静脉血栓栓塞症发生率方面没有差异，血红蛋白下降量低于LMWH；阿司匹林与空白对照、LMWH的其他并发症比较没有差异。     

肌内效贴联合艾灸疗法改善骨科术后患者功能性便秘的效果评价

目的 探讨肌内效贴联合艾灸疗法对骨科术后功能性便秘的疗效。方法 选取2019年1—12月在上海市浦东医院康复医学科住院的骨科术后患者40例，入选患者符合功能性便秘的诊断标准。采用电脑生成随机数字法将患者平均随机分成观察组和对照组，观察组同时接受肌内效贴和艾灸治疗，对照组只接受艾灸治疗。采用首次自主排便时间、便秘患者临床评分量表以及便秘诊治效果分级作为疗效评价指标。结果 所有入组的40例患者均完成了为期10天的干预。观察组患者8 h内首次排便率为40%，高于对照组，差异有统计学意义（P<0.001）；干预前两组患者的便秘患者临床评分量表差异无统计学意义（P=0.29），干预后观察组评分显著优于对照组（P<0.001）；干预后观察组便秘临床痊愈率（50%）高于对照组（5%），整体便秘诊治效果分级也显著优于对照组（P<0.001）。结论 肌内效贴联合择时艾灸疗法可以明显改善骨科术后功能性便秘，值得开展进一步研究以明确其临床疗效。     

Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge,Anxiety, and Informed Consent

BackgroundPatient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty.MethodsA team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05.ResultsSeventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047).ConclusionOn this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.     

大鼠腹腔脂肪干细胞的分离培养及诱导成骨

背景：脂肪干细胞取材方便、增殖旺盛、具有多向分化潜能，有望取代骨髓间充质干细胞而成为新一代组织工程的种子细胞。然而，脂肪干细胞的分离培养仍存在诸多困难与不足。目的：优化脂肪干细胞的分离培养方法，并鉴定其成骨分化潜能。方法：选取200g成年雌性大鼠1只，无菌环境下切取大鼠肾脏、子宫周围及腹后外侧白色脂肪组织，多次胶原酶消化法分离消化，低糖培养基培养脂肪干细胞，倒置显微镜下观察脂肪干细胞的形态变化及增殖能力。采用成骨诱导培养液对第3代细胞进行成骨诱导，并采用碱性磷酸酶、茜素红染色方法进行鉴定。结果与结论：脂肪干细胞形态以长梭形为主，增殖活跃呈旋涡状生长。经成骨诱导10d后，碱性磷酸酶染色为阳性；成骨诱导28d后，茜素红染色阳性。提示采用多次酶消化法得到的大鼠腹腔源性脂肪干细胞在体外易于分离培养，可以稳定传代。在一定条件诱导下，可以向成骨细胞分化。采用以上方法进行脂肪干细胞的分离培养可以为组织工程提供大量、优质的种子细胞。