前交叉韧带断裂合并半月板ramp区损伤的临床治疗经验

目的 分享和探讨前交叉韧带断裂合并半月板ramp区损伤在关节镜下的临床经验与疗效。方法 56例前交叉韧带断裂合并半月板ramp区损伤的患者，按手术方式分为2组，对照组29例行膝关节镜下可调节袢-自体腘绳肌腱单束重建术，观察组27例在其基础上采用膝关节镜下可调节袢-自体腘绳肌腱单束重建术+半月板ramp区缝合修复术。术后随访以IKDC、Lysholm、步态测试仪，关节稳定测定为膝关节功能恢复的主观评价指标。结果 56例平均随访18.7个月，平均年龄26.3岁，未发生感染及关节僵硬等并发症。观察组半月板临床愈合率为92.59%,明显高于对照组的68.96%,术前2组患者IKDC、Lysholm评分差异无显著性(P>0.05),术后6个月观察组膝关节IKDC、Lysholm评分均明显优于对照组(P<0.05)。结论 膝关节镜下同期行可调节袢-自体腘绳肌腱单束重建术+半月板ramp区缝合修复术更有利于半月板愈合，能够获得更好的膝关节稳定性，值得临床推广。     

关节镜下同时修复膝关节前交叉韧带及半月板损伤的修复效果及临床价值

目的 探讨膝关节前交叉韧带（ACL）及半月板损伤同时进行关节镜下修复的临床价值。方法 选取2020年2月至2021年3月武警广东省总队医院外二科接收的86例ACL合并半月板损伤患者,应用随机数字表法分为研究组和对照组。对照组单纯采取ACL重建,研究组采用关节镜下同时修复,比较两组膝关节优良率与半月板愈合率,手术前后疼痛评分与膝关节功能评分,并对两组术后并发症进行比较分析。结果研究组患者的优良率及半月板愈合率均高于对照组,差异有统计学意义（P <0.05）;研究组患者的术后视觉疼痛模拟量表评分（VAS）低于对照组,而Lysholm评分高于对照组,差异有统计学意义（P <0.05）;研究组患者的并发症总发生率低于对照组,差异有统计学意义（P <0.05）。结论 膝关节ACL及半月板损伤患者采用关节镜下同时修复,其效果较好,利于减轻患者术后疼痛,促进其膝关节功能恢复,且安全性较高,值得应用及推广。     

关节镜下前交叉韧带重建术后的康复护理

<正>膝关节前交叉韧带(anterior cruciate ligament,ACL)损伤是目前常见而严重的运动损伤,伤后可引起膝关节不稳,进而导致关节软骨和半月板损伤,并最终发展成为退行性骨关节病。随着关节镜外科学的不断发展,利用自体腘绳肌腱重建ACL术已逐步成为常规术式~([1])。笔者尝试针对患者具体病情系统化制定和实施康复训练计划,临床观察取得一定效果。现报告如下。1资料与方法     

膝关节镜下半腱肌及股薄肌肌腱重建前交叉韧带的临床观察

<正>膝关节是人体结构最复杂的关节,前交叉韧带(ACL)是维持膝关节内稳定性的重要结构。随着道路交通伤、运动伤等的增加,ACL损伤发生率逐渐增高,并常伴有半月板及侧副韧带损伤。当ACL损伤后,膝关节正常活动失稳,继发出现关节韧带松弛,半月板及关节软骨退变等并发症[1],重建ACL能够为膝关节的稳定提供缰绳作用。传统切开关节囊直视下手术创伤大,影响了术后的康复。目前随着膝关节镜技术的发展和内固定技术的改进,关节镜下重建交叉韧带逐步向着     

康复干预对关节镜下膝前交叉韧带重建术后作用的研究

前交叉韧带是膝关节重要的稳定结构,损伤后可以产生明显的膝关节前向不稳,严重影响膝关节功能,随之继发关节软骨、半月板等主要结构损害,导致关节退变和骨关节病的早期发生.我们采用单切口全镜内半腱肌和股薄肌腱重建ACL,采用四股合一进行重建明显提高了整体抗拉抗张强度,移植重建经塑形改建完全可以达到甚至高于正常ACL的断裂强度,恢复膝关节稳定性.关节镜下膝前交叉韧带重建后的长期疗效与术后的康复干预密切相关,本研究课题分为实验组和对照组分别采用"保守"康复训练与"激进"康复训练,比较其膝关节的肿胀、关节活动度、关节的稳定性,来评价膝关节的功能.     

关节镜下前交叉韧带重建手术联合半月板修复手术治疗前交叉韧带合并半月板损伤的疗效研究

目的探讨关节镜下前交叉韧带(ACL)重建手术联合半月板修复手术治疗ACL合并半月板损伤的疗效。方法 50例ACL合并半月板损伤患者,随机分为对照组与观察组,各25例。对照组使用中西医结合保守治疗,观察组使用关节镜下ACL重建手术联合半月板修复手术。比较两组治疗后6个月膝关节功能优良率及半月板愈合率;治疗前及治疗后6个月膝关节功能各项指标[视觉模拟评分法(VAS)评分、Tegner运动水平评分、Lysholm评分];治疗后6个月Lachman试验、前抽屉试验、轴移试验阳性率。结果观察组治疗后6个月膝关节功能优良率92.00%及半月板愈合率96.00%均高于对照组的64.00%、60.00%, Lachman试验、前抽屉试验、轴移试验阳性率分别为4.00%、4.00%、0,均低于对照组的28.00%、24.00%、16.00%,差异具有统计学意义(P<0.05)。治疗后,两组VAS评分、Tegner运动水平评分、Lysholm评分均优于治疗前,且观察组VAS评分(1.01±0.34)分、Tegner运动水平评分(6.47±0.82)分、Lysholm评分(93.13±2.65)分均优于对照组的(2.89±0.63)、(4.97±1.03)、(78.84±3.23)分,差异具有统计学意义(P<0.05)。结论关节镜下ACL重建手术联合半月板修复手术治疗ACL合并半月板损伤疗效显著,能有效修复ACL及半月板损伤,促进膝关节稳定性和功能的恢复,提高整体治愈效果,具有积极的临床意义。     

关节镜下交叉韧带重建术围手术期护理及康复训练效果研究

目的研究关节镜下交叉韧带重建术围手术期护理及康复训练的效果。方法本研究选取2013年3月~2017年10月期间在我院进行关节镜下交叉韧带重建术治疗的交叉韧带损伤患者,将36例患者计算机随机分为两组,每组18例。将实施常规护理干预的患者纳入对照组,将采用围术期护理及康复训练的患者设为观察组。将两组交叉韧带损伤患者的遵医行为、膝关节Lysholm评分、膝关节伸屈活动度以及膝关节功能恢复优良率进行比较。结果观察组交叉韧带损伤患者的遵医行为、膝关节伸屈活动度数据均高于对照组,差异有统计学意义(P0.05);两组之间对比术后膝关节Lysholm评分差异较大,差异有统计学意义(P0.05);膝关节功能恢复优良率显著是观察组数据更高,差异有统计学意义(P0.05)。结论加强行关节镜下交叉韧带重建术患者围手术期护理干预并进行康复训练,对于其遵医行为的提高以及膝关节功能的恢复具有良好的促进作用。     

关节镜下膝关节前交叉韧带重建的远期临床效果及常见影响因素

目的分析关节镜下膝关节前交叉韧带(ACL)重建的远期临床效果及常见影响因素。方法选取湛江中心人民医院2018年1月至2019年1月收治的48例膝关节ACL损伤患者,以双盲随机抽样法分组,每组各24例,对照组采纳Endobutton悬吊固定术治疗,观察组采纳关节镜下膝关节前交叉韧带重建术治疗,比较两组临床总有效率、膝关节评分(Lysholm)评分、视觉模拟自评量表(VAS)评分、并发症发生率。对所有研究对象均随访1年,logistic分析膝关节ACL患者关节镜下膝关节前交叉韧带重建术远期临床效果的影响因素。结果观察组临床总有效率(91.67%)高于对照组(66.67%),观察组治疗后1个月Lysholm评分高于对照组,VAS评分低于对照组,观察组并发症总发生率(4.17%)低于对照组(29.17%),差异均有统计学意义(P 0.05)。移植物张力、髁间窝撞击、康复训练、骨髓道位置是影响关节镜下膝关节ACL重建术远期疗效的危险因素(P 0.05)。结论关节镜下膝关节ACL重建可有效改善膝关节ACL患者膝关节功能,缓解疼痛感,降低并发症发生率,效果显著,但远期临床疗效容易受到移植物张力、髁间窝撞击、康复训练、骨髓道位置等因素的影响,应当引起临床重视,及早予以针对性治疗,提高远期疗效。     

膝关节镜下关节半月板缝合术后早期康复护理的临床价值分析

目的探讨膝关节镜下关节半月板缝合术后早期康复护理的临床效果。方法选取我院2015年3月~2016年9月接受膝关节镜下关节半月板缝合术治疗的半月板损伤患者74例为研究对象,经随机数字表法分为2组,每组37例,对照组术后行常规护理,观察组在对照组基础实施早期康复护理,观察两组患者膝关节功能、疼痛程度变化以及术后并发症发生情况。结果两组患者术前膝关节功能及疼痛程度无显著差异(P>0.05),术后1个月Lysholm评分、VAS评分与对照组比较,差异有统计学意义(P<0.05);观察组并发症发生率为2.70%,与对照组比较明显较低,差异有统计学意义(P<0.05)。结论在膝关节镜下关节半月板缝合术后实施早期康复护理,能有效促进患者膝关节功能恢复,缓解疼痛,预防并发症发生,值得推广。     

前交叉韧带重建合并软骨损伤术后康复期应用玻璃酸钠的疗效观察

目的观察玻璃酸钠应用于前交叉韧带重建合并软骨损伤术后康复期中的临床效果。方法 2015年5月～2018年5月抽取本院收治的行前交叉韧带重建合并软骨损伤手术患者80例,随机将其分为对照组、试验组,各40例,对照组康复期不应用任何药物,试验组康复期应用玻璃酸钠。对比两组膝关节评分、膝关节功能优良率、炎性因子水平。结果膝关节评分、膝关节功能优良率相较于对照组,试验组较高(P 0.05);炎性因子水平相较于对照组,试验组较优(P 0.05)。结论前交叉韧带合并软骨损伤术后康复期应用玻璃酸钠,既可缓解炎性因子水平,又能促使膝关节功能尽快康复,临床应用价值较高,值得推广。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.