H/G非骨水泥人工全髋关节置换术后聚乙烯内杯磨损临床研究

目的 对H/G非骨水泥人工全髋关节置换术后聚乙烯内杯的磨损及髋臼周围骨溶解的情况进行总结.方法 我院1991至1995年共进行58例(65髋)H/G非骨水泥人工全髋关节置换,其中35例(40髋)获得10年以上随访.对这35例(40髋)患者获得随访的病例,采用计算机数字化方法测量髋臼聚乙烯内杯的二维线性磨损.结果 35例40髋均有不同程度的磨损,磨损范围2～8 mm,平均磨损为(0.32±0.31)mm/年.10髋聚乙烯磨损超过6 mm,髋臼假体周围的骨溶解严重,并伴有金属假体的移位,其中5髋聚乙烯内杯完伞磨透,金属股骨头与金属髋臼相接触;5髋聚乙烯内杯磨损严重伴明显骨溶解,内杯松动.2髋聚乙烯内杯脱位.共实施翻修手术12例,包括更换聚乙烯内杯和金属股骨头2例、金属闩杯翻修2例、全髋翻修8例.28髋在髋臼侧发现骨溶解,其中14髋股骨侧亦有骨溶解发生.结论 本组病例所观测到的H/G髋臼聚乙烯内杯的磨损程度超过文献所报道,而且由于磨损产生的大量磨屑,导致假体周围出现明显骨溶解,直接影响到假体的稳定.关节置换术后应定期随访,避免出现严重骨溶解后增加翻修手术的困难.     

Charnley型人工全髋置换术后10年以上随访的X线分析

目的:通过对骨水泥固定的Charnley型人工全髋置换术患者10年以上X线随访,探讨骨水泥型人工全髋的固定效果、松动及影响寿命的因素等。方法:获得10年以上随访的38例45髋作为研究对象,平均随访14.6年。X线包括术后及最后随访时髋关节正侧位片。结果:髋臼假体松动有24髋(53％),其中明显松动(definite loosening)14髋(13％),可能松动(possible loosening)10髋(22％)。臼杯磨损共35髋(78％),平均磨损率为0.123mm/年;股骨假体柄松动有12髋(27％),其中明显松动8髋(18％),可能松动4髋(9％)。假体柄周围骨溶解18髋(40％)。本组45髋中8髋(18％)行翻修术,其中4髋因髋臼假体松动单纯髋臼假体翻修,其余4例行髋臼和股骨假体全部翻修。结论:骨水泥固定的Charnley型人工全髋置换术后10年以上长期随访结果,股骨假体的固定效果较好,但髋臼假体的固定效果并不满意。聚乙烯臼杯磨损不可避免,作为人工关节材料,聚乙烯对金属的关节组合应重新考虑。采用改良的骨水泥固定方法对人工全髋假体的早期稳定性和长期寿命非常重要。从髋臼假体的固定效果来看,金属臼(metal shell)假体的非骨水泥固定效果优于聚乙烯臼的骨水泥固定效果。     

Charnley型人工全髋置换术后10年以上随访的X线分析

目的：通过对骨水泥固定的Charnley型人工全髋置换术患者10年以X线随访，探讨骨水泥型人工全髋的固定效果、松动及影响寿命的因素等。方法：获得10年上随访的38例45髋作研究对象，平均随访14.6年。X线包括术后及最后随访时髋关节正侧位片。结果：髋臼假体松动有24髋（53％），其中明显松动（definite loosening）14髋（13％），可能松动（possible loosening）10髋（22％）。臼杯磨损共35髋（78％），平均磨损率为0.133mm/年；股骨假体柄松动有12髋（27％），其中明显松动8髋（18％），可能松动4髋（9％）。假体柄周围骨溶解18髋（40％）。本组45髋中8髋（18％）行翻修术，其中4髋因髋臼假体松动单纯髋臼假体翻修，其余4例行髋臼和股骨假体全部翻修。结论：骨水泥固定的Charnley型人工全髋置换术后10年以上长期随访结果，股骨假体的固定效果较好，但髋臼假体的固定效果并不满意。聚乙烯臼杯磨损不可避免，作为人工关节材料，聚乙烯对金属的关节组合应重新考虑。采用改良的骨水泥固定方法对人工全髋假体的早期稳定性和长期寿命非常重要。从髋臼假体的固定效果来看，金属臼（metal shell）假体的非骨水泥固定效果优于聚乙烯臼的骨水泥固定效果。     

Charnley型人工全髋置换术后10年以上随访的X线分析

目的:通过对骨水泥固定的Charnley型人工全髋置换术患者10年以上X线随访,探讨骨水泥型人工全髋的固定效果、松动及影响寿命的因素等.方法:获得10年以上随访的38例45髋作为研究对象,平均随访14.6年.X线包括术后及最后随访时髋关节正侧位片.结果:髋臼假体松动有24髋(53%),其中明显松动(definite loosening)14髋(13%),可能松动(possible loosening)10髋(22%).臼杯磨损共35髋(78%),平均磨损率为0.123mm/年;股骨假体柄松动有12髋(27%),其中明显松动8髋(18%),可能松动4髋(9%).假体柄周围骨溶解18髋(40%).本组45髋中8髋(18%)行翻修术,其中4髋因髋臼假体松动单纯髋臼假体翻修,其余4例行髋臼和股骨假体全部翻修.结论:骨水泥固定的Charnley型人工全髋置换术后10年以上长期随访结果,股骨假体的固定效果较好,但髋臼假体的固定效果并不满意.聚乙烯臼杯磨损不可避免,作为人工关节材料,聚乙烯对金属的关节组合应重新考虑.采用改良的骨水泥固定方法对人工全髋假体的早期稳定性和长期寿命非常重要.从髋臼假体的固定效果来看,金属臼(metal shell)假体的非骨水泥固定效果优于聚乙烯臼的骨水泥固定效果.     

病灶清除颗粒骨植骨治疗全髋关节置换术后髋臼周围骨溶解

目的 探讨全髋关节置换（THA)术后髋臼周围骨溶解的治疗方法及疗效.方法 对24例(24髋)THA术后髋臼周围骨溶解行骨溶解病灶清除、同种异体颗粒骨植骨、更换高交联聚乙烯内衬和股骨头假体.14例（14髋）髋臼杯稳定保留金属臼杯;2例（2髋）髋臼杯稳定卡环损坏,被迫取出稳定臼杯,行非骨水泥型髋臼杯翻修术;8例（8髋）髋臼杯松动行髋臼翻修术.采用Harris评分评价髋关节功能.通过X线片观察假体是否松动和移植骨愈合情况.结果 23例获得随访,1例失访,平均随访16个月（10～45个月）.Harris评分由术前(58±23)分（17～86分）,提高到末次随访时(92±12)分（80～98分）,差异有统计学意义(P＜0.05).术后无感染、脱位、静脉血栓形成等.X线片显示髋臼假体无松动和异位骨化,可见移植骨-宿主骨交界处有连续性骨小梁通过.结论 保留髋臼杯积极进行骨溶解病灶清除,同种异体颗粒骨植骨,更换聚乙烯内衬和股骨头假体可阻断骨溶解的进展;髋臼翻修,同种异体颗粒骨植骨,短期随访示移植骨愈合、髋臼杯稳定,临床效果满意.     

病灶清除植骨保留髋臼假体的翻修术治疗假体周围局灶性骨溶解

目的 探讨病灶清除植骨保留髋臼假体的翻修术治疗全髋关节置换(total hip arthroplasty,THA)术后稳定固定的髋臼假体周围局灶性骨溶解的疗效.方法 2006年3月至2009年3月,THA术后髋臼假体稳定固定的假体周围局灶性骨溶解患者23例(23髋),男13例,女10例;年龄39～54岁,平均46.6岁.23例均为非骨水泥髋臼.初次THA至诊断髋臼假体周围骨溶解的时间为4.6～7.4年,平均5.5年.术前HarTis髋关节评分74分.手术经腹股沟入路,行髂骨内板开窗,清除髋臼骨溶解病灶、同种异体颗粒骨植骨;经后外侧人路更换聚乙烯内衬、股骨头假体,保留髋臼假体.翻修术后1、3、6、12个月及之后每年随访1次,以髋关节Harris评分评价临床疗效,摄X线片、CT扫描观察植骨区愈合、新发骨溶解病灶及假体移位情况.结果 16例获得随访,随访时间8～38个月,平均28个月.末次随访时Harris髋关节评分86～100分,平均93.8分.16例植骨区成骨均良好,12例植骨区完全被周围骨爬行替代,髋臼假体固定好,无髋臼假体松动及移位,无新发髋臼假体周围骨溶解,无异位骨化、脱位、深静脉血栓形成及感染等并发症.结论 清除病灶植骨、保留髋臼假体、更换聚乙烯内衬和股骨头假体的翻修术可有效减少聚乙烯磨损颗粒产生,避免骨溶解病灶进展导致的假体松动,近期随访结果良好.     

混合型初次全髋关节置换术中骨水泥柄10年以上的随访研究

目的回顾性分析混合型初次全髋关节置换术（THA）中骨水泥柄的临床和影像学疗效及其相关影响因素。方法对1999年1月至2001年12月期间接受混合型初次THA治疗髋部疾病的患者126例（135髋）进行至少10年的随访。观察Harris评分、股骨假体位置、骨水泥壳及其周围骨质变化。假体生存率采用Kaplan-Meier方法进行分析,以无菌性松动导致翻修及单纯骨溶解病灶清除植骨术为随访终点。结果共有79例（85髋）获得10年以上随访。Harris评分由术前（44.5±18.8）分提高至末次随访时（92.1±5.6）分。截至随访终点,在Gruen 1区观察到2髋发生骨溶解,7区4髋发生骨溶解现象。共有4例（4髋）接受翻修手术,其中1例男性患者因骨溶解致髋臼假体松动,同侧股骨近端骨溶解,同期行右髋臼侧翻修及股骨侧骨溶解病灶清除植骨术。另3例因髋臼假体松动行髋臼侧翻修术,影像学及术中见股骨假体稳定。以无菌性松动为随访终点,股骨假体生存率为100%;以无菌性松动翻修、单纯骨溶解病灶清除植骨术为随访终点,股骨假体生存率为98.8%（95%可信区间,12.23~12.32）。结论混合型初次THA术中骨水泥假体的远期生存率令人满意;采用第3代骨水泥技术固定的股骨柄取得与现代非骨水泥假体柄相近的远期生存率。     

人工全髋关节置换术后翻修的假体选择

目的探讨人工全髋关节置换术后翻修的假体选择. 方法 1995年1月～2002年6月进行全髋关节翻修术33例(33髋),其中男7髋,女26髋.翻修原因:无菌性松动22例,感染后松动8例(其中2例合并窦道形成);股骨头置换术后髋臼磨损3例,不伴有假体中心性脱位.对无菌性松动和股骨头磨损患者采用骨水泥固定型假体13例,生物固定型假体12例,股骨侧翻修假体均选择骨水泥固定型广泛涂层假体,8例感染患者均行一期骨水泥固定型全髋置换. 结果随访6个月～7年6个月,平均3年11个月.2例出现X线透亮带,但无临床不稳;4例遗留持续性疼痛,无假体脱位、断裂.本组Harris评分由术前的24～47分(平均38.6分),上升为术后的68～88分(平均82.4分),满意率87.9%. 结论无菌性松动是全髋关节置换术后翻修的主要原因.髋臼侧翻修假体可选择骨水泥型假体、也可选择生物型假体,股骨侧翻修假体均选择骨水泥固定型广泛涂层假体,感染后的翻修选择骨水泥假体较好.     

人工髋关节置换术后翻修的原因分析及处理

[目的]探讨人工髋关节置换术后翻修的原因及处理方法。[方法]回顾性分析1993年4月～2015年5月在本科行人工髋关节翻修术患者405例,其中男性202例,女性203例,左侧224例,右侧181例,年龄28岁～93岁,平均(61.43±27.82)岁,总结翻修原因以及手术处理方法等。[结果]假体松动280例,其中柄松动87例,臼松动39例,柄和臼假体均松动154例;翻修前假体平均使用时间6个月～24年,平均(6.68±4.82)年。感染66例,其中16例一期旷置,待感染控制后二期再行假体置入;其余50例均行一期翻修假体置入。关节不稳所致脱位15例,均为闭合复位失败或保守治疗失败, 3例行单纯切开复位, 3例更换内衬和股骨头,1例更换股骨侧假体,3例更换髋臼侧假体,3例行全髋翻修。聚乙烯衬垫磨损但假体无松动14例,8例予以更换内衬和股骨头,4例更换髋臼侧假体和股骨头,2例行全髋翻修。股骨头置换术后髋臼磨损11例,5例仅置换髋臼侧,更换股骨头假体,6例行全髋翻修。股骨柄假体周围骨折11例,以捆绑带固定或钢板螺钉固定或更换加长柄假体结合内固定等治疗。假体机械断裂6例,予以更换假体。股骨柄假体偏心距过大导致疼痛1例,予以更换股骨柄假体。髋臼螺钉位置不当导致坐骨神经症状1例,予以调整髋臼假体和螺钉位置。[结论]假体松动是人工髋关节翻修最常见原因,其次为感染、脱位、聚乙烯磨损、股骨头置换术后髋臼磨损、假体周围骨折等;人工髋关节翻修的方案需根据假体失败的原因、患者具体情况以及医生的经验等因素综合考虑。     

骨水泥填充修复骨缺损在翻修髋臼假体内侧移位松动中的疗效

目的探讨骨水泥填充修复骨缺损结合骨水泥髋臼假体在翻修髋臼假体内侧移位松动中的临床疗效。方法 2006年4月~2011年3月收治16例髋臼假体内侧移位松动患者,均采用骨水泥填充修复骨缺损结合骨水泥聚乙烯髋臼假体翻修松动的髋臼假体,对伴有股骨假体松动的患者,根据患者的骨质情况和骨缺损情况选择骨水泥翻修长柄假体(9例)、非骨水泥型广泛涂层假体(2例)或打压植骨结合骨水泥固定股骨柄假体(1例)。术后进行临床评估及X线评估。结果 16例患者术后平均随访2.6(1.5~6.2)年,未出现臼杯松动病例,Harris评分从术前的35(18~63)分提高到末次随访时的89(60~99)分。结论应用骨水泥填充修复骨缺损结合骨水泥髋臼假体翻修内侧移位松动的髋臼假体是一种有效的手术方法。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。