髋臼Y形软骨损伤对髋关节发育影响的实验研究

目的探讨“Y”形软骨损伤后骨骺早闭对髋关节发育的影响。方法选用10只4~5周龄大白兔,切除、破坏右侧髋臼部分“Y”形软骨,左侧髋关节不行处理,作为对照。X线动态观察双侧髋关节发育状况,术后12周处死动物,进行形态学及组织学观察。结果手术侧术后3周“Y”形软骨均出现骨骺早闭,髋臼内壁增厚、髋臼变浅;术后6~9周髋臼浅且形态不规则,4例出现半脱位;术后12周全部出现关节发育不良,50%的髋关节发生半脱位。形态学观察见髋臼变浅,内壁厚度增加,股骨头增大、变扁,关节软骨失去光泽,部分缺失。HE染色见髋臼及股骨头软骨层变薄,软骨细胞排列紊乱,骺板扭曲、变薄。对照侧各髋关节形态结构正常。手术侧各期臼头指数、相对髋臼指数及臼壁厚度与对照侧相比差异均有显著性意义(P<0.05)。手术侧术后12周臼头指数及相对髋臼指数与术后第2d相比差异有非常显著性意义(P<0.01)。结论“Y”形软骨损伤可导致骨桥形成、骨骺早闭,使髋臼内壁增厚、髋臼变浅,继而引发髋关节发育不良和半脱位。     

儿童骶臼发育不良的手术治疗

髋臼发育不良是儿童髋关节的常见病，也是发生退行性骨关节炎的主要原因之一犤１－３犦。Stulberg等犤４犦报告１３０例成人骨关节炎患者中，有４８％继发于婴幼儿时期的髋臼发育不良。正常髋关节的股骨头和髋臼呈同心圆关系。儿童髋臼的正常发育主要依赖于股骨头对“Y”形软骨中心的刺激。在髋臼发育不良状态下，头臼失去同心圆关系，股骨头不能刺激“Y”形软骨中心，髋臼软骨骨化迟缓、停滞，髋臼的深度逐渐变浅、坡度增加，使髋关节受力面积减小，应力增大，负重力线移向髋臼外侧缘。随患儿步行和负重的增加，髋关节可出现进行性半脱位…     

髋臼发育不良的动物模型制作及其临床意义

目的: 该实验借助大体标本、X线片和组织病理切片观察, 阐述髋臼发育不良导致髋关节脱位的发病过程和评价动物模型的可靠性。方法: 将 12只 4个月龄兔通过外科手术造成单侧髋关节半脱位动物模型, 手术后 4、6、8周, 观察兔髋关节脱位和继发性假臼形成的过程。结果: 手术后 4周, X线片未发现髋关节脱位, 大体解剖和组织病理切片观察髋臼缘软骨面基本完好。手术后6、8周, X线片示完全性髋关节脱位, 大体解剖和组织病理切片观察髋臼顶缘软骨不同程度变性脱落坏死, 而且手术后 8周, 髋臼缘上部髂骨外板有假臼形成。结论: 本实验所建立的近似于髋臼发育不良导致先天性髋关节脱位的动物模型, 简单可靠, 为此类疾病的研究提供了必要的实验基础。     

髋臼发育不良髋臼缘生物力学测定

[目的]证实由于兔髋臼发育不良，股骨头被髋臼所覆盖的面积减少，股骨头的球状关节和髋臼的舟状关节负重面趋于集中，头臼关节不能耐受高度集中的强大的机械应力作用，最终导致髋关节脱位．[方法]本实验利用七V13型数据采集记录仪、X线片和组织病理切片对对照组和实验组髋关节进行力学测定和病理学观察一[结果]实验组髋臼缘软骨逐渐发生退变和变形，髋臼缘A、B、C、D4点位置，所受应力均有变化。对照组和实验组，t检验，P〈0．01。[结论]本实验对髋臼发育不良兔髋臼缘力学测定，可以推测人类先天性髋关节脱位的机理和原冈与髋臼发育不良有密切联系。先天性髋关节脱位患儿应早期发现，早期治疗，提高临床治疗效果。     

髋臼发育不良（developmental dysplasia of thehip，DDH）

髋臼发育不良属于髋关节发育异常（developmental dysplasia of hip，DDH）的一种，是指由于髋臼发育缺陷造成髋臼对股骨头的覆盖不良，导致长期生物力学的异常而逐渐出现股骨头半脱位、负重区软骨退变及股骨头局灶性坏死、严重骨关节炎的一种疾病，主要病理改变表现为髋臼外上方和前方缺损，髋臼变浅，髋关节中心外移，致使髋臼对股骨头的包容与覆盖不足。髋臼发育不良可以伴有髋关节不同程度的半脱位。由于髋臼对股骨头覆盖率减低，髋臼和股骨关节面对合关系不正常，     

挖深髋臼对髋关节发育影响的实验研究

目前，对治疗先天性髋关节脱位的挖臼手术，尚有争论。为探讨挖除范围对髋关节发育的影响，作者将出壳饲养２个月的鸡雏６０只，分成左髋切开脱位再复位、左髋臼软骨部分挖除和左髋臼软骨全部挖除三组。全部动物均以自身右侧为对照。结果发现：局挖组（部分挖臼）关节活动尚可，粘连局限且轻微，对关节发育影响不大。而全挖组，则关节功能严重受损，臼内广泛粘连；光镜和电镜观察见髋臼表面被纤维组织替代，残留的软骨细胞或再生的软骨细胞有变异；股骨头亦发生类似变化。提示临床：治疗先天性髋脱位，全部挖除髋臼软骨是不可取的；若臼底有限局性骨性突起，局部挖除是允许的。     

CroweⅡ和Ⅲ型发育性髋关节发育不良髋臼重建的研究现状

发育性髋关节发育不良因其往往造成严重髋关节炎影响髋关节功能而成为目前全髋关节置换手术的一大病因.因其特殊的髋臼形态使得在为此类患者进行全髋关节置换时髋臼的重建成为一直以来讨论的重点问题.尤其是在分型为CroweⅡ、Ⅲ型的髋臼中,由于股骨头的脱位造成真臼上方的骨缺损导致在真臼处重建髋臼时臼杯的稳定性必将受到影响.许多髋臼...     

机械应力对幼鼠髋臼发育影响的实验研究

目的阐明异常机械应力对髋臼发育和髋臼软骨生长板内软骨细胞增殖的影响,探讨髋臼发育不良的修复方法。方法将60只3周龄的雌性Wistar大鼠分成3组,每组20只,左侧髋关节为实验侧,右侧为对照侧。A组:在2周内反复将髋关节手法脱位后再复位;B组:膝关节伸直位钢针固定,制作髋臼发育不良的动物模型,2周后拔出钢针;C组:持续伸直位固定膝关节。三组动物分别于第5、7、9、12周时进行钼靶软X线、组织形态学及透射电镜观察。结果A组第5周时唇缘变钝,髋臼角比对侧增大约5°,软骨生长板内增殖层软骨细胞极向紊乱,SO染色无差异,圆韧带有淋巴细胞浸润,第7、9、12周时变化小,两侧无差异;B组第5周时髋臼角比对侧明显增大,第7周时唇缘变钝、内翻,纤维增生,柱状细胞极性紊乱,肥大细胞层增多,第9、12周时接近正常,12周时髋臼角为23.4°,髋臼入口最短径为5.0mm;C组髋臼角比对侧持续增大,没有任何改善倾向,第12周时唇缘内翻、扁平,无明显柱状细胞排列,细胞核变小,细胞器减少,空泡形成,髋臼角为71.3°,髋臼入口最短径为2.9mm。结论在髋臼发育旺盛期解除异常机械应力、恢复头臼同心,髋臼发育不良有治愈倾向。造成髋臼发育不良的直接原因是软骨生长板内增殖层软骨细胞代谢功能发生改变,骨化延迟。     

V形镍钛合金支架植入治疗犬髋臼发育不良的实验研究

目的 探讨Ｖ形镍钛合金（记忆合金）支架植入髋臼顶部后,对其髋臼发育不良的矫正及对其髋臼发育的影响。方法 选用髋臼发育不良的幼犬１０只,随机分为２组,在髋臼顶部距臼缘上０．５ｃｍ处用弧形骨刀做与髋臼弧度一致的截骨,其截骨深达Ｙ形软骨,将截骨后的骨瓣向下扳压,在骨瓣上方植入２￣３只Ｖ形镍钛合金支架,术后４、１２周行双髋关节Ｘ线摄片,进行大体及组织学观察。结果 术后１２周髋臼顶部由术前斜坡形恢复为弧形,     

髋关节发育不良的病理演变

髋关节发育不良是指髋臼或股骨头的形状、大小以及他们之间的关系发育异常 ,常见类型是髋臼发育不良及头臼包容异常。其病因尚不清楚 ,临床上缺乏统一的诊断和分型标准 ,治疗方法的选择也有较多分歧。本文就髋关节发育不良的病理特征、病理演变规律及治疗后病变转归等情况做一综述。1　髋关节的正常发育髋关节的正常发育依赖于股骨近端、髋臼软骨、“Ｙ”形软骨和周围骨的平衡生长 ,受基因调控。胚胎 8周时 ,髋关节的轮廓形成 ,1 1周时髋关节已完全形成。胎儿期髋关节全部由软骨组成 ,髋臼顶由髂骨干骺部组成 ,向后方呈偏心性生长 ,由于髋臼…     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.