不同浓度臭氧注入猪椎间盘后氧化效果的实验研究

目的观察低、中、高浓度臭氧注入猪正常椎间盘后不同时间段髓核组织的变化,探索既高效又安全的臭氧浓度,为临床注射臭氧治疗腰椎间盘突出症提供实验依据。方法小型猪10只,于透视下用21G Chiba针刺入猪腰椎间盘中心部,经穿刺针注入臭氧3 ml,重复3次,在椎间孔处注入5 ml于椎旁组织内。其中L5~6,L4~5,L3~4和L2~3分别注入臭氧浓度为90μg/ml,60μg/ml,30μg/ml及无菌空气,L6~S1不进行任何干预,为空白对照。分别在注射后1天、1周、1个月、2个月和3个月后处死动物各2只,在相同时间点进行CT及MR检查。处死后取出椎间盘及椎旁肌肉标本,作大体和光镜下观察,对髓核氧化及退变程度进行量化评分。结果术后3个月内髓核氧化及退变程度评分随时间推移逐渐增高,臭氧浓度越高,增高趋势越明显。术后MRI随访1个月时高浓度组髓核信号T2加权开始减低,其他组不明显。术后2个月注射组所有椎间盘信号均减低,臭氧浓度越高,信号减低越明显。光镜下1天出现髄核细胞的肿胀变性,1周髄核细胞出现与注射浓度正相关的体积缩小和基质含量减少,此后胶原纤维增生,逐渐取代髄核组织,在3个月时,高浓度组髄核干涸的程度,继发纤维化均较中、低浓度组高,并且出现相邻椎体骨性融合。中、高浓度椎旁肌肉注射1周时出现肌纤维肿胀变性及间质黏液变性。结论臭氧浓度越高,髄核的干涸效果越明显,椎间盘退行性变也越明显。高浓度臭氧盘内注射,3个月后椎间盘退变严重,不宜进行临床应用,椎旁肌肉内不宜注射中、高浓度臭氧。     

局部应用GDNF对运动神经的保护作用研究

目的研究周围神经损伤后,经蛛网膜下腔置管局部应用外源性胶质细胞源性神经营养因子（glial cellline-derived neurotrophic factor,GDNF）对脊髓前角运动神经元的保护作用。方法成年SD大鼠随机分为两组,即手术加生理盐水组和手术加GDNF组。切断大鼠坐骨神经致相应脊髓前角运动神经元损伤,于L5、6腰椎椎间隙行蛛网膜下腔置管,并注入外源性GDNF（10μg/mL）,分别与术后4、8、12周行神经功能指数检测;于不同时间处死动物并取材,对L4～6节段脊髓标本冰冻切片,行尼氏体染色、光镜检查,并于术后12周取坐骨神经,行电镜检查并采用图象分析仪检测有髓神经纤维数目、髓鞘厚度和轴突直径。结果GDNF组的坐骨神经功能指数、脊髓前角运动神经元的存活率、有髓神经纤维数目、髓鞘厚度和轴突直径均优于对照组,经统计学处理,两组差异有显著性（P〈0.05）。结论通过蛛网膜下腔注入外源性GDNF保护相应的脊髓运动神经元的同时也促进外周神经功能的恢复。     

罗哌卡因用于蛛网膜下腔阻滞的实验研究

目的：观察不同浓度不同剂量罗哌卡因注入犬的蛛网膜下腔后，脊髓，神经根早期超微结构及脊髓组织髓钙含量的变化。方法：杂种犬18只，雌雄兼有，体重10kg左右，随机分为三组，A组为对照组6只，生理盐水2ml，B组6只，0.5％罗哌卡因2ml(10mg)，C组6只，1％罗哌卡因2ml(20mg)，动物麻醉后对氯胺酮，芬太尼间断静脉注射射维持麻醉。于L3－4穿刺，注入生理盐水或罗哌卡因，于注药后3h，迅速处死动物后，取L1－2脊髓及神经根，每组随机取1mm3脊髓前角组织和神经根，固定于2．5％戊二醛磷酸缓冲液中行透射电镜观察脊髓及神经根超微结构的改变。并采用原子吸收分光光度法测脊髓组织钙含量。结果：（1）C组脊髓组织钙离子含量明显高于A，B两组。（2）A，B两组电镜标本正常，神经膜完整，脊髓标本显示线粒体，内质网完整。C组神经膜分层，部分断裂，脊髓组织线粒体肿胀，部分空泡变性，内质网肿胀。结论：1％浓度的罗哌卡因用于蛛网膜下腔可以造成脊髓缺血损伤，所以诮地蛛网膜下腔还需谨慎。     

腹股沟斜疝患者腰麻术后右下肢股神经损伤一例

正患者,男,65岁,因右侧腹股沟嵌顿疝,拟于蛛网膜下腔麻醉下行右侧腹股沟嵌顿疝松解加无张力补片修补术。麻醉方式为单次蛛网膜下腔阻滞,患者取右侧卧位,于L3~4椎间隙垂直进针穿刺,一次成功,见脑脊液回流后注入0.75%盐酸布比卡因1.8ml,穿刺过程顺利,患者未见任何异常反应,麻醉过程平稳,术毕将患者安全送回病房。术后第2天,患者自述右下肢无力并皮肤感觉障碍,检查示患者右侧大腿前、小腿内     

局部应用GDNF对脊髓前角运动神经元的保护作用研究

目的:研究周围神经损伤后经蛛网膜下腔置管局部应用外源性胶质细胞源性神经营养因子(glial cell line-derived neurotrophic factor,GDNF)对脊髓前角运动神经元的保护作用.方法:成年SD大鼠随机分为2组,GDNF组和生理盐水(NS)组各24只.切断大鼠坐骨神经致相应眷髓前角运动神经元损伤,于L5.6椎间隙行蛛网膜下腔置管,GDNF组注入外源性GDNF 6μl(10μg/ml),NS组同法注6μl生理盐水.不同时间处死动物并取材,对L4-L6节段脊髓标本冰冻切片,行HE染色,尼氏体染色、胆碱酯酶染色.结果:GDNF组脊髓前角运动神经元的存活率、胆碱酯酶阳性颗粒面积均比NS组有明显提高,两组差异有统计学意义(P<0.05).结论:周围神经损伤后通过蛛网膜下腔注入外源性GDNF对相应的脊髓运动神经元有保护作用.     

脑脊液置换治疗颅脑手术后严重颅内感染的护理

对１５例颅脑术后严重颅内感染患者行脑室、脑室－蛛网膜下腔、蛛网膜下腔脑脊液置换治疗。置换过程中通过密切观察病情变化，严格无菌操作，保持引流通畅，正确控制滴速，保持引流量与注入量相等的措施，无并发症，均痊愈出应注意每日留取脑脊液标本行生化检查，及发现神经系统内环境系乱和电解质失衡。     

硬膜外不同浓度辣椒辣素对兔痛阈、神经功能和脊髓神经元结构的影响

目的 观察硬膜外不同浓度辣椒辣素（CAP）对兔痛阈、神经功能和脊髓神经元结构的影响。方法健康新西兰雄性白兔36只，随机分为4组：对照组、C1、C2、C3组，每组9只。L6.7间隙硬膜外穿刺置管，C1、C2、C3组分别注入0．1％、0．25％、0．5％CAP1ml，对照组注入0．9生理盐水1ml。观察后肢热痛阈和神经功能改变，注药后24h，每组处死3只家兔，在光镜、电镜下观察L6.7脊髓神经元的病理改变。结果与对照组相比，注药后C1、C2、C3组痛阈延长（P〈0．05），随CAP浓度增加，痛阈延长时间增加，而神经功能评分下降。光镜、电镜下显示C2组神经元发生可逆性改变，C3组发生不可逆性改变。结论兔硬膜外注入CAP可延长痛阈，高浓度CAP可导致神经功能和脊髓神经元结构损害。     

椎管内注入Gd-DTPA磁共振造影术

目的 探讨椎管内注入Gd-DTPA磁共振造影术的临床应用价值。方法 41患者造影术前术后均常规自旋回波矢状和轴位扫描，22例术前行水成像脊髓造影术，10例术后行T2WI矢状扫描，9例术后行脂肪抑制自旋回波扫描，腰穿注药量1-2ml，注药后间隔扫描时间为1/2-1h(n=8),1-2h(n=23),2-5h(n=10),5例10-32h内造影术后第2次重复扫描，依据Gd-DTPA与脑脊液混合均匀程度，信号强度和弥散范围分为图像一般和图像良好两类，结果 造影术显示脊髓损伤坏死液化灶与脑脊液相通3例，脑脊液外漏3例，蛛网膜下腔阻塞6例，骶管囊肿与脑脊液相通2例。注药后1h内复查，图像良好3例；2-5h复查，图像良好33例，3例出现轻度头痛，头晕及恶心。结论 该方法是一种安全，有价值的检查技术，它集常规MR检查，X线脊髓造影和CTM的优点，可以发现常规MR检查不能显示的异常改变。     

蛛网膜下隙应用罗比卡因对家兔脊髓和脊神经根的毒性作用

目的家兔蛛网膜下隙注入不同剂量的0.75%罗比卡因后,观察脊髓和脊神经根在光镜和电镜下的改变,以及脊神经纤维的髓鞘面积、轴突面积及其面积比的改变,评价罗比卡因蛛网膜下隙用药的安全性。方法健康家兔24只,雌雄不拘,体重(2.0±0.2)kg。随机分为四组:Ⅰ组6只,0.75%罗比卡因2 mg;Ⅱ组6只,0.75%罗比卡因3 mg;Ⅲ组6只,0.75%罗比卡因4 mg;Ⅳ组(对照组)6只,生理盐水0.2 ml。在蛛网膜下隙穿刺注入生理盐水和罗比卡因后6 h灌注固定,分别从L1及L5脊髓和脊神经根处各取一份标本,染色后作光镜观察及测量,取L1脊髓后角组织和脊神经根作电镜观察。结果光镜下Ⅳ组无明显改变,Ⅰ组和Ⅱ组同Ⅳ组,Ⅲ组中有部分家兔脊髓神经细胞出现水肿,浆内尼氏小体欠清,个别神经节细胞水肿。各组神经根无明显改变,神经纤维的髓鞘面积、轴突面积及其面积比均无显著改变。电镜下Ⅳ组结构基本正常,Ⅰ组和Ⅱ组部分髓鞘出现分离及排列紊乱,Ⅲ组部分髓鞘出现分离及排列紊乱,有的出现断裂,部分线粒体出现空泡变性,少数粗面内质网脱颗粒。结论家兔蛛网膜下隙应用0.75%罗比卡因2 mg可引起髓鞘分离及排列紊乱。     

椎管内注射氯胺酮

1980年 Altura 等研究氯胺酮对血管平滑肌功能的影响时,发现氯胺酮有类似局麻药效果。1981年 Tung 将微量氯胺酮注入鼠的蛛网膜下腔,证实有止痛效果而无明显副作用。1982年 Brock-utne等为了观察氯胺酮及其防腐剂氯化苄乙氧铵(ben-zethonium chloride)注入蛛网膜下腔是否安全,所以选6只成年狒狒进行单盲法随机试验。给狒狒肌注氯胺酮后施行腰穿,其中2只注生理盐水作对照,给另外4只的蛛网膜下腔内注入上述含防腐剂的氯胺酮0.06mg/kg。麻醉很快苏醒,在3～4小时内未见任何异常反应或活动。1个月后将此6只狒狒全部宰杀并进行解剖,肉眼观察脊髓及其各层被膜未发现异常,显微镜检查也没有发现任何炎症反应或硬膜增厚。注生理盐水和注氯胺酮的两组动物均有1～2对神经根水肿,但与穿刺部位无关。结论是氯胺酮注入蛛网膜下腔是安全的。     

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。