关于镜下清理与注入玻璃酸钠治疗膝关节骨关节炎的疗效分析

目的:探讨应用关节镜下清理术联合术后关节腔内注射玻璃酸钠治疗膝关节骨关节炎的临床疗效.方法:2005年2月～2007年11月的41例膝关节骨关节炎患者经关节镜下清理术联合术后关节腔内注射玻璃酸钠1个疗程的资料进行分析.结果:术后随访8～26个月,平均随访13个月,疗效:优18例,良13例,可7例,差3例.结论:关节镜下清理术联合术后关节腔内注射玻璃酸钠是治疗膝关节骨关节炎的一种较好方法,具有手术创伤小,并发症少,关节功能恢复满意等优点.     

关节镜下清理并置管冲洗治疗膝关节化脓性关节炎27例

目的 探讨关节镜下清理及术后大流量持续冲洗治疗膝关节化脓性关节炎的效果.方法 我科2007年9月-2011年10月采用关节镜下清理及术后持续大流量冲洗治疗膝关节化脓性关节炎27例(29膝).结果 本组26例(28膝)获得随访,1例失访,随访时间6～36个月.获随访患者关节感染均治愈,无复发,无切口感染等手术并发症;手术后平均住院日10 d;术后6个月采用Lysholm评分标准评定疗效:优20例(21膝),良5例(6膝),差1例(1膝),优良率为96.43%.结论 采用关节镜下清理及术后持续冲洗治疗膝关节化脓性关节炎具有损伤小、清理彻底、治疗时间短、并发症少等优点,是一种理想的治疗方法.     

关节镜下清理术治疗膝关节化脓性关节炎22例

目的探讨关节镜下清理术治疗膝关节化脓性关节炎的方法及疗效。方法对22例膝关节化脓性关节炎采用关节镜下关节清理术,术后关节腔持续冲洗引流,早期渐进性膝关节功能锻炼。定期随访进行疗效评价。结果22例急性膝关节化脓性关节炎患者均治愈,无1例复发,关节功能恢复良好。结论采用关节镜下关节清理术治疗膝关节化脓性关节炎,创伤小、恢复快、疗效明显。     

关节镜清理术联合关节腔注射透明质酸治疗膝关节骨性关节炎

目的:探讨关节镜清理术联合关节腔注射透明质酸治疗膝关节骨性关节炎的疗效。方法:30例(30膝)膝关节骨性关节炎患者采用关节镜微创治疗,术后应用透明质酸关节腔内注射治疗。结果:30例均获随访,时间3个月～2年。优20例,良8例,可1例,差1例。结论:关节镜清理术联合应用透明质酸关节腔注射治疗膝关节骨性关节炎临床疗效满意。     

膝关节滑膜软骨瘤病的关节镜诊断与治疗

目的总结关节镜诊断和治疗膝关节滑膜软骨瘤病的疗效。方法11例（12膝;左膝4例,右膝6例,双膝1例）,主要临床症状为膝关节疼痛、交锁及复发性的关节肿胀。所有患者均采用关节镜诊断与手术治疗。包括关节镜探查,切除病变滑膜,取出游离体,对退行性病变进行清理。结果平随访均24．4个月,所有病例术前疼痛、交锁症状消失,术后关节功能恢复良好,未见复发。结论关节镜有手术创伤小,恢复快和病变滑膜切除彻底等优点,是膝关节滑膜软骨瘤病的有效诊断和治疗方法。     

关节镜膝关节(含后关节腔)游离体取出术43例临床分析

目的探讨和评价关节镜膝关节(含后关节腔)游离体取出的手术治疗方法及效果。方法对2010年1月至2012年12月收治的43例膝关节(含后关节腔2例)游离体患者采取关节镜手术,行游离体取出,若并发骨关节炎,术中先进行关节清理,若并发半月板损伤,术中先进行关节镜半月板修整成形术或缝合修复术。后关节腔游离体取出术需辅助后内入路。结果 43例患者术后全部得到随访,膝关节疼痛大部分得到缓解,关节屈伸功能明显改善,无一例患者发生感染,其中1例患者术后出现反复关节积液,经抽液、对症等处理1个月后缓解。结论关节镜膝关节(含后关节腔)游离体取出术创伤小,效果确切,不良反应小,值得推荐。     

关节镜下骨髓间充质干细胞复合纤维蛋白封闭剂治疗膝关节软骨缺损

目的:比较关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂与关节清理灌洗术治疗膝关节软骨全层缺损的临床疗效。方法:对2002年1月-2005年5月膝关节全层软骨缺损患者,分别行膝关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂(实验组24例)与关节清理灌洗术(对照组21例),根据临床症状及Tenner运动评级判定疗效,随访观察6~24个月。结果:关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂总有效率91.7%,关节清理灌洗术总有效率66.7%,组间比较有统计学意义(P<0.05)。结论:关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂治疗膝关节软骨全层缺损优于关节清理灌洗术。     

关节镜下清理＋髁间窝成形术在膝关节骨性关节炎伴髁让窝狭窄治疗中的临床观察

目的探讨关节镜下膝关节清理＋髁间窝成形术对膝关节骨性关节炎伴髁间窝狭窄治疗的临床效果。方法选择膝关节骨性关节炎伴髁间窝狭窄的患者12例在关节镜下行膝关节清理＋髁间窝成形术,所有患者术后随访6～24个月。结果术后膝关节伸直受限及铰锁完全解除;膝关节疼痛完全消失9例,关节行走时偶有疼痛2例,行走时轻度疼痛但可忍受1例。结论关节镜下关节清理＋髁间窝成形手术具有创伤小,痛苦少,疗效显著,是治疗治疗膝关节骨性关节炎伴髁间窝狭窄的一种有效措施。     

利奈唑胺对骨科手术患者术后抗革兰阳性菌感染的临床疗效评价

目的:分析利奈唑胺对骨科手术患者术后革兰阳性菌感染特点及其抗感染治疗的临床疗效。方法:选取2015年1月—2017年3月期间收治的骨科手术革兰阳性菌感染患者54例临床资料,采用回顾性分析法分析术后革兰阳性菌感染的特点。结果:54例患者中,经检测结果示革兰阳性菌感染,其中26例患者为腰椎术后感染,16例患者为四肢管状骨骨折内固定术后感染,12例患者为髋关节术后假体周围发生感染;用药后治疗的总有效率为96.30%,药效起作用时间在3～10 d内,其中33例患者直接采用利奈唑胺治疗,用药之后有效的为31例(93.94%),21例患者经万古霉素治疗无效或耐受效果较差,则采用利奈唑胺治疗后有效的为16例(76.19%);12例患者用药期间发生不良反应,用药停止后不良反应消失。结论:骨科手术患者术后感染革兰阳性菌,采用利奈唑胺治疗安全有效,且治疗效果较为确切。     

关节镜清理术联合关节腔注射透明质酸治疗膝关节骨性关节炎

目的：探讨关节镜清理术联合关节腔注射透明质酸治疗膝关节骨性关节炎的疗效。方法：30例（30膝）膝关节骨性关节炎患者采用关节镜微创治疗,术后应用透明质酸关节腔内注射治疗。结果：30例均获随访,时间3个月～2年。优20例,良8例,可1例,差1例。结论：关节镜清理术联合应用透明质酸关节腔注射治疗膝关节骨性关节炎临床疗效满意。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.