老年髋部骨折患者行前方入路和后外侧入路人工全髋关节置换术的效果观察

目的 观察老年髋部骨折患者行前方入路和后外侧入路人工全髋关节置换术的效果。方法 将446例行人工全髋关节置换术的患者随机分为观察组(前方入路人工全髋关节置换术,n=176)和对照组(后外侧入路人工全髋关节置换术,n=270)。观察两组相关指标。结果 观察组切口长度、出血量、引流量、部分负重时间、住院时间均短于或少于对照组,差异有统计学意义(P<0.05);两组手术时间比较无差异(P>0.05);术后1周,两组Harris、VAS评分比较无差异(P>0.05),术后3个月,两组Harris评分均升高,VAS评分均降低,且观察组更显著,差异有统计学意义(P<0.05);治疗后,观察组生活质量的各项评分均高于对照组,差异有统计学意义(P<0.05);术后1周,两组髋关节活动度比较无差异(P>0.05),术后3个月,两组髋关节活动度均升高,且观察组更高,差异有统计学意义(P<0.05);两组并发症发生率比较无差异(P>0.05)。结论 前方入路人工全髋关节置换术治疗老年髋部骨折创伤小,术后恢复时间短,髋关节功能恢复好,增大髋关节活动度,减轻疼痛感...     

全髋关节置换术治疗强直性脊柱炎髋关节骨性强直的疗效观察

目的 探讨全髋关节置换术治疗强直性脊柱炎髋关节骨性强直的临床疗效.方法 将强直性脊柱炎髋关节骨性强直患者43例遵照知情同意原则随机分为观察组（23例）和对照组（20例）,分别采用全髋关节置换术与保守治疗,比较分析两组患者的临床疗效.结果 观察组患者的术后髋关节Harris评分及VAS疼痛评分均明显优于对照组,组间差异均有统计学意义（均P＜0.05）.两组优良率分别为91.3%、60.0%,差异有统计学意义（x2=4.328,P＜0.05）.结论 全髋关节置换术治疗强直性脊柱炎髋关节骨性强直的临床疗效佳,可以提高患者的生活质量,值得临床推广应用.     

老年股骨颈骨折患者内固定与关节置换术后近期生存质量的比较分析

目的：比较切开复位内固定术与全髋关节置换术治疗股骨颈骨折术后老年患者的生存质量。方法回顾性分析了2011年1月至2012年12月在我科室手术治疗股骨颈骨折的老年患者89例。其中行切开复位内固定手术治疗的为对照组,行全髋关节置换术治疗的为观察组。采用Harris评分及SF-36量表评估患者术后1个月、2个月、3个月、6个月及12个月等不同时间点的生存质量。结果共75例患者获得全程随访,随访时间为12个月。前3个月Harris评分及优良率观察组均高于对照组,有统计学差异（P＜0.05）;第6个月及第12个月比较两组间无统计学差异（P＞0.05）;前两个月SF-36量表躯体健康评分观察组高于对照组,有统计学差异（P＜0.05）;第3个月、第6个月及第12个月两组间比较均无统计学差异（P＞0.05）;而SF-36量表精神健康评分两组间比较均无统计学差异（P＞0.05）。结论老年股骨颈骨折患者无论采取切开复位内固定术还是全髋关节置换术治疗,患者术后半年至1年即能获得满意的生存质量;但由于全髋关节置换术治疗患者比切开复位内固定术治疗患者能够更早下床活动,术后并发症相对较少,故患者能够更早获得满意的近期生存质量。     

不同髋关节置换术对髋臼骨折术后髋关节功能的影响及术后并发症观察

目的 研究不同髋关节置换术对髋臼骨折术后髋关节功能的影响并观察术后并发症.方法 抽选2011年1月至2014年12月就诊于本院的髋臼骨折患者96例,按照手术方法不同将入组患者分为观察组(n=51)和对照组(n=45),全麻下观察组给予全髋关节置换术治疗,对照组以全髋关节表面置换术治疗.比较两组患者术前、术后1个月、术后1年髋关节功能评分(Harris评分)、髋关节活动度及并发症发生情况,采用数字等级评估量表(NRS)评估比较两组患者患髋疼痛程度.结果 两组患者术后1个月及术后1年Harris评分均较术前显著提高,且术后1年明显高于术后1个月,差异有统计学意义(P＜0.05);两组患者术前及术后同期比较,差异无统计学意义(P＞0.05).两组患者术后1年髋关节屈曲、外展、内收、外旋、内旋活动度较术前显著较大,差异有统计学意义(P＜0.05);术前及术后两组组间比较髋关节活动度无统计学差异(P＞0.05).观察组与对照组患者术后髋关节疼痛程度较术前显著较低,差异有统计学意义(P＜0.05);术前及术后两组患者组间比较均无统计学差异(P＞0.05).结论 全髋关节置换术及全髋关节表面置换术治疗髋臼骨折患者能获得相当的术后髋关节功能,缓解患髋疼痛,且并发症少,临床可根据患者病情及需要酌情选择手术.     

重建股骨偏心距对人工髋关节置换术后髋关节功能的影响

目的 探讨重建股骨偏心距对人工髋关节置换术后髋关节功能的影响分析。方法 纳入对象为80例于2018年1月至2021年6月在广东省中山市中医院骨科接受人工髋关节置换术治疗的患者,根据股骨偏心距是否得到重建分为对照组与观察组。其中对照组患者30例,未得到重建,观察组患者50例,得到重建。比较两组髋臼外展角及前倾角、髋关节活动度、髋关节功能以及髋外展肌力臂差异。结果 治疗前,观察组与对照组患者健侧以及患侧股骨偏心距比较,差异无统计学意义（P> 0.05）;术后1 d观察组与对照组患者患侧股骨偏心距以及患侧与健侧的偏心距差值比较,观察组小于对照组,差异有统计学意义（P <0.05）;治疗前,观察组与对照组患者的髋关节活动度、髋关节Harris评分以及髋外展肌力臂比较,差异无统计学意义（P> 0.05）;术后半年、术后3个月以及术后1个月,观察组与对照组患者的髋关节活动度、髋关节Harris评分以及髋外展肌力臂比较,观察组大于对照组,差异有统计学意义（P <0.05）;治疗前、术后半年,观察组与对照组患者髋臼前倾角以及外展角的值比较,差异无统计学意义（P> 0.05...     

人工髋关节置换术治疗股骨头缺血性坏死的疗效观察

目的观察人工髋关节置换术治疗股骨头缺血性坏死的疗效。方法选取我院收治的112例股骨头缺血性坏死患者,根据人工髋关节置换术中假体类型的不同分成生物型组与骨水泥组。观察两组疗效。结果两组患者术前Harris评分相比差异无统计学意义（P〉0.05）;术后各个时间点组间差异无统计学意义（P〉0.05）。两组患者治疗后3、6、12个月Harris评分相比术前均显著提高,差异有统计学意义（P〈0.05）。两组患者术中出血量与住院时间相比差异无统计学意义（P〉0.05）;生物型组患者手术时间相比骨水泥组患者显著减少,差异有统计学意义（P〈0.05）。两组患者并发生发生率相比差异有统计学意义（P〈0.05）。结论人工髋关节置换术治疗股骨头缺血性坏死选择生物型假体与骨水泥型假体均能够取得显著的近期效果,在临床中应根据具体情况进行选择。     

全髋关节置换治疗老年股骨颈骨折的疗效和安全性分析

目的：探讨全髋关节置换术在治疗老年股骨颈骨折中的疗效和安全性。方法选取我院老年股骨颈骨折患者98例,其中实验组50例使用全髋关节置换术治疗,对照组48例用人工股骨头置换术治疗,观察对比两组手术时间、术后出血量、术后引流量、住院时间以及两组Harris评分和优良率的差别。结果实验组手术时间明显长于对照组,术后出血量和术后引流量较对照组多,两组差异有统计学意义（P〈0.05）,实验组住院时间长于对照组（P〈0.05）。术后1年实验组和对照组的Harris评分以及优良率无明显差异（P〉0.05）,但在术后3年和术后5年两组Harris评分以及优良率比较,实验组明显高于对照组,两组差异有统计学意义（P〈0.05）。结论人工股骨头置换术创伤小、手术时间短、出血量和术后引流量较少、住院时间短,但全髋关节置换术在远期疗效上要优于人工股骨头置换术。     

人工髋关节置换术与常规内固定手术治疗髋关节骨折的疗效比较

目的 观察并比较对髋关节骨折患者实施人工髋关节置换术与常规内固定手术的效果。方法 将本院2020年1月至2021年6月收治的68例髋关节骨折纳入研究,以入院先后顺序按奇偶数分为2组（各34例）,对照组采取常规内固定手术治疗,观察组行人工髋关节置换术治疗,比较2组手术效果。结果 观察组手术总优良率（97.06%）优于对照组（82.35%）(P<0.05);观察组术中出血量、术后引流量少于对照组,手术时间及下地负重时间短于对照组（P<0.05）;术前2组Harris评分及术后1d的VAS评分比较无统计学意义（P>0.05）,观察组术后1周VAS评分低于对照组（P<0.05）;术后6个月观察组Harris评分高于对照组;观察组并发症总发生率（5.88%）低于对照组（23.52%）(P<0.05)。结论 人工髋关节置换术治疗髋关节骨折疗效确切,较常规内固定术相比,手术时间短,下地负重时间早,术中出血量及术后引流量、并发症少,并能减轻术后疼痛感,促进髋关节功能恢复,值得推广实施。     

延续功能康复训练对社区老年全髋关节置换术后患者机体康复的影响

目的 探讨延续功能康复护理对社区老年全髋关节置换术后患者机体康复的影响.方法 对社区在2015年1月至2016年10月期间接受全髋关节置换术后的85例患者,分成对照组40例,出院后定期回院复诊;观察组45例出院后定期门诊复诊,并接受延续功能康复护理指导.两组患者出院前和出院后Harris髋关节评分,康复护理知识掌握、术后并发症发生、服务满意度比较.结果 两组患者术后满2周Harris髋关节评分,差异无统计学意义(P＞0.05),但术后满4、8、16、24周的Harris髋关节评分,观察组患者优于对照组患者,差异有统计学意义(P＜0.05);术后发生关节脱位对照组有4例,观察组为0例,两组比较,差异有统计学意义(P＜0.05);掌握康复护理知识观察组高于对照组,差异有统计学意义(P＜0.05).结论 延续功能康复训练能促进社区老年全髋关节置换术后患者的术后康复训练,促进髋关节功能恢复,减少并发症,提高患者术后康复质量和生活质量.     

髓芯减压与钽棒植入治疗早期股骨头坏死的比较

目的：对比多孔髓芯减压与钽金属棒治疗早期股骨头坏死的临床疗效。方法：将早期股骨头坏死患者29例36髋随机分为2组,髓芯减压组17例22髋采用多孔髓芯减压治疗患髋,钽棒组12例14髋采用多孔钽金属棒治疗。术后3月、6月、12月随访比较2组病例髋关节功能Harris评分和视觉模拟疼痛评分(VAS)。并于末次随访时,根据ARCO分期和坏死面积大小进行VAS评分及Harris评分。结果：所有患者均获得随访,随访时间6～12个月,平均10.5个月。术后3月、6月、12月2组患者VAS评分均较术前明显降低（P＜0.05）,髋关节功能Harris评分均较术前明显提高（P＜0.05）。但相同随访时间点2组VAS评分和Harris评分均无显著差异（P＞0.05）。末次随访时ARCOⅡb期、Ⅲ期患者VAS评分明显高于Ⅰ期、Ⅱa期患者,髋关节功能Harris评分明显低于Ⅰ期、Ⅱa期患者（P＜0.05）。股骨头坏死面积＜25%患者VAS评分明显低于坏死面积＞25%患者,髋关节功能Harris评分明显高于坏死面积＞25%患者（P＜0.05）。结论：多孔髓芯减压和钽金属棒治疗早期股骨头坏死均有效,但ARCOⅡb期、Ⅲ期及股骨头坏死面积＞25%患者预后欠佳。     

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.     

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.     

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.