自体骨修复初次全膝关节置换术中胫骨骨缺损的临床研究

目的为了探讨初次全膝关节置换术中自体骨修复胫骨平台骨缺损患者植骨处的骨密度变化及骨愈合情况,对自体骨修复胫骨平台骨缺损患者的随访探讨。方法收集2008年6月至2010年3月,在15例（16膝）初次全膝关节置换术中,采用自体骨移植的方法修复胫骨平台骨缺损的患者。对照组收集同期的14例（16膝）无骨缺损患者。应用X线拍片及双能X线骨密度仪（DEXA）观察术后6个月、12个月时胫骨假体下骨密度。分为3个兴趣区（ROI）,对各个区内平均骨密度变化进行观察和分析。结果术后6个月时胫骨平台骨缺损处ROI的骨密度：（0.967±0.320）g/cm2,对照组ROI的骨密度：（0.946±0.263）g/cm2;术后12个月时胫骨平台骨缺损处ROI的骨密度：（0.808±0.258）g/cm2,对照组ROI的骨密度：（0.806±0.262）g/cm2。术后12个月时胫骨平台骨缺损植骨处平均骨密度较6个月时均数略有下降,但无统计学差异（P〉0.05）;术后6个月与12个月时胫骨平台骨缺损自体骨植骨处平均骨密度较无骨缺损患者ROI的骨密度无显著性差异（P〉0.05）。结论自体骨修复胫骨平台骨缺损的全膝关节置换术后患者植骨处骨密度较无骨缺损患者的骨密度无明显变化,骨愈合情况良好。     

全膝关节置换术中胫骨近端倾斜型骨缺损的重建

目的 通过对全膝关节置换术中腔骨近端倾斜型骨缺损的重建，介绍应用自体胫骨进行胫骨平台重建的方法和体会。方法 1992年11月～2000年9月．对22例(29膝)有胫骨近端倾斜型骨缺损的膝关节行全膝关节置换及自体胫骨移植术，男5例(5膝)，女17例(24膝)；年龄43～78岁，平均61．2岁。手术前诊断：骨关节炎13例(14膝)，其中膝内翻12例(13膝)，膝外翻1例(1膝)；类风湿关节炎7例(12膝)；滑膜软骨瘤病1例(1膝)；大骨节病1例(2膝)。术中将胫骨平台倾斜型骨缺损修整成台阶状水平型骨缺损。将截下的胫骨平台骨块修整后使其厚度和形状与缺损处匹配，并将带有皮质骨的部分尽量放置在台阶状缺损的外缘，以承受平台的压力。术中植骨厚度为8～15mm，平均10mm在置入假体以及在骨水泥固化之前，应在植骨块侧方加压。所有膝关节假体均采用抗生素骨水泥固定。结果 术后随访1～9年，平均4．2年，除1例因迟发性感染和植骨吸收再次出现膝内翻畸形和假体松动而行Ⅰ B-Ⅱ楔形假体翻修外．其它病例未发现自体移植骨的不愈合、移位、骨折、骨吸收和胫骨假体松动，HSS膝关节评分由术前10～26分提高到术后76～94分。结论 在胫骨近端倾斜型骨缺损的全膝关节置换术中，采用自体胫骨移植可恢复胫骨平台的完整性．防止平台塌陷．并为假体提供良好的初始稳定性，提高手术的成功率。     

外侧闭合楔形胫骨近端截骨术的远期疗效分析//韩国首尔庆熙大学医学院矫形外科

[目的]探讨胫骨近端截骨术治疗原发性胫骨近端骨性关节炎的远期疗效以及最佳的截骨矫正角度。[方法]自1985～1997年，79例（111膝）原发性骨性关节炎患者接受了胫骨近端截骨术。其中男5例（5膝），女74例（106膝）；年龄37～70岁（平均55岁）。根据术后胫股角（FTA）分为3组。Ⅰ组61膝FTA〈7°；Ⅱ组23膝FTA7°～9°；Ⅲ组27膝FTA≥10°。所有病例术前、术后按特种外科医院评分系统（HSS）评分。[结果]术后随访2年4个月～14年1个月（平均9年6个月）。术前HSS平均60分，术后1年平均94分，末次随访平均87分。采用2种方法判定手术失败：方法1为需行人工全膝关节置换术者，随访4年和14年手术成功率分别为99％和85％；方法2为需行人工全膝关节置换术者或术后HSS评分〈60分，随访4年和14年手术成功率分别为96．4％和75．1％。[结论]胫骨近端截骨术是治疗单间室骨性关节炎的有效方法，但术后胫股角应矫正到外翻7°以上（范围10°～15°）。     

同种异体骨颗粒复合自体骨移植治疗近膝关节骨巨细胞瘤骨缺损

[目的]探讨同种异体骨颗粒和自体骨复合体在近膝关节骨巨细胞瘤骨缺损的疗效。[方法]自1996年3月-2006年3月,24例膝周患者经病理检查证实为骨巨细胞瘤;其中股骨远端骨巨细胞瘤11例,胫骨近端骨巨细胞瘤13例。以机械及化学方法将同种异体骨进行脱抗原处理为骨颗粒,术中将骨巨细胞瘤于外科边缘彻底刮除,将同种异体骨颗粒复合取得的自体骨彻底紧密填塞骨缺损空腔;术后支具外固定辅助活动膝关节12周。[结果]本组术后早期均未发生严重并发症。24例病例术后随访1-6年,平均2年8个月。所有病例均未见肿瘤复发,1例发生轻度病理性骨折,经制动2个月治愈。所有骨移植体X线片上显示理想的替代形态。疗效评定采用M ank in评定标准,优：20例,良：4例,优良率达100%。[结论]同种异体骨颗粒复合自体骨移植能有效治疗近膝关节骨巨细胞瘤造成的骨缺损。     

骨性关节炎患者人工膝关节假体旋转定位标志研究

目的探讨对合并内、外翻畸形的膝关节骨性关节炎行人工全膝关节置换术，以股骨内外上髁外科轴（surgical epicondylar axis，SEA）作为股骨假体旋转参考轴，以胫骨结节内1／3作为胫骨假体旋转定位的骨性标志，判断股骨假体和胫骨假体的旋转对线情况。方法2004年7月～2005年1月，对32例（62膝）拟行人工全膝关节置换术的膝关节骨性关节炎患者（病例组），男2例，女30例；年龄58～80岁，平均68．9岁；内翻畸形55膝，胫股角平均内翻-8．23°；外翻畸形7膝，胫股角平均外翻＋15．48°。于术前行伸膝旋转中立位CT扫描，测量膝关节股骨后髁角（posterior condylar angle，PCA），并以10个正常膝关节作为对照组，测量SEA中点C与髌腱内1／3连线（BC）和经SEA中点C的垂线（AC）之间的夹角，即α角。结果病例组80％以上膝关节CT图像显示股骨内上髁陷凹；PCA中位数为＋2．36°（0～＋7．5°）；对照组膝关节α角为＋6．45±3．68°（0～＋11．8°）；病例组内翻畸形患者膝关节α角为＋10．85±10．47°（0～＋28．1°），与对照组比较差异有统计学意义（P〈0．05），病例组外翻畸形患者膝关节α角为＋11．6±7．3°（-6．5～＋26．8°），与对照组比较差异有统计学意义（P〈0．05）。结论以胫骨结节内1／3作为胫骨假体旋转参考轴线，胫骨假体相对于股骨假体处于轻度外旋位；合并内、外翻畸形患者的胫骨假体外旋角度明显增大，容易使股骨假体和胫骨假体间出现旋转对线不良。     

人工全膝关节置换术治疗膝关节伸直位强直畸形

目的探讨膝关节伸直位强直畸形患者行人工全膝关节置换术的手术要点和术后效果。方法1996年1月至2006年6月,对8例（9膝）膝关节伸直位强直畸形患者行人工全膝关节置换术。术前膝关节活动度均为0°,KSS膝关节评分平均为44分（10～68分）,功能评分平均为17分（-10～55分）。结果8例患者（9膝）围手术期出现的并发症包括髌腱止点撕脱1膝,髌骨下极部分撕脱骨折1膝,术后早期关节血肿1膝,皮肤浅表性感染1膝,经对症治疗后所有患者均治愈出院。术后平均随访40．4个月（7．0～120．0个月）,术后膝关节平均活动度89°（50°～120°）,术后KSS膝关节评分平均为81分（55～93分）,功能评分平均为79分（50～90分）。2例2膝分别存在5°和25°的伸展滞缺。1例1膝因为关节不稳于术后1年行翻修术,更换加厚的胫骨平台垫片。结论膝关节伸直位强直畸形患者行人工全膝关节置换术难度大,并发症发生率较高,但如能恰当处理,仍可以取得较满意的临床效果。术中膝关节的充分暴露,保留足够的髌骨床厚度,保护髌腱和膝关节的血液供应以及正确的软组织平衡技术是手术的关键。     

计算机辅助与传统方法全膝关节置换术术后下肢机械轴的比较研究

目的对比计算机辅助下（导航）全膝关节置换术及同期传统方法全膝关节置换术术后下肢轴线的差异。方法连续无选择病例30例39膝在计算机导航下行全膝关节置换术并与同期采用传统方法连续无选择的全膝关节置换术29例39膝进行对照。分别拍摄术后膝关节正侧位X线片、双下肢全长X线片，分别记录两组的术后下肢轴线与股骨及胫骨解剖轴线的关系，并对两组进行比较。结果导航组术后机械轴范围176°-185°，平均180．3°±1．79°。传统组术后机械轴范围176°-187°，平均181．32°±2．51°。两组样本，采用独立样本t检验，t=2．45，P〈0．05，差异有统计学意义。其中：术后机械轴偏差0°（180°）导航组10／39膝（25．64％），传统组9／39膝（23．08％），经卡方检验，χ2=0．07，P〉0．05，差异无统计学意义。偏差≤±1°（179°-181°）导航组27／39膝（69．23％），传统组16／39膝（41．03％），X。=6．27，P〈0．05，两组差异有统计学意义。偏差≤±3°（177°-183°）导航组36／39膝（92．31％），传统组29／39膝（74．36％），χ2=4．52，P〈0．05，两组差异有统计学意义。偏差≥±4°（≤176°或≥184°）导航组为3膝（7．69％），传统组为10膝（25．64％），χ2=4．51，P〈0．05，两组差异有统计学意义。结论计算机辅助下（导航）行全膝关节置换术术后下肢机械轴明显优于传统方法。边缘值（大于184°及小于176°）明显低于传统组。     

髁限制性膝关节假体治疗严重膝内翻畸形合并胫骨平台内侧骨缺损

目的探讨髁限制性膝关节假体在膝骨关节炎严重内翻畸形合并胫骨平台内侧骨缺损行全膝关节置换术中的应用及疗效观察。方法回顾分析2008年1月至2011年1月12例骨性关节炎严重膝内翻畸形合并胫骨平台内侧骨缺损行髁限制性膝关节假体全膝关节置换术患者资料,术前负重位膝内翻畸形平均34°,胫骨平台内侧骨缺损为非包容性,依据AORI分型为Ⅱ、Ⅲ型,采用美国膝关节学会评分（knee society score,KSS）系统评估膝关节功能,包括膝评分和膝功能评分。结果本组均获随访,随访6～18个月,平均13个月,KSS膝评分和膝功能评分从术前（19.5±4.2）分、（16.2±5.4）分提高到术后（87.7±5.6）分、（85.4±8.3）分,分析术前及术后KSS膝评分及膝功能评分的差异有统计学意义。结论髁限制性膝关节假体全膝关节置换是治疗膝骨关节炎严重内翻畸形合并胫骨平台内侧骨缺损的有效方法,术中采取适度的软组织松解及正确的截骨,针对胫骨平台内侧骨缺损选用组合式金属垫块及假体延长柄,适度增加关节的限制性,可以转移力学负荷,增加假体的稳定性,最终获得良好效果。     

初次全膝置换自体骨移植修复胫骨平台骨缺损

[目的]探讨初次行全膝置换术中采用自体骨移植修复严重膝内翻胫骨内侧平台骨缺损的疗效.[方法]回顾性分析2006年2月-2019年3月收治的行初次膝关节表面置换术180例严重膝内翻患者的临床资料,其中86例胫骨截骨后仍存在内侧平台骨缺损、行自体骨移植修复.总结86例患者的临床与影像结果.[结果] 86例患者均顺利完成手术...     

微创技术在人工全膝关节置换术中的应用

目的 探讨微创人工全膝关节置换术的优点及手术风险。方法 2005年2月至2006年4月，对54例患者（70膝）行小切口人工全膝关节置换术，女48例（63膝），男6例（7膝）。年龄43-75岁，平均62．4岁。切口长度9—13cm，平均10．5cm。所有患者均诊断为膝关节骨关节炎，术前关节活动度为伸0°～25°（平均-10．5°），屈80°-135°（平均100°）。手术采用膝正中切口，髌旁内侧入路。不翻转髌骨，利用皮肤的可移动性和膝关节屈伸活动的特点，采用特殊手术器械，完成股骨和胫骨的截骨。通过改变手术操作顺序以尽快创造出操作空间，尽可能减少对髌上囊和后关节囊等软组织的切除和剥离。结果所有患者均未出现皮肤坏死或伤口感染等并发症，手术时间平均为70min（55-150min）。手术切口长度平均为10．5cm（9～13cm）。前35膝术后平均引流530ml（200-800m1），后35膝引流为380ml（200-460ml），平均输血500ml（0-1000m1）。术后第2天即开始进行主动股四头肌功能锻炼，患者术后平均下床时间为5．6d（4-8d），术后9-14d出院，出院时关节活动度平均为100°（90°～120°）。术后末次随访，关节活动度为伸5°-5°（平均0°），屈95°～125°（平均115°）。术前膝关节学会评分为46～69分[平均（51±7）分]，术后为82-98分[平均（91±5）分]。结论 微创人工全膝关节置换术最主要的优势在于股四头肌损伤小，膝关节主动活动的时间较早，术后膝关节功能恢复相对较快，且不增加手术风险。     

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.     

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。     

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.     

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。     

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.