氨甲环酸关节腔内注射对全膝关节置换术后隐性失血的影响

目的探讨氨甲环酸关节腔内注射对全膝关节置换术后隐性失血的影响。方法选取2012年6月~2014年12月在我院行单侧全膝关节置换术治疗的60例患者为研究对象。男性14例,女性46例,年龄58~77岁,平均66.7岁,病程6~15年,平均9.1年。手术及麻醉均由同一组医生完成。将符合条件的患者随机分为2组,试验组(氨甲环酸组)30例,切口缝合完毕后将氨甲环酸1 g稀释至50 m L生理盐水中,用注射器沿引流管注入关节腔内。对照组30例,直接将50 m L生理盐水沿引流管注入关节腔内。比较二组患者术后显性失血量、隐性失血量、异体输血人数、输血比率。结果术后试验组与对照组显性失血量分别为389m L(170~505m L)和628m L(225~874m L),差异有统计学意义(0.05)。术后试验组与对照组隐性失血量分别为514 m L(374~819 m L)和917 m L(542~1297 m L),差异有统计学意义(0.05)。两组术后凝血机制无显著性差异。术后试验组输血人数及输血比率明显小于对照组,差异有统计学意义(0.05)。结论膝关节腔内应用氨甲环酸能够有效地降低全膝关节置换术后患者的显性失血量和隐性失血量,减少术后异体输血的可能性,局部使用方便,未发现不良反应。     

氨甲环酸对初次单侧全髋关节置换术后失血量的影响

目的探讨氨甲环酸减少单侧全髋关节置换术后出血量的有效性和安全性。方法根据随机对照原则设计,选取潍坊市人民医院关节外科行初次单侧全髋关节置换术的患者80例,男29例,女51例,随机分为试验组和对照组(n=40),试验组在切皮前15min时静脉单次使用10mg/kg的氨甲环酸,对照组予以同等剂量的生理盐水,比较两组患者术后失血量。结果试验组患者显性失血量和隐性失血量均较对照组减少,差异有统计学意义(P<0.05),两组患者术后14 d均未发现下肢深静脉血栓形成。结论氨甲环酸可以有效减少初次单侧髋关节置换手术围手术期的失血量且不增加并发症的发生风险。     

静脉滴注联合局部应用氨甲环酸可减少全髋关节置换后隐性失血

背景：氨甲环酸在减少人工关节置换后出血方面的应用越来越多,但其使用方法及剂量仍存在争议,是近几年研究的热点。 目的：观察静脉滴注联合局部应用氨甲环酸对减少初次全髋关节置换后隐性失血的有效性和安全性。 方法：将65例初次全髋关节置换患者随机分为试验组与对照组。试验组患者于置换术中使用0.5 g氨甲环酸静脉滴注,缝合后经引流管推注0.5 g氨甲环酸,保留6 h;对照组给予生理盐水静脉滴注,缝合后经引流管推注50 mL生理盐水,保留6 h。对比两组患者的术中出血量、置换后显性失血及隐性失血量、疼痛评分、输血率、深静脉血栓形成情况及住院日。 结果与结论：试验组置换后血红蛋白及红细胞压积均高于对照组(P < 0.05),置换后显性失血及隐性失血量均低于对照组(P < 0.05),输血率、住院日均少于对照组(P < 0.05);而两组术中出血量、疼痛评分、深静脉血栓形成发生率差异无显著性意义(P > 0.05)。提示全髋关节置换过程中静脉滴注联合经引流管内注射氨甲环酸能降低患者置换后显性、隐性失血量及输血率,并且没有增加下肢深静脉血栓形成的风险。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

初次单侧骨水泥型全膝关节置换:氨甲环酸使用方式对失血量的影响

背景:目前有关氨甲环酸在全膝关节置换过程中减少出血的报道越来越多,但对于优先选用何种使用方式仍存在争议。目的:探讨氨甲环酸及其不同使用方式对初次单侧骨水泥型全膝关节置换围手术期失血量的影响。方法:选取滕州市中心人民医院关节运动医学二科2013年1月至2014年6月拟行单侧骨水泥型全膝关节置换的患者60例,均采用骨水泥型人工膝关节假体。按性别以分层随机分组法分成3组:A组(n=20):置换开始时予100 m L生理盐水静滴,缝皮后关节腔内注射生理盐水10 mL;B组(n=20):置换开始时将氨甲环酸按10 mg/kg稀释于100 mL生理盐水中静滴,缝皮后关节腔内注射生理盐水10 mL;C组(n=20):置换开始时予100 mL生理盐水静滴,缝皮后关节腔内注射氨甲环酸500 mg与10 m L生理盐水混合液。记录各组置换后显性失血量、隐性失血量、输血比率、输血量,同时观察是否有肺栓塞及下肢深静脉栓塞的临床症状,必要时行下肢血管多普勒超声检查。结果与结论:B组及C组患者显性失血量和隐性失血量均较A组明显减少,差异有显著性意义(P0.05);B组与C组在显性失血量方面差异无显著性意义(P0.05),在隐性失血量方面B组显著小于C组(P0.05);B组及C组患者输血人数及输血比率明显小于A组,差异有显著性意义(P0.05);3组患者置换后14 d均未发现下肢深静脉血栓形成。提示氨甲环酸能明显减少初次单侧人工骨水泥型全膝关节置换后的显性失血量、隐性失血量、输血比率及人均输血量,不增加下肢深静脉血栓形成的风险,且静脉用药更为有效。     

关节内注射氨甲环酸减少全膝关节置换术后失血的临床分析

目的探讨关节内注射氨甲环酸对人工全膝关节置换术后失血的影响。方法将50例采取单侧初次人工全膝关节置换患者,随机分为治疗组25例和对照组25例。治疗组采用关节腔内注射氨甲环酸1 000 mg,术后夹闭引流2 h,对照组采用生理盐水。术后记录术中失血量、术后引流量、血红蛋白(Hb)、红细胞压积(Hct)和输血例数、D-二聚体改变以及深静脉血栓发生例数。结果治疗组术后引流量、输血例数和D-二聚体值显著低于对照组(P0.05);治疗组血红蛋白、红细胞压积显著高于对照组(P0.05);2组均无深静脉血栓形成。结论人工全膝关节置换术后关节腔内注射氨甲环酸并夹闭引流2 h的方法能够有效减少术后失血量,同时不增加深静脉血栓发生率。     

鸡尾酒疗法减少全膝关节置换后隐性失血

背景:全膝关节置换术后失血是比较常见的临床问题,会影响患者的置换效果。氨甲环酸作为一种止血药物,越来越多的被应用于减少人工关节置换术后出血,但是对同时使用氨甲环酸和其他药物止血效果的研究还很少。目的:评估初次单侧全膝关节置换术中局部应用鸡尾酒(氨甲环酸和肾上腺素混合液)对减少患者围手术期失血量、降低输血率的有效性和安全性。方法:将中日友好医院骨关节外科2013年7月至2015年10月入院拟行初次单侧全膝关节置换的113患者随机分为鸡尾酒组(57例)和氨甲环酸组(56例)。手术过程中在鸡尾酒组患者关节腔内注射鸡尾酒[3 g氨甲环酸和0.25 mg稀释肾上腺素(1∶200 000)的混合溶液],氨甲环酸组关节腔内单纯注射3 g氨甲环酸溶液,所有患者置换术后均不放置引流管。围手术期观察患者术中失血量、术后显性失血量、隐性失血量及异体输血量;在术后90 d内,观察患者有无症状性深静脉血栓和肺动脉栓塞的发生。结果与结论:(1)全膝关节置换时,与单纯局部应用氨甲环酸相比,鸡尾酒组患者手术总失血量(P=0.007)、隐性失血量(P=0.000)以及术后异体输血率(0%vs.5.4%)均较低,并且不增加患者血栓栓塞及血栓形成等并发症的风险(P0.05);(2)结果提示,全膝关节置换时稀释肾上腺素联合使用氨甲环酸的止血效果优于单纯使用氨甲环酸,而且不会产生严重的不良反应,可作为减少全膝关节置换术后失血的重要方法。     

氨甲环酸用于全膝关节置换降低失血量的有效性及安全性

背景：氨甲环酸是一种人工合成的抗纤维蛋白溶解的药物,可以经静脉有效的控制全膝关节置换后失血。 目的：观察氨甲环酸对初次行单侧全膝关节置换患者置换后失血的有效性及安全性。 方法：选取2014至2015年在四川省骨科医院下肢科行单侧全膝关节置换的100例患者。以使用氨甲环酸与否分为试验组和对照组,各50例。试验组患者在全膝关节置换前10 min静脉注射氨甲环酸1 g,而对照组不给予氨甲环酸。 结果与结论：试验组患者置换后围手术期总失血量、置换后24 h引流量、输血量明显少于对照组(P < 0.05);试验组与对照组术中出血量、输血人数差异无显著性意义。两组患者患者置换前血红蛋白水平差异无显著性意义,而置换后血红蛋白水平均下降,且试验组患者置换后血红蛋白水平均明显高于对照组。置换后24 h,两组患者凝血功能差异无显著性意义。置换后6 d,2组患者双下肢静脉彩色多普勒超声检查均未见深静脉血栓。提示初次单侧全膝关节置换前静脉给予氨甲环酸能明显减少围手术期失血量及输血量,降低输血风险及输血费用,利于术后功能恢复,且不增加下肢深静脉血栓的风险。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

静脉输注氨甲环酸对全膝关节置换后隐性失血的影响

背景：人工全膝关节置换过程中,止血带的使用、手术创伤等因素会导致纤溶系统的异常激活,是术后失血的主要原因。氨甲环酸是一类抗纤溶药物,在人工全膝关节置换中使用,可减少置换后显性失血、总失血量,并降低异体血输血率。然而,氨甲环酸对人工全膝关节置换后隐性失血的影响尚未明确。 目的：观察静脉输注氨甲环酸对初次全膝关节置换后隐性失血的影响。 方法：回顾性分析2013年6至12月北京大学第三医院行初次单侧全膝关节置换54例患者的临床资料,按照是否使用氨甲环酸分为两组。氨甲环酸组22例在术中经静脉给予总量2 g的氨甲环酸,对照组32例使用等量生理盐水。两组患者置换后均口服利伐沙班抗凝。记录患者置换前及置换后连续5 d的血红蛋白、血红细胞压积,采用Gross方程计算总失血量和隐性失血量,比较两组间失血量的差异性。置换后1周行下肢静脉超声检查,判断有无下肢深静脉血栓形成。 结果与结论：两组患者一般资料、围术期情况等比较差异均无显著性意义(P > 0.05)。氨甲环酸组患者置换后引流量、显性失血量、总失血量、自体血回输量、异体血输注量均明显少于对照组,差异有显著性意义(P < 0.05)。根据Gross方程计算隐性失血量,氨甲环酸组为(302.9±189.9) mL,对照组为(596.8±271.4) mL,差异有显著性意义(P < 0.05)。置换后两组各发生1例下肢肌间静脉血栓。提示静脉输注氨甲环酸能显著减少单侧全膝关节置换后隐性失血量,降低异体血输血量,同时不增加下肢静脉血栓的发生率。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

《生物骨科材料与临床研究》第十三卷索引

正检索格式:文题(第一作者)总期数:起始页码排列顺序:1.以文题第一个字的汉语发音首字母为依据;2.若首字母相同,按照期数先后原则排列;3.以数字或字母开头的,排在所属最前面。A Acutrak无头加压螺钉治疗股骨颈骨折疗效分析(张鹏翼等)77:75氨甲环酸关节腔内灌注联合2小时引流管夹闭在初次单侧全膝关节置换术后失血量的临床研究(卞春喜等)74:10氨甲环酸关节腔内注射对全膝关节置换术后隐性失血的影响(王国强等)77:31     

全膝关节置换后静脉与局部应用氨甲环酸对失血量的影响

背景：目前关于全膝关节置换过程中使用氨甲环酸减少出血的报道越来越多,但对于使用方式的选择仍存在争议。 目的：通过术中关节腔周围组织局部注射和静脉注射两种不同的给药途径,探讨氨甲环酸对初次单侧全膝关节置换后失血量的影响。 方法：根据随机对照原则设计,选取滕州市中心人民医院2013年10月至2014年12月收治拟行单侧全膝关节置换的患者90例,随机分为静脉组和局部组(n=45)。静脉组患者在全身麻醉诱导期接受静脉输注氨甲环酸(10 mg/kg 最大剂量1.2 g);局部组于假体安装结束后,缝合关节囊前,在关节周围软组织注射氨甲环酸(2 g溶于50 mL生理盐水)。比较两组患者置换后引流量、置换后次日血红蛋白及红细胞压积、输血例数,同时观察是否有肺栓塞及下肢深静脉栓塞的临床症状出现,必要时行下肢血管多普勒超声检查。 结果与结论：置换后引流量、置换后次日血红蛋白值及红细胞压积、输血人数及输血比率比较,两组差异无显著性意义(P > 0. 05)。两组患者置换后14 d 均未发现下肢深静脉血栓形成。提示与静脉全身应用相比,全膝关节置换过程中关节周围局部应用氨甲环酸同样能达到有效减少置换后失血和输血的效果,并可避免静脉应用氨甲环酸可能带来的相关并发症。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.