股骨髁上V形截骨术治疗膝屈曲畸形：附62例临床观察

本文总结了股骨髁上V形截骨术治疗62例小儿麻痹后遗膝屈曲的临床资料,有效率96.7％。该术式能将V形尖部嵌入远断端松质骨内,接触面大,位置稳,不需内固定,愈合快;还可同时矫正膝内外翻。在矫正膝屈曲的同时对截骨处做5～18°的后倾角;试验证明:后倾角处可产生向后的分力,以代替股四头肌之拉力。截骨点的选法:髌骨上缘二横指,则相当于股骨髁上4～5cm处;畸形矫正理想,并发症少。采用前内侧斜切口并顺肌间隙分离,可避免肌肉出血和髌上囊损伤,以消除膝部粘连与膝关节僵硬的直接因素,有利于术后膝关节伸屈功能的恢复。故V形截骨法是股髁上截骨术式中较好的一种;以上手术要点是保证疗效的关键。     

The measurement of serum cholinesterase activities by an integration strategy with expanded linear ranges and negligible substrate-activation

Objectives

To measure serum cholinesterase (SCHE) with an integration strategy.

Design and methods

At 54.0 μmol/L butyrylthiolcholine, SCHE initial rates were calculated with 50.0 μmol/L butyrylthiolcholine and maximal rates via an improved integrated method if substrate consumptions within 5.0 min were over 60%, or were determined by the classical initial rate method.

Results

The linear range was from 16 to 1560 nkat/L, and SCHE in clinic sera showed negligible substrate-activation.

Conclusion

This strategy was effective.     

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

Purpose

To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery.

Methods

A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10–48 years). There were 52 adolescent patients (with an age <18 years) and 24 adult patients (with an age ≥18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis.

Results

No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P < 0.05): location of apex at main curve (X ₃), Cobb angle at the main curve at the coronal plane (X ₄), scoliosis associated with thoracic hyperkyphosis (X ₅), level of vertebral column resected (X ₆), number of segmental vessels ligated (X ₇), preexisting neurologic dysfunction (X ₈), and associated with intraspinal and brain stem anomalies (X ₉). The multi-factor unconditional logistic regression analysis revealed that X ₈ (OR = 49.322), X ₉ (OR = 18.423), X ₅ (OR = 11.883), and X ₆ (OR = 8.769) were independent and positively correlated with the neurologic deficit.

Conclusions

Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.     

Radiological studies on the best entry point and trajectory of anterior cervical pedicle screw in the lower cervical spine

Objective

To explore the best entry point and trajectory of anterior cervical transpedicular screws in the lower cervical spine by radiological studies, and provide reference for clinical application.

Methods

Fifty patients were scanned by computed tomography and confirmed no obvious defect of the cervical spine. On horizontal axis, camber angle (α) and axial length (AL) were measured from C₃ to C₇. On sagittal view, the cranial or caudal angle (β) and sagittal length (SL) were also measured from C₃ to C₇. On the sagittal and horizontal planes vertebrae were respectively divided into four areas, ordered 1–4, on the anterior side of the pedicle. The areas and angles of pedicle intersect into the vertebral body were recorded. We inserted six anterior pedicle screws into the lower cervical spine of three patients by this technique.

Results

On transverse plane, camber angle (α) of C₃–C₅ increased gradually, while it decreased from C₅ to C₇. On sagittal view, C₃ and C₄ pedicles showed cranial tilting, while C₅ to C₇ were caudally tilted. AL and SL values increased gradually from C₃ to C₇. The number of the intersections of C₃–C₇ in each area was also different. Six pedicle screws of three cases were inserted into the lower cervical spine with proper placement and no complications.

Conclusion

Anterior transpedicular screw (ATPS) is a theoretically feasible option for internal fixation. The technique described in this paper was subsequently used in three patients without complication. Future improvement of ATPS insertion remains necessary for this technically demanding procedure.     

护士长主导的大型三甲医院院外门诊运作模式

目的建立适合大型三级甲等医院的院外门诊部,缓解医院本部门诊压力,为出院患者提供延续服务。方法采取护士长主导的管理模式,负责院外门诊日常运作,组织和协调医护、医技工作人员调配,业务技术及诊疗质量监管,以及医务人员绩效考核等工作。结果3个院外门诊每年门诊量近20万例次,患者满意度大于99％,每年送回院本部检验、检查近10万例次,向院本部输送急诊、危重住院患者近1000例次。结论护士长主导型管理模式建立和运行三级甲等医院院外门诊,效率高,团队协作能力强,能保持较高水平的诊疗效果,可取得良好的社会效益和经济效益。     

The role of urethral pressure profile on treating premature ejaculation by tamsulosin

Dear Editor,
I am Dr. Hui-Rong Chen, from the Department of Urology in Shanghai First People＇s Hospital at Shanghai Jiao Tong UnNersity, Shanghai, China. Premature ejaculation （PE） is a common sexual dysfunction, affecting approximately 20%-30% of sexually active men. According to intravaginal ejaculatory latency time （IELT） of l min, the incidence is approximately 1%-3%.1 PE is significantly associated with many personal and negative consequences, such as distress, frustration, and avoidance of sexual intimacy due to the inability of successful delayed ejaculation, α1-adrenergic blockers were effective in delaying ejaculation in approximately 50%-67% of the cases.2,3 Recently, abnormal ejaculation, an adverse infrequent side effect associated with the use of α1A-adrenergic blockers such as silodosin or tamsulosin, has drawn significant attention. Clinical studies suggested that this represents a relative anejaculation rather than a retrograde ejaculation. We present here the study to investigate the role of urethral pressure profile （UPP） on treating PE by tamsulosin.     

Solid lipid nanoparticles for enhancing vinpocetine's oral bioavailability.

An ultrasonic-solvent emulsification technique was adopted to prepare vinpocetine loaded Glyceryl monostearate (GMS) nanodispersions with narrow size distribution. To increase the lipid load the process was conducted at 50 degrees C, and in order to prepare nanoparticle using an ultrasonic-solvent emulsification technique. The mean particle size and droplet size distribution, drug loading capacity, drug entrapment efficiency (EE%), zeta potential, and long-term physical stability of the SLNs were investigated in detail respectively. Drug release from two sorts of VIN-SLN was studied using a dialysis bag method. A pharmacokinetic study was conducted in male rats after oral administration of 10 mg kg(-1) VIN in different formulations, it was found that the relative bioavailability of VIN in SLNs was significantly increased compared with that of the VIN solution. The amount of surfactant also had a marked effect on the oral absorption of VIN with SLN formulations. The absorption mechanism of the SLN formulations was also discussed. These results indicated that VIN absorption is enhanced significantly by employing SLN formulations. SLNs offer a new approach to improve the oral bioavailability of poorly soluble drugs.     

中老年女性练习五禽戏时的实时心率变化

目的 监测中老年女性练习1套五禽戏新功法时的实时心率变化。方法 随机选择健康、自愿参加测试的五禽戏练习者35人，监测练习1套五禽戏时的实时心率变化。结果 练习1套五禽戏，中年女性组平均心率达靶心率时间为9min，平均最大心率122次／min，较安静心率增加44次／min；老年女性组平均心率达靶心率时间11min，平均最大心率131次／min，较安静心率提高55次／min。结论 五禽戏是一项适合中老年女性的健身项目。     

河南农村中医药文化的发展阶段与特征初探

河南是中医药文化的发祥地之一,在华夏文明、黄河文明和中原文化的滋养中产生了中医药文化,中医药文化作为传统文化的代表又进一步丰富发展了中原文化、黄河文明,成为中华中医药文化的主要贡献者、创造者、发展者。中医药文化是农业文化的典型代表,与农村农民农业有着天然的联系,特别是在以农业生产为主的河南大地生根发芽,经历萌芽期、形成期、固化成熟期、没落期、复兴期、严峻考验期六个时期,并具有原创性、完整性、包容性等特色。随着时代的发展,农村单一化发展模式被打破,要促进农村中医药文化的复兴,就要与时俱进,继承创新。     

电针分型预测结合面神经肌电图治疗周围性面神经麻痹80例

目的:观察电针穴位分型预测与面神经肌电图检查相结合,治疗周围性面神经麻痹的临床疗效。方法:选择2002-09/2005-02济南第四人民医院门诊及住院80例周围性面神经麻痹患者,按电针穴位分型法划分为一般型和顽固型,一般型为电针1组,顽固型分为电针2组、综合治疗组。电针1组、电针2组均都采用电针治疗:取穴阳白、太阳、地仓、下关、风池、翳风、迎香、攒竹、承浆。均取患侧。同时取健侧的合谷。针刺得气后采用电针治疗仪治疗,频率120～250次/min,每次留针30min,治疗1次/d,10次为1个疗程,休息两天,再行第2个疗程。综合治疗组:在常规电针治疗的同时,针刺时均采用中等手法刺激,同时加取双侧足三里穴,均采用补法,每10min行针1次,面部患侧采用特定电磁波照射,以下关、翳风穴为主进行局部照射,距离30～40cm,温度舒适为宜,每次电针加照射40min,1次/d,10次为1个疗程,休息两天再进行第2个疗程。所有患者均行面部面神经肌电图检查。结果:80例患者进入结果分析,无脱落者。①各组疗效的比较:电针1组43例中42例痊愈,占95%,顽固型37例仅痊愈15例,电针2组和综合治疗组分别占30%,53%,差异明显(P<0.05)。②各分型患者有效病例疗程长短比较:电针1组基本上在两个疗程内痊愈,电针2组,综合治疗组多在两三个疗程或3个疗程后好转,治疗时间较长。③不同分型患者面神经潜伏期M波比较:80例患侧面神经运动潜伏期有不同程度的延长,M波波幅降低,与健侧比较差异有极显著性(P<0.01)。其中患健侧M波波幅比值>505例、50%～302例,<30例,3个月后随访,M波波幅比值<30%中的5例仍有明显面瘫体征,>30%的67例中面瘫体征基本恢复。④按肌电图分型标准各型所占比例数比较:按肌电图分类的一般型43例中治愈41例,占95%,而顽固型中,按肌电图分类的轻中型31例中痊愈15例,占48%,无效的5例均提示为重度失神经性损害。虽然面神经肌电图,从面神经运动潜伏期是否延长及根据其失神经性损害进行分类,判断患者预后有一定的准确性,但同电针穴位分型两法合用,分型预测更直接明确。结论:电针分型可以预测该病的预后,对比面神经肌电图情况,判断其预后基本一致。同时根据分型,及时调整治疗方案,可减少后遗症的发生。