富血小板血浆治疗肩袖损伤术后的疗效:随机对照试验Meta分析

目的 比较单纯使用关节镜治疗与联合使用富血小板血浆(PRP)的疗效,为肩袖损伤的治疗方法提供循证依据.方法 检索CENTRAL、Medline、PubMed、EMbase、CNKI、万方、维普、CBM数据库和手工检索会议文献等.通过制定纳入标准及排除标准纳入记录相关的随机对照试验的文献.检索时间均从该库建库始至2019...     

10 s团注对比剂方案联合80 kV管电压在颈动脉CT血管成像的应用

目的:探讨80 kV管电压联合个体化对比剂低剂量注射方案行颈动脉CT血管成像的可行性。方法:前瞻性纳入需要行颈部CT血管成像(CTA)检查的136名患者,采用完全随机区段法分成A、B、C、D 4组,A组为100 kV 15 s团注常规组,53例;其他3组为80 kV 10 s团注对照组,根据≤50 kg、50～70 k...     

Acetabular reinforcement ring with additional hook improves stability in three-dimensional finite element analyses of dysplastic hip arthroplasty

Background

The stability of acetabulum reconstructions using reinforcement rings and hooks is important for successful replacement surgery. The objective of this study was to biomechanically determine the effects of the hook on stress and the related micromotions of the acetabular reinforcement ring during the immediate postoperative period.

Methods

Acetabular reinforcement ring models were developed using a nonlinear, three-dimensional, finite element method. Using a pre-prepared template, we constructed without-hook and bone graft models of varying volumes and material properties.

Results

The stress on the inferior margin of the acetabulum was higher in the with-hook model than in the without-hook model, especially with increased bone graft volumes, and the stiffness of the bone graft material was decreased. Relative micromotions in the without-hook model were higher than in the with-hook models. The highest relative micromotion was observed in the model with increased bone graft volume and lower stiffness of bone graft material.

Conclusions

In biomechanical analyses, the hook effectively dispersed stress and improved the initial fixation strength of the acetabular reinforcement ring.

     

基于第三代双源CT动态心肌灌注成像不同负荷后心率增量者的正常心肌血流量范围

目的:探讨基于第3代双源CT动态心肌灌注成像（CT-MPI）定量的正常心肌血流量（MBF）与负荷后心率增量的关系。方法:回顾性分析2016年10月至2019年11月于上海交通大学附属第六人民医院行动态CT-MPI及冠状动脉CTA（CCTA）检查的冠状动脉正常或冠状动脉轻微狭窄（定义为任一心外膜血管直径狭窄<25%）44...     

Assessment of human pancreatic islets after long distance transportation

Pancreatic islet transplantation can replace functional insulin-secreting beta cells for patients with type 1 diabetes. More than 300 patients who have received islet transplantation have returned to a euglycemic condition without using insulin. Therefore, islet transplantation has gained public attention and interest. Unfortunately, shortages in organ donations, suboptional antirejection regimens, and difficulties in islet isolation limit clinical utilization of this therapy. Recently, successful islet transplantation has been reported using a centralized islet isolation facility. The advantage of this experience is that it avoids the high costs in building an isolation facility and maintaining an experienced technical team. However, a private airplane carrier was required for transporting islets back to the transplantation site in a remote hospital. The cost of this specialized transportation was still too high to be considered as a routine procedure. In this study, we report our experience using commercial carriers to deliver isolated human islets from an established isolation facility to a remote medical center.     

The use of non-heart-beating donors for isolated pancreatic islet transplantation

Recent improvements in isolated islet transplantation indicate that this therapy may ultimately prove applicable to patients with type I diabetes. An obstacle preventing widespread application of islet transplantation is an insufficient supply of cadaveric pancreata. Non-heart-beating donors (NHBDs) are generally not deemed suitable for whole-organ pancreas donation and could provide a significant source of pancreata for islet transplantation. Isolated pancreatic islets prepared from 10 NHBDs were compared with those procured from 10 brain-dead donors (BDDs). The success of the isolation for the two groups was analyzed for preparation purity, quality, and recovered islet mass. The function of NHBD and BDD islets was evaluated using in vitro and in vivo assays. On the basis of the results of this analysis, an NHBD isolated islet allograft was performed in a type I diabetic. The recovery of islets from NHBDs was comparable to that of control BDDs. In vitro assessment of NHBD islet function revealed function-equivalent BDD islets, and NHBD islets transplanted to non-obese diabetic-severe combined immunodeficient (NOD-SCID) mice efficiently reversed diabetes. Transplantation of 446,320 islet equivalents (IEq) (8,500 IEq/kg of recipient body weight) from a single NHBD successfully reversed the diabetes of a type I diabetic recipient. Normally functioning pancreatic islets can be isolated successfully from NHBDs. A single donor transplant from an NHBD resulted in a state of stable insulin independence in a type I diabetic recipient. These results indicate that NHBDs may provide an as yet untapped source of pancreatic tissue for preparation of isolated islets for clinical transplantation.     

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).

Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n?=?72) received MeroGel as the MEPA, Group 2 (n?=?64) cartilage, and Group 3 (n?=?69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4?kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.

Results: Mean pre- and post-operative ABG was 30.9?dB and 17.6?dB in Group 1, 31.4?dB and 21.9?dB in Group 2, and 32.2?dB and 19.1?dB in Group 3. The ABG closure was 13.3?±?7.5 in Group 1, 9.5?±?5.9 in Group 2, and 13.1?±?9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p?p?Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.     

不同型号配对固定平台型膝关节假体生物力学有限元分析研究

目的 针对组配式固定平台型膝关节假体在临床使用中为适应骨骼解剖形态,经常出现股骨和胫骨侧假体不同型号配对情况,采用有限元分析方法分析不同配对假体接触表面的应力变化,了解目前临床上常用的膝关节假体不同型号配对是否具有潜在风险.方法 选择美国DePuy公司PFC Sigma固定平台型膝关节假体为研究对象,选用股骨侧3号钴铬合金假体,胫骨侧2.5号、3号、4号钛合金金属托及对应尺寸的10mm厚度聚乙烯垫片.实验组:股骨侧3号假体选配胫骨侧2.5号假体(3/2.5配对)或4号假体(3/4配对);对照组:3号股骨假体对应3号胫骨侧假体(3/3配对).两组分别构建计算机有限元模型后,模拟双腿站立、平地行走、上楼梯情况下,对膝关节活动处于0°、10°、20°、30°、45°、60°、75°夹角时最大等效应力进行有限元分析,比较实验组与对照组间最大等效应力差异.结果 实验组(3/2.5配对或3/4配对)最大等效应力高于对照组(3/3配对).其中模拟双腿站立时,3/3配对与3/2.5配对最大等效应力无显著差异(P＞0.05),3/3配对与3/4配对最大等效应力有显著性差异(P＜0.05);模拟平地行走时,3/3配对与3/2.5配对、3/4配对应力值在0°～75°范围内各角度之间差异均有统计学意义(P＜0.05);模拟上楼梯时,3/3配对与3/2.5配对、3/4配对应力值在0°～30°范围内各角度之间差异均有统计学意义(P＜0.05),45°～75°范围内各角度之间差异均无统计学意义(P＞0.05).结论 实验组(3/2.5配对或3/4配对)假体型号不完全匹配,假体接触面最大等效应力在不同膝关节活动角度和不同运动状态时增高,可能增加聚乙烯垫片磨损风险.     

宁夏儿童头颅、胸部CT辐射剂量状况分析

目的 评估宁夏地区儿童头颅、胸部CT检查的辐射剂量水平,为不同年龄段儿童的CT辐射剂量优化提供基础。方法 采用分层整群抽样的方法,实地采集宁夏地区不同市、县、区不同规模医院1~2周内儿童（≤15岁）头颅、胸部CT的扫描参数、容积CT剂量指数（CTDI_vol）及剂量长度乘积（DLP）,计算患者有效剂量（E）值;并将CTDI_vol、DLP的第75百分位数（P₇₅）与其他国家推荐的DRL值进行比较;所有儿童分4个年龄组：<1岁、1~5岁、6~10岁、11~15岁。结果 走访调查39家医院,调查CT设备47台,采集头颅断层扫描1 134例,胸部平扫636例。头颅CTDI_vol、DLP的P₇₅分别为：<1岁：44.2 mGy、456.2 mGy·cm;1~5岁：57.2 mGy、659.6 mGy·cm;6~10岁：61.1 mGy、668.7 mGy·cm;11~15岁：63.6 mGy、849.3 mGy·cm。胸部CTDI_vol、DLP的P₇₅分别为：<1岁：5.0 mGy、89.2 mGy·cm;1~5岁：5.9 mGy、124.8 mGy·cm;6~10岁：6.0 mGy、167.9 mGy·cm;11~15岁：7.1 mGy、235.0 mGy·cm。结论 宁夏地区儿童胸部CT的辐射剂量与其他报道相近,但头颅CT的辐射剂量相对偏高,且各年龄段均存在偏高现象,尤以婴儿患者较著;应加强宁夏地区儿童头颅CT的辐射剂量优化与监管,增强儿科医生、放射科医生的剂量控制意识,提高对辐射相关风险的认识。     

民航飞行学员飞行训练应激源研究

目的确定我国民航飞行学员飞行训练的应激源。方法采用德尔菲法形成量表初步维度并在此基础上编制初测量表,从不同训练分院及国外训练归校的学员中采取分层随机取样;选取524名飞行学员进行测试,对所得数据进行分析形成正式问卷。对所获数据进行探索性因素分析和验证性因素分析,并分别检验量表的内部一致性系数、重测信度、内容效度与结构效度。结果训练环境、职业前景、飞行教员、座舱环境4个维度共解释了总变异的57.154%。量表总体的Cronbach’sα系数为0.830,各因子的Cronbach’sα系数为0.751~0.782,重测的相关系数均在0.806(P<0.01)以上。维度间的相关系数为0.134~0.438(P<0.05),各维度与总体的相关系数在0.617~0.748(P<0.01)。一阶4因素模型(GFI=0.929、IFI=0.989、TLI=0.986、CFI=0.989、RMSEA=0.013)拟合效果较好。结论民航飞行学员飞行训练应激源量表符合心理测量学标准,具有良好信效度,民航飞行学员飞行训练应激源主要来源于训练环境、职业前景、飞行教员、座舱环境。