数字化导航模板辅助全膝关节置换的模拟研究

 目的 探讨数字化导航模板辅助全膝关节置换的准确性和可行性。方法 取成年尸体下肢标本 20具,随机分为导航模板组和传统方法组,每组 10具 20个膝关节。导航模板组术前行下肢全长 CT扫描,利用逆向工程软件对 CT数据进行处理,设计与股骨远端和胫骨近端匹配的可定位截骨平面和外旋轴的导航模板,通过快速成型机制作模板实物用于尸体标本的全膝关节置换手术操作。传统方法组按常规全膝关节置换手术操作。术后通过 CT扫描比较两种方法定位的截骨准确性。结果 导航模板与股骨髁和胫骨平台贴合紧密,无明显移动。导航模板组 18个膝关节的股骨远端和胫骨近端截骨面与下肢机械轴垂直,2个膝关节内翻; 17个膝关节后髁截骨面与通髁轴完全平行,3个膝关节有成角。传统方法组 20个膝关节均出现下肢机械轴内外翻,其中 5个膝关节大于 5°; 20个膝关节均出现后髁截骨面与通髁轴成角,其中 10个膝关节大于 3°。结论 导航模板法的股骨远端、胫骨近端和股骨外旋截骨准确性均高于传统手术方法。     

Effects of chronic sympatho-inhibition on reflex control of renal blood flow and plasma renin activity in renovascular hypertension

Background and purpose:

We determined if chronic sympatho-inhibition with rilmenidine has functional significance for the kidney by altering responses of renal blood flow (RBF) and plasma renin activity (PRA) to stress and acute hypotension in rabbits with renovascular hypertension.

Experimental approach:

RBF to each kidney and renal sympathetic nerve activity (RSNA) to the left kidney were measured in rabbits in which a renal artery clip induced hypertension (2K1C) and in sham-operated rabbits. After 2 weeks, a subcutaneous minipump was implanted to deliver rilmenidine (2.5 mg·kg⁻¹·day⁻¹) to 2K1C rabbits for 3 weeks.

Key results:

After 5 weeks of renal artery stenosis, mean arterial pressure (MAP) was 23% higher and PRA 3-fold greater than in sham-operated rabbits. Blood flow and renal vascular conductance in the stenosed kidney were lower (−75% and −80%) compared with sham, and higher in the non-clipped kidney (68% and 39%). Responses of RBF and PRA to hypotension were similar in 2K1C and sham rabbits. Airjet stress evoked a greater increase in MAP in 2K1C rabbits than sham controls. Chronic rilmenidine normalized MAP, reduced RSNA and PRA, and did not reduce RBF in the stenosed kidney. Responses of RBF (clipped and non-clipped kidney), RSNA and PRA to hypotension and airjet were little affected by rilmenidine.

Conclusions and implications:

Our observations suggest that chronic sympatho-inhibition is an effective antihypertensive therapy in renovascular hypertension. It normalizes MAP and reduces basal PRA without compromising blood flow in the stenosed kidney or altering responses of MAP, haemodynamics and PRA to acute hypotension and stress.     

Serum Concentration of Lignocaine After Pertubation: An Observational Study

Objective

The objective of this study was to report the serum concentration of lignocaine after pertubation in patients with endometriosis.

Design

Prospective observational study.

Setting

The study was carried out at a gynaecological outpatient unit in Stockholm, Sweden.

Population

Eligible patients had endometriosis with a dysmenorrhoic pain score of >50 mm on a visual analogue scale, and patent fallopian tubes.

Methods

Patients with endometriosis (n = 25) were included in the study. The patients received pre-ovulatory pertubations with lignocaine hydrochloride 10 mg (n = 16) or ringer acetate (placebo, n = 9). The procedure comprised passing the study solution through the uterus and the fallopian tubes via an intra-cervical balloon catheter. Serum samples were collected at 0, 5, 15 and 30 min after pertubation.

Main Outcome Measures

The serum samples were analysed for the concentration of lignocaine with an LCMS-SIM method.

Results

Low levels of lignocaine were detected in the serum samples following pertubation of 10 mg lignocaine hydrochloride. The highest observed concentration was seen after 30 min (mean 0.050 μg/ml), with an individual maximum of 0.124 μg/ml. Maximum concentration (C_max) and time to C_max (T_max) could not be calculated, since the highest values were observed in the 30-min samples, which was the last sample obtained. Lignocaine was not detected after pertubation with placebo.

Conclusions

The serum levels of lignocaine following pertubation of 10 mg lignocaine hydrochloride are detectable but low. Lignocaine pertubated through the fallopian tubes reaches the peritoneal cavity and diffuses through the peritoneum into the blood circulation. Pertubation with lignocaine is safe and has no lignocaine-related adverse events.     

自发性小脑出血118例的外科治疗临床分析

目的：探讨颅内血肿清除去骨瓣减压术治疗自发性小脑出血的临床疗效。方法：采用对比分析方法,观察颅内血肿清除去骨瓣减压术与内科保守治疗自发性小脑出血患者的疗效,手术治疗组118例,内科保守治疗组56例。结果：内科保守治疗组有效率为46.4%,死亡率为33.9%;手术治疗组有效率为77.3%,死亡率为10.2%;两组比较,差异有统计学意义（P〈0.05）。结论：颅内血肿清除去骨瓣减压术安全、有效、简便,能提高有效率,降低死亡率。     

Mineral Status of Myocardial Sarcocystosis

Background

The role of minerals on parasite persistency and the interaction between minerals and animal responses to the parasite infestation is not clear. For these reasons, the present research was aimed to compare copper, zinc and iron status in sheep with parasitic myocarditis and healthy ones in 2009.

Methods

Blood and heart tissue samples were collected from 145 slaughtered sheep and histopathological findings were confirmed as myocardial sarcocystosis in 27 cases. Serum and tissue mineral level were determined by atomic absorption spectroscopy. Data were analyzed by Sigmastat program, using One Way Analysis of Variance (ANOVA) at the level of P<0.05.

Results

Myocardial sarcocystosis significantly increase myocardial concentration of Cu, Zn and Fe (P<0.05).

Conclusion

These findings may explain the role of copper, zinc and iron in parasite persistency and may discuss the pathogenesis of sarcocystosis, which relates to evocate mentioned micronutrient to cardiac muscle.     

利用网络进行神经病学教学的应用与思考

总结传统神经病学教学模式的弊病,结合多年教学实践和经验,探讨利用网络进行神经病学教学的优势,对其具体实施进行了尝试。并指出了当前神经病学网络教学存在的问题,展望了神经病学网络教学的前景。     

Acute-phase response predicts erythropoietin resistance in hemodialysis and peritoneal dialysis patients

We defined erythropoietin (EPO) resistance by the ratio of the weekly EPO dose to hematocrit (Hct), yielding a continuously distributed variable (EPO/Hct). EPO resistance is usually attributed to iron or vitamin deficiency, hyperparathyroidism, aluminum toxicity, or inflammation. Activation of the acute-phase response, assessed by the level of the acute-phase C-reactive protein (CRP), correlates strongly with hypoalbuminemia and mortality in both hemodialysis (HD) and peritoneal dialysis (PD) patients. In this cross-sectional study of 92 HD and 36 PD patients, we examined the contribution of parathyroid hormone (PTH) levels, iron indices, aluminum levels, nutritional parameters (normalized protein catabolic rate [PCRn]), dialysis adequacy (Kt/V), and CRP to EPO/Hct. Albumin level serves as a measure of both nutrition and inflammation and was used as another independent variable. Serum albumin level (deltaR2 = 0.129; P < 0.001) and age (deltaR2 = 0.040; P = 0.040) were the best predictors of EPO/Hct in HD patients, and serum albumin (deltaR2 = 0.205; P = 0.002) and ferritin levels (deltaR2 = 0.132; P = 0.015) in PD patients. When albumin was excluded from the analysis, the best predictors of EPO/Hct were CRP (deltaR2 = 0.105; P = 0.003) and ferritin levels (deltaR2 = 0.051; P = 0.023) in HD patients and CRP level (deltaR2 = 0.141; P = 0.024) in PD patients. When both albumin and CRP were excluded from analysis in HD patients, low transferrin levels predicted high EPO/Hct (deltaR2 = 0.070; P = 0.011). EPO/Hct was independent of PTH and aluminum levels, PCRn, and Kt/V. High EPO/Hct occurred in the context of high ferritin and low transferrin levels, the pattern expected in the acute-phase response, not in iron deficiency. In well-dialyzed patients who were iron replete, the acute-phase response was the most important predictor of EPO resistance.