异丙酚混合氯胺酮对大鼠海马神经元钠电流的影响

目的研究异丙酚混合氯胺酮对大鼠海马神经元钠电流的影响。方法酶消化法急性分离SD大鼠(出生10～14 d)海马神经元,全细胞膜片钳技术记录不同浓度氯胺酮、异丙酚或异丙酚混合氯胺酮对海马神经元钠电流的影响。结果在钳制电压-80 mV、刺激电压0 mV条件下,5．6- 560μmol·L-1异丙酚对钠电流的抑制作用逐渐增加,其抑制钠电流的IC50为(44±4)μmol·L-1;0．18 mmol·L-1氯胺酮对钠电流没有影响,0．54、1．8、5．4、10．8 mmol·L-1氯胺酮对钠电流均有抑制作用,其抑制钠电流的IC50为(2．7±0．7)mmol·L-1。1/4和3/4 IC50的异丙酚与0．54、1．8、5．4、10．8 mmol·L-1氯胺酮混合应用抑制钠电流的IC50分别为1．14±0．21、(0．97±0．32)mmol·L-1,异丙酚与氯胺酮混合应用产生相加作用。结论异丙酚混合氯胺酮对抑制大鼠海马神经元钠电流产生相加作用。     

The Application of H‐Loop in Arthroscopic Knotless Double‐Row Rotator Cuff Repairs

ObjectiveTo determine the functional outcomes after a novel method of H‐loop knotless double‐row technique in patients with rotator cuff tears.MethodFrom June 2020 to September 2020, a total of six patients (five women, one man) with arthroscopic rotator cuff repair using the H‐loop knotless double‐row technique were enrolled in our study. The average age is 54 years (range: 50–61 years). The preoperative and final follow‐up clinical outcome were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), University of California Los Angeles (UCLA) score, and Constant–Murley score. The active shoulder range of motion (ROM) was also collected preoperatively and postoperatively at the final follow‐up (forward flexion and abduction). Accordingly, intraoperative and postoperative complications were observed as well.ResultThere were six patients that underwent arthroscopic rotator cuff repair using the H‐loop knotless double‐row technique. The average follow‐up period was 7.52 ± 0.70 months. The VAS, UCLA, ASES, and Constant–Murley scores improved from 5 ± 2.45, 15.67 ± 3.44, 47.67 ± 17.41 and 49.17 ± 8.98 preoperatively, to 0.83 ± 0.75, 36.27 ± 3.83, 91.67 ± 10.76 and 85.83 ± 4.31 at the final follow‐up, with statistical significances of P = 0.009, P < 0.001, P = 0.006, and P = 0.001, respectively. Meanwhile, the active shoulder ROM (forward flexion and abduction) improved from 135.00 ± 46.80 and 125 ± 56.48 preoperatively, to 173.67 ± 4.13 and 172 ± 3.27 at final follow‐up, respectively (P = 0.082, P = 0.088). During the follow‐up, there were no postoperative complications such as wound‐site infection, nerve or vessel damage, subcutaneous hematoma, and suture anchor problems.ConclusionWith the benefit of reducing the possibility of strangulation and blood supply affection for the rotator cuff, The H‐loop knotless double row technique may be an alternative method to significantly improve subjective functional outcomes and increase the healing rate of medium‐sized rotator cuff tears with degeneration issues and poor tissue quality.     

Percent fat mass is inversely associated with bone mass and hip geometry in rural Chinese adolescents

This study was an attempt to examine the phenotypic, genetic, and environmental correlations between percent fat mass (PFM) and bone parameters, especially hip geometry, among 786 males and 618 females aged 13 to 21 years from a Chinese twin cohort. PFM, bone area (BA), bone mineral content (BMC), cross‐sectional area (CSA), and section modulus (SM) were obtained by dual‐energy X‐ray absorptiometry. Multiple linear regression models were used to assess the PFM‐bone relationships. A structural equation model for twin design was used to estimate genetic/environmental influences on individual phenotype and phenotypic correlations. After controlling for body weight and other pertinent covariates, we observed inverse associations between PFM and bone parameters: Compared with the lowest age‐ and gender‐specific tertile of PFM, males in the highest tertile of PFM had lower measures of whole‐body‐less‐head BA (WB‐BA), lumbar spine BA (L₂–L₄‐BA), total‐hip BA (TH‐BA), total‐hip BMC, CSA, and SM (p < .005 for all, adjusted p < .05). Similar inverse associations were observed in females for all the preceding parameters except WB‐BA and L2–L₄‐BA. These associations did not vary significantly by Tanner stages. In both genders, the estimated heritabilities were 80% to 86% for BMC, 67% to 80% for BA, 74% to 77% for CSA, and 64% for SM. Both shared genetics and environmental factors contributed to the inverse PFM‐bone correlations. We conclude that in this sample of relatively lean Chinese adolescents, at a given body weight, PFM is inversely associated with BA, BMC, and hip geometry in both genders, and such associations are attributed to both shared genetic and environmental factors. © 2010 American Society for Bone and Mineral Research     

术后同步放化疗在Ⅲ期低位直肠癌中的应用价值

目的 探讨Miles术后同步放化疗对改善Ⅲ期低位直肠癌患者预后的价值.方法 对2002-2003年行Miles术的132例Ⅲ期直肠癌患者的临床资料进行回顾性分析.根据患者意愿分为术后同步放化疗组（78例）和单纯化疗组（54例）.采用奥沙利铂加亚叶酸钙加氟尿嘧啶进行化疗 放疗方案为15MVX线,2 Gy/次,5次/周,总剂量50 Gy 与第1个疗程的化疗同步进行放疗.结果 术后随访5年,单纯化疗组和同步放化疗组分别有12例（22.2%）和6例（8.3%）局部复发,差异有统计学意义（P＜0.05）.两组远处转移率分别为51.9%（28/54）和47.4%（37/78）,差异无统计学意义（P＞0.05）.两组5年生存率分别为29.6%和47.4%,差异有统计学意义（P＜0.05）.除了6例（7.7%）放射性肠炎外,同步放化部组与单纯化疗组恶心呕吐和白细胞下降等不良反应的差异无统计学意义（P＞0.05）.结论 对于行Miles术Ⅲ期直肠癌患者,术后予以同步放化疗可降低局部复发率,提高5年生存率,是一项安全有效的辅助治疗方法.     

阿帕替尼联合奥沙利铂和替吉奥在胃癌腹膜转移转化治疗中的安全性及近期疗效观察

目的:探讨阿帕替尼联合奥沙利铂和替吉奥在胃癌腹膜转移转化治疗中的安全性和近期疗效。方法:回顾性分析"甲磺酸阿帕替尼联合替吉奥及奥沙利铂转化治疗晚期胃癌的单臂探索性临床研究"（中国临床试验注册号：ChiCTR-ONC-17010430）的前瞻性研究病例数据库,纳入18~70岁,经组织学及腹腔镜探查证实为胃癌腹膜转移,治疗...     

成都379例新型冠状病毒肺炎的临床分析

目的分析新型冠状病毒肺炎(COVID-19)患者的临床特征及预后。方法纳入成都市公共卫生临床医疗中心2020年1月16日至11月30日收治的379例COVID-19确诊病例,按照年龄分为老年组(42例,年龄≥60岁)和非老年组(337例,年龄<60岁),比较两组患者的流行病学、临床特征、实验室检查、治疗及预后。结果379例患者年龄2个月至87岁,平均41.2岁,其中男286例(75.5%),女93例。老年组平均年龄为69.5岁,女性更多见(占61.9%),大多为武汉输入和本土续发(占73.8%),以普通型和危重型为主(88.1%)。非老年组的平均年龄为37.8岁,男性更多见(80.1%),主要来自境外输入(75.7%),以轻型和普通型为主(95.0%)。179例患者(47.2%)合并一种或多种基础疾病,老年组以高血压病(15例,35.7%)及糖尿病(11例,26.2%)多见,而非老年组则以非酒精性脂肪性肝炎(132例,39.2%)多见。最常见的临床表现是发热(138例,36.4%)和咳嗽(129例,34.0%),但老年组的发热、咳嗽、呼吸困难及乏力等症状较非老年组更多见(P<0.05)。与非老年组相比,老年组的总淋巴细胞计数、CD4⁺及CD8⁺T淋巴细胞计数更低,而心肌损伤标志物及炎症指标更高(P<0.05)。139例患者(36.7%)的心脏彩色超声心动图异常,主要为左室舒张功能降低(22.7%)及心脏瓣膜反流(14.0%),且老年组患者的心脏彩色超声心动图异常率明显高于非老年组(85.7%vs.30.6%,P<0.05)。经治疗后,除老年组死亡3例外,其余均已治愈出院;但老年组的住院时间较非老年组更长(22.1 d vs.18.8 d,P=0.033)。结论成都老年COVID19患者主要来自武汉输入和本地续发,以普通型和危重型为主,常合并高血压或糖尿病等基础疾病;成都非老年COVID-19患者主要来自境外输入,以轻型和普通型为主,常合并非酒精性脂肪性肝炎;经治疗后,患者大多预后良好。     

Direct Anterior Approach in Lateral Decubitus Position Versus Supine Position for Unilateral Total Hip Arthroplasty: A Comparative Study

ObjectiveTo compare the clinical efficacy of the direct anterior approach in lateral decubitus position (L‐DAA) and supine position (S‐DAA) for unilateral total hip arthroplasty.MethodsA retrospective study was conducted on 89 patients who underwent primary unilateral total hip arthroplasty in our department between August 2016 and December 2017. There were 46 patients who underwent L‐DAA and 43 patients who underwent S‐DAA. The body mass index (BMI), operation time, blood loss, preoperative Hb, first day and third day postoperative Hb, incision length, hospital stay, preoperative and postoperative Harris score, preoperative and postoperative visual analogue scale (VAS) score, radiological evaluation, intraoperative and postoperative complication, postoperative absolute length difference of lower extremity were recorded and analyzed. P < 0.05 was set as the significant difference.ResultsAll patients were followed up for 8–23 months, with an average of 15.6 months. No significant differences were found in preoperative and postoperative Harris scores, preoperative Hb, incision lengths, radiological evaluations, preoperative and postoperative VAS scores, and hospital stay (P > 0.05). However, significant differences were detected in BMI, blood loss, first day and third day postoperative Hb, and operation time (P < 0.05). There were no postoperative complications in the L‐DAA and S‐DAA groups. During the operation, two cases of proximal femoral fracture occurred in the L‐DAA group, four in the S‐DAA group, and the difference was statistically significant. There were significant differences found in the postoperative absolute length difference of lower extremity between the two groups.ConclusionCompared with the S‐DAA approach, the L‐DAA approach had the advantages of shorter operation time and less blood loss. Compared with S‐DAA, it was easier to expose the proximal femur, and lower BMI was required in L‐DAA. However, it was more difficult to compare the length of both lower extremities in the L‐DAA approach than in the S‐DAA approach.     

Insulin Dependence Increases the Risk of Complications and Death in Total Joint Arthroplasty: A Systematic Review and Meta‐(Regression) Analysis

ObjectivesTo investigate the proportion of insulin‐dependent diabetes mellitus (IDDM) patients among diabetic patients undergoing total joint arthroplasty (TJA) and whether insulin dependence is associated with postoperative complications.MethodsA systematic literature search was performed in EMBASE, PubMed, Ovid, Medline, the Cochrane Library, Web of Science, the China Science and Technology Journal Database, and China National Knowledge Infrastructure from the inception dates to 10 September 2019. Observational studies reporting adverse events with IDDM following TJA were included. Primary outcomes were cardiovascular complications, pulmonary complications, kidney complications, wound complications, infection, and other complications within 30 days of surgery. Secondary outcomes were the proportion of IDDM patients among diabetic patients undergoing TJA and its time trend.ResultsA total of 19 studies involving 85,689 participants were included. Among patients undergoing TJA, 26% of diabetic patients had IDDM. Compared with non‐insulin‐dependent diabetes (NIDDM), the incidences of cardiac arrest (risk ratio [RR], 2.346; 95% confidence interval [CI], 1.553 to 3.546), renal failure (relative risk [RR], 2.758; 95% CI, 1.830 to 4.156), deep incisional surgical site infection (RR, 1.968; 95% CI, 1.107 to 3.533), wound dehiscence (RR, 2.209; 95% CI, 1.830 to 4.156), and death (RR, 2.292; 95% CI, 1.568 to 3.349) were all significantly increased in IDDM. A significant time trend was witnessed for the prevalence of IDDM (P = 0.014). There was no statistical significance for organ/space surgical site infection, thrombotic events (deep venous thrombosis/ pulmonary embolism), and revision rates.ConclusionInsulin‐dependent diabetes is an independent high‐risk factor for increased adverse outcomes relative to NIDDM, suggesting that hierarchical and optimal blood glucose management may contribute to reducing the adverse complications after surgery for these patients. In addition, because the risk of sepsis, deep wound infection, organ/space surgical site infection, urinary tract infection, renal insufficiency, and renal failure significantly increase after TJA in IDDM patients, more active postoperative antimicrobial prophylaxis may be needed on the premise of protecting renal function.     

Mid‐ to Long‐Term Outcomes of Cementless Modular,Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty

ObjectiveTo evaluate mid‐ to long‐term results of revision total hip arthroplasty for massive femoral bone loss using a cementless modular, fluted, tapered stem.MethodsThis is a retrospective study performed at a single hospital. During the period of January 2007 to January 2015, 33 patients (34 hips) underwent primary revision surgery with cementless modular, fluted, tapered stems due to femoral bone loss. Sixteen men and 17 women were included in the study, with an average age of 63.9 ± 11.7 years (range, 27 to 88 years). Operative data including operative duration, length of incision, drainage volume and duration, blood loss and transfusion, cases of bone graft and extended trochanteric osteotomy were recorded. Clinical evaluation was performed using Harris hip score (HHS), visual analogue scale (VAS), and patients'' satisfaction. Radiographic data including femoral stem fixation, subsidence, integrin of allograft bone, and leg length discrepancy were assessed. Complications and survivorship were evaluated using Kaplan–Meier survival rate.ResultsThe mean follow‐up was 9.1 ± 2.5 years (range, 5–13 years). The Harris hip score was 43.6 ± 11.5 preoperatively and maintained at 86.5 ± 6.6 at the time of latest follow‐up (P < 0. 05). The X‐ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in three hips (9%), and instability in one hip (3%). The average stem subsidence was 3.9 ± 2.2 mm (range, 1 to 10 mm). The mean difference in leg length in our study was 3.3 ± 2.7 mm (range, 0 to 10 mm), and the leg length discrepancy in 28 (82%) patients was within 5 mm. No case of junction fracture was observed. Seven (21%) intraoperative fractures occurred in our study. Three (9%) cases with infection were observed after revision. Six (18%) patients had lower limb vein thrombosis. The survivorship of prostheses with re‐revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10‐year follow‐up. Three (9%) re‐revisions were needed, including one for aseptic loosening, one for dislocation, and one for infection.ConclusionThe mid‐ to long‐term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stems are encouraging for massive femoral bone loss.