离退休老年患者生理心理变化的观察及护理对策

目的 :探讨离退休老年患者的生理心理变化 ,提出护理措施。方法 :在临床工作中观察了解其心理素质、性格、修养及他们对疾病的认识和敏感程度 ,采取相应的护理对策。结果 :离退休老年患者消除了失落感和孤独感 ,主动了解自身的疾病和保健。结论 :组织和指导老年患者学习医学常识有助于提高自我认识与自我调节能力 ,达到健康长寿     

脊髓损伤患者骨化性肌炎的预防及康复护理

骨化性肌炎最早由Guy Patin于1692年提出,1868年由Von Dusch命名.其实质是一种异位性骨化,是发病机制不明的少见的良性局限的骨化的软组织肿块,是肌肉及其邻近结构的局限性的、含有非肿瘤性的钙化和骨化的病变….脊髓损伤后骨化性肌炎据研究[2]报道其发病率为10%-53%,脊髓损伤患者的异位骨化属于神经源性,好发于髋关节前方,也可发生于膝、肩、肘关节等处.严重的骨化性肌炎可以限制关节活动,甚至造成关节强直,使关节丧失活动功能,因而加重了脊髓损伤患者的痛苦,影响其康复治疗的进展和效果.鉴于骨化性肌炎是一种可以防治的并发症,因此在临床护理工作中的预防和康复具有重要的意义.现报道如下.     

A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

Purpose

A prospective study was conducted to detect whether a relationship exists between metal allergy and post-operative pain in total hip and knee arthroplasty patients. We postulated that to some extent a relationship does exist between them.

Materials and methods

Patients who had undergone total hip and knee arthroplasty surgery because of hip and knee disease were included. The exclusion criteria were patients who were treated with immunosuppressor two weeks pre-operatively, skin conditions around the patch testing site, and other uncontrollable factors. Each patient agreed to patch testing for three days before surgery. Photographic images before patch testing, two and three days after patch testing were obtained to evaluate the final incidence of metal allergy. The patch tests contained 12 metal elements; chromium, cobalt, nickel, molybdenum, titanium, aluminium, vanadium, iron, manganese, tin, zirconium, and copper. Two independent observers evaluated the images. The results were divided into a non-metal allergy group and a metal allergy group. Pre-operative and postoperative VAS score, lymphocyte transforming test, and X-rays were collected to detect the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty.

Results

There were 96 patients who underwent pre-operative patch testing. The overall metal allergy rate was 51.1 % (49/96) in our study. Nickel, cobalt, manganese, and tin were the most common allergic metal elements in our study. Nine inappropriate cases were excluded, and 87 patients were finally included in our study. There were 36 metal allergy and 26 non-metal allergy patients in the THA group, while 11 metal allergy and 14 non-metal allergy patients were found in the TKA group. We found no relationship existed between metal allergy and post-surgery pain in total hip and knee arthroplasty.

Conclusion

Pain caused by metal allergy usually presents as persistent and recurrent pain. The white cell count, C-reactive protein, erythrocyte sedimentation rate and postoperative radiographs were not affected. Currently, patch testing and lymphocyte transforming tests are used for metal allergy diagnosis. We deemed that a relationship between post-surgery pain and metal allergy in total hip and knee patients may exist to some extent. Larger samples and longer follow-up time are essential for further study.     

New bone formation enhanced by ADSCs overexpressing hRunx2 during mandibular distraction osteogenesis in osteoporotic rabbits

Promoting new bone formation during distraction osteogenesis (DO) in elderly patients with osteoporosis is still a challenge. In this study, we investigated the effect of gene therapy using local Runt‐related gene 2 on new bone formation during osteoporotic mandibular DO in rabbits. First, we successfully established a mandibular osteoporotic animal model by ovariectomizing rabbits. Second, the right mandibles of the osteoporotic rabbits were distracted after corticotomy. The distraction gap of the rabbits in Group A2 and B2 were injected with Adv‐hRunx2‐GFP‐transfected adipose‐derived stromal cells (ADSCs) and Adv‐GFP‐transfected ADSCs, respectively. Rabbits in Groups C2 (ovariectomized control) and D2 (sham surgery control) were injected with physiologic saline. New‐generation bone tissue in the distraction gap was analyzed via plain radiographic examinations, micro‐computed tomography, histological examinations, and biomechanical testing at weeks 3, 6, and 9 of the consolidation period. Results of above examinations showed that no ideal new bone formation was observed in Groups B2 and C2, but obvious ideal new bone formation was observed in Group A2 and D2. The results suggested that gene therapy using rhRunx2‐modified ADSCs promoted new bone formation during osteoporotic mandibular DO and effectively compensated for the detrimental effects of systemic osteoporosis on new bone formation. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:709–720, 2014.     

Single-Incision Versus Conventional Laparoscopic Appendectomy: A Meta-analysis of Randomized Controlled Trials

Background

Single-incision laparoscopic appendectomy (SILA) has gained enormous popularity worldwide. We conducted a meta-analysis to assess feasibility, safety, and benefits of SILA as compared with conventional laparoscopic appendectomy (CLA).

Methods

A literature search in MEDLINE, EMBASE, and Cochrane Library was performed to identify eligible randomized controlled trials (RCTs). Primary outcome measures were total postoperative complications, wound infection, intra-abdominal abscess, and ileus. Secondary outcome measures were operative time, length of hospital stay, pain scores, conversion rate, reoperation rate, and time to return to normal activity.

Results

Eight RCTs, totaling 1,211 patients (604 for SILA and 607 for CLA), met the inclusion criteria. The incidences of total postoperative complications, wound infection, intra-abdominal abscess, and ileus were statistically similar between the SILA and CLA groups. Compared with CLA, SILA was associated with a significantly longer operative time (weighted mean difference?=?5.28 min; 95 % confidence interval?=?3.61 to 6.94). Time to return to normal activity was shorter in the SILA group (by 0.69 days). Length of hospital stay, pain scores, conversion rate, and reoperation rate were similar between groups.

Conclusion

SILA is feasible and safe with no obvious advantages over CLA. Therefore, it may be considered as an alternative to CLA.