98例原发性胆汁性肝硬化的临床分析

目的通过对临床资料的分析,总结原发性胆汁性肝硬化(PBC)患者的临床表现和病理特征。方法对98例PBC患者的临床资料进行回顾性分析。结果本组98例原发性胆汁性肝硬化患者,女性占据了91例,远远高于男性;年龄在30～62岁,常见的临床症状是疲劳、倦怠,也会出现皮肤瘙痒、黄疸,伴有高胆红素血症、高球蛋白血症、碱性磷酸酶和γ谷氨酰转肽酶升高、ALT、AST异常等,并且存在自身的抗体,经检测大部分的患者的抗线粒体抗体或抗线粒体M2亚型抗体呈阳性。结论 PBC好发于中年女性,此病对肝脏的的损伤较为严重,经确诊后往往已到达晚期,预后较差。因此早期的诊断和积极的治疗,不仅可以延缓病程的发展,而且一定程度上可以改善预后。     

急性白血病化疗期间医院感染因素分析

目的分析AL患者化疗期间医院感染的临床特征及预防措施。方法对125例次AL化疗后医院感染患者临床资料进行分析。结果感染的病原菌主要是革兰阴性杆菌，医院感染感染者部位以呼吸道最多见。结论应针对危险因素加强预防措施，积极预防医院感染，提高患者生存质量。     

闭合复位穿针治疗锁骨中外1/3骨折并肩锁关节脱位

锁骨中外1／3骨折合并肩锁关节脱位在房部损伤中较为少见，常易漏诊。目前临床对此的治疗主要是切开复位内固定，自2003年至2007年共收治此类患者26例，采用闭合复位穿针内固定，取得良好效果，总结报告如下。     

糖尿病视网膜病变与红细胞变形能力和膜磷脂及收缩蛋白变化的关系

目的 探讨糖尿病视网膜病变(diabetic retinopathy,DR)与红细胞变形能力(erythrocyte deformability,ED)、红细胞膜磷脂成分及红细胞膜收缩蛋白(spectrin,SP)变化的关系。 方法 108例Ⅱ型糖尿病患者根据视网膜病变的有无分为DR组(55例)和非DR(non-diabetic retinopathy,NDR)组(53例),检测其ED、红细胞膜磷脂成分和红细胞膜收缩蛋白二聚体(spectrin dimer,SP-D)、四聚体(spectrin tetramer,SP-T)相对含量的变化。并与正常对照组53例的相同检测结果作对比。 结果 DR患者红细胞滤过指数(erythrocyte filtration index,EFI)、SP-D、SP-D/SP-T、神经鞘磷脂(spingomyline,SM)/磷脂酰胆碱(phophatidylcholine,PC)明显增高,而SP-T、SM、PC、磷脂酰丝氨酸(phophatidylserine,PS)和磷脂酰乙醇胺(phatidylthanolamine,PE)明显降低,与对照组和NDR组比较有显著差异(F=8.467～18.925, q=6.745～12.627,P＜0.001),且增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)者各指标变化较单纯性糖尿性视网膜病变(backgrouｎd diabetic retinopathy,BDR)者更明显(t=5.826～15.443, P＜0.001)。DR患者EFI与SM/PC、SPD、SPD/SPT呈正相关(r=0.613,0.596,0.660, P<0.01),与PE、PS、PC、SM、SP-T呈负相关(r=－0.519,－0.623,－0.639,－0.580,－0.611,P<0.01)。 结论 红细胞膜磷脂成分和SP异常引起的ED降低可能参与了DR的发生与发展,且与病变程度有关。 (中华眼底病杂志, 1999, 15: 160-162)     

成人成骨细胞与多孔钛联合培养观察

目的观察成人成骨细胞在多孔钛表面的生长情况，评价多孔钛的生物相容性。方法将成人骨髓来源的成骨细胞与多孔钛联合培养，以多孔羟基磷灰石（hydroxyapatite，HA）为对照，倒置显微镜、扫描电镜观察细胞生长情况，MTT法检测细胞活性。结果成骨细胞在钛微孔表面生长良好，MTT法检测细胞活性，两组吸光度值无显著性差异（P〉0．05）。结论多孔钛具有良好的生物相容性，是比较理想的成骨细胞载体。     

Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation

IntroductionFew studies have specifically evaluated the comminution extent of lateral femoral wall (LFW) fracture and risk factors of implant failure in intertrochanteric fractures with LFW fracture. The aim of present study was to evaluate the influence of comminution extent of LFW fracture on implant failure and identify risk factors of implant failure in cases with LFW fracture after intramedullary fixation.MethodsThis retrospective study included 130 intertrochanteric fracture with LFW fracture treated with intramedullary fixation at a teaching hospital over a 13-year period from January 2006 to December 2018. Demographic information, cortical thickness index, the reduction quality, status of medial support, position of the screw/blade and status of lateral femoral wall were collected and compared. The logistic regression analyzes was performed to evaluate risk factors of implant failure in intertrochanteric fractures with LFW fracture after intramedullary nail fixation.Results10 patients (7.69%) suffered from mechanical failure after intramedullary fixation. Univariate analyzes showed that comminuted LFW fracture (OR, 7.625; 95%CI, 1.437~40.446; p = 0.017), poor reduction quality (OR, 49.375; 95%CI, 7.217~337.804; p < 0.001) and loss of medial support (OR, 17.818; 95%CI, 3.537~89.768; p < 0.001) were associated with implant failure. After adjustment for confounding variables, the multivariable logistic regression analyzes showed that poor reduction quality (OR, 11.318; 95%CI, 1.126~113.755; p = 0.039) and loss of medial support (OR, 7.734; 95%CI, 1.062~56.327; p = 0.043) were independent risk factors for implant failure. Whereas, comminuted LFW fracture was not associated with implant failure (p = 0.429).ConclusionsThe comminution extent of the LFW fracture might influence the stability of intertrochanteric fractures; and intramedullary fixation might be an effective treatment method. Furthermore, poor reduction quality and loss of medial support could increaze the risk of implant failure in intertrochanteric fractures with LFW fractures after intramedullary fixation. Therefore, we should pay great emphasis on fracture reduction quality in future.     

Early recovery of basic mobility under femoral nerve block after hip fracture surgery – A propensity score matched pilot study

Background: Previous studies have shown better pain reduction utilizing femoral nerve block (FNB) in patients who underwent hip fracture surgery. However, few studies have focused on the recovery of physical function after FNB, and most studies excluded patients with dementia. We investigated the association between FNB performed in the operating room and the recovery of physical function after hip fracture surgery, including patients with dementia.MethodsA total of 103 patients with a mean age of 87.4 years who underwent hip fracture surgery under spinal anesthesia between July 2015 and December 2017 (46 patients receiving a single injection of FNB and 57 standard care) were enrolled. Patients with FNB versus standard care were matched by a propensity score to adjust for patient characteristics. An anesthesiologist performed FNB with 20ml of 0.2% ropivacaine, and the standard care group received intravenous 1000 mg acetaminophen or 50mg flurbiprofen once after surgery. After matching, 78 patients were analyzed. Our primary outcome was 3-day cumulated ambulation score (CAS, 0-18 points) and secondary outcomes were 1-day CAS on postoperative day 1-3 and length of hospital stay. We also stratified patient groups based on the presence of dementia and fracture type.ResultsPatients undergoing FNB had significantly better 3-day CAS compared to standard care (mean [SD], 8.72 [3.42] vs 7.33 [2.62]; mean difference, 1.38 [95%CI; 0.03 - 2.74]; p = 0.048) and 1-day CAS on postoperative day two (mean [SD], 3.10 [1.39] vs 2.56 [0.94]; mean difference, 0.54 [0.01 - 1.07]; p = 0.049). Length of hospital stay did not significantly differ among the two groups (p = 0.65). Larger positive effect was likely to be seen for patients with a femoral neck fractures and for those without dementia.ConclusionsPatients who underwent surgery with spinal anesthesia plus FNB had better ambulatory status early after hip fracture surgery compared to patients not offered FNB. The beneficial association between FNB and ambulatory status was likely to be observed especially in patients with femoral neck fracture and without dementia.     

Outcomes following traumatic inhalational airway injury – Predictors of mortality and effect of procedural intervention

ObjectiveStudy outcomes, predictors of mortality, and effects of procedural interventions on patients following traumatic inhalational airway injury.StudyDesign: Retrospective study.SettingNational Trauma Data BankMethodsPatients over the age of eighteen admitted between 2008 and 2016 to NTDB-participating sites were included. In-hospital mortality and length of stay were the primary outcomes.ResultsThe final study cohort included 13,351 patients. History of active smoking was negatively associated with in-house mortality with an OR of 0.33 (0.25–0.44). History of alcohol use, and presence of significant medical co-morbidities were positively associated with in-house mortality with OR of 5.28 (4.32–6.46) 2.74 (19.4–3.86) respectively. There was little to no association between procedural interventions and in-house mortality. Intubation, laryngobronchoscopy, and tracheostomy had OR of 0.90 (0.67–1.20), 1.02 (0.79–1.30), and 0.94 (0.58–1.51), respectively. However, procedural intervention did affect both the median hospital and ICU lengths of stay of patients. Median hospital and ICU length of stay were shorter for patients receiving endotracheal intubation. Median hospital length of stay was longer for patients undergoing bronchoscopy and laryngoscopy, but median ICU length of stay was shorter for patients undergoing bronchoscopy and laryngoscopy. Patients receiving a tracheostomy have both significantly increased median hospital and ICU lengths of stay.ConclusionsActive smoking was associated with decreased odds of in-hospital mortality, while presence of pre-existing medical comorbidities and history of alcohol use disorder was associated with increased odds of in-hospital mortality. Procedural intervention had little to no association with in-hospital mortality but did affect overall hospital and ICU LOS.     

幼兔表层软骨移植修复全层软骨缺损的实验研究

为研究生长发育期表层关节软骨在全层软骨缺损中的修复作用,建立生长发育期幼兔表层软骨移植修复自身全层软骨缺损的动物模型,6周后取标本进行大体和光镜下观察,并行Ⅱ型胶原免疫组化染色.结果显示表层软骨移植组28例标本缺损完全由透明样软骨修复,修复组织Ⅱ型胶原表达强阳性;对照组2例由透明样软骨组织部分修复,Ⅱ型胶原表达阳性,其余由纤维软骨组织、纤维组织修复.说明生长发育期表层软骨移植能够修复全层软骨缺损,生长发育期表层软骨细胞具有增生、迁徙、修复软骨缺损的功能.