Rockall危险性积分在急性上消化道出血中的应用

目的：探讨Rockall危险性积分在急性上消化道出血中的应用。方法：262例按Rockall危险性积分进行评分，并分为低危组（0～3）、中危组（4～7）、高危组（≥8）。结果：高危组与中危组相比再出血率差异无统计学意义（P〉0．05）。高危组与中危组相比死亡率明显升高（P〈0．05）。结论：Rockall危险性积分对急性上消化道出血患者的病情评估具有重要的意义。     

336例创伤数据对中国人创伤评分权重系数的评价

目的为了评价国内对ＴＲＩＳＳ评分权重系数的修订，对３３６例创伤患者分别用国外权重和国内权重评定伤情后进行比较。方法３３６例采用ＴＲＩＳＳ法计算生存概率Ｐｓ，所需权重分别采用新近报道的国内权重和国外ＭＴＯＳ权重。Ｐｓ≥０．５预测生存，Ｐｓ＜０．５预测死亡，将预测生死与实际生死结果进行比较。结果中国人权重在敏感性和区别度方面高于国外权重，误判率低于国外权重。结论中国人权重对中国人的创伤程度评估有价值，为进一步精确修订权重，建议建立大型中国人创伤数据库     

Proteoglycan fragments in knee joint fluid after exercise

The concentration of cartilage proteoglycan fragments in knee joint fluid was measured before and after one event of physical exercise in 33 healthy athletes. Nine athletes ran on a treadmill for 60 min, 16 ran on road for 80 min and 8 played one soccer game (90 min). Before exercise, the levels of proteoglycan fragments in the athlete joint fluid were lower than in a previously analyzed reference group. After exercise, the concentration of proteoglycan fragments increased in all of the 7 athletes that could be directly compared before and after exercise. This increased concentration of proteoglycan fragments in the joint fluid could be an effect of mechanical loading of the cartilage in combination with a possible high turn-over rate of the cartilage matrix in the athletes.     

基于术前脾脏CT影像组学列线图预测胃癌的浆膜浸润

目的：联合临床检验指标及影像学特征构建一种能够术前识别胃癌浆膜浸润的模型。方法：选取2015年1月至2019年12月温州医科大学附属第一医院经病理证实的656例胃癌患者,采用随机数字表法分为建模组（394例）和验证组（262例）。收集建模组患者的脾脏影像学资料,对收集的数据进行套索回归并选取差异有统计学意义的特征来构建浆膜浸润预测模型。在最大约登指数下取肿瘤浸润风险评分截断值将患者分为高危组（238例）和低危组（418例）,然后与其他浸润相关因素如BMI、年龄、性别、高血压、糖尿病等进行单变量和多变量Logistic回归分析,结合显著的独立影响因素共同建立可视化的浆膜浸润预测列线图。结果：将患者以肿瘤浸润评分≤-0.335分为低危组,＞-0.335为高危组,经验证组验证,建模组和验证组的诊断准确性较为一致（P＜0.001）。经浸润影响因素的单变量和多变量Logistic回归分析发现,影像组学肿瘤浸润评分（OR=2.9,95%CI=2.1～4.2,P＜0.001）、术前低白蛋白（OR=1.3,95%CI=1.2～3.1,P=0.003）、血小板与淋巴细胞比值（OR=1.8,95%CI=1.2～2.7,P=0.004）、肿瘤分化程度（OR=2.6,95%CI= 1.8～3.7,P＜0.001）是浆膜浸润的独立影响因素。基于这4个指标建立的预测模型能够较为准确地预测浆膜浸润风险,其AUC值为0.733。结论：基于脾脏影像的肿瘤浸润评分联合其他临床因素可准确预测胃癌浆膜浸润与否,提高诊断精度。     

Frailty评分对枸橼酸伊沙佐米治疗多发性骨髓瘤不良反应的预测价值

目的 探讨Frailty评分对枸橼酸伊沙佐米治疗多发性骨髓瘤(multiple myeloma, MM)不良反应的预测价值。方法 选取MM患者72例,均予以枸橼酸伊沙佐米联合沙利度胺、地塞米松方案治疗,观察治疗效果及不良反应。并根据患者不良反应程度分为Ⅰ～Ⅱ级组和Ⅲ～Ⅳ级组。比较2组Frailty评分;采用Cox回归模型分析化疗相关Ⅲ～Ⅳ级不良反应的影响因素;采用ROC曲线模型分析Frailty评分对化疗相关Ⅲ～Ⅳ级不良反应的预测价值。结果 72例MM患者均实施枸橼酸伊沙佐米治疗,总有效率为80.55%;出现不良反应70例、以乏力占比最高,发生率为72.22%,其次为淋巴细胞降低25.00%、贫血18.06%,未出现任何不良反应2例。Ⅲ～Ⅳ级组Frailty评分高于Ⅰ～Ⅱ级组(P<0.05)。70例出现不良反应患者均随访12个月,其平均生存时间(22.30±2.28)个月。Cox回归分析结果显示,Frailty评分≥2分是MM患者发生Ⅲ～Ⅳ级不良反应的影响因素。ROC曲线分析显示,Frailty评分预测化疗相关Ⅲ～Ⅳ级不良反应AUC值为0.925(95%CI:0.816～1.00...     

自体PRP注射联合依托考昔治疗膝关节骨性关节炎效果及对细胞因子的影响

目的 研究自体富血小板血浆(platelet rich plasma, PRP)注射联合依托考昔治疗膝关节骨性关节炎(knee osteoarthritis, KOA)的效果及对细胞因子的影响。方法 选取KOA患者68例,按照随机数字表法分为单一组和联合组,每组34例。单一组采用依托考昔治疗,联合组采用自体PRP注射联合依托考昔治疗。治疗6周后比较2组疗效,治疗前、治疗6周后比较2组骨关节炎指数[西安大略和麦克马斯特大学骨关节指数(Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC评分)]、膝关节功能Lysholm评分(Lyshom Knee Rsting System)、生活质量[膝关节骨性关节炎严重性指数(Index of Severity Forosteo Arthritis, ISOA评分)]及细胞因子[白细胞介素1β(interleukin-1β,IL-1β)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(high sensitivity C...     

术后快速康复对全膝关节置换术后功能的影响

目的 通过对比全膝关节置换术(total knee arthroplasty, TKA)患者术后功能结果,探讨术后快速康复(enhanced recovery after surgery, ERAS)方案对TKA术后功能的影响。方法 以首都医科大学附属北京朝阳医院2010年1月1日到2021年12月31日1 881例诊断为膝关节骨关节炎的住院患者为研究对象,根据是否应用ERAS方案分为ERAS组和对照组。收集两组患者基本信息、术前和术后1个月的膝关节活动度、美国膝关节协会评分(American Knee Society Score, KSS)、西大略湖和麦克马斯特大学骨关节炎评分(the Western Ontario and McMaster Universities, WOMAC)以及术后1个月患者满意度。结果 实施术后快速康复方案后,ERAS组住院时间及住院费用明显低于对照组,组间差异有统计学意义(P<0.01)。术后1个月,ERAS组患者KSS临床和功能评分以及膝关节活动度明显优于对照组,患者术后满意度明显高于对照组,组间差异有统计学意义(P<0.05);而术后1个...     

脓毒症患者外周血单核细胞miR-147b的表达及其与病情严重程度和预后的关系

目的 探讨脓毒症患者外周血单核细胞miR-147b的表达水平及其与病情严重程度及预后的相关性。方法 选择2019年1月至2021年6月于安徽医科大学第一附属医院就诊的46例脓毒症患者(脓毒症组)和50例普通感染患者(普通感染组)作为研究对象。查阅患者病历,记录年龄、性别、感染部位等一般资料。采用酶联免疫吸附试验试剂盒检测研究对象血清中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C反应蛋白(C-reactive protein, CRP)的浓度。计算序贯性器官衰竭评分(sequential organ failure score, SOFA)和急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health scoreⅡ,APACHEⅡ)。观察或随访脓毒症患者的28 d预后情况,分为生存组和死亡组。应用逆转录聚合酶链反应测定外周血单核细胞中miR-147b的表达水平。结果 脓毒症组和普通感染组的年龄、性别、感染部位分布比较差异无统计学意义(P>0.05)。脓毒症组患者的TNF-α、CRP水平、SOFA评分和A...     

Comparison of the biomechanical effect of posterior condylar offset and kinematics between posterior cruciate-retaining and posterior-stabilized total knee arthroplasty

Background

The effect of the changes in the femoral posterior condylar offset (PCO) on anterior–posterior (AP) translation and internal–external (IE) rotation in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare the kinematics in CR and PS TKA with respect to the difference in prosthetic design and PCO change through a computational simulation.

Subchondroplasty in the treatment of bone Marrow lesion in early Knee Osteoarthritis: A systematic review of clinical and radiological outcomes

BackgroundKnee osteoarthritis (KOA) is increasingly prevalent in North American society. The significant societal burden it represents makes it essential to promote and target new treatments in earlier phases of the disease. Among others, subchondroplasty is a newly documented technique using calcium phosphate injection targeting the osteochondral lesions preceding KOA, also known as Bone Marrow Lesions (BMLs). This article aimed to review the existing literature on clinical and radiological outcomes of subchondroplasty in the treatment of BMLs in KOA.MethodA systematic review was performed using PubMed, Embase, Medline and Cochrane Database of Systematic Reviews. Studies on calcium phosphate injections into BMLs for KOA and its clinical and radiological outcomes were screened and reviewed by independent evaluators.ResultsAfter screening, ten articles were included, totaling 540 patients. Follow-up ranged from 6 months to 7 years. Overall, the procedure showed significant functional and quality of life improvement, as well as pain relief, as shown by Patients-Reported Outcomes Measures (PROMs). There were very few complications reported, the most important being leakage of calcium phosphate outside the targeted site. Conversion rate to total knee arthroplasty (TKA) ranged from 14 % to 30 % at 2 years post-procedure. Long term radiological outcomes have been poorly documented.ConclusionsSubchondroplasty is a promising avenue for the treatment of KOA. However, quality evidence is still required before any real conclusions and practical management guidelines can be drawn. Prospective, randomized studies with a control group and a rigorous assessment of long-term clinical and radiological outcomes are recommended.