颅骨缺损状态下区域血流速度变化

目的 :探讨颅骨缺损病理状态下区域血流速度变化。方法 :应用TCD测定不同缺损面积的颅骨缺损病人术前患侧及健侧和术后患侧ICA、ACA、MCA、PCA、BA平均血流速度。结果 :≥ 35cm2 病人患侧颅内血管平均血流速度高于正常 ,而健侧颅内血管平均血流速度正常。 <35cm2 病人患侧及健侧颅内血管平均血流速度均在正常范围。结论 :颅骨缺损病理状态下常可引起区域血流速度改变 ,血流速度改变是指导颅骨缺损修补的重要依据     

听骨检测实验装置

目的：探讨对人工听骨赝复物传音功能进行评价的客观方法。方法：用两块圆形的弹性膜来分别代替鼓膜和卵圆窗，两膜之间放置人工听骨，在人工外耳道侧给予纯音刺激，同时记录其声强，在卵圆窗膜处用激光测振仪测量卵圆窗膜的振动速度，通过比较振动速度的大小来比较人工听骨的传音特性。结果：模型“感觉阈曲线”和正常人听阈曲线对比，两者走势基本相同。结论：中耳机械模型是检验人工听骨传音特性并进行人工听骨赝复物客观评价理想的工具之一。     

A quantitative method for thein vitro study of sounds produced by prosthetic aortic heart valves Part II: an experimental,comparative study of the sounds produced by a normal and simulated-abnormal Starr-Edwards series 2400 aortic prosthesis

A comparative study was made of the sounds produced by a normal Starr-Edwards 2400 aortic valve prosthesis with those produced by the same valve but having a simulated overgrowth at the apex of the struts. Comparisons were made over the entire cardiac cycle for time and amplitude, power-density spectra, power-distribution spectra, power-distribution surfaces associated with individual valves, and three-dimensional power-distribution-difference surface. Power-density spectra were compared for portions of the cycle corresponding to the opening, systolic, and closing sounds of the valve. Physical parameters of an acoustical model were estimated from the power-density spectra. The results showed that each comparison gave information pertinent to the simulated malfunction. Opening. systolic and closing sounds, respectively, were different for each valve. The opening sound of the abnormal valve displayed a much lower frequency. Systolic sounds for the two valves were similar in frequency, but the normal valve produced more total power for this sound. The closing sound of the abnormal valve occurred later than that of the normal valve. These differences were more clearly seen when viewed in the frequency domain.     

一种自动优选标准型股骨柄的方法

髋关节置换手术中采用标准型假体时,术前只能大致选取假体,术中还要预备多个假体,往往手术时间增长。为了解决这一问题,本文提出一种利用计算机优选标准型髋关节假体的方法。从X线片中获取患者股骨解剖数据。利用这些解剖数据和股骨近端截面平均数据库三维重建患者股骨近端,重建出的股骨近端模型使优选标准假体成为可能。理论分析表明,该方法切实可行。     

Molecular diagnosis of a vascular prosthesis infection, due to Propionibacterium acnes, by amplification and sequencing of 16S rDNA

We describe a case of indolent vascular prosthesis infection due to Propionibacterium acnes. The microorganism was identified only by amplification and sequencing of 16S rDNA, while standard cultures remained negative. This observation underscores the usefulness of molecular techniques for the diagnosis of infection caused by fastidious microorganisms.     

老年髋部骨折患者围术期“2P-3R”营养管理模式构建

目的构建老年髋部骨折患者围术期营养管理模式,促进患者早手术、早下地、早康复。方法针对老年髋部骨折患者营养管理现状,采用课题研究型品管圈活动进行改进。经过科学循证、专家指导等,从术前、术后及家庭三个环节,骨科、营养科、家庭三个维度,人员、制度、材料设备、方法、信息五个方面,制定三大对策群组并予以实施,包括组建营养支持团队、构建营养管理策略、搭建多维信息交互平台等。结果老年髋部骨折患者首次下地时间缩短为26.7 h,平均住院日缩短为5.6 d,实现了早手术、早下地、早康复的目标。结论对老年髋部骨折患者实施个性化、全流程的序贯性营养干预具有重要意义。后续还需开展大样本多中心研究以进一步验证成效,数据自动采集与智能反馈也是今后研究重点。     

Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients

ObjectivesWe examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures.DesignPopulation-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR).Setting and ParticipantsPatients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443).MethodsComorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes.ResultsThe overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity.Conclusion and ImplicationsIncreasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years.     

心脏瓣膜置换术48例围手术期的处理

目的：总结瓣膜置换术围手术期处理所临床经验。方法：回顾性分析48例瓣膜置换术病人术前、术中、术后处理的临床资料。结果：发生围手术期并发症共14例,其中低心排4例,心律失常4例最多。长期存活47例,死于多器官功能衰竭1例。结论：术前注意纠正心功能不足与合并症的治疗,术中注意心肌保护与三尖瓣关闭不全的矫治,术后强调补足血容量和血清钾后强心利尿。     

全髋关节置换术后异位骨化及其预防

目的：探讨全髋关节置换术后异位骨化发生的原因、机制及其预防方法。方法：将139例接受全髋关节置换的患者入院时随机分为3组,A组53例,B组49例,C组37例,分别于术后次日口服维生素C（100mg,3/d)、消炎痛（25mg/3/d)和布洛芬（200mg,3/d),连续应用4周。术后3个月复查时行X线片检查。结果：异位骨化情况按Brooker分类,A组：0级24例,I级6例,Ⅱ级13例,Ⅲ级7例,Ⅳ级3例,异位骨化发生率54．7％（29／53）。B组：0级42例,Ⅰ级5例,Ⅱ级2例,发生率14．3％（7／49）。C组：0级32例,Ⅰ级3例,Ⅱ级、Ⅲ级各1例,发生率13．5％（5／37）。经统计学分析,异位骨化发生率A组与B组、A组与C组之间有显著差别（P＜0．01）,B组与C组之间无显著差别（P＞0．05）。结论：全髋关节置换术后发生异位骨化的原因很多,发生机制尚不清楚,非甾体类消炎镇痛类药物可有效地预防其发生。