Closed suction drainage after orthopaedic surgery: evidence versus practice

Abstract Closed suction drainage systems are commonly used in orthopaedic surgery, particularly in joint arthroplasty. The rationale for the use of drains is a theoretical reduction of wound haematomas and infection. However the benefit of using drains after total hip or knee arthroplasty is controversial. Several reports have shown that the use of drains does not reduce infection and morbidity and is an unnecessary and potentially dangerous practice. In fact most studies highlighted that at best their use appears to make no difference to important clinical outcomes. Recently a metaanalysis raised the question about the usefulness of closed suction drainage again, concluding that it has no major benefits. The purpose of this study was to review the evidences available concerning the utility of closed suction drainage outlining that this practice is not supported by clinical evidence.     

自行下体负压训练器的研制

目的 研制一种自行下体负压训练器。方法 自行下体负压训练器由若干环形钢圈及涂胶布材料构成的密闭完整的空腔壳体，可上下随意伸缩。上表面安装有单向排气阀门、可调进气阀门、把手及肩带。沿筒体纵轴进行屈／伸膝关节运动，使之被动扩张产生负压。结果 进气阀门完全关闭、打开1／4、1／2至完全打开时，训练器负压峰值逐渐降低，分别为-58、-46、-38和-26mmHg。结论 自行下体负压训练器集体育锻炼和下体负压于一体，安全可靠，使用方便，可望应用于对抗失重生理影响和飞行员抗荷生理训练。     

再生医学技术在烧伤传统治疗无效病人中的应用(附38例报告)

目的：总结重度烧伤传统疗法无效改为再生医学(MEBT/MEB0)技术治疗变化规律和临床验．方法：将我科l995年5月至2002年5月收治的院外采用传统疗法无效改用MEBT/MEBO技术治疗的38例重度烧伤病人临床资料进行回顾性总结，病人一旦入院创面均改用MEBT/MEBO治疗，初始予以彻底清创，规范用药、规范操作，规范认识；全身实行系统综合治疗措施．以临床观察和病人感觉评价治疗效果。结果：本组38例全部治愈，末植皮自行愈合者21例．占55.26％．深Ⅲ度创面自愿要求植皮者17例，占44.74％。经随访多数无增生性瘢痕，部分愈后有局限性瘢癌，质软无残废。结论：重度烧伤经传统疗法久治不愈或疗效欠佳病人．病情复杂，并发症较多治疗难度也较大，再生医学可有效改善以上缺陷和病症．是重度烧伤病人传统治疗无效时的理想疗法。     

Stochastic models for geriatric in-patient behaviour

Departments of geriatric medicine engage in two distinct formsof clinical activity: acute/rehabilitative and long-stay care.These are organizationally distinct and have very differentresource needs. Current hospital planning models, however, assumethat patients all move through the system at the same rate,thereby ignoring this effect of inherent heterogeneity in patientbehaviour. The present paper describes the movement of patientsthrough geriatric hospitals by a two-stage continuous-time Markovmodel, where the stages represent acute/rehabilitative and long-staypatients respectively. Patients are initially admitted to thefirst stage, from which they may depart from the system, bydeath or discharge, or move into the second stage, from whichthey eventually depart by death or discharge (unlikely). Admissionsare modelled in two ways: either as replacements for departuresor as a Poisson stream. Expressions for the distribution andmovement of numbers of patients are derived and evaluated fordata from a number of hospitals. Such an approach has the advantage,over previous crude models, of taking into account differenttypes of patients and introducing variability, thus making itpossible to extract variances as well as means of numbers ofgeriatric patients requiring hospital care.     

Additive effects of earthworm extract with HpD-laser on the enhancement of reactive oxygen production and the inhibition of[~3H]—thymidine.uptake in mouse ascitic tumor cells

The effects of combined use of earthworm extract(912)and HpD-laser on the produc-tion of reactive oxygen and the biosynthesis of DNA in S_(180) tumor cells were studied throughchemiluminescence measurement and[~3H]-TdR incorporation assay.The results showed that as com-pared with the control,the intensity of chemiluminescence emitted by tumor cells treatedsimultaneously with 912 and HpD-laser was enhanced more than ten-folds,while that treated with912 or HpD-laser alone was increased only 2～4 folds.The[~3H]-TdR incorporation into tumorcells of the former group was inhibited upto 74.1%,and that of the latter groups decreased onlyby 42.2% and 40.0%,respectively.In accordance with these biochemical changes,the ultrastructuraldamage of tumor cells of the former,combinedly treated group appeared to be the most serious.This suggests an additive effect of 912 with HpD-laser on tumor cells.In addition,if free radicalscavengers,such as catalase and superoxide dismutase,were added to the reaction systembefore chemiluminescence assay,the luminescent enhancement effect mentioned above was dramaticallyalleviated,implying the presence of O_2~ and H_2O_2 in the system.Therefore,as to the toxic effecton tumor cells,912 and HpD-laser are not only additive in efficiency,but also similar in theunderlying mechanism of action.     

Epilepsy in Ancient India

The ancient Indian medical system, Ayurveda, meaning science of life, is the oldest system of medicine in the world. Epilepsy is defined as Apasmara: apa, meaning negation or loss of; smara, meaning recollection or consciousness. Aura was recognized and was called Apasmara Poorva Roopa. A large number of symptoms indicative of aura were listed. Worthy of mention are subjective sensation of sounds, sensation of darkness, feeling of delusion, and dream-like state. An actual attack of Apasmara includes falling down; shaking of the hands, legs, and body; rolling up of the eyes; grinding of the teeth; and foaming at the mouth. Four major types of epilepsy based on the disturbance of doshas (humors) that govern the physiological and physiochemical activities of the body are mentioned. Apasmara is considered a dangerous disease that is chronic and difficult to treat. Several causes are mentioned. Treatment included correcting the etiological factors and dietary regimen and avoiding dangerous places that may result in injuries.     

变应性鼻炎、哮喘患者血白细胞介素的循证医学研究

目的 评价变应性鼻炎、哮喘患者血清中白细胞介素IL-4、IL-6、IL-8检测指标的意义。方法 检索策略:通过中国生物医学文献数据库(CBMdisc)、中文全文数据库全面检索国内已发表的相关文献。选择标准:中国成人变应性鼻炎、哮喘患者与对照组血清白细胞介素IL-4、IL-6、IL-8水平检测。资料收集和分析:由2位评价者按照上述检索策略收集文献。排除那些不符合选择标准要求的试验。结果 经Meta分析,发作期、缓解期变应性鼻炎患者血清中IL-4水平分别较对照组上升129.45 ng/mL(95％CI 124.95～133.96)、35.00 ng/mL(95％CI 32.01～39.78),有显著统计学意义(P<0.000 01):缓解期IL-6水平较对照组上升21.87 ng/mL(95％CI 19.83～23.91),有显著统计学意义(P<0.000 01);发作期、缓解期IL-8水平分别较对照组上升41.75 ng/mL(95％CI 29.14-54.36)、98.94 ng/mL(95％CI 96.48-101.41),有显著统计学意义(P<0.000 01);发作期IL-4水平较缓解期上升129.99 ng/mL(95％CI 125.00～134.99),有显著统计学意义(P<0.000 01)。结论 IL-4、IL-6和IL-8参与了变应性鼻炎、哮喘的发生和促进了变态反应性疾病的发展,有必要开展更广泛研究和更深层的原因探索。     

桂枝汤各组分作用的比较

以急性毒性、镇痛及体温降低作用为指标比较了桂枝汤及其组方中五味中药的作用。证实桂枝汤的镇痛作用主要由桂皮和芍药所致；降温作用主要因桂皮和甘草所致。在方剂中各味中药可产生协同效应。桂枝汤毒性主要由桂皮和甘草所致。方剂中各药的毒性均较单独用药降低。表明桂枝汤组方后各味中药的疗效增强而毒性降低。     

关于口腔医学多媒体及网络教学实验效果的分析

采用比较研究的方法进行了口腔医学多媒体及网络教学实验，旨在观察比较网络教学环境、多媒体课件演示以及传统教师讲授等多种教学方式的教学效果，分析传统教学与网络教学模式下的教学环节、教学效果以及存在问题，对课件进行总体评价，对影响因素进行分析，对多媒体及网络教学模式作一初步的实践和探索。