预后营养指数和患者主观整体评估对食管癌患者围手术期营养预测的比较研究

目的探讨预后营养指数(prognostic nutritional index,PNI)和患者主观整体评估(patientgenerated subjective global assessment,PG-SGA)对食管癌患者围术期营养状况的预测价值及一致性。方法回顾性分析我院2017年11月至2018年8月224例接受食管癌根治手术患者的临床资料,其中男186例、女38例,平均年龄(63.08±8.42)岁。根据患者入院首次血常规及生化检验结果计算PNI并进行PG-SGA评估。根据PNI值将患者分为营养良好组(PNI≥45,60例)和营养不良组(PNI<45,164例),根据PG-SGA评分将患者分为营养良好组(PG-SGA<4,75例)和营养不良组(PG-SGA≥4,149例),分别比较两组患者围手术期营养相关血液学指标及体重指数(BMI)的纵向变化,并分析PNI与PG-SGA对营养评估的一致性。结果不同PNI分组患者的营养相关血液学指标在围手术期的纵向变化差异有统计学意义(P<0.01);不同PG-SGA分组患者的前白蛋白在围手术期纵向变化差异有统计学意义(P<0.05);不同PG-SGA分组患者的BMI在围手术期纵向变化差异有统计学意义(P<0.01);两者一致性Kappa系数为0.589(P<0.001)。结论 PNI和PG-SGA均能一定程度上预测食管癌患者围术期的营养风险,PNI为客观监测指标,PG-SGA为主观评价指标,两者联合使用对食管癌患者进行营养评估能更全面地反映和预测患者的营养状况,为制定个体化营养支持方案提供重要参考依据。     

Fracture stiffness measurement in tibial shaft fractures: a non-invasive method

This paper presents a non-invasive method of assessing healing by measurement of fracture stiffness. The method works on the principle that if the load (F) applied at a certain known distance (Y) from the fracture is measured, then the moment (M = FY) at the fracture site can be calculated. By measuring the angle/deflection (θ) occurring at the fracture site using a suitable instrument (electrogoniometer), the necessary data to calculate fracture stiffness (FY/θ) would be available. The method was employed to assess the stiffness in a series of tibial shaft fractures treated conservatively, all of which healed uneventfully. This paper concentrates on a group of tibial shaft fractures in which the radiological criteria for fracture union were not satisfied even after a mean duration of 20 weeks treatment. The non-invasive method of measuring fracture stiffness supported the clinical impression of union in most cases at the first test, but was repeated on two more occasions to confirm the trend of progressive healing. The objective evaluation of fracture healing led to avoidance of surgical intervention in these patients, who went on to sound union.     

广泛软组织机械性损伤所致多脏器功能障碍综合征的实验研究

目的 研究广泛软组织机械性损伤所致多脏器功能和形态学改变。方法 健康纯种新西兰大白兔25只，随机分成实验组（17只）和对照组（8只）。对实验组动物进行全身大量失血再灌注复合双后肢肌肉丰富部位挤压伤，造成广泛软组织机械性损伤，分别于放血前、减压后24、48、72h采取动物血检测尿素氮、肌酐、谷丙转氨酶；死后或72h活杀后取心、肺、肝、肾、脑及受压后腿肌组织，备行光镜和透射电镜观察，肾组织行肌红蛋白免疫组化染色观察。对照组无上述致伤过程，与实验组对应时刻取血测定上述生化指标，72h提取组织行光、电镜观察。结果 伤后实验动物上述功能指标有显著性改变，形态学有明显改变。结论 广泛软组织机械性损伤可导致多脏器功能障碍综合征的发生，肾组织肌红蛋白免疫组化染色和其他受损器官的组织学雯化为实践中此类损伤引起死亡的定性提供了法医病理学的诊断依据。     

青少年截瘫患者父母心理状况的调查及干预

目的了解青少年截瘫患者父母亲的心理状况和需求,探索促进其身心健康的相关因素及干预方法。方法对42例青少年截瘫患者父母亲选用自编一般情况调查表及症状自评量表(SCL-90)进行调查及分析,并与全国常模比较,并根据调查存在的心理问题与实施3个月的心理干预,并比较干预前后的差异。结果截瘫患者父母(SCL-90)中躯体化、强迫症状、人际关系敏感、焦虑、抑郁、恐怖显著高于我国常模值(P<0.05);经3个月的心理干预后与干预前相比其(SCL-90)的得分显著降低(P<0.05)。结论在护理和关注青少年截瘫的同时,医护人员应深入了解其父母的心理状况,并给予相应的心理指导,更好促进患者身心健康。     

维库溴铵在重症支气管哮喘急性发作治疗中的应用

目的探讨维库溴铵在重症支气管哮喘急性发作治疗中的应用效果。方法前瞻性研究,双盲随机标准对照,将46例转入ICU使用呼吸机的重症支气管哮喘急性发作患者按病案号随机分为肌松组（予常规镇静＋维库溴铵）和常规组（予常规镇静）,每组各23例,比较两组治疗效果和对预后的影响。结果肌松组病情较常规组明显改善,呼吸、pH值、PaO2、PaCO2、SpO2参数比较差异均有统计学意义（均P〈0．05）;肌松组较常规组滞留ICU时间[（146．20±17．92）h与（214．15±22．21）h],使用呼吸机时间[（125．93±16．23）h与（192．89±22．60）h],糖皮质激素[（2．61±0．17）mg·kg^-1·d^-1与（3．55±0．26）mg·kg^-1·d^-1]、抗胆碱药[（6．25±0．51）μg·kg^-1·d^-1与（10．64±0．75）μg·kg^-1·d^-1]、β2肾上腺素受体激动剂[（0．06±0．01）mg·kg^-1·d^-1与（0．15±0．04）mg·kg^-1·d^-1]使用剂量均减少（均P〈0．05）;患者顺利转出ICU,无机械通气及心血管不良事件发生。结论维库溴铵使重症支气管哮喘急性发作患者在常规镇静使用呼吸机时,可迅速纠正临床症状,改善短期预后。     

住院痴呆患者照料者心理健康状况及相关因素研究

目的探讨住院痴呆患者照料者的心理健康状况及其相关因素。方法采用症状自评量表（SCL-90）作为评定工具,对住院痴呆患者照料者的心理健康状况进行调查。结果（1）住院痴呆患者照料者的SCL-90总分及抑郁因子分与国内常模比较,差异无统计学意义（P〉0.05）：躯体化因子分显著高于常模,其他因子评分显著低于国内常模,差异有统计学意义（P〈0．01）。（2）SCL．90总分显示,女性、高龄、受教育水平低、身体健康状况差、收入较低、照料人数多、照料时间长的照料者心理健康状况较差,差异有统计学意义（P〈0．05）。（3）男性、低年龄、病程长、痴呆程度较严重、躯体疾病较多对照料者心理健康影响更明显,差异有统计学意义（P〈0.01）。（4）照料者年龄、文化水平、过去经历、身体状况、亲子关系、照料时间及患者病程进入回归方程．决定系数为0．599。结论住院痴呆患者照料者心理健康受多方面因素的影响．要提高照料者的心理健康水平,必须从多个方面综合考虑并采取措施。     

Efficacy of a sclerostin antibody compared to a low dose of PTH on metaphyseal bone healing

We compared the effect of a sclerostin antibody to that of a clinically relevant dose of parathyroid hormone (PTH) in a rat model for metaphyseal bone healing. Screws of steel or poly methyl methacrylate (PMMA) were inserted bilaterally into the proximal tibia of young male rats. During 4 weeks the animals then received injections of either phosphate buffered saline (control), sclerostin antibody (25 mg/kg, twice weekly) or PTH (5 µg/kg, daily). The healing response around the screws was then assessed by mechanical testing and X‐ray microtomography (µCT). To distinguish between effects on healing and general effects on the skeleton, other untraumatized bone sites and serum biomarkers were also assessed. After 4 weeks of treatment, PTH yielded a 48% increase in screw pull‐out force compared to control (p = 0.03), while the antibody had no significant effect. In contrast, the antibody increased femoral cortical and vertebral strength where PTH had no significant effect. µCT showed only slight changes that were statistically significant for the antibody mainly at cortical sites. The results suggest that a relatively low dose of PTH stimulates metaphyseal repair (screw fixation) specifically, whereas the sclerostin antibody has wide‐spread effects, mainly on cortical bone, with less influence on metaphyseal healing. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:471–476, 2014.     

Improved Radiographic Outcomes With Patient-Specific Total Knee Arthroplasty

Patient-specific guides can improve limb alignment and implant positioning in total knee arthroplasty, although not all studies have supported this benefit. We compared the radiographs of 100 consecutively-performed patient-specific total knees to a similar group that was implanted with conventional instruments instead. The patient-specific group showed more accurate reproduction of the theoretically ideal mechanical axis, with fewer outliers, but implant positioning was comparable between groups. Our odds ratio comparison showed that the patient-specific group was 1.8 times more likely to be within the desired + 3° from the neutral mechanical axis when compared to the standard control group. Our data suggest that reliable reproduction of the limb mechanical axis may accrue from patient-specific guides in total knee arthroplasty when compared to standard, intramedullary instrumentation.     

Head Computed Tomography Is Not Useful for Evaluating Patients Change in Mental Status Following Total Joint Arthroplasty

We retrospectively reviewed 187 patients who presented with neurologic abnormality after total joint arthroplasty to establish the incidence of diagnosed organic brain disorders in these patients and determine the utility of advanced head imaging studies. 139 of 187 (74.3%) patients underwent imaging for altered mental status (AMS) and 48 patients for a focal neurologic deficit (FND). Acute findings on head imaging were more common in the FND group. The incidence of stroke and transient ischemic attack was significantly lower in the AMS group compared to FND group (Stroke: 0% vs 12.5%, p < 0.001; TIA: 0% vs. 16.7%, P < .001). Advanced head imaging for evaluation of TJA patients with a change in mental status is of low yield. An algorithm for evaluation of these patients is proposed.