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21.
Luca M. Sconfienza Domenico Albano Carmelo Messina Rocco D’Apolito Elena De Vecchi Luigi Zagra 《The Journal of arthroplasty》2021,36(8):2962-2967
BackgroundTo diagnose periprosthetic joint infection (PJI) preoperatively, ultrasound-guided joint aspiration (US-JA) may not be performed when effusion is minimal or absent. We aimed to report and investigate the diagnostic performance of ultrasound-guided periprosthetic biopsy (US-PB) of synovial tissue to obtain joint samples in patients without fluid around the implants.MethodsOne-hundred nine patients (55 men; mean age: 68 ± 13 years) with failed total hip arthroplasty (THA) who underwent revision surgery performed preoperative US-JA or US-PB to rule out PJI.ResultsSixty-nine of 109 patients had joint effusion and underwent US-JA, while the remaining 40 with dry joint required US-PB. Thirty-five of 109 patients (32.1%) had PJI, while 74/109 (67.9%) had aseptic THA failure. No immediate complications were observed in both groups. Technical success of US-PB was 100%, as the procedure was carried on as planned in all cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-JA were 52.2%, 97.8%, 92.3%, 80.3%, and 82.6%, while for US-PB, they were 41.7%, 100%, 100%, 80%, and 82.5%, respectively, with no significant difference (P = .779). Using the final diagnosis as reference standard, we observed a moderate agreement with both US-JA (k = 0.56) and US-PB (k = 0.50).ConclusionWe present a novel US-guided technique to biopsy periprosthetic synovial tissue of failed THA to rule out PJI. We found similar diagnostic performance as compared with traditional US-JA. This supports future larger studies on this procedure that might be applied in patients without joint effusion. 相似文献
22.
Daniel B. Buchalter David J. Kirby Greg M. Teo Richard Iorio Vinay K. Aggarwal William J. Long 《The Journal of arthroplasty》2021,36(1):286-290.e1
BackgroundVancomycin powder and dilute povidone-iodine lavage (VIP) was introduced to reduce the incidence of periprosthetic joint infection (PJI) in high-risk total knee arthroplasty (TKA) patients. We hypothesize that VIP can reduce the incidence of early PJI in all primary TKA patients, regardless of preoperative risk.MethodsAn infection database of primary TKAs performed before a VIP protocol was implemented (January 2012-December 2013), during a time when only high-risk TKAs received VIP (January 2014-December 2015), and when all TKAs received VIP (January 2016-September 2019) at an urban, university-affiliated, not-for-profit orthopedic hospital was retrospectively reviewed to identify patients with PJI. Criteria used for diagnosis of PJI were the National Healthcare Safety Network and Musculoskeletal Infection Society guidelines.ResultsVIP reduced early primary TKA PJI incidence in both the high-risk and all-risk cohorts compared with the pre-VIP cohort by 44.6% and 56.4%, respectively (1.01% vs 0.56% vs 0.44%, P = .0088). In addition, after introducing VIP to all-risk TKA patients, compared with high-risk TKA patients, the relative risk of PJI dropped an additional 21.4%, but this finding did not reach statistical significance (0.56% vs 0.44%, P = .4212). There were no demographic differences between the 3 VIP PJI cohorts.ConclusionVIP is associated with a reduced early PJI incidence after primary TKA, regardless of preoperative risk. With the literature supporting its safety and cost-effectiveness, VIP is a value-based intervention, but given the nature of this historical cohort study, a multicenter randomized controlled trial is underway to definitively confirm its efficacy. 相似文献
23.
目的 在“药辅合一”理念下导入Pickering乳技术,提升儿科用药羚珠散中石菖蒲挥发油的稳定性。方法 对羚珠散各饮片粉末进行初步表征,确定稳定剂。通过成乳量、包油量和乳剂形态筛选出最佳稳定剂质量浓度、油水比和制备方法。并使用近红外光谱(nearinfraredspectroscopy,NIRS)分析石菖蒲油在Pickering乳中的包裹状态。比较不同时间下各组别挥发油的保有量、丙二醛和过氧化物的含量。再通过GC-MS分析其中成分的变化趋势。结果 筛选出珍珠粉作为Pickering乳的稳定剂,珍珠粉质量浓度为65 mg/mL,油水比9∶11为最优成乳条件,高压均质法为最优的制备方法,NIRS分析可知石菖蒲挥发油被珍珠粉包裹,Pickering乳液中没有形成新的化学键。对比各组在不同时间段下石菖蒲油的保有率和其中丙二醛和过氧化物含量,可知40℃放置1、3、8 h的Pickering乳剂相比于石菖蒲挥发油组有更高的保有率和更低的氧化程度。GC-MS分析结果表明,相比于石菖蒲挥发油组,Pickering乳组挥发性成分的稳定性显著提高。结论 在“药辅合一”理念下Pickering乳可用于含油固... 相似文献
24.
目的 观察布地奈德联合福莫特罗干粉剂在急诊治疗重症支气管哮喘患者中的应用效果。方法 参照随机数字表法,将2017年7月—2019年6月在某医院接受急诊治疗的40例重症支气管哮喘患者分为两组,每组各20例。对照组患者采用布地奈德治疗,观察组在对照组基础上联合福莫特罗干粉剂治疗。两组患者均治疗1个月,观察两组C反应蛋白(CRP)、血常规水平及肺功能指标[第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FCV)比值(FEV1/FCV)和最大呼气流量(PEF)]。结果 治疗期间对照组患者夜间睡眠时憋醒次数为(13.55±3.25)次,观察组患者夜间睡眠时憋醒次数为(5.25±0.95)次;组间相比,差异有统计学意义(t=10.962,P<0.05);治疗后,观察组CRP、白细胞计数、嗜酸性粒细胞比率、淋巴细胞比率分别为:(12.36±1.43)mg/L、(6.31±1.05)×109/L、(4.82±2.03)%、(20.06±2.48)%,均低于对照组的(15.98±1.95)mg/L、(8.59±1.34)×109/L、(6.79±2.68)%、(25.09±3.12)%,(t值分别为6.695、5.990、2.621、5.644,P值均<0.05);治疗后,观察组FEV1、PEF及FEV1/FCV水平分别为:(2.51±0.70)L、(3.28±0.75)L/s、(75.38±8.49)%,均高于对照组(2.02±0.52)L、(2.76±0.66)L/s、(62.63±6.89)%,(t 值分别为2.513、2.328、5.215,P值均<0.05)。结论 布地奈德联合福莫特罗干粉剂在急诊重症支气管哮喘患者的治疗中效果较好,能有效改善CRP及血常规水平,提高肺功能。 相似文献
25.
脱脂豆粉对去卵巢大鼠骨质量的保护作用 总被引:1,自引:0,他引:1
目的 探讨脱脂豆粉对去卵巢大鼠骨质量减低的预防作用。方法 30只3月龄SD大鼠随机分为3组:假手术(sham,S)组、脱脂粉(lipid-free soy powder,SP)组和酪蛋白(casein,C)组。8周后测骨密度(BMD)等指标。结果 ①SP组的腰椎BMD低于S组(P〈0.05),股骨BMD与S组无差异,两者均高于C组(P均〈0.05)。②SP组腰椎的抗压强底低于S组(P〈0.01),股骨的抗弯强度与S组无差异,两者均高于C组(P均〈0.01)。③SP组和C组的子宫重量均代于S组(P均〈0.05)。结论 脱脂豆粉可以预防去卵巢大鼠股骨及部分预防其腰椎骨质量的降低,对子宫无不良影响。 相似文献
26.
27.
张基栋 《辽宁中医药大学学报》2000,(1)
探讨中药玉屏风散加味对强的松不良反应的拮抗作用及对肾病综合征Ⅰ型的病程的影响 ,将病人随机分为玉屏风散加味治疗组(37例 ) 和对照组(2 1例 ) ,观察用药后 2、4、6周自汗、心悸症状及心率变化情况及治疗后 1年内各种感染次数 ,治疗 1年后强的松服药量及 2 4小时尿蛋白定量情况。结果 :治疗第 4、6周自汗、心悸症状发生率及心率治疗组均低于对照组 ,感染次数治疗组低于对照组 ,1年未服强的松量及其 2 4小时尿蛋白量均低于对照组 ,两组数据经统计学处理有显著性差异。结论 :玉屏风散加味能明显减轻强的松引起的自汗、心悸等不良反应 ,减少感染次数 ,缩短NSI型的病程。 相似文献
28.
S. J. Rosansky MD R. Rhinehart MD D. Whittman MPH S. J. Menachery 《Clinical autonomic research》1995,5(3):151-154
In published studies of chronic haemodialysis patients, the frequency of autonomic dysfunction varies widely. One reason for the variation may be the time of testing with respect to time of dialysis. The current study tests the hypothesis that autonomic function — as measured by heart rate responses to the Valsalva manoeuvre (Valsalva ratio) and 30:15 electrocardiogram (ECG) R—R interval to upright posture (postural ratio) — is different when patients are above dry weight (predialysis) than when they are at or below dry weight (postdialysis). The study also reviews available literature to analyze other factors that may affect the results of autonomic testing in this population. A total of 25 chronic haemodialysis patients underwent standard Valsalva and 30:15 R—R interval postural autonomic testing prior to and after haemodialysis. In addition, pre- and postdialysis orthostatic responses were measured and compared with a control population. The 30:15 ratio increased after dialysis (p = 0.001). The Valsalva ratio did not change with dialysis. Out of 25 subjects, seven had an abnormal 30:15 ratio prior to dialysis decreasing to two out of 25 patients postdialysis (p < 0.03). Orthostatic responses predialysis did not differ from those in the control group. Review of the literature shows great variability in definition of normal Valsalva and postural (30:15 R—R interval) ratios. Diabetic patients in the current and prior studies were more likely to have abnormal responses. In conclusion, the prevalence of autonomic dysfunction in chronic dialysis patients as determined by Valsalva and 30:15 ECG postural ratios may be influenced by the following factors: when subjects are studied with respect to their dialysis treatment; the number of subjects with diabetes; and the cut-off point used to define abnormal test results. Abnormal Valsalva ratios are less frequent when measured postdialysis. 相似文献
29.
15kg负重沙漠干热应激行军速度和时间对人体GSH和SOD的影响 总被引:1,自引:0,他引:1
目的 探讨沙漠干热负重应激行军人体GSH 和SOD 作用机制。方法 对74 名15 kg 负重在沙漠干热环境以不同速度和时间行军战士和对照人群血浆的变化进行了研究。结果 15 kg 负重,3-5km/h 和5 km/h 行军者GSH 在应激的最初1 小时内迅速上升,约1 小时达到高峰,之后迅速下降;随着行军速度的增加,机体抗氧化作用所消耗的SOD 量增加,血浆SOD 浓度亦随之下降。结论 从行军时间来看,在应激的最初1 小时内,因应激诱导的GSH 的合成和SOD 的量增加,故沙漠干热环境负荷应激行军以15 kg、3-5 km/h 为宜。 相似文献
30.