Are Ceramic Bearings Becoming Cost-Effective for All Patients?

Background

The purpose of this study is to analyze whether the cost for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) bearings used in primary total hip arthroplasty (THA) was changing over time, and if the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of $325.

Spinout/Dislocation in Mobile-Bearing Total Knee Arthroplasty: A Report of 26 Cases

Background

Excellent medium-term to long-term results for function and survivorship have been shown with mobile-bearing (MB) total knee arthroplasty (TKA). One of the key arguments against its use is the risk of “spinout” or dislocation of the MB.The aim of this study is to discuss the etiology, prevention, incidence, management, and outcome of spinout.

Change in pulse transit time and pre-ejection period during head-up tilt-induced progressive central hypovolaemia

Objective Traditional vital signs such as heart rate (HR) and blood pressure (BP) are often regarded as insensitive markers of mild to moderate blood loss. The present study investigated the feasibility of using pulse transit time (PTT) to track variations in pre-ejection period (PEP) during progressive central hypovolaemia induced by head-up tilt and evaluated the potential of PTT as an early non-invasive indicator of blood loss. Methods About 11 healthy subjects underwent graded head-up tilt from 0 to 80°. PTT and PEP were computed from the simultaneous measurement of electrocardiogram (ECG), finger photoplethysmographic pulse oximetry waveform (PPG-POW) and thoracic impedance plethysmogram (IPG). The response of PTT and PEP to tilt was compared with that of interbeat heart interval (RR) and BP. Least-squares linear regression analysis was carried out on an intra-subject basis between PTT and PEP and between various physiological variables and sine of the tilt angle (which is associated with the decrease in central blood volume) and the correlation coefficients (r) were computed. Results During graded tilt, PEP and PTT were strongly correlated in 10 out of 11 subjects (median r = 0.964) and had strong positive linear correlations with sine of the tilt angle (median r = 0.966 and 0.938 respectively). At a mild hypovolaemic state (20–30°), there was a significant increase in PTT and PEP compared with baseline (0°) but without a significant change in RR and BP. Gradient analysis showed that PTT was more responsive to central volume loss than RR during mild hypovolaemia (0–20°) but not moderate hypovolaemia (50–80°). Conclusion PTT may reflect variation in PEP and central blood volume, and is potentially useful for early detection of non-hypotensive progressive central hypovolaemia. Joint interpretation of PTT and RR trends or responses may help to characterize the extent of blood volume loss in critical care patients. Chan GSH, Middleton PM, Celler BG, Wang L, Lovell NH. Change in pulse transit time and pre-ejection period during head-up tilt-induced progressive central hypovolaemia.     

食管癌围手术期营养支持研究

目的：研究食管癌病人围手术期营养支持的临床疗效以及肠内肠外营养方式的优缺点。方法：将40例食管癌病人随机分为肠内营养（enteral nutrition，En组）和肠外营养（parenteral nutrition．PN组）两组，每组20例。围术期给予等热量等氮量的营养支持，术前进行7天营养支持，术后3-10天经不同途径进行营养支持。结果：术后10天，PN组血清转铁蛋白（TF），前白蛋白（prealb）视黄醇结合蛋白（FN）水平显著高于EN组（P（0．01），而EN组肠功能恢复早干PN组，住院时间和营养费用少于PN组。结论：营养不良的食管癌患者，围术期营养支持能改善病人营养状况，PN优于EN。而EN有利于肠功能恢复、可减少营养费用和住院日及增强免疫功能，减少肠源性感染率。     

米非司酮治疗围绝经期功能性子宫出血的疗效

目的:观察米非司酮治疗围绝经期功能性子宫出血的临床疗效。方法:80例确诊为围绝经期功能性子宫出血患者,口服米非司酮12.5 mg,连服6个月,观察子宫大小、内膜厚度、月经恢复情况及血清激素水平。结果:所有患者用药期间均闭经,其中33例直接进入绝经期,其余停药后28~70 d,平均42 d恢复月经,15例月经稀发、量少。用药前子宫内膜(5.8±0.2)mm与用药后(2.7±0.3)mm比较有显著性差异(P<0.05);用药前后子宫大小无明显差异(P>0.05)。治疗6个月后血清激素检查显示促卵泡生成素(FSH)、黄体生成素(LH)、孕激素(P)、雌二醇(E2)水平均有明显降低。结论:米非司酮可有效抑制子宫内膜生长,治疗围绝经期功能性子宫出血效果满意。     

加速康复理念在脊柱手术患者围术期中的应用

目的探讨加速康复理念在脊柱手术患者围术期中的应用效果。方法选取该院2014年3月~2017年3月收治的脊柱手术患者80例作为研究对象,按照床位单双号顺序分为研究组和对照组各40例,其中研究组采取加速康复护理,对照组采取常规护理,比较两组患者的护理效果。结果研究组下床活动时间、住院时间均短于对照组,且并发症发生率明显低于对照组,对护理满意度明显高于对照组,差异有统计学意义(P<0.05)。结论加速康复理念在脊柱手术患者围术期中具有重要意义,可明显缩短治疗时间,促进病情快速恢复,安全性较高,有效维持了良好医患关系。     

护理干预对更年期子宫功能失调性出血患者服药依从性的影响

目的 观察护理干预对更年期子宫功能失调性出血患者服药依从性及治疗效果的影响.方法 2006年2-12月将96例更年期子宫功能失调性出血患者随机分为干预组和对照组各48例.干预组由专门护士进行健康宣教及跟踪督导.对照组单纯由医生进行服药指导,不进行护理干预.首次就诊时登记个人基本信息和病史信息,每次复诊时询问服药情况、药物不良反应、疗效等信息并登记.所有患者于初诊3个月后进行统一随访,随访内容包括服药依从性和就诊依从性,并观察治疗效果.结果 干预组失访1例,对照组失访11例,干预组服药依从率87.2%,就诊依从率93.6%,明显优于对照组(67.6%,56.8%).激素治疗有效率亦明显高于对照组,P＜0.05.结论 护理干预能够提高子宫功能失调性出血患者的依从性和药物疗效.     

Syndrome of depressed vital functions in the immediate post-operative period of surgical patients: Some aspects of its pathogenesis

Fifty adult male and female surgical patients (age 25–40 years) undergoing elective and emergency surgical procedures were subjected to isocapnoeic, hypocapnoeic and hypercapnoeic ventilation during anaesthesia; the PaCO₂ ranged between 22–90 mm Hg. Three developed the syndrome of depressed vital functions in the post-surgical period by scoring less than 7 out of 10, the others recovered normally with complete restoration of reflex activity, consciousness and skeletomuscular tone, scoring on an average 8 out of 10 points. The role of muscle relaxant drugs in this syndrome and also the depression of the central nervous system is discussed.Supported by the State Medical Research Council of Government of Andhra Pradesh, Hyderabad 500 029, India.     

全程营养管理对消化道肿瘤患者围放疗期营养状况的影响

目的 探讨给予全程营养管理干预后，对围放疗期间消化道肿瘤患者营养状况以及住院日的影响。方法 选取2020年1月至2021年12月南通大学附属肿瘤医院收治的有放射治疗指征的消化道肿瘤患者160例，均采用精确放疗[三维适形放疗（3D-CRT）、调强放疗（IMRT）或容积调强放射治疗（VMAT）]，分为常规营养组（n=79）、营养干预组（n=81）。在放疗开始时、放疗结束时及放疗结束后1个月分别测量营养相关血液学指标，包括血红蛋白（Hb）、血白蛋白（Alb）、前白蛋白（PAB）浓度及评分营养评估量表[营养风险筛查（NRS-2002）和患者主观整体营养评估量表（PGSGA）]，比较两组指标变化情况。结果 营养干预组的Hb、Alb、PAB高于常规营养组（P<0.05），体质量、BMI、NRS-2002、PG-SGA评分优于常规营养组（P<0.05），平均住院日短于常规营养组（P<0.05）。结论 全程营养管理可以改善消化道相关肿瘤放、化疗患者基础营养状况，提高患者放疗依从性，缩短患者平均住院日。