Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

肾下型腹主动脉瘤的外科治疗

目的总结26例肾下型腹主动脉瘤的手术治疗经验。方法回顾性分析近5年多来手术治疗26例肾下型腹主动脉瘤的临床资料，全组26例，术前均经影像检查证实诊断。行择期手术21例，破裂型腹主动脉瘤急诊手术5例。26例均行腹主动脉瘤切除，人工血管重建术。结果围手术期死亡2例，均为急症手术患者，总病死率7．7％，急诊手术病死率40．0％。随访时间1-5年。术后1，3，5年生存率分别为96％，88％，75％。死亡原因均与腹主动脉瘤和手术无关。结论CTA检查是诊断腹主动脉瘤的可靠方法。手术治疗仍是治疗腹主动脉瘤的重要方法。瘤体直径不是决定手术的唯一指征。影响手术的危险因素主要是高龄、严重的心肺疾病和肾功能不全。     

三个统一:21世纪中医学发展取向的思考

21世纪中医学的发展，面临着理顺民族性表述方式与国际性科学内涵关系的问题，因此必须辩证地把握结构与机能、实证科学手段与人文精神、过程与结果之间的谐调统一，这样既符合中医学术体系特征，又能与当代生命科学研究保持一致。     

Mammalian response to subdermal implantation of textured microimplants

The development of small, textured implant particles suspended in a hydrogel has allowed for subdermal injection therapy to fill tissue defects. The microimplant particles were placed subdermally into the ears of white New Zealand rabbits in order to characterize the foreign body response and the permanence of the implant. Serial micrometer readings were performed on the implant sites to determine any change in thickness of the augmentation following baseline measurement. An initial increase in the thickness was noted approximately 20–30 days postimplantation, as expected. A stable thickness was noted for the remainder of the experiment. Serial histological sections were performed at irregular intervals from one week to one year. Histology demonstrated a mild foreign body response with collagen surrounding each individual microimplant particle. The response was stable after 30–40 days and has remained stable for over one year. It was determined that the histology demonstrated a Boros IA type, or nonimmunogenic, low-turnover foreign body reaction.     

外科治疗急性胆源性胰腺炎

目的探讨急性胆源性胰腺炎（ABP）手术时机和术式的选择.方法回顾性分析247例急性胆源性胰腺炎的临床资料.结果非手术治疗10例,死亡4例;12例急诊手术后发生并发症5例,死亡2例;169例延期手术术后发生并发症1例,治愈;56例择期手术无并发症发生.结论以胆道梗阻为主的ABP应急诊手术解除胆道梗阻;胆道无梗阻先采用非手术治疗,胰腺炎控制后,再处理胆道病变.     

Relationship between numbers of beta adrenergic receptors in lymphocytes and disease severity in asthma

In order to assess the status of beta adrenergic receptors in bronchial asthma, binding studies using (−) [³H] dihydroalprenolol (DHA) were performed on lymphocytes of 10 control subjects and 11 stable asthmatic patients. Specific DHA binding was generally lower at all DHA concentrations in asthmatics. At 12 nM DHA concentration, specific DHA binding was 391 ± 40 fM/mg protein in controls and 263 ± 35 fM/mg protein for asthmatic subjects (p < 0.05). A highly statistically significant positive correlation between specific DHA binding (at 12 nM DHA) and FEV₁/FVC% was observed (r = 0.93, p < 0.01), with those asthmatic subjects with the more severe airway obstruction and disease severity showing lower DHA binding. The results of the study suggest that a lymphocyte beta adrenergic receptor defect may be present among some patients with asthma. The magnitude of the receptor abnormality appears to be related to disease severity and degree of airway obstruction as measured by FEV₁/FVC%. Documentation of drug consumption was made, and restriction of beta adrenergic agonists was attempted; theophylline and corticosteroids were the predominant drugs used in the study. Even with these precautions, it is possible that the differences in DHA binding observed among subjects are the results of greater drug (e.g., theophylline and corticosteroids) consumption by the clinically more severe patients. On the other hand, the lymphocyte receptor alteration noted may reflect a more general beta adrenergic receptor abnormality in bronchial asthma.     

明代《伤寒论》研究对后世的影响

系统研究了明代《伤寒论》文献,指出明代《伤寒论》研究对后世的影响,主要表现在温病学说直接受其催化而趋于成熟,明刻本《伤寒论》为后世提供了研究依据,重编整理导致了后世编次方法之多样,学术论争深化了后世的《伤寒论》研究。认为明代是《伤寒论》研究史上承前启后的重要时期,明代的《伤寒论》研究影响并规定了清代乃至近代的《伤寒论》研究模式和水平。     

散发性甲型肝炎发病危险因素的病例对照研究

以浙江省嘉兴市１９９６ 年的１０３ 例确诊的甲肝散发病人为研究对象,进行１∶１ 配比的病例对照研究,用条件Ｌｏｇｉｓｔｉｃ回归模型进行多因素分析得出甲肝发病的危险因素。按ＯＲ值由大到小排列依次是：接触甲肝病人、在外就餐、家庭收支状况差、就餐点卫生条件差、家庭卫生设施差。建议对其中的某些可干预因素采取针对性的预防措施     

Diabetic retinopathy in a black population: the Barbados Eye Study.

OBJECTIVE: The distribution of diabetic retinopathy in black populations is largely unknown. The authors present retinopathy data from the predominately black participants of the Barbados Eye Study (BES). DESIGN AND PARTICIPANTS: Prevalence study of 4631 participants based on a random sample of the Barbados population 40 to 84 years of age (84% participation). MAIN OUTCOME MEASURES: Diabetes was defined as self-reported history of physician-diagnosed diabetes or glycosylated hemoglobin greater than 10% (>2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent gradings of 30 degrees color stereo fundus photographs of the disc and macula. RESULTS: Diabetes was present in 19.4% of black (n = 4314), 15.2% of mixed (black and white; n = 184), and 7.5% of white/other (n = 133) self-reported racial groups. In the black/mixed population, regardless of diabetes status, the prevalence of retinopathy was 5.9%. In the 636 black and mixed participants with diabetes, the prevalence of retinopathy was 28.5%: 19.8% had minimum changes, 7.7% had moderate changes, and 0.9% had severe retinopathy. Clinically significant macular edema (CSME) was found in 8.6% of those with diabetes. CONCLUSIONS: In the population of African origin, approximately 1 in 17 persons had retinopathy. Among those with diabetes, 28.5% had retinopathy and 8.6% had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the black population.     

湖南省学生1995年和2000年肺活量抽样调查分析

目的了解湖南省学生呼吸功能发育状况,探讨其变化趋势.方法于1995年和2000年在湖南省的长沙市、常德市、衡阳市和湘西自治州采用整群分层抽样和统一调查、检测方法,对学生体质健康状况调查,采用U检验对调查资料按年度、年龄、性别和城乡比较分析.结果从肺活量(ml)和肺活量指数(ml/kg)进行统计分析的结果显示,总体水平低于全国平均水平,1995年未达到全国平均水平的城乡男女年龄组有36个,2000年则增至38个;2000年与1995年进行肺活量指数比较,城乡男女共有33个年龄组下降;另外还呈现出城市高于农村,男生大于女生的特点.结论湖南省学生肺活量在全国处较低水平,且城乡男女多数年龄组呈现下降趋势,并有较明显的城乡差异和性别差异.