镜下清理并注射玻璃酸钠治疗膝骨关节炎

目的探讨关节镜有限清理加局部注射玻璃酸钠对中重度软骨退变的膝关节骨关节炎的治疗作用。方法25例中重度软骨退变的膝关节骨关节炎患者,根据关节镜下软骨退变的不同程度,行不同程度和范围的膝关节腔内有限清理术,术后关节腔内注射玻璃酸钠,并辅以较完善的术前、术后康复训练以及出院康复指导。结果随访5个月～3年,平均21个月。良好20例（23膝）,尚可3例（5膝）,差2例（2膝）。结论关节镜下膝关节有限清理加局部注射玻璃酸钠配合完善的康复训练措施对中重度软骨退变的膝关节骨关节炎有一定的治疗效果。     

关节镜清理结合胫骨高位截骨治疗膝内翻骨关节炎

目的探讨膝内翻骨关节炎的诊治措施。方法19例（20膝）膝内翻骨关节炎患者采用关节镜清理，同时进行胫骨高位截骨术。先行关节镜清理术，同时探查关节内情况，确保外侧间室关节软骨无明显退变，然后行胫骨高位截骨术，术后行康复锻炼。结果本组随访时间16～52个月，平均34个月。全部病例均在术后6～10周获得骨性愈合，术后股胫角171°～175°，平均172．5°。Lyshoml-Ⅱ膝关节评分评定：术前19个膝评分40～56分，平均52分，术后评分82～98分，平均95分。结论关节镜清理术可以改善关节内紊乱，胫骨高位截骨术可以矫正异常的负重力线，二者结合用治疗膝内翻骨关节炎疗效肯定，较单一胫骨高位截骨术具有明显优势。     

关节镜下治疗不同程度软骨退变疗效观察

目的:观察对比关节镜对不同程度软骨退变的近期与远期临床疗效.方法:对38例膝关节骨性关节炎患者进行关节镜镜检后关节镜下关节清理术,术前根据Kellgren-Lawrence分级法进行分级,术后随访半年～3年,采用Lysholm膝关节功能评分标准进行疗效判定.结果:I～III度关节软骨退变病例术后近期与远期优良率无显著性差异; 但IV度关节软骨退变病例术后远期优良率明显低于近期(P<0.05).结论:关节镜治疗II度及III度膝关节骨性关节炎患者具有较好较好的中远期疗效,但对于对于IV度关节软骨退变的骨性关节炎患者,关节镜下灌洗清理术的远期疗效不理想.     

关节镜下清理术联合中药离子导入治疗膝骨关节炎41例

目的：观察关节镜下清理术联合中药离子导入治疗膝骨关节炎的的临床效果。方法：将41例患者采用关节镜下膝关节清理术;术后2周膝关节局部进行中药舒筋止痛液离子导入治疗,20min/次,1次/d,连续治疗4周。采用Lequesne指数对临床结果进行评价。结果：显效19例,有效21例,无效1例。结论：关节镜下清理术联合中药离子导入治疗膝骨关节炎有较好的临床效果。     

膝骨性关节炎关节镜清理术治疗进展

膝骨关节炎(knee osteoarthritis,KOA)是老年性的膝关节慢性退行性病变,是引起老年人下肢功能障碍、活动受限的主要原因,是基本病变为关节软骨退变,继而新骨增生的一种慢性、进行性关节病。患者多为中老年人,随着社会人口老龄化,发病率逐年上升。本文对膝关节镜治疗膝骨关节炎的进展综述如下。1历史背景自从1960年Wantanabe和Takeda将第一台实用关节镜用于临床以来,关节镜治疗膝退行性关节炎再次引起人们的重视,已成为膝关节疾病诊断和治疗的重要方法之一。1972年,Jackson对200例膝关节疼痛患者,采用关节镜观察关节内部的病理变化,并行镜下摘除游离体,切除损伤半月板,临床症状有所好转。1981年,Sprague[1]采用关节镜清理术治疗膝退行性关节炎,采用切除损伤半月板、滑膜、骨赘,刨削软骨面等方法治疗69膝,结果优良率为74%。近年来,由于微骨折技术简便易行、并发症少及其使用成本较低,常被用作首选治疗方案。2手术方法2.1关节镜冲洗术老年性膝骨关节炎病变常累及关节软骨、软骨下骨和滑膜。软骨表面软化、脱落、溃疡,形成关节内游离体。滑膜充血、炎症细胞浸润,后期滑膜呈绒毛样增生,包埋破碎软骨...     

关节镜清理术治疗老年性膝骨关节炎

目的探讨关节镜对老年性膝骨关节炎的诊断价值及治疗效果。方法自2001年10月至2003年3月使用关节镜清理治疗膝关节骨关节炎患者37例,按照Lysholm膝关节功能评分,术前膝关节功能评分为(53.6±7.3)分。随访3～15个月,平均9个月。结果本组37例病人经关节镜检查均证实有骨关节炎存在,术前摄片,21例出现病理改变,16例未发现病理改变。本组病人术后3个月症状缓解明显,Lysholm膝关节功能评分平均提高到(92.7±1.5)分,统计学分析显示术后与术前评分相比差异有显著性意义。结论关节镜清理术可有效治疗膝骨关节炎;膝关节镜术可早期诊断膝骨关节炎;其损伤小、疗效好、并发症少,可重复手术治疗,能早期恢复关节的功能。     

关节镜下关节有限清理术联合玻璃酸钠治疗膝骨关节炎

目的探讨关节镜下关节有限清理术治疗早中期膝骨关节炎(knee osteoarthritis,KOA)的疗效。方法 2004年4月~2013年10月,对45例早中期KOA在关节镜下进行刨削清理增生肥厚的炎性滑膜组织,修平退变剥脱的软骨创面,游离体摘除,去除影响关节活动的骨赘,半月板修整或成形等,术后关节腔内注入玻璃酸钠4 ml。治疗前后采用膝关节Lysholm评分进行疗效评估。结果关节镜手术时间(从关节镜进入膝关节到开始缝合切口)为(55±15)min。术后住院时间4~10 d,平均6 d。术后均无关节感染、血管神经损伤、深静脉栓塞等并发症的发生。45例随访时间3~26个月,平均12个月,Lysholm评分由术前(45.5±6.3)分提高到(78.7±8.3)分,手术前后有统计学差异(t=9.841,P=0.005)。结论关节镜下关节有限清理术联合玻璃酸钠具有创伤小,并发症少,有效缓解KOA症状,有效改善关节功能的优点,是治疗早中期KOA的有效方法。     

膝关节骨性关节炎的关节镜检查和清理术(附82例分析)

作者对82例膝关节骨性关节炎做了关节镜检查和清理手术.结果表明本病主要病变有软骨损害、滑膜炎症性改变和半月板退变.关节清理术后81例随访1～4年.有效率达87.8%,作者重对该病的病变发生和发展作了讨论,并认为清理术是治疗膝OA的一种可取方法.     

关节镜清理术治疗膝骨关节炎护理体会

目的:探讨关节镜清理术治疗膝骨关节炎的护理措施。方法:选取采用关节镜下清理术治疗的膝骨关节炎患者68例,对其术前和术后进行系统的护理、心理指导、病情观察、康复锻炼指导。结果:68例患者关节镜手术顺利,平均住院(7.0±0.8)d,术后膝关节功能恢复良好。8例发生膝关节积液,无感染及静脉血栓等其他并发症。结论:关节镜下清理术治疗膝骨关节炎,做好术前和术后精心护理,能避免手术并发症,是膝关节功能恢复和手术成功的重要保证。     

关节镜下有限清理术治疗老年膝关节骨性关节炎

目的 探讨关节镜下有限清理术治疗老年膝关节骨性关节炎(A0)的方法 与疗效.方法 对34例(48膝)老年OA行关节镜下有限清理术.在关节镜下创削增生肥厚的滑膜组织,清理剥脱的关节软骨创面,修整破裂的半月板,清除骨赘及游离体,扩大髁间窝成型.结果 患者术后膝关节疼痛消失或明显减轻,关节功能改善.Lyshoml膝关节功能评分术前平均(41±3.2)分,术后3个月平均(77±2.3)分.结论 关节镜下有限化清理手术创伤小,恢复快,可有效解除临床症状,改善功能.延缓病程发展,是治疗老年OA的一种有效措施.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.