Objective To evaluate the therapeutic outcome of artificial total hip arthroplasty (THA) with collum femoris preserving for hip joint desease in young and middle-aged patients. Methods From March 2002 to March 2005, 26 cases (31 hips) of hip joint disease were treated with artificial THA with collum femoris preserving, including 19 males (23 hips)and 7 females (8 hips) and aged 32-48 years with an average of 37 years. In 31 hips, 17 left hips and 14 right hips were involved. There were 9 cases of osteoarthritis of the hip joint caused by avascular necrosis of the femoral head (ANFH), 7 cases of ANFH, 3 cases of femoral head necrosis caused by dysplasia of acetabular, 1 case of osteoarthritis of the hip joint caused by ankylosing spondyl itis, and 2 cases of rheumatoid arthritis; the course of disease was 2-11 years (5.6 years on average). Two cases of femoral neck fracture (Garden IV), and 2 cases of non-union femoral neck fractures (1 for Garden III and 1 for Garden IV), the course of disease was 5 days, 24 months, and 26 months. The prime symptoms were pain, difficult walk and l imp. All patients were taken X-ray to exclude osteoporosis. Results The right distal femur prosthesis of a bilateral patient cracked owing to excessive amputation of collum femoris, and fracture healed after symptomatic treatment. All the incisions healed by first intention and no compl ications occurred. All patients were followed up for 4-7 years, with an average of 5.6 years. One case had poor hip function because he did not follow rehabil itation procedure, and the others achieved good outcome with normal gait. One case complained of persistent pain 6 months after operation, and was rel ieved by administration of some non-steroidal antiinflammatory drugs and anti-osteoporosis drugs 6 months later. The X-ray films after operation and at last follow up showed good location of prosthesis and no bone resorption. Harris score at last follow-up was 91.31 ± 0.77, and it was significantly higher than that before operation (50.88 ± 0.90), (P lt; 0.05). The excellent and good rate was 93.5% (excellent in 11 hips, good in 18 hips, and fair in 2 hips). Conclusion Artificial THA with collum femoris preserving can retain more bone, be easier for revision, and has an excellent outcome.
摘要:目的:探討老年耐亞胺培南銅綠假單胞菌(IRPA)感染的危險因素以指導臨床救治。 方法:采用病例對照研究,選取四川省人民醫院干部科2006年1月~2008年12月IRPA院內感染老年患者32例,并隨機選擇同時期敏感銅綠假單胞菌院內感染48例作為對照,采用單因素(t檢驗,χ2檢驗)及多因素Logistic回歸進行分析。結果:IRPA分離率為34.8%,IRPA對抗生素的耐藥性遠遠高于敏感銅綠假單胞菌組,但對阿米卡星敏感率達81.3%。單因素分析發現,下列因素與IRPA感染有關:高齡、住院時間≥4周、高急性生理和慢性健康狀況(APACHEⅡ)評分、慢性肺部疾病(慢性阻塞性肺疾病COPD/支氣管擴張)、分離出IRPA前2周用過亞胺培南/美羅培南、早期聯用抗生素、院內獲得性肺炎(HAP)。多因素Logistic回歸分析表明:長程住院［比值比(OR)= 14.887］,APACHEⅡ評分≥16分(OR=38.908)以及分離出IRPA前2周用過亞胺培南/美羅培南(OR =12.945)是IRPA感染的獨立危險因素。結論:長程住院、APACHEⅡ評分≥16分以及亞胺培南/美羅培南的使用是IRPA感染的危險因素。IRPA對阿米卡星敏感率相對較高,但治療難度大。Abstract: Objective: To study the infection status and risk factors of nosocomial infection caused by imipenemresistant Pseudomonas aeruginosa (IRPA) in elderly patients. Methods: By a casecontrol study, the data of 32 cases of IRPA nosocomial infections were analyzed from Jan. 2006. to Dec. 2008 in cadres Ward of Sichuan Provincial People’s Hospital; 48 cases of Imipenemsensitive pseudomonas aeruginosa infection were randomized as control. Univariate analysis (T test and chisquare test )and multivariate logistic regression analysis were used for statistics. Results: The resistance to antibiotics of IRPA is much higher than the sensitive group.81.3％ of IRPA were sensitive to amikacin. According to univariate analysis,the factors associated with the infection caused by IRPA were age, length of stay in hospital more than 4 weeks, high score of APACHEⅡ, chronic pulmonary disease (COPD/bronchiectasis),imipenem/meropenem used 2 weeks before isolation of IRPA, early combination therapy of antibiotics and hospital acquired pneumonia (HAP). Multivariate logistic regression analysis identified three independent factors: Length of stay in hospital more than 4 weeks, APACHEⅡ score≥16 and imipenem/meropenem used 2 weeks before isolation of IRPA. Conclusion: Long length of stay in hospital, APACHEⅡ score ≥16 and previous imipenem/meropenem use were independent risk factors for IRPA infection. Although the sensitivity of IRPA to amikacin was relatively high, it was difficult to treat in clinical practice.
Objective To explore the effect of age and gene therapyon the differentiation of marrow mesenchymal stem cells （MSCs） of the rats. Methods MSCs from the young (1-month-old), adult (9-month-old), and the aged(24monthold) rats were expanded in culture and infected with adenovirus mediated human bone morphogenetic protein 2 gene (Ad-BMP-2). The expression of BMP-2 and osteoblastic markers such as alkaline phosphatase(ALP), collagen Ⅰ(Col Ⅰ), bone sialoprotein(BSP) and osteopontin(OPN) were assayed during the process of differentiation. Their abilities to induce ectopic bone formation in nude mice were also tested. Results There was no significant difference in the expression of BMP-2 among the 3 groups. ALP activity assay and semi-quantitative reverse transcription polymerase chain reaction(RT-PCR) demonstrated that there were no significant differences in the expression of osteoblastic markers ALP, Col-Ⅰ, OPN and BSP amongthe 3 groups. Histomorphometric analysis indicated that there were no significant differences in the volume of the newly formed ectopic bones in nude mice amongthe 3 groups. Conclusion MSCs obtained from the aged ratscan restore their osteogenic activity following human BMP-2 gene transduction, therefore provides an alternative to treating the aged bone disease.
ObjectiveTo explore the safety and efficacy of preoperative liver regeneration and then two-stage liver resection for advanced hepatic alveolar echinococcosis (HAE) patients pre-evaluating insufficient future liver remnant (FLR) after resection. MethodThe clinical data of the advanced HAE patients who were expected to have insufficient FLR after liver resection and underwent two-step liver resection in the Sichuan Provincial People’s Hospital from December 2016 to December 2022 were retrospectively collected and summarized. ResultsA total of 11 patients with advanced HAE pathologically confirmed were collected. Among them, 2 cases underwent portal vein embolization (PVE), 2 cases underwent liver vein deprivation (LVD), and 7 cases underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to promote residual liver regeneration in the first stage. The FLR/standard liver volume (SLV) exceeded the surgical requirement standard of 40%. Then the ex-vivo liver resection and autotransplantation, or directly radical liver resection was performed in the second stage. Only one patient underwent surgery to remove packed gauze on day 3 postoperatively due to massive intraoperative bleeding (approximately 4 000 mL). The median (P25, P75) follow-up time after surgery was 36 (15, 75) months, only one case was found to relapse at the third year after surgery and underwent surgical resection again, and the rest patients had no recurrence, long-term complications, or death. ConclusionsBased on the results from these cases, applying PVE, LVD, or ALPPS in the patients with advanced HAE who were expected to have insufficient FLR after resection aids to residual liver regeneration, creating conditions for the second stage radical resection. The second stage treatment including ex-vivo liver resection and autotransplantation or directly radical liver resection could achieve good results and is feasible and safe, which brings a hope of survival for the advanced HAE patients who could not previously undergo curative resection. However, this treatment strategy still incurs high costs and requires further optimization in the future.
ObjectiveTo evaluate the reading speed and related factors of normally-sighted middle-aged and elderly people, and compare with those assessed in age-related macular degeneration (AMD) patients.MethodsProspective case control study. Participants aged 45 to 85 years old with junior high school or above education and BCVA no less than 0.6 from the community around the First Hospital of Tsinghua University were recruited. People with ocular and nervous system diseases were excluded. AMD patients without other ocular and nervous system diseases, with the BCVA of their better eye above 0.05, were recruited from the Low Vision Clinic of the First Hospital of Tsinghua University. The best corrected vision, contrast sensitivity, and reading acuity were tested. Reading speed was evaluated with IReST Chinese version. Single factor correlation analysis was used to assess different factors which may be related with the reading speed, then multiple linear regression analysis was conducted further.ResultsFrom January to April, 2016, 53 volunteers aged 60.7±8.8 years old participated in the survey including 17 males and 36 females. Their median of best vision acuity both distance and near was 1.0, and their average reading speed was 244±55 characters/min. The average reading speed of younger participants in the middle-aged group (45-59 years old) was statistically faster (P＜0.05) than the elderly group (≥60 years old), which was 267±53 and 227±51 characters/min separately. The reading speed was correlated with age (r=－0.476, P=0.000), gender (t=－2.291, P=0.031), educational level (t=2.656, P=0.011), reading habits (t=7.346, P=0.000), best corrected distance vision (r=－0.293, P=0.033), best corrected near vision (r=－0.460, P=0.001), and reading acuity (r=－0.558, P=0.000) by single factor correlation analysis. Further analysis with multiple linear regression showed that reading acuity, gender, education level, and reading habits were significantly correlated with reading speed (β=－283.312, 28.303, －37.700, －45.505; P=0.000, 0.022, 0.019, 0.023). Totally 22 AMD patients aged 77.4±8.2 (59-90) years old joined the study from September 2016 to August 2018, including 16 males and 6 females. The median reading speed was 118 characters/min. Compared with the normally-sighted elderly, there were more males in AMD patients (χ2=3.981, P=0.046). They were older (t=－4.285, P=0.000), with significant poorer visual acuity (t=-6.176, P=0.000) and lower reading speed (t=-5.719, P=0.000). Significant correlation was found between reading speed and best binocular distance or near vision, reading acuity and contrast sensitivity (r=－0.771, －0.805, －0.776, 0.511; P=0.000, 0.000, 0.000, 0.015), no statistic relationship was found between reading speed and age(r=0.021, P=0.926) or gender(Z=－0.382, P=0.703) in AMD patients.ConclusionsThe reading speed of normally-sighted people declined with age. Reading acuity may be a better predictive factor than distance vision for reading function. Compared with normally-sighted group, the reading acuity and reading speed of AMD patients was significantly lower. The main factor affecting their reading speed was the severity of their visual impairment.
摘要:目的:探討老年人梗阻性大腸癌的圍手術期處理。方法:回顧性分析2003年至2008年間71例60歲以上老年人梗阻性大腸癌的圍手術期處理情況。 結果:術前發現并存病者43例,術中出現并發癥19例,術后發生并發癥37例得,除5例死亡外,均得到有效控制,死亡原因與并存疾病有關。結論:加強圍手術期處理,積極治療并存疾病,老年人梗阻性大腸癌的治療同樣能取得滿意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
Objective To understand the advances in animal model and basic research of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), and to provide new ideas for basic research and clinical application of ALPPS. Methods The literatures on the basic research and animal models of ALPPS were analyzed and reviewed. Results By March 2018, there were 19 articles related to ALPPS animal models published, including 11 rat model articles, 4 mouse model articles, 2 pig model articles, 1 rabbit model article, and 1 sheep model article. These models of ALPPS were mainly simulated in normal liver background (16 articles), only 2 mouse model of colorectal liver metastasis and 1 rat model of ALPPS under the sclerotic liver background on Chinese article. In cases of rat’s models, portal blood flow deprivation of 20%–90% was finished by portal vein ligation, and the liver was localized and segmented according to the ischemic line and the ligaments of the liver, and the liver partition was mostly sutured and electrocoagulated to stop bleeding. In the above models, remnant liver hyperplasia was observed after surgery. The main causes of hyperplasia were serum cytokines-mediated ［hepatocyte growth factor (HGF), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and so on］ enhancement of proliferative gene, and secondly preservation of the portal vein lobes to increase blood volume and to accelerate liver proliferation. ConclusionsThe animal model is the main tool to study the safety of ALPPS and liver regeneration, but there are still few studies in the models with liver cirrhosis and liver tumors. The mechanism of liver regeneration after ALPPS is still unclear, and more basic experiments and clinical cases are needed for further study.
ObjectiveTo investigate the current status of work readiness and its influencing factors among postoperative lung cancer patients returning to work. MethodsA retrospective study was conducted on young and middle-aged postoperative lung cancer patients who were treated at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to September 2023 and returned to their jobs. Data were collected through a general information questionnaire, readiness for return-to-work scale (RRTW), general self-efficacy scale (GSES), and simplified coping style questionnaire (SCSQ). Univariate and multivariate logistic regression analyses were used to explore the factors affecting the work adaptation of returning patients. ResultsA total of 219 patients were included, with 59 males and 160 females aged 18-60 years. Among the postoperative lung cancer patients returning to work, 73.1% were in the active maintenance stage of return-to-work readiness with a RRTW score of (17.59±1.48) points, and 26.9% were in the uncertain maintenance stage with a RRTW score of (16.22±1.50) points. Bivariate logistic regression analysis showed that patients aged≤30 years (OR=52.381), employees of enterprises and institutions (OR=7.682), agricultural, pastoral, fishery, forestry laborers (OR=15.665), and those with higher self-efficacy (OR=1.157) had higher return-to-work readiness, while patients with≥2 children (OR=0.055), positive coping (OR=0.022), and out-of-pocket expenses (OR=0.044) had lower return-to-work readiness. ConclusionThe return-to-work readiness of young and middle-aged postoperative lung cancer patients needs to be improved, and occupation, job nature, main coping styles, and general self-efficacy are associated with return-to-work readiness.
ObjectiveTo evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation.MethodsIn this study, 108 patients with all long-standing persistent atrial fibrillation (LSPAF) received thoracoscopic epicardial ablation (TEA) after enrollment. There were 82 males and 26 females at age of 56.5±9.4 years. After blanking-period, patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation (HA) group (50 patients) and a TEA group (58 patients). Only patients in the HA group received catheter ablation after randomization subsequently. In at least two-year observation period, cardiovascular risk factors were observed in all groups’ patients.ResultsThe mean follow-up duration was 17.3-41.8 (26.9±6.1) months and there was no significant difference between two groups [8.2-40.6 (27.5±5.7) months in the HA group and 17.3-41.8 (26.4±6.7) months in the TEA group]. The off antiarrhythmic agents (AADs) sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6, 12, 24 and 36 months ［96.0%, 90.0%, 83.7%, 83.7% versus 79.3%, 75.9%, 67.3%, 63.1%, HR=0.415 (95%CI 0.206-0.923)].ConclusionWe can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone. Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation, instead of those without a supplemental ablation.
Objective To evaluate the short-term cl inical outcomes of metal-on-metal total hi p resurfacing arthroplasty in treating osteonecrosis of the femoral head (ONFH) in young and middle-aged patients and to compare with patients of hip osteoarthritis at the same period. Methods From July 2006 to October 2008, 33 patients (45 hips) with ONFH (ONFH group) and 39 patients (45 hips) with osteoarthritis (osteoarthritis group) were treated with metal-on-metal total hipresurfacing arthroplasty. In ONFH group, there were 18 males (27 hips) and 15 females (18 hips) with an average age of 42.7 years (range 19-58 years), including 22 left hips and 23 right hips. The causes were trauma (4 cases), glucocorticoid (25 cases), drugs (2 cases), alcohol (1 case), and psoriasis (1 case). According to Steinberg classification, there were 10 hips at stage III, 18 hips at stage IV a, 13 hips at stage IV b, and 4 hips at stage IV c. The Harris score was 52.0 ± 4.6. The disease course was 1-12 years. In osteoarthritis group, there were 26 males (30 hips) and 13 females (15 hips) with an average age of 47.1 years (range 42-65 years), including 17 left hips and 28 right hips. The causes were degenerative arthritis (23 cases), trauma (11 cases), and ankylosing spondyl itis (5 cases). The Harris score was 57.0 ± 3.8. The disease course was 3-17 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention without compl ications of infection and thrombosis of deep vein of lower extremities. The patients were followed up for 26 months in ONFH group and 28 months in osteoarthritis group. Femoral neck fracture occurred in 1 case of osteoarthritis group after 4 months, who received total hip arthroplasty; no compl ication of prosthesis loosening, dislocation, incision infection, osteonecrosis, and bone absorption occurred in other patients. At last follow-up, the Harris scores were 93.0 ± 5.5 in ONFH group and 94.0 ± 2.4 in osteoarthritis group, showing no significant difference between two groups (P gt; 0.05); but there were significant differences between pre- and post-operation (P lt; 0.01). Conclusion The cl inical short-term outcomes ofmetal-on-metal total hip resurfacing arthroplasty to treat ONFH are satisfactory. It can achieve similar outcomes to that ofosteoarthritis group. More cases and long-term follow-up are needed to investigate long-term cl inical outcomes.