糖尿病性下肢缺血性血管病的外科治疗

目的:探讨糖尿病性下肢缺血性血管病的治疗方法。方法:对24例Ⅰ型糖尿病患者合并下肢动脉缺血性疾病的39条肢体体进行了手术,其中动脉旁路手术31例,占79%。对3例患者进行了下肢截肢处理。结果:接受动脉旁路手术的患者出院时动脉血流均保持通畅。一例51岁男性患者四肢肿胀、变黑,经治疗无效死亡。结论:糖尿病性缺血性血管病可以通过外科手术治疗。如下肢远端动脉旁路移植、腔内血管成型术等。外科治疗的方法正在探讨阶段,研究方法不断进展。外科治疗不仅可以挽救肢体或降低截肢平面,而且可为足部创面的愈合提供较好的营养环境,有利于创面的愈合和提高生活质量。     

Connective tissue changes in surgically overloaded muscle

Summary The effects of overload on the connective tissue component of the soleus muscle of the rat have been investigated. Three weeks after tenotomy of its synergistic muscles the soleus underwent considerable increase in weight. This was shown to have resulted from an increase in size of the predominant fibre type. Whilst occasional groups of fibres appeared to have resulted from the splitting of large single fibres, there was no significant increase in the number of fibres in cross-section of the muscle belly. The connective tissue content of the overloaded muscles was investigated using both histological and biochemical techniques. It was found that muscle fibre hypertrophy was accompanied by an increase in the connective tissue component. Furthermore, there was an increase in the proportion of collagen to muscle fibre tissue.The author wish to acknowledge the expert technical assistance given by Mr P. Prentis. This investigation was supported by a grant from the Medical Research Council.     

Aortic valve implantation-induced conduction block as a framework towards a uniform electrocardiographic definition of left bundle branch block

IntroductionNew-onset left bundle branch block (LBBB) following transcatheter or surgical aortic valve replacement (LBBB_AVI) implies a proximal pathogenesis of LBBB. This study compares electrocardiographic characteristics and concordance with LBBB definitions between LBBB_AVI and non-procedure-induced LBBB controls (LBBB_control).MethodsAll LBBB_AVI patients at Ghent University Hospital between 2013 and 2019 were enrolled in the study. LBBB_AVI patients were matched for age, sex, ischaemic heart disease and ejection fraction to LBBB_control patients in a 1:2 ratio. For inclusion, a non-strict LBBB definition was used (QRS duration ≥ 120 ms, QS or rS in V1, absence of Q waves in V5-6). Electrocardiograms were digitally analysed and classified according to three LBBB definitions: European Society of Cardiology (ESC), Strauss and American Heart Association (AHA).ResultsA total of 177 patients (59 LBBB_AVI and 118 LBBB_control) were enrolled in the study. LBBB_AVI patients had more lateral QRS notching/slurring (100% vs 85%, p = 0.001), included a higher percentage with a QRS duration ≥ 130 ms (98% vs 86%, p = 0.007) and had a less leftward oriented QRS axis (−15° vs −30°, p = 0.013) compared to the LBBB_control group. ESC and Strauss criteria were fulfilled in 100% and 95% of LBBB_AVI patients, respectively, but only 18% met the AHA criteria. In LBBB_control patients, concordance with LBBB definitions was lower than in the LBBB_AVI group: ESC 85% (p = 0.001), Strauss 68% (p < 0.001) and AHA 7% (p = 0.035). No differences in electrocardiographic characterisation or concordance with LBBB definitions were observed between LBBB_AVI and LBBB_control patients with lateral QRS notching/slurring.ConclusionNon-uniformity exists among current LBBB definitions concerning the detection of proximal LBBB. LBBB_AVI may provide a framework for more consensus on defining proximal LBBB.Supplementary InformationThe online version of this article (10.1007/s12471-021-01565-8) contains supplementary material, which is available to authorized users.     

An indicator framework for assessing progress in land and marine planning in Colombia and Cuba

Achievement of environmental management goals and objectives in coastal areas, including how to measure success, remains a significant subject for discussion among scholars and practitioners, meanwhile four distinct management efforts potentially converge within the coastal zone: land-use planning (LUP), river basin management (RBM), marine spatial planning (MSP) and integrated coastal management (ICM). This paper examines the general lack of attention being paid to overlapping spatial boundaries within the landward and marine areas and proposes an indicator-based framework to measure the effectiveness of the individual planning instruments, as opposed to specific initiatives, in achieving management goals. The six indicators used in the framework (planning; participation; communication; integration; responsibility and balance) are based on a modified version of the Coastal Sustainability Standard methodology described by Gallagher (2010). The framework provides for four scenarios of progress in three geographical dimensions (river, municipality and marine area) to be assessed. For this study, the Caribbean coast of Colombia and Cuba were identified as the areas to test the feasibility and relevance of the indicator framework to monitor progress in the different management approaches established to achieve coastal sustainability. Several key observations and lessons from the indicator-based framework are discussed in order to analyze the overlapping of the four space-based instruments, identify areas for targeted intervention and improve their integration.     

Equipment used for testing anaerobic biodegradability and activity

Recently there has been a growing demand for information on the biodegradability and microbial toxicity of xenobiotic compounds. The environmental fate and effect of these chemicals in aerobic and anaerobic conditions has been extensively studied using a variety of different methods. This paper reviews the different protocols, equipment and instruments used in anaerobic biodegradation and activity tests, including the more sophisticated automated techniques recently developed. The different systems for detecting biogas production are given particular attention. As well as gasometric methods, the different instrumental techniques used to follow the fate of compounds under anaerobic conditions, via analysis of substrate consumption and product formation are evaluated.     

围术期手术麻醉安全体系的构建

麻醉安全性在增加,但围术期仍存有诸多挑战。“外科手术的围术期医疗模式 新策略的提出,期望有助于提高医疗质量、降低医疗成本。麻醉医师应该主动迎接时代挑战,承担起学科发展的历史使命,通过调整专业定位、规范医疗行为、加强病人安全管理建设,来构建起围术期手术麻醉的安全体系。     

髋关节后侧入路结合大粗隆截骨治疗PipkinⅣ型股骨头骨折

目的:探讨髋关节后侧入路结合大粗隆截骨治疗Pipkin IV型股骨头骨折的疗效。方法:回顾性分析我院2006年3月至2012年10月采用髋关节后侧入路结合大粗隆截骨治疗Pipkin IV型股骨头骨折患者共8例。其中男5例,女3例。结果:本组病例随访时间为18~58个月,平均36个月。按照采用Thompson-Epstein疗效评定标准,优:3例;良:3例;可:2例。结论:髋关节后侧入路结合大粗隆截骨治疗PipkinⅣ型股骨头骨折可获得充分的显露,并为股骨头的复位、固定提供极大方便,损伤相对较小,对股骨头血运影响小,效果良好。     

胫骨平台后侧骨折的手术治疗

目的:探讨对于胫骨平台后侧骨折患者的手术治疗方法及治疗效果。方法:选取本院2010年4月至2012年1月间采用手术治疗的胫骨平台后侧骨折患者23例设为治疗组,本组所有患者均采用后外侧入路的内固定手术治疗方法。另选取同期采用保守治疗的胫骨平台后侧骨折患者20例设为对照组。两组患者治疗后均获得12个月以上的随访。针对两组患者治疗后骨愈合时间、膝关节功能评分以及治疗总有效率等情况进行回顾性对比分析。结果:所有两组患者经治疗后,治疗组患者骨愈合时间明显低于对照组(P0.05),其结果具有统计学意义。且经随访后,治疗组患者膝关节功能评分显著高于对照组(P0.05)。而两组患者经综合评价其治疗总有效率对比差异也具有显著性(P0.05),且结果具有统计学意义。结论:对于胫骨平台后侧骨折患者采用后外侧入路的内固定手术治疗拥有显著的临床疗效。此术式具有对骨折部位起到很好的显露及复位稳定等优点,且在治疗效果及患者膝关节功能恢复情况等方面明显优于其它治疗方式。故此方法安全、有效,不失为治疗胫骨平台后侧骨折的首选治疗方法。     

Preoperative statin therapy and infectious complications in cardiac surgery

AimTo assess whether preoperative statin therapy is associated with the risk of postoperative infection in patients undergoing cardiac surgery.Methods520 patients undergoing cardiac surgery in 2010 were retrospectively examined. Data regarding statin and antibiotic use prior to and after surgery were available from the hospital pharmacy information system. Cultures and clinical data of patients on postoperative antibiotics other than standard prophylactic therapy were studied to identify postoperative infections up to 30 days from day of surgery.Results370 (71.2 %) patients were on preoperative statin therapy. Overall, 82 patients (15.8 %) suffered from postoperative infection of which 11 were surgical site infections. In multivariable regression analysis, statin therapy was associated with a reduced risk of postoperative infection (adjusted odds ratio: 0.329, 95 %: CI 0.19–0.57; P < 0.001).ConclusionsPreoperative statin use was associated with a considerable reduced risk of postoperative infections following cardiac surgery. Randomised controlled trials are required to clarify the role of statin therapy in the prevention of postoperative infections.     

盐酸纳美芬用于腹腔镜下宫外孕手术麻醉复苏的临床观察

目的 ：本文旨在探讨盐酸纳美芬用于腹腔镜下宫外孕手术麻醉复苏的临床效果。方法：将50例ASAⅠ-Ⅱ级于腹腔镜下行宫外孕手术患者随机分为两组：盐酸纳美芬组（A组）和对照组（B组）。两组患者分别于手术缝皮结束时静脉注射盐酸纳美芬注射液0.25μg/kg和盐酸纳洛酮4μg/kg。观察并记录手术维持时间,术中输液量、术中输血量、失血量和尿量,术中麻醉用药消耗量。术毕停麻醉用药后自给目的药物起病人恢复自主呼吸时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开手术室时间;同时观察病人离开手术室时的意识及躁动情况。结果：比较两组患者术后自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间和离开手术室时间,纳美芬处理组患者麻醉复苏效果优于对照组（P〈0.05）。A组患者于离开手术室时的意识状态优于B组（P〈0.05）。结论：与纳洛酮相比,盐酸纳美芬用于腹腔镜下宫外孕手术麻醉后复苏临床效果良好且更加稳定,有利于患者麻醉复苏。