Lifetime risk of cardiovascular disease and life expectancy with and without cardiovascular disease according to changes in metabolic syndrome status

Background and aimsThe relationship between dynamic changes in metabolic syndrome (MetS) status and lifetime risk of cardiovascular disease (CVD) has not been reliably quantified. This study aimed to estimate lifetime risk of CVD and life expectancy with and without CVD according to dynamic MetS status.Methods and ResultsDynamic changes in MetS status were assessed: MetS-free, MetS-chronic, MetS-developed, and MetS-recovery groups. We used Modified Kaplan–Meier method to estimate lifetime risk and used multistate life table method to calculate life expectancy. Participants free of CVD at index ages 35 (n = 40 168), 45 (n = 33 569), and 55 (n = 18 546) years. At index age 35 years, we recorded 1341 CVD events during a median follow-up of 6.1 years. Lifetime risk of 33.9% (95% CI: 26.9%–41.0%) in MetS-recovery group was lower than that of 39.4% (95% CI: 36.1%–42.8%) in MetS-chronic group. Lifetime risk of 37.8% (95% CI: 30.6%–45.1%) in MetS-developed group was higher than that of 26.4% (95% CI: 22.7%–30.0%) in MetS-free group. At index age 35 years, life expectancy free of CVD for MetS-recovery group (44.1 years) was higher than that for MetS-chronic group (38.8 years). Life expectancy free of CVD for MetS-developed group (41.9 years) was lower than that for MetS-free group (46.7 years).ConclusionsRecovery from MetS was associated with decreased lifetime risk of CVD and a longer life expectancy free of CVD, whereas development of MetS was associated with increased lifetime risk of CVD and a shorter life expectancy free of CVD.     

三维重建及3D打印技术在骨盆三维特征测量准确性研究

目的　研究分析尸体骨盆与其三维重建数字化模型及3D打印实体模型的三维特征测量结果差异。 方法　选择1具中年男性骨盆标本,根据骨盆的生理学结构特点在骨盆标本表面选取并固定共计14个特征点,并使用三坐标仪测量并记录特征点的三维坐标;使用CT设备对固定了特征点的骨盆标本进行1.0 mm的断层扫描;使用三维医学图像软件（Delta Medical Studio,DMS）对获取的扫描图像进行三维重建,并记录特征点的三维坐标;使用3D打印设备（熔融沉积成型,FDM）及光固化成型（Stereo Lithography Appearance,SLA）打印三维重建模型,三坐标仪测量记录特征点的三维坐标;通过记录的三维坐标分别计算尸体标本、数字模型、3D打印实体模型的特征点之间的距离及夹角;从最大误差、平均误差、t值验证等角度分析三组数据的误差情况。 结果　三维重建数字化骨盆模型的特征测量距离的平均误差约为0.5 mm,角度平均误差约为0.35 o;3D打印模型相对于骨盆标本的距离测量的平均误差约为0.8~1.1 mm,角度平均误差约为0.4°~0.5°。 结论 三维重建模型和3D打印实体模型对于骨盆术前的参考及测量精度方面具备可靠性,可根据实际需求选择3D打印模型作为骨盆术前规划的参考。     

穿支皮瓣的发展及最新进展

穿支皮瓣是对传统肌皮瓣的改进,不仅保留了供区的肌肉、神经,降低了对供区的伤害,减少了供区并发症,而且由于不带肌肉、筋膜等,受区不至于显得过分臃肿,既满足了患者的美观要求,也有利于受区进行功能锻炼。穿支皮瓣是组织缺损修复的一项新技术,是皮瓣外科学发展的最新方向。现结合近年来穿支皮瓣的研究进展予以综述。     

动态稳定系统的生物力学和临床应用进展

动态稳定系统（Dynesys）由Stoll等^[1]在Graf韧带系统的基础上改进设计而成,现已广泛应用于治疗腰椎退行性疾病（LDD）。LDD主要包括腰椎椎间盘突出、继发性腰椎椎管狭窄、退行性椎体滑脱及退行性脊柱侧凸等,当引发严重腰腿部疼痛、神经根压迫等临床症状时往往需要手术治疗。与传统后路腰椎椎间融合术（PLIF）及经椎间孔腰椎椎间融合术（TLIF）相比,Dynesys通过椎弓根螺钉连接产生的动态推拉关系在固定节段对抗异常折弯力和剪切力、改善固定节段应力传导的同时保留固定节段活动度（ROM）,进而减少术后邻近节段退行性变（ASD）的发生^[2]。然而,目前关于Dynesys的临床疗效尚存在争议。本文对近年来国内外关于Dynesys的相关研究进行分析,从生物力学、临床应用等方面作如下综述。     

Le coup de chaleur

Heatstroke is a potentially fatal disorder caused by an extreme increase in body temperature. It can result in widespread damage to the cardiovascular system, liver, kidney and blood clotting function. Classical heatstroke can occur during heat waves or as a result of intense environmental heat in persons in whom the thermoregulatory functions fail to adapt to a sudden increase in temperature, as during a heat wave, or to a high regional temperature. Exertional heatstroke can occur as a result of strenuous exercise, especially in hot, humid conditions, and may affect young, healthy individuals such as athletes during severe physical exertion and military recruits during training. A significant number of the histopathological and clinical characteristics described in persons with heatstroke indicate that these changes are a consequence of hyperthermia per se. A new hypothesis is that splanchnic vasoconstriction following heat stress leads to an increase in epithelial permeability and endotoxic translocation. The inflammatory factors involved could be similar to those observed in sepsis. Classical heatstroke is characterized by the following triad: rectal temperature 0≥40.6°C (> 105° F); neurological dysfunction with coma; and anhydrosis. Exertional heatstroke is characterized by a sudden collapse and loss of consciousness during exercise. The internal body temperature often exceeds 40.6 °C at the time of collapse, but hyperthermia is not indispensable to the diagnosis. Following heatstroke, rhabdomyolysis, renal damage, hepatic disorders and blood clotting dysfunction rapidly occur. An early diagnosis, the prompt institution of body cooling, and the rapid transportation of patients to an intensive care unit are essential for a favorable outcome. The mortality rate in these patients can be as low as 5% or less in centers where appropriate facilities for whole body cooling and emergency treatment are available.     

Hepatoprotective effects of emodin from Ventilago leiocarpa

A major component of ethyl acetate (EtOAc) and chloroform (CHCl₃) fractions of Ventilago leiocarpa Bunge (Rhamnaceae), emodin, was isolated and exhibited hepatoprotective effects on carbon tetrachloride (CCl₄) as well as d-galactosamine (D-GalN)-induced liver damage. The histopathological examination also clearly showed that emodin reduced lymphocyte cells, Kupffer cells, ballooning degeneration, cell necrosis and hyaline degeneration on CCl₄ and d-galactosamine-induced tests.     

Hijama therapy (wet cupping) – its potential use to complement British healthcare in practice,understanding, evidence and regulation

Wet cupping was used in the nineteenth century for treatment of patients in the United Kingdom (UK) by a few experienced practitioners. Revival Hijama use by practitioners in the UK in recent years has been observed as well as interest from the public, with developments of specific certified training programmes, established businesses providing tailored Hijama therapy Clinical Waste disposal services, provisions of insurance cover, involvement of medical professionals and membership with the General Regulatory Council for Complementary Therapies (GRCCT). However, there has also been noted that there is not much in the way of guidance or regulation. Therefore, we would like to initiate some communication and understanding of Hijama (wet cupping) to benefit medical professionals, discussing recent research undertaken as a basis for potentially more in the future (evidence-based practice), in the likely event that a patient might request to be referred for this therapy during a consultation.     

Paeoniflorin ameliorates symptoms of experimental Sjogren's syndrome associated with down-regulating Cyr61 expression

Paeoniflorin (PF), an active compound extracted from Paeony root, has been used in therapy of autoimmune diseases with effective clinical efficiency and higher safety. Sjogren's syndrome (SS) is a chronic, systemic, immune-mediated inflammatory disease. In this study, we demonstrated that novel pro-inflammatory factor Cyr61/CCN1 was up-regulated in epithelial cells of salivary glands of primary SS patients and submandibular gland autoantigen-induced experimental SS mice. Blocking Cyr61 expression with special monoclonal antibody improved saliva secretion by ameliorating inflammatory infiltration and cytokines production in vivo. Furthermore, we showed that PF could alleviate inflammation by down-regulating Cyr61 expression in experimental SS mice. In conclusion, our new findings revealed for the first time that Cyr61 involves the pathogenesis of primary SS and PF alleviates SS-like symptoms associated with inhibiting Cyr61 expression, providing new insights into the potential molecular mechanism of PF in primary SS treatment.     

Agreement between Sanders classification of intraarticular calcaneal fractures and assessment during the surgery

BackgroundSanders classification, based on the number of displaced fractured fragments of posterior facet, can predict the prognosis of calcaneal intraarticular fractures. The aim of the study was assessing not only intraobserver reproducibility and interobserver reliability of Sanders classification but also the agreement between preoperative reported types based on computed tomography (CT) scan and direct observation during the surgery.MethodsIn this cross-sectional study, preoperative CT scans of 100 patients with intra-articular calcaneal fracture operated by a single surgeon were studied by two orthopedic and trauma surgeons (A & B), twice with an interval of three weeks. Their result were compared with each other and with the number of displaced fractured fragments recorded in the operation notes. Quadratic weighted kappa test was used to check the agreement between two observers and between the observers and the surgeon.ResultsIntraobserver reproducibility for Sanders classification of intraarticular calcaneal fractures was found to be good to excellent (A1–A2: 0.91 and B1–B2: 0.75). There was a moderate agreement between the two observers (A1–B1: 0.56, A1–B2:0.58, A2–B1:0.48, and A2–B2:0.51). The agreement between reported types of Sanders classification and the number of displaced fractured fragments seen during the surgery was fair (A1-surgeon: 0.27, A2-surgeon: 0.29, B1-surgeon: 0.38, and B2-surgeon: 0.50).ConclusionsAgreement between Sanders classification and what is real during surgery is fair. Hence, Sanders classification as determined in the widest cut of coronal CT scan extended posteriorly should be cautiously interpreted for surgery.