MRI在软组织肿瘤及肿瘤样病变中的应用进展

MRI是显示软组织病变最好的影像学检查技术,可以很好地显示病变及其范围,但对于病变的定性诊断特异性不高。采用系统化的诊断策略,通过几个关键性问题的分析,即以病变组织的MRI信号特征为基础,综合患者的临床资料及X线检查显示的病变内钙化和骨化情况,对有特征性表现者可以明确诊断,对不能明确诊断者可以缩小鉴别诊断的范围,而对于不能明确为良性病变者推荐通过组织学活检排除恶性病变。此影像诊断策略有助于临床对软组织病变治疗方案的制定。     

A novel class of apical sodium--dependent bile salt transporter inhibitors: 1-(2,4-bifluorophenyl)-7-dialkylamino-1,8-naphthyridine-3-carboxamides

The apical sodium--dependent bile acid transporter (ASBT) is the main transporter to promote re-absorption of bile acids from the intestinal tract into the enterohepatic circulation. Inhibition of ASBT could increase the excretion of bile acids, thus increasing bile acid synthesis and consequently cholesterol consumption. Therefore, ASBT is an attractive target for developing new cholesterol-lowering drugs. In this report, a series of 1-(2,4-bifluorophenyl)-7-dialkylamino-1,8-naphthyridine-3-carboxamides were designed as inhibitors of ASBT. Most of them demonstrated potency against ASBT transport of bile acids. In particular, compound 4a₁ was found to have the best activity, resulting in 80.1% inhibition of ASBT at 10 μmol/L.     

The impact of the Major Trauma Network: will trauma units continue to treat complex foot and ankle injuries?

IntroductionApril 1st 2012 saw the introduction of National Trauma Networks in England. The aim to optimise the management of major trauma. Patients with an ISS ≥ 16 would be transferred to the regional Major Trauma Centre (level 1). Our premise was that trauma units (level 2) would no longer manage complex foot and ankle injuries thereby obviating the need for a foot and ankle specialist service.MethodsRetrospective analysis of the epidemiology of foot and ankle injuries, using the Gloucestershire trauma database, from a trauma unit with a population of 750,000. Rates of open fractures, complex foot and ankle injuries and requirement for stabilisation with external fixation were reviewed before and after the introduction of the regional Trauma Network. Secondly, using the Trauma Audit & Research Network (TARN) database, all foot and ankle injuries triaged to the regional Major Trauma Centre (MTC) were reviewed.ResultsIncidence of open foot and ankle injuries was 2.9 per 100,000 per year. There were 5.1% open injuries before the network and 3.2% after (p > 0.05). Frequency of complex foot and ankle injuries was 4.2% before and 7.5% after the network commenced, showing no significant change. There was no statistically significant change in the numbers of patients with complex foot and ankle injuries treated by application of external fixators. Analysis of TARN data revealed that only 18% of patients with foot and ankle injuries taken to the MTC had an ISS ≥ 16. The majority of these patients were identified as requiring plastic surgical intervention for open fractures (69%) or were polytrauma patients (43%). Only 4.5% of patients had isolated, closed foot and ankle injuries.ConclusionWe found that at the trauma unit there was no decrease in the numbers of complex foot and ankle injuries, open fractures, or the applications of external fixators, following the introduction of the Trauma Network. These patients will continue to attend trauma units as they usually have an ISS < 16. Our findings suggest that there is still a need for foot and ankle specialists at trauma units, in order to manage patients with complex foot and ankle injuries.     

黏附因子联合肾阻力指数对脓毒症相关性肾损伤的早期肾功能恢复的预测价值

目的 探讨联合应用黏附因子和肾阻力指数(renal resistace index，RRI)对脓毒症相关性急性肾损伤患者早期肾功能恢复的预测价值。 方法 选择河北医科大学第三医院重症医学科住院的脓毒症相关性肾损伤成年患者为研究对象，收集研究对象的一般资料，应用床旁超声检测患者RRI，采用酶联免疫吸附测定法测定血浆E-选择素、L-选择素和P-选择素及 内皮细胞黏附因子（intercellular cell adhesion molecule-1，ICAM-1）及血管细胞黏附分子1（vascular cell adhesion molecule-1，VCAM-1）水平,对患者进行随访1个月，将研究对象根据入组30 d是否肾功能恢复作为标准，分为肾功能恢复组和肾功能未恢复组。应用Logistics回归分析方法及接受者操作特征(receiver operating characteristic，ROC)曲线分析RRI、黏附因子、RRI联合黏附因子对脓毒症急性肾损伤患者肾功能恢复的预测价值。 结果 共纳入脓毒症相关性急性肾损伤者78例，其中男性54例，女性24例，平均年龄(70.8±23.3)岁；脓毒症急性肾损伤早期肾功能恢复组的VCAM-1表达均低于肾功能未恢复组（P=0.035 5），肾功能早期恢复组的APACHEⅡ评分及白细胞计数明显低于肾功能未恢复组（P＜0.05）。应用ROC曲线分析，VCAM-1联合RRI预测脓毒症患者早期肾功能恢复的敏感度为90.9%，特异度为32.1%，AUC=0.68。 结论 VCAM-I联合RRI对于脓毒症相关性急性肾损伤患者的早期肾功能恢复有较高的预测价值，以肾脏阻力指数的界值为0.71，VCAM-1的界值为1 233 ng/L，可以作为脓毒症相关性急性肾损伤患者的早期肾功能恢复的预测指标。     

扶正利胆汤对贲门癌术后胆囊收缩障碍的临床疗效观察

目的 研究扶正利胆汤对贲门癌术后胆囊收缩障碍的临床治疗作用及其机制探讨.方法 选择120例贲门癌术后患者,随机分为试验组60例和对照组60例;试验组患者,在术后第10天开始口服扶正利胆汤,连服20天;对照组患者,在术后第10天口服等体积的水,连服20天;在实验治疗期间,对上述两组患者均进行常规抗炎、补液等治疗.所有患者分别于术前3天、术后30天对胆囊进行超声波指标测定,测定条件是空腹、服用脂餐0.5小时后、服用脂餐1小时后,应用超声波测定胆囊最大纵切面积、长径、短径,计算胆囊超声容积、排空率指标,并在术前3天、术后30天测定空腹血清胆囊收缩素浓度.比较两组患者手术前后胆囊的容积、排空、排空率及空腹血清胆囊收缩素浓度.结果 1）两组患者手术前后胆囊收缩功能比较：对照组患者术后胆囊容积较术前明显增大（P＜0.05）,治疗组患者术后胆囊容积较术前没有显著性改变;术前治疗组和对照组患者胆囊容积无显著差别（P＞0.05）;术后试验组胆囊容积比对照组患者的胆囊容积明显缩小,两组比较具有显著性差异（P＜0.05）.2）两组患者手术前后空腹血清胆囊收缩素（CCK）浓度比较：术前两组CCK浓度无明显差别（P＞0.05）;术后对照组患者CCK浓度较术前明显下降（P＜0.05）,治疗组患者术后CCK浓度较术前无明显改变（P＞0.05）,术后试验组患者较对照组血清CCK浓度明显升高,两组比较有显著性差异（P＜0.05）.结论 贲门癌术后出现胆囊排空障碍,术后胆囊容积与术前相比明显增大.扶正利胆汤可以提高血清CCK浓度,改善术后胆囊容积,对于贲门癌术后的胆囊收缩障碍有一定的治疗作用.     

The role of post-operative radiographs in predicting risk of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures – A case control study

Background and aimVolar plating of distal radius fractures is one of the common procedures performed in trauma surgery. Flexor pollicis longus (FPL) rupture has been described as complication following volar plating of distal radius fractures.The aim of our study was to investigate the possible relation between parameters measured on post-operative radiographs and the occurrence of FPL ruptures.Materials and methodsThis was a case control study. The post-operative radiographs of 11 FPL rupture, and 22 non-FPL rupture patients were reviewed with respect to fracture reduction and plate position and the various parameters were calculated by five independent people.Logistic regression was used to examine the importance of the variables.ResultsWe identified two significant factors to predict FPL rupture after volar plating of distal radial fractures. These were radial tilt and plate distance from the joint line. The odds ratio of ruptures was 0.74 (95% CI 0.57–0.95) for every degree of radial tilt <25° and 0.50 (95% CI 0.28–0.88) for every millimetre that the distal end of the plate was away from the volar lip of the distal radius at the wrist joint.ConclusionPost-operative radiographs could help us predict FPL rupture after distal radius volar plating. The findings also highlight the need for good fracture reduction and thoughtful placement of the volar plate intraoperatively to minimise the risk of FPL tendon rupture.     

GAO's governor vessel-regulating and collaterals-unblocking technique for headache

Governor vessel-regulating and collaterals-unblocking technique is a specific acupuncture therapy for treatment of headache of “GAO's acupuncture-moxibustion academic school in Yanzhao land (around Hebei Province area)”. This method is a specific acupuncture therapy for treatment of various types of headache through combining GAO's four groups of empirical paired acupoints with governor vessel-regulating needling, z?w?liúzhù acupoint opening needling and meridian sinew needling in Yanzhao land correctly according to the clinical conditions of patients. Immediate effect can be obtained, and the duration of treatment can be shortened through appropriate clinical application, so that good long-term effects can be obtained. In this paper, the specific manipulations and theoretical basis of this needling method will be illustrated, and two cases will be attached for explanation.     

Metabolic surgery: Action via hormonal milieu changes,changes in bile acids or gut microbiota? A summary of the literature

Obesity and type 2 diabetes remain epidemic problems. Different bariatric surgical techniques causes weight loss and diabetes remission to varying degrees. The underlying mechanisms of the beneficial effects of bariatric surgery are complex, and include changes in diet and behaviour, as well as changes in hormones, bile acid flow, and gut bacteria. We summarized the effects of multiple different bariatric procedures, and their resulting effects on several hormones (leptin, ghrelin, adiponectin, glucagon-like peptide 1 (GLP-1), peptide YY, and glucagon), bile acid changes in the gut and the serum, and resulting changes to the gut microbiome. As much as possible, we have tried to incorporate multiple studies to try to explain underlying mechanistic changes. What emerges from the data is a picture of clear differences between restrictive and metabolic procedures. The latter, in particular the roux-en-Y gastric bypass, induces large and distinctive changes in most measured fat and gut hormones, including early and sustained increase in GLP-1, possible through intestinal bile acid signalling. The changes in bile flow and the gut microbiome are causally inseparable so far, but new studies show that each contributes to the effects of weight loss and diabetes resolution.