Anterior tibial artery injury is not the contraindication of medial plantar flap: digital subtraction angiography evidence and clinical application

The medial plantar artery (MPA) is often sacrificed as the vascular pedicle of the medial plantar flap (MPF). However, for patients with ankle soft tissue defect caused by traffic accident, the anterior tibial artery (ATA) could be damaged and the blood supply of the distal foot would only come from the MPA and the lateral plantar artery (LPA). In this case, sacrificing the MPA for the MPF means that the LPA will become the mainly source of blood supply of the distal foot. Whether the blood supply of the distal foot is adequately guaranteed remains to be discussed. A total of seven patients with ankle soft tissue defect and ATA injury were enrolled in the study. The digital subtraction angiography (DSA) was performed to observe the hemodynamics of the ipsilateral foot. The MPF was harvested only when the foot arterial network consisting of the MPA, the LPA, the deep plantar arch, and the deep plantar artery of DPA, and the blood redistribution existed. DSA results showed the blood from the posterior tibial artery was redistributed to the ipsilateral foot and the MPA is not the dominant artery in the foot. Seven MPFs were harvested, and all flaps survived completely. No complications, such as pain, ulcer, and necrosis, occurred in the ipsilateral toes. The DSA could accurately and intuitively evaluate the hemodynamics of foot in patients with ATA injury. The DSA data and clinical practice proved that the ATA injury is not the contraindication of the MPF.     

内源性一氧化碳对肺动脉平滑肌细胞增殖基因表达谱的影响

目的 运用芯片技术研究内源性一氧化碳（CO）刺激下血管平滑肌细胞内增殖相关基凼表达谮的变化。方法 取SD大鼠肺动脉平滑肌细胞进行离体培养,用血小板源性生长因子（PDGF,20ng／m1）和Hemin（20μmol／L）进行刺激后,用Affymetrix表达基因谱芯片检测其基因表达谱变化。结果 Hemin刺激与PDGF刺激相比差异表达基因366条,与增殖相关的差异表达基因21条,上调11条,下调10条。其中原来在PDGF刺激下上调表达的一些基因（Map2k3、cyclinD1、PDGFA、mybL1、a．nape10、MMP14等）在经内源性CO刺激后其表达则显著下调。结论 内源性CO很可能是通过作用于MAPK途径来抑制PDGF的促增殖功能,同时伴有cyclinD1、cyclinG1、P21等的参与。     

Incidence of brain injuries in premature infants with gestational age ≤34 weeks in ten urban hospitals in China

Background

There is a large number (1.5 million per year) of premature births in China. It is necessary to obtain the authentic incidences of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), the common brain injuries, in Chinese premature infants. The present multicenter study aimed to investigate the incidence of brain injuries in premature infants in ten urban hospitals in China.

Methods

The research proposal was designed by the Subspecialty Group of Neonatology of Pediatric Society of the Chinese Medical Association. Ten large-scale urban hospitals voluntarily joined the multicenter investigation. All premature infants with a gestational age ≤34 weeks in the ten hospitals were subjected to routine cranial ultrasound within three days after birth, and then to repeated ultrasound every 3–7 days till their discharge from the hospital from January 2005 to August 2006. A uniform data collection sheet was designed to record cases of brain injuries.

Results

The incidences of overall IVH and severe IVH were 19.7% (305/1551) and 4.6% (72/1551), respectively with 18.4% (56/305) for grade 1, 58.0% (177/305) for grade 2, 17.7% (54/305) for grade 3 and 5.9% (18/305) for grade 4 in nine hospitals. The incidences of overall PVL and cystic PVL were 5.0% (89/1792) and 0.8% (14/1792) respectively, with 84.3% (75/89) for grade 1, 13.5% (12/89) for grade 2, and 2.2% (2/89) for grade 3 in the ten hospitals. The statistically significant risk factors that might aggravate the severity of IVH were vaginal delivery (OR=1.883, 95% CI: 1.099–3.228, P=0.020) and mechanical ventilation (OR=4.150, 95% CI: 2.384–7.223, P=0.000). The risk factors that might result in the development of cystic PVL was vaginal delivery (OR=21.094, 95% CI: 2.650–167.895, P=0.000).

Conclusions

The investigative report can basically reflect the incidence of brain injuries in premature infants in major big cities of China. Since more than 60% of the Chinese population live in the rural areas of China, it is expected to undertake a further multicenter investigation covering the rural areas in the future.     

杨振国教授术柏痛风汤治疗痛风52例

[目的]观察杨振国术柏痛风汤治疗痛风疗效。[方法]将52例痛风使用术柏痛风汤,1剂/d,早晚各1次,水煎服。15d为1疗程。治疗3个疗程进行疗效判定。[结果]临床治愈32例,显效11例,有效5例,无效4例,总有效率为92.31%。[结论]术柏痛风汤治疗痛风疗效满意,值得推广。     

������������ͪ�ֱ����Ϸ�������������ʹ�������PCIA����Ч������������

??OBJECTIVE To evaluate the efficacy, safety and economy of tramadol and hydromorphone combined with flurbiprofen axetil in the treatment of PCIA for postoperative cesarean through the empirical study, optimize the drug treatment program and provide certain evidence-based medicine and pharmacoeconomics basis for clinical use of drugs. METHODS Included 240 cases of maternal, these maternal need to use PCIA for postoperative analgesia and meet the inclusion and exclusion criteria. The maternal samples included in the study were divided into two groups: tramadol(tramadol 2 mg ??kg^-1+flurbiprofen axetil 5 mg??kg^-1) and hydromorphone(hydromorphone 0.04 mg ??kg^-1+flurbiprofen axetil 5 mg??kg^-1). The efficacy index, safety index and cost index of the two groups were observed. The effectiveness, adverse reactions and cost data were collected. Statistical analysis and cost effectiveness analysis were used to evaluate the economic effects of the two groups. RESULTS The analgesic effect of tramadol group was same as the hydromorphone group, but the total cost of analgesia in tramadol group was lower than that in hydromorphone group, the results of the minimum cost analysis showed that the tramadol regimen was superior and the results were stable. CONCLUSION The PCIA regimen of tramadol group is superior to that of the hydromorphone group, considering the efficacy, safety and economy.     

贝伐珠单抗联合紫杉醇治疗转移性乳腺癌的成本效果分析

【摘要】 目的 从现阶段医疗卫生角度出发,评价四川地区贝伐珠单抗联合紫杉醇治疗转移性乳腺癌的成本 效果优势。方法〓根据E2100临床试验数据,结合四川地区医疗费用水平,采用成本 效果分析法,以增量成本 效果比（ICER）为评价指标,评价贝伐珠单抗联合紫杉醇治疗转移性乳腺癌方案的优劣,并分析结果敏感度。结果〓紫杉醇与贝伐珠单抗联合组与紫杉醇单药组相比,ICER值远远高于3倍GDP;敏感度分析结果提示,当贝伐珠单抗药品费用下降50%时,联合组仍不具有成本 效果优势。贝伐珠单抗使用成本和医疗检查成本对总成本影响最大,其他参数影响较小。结论〓从我国现阶段医疗卫生角度出发,四川地区转移性乳腺癌使用贝伐珠单抗联合紫杉醇治疗,尚不具有成本效果优势。     

Waist-to-thigh ratio is a predictor of internal organ cancers in humans: findings from a cohort study

ObjectiveStudies have shown that some specific body measures are associated with the occurrence of cancers. Few studies have demonstrated the relationship with more comprehensive approaches. This study aims to explore body measures and the combinations associated with internal organ cancers.MethodsThree-dimensional anthropometric body surface scanning data collected 10,215 participants from the health examination department in a medical center of Taiwan during 2000–2010. Follow-up was conducted for an average of 8 years, and 244 internal organ cancer cases were identified.ResultsAn increased risk of internal organ cancers was observed among the subjects with larger waist circumference/smaller thigh circumference, in which waist-to-thigh ratio (WTR) was constructed. Comparing the subjects in the fourth quartile for WTR to the subjects in the first quartile with multiple Cox regression analysis yielded a hazard ratio of 1.842 (95% confidence interval, 1.131～2.999). The association between WTR quartile and internal organ cancers was stronger among male participants, older participants, and participants with chronic conditions.ConclusionsThe study has revealed that WTR is the most significant predictor for the occurrence of cancer in Asian populations. Because it is easy to measure and open to modification, WTR may be more useful in clinical and preventive medicine in the future.