Heterotopic ossification associated with myelopathy following cervical disc prosthesis implantation

This case report presents a 37-year-old man with clinical signs of myelopathy almost 9 years after implantation of a Bryan disc prosthesis (Medtronic Sofamor Danek, Memphis, TN, USA) for C5/C6 soft disc herniation. As demonstrated on MRI and CT scan, spinal cord compression was caused by bony spurs due to heterotopic ossification posterior to the still moving prosthesis. The device, as well as the ectopic bone deposits, had to be removed because of myelopathy and its imminent aggravation. Conversion to anterior spondylodesis was performed.     

Shaving effects on percutaneous penetration: clinical implications

Context: Human/animal shaving biology.

Objective: To assess the effect of shaving on percutaneous penetration and skin function.

Methods: We screened 500+publications in Pub Med, Scopus, Cochrane Library and pertinent journals out of which only 17 were deemed relevant. Terms for searches included shaving and skin, percutaneous penetration and shaving, skin absorption and shaving, absorption of dyes and shaving, skin penetration, effects of shaving and absorption, shave and dyes, axillary shaving and stratum corneum, shaving and breast cancer, shaving and infections, etc.

Result: Shaving appears to have an exaggerated effect on percutaneous absorption; however, some studies do not support this evidence.

Conclusion: Shaving enhances percutaneous penetration of some chemicals; however this effect is species and chemical specific. Further investigations of chemicals of varying physio-chemical properties are mandated before a generalized theory can be promulgated.     

CD36与动脉粥样硬化的相关性研究

目的 探讨清道夫受体CD36在动脉粥样硬化患者血清中的变化及CD36在人主动脉粥样硬化组织中的表达情况,并研究两者的相关性及其临床意义.方法 选择心血管内科冠心病患者(CHD) 100例作为冠心病组,其中包括稳定型心绞痛(SAP)31例,不稳定型心绞痛(UAP) 29例,急性心肌梗死(AMI)40例.同时选择健康体检者50例作为对照组.ELISA法对两组血清进行CD36的浓度检测,检测其甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、hs-CRP、同型半胱氨酸(Hcy)含量,并对结果数据进行统计学分析.选择经冠脉造影诊断为冠心病的心脏手术患者的冠状动脉组织,同时选择因意外伤害需要心脏手术患者的冠状动脉组织作为对照组,免疫组化法检测两组组织中的CD36的表达.结果 ELISE法检测健康对照组CD36的含量为3.81 ±0.95pg/mL,而冠心病患者血清中CD36含量为25.17±3.76pg/mL,冠心病患者血清中CD36含量较健康对照组明显升高,差异有统计学意义(P＜0.05).其中稳定型心绞痛(SAP)CD36含量为18.68 ±2.17 pg/mL,不稳定型心绞痛(UAP)24.19±0.82 pg/mL,急性心肌梗死(AMI)27.17±5.83 pg/mL,不稳定型心绞痛和急性心肌梗死组CD36水平较稳定型心绞痛的明显升高(P＜0.01).动脉粥样硬化患者组CD36表达明显高于健康对照组,差异有统计学意义(x2 =23.018,P＜0.05).结论 清道夫受体CD36在动脉粥样硬化患者血清中浓度明显升高,且在动脉粥样硬化患者组织中高表达,临床上动脉粥样硬化患者检测CD36具有重要临床意义.     

短期留置导尿管拔除在泌尿外科肾部分切除术后患者中的应用研究

【目的】 将短期留置导尿管拔除的最佳证据应用于临床,提高护士在肾部分切除术后尿管拔除实践活动中证据应用的依从性,降低留置尿管感染风险发生率,提高患者舒适度。【方法】 遵循JBI循证护理中心的临床证据实践应用系统(JBI-PACES)的标准程序,采用现场观察、查阅护理病历及资料收集等方法,以护士行为依从性水平、留置导尿管感染风险发生率、患者舒适度改变程度评价证据应用前后的有效性。【结果】 基线审查标准中护士对“肾部分切术后患者在午夜拔尿管”“护士主导评估尿管拔除时机”“拔除导尿管前给予单剂量a受体阻滞剂”等3条标准中在证据应用后依从性显著提高(p≤0.005);平均留置尿管时间由证据应用前的平均(135.75±11.70)h缩短至(90.45±9.62)h(p＜0.005);患者舒适度明显提高。【结论】 本课题研究应用于临床,提高了护士在主导短期尿管拔除实践中的依从性,帮助形成导尿管拔除和管理规范,降低留置尿管感染风险发生率,并提高患者舒适度。     

Utility of risk scores to predict adverse events in cardiac lead extraction

Introduction: Increasing device implantations, patient comorbidities, and longer life expectancy contribute to an increased need for lead extraction. Even if transvenous lead extraction (TLE) is a highly successful procedure, some serious procedural complications are reported. In order to identify those patients who are at higher risk, risk stratification scores were proposed.

Areas covered: The major obstacles to lead extractions are represented by the body’s response to the foreign implanted material and by the following development of fibrotic reaction between the lead and the vascular system. Several clinical factors and device features are associated with major complications and worse outcomes. Although different multiparametric scores predicting the safety and the efficacy of TLE procedures were reported, none of these scores were prospective evaluated.

Expert commentary: A correct risk stratification is needed in order to refer complex patients to centers with proven experience and avoid futile procedures. Furthermore, the identification of high-risk patients allows to perform the extraction procedure in the operating room instead of electrophysiology lab. Albeit some risk scores able to predict adverse event in cardiac lead extraction were described, there are still several limitations to their use and reproducibility.     

米非司酮片配伍欧维婷软膏在绝经后妇女取环中的作用

目的 探讨米非司酮片配伍欧维婷软膏在绝经后妇女取环中的效果。方法 将300例绝经后要求取环的妇女随机分为欧维婷组(实验组一)、欧维婷配伍米非司酮组(实验组二)和米非司酮组(对照组)各100例。实验组一术前7d予以欧维婷软膏0.5g/d,睡前阴道上药;实验组二术前7d予以每日欧维婷软膏0.5g,睡前阴道上药,并于术前3d分别于每日6Am及18Pm各口服米非司酮25mg;对照组仅术前3d在每日6Am及18Pm各口服米非司酮25mg,观察3组术中宫颈软化情况、手术时间、取环成功率、疼痛程度、阴道出血量及药物副反应。结果欧维婷组和欧维婷配伍米非司酮组与单用米非司酮组相比在宫颈软化程度、取环成功率、手术时间、疼痛程度及药物副反应等均有显著性差异(P<0.05)。结论 欧维婷软膏配伍米非司酮片有协同增效作用,应用于绝经后妇女取环安全、有效,成功率高,是一种值得临床推广使用的方法。     

新疆奎屯地区砷暴露致肝损伤现况调查

目的调查新疆奎屯高砷地区水砷含量及当地居民健康状况,分析砷对人体肝脏的损害作用,为进一步探讨砷的肝毒性作用机制提供基础资料。方法采用现场流行病学的调查方法在新疆奎屯水砷监测点进行调查,调查对象377例,其中砷暴露组137例,内对照组126例,外对照组114例;分别进行问卷调查、临床检查及样品采集,比较3组肝B超检查结果、尿砷含量及肝损伤血清标志物的差异。结果砷暴露组居民尿砷含量为(121.25±18.70)μg/L,高于内对照组的(22.47±19.21)μg/L和外对照组的(18.52±15.98)μg/L,3组差异有统计学意义(F=65.491,P<0.001)。B超检查结果显示肝功能正常者325例,异常者52例。砷暴露组和内对照组、外对照组发生肝脏异常分布比较差异有统计学意义(χ2=6.440,P=0.040)。血清肝纤维化指标检测显示砷暴露组的血清透明质酸、层粘连蛋白及Ⅳ型胶原含量与内对照组、外对照组比较差异有统计学意义;暴露组Ⅲ型前胶原肽与内对照组比较差异无统计学意义,而与外对照组比较差异有统计学意义;内对照组与外对照组的层粘连蛋白和Ⅳ型胶原差异有统计学意义。结论新疆奎屯高砷地区居民饮用高砷水与当地居民肝病高发有一定的联系,砷暴露可能是导致肝功能损害尤其是肝纤维化的主要原因之一,应进一步采取针对性措施降低肝损伤发生率,以促进高砷地区各族居民的身体健康。     

Punishing parents: Child removal in the context of drug use

New amendments to child welfare policy in New South Wales turn a spotlight on parents who use drugs and raise concerns about adequate provision of services for families facing issues with alcohol and other drug use. Sections of the new legislation are explicitly focused on parents who use illicit drugs, expanding the reach of child protection services over expectant parents during pregnancy. This targeting of women who are ‘addicted’ highlights the ambiguous scientific and moral attention to drug use in pregnancy. It also raises practical questions about the potential for the legislation to increase stigma towards drug use and disproportionately affect vulnerable and disadvantaged families. [Olsen A. Punishing parents: Child removal in the context of drug use. Drug Alcohol Rev 2015;34:27–30]     

2种方法治疗良性前列腺增生并电切镜进镜困难患者的比较

比较2种方法在治疗良性前列腺增生（BPH）行经尿道前列腺等离子电切术中电切镜置入困难患者的临床疗效。选择2007年9月至2014年1月曲靖市第二人民医院泌尿外科收治的BPH患者行经尿道前列腺等离子电切术中发现电切镜进镜困难患者90例,随机分成观察组和对照组,每组45例。观察组采用去除外鞘电切术联合耻骨上膀胱微穿刺负压引流治疗,对照组采用扩张尿道和（或）尿道外口剖开,再置入电切镜行电切术治疗。2组手术均取得成功,平均手术时间、出血量无显著性差异（P＞0。05）,观察组术后平均住院时间、继发尿道狭窄的发生率均小于对照组（分别为P＜0.05、P＜0.01）。去除外鞘电切术联合耻骨上膀胱微穿刺负压引流在治疗BPH并电切镜进镜困难患者可降低术后继发尿道狭窄发生率,减少术后住院时间,临床疗效较好。