动力髋螺钉与人工股骨头置换治疗高龄患者股骨粗隆间骨折的对比分析

[目的]对比分析动力髋螺钉内固定(DHS)与人工股骨头置换术治疗高龄股骨粗隆间骨折的临床疗效,评价两种手术治疗方案的优劣.[方法]选取2002年4月至2007年3月本院收治的高龄股骨粗隆间骨折患者69例,其中应用DHS手术内固定治疗37例,人工股骨头置换术治疗32例.对两组患者的手术时间、术中失血量、住院时间、卧床时间、并发症、疗效优良率等6项临床指标以及患侧髋关节功能评估进行统计学分析.[结果]所有患者均获得随访,随访时间6个月至3年,平均2.1年,6项临床指标均显示股骨头置换组疗效明显优于DHS组, 两组数据差异均有统计学意义(P＜0.05).[结论]人工股骨头置换术治疗高龄股骨粗隆间骨折较DHS内固定有明显优势,可作为临床治疗高龄股骨粗隆间骨折的一种合理选择.     

B超定位微创经皮肾穿刺取石术治疗上尿路结石的疗效

[目的]探讨B超定位下微创经皮肾穿刺取石术(MPCNL)治疗上尿路结石的疗效。[方法]回顾性分析总结2003年6月至2004年6月B超定位下MPCNL治疗上尿路结石病例31例的临床资料。31例中铸型肾结石18例，输尿管上段结石13例。[结果]28例患者一期穿刺取石成功，3例穿刺造瘘后二期取石成功。31例均取得良好效果，且无远期并发症。[结论]MPCNL治疗上尿路结石可取得良好效果，较开放手术有明显优越性。而B超在术中定位可提高肾穿刺准确度，减少C臂X线机使用时间，值得推广应用。     

腰穿放液后脑血流变化预测正常压力脑积水分流效果的研究

【目的】通过腰穿放液前后脑血流变化预测正常压力脑积水(NPH)患者行分流手术的效果。【方法】回顾性分析26例NPH患者腰穿放液前后脑血流变化与脑室-腹腔(V-P)分流术后效果的相关性。【结果】分流术后2个月患者症状改善与腰穿放液前后脑血流的变化呈正相关,其中症状改善显效和有效患者腰穿后脑血流速度较前明显增加,而无效患者前后差异无统计学意义。【结论】腰穿放脑脊液前后脑血流的变化可作为预测NPH患者行分流手术疗效的指标。     

Direct comparison of rapid deployment versus sutureless aortic valve replacement: a meta-analysis

BackgroundThis meta-analysis was conducted to compare the procedural and early outcomes of aortic valve replacement (AVR) using rapid deployment valve (RD group) versus sutureless valve (SU group).MethodsA literature search of 5 online databases was conducted. The primary outcomes were mean transvalvular pressure gradient (MPG) after AVR, the incidence of paravalvular leak (PVL) and the need for a permanent pacemaker implantation (PPI). The secondary outcomes included aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, early mortality and other postoperative complications, such as atrial fibrillation, bleeding reoperation and stroke.ResultsEight articles were included, and all outcomes except MPG after AVR in matched valve sizes were extracted from 7 studies (RD group =842 patients and SU group =1,386 patients). The pooled analysis demonstrated a lower MPG in the RD group than in the SU group, with mean difference (MD) of 2.64 mmHg. The pooled risk ratios of any PVL and grade ≥2 (or moderate) PVL were not significantly different between the groups; however, the incidence of PPI was significantly lower in the RD group than in the SU group, with a risk ratio of 0.69. The pooled analyses showed that the ACC and CPB times were significantly longer in the RD group than in the SU group, with weighted MDs of 8.74 (P<0.001) and 9.94 (P<0.001) minutes, respectively. The risks of early mortality and other postoperative complications were not significantly different between the groups.ConclusionsAVR using RD valve was associated with better valve hemodynamics in terms of the MPG than AVR using SU valve, and better outcomes were observed in the RD group regarding PPI. Procedural times were longer in AVR using RD valve than SU valve. Early clinical outcomes showed no difference between RD and SU valve.     

Can FLT3 inhibitors overcome resistance in AML?

The identification of FLT3 mutations across a range of the cytogenetic subgroups of AML has opened up the possibility of a targeted therapeutic approach with broad applicability. Four agents are currently in clinical trials, at least 3 of which have both sufficient activity against AML and sufficiently acceptable toxicity profiles to support continued efforts to refine their inclusion into therapeutic regimens for AML. Better understanding of the genetics of inherent and acquired resistance is needed to guide development of second-generation agents. Optimizing the integration of FLT3 inhibitor therapy with chemotherapy has the potential both to decrease toxicity and improve response.     

Canagliflozin,a sodium glucose co-transporter 2 inhibitor,reduces post-meal glucose excursion in patients with type 2 diabetes by a non-renal mechanism: results of a randomized trial

Objective

Canagliflozin is a sodium glucose co-transporter 2 inhibitor approved for treating patients with type 2 diabetes. This study evaluated renal and non-renal effects of canagliflozin on postprandial plasma glucose (PG) excursion in patients with type 2 diabetes inadequately controlled with metformin.

Materials/Methods

Patients (N = 37) were randomized to a four-period crossover study with 3-day inpatient stays in each period and 2-week wash-outs between periods. Patients received Treatments (A) placebo/placebo, (B) canagliflozin 300 mg/placebo, (C) canagliflozin 300 mg/canagliflozin 300 mg, or (D) canagliflozin 300 mg/canagliflozin 150 mg on Day 2/Day 3 in one of four treatment sequences (similar urinary glucose excretion [UGE] expected for Treatments B–D). A mixed-meal tolerance test (MMTT) was given 20 minutes post-dose on Day 3 of each period.

Results

A single dose of canagliflozin 300 mg reduced both fasting and postprandial PG compared with placebo, with generally similar effects on fasting PG and UGE observed for Treatments B–D. An additional dose of canagliflozin 300 mg (Treatment C), but not 150 mg (Treatment D), prior to the MMTT on Day 3 provided greater postprandial PG reduction versus placebo (difference in incremental glucose AUC_0–2h, − 7.5% for B vs A; − 18.5% for C vs A; − 12.0% [P = 0.012] for C vs B), leading to modestly greater reductions in total glucose AUC_0–2h with Treatment C versus Treatment B or D. Canagliflozin was generally well tolerated.

Conclusions

These findings suggest that a non-renal mechanism (ie, beyond UGE) contributes to glucose lowering for canagliflozin 300 mg, but not 150 mg.     

额叶脑挫裂伤合并颅内血肿单侧开颅手术临床疗效评价

【目的】探讨单侧开颅手术治疗额叶脑挫裂伤合并颅内血肿的临床疗效。【方法】选取2015年6月至2017年6月本院手术治疗的额叶脑挫裂伤合并颅内血肿患者110例,根据手术入路分为单侧开颅手术(观察组,n=60)、双侧开颅手术(对照组,n=50),对比两组患者的手术时间、输血量、住院时间、术后不同时间的格拉斯哥昏迷(GCS)评分、格拉斯哥预后评分,手术前后患者血清神经元烯醇化酶(NSE)、S100β蛋白、乳酸水平变化。【结果】观察组患者的手术时间、输血量、住院时间均显著地低于对照组患者,差异均具有统计学意义(P<0.05)。术后1周,观察组患者的GCS评分显著地高于对照组患者,差异均具有统计学意义(P<0.05)。术后3个月进行患者预后评估,观察组患者的预后良好率66.67%显著高于对照组患者的46.00%,差异具有统计学意义(P<0.05)。术后1d,两组患者的血清NSE、S100β蛋白、血乳酸浓度差异不具有统计学意义(P>0.05);术后1周,观察组患者的血清NSE、S100β蛋白、血乳酸浓度均显著低于对照组患者,差异具有统计学意义(P<0.05)。【结论】额叶脑挫裂伤合并颅内血肿患者采用单侧开颅手术相对于双侧开颅手术其创伤更小、术后恢复效果更好。     

乌司他丁对脊柱手术患者围术期凝血功能的影响

[目的]观察胰蛋白酶抑制剂乌司他丁对脊柱手术患者围术期凝血功能及血小板聚集率的影响.[方法]选择36例无血液疾病及凝血功能障碍、肝肾功能异常或未服用影响血小板功能药物的择期脊柱手术患者(ASAⅡ～Ⅲ),随机分为乌司他丁组(W组,5000 U/kg,n=18)和生理盐水组(C组,n=18)；分别于注射前(T0)、注射后1 h(T1)、注射后2 h(T2)、注射后3 h(T3)抽出静脉血测定凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、国际标准化比值(INR)、及血小板1 min,5 min和最大聚集率(PAG1、PAG5、PAGM),并记录两组手术出血量.[结果]注射乌司他丁组后1h,W组APTT,PT较注射前明显延长(P＜0.05),用药后2h,TT较注射前明显延长(P＜0.05),用药后3h,APTT,PT,TT差异无统计学意义(P＞0.05).与C组比较,注射后1h,APTT显著性延长(P＜0.01),用药后2h,PT显著性延长(P＜0.05),用药后3h,APTT,PT,TT差异无统计学意义(P＞0.05).两组注射前后及组间比较PAgT差异无统计学意义(P＞0.05).两组患者出血量比较差异无统计学意义(P＞0.05).[结论]围术期应用5000 U/kg乌司他丁可改善脊柱手术患者术中患者的凝血状态,减少术中微血栓综合征,预防术中术后血栓形成.     

七氟醚麻醉在小儿气道异物取出术中的应用

[目的]探讨七氟醚麻醉在小儿气道异物取出术中的应用效果.[方法]随机选取患儿34例,男18例,女16例,年龄1～3岁,体重9～15kg,ASAⅠ～Ⅱ级,病程8～48 h,分为七氟醚组（S组）和氯胺酮组（K组）,每组17例.S组吸入8%七氟醚诱导,持续吸入4%～6%七氟醚维持;K组静注氯胺酮1～2 mg/kg诱导,麻醉深度不够时单次静脉追加氯胺酮1 mg/kg.监测患入室时、置镜前、置镜后、术中、退镜后、苏醒时各时间点的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）等指标,观察患儿诱导期、维持期、苏醒期不良反应.[结果]K组患儿置镜前、后MAP、HR 、RR较S组高.K组麻醉诱导时间较S组短,但苏醒时间较S组长（P〈0.05）.两组均未发生呼吸抑制.术中S组有4例呛咳、3例屏气,K组有3例呛咳、5例屏气,苏醒期S组有3例舌后坠、1例喉水肿;K组有5例舌后坠、3例喉水肿、2例恶心呕吐;两组不良反应的发生率差异无统计学意义（P〉0.05）.[结论]七氟醚麻醉可安全有效的应用于小儿气道异物取出术.     

巨大积水肾后腹腔镜下肾切除术56例经验总结

【目的】总结巨大积水肾行后腹腔镜下肾切除术的经验。【方法】分析了2004年至2008年56例因巨大肾积水接受了后腹腔镜下肾切除术的病例资料。[结果]56例均在腹腔镜下完成手术。手术时间为70～180min，平均121min。所有患者均未输血，术中及术后未发生明显并发症。检查标本发现36例存在肾盂输尿管交界处梗阻，另20例巨大肾积水继发于输尿管上段结石。【结论】尽管巨大积水肾占据了大部分腹膜后腔，后腹腔镜下肾切除术仍可以安全有效地完成。