代谢手术治疗肥胖型多囊卵巢综合征的 meta 分析

目的: 系统评价代谢手术对肥胖型多囊卵巢综合征的影响。方法: 检索 PubMed、EMBASE、Cochrane Library、CNKI 和万方数据库。检索时间为 2000－01 ～ 2017－05。结局指标包括 PCOS、月经周期异常、多毛症、不 孕症。结果: 纳入的 19 篇报道中，共纳入接受代谢手术病人共 2716 例，其中女性病人 2274 例。经代谢手术后， PCOS 发生率术前12．27%术后降低为4．76%( 95%CI: 2．14 ～ 9．86，Z = 3．92，P＜0．0001) 。月经周期异常发生率术前 34．43%术后降低为10．79%( 95%CI: 5．62～ 26．15，Z= 6．36，P＜0．0001) 。多毛症发生率70．59%降低为21．01%( 95% CI: 3．57～ 31．06，Z= 4．27，P＜0．0001) 。不孕症发生率7．69%术后降低为2．56% ( 95% CI: 1．77 ～ 5．81，Z = 3．85，P = 0．0001) 。结论: 代谢手术可显著改善肥胖型多囊卵巢综合征的临床症状。     

经额部与经颞部血肿钻孔引流术治疗高血压脑出血疗效的Meta分析

目的比较经额部与经颞部血肿钻孔引流术治疗高血压脑出血的疗效。 方法按照制定的检索策略，检索中国知网、万方、维普等中文数据库及Medline、Embase、Cochrane等英文数据库，对于符合纳入排除标准的研究利用RevMan 5.3软件进行Meta分析。 结果经检索，5个临床研究符合标准，共488例病例，其中经额部钻孔引流组236例，经颞部钻孔引流组252例。2组在手术时间、术后第7天血肿残余量及术后并发症发生率方面比较差异无统计学意义，经额部钻孔引流组在术后第3天血肿残余量、住院时间、术后日常活动能力方面更有优势。 结论经额部血肿钻孔引流较经颞部在血肿清除效率、改善预后方面更有优势。     

超声引导下经皮经肝胆囊穿刺后继发性脓肿发生的危险因素分析

目的 探讨超声引导下经皮经肝胆囊穿刺置管引流术(Percutaneous Transhepatic Gallbladder Drainage,PTGD)术后发生继发性脓肿(Secondary abscess,SA)的发生率及其危险因素。方法 回顾性分析南京医科大学附属无锡人民医院2010年1月至2017年12月间410例经超声引导下PTGD患者的临床资料,采用单因素和多因素Logistic回归分析相关危险因素。结果 12例(2.93%,12/410)患者PTGD术后出现SA,再次针对SA穿刺引流的成功率100%。对良性疾病梗阻、基础疾病、胆囊大小、腹水、凝血功能、血小板、糖化血红蛋白(HbA_1C)、短期内引流管脱落/自行拔出等混杂因素进行校正后,Logistic回归分析表明短期内引流管脱落/自行拔出(OR=6.64,95%Cl：3.34～13.81,P=0.03)和HbA_1C＞9.0%(OR=3.38,95%Cl：1.22～7.95,P=0.04)是引起术后SA的独立危险因素。结论 SA是超声引导下PTGD术后罕见的并发症,再次穿刺引流是治疗SA有效和安全的方法。临床可通过加强对穿刺引流管的保护和应用降血糖药物,降低PTGD术后SA的发生。     

Effect of altered sagittal-plane knee kinematics on loading during the early stance phase of gait

BackgroundIndividuals with knee osteoarthritis (OA) show various dynamic sagittal-plane changes during the early stance phase of gait. However, the effect of these kinematic alterations on knee load during the early stance remains poorly understood. Research question: The purpose of this study was to examine the effect of altered sagittal- plane knee kinematics on knee load during the early stance.MethodsA total of 13 healthy adult men underwent gait analysis trials using four conditions (baseline and three altered conditions). The three altered conditions were defined as follows:1) Less flexion (LF): a gait that decreased knee flexion excursion (KFE) owing to a reduced peak knee flexion angle compared to baseline.2) Initial flexion (IF): a gait with decreased KFE owing to an increased knee flexion angle at initial contact, during which the peak knee flexion angle did not differ from baseline.3) Flexion gait (FG): a gait that increased the knee flexion angle at initial contact but did not reduce KFE compared with the baseline.Data analyzed included peak external knee flexion moment (KFM), KFM impulse (impulse was an integral value from initial contact to peak value), peak vertical ground reaction force (VGRF), and maximum loading rate.ResultsBoth LF and IF conditions significantly decreased peak VGRF (p < 0.05) compared with the baseline. Peak KFM decreased in the LF condition and increased in the FG condition versus baseline (p < 0.05). A significantly increased KFM impulse was found in both IF and FG conditions when compared with baseline (p < 0.05).SignificanceAn increase in knee flexion angle during early stance increased knee loading. Interventions are likely required for improving excessive knee flexion during early stance phase of gait in individuals with knee OA.