Racial and Socioeconomic Disparities in the Presence of Acute Type A Aortic Dissections

Nonadherence to hypertensive medications is the most common predisposing factor associated with acute aortic dissections. Acute dissections are more likely to occur in African Americans due to higher rates of uncontrolled hypertension. Through a patient case study, the effects of racial and socioeconomic disparities will be illustrated. Through discussing the case of a 39-year-old African American man who presented with hypertensive crisis and nonadherence to hypertension treatment resulting in the diagnosis of an acute aortic dissection. His case exemplifies the effect of health disparities on postoperative outcomes, morbidity, and mortality in the African American population diagnosed with aortic dissections.     

丹参注射液对带蒂皮瓣移植修复术后成活率及预后的影响

目的:探讨丹参注射液对带蒂皮瓣移植修复术后成活率及预后的影响。方法:将68例接受带蒂皮瓣移植修复术的患者简单随机分成观察组与对照组各34例。对照组给予术后常规治疗,观察组在此基础上加用丹参注射液治疗,持续给药1周。随访3～12个月,比较两组患者术后皮瓣成活率、皮瓣肿胀程度、凝血指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平变化及并发症发生率。结果:观察组患者皮瓣成活率为97.06%,明显高于对照组的76.47%,差异有统计学意义(P<0.05)。观察组术后7 d皮瓣肿胀程度明显轻于对照组,差异有统计学意义(P<0.05)。观察组患者术后3 d的PT、APTT、FIB水平[(17.84±2.45)s、(35.38±3.14)s、(2.24±0.17)g/L]均明显低于对照组患者[(23.07±2.69)s、(41.56±3.34)s、(2.79±0.32)g/L],差异有统计学意义(P<0.05)。观察组患者术后伤口感染、瓣下积液、动静脉危象的总并发症率为8.82%,明显低于对照组的29.41%,差异有统计学意义(P<0.05)。结论:丹参注射液能提高带蒂皮瓣移植修复术后成活率,减轻术后皮瓣肿胀程度,改善凝血指标,降低血管危象、皮瓣坏死等并发症风险。     

Reflection of neuroblastoma intratumor heterogeneity in the new OHC-NB1 disease model

Accurate modeling of intratumor heterogeneity presents a bottleneck against drug testing. Flexibility in a preclinical platform is also desirable to support assessment of different endpoints. We established the model system, OHC-NB1, from a bone marrow metastasis from a patient diagnosed with MYCN-amplified neuroblastoma and performed whole-exome sequencing on the source metastasis and the different models and passages during model development (monolayer cell line, 3D spheroid culture and subcutaneous xenograft tumors propagated in mice). OHC-NB1 harbors a MYCN amplification in double minutes, 1p deletion, 17q gain and diploid karyotype, which persisted in all models. A total of 80–540 single-nucleotide variants (SNVs) was detected in each sample, and comparisons between the source metastasis and models identified 34 of 80 somatic SNVs to be propagated in the models. Clonal reconstruction using the combined copy number and SNV data revealed marked clonal heterogeneity in the originating metastasis, with four clones being reflected in the model systems. The set of OHC-NB1 models represents 43% of somatic SNVs and 23% of the cellularity in the originating metastasis with varying clonal compositions, indicating that heterogeneity is partially preserved in our model system.     

How to implement guidelines and models of care

In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.     

Current surgical management of metastatic pathological fractures of the femur: A multicentre snapshot audit

AimsWe aimed to find out: the typical workload for metastatic bone disease, the conventional treatment for femoral metastases and whether there is a trend for arthroplasty and endoprosthetic reconstruction.Materials and methodsAll sequential patients undergoing surgery for femoral metastatic lesions (both pathological fracture and impending pathological fracture) of any age patient were included in the multicenter snapshot audit. Data on demographics, institutions and operative procedures were recorded.Results24 UK Institutions were enrolled, including 7 Major Trauma Centres (MTCs). It was a 2 month audit from 1^stMarch 2018. 95 cases were recorded. The mean age was 71 and 65% were female. 66 patients had a fracture at presentation and 23 an impending fracture. Breast carcinoma was the primary tumour at 23%. The mean Mirel’s score is 9. The commonest fixation was with a long cephalomedullary nail (38%). Endoprostheses accounted for 24%. None of the endoprostheses were implanted at MTCs.ConclusionThis audit revealed large numbers of cases of femoral metastases. Although the use of endoprostheses may be increasing in Trauma Units, intramedullary nailing still predominates. Future pathways may benefit from directing resources to allow greater arthroplasty.     

BRCA1/2突变的中国健康女性乳腺预防性切除及Ⅰ期重建的临床实践

目的:探讨对携带BRCA1/2突变的中国健康女性实施乳腺预防性切除及I期重建的可行性。方法:选择2018年1月至2019年2月3例于北京大学国际医院就诊的携带BRCA1/2突变的中国健康女性,其中2例携带BRCA1突变、1例携带BRCA2突变,均有乳腺癌家族史,年龄为34~36岁,实施预防性保留乳头-乳晕的双侧乳腺切除和Ⅰ期假体重建术。结果:3例患者术后无并发症发生,术后中位随访时间为18个月,均无乳腺癌发生,对重建乳房外形满意,且焦虑和恐惧情绪显著下降,取得良好的疗效。结论:对携带BRCA1/2突变且有乳腺癌家族史的中国健康女性,在严格筛选的基础上,可慎重开展乳腺预防性切除及Ⅰ期重建术。     

Adverse effects of semicircular circle angles variation on Epley repositioning procedure: a study on reconstruction of Micro-CT images 3D

Abstract

Background: For patients with posterior semicircular canal (PSC) BPPV, Epley re-position maneuver and some improvement methods are the most efficient treatment methods. But there were still 9.43% patients who were not benefit from Epley re-position maneuver.

Objective: To measure the angles of semicircular canals and evaluate its effect on Epley maneuver.

Methods: Fifteen skull specimens, containing 30 temporal bone specimens were included. After Micro-CT scanning, 3D reconstruction was loaded with the CT image. The angles between each semicircular canal and each standard skull plane were measured. Furthermore, the angles’ effect on Epley maneuver was evaluated according to the three-dimension (3D) model.

Results: Angles of PSC plane: Frankfurt plane was 71.54?±?6.51, sagittal plane was 53.77?±?5.36°, and the coronal plane was 43.33?±?3.56°. Angles between PSC and the sagittal plane of skulls had an adverse effect on Epley maneuver, when it was less than 45°.

Conclusion: 1. Variation could be found in angles between the semicircular canals and the standard planes of skulls, which meant variation of semicircular canals’ location existing in skulls. 2. The variation of angles between PSC and sagittal plane could have an adverse effect on the Epley maneuver when the angle was less than 45°, which may cause the Epley maneuver to be invalid.