冠状动脉粥样硬化患者高危因素相关分析与护理指导

目的 研究冠状动脉粥样硬化患者危险因素,有利于预防和改善预后。方法 回顾2011年1月-2012年3月我科行冠脉造影的连续住院的患者245例。通过冠脉造影确定为冠状动脉粥样硬化患者狭窄程度>50%者188例为冠心病组,57例为冠状动脉粥样硬化患者狭窄程度<50%者为对照组。记录纳入样本的临床资料,分析心血管病危险因素,包括左心射血分数、血脂系统等。进行单因素分析和多因素非条件逐步Logistic回归。结果 冠心病组患者在高血压、高血糖、高血脂、抽烟明显高于对照组(P<0.01)。进一步对血压、血糖、血脂、抽烟危险因素作非条件逐步Logistic回归,其OR值依次为:抽烟OR=2.78,高血脂OR=3.10,高血压OR=1.65,高血糖OR=1.02。结论 冠状动脉粥样硬化患者狭窄程度>50%者在高血压、高血糖、高血脂、抽烟等危险因素均与冠状动脉病变严重程度密切相关,因此有必要在疾病的进行性发展过程中重视护理干预,如戒烟酒、提倡规律生活、改善遵医行为等,以减少危险因素对冠状动脉的进一步的损害。     

Axillary nerve injury in young adults-An overlooked diagnosis? Early results of nerve reconstruction and nerve transfers

Abstract An injury to the axillary nerve from a shoulder trauma can easily be overlooked. Spontaneous functional recovery may occur, but occasionally reconstructive surgery is required. The time frame for nerve reconstruction procedures is from a neurobiological view crucial for a good functional outcome. This study presents a group of operatively and non-operatively treated young adults with axillary nerve injuries caused by motorcycle accidents, where the diagnosis was set late. Ten young men (median age at trauma 13 years, range 9-24) with an axillary nerve injury were diagnosed by examination of shoulder function and electromyography (EMG). The patients had either a nerve reconstruction procedure or were treated conservatively and their recovery was monitored. The axillary nerve was explored and reconstructed at a median of 8 months (range 1-22 months) after trauma in 8/10 patients. Two patients were treated non-operatively. In 4/8 cases, a reconstruction with sural nerve graft was performed and in 1/8 case only exploration of the nerve was made (minor neuroma). In 3/8 cases a radial nerve branch transfer to the axillary nerve was chosen as the procedure. The shoulder was mobilised after 3 weeks with physiotherapy and the patients were monitored regularly. Functional recovery was observed in 9/10 cases (median follow up 11 months, range 7-64) with EMG signs of reinnervation in seven patients. Axillary nerve function should not be overlooked in young patients with a minor shoulder trauma. Nerve reconstruction can successfully recreate function.     

Integrated concept of treatment for reduction of morbidity after resection of panniculus morbidus associated with lymphoedema

Abstract A subgroup of grossly obese patients may develop a large hanging abdominal apron, panniculus morbidus, which can contain an element of lymphoedema. This hinders normal activities and prevents adequate hygiene. We reviewed published reports and found that the complications that result from resection of a panniculus had been well described, but the presence of lymphoedema and the possible benefit of appropriate physiotherapy was not addressed. Our first aim was to assess our overall morbidity. Secondly we assessed whether perioperative complex decongestive physical therapy had the potential to reduce the incidence of commonly encountered complications. We retrospectively reviewed the casenotes of all massively obese patients who had panniculectomies between 1998 and 2008. We identified two groups of patients, in the first of which were 38 patients who were given perioperative complex decongestive physical therapy (CDP). In the second group were 18 patients who had no additional treatment perioperatively. We then compared the differences between the groups in the incidence of complications, reoperation rate, duration of hospital stay, and wound complications. All the patients not given perioperative treatment developed a postoperative complication. Only 6 patients in the treated group had minor wound problems. The rates and severity of complications associated with this type of operation can be improved if the patient has access to additional care in a specialised rehabilitation centre during the perioperative period.     

The comparative gastrointestinal tolerability of proprietary versus generic alendronate in patients treated for primary osteoporosis

ObjectiveThe objective of this study was to analyze the comparative gastrointestinal tolerability of proprietary versus generic alendronate in patients treated for primary osteoporosis.MethodsThe study was based on all patients starting therapy with alendronate in Sweden between 2005 and 2009. The primary outcome measure was the start of treatment with a gastroprotective agent and the secondary outcome was hospitalization for gastrointestinal adverse event (GIAE). The incidence of both outcomes was measured within the first six months after the initiation of the alendronate treatment.ResultsThe crude incidence of gastroprotective treatment during the first six months following the start of the alendronate therapy was 5.45% (bootstrapped CI₉₅ 4.09%–7.19%) and 5.04% (bootstrapped CI₉₅ 4.74%–5.38%) for patients prescribed proprietary and generic alendronate, respectively. The crude six-month incidence of hospitalization for GIAE was 0.43% (bootstrapped CI₉₅ 0.14%–1.29%) and 0.71% (bootstrapped CI₉₅ 0.55%–0.91%) for proprietary and generic alendronate, respectively. Controlling for age, sex, and other available covariates, there was no significant difference in the risk of GIAEs between proprietary and generic alendronate.ConclusionsNo significant difference in the incidence of GIAEs was identified between patients prescribed proprietary and generic alendronate between 2005 and 2009 in Sweden. More research is needed to provide conclusive evidence of the gastrointestinal tolerability profiles of proprietary and generic alendronate.     

Impact of oral ibandronate 150 mg once monthly on bone structure and density in post-menopausal osteoporosis or osteopenia derived from in vivo μCT

The effect of ibandronate 150 mg/once monthly in the treatment of post-menopausal osteopenia and osteoporosis on bone micro-structure at the distal tibia and radius has not been considered to date. Seventy post-menopausal women with osteoporosis or osteopenia were recruited. All subjects received calcium and vitamin D supplementation and were randomized to either a group which took 150 mg ibandronate oral monthly or a placebo group over a 12-month period. μCT measures of the distal tibia and radius were conducted every three months, with DXA lumbar spine and hip measurements conducted only pre and post and serum markers of bone formation and resorption measured every 6 months. After 12-months no significant impact of ibandronate on the primary outcome measures bone-volume to tissue-volume and trabecular separation at the distal tibia (p ≥ 0.15) was found. Further multiple regression analyses of the primary end-points indicated a significant effect favoring the ibandronate intervention (p = 0.045). Analysis of secondary end-points showed greater increases in distal tibia cortical thickness, cortical density and total density (p ≤ 0.043) with ibandronate and no significant effects at the distal radius, but greater increases of hip DXA-BMD and lumbar spine DXA-BMD (p ≤ 0.017). Ibandronate use resulted in a marked reduction in bone turnover (p < 0.001). While ibandronate resulted in greater mineralization of bone, this effect differed from one body region to another. There was some impact of ibandronate on bone structure (cortical thickness) at the distal tibia, but not on bone-volume to tissue-volume or trabecular separation.     

Long term higher urinary calcium excretion within the normal physiologic range predicts impaired bone status of the proximal radius in healthy children with higher potential renal acid load

Reduced bone mineral density (BMD) and bone mass have been observed in children with idiopathic hypercalciuria. Whether urinary calcium excretion at the higher end of the normal physiologic range can influence bone health in healthy children independent of dietary intake is unknown. Urinary calcium was quantified in 603 24-h urine samples from 154 healthy children and adolescents who had ≥3 urine collections and parallel 3-day weighed dietary records during the 4years preceding proximal forearm bone analyses by peripheral quantitative computed tomography (pQCT). Urinary potential renal acid load (uPRAL) was determined according to urine ionogram by subtracting measured quantitatively important mineral cations from nonbicarbonate anions. Urinary calcium excretion was significantly associated with volumetric (v)BMD (P=0.04), almost significantly with cortical bone mineral content (BMC) (P=0.05), but not with cortical cross-sectional area (CSA) (P=0.09), total CSA (P=0.3), or Strength-Strain Index (P=0.8) in the total population sample. Stratified analyses based on the median split of uPRAL showed that calcium excretion was negatively associated with vBMD (P=0.007), cortical BMC (P=0.001), and cortical CSA (P=0.004) in those children with higher uPRALs, but not in those with low uPRALs (P>0.3). In conclusion, long-term higher calciuria within the physiological range predicts reduced diaphyseal bone mass and bone density particularly in healthy children and adolescents with long-term unfavorable higher dietary acid load, i.e., with lower fruit and vegetable intake.     

L51P - A BMP2 variant with osteoinductive activity via inhibition of Noggin

Bone morphogenetic proteins (BMP) have to be applied at high concentrations to stimulate bone healing. The limited therapeutic efficacy may be due to the local presence of BMP antagonists such as Noggin. Thus, inhibiting BMP antagonists is an attractive therapeutic option. We hypothesized that the engineered BMP2 variant L51P stimulates osteoinduction by antagonizing Noggin-mediated inhibition of BMP2. Primary murine osteoblasts (OB) were treated with L51P, BMP2, and Noggin. OB proliferation and differentiation were quantified with XTT and alkaline phosphatase (ALP) assays. BMP receptor dependent intracellular signaling in OB was evaluated with Smad and p38 MAPK phosphorylation assays. BMP2, Noggin, BMP receptor Ia/Ib/II, osteocalcin, and ALP mRNA expressions were analyzed with real-time PCR. L51P stimulated OB differentiation by blocking Noggin mediated inhibition of BMP2. L51P did not induce OB differentiation directly and did not activate BMP receptor dependent intracellular signaling via the Smad pathway. Treatment of OB cultures with BMP2 but not with L51P resulted in an increased expression of ALP, BMP2, and Noggin mRNA. By inhibiting the BMP antagonist Noggin, L51P enhances BMP2 activity and stimulates osteoinduction without exhibiting direct osteoinductive function. Indirect osteoinduction with L51P seems to be advantageous to osteoinduction with BMP2 as BMP2 stimulates the expression of Noggin thereby self-limiting its own osteoinductive activity. Treatment with L51P is the first protein-based approach available to augment BMP2 induced bone regeneration through inhibition of BMP antagonists. The described strategy may help to decrease the amounts of exogenous BMPs currently required to stimulate bone healing.