Diagnostic blood loss from phlebotomy and hospital acquired anemia in patients with severe burns

PurposeThe study was performed to estimate the diagnostic blood loss (DBL) volume during hospitalization and investigate its relationship with the development of moderate to severe hospital acquired anemia (HAA) and increased number of red blood cell (RBC) transfusion following extensive burns.Materials and methodsThis was a retrospective study of adult burned patients with total body surface area (TBSA) burn larger than 40%, who were admitted to burn center of Changhai hospital between January 2005 and December 2017.ResultsWe included a final number of 157 patients in the present study. Moderate to severe HAA within the fourth week postburn was developed in 46 of 121 patients who stayed over 28-day hospitalization. Patients with moderate to severe HAA had both significantly higher total DBL volume [245 (IQR: 183.75, 325.25) mL vs 168 (119, 163) mL ; P = 0.001] and DBL volume per day [10.22 (IQR: 8.57, 12.38) mL vs 6.63 (5.22, 10.42) mL/day; P = 0.005]. Logistic regression analysis revealed that both DBL volume per day and TBSA burn were independent risk factors for the development of moderate to severe HAA.ConclusionsSeverely burned patients appear to be prone to develop HAA during hospitalization. The DBL volume contribute to the occurrence of moderate to severe HAA, which might be a modifiable target for preventing HAA.     

Does angiogenesis play a role in the establishment of mesial temporal lobe epilepsy?

Mesial temporal lobe epilepsy (MTLE) is a focal epileptic disorder that is frequently associated with hippocampal sclerosis. This study investigated whether blocking angiogenesis prevents the development of seizures and hippocampal atrophy in the pilocarpine rat model of MTLE. To block angiogenesis, a subset of animals were given sunitinib orally. Continuous video recordings were performed to identify seizures. Brains were then extracted and sectioned, and hippocampal surfaces and angiogenesis were assessed. After a latent period of 6.6 ± 2.6 days, the sham-treated pilocarpine rats presented convulsive seizures, while the pilocarpine rats treated with sunitinib did not develop seizures. Sham-treated pilocarpine rats but not sunitinib-treated pilocarpine rats had significantly smaller hippocampi. Endothelial cell counts in sham-treated pilocarpine rats were significantly greater than in controls and sunitinib-treated pilocarpine rats. Blocking angiogenesis immediately following the initial insult in this animal model prevented thus angiogenesis and hippocampal atrophy and averted the development of clinical seizures.     

抗凝药物在系统性红斑狼疮中的应用研究现状

系统性红斑狼疮是可以累及全身各系统的免疫性疾病,其发病机制是免疫介导的血管炎。在众多研究中,不难发现系统性红斑狼疮及其并发症的治疗中抗凝药物的使用变得越来越普遍,并且中药作为辅助手段治疗系统性红斑狼疮中也多加用活血化瘀药物,现将系统性红斑狼疮应用抗凝药物的研究进展做一综述。     

止汗除湿散治疗高温湿热条件下局部多汗及其皮损的效果观察

 目的 观察自制外用止汗除湿散治疗高温湿热条件下局部多汗及皮损的临床疗效。方法 纳入某部官兵550例,按照足多汗、阴部多汗及足癣者分为3组,每组随机分为实验组和对照组,实验组使用附带止汗除湿散的对应生活用品,对照组使用普通的生活用品,连续使用2周,采用自创印录法测量多汗者汗液浸染面积,并对足癣者进行真菌镜检及培养。结果 实验组各组症状及测量指标与对照组相比明显改善,足多汗、足癣、阴部多汗组中实验组总有效率分别为83%、76%、86%,均明显高于对照组,差异均具有统计学意义(P＜0.05)。结论 止汗除湿散能有效地预防高温湿热条件下局部多汗及足癣。     

Functional outcome of salvage of residual and recurrent deformities of clubfoot with Ilizarov technique

Relapse may occur in severe clubfeet deformities whether treated surgically or nonsurgically. In this study, we evaluate the results of correction of residual and recurrent congenital clubfoot using soft tissue distraction or osteotomy using the Ilizarov external fixation system. This study included 35 feet in 28 patients who were treated between 1999 and 2007. Of these 16 feet in 13 patients with an average age of 13.7 years (range from 11 to 29 years) were treated by percutaneous calcaneal V-osteotomy and gradual correction by the Ilizarov method. Nineteen feet in 15 patients with an average age 10.5 years (range from 4 to 22 years) were treated by soft tissue distraction by the Ilizarov technique. The mean average follow up period was 5.6 years (range from 1 to 8 years). At the time of fixator removal, a plantigrade foot was achieved in 30 feet. Mild residual varus and equinus deformities were present in five feet.At the final follow foot pressure measurement showed recurrent or residual deformity in 10 feet (7 treated by osteotomy and 3 treated by soft tissue distraction). Recurrence may occur with both techniques, depending on many factors such as bone morphology, the number of the pervious operations and the degree of stiffness of the foot prior to the operation.     

ST段抬高急性心肌梗死患者血清氧化低密度脂蛋白抗体-IgM水平与冠状动脉病变程度及住院期间预后的相关研究

目的：探讨血清氧化低密度脂蛋白抗体-IgM（ox-LDL-Ab IgM）水平在ST段抬高急性心肌梗死（STEMI）患者中与冠状动脉病变程度及近期预后的相关性。方法选取2008年8月至2009年5月诊断明确并行急诊经皮冠状动脉介入（PCI）治疗的STEMI患者95例,根据冠状动脉造影结果分为单支病变组、双支病变组及三支病变组,并以Gensini积分评价冠状动脉狭窄程度,分别测定血清ox-LDL-Ab IgM、丙二醛（MDA）、血脂,计算体质量指数（BMI）,统计患者住院期间心血管事件发生情况,分析ox-LDL-Ab IgM水平与冠状动脉病变程度及近期预后的关系。结果 STEMI患者血清ox-LDL-Ab IgM水平随冠状动脉病变支数增加而降低（P＜0.05）,但与Gensini积分无明显相关性（P＞0.05）;ox-LDL-Ab IgM水平与血脂、血糖水平等无明显相关性（P＞0.05）,与MDA水平呈显著负相关（r＝-0.319,P＜0.05）;ox-LDL-Ab IgM水平与患者住院期间心血管事件发生率呈显著负相关（r＝-0.708,P＜0.05）,logistic回归分析显示, ox-LDL-Ab IgM是STEMI患者住院预后的保护因素（OR＝-0.588,P＜0.05）。结论血清ox-LDL-Ab IgM水平可在一定程度上反映STEMI患者冠状动脉病变的严重程度。其可能通过调节机体氧化应激水平,减少LDL氧化修饰生成ox-LDL,从而减轻冠状动脉粥样硬化的面积,可能对STEMI患者近期预后具有保护作用。     

Accuracy assessment of a marker-free method for registration of CT and stereo images applied in image-guided implantology: A phantom study

To assess the accuracy of a proposed marker-free registration method as opposed to the conventional marker-based method using an image-guided dental system, and investigating the best configurations of anatomical landmarks for various surgical fields in a phantom study, a CT-compatible dental phantom consisting of implanted targets was used. Two marker-free registration methods were evaluated, first using dental anatomical landmarks and second, using a reference marker tool. Six implanted markers, distributed in the inner space of the phantom were used as the targets; the values of target registration error (TRE) for each target were measured and compared with the marker-based method. Then, the effects of different landmark configurations on TRE values, measured using the Parsiss IV Guided Navigation system (Parsiss, Tehran, Iran), were investigated to find the best landmark arrangement for reaching the minimum registration error in each target region.It was proved that marker-free registration can be as precise as the marker-based method. This has a great impact on image-guided implantology systems whereby the drawbacks of fiducial markers for patient and surgeon are removed. It was also shown that smaller values of TRE could be achieved by using appropriate landmark configurations and moving the center of the landmark set closer to the surgery target. Other common factors would not necessarily decrease the TRE value so the conventional rules accepted in the clinical community about the ways to reduce TRE should be adapted to the selected field of dental surgery.     

急性冠脉综合征患者经皮冠状动脉介入治疗后心力衰竭高危因素分析

目的探讨急性冠脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）术后发生心力衰竭的高危因素。方法连续选取解放军第252医院2009年1月至2012年12月因ACS行PCI治疗的患者520例,根据患者术后是否发生心力衰竭分为心力衰竭组（n＝67）和对照组（n＝453）,分别统计患者合并高血压、糖尿病病史、吸烟史、陈旧性心肌梗死史、既往心力衰竭病史,分析患者冠状动脉造影影像结果、手术操作时间、对比剂用量及住院期间血糖、血脂、血常规等血液检查指标。结果67例患者术后发生心力衰竭。与对照组比较,心力衰竭组住院时间明显延长、死亡率明显升高（P＜0.05）。此外,心力衰竭组手术操作时间明显较长、对比剂用量明显增多、合并糖尿病比例明显升高、累及前降支病变比例明显增多、不稳定型心绞痛比例明显减少、心肌梗死比例明显增加（P＜0.05）。血液检查指标分析显示,心力衰竭组低密度脂蛋白胆固醇、肌酐、尿酸、白细胞水平明显高于对照组（P＜0.05）。多因素logistic回归分析显示,年龄、前降支病变、白细胞计数、尿酸是ACS患者PCI术后发生心力衰竭的高危因素。结论前降支病变合并入院白细胞计数、尿酸水平明显升高的老年患者为PCI术后发生心力衰竭的高危患者。