紫杉醇药物涂层球囊成形术治疗症状性椎动脉开口处狭窄的疗效

目的 探讨紫杉醇药物涂层球囊（P-DCB）成形术治疗症状性椎动脉开口狭窄的安全性和有效性。方法 回顾性分析2017 年12月至2019年6月经P-DCB成形术治疗的43例症状性椎动脉开口处狭窄的临床资料。结果 所有病人均完成介入治疗，成功率为100%。术后即刻狭窄率[（12.03±2.15）%]较术前[（86.32±10.26）%]明显降低（P<0.05）。围手术期发生动脉夹层1例，无其他并发症。随访12~16个月，平均13.5个月；症状改善43例，无变化例，症状改善率为95.3%（41/43）；全部病人接受DSA或CTA随访，随访狭窄率[（16.1±3.12）%]与术后即刻无统计学差异（P>0.05）；5例发生再狭窄，再狭窄率为11.6%。结论 P-DCB成形术治疗椎动脉开口狭窄具有较好的临床疗效。     

The effects of carnitine supplementation on clinical characteristics of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThe beneficial effects of carnitine supplementation on nonalcoholic fatty liver disease are unclear. We conducted a systematic review and meta-analysis to evaluate the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance in patients with nonalcoholic fatty liver disease.MethodsA comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were performed. Only randomized placebo-controlled human studies that examined the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance up to September 2019 were included. Fixed effects or random-effects models were applied to compute the pooled effect size. Heterogeneity assessments were performed using Cochran’s Q test and I-squared statistics. The quality of the studies was assessed using the Jaded scale.ResultsA total of 5 articles were selected, including 334 individuals (167 in control and 167 in intervention groups). The results demonstrated that carnitine supplementation significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: −0.91; 95 % CI: −1.11, −0.72; p < 0.001, I² = 0.0 %) and the levels of aspartate aminotransferase (AST) (WMD: −16.62; 95 % CI: −28.11, −5.14; IU/l; p = 0.005, I² = 93.5 %), alanine aminotransferase (ALT) (WMD: -33.39; 95 % CI: −45.13, −21.66; IU/l; p < 0.001, I² = 93.4 %), and triglycerides (TG) (WMD: −22.13; 95 % CI: −38.91, −5.34; mg/dl; p = 0.01; I² = 0.0 %). However, the results of the pooled effect size did not show any significant effect of carnitine supplementation on body mass index (BMI) (WMD: 0.07; 95 % CI: −0.15, 0.29; p = 0.55; I² = 0.0 %), body weight (WMD: −0.28; 95 % CI: −2.23, 1.68; p = 0.78; I² = 45.7 %), the levels of gamma-glutamyl transferase (γGT) (WMD: −11.31; 95 % CI: −24.35, 1.73; IU/l; p = 0.09, I² = 61.1 %), cholesterol (WMD: −13.58; 95 % CI: −46.77, 19.60; mg/dl; p = 0.42; I² = 94.9 %), high-density lipoprotein-cholesterol (HDL-C) (WMD: 1.36; 95 % CI: −0.96, 3.68; mg/dl; p = 0.25; I² = 64.7 %), and low density lipoprotein-cholesterol (LDL-C) (WMD: −14.85; 95 % CI: −45.43, 15.73; mg/dl; p = 0.34; I² = 96.4 %).ConclusionsThis analysis shows that carnitine supplementation for patients with nonalcoholic fatty liver disease demonstrates a reduction in AST, ALT, TG levels and HOMA-IR. However, no significant effect of carnitine supplementation was observed on BMI, body weight, the levels of γGT, TC, HDL-cholesterol and LDL-cholesterol.     

Cumulative impact of adding frozen-thawed cycles to single versus double fresh embryo transfers

Randomized control trials have shown that single embryo transfer (SET) results in lower live birth rates than double embryo transfer (DET), while observational, retrospective studies find no decrease in overall live birth rate when using a SET policy. The cumulative (fresh transfer followed by frozen - thawed transfers of embryos from the same stimulated cycle) live birth rate after the first and the second stimulated cycle of SET and DET respectively has been analysed. All couples who received their first fresh embryo transfer at Sahlgrenska University Hospital during 2003 and 2004 were included (n = 689). The live birth rates after DET versus SET in the first and second fresh cycles were 29.7 (47/158) versus 23.9% (127/531) and 30.8 (41/133) versus 22.0% (45/205). The cumulative live birth rate per patient after the addition of frozen-thawed embryo transfers were similar: 33.5 (53/158) and 34.8% (185/531) for DET and SET respectively after the first cycle and 32.3 (43/133) versus 32.2% (66/205) after the second cycle. A logistic regression analysis showed no significant correlation for SET or DET with cumulative live birth. Thus, cumulative live birth rates are similar after SET and DET in a routine IVF programme with a majority of SET transfers, although a higher number of frozen-thawed cycles were needed in the SET group.     

瑞芬太尼与舒芬太尼对老年腹腔镜直肠癌根治术患者围术期血流动力学影响的比较研究

目的探讨瑞芬太尼和舒芬太尼对行腹腔镜直肠癌根治术的老年患者围术期f血流动力学的影响。方法选取2019年9月一2020年6月在北部战区总医院行直肠病根治术的老年患者40例,随机分为I组和II组.各20例。I组给予七氟烷联合瑞芬太尼麻醉,II组给予七氟烷联合舒芬太尼麻醉。观察比较两组围术期各时间点脑电双频指数.血压、心率,以及麻醉恢复期情况。结果两组气腹后血压和心率均升高,I组气腹后5minf血压高于II组,差异有统计学意义(P<0.05)。拔除气管导管后5 min两组血压和心率均较术前升高,而且I组血压和心率均较II组高,差异有统计学意义(P<0.05)。两组不同时间点脑电双频指数值差异均无统计学意义(P>0.05)。I组自主呼吸恢复时间与拔管时间均较I组长,差异有统计学意义(P<0.05)。两组气腹前后呼气末二氧化碳分压差异无统计学意义(P>0.05)。结论瑞芬太尼和舒芬太尼均能满足行腹腔镜直肠癌根治术老年患者的麻醉要求,而且舒芬太尼对患者围术期血流动力学的影响较小,更有利于老年患者术中麻醉的维持与术后恢复。     

网格定位器在腰椎椎体成形术中的应用

目的比较网格优化椎体成形术(percutaneous vertebroplasty,PVP)与传统PVP治疗骨质疏松性椎体压缩骨折的疗效。方法回顾性分析2016年5月至2019年5月北部战区总医院脊柱外科收治196例腰椎单节段行PVP治疗患者的临床资料,根据手术方法不同分为网格优化组(102例)和传统PVP组(94例)。网格优化组:男38例、女64例,年龄(67.3±8.5)岁,病程(2.3±1.2)d,L1椎体59例、L2椎体31例、L3椎体8例、L4椎体3例、L5椎体1例。传统PVP组:男26例、女68例,年龄(71.5±5.6)岁,病程(2.1±1.1)d,L1椎体52例、L2椎体33例、L3椎体7例、L4椎体2例。术前按两组不同方法选择最佳穿刺点及穿刺角度,完成穿刺后置入导丝及工作通道,推入骨水泥,术毕。主要观察指标为手术时间、术中X线透视次数、骨水泥注入量、骨水泥渗漏情况,以及疼痛视觉模拟评分(visual analogue scale,VAS)、伤椎前缘和伤椎中缘高度。结果两组患者术前一般资料的差异均无统计学意义(P>0.05),证明两组患者的基线资料具有可比性。所有患者均顺利完成手术,术中、术后均未出现脊髓神经损伤、切口感染、肺栓塞、死亡等严重并发症。网格优化组患者手术时间(34.8±6.5)min、透视次数(29.5±5.5)次、骨水泥注入量(5.3±2.1)ml、骨水泥渗透率3.9%(4/98)均优于传统PVP组,差异均有统计学意义(P<0.05)。网格优化组术后第3天、3个月及末次随访时VAS评分分别为(1.1±0.6)分、(1.0±0.3)分和(0.9±0.2)分,均优于传统PVP组(P<0.05)。两组患者术后第3天伤椎前缘及中缘高度的差异均无统计学意义(P>0.05),但网格优化组术后3个月伤椎前缘和中缘高度分别为(1.8±0.4)mm、(1.8±0.3)mm,末次随访时分别为(1.7±0.3)mm、(1.7±0.3)mm,均优于传统PVP组,差异均有统计学意义(P<0.05)。结论相比传统PVP手术,术前应用网格定位器进行网格优化PVP手术治疗骨质疏松性椎体压缩骨折更安全、有效。     

丹皮酚对增生性瘢痕成纤维细胞的抑制作用

目的探讨丹皮酚对增生性瘢痕成纤维细胞的抑制作用。方法自2018年9月至2020年6月北部战区总医院烧伤整形科提取原代增生性瘢痕成纤维细胞后,将细胞平分为4组,分别采用0μmol/L(对照组)、50μmol/L、100μmol/L的丹皮酚及10μmol/L的5-氟尿嘧啶(5-Fu)处理;CCK-8实验检测细胞处理后第0、3、5、7天的增殖情况。处理3 d后通过ELISA实验检测增生性成纤维细胞中活性氧基团或分子、丙二醛和超氧化物歧化酶的含量;Western blot实验检测丹皮酚对于细胞中TGF-β1、Ⅰ和Ⅲ型胶原的表达情况。结果50、100μmol/L的丹皮酚和10μmol/L的5-FU分别作用于细胞3 d后与对照组相比,对于细胞增殖的抑制率分别为(32.63±3.06)%、(46.41±4.41)%和(45.32±9.26)%,组间比较差异显著,具有统计学意义(P<0.05)。丹皮酚能够显著下调增生性成纤维细胞中ROS和MDA的表达情况,上调SOD的含量,降低TGF-β1、Ⅰ和Ⅲ型胶原的表达。结论丹皮酚能够抑制增生性瘢痕成纤维细胞的生长、减轻氧化应激损伤,下调TGF-β1和胶原的表达。     

负压封闭引流促进糖尿病足溃疡的愈合

目的分析负压封闭引流(vacuum sealing drainage,VSD)能否促进糖尿病足溃疡的愈合。方法回顾分析自2015年1月至2019年12月,北部战区总医院烧伤整形科收治的糖尿病足溃疡患者60例,并根据患者的治疗方式分为常规治疗组(30例)和VSD治疗组(30例)。统计对比分析两组患者的平均换药次数、平均愈合时间、疼痛程度及满意度。搜集治疗前和治疗14 d后的肉芽组织进行HE染色和VEGF免疫组化染色,分析创面愈合情况以及VEGF的表达情况。结果VSD治疗组换药次数[(5.40±0.28)次]显著少于常规治疗组[(31.41±1.11)次],组间比较P<0.05;VSD治疗组平均愈合时间(29.38±0.63)d显著短于常规治疗组(50.81±2.15)d,组间比较P<0.05;VSD治疗组患者的痛苦程度明显轻于常规治疗组,满意度显著优于常规治疗组,组间比较P<0.05。结论VSD治疗能够促进创面成纤维细胞的增殖、减少炎性细胞的浸润、促进VEGF的表达及创面的愈合。     

角膜碱烧伤中PMNs与MMP-9的关系

目的：研究角膜碱烧伤后基质损伤修复病程中多形核中性白细胞(PMNs)的浸润和基质金属蛋白酶-9(MMP-9)的表达的关系。

方法：建立25只家兔角膜碱烧伤模型,分别于伤后3、7、14、21、28d随机处死5只兔,裂隙灯下观察角膜病理修复情况,摘除角膜做病理切片,测定PMNs的浸润量值。免疫组化法测定MMP-9的表达。

结果：PMNs和MMP-9在角膜碱烧伤后的3d开始升高,14d上升达到最大峰值,之后逐渐降低,碱烧伤后角膜基质在第14d溃疡面积及深度最为严重。

结论：角膜碱烧伤病灶中PMNs和MMP-9的量值呈正相关,且角膜的病理损伤与PMNs的浸润和MMP-9的表达密切相关。