经皮椎体成形术对骨质疏松椎体压缩性骨折患者疼痛程度、椎体高度及Cobb角的影响

目的骨质疏松椎体压缩性骨折患者在行经皮椎体成形术后疼痛程度、椎体高度及Cobb角。方法选取该院2013年6月至2014年7月收治的90例骨质疏松椎体压缩性骨折患者,按照入院编号顺序,随机分为手术组和保守组各45例,手术组患者接受经皮椎体成形术,保守组患者接受保守治疗,比较两组(NRS)疼痛评分、椎体高度及Cobb角、Oswestry评分。结果手术后1、2、3、6个月时,手术组患者的NRS疼痛评分均明显低于B组(P0.05);手术后1、6个月时,手术组患者术后的Cobb角明显低于保守组(P0.05),伤椎椎体前缘高度比明显高于保守组(P0.05);术后1、6个月时,手术组后Oswestry评分均明显低于保守组组(P0.05)。结论经皮椎体成形术有助于缓解疼痛程度,改善椎体高度及Cobb角,提高日常生活质量。     

椎体成形术中椎体内骨水泥特性与疼痛缓解程度关系的研究进展

骨质疏松性椎体压缩性骨折(OVCF)是骨质疏松症最常见的并发症之一,多见于老年人脆性骨折。从传统的保守治疗、开放性手术到如今的微创手术阶段,椎体成形术因其安全、高效及微创特性成为OVCF的重要治疗手段。骨水泥在椎体内的特性对OVCF患者术后疼痛的缓解起着极其关键的作用。现就骨水泥在椎体内的注入量、弥散情况、分布形态及黏稠度对患者术后疼痛缓解程度关系作一综述,为临床实践提供参考。     

老年骨质疏松椎体压缩性骨折的介入治疗

目的 探讨DSA三维路径引导经皮球囊扩张椎体成型术在老年骨质疏松椎体压缩性骨折中的临床应用价值.方法 采用DSA三维路径引导经皮球囊扩张椎体后凸成型术治疗老年骨质疏松性椎体压缩性骨折患者31例(37个椎体),比较术前和术后视觉模拟评分(VAS)及X线片椎体前、中柱高度的变化.结果 本组31例患者均安全完成手术,未发生并发症,术后患者胸腰背部疼痛均明显缓解,VAS术前为(8.2±1.4)分,术后24 h为(2.3±1.1)分,术前术后比较差异显著(P<0.05);椎体前、中柱高度分别由术前(17±0.7)mm、(23±1.4)mm恢复到术后的(21±1.1)mm、(27±0.9)mm,术前术后比较差异显著(P<0.05).结论 DSA三维路径引导经皮球囊扩张椎体后凸成型术治疗老年骨质疏松性椎体压缩性骨折是一种精确、简便、安全、微创的治疗方法.术后可明显缓解疼痛,恢复受损椎体高度,降低骨水泥渗漏风险.     

PVP治疗妊娠相关骨质疏松性脊椎压缩性骨折29例临床观察

目的 探讨经皮椎体成形术（PVP）治疗妊娠相关骨质疏松性脊椎压缩性骨折（VCF）的临床疗效及安全性.方法 将同期收治的58例妊娠相关骨质疏松性VCF患者随机分为观察组和对照组各29例,分别行PVP和常规保守治疗.术后采用WHO标准评定临床治疗效果;复查X线及CT,记录伤椎前缘高度、后凸Cobb角变化;治疗前及治疗后48 h分别行疼痛视觉评分法（VAS）评分;记录住院时间、疼痛缓解时间及并发症发生率.结果 观察组总有效率及术后伤椎前缘高度均显著高于对照组（P＜0.01）,后凸Cobb角及VAS评分显著低于对照组（P＜0.05）,住院时间及疼痛缓解时间均显著短于对照组（P＜0.05）,并发症发生率显著低于对照组（P＜0.05）.结论 PVP治疗妊娠相关骨质疏松性VCF临床效果好、并发症发生率低,值得临床推广应用.     

后正中入路和经通道椎旁入路椎间融合术治疗老年Ⅰ~Ⅱ度腰椎滑脱症患者的围术期分析

目的比较后正中入路腰椎椎体间融合术(PLIF)、开放经椎间孔腰椎椎体间融合术(TLIF)和经通道椎旁入路椎间融合术(MIS-TLIF)治疗老年I~Ⅱ°腰椎滑脱症患者围术期差异。方法回顾性分析我院2014年1月至2017年12月因腰椎滑脱症行后路手术的老年患者(年龄≥60岁)68例的临床资料,按手术方式将行PLIF和TLIF手术的患者40例纳入开放组,男12例,女28例;行MIS-TLIF的28例患者为微创组,男6例,女22例。比较两组患者围术期手术时间、出血量、投照次数、术后引流量、尿管留置时间、术后住院天数及并发症差异。结果开放组和微创组患者手术时间为(156±51)min比(153±38)min,(P=0.77);术中出血量(458±272)ml比(157±104)ml(P<0.001);透视次数(6.7±1.5)次比(30.6±6.9)次(P<0.01);术中并发症开放组25.0%(10例),微创组7.1%(2例),差异无统计学意义(P=0.057)。术后引流量开放组患者(664±351)ml多于微创组患者(210±127)ml(P<0.001);尿管留置时间开放组患者(3.7±2.9)d长于微创组患者(2.2±0.8)d(P=0.002),术后住院时间开放组患者(9.2±3.6)d多于微创组患者(6.9±1.7)d(P=0.001)。术后神经并发症分别为7.5%(3例)和14.3%(4例),差异无统计学意义(P=0.365),术后非神经并发症发生率开放组27.5%(11例)高于微创组7.1%(2例),差异有统计学意义(P=0.036)。结论与PLIF和TLIF术比较,MIS-TLIF治疗老年I~Ⅱ°腰椎滑脱症具有出血少、引流量少、尿管留置时间短、住院时间短、非神经并发症较低等优点,但其投照次数较多。     

椎体成形术与椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效比较

目的比较椎体成形术与椎体后凸成形术治疗有症状的骨质疏松性椎体压缩骨折的疗效。方法 48例年龄65岁、因脊柱压缩性骨折的患者分别行经皮椎体成形术(PVP)与椎体后凸成形术(PKP),统计术前VAS评分、手术时间、术中X线透视时间、平均每节椎体注入骨水泥量、骨水泥渗漏情况、术后第1天VAS评分、术后6个月VAS评分、术后6个月功能障碍指数(ODI)评分、住院总花费等指标。结果 48例患者的82节椎体均经双侧入路成功完成手术,PVP组为24例37节椎体,每节椎体骨水泥注射量平均为(2.82±0.41)mL;PKP组为24例45节椎体,每节椎体骨水泥注射量平均为(2.94±0.32)mL,2组患者骨水泥注射量差异无统计学意义(P=0.275)。2组术后疼痛症状均明显缓解,疼痛缓解程度差异无统计学意义(P=0.719);PVP组术中透视累计时间为(13.58±3.79)s,PKP组为(21.38±4.18)s,差异有统计学意义(P=0.000)。2组患者术后6个月的ODI评分差异无统计学意义(P=0.409)。结论 PVP与PKP均为微创手术,均可缩短脊柱压缩性骨折患者的卧床时间,在缓解疼痛和增加椎体稳定性方面疗效较好,疼痛缓解可维持至术后6个月以上。     

老年人胆源性重症急性胰腺炎急诊内镜治疗与手术治疗的比较

目的探讨急诊内镜治疗老年人胆源性重症急性胰腺炎(biliary severe acute pancreatitis, BSAP)的价值。方法25例老年人BSAP经内镜治疗(ERCP EST或ENBD),与29例老年人BSAP手术治疗组进行比较,观察急诊内镜治疗老年人胆源性重症急性胰腺炎的临床疗效与安全性。结果内镜组的体温恢复时间、腹痛消失时间、上腹压痛消失时间、白细胞恢复正常时间、血清淀粉酶恢复正常时间、手术时间、住院时间、治愈率、死亡率、并发症发生率和复发率分别为3.6±1.3 d、6.4±2.2 d、8.2±3.4 d、6.5 ±2.4 d、7.3±2.1 d、37.5±6.5min、21.4±5.0d、72.0%、8.0%、16.0%和4.0%;而手术组分别为:6.5±1.6 d、10.0±3.8 d、15.8±4.2 d、11.2±3.8 d、13.5±4.8 d、132.6±34.5 min、33.0±6.8 d、51.7%、17.3%、37.9%和10.3%,两组相比,内镜组明显优于手术组,上述指标差异均有显著性(P<0.05);而肝功能恢复正常时间却无显著性差异(P>0.05)。结论内镜治疗BSAP具有微创有效,可分期分步进行治疗,清除胆道结石等优点,是治疗老年人BASP的首选方案。     

经皮微创与传统开放椎弓根螺钉内固定治疗老年胸腰段脊柱压缩性骨折患者的对比研究

目的对比经皮微创与传统开放椎弓根螺钉内固定技术治疗老年胸腰段脊柱压缩性骨折患者的疗效。方法入选2013年6月至2017年2月解放军总医院海南分院骨科收治的老年胸腰段脊柱压缩骨折患者245例。依据手术方式分为2组:微创手术组(n=126)和传统手术组(n=119)。比较2组患者的手术时间、住院时间、术中出血量、住院费用、切口长度等围术期参数。术后随访至少6个月并测量伤椎前缘高度、Cobb角和矢状位指数。采用SPSS 18. 0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ2检验。结果与传统手术组患者相比,微创手术组患者的手术时间[(95. 2±16. 3) vs(126. 5±39. 0) min]和住院时间[(10. 8±4. 0) vs (22. 5±13. 6) d]显著缩短,术中出血量[(82. 7±39. 9) vs (327. 2±143. 1) ml]、术后引流量[(33. 5±15. 8) vs (301. 5±110. 8) ml]、住院费用[(5. 1±0. 3)×104vs (5. 7±0. 2)×104RMB yuan]和切口长度[(9. 3±0. 6) vs (12. 8±1. 9) cm]也显著减小,差异均有统计学意义(均P 0. 05)。与手术前相比,2组患者手术后的伤椎椎体前缘高度[微创手术组:(11. 2±7. 3) vs (20. 1±3. 3) mm;传统手术组:(12. 2±7. 6) vs (21. 7±2. 4) mm]、Cobb角[微创手术组:(14. 0±6. 8)°vs (4. 3±1. 8)°;传统手术组:(14. 8±7. 0)°vs (4. 6±2. 8)°]和矢状位指数[微创手术组:(64. 5±12. 6)%vs (93. 8±13. 9)%;传统手术组:(63. 8±13. 8)%vs (95. 0±9. 6)%]均得到显著改善(均P 0. 05)。结论与传统开放椎弓根螺钉内固定技术相比,采用经皮微创椎弓根螺钉内固定治疗老年胸腰段脊柱压缩性骨折患者的疗效确切,且手术时间短、住院时间短、手术切口小、术中出血量少和住院费用少,值得临床推广。     

经皮椎体成形术对老年骨质疏松性椎体压缩性骨折患者生存质量的影响

目的探讨经皮椎体成形术对老年骨质疏松性椎体压缩性骨折(OVCFs)患者生存质量的影响。方法老年OVCFs患者101例,随机分为非手术组48例和经皮椎体成形术组(手术组)53例,分析治疗前、治疗后2 w、1、6个月、1年利用生存质量量表(COQOL)判断生存质量变化。结果随访期间,手术组生存质量得分与非手术组比较有统计学意义(P<0.05)。结论手术可改善患者生存质量,快速减轻疼痛,改善身体功能,提高社会适应能力及减轻患者心理精神功能。     

3种方法治疗老年骨质疏松性椎体压缩骨折的效果对比

目的对比经皮椎体后凸成形术、过伸位复位联合经皮椎体成形术和保守法治疗老年骨质疏松性胸腰段椎体压缩骨折的临床效果。方法154例胸腰椎单椎体压缩骨折患者中经皮椎体后凸成形术61例和过伸位复位联合经皮椎体成形术56例为手术组,保守治疗37例为保守治疗组。多时间点行视觉模拟疼痛评分(VAS)、改良Oswestry功能障碍指数(ODI)评估,测量Cobb角、伤椎前缘高度百分比,计算并发症发病率。结果术后3 d手术组VAS评分均较术前显著降低(P0.001),PKP组和联合组VAS评分差异无统计学意义(P0.05);同期保守治疗组VAS评分较术前无显著改变(P0.05)。3个月随访时3组VAS评分均较术前明显减小(P0.001)。与保守治疗组比较,PKP组和联合组术后3 d和3个月VAS差异有统计学意义(P0.05),末次随访时差异无统计学意义(P0.05)。PKP组和联合组在术后3 d、术后3个月及末次随访时ODI评分较术前均明显降低(P0.001)。与术前对比,保守治疗组术后3个月及末次随访时差异有统计学意义(P0.001)。与保守治疗组相比较,手术组术后3 d、3个月及末次随访时ODI差异有统计学意义(P0.05)。术后PKP组和联合组间DOI差异无统计学意义(P0.05)。术后3 d及末次随访时,PKP组和联合组Cobb角均较术前显著减小,椎体前缘高度较术前差异有统计学意义(P0.001);保守治疗组末次随访时Cobb角较术前显著减小,椎体前缘高度较术前差异有统计学意义(P0.05)。和保守治疗组比较,术后手术组在纠正Cobb角、恢复椎体高度上差异有统计学意义(P0.001)。结论三种方法均可减轻疼痛,矫正Cobb角并恢复椎体高度,提高病人生活质量;两手术组短期随访效果接近,较保守治疗组存在一定优势;保守治疗时需防治并发症。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.