血尿酸与冠心病的相关性

目的探讨血尿酸水平与冠心病的关系。方法选择129例冠状动脉造影病例,分为冠心病组100例和非冠心病组29例;冠心病组又分为单支病变组34例、双支病变组35例和三支病变组31例。两组均常规空腹采集静脉血测定血尿酸(SUA)水平,分析各组血尿酸水平与冠状动脉病变的相关性。结果冠心病组血尿酸水平(337.27±88.04)μmol/L明显高于非冠心病组(284.93±59.48)μmol/L(P<0.01)。单支病变亚组、双支病变亚组和三支病变亚组SUA水平呈递增趋势,分别为(323.00±80.30)μmol/L、(337.87±95.77)μmol/L和(352.15±80.04)μmol/L,但三者之间的差异无统计学意义(P>0.05),多元逐步回归结果显示SUA、纤维蛋白元、空腹血糖、高密度脂蛋白、低密度脂蛋白与冠状动脉病变评分独立相关(P值均<0.05)。结论血尿酸升高是冠心病发病的相关危险因素。     

10年来冠心病行PCI治疗患者的危险因素的变化趋势研究

目的：探讨十年来冠心病PCI治疗患者的主要危险因素的变化趋势。方法回顾分析2003年和2013年全年上海长海医院收治并行冠脉内支架植入术冠心病患者的临床资料。比较2003年和2013年两组患者的年龄、吸烟史及血脂水平等主要危险因素、冠脉病变、冠脉内支架植入情况的差异。结果2003年入组患者共240例，2013年组为1254例；平均年龄、女性患者比例及高血压、糖尿病发病率无明显统计学差异。2013年吸烟比例2003年的51.9%降至35.7%（P<0.01），高密度脂蛋白水平升高（P<0.01）。2013年冠脉多支病变比例从2003年的26.3%上升至45.1%（P<0.01）；复杂病变的比例从35.8%增加至53.5%（P<0.01）；植入支架个数从1.38±0.61增加至1.64±0.84（P<0.01）；植入支架总长度由（27.30±14.95）mm增长至（40.20±24.12）mm（P<0.01）。2013年组患者住院期间死亡率为0.3%，较2003年组1.7%相比有所下降（P<0.05）。结论本院冠心病PCI治疗患者的主要危险因素与10年前比，吸烟比例下降，高密度脂蛋白胆固醇上升。尽管冠脉三支病变、复杂病变比例增加，使得植入支架的数量和长度增加，但术中和术后并发症及死亡率明显降低。     

STEMI多支血管病变患者采用血流储备分数指导下进行支架植入的远期疗效

目的探讨ST段抬高型心肌梗死(STEMI)多支血管病变患者采用血流储备分数(FER)指导下进行支架植入的远期疗效。方法选择2014年2月-2015年2月内蒙古医科大学第一附属医院心血管内科行经皮冠状动脉介入治疗(PCI)开通梗死相关血管(IRA),拟分期PCI治疗非IRA(non-IRA)的86例STEMI多支血管病变患者作为研究对象,按随机数字表法将其分为冠状动脉造影(CAG)指导下支架植入组(CAG组,n=43)与FFR指导下支架植入组(FFR组,n=43),FFR组对狭窄>90%的non-IRA病变及FFR<0.80且直径≥2.5 mm的non-IRA病变行PCI治疗,对狭窄70%-90%的non-IRA病变行FFR检查,对FFR≥0.80的non-IRA病变给予药物治疗;CAG组对狭窄270%且直径22.5 mm的non-IRA病变行PCI治疗。比较两组临床基线资料、冠状动脉病变程度、PCI治疗资料,随访两组患者术后36个月主要不良心脑血管事件(MACCE)的发生情况。结果两组PCI成功率、平均支架直径、住院费用、PCI时间、围术期主要并发症、住院时间P>0.05;FFR组患者平均支架置入数、人均支架总长度、狭窄≥70%病变支架置入率、造影剂用量明显低于CAG组,P<0.0);随访期间FFR组MACCE发生率(23.26%)显著低于CAG组(44.19%),P<0.05。结论STEMI多支血管病变患者采用FFR指导下进行支架植入可减少造影剂用量和支架置入数量,降低术后36个月MACCE发生率。     

CYP2C19基因多态性结合DSA造影检查对急性脑梗死患者血管内介入治疗疗效及预后的评估

目的 探讨CYP2C19基因多态性结合数字减影血管造影技术(DSA)造影检查对急性脑梗死患者血管内介入治疗疗效及预后的评估。方法 选取保定市第一中心医院2019年6月—2021年6月收治急性脑梗死患者60例为研究对象,将采取血管内介入治疗的患者分为观察组(n=30),将仅采取单纯静脉溶栓治疗的患者分为对照组(n=30),比较两组CYP2C19基因多态性和DSA造影结果及其与血管再通率、美国国立卫生研究院卒中量表(NHISS)、Fugl-Meyer评测法(FMA)、功能独立性评定(FIM)及并发症发生率相关性,同时分析CYP2C19基因多态性联合DSA造影检测对评价血管内介入治疗急性脑梗死的灵敏度,特异性及准确性。结果观察组共检测330支血管,发现完全闭塞血管8支,狭窄率70%～99%血管30支,狭窄率50%～69%血管15支,狭窄率<50%血管27支;对照组共检测330支血管,发现完全闭塞血管18支,狭窄率70%～99%血管52支,狭窄率50%～69%血管33支,狭窄率<50%血管46支;观察组各项指标均低于对照组(P<0.05);两组CYP2C19基因分型比较,差异...     

冠心病合并梅毒男性患者超声心动图的特征表现

目的探讨冠心病合并梅毒男性患者超声心动图的特征表现。方法选取2017年3月至2019年7月汉川市人民医院收治的32例有梅毒感染史或确诊梅毒且合并冠心病男性患者作为研究对象。将这32例患者纳入冠心病合并梅毒组。选取同期汉川市人民医院住院的64例单纯冠心病男性患者纳入单纯冠心病组。两组均接受超声心动图的检查。比较两组超声心动图的心脏主动脉根部直径、升主动脉直径和主动脉瓣反流、主动脉钙化的差异。结果冠心病合并梅毒组心脏主动脉钙化、心脏主动脉瓣反流的几率明显比单纯冠心病组高,升主动脉直径明显比单纯冠心病组大,差异具有统计学意义(P<0.05);两组心脏主动脉根部直径比较,差异无统计学意义(P>0.05);冠心病合并梅毒组两亚组的心脏超声相关指标比较,差异无统计学意义(P>0.05)。结论冠心病合并梅毒男性患者会增加心脏主动脉钙化、心脏主动脉瓣反流、升主动脉直径变大的几率,应给予密切监测。     

雷公藤多苷联合咪唑斯汀治疗慢性特发性荨麻疹22例疗效观察

目的:探讨雷公藤多苷对自体血清皮肤试验(autologous serum skin test,ASST)阳性的慢性特发性荨麻疹(chronic idiopathic urticaria,CIU)的疗效。方法:对185例CIU患者采用自体血清皮肤试验,将ASST阳性的43例患者随机分为两组,治疗组服用雷公藤多苷和咪唑斯汀,对照组服用咪唑斯汀,记录临床症状评分及病史,治疗后第4周再次进行ASST。结果:治疗组痊愈率为33.3%,对照组为5.26%;有效率两组分别为71.4%和36.8%,两者差异均有统计学意义(P<0.05)。第4周两组ASST的血清风团及组胺风团直径小于治疗前直径,药物有明显的抑制作用(P<0.05)。两组对ASST的血清风团及组胺风团的影响程度差异无统计学意义(P>0.05)。结论:雷公藤多苷能有效治疗ASST阳性的慢性特发性荨麻疹,安全性好。     

银屑病患者血浆C反应蛋白水平变化及临床意义

目的探讨银屑病患者血浆C反应蛋白(CRP)的水平变化及临床意义。方法采用乳胶凝集反应法检测105例寻常型银屑病患者和45例健康体检者CRP含量,并进行统计学处理。结果进行期银屑病组CRP浓度与健康人对照组比较差异有高度显著性(P<0.001);静止期银屑病患者组血浆CRP浓度与健康人对照组比较差异有显著性(P<0.05);消退期银屑病患者组与健康人对照组比较差异无显著性(P>0.05)。结论观测银屑病患者CRP水平,对于判断病情转归和指导临床治疗具有重要意义。     

宫颈高频电波刀环切术联合氯喹那多-普罗雌烯阴道片治疗宫颈病变临床分析

目的:研究宫颈高频电波刀环切(LEEP)术联合氯喹那多-普罗雌烯阴道片治疗宫颈病变的术后创口组织恢复情况及并发症的发生情况。方法:将我院2013年1月至2014年12月因宫颈病变在妇科门诊进行宫颈LEEP术的患者122例,按随机数字表达将纳入病例分为观察组和对照组,每组61例;对照组患者进行宫颈LEEP术后无其他处理,观察组在术后给予氯喹那多-普罗雌烯阴道片;观察两组患者第2周、第4周、第6周、第8周的水肿、上皮修复、脱痂情况,阴道流液量及分泌物清洁程度,感染、出血、宫颈狭窄情况。结果:两组患者的上皮修复情况在第6周、第8周比较具有统计学差异(P0.05);两组患者的脱痂情况在第6周时具有统计学差异(P0.05);在进行宫颈LEEP术后都会出现阴道流液增多现象,为淡红色或淡黄色液体,两组患者在第4周、第6周、第8周比较具有统计学差异(P0.05);观察组分泌物的清洁度大部分均保持Ⅰ°~Ⅱ°,对照组分泌物清洁度相对较差,容易引起细菌感染。观察组无感染、出血、宫颈狭窄等并发症发生,对照组有4例患者出现脱痂出血,感染患者2例,宫颈粘连狭窄者2例,两组比较具有统计学差异(P0.05)。结论:在进行LEEP术后联合氯喹那多-普罗雌烯阴道片进行治疗能明显增强上皮组织的修复能力,加快创伤组织的结痂速度,减少阴道流液量,提高阴道分泌物的清洁程度,降低感染、出血、宫颈粘连、狭窄等并发症的发生率。     

同型半胱氨酸、D-D二聚体与冠状动脉病变程度的临床分析

目的探讨血同型半胱氨酸、D-D二聚体与冠状动脉病变程度相互关系。方法回顾性分析2012年1月～2014年1月,在海军总医院住院行冠状动脉造影检查者315例。根据造影结果,分为对照组（n=112）和冠心病组CHD（n=203）,根据SYNTAX评分,将冠心病分低危组（1～22分）、中危组（23～32分）和高危组（〉33分）。测定血同型半胱氨酸、血尿酸、D-D二聚体、C反应蛋白及空腹血脂：TC、TG、HDL-C、LDL-C、BMI、载脂蛋白A和载脂蛋白B,并且比较各组患者上述检测的指标。结果冠心病CHD组血同型半胱氨酸（6．86±2．63VS,15．97±9．23umol／l,P〈0．011、D—D二聚体（104．01±49．9VS,329．03±394．24,P〈0．01）、高密度脂蛋8（1．79±1．31VS,1．26±0．55,P〈O．01）、血尿酸（244．82±110．83vs,301．95±72．25umol／L,P〈0．05）、C反应蛋白（2．12±1．31vs,6．39±5．42,P〈0．01）值显著高于对照组。TC、TG、LDL—C、载脂蛋白A和载脂蛋白B两者无明显差别。SYNTAX评分高危组、中危组、低危组与对照组比较血同型半胱氨酸、血尿酸、D—D二聚体、c反应蛋白、高密度脂蛋白显著增高,差异有统计学意义,P〈0．05;SYNTAX评分高危组、中危组、低危组与对照组比较TC、TG、LDL—C、BMI、载脂蛋白A和载脂蛋白B无明显差异,P〉0．05。多元LogistiC回归分析表明血同型半胱氨酸、D—D二聚体与冠状动脉病变程度相关。结论血同型半胱氨酸、D—D二聚体是冠状动脉病变严重程度的相关危险因素,随着血同型半胱氨酸、D—D二聚体水平的增高,冠状动脉病变程度增加。     

输尿管镜微创术与开放性尿道吻合术治疗尿道损伤临床效果的对比研究

目的:观察输尿管镜微创术与开放性尿道吻合术在临床治疗尿道损伤的疗效。方法:临床纳入尿道损伤患者40例,根据入院后手术方案的不同分为研究组与对照组。研究组手术方案选择为输尿管镜微创术,对照组手术方案选择为开放性尿道吻合术,每组20例。观察两组患者治疗情况(包括手术时间、住院时间、膀胱冲洗、留置导管、术中出血等)、术后相关并发症发生情况(包括术后出血、尿道狭窄、勃起障碍、尿瘘、尿失禁等)以及治疗有效率等。结果:研究组患者治疗总有效率为95.0%,对照组患者治疗总有效率为90.0%,差异无显著性(P<0.05)。但研究组术后最大尿流率(MFR)为(15.1±3.6)m L/s,对照组术后最大MFR(10.2±2.5)m L/s,差异有显著性(P<0.05)。研究组手术时间、住院时间短于对照组,术中出血少于对照组,差异有显著性(P<0.05)。并发症方面,研究组尿道狭窄、勃起障碍、尿失禁的发生率均明显低于对照组,差异有显著性(P<0.05)。结论:输尿管镜微创治疗尿道损伤的疗效确切,患者恢复较快,并发症较少,值得推广。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.