多发伤后急性肾损伤导致慢性肾功能不全的临床分析

目的 探讨多发伤后急性肾损伤(AKI)患者的肾功能恢复情况及预测指标.方法 前瞻性收集南京大学医学院附属鼓楼医院2014年3月—2017年10月收治的103例多发伤合并AKI患者的临床资料,男性68例,女性35例,年龄22～69岁,平均39.9岁.致伤原因:道路交通伤55例,高处坠落伤30例,砸伤12例,其他6例.AK...     

Assessing diagnostic confidence: a comparative review of analytical methods

RATIONALE AND OBJECTIVES: The ability of a test to influence diagnostic confidence is used as a measure of its efficacy. Our aim was to compare analytic methods that evaluate changes in confidence. MATERIALS AND METHODS: The approaches compared were "basic," "retained diagnoses," "Omary," "Tsushima," and "score-based" methods. For illustration, data from a clinical study assessing changes in diagnostic confidence (0%-100%) before and after abdominopelvic computed tomography (CT) in patients with acute abdominal pain were used. RESULTS: The basic, retained diagnoses and Omary methods all ignore whether the test yields a correct diagnosis (confident, but incorrect, diagnoses are regarded positively). Although the Tsushima method takes some account of diagnostic accuracy, all misdiagnoses are considered equal. The score-based method addresses some of the fundamental limitations in the other analytical methods, such as diagnostic accuracy and the varying nature of different misdiagnoses. In the case study, mean (SD) diagnostic confidence for the cohort as a whole (n = 62) increased following CT: 50.7% (20.8%) to 73.2% (20.9%). Pretest diagnoses were changed following CT in 43% (27 of 62) of patients. Pretest diagnoses proved to be incorrect in 52% (32 of 62), and post-test diagnoses incorrect in as many as 19% (12 of 62) of patients. All five analytic methods indicated a positive contribution for CT (all P < or = .003). CONCLUSION: Although our illustrative case study revealed no consequential differences across the five methods, there remain substantial differences in the fundamental principles underlying them that should affect choice of analytic method when assessing diagnostic confidence.     

Infantile acute subdural hemorrhage probably caused by injury to the diploic channels

A 6-month-old, previously healthy boy hit the right frontal region of his head against the corner of a plastic toy box. At presentation, a small area with scalp discoloration was noted in the right frontal region. Head computed tomography at the level of discoloration revealed an intracranial hematoma, 5 mm in maximal thickness, below the coronal suture. In addition, there were bony bridges connecting the frontal and parietal bones. Furthermore, a linear crack was found in the diploe of the frontal bone in contact with the coronal suture. Cerebral MRI confirmed linear hyperintensity between the inner tables. We assumed that a kind of ping-pong ball fracture was caused by the head blow, centering on the coronal suture, resulting in rupture of contacting diploic channels and tear of the dura mater, and forming a subdural hematoma. Acute subdural hemorrhage may be caused by an insignificant blow to the coronal suture in infantile patients with underdeveloped cranial bones and sutures, accompanied by subtle external findings.     

Modulation of immune response by the acute and chronic exposure to high altitude

PURPOSE: The chronic exposure at high altitude (HA) represents an ideal model for evaluating the in vivo effects of hypobaric hypoxia. Taking advantage of the EV-K2-CNR Pyramid, this study was designed to evaluate whether acute and chronic hypoxia differently modulates the in vivo immune responses. METHODS: The study includes 13 healthy female moderately active volunteers participating to the Italian HA project EV-K2-CNR. Peripheral blood lymphocytes, collected at sea level and at HA in the Pyramid Laboratory of CNR, Nepal (5050 m), were immunologically characterized by flow cytometry and a series of molecular and functional analyses. RESULTS: Flow cytometric analyses showed that: a) CD3+ T lymphocytes significantly decreased during both acute and chronic exposure to HA, b) T-cell fall was totally due to CD4+ T-cell reduction, c) B lymphocytes were not influenced by the exposure to HA, and d) natural killer (NK) cells significantly increased during acute and chronic exposure. The evaluation of the Th1/Th2 pattern demonstrated a significant decrease of the expression of the Th1 cytokine interferon-gamma (IFN-gamma) by circulating T cells during acute and chronic exposure to HA. The expression by T cells of CXCR3, a chemokine receptor typically expressed by Th1/Tc1 cells, paralleled the decrease of IFN-gamma. On the contrary, the expression of IL-4 was not conditioned by the exposure to HA. Finally, functional studies showed a significant reduction of the proliferative activity in response to mitogen (PHA) both in acute and chronic HA exposure. Despite the increased number of NK cells, NK cytotoxic activity was not influenced by the HA exposure. CONCLUSIONS: Our results indicate that the in vivo exposure to HA leads to an impairment of the homeostatic regulation of Th1/Th2 immune balance that potentially could favor long-term immunological alterations and increase the risk of infections.     

A case of complex suicide due to acute nicotine intoxication caused by cigarette ingestion

International Journal of Legal Medicine - This paper presents an unusual complex suicide case that died of nicotine addiction. The deceased was a 40-year-old male who was found lying dead on the...     

Gastric volvulus: acute and chronic presentation

Diaphragmatic hernia may be congenital or traumatic in origin. Traumatic hernia may menifest immediately or several months/years after the incident. Congenital hernia usually manifests in the early years of life. Diaphragmatic hernia may be complicated by gastric volvulus. Acute gastric volvulus is surgical emergency where as chronic gastric volvulus presents with nonspecific abdominal symptoms. Diagnosis of gastric volvulus is difficult and is based on imaging studies. We describe four cases of diaphragmatic hernia complicated by gastric volvulus, diagnosed on imaging and managed surgically.     

Advanced analytical methods to assess physical activity behavior using accelerometer time series: A scoping review

Physical activity (PA) is a complex human behavior, which implies that multiple dimensions need to be taken into account in order to reveal a complete picture of the PA behavior profile of an individual. This scoping review aimed to map advanced analytical methods and their summary variables, hereinafter referred to as wearable-specific indicators of PA behavior (WIPAB), used to assess PA behavior. The strengths and limitations of those indicators as well as potential associations with certain health-related factors were also investigated. Three databases (MEDLINE, Embase, and Web of Science) were screened for articles published in English between January 2010 and April 2020. Articles, which assessed the PA behavior, gathered objective measures of PA using tri-axial accelerometers, and investigated WIPAB, were selected. All studies reporting WIPAB in the context of PA monitoring were synthesized and presented in four summary tables: study characteristics, details of the WIPAB, strengths, and limitations, and measures of association between those indicators and health-related factors. In total, 7247 records were identified, of which 24 articles were included after assessing titles, abstracts, and full texts. Thirteen WIPAB were identified, which can be classified into three different categories specifically focusing on (1) the activity intensity distribution, (2) activity accumulation, and (3) the temporal correlation and regularity of the acceleration signal. Only five of the thirteen WIPAB identified in this review have been used in the literature so far to investigate the relationship between PA behavior and health, while they may provide useful additional information to the conventional PA variables.     

心肌显像病人所致伪影的辨析及其对策研究

重点介绍了在心肌灌注显像过程中,由于病人因素导致的位移、膈肌衰减和肝脏放射性聚集等所产生的伪影的表现和校正方法。     

急性甲醇中毒致视力损害临床研究

目的探讨急性甲醇中毒致视力损害的临床特点及预后。方法收集2014年4—8月收治的7例急性甲醇中毒致视力损害住院患者的临床资料。急诊住院后患者均进行视力和眼底检查,给予经纠正酸中毒、激素冲击及大剂量B族维生素辅助治疗,并对患者进行随访,探讨患者临床特点及预后情况。结果患者均急性起病,病程早期伴有全身中毒症状,同时,出现双眼不同程度的视力下降。视力下降3 d内达顶峰,7例患者14眼视力从无光感至0.5,均有色觉改变。急性期眼底视盘大致正常,病变部位以球后部视神经受累为主。随访2个月,除2例因代谢性酸中毒死亡外,其余5例患者视力均有不同程度改善。结论急性甲醇中毒可导致严重的视神经损害,全身症状重,预后差。     

Metabolic design of combination therapy: use of enhanced fluorodeoxyglucose uptake caused by chemotherapy.

In order to quantify effects of an experimental chemotherapy, MCF7 cells were studied with 14C-fluorodeoxyglucose (FDG) and high-performance liquid chromatography (HPLC). Uptake measurements were performed 1 and 4 hr after the end of a therapy with hexadecylphosphocholine (HPC). A dose- and time-dependent increase of the FDG uptake after therapy was observed, with a maximum at 1 hr after therapy. These data were used to develop a new metabolic design of combination treatment. Several time-dose combinations of HPC and deoxyglucose (DOG) were analyzed for their effects on growth inhibition. The combinations using DOG in the period of pronounced enhancement of FDG uptake (1 hr after HPC treatment) were found to be the most effective with an improvement of up to 520% in growth inhibition. This metabolic design of combination treatment may also be applied in vivo, and PET can be used to optimize the time and dose schedule of the modified treatment protocol.     

结肠切除吻合术灌洗治疗急性左半结肠癌性梗阻26例

目的:探讨急性左半结肠癌性梗阻术中结肠灌洗一期切除吻合的可行性及适应症。方法:对我院2002年6月~2005年12月收治的左半结肠癌并梗阻,经术中灌洗一期切除吻合治疗的26例进行回顾性分析。结果:本组26例左半结肠癌患者经此法治疗后,无吻合口漏发生,切口感染4例,无住院死亡病例。结论:对急性左半结肠癌性梗阻患者经术中结肠灌洗后行一期切除吻合治疗是安全可行的。     

Heart evaluation by cine CT: use of two new oblique views

Two new oblique views on cine computed tomography for examination of the left ventricle of the heart are described. A short-axis view sections the left ventricle transversely, demonstrating all the ventricular walls; a long-axis view sections the left ventricle longitudinally, demonstrating the mitral valve, proximal aortic root, aortic outflow tract, and ventricular apex. These views are produced by a combination of table slew and patient positioning. Reproducible short-axis views were obtained in 16 healthy volunteers and 11 patients. Long-axis views were obtained in 11 patients. Patient studies in the long-and short-axis views were compared with results from angiocardiography, with nearly identical findings.     

氩氦刀或唑来膦酸单用及联合应用治疗骨转移癌疼痛对照研究

目的比较氩氦刀或唑来膦酸单一治疗和联合治疗骨转移癌疼痛的疗效和安全性。方法 84例患者随机分为A组(联合)、B组(氩氦刀)、C组(唑来膦酸)各28例;A组氩氦刀冷冻消融治疗结束后给予唑来膦酸注射液4 mg加入0.9%氯化钠注射液100 ml静脉滴注15 min以上;B组单一使用氩氦刀冷冻消融骨转移癌局部组织;C组给子唑来膦酸注射液4 mg加入0.9%氯化钠注射液100 ml静脉滴注15 min以上。结果①A组止痛总有效率为85.7%,其中显效为35.7%(10/28),有效为50.0%(14/28);B组止痛总有效率为50.0%,其中显效为14.3%(4/28),有效为35.7%(10/28),C组总有效率为67.9%(19/28),其中显效为21.4%(6/28),有效为46.4%(13/28),3组间比较差异有统计学意义(P<0.05)。②平均起效时间:A组为(1.96±2.26)d,B组为(1.43±1.79)d,C组为(11.67±3.14)d,A、B两组与C组之间差异有统计学意义(P<0.05)。③疗效维持时间:A组为(146.68±1.89)d,B组为(71.60±2.94)d,C组为(112.99±1.37)d,3组间比较差异有统计学意义(P<0.01)。结论氩氦刀冷冻消融联合唑来膦酸治疗骨转移癌性疼痛是一种安全、有效的技术。