孤立性自发性中主动脉夹层患者的诊断与治疗

目的 探讨少见的中主动脉自发性孤立性夹层的诊断及治疗方式选择.方法 回顾性分析2007年1月至2011年6月北京协和医院血管外科收治的7例中主动脉自发性孤立性夹层(SIMAD)患者.结果 7例患者中,男3例,女4例,平均年龄53岁,急性起病5例.根据夹层第一破口的部位和邻近内脏动脉的情况,6例患者采用腔内隔绝治疗,另1例行开腹主动脉-双股动脉人工血管置换术.手术均取得成功.术后6例患者均恢复良好,肝肾功能正常;1例腔内治疗患者术后第2天并发急性冠脉综合征,转入心内科行急诊冠脉支架植入术,之后恢复正常.术后复查CTA显示,腔内治疗后主动脉假腔内已基本血栓化,未发现内漏和支架移位.结论 孤立性自发性中主动脉夹层因发生部位特殊且存在一定程度破裂和成瘤风险,应受到血管外科医生重视.在治疗方式上除非因解剖条件的原因,腔内治疗应当作为首选,但是腔内治疗远期效果值得我们进一步监测和评价.     

富血小板血浆和脱钙骨基质促进牵拉成骨矿化过程的实验研究

目的观察局部植入富血小板血浆(platelet-rich plasma,PRP)复合脱钙骨基质(decalcified bone matrix,DBM)是否具有协同作用加速牵拉成骨矿化过程,促进骨愈合。方法健康雄性新西兰大白兔40只,体重2.2～2.8 kg,随机分为4组,每组10只。于兔耳中央动脉取血采用Landesberg法制备PRP。于兔左胫骨胫腓关节下制备1 cm骨缺损模型。A组为对照组,行牵拉成骨1 cm;B组:植入0.5 cm长DBM并牵拉成骨0.5 cm;C组:牵拉成骨1 cm加局部注射PRP 1 mL;D组:植入0.5 cm长复合1 mL PRP的DBM并牵拉成骨0.5 cm。术后7 d开始延长,每天2次,每次0.5 mm;A、C组延长10 d,B、D组延长5 d。延长结束后进入矿化期。术后0、12、17、27、37 d摄X线片观察新生骨矿化过程;术后37 d处死实验动物,完整切取胫骨行Micro-CT扫描及三维重建,并进行生物力学测试。结果 X线片观察示术后37 d内B、C组新生骨生成情况明显优于A、D组。B、C组新生骨的骨矿物质密度(bone mineral density,BMD)、骨矿物质含量(bone mineral content,BMC)和骨体积分数(bone volume fraction,BVF)均显著高于A、D组(P<0.05);C组BMC、BMD显著高于B组(P<0.05),B、C组间BVF差异无统计学意义(P>0.05);A、D组间BMD、BMC及BVF比较差异无统计学意义(P>0.05)。C组骨小梁数量(trabecula number,Tb.N)明显多于其余各组,骨小梁间隔(trabecula spacing,Tb.Sp)小于其余各组(P<0.05);其余各组间Tb.N和Tb.Sp比较差异均无统计学意义(P>0.05)。各组骨小梁厚度比较,差异均无统计学意义(P>0.05)。生物力学测试显示,各组极限角位移比较差异均无统计学意义(P>0.05)。B、C组最大扭矩明显大于A、D组,C组大于B组,差异均有统计学意义(P<0.05);A、D组间差异无统计学意义(P>0.05)。结论 局部注射PRP可促进牵拉成骨矿化过程,加速骨缺损愈合;在正常牵拉速度下,DBM可促进牵拉成骨矿化过程;但在牵拉成骨早期植入复合PRP的DBM并未进一步加速矿化促进骨愈合。     

Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale

Background

Despite widespread adoption of the six-item erectile function (EF) domain of the International Index of Erectile Function (IIEF) as a clinical trial end point, there are currently no objective data on what constitutes a minimal clinically important difference (MCID) in the EF domain.

Objective

Estimate the MCID for the IIEF EF domain.

Design, setting, and participants

Anchor-based MCIDs were estimated using data from 17 randomized, double-blind, placebo-controlled, parallel-group clinical trials of the phosphodiesterase type 5 inhibitor (PDE5-I) tadalafil for 3345 patients treated for 12 wk.

Measurements

The anchor for the MCID is the minimal improvement measure calculated using change from baseline to 12 wk on IIEF question 7: “Over the past 4 weeks, when you attempted sexual intercourse how often was it satisfactory for you?” MCIDs were developed using analysis of variance (ANOVA)- and receiver operating characteristic (ROC)-based methods in a subset of studies (n = 11) by comparing patients with and without minimal improvement (n = 863). MCIDs were validated in the remaining six studies (n = 377).

Results and limitations

The ROC-based MCID for the EF domain was 4, with estimated sensitivity and specificity of 0.74 and 0.73, respectively. MCIDs varied significantly (p < 0.0001) according to baseline ED severity (mild: 2; moderate: 5; severe: 7). MCIDs consistently distinguished between patients in the validation sample classified as no change or minimally improved overall and by geographic region, ED etiology, and age group. MCIDs did not differ by age group, geographic region, or ED etiology. Current analyses were based on 17 clinical trials of tadalafil. Results need to be replicated in studies using other PDE5-Is or in nonpharmacologic intervention studies.

Conclusions

The contextualization of treatment-related changes in terms of clinically relevant improvement is essential to understanding treatment efficacy, to interpreting results across studies, and to managing patients effectively. This analysis provides, for the first time, anchor-based estimates of MCIDs in the EF domain score of the IIEF.     

微创技术在不同类型胸腰段骨折中的应用

目的 探讨微创技术在胸腰段骨折的应用及疗效.方法 回顾性分析2005年2月至2010年6月采用微创手术治疗并有随访资料的胸腰段骨折患者共183例,男性126例,女性57例;年龄18～68岁,平均38.9岁.T11 22例,T12 61例,L1 71例,L2 29例.骨折按Gertzbein分型,A型145例,B型34例,C型4例;Load-sharing评分,4分51例,5分56例,6分17例,7分12例,8分24例,9分23例.根据微创手术策略选择不同的手术方法,采用经皮椎弓根螺钉内固定术( MIPPSO)治疗22例,小切口肌间隙椎弓根螺钉内固定术( SISPSO)治疗102例,胸腔镜或头灯光源辅助的小切口胸腰椎前路手术(SIATS)治疗31例,后路小切口270°减压重建术(270° DRS)治疗28例.Frankel 分级评定术后神经功能恢复情况,比较伤椎Cobb角的矫正和丢失及评估椎管减压范围及愈合情况.结果 183例患者均一期完成手术,术后随访12 ～60个月,平均35个月.MIPPSO治疗患者的手术时间为52～100 min,术中出血量为35～55 ml;SISPSO治疗患者的手术时间为48 ～ 68 min,术中出血量45～65 ml;两种术式治疗患者的Cobb角矫正8°～19°.SIATS手术治疗患者的手术时间为140～220 min,术中出血量160～1500 ml,术后X线检查显示脊柱序列和生理曲度基本恢复正常,Cobb角矫正15° ～25°;术后出现肺不张1例,股外侧皮神经损害1例,经治疗后症状消失.270° DRS治疗患者的手术时间为160 ～ 280 min,术中出血700～4700 ml,术后Cobb角矫正15° ～28°,1例术后神经症状加重.所有病例术后随访未发生内固定器松脱、移位及断裂,植骨均融合.所有椎管占位病例术后CT显示椎管腔扩大,减压彻底.除1例术后神经症状加重外,其余术前不完全性神经损伤患者术后神经功能Frankel分级均恢复1级或以上.结论 合理运用微创技术治疗胸腰段骨折效果满意.     

脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究

目的 探讨颈椎后路开门手术后脊髓减压程度的预测及方法.方法 收集2008年3月至2009年8月25例行颈椎单开门椎管成形术患者术前、术后的MRI图像.根据脊髓前方的压迫程度可分为0～4分;其中＞3分(3和4分)表明有脊髓压迫,＜3分表明脊髓无压迫.在开门节段上位椎体下终板做一水平线与脊髓前方成一交点,在开门节段下位椎体...     

Antitumor vaccination by Newcastle Disease Virus Hemagglutinin-Neuraminidase plasmid DNA application: changes in tumor microenvironment and activation of innate anti-tumor immunity

A plasmid encoding the Hemagglutinin-Neuraminidase (HN) protein of Newcastle Disease Virus (pHN) was tested for its capacity to stimulate innate anti-tumor activity in tumor-bearing mice. We observed that application of the pHN plasmid at the ear pinna site (i.e.) of mice induces higher levels of systemic interferon-α and reduced tumor growth in the prophylactic mammary carcinoma DA3 tumor model in comparison to application of a control plasmid not encoding the HN protein. Analysis of the tumor microenvironment revealed a significant increase in NK cell infiltration and decrease in infiltration of CD11b⁺Gr-1^high myeloid cells bearing the myeloid-derived suppressor cell (MDSC) phenotype after vaccination with the pHN DNA compared to a control DNA. Finally, innate immunity and partially type I IFN responses were proved important for the reduction of s.c. RMA-S tumor growth after pHN vaccination, as shown with the use of RAG2^−/− and RAG2^−/−IFNAR1^−/− mice.These data demonstrate that triggering innate immunity by pHN application at the ear pinna of mice modulates the immune cell compartment in the tumor microenvironment and reduces tumor growth. This highlights thus the potential adjuvant activity of the HN gene in tumor therapy.     

Covariate-adjusted non-parametric survival curve estimation

Kaplan-Meier survival curve estimation is a commonly used non-parametric method to evaluate survival distributions for groups of patients in the clinical trial setting. However, this method does not permit covariate adjustment which may reduce bias and increase precision. The Cox proportional hazards model is a commonly used semi-parametric method for conducting adjusted inferences and may be used to estimate covariate-adjusted survival curves. However, this model relies on the proportional hazards assumption that is often difficult to validate. Research work has been carried out to introduce a non-parametric covariate-adjusted method to estimate survival rates for certain given time intervals. We extend the non-parametric covariate-adjusted method to develop a new model to estimate the survival rates for treatment groups at any time point when an event occurs. Simulation studies are conducted to investigate the model's performance. This model is illustrated with an oncology clinical trial example.     

Action mechanism of Zuo Gui Yin Decoction's promotion on estradiol production in rats during the peri-menopausal period

Aim of the study

Although Zuo Gui Yin Decoction has long been used in Traditional Chinese Medicine to treat menopausal symptoms, the underlying mechanism(s) by which these effects are induced remains to be defined. The aim of this study was to investigate the action mechanism of Zuo Gui Yin Decoction on estradiol production in the rat ovary during peri-menopause.

Materials and methods

The peri-menopausal animal model was established by natural aging. Peri-menopausal rats were treated by intragastric administration (ig) with low (13.78 g kg⁻¹), middle (20.67 g kg⁻¹) or high (31 g kg⁻¹) dose of Zuo Gui Yin Decoction per day for 8 weeks. At the 8th weekend, the rats were sacrificed for sampling. Estradiol (E₂) levels in rats’ serum were evaluated by radioimmunoassay (RIA). RT-PCR, in situ hybridization and immunohistochemistry were used to determine mRNA and protein expression of relevant genes.

Results

Medium- and high-dose of Zuo Gui Yin Decoction could significantly increase serum estradiol concentration, ovarian CYP19 mRNA levels, and P450_arom protein expression in rats during peri-menopause. Zuo Gui Yin Decoction at three different dosages all could promote FSHR expression and the effect of low-dose was the greatest. Zuo Gui Yin Decoction could elevate LRH-1 and ER_α expression in a dose dependent manner.

Conclusions

Taken collectively, these findings suggest that Zuo Gui Yin Decoction could promote estradiol production in rat serum during peri-menopausal period through ovarian ER_α → LRH-1 → CYP19 pathway as well as the ovarian classical FSHR → CYP19 mechanism.     

海洋来源真菌Penicillium citrinum中的一个新半缩醛类化合物(英文)

利用硅胶、Sephadex LH-20及半制备HPLC等柱色谱方法从一株海洋来源真菌Penicillium citrinum中分离得到了一个结构新颖的半缩醛类化合物(1)。通过高分辨电喷雾质谱、一维以及二维核磁等方法确定了它的平面和立体结构,同时,从核磁谱图中发现了化合物1在溶剂中是以互变异构体的形式存在的。在对人白血病细胞HL-60、人肺癌细胞A-549、人宫颈癌细胞HeLa以及人白血病细胞K562等4种细胞株的抗肿瘤活性筛选中,发现化合物1对人白血病细胞HL-60显示弱的抑制活性,其IC50值为77.4μmol·L-1。