Teenager mit Halsschmerzen,Fieber und Luftnot – lebensbedrohliche Komplikation der Angina tonsillaris

Monatsschrift Kinderheilkunde -     

全髋关节置换非骨水泥型股骨柄假体髓腔准备的精确性研究

目的观察非骨水泥型股骨柄假体在股骨近端髓腔中与骨组织的接触情况及使用机器人辅助手术与传统手术结果的比较。方法在10具新鲜成人尸体股骨标本上,分别采用传统手术及机器人辅助手术行股骨近端髓腔准备后植入近端固定的非骨水泥型股骨柄假体(Osteolock)。经一系列处理后,用钻石刀按层厚3mm行硬组织切片,摄片,扫描输入计算机并用特殊软件(IDL)分析假体近端情况。分别测量假体与骨组织间缝隙的宽度以及假体表面缝隙的长度及其所占假体周径的百分比,假体表面与骨直接接触所占的百分比。结果机器人辅助手术组(实验组)平均假体近端表面与骨直接接触率达93.2%(87.6%～99.7%),假体表面与骨组织间存在由手术造成的缝隙率仅为2.9%(0.3%～7.8%),最大缝隙宽度小于1mm;而传统手术组(对照组)骨直接接触率为60.1%(49.2%～70.4%),由手术造成的缝隙率达32.8%(25.1%～39.9%),最大缝隙宽度达3mm。采用机器人辅助手术可使假体表面与骨直接接触率较传统手术增加约33%,手术误差造成的缝隙率仅为传统手术的9%,最大缝隙宽度为传统手术的26%。结论机器人辅助手术可使股骨近端髓腔与非骨水泥型股骨柄的直接接触率明显提高(P<0.001)。     

Mean glucose during ICU admission is related to mortality by a U-shaped curve in surgical and medical patients: a retrospective cohort study

Introduction  

Lowering of hyperglycemia in the intensive care unit (ICU) is widely practiced. We investigated in which way glucose regulation, defined as mean glucose concentration during admission, is associated with ICU mortality in a medical and a surgical cohort.     

PRAVASTATIN IN ACUTE ISCHAEMIC SYNDROMES: RESULTS OF A RANDOMISED PLACEBO-CONTROLLED TRIAL

Therapy with individual 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been shown conclusively to diminish coronary event rates and mortality in both primary and secondary prevention. To date, scant attention has been paid to whether initiation of such regimens in the hospital phase of acute coronary syndromes might confer cardioprotective benefits. The purpose of this study was to determine the safety and tolerability of early initiation of statin therapy in patients with acute coronary syndromes. In this randomised, double-blind, three-month, pilot study, 100 patients with acute myocardial infarction or unstable angina and low-density lipoprotein cholesterol >3.5 mmol/l were randomly assigned to pravastatin 40 mg daily or placebo initiated within 48 hours of hospital admission. Pravastatin proved safe and well tolerated in these patients, who were well matched at baseline. No statistically significant differences in death, MI and drug-related adverse events were observed in the pravastatin group compared with control subjects. This pilot study shows that therapy with pravastatin early after an acute coronary event is safe and well tolerated. Larger, long-term studies are needed to confirm these findings.     

SELF-MUTILATION: REVIEW AND CASE STUDY

This article reviews in a systematic way the literature on severe self-mutilation, emphasising possible aetiological factors and warning signs of impending self-mutilation. It provides practical advice on the prevention and management of such events, including legal issues of capacity and consent. An illustrative case history is provided of an artist who cut off his ear.     

美通宁片中褪黑素的含量测定

目的：制定美通宁片中褪黑素质量控制指标。方法：采用薄层扫描法测定美通宁片中褪黑素的含量。以苯;氯仿：甲醇（4：9：1）为展开剂。结果;通过方法学考察,平均回收率98．5％。变异系数RSD＝4．12％。结论：方法可靠、准确,操作简便可行。     

Aberrant expression of nNOS in pyramidal neurons in Alzheimer's disease is highly co-localized with p21 and p16

Aberrancies of growth and proliferation-regulating mechanisms might be critically involved in the processes of neurodegeneration in Alzheimer's disease (AD). Expression of p21ras and further downstream signalling elements involved in regulation of proliferation and differentiation as, for example, MEK, ERK1/2, cyclins, cyclin-dependent kinases and their inhibitors such as those of the p16^INK4a family, are elevated early during the course of neurodegeneration. Activation of p21ras can also directly be triggered by nitric oxide (NO), synthesized in the brain by various isoforms of nitric oxide synthase (NOS) that might be differentially involved into the pathomechanism of AD. To study the potential link of NO and critical regulators of cellular proliferation and differentiation in the process of neurofibrillary degeneration, we analyzed the expression pattern of NOS-isoforms, p21ras and p16^INK4a compared to neurofibrillary degeneration in AD. Additionally to its expression in a subtype of cortical interneurons that contain the nNOS-isoform also in normal brain, nNOS was detected in pyramidal neurons containing neurofibrillary tangles or were even unaffected by neurofibrillary degeneration. Expression of nNOS in these neurons was highly co-localized with p21ras and p16^INK4a. Because endogenous NO can activate p21ras in the same cell which in turn leads to cellular activation and stimulation of NOS expression [H.M. Lander, J.S. Ogiste, S.F.A. Pearce, R. Levi, A. Novogrodsky, Nitric oxide-stimulated guanine nucleotide exchange on p21 ras, J. Biol. Chem. 270 (1995) 7017–7020], the high level of co-expression of NOS and p21ras in neurons vulnerable to neurofibrillary degeneration early in the course of AD thus provides the basis for an autocrine feedback mechanism that might exacerbate the progression of neurodegeneration in a self-propagating manner.     

直肠癌的术前影象学分期

直肠癌是常见的恶性肿瘤,其发病率和病死率居高不下.近10年来,直肠癌治疗方式进展较快,包括手术治疗、术前术后化疗、放疗、内分泌治疗等.其中手术方式又包括局部切除、全系膜切除,对于个体患者,选择合适的治疗方式显得尤为重要,日益强调治疗方式的个体化.治疗方式的选择取决于肿瘤的可切除性和术后复发的风险,这皆归于准确的术前分期[1-3 ].有报道35%患者的治疗方案因术前分期的改变而得到及时调整,如何进行准确的术前分期,是个急需解决的问题.