皮下注射低分子肝素钙预防烧伤植皮后深静脉血栓形成的效果评价

目的：评估皮下注射低分子肝素钙对预防烧伤植皮后深静脉血栓(DVT)形成的效果。方法选取2013年1月~2014年12月本院收治的79例烧伤后需植皮的患者,其中皮下注射低分子肝素钙预DVT患者41例设为治疗组。植皮术后仅使用红外线治疗仪照射,硫酸镁热敷,活动肌肉组织等基础措施的38例为对照组。统计血浆D-二聚体(D-dimer)浓度、血小板计数、植皮成活率、创面愈合时间、感染病例数、组织器官出血病例数和DVT形成数等指标。结果治疗组术后第3、7、11、15 d的血浆D-dimer浓度均低于对照组(P<0.05);对照组的血栓形成率为10.5%,明显高于治疗组的0(P<0.05);两组术前1 d的D-dimer浓度、血小板计数,植皮成活率、创面愈合时间、感染及出血发生率差异无统计学意义(P>0.05)。结论皮下注射低分子肝素钙对预防烧伤植皮术后患者DVT形成有一定的临床意义。     

Combined strategy of knowledge‐based rule selection and historical data percentile‐based range determination to improve an autoverification system for clinical chemistry test results

BackgroundCurrent autoverification, which is only knowledge‐based, has low efficiency. Regular historical data analysis may improve autoverification range determination. We attempted to enhance autoverification by selecting autoverification rules by knowledge and ranges from historical data. This new system was compared with the original knowledge‐based system.MethodsNew types of rules, extreme values, and consistency checks were added and the autoverification workflow was rearranged to construct a framework. Criteria for creating rules for extreme value ranges, limit checks, consistency checks, and delta checks were determined by analyzing historical Zhongshan laboratory data. The new system''s effectiveness was evaluated using pooled data from 20 centers. Efficiency improvement was assessed by a multicenter process.ResultsEffectiveness was evaluated by the true positive rate, true negative rate, and overall consistency rate, as compared to manual verification, which were 77.55%, 78.53%, and 78.3%, respectively for the new system. The original overall consistency rate was 56.2%. The new pass rates, indicating efficiency, were increased by 19%‒51% among hospitals. Further customization using individualized data increased this rate.ConclusionsThe improved system showed a comparable effectiveness and markedly increased efficiency. This transferable system could be further improved and popularized by utilizing historical data from each hospital.     

High serum soluble CD155 level predicts poor prognosis and correlates with an immunosuppressive tumor microenvironment in hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is one of the most prevalent malignancies with poor prognosis. There is no research about the clinical significance of serum soluble CD155 (sCD155) level for HCC. We aim to explore the prognostic and diagnostic value of sCD155 in HCC patients undergoing curative resection.MethodsSerum sCD155 level in HCC patients was determined by enzyme‐linked immunosorbent assay. The prognostic significance of sCD155 was evaluated by Cox regression and Kaplan–Meier analyses. CD155 expression and biomarkers of immune cells in HCC tissues were detected by immunohistochemistry staining. The diagnostic significance of sCD155 was evaluated using receiver operating characteristic curve.ResultsSerum sCD155 level was significantly increased in HCC patients and predicted poor prognosis. The prognostic value of sCD155 remained in low recurrent risk subgroups of HCC. Serum sCD155 level was positively related to CD155 expression in HCC tissues. High serum sCD155 level was associated with decreased numbers of CD8⁺T cells and CD56⁺NK cells and increased number of CD163⁺M2 macrophages. Serum sCD155 level had better performance in distinguishing HCC patients from healthy donors and patients with chronic liver conditions than α‐fetoprotein. Among patients with α‐fetoprotein ≤ 20 ng/ml, serum sCD155 level could differentiate HCC patients from non‐HCC patients.ConclusionSerum sCD155 level represents a promising biomarker for diagnosis and prognosis of HCC. High serum sCD155 level may reflect an immunosuppressive tumor microenvironment in HCC.     

Sumatriptan - Nonresponders: A Survey in 366 Migraine Patients

Sumatriptan, notably after subcutaneous administration, is highly effective in the acute treatment of migraine in the majority of patients. The response is consistent within patients and over time. To determine risk factors for nonresponse to sumatriptan, we compared clinical characteristics. In responders and nonresponders and, within patients, between attacks with and without response. We found no differences at the strict level of significance (P<0.001 because of multiple comparisons), but only tendencies for differences (0.001相似文献   

Encouraging family engagement in the rehabilitation process: a rehabilitation provider's development of support strategies for family members of people with traumatic brain injury

Purpose: After a moderate to severe traumatic brain injury, it is widely recommended that family members be actively engaged in the client's rehabilitation journey because evidence suggests that this is associated with better outcomes. The ability of family members to fully engage in rehabilitation may be hindered by the barriers (logistical and psychological) they encounter. However, rehabilitation services can facilitate family engagement through a person-centred approach that provides support to remove barriers. Limited published guidance exists regarding practical and effective methods for delivering such support. This paper describes how one rehabilitation service has developed an eight-tiered approach. Key messages and implications: Family support is provided by explicit structuring of services to include (i) early engagement, (ii) meeting cultural needs, (iii) keeping families together, (iv) actively listening, (v) active involvement, (vi) education, (vii) skills training, and (viii) support for community re-integration. Implementation of these support strategies are individualised based on the expressed needs of each family. Families report a high level of satisfaction with the service. Conclusion: A practice-based quality improvement model identified challenges, implemented changes, and observed/evaluated the results to successfully develop a multifaceted strategy for supporting families, thereby encouraging their engagement in rehabilitation. Ongoing refinements and evaluation are planned. [Box: see text].     

Stenting for restenotic lesions with the BARD XT stent

BACKGROUND: Conventional PTCA for the treatment of restenotic lesions is associated with a high rate of recurrence (30-50%). Primary stenting decreases the restenosis rate at long-term follow-up. METHODS: One-hundred consecutive patients with restenosis received a Bard XT stent. Follow-up angiography was performed after 6 months. Angiograms were compared by means of computed quantitative analysis. RESULTS: The mean pretreatment reference diameter was 2.88 +/- 0.51 mm. The mean minimal luminal diameter (MLD) increased from 1.09 +/- 0.57 mm to 2.70 +/- 0.44 mm. The percent diameter stenosis decreased from 66 +/- 13% to 15 +/- 10%. The procedural success rate was 99%. At 6 month follow-up repeat angiography was performed in 86 patients. The mean MLD was 1.74 +/- 0.67 mm with a mean diameter stenosis of 41 +/- 20%. Residual anginal complaints were reported in 29% of patients. In-stent restenosis (defined as diameter stenosis of more than 50%) occurred in 18% of the patients. CONCLUSION: Placement of the Bard XT stent in restenotic lesions is feasible, has an excellent short term outcome and yields a favorable result at 6 month follow-up angiography.     

伤椎置钉法在胸腰椎骨折治疗中的应用价值

目的探讨伤椎置钉法对胸腰椎骨折的复位与固定效果。方法对38例胸腰椎骨折椎双侧或一侧椎弓根完整、椎体下半部及下终板无爆裂患者,通过伤椎植入椎弓根螺钉,在后路行椎间撑开、连接钉棒使伤椎复位的过程中,使伤椎获得垂直向前的推顶力,以期恢复伤椎前柱高度和后凸Cobb角的矫正,达到局部的应力平衡。所有患者外伤至手术时间为1～10d,平均5.1d。结果术后随访6～40个月,平均18个月。后凸Cobb角由术前平均25.4°恢复至术后平均2.3°;椎体前缘由术前正常椎体平均高度的58.8%矫正至术后正常椎体平均高度的90.3%;伤椎脱位均基本复位,无椎间隙过度撑开、内固定物松动断裂现象;33例合并圆锥、马尾神经损伤的病例,术后神经功能按Frankel分级比较,31例(93.9%)有1～3级的改善。6例术后15～18个月行内固定物取出术,见后外侧植骨融合良好。结论伤椎置钉法是安全的,可有效地使伤椎获得良好复位与固定,有利于维持矫正效果、减少内固定的松动或断裂。     

Secondary and tertiary structure modeling reveals effects of novel mutations in polycystic liver disease genes PRKCSH and SEC63

Waanders E, Venselaar H, te Morsche RHM, de Koning DB, Kamath PS, Torres VE, Somlo S, Drenth JPH. Secondary and tertiary structure modeling reveals effects of novel mutations in polycystic liver disease genes PRKCSH and SEC63. Polycystic liver disease (PCLD) is characterized by intralobular bile duct cysts in the liver. It is caused by mutations in PRKCSH, encoding hepatocystin, and SEC63, encoding Sec63p. The main goals of this study were to screen for novel mutations and to analyze mutations for effects on protein structure and function. We screened 464 subjects including 76 probands by direct sequencing or conformation‐sensitive capillary electrophoresis. We analyzed the effects of all known and novel mutations using a combination of splice site recognition, evolutionary conservation, secondary and tertiary structure predictions, Poly Phen , and p Mut and sift . We identified a total of 26 novel mutations in PRKCSH (n = 14) and SEC63 (n = 12), including four splice site mutations, eight insertions/ deletions, six non‐sense mutations, and eight missense mutations. Out of 48 PCLD mutations, 13 were predicted to affect splicing. Most mutations were located in highly conserved regions and homology modeling for two domains of Sec63p showed severe effects of the residue substitutions. In conclusion, we identified 26 novel mutations associated with PCLD and we provide in silico analysis in order to delineate the role of these mutations.