牵引成骨关节成形在颞下颌关节强直中的应用：12例报告

目的：传统的手术方法治疗颞下颌关节强直的弱点就是高复发率，观察新出现的治疗技术牵引成骨术治疗颞下颌关节强直的效果。 方法：2001—07／2005—09大连市口腔医院颌面外科收治例颞下颌关节强直病例12例，均伴有不同程度的阻塞性睡眠呼吸暂停低通气综合征。所有患者采用牵引成骨关节成形术治疗，通过测量开口度及牵开长度观察其疗效，并观察并发症情况及阻塞性睡眠呼吸暂停低通气综合征症状改善情况。 结果：12例患者均完成治疗进入结果分析。①治疗结果：12例患者最低牵开长度12mm，最高牵开长度30mm，平均20mm。开口度由术前平均7mm提高到术后平均31mm，开闭口运动正常。成骨良好，术后3个月x射线片检查及创口内检查均证实骨质形成良好。②并发症：所有患者无明显并发症出现，无感染、神经损伤、牵开器脱落或断裂，未发现复发者。③术后阻塞性睡眠呼吸暂停低通气综合征症状缓解明显，睡眠打鼾症状均有减轻，4例完全消除。 结论：牵引成骨术治疗颞下颌关节强直具有手术简单，风险小，治疗效果确实可靠，复发率低等优点，同期还可以治疗颌骨发育不足导致的睡眠呼吸暂停低通气综合征。     

消炎痛灌肠降温疗效观察

对体温在３８．５℃以上的患儿进行了消炎痛灌肠与安痛定肌注降温疗效观察。结果表明：消炎痛灌肠组的显效率为７８％，安痛定肌注组的显效率为３４％。     

Relative Efficacy of Granulocyte-Macrophage Colony-Stimulating Factor,Dacarbazine, and Glycoprotein 100 in Metastatic Melanoma: An Indirect Treatment Comparison

Introduction

Advances in the treatment of metastatic melanoma have been achieved in recent years: immunotherapies and targeted therapies have demonstrated survival benefits over older agents such as granulocyte-macrophage colony-stimulating factor (GM-CSF), dacarbazine, and glycoprotein peptide vaccine (gp100) in pivotal phase 3 trials. It is important to compare therapies to guide the treatment decision-making process, and establishing the relationship between older agents can strengthen the networks of evidence for newer therapies. We report the outcome of an indirect comparison of GM-CSF, dacarbazine, and gp100 in metastatic melanoma through meta-analysis of absolute treatment effect.

Methods

A systematic literature review identified trials for inclusion in the meta-analysis. A valid network meta-analysis was not feasible: treatment-specific meta-analysis was conducted. A published algorithm was used to adjust overall survival estimates from trials of GM-CSF, dacarbazine, and gp100 for heterogeneity in baseline prognostic factors. Survival estimates were compared in three patient groups: stage IIIB–IV M1c, stage IIIB–IV M1a, and stage IV M1b/c.

Results

One trial of GM-CSF, four of dacarbazine, and one of gp100 were included in the analysis. After adjusting for differences in baseline prognostic factors, median overall survival (OS) in all patient groups was longer for those receiving GM-CSF than for those receiving dacarbazine or gp100. The observed survival over time for GM-CSF was similar to the adjusted survival for dacarbazine and greater than for gp100 in all patient groups.

Conclusion

The relative treatment effect of GM-CSF, dacarbazine, and gp100 has been reliably estimated by adjusting for differences in baseline prognostic factors. Results suggest that OS with GM-CSF is at least as good as with dacarbazine and greater than with gp100. Given the role of these agents as controls in phase 3 trials of new immunotherapies and targeted agents, these results can be used to contextualize the efficacy of newer therapies.

Funding

Amgen Inc.

     

Automatic removal of the eye blink artifact from EEG using an ICA-based template matching approach

Independent component analysis (ICA) proves to be effective in the removing the ocular artifact from electroencephalogram recordings (EEG). While using ICA in ocular artifact correction, a crucial step is to correctly identify the artifact components among the decomposed independent components. In most previous works, this step of selecting the artifact components was manually implemented, which is time consuming and inconvenient when dealing with a large amount of EEG data. We present a new method which automatically selects the eye blink artifact components based on the pattern of their scalp topographies, which can be exemplified as a template matching approach. The feasibility of using a fixed template for singling out the eye blink component after ICA decomposition was validated by an experiment in which 18 subjects among the 21 subjects involved exhibited a highly consistent pattern of eye blink scalp topographies. Since only the spatial feature is employed for singling out the eye blink component, the proposed method is very efficient and easy to implement. Objective evaluation of the real results shows that the proposed algorithm can remove the eye blink artifact from the EEG while causing little distortion to the underlying brain activities.     

Determinants of mitotic catastrophe on abrogation of the G2 DNA damage checkpoint by UCN-01

Genotoxic stress such as ionizing radiation halts entry into mitosis by activation of the G(2) DNA damage checkpoint. The CHK1 inhibitor 7-hydroxystaurosporine (UCN-01) can bypass the checkpoint and induce unscheduled mitosis in irradiated cells. Precisely, how cells behave following checkpoint abrogation remains to be defined. In this study, we tracked the fates of individual cells after checkpoint abrogation, focusing in particular on whether they undergo mitotic catastrophe. Surprisingly, while a subset of UCN-01-treated cells were immediately eliminated during the first mitosis after checkpoint abrogation, about half remained viable and progressed into G(1). Both the delay of mitotic entry and the level of mitotic catastrophe were dependent on the dose of radiation. Although the level of mitotic catastrophe was specific for different cell lines, it could be promoted by extending the mitosis. In supporting this idea, weakening of the spindle-assembly checkpoint, by either depleting MAD2 or overexpressing the MAD2-binding protein p31(comet), suppressed mitotic catastrophe. Conversely, delaying of mitotic exit by depleting either p31(comet) or CDC20 tipped the balance toward mitotic catastrophe. These results underscore the interplay between the level of DNA damage and the effectiveness of the spindle-assembly checkpoint in determining whether checkpoint-abrogated cells are eliminated during mitosis.     

Glycaemic control in type 2 diabetes: the impact of body weight, beta-cell function and patient education

We examined the determinants of glycaemic control in a consecutive cohort of 562 newly-referred Chinese type 2 diabetic patients (57% women) during a 12-month period. All patients underwent a structured assessment with documentation of clinical and biochemical characteristics. Pancreatic beta-cell function was assessed by fasting plasma C-peptide concentration. Insulin deficiency was defined as fasting plasma C-peptide <0.2 pmol/ml. Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA) based on a product of fasting plasma glucose and insulin concentrations. Treatment was considered appropriate when insulin-deficient patients were treated with insulin and non-insulin-deficient patients were treated with oral agents or diet. Mean (+/-SD) age was 54.3+/-13.8 years (range 17-87 years) and disease duration was 5.0+/-5.9 years. At the time of referral, 70.5% (n=396) were on drug therapy (9% on insulin and 62.8% on oral agents), 20.6% (n=116) were on diet and 9% (n=50) had not received any form of treatment. The mean HbA(lc) was 8.4+/-2.3%. The geometric mean (x// antilog SD) of IR was 4.62x//2.51 (range 0. 63-162.7) and correlated only with waist : hip ratio (WHR, p=0.008). The geometric mean of plasma C peptide was 0.47x//2.89 nmol/l and correlated with BMI (p<0.001). Glycated haemoglobin was correlated positively with age (p=0.013), disease duration (p<0.001), IR (p<0. 001) and negatively with BMI (p<0.001). Glycated haemoglobin was lower in patients who had seen a dietitian (7.9% vs. 8.7%, p<0.001) or diabetes nurse (7.8% vs. 8.7%, p<0.001) or who performed self blood glucose monitoring (7.9% vs. 8.6%, p=0.001) and higher among smokers (8.9% vs. 8.2%, p=0.003). Compared to insulin-deficient patients (n=118), non-insulin-deficient patients (n=413) had features resembling that of the Metabolic Syndrome with increased WHR (p=0.005), blood pressure (p<0.001), BMI (p=0.001) and were older (p=0.04). Amongst the insulin-deficient patients, 27% were treated with oral agents or diet. Patients receiving appropriate therapy (n=362) had a lower HbA(lc) than those treated inappropriately (n=173) (8.2% vs. 8.7%, p=0.02). On multivariate analysis, short disease duration (p<0.001), low IR (p<0.001), high BMI (p=0.001), diabetes education (p<0.001), lack of smoking (p=0. 014) and choice of appropriate treatment (p=0.009) were the independent determinants of good glycaemic control.     

Increased risk of kidney damage among Chinese adults with simple renal cyst

Background

The presence of simple renal cyst (SRC) has been related to hypertension, the early and long-term allograft function, and aortic disease, but the relationship with kidney damage was still controversial. Accordingly, we conducted a large sample cross-sectional study to explore the association of SRC with indicators of kidney damage among Chinese adults.

Methods

A total of 42,369 adults (aged 45.8?±?13.67 years, 70.6% males) who visited the Health Checkup Clinic were consecutively enrolled. SRC was assessed by ultrasonography according to Bosniak category. Multiple regression models were applied to explore the relationships between SRC and indicators of kidney damage [proteinuria (dipstick urine protein?≥?1+) and decreased estimated glomerular filtration rate (DeGFR)?<?60 ml/min/1.73 m²].

Results

Among all participants in the study, the prevalence of SRC was 10.5%. As a categorical outcome, participants with more 1 cyst and with 1 cyst had higher percentage of proteinuria [53 (5.3%) and 93 (2.7%) vs. 596 (1.6%), p?<?0.001] and DeGFR [57 (5.7%) and 85 (2.5%) vs. 278 (0.7%), p?<?0.001] compared with participants with no cyst. SRC significantly correlated with proteinuria [OR 1.59 (95% CI 1.30–1.95)] and DeGFR [OR 1.97 (95% CI 1.56–2.47)] after adjusting for potential confounders. Furthermore, the results also demonstrated that maximum diameter (per 1 cm increase), bilateral location, and multiple cysts significantly correlated with DeGFR in the multiple logistic regression analysis.

Conclusions

The study revealed that SRC significantly correlated with kidney damage and special attention should be paid among Chinese adults with SRC.

     

Relationship between heparin dosing and coagulation tests after cardiopulmonary bypass in young infants with congenital heart disease and low birth weight北大核心CSCD

ObjectiveTo explore the effect of early heparin anticoagulation on D-dimer of blood coagulation parameters in young and low-birth-weight congenital heart disease (CHD) after cardiopulmonary bypass (CPB). MethodsFrom December 2019 to December 2021, the relevant clinical data were retrospectively reviewed for 102 children undergoing CPB-assisted open-heart surgery for CHD at Shanxi Children's Hospital.There were 57 boys and 45 girls.Based upon an injection of heparin or not, they were assigned into two groups of observation (5 U·kg -1·h -1 low-dose heparin dosing) and control (non-heparin dosing). Fifty-four children in observation group were (119.81±66.90) day in age and (5.4±1.1) kg in weight.And 48 children in control group were (138.00±67.67) day in age and (5.65±1.31) kg in weight.Coagulation functions of two groups were detected preoperatively, postoperatively (admission into CCU), before medication (before heparin on the next day post-operation) and after medication (24h after heparin dosing). The change trends of D-dimer of coagulation function and the difference were observed between two groups.Pearson χ 2 test was utilized for counting data and t-test or Wilcoxon two-sample rank sum test for measurement data. ResultsNo significant inter-group differences existed in gender, age or weight ( P>0.05). No significant inter-group differences in D-dimer distribution pre/postoperatively or before medication ( P>0.05); After medication, D-dimer was significantly lower in observation group than that in control group and the difference was statistically significant ( Z=-2.21, P=0.027). The inter-group change of D-dimer after and before medication was statistically significant ( Z=-2.17, P=0.030). In observation group, D-dimer level continued rising pre/postoperatively and before medication and the difference was statistically significant ( P<0.05); No significant difference existed between before and after medication ( Z=-0.33, P=0.740). The difference was statistically significant after medication and post-operation ( Z=-3.41, P=0.001). The difference of D-dimer was statistically significant after medication as compared with that preoperatively ( Z=-3.06, P=0.002). It was still higher than that pre-operation.In control group, D-dimer continued rising from preoperative to after medication and statistically significant differences existed in D-dimer during each period ( P<0.05). ConclusionsEarly use of low-dose heparin anticoagulant therapy after CPB can relieve the coagulation dysfunction caused by CPB, and is conducive to the prevention of postoperative thrombosis and DIC. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.