A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan,China

We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classified into three types: type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open transection nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmacotherapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity declined with increasing duration of being trapped. In the first year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor(0 or 1) after a 1-year period of treatment, further treatment was not effective.     

Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States

Background and Purpose

The purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States.

Methods

Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged ≥65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for ≥12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year "clean" period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence.

Results

The estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. The incidence and prevalence rates were significantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). The prevalence rates were significantly higher for non-Hispanic Blacks and male beneficiaries than for non-Hispanic Whites and female beneficiaries, respectively (p<0.05).

Conclusions

This patient population had higher epilepsy incidence and prevalence compared with the general US population. These differences may be at least in part attributable to their low socioeconomic status.     

新型彩头输液管用于多通道微量泵静脉输注的模拟实验研究

目的 探讨新型彩头输液管在多通道微量泵静脉输注时识别的准确性、效率,降低微量泵用药风险及提高抢救效率.方法 模拟微量泵静脉输注试验,设实验组和对照组,各组1个操作站,各有5台微量泵,2个操作站所用药物一致.对照组采用5根传统微量泵输液管连接注射器与三通,实验组采用新型彩头微量泵输液管连接注射器与三通.结果 对照组受试者完成所有药物与三通一一对应所用时间为(45.2±18.4)s,平均每种药物对应所需时间为(9.0±3.7)s,实验组用时分别为(15.7±3.1)s和(3.1±0.7)s;对照组91.95％受试者将药物与三通对应操作完全准确,实验组为99.66％,两组比较,差异有统计学意义(均P＜0.01).结论 新型彩头输液管能提高工作效率,保证微量泵用药的安全性和准确性,有助于降低医疗风险和提高抢救效率;且操作方便快捷.     

慢性肾脏病患者血清胎盘生长因子水平及其与左心室结构和功能的关系

目的 探讨慢性肾脏病(CKD)患者血清胎盘生长因子(placental growth factor,PLGF)水平及其与左心室结构和功能的关系.方法 选取CKD非透析患者72例,年龄、性别相匹配的健康体检者16例作为对照组.采用酶联免疫吸附法测定血清PLGF浓度,心脏超声评定心脏形态和结构.结果 (1)CKD患者血清PLGF显著高于对照组[3.32(2.97,19.77) ng/L比2.33 (2.27,2.49) ng/L,P＜0.01];且随着肾功能的减退,PLGF水平进行性升高(P＜ 0.05/6).(2)CKD各期患者的室间隔厚度(IVST)和左室后壁厚度(LVPWT)升高,射血分数(EF)下降.(3)CKD患者左心室肥厚组血清PLGF显著高于非左心室肥厚组[19.05 (3.31,21.05) ng/L比2.99 (2.60,3.32) ng/L,P＜0.05].PLGF高浓度组左室肥厚发生率显著高于PLGF低浓度组(70％比18％,P＜ 0.01).(4)相关分析显示PLGF与左心室质量指数、收缩压、舒张压、24 h尿蛋白、血肌酐(Scr)、血尿酸(UA)、血尿素氮(BUN)、甲状旁腺激素(iPTH)、高血压病史呈正相关(P＜0.05),与左心室射血分数、血红蛋白(Hb)、血白蛋白(Alb)、肾小球滤过率(eGFR)呈负相关(P＜0.01).多元线性逐步回归分析显示,血肌酐、血红蛋白、射血分数、血尿酸是PLGF的独立相关因素(P＜0.05).结论 CKD患者血清PLGF显著升高,PLGF与CKD患者心脏结构和功能改变密切相关,其可能参与CKD患者心血管事件的发生.     

Risk factors for cardiovascular and cerebrovascular morbidity and mortality in maintenance hemodialysis patients

Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease (CCVD) in maintenance hemodialysis (MHD) patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 3rd Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1st, 2009 to Dec 31st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of (53.2±16.4) years old, and 138 of them were male (56.8%). The multivariate Cox proportional model revealed that age (HR=1.040, 95%CI: 1.015-1.065, P=0.002), Erythropoietin (EPO) dose (HR=0.914, 95%CI: 0.846-0.987, P=0.022) and history of cardiovascular and cerebrovascular disease (HR=4.045, 95%CI: 2.074-7.890, P＜0.001) were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time-dependent serum phosphorus level (HR=1.722, 95%CI: 1.034-2.866, P=0.037) was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovascular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.     

原发性肝癌术后超声引导下经皮经肝门静脉穿刺化疗安全性分析

目的 研究原发性肝癌术后超声引导下经皮经肝门静脉穿刺化疗安全性.方法 总结2004年1～10月实施的原发性肝癌术后行超声引导下经皮经肝门静脉穿刺化疗病例,分析其术后常见并发症及其预防及处理措施.结果 共有524例原发性肝癌病人在肝切除手术后接受了超声引导下经皮经肝门静脉穿刺化疗,累及实施1865例次.共发生穿刺操作相关性并发症149例次,并发症发生率为79.89‰(149/1865),其中包括术后穿刺点疼痛118例次(118/1865,63.27％0),肝包膜下出血3例次(3/1865,1.61‰),腹腔出血2例次(2/1865,1.07‰),胆汁漏6例次(6/1865,2.54‰),门静脉血栓形成8例次(8/1865,4.29％0),导管相关性感染4例次(4/1865,2.14‰),气胸3例次(3/1865,1.61％0),导管脱落5例次(5/1865,2.68‰).化疗相关并发症587例次(587/1865,31.47％),其中包括胃肠道不良反应385例次(385/1865,20.64％),白细胞减少121例次(385/1865,20.64％),转氨酶升高62例次(62/1865,3.32％),皮疹11例次(11/1865,5.90％),其他8例次(8/1865,4.29％).所有并发症经保守治疗后均痊愈,未有致死性并发症.结论 肝癌术后超声引导下经皮经肝门静脉穿刺化疗操作简单、安全,术后并发症发生率在可接受范围.     

Ex vivo treatment of proliferating human cord blood stem cells with stroma-derived factor-1 enhances their ability to engraft NOD/SCID mice

Ex vivo proliferation of hematopoietic stem cells (HSCs) is important for cellular and gene therapy but is limited by the observation that HSCs do not engraft as they transit S/G(2)/M. Recently identified candidate inhibitors of human HSC cycling are transforming growth factor-beta(1) (TGF-beta(1)) and stroma-derived factor-1 (SDF-1). To determine the ability of these factors to alter the transplantability of human HSCs proliferating in vitro, lin(-) cord blood cells were first cultured for 96 hours in serum-free medium containing Flt3 ligand, Steel factor, interleukin-3, interleukin-6, and granulocyte colony-stimulating factor. These cells were then transferred to medium containing Steel factor and thrombopoietin with or without SDF-1 and/or TGF-beta(1) for 48 hours. Exposure to SDF-1 but not TGF-beta(1) significantly increased (> 2-fold) the recovery of HSCs able to repopulate nonobese diabetic/severe combined immunodeficiency mice. These results suggest new strategies for improving the engraftment activity of HSCs stimulated to proliferate ex vivo.