锁定钢板与动力髋螺钉治疗老年股骨粗隆粉碎性骨折疗效分析

目的：评价锁定钢板治疗股骨粗隆粉碎性骨折的临床疗效。方法对我科2009年至2013年就诊的115例老年股骨粗隆粉碎性骨折患者随机分为：观察组58例应用锁定钢板;对照组57例应用动力髋螺钉,手术后通过至少6个月的观察和随访并进行Sanders髋关节等级评分,比较分析其临床治疗效果。结果观察组总满意率为96.6%（56/58）,对照组78.9%（51/57）,有统计学意义（P＜0.01）。结论锁定钢板治疗股骨粗隆粉碎性骨折疗效比较确切,具有良好的临床应用价值,值得借鉴和推广。     

急性冠脉综合症患者住院期和出院后脑卒中的患病危险因素研究--GRACE研究

背景脑卒中是急性心肌梗塞的一个重要并发症,但有关急性冠脉综合症(acutecoronarysyndrome,ACS)患者中脑卒中的发生率和结局的报道很少。本研究探讨了ACS患者发生出血性和非出血性脑卒中的危险因素。方法和结果研究对象为急性冠脉事件全球性登记研究(GlobalRegistry0fAcuteCoronaryEvents,GRACE)入选的35,233名ACS患者。住院期间发生脑卒中310冽(0.9%),其中100例死亡(占32.6%)。ST段抬高的心肌梗塞患者住院期间的脑卒中发生率显著高于非ST段抬高的心肌梗塞患者以及不稳定型心绞痛(分别为1.3%,0.9%,0.5%;P<0.001)。有35.50A,的脑卒中发生在入院6天内。增加住院期间非出血性卒中的最重要危险因素是冠脉搭桥术(CABG),其次是住院期间发生房颤、脑卒中史、谷草转氨酶和高龄。服用他汀类药物是一个保护因素。校正混杂因素后,脑卒中显著增加ACS患者的住院死亡率达8.3倍(95%可信区间:6.0-11.4)。出院后的ACS患者发生脑卒中者有269例(占1.1%),其中56例死亡(占20.9%)。住院期间发生过脑卒中是增加出院后脑卒中的最重要危险因素。结论脑卒中在ACS患者中的发生率并不高,但有很高的死亡率。出院后脑卒中的发生率也较高,因此有待采取新措施以降低ACS患者发生脑卒中的危险。简介:GRACE研究-GlobalRegistryofAcuteCoronaryEvents,急性冠脉事件全球性登记研究,是一项国际多中心针对ACS患者进行的登记研究,随访6个月。研究设计为非随机化的观察性研究,研究者为FoxKAA,GoodmanSG,KleinW,etal.GRACE研究主要研究急性冠脉综合征的对策,不同治疗措施及其临床后果的差异,为急性冠脉综合征患者提供充分有力的人群水平的治疗资料。     

剖宫产术后再次妊娠经阴道分娩的临床观察

目的探讨剖宫产术后再次妊娠经阴道分娩(vaginal birth after cesarean,VBAC)的可行性。方法选取2010~2012年江苏省海门市中医院98例VBAC孕妇为观察组,选取同期住院的96例初产妇为对照组,分析比较两组产妇在分娩结局、围产儿结局、并发症上的差异。结果观察组分娩成功率[57.1%(56/98)]、分娩时间(9.9±0.6)h、并发症发生率[7.1%(7/98)]、产时出血量(281.9±13.4)m L、新生儿窒息发生率[2.0%(2/98)]、产妇满意率[96.9%(95/98)]等方面与对照组[分别为59.4%(57/96)、(9.7±0.7)h、5.2%(5/96)、(284.5±12.3)m L、3.1%(3/96)、94.8%(91/96)]比较,差异均无统计学意义(P0.05)。结论严格按照适应证选择,剖宫产术后瘢痕子宫再次妊娠经阴道分娩是可行的。     

Strawberry Phytochemicals Inhibit Azoxymethane/Dextran Sodium Sulfate-Induced Colorectal Carcinogenesis in Crj: CD-1 Mice

Human and experimental colon carcinogenesis are enhanced by a pro-inflammatory microenvironment. Pharmacologically driven chemopreventive agents and dietary variables are hypothesized to have future roles in the prevention of colon cancer by targeting these processes. The current study was designed to determine the ability of dietary lyophilized strawberries to inhibit inflammation-promoted colon carcinogenesis in a preclinical animal model. Mice were given a single i.p. injection of azoxymethane (10 mg kg⁻¹ body weight). One week after injection, mice were administered 2% (w/v) dextran sodium sulfate in drinking water for seven days and then an experimental diet containing chemically characterized lyophilized strawberries for the duration of the bioassay. Mice fed control diet, or experimental diet containing 2.5%, 5.0% or 10.0% strawberries displayed tumor incidence of 100%, 64%, 75% and 44%, respectively (p < 0.05). The mechanistic studies demonstrate that strawberries reduced expression of proinflammatory mediators, suppressed nitrosative stress and decreased phosphorylation of phosphatidylinositol 3-kinase, Akt, extracellular signal-regulated kinase and nuclear factor kappa B. In conclusion, strawberries target proinflammatory mediators and oncogenic signaling for the preventive efficacies against colon carcinogenesis in mice. This works supports future development of fully characterized and precisely controlled functional foods for testing in human clinical trials for this disease.     

Bilateral Adie’s Tonic Pupil and Hyperopic Shift in Idiopathic Sclerochoroidal Calcification

Sclerochoroidal calcification is a rare but recognised ophthalmic manifestation seen mostly in elderly Caucasian individuals. The lesions, often bilateral, appear as yellow-white irregular subretinal lesions usually found along the mid-peripheral fundus. Though typically asymptomatic, sclerochoroidal calcification has rarely been associated with parafoveal involvement, choroidal neovascularisation, and serous detachment of the calcifications. Visual involvement is typically minimal, and neovascularisation is often visually insignificant. We present a rare case of sclerochoroidal calcification in a 64-year-old Caucasian female who presented with painless progressive bilateral vision loss and a hyperoptic shift with subsequent development of bilateral sequential Adie’s tonic pupil. To the best of our knowledge, this is the first such report in the English language literature.     

Gene–gene interaction of CFH,ARMS2, and ARMS2/HTRA1 on the risk of neovascular age-related macular degeneration and polypoidal choroidal vasculopathy in Chinese population

Purpose

To evaluate the association and interaction of five single-nucleotide polymorphisms (SNPs) in three genes (CFH, ARMS2, and ARMS2/HTRA1) with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) in Chinese population.

Methods

A total of 300 nAMD and 300 PCV patients and 301 normal subjects participated in the present study. The allelic variants of rs800292, rs2274700, rs3750847, rs3793917, and rs1065489 were determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Gene–gene interactions were evaluated by the data mining approach multifactor-dimensionality reduction (MDR) method.

Results

The risk alleles of CFH rs800292, rs2274700, ARMS2 rs3057847, and ARMS2/HTRA1 rs3793917 showed significant difference between nAMD or PCV patients and controls (all P<0.01). The homozygosity of risk alleles for rs800292, rs2274700, rs3750847, and rs3793917 were significantly different between nAMD patients and controls (all P<0.01), and predisposed to PCV patients (all P<0.01). After cross-validation consistency (CVC) and permutation tests, the two-locus model rs2274700_rs3750847 has a balanced accuracy of 64.37% in predicting nAMD disease risk. The one-marker model, rs3750847, and two-locus model rs2274700_rs3750847 has a balanced accuracy of 66.07% and 65.89% in predicting PCV disease risk, respectively. Furthermore, CFH rs1065489 did not show significant association with nAMD (P>0.01), but was strongly associated with PCV in Chinese patients (P<0.001).

Conclusions

In this study, we found that the interaction of ARMS2 and ARMS2/HTRA1 is significantly associated with nAMD, and the interaction of CFH and ARMS2 is pronounced in PCV development in Chinese population.     

骨髓增殖性肿瘤治疗进展:第56届美国血液学会年会报道

近年对bcr-abl阴性的骨髓增殖性肿瘤的发病机制、诊断、风险分层及治疗等方面的研究取得了长足进展,文章就2014年第56届美国血液学会(ASH)年会上关于bcr-abl阴性的骨髓增殖性肿瘤治疗进展等内容作一介绍.