低氧血症新生儿循环内皮细胞数量的变化及其临床意义

目的：探讨低氧血症新生儿外周血循环内皮细胞（CECs）水平变化及其临床意义。方法采用 Hladovec 计数法测定40例不同程度缺氧的低氧血症患儿（低氧血症组）及20例血氧分压正常的健康新生儿（对照组）外周血 CECs 数量。结果低氧血症组 CECs 为（0．910±0．422）×106／L 与对照组比较,高于对照组的（0．180±0．100）×106／L,差异有统计学意义（t＝7．539, P ＜0．05）;中度低氧血症组 CECs 为（1．140±0．135）×106／L,高于轻度低氧血症组的（0．540±0．127）×106／L,差异有统计学意义（t＝13．43,P ＜0．05）;重度低氧血症组 CECs 为（1．660±0．114）×106／L,高于中度低氧血症组的（1．140±0．135）×106／L,差异有统计学意义（t＝7．698,P ＜0．05）。结论外周血 CECs 数量可反映低氧血症患儿缺氧严重程度,可作为低氧血症的早期诊断指标,为临床早期诊断、病情判断及疗效评估提供新的判断依据。     

关节镜下滑膜切除术治疗局限型膝关节色素沉着绒毛结节性滑膜炎的临床分析

【摘要】 目的 探讨关节镜下治疗局限型膝关节色素沉着绒毛结节性滑膜炎(PVNS)的方法及疗效。方法 回顾性分析2008年9月~2014年5月在我院术前行MRI检查、术后经病理证实的10例色素着绒毛结节性滑膜炎患者的临床资料及治疗方法,并对患者进行跟踪随访9~68个月,采用Lysholm膝关节功能评分了解患者术后患膝疼痛、肿胀及活动度等功能恢复情况。结果 10例患者在术后随访期均无并发症发生,复发2例,Lysholm 膝关节功能评分为91.80±5.28分,明显高于术前(P<0.01)。结论〓关节镜下对局限型色素沉着绒毛结节性滑膜炎的患者实施滑膜切除术,手术创伤小,术后膝关节功能恢复好,是一种安全有效的治疗膝关节局限型色素沉着绒毛结节性滑膜炎的方法。     

偏心改向髋臼内衬的设计与模拟手术

目的：设计出偏心改向髋臼内衬,以解决臼杯位置不良时内衬补救或翻修,及小髋臼关节置换问题。方法在Solidworks2012软件平台上,利用三维实体建模技术,设计一套偏心改向髋臼内衬,并进行模拟手术,预测手术效果。结果成功设计出一套偏心改向髋臼内衬,改向规格有0°、10°、20°、30°;偏心规格有球心偏向非负重侧2 mm的外径／内径的比值分别为42 mm／28 mm、40 mm／28 mm和38 mm／24 mm、36 mm／24 mm四种。模拟手术显示髋关节置换或翻修术后防脱位效果和活动范围。结论偏心改向髋臼内衬设计合理,用于臼杯位置不良时内衬补救或翻修及小髋臼大球头置换,模拟手术提示有防脱位功能。     

Spinal Cord Kinking in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

Background:

Ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy. This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF.

Methods:

The data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively. The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI). The clinical presentation and radiological characteristics in patients with SK were analyzed. Posterior en bloc laminectomy with OLF was performed, and the surgical results were evaluated.

Results:

SK was found in seven patients (7.4%) based on preoperative MRI. The patients included one male and six females with an average age of 55.6 years (range, 48–64 years). Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis. In all cases, the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF. The degree of SK varied from mild to severe. The tip of the CM was located between the upper third of T11 to the lower third of L1, above the lower edge of L1. With an average follow-up of 30.4 months, the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t = 12.05; P < 0.0001) with an improvement rate of 63.1 ± 12.3%.

Conclusions:

SK is a rare radiological phenomenon. It is typically located at the thoracolumbar junction, where the CM is compressed by the OLF. Our findings indicate that these patients may benefit from a posterior decompressive procedure.     

不同剂量芬太尼麻醉对小儿唇腭裂手术中平均动脉压及心率的影响

目的:研究不同剂量芬太尼麻醉对小儿唇腭裂手术患儿血流动力学参数及苏醒过程的影响。方法:随机选取60例先天性唇腭裂手术患儿,平均分为A、B、C三组,每组20例,分别给予芬太尼3、5、7μg/kg,观察患儿心率(HR)、平均动脉压(MAP)、苏醒时间以及嗜睡、躁动、恶心呕吐等不良反应情况。结果:3组中,B组患儿在麻醉过程中血流动力学参数(HR和MAP)最稳定,不同时点间差异无统计学意义(P<0.05);B组患儿苏醒时间平均(18.9±5.6)min,居A、C两组之间,不良反应较少,其中嗜睡1例,躁动2例,恶心呕吐病例1例。结论:小儿唇腭裂手术麻醉诱导时用5μg/kg剂量的芬太尼,可以维持稳定的血流动力学,更安全。     

膜联蛋白A7与IGFBP2结合抑制肝癌细胞增殖

目的 分析膜联蛋白A7(ANXA7)与肝癌发生的相关性及筛选、鉴定ANXA7的相互作用分子,探讨ANXA7在肝癌发生中的机制.方法 通过实时定量PCR法检测48对肝癌与癌旁组织以及多种肝和肝癌细胞株中ANXA7表达量的差异,并通过肝癌细胞ANXA7过表达及特异性干扰抑制分析其对肝癌细胞增殖的影响.采用免疫共沉淀法筛选与ANXA7发生结合的蛋白,并以点突变法分析蛋白质相互作用的关键位点;用蛋白免疫印迹法分析了ANXA7对肝癌相关的重要信号通路中ERK1/2磷酸化水平的影响.结果 ANXA7在肝癌组织与肝癌细胞中均呈下调表达.胰岛素样生长因子结合蛋白2(insulin-like growth factor binding protein 2,IGFBP2)能与ANXA7蛋白发生特异性结合,且IGFBP2上的RGD序列是两者结合的关键位点.肝癌细胞中ANXA7表达上调能抑制肿瘤细胞增殖(P＜0.05),并能使IGFBP2介导的ERK1/2的磷酸化水平降低.下调ANXA7的表达可促进肝癌细胞增殖(P＜0.01),磷酸化ERK1/2的水平升高.结论 ANXA7可能作为一种抑癌基因,通过介导IGFBP2对ERK1/2磷酸化水平的影响参与对肝癌增殖的调控.     

Memory Dysfunction in Type 2 Diabetes Mellitus Correlates with Reduced Hippocampal CA1 and Subiculum Volumes

Background:

Little attention has been paid to the role of subcortical deep gray matter (SDGM) structures in type 2 diabetes mellitus (T2DM)-induced cognitive impairment, especially hippocampal subfields. Our aims were to assess the in vivo volumes of SDGM structures and hippocampal subfields using magnetic resonance imaging (MRI) and to test their associations with cognitive performance in T2DM.

Methods:

A total of 80 T2DM patients and 80 neurologically unimpaired healthy controls matched by age, sex and education level was enrolled in this study. We assessed the volumes of the SDGM structures and seven hippocampal subfields on MRI using a novel technique that enabled automated volumetry. We used Mini-Mental State Examination and Montreal Cognitive Assessment (MoCA) scores as measures of cognitive performance. The association of glycosylated hemoglobin (HbA1c) with SDGM structures and neuropsychological tests and correlations between hippocampal subfields and neuropsychological tests were assessed by partial correlation analysis in T2DM.

Results:

Bilaterally, the hippocampal volumes were smaller in T2DM patients, mainly in the CA1 and subiculum subfields. Partial correlation analysis showed that the MoCA scores, particularly those regarding delayed memory, were significantly positively correlated with reduced hippocampal CA1 and subiculum volumes in T2DM patients. Additionally, higher HbA1c levels were significantly associated with poor memory performance and hippocampal atrophy among T2DM patients.

Conclusions:

These data indicate that the hippocampus might be the main affected region among the SDGM structures in T2DM. These structural changes in the hippocampal CA1 and subiculum areas might be at the core of underlying neurobiological mechanisms of hippocampal dysfunction, suggesting that degeneration in these regions could be responsible for memory impairments in T2DM patients.     

Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background:

Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation.

Methods:

Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years.

Results:

After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm² vs. 0.9 ± 0.3 cm², P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm² vs. 14.2 ± 6.5 cm², P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm² vs. 25.4 ± 4.3 cm², P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15.5 mmHg, P < 0.01). The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years (average 75 ± 32 months), 2 patients with severe regurgitation died (1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively), 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative (1.4 ± 0.4 cm² vs. 1.7 ± 0.3 cm², P < 0.05); LAD slightly increased compared with the postoperative (45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P < 0.05), RAD slightly also increased compared with the postoperative (36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P < 0.05), but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant (P > 0.05). The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05), the remaining patients without serious complications.

Conclusions:

PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.     

Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

Background:

Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy. This study was to compare two tests, light transmittance aggregometry (LTA) and modified thrombelastography (mTEG), for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention (PCI).

Methods:

Prospective, observational, single-center study of 789 Chinese patients undergoing PCI was enrolled. This study was investigated the correlations between the two tests and performed receiver operating characteristic curve (ROC) analysis for major adverse cardiovascular events (MACEs) at 1-year follow-up.

Results:

MACEs occurred in 32 patients (4.1%). Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity (Spearman r = 0.733, P < 0.001). ROC-curve analysis demonstrated that LTA (area under the curve [AUC]: 0.677; 95% confidence interval [CI]: 0.643–0.710; P = 0.0009), and mTEG (AUC: 0.684; 95% CI: 0.650–0.716; P = 0.0001) had moderate ability to discriminate between patients with and without MACE. MACE occurred more frequently in patients with high on-treatment platelet reactivity (HPR) when assessed by LTA (7.4% vs. 2.7%; P < 0.001), and by TEG (6.7% vs. 2.6%; P < 0.001). Kaplan–Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up.

Conclusions:

The correlation between LTA and mTEG is relatively high in Chinese patients. HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.