108例创伤性动静脉瘘的介入诊疗分析

目的分析创伤性动静脉瘘（AVF）的临床特点、造影表现、造影技术及治疗方式的选择。方法回顾性分析纽约Kings County医疗中心25年间全部确诊的108例创伤性AVF的介入相关诊疗资料。分析内容包括患者外伤种类、临床表现、损伤部位、血管造影异常特征、AVF血流动力学特征（分5个类型）、治疗方式的选择等。结果 108例患者中共发现117处AVF,大多数患者临床特征不明确。创伤种类包括枪伤（导致72处AVF）、刺伤（24处）、钝性伤（8处）、高处坠落伤（3处）、医源性损伤（2处）。损伤部位常见于肢体（46例）、颈部（19例）、肝脏（13例）和锁骨下血管（11例）。所有病变均可见静脉早显,显示动脉横断52处,撕裂37处,49.6%的AVF与假性动脉瘤有关。最常见的血流特点是Ⅰ型,即瘘口所在的动脉近段和远段、静脉的近段和远段都显示,伴远侧段静脉瓣功能不全,共40处瘘（34.2%）,其次是Ⅲ型22个（18.8%）,Ⅴ型最不常见（4.3%）。34例接受手术治疗,61例栓塞治疗,7例临床观察。分别采用弹簧圈（47例）、明胶海绵（9例）、无水乙醇（3例）、可脱球囊（2例）,其中弹簧圈效果理想、并发症少。6例采用覆膜支架效果好。结论血管造影是诊断创伤性AVF的金标准,造影时准确观察动脉损伤的性质,瘘口的解剖和血流特点及所有进入瘘口的动脉分支,对于选择治疗方式及保证介入治疗的成功完成至关重要。     

The psychometric properties of three self-report screening instruments for identifying frail older people in the community

Background  

Frailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. Therefore, disability prevention in community-dwelling frail older people is considered to be a priority for research and clinical practice in geriatric care. With regard to disability prevention, valid screening instruments are needed to identify frail older people in time. The aim of this study was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added.     

人血清脱金属铁传递蛋白裂解焦磷酸键的研究

目的:测定人血清脱金属铁传递蛋白裂解焦磷酸键的反应速率常数.方法:应用31P NMR技术,在不同pH值及不同浓度MgCl2存在条件下,测定了脱金属铁传递蛋白与焦磷酸二钠反应的核磁共振图谱,根据焦磷酸盐的摩尔浓度(对应于其谱峰强度)随时间的变化情况,应用动力学公式对数据进行拟合.结果:当人血清脱金属铁传递蛋白(0.5～1.0 mmol/L)与焦磷酸盐的反应摩尔浓度比为15时,在312 K条件下,反应速率常数分别为:8.83×10-4 L·mmol-1·h-1(pH 6.85)、9.59×10-4 L·mmol-1·h-1(pH 7.40)和1.38×10-3 L·mmol-1·h-1(pH 8.15).在2 mmol/L MgCl2存在时,pH 7.40、312 K条件下,反应速率常数为1.21×10-3L·mmol-1·h-1.结论:人血清脱金属铁传递蛋白能缓慢地将焦磷酸根裂解为磷酸根,反应具有二级反应动力学性质,Mg2 对该裂解反应有弱催化作用.     

Preventing mother-to-child transmission of HIV

HIV transmission from mother-to-child remains a major cause of infant morbidity and mortality in resource-poor settings. There is consensus that women who need antiretroviral treatment should receive this during pregnancy and beyond, and that an appropriate antiretroviral prophylactic regimen should be given to those who do not yet need ongoing therapy. Infant feeding remains a major source of infection and new antiretroviral strategies, for mothers or children, are emerging with the potential to control this. Access to HIV testing and antiretroviral treatment or prophylaxis remain very limited in low resource settings and needs to be expanded.     

Concerns about anti-angiogenic treatment in patients with glioblastoma multiforme

Background  

The relevance of angiogenesis inhibition in the treatment of glioblastoma multiforme (GBM) should be considered in the unique context of malignant brain tumours. Although patients benefit greatly from reduced cerebral oedema and intracranial pressure, this important clinical improvement on its own may not be considered as an anti-tumour effect.     

Why screen for cystic fibrosis? A clinician's view

Cystic fibrosis (CF) is relatively common, serious, and causes progressive lung damage. Clinical diagnosis may be delayed until lung damage has occurred, and infection may start as early as six weeks of life. A well organised screening programme should identify the great majority of affected infants within the first three weeks after birth, which leaves a small time window during which effective preventive treatment and surveillance may be instituted. Active treatment, whether for screened or unscreened infants, improves clinical status and long-term survival of CF patients. It is anticipated that new treatments will become available within the next few years, and these will clearly give maximal benefit to young infants if instituted before lung damage is evident. In addition to any hypothetical effects on morbidity and survival, pre-symptomatic diagnosis greatly improves the doctor-parent relationship. Economic arguments may be distorted, but, at best, screening is cost-beneficial, and, at worst, it is cost-neutral. The overwhelming majority of CF professionals and parents universally support neonatal screening, so the onus is therefore on those who oppose screening to prove that their approach offers a superior strategy.     

DEEP VEIN THROMBOSIS AS A PRESENTING SYMPTOM OF CONGENITAL INTERRUPTION OF THE INFERIOR VENA CAVA

Intrahepatic interruption of the inferior vena cava is a congenital anomaly, resulting in venous drainage of the lower extremities by way of a compensatory enlarged vena azygos system. We report the case of a 37-year-old male who presented with symptoms of deep vein thrombosis of the entire right lower extremity. A right-sided mediastinal mass on the chest X-ray was mistaken for a haematological malignancy but proved later to represent an enlarged azygos vein. The case illustrates that in a case of deep vein thrombosis, especially in younger patients, interruption of the inferior vena cava should be considered. A right-sided paratracheal mass on the chest X-ray may give a clue in making the correct diagnosis.