脾切除术后凝血机制的变化对骨折手术治疗的影响

目的 探讨骨折合并脾破裂的患者,脾脏切除术后凝血功能的异常对骨折治疗的影响.方法 脾切除术后,严密监测凝血功能,尤其是纤维蛋白原(Fbg)和D-二聚体(D-Dimer)及血小板的变化.结果 骨折合并脾破裂的患者,脾切除后,多数会出现高凝状态,表现为血小板数量升高,纤维蛋白原和D-二聚体阳性而影响骨折的治疗.结论 骨折合并脾破裂的患者,脾切除术后,多数会出现高凝状态,必须动态监测凝血功能,主要是血小板,Fbg及D-Dimer,必要时给予药物治疗,以防止血栓形成而影响骨折的手术治疗.     

Intrathecal morphine remotely preconditions the heart via a neural pathway

ABSTRACT:: Central opioid receptor activation triggers cardioprotection against ischemia reperfusion injury, independent of peripheral opioid receptor activity. Using a rodent model of myocardial ischemia reperfusion injury with infarct size as the primary outcome, we tested the hypothesis that spinal opioids confer this beneficial effect via a neural pathway. Intrathecal morphine reduced the infarct size compared with control (23% ± 7% vs. 58% ± 3%, respectively, P < 0.01). Prior antagonism of the autonomic pathway, and the receptors for bradykinin, calcitonin gene-related peptide, and the KATP channel, respectively, abolished this cardioprotection (54% ± 13%, 52% ± 10%, 56% ± 9%, and 49% ± 8%, respectively, P < 0.05). In a second set of experiments, we demonstrated that the increased expression of myocardial phosphorylated-Akt and endothelial nitric oxide synthase induced by intrathecal morphine was blocked by prior administration of hexamethonium. These findings support the notion that spinal opioid receptors stimulate a neural pathway that uses nonopioid neurotransmitters to confer cardioprotection from ischemia reperfusion injury. The use of intrathecal morphine for this purpose has potential clinical application, and it is already being used in the perioperative period to provide prolonged analgesia.     

Collagen-related genes influence the glaucoma risk factor, central corneal thickness

Central corneal thickness (CCT) is a risk factor of glaucoma, the most common cause of irreversible blindness worldwide. The identification of genetic determinants affecting CCT in the normal population will provide insights into the mechanisms underlying the association between CCT and glaucoma, as well as the pathogenesis of glaucoma itself. We conducted two genome-wide association studies for CCT in 5080 individuals drawn from two ethnic populations in Singapore (2538 Indian and 2542 Malays) and identified novel genetic loci significantly associated with CCT (COL8A2 rs96067, p(meta) = 5.40 × 10?13, interval of RXRA-COL5A1 rs1536478, p(meta) = 3.05 × 10??). We confirmed the involvement of a previously reported gene for CCT and brittle cornea syndrome (ZNF469) [rs9938149 (p(meta) = 1.63 × 10?1?) and rs12447690 (p(meta) = 1.92 × 10?1?)]. Evidence of association exceeding the formal threshold for genome-wide significance was observed at rs7044529, an SNP located within COL5A1 when data from this study (n = 5080, P = 0.0012) were considered together with all published data (reflecting an additional 7349 individuals, p(Fisher) = 1.5 × 10??). These findings implicate the involvement of collagen genes influencing CCT and thus, possibly the pathogenesis of glaucoma.     

Association of variants in FRAP1 and PDGFRA with corneal curvature in Asian populations from Singapore

Corneal curvature (CC) is a key determinant of major eye diseases, such as keratoconus, myopia and corneal astigmatism. No prior studies have discovered the genes for CC. Here we report the findings from four genome-wide association studies of CC in 10 008 samples from three population groups in Singapore. Our discovery phase surveyed 2867 Chinese and 3072 Malays, allowing us to identify two loci that were associated with CC variation: FRAP1 on chromosome 1p36.2 and PDGFRA on chromosome 4q12. These findings were subsequently replicated in a validation study involving an additional 2953 Asian Indians and a further collection of 1116 Chinese children. The effect sizes of the identified variants were consistent across all four cohorts, with seven single nucleotide polymorphisms (SNPs) in FRAP1 (lead SNP: rs17036350, meta P-value = 4.06 × 10(-13)) and six SNPs in PDGFRA (lead SNP: rs2114039, meta P-value = 1.33 × 10(-9)) attaining genome-wide significance in the SNP-based meta-analysis of the four studies. This is the first genome-wide survey of CC variation and we have identified two implicated loci in three genetically diverse Asian populations, suggesting the presence of common genetic etiology across multiple populations.     

A rare case of adult Wilms' tumor

Although Wilms tumor is the most common primary renal malignancy in children, it is exceedingly rare in adults and has an estimated incidence of less than 0.2 cases per million. Little is known about the biology of this tumor in adults and clinicians have had to rely on pediatric treatment protocols. Overall, prognosis is worse in adults, though like in children, unfavorable histology and higher stage at presentation confer a worse prognosis.