Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair

Objective: Limited availability and durability of allograft conduits require that alternatives be considered. We compared bovine jugular venous valved (JVV) and allograft conduit performance in 107 infants who survived truncus arteriosus repair. Methods: Children were prospectively recruited between 2003 and 2007 from 17 institutions. The median z-score for JVV (n = 27, all 12 mm) was +2.1 (range +1.2 to +3.2) and allograft (n = 80, 9–15 mm) was +1.7 (range −0.4 to +3.6). Propensity-adjusted comparison of conduit survival was undertaken using parametric risk-hazard analysis and competing risks techniques. All available echocardiograms (n = 745) were used to model deterioration of conduit function in regression equations adjusted for repeated measures. Results: Overall conduit survival was 64 ± 9% at 3 years. Conduit replacement was for conduit stenosis (n = 16) and/or pulmonary artery stenosis (n = 18) or regurgitation (n = 1). The propensity-adjusted 3-year freedom from replacement for in-conduit stenosis was 96 ± 4% for JVV and 69 ± 8% for allograft (p = 0.05). The risk of intervention or replacement for branch pulmonary artery stenosis was similar for JVV and allograft. Smaller conduit z-score predicted poor conduit performance (p < 0.01) with best outcome between +1 and +3. Although JVV conduits were a uniform diameter, their z-score more consistently matched this ideal. JVV exhibited a non-significant trend towards slower progression of conduit regurgitation and peak right ventricular outflow tract (RVOT) gradient. In addition, catheter intervention was more successful at slowing subsequent gradient progression in children with JVV versus those with allograft (p < 0.01). Conclusions: JVV does match allograft performance and may be advantageous. It is an appropriate first choice for repair of truncus arteriosus, and perhaps other small infants requiring RVOT reconstruction.     

新型冠状病毒肺炎中医康复专家共识(第一版)

为了有效减轻新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者的症状、提高出院率及促进出院后身心健康的全面恢复,世界中医药学会联合会肺康复专业委员会和中国民族医药学会肺病分会组织专家,参照国际上公认的共识形成方法,制订了《新型冠状病毒肺炎中医康复专家共识》(第一版),其主要内容包括功法训练(八段锦、简式太极拳、呼吸导引和六字诀)、针刺与灸法(针刺、艾灸、耳针和穴位贴敷)、推拿/按摩(穴位按摩、经络推拿)、刮痧、拔罐、膳食指导和情志疗法,并介绍了推荐要点及证据概述。为中医康复技术在COVID-19治疗中的合理选择及规范应用提供了参考。     

用有限单元法分析固定桥受载的应力分布

作者用平面有限单元法,对下颌第一磨牙缺失的固定桥进行七种垂直向和两种斜向受载的基牙牙槽骨的应力分布进行了研究,得出定量分析的结果,并绘出牙周组织应力值的曲线图。作者认为:①从固定桥的七种垂直受载情况看,均为第二双尖牙根尖的近中部受到较大的压应力。以两个基牙和桥体同时受载时,应力为最大,σ_2为-120.0,而磨牙牙周组织应力分布较均匀。②固定桥桥体受斜向载荷时,双尖牙根尖的近中部受拉应力和压应力,以压应力为最大,σ_2为-75.0。③磨牙是固定桥的理想基牙。     

Effect of Alendronate on Risk of Fracture in Women With Low Bone Density but Without Vertebral Fractures: Results From the Fracture Intervention Trial

Context.— Alendronate sodium reduces fracture risk in postmenopausal women who have vertebral fractures, but its effects on fracture risk have not been studied for women without vertebral fractures. Objective.— To test the hypothesis that 4 years of alendronate would decrease the risk of clinical and vertebral fractures in women who have low bone mineral density (BMD) but no vertebral fractures. Design.— Randomized, blinded, placebo-controlled trial. Setting.— Eleven community-based clinical research centers. Subjects.— Women aged 54 to 81 years with a femoral neck BMD of 0.68 g/cm² or less (Hologic Inc, Waltham, Mass) but no vertebral fracture; 4432 were randomized to alendronate or placebo and 4272 (96%) completed outcome measurements at the final visit (an average of 4.2 years later). Intervention.— All participants reporting calcium intakes of 1000 mg/d or less received a supplement containing 500 mg of calcium and 250 IU of cholecalciferol. Subjects were randomly assigned to either placebo or 5 mg/d of alendronate sodium for 2 years followed by 10 mg/d for the remainder of the trial. Main Outcome Measures.— Clinical fractures confirmed by x-ray reports, new vertebral deformities detected by morphometric measurements on radiographs, and BMD measured by dual x-ray absorptiometry. Results.— Alendronate increased BMD at all sites studied (P<.001) and reduced clinical fractures from 312 in the placebo group to 272 in the intervention group, but not significantly so (14% reduction; relative hazard [RH], 0.86; 95% confidence interval [CI], 0.73-1.01). Alendronate reduced clinical fractures by 36% in women with baseline osteoporosis at the femoral neck (>2.5 SDs below the normal young adult mean; RH, 0.64; 95% CI, 0.50-0.82; treatment-control difference, 6.5%; number needed to treat [NNT], 15), but there was no significant reduction among those with higher BMD (RH, 1.08; 95% CI, 0.87-1.35). Alendronate decreased the risk of radiographic vertebral fractures by 44% overall (relative risk, 0.56; 95% CI, 0.39-0.80; treatment-control difference, 1.7%; NNT, 60). Alendronate did not increase the risk of gastrointestinal or other adverse effects. Conclusions.— In women with low BMD but without vertebral fractures, 4 years of alendronate safely increased BMD and decreased the risk of first vertebral deformity. Alendronate significantly reduced the risk of clinical fractures among women with osteoporosis but not among women with higher BMD.      

急性肺水肿是输液相关性死亡的主要原因

目的探讨输液相关性死亡的病理学特点及死亡原因.方法对1990年～2001年间医疗纠纷尸检档案中28例输液相关性死亡的资料进行分析.结果输液过程中死亡以中老年男性为主,输液相关死亡多发生在基层医疗单位内科性质科室.死亡多发生在输液4 h内,绝大多数患者在临死前有呼吸困难的表现.尸检发现死者大体呈溺死肺样改变,重量增加1～2倍.结论输液引起死亡的原因以急性肺水肿为主,其次为输液过多致动脉瘤破裂.     

The remedial effect of soluble interleukin-1 receptor type Ⅱ on endometriosis in the nude mouse model

Objective： Recent studies have shown that the local expression of soluble interleukin （IL） -1 receptor type Ⅱ （slL-1 R Ⅱ ） in endometrial tissue of women with endometriosis is decreased, and the depression of IL-1 R Ⅱ was more significant in infertile women than that in fertile women with endometriosis. In this research, we investigated the remedial effect of slL-1-R Ⅱ administration on endometriosis in the nude mouse model. Methods： Nineteen nude model mice with endometriosis were randomly divided into three groups： group A was treated by intraperitoneal administration with only slL-1 R Ⅱ for two weeks, group B was similarly treated with only IL- 1, and group C （control） was administered saline. After 2 weeks, the size of the ectopic endometrial lesions was calculated, and the expression of vascular endothelial growth factor （VEGF） and B-cell lymphoma leukemia-2 （Bcl- 2） were detected by immunohistochemistry. The IL-8 and VEGF levels in the peritoneal fluid （PF） and serum were also measured by enzyme-linked immunosorbent assay （ELISA）. Results： The mean size of ectopic endometrial lesion did not differ between the three groups （P 〉 0.05）. Compared with the control, the expression of VEGF and Bcl-2 was significantly lower in group A, and higher in group B. In the three groups, the levels of IL-8 in the PF and serum were highest in group A, and lowest in group B. Conclusion： slL-1 R Ⅱ may suppresse hyperplasia of ectopic endometriosis, perhaps by reducing the expression of certain cytokines, such as VEGF, IL-8, and Bcl-2, which could provide a new clinical strategy for the treatment of endometriosis.     

血脉宁颗粒制备工艺研究

目的 :优选血脉宁颗粒制备工艺。方法 :以黄芪甲苷收率为指标 ,应用正交设计试验优选血脉宁颗粒提取工艺。结果 :影响乙醇渗漉提取的主次因素 :A >B >C(A为乙醇加入量 ;B为提取时间 ;C为乙醇浓度 ) ,优选的提取工艺条件 :乙醇加入量为药材量的 4 8倍 ,乙醇浓度 80 % ,提取 2 4h ;优选的沸腾制粒工艺条件为 :稠浸膏 :糊精=1 5∶1,稠浸膏相对密度为 1 2 0 ,喷液电压为 80伏特 ,每批料抖袋 6 5个周期 (每个抖袋周期来回抖袋 2次 )。结论 :优选的制备工艺稳定可行     

医院质量管理发展现状及展望

卫生改革逐步深化、中国入世给医院带来前所未有的机遇与挑战。论述了当前医院质量管理的研究热点:医疗质量实时控制、持续质量改进、ISO9000质最体系认证、循证医学、临床途径等。介绍了医院质量管理发展趋势:以超严质量要求为目标,数字化管理为基础,持续质量改进和质量管理创新为手段,科学管理和“文化管理”的有机结合为根本。     

技术医学时代与医学教育大基础观

随着技术医学时代的到来,面临新技术革命、社会经济转型、两种文化冲突、医学模式转变多重挑战的２１世纪医学教育,必然由单纯以生命保健科学为主体的医学教育小基础观,转变为以现代自然科学、工程技术科学、人文社会科学和生命保健科学有机统一医学教育大基础观。实现大基础医学教育的现实途径,是改变现行的专科办学模式,通过内涵发展、联合、兼并等办学形式,把医科院校办成医理、医工、医文结合的名符其实的综合性大学。     

Platelet Function and Genotype after DES Implantation in East Asian Patients: Rationale and Characteristics of the PTRG-DES Consortium

PurposePlatelet function test (PFT) results and genotype hold unique prognostic implications in East Asian patients. The aim of the PTRG-DES (Platelet function and genoType-Related long-term proGnosis in Drug-Eluting Stent-treated Patients with coronary artery disease) consortium is to assess the clinical impact thereof on long-term clinical outcomes in Korean patients with coronary artery disease during dual antiplatelet therapy (DAPT) including clopidogrel.Materials and MethodsSearching publications on the PubMed, we reviewed clopidogrel treatment studies with PFT and/or genotype data for potential inclusion in this study. Lead investigators were invited to share PFT/genotype results, patient characteristics, and clinical outcomes to evaluate relationships among them.ResultsNine registries from 32 academic centers participated in the PTRG-DES consortium, contributing individual patient data from 13160 patients who underwent DES implantation between July 2003 and August 2018. The PTRG-PFT cohort was composed of 11714 patients with available VerifyNow assay results. Platelet reactivity levels reached 218±79 P2Y12 reaction units (PRU), and high on-clopidogrel platelet reactivity based on a consensus-recommended cutoff (PRU >208) was observed in 55.9%. The PTRG-Genotype cohort consisted of 8163 patients with candidate genotypes related with clopidogrel responsiveness. Of those with cytochrome P450 (CYP) 2C19 genotype, frequencies of carrying one and two loss-of-function allele (s) (^*2 or ^*3) were 47.9% (intermediate metabolizers) and 14.2% (poor metabolizers), respectively.ConclusionThe PTRG-DES consortium highlights unique values for on-clopidogrel platelet reactivity and CYP2C19 phenotype that may be important to developing optimal antiplatelet regimens in East Asian patients.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT04734028","term_id":"NCT04734028"}}NCT04734028.