��Ƥ΢������Ƶ���ڸ�ʵ�ʷָ������ž���˨���ƻ��Ը��г�����������������ΰ������ܰ�3������

??Percutaneous microwave/ radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP) for HCC and perihilar cholangiocarcinoma with insufficient future liver remnant:A report of 3 casess HONG De-fei*,FAN Xiao-ming??LUO Zu-yan??et al. *Department of Hepatopancreaticobiliary Surgery??Zhejiang Provincial People’s Hospital??Hangzhou 310014??China
Corresponding author??HONG De-fei,E-mail:HONG Defi@163.com
Abstract Objective To evaluate the safety and effectiveness of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP) for hepatocelluar carcinoma(HCC) and perihilar cholangiocarcinoma with insufficient future liver remnant. Methods B ultrasound guided percutaneous microwave ablation liver partition (PMA) was applied on the future transection plane, the tumor in the left lobe was synchronal treated by dehydrated alcohol injection. one to three days after PMA, portal vein embolization (PVE) was performed. Ten to thirteen days after PVE, right trisectionectomy extended right hepatectomy surgery procedure was performe. Results The standard liver volume (SLV)was 1231.2mL??1202.9mL and 1217.1mL respectively, and the remnant liver volume was 355.6mL??383.4mL and 385.0mL, which was 28.9%??31.9% and 31.6% of the SLV before PMA. The time for PMA and PVE was 118~132min and 158~180min respectively. The FLR was increased by 41.2%, 37.6%, 23.7% to 502.1mL, 527.4mL, 476.3mL after PMA + PVE. The operation time was 230~440min, the intraoperative blood loss was 120-1800mL. One of HCC patients complicated ascites and jaundice was cured by expectant treatment; the PHCC patient suffered subphrenic abscess which was cured by percutaneous drainage. The patients were discharged 15~40d postoperatively. Conclusion PAPEP maybe a revolutionary strategy in place of ALPPS to treat HCC and PHCC with insufficient FLR.     

��������1����ͻ�����²�ͬ�ٴ�����������������ȱ�ݲ�3������

??Abstract?? Objective To investigate the different clinical and immune features of variable phenotypes of severe combined immunodeficiency caused by RAG 1 mutations.Methods From 2012.9 to 2013.04?? three patients were included in the study??and records of clinical details were reviewed. Results The phenotypes of three patients were typical SCID for patient 1??Omenn syndrome for patient 2 and atypical SCID complicated with recurrent autoimmune hemolytic anemia for patients 3??respectively.RAG 1 mutations were compound heterozygous allele 1??1870 C??T/Arg624Cys??allele 2??2005 G??A/Glu669Lys??allele 1 was published mutation??allele 2 was de novel mutation?? for patient 1??compound heterozygous allele 1??994 C??T/Arg332X??allele 2??1439 G??A/Ser480Asn??both mutations were de novel mutations??for patient 2??homozygous 2095 C??T/R699W for patient 3 and was published mutation. First two patients died soon after discharge.Patient 3 was treated for recurrent autoimmune hemolytic anemia in our ward.Conclusion RAG1 mutations can lead to variable SCID phenotypes.Patients with typical SCID and Omenn syndrome were with poor prognosis??which need transplantation treatment.     

老年科住院患者抗抑郁药物应用77例分析

目的 探讨老年人应用抗抑郁药的安全性,为老年人合理使用抗抑郁药提供参考。方法 回顾性分析2012年1月至2013年12月北京协和医院院老年示范病房77例65岁以上患者的抗抑郁药物的使用情况、起始剂量及不良反应。结果 经老年医学跨学科团队会诊,77例均服用新型抗抑郁药,其中舍曲林使用率最高,对低体重指数患者更多选择米氮平治疗,伴有慢性疼痛的患者中50%使用5-羟色胺和(或)去甲肾上腺素再摄取抑制剂。70例住院后开始抗抑郁药治疗,72.8%的患者初始给药量从小剂量开始,不良反应发生率为8.6%(6/70)。结论 应结合老年患者特点,以及抗抑郁药的特点、不良反应和药物之间的相互作用来选择适当的抗抑郁药物。     

Susceptibility genes and modifiers for cardiac arrhythmias

The last decade has seen a dramatic increase in the understanding of the molecular basis of arrhythmias. Much of this new information has been driven by genetic studies that focused on rare, monogenic arrhythmia syndromes that were accompanied or followed by cellular electrophysiological or biochemical studies. The marked clinical heterogeneity known from these familial arrhythmia syndromes has led to the development of a multifactorial ("multi-hit") concept of arrhythmogenesis in which causal gene mutations have a major effect on disease expression that is further modified by other factors such as age, gender, sympathetic tone, and environmental triggers. Systematic genetic studies have unraveled an unexpected DNA sequence variance in these arrhythmia genes that has ethnic-specific patterns. Whether this genetic variance may contribute as a second genetic modifier for arrhythmia development is under current investigation. The aim of this article is to review common genetic variation in ion channel genes and to compare these recent findings.     

Management of infusion reactions to infliximab in patients with rheumatoid arthritis or spondyloarthritis: experience from an immunotherapy unit of rheumatology

OBJECTIVE: To suggest recommendations for management of acute infusion reactions induced by infliximab in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). METHODS: In total, 203 patients were treated with infliximab (120 ml/h). Prevalence of acute infusion reaction was evaluated. To manage these conditions, recommendations were devised according to the type and the severity of clinical manifestations, which were classified beforehand in 2 groups: A (hypertension, pruritus, sudden flush, vomiting, tachycardia or bradycardia, shivers, fever) and B (urticaria, tickling throat, Quincke's edema, dyspnea, and hypotension). Recommendations were based mainly on adjustment of the infusion rate. RESULTS: It was observed that 23/203 patients (11.3%) had acute infusion reactions. Among them and prior to our recommendations, infliximab was completely discontinued in 8/23 patients. After our recommendations were implemented, 15/23 patients presented an acute infusion reaction: 8 and 7 patients with symptoms of Group A and B, respectively. In Group A (8 patients), reducing the infusion rate to 60-80 ml/h led to disappearance of symptoms; the modified treatment was then maintained. In Group B (7 patients), the infusion was immediately stopped and appropriate drugs were administered. Once clinical manifestations were alleviated, the infusion was resumed (60 ml/h). Prior to subsequent infusions (60 ml/h), a premedication was administered. CONCLUSION: Based on these recommendations, infliximab could be maintained with great efficacy on disease activity in every patient with an acute infusion reaction. Our recommendations permit sustained administration of infliximab and allow every patient to benefit from this therapy.     

һ��΢�������������ѺϽ�����������������о�

??Objective??To study the in vitro biocompatibility of titannium alloy treated with micro-arc oxidation??MAO????in order to provide the theoretical basis for the next application of MAO in the treatment of titanium alloy implants. Methods??The biofilm layer containing hydroxyapatite ??HA?? was formed on the surface of Ti6Al4V by one-step  MAO ??experiment group??. The control groups were the untreated Ti6Al4V and the sandblasted Ti6Al4V. The three groups were co-cultured with osteoblasts to determine the proliferation??alkaline phosphatase ??ALP?? activity and mRNA expression of collagen ?? ??COL-?? and osteocalcin ??OC??. Results??The surface after the treatment was "crater" structure with a large number of HA. The in vitro results of three groups of materials showed that the cell proliferation rate of the Ti6Al4V treated with MAO was higher than that of the other two groups??and the ALP activity and COL-??and OC mRNA expression of cells were higher than those in the other two groups. Conclusion??The biofilm layer formed on the surface of Ti6Al4V by  MAO  has a beneficial effect on the adhesion and proliferation of cells??which promotes the differentiation  and shows good biocompatibility.     

�����������ֲ�޸������Ӳ��֯��������ٴ���Ӱ��ѧЧ����������

??Objective    Implant therapy combined with simultaneous guided bone regeneration??GBR??and different soft tissue management was applied to patients to repair their missing maxillary center incisors. This article aims to analyze the effects of hard and soft tissue augmentation quantitatively. Methods    Six patients who accepted implant therapy in combination with simultaneous GBR and different soft tissue management for their single missing maxillary central incisor were screened. They were called for a review visit at 7 to 24 months after final restoration. The clinical periodontal status of the maxillary anterior teeth was examined??and the bone height and thickness at middle labial aspect of implants were measured by CBCT quantitatively. The relationship of gingival zenith position between implants and the control teeth??as well as the papilla height and filling degree of implants were measured quantitatively on the standardized photographs. Pink esthetic score??PES??was applied to evaluate the esthetic effect. Results    All the implants were in stable and healthy periodontal status at the review visit. Vertical and horizontal bone augmentation could be observed on 5 implants. The mean facial bone thickness at 2??4??and 6 mm apical to implant shoulder was??1.7 ± 1.1??mm????2.3 ± 1.1??mm??and??2.2 ± 1.3??mm??respectively. The mean position of gingival zenith of implants was??1.0 ± 0.6??mm more distally??and??0.4 ± 0.8??mm more apically??compared to the control teeth. The mean height??2.8 ± 0.5??mm and filling ??76.9 ± 19.2??% of distal papilla of implants were less than those of mesial papilla??4.2 ± 0.7??mm??and ??89.8 ± 11.1??%. Mean PES was 11.5 ± 1.4. Conclusion    For the patients with bone and soft tissue defect at edentulous areas??implant therapy combined with GBR and different soft tissue management for the missing maxillary center incisors can obtain adequate bone augmentation and harmonious soft tissue profile to the control teeth??and consequently improve esthetic outcomes in a certain degree.     

血清脂蛋白磷脂酶A2 和血浆抗凝血酶Ⅲ对2 型糖尿病患者发生缺血性脑卒中风险的评估价值

目的 探讨血清脂蛋白磷脂酶A2 （lipoprotein-associated phospholipase A2,Lp-PLA2）、血浆抗凝血酶Ⅲ（Antithrombin Ⅲ,AT- Ⅲ）在2 型糖尿病患者发生缺血性脑卒中风险评估中的运用价值。方法 选取2018 年7 月~2019 年12 月于成都市郫都区中医医院就诊的84 例伴缺血性脑卒中、无脑卒中以外其他并发症的2 型糖尿病患者作为研究组,另选取84 例无并发症的单纯2 型糖尿病患者作为对照组。采用免疫比浊法于日立7180 生化分析仪上检测血清Lp-PLA2,采用免疫比浊法于积水CP3000 凝血分析仪上进行血浆AT- Ⅲ的检测。运用独立样本t 检验比较研究组与对照组间各检测指标的差异,并观察研究组中各检测指标的异常率,判断血清Lp-PLA2、血浆AT- Ⅲ在2 型糖尿病患者发生缺血性脑卒中风险评估中的运用价值。结果 2 型糖尿病伴缺血性脑卒中患者与单纯2 型糖尿病患者的血清Lp-PLA2 结果分别为229.31±37.92 ng/ml 和101.56±24.32 ng/ml;血浆AT- Ⅲ结果分别为79.43%±14.10% 和100.18%±19.40%。2 型糖尿病伴缺血性脑卒中患者的血清Lp-PLA2 水平显著高于单纯2 型糖尿病患者（t=-25.835,P<0.01）,血浆AT- Ⅲ则显著低于单纯2 型糖尿病患者（t=7.881,P<0.01）,两个检测项目的组间差异均具有统计学意义。2 型糖尿病伴缺血性脑卒中患者中血清Lp-PLA2,血浆AT- Ⅲ和血清Lp-PLA2 联合血浆AT Ⅲ检测指标的异常率分别为82.14%,77.38% 和88.10%;血清Lp-PLA2 异常率较血浆AT- Ⅲ高,而两项同时检测具有更高的异常率。结论 检测血清Lp-PLA2 和血浆AT- Ⅲ对2 型糖尿病患者发生缺血性脑卒中风险的评估具有重要价值。