2型糖尿病患者脂蛋白（a）水平、载脂蛋白（a）多态性和冠状动脉粥样硬化严重程度的关系

背景:针对糖尿病患者Lp(a)水平和冠状动脉疾病(CAD)严重程度之间关系的研究较少并且结论有争议。另外,目前尚无关于apo(a)多态性与上述疾病关系的研究。本研究旨在探讨大样本2型糖尿病患者中冠状动脉粥样硬化的程度与Lp(a)水平及apo(a)多态性的相关性。方法:连续选取227例2型糖     

Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution.

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates geared to simplified preparation without biochemical blood handling. In this initial article, we describe the conceptual and technical evolution from fibrin glues to platelet concentrates. This retrospective analysis is necessary for the understanding of fibrin technologies and the evaluation of the biochemical properties of 3 generations of surgical additives, respectively fibrin adhesives, concentrated platelet-rich plasma (cPRP) and PRF. Indeed, the 3-dimensional fibrin architecture is deeply dependent on artificial clinical polymerization processes, such as massive bovine thrombin addition. Currently, the slow polymerization during PRF preparation seems to generate a fibrin network very similar to the natural one. Such a network leads to a more efficient cell migration and proliferation and thus cicatrization.     

Gonadotropin-releasing hormone antagonists increase follicular fluid insulin-like growth factor-I and vascular endothelial growth factor during ovarian stimulation cycles.

The aim of the present study was to investigate the effect of gonadotropin-releasing hormone (GnRH) antagonists (GnRH-ant) on follicular fluid (FF) insulin-like growth factor-I (IGF-I) and FF vascular endothelial growth factor (VEGF) levels. Sixty women undergoing assisted reproduction were randomized and assigned to two different GnRH analog regimens: GnRH agonist (GnRH-a) and GnRH-ant. FF VEGF and FF IGF-I concentrations were significantly increased in the patients treated with GnRH-ant (p < 0.001). In the same patients we observed a statistically significant reduction in serum luteinizing hormone (LH) and estradiol (E2) levels (p < 0.001 and p < 0.05, respectively), FF E2 and FF androstenedione levels (p < 0.05 and p < 0.001, respectively), as well as a reduction in the number of pregnancies although this was not statistically significant. In the GnRH-ant group, FF VEGF levels were positively correlated with FF IGF-I levels, and both were negatively correlated with serum LH levels. The increase in FF IGF-I and FF VEGF levels in women treated with GnRH-ant could be explained by a deleterious follicular environment in response to profound suppression of LH and E2 levels.     

Idiopathic Headache as a Possible Risk Factor for Phantom Tooth Pain

Following tooth pulp extirpation, some subjects suffer from persistent pain which affects edentate sites in absence of any local pathology. As regards this peculiar pain, called phantom tooth pain (PTP), what is puzzling is the fact there is a low prevalence of PTP in a very large population showing identical conditions of tooth pulp extirpation. The present investigation indicates that PTP mainly affects migraine (M) and cluster headache (CH) sufferers, whereas it does not affect subjects who have a negative personal and family history for idiopathic headache (IH). These results circumscribe the presence of PTP to a specific section of the population. The present results, besides indicating that PTP may be the result of a peculiar neuronal predisposition relating to IH pathogenesis, suggests some practical therapeutic hints. In fact, successful anti- M and anti-CH prophylactic treatment greatly improve PTP syndrome.     

Poor Intraoperative Blood Glucose Control Is Associated with a Worsened Hospital Outcome after Cardiac Surgery in Diabetic Patients

Background: Tight perioperative control of blood glucose improves the outcome of diabetic patients undergoing cardiac surgery. Because stress response and cardiopulmonary bypass can induce profound hyperglycemia, intraoperative glycemic control may become difficult. The authors undertook a prospective cohort study to determine whether poor intraoperative glycemic control is associated with increased intrahospital morbidity.

Methods: Two hundred consecutive diabetic patients undergoing on-pump heart surgery were enrolled. A standard insulin protocol based on subcutaneous intermediary insulin was given the morning of the surgery. Intravenous insulin therapy was initiated intraoperatively from blood glucose concentrations of 180 mg/dl or greater and titrated according to a predefined protocol. Poor intraoperative glycemic control was defined as four consecutive blood glucose concentrations greater than 200 mg/dl without any decrease in despite insulin therapy. Postoperative blood glucose concentrations were maintained below 140 mg/dl by using aggressive insulin therapy. The main endpoints were severe cardiovascular, respiratory, infectious, neurologic, and renal in-hospital morbidity.

Results: Insulin therapy was required intraoperatively in 36% of patients, and poor intraoperative glycemic control was observed in 18% of patients. Poor intraoperative glycemic control was significantly more frequent in patients with severe postoperative morbidity (37% vs. 10%; P < 0.001). The adjusted odds ratio for severe postoperative morbidity among patients with a poor intraoperative glycemic control as compared with patients without was 7.2 (95% confidence interval, 2.7-19.0).     

Beobachtungen beim Nervenschu\schmerz (Kausalgie)

Zusammenfassung Die Kausalgie ist eine Erkrankung mit vorwiegender Beteiligung des sympathischen Nervensystems, die h?ufig im Anschlu\ an Teill?sionen des N. medianus und tibialis auftritt. Denn nur zu diesen beiden Nerven führen auch marklose sympathische Fasern in gr?\erer Zahl. Die Erkrankung wird — wie an den genau beobachteten 3 F?llen festgestellt wurde — nicht oder erst sehr sp?t erkannt, obwohl die typischen Erscheinungen (starker Handschwei\, hochgradiges Schmerzgefühl mit dem Ausdruck brennender Hitze) schon bald nach der Verletzung (4-6-13 Wochen) auftreten. Dieses Nichterkennen geht soweit, da\ die davon Betroffenen als Hysteriker und Psychopathen angesehen werden. Durch Entfernen des Ganglion stellatum und aller Verbindungen, die zum Armnervengeflecht führen, ist eine vollkommene Heilung zu erzielen. Wenn die benachbarten Ganglien und ihre Anastomosen zum Plexus nicht entfernt werden (s. Fall 3) bleiben geringe, leicht ertr?gliche Beschwerden zurück. Nach der Operation tritt vollst?ndige Schmerzfreiheit und derHornersche Symptomkomplex auf. Klinische Erscheinungen wie Schwindel gehen nach wenigen Tagen zurück. Bemerkenswert ist noch die Tatsache, da\ in einem Fall die kausalgischen Reizerscheinungen an beiden Armen vorhanden waren (Schu\verletzung beider mediani) und durch die Operation an der st?rker betroffenen rechten Seite die Krankheitserscheinungen beiderseits geschwunden sind. Geringe histologische Ver?nderungen an den entfernten Ganglien sind vorgefunden worden. Herrn Prof.Feyrter, Vorstand des Pathologisch-anatomischen Institutes der Universit?t Graz, sei in diesem Zusammenhang für die Untersuchung und überlassung der histologischen Pr?parate bestens gedankt.