高黏度与低黏度骨水泥在经皮椎体后凸成形术中的应用比较

目的对比高黏度与低黏度骨水泥经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的疗效差异。方法将2013年3月至2014年9月高要市人民医院收治的60例OVCF患者采用随机抽签法分为低黏度组(低黏度骨水泥PKP治疗)和高黏度组(高黏度骨水泥PKP治疗),每组各30例。对比两组手术前后伤椎椎体高度和后凸Cobb角;采用视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、36项健康调查简表(SF-36)评分对患者疼痛程度、功能障碍和生活质量等主观感受进行评价;统计骨水泥渗漏、近期肺栓塞等并发症发生情况。结果低黏度组和高黏度组骨水泥注入量分别为(3.1±0.6)m L和(3.6±0.8)m L,两组比较,差异有统计学意义(P0.05)。术后随访3~6个月(平均4个月),两组术后1 d、3个月VAS评分、ODI、SF-36评分、伤椎椎体高度和后凸Cobb角均优于术前(P0.05),其中高黏度组术后1 d、3个月上述指标均优于低黏度组(P0.05)。低黏度组和高黏度组术后发生骨水泥渗漏、近期肺栓塞分别为6、2例和1、0例,两组并发症发生率比较,差异有统计学意义(P0.05)。结论与低黏度骨水泥比较,高黏度骨水泥PKP治疗OVCF近期疗效更为理想,骨水泥渗漏、近期肺栓塞等并发症发生率相对较低,值得临床推广应用。     

改良颈腮腺入路切除咽旁间隙高位良性肿瘤

目的 探讨改良颈腮腺入路在高位咽旁间隙良性肿瘤手术中的应用疗效。 方法 7例咽旁间隙良性肿瘤患者,术前影像学检查提示为高位、肿瘤巨大、哑铃型且边界欠清,采用改良颈腮腺入路术式,解剖辨认面神经总干及颞面干后,于外耳道软骨前方、腮腺的后缘以及颞面干的上方间隙向深部分离至肿瘤上极,剥离子分离并下压肿瘤与下方常规颈部自下而上肿瘤游离会师后,从颌下区取出肿瘤。腮腺浅叶不切除,面神经分支不做过多解剖。 结果 所有患者均一次性完整切除肿瘤;术后病理示多形性腺瘤6例,神经鞘瘤1例;术中出血均少于300 mL;1例患者出现术后同侧眼睑轻度闭合障碍,两周后完全正常;所有患者面容美学保存理想。 结论 对于高位咽旁间隙良性肿瘤采用改良颈腮腺入路术式,不仅可以安全完整地切除肿瘤,同时由于减少了面神经及腮腺浅叶的处置,术后相关神经并发症及腮腺区凹陷性改变的发生率下降。     

Augmenting muscle diacylglycerol and triacylglycerol content by blocking fatty acid oxidation does not impede insulin sensitivity

A low fat oxidative capacity has been linked to muscle diacylglycerol (DAG) accumulation and insulin resistance. Alternatively, a low fat oxidation rate may stimulate glucose oxidation, thereby enhancing glucose disposal. Here, we investigated whether an ethyl-2-[6-(4-chlorophenoxy)hexyl]-oxirane-2-carboxylate (etomoxir)-induced inhibition of fat oxidation leads to muscle fat storage and insulin resistance. An intervention in healthy male subjects was combined with studies in human primary myotubes. Furthermore, muscle DAG and triacylglycerol (TAG), mitochondrial function, and insulin signaling were examined in etomoxir-treated C57bl6 mice. In humans, etomoxir administration increased glucose oxidation at the expense of fat oxidation. This effect was accompanied by an increased abundance of GLUT4 at the sarcolemma and a lowering of plasma glucose levels, indicative of improved glucose homeostasis. In mice, etomoxir injections resulted in accumulation of muscle TAG and DAG, yet improved insulin-stimulated GLUT4 translocation. Also in human myotubes, insulin signaling was improved by etomoxir, in the presence of increased intramyocellular lipid accumulation. These insulin-sensitizing effects in mice and human myotubes were accompanied by increased phosphorylation of AMP-activated protein kinase (AMPK). Our results show that a reduction in fat oxidation leading to accumulation of muscle DAG does not necessarily lead to insulin resistance, as the reduction in fat oxidation may activate AMPK.     

Low rate of active treatment of patients with hilar cholangiocarcinoma

Introduction

The results of surgical resection and palliative chemotherapy use in hilar cholangiocarcinoma (HC) have been well publicised but the proportion of patients able to undergo these treatments and the comparative outcomes in a population of patients with HC are less well known.

Methods

Patients with HC were identified by review of all patients undergoing percutaneous cholangiography over a nine-year period (2002–2010) in a tertiary facility. The treatment undertaken and outcomes were recorded.

Results

Overall, 68 patients were identified (37 female) with a median age of 70 years. Forty-five (66%) were treated solely by insertion of a metal stent (median survival 4.73 months) and nine (13%) also received palliative chemotherapy (median survival 13.7 months). Persisting jaundice after stent insertion was noted in 18 of 35 patients (51%) tested within one month of death. Fourteen patients (21%) underwent surgical resection (median survival 20.2 months).

Conclusions

Patients undergoing surgical resection had significantly longer survival than those receiving only a palliative stent but not compared with those also receiving palliative chemotherapy, with short-term follow-up. Only a third of patients, however, receive active treatment (surgery or chemotherapy) and improvements in long-term biliary palliation are needed.     

腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后疗效比较中的系统评价

目的评价腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后的临床疗效。方法计算机检索Co-chrane Library、PubMed、Embase、SCI、CNKI、CBM、VIP、WANFANG DATA,纳入腹膜外切口单层缝合与常规分层缝合法在化脓性或坏疽性阑尾炎术后疗效比较的随机对照试验,对纳入研究的方法学质量进行评价,用Cochrane协作网提供的RevMan 5.1软件对数据进行统计分析,并对统计结果进行系统评价。结果共纳入6个随机对照试验,共计1 885例患者。Meta分析结果显示:腹膜外切口单层缝合与常规分层缝合法在手术时间[MD=-17.09,95%CI(-19.32,-14.87)],术后切口感染率[RR=0.06,95%CI(0.03,0.12)],7 d内出院率[RR=1.17,95%CI(1.13,1.22)]方面差异均具有统计学意义,但两者在术后疼痛程度(需应用镇痛药物比率)[RR=1.05,95%CI(0.91,1.20)]方面的差异无统计学意义。结论目前研究表明,与常规分层缝合法相比,腹膜外切口单层缝合法能显著缩短化脓性或坏疽性阑尾炎患者的手术时间,降低术后切口感染率,提高7 d内出院率,但本研究纳入的样本量小且质量不高,因此,有必要开展更多高质量、多中心的随机盲法对照试验进一步予以证实其疗效。     

Treatment of Steroid‐Resistant Acute Renal Allograft Rejection With Alemtuzumab

Steroid‐resistant renal allograft rejections are commonly treated with rabbit antithymocyte globulin (RATG), but alemtuzumab could be an effective, safe and more convenient alternative. Adult patients with steroid‐resistant renal allograft rejection treated with alemtuzumab (15–30 mg s.c. on 2 subsequent days) from 2008 to 2012 (n = 11) were compared to patients treated with RATG (2.5‐4.0 mg/kg bodyweight i.v. for 10–14 days; n = 20). We assessed treatment‐failure (graft loss, lack of improvement of graft function or need for additional anti‐rejection treatment), infections during the first 3 months after treatment and infusion‐related side effects. In both groups, the median time‐interval between rejection and transplantation was 2 weeks, and approximately 75% of rejections were classified as Banff‐IIA or higher. Three alemtuzumab‐treated patients (27%) experienced treatment failure, compared to eight RATG treated patients (40%, p = 0.70). There was no difference in the incidence of infections. There were mild infusion‐related side‐effects in three alemtuzumab‐treated patients (27%), and more severe infusion‐related side effects in 17 RATG‐treated patients (85%, p = 0.013). Drug related costs of alemtuzumab‐treatment were lower than of RATG‐treatment (€1050 vs. €2024; p < 0.01). Alemtuzumab might be an effective therapy for steroid‐resistant renal allograft rejections. In contrast to RATG, alemtuzumab is nearly devoid of infusion‐related side‐effects. These data warrant a prospective trial.     

不同呼吸机湿化管道系统在老年机械通气患者中的应用效果对比

目的:探讨不同呼吸机湿化管道系统在老年机械通气患者中的应用效果。方法:选取老年机械通气患者140例,随机分为3组,其中A组(n=43)使用MR410型湿化管道系统,B组(n=47)使用MR730型湿化管道系统,C组(n=50)采用MR 850型一次性双加热式、自动加水加湿湿化管道系统。观察3组湿化效果、并发症发生情况、通气时间及管道护理情况。结果:C组湿化效果适中比例最高,其次为B组,A组最低,3组间差异有统计学意义(P<0.01)。C组无导管痰痂和气道痉挛的发生,A组发生率最高,3组间差异有统计学意义(P<0.01)。C组通气时间、管道总更换次数、呼吸机管道护理时数均低于A、B组,差异有统计学意义(P<0.01)。结论:使用MR850型一次性双加热式、自动加水加湿湿化管道系统湿化效果最好,能降低并发症发生率,缩短通气时间和护理工作量。     

湖北省接受艾滋病HAART患者CD4+T淋巴细胞变化趋势及影响因素

目的 分析湖北省接受艾滋病HAART患者CD4⁺T淋巴细胞变化趋势及影响因素。 方法 筛选2012年1月1日以后接受HAART的成年患者,利用一般线性模型、重复测量方差分析来分析患者的基线、治疗后6、12个月的CD4⁺T淋巴细胞计数情况及影响因素。 结果 1 843例研究对象基线CD4⁺T淋巴细胞计数均值为(218.94±143.96)个/μl,接受HAART后6个月为(334.31±188.62)个/μl,12个月后为(382.79±204.44)个/μl,差异有统计学意义(F=6 856.98,P=0.000)。影响HAART治疗后CD4⁺T淋巴细胞计数上升的主要因素是:性别、开始治疗年龄、WHO临床分期、初始治疗方案、基线CD4⁺T淋巴细胞计数。受性别、基线CD4⁺T淋巴细胞计数、开始治疗年龄、初始治疗方案等影响,治疗后CD4⁺T淋巴细胞计数随时间推移呈线性上升趋势;其中,女性、开始治疗年龄越小、基线CD4⁺T淋巴细胞计数越高、初始治疗方案含二线药物的患者上升较快。受WHO临床分期因素影响,治疗后CD4⁺T淋巴细胞计数随时间推移上升趋势符合二次方曲线方程,WHO临床分期越靠前,上升速度较快。 结论 湖北省艾滋病患者接受HAART后CD4⁺T淋巴细胞计数上升受多种因素影响,建议针对不同的患者及早开展HAART,提高抗病毒治疗的效果和患者生命质量。     

Cross-sectional analysis of the implant-abutment interface

The purpose of this study was to develop a technique to evaluate the implant-abutment gap of an external hexagon implant system as a function of radius. Six implants of 3.75 mm in diameter (Conexao Sistema de Protese Ltda, Sao Paulo, Brazil) and their respective abutments were screw connected and torqued to 20 N cm(-1). The implants were mounted in epoxy assuring an implant long-axis position perpendicular to the vertical axis. Each implant was grounded through its thickness parallel to implant long-axis at six different distance interval. Implant-abutment gap distances were recorded along the implant-abutment region for each section. Individual measurements were related to their radial position through trigonometric inferences. A sixth degree polynomial line fit approach determined radial adaptation patterns for each implant. Micrographs along implant sections showed a approximately 300 mum length implant-abutment engagement region. All implants presented communication between external and internal regions through connection gaps and inaccurate implant-abutment alignment. Average gap distances were not significantly different between implants (P > 0.086). Polynomial lines showed implant-abutment gap values below 10 mum from 0 mum to approximately 250 mum of the implant-abutment engagement region. Gap distances significantly increased from approximately 250 mum to the outer radius of the implant-abutment engagement region. The technique described provided a broader scenario of the implant-abutment gap adaptation compared with previous work concerning implant-abutment gap determination, and should be considered for better understanding mechanical aspects or biological effects of implant-abutment adaptation on peri-implant tissues.     

COVID-19 in solid organ transplant recipients: a single-center experience

Solid organ transplant (SOT) recipients may be at risk for severe COVID-19. Data on the clinical course of COVID-19 in immunosuppressed patients are limited, and the effective treatment strategy for these patients is unknown. We describe our institutional experience with COVID-19 in SOT. Demographic, clinical, and treatment data were extracted from the electronic patient files. A total of 23 SOT transplant recipients suffering from COVID-19 were identified (n = 3 heart; n = 15 kidney; n = 1 kidney-after-heart; n = 3 lung, and n = 1 liver transplant recipient). The presenting symptoms were similar to nonimmunocompromised patients. Eighty-three percent (19/23) of the patients required hospitalization, but only two of these were transferred to the intensive care unit. Five patients died from COVID-19; all had high Clinical Frailty Scores. In four of these patients, mechanical ventilation was deemed futile. In 57% of patients, the immunosuppressive therapy was not changed and only three patients were treated with chloroquine. Most patients recovered without experimental antiviral therapy. Modification of the immunosuppressive regimen alone could be a therapeutic option for SOT recipients suffering from moderate to severe COVID-19. Pre-existent frailty is associated with death from COVID-19.