健康老年人群血浆可溶性血栓调节蛋白和肾小球滤过率的关系

目的：探讨老年人群血浆可溶性血栓调节蛋白（sTM）与估算的肾小球滤过率（eGFR）的相关性。方法采用整群随机抽样的方法对北京市9个社区283名≥65岁健康老年人进行研究,酶联免疫吸附法测定血浆可溶性血栓调节蛋白水平,应用CKD-EPI公式评估eGFR,同时行人体学测量及血清生化指标测定,并做相关和回归分析。结果北京社区健康老年人群eGFR水平与sTM、年龄、尿素氮、肌酐、C反应蛋白（CRP）及收缩压呈负相关,与白蛋白、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平呈正相关;在校正了年龄、血压、血糖（GLU）、CRP、血脂、尿酸（UA）等指标后,健康老年人血浆sTM仍然和eGFR呈负相关（B＝-3.340,P＝0.000）。在进一步的研究中,将入组的北京社区健康老年人分为老年（65～80岁）和高龄老年（＞80岁）两组;两组之间eGFR和sTM水平差异均无统计学意义（P＞0.05）,老年组和高龄老年组eGFR均与sTM水平呈负相关（r＝-0.229,P＝0.000;r＝-0.3613,P＝0.02）,校正了年龄、血压、GLU、CRP、血脂、UA等指标后差异仍有统计学意义（B＝-3.26,P＝0.000;B＝-4.45,P＝0.013）。结论 sTM可作为判断老年人群肾功能下降的指标。     

介入途径对冠状动脉介入术后焦虑和抑郁状态的影响

目的:研究经桡动脉或经股动脉冠状动脉介入治疗术后,患者焦虑抑郁状态的发生情况。方法:对99例因冠心病准备行经皮冠状动脉介入治疗(PCI)的患者根据采用路径分为两组:经桡动脉冠状动脉介入治疗(TRI,n=50)和经股动脉行冠状动脉介入治疗(TFI,n=49)。同时采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD),对两组患者术前及术后1d分别进行焦虑抑郁状态评分。HAMA8分定义为焦虑状态,HAMD8分定义为抑郁状态。结果:术前两组患者的HAMA和HAMD评分差异均无统计学意义[分别为(7.15±1.78)vs.(7.75±1.82),P=0.216]和[(6.80±1.75)vs.(6.78±2.15),P=0.763]。术后TRI组的HAMA平均评分:[(9.74±3.36)vs.(12.82±5.68),P=0.038]和HAMD的平均评分:[(9.94±3.37)vs.(13.02±3.75),P=0.022)]均显著低于TFI组。TRI组患者焦虑和抑郁状态的发生率显著低于TFI组[焦虑状态:18.0%vs.38.8%,P=0.022);抑郁状态:16.0%vs.34.7%,P=0.032]。多因素Logistic分析显示TFI和TRI相比是术后抑郁和焦虑状态的独立预测因素。结论:焦虑和抑郁状态均是PCI术后常见的情绪障碍,而TRI在对患者这两种情绪障碍的影响上均明显优于TFI。     

Situation of antithrombotic therapy in elderly patients with atrial fibrillation and acute coronary syndrome

Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients(more than 60 years old) with non-valvular atrial fibrillation(NVAF) and acute coronary syndrome(ACS) / percutaneous coronary intervention(PCI).Methods This study enrolled 381 elderly patients [mean age(69.95 ± 8.41) years; 289 males, 92 females]with NVAF and ACS / PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups: triple therapy(TT) group, dual antiplatelet therapy(DAT) group,vitamin K antagonist(VKA) plus single antiplatelet therapy(SAT) group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients(9.97%) received TT and 300 patients(78.74%) received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2-VASc≥2 and HAS-BLED 3. Conclusions Elderly patients who suffered NVAF and ACS / PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT.     

Healing responses following transverse root fracture: a historical review and case reports showing healing with (a) calcified tissue and (b) dense fibrous connective tissue

Background

The understanding and management of transverse intra‐alveolar root fractures has evolved to its current high level of sophistication and clinical success from foundations laid down by histological studies as early as the mid‐nineteenth century.

Significance

The aim of the review was to highlight those earlier histological reports and studies that have contributed to the current understanding of the biological processes involved in the healing of transverse root fractures. Healing of a transverse root fracture by calcified tissue was demonstrated histologically by Howe in 1926, while Boulger in 1928 showed the two other patterns of root fracture healing, namely the interposition of fibrous connective tissue and the interposition of bone and periodontal ligament around both fractured segments. Other major histological reports around that time came from members of the so‐called ‘The Vienna group of Illinois’, who had a significant influence in the development of oral biology worldwide. Other important reports and an experimental study emanated from Germany and Switzerland in the late 30s and early 40s, followed in the 1950s and early 1960s by histological material principally from Sweden, Denmark, France, the USA and Britain. Jens Andreasen and Erik Hjörting‐Hansen's landmark paper in 1967 included new histological reports and a classification of healing responses following transverse root fractures. The expansion of knowledge related to root fractures since that time has been exponential, with major contributions from Scandinavia and several other countries.

Case reports

Accompanying the historical review are two case reports with histology of root fracture healing by (a) calcified tissue and (b) dense fibrous connective tissue. The role of the pulp and the periodontal ligament in the repair process is described and the clinical significance discussed with particular emphasis to diagnosis and orthodontic management.     

肝上皮样血管内皮瘤1例

上皮样血管内皮瘤(epithelioid hemangioendothelioma,EHE)是一种病因及发病机制不明,累及单个或多个器官的血管源性肿瘤,具有低至中度恶性潜能,呈慢性进行性发展过程.肝脏是EHE受累的常见器官之一.Ishak等[1]在1984年首次报道了肝上皮样血管内皮瘤(hepatic epithelioid hemangioendothelioma,HEHE),此后相关报道逐渐增多.影像学检查是诊断HEHE常用的手段之一,如螺旋X线计算机断层摄影术(CT)、磁共振成像(MRI)、核医学检查等,但存在一定的局限性.我们在此报道1例病史长达17年的HEHE患者的肝脏CT灌注特点及其在HEHE诊断中的价值.     

生脉注射液治疗急性心肌梗死后心源性休克的临床研究

目的研究生脉注射液治疗急性心肌梗死后心源性休克的临床疗效。方法选取2015年6月—2016年8月十堰市太和医院治疗的急性心肌梗死后心源性休克患者164例,随机分为对照组和治疗组,每组各82例,对照组给予常规治疗,治疗组在对照组的基础上静脉滴注生脉注射液,60 m L加入5%葡萄糖溶液250~500 m L,1次/d。两组均连续治疗7 d。治疗后,观察两组患者临床疗效,同时比较血清心肌肌钙蛋白I(c Tn I)、钙调蛋白(Ca M)及其基因表达,心功能指标左心室内压最大上升速率(dp/dtmax)、左心室内压最大下降速率(-dp/dtmax)、左室射血分数(LVEF)、舒张末期室间隔厚度(IVST)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、心脏指数(CI),及肺毛细血管楔压(PCWP)、心率(HR)、收缩压(SBP)、舒张压(DBP)、脉压(PP)和尿量(UV)的变化。结果治疗后,对照组和治疗组总有效率分别为60.97%和74.39%,两组总有效率比较差异有统计学意义(P0.05)。两组c Tn I、Ca M、c Tn I-m RNA和Ca MKII-m RNA均较治疗前显著降低,同组治疗前后差异有统计学意义(P0.05),且治疗组上述指标降低更明显,两组比较差异有统计学意义(P0.05)。两组±dp/dtmax、LVEF和CI均升高、LVEDD增大,IVST和LVESD均缩小(P0.05),且治疗组上述指标改善更明显(P0.05)。两组患者PCWP和HR均降低,SBP和DBP均升高,PP增大,UV增多(P0.05),且治疗组上述指标改善更明显(P0.05)。治疗组并发症中室间隔穿孔、急性肾衰竭和心律失常和死亡率明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论生脉注射液治疗急性心肌梗死后心源性休克疗效显著,纠正急性心肌梗死时心肌"钙超载"现象,明显增强心脏泵血功能,具有一定的临床推广应用价值。     

O型臂导航引导下经皮椎体成形术治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性

目的 探讨O型臂导航引导下经皮椎体成形术（percutaneous vertebroplasty,PVP）在治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性。方法 2019年12月—2021年8月复旦大学附属浦东医院骨科收治中段胸椎骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture,OVCF）患者15例（15个椎体）,男5例,女10例;年龄70~89岁,平均（76.7±5.8）岁。均采用O型臂导航引导下经单侧穿刺行PVP治疗。主要疗效指标：术中规划路径与实际路径的符合率,微创经皮开路器穿刺成功需要的次数,主要指标用于评价该手术操作的精准性。次要疗效指标包括：记录患者术前、术后2天以及末次随访时视觉模拟（visual analogue scale,VAS）疼痛评分,Oswestry功能障碍指数（Oswestry disability index,ODI）。同时记录患者的手术时间、骨水泥使用量、术中出血量及手术相关并发症发生情况等,测量并记录术前、术后2天及末次随访时伤椎前缘高度,次要指标用于评价该手术方案的临床疗效与安全性。结果 15例患者均顺利完成手术,术中规划路径与实际路径的符合率：优6例,良9例,优良率达100%,所有病例均为1次穿刺成功,无患者出现骨水泥渗漏或严重并发症。平均随访11.7个月。术前、术后2天及末次随访时患者VAS评分分别为7.2±0.7、2.3±0.5和1.9±0.5,患者ODI评分分别为68.1±4.0、23.6±4.3和23.0±4.6,患者伤椎前缘高度分别为（2.4±0.3）cm、（2.7±0.3）cm和（2.6±0.3）cm。术后2天患者VAS评分、ODI评分较术前明显改善（P<0.05）,术后2天及末次随访时患者伤椎前缘高度较术前均增加（P<0.05）。结论 O型臂导航引导下PVP治疗中段胸椎OVCF,可提高手术操作精准度及安全性,在治疗中段胸椎OCVF中可能具有较大的临床应用价值。     

右美沙芬缓释混悬液治疗慢性咽炎所致咳嗽90例的临床观察

目的：研究右美沙芬缓释混悬液治疗成人慢性咽炎所致咳嗽的临床效果。方法：将90例慢性咽炎咳嗽患者随机分为3组,对照组给予万应胶囊治疗,治疗组l给予万应胶囊联合右美沙芬缓释混悬液治疗,治疗组2给予万应胶囊联合右关沙芬缓释混悬液及抗组胺药治疗,疗程均为14d。结果：治疗组1及治疗组2在7d、14d时疗效均优于对照组,差异有统计学意义（P〈O．01）;治疗组2在7d时疗效优于治疗组1,差异有统计学意义（P〈O．01）。结论：右美沙芬缓释混悬液用于成人慢性咽炎所致咳嗽临床效果良好,右关沙芬缓释混悬液联合抗组胺药对成人慢性咽炎所致咳嗽的临床疗效更快、更好。