创伤性凝血病患者血清hs-CRP及TNF-α水平与预后的关系

目的：探讨创伤性凝血病患者血清hs-CRP及TNF-α水平及与预后的关系。方法回顾性分析50例创伤性凝血病患者的临床资料,根据患者不同预后分为存活组与死亡组,比较2组凝血功能指标及血清 TNF-α及hs-CRP水平。结果治疗28 d时,存活31例,死亡19例,病死率38％;存活组患者入院时PLT显著高于死亡组,且PT、APTT、D-dimer显著低于死亡组,差异均有统计学意义（P＜0.05）;存活组患者入院时血清hs-CRP及TNF-α水平均显著低于死亡组,差异有统计学意义（P＜0.05）。结论创伤性凝血病患者血清hs-CRP及TNF-α水平显著升高,并可作为判断患者预后的指标。     

Development of a Valid Simplified Chinese Version of the Oxford Hip Score in Patients With Hip Osteoarthritis

Background

Although the Oxford Hip Score has been translated and validated in several languages, there is currently no Chinese version of the outcomes measurement. Our study aims to crossculturally adapt and validate the Oxford Hip Score into a simplified Chinese version.

Questions/purposes

We tested the (1) reliability; (2) validity; and (3) responsiveness of the Chinese version of the Oxford Hip Score.

Methods

First we translated the Oxford Hip Score into simplified Chinese, then back into English, then held a consensus meeting to achieve the final simplified Chinese version. Then we evaluated the psychometric properties of Chinese version of the Oxford Hip Score in patients undergoing total hip arthroplasty (THA). All patients undergoing THA between July and December 2012 were invited to participate in this study; a total of 108 (79% of 136 invited) did so. To assess the test-retest validity, all participants completed the Chinese version of the Oxford Hip Score again with a 2-week interval. Pearson correlation coefficient was used to evaluate the construct validity between the Chinese version of the Oxford Hip Score and visual analog scale (VAS), Harris hip score, and eight individual domains of the SF-36. Responsiveness was demonstrated by comparing the pre- and postoperative scores of the Chinese version of the Oxford Hip Score.

Results

The test-retest reliability with intraclass correlation coefficient (0.937) and internal consistency with Cronbach’s alpha (0.91) were excellent. The Chinese version of the Oxford Hip Score correlated with the Harris hip score (0.89, p < 0.01), VAS (−0.79, p < 0.01), and Physical Functioning (0.79, p < 0.01) and Bodily Pain (0.70, p < 0.01) domains of SF-36, which suggested construct validity. No floor or ceiling effects were found. The effect size and standardized response mean values were 3.52 and 3.31, respectively, indicating good responsiveness.

Conclusions

The Chinese version of the Oxford Hip Score showed good reliability, validity, and responsiveness in evaluating standard Chinese-speaking patients with hip osteoarthritis undergoing THA. It can be used by clinical surgeons as a complement to the traditional outcome measures.     

颈外动脉超选择栓塞在窦旁肿瘤手术中的应用

目的 探讨颈外动脉超选择栓塞在上矢状窦旁肿瘤手术中的应用价值.方法 回顾性分析45例上矢状窦旁肿瘤患者的临床资料,根据肿瘤大小及术前是否栓塞进行分组,对各组间术中出血量、手术时间、手术切除程度进行比较.结果 ＜4 cm的窦旁肿瘤,栓塞组与未栓塞组相比,平均失血量、手术全切率及手术时间差异均无统计学意义（P＞0.05）,但对于＞4 cm的肿瘤,栓塞组较未栓塞组手术术中失血明显减少（P＜0.01）,全切率高,手术时间短.结论 术前颈外动脉超选择栓塞能明显减少窦旁肿瘤术中出血,尤其是对较大肿瘤,术前颈外动脉超选择栓塞不但能明显减少术中出血,还能有效缩短手术时间,提高手术安全性及全切率.     

术中 X-线定位在神经内镜切除甲介型蝶窦垂体瘤手术中的应用简

目的探讨术中x-线定位在经神经内镜下甲介型蝶窦垂体瘤手术的应用。方法回顾性分析6例甲介型蝶窦垂体瘤病人的临床资料,均采用神经内镜下垂体瘤切除结合术中X-线定位方法。结果术中X-线定位准确4例;2例发生纵向偏差,均纠正。肿瘤全切除5例,次全切除1例。术后激素水平正常,视力视野改善。出现暂时性尿崩1例,治疗后痊愈。无脑脊液鼻漏、垂体功能低下、蝶窦炎发生,无死亡病例。6例病人随访3年,均无复发。结论神经内镜技术结合术中X-线定位是一种治疗甲介型蝶窦垂体瘤的安全、有效方法。     

胸腰段脊柱骨折前路减压与内固定术的技术改进

目的 针对胸腰段前路手术创伤大、时间长、出血多等问题进行技术改进。方法 采用经第12肋胸膜外-腹膜后入路显露，L4骨折保留第12肋；对伤椎相邻椎体血管不予处理；对螺钉固定位置和操作程序进行改进；同时实施控制性降压。每例病人至少实施四项技术改进中的两项。结果 采用改进技术，治疗胸腰段脊柱骨折25例，手术均获成功，手术时间110～150min（平均130min），术中失血350～900ml（平均550ml），切口长度12～20cm（平均15cm），术中损伤腹主动脉1例，损伤胸膜2例。所有病例均获随访，随访时间3～50个月（平均18．3个月），术后椎管明显扩大，无神经压迫症状加重，发生内固定松动1例。神经功能按ASIA分级标准改变如下：术前3例A级，术后恢复为A级2例，B级1例；术前B级4例，术后恢复为B级1例，C级1例，D级2例；术前14例C级，术后恢复为C级1例，D级3例，E级10例；术前4例D级，术后恢复为E级4例。结论 本技术改进具有缩短手术时间，减少术中失血和减轻手术创伤的优点，更有利于选择前路手术来治疗胸腰段爆裂骨折。     

高血压对扩张型心肌病长期预后的影响

目的 :探讨高血压对扩张型心肌病患者的远期预后的影响。方法 :将心力衰竭患者分成合并高血压组 (n =4 2 )和未合并高血压组 (n =4 2 ) ,两组基础状态相似 ,随访比较其长期预后情况 ,包括生存率 ,死亡原因 ,死亡患者生存时间以及死亡患者的临床特点。结果 :高血压组与非高血压组患者的生存率、死亡原因、死亡患者生存时间相似 (P >0 .0 5 ) ,两组患者中死亡患者的左心室舒张末期内径 ,左心房内径以及室间隔厚度、左心室后壁厚度存在差异 (P <0 .0 5 )。结论 :经严格降压治疗 ,合并高血压的扩张型心肌病患者远期预后与未合并高血压者相似 ,ACEI对上述两组患者作用效果相似。     

Curative antitumor immune response is optimal with tumor irradiation followed by genetic induction of major histocompatibility complex class I and class II molecules and suppression of Ii protein

Transfecting genes into tumors, to upregulate major histocompatibility complex (MHC) class I and class II molecules and inhibit MHC class II associated invariant chain (Ii), induces a potent anti-tumor immune response when preceded by tumor irradiation, in murine RM-9 prostate carcinoma. The transfected genes are cDNA plasmids for interferon-gamma (pIFN-gamma), MHC class II transactivator (pCIITA), an Ii reverse gene construct (pIi-RGC), and a subtherapeutic dose of adjuvant IL-2 (pIL-2). Responding mice rejected challenge with parental tumor and demonstrated tumor-specific cytotoxic T lymphocytes (CTLs). We have extended our investigation to determine the relative roles of each one of the four plasmids pIFN-gamma, pCIITA, pIi-RGC, and pIL-2 in conjunction with radiation for the induction of a curative immune response. Upregulation of MHC class I with pIFN-gamma or class II with pCIITA, separately, does not lead to a complete response even if supplemented with pIL-2 or pIi-RGC. An optimal and specific antitumor response is achieved in more than 50% of the mice when, after tumor irradiation, tumor cells are converted in situ to a MHC class I+/class II+/Ii- phenotype with pIFN-gamma, pCIITA, pIi-RGC, and pIL-2. We demonstrate further that both CD4+ helper T cells and CD8+ cytotoxic T cells are essential for induction of an antitumor response because in vivo depletion of either subset abrogates the response. The radiation contributes to the gene therapy by causing tumor debulking and increasing the permeability of tumors to infiltration of inflammatory cells.     

Correlation between Postoperative Weight Loss and Diabetes Mellitus Remission: A Meta-Analysis

Objective

This meta-analysis was conducted to determine the effect of percent excess weight loss (%EWL) after bariatric surgery on diabetes remission.

Methods

The Cochrane Library, PubMed, MEDLINE, Embase, and CINAHL were searched. All reports on %EWL involving humans and published in English between 1 January 1992 and 1 September 2013 were included in the analysis.

Results

Eight studies involving 1,247 patients who underwent bariatric surgery were selected. %EWL was positively associated with remission rate (WMD?=?11.15, 95 % CI: 6.73–15.56, p?Conclusions Patients with extensive weight loss were more likely to achieve T2DM remission after bariatric surgery. Further randomized controlled trials (RCTs) with uniform remission criterion should be performed to provide more reliable evidence.     

Radiological studies on the best entry point and trajectory of anterior cervical pedicle screw in the lower cervical spine

Objective

To explore the best entry point and trajectory of anterior cervical transpedicular screws in the lower cervical spine by radiological studies, and provide reference for clinical application.

Methods

Fifty patients were scanned by computed tomography and confirmed no obvious defect of the cervical spine. On horizontal axis, camber angle (α) and axial length (AL) were measured from C₃ to C₇. On sagittal view, the cranial or caudal angle (β) and sagittal length (SL) were also measured from C₃ to C₇. On the sagittal and horizontal planes vertebrae were respectively divided into four areas, ordered 1–4, on the anterior side of the pedicle. The areas and angles of pedicle intersect into the vertebral body were recorded. We inserted six anterior pedicle screws into the lower cervical spine of three patients by this technique.

Results

On transverse plane, camber angle (α) of C₃–C₅ increased gradually, while it decreased from C₅ to C₇. On sagittal view, C₃ and C₄ pedicles showed cranial tilting, while C₅ to C₇ were caudally tilted. AL and SL values increased gradually from C₃ to C₇. The number of the intersections of C₃–C₇ in each area was also different. Six pedicle screws of three cases were inserted into the lower cervical spine with proper placement and no complications.

Conclusion

Anterior transpedicular screw (ATPS) is a theoretically feasible option for internal fixation. The technique described in this paper was subsequently used in three patients without complication. Future improvement of ATPS insertion remains necessary for this technically demanding procedure.