闭合性胰腺损伤的诊断和治疗：附32例报告

目的：探讨闭合性胰腺损伤的早期诊断和治疗方法。
方法：回顾性分析收治的闭合性胰腺损伤32例的临床资料。
结果：CT诊断符合率为79.3%。非手术治疗4例,其中I级3例,II级1例。 手术治疗28例,I级5例和II级7例行胰周清创外引流术;6例Ⅲ级胰腺损伤中,行远端胰腺切除术和脾切除术4例,行保脾远端胰腺切除术2例;5例Ⅳ级胰腺损伤中,行胰腺空肠Roux-en-Y吻合术4例,行远端胰腺切除术和脾切除术1例;5例Ⅴ级胰腺损伤中,行十二指肠憩室化手术1例,2例胰头严重毁损伤行胰十二指肠切除术,2例由于复合伤情较重,首先应用损伤控制手术,于受伤后48 h再次行彻底性手术。全组死亡3例,死亡原因主要为多器官功能衰竭,余25例中术后发生并发症19例（76.0%）,包括胰瘘、胰腺假性囊肿等,均经治疗而愈。
结论：无明确主胰管损伤、临床情况稳定时,胰腺损伤可先行非手术治疗。手术治疗适于重度闭合性胰腺损伤,根据胰腺损伤的程度选择合理的手术方式可提高治愈率,降低病死率。     

替米沙坦和赖洛普利降压及对尿酸作用的比较

目的比较替米沙坦和赖洛普利的降压疗效及对血尿酸的影响。方法采用随机、平行对照研究,一组35例高血压患者给予替米沙坦40mg,qd;另一组33例给予赖洛普利5mg,bid。12周后观察疗效及不良反应。结果替米沙坦组最高血压由(169.36±10.8)(/102.92±10.47)mmHg降为(145.48±14.78)(/81.45±9.57)mmHg,P<0.05;24h平均压由(149.73±8.93)(/93.21±10.68)mmHg降为(132.24±14.40)(/83.45±9.47)mmHg,P<0.05。赖洛普利组最高血压由(168.17±10.16)(/102.63±11.29)mmHg降为(146.9±14.83)(/85.25±7.14)mmHg,P<0.05;24h平均压由(148.90±9.16)/(92.54±11.23)mmHg降为(133.47±13.08)(/83.68±8.92)mmHg,P<0.05。替米沙坦组血尿酸由(446.56±110.56)"mol/L降为(378.52±78.95)"mol/L,P<0.05;赖洛普利组血尿酸治疗前、后为(445.23±112.14)"mol/L和(437.34±113.87)"mol/L,P>0.05。结论替米沙坦和赖洛普利降压疗效相似,但替米沙坦有降低尿酸的作用,建议高血压合并血尿酸增高患者选用替米沙坦。     

On the role of RNA binding proteins in polyglutamine diseases:from pathogenesis to therapeutics

<正>Polyglutamine(polyQ) diseases are a group of different neurodegenerative disorders characterized by an abnormal expansion of the trinucleotide cytosine-adenine-guanine(CAG)within coding regions of each disease-associated gene.The abnormal expansion translates into a protein bearing an abnormally long tract of glutamines.     

地塞米松对实验性哮喘大鼠气道细胞DNA合成和气道重塑的影响

目的 观察地塞米松对实验性哮喘大鼠气道细胞ＤＮＡ合成和气道重塑的干预效果。 方法 应用ＳＤ大鼠建立哮喘动物模型,采用免疫组化技术和其它形态学研究的方法,研究雾化吸入地塞米松对气道细胞ＤＮＡ合成和气道重塑反应的影响。 结果 ① 地塞米松治疗组气道上皮下胶原沉积以及粘液的分泌比模型组明显减少。② 模型组气道平滑肌细胞Ｂｒｄｕ阳性计数（１０．２５±２．０９）明显高于正常对照组（７．１５±２．０５）和地塞米松治疗组（６．８５±２．２０）（Ｐ＜０．０１）;模型组气道上皮细胞Ｂｒｄｕ阳性计数（２１．８３±７．０１）亦明显高于正常对照组（１６．２２±４．３６）和地塞米松治疗组（１６．９２±３．４８）（Ｐ＜０．０５）。 结论 应用地塞米松干预可减轻实验性哮喘大鼠气道炎症,抑制气道细胞ＤＮＡ合成,延缓气道重塑反应的发生。     

房间隔缺损并肺动脉瓣狭窄介入治疗20例临床分析

目的　应用国产双盘状封堵器及国产球囊经导管治疗房间隔缺损 (ASD)并肺动脉瓣狭窄 ,并对其疗效进行初步评价。方法　全组 2 0例 ,年龄 2～ 17岁 ,平均 8.4± 6 .2岁。术前均经超声心动图检测 ,ASD直径为5～ 2 1mm ,平均 14± 6mm ,同时测肺动脉瓣狭窄程度及经超声心动图估测肺动脉压及跨瓣压 ,所有病例均在透视及超声心动图监视下经导管肺动脉瓣球囊扩张术 (PBMV)及置入国产双盘封堵器封堵ASD。全部患儿于术后 4 8h、1～ 3月及 1年分别行超声心动图、心电图、X线胸片检查评价治疗效果。结果　全组技术成功率 10 0 % ,均无重要并发症发生 ,PBMV术后即刻右室收缩压由 84± 2 5mmHg降至 4 0± 10mmHg ,肺动脉至右室跨瓣压由 6 7± 2 6mmHg降至 13.0± 11.5mmHg (P <0 .0 1) ,ASD 1例存在微～少量残余分流 ,19例封堵完全无残余分流。术后2 4h、术后 1月及 1年超声心动图未见残余分流及再通。结论　应用双盘状封堵器及国产球囊经导管治疗房间隔缺损并肺动脉瓣狭窄是一种安全有效的介入方法 ,操作简便 ,成功率高 ,近期疗效可靠 ,中远期疗效尚需进一步观察。     

纤维蛋白原与冠心病相关分析

目的探讨纤维蛋白原（Fg）与冠心病（CHD）类型及冠状动脉病变程度的相关性。方法将经冠状动脉造影的195例患者分为冠心病组（158例）与健康对照组（37例）,其中冠心病组又分为急性心肌梗死（AMI）组50例,不稳定型心绞痛（UAP）组60例,稳定型心绞痛（SAP）组48例。再将冠心病组按冠状动脉造影结果分为单支54例,双支55例,和三支病变组49例。应用Clauss凝固法测定195例全部入选者的Fg水平。比较各CHD类型及冠脉病变程度组间血浆Fg水平差异。结果Fg水平在正常对照组与SAP、UAP、AMI中差异有统计学意义,并随冠心病的严重程度呈上升趋势,Fg水平（g/L）分别为2.47±0.30、2.53±0.49、3.02±0.54和3.26±0.64,4组间比较,差异有统计学意义,P〈0.05。CHD患者Fg水平（g/L）在冠状动脉病变不同支数中分别为2.66±0.54、2.98±0.54和3.22±0.69,3组间比较,单支与其他支病变差异有统计学意义,P〈0.05,双支与多支病变间比较差异无统计学意义。结论CHD患者血浆Fg水平与冠心病的发展方向有关,随着斑块的不稳定呈现上升趋势,且与冠脉病变的程度呈正相关。     

Obesity has a negative impact on clinical outcome after total knee arthroplasty

Background and Aims: Obesity has been linked to the development of osteoarthritis of the knee and since the incidence of obesity is increasing, the need for total knee arthroplasty (TKA) is likely to increase. Conflicting findings have been reported concerning the relationship between obesity and TKA. It has been shown in several studies, that obese patients have poorer clinical results after operation. On the other hand it has also been reported similar results for obese and non-obese patients. The purpose of this study was to analyze clinically and radiologically the results of total knee artrhoplasty in obese patients. Material and Methods: The study consisted of 48 patients who had a TKA. The patients were divided in two groups according their body mass index. Patients of BMI over 30 were regarded as obese.Results: The obese patients had poorer clinical success at the final follow-up, their WOMAC scores were significantly higher compared to non-obese (pain 20.7 vs. 11.6; p = 0.021, stiffness 26.9 vs. 13.4; p = 0.006, physical function 26.5 vs. 14.4; p = 0.003). Differences were also found in the Knee (KS) and Function (FS) scores and a long-term postoperative ROM and (KS: 83.6 vs. 88.9; p = 0.01, FS: 63.6/76.3; p = 0.051, ROM: 104.6 vs. 109.6; p = 0.016). Non-obese patients reached better percentage improvement in the KSS compared to obese patients (KS change + 194.5% vs. + 59.5%, p = 0.03; FS change + 51.5% vs. + 14.9%, p = 0.19). Conclusions: Obesity has a negative impact on the outcome of TKA, assessed by patients' clinical function and satisfaction level.     

Modic type I change may predict rapid progressive, deforming disc degeneration: a prospective 1-year follow-up study

Introduction

This prospective magnetic resonance imaging (MRI) study in chronic low-back pain (CLBP) patients evaluated the natural course of degenerative lumbar spine changes in relation to Modic 1 type changes (M1) within 1 year.

Materials and methods

From 3,811 consecutive CLBP patients referred to lumbar spine MRI 54 patients with a large M1 were selected using strict exclusion criteria to exclude specific back disorders. Follow-up MRI was obtained within 11–18 months.

Results

At baseline M1 was associated with an adjacent endplate lesion in 96% of the cases. In follow-up, an unstable M1 was associated both with an increase of endplate lesions, decrease of disc height and change in disc signal intensity, most found at L4/5 or L5/S1. In disc spaces without M1, progression of degenerative changes was rare.

Conclusion

Endplate deformation, decreasing disc height and change of disc signal intensity appear essential features of accelerated degenerative process associated with M1.     

Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: a case-control study

Frequent fractures in children may be a sign of impaired bone health, but it remains unestablished when and how fracture‐prone children should be assessed. This prospective study elucidated skeletal characteristics and predisposing factors in children with recurrent fractures. Findings were used to establish guidelines for screening. During a 12‐month period we recorded fracture history for all children (n = 1412) treated for an acute fracture at a large university hospital. All apparently healthy children over 4 years of age, who had sustained: (1) at least one vertebral fracture; (2) two long‐bone fractures before age 10 years; or (3) three long‐bone fractures before age 16 years, were recruited. They underwent dual‐energy X‐ray absorptiometry (DXA), laboratory tests, and spinal radiography. Information regarding family history and lifestyle factors were collected. Findings were compared with healthy controls. Sixty‐six fracture‐prone children (44 males, mean age 10.7 years; 5% of all children with fractures) were identified. Altogether, they had sustained 183 long‐bone fractures (median 3, range 0–7); 11 children had sustained vertebral fracture(s). Patients had significantly lower bone mineral density (BMD) at lumbar spine (p < 0.001), hip (p = 0.007), and whole body (p < 0.001) than the controls; only 5 children (8%) had a BMD Z‐score < ?2.0. Asymptomatic vertebral compressions were prevalent, especially in those under 10 years of age. Hypercalciuria (11%) and hyperphosphaturia (22%) were significantly more prevalent than in controls. Serum concentration of 25‐hydroxyvitamin D (S‐25OHD) was below 50 nmol/L in 55%; low levels were associated with low BMD and vertebral compressions. The fracture‐prone children had lower calcium intake, less physical activity, and more often had siblings with fractures than the controls. The findings suggest that a thorough pediatric evaluation, including DXA and spinal radiography, is often indicated already after a second significant low‐energy fracture in children, in order to detect potentially preventable adverse lifestyle factors and nutritional deficits and to identify those with compromised overall bone health. © 2012 American Society for Bone and Mineral Research.     

Recurrent torsades de pointes after catheter ablation of incessant ventricular bigeminy in combination with QT prolongation

A 45-year-old woman, who had received a single-chamber implantable cardioverter defibrillator (ICD) due to ventricular fibrillation 5 years ago, was admitted for catheter ablation of incessant right ventricular outflow tract bigeminy. After successful ablation recurrent torsades de pointes associated with a prolonged corrected QT (QTc) interval were initiated by polymorphic premature ventricular complexes. Genetic testing revealed a heterozygous missense mutation in the SCN5A-gene (p.Arg190Gln, Exon 5), consistent with long QT-syndrome 3. DDDR pacing following implantation of an atrial lead prevented further ventricular tachyarrhythmias.