Left atrial thrombus two years after placement of a left atrial appendage closure device: Unexplored area of the Watchman

A 72‐year‐old man who underwent a left atrial appendage (LAA) closure device 2 years ago presented with atrial flutter with rapid ventricular rate and was referred for cardioversion. Precardioversion transesophageal echocardiogram showed left atrial thrombus and therefore the procedure was aborted. Currently, there is no guideline on imaging surveillance or anticoagulation in patients with LAA closure device who develop intracardiac thrombus after the initial 6‐month surveillance period.     

Management of dyspepsia—The role of the ED Observation unit to optimize patient outcomes

Background

Dyspepsia is a common complaint that can confer significant burden on one's quality of life and may also be associated with serious underlying conditions. The objective of this study was to determine if patients admitted to the emergency department observation unit (EDOU) for severe or persistent dyspepsia would have cost effective management in terms of investigations performed, length and cost of hospital stay. The secondary objective was to determine if any patient characteristics could predict a need for admission to the inpatient unit.

计算机辅助设计与制作技术在眼眶爆裂性骨折治疗中的应用及疗效评价

背景 眼眶爆裂性骨折引起明显的眼球形态和功能的异常.眼眶解剖结构复杂,故眼眶骨折修复手术中植入物的设计和制作具有一定的难度,而计算机辅助设计与制作(CADM)技术有望提供一种新的方法,但其临床应用价值有待评估.目的 研究CADM技术在眼眶爆裂性骨折治疗中的应用方法,评价其临床效果.方法 对河南省眼科研究所河南省立眼科医院2006年7月至2012年7月收治的眼眶爆裂性骨折患者74例74眼的手术过程和疗效进行回顾性分析,其中CADM手术者58例58眼,非CADM手术者16例16眼,2个组间患者基线特征,如年龄、性别和眼别均匹配.CADM手术组术眼采用CADM技术进行个体化三维立体植入物的设计和制作并进行眶骨骨折缺损处的填充,非CADM手术组术眼采用常规羟基磷灰石人工骨或多孔聚乙烯高分子合成材料(Medpor)填充法.所有术眼术前均行常规眼部检查以及CT检查,术后随访22～69个月,在随访期间内定期进行眼部临床观察和CT检查.观察指标包括最佳矫正视力、眼球突出度、眼球位置、眼球运动和复视改善情况以及并发症情况.结果 CADM手术组和非CADM手术组术眼术前最佳矫正视力分别为0.71±0.37和0.69±0.41,术后最佳矫正视力分别为0.74±0.38和0.72±0.41,组间差异无统计学意义(F分组=0.043,P=0.837),术眼手术前后视力的总体比较差异有统计学意义(F时间=13.576,P＜0.01),其中2个组术眼术后视力均好于术前,差异均有统计学意义(均P＜0.05).2个组间复视和眼球运动障碍治愈和好转的眼数分布差异均无统计学意义(Z=-0.298,P=0.766;Z=-0.548,P=0.584).CADM手术组和非CADM手术组术眼术前眼球眼球内陷度值分别为(3.93±0.99) mm和(3.88±0.97)mm,术后分别为(0.91±0.67)mm和(1.84±0.80)mm,组间总体比较差异无统计学意义(F分组=3.558,P=0.063),各组术眼术后眼球眼球内陷度值均明显低于术前,差异均有统计学意义(均P＜0.05).CT影像显示,CADM手术组术眼植入物在位,与眶骨骨折缺损处贴合良好,患者眼球位置及外观均恢复正常.非CADM手术组术眼发生植入物翘起并损伤内直肌.随访期内CADM手术组未发现组织感染、排斥反应等不良反应.结论 CADM技术用于眼眶爆裂性骨折的治疗可重建三维立体骨性眼眶,并有效改善患眼位置、眼球运动功能和视觉功能,其疗效优于传统植入物填充术.     

一个以肾上腺皮质功能减退起病的X连锁肾上腺脑白质营养不良家系报道

报道1个以肾上腺皮质功能减退起病的X连锁肾上腺脑白质营养不良(X-ALD)家系。家系中3例患者均以肾上腺皮质功能减退起病,经基因检测发现位于X染色体的ABCD1基因(转录版本Exon编号:NM_000033.3 exon6)存在c.1552C>T chrX-153005609(p.R518W)变异,该突变为致病突变。该家系报道的突变位点为国内第3次报道,为深入认识X-ALD提供信息。     

Comparison analysis of first-line asparaginase- versus non-asparaginase-based regimens for early-stage extranodal NK/T-cell lymphoma

Annals of Hematology - The present study investigated the efficacy and toxicity profile of first-line asparaginase (ASP)-based versus non-ASP-based regimens in treating early-stage extranodal...