Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Predicts Hemodynamic Outcome In Humans With Coronary Artery Disease: Primary Results of the International Multicenter iFR GRADIENT Registry

Objectives

The authors sought to evaluate the accuracy of instantaneous wave-Free Ratio (iFR) pullback measurements to predict post-percutaneous coronary intervention (PCI) physiological outcomes, and to quantify how often iFR pullback alters PCI strategy in real-world clinical settings.

Transthoracic Echocardiographic Documentation of Disappearance of Massive Pulmonary Artery Thromboemboli after Fibrinolytic Therapy

In this paper, we report two cases of acute massive pulmonary thromboemboli with pulmonary artery thrombus, in which disappearance of thrombus followed fibrinolytic therapy were documented at transthoracic echocardiographic follow-up. Data from these limited experiences suggest that, transthoracic echocardiography might be useful as a first diagnostic screening in cases of suspect pulmonary thromboembolism and thrombolytic therapy might be considered in patients with pulmonary artery thrombus with pulmonary embolism.     

Lung cancer in women: clinical features and factors related to survival

Lung cancer in women is increasing in worldwide. This process beginning with the difference on the susceptibility of lung cancer in women smokers may be different from men in the prognosis. In this study, it was aimed to evaluate the clinical features, and prognostic factors of female patients with lung cancer diagnosed between January 2000-December 2005. The data of 109 patients data was evaluated. The mean age was 59.40 +/- 11.56 and 17 (15.6%) patients were smokers. In 20 patients (18.3%) having a family history of cancer, 55% of them had a relative with lung cancer. In admission, cough (81.7%), dyspnea (78.9%), chest pain (40.3%) were the most frequent presenting symptoms. The most common site of tumoral lesion in bronchoscopy were right upper lobe (16.5%). In the study group histopathological diagnosis were as follows; adenocarcinoma (44.9%), small cell lung cancer (SCLC) (19.3%), squamous cell (10.1%), non-small cell lung cancer (NSCLC) --undefined (22.0%), carsinoid tumors (2.8%), in non-smokers adenocarcinoma was significantly higher than smokers (44.9%/17.7%) (p< 0.001). 61.9% of NSCLC patients and 57.1% of SCLC patients had a stage IV disease at the initial evaluation. The most common sites of metastasis were bone (28.4%), liver (22.9%), and brain (11.9%), there were multiple metastasis in 10 patients. Median survival time was found as 288 days. In univariate analysis, comorbidity, primary tumor stage, bone metastasis, advanced disease stage, ECOG performance score >or= 2 and supportive care alone were poor prognostic factors. In multivariate analysis, poor performance status (p= 0.003), advanced disease stage (p= 0.002) and bone metastasis (p= 0.04) were negatively related to survival. In women, the definition of the clinical features, disease course and survival related factors may contribute to our future treatment approaches based on our national data.     

卡巴胆碱减轻大鼠烫伤休克期肠内补液时肠组织氧自由基的损伤

目的:研究拟胆碱药卡巴胆碱(carbachol,CAR)对大鼠烫伤休克期肠内补液时肠组织氧自由基损伤的影响.方法:38只♂ Wistar大鼠,采用沸水法(100℃,10 s)造成35%TBSAⅢ度烫伤.随机分为不复苏组(单烫组,n=8)、葡萄糖-电解质溶液(glucose electrolyte solution)复苏组(GES组,n=10)、单纯卡巴胆碱治疗组(CAR组,n=10)和GES CAR复苏组(GES/CAR组,n=10).两液体复苏组在伤后30 min将GES经十二指肠造口匀速泵入,按Parkland公式设定补液速率,CAR组和GES/CAR组在伤后30 min将CAR以60 μg/kg溶于0.5 mL生理盐水中一次注入十二指肠.所有大鼠在伤后4 h处死,取空肠组织测定脂质过氧化物丙二醛(malondialdehyde.MDA)含量、黄嘌呤氧化酶(xanthine oxidase,XOD)和髓过氧化物酶(myeloperoxidase,MPO)活性,并观察肠组织病理学变化.结果:烫伤后GES组肠组织XOD、MP0活性和MDA含量分别高于单烫组13.2%、21.3%和21.1%,并有统计学意义(P＜0.05);GES/CAR组XOD,MPO和MDA均较GES组明显下降(1.36±0.37 vs 2.5l±0.56;0.47±0.14 vs 0.83±0.21;3.97±1.57 vs 6.59±1.50,P＜0.01);CAR组各指标数值最低.肠组织病理损伤也表现为CAR组和GES/CAR组最轻,单烫组次之,GES组损伤最重.结论:卡巴胆碱能有效减轻烫伤休克大鼠肠内复苏时的肠道氧自由基损伤,机制可能与其抗炎作用和抑制黄嘌呤氧化酶活性、减少氧自由基生成有关.     

经心外膜聚焦超声环肺静脉消融与左房盒式消融治疗犬心房颤动的比较研究

目的探讨聚焦超声经心外膜的环肺静脉消融(CPVa)和左房盒式消融(BOXa)两种不同术式对心房颤动(简称房颤)的影响。方法成年杂种犬20只,随机分为两组,建立肺静脉起源的阵发性房颤模型后,直视下分别行CPVa和BOXa。测定消融前、后左房有效不应期(LAERP)、计算房颤诱发率、房颤持续时间,术毕行组织学检查。结果所有犬均能诱发出肺静脉起源的阵发性房颤,房颤终止后的LAERP较基线水平显著缩短(CPVa组:140±10msvs102±10ms;BOXa组:139±11msvs105±8ms;P均<0.01),但消融前后的LAERP并无显著性差异。消融后两组的房颤诱发率均较消融前显著降低(CPVa组:98%vs28%;BOXa组:97%vs14%;P均<0.01),房颤持续时间均显著缩短(CPVa组:233±40svs70±29s;BOXa组:240±41svs34±22s;P均<0.01);部分犬可见肺静脉-心房双向电传导阻滞;消融后BOXa组房颤诱发率和房颤持续时间低于/短于CPVa组(P<0.05)。消融后焦域内的组织呈凝固性坏死。结论经心外膜聚焦超声CPVa可显著降低房颤诱发率和缩短房颤持续时间,而BOXa则可进一步提高成功率。     

The prevalence of Helicobacter pylori and related factors among university students in Turkey

The frequency and risk factors for contamination of Helicobacter pylori infection was investigated among Sakarya University students. Two-hundred students randomly chosen from among those who volunteered for the study and met its criteria were included. Data were obtained by a questionnaire. H. pylori positivity was checked with the monoclonal H. pylori stool antigen test. Statistical analysis was done with chi-square test. The average age of the subjects was 21.14 +/- 2.06, and 76% of them were female. Monthly family income was below 575 Euros in 69.5% of them, and 56% were living in state dormitories. H. pylori positivity was found to be as high as 63% in our group. According to the qustionnaire (age, gender, blood groups, family income, crowded family living conditions, smoking, alcohol and caffeine consumption, the presence of gastric symptoms, family history, and hygienic behaviors), no statistical differences were found between the H. pylori positive and negative students. These data support the finding that personal and environmental conditions in adults did not affect H. pylori infectivity, and that H. pylori might be acquired in childhood.     

孕酮对脑损伤神经保护作用的Meta分析

目的 评价孕酮对脑损伤的神经保护作用.方法 计算机检索2005～2014年关于孕酮治疗创伤性脑损伤(TBI)的随机对照临床试验,并用Revman 5.1软件对符合纳入标准的研究进行系统评价.结果 本研究共纳入3个研究,Meta分析显示:孕酮和安慰剂对TBI患者的预后有差异性,且差异有统计学意义[病死率和格拉斯哥预后量表评分(4～5分)RR (95％CI)值分别为0.6(0.41～0.88)、1.61(1.18～2.27),格拉斯哥昏迷量表评分均数差(MD)值为0.87 (0.24～1.51)].结论 孕酮能降低TBI患者病死率,提高格拉斯哥预后量表和格拉斯哥昏迷量表评分,从而改善预后,促进患者神经功能恢复.     

丙酮酸盐糖液对烫伤大鼠肠内补液时肠黏膜血流量及Na ＋-K ＋-ATP 酶活性和吸收效率的影响

目的：口服胃肠道补液是战时、火灾等恶劣条件下救治烧伤休克的一种简便易行且有效的方法,实践证明HCO3盐糖液有确切疗效。文中通过与之比较,研究丙酮酸盐糖液对35％总体表面积Ⅲ度烫伤大鼠肠内补液时肠黏膜血流量（ intestinal mucosa bloodflow , IMBF）、Na＋-K＋-ATP酶活性和吸收效率的影响。方法雄性SD大鼠90只,随机数字表法分为5组：烫伤不补液组、HCO3盐糖液假烫组、丙酮酸（Pyruvat）盐糖液假烫组、HCO3盐糖液烫伤组、丙酮酸盐糖液烫伤组,每组18只,每组又分为伤后1．5 h和4．5 h亚组,分别检测小肠对水和Na＋的吸收速率、IMBF和Na＋-K＋-ATP酶活性。结果与假烫组比较,烫伤补液组大鼠小肠对水和Na＋的吸收速率均显著降低（P＜0．05）;自伤后1 h,丙酮酸盐糖液烫伤组对水和Na＋的吸收速率均高于HCO3盐糖液烫伤组（P＜0．05）。与假烫组比较,烫伤补液组大鼠的IMBF和Na＋-K＋-ATP酶含量在伤后1．5、4．5 h均明显降低（P＜0．05）;丙酮酸盐糖液烫伤组IMBF在伤后1．5、4．5 h[（95．250±5．096）、（112．765±7．215）U]明显高于HCO3盐糖液烫伤组[（80．764±7．852）、（94．671±8．469）U]差异有统计学意义（P＜0．05）。结论丙酮酸盐糖液口服胃肠道补液可作为战时、火灾等恶劣条件下救治烧伤休克的一种简便有效的方法。     

Posterior endoscopic discectomy: Results in 300 patients

Background:

Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system.

Materials and Methods:

A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab''s criteria after a minimum followup of 12 months and maximum up to 24 months.

Results:

Based on modified Macnab''s criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months.

Conclusion:

Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.