Inhibition of TNF-α improves the bladder dysfunction that is associated with type 2 diabetes

Diabetic bladder dysfunction (DBD) is common and affects 80% of diabetic patients. However, the molecular mechanisms underlying DBD remain elusive because of a lack of appropriate animal models. We demonstrate DBD in a mouse model that harbors hepatic-specific insulin receptor substrate 1 and 2 deletions (double knockout [DKO]), which develops type 2 diabetes. Bladders of DKO animals exhibited detrusor overactivity at an early stage: increased frequency of nonvoiding contractions during bladder filling, decreased voided volume, and dispersed urine spot patterns. In contrast, older animals with diabetes exhibited detrusor hypoactivity, findings consistent with clinical features of diabetes in humans. The tumor necrosis factor (TNF) superfamily genes were upregulated in DKO bladders. In particular, TNF-α was upregulated in serum and in bladder smooth muscle tissue. TNF-α augmented the contraction of primary cultured bladder smooth muscle cells through upregulating Rho kinase activity and phosphorylating myosin light chain. Systemic treatment of DKO animals with soluble TNF receptor 1 (TNFRI) prevented upregulation of Rho A signaling and reversed the bladder dysfunction, without affecting hyperglycemia. TNFRI combined with the antidiabetic agent, metformin, improved DBD beyond that achieved with metformin alone, suggesting that therapies targeting TNF-α may have utility in reversing the secondary urologic complications of type 2 diabetes.     

连续性肾脏替代治疗中滤器后加热法对患者体温的影响

目的探讨连续性肾脏替代治疗(CRRT)中滤器后加热法对患者体温的影响。方法将60例行CRRT治疗的患者随机分为对照组和观察组各30例,对照组按常规将加温装置连接到置换液的管路上,观察组将加温装置连接到滤器后静脉端血液回输管路上。两组均于CRRT治疗开始3h、6h、12h时测量患者体温及深静脉置管的动、静脉端的血液温度;比较两组治疗前后溶血反应相关检验结果。结果在CRRT治疗不同时段,两组深静脉置管的动、静脉端的血液温度比较,干预主效应均P<0.05;治疗12h时观察组低体温发生率显著低于对照组(P<0.05)。两组治疗前后溶血反应相关检验结果比较,差异无统计学意义(均P>0.05)。结论滤器后加热血液回输管路的方式可安全有效地补充CRRT治疗中循环热量,降低CRRT治疗中低体温发生率。     

Reengineering of blood transfusion process by using Six Sigma

目的 降低输血缺陷,保证患者输血安全°方法 成立输血质量管理小组,按照六西格玛管理体系的定义、测量、分析、改进和控制5个步骤,对输血关键环节展开调查和分析,以数据为基础,找出流程中的关键问题并进行改进和输血流程重组.结果 输血流程重组后,输血各环节双人核对落实率达100％,取血等待时间减少1 267.81 s,取血核对时间减少142.57 s.合血标本合格率由97.04％提高至99.14％,输血缺陷由0.05％下降到0.01％,六西格玛管理法实施前后合血标本合格率、输血缺陷发生率比较,差异有统计学意义(P＜0.05,P＜0.01).结论 运用六西格玛管理法重组输血流程能有效减少输血缺陷,提高护理工作效率.     

大转子式股骨柄置换及股骨近端防旋髓内钉治疗老年股骨转子间骨折

目的 探讨大转子式股骨柄(GTF)双极股骨头置换及股骨近端防旋髓内钉(PFNA)治疗老年不稳定性股骨转子间骨折的临床疗效.方法 对34 例老年股骨转子间骨折患者分别采用GTF双极股骨头置换(GTF组,19例)和PFNA内固定治疗(PFNA组,15例),比较两组手术时间、出血量、住院天数、下床时间、术后并发症、髋关节功能Harris评分等指标.结果 34例均得到随访,时间6～48(12.7±5.8)个月.PFNA 组均获得骨性愈合.PFNA组手术时间、出血量低于GTF组,GTF组下床时间、并发症、早期Harris评分优于PFNA组,差异均有统计学意义(P<0.05);两组患者住院天数及中晚期Harris评分差异无统计学意义(P>0.05).结论 GTF柄双极股骨头置换与PFNA内固定治疗老年不稳定性股骨转子间骨折,均可获得满意的临床效果,在一定适应证范围内,GTF具有相应优势.     

妇科腹腔镜中转开腹23例临床分析

目的 分析导致腹腔镜手术中转开腹的临床因素. 方法 回顾性分析浙江大学附属第二医院2006年5月～ 2011年5月,2 618例腹腔镜手术中转开腹的23例的临床特点.结果 中转开腹率0.88％.因良性疾病致盆腹腔严重粘连、恶性肿瘤、术中出血这3种原因是中转开腹的主要原因,所占的比例分别为56.5％、26.1％、8.7％. 结论 盆腹腔严重粘连、恶性肿瘤、出血是腹腔镜中转开腹的主要原因.加强对患者术前病情的评估可以减少中转开腹率,及减少并发症的发生.     

Ethnic difference of clinical vertebral fracture risk

Summary

Vertebral fractures are the most common osteoporotic fractures. Data on the vertebral fracture risk in Asia remain sparse. This study observed that Hong Kong Chinese and Japanese populations have a less dramatic increase in hip fracture rates associated with age than Caucasians, but the vertebral fracture rates were higher, resulting in a high vertebral-to-hip fracture ratio. As a result, estimation of the absolute fracture risk for Asians may need to be readjusted for the higher clinical vertebral fracture rate.

Introduction

Vertebral fractures are the most common osteoporotic fractures. Data on the vertebral fracture risk in Asia remain sparse. The aim of this study was to report the incidence of clinical vertebral fractures among the Chinese and to compare the vertebral-to-hip fracture risk to other ethnic groups.

Methods

Four thousand, three hundred eighty-six community-dwelling Southern Chinese subjects (2,302 women and 1,810 men) aged 50 or above were recruited in the Hong Kong Osteoporosis Study since 1995. Baseline demographic characteristics and medical history were obtained. Subjects were followed annually for fracture outcomes with a structured questionnaire and verified by the computerized patient information system of the Hospital Authority of the Hong Kong Government. Only non-traumatic incident hip fractures and clinical vertebral fractures that received medical attention were included in the analysis. The incidence rates of clinical vertebral fractures and hip fractures were determined and compared to the published data of Swedish Caucasian and Japanese populations.

Results

The mean age at baseline was 62?±?8.2?years for women and 68?±?10.3?years for men. The average duration of follow-up was 4.0?±?2.8 (range, 1 to 14) years for a total of 14,733 person-years for the whole cohort. The incidence rate for vertebral fracture was 194/100,000 person-years in men and 508/100,000 person-years in women, respectively. For subjects above the age of 65, the clinical vertebral fracture and hip fracture rates were 299/100,000 and 332/100,000 person-years, respectively, in men, and 594/100,000 and 379/100,000 person-years, respectively, in women. Hong Kong Chinese and Japanese populations have a less dramatic increase in hip fracture rates associated with age than Caucasians. At the age of 65 or above, the hip fracture rates for Asian (Hong Kong Chinese and Japanese) men and women were less than half of that in Caucasians, but the vertebral fracture rate was higher in Asians, resulting in a high vertebral-to-hip fracture ratio.

Conclusions

The incidences of vertebral and hip fractures, as well as the vertebral-to-hip fracture ratios vary in Asians and Caucasians. Estimation of the absolute fracture risk for Asians may need to be readjusted for the higher clinical vertebral fracture rate.     

混合型肝癌临床特点及近期预后分析

目的 探讨混合型肝癌(mixed hepatocellular carcinoma and cholangiocarcinoma,mHCCCC)的临床特点及近期预后.方法 回顾分析2009年4月至2010年2月在浙江大学医学院附属第一医院病理确诊为mHCC-CC的17例患者的临床资料,总结其临床特点并统计术后生存时间. 结果 患者平均发病年龄27～76岁;其中男性11例(64.7％);无临床症状10例(58.8％);乙肝表面抗原阳性12例(70.6％);甲胎蛋白阳性( ＞25 ng/ml) 12例(75.1％);糖类抗原199阳性(≥37 U/ml)4例(25.0％).17例患者中肿瘤均完整切除,即包括转移灶在内的肿瘤切除,切缘离肿瘤边缘1.5 cm以上,同时清扫肉眼可见或影像学提示的肿大淋巴结.术后6、12和18个月累积生存率分别为93.8％、86.5％、57.7％;术后100、200 d的无瘤生存率分别为65.3％、43.5％;中位无瘤生存期为161 d.结论 mHCC-CC术前诊断困难,确诊依靠病理诊断;手术切除是主要治疗手段,但总体预后较差.     

膝关节前交叉韧带翻修及影响首次重建疗效的相关因素分析

目的总结影响关节镜下前交叉韧带重建疗效的相关因素。方法回顾性分析135例前交叉韧带翻修病例的相关临床资料,进行膝关节Lysholm评分综合分析。结果膝关节继发性疾患、骨隧道位置、移植物的张力、髁间窝撞击、所移植肌腱的固定和术后康复训练6大因素是影响关节镜下膝关节前交叉韧带重建疗效的关键因素。结论高度重视以上6方面因素并正确处理,能有效提高关节镜下膝关节前交叉韧带重建的成功率和治疗效果。     

经直肠超声造影在外周带前列腺癌诊断中的应用价值

目的探讨经直肠超声造影在外周带区前列腺癌（PCa）诊断中的应用价值。方法对56例经病理证实为前列腺癌患者的超声造影表现进行回顾性分析。观察灰阶超声、彩色多普勒超声特点,以及病灶造影增强模式.用Q-LAB软件对病灶及其周围组织造影参数进行对比分析。结果 56例外周型前列腺癌患者,常规灰阶超声低回声结节42例,高回声结节8例,混合回声结节6例;彩色血流异常丰富38例。前列腺癌超声造影表现以快速高增强为主,45例前列腺癌表现为高增强,8例前列腺癌表现为等增强,3例表现为低增强,同时16例增强病灶内存在无增强区。结论经直肠超声造影检查对前列腺外周带癌的诊断有重要价值。     

阿米替林对非糜烂型胃食管反流病合并单纯抑郁症状的治疗效果分析

目的探讨非糜烂型胃食管反流病(non-erosive reflux disease,NERD)合并单纯抑郁症状的治疗效果。方法使用综合医院焦虑、抑郁量表(the Hospital anxiety and depressive scale HADS)对NERD患者进行心理测评,对合并单纯抑郁症状患者按轻度、中度、重度分层随机分为常规组、治疗组、对照组三组,每组90例。常规组:奥美拉唑20mg,2次/d,西沙比利10 mg,3次/d,口服;治疗组90例,给予阿米替林12.5 mg,3次/d,奥美拉唑20 mg,2次/d,西沙比利10 mg,3次/d,口服;对照组90例,安慰剂,半片,3次/d,奥美拉唑20 mg,2次/d,西沙比利10 mg,3次/d,口服。疗程为8周,并于治疗后2、4、6、8周观察反酸、烧心、反胃、胸骨后疼痛及抑郁症状的缓解情况。结果对照组和治疗组患者治疗8周后,精神、躯体症状均显著改善,与常规组有显著差异(P(0.01),相互间也有显著差异(P(0.01)。结论抗抑郁药治疗能显著改善合并有单纯抑郁症状的NERD患者的精神和躯体两方面症状。