经食管电生理检查中的裂隙现象

在165例食管电生理检查中发现39例患者存在心脏传导系统多部位的裂隙现象共46例次(占24%),其中7例同时发生在2个部位.根据发生部位的不同试将其分成6型,探讨其发生部位及产生机理.     

Serum osmolal gap in clinical practice: usefulness and limitations

Background: Although serum osmolal gap can be a useful diagnostic tool, clinicians are not familiar with its use in clinical practice.

Objectives: The review presents in a series of questions-answers and under a clinical point of view the current data regarding the use of osmolal gap.

Discussion: The definition and the best formula used for the calculation of osmolal gap, the main causes of increased osmolal gap with or without increased anion gap metabolic acidosis, as well as the role of concurrent lactic acidosis or ketoacidosis are presented under a clinical point of view.

Conclusions: The calculation of osmolal gap is crucial in the differential diagnosis of many patients presenting in emergency departments with possible drug or substance overdose as well as in comatose hospitalized patients.     

耳内镜与显微镜下鼓室成形术手术效果的比较分析

目的 比较耳内镜与传统显微镜下鼓室成形术的安全性和疗效.方法 回顾性分析2018年12月-2019年12月在清远市人民医院耳鼻喉科接受鼓室成形术患者的病历资料.根据手术方式将患者分为经耳内镜鼓室成形术组(耳内镜组)和经显微镜鼓室成形术组(显微镜组).比较两组患者手术引起感音神经性耳聋的风险(骨导听阈上升)、手术对听觉的...     

Wiltse肌间隙入路与常规入路治疗胸腰椎骨折的临床比较

目的：探讨经Wiltse肌间隙入路治疗胸腰椎骨折的可行性.方法：回顾性分析48例胸腰椎骨折患者的病历资料,经常规手术入路行后路椎弓根螺钉内固定术者25例为对照组（A组）;经Wiltse肌间隙入路行椎弓根螺钉内固定者23例为观察组（B组）.比较2组患者的手术时间、切口长度、术中出血量、引流量、术后疼痛视觉摸拟评分、Cobb＇s角及术后日本骨科协会评分.结果：A组患者的手术时间、出血量、引流量术后VAS评分均大于B组[（80.04±9.650）min,（60.48±6.374）min,t=8.210,P=0.000;（280.40±56.60）mL,（180.43±60.11）mL,t=5.934,P=0.000;（161.60±44.31）mL,（120.00±28.28）mL,t=3.838,P=0.000;（5.792±1.444）,（3.087±1.203）,t=3.838,P=0.000];2组患者的切口长度、术后JOA评分及手术前后Cobb＇s角比较,差异均无统计学意义[（10.40±1.49）cm,（10.33±1.49）cm,t=0.171,P=0.865;（27.280±1.487）,（26.348±1.921）,t=1.889,P=0.065;（22.060±4.887）,（22.870±5.513）,t=-0.539,P=0.592;（6.204±1.737）,（6.844±1.359）,t=-1.412,P=0.165].结论：与常规手术入路相比,经Wiltse肌间隙入路内固定治疗胸腰椎骨折具有手术时间短、出血量少及术后疼痛程度低的优点,值得推广.     

Improving programme-led and focused interventions for eating disorders: An experts' consensus statement—A UK perspective

Objective

Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch.

Method

In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap.

Results

Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal.

Conclusions

Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.     

Hearing results of surgery for tympanosclerosis

Between January 1990 and December 2003, 117 patients were surgically treated for tympanosclerosis at a tertiary referral center. The objective of our study was to review the hearing results in this cohort. The patients were divided into three groups: predominant involvement of tympanic membrane (33 cases), predominant fixation of malleus or/and incus (72 cases), and stapedial fixation (12 cases). Preoperative and postoperative air–bone gap (ABG), and pure tone average (PTA) were compared after short-term and long-term follow-up, and statistical significance was determined. After surgery, air–bone gap was improved by 11.7 dB after short-term, and by 10.9 dB after long-term observation period. The improvement of ABG was not significantly different between the groups. Pure tone average (PTA) was improved by 15.2 dB in short-term period, with decrease of results in the long-term follow-up to 10.3 dB. Successful hearing result as judged by ABG was obtained in 66.7% with affected tympanic membrane, in 65.3% with malleus or/and incus fixation, and in 50.0% with stapedial fixation. Statistical analysis confirmed significant improvement of hearing for all groups. Highly significant difference was noted for low frequency ABG (0.5, 1, and 2 kHz). Hearing improvement on ABG was preserved after long-term observation. No significant sensorineural hearing loss was seen in this series. Surgery for tympanosclerosis results in significant improvement of ABG and PTA. Most of the improvement is obtained in lower frequencies. Long-term results are comparable to short-term results, with slight hearing deterioration in stapedial fixation.     

Evolution of left-sided thoracoscopic approach for long gap esophageal atresia repair

BackgroundLeft-sided repair for long gap esophageal atresia (LGEA) has been described for patients with a large leftward upper pouch, no thoracic tracheoesophageal fistula (TEF) nor tracheobronchomalacia (TBM), or as salvage plan after prior failed right-sided repair. We describe our experience with left-sided MIS traction induced growth process.MethodsWe retrospectively reviewed patients who underwent Foker process for LGEA at two institutions between December 2016 and November 2021. Patient characteristics, surgical techniques, and outcomes were reviewed.Results71 patients underwent Foker process. Of 34 MIS cases, 28 patients (82%) underwent left-sided repair (median gap length 5 cm) at median age 4 months with median 3 (range 2–8) operations and median 13.5 (IQR 11–21) days on traction until esophageal anastomosis. 9 patients (32%) underwent completely MIS approach, whereas 5 patients (18%) converted to open at first operation and 14 patients (50%) converted to open later in the traction process. Traction was internal in 68%, external in 11%, and combination in 21%. Median follow-up was 15.4 (IQR 7.5–31.7) months after anastomosis. 14% had anastomotic leak managed with antibiotics and/or esophageal vacuum therapy. Median number of esophageal dilations was 3.5 (range 0–13). 18% required stricture resection. 39% underwent Nissen fundoplication. None have needed esophageal replacement.ConclusionsFor multiple reasons including the tendency of both esophageal pouches to have a leftward bias, less tracheal compression by upper pouch, and clean field of surgery for reoperative cases, we now more commonly use left-sided approach for MIS LGEA repair compared to right side, regardless of left aortic arch.Level of evidenceLevel IV Treatment Study.     

Homing endonucleases catalyze double-stranded DNA breaks and somatic transgene excision in Aedes aegypti

Aedes aegypti is a major vector of arthropod-borne viruses such as yellow fever virus and dengue viruses. Efforts to discern the function of genes involved in important behaviours, such as vector competence and host seeking through reverse genetics, would greatly benefit from the ability to generate targeted gene disruptions. Homing endonucleases are selfish elements which catalyze double-stranded DNA (dsDNA) breaks in a sequence-specific manner. In this report we demonstrate that the homing endonucleases I- Ppo I, I- Sce I, I- Cre I and I- Ani I are all able to induce dsDNA breaks in adult female Ae. aegypti chromosomes as well as catalyze the somatic excision of a transgene. These experiments provide evidence that homing endonucleases can be used to manipulate the genome of this important disease vector.     

The Renin–Angiotensin System Mediates the Effects of Stretch on Conduction Velocity,Connexin43 Expression,and Redistribution in Intact Ventricle

Effect of Stretch on Conduction and Cx43 . Introduction: In disease states such as heart failure, myocardial infarction, and hypertrophy, changes in the expression and location of Connexin43 (Cx43) occur (Cx43 remodeling), and may predispose to arrhythmias. Stretch may be an important stimulus to Cx43 remodeling; however, it has only been investigated in neonatal cell cultures, which have different physiological properties than adult myocytes. We hypothesized that localized stretch in vivo causes Cx43 remodeling, with associated changes in conduction, mediated by the renin–angiotensin system (RAS). Methods and Results: In an open‐chest canine model, a device was used to stretch part of the right ventricle (RV) by 22% for 6 hours. Activation mapping using a 312‐electrode array was performed before and after stretch. Regional stretch did not change longitudinal conduction velocity (post‐stretch vs baseline: 51.5 ± 5.2 vs 55.3 ± 8.1 cm/s, P = 0.24, n = 11), but significantly reduced transverse conduction velocity (28.7 ± 2.5 vs 35.4 ± 5.4 cm/s, P < 0.01). It also reduced total Cx43 expression, by Western blotting, compared with nonstretched RV of the same animal (86.1 ± 32.2 vs 100 ± 19.4%, P < 0.02, n = 11). Cx43 labeling redistributed to the lateral cell borders. Stretch caused a small but significant increase in the proportion of the dephosphorylated form of Cx43 (stretch 9.95 ± 1.4% vs control 8.74 ± 1.2%, P < 0.05). Olmesartan, an angiotensin II blocker, prevented the stretch‐induced changes in Cx43 levels, localization, and conduction. Conclusion: Myocardial stretch in vivo has opposite effects to that in neonatal myocytes in vitro. Stretch in vivo causes conduction changes associated with Cx43 remodeling that are likely caused by local stretch‐induced activation of the RAS. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1276‐1283, November 2010)