Importancia pronóstica de la enfermedad arterial periférica diagnosticada mediante el índice tobillo-brazo en población general española

ObjectiveThe objectives have been to determine the prognostic value of having a low ankle-brachial index (ABI) for different cardiovascular diseases and whether it improves the predictive capacity of the main cardiovascular risk scores proposed for Spain.DesignPopulation-based cohort studyLocationA health area of the province of Badajoz (Spain)Participants2,833 subjects, representative of residents, between 25 and 79 years old,MeasurementsThe ABI was measured at baseline and the first episode of ischemic heart disease or stroke, cardiovascular and total mortality, was recorded during 7 years of follow-up. The hazard ratio (HR) adjusted for cardiovascular risk factors and net reclassification index (NRI) by category, clinical and continuous for the risk functions REGICOR, FRESCO coronary heart disease, FRESCO cardiovascular disease and SCORE, were calculated.Results2,665 subjects were analysed after excluding people with cardiovascular history and loss of follow-up. Low ABI was associated with adjusted HR (95% CI): 6.45 (3.00 - 13.86), 2.60 (1.15 - 5.91), 3.43 (1.39 - 8.44), 2.21 (1.27 - 3.86) for stroke, ischemic heart disease, cardiovascular mortality and total mortality respectively. The ABI improved the NRI (95% CI) in the intermediate risk category according to FRESCO cardiovascular equation by 24.1% (10.1 - 38.2).ConclusionsLow ABI is associated with a significant increase in the risk of stroke, ischemic heart disease, cardiovascular mortality and total mortality in our population. The inclusion of ABI improved the reclassification of people at intermediate risk, according to FRESCO cardiovascular, so its use in that risk category would be justified.     

连续臂丛神经阻滞治疗上肢带状疱疹后遗神经痛的临床分析

目的探讨连续臂丛神经阻滞治疗上肢带状疱疹后遗神经痛的临床效果。方法回顾性分析自2008～2011年68例进行连续臂丛神经阻滞治疗上肢带状疱疹后遗神经痛患者的临床资料,对比同期行口服药物、外用药物及针灸理疗(保守治疗)的患者。结果治疗后重新进行疼痛视觉模拟评分并综合评估,连续臂丛治疗组的治疗优良率为92.4%,对比的保守治疗组的治疗优良率为79.0%,两组优良率差异具有统计学差异(P<0.05)。臂丛组治疗后共出现不良反应例数22例,其主要不良反应为患区后遗症状,如痒感,蚁行感和牵拉或紧束感仍然存在,19例患者均能够耐受,并在治疗后1个月内缓解。3例患者在天气骤变后出现暂时性疼痛加重,气温升高后缓解。保守治疗组治疗后共出现不良反应例数9例,其中恶心、呕吐4例,复视、视物模糊3例,晕针现象2例,均于停药及停止针炙治疗后好转。结论连续臂丛阻滞在治疗带状疱疹后遗神经痛较传统的药物和理疗具有治疗效果确切,镇痛完全的特点,可成为治疗带状疱疹后遗神经痛的重要临床治疗手段。     

瑞舒伐他汀对轻中度高血压伴高脂血症患者炎性因子及踝臂指数的影响

目的：观察瑞舒伐他汀对轻中度高血压伴高脂血症患者炎性因子及踝臂指数的影响。方法将100例轻中度高血压伴高脂血症患者随机分为普伐他汀组和瑞舒伐他汀组,分别口服普伐他汀10 mg,每晚1次;瑞舒伐他汀5 mg,每晚1次;疗程8周,观测患者治疗前后的各项血脂指标、超敏 C 反应蛋白(hs-CRP)及踝臂指数(ABI)的变化。结果两组治疗前各项指标比较差异无统计学意义;与普伐他汀组比较,瑞舒伐他汀组治疗后总胆固醇(TC)、低密度脂蛋白(LDL-C)、hs-CRP 降低,ABI 增高(P <0.05);与治疗前比较,治疗后瑞舒伐他汀组 TC、LDL-C、hs-CRP降低(P <0.05)。结论瑞舒伐他汀可明显降低轻中度高血压伴高脂血症患者各项血脂指标及 hs-CRP 水平,减轻血管炎性反应,并且明显改善患者的动脉弹性功能。     

干细胞移植治疗糖尿病足

背景：以自体骨髓、脐血单个核细胞移植治疗糖尿病足,对缺血性病变及周围神经损伤所致临床症状有改善作用,对糖尿病足也有较好的疗效。脐带间充质干细胞与骨髓干细胞和脐血干细胞相比有其自身的优势。 目的：观察脐带间充质干细胞移植治疗糖尿病足病缺血及神经损伤的疗效。 方法：选取2010至2012年住院行脐带间充质干细胞移植治疗的糖尿病足病患者32例,将脐带间充质干细胞稀释后行双下肢肌肉内注射,每个注射点间隔约3 cm,每个肢体移植(5.02±1.37) ×108个。于3个月和6个月后评价其下肢缺血和下肢周围神经病变情况。并检索CNKI数据库,对国内干细胞移植治疗糖尿病足的研究状况进行分析。 结果与结论：移植后踝肱指数升降不一,移植后6个月疼痛评分及冷感评分明显改善,间歇性跛行及皮肤温度、经皮氧分压治疗后3,6个月与移植前比较差异均有显著性意义;对神经病变损伤自觉症状评分、临床检查评分、振动感觉阀值移植后6个月与移植前比较差异有显著性意义。腓浅神经、胫神经感觉神经传导速度,腓总神经、胫神经运动神经传导速度,在移植后3个月与移植前比较,差异无显著性意义(P > 0.05),移植6个月与移植前相比较有升高,差异有显著性意义(P < 0.05)。可见脐带间充质干细胞可以改善糖尿病缺血性病变及周围神经病变的临床症状及客观指标。文献分析结果发现,已有的研究中治疗结果都比较理想,多数研究中的移植方法为进行肌肉注射。     

幼年特发性关节炎患儿血管内皮功能的系统评价和meta分析

目的 通过系统评价肱动脉血流介导的血管舒张(flow mediated dilation,FMD)功能与幼年特发性关节炎患儿(juvenile idiopathic arthritis,JIA)的相关性,探讨JIA患儿的血管内皮功能.方法 计算机检索Pubmed、Embase、Web of Science、The Co...     

Musculoskeletal deformities secondary to neurotomy of the superior trunk of the brachial plexus in neonatal mice

The developmental course of musculoskeletal deformities in neonatal brachial plexus palsy (NBPP) has not been studied extensively. The goals of this study were to: (1) evaluate a new animal model of NBPP, (2) characterize the development of musculoskeletal abnormalities in paralyzed shoulders, and (3) investigate the expression of myogenic and adipogenic genes in paralyzed rotator cuff muscles. Neonatal mice were divided into neurotomy and sham groups. The neurotomy group underwent surgical transection of the superior trunk of the brachial plexus within 24 h of birth. The sham group underwent the same surgical exposure, but the brachial plexus was left intact. Musculoskeletal deformities were evaluated with radiological and histological assays at 2, 4, 8, 12, and 30 weeks after birth. The supraspinatus muscles of a separate group of mice were used to examine expression of myogenic and adipogenic genes at 8 weeks. The neurotomized forelimbs developed deformities similar to those seen in human NBPP. The deformities progressed with age. The denervated supraspinatus muscles showed intramuscular fat accumulation and upregulation of both myogenic and adipogenic genes compared to the normal. The current study presents a useful animal model for future research examining musculoskeletal changes secondary to neonatal nerve injury. Published by Wiley Periodicals, Inc. J Orthop Res 28:1391–1398, 2010     

不同病因尿毒症患者肱动脉内-中膜厚度与内皮舒张功能的临床研究

[目的]探讨不同病因所致尿毒症行维持性血液透析(MHD)患者肱动脉内-中膜厚度(IMT)与内皮舒张功能(EDD)间有无差异.[方法]应用高分辨率超声诊断仪,对51例应用动静脉内瘘行MHD的尿毒症患者(其中高血压肾病所致16例、糖尿病肾病所致15例、慢性肾小球肾炎所致20例)和30例正常对照组,检测尿毒症MHD患者无动静脉内瘘侧肱动脉及健康人右侧肱动脉IMT、基础内径、反应性充血后内径并计算肱动脉EDD.[结果]在高血压肾病、糖尿病肾病和慢性肾小球肾炎所致尿毒症MHD患者中,三组的EDD与健康对照组比较(14.98±4.87)%,差异有显著性意义(P<0.01);糖尿病肾病组的EDD(4.78±0.85 )%与高血压肾病组(7.39±1.54)%和慢性肾小球肾炎组(7.81±2.11 )%比较,差异有显著性意义(P<0.01),高血压肾病组与慢性肾小球肾炎组EDD比较,差异无显著性意义(P>0.05).高血压肾病组(0.38±0.10) mm、糖尿病肾病组(0.46±0.07) mm、慢性肾小球肾炎组(0.40±0.10) mm的IMT与健康对照组(0.28±0.09) mm比较,差异有显著性意义(P<0.01);三组病例组间的IMT比较,差异无显著性意义(P>0.05).[结论]不同病因所致尿毒症MHD患者中,糖尿病肾病所致尿毒症EDD受损最严重,而三组病例组间IMT无差异.     

Seizure complicating placement of a nerve stimulator-guided infraclavicular block: could the use of ultrasound decrease the risk?

The case of a patient who suffered a seizure following a nerve stimulator-guided coracoid infraclavicular brachial plexus block, is reported. Following the seizure, an ultrasound machine was used to image the patient's infraclavicular region, which showed an anatomical variation in the position of the axillary vein relative to the axillary artery. The use of ultrasound in regional anesthesia provides additional safety information beyond nerve stimulation, which may help decrease the likelihood of such complications.