先天性双侧输精管缺如患者囊性纤维化跨膜传导调节因子基因的检测

目的 探讨先天性双侧输精管缺如(CBAVD)患者与囊性纤维化跨膜传导调节因子(CFTR)基因突变的关系. 方法 收集2007年5月至2009年5月85例CBAVD患者.CBAVD诊断依据:无精子;性激素4项正常;双侧输精管未触及;双睾丸体积正常,附睾饱满淤积.另设健康已生育男性85例作为对照.抽取外周血,应用聚合酶链反应-单链构象多态及PCR产物直接序列测定法检测患者及对照组CFTR基因第10,11外显子,比较两组的突变情况. 结果 CBAVD组85例,CFTR基因突变10例,占11.8％,分别是I556V突变4例,M469V突变2例,E527N、△F508、L558S、S485C各1例.对照组85例均未见突变.两组间比较差异有统计学意义(x2=8.606,P=0.003).结论 CBAVD主要由CFTR基因突变引起,CFTR基因突变的位点与频率与西方白种人有所不同.     

Abbe’s瓣修复双侧唇裂术后继发畸形患者围手术期护理

目的:探讨Abbe’s瓣修复双侧唇裂术后继发畸形患者的围手术期观察与护理措施及效果。方法:回顾性分析2008年7月～2012年6月我科收治15例选用Abbe’s瓣修复双侧唇裂术后继发畸形患者的临床资料。结果:15例患者未出现术后并发症,唇交叉瓣成活,伤口愈合良好,鼻唇畸形得到矫正,功能外形大为改观,患者心理状态获得促进和最大程度的康复。结论:安全、有效的围手术期观察与护理是Abbe’s瓣修复双侧唇裂术后继发畸形手术成功与否的重要保证。     

双侧肢体电刺激对脑卒中早期患者神经功能恢复的影响

目的:探讨脑卒中早期双侧康复训练对神经功能恢复的影响。方法:选取急性脑卒中患者90例,分成单侧、双侧康复治疗组与对照组,对康复组进行肢体电刺激治疗,比较3组治疗后神经功能缺损、肢体运动功能和日常生活活动能力的改善。结果:双侧治疗组、单侧治疗组和对照组治疗后CNS评分为13±5,16±6,19±5,FMA评分为68±18,58±17,41±19,MBI评分为66±14,58±14,44±15,差异有显著性意义(F值分别为9.93,16.75,19.72,P<0.05)。结论:脑卒中早期康复治疗可以促进神经功能恢复,并且双侧康复训练优于单侧康复。     

Bilateral Tubal Ectopic Pregnancy: A Tale of Caution

Diagnosis of ectopic pregnancy continues to be an important challenge facing emergency physicians. The authors present a case of bilateral tubal ectopic pregnancy and discuss its clinical features and diagnostic difficulties. A review of the English-language literature on the subject is discussed. Suggestions are made on ways to increase diagnostic accuracy, reduce complications, and preserve future fertility in this group of patients.     

子宫浆肌层缝扎加双侧子宫动脉上行支结扎对产后出血的治疗效果

目的:研究子宫浆肌层缝扎加双侧子宫动脉上行支结扎对产后出血的治疗效果。方法:取某院剖宫产术中子宫腔内出血患者70例为研究对象,随机分为研究组(子宫浆肌层缝扎联合双侧子宫动脉上行支结扎)与对照组(子宫按摩联合催产素常规止血)各35例,比较观察指标、治疗效果与并发症。结果:研究组产后出血率(5.71%)较对照组(22.85%)低,出血量较对照组少,血性恶露消失时间较对照组短,研究组并发症率(8.57%)低于对照组(28.57%),研究组治疗效果(97.14%)高于对照组(82.85%),具有统计学差异(P<0.05)。结论:对剖宫产术中子宫腔内出血患者采用子宫浆肌层缝扎联合双侧子宫动脉上行支结扎治疗能减少产后出血量与产后出血发生率,缩短血性恶露消失时间,减少并发症且提高治疗效果,安全性高,值得借鉴。     

Coronary Artery Target Selection and Survival After Bilateral Internal Thoracic Artery Grafting

BackgroundThe importance of a coronary artery, based on the myocardial mass it perfuses, is well documented, but little is known about the importance of a vessel that has been bypassed and its effect on survival in the context of bilateral internal thoracic artery (BITA) grafting.ObjectivesThis study determined the effect of a dominant left anterior descending (LAD) artery and important non-LAD targets on outcomes after BITA grafting.MethodsFrom January 1972 to January 2011, of 6,127 patients who underwent BITA grafting, 2,551 received 1 ITA grafted to the LAD and had an evaluable coronary angiogram. A dominant LAD was defined as one that was wrapped around the left ventricular apex. Non-LAD targets were graded based on their terminal reach toward the apex: important: >75% (n = 1,698); and less important: ≤75% (n = 853). Mean follow-up was 14 ± 8.7 years. Multivariable analysis was performed to identify risk factors for time-related mortality.ResultsA dominant LAD was present more frequently in patients with less important additional targets (51% vs. 35%; p < 0.0001). A total of 179 patients (7.0%) received a second ITA to multiple targets, 77 (43%) of which were to multiple important target vessels. Unadjusted late survival was similar regardless of degree of importance of the second ITA target—77% at 15 years (p = 0.70) for the important and less important targets, respectively. In the multivariable model, grafting the second ITA to multiple important targets was associated with better long-term survival (p = 0.005). In patients with a nondominant LAD, a second ITA grafted to a less important artery was associated with higher risk of operative mortality (2.4% vs. 0.51%; p = 0.007). A saphenous vein graft to an important or less important target did not influence long-term survival.ConclusionsIn BITA grafting, bypassing multiple important targets to maximize myocardium supplied by ITAs improved long-term survival. In patients with a nondominant LAD, selecting an important target for the second ITA lowered operative mortality.     

Measures to Increase Use of Multiple Arterial Grafts for Isolated Coronary Artery Bypass Grafting

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Can young dancers skip/recover from patellofemoral pain? A two-year follow-up

ABSTRACT

Aiming to follow the prevalence of patellofemoral pain (PFP) among young dancers over 2-years, and to assess the prevalence of re-injured/recovered dancers; 67 dancers (aged 12.8 ± 0.5) were screened for PFP at baseline, 65 dancers at 1^st follow-up and 51 dancers at 2^nd follow-up. All dancers (46) that took part in all the 3 screenings had at least one episode of PFP along the screenings. No dancers recovered in the 1^st follow-up, yet 40.5% of the dancers with PFP at the 1^st follow-up recovered in the 2^nd follow-up. Along the 3 screenings, 23.9%, 34.8%, and 41.3% of the dancers had 1,2 or 3 PFP episodes, respectively. None of the dancers skipped PFP along the 3 screenings. A high prevalence of dancers had sustained PFP along the 2 follow-ups, with low recovery rate. Dancers and teachers should be alert to the need for devising modifications of training and injury prevention strategies from young age.