Third International Conference on Shape Memory and Superelastic Technologies

Summary. More than 10 years after its clinical introduction, extracorporeal shock wave lithotripsy (ESWL) has proved to be the safest treatment modality for more than 90% of urinary stones. Absolute contraindications are untreated coagulopathy, urinary tract infection and pregnancy. After careful preparation, even patients with severe coagulopathy (haemophiliacs A/B, thrombocytopenia) can be treated successfully by ESWL. Shock wave lithotripsy for an increasing amount of small symptomatic renal calculi resulted in a stone-free rate of 50% and a complaint-free rate of 52%. A 50% chance of success justifies initial ESWL treatment for stones in caliceal diverticula. A stone-free rate of 70% was reported for stone-bearing horseshoe kidneys, but the recurrence rate was 29%. Therefore, percutaneous stone removal may become necessary in such cases.

The utilization of indwelling stents has contributed to the extension of indication for ESWL monotherapy, even for staghorn calculi, as acute morbidity is reduced. Double-J stents, however, do not improve the stone-free rate and special attention should be paid to double-J morbidity. Depending on stone localization, post-ESWL long-term stone-free rates are 58–84% with a recurrence rate of 6–11 % and despite persisting fragments, the infection rate is low.

The main features of third generation lithotripters are a combined localization system allowing interdisciplinary shock wave lithotripsy, a wide energy range of the shock wave source resulting in an efficacy similar to that of the Dornier HM3 and integration of the shock wave source and fluoroscopy unit in an endoscopic treatment table for multifunctional use. Finally, a modified version of the Clayman-Preminger efficacy quotient for clinical comparison of different lithotripters, is outlined.     

Fibrinogen concentrate – a potential universal hemostatic agent

Background: Human fibrinogen concentrates have been commercially available for decades for substitution therapy in hypofibrinogenemia, dysfibrinogenemia and afibrinogenemia. Accumulating new data suggest that fibrinogen plays a critical role in achieving and maintaining hemostasis, particularly in patients suffering from acquired fibrinogen deficiency during massive bleeding, where benefit from early intervention with fibrinogen concentrate appears to be important. Objective/methods: This work focuses on pasteurized fibrinogen concentrate, with special emphases on product characteristics, pharmacodynamics, pharmacokinetics, laboratory monitoring, dosing, clinical efficacy, safety and tolerability. Future clinical and laboratory perspectives on fibrinogen are discussed and outlined. Results/conclusion: Pasteurized fibrinogen concentrate is derived from human plasma. Its half life is 2.7 days in patients with congenital fibrinogen deficiency. For congenital and acquired deficiency in vivo recovery rates vary from 60% to 109%. Reportedly, administration of pasteurized fibrinogen in patients with congenital deficiency is efficacious. Acquired deficiency of fibrinogen appears to be an early event in seriously bleeding patients, preceding critical levels of platelets or other coagulation factors. Experimental animal studies, as well as clinical observations suggest a beneficial role of early substitution with fibrinogen in management of critical traumatic and surgical bleeds. Pasteurized fibrinogen concentrate is well tolerated and associated with a low incidence of adverse thrombo-embolic events.     

Integrated analysis of safety and efficacy of a plasma- and albumin-free recombinant factor VIII (rAHF-PFM) from six clinical studies in patients with hemophilia A

Background: Hemophilia A is an X-linked bleeding disorder that results from insufficient levels of factor VIII (FVIII) coagulant activity. Objective: To evaluate the efficacy and safety of ADVATE^® rAHF–PFM (Baxter Healthcare Corporation), a recombinant FVIII concentrate manufactured without human or bovine blood-derived additives, and to assess the effect of compliance with prophylactic use in preventing bleeding episodes (BEs). Methods: Clinical data were integrated from six prospective studies. Two hundred thirty-four hemophilia A subjects (FVIII levels ≤ 2%) (median age 14.7 (range: 0.02 – 72.7) years) were included. Results: BEs were managed with one or two infusions and nearly all (1953/1956) responded to treatment. Compliance with a prophylactic treatment regimen significantly reduced the incidence of BEs (p = 0.0061) and prevented non-traumatic joint BEs (median annualized BE rate was 0). One previously treated subject developed an inhibitor; no other safety concerns were observed. Conclusions: These results reinforce the efficacy and safety of rAHF-PFM and suggest that compliance is an essential contributor to the effectiveness of prophylaxis in the treatment of hemophilia A.     

Apelin receptor: its responsiveness to stretch mechanisms and its potential for cardiovascular therapy

It has recently been demonstrated that the apelin receptor (APJ) plays a significant role in mediating the stretch response within the heart in a G-protein-independent and β-arrestin-dependent fashion. This discovery adds to the consolidated literature describing the potential benefits of APJ agonists. In this review, the authors will examine the functional selectivity of APJ and stretch with respect to their ability to signal via both G-protein-dependent and G-protein-independent mechanisms, with a focus on the multifunctional protein, β-arrestin. The possibility of selecting or designing novel ligands that differentially activate only a subset of functions via a single receptor holds great promise for the treatment of diseases such as heart failure and hypertension. Finally, hypothetical approaches to target APJ, taking into account its downstream pathways, will be described.     

中西医结合治疗对脊柱压缩性骨折患者临床疗效、疼痛症状及骨折愈合效果的影响

目的:分析中西医结合治疗脊柱压缩性骨折的临床疗效,及对患者治疗过程中疼痛评分、骨折愈合效果的影响,为临床脊柱压缩性骨折患者的临床治疗方案的选择提供参考。方法:选取2016年9月至2018年8月广州市番禺区中医院收治的脊柱压缩性骨折患者138例作为研究对象,采取抽签法随机分为对照组和观察组,每组69例。2组患者均行日常生活指导、常规药物治疗及分阶段康复锻炼,观察组在常规治疗的基础上予以分阶段辨证中药汤剂辅助治疗。2组患者均以连续治疗2个月为1个疗程。比较2组患者治疗前、治疗3 d、治疗7 d、治疗1个月时疼痛评分(VAS)变化,治疗前、治疗后椎体前缘高度、矢状面指数、Cobb角变化比较,治疗前、治疗1个月、治疗2个月后骨密度变化,完成治疗后,2组患者骨折愈合临床疗效判断并比较。结果:1) 2组患者治疗前VAS评分比较,差异无统计学意义(P 0. 05),治疗3 d、7 d、1个月后2组患者VAS评分均较治疗前明显降低,且观察组低于对照组(P 0. 05)。2) 2组患者椎体在治疗前,椎体前缘高度、矢状面指数和Cobb的椎体角比较,差异无统计学意义(P 0. 05);治疗后2组患者的椎体前缘高度明显增加,且观察组高于对照组(P 0. 05),2组患者矢状面指数、Cobb角均较治疗前降低,且观察组均低于对照组(P 0. 05)。3) 2组患者治疗前骨密度比较,差异无统计学意义(P 0. 05),治疗后1、2个月骨密度均较治疗前明显提升,且观察组均高于对照组(P 0. 05)。4)完成治疗后观察组治疗有效率(94. 4%)显著高于对照组(75. 3%),2组比较差异有统计学意义(P 0. 05)。结论:采用中西医结合治疗脊柱压缩性骨折患者,可有效降低患者治疗期间骨关节疼痛,提升骨密度,促进骨折结构恢复,提高临床治疗效果,具有较高的临床价值。     

乳酸菌阴道胶囊联合抗真菌栓剂序贯给药治疗妊娠期外阴阴道假丝酵母菌病疗效及安全性的Meta分析

目的 用meta分析评价乳酸菌阴道胶囊联合抗真菌栓剂序贯给药治疗妊娠期外阴阴道假丝酵母菌病疗效及安全性。方法 计算机检索PubMed、EMbase、Cochrane Libraries、CNKI、万方和维普数据库（各数据库检索时间均从创建至2016年12月）,收集相关文献。根据纳入和排除标准筛选并提取资料,采用RevMan 5.2软件进行meta分析。结果 共纳入15项研究,2 522例患者。Meta分析结果显示：乳酸菌阴道胶囊联合抗真菌栓剂试验组的治愈率高于单用抗真菌栓剂对照组,2组相比总治愈率具有统计学差异（P<0.000 01）;乳酸菌阴道胶囊联合抗真菌栓剂试验组的复发率低于单用抗真菌栓对照组,2组相比总复发率具有统计学差异（P<0.000 01）;乳酸菌阴道胶囊联合抗真菌栓试验组的不良反应发生率和单用抗真菌栓剂对照组接近,2组相比总不良反应发生率不具有统计学差异（P=0.68）。结论 基于现有临床证据,乳酸菌阴道胶囊联合抗真菌栓剂治疗妊娠期外阴阴道假丝酵母菌病比单用抗真菌栓剂的疗效好,且复发率低,安全性好。     

经皮激光气化减压术治疗腰椎问盘突出症后椎问隙高度改变和中长期临床疗效

目的观察经皮激光气化减压术（pereutaneous laser disc decompression,PLDD）治疗腰椎间盘突出症后椎间隙高度的变化和中长期临床疗效。方法腰椎间盘突出症患者（L4-5）256例,行PLDD治疗,激光输出功率10w,脉冲时间1s,脉冲间隔时间1s。术后随访6、18和60个月,比较术前、术后手术节段椎间隙高度（intervertebral height,IH）变化、手术前后疼痛的VAS评分、Oswestry功能障碍指数（Oswestry Disability Index,ODI）和改良Menab疗效评分法,以评估临床疗效。结果术前、术后VAS疼痛评分及ODI评分较术前明显缓解（P〈0．05）;术前、术后手术节段椎间隙高度比较差异无显著性（P〉0．05）;术后18和60个月满意率（Menab评分优良者）分别为90．3％和86．2％。结论PLDD治疗腰椎间盘突出症远期效果好,同时可有效维持椎间隙高度。     

早期输尿管癌保肾手术的临床疗效分析（附15例报告）

目的：探讨早期输尿管癌保留肾脏手术的可行性及疗效。方法：回顾性分析2004年6月～2010年8月15例早期输尿管癌保肾手术患者的临床资料,9例行输尿管节段切除端端吻合术;6例行输尿管末端及膀胱袖口状切除,输尿管膀胱再植术。术后均行膀胱灌注化疗。结果：本组15例患者术后病理均为移行细胞癌。14例获得随访6个月～5年,所有患者同侧输尿管及肾盂均未见复发,2例术后分别于9个月及3年出现膀胱移行细胞癌,术后膀胱癌发生率为14．3％（2／14）。结论：输尿管癌为少见尿路上皮肿瘤,保肾手术有复发的风险。但对早期、低级别输尿管癌,保肾手术效果良好。