High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology

Both high-resolution manometry (HRM) and impedance-pH/manometry monitoring have established themselves as research tools and both are now emerging in the clinical arena. Solid-state HRM capable of simultaneously monitoring the entire pressure profile from the pharynx to the stomach along with pressure topography plotting represents an evolution in esophageal manometry. Two strengths of HRM with pressure topography plots compared with conventional manometric recordings are (1) accurately delineating and tracking the movement of functionally defined contractile elements of the esophagus and its sphincters, and (2) easily distinguishing between luminal pressurization attributable to spastic contractions and that resultant from a trapped bolus in a dysfunctional esophagus. Making these distinctions objectifies the identification of achalasia, distal esophageal spasm, functional obstruction, and subtypes thereof. Ambulatory intraluminal impedance pH monitoring has opened our eyes to the trafficking of much more than acid reflux through the esophageal lumen. It is clear that acid reflux as identified by a conventional pH electrode represents only a subset of reflux events with many more reflux episodes being composed of less acidic and gaseous mixtures. This has prompted many investigations into the genesis of refractory reflux symptoms. However, with both technologies, the challenge has been to make sense of the vastly expanded datasets. At the very least, HRM is a major technological tweak on conventional manometry, and impedance pH monitoring yields information above and beyond that gained from conventional pH monitoring studies. Ultimately, however, both technologies will be strengthened as outcome studies evaluating their utilization become available.     

注意训练对非流畅性失语患者双任务范式干扰效应影响的功能磁共振研究

目的考察注意训练对非流畅性失语患者汉字加工任务中双任务范式干扰效应的激活区及偏侧化指数的影响。方法将20例脑卒中后非流畅性失语患者分成实验组及对照组各10例,分别给予注意训练和认知训练,每次30 min,每周5次,共4周。训练前后分别采用组块设计对患者汉字加工任务进行功能磁共振扫描,比较训练前后双任务范式干扰效应的激活区及偏侧化指数。结果训练前两组患者均为右侧额下回、双侧顶叶、双侧小脑显著激活;训练后,实验组各激活区更加显著,而对照组各激活区未见显著变化;训练前两组患者均呈右半球优势;训练后实验组呈左半球优势,而对照组仍呈右半球优势。结论在双任务范式干扰效应中,右侧额下回、双侧顶叶、双侧小脑可能在知觉注意阶段对解决双重任务干扰非常重要;注意训练后激活更加显著;注意训练可能使失语症患者语义加工产生了功能重组。     

胫骨延长柄在重度肥胖患者初次全膝关节置换术中的应用及疗效观察

目的：探讨胫骨延长柄在重度肥胖的终末期膝骨性关节炎患者初次全膝关节置换术（ TKA)中的应用及疗效。方法回顾性分析河南省人民医院骨科2009年5月—2012年5月在初次TKA中应用胫骨延长柄治疗的19例（23膝)终末期膝骨性关节炎患者的临床资料,其中男4例、女15例,年龄53~78岁,BMI （37．7±1．75) kg/m2。单侧置换15例（左侧9例、右侧6例),双侧置换4例。应用美国膝关节学会评分（ KSS)系统,记录患者手术前后KSS膝评分及膝功能评分,采用SPSS 17．0进行统计学分析,以评价临床疗效及假体生存率。结果17例（21膝)获得随访,平均随访44个月（27~65个月);2名患者失访。术后下肢力线良好,关节稳定,随访患者均无假体松动等相关并发症。17例患者末次随访时,21膝评分从术前的（20．8±4．5)分提高到（90．7 ± 3．4)分,膝功能评分从术前的（25．7 ± 4．8)分提高到（87．0 ± 3．7)分,差异均有统计学意义（P值均<0．01);经侧方应力试验,17例患者均未出现内翻和外翻类型的关节不稳;未出现假体周围骨折、感染、无菌性松动、髌骨骨折等并发症,假体生存率为100%。结论重度肥胖的终末期膝骨性关节炎患者接受初次TKA治疗时,应用胫骨延长柄可以分散应力,增强假体稳定性,降低术后并发症,可获得良好的临床疗效。     

Artificial disc and vertebra system: a novel motion preservation device for cervical spinal disease after vertebral corpectomy

OBJECTIVE:To determine the range of motion and stability of the human cadaveric cervical spine after the implantation of a novel artificial disc and vertebra system by comparing an intact group and a fusion group.METHODS:Biomechanical tests were conducted on 18 human cadaveric cervical specimens. The range of motion and the stability index range of motion were measured to study the function and stability of the artificial disc and vertebra system of the intact group compared with the fusion group.RESULTS:In all cases, the artificial disc and vertebra system maintained intervertebral motion and reestablished vertebral height at the operative level. After its implantation, there was no significant difference in the range of motion (ROM) of C3–7 in all directions in the non-fusion group compared with the intact group (p>0.05), but significant differences were detected in flexion, extension and axial rotation compared with the fusion group (p<0.05). The ROM of adjacent segments (C₃₋₄, C₆₋₇) of the non-fusion group decreased significantly in some directions compared with the fusion group (p<0.05). Significant differences in the C_4-6 ROM in some directions were detected between the non-fusion group and the intact group. In the fusion group, the C₄₋₆ ROM in all directions decreased significantly compared with the intact and non-fusion groups (p<0.01). The stability index ROM (SI-ROM) of some directions was negative in the non-fusion group, and a significant difference in SI-ROM was only found in the C₄₋₆ segment of the non-fusion group compared with the fusion group.CONCLUSION:An artificial disc and vertebra system could restore vertebral height and preserve the dynamic function of the surgical area and could theoretically reduce the risk of adjacent segment degeneration compared with the anterior fusion procedure. However, our results should be considered with caution because of the low power of the study. The use of a larger sample should be considered in future studies.     

关节镜治疗踝关节继发性骨关节炎中短期疗效分析

目的：探讨应用踝关节镜治疗踝关节继发性骨关节炎的疗效。方法：9例踝关节骨关节炎患者行踝关节镜检查和关节镜手术治疗。结果：所有患者均获得随访,术后平均随访18个月。根据美国足踝骨科协会(AOFAS)的评分标准,优4例、良4例、可1例,优良率为88.89%,所有患者均未出现术后感染及神经血管损伤等并发症。结论：踝关节镜手术可明显改善踝关节继发性骨关节炎的疼痛症状,对踝关节炎的诊治有重要意义,值得临床推广。     

Non-HDL-C和AI对冠心病患者病情的评估价值

目的：探讨非高密度脂蛋白(Non-HDL-C)和粥样动脉硬化指数(AI)评估冠心病病情的临床价值。方法以冠心病患者为病例组(398例),以健康者为对照组(150例),全自动生化分析仪检测并比较不同组别受试者的一般临床资料、血脂、血糖、Non-HDL-C、AI等指标。结果冠心病组年龄、BMI、血压、甘油三酯、Non-HDL-C、AI等均高于对照组(P<0.05);慢性冠心病组年龄、BMI、收缩压、甘油三酯、TC、LDL-C、HDL-C、空腹血糖、Non-HDL-C、AI等高于不稳定型心绞痛组、急性心肌梗死组(P<0.05);Non-HDL-C与AI具有正相关关系(r2=0.1611,P<0.05);Non-HDL-C、AI均与年龄、HDL-C呈负相关,与LDL-C、TC、甘油三酯呈正相关(P<0.05);Non-HDL-C、AI与冠状动脉病变总分呈正相关(P<0.05)。结论冠心病患者的Non-DHL-C和AI水平明显高于对照组,且Non-DHL-C和AI水平越高,冠心病病变越严重。二者可用于评价冠心病病情严重程度。