长节段固定治疗成人退变性腰椎侧凸不同近端固定椎患者手术并发症和翻修情况的Meta分析

目的 :分析长节段固定治疗成人退变性腰椎侧凸不同近端固定椎患者的手术并发症和翻修情况。方法:于2018年3月15日通过计算机系统检索Pubmed、Embase、Cochrane、维普、万方数据库、中国知网数据库,截止时间为2018年3月15日。根据上端内固定椎的不同分为两组:近端固定到T10及以上节段为高位椎(upper vertebra,UV)组,近端固定到T10以下节段为低位椎(lower vertebra,LV)组。纳入标准:(1)国内外公开发表比较后路长节段不同上端内固定椎治疗成人退变性腰椎侧凸文献;(2)随机或者非随机对照研究;(3)患者年龄≥18岁;(4)随访时间≥1年。提取文献基本信息,并发症[围手术期及非围手术期术后并发症:硬脊膜破裂,深静脉血栓形成,创口深部感染,创口浅表感染,神经系统并发症,近端邻近节段退变性疾病,近端交界处后凸畸形(proximal junctional kyphosis,PJK),内固定失败,假关节形成,总并发症等],术中出血量和翻修情况(如PJK、假关节形成、内固定失败、感染等不同原因导致的翻修情况)。并通过非随机实验方法学指数法(methodological index for non-randomised studies,MINORS)评价方法对最终纳入文献进行质量评分,Begg法评估发表偏倚。通过STATA 12.0软件进行Meta分析。结果:最终纳入10篇文献,中文2篇,英文8篇,共883例患者,其中UV组353例,LV组530例。所有文献MINORS评分为16~20分,Begg法分析无明显发表偏倚。并发症包括围手术期并发症和非围手术期并发症两大类。其中围手术期并发症中,UV组患者术中出血量显著多于LV组,权重均数差(weight mean difference,WMD)(95%CI)为409.33ml(288.74,529.92),而硬脊膜破裂、深静脉血栓形成、创口深部感染、创口浅表感染、神经系统并发症和围手术期总并发症对比无显著性差异(P0.05)。非围手术期术后并发症中,UV组近端邻近节段退变性疾病发生率低于LV组,风险比(relative risk,RR)(95%CI)为0.26(0.11,0.63),P0.05;PJK、内固定失败、假关节形成和非围手术期术后总并发症对比无显著性差异(P0.05);PJK、假关节形成、内固定失败、感染等原因引起翻修及总翻修率均无统计学差异(P0.05)。结论:长节段固定治疗成人退变性腰椎侧凸近端固定椎向中上胸椎延长可能有利于降低近端邻近节段退变性疾病的发生,但患者术中出血量更多,在其他并发症和翻修率方面尚未发现优势。     

长航人员肠道微生态平衡与疾病相关性研究进展

随着高通量测序技术的发展,越来越多的研究证实,肠道菌群与宿主共同进化,在维持机体免疫稳态中发挥重要作用。肠道菌群可以直接或通过代谢产物间接参与多种疾病的发生发展。研究人员根据肠道微生态与其他脏器间的相互关联,提出了“肠-脑轴”、“肠-肺轴”等学说,并在基础和临床研究领域得到广泛验证。长航人员容易发生肠道菌群紊乱,也经常出现其他健康问题。现阶段需积极开展相关研究,明确长航人员肠道菌群紊乱与健康状态的关系,探索合理的干预措施。维护肠道微生态平衡,对提高长航人员生活质量、预防疾病发生具有重要意义。     

Intramural injection with botulinum toxin significantly elongates the pig esophagus

Background/Purpose

Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch.

Methods

Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device.

Results

The mean esophageal elongation was 84% (range 83–101) in the BTX-A-group and 65% (50–78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001).

Conclusion

Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.     

活动平板试验QTc离散度变化对冠心病的诊断意义

目的　研究活动平板运动试验后QTc离散度变化对冠心病诊断的意义。方法　经冠状动脉造影证实为冠心病的患者 32例 ,冠状动脉正常者 2 8例。分析比较两组活动平板运动前和运动后即刻、2min及 4min12导联心电图QTc离散度变化及ST段变化。结果　运动前和运动后即刻、2min及 4min冠心病组QTc离散度分别为 :(4 2± 11)ms;(6 5± 12 )ms ;(6 0± 15 )ms;(4 8± 11)ms。运动后各时间点QTc离散度比运动前明显升高(P <0 0 1) ;冠状动脉正常组运动前、运动后即刻、2min及 4minQTc离散度分别为 (36± 13)ms ;(39± 11)ms;(4 0± 12 )ms ;(38± 14)ms。运动后各时相QTc离散度与运动前比较无明显差异 (P >0 0 5 ) ;运动后冠心病组QTc离散度比正常对照组均明显升高 (P <0 0 1)。以运动后即刻QTc离散度≥ 5 0ms为标准 ,诊断冠心病的敏感性为 84 6 %,特异性为 80 2 %,预测准确性为 87 5 %。高于运动后ST段阳性标准的改变 (P <0 0 5 )。结论运动高峰时QTc离散度增加有助于观察心肌缺血程度 ,可作为诊断冠心病的参考指标。     

Electrophysiologic and histopathologic correlations in a case of permanent form of reciprocating tachycardia

A case of permanent junctional reciprocating tachycardia withpost-mortem documentation of an accessory atrioventricutar pathwayas the substrate of the arrhythmia is reported. Tachycardiahad lasted for 15 years and showed a retrograde P wave (P')and R–P' longer than P'–R interval. The tachycardiacircuit utilized a concealed posterior septal accessory pathwayas the retrograde limb. Because the arrhythmia was disablingand unresponsive to pharmacological treatment, the patient underwentclosed chest ablation of the His bundle. After the procedure,no anterograde or retrograde conduction over the normal conductionsystem was observed; anterograde conduction over the anomalouspathway showed decremental properties. Because of previous myocardialinfarction, the patient developed a ventricular aneurysm anddied suddenly 5 months after His bundle ablation. Histologicalexamination of the heart revealed a group of tiny fibromuscularbundles joining the lower rim of the coronary sinus outlet tothe summit of the interventricular septums; the anomalous atrioventricularconnection pursued a sinuous, tortuous path. The geometricaldisposition of the accessory pathway may have been responsiblefor the decremental properties of conduction observed duringlife.     

Newly developed T-wave inversion with cardiac wall-motion abnormality predominantly occurs in middle-aged or elderly women after noncardiac surgery

Purpose. The study was done to determine the characteristics and prevalence of myocardial ischemia with inverted T waves after noncardiac surgery. Methods. A list of patients who developed electrocardiogram (ECG) T-wave inversion associated with wall-motion abnormalities observed by transthoracic echocardiography (TTE) following noncardiac surgery was generated from the intensive care unit (ICU) medical records database between January 1, 1995, and December 31, 2000. The hospital records of these patients were analyzed retrospectively. Results. Among 4219 patients (2187 men and 2032 women) who were admitted to the ICU after noncardiac surgery, 13 developed myocardial ischemia with inverted T waves postoperatively. All of the patients were middle-aged or elderly women with no history of coronary artery disease; nine of them had undergone intraabdominal surgery. Characteristic ECG findings included inverted T waves in the left precordial leads, which subsequently became prominent with QT prolongation. In all of these patients, wall-motion abnormalities were observed on the anterior wall, but these resolved within 60 days of the episode. Myocardial ischemia was asymptomatic, with neither hemodynamic changes nor adverse cardiac events. Conclusion. Newly developed giant negative T waves with QT prolongation in the ECG may indicate myocardial stunning, but do not in themselves imply a poor prognosis. The marked preponderance of middle-aged and elderly women with this type of myocardial ischemia remains to be explained. Received: June 7, 2002 / Accepted: December 20, 2002 Address correspondence to: Y. Esaki     

Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.     

Supra-acetabular line is better than supra-iliac line for coronal balance referencing—a study of perioperative whole spine X-rays in degenerative lumbar scoliosis and ankylosing spondylitis patients

Background Context

The aim of spinal deformity correction is to restore the spine's functional alignment by balancing it in both the sagittal and coronal planes. Regardless of posture, the ideal coronal profile is straight, and therefore readily assessable.

长方案添加HMG时机对供精体外受精-胚胎移植结局的影响

目的比较长方案添加人绝经期促性腺激素(HMG)时机对供精体外受精-胚胎移植(IVF-D)结局的影响。方法回顾性分析2010年1月至2016年1月在本院生殖中心就诊进行IVF-D助孕的371例不育患者资料。所有患者均采取长方案进行控制性促排卵(COH),按照添加HMG时机分为两组:卵泡14mm时添加HMG为A组(227个周期),与rFSH同时添加HMG为B组(144个周期)。比较两组Gn总量及天数、HCG日E_2和P、获卵数、2PN率、成胚数、优胚率、胚胎着床率、临床妊娠率、流产率和活产率,并以年龄进行亚组分析。结果与B组相比,A组Gn总量和天数、HCG日的孕酮(P)水平以及优胚率均显著性降低,差异有统计学意义(P0.05);两组间HCG日E_2、获卵数、2PN率、成胚数、胚胎着床率的差异均无统计学意义,A组临床妊娠率和活产率均高于B组,流产率低于B组,但差异无统计学意义;35岁的患者中,A组比B组的Gn总量和天数少,差异有统计学意义(P0.05);≥35岁的患者中,B组的优胚率比A组多,差异有统计学意义(P0.05)。结论长方案促排卵于卵泡晚期添加HMG在不影响妊娠结局的情况下,可以减少Gn用量,降低费用。