中风危险度和颈动脉阈狭窄

严重的颈动脉狭窄可导致缺血性脑血管病,但二者是否存在正比关系,尚且不明。本文自1982年起,对500名无症状颈部杂音患者进行前瞻性研究,平均随访52个月,分析缺血性中风发病率与颈动脉狭窄程度以及狭窄是否进展加重的关系,发现首次颈部多普勒检查时的颈内动脉狭窄程度的频率分布呈双峰型,双峰的结合部85％颈动脉狭窄,而且缺血性中风的最高发病率在75～90％颈动脉狭窄的病人,具有统计学意义,说明对75～90％颈内动脉狭窄的无症状病人应采取预防性治疗措施。     

糖化白蛋白与糖尿病并发冠心病的关系

目的探讨糖化白蛋白与糖尿病并发冠心病的关系。方法测定349例糖尿病患者和340例正常对照者的血清糖化白蛋白和糖化血红蛋白浓度。糖尿病患者根据冠状动脉造影管腔直径狭窄是否超过70%分为冠状动脉非显著狭窄组(n=166)和显著狭窄组(n=183)。采用多元回归分析判断糖尿病患者冠状动脉显著狭窄的独立危险因素。结果冠状动脉显著狭窄组血清糖化白蛋白浓度显著高于非显著狭窄组和对照组(P<0.01)。血清糖化白蛋白浓度与冠状动脉血管病变数呈显著相关(r=0.19,P<0.01)。但冠状动脉非显著狭窄组和显著狭窄组之间糖化血红蛋白浓度无统计学差异。多元回归分析发现年龄≥65岁、男性、血清糖化白蛋白浓度、脂蛋白(a)和高血压是糖尿病并发冠心病的独立危险因素。结论糖尿病患者糖化白蛋白水平与冠心病发生及病变严重程度显著相关,是并发冠心病的独立危险因素。     

盐酸利多卡因及其制剂质量分析与探索性研究

摘 要 目的：监测和评价盐酸利多卡因及其制剂的质量现状,为进一步改进提高其生产工艺和质量标准提供参考。 方法: 采用法定检验方法对抽样进行检验,以主要指标分析评价其质量;并对抽样进行如下探索性研究：测定盐酸利多卡因的残留溶剂及稳定性,比较不同色谱条件下有关物质杂质谱及建立近红外一致性模型。 结果: 按法定方法检验,样品合格率为 100%,但应关注装量限度和pH控制范围。探索性研究结果表明,不同生产厂家的生产工艺和原料来源有所差异,但原料药及制剂在生产过程中得到了良好的控制。原料药溶剂残留均在限度范围内,中国药典有关物质色谱条件能有效控制杂质。盐酸利多卡因在氧化条件下不稳定,应注意生产及贮藏条件。 结论: 法定检验和探索性研究结果表明,盐酸利多卡因及其制剂总体质量良好。通过探索性研究,可为该产品质量进一步提高提供参考。     

Rationale and design of J-ACCESS 4: Prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease

BackgroundThe findings of our recent study entitled, “Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS)” showed that myocardial perfusion single photon emission computed tomography (MPS) can detect coronary artery disease (CAD) and help to predict future cardiac events in patients with suspected or extant CAD. However, the extent of the benefit conferred by percutaneous coronary intervention (PCI) as an initial management strategy compared with optimal medical therapy remains controversial. Little evidence supports the notion that myocardial ischemia identified using MPS is an alternative target of coronary revascularization to reduce the likelihood of developing cardiac events.MethodsThe multicenter, prospective cohort J-ACCESS 4 study aims to clarify the prognostic impact of reducing myocardial ischemia determined using electrocardiogram-gated MPS in Japanese patients with coronary artery disease. We started to register patients in J-ACCESS 4 at 74 facilities during June 2012 and will continue to do so until December 2013 or until the cohort comprises 500 patients who will participate in the study from one month before, until two months after stress/rest MPS assessment. Imaging data, the background of the patients including coronary risk factors and treatment before MPS assessments will be analyzed. The patients will undergo coronary revascularization within two months after MPS and/or receive appropriate medical therapy. The second stress/rest MPS will be performed from 4 to 10 months after coronary revascularization or registration. They will be followed up for over one year after the second MPS assessment. The primary endpoints will be cardiac death, sudden death of unknown cause, non-fatal myocardial infarction, and hospitalization for heart failure. The secondary endpoints will comprise death due to all causes including non-cardiac death and any cardiovascular events.This study will be completed in 2015. Here, we describe the design of the J-ACCESS 4 study.     

利用个性化注射方案优化64层螺旋CT下肢动脉成像

目的探讨64层螺旋 CT 血管成像(CTA)技术在下肢动脉成像中最优化的检查方案.方法利用GE LightSpeed VCT 对临床疑有下肢血管病变的48例病人进行下肢血管成像检查,分别采用个性化注射方案和传统注射方案进行检查,对两方案病例的影像评分进行比较,并以数字减影血管造影(DSA)检查作为标准.结果在接受检查的48例病例中,47例取得了满意的影像,1例在工作站上进行适当处理后,也获得满足临床诊断要求的影像.在采用不同注射方案的两组病例中,个性化注射方案组的影像评分明显优于传统注射方案组(t=2.343,P=0.028);对于中度及以上狭窄(50%~100%)的下肢血管,CTA 的敏感度、特异度分别为86.1%、86.6%.结论64层螺旋 CTA 是评估下肢动脉病变的一种可靠的检查方法,且与个体化注射方案结合是一种更为理想的方法.     

A Pilot Randomized Controlled Trial of Flexion-Distraction Dosage for Chiropractic Treatment of Lumbar Spinal Stenosis

Objective

The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation.

Methods

This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments). The fourth group was given 8 treatments of placebo care. Feasibility measures included recruitment goals, adherence to various treatment schedules, credibility of the placebo treatment, and rates of adverse events. The primary outcome measure was the Swiss Spinal Stenosis Questionnaire, a validated self-report of LSS symptom severity and physical function.

Results

The recruitment and adherence goals of the study were met with a total of 60 subjects randomized (n = 15 per group) and most subjects attending at least 75% of their scheduled visits. No adverse events were reported by any of the subjects in the trial. Our placebo treatment did not appear to be credible; most subjects correctly guessed that they were receiving a placebo treatment. Between-group effect size estimates were small, indicating larger samples are needed for future studies.

Conclusion

This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a 6-week treatment schedule. The information gained from this trial will be useful to inform the design of larger trials.     

膀胱腹直肌间置术治疗逼尿肌无反射性神经源性膀胱

目的：评价膀胱腹直肌间置术治疗神经源性膀胱的临床效果。方法：通过尿动力学检查选择逼尿肌无反射性膀胱患者8例,通过手术将膀胱置于腹直肌及其前后鞘之间,观察手术后患者症状、排尿情况及残余尿量的改变。结果：手术后62．5％的患者可自行排尿,症状好转或消失;手术后残余尿量较手术前有显著性减少。结论：膀胱腹直肌间置术是治疗神经源性膀胱的有效方法之一,有利于患者的康复。     

血管扩张器法解除内瘘狭窄的临床疗效观察

目的 观察血管扩张器对内瘘狭窄干预的临床疗效。方法 针对42例接受维持性血液透析治疗并经彩色多普勒超声证实存在内瘘狭窄的患者,以血管扩张器行腔内血管扩张,记录扩张前、后的血流量、狭窄部位内径,计算尿素清除指数（Kt／V）值,并进行对比。结果 经血管扩张器扩张狭窄内瘘后,内瘘血流量、狭窄部位内径及Kt／V值较扩张前的改变存在统计学差异（P〈0．05）。结论 血管扩张器解除内瘘狭窄作用明显,该方法安全、成功率高,复发率低,术后并发症少,易于掌握。     

Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn?

Aim The aim of the study was to analyse the incidence of benign colorectal anastomotic stenoses in consecutive patients operated on in a single institution and to assess risk factors for their development. Their impact on quality of life was also evaluated. Method Patient characteristics, indications for surgery, surgical technique and postoperative complications were prospectively recorded. Stenosis was evaluated by rectoscopy at regular intervals, and patients were treated only if symptomatic. After at least 6 months following surgery, patients were asked to respond to the Short Form 36‐item quality‐of‐life questionnaire during a telephone interview. Results Of the original 211 patients considered, 195 underwent a follow‐up rectoscopy and were included in the study. Benign stenosis were found in 26 (13%), and 19 (73%) symptomatic patients were treated successfully (15 with endoscopic dilatation and four with radial diathermic surgical incisions). Risk factors for anastomotic stenosis according to univariate analysis were female sex, diverticulitis, mechanical anastomosis, and anastomosis located between 8 and 12 cm from the anal verge. The significant risk factors identified by multivariate analysis were diverticulitis (OR 5, P = 0.002) and mechanical anastomosis (OR 9, P = 0.04). The self‐perceived quality of life of patients with stenosis was significantly worse compared with controls. Conclusion Since diverticulitis and mechanical anastomosis are risk factors for anastomotic stenosis, surgeons should take this into account when they are considering what type of anastomotic technique to utilize.     

Residual association at C9orf72 suggests an alternative amyotrophic lateral sclerosis-causing hexanucleotide repeat

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of motor neurons. Single-nucleotide polymorphism rs3849942 is associated with ALS, tagging a hexanucleotide repeat mutation in the C9orf72 gene. It is possible that there is more than 1 disease-causing genetic variation at this locus, in which case association might remain after removal of cases carrying the mutation. DNA from patients with ALS was therefore tested for the mutation. Genome-wide association testing was performed first using all samples, and then restricting the analysis to samples not carrying the mutation. rs3849942 and rs903603 were strongly associated with ALS when all samples were included (rs3849942, p = [3 × 2] × 10⁻⁶, rank 7/442,057; rs903603, p = [7 × 6] × 10⁻⁸, rank 2/442,057). Removal of the mutation-carrying cases resulted in loss of association for rs3849942 (p = [2 × 6] × 10⁻³, rank 1225/442,068), but had little effect on rs903603 (p = [1 × 9] × 10⁻⁵, rank 8/442,068). Those with a risk allele of rs903603 had an excess of apparent homozygosity for wild type repeat alleles, consistent with polymerase chain reaction failure of 1 allele because of massive repeat expansion. These results indicate residual association at the C9orf72 locus suggesting a second disease-causing repeat mutation.