探讨选择性与急症子宫切除术在产科临床中的应用

目的：探究选择性和进行子宫切除术在产科中的应用效果。方法选取我院2011年1月-2013年1月收治的42例行产科子宫切除术的患者作为研究对象，按照患者行子宫切除术的类型分为选择性组和急症组，其中选择性组有28例患者，急症组有14例患者，对两组患者的应用效果进行分析。结果两组产妇全子宫切除和次全子宫切除比例无差异（P＞0.05）。选择性组患者早产儿的发生率、新生儿的重度窒息率、新生儿死亡率明显高于急症组患者，两组之间的差异具有统计学意义（P〈0.05）。其中选择性组早产儿比例14.3%，死亡率为10.7%，急症组早产儿比例为7.14%，死亡率为0；选择性组新生儿重度窒息率为10.7%，急症组为7.14%；选择性组新生儿的畸形率（3.6%）以及并发症发生率（3.6%）明显低于急症组患者的（分别为28.6%和35.7%），两组之间的差异具有统计意义（P〈0.05）。结论选择性和急症子宫切除术在临床应用的效果各有利弊，在实际的应用中应该根据患者的具体情况有选择的行子宫切除术，以降低不必要的负面影响。     

雷洛昔酚对大鼠垂体的作用

目的 观察雷洛昔酚是否能诱发出催乳素瘤的动物模型以及对PRL水平的影响,以研究雷洛昔酚对大鼠垂体的作用。方法雌性Wistar大鼠切除卵巢后,分别在皮下埋植含有雷洛昔酚、雌激素和空白硅胶管,术后8周处死大鼠,检测大鼠体重变化、垂体重量变化、血清催乳素(PRL)水平和垂体组织学变化。结果雷洛昔酚组与阴性对照组大鼠体重无明显统计学差异,与雌激素组大鼠体重具有统计学差异(P<0.05)；雷洛昔酚组与阴性对照组大鼠垂体重相比无明显差异,与雌激素组大鼠垂体重相比具有统计学差异(P<0.05)；雌激素组大鼠血清PRL水平最高,阴性对照组血清PRL水平最低,雷洛昔酚组介于两者之间,分别与雌激素组、对照组相比较差异均具有统计学意义(P<0.05)；雷洛昔酚组与对照组垂体病理为正常细胞形态,雌激素组垂体病理为PRL瘤表现。结论雷洛昔酚对大鼠垂体有一定的影响,但不能诱发催乳素瘤。     

Efficacy and Tolerability of Prucalopride in Patients with Constipation due to Spinal Cord Injury

Background: Chronic constipation (CC) often occurs after spinal cord injury (SCI). Prucalopride is a novel, highly selective, specific serotonin 4 receptor agonist with enterokinetic properties. We evaluate the tolerability and pilot efficacy of prucalopride in the treatment of CC due to SCI. Methods: Double-blind, placebo-controlled, pilot, phase II, dose-escalation study. After 4 weeks' run in, patients received prucalopride 1 mg ( n = 8) or placebo ( n = 4); 11 new patients were randomized to prucalopride 2 mg ( n = 8) or placebo ( n = 3) once daily for 4 weeks. Patients recorded bowel function (diary) and assessed constipation severity and treatment efficacy (visual analogue scale (VAS) 0-100 mm). Colonic transit times were determined. Results: Compared with run in, mean changes in constipation severity (VAS) increased with placebo, but decreased with prucalopride 1 and 2 mg. The VAS score for treatment efficacy showed a clear dose response (medians 4, 52 and 73 for placebo, 1 and 2 mg, respectively). Diary data showed an improvement in average weekly frequency of all bowel movements over 4 weeks within the 2 mg group (median 0.6; 95% CI 0.2; 1.2). There was a significant reduction in median colonic transit time with 2 mg ( n = 4; -38.5 h (95% CI-80; -5)). Four patients (2 mg) reported moderate/severe abdominal pain, and two of these discontinued treatment. There were no clinically relevant effects on any of the safety parameters. Conclusion: This pilot study indicates that prucalopride can play an important role in the management of patients with CC due to SCI.     

Chemoembolization and radioembolization

Chemoembolization and radioembolization are at the core of the treatment of patients with hepatocellular carcinoma who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. They differ in the mechanism of action (ischaemia and increase cytotoxic drug exposure for chemoembolization, internal irradiation for radioembolization) and may target different patient populations. Chemoembolization with cytotoxic drug-eluting beads is a more standardized although not necessarily more effective way of performing chemoembolization. Cytoreduction is achieved in most patients but complete tumor ablation may be achieved and lead to extended survival. Grade 1 level of evidence support the use of chemoembolization for the treatment of patients in the early and intermediate stages while grade 2 evidence supports the use of radioembolization for the treatment of patients in intermediate to advanced stages. Selecting the best candidates for both techniques is still a work in progress that ongoing clinical trials are trying to address.     

原发性高血压与冠状动脉造影病变程度相关性的研究

目的:探讨原发性高血压与冠状动脉造影病变程度的相关性。方法:回顾总结920例行冠状动脉造影者的临床资料,其中原发性高血压606例(65.87%),冠心病728例(79.13%),排除冠心病患者192例(20.87%)。冠状动脉造影病变程度由三方面表示:造影是否诊断冠心病、冠状动脉病变支数,冠状动脉病变Gensini总积分。采用单因素和多因素分析方法,分析冠状动脉造影病变程度与原发高血压发生率的关系。结果:冠状动脉造影病变程度随高血压发生率增加而加重。结论:冠状动脉造影病变程度随原发高血压发生率的增加而加重,故有效地控制高血压在干预冠状动脉粥样硬化发生和发展中具有重要意义。积极处理冠心病的其他相关危险因素也十分重要。     

Role of transesophageal echocardiography in the clinical management of a patient with a giant coronary artery aneurysm

Transthoracic echocardiography (TTE) has substantial limitations for the study of abnormalities of the coronary tree. Transesophageal echocardiography (TEE) allows a more complete examination of the coronary arteries, particularly the proximal segments. This report describes the use of TEE after cardiac catheterization in the clinical management of a patient with unstable angina. While angiography first showed the giant aneurysm of the left circumflex coronary artery, TEE, by revealing an active thrombus of the lumen, prompted an immediate surgical resolution.     

军队医院开展学科化服务的内容及实践

简要介绍军队医院开展学科化服务的内涵,对相关调查表进行设计,提出围绕军队医院临床医疗、教学、科研及重大课题开展学科化服务的具体内容,结合中国人民解放军空军总医院实践阐述开展学科化服务的具体做法及今后的发展方向。     

选择性与完全性置钉内固定术矫治AIS的比较

目的 初步探讨选择性与完全性置钉内固定术治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床疗效.方法 回顾性分析2008年1月至2012年7月我科收治的48例青少年特发性脊柱侧弯两种不同置钉方法的临床资料,治疗组24例和对照组24例分别经过选择性与完全性椎弓根钉棒内固定术,进行侧弯矫形及预弯、后凸旋转矫形,并行结构性节段丰富植骨融合.随访时间18～32个月,平均24个月,对比手术前后Cobb角和主弯畸形矫正率,并进行统计学分析.结果 术前胸主弯Cobb角分别为(39.5±1.2)°和(40.8±1.7)°,胸腰弯/腰弯Cobb角分别为(22.3±1.6)°和(19.8±2.2)°.术后矫正角度分别为(11.4±0.8)°和(12.2±0.3)°.矫正率分别为(72.3±0.2)％和(71.4±0.4)％(P＞0.05),至随访末两者无明显差异.结论 应用选择性置钉的方法可以有效地减少置入的椎弓根螺钉数量,有效矫正AIS畸形,减少手术创伤和费用,是一种可行的手术方式.     

Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent: Multimodality Imaging Through 3 Years

ObjectivesThe aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging.BackgroundSerial comprehensive image assessments after BVS implantation in the context of a randomized trial have not yet been reported.MethodsIn the ABSORB Japan trial, 400 patients were randomized to a BVS (n = 266) or a cobalt-chromium everolimus-eluting stent (n = 134). Through 3 years, patients underwent serial angiography and intravascular ultrasound or optical coherence tomography (OCT).ResultsLuminal dimension at 3 years was consistently smaller with the BVS than with the cobalt-chromium everolimus-eluting stent (mean angiographic minimal luminal diameter 2.04 ± 0.63 mm vs. 2.40 ± 0.56 mm, mean difference −0.37 mm [95% confidence interval: −0.50 to −0.24 mm]; p < 0.001), mainly because of smaller device area (6.13 ± 2.03 mm² vs. 7.15 ± 2.16 mm², mean difference −1.04 mm² [95% confidence interval: −1.66 to −0.42 mm²]; p < 0.001), and larger neointimal area (2.10 ± 0.61 mm² vs. 1.86 ± 0.64 mm², mean difference 0.24 mm² [95% confidence interval: 0.06 to 0.43 mm²]; p = 0.01) by OCT. BVS-treated vessels did not show previously reported favorable vessel responses, such as positive vessel remodeling, late luminal enlargement, and restoration of vasomotion, although the OCT-based healing score was on average zero (interquartile range: 0.00 to 0.00). At 3 years, intraluminal scaffold dismantling (ISD) was observed in 14% of BVS. On serial OCT, ISD was observed in 6 lesions at 2 years, where the struts had been fully apposed at post-procedure, while ISD was observed in 12 lesions at 3 years, where 8 lesions were free from ISD on 2-year OCT. In 5 cases of very late scaffold thrombosis, strut discontinuities were detected in all 4 cases with available OCT immediately before reintervention.ConclusionsIn this multimodality serial imaging study, luminal dimension at 3 years was smaller with the BVS than with the cobalt-chromium everolimus-eluting stent. ISD, suspected to be one of the mechanisms of very late BVS thrombosis, was observed in a substantial proportion of cases at 3 years, which developed between post-procedure and 2 years and even beyond 2 years. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb™ BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284)