恶性肿瘤患者低相位角与营养风险和住院时间相关性研究

目的探讨恶性肿瘤患者相位角与营养风险和住院时间相关性。方法利用生物电阻抗分析对2017年10月至2018年9月在河北医科大学第一医院接受治疗的259例恶性肿瘤患者进行人体成分检测、应用营养风险筛查2002和患者主观整体营养评估进行营养风险筛查和评估、同时收集患者血清ALB指标和住院时间。结果正常相位角组患者的BMI、ICW、FFM、SMM、BCM、蛋白质等均高于低相位角组（P<0.05）;正常相位角组与低相位角组男性患者ICW、FFM、SMM、BCM、蛋白质等均高于女性患者（P<0.05）;相位角与营养风险筛查2002评分（r=－0.346,P<0.05）、患者主观整体营养评估（r=－0.393,P＜0.05）呈负相关,与血清ALB值呈正相关（r=0.363,P<0.05）;与正常相位角组患者相比,低相位角组营养风险更高,计算相关风险比发现,按营养风险筛查2002评价营养不良分组,发现存在营养风险（OR=3.7,95%CI=1.8～7.7）,按PG-SGA评估分组,结果显示中度风险（OR=4.5,95％CI=2.1～9.4）,重度风险（OR=12.6,95％CI=5.1～31.3）,按血清ALB值分组,ALB<40g/L（OR=3.7,95％CI=2.1～6.4）（P<0.05）;与正常相位角组患者相比,低相位角组住院时间较长,住院时间≥14d（OR=1.9,95％CI=1.0～3.3）（P<0.05）。 结论低相位角与营养风险和住院时间密切相关。与正常相位角患者相比,低相位角患者存在营养风险高,住院时间延长。因此对肿瘤患者进行相位角测量有助于快速判断其是否存在营养风险,为及时进行营养干预的实施提供了客观依据,利于患者疾病控制与好转。     

曲伏前列素联合布林佐胺治疗原发性开角型青光眼的临床疗效及安全性

目的 探讨曲伏前列素联合布林佐胺治疗原发性开角型青光眼（POAG）的临床疗效及安全性。方法 选取2016年1月~2018年12月我院收治的POAG患者112例,采用随机数字表法分为对照组和观察组,每组56例。对照组给予曲伏前列素滴眼液治疗,观察组在对照组基础上给予布林佐胺滴眼液。比较两组平均眼压、昼夜眼压差、临床疗效及不良反应。结果 治疗后,观察组平均眼压和昼夜眼压差均低于对照组[（16.26±2.14）mmHg vs（17.70±2.66）mmHg]、[（1.89±0.52）mmHg vs（2.33±0.56）mmHg],差异有统计学意义（P＜0.05）。观察组总有效率为96.43%,高于对照组的75.00%,差异有统计学意义（P＜0.05）。两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论 曲伏前列素联合布林佐胺治疗POAG临床疗效确切,可有效降低眼压,稳定昼夜眼压,不增加不良反应。     

The birth canal: correlation between the pubic arch angle,the interspinous diameter,and the obstetrical conjugate: a computed tomography biometric study in reproductive age women

Background: Assessment of pelvic configuration is an important factor in the prediction of a successful vaginal birth. However, manual evaluation of the pelvis is practically a vanishing art, and imaging techniques are not available as a real-time bed-side tool. Unlike the obstetrical conjugate diameter (OC) and inter spinous diameter (ISD), the pubic arch angle (PAA) can be easily measured by transperineal ultrasound.

Objectives: Three-dimensional computed tomography bone reconstructions were used to measure the three main birth canal diameters, evaluate the correlation between them, and establish the normal reference range for the inlet, mid-, and pelvic outlet.

Study design: Measurements of the PAA, obstetric conjugate (OC), and ISD were performed offline using three-dimensional post processing reconstruction in bone algorithm application of the pelvis on examinations performed for suspected renal colic in nonpregnant reproductive age woman. The mean of two measurements was used for statistical analysis which included reproducibility of measurements, regression curve estimation between PAA, OC, and ISD, and calculation of the respective reference range centiles for each PAA degree.

Results: Two hundred ninety-eight women comprised the study group. The mean?±?SD of the PAA, ISD, and OC were 104.9° (±7.4), 103.8?mm (±7.3), and 129.9?mm (±8.3), respectively. The intra- and interobserver agreement defined by the intraclass correlation coefficient (ICC) was excellent for all parameters (range 0.905–0.993). A significant positive correlation was found between PAA and ISD and between PAA and OCD (Pearson’s correlation?=?0.373 (p?p?=?.022), respectively). The best regression formula was found with quadratic regression for inter spinous diameter (ISD): 34.122778?+?(0.962182*PAA???0.002830*PAA²), and linear regression for obstetric conjugate (OC): 110.638397?+?0.183156*PAA. Modeled mean, SD, and reference centiles of the ISD and OCD were calculated using the above regression models as function of the PAA.

Conclusions: We report significant correlation between the three pelvic landmarks with greatest impact on the prediction of a successful vaginal delivery: the PAA which is easily measured sonographically and the ISD and OC which are not measurable by ultrasound. This correlation may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery.     

Interplay between post-translational cyclooxygenase-2 modifications and the metabolic and proteomic profile in a colorectal cancer cohort

BACKGROUND Colorectal cancer(CRC) is the second most common cause of cancer death worldwide. It is broadly described that cyclooxygenase-2(COX-2) is mainly overexpressed in CRC but less is known regarding post-translational modifications of this enzyme that may regulate its activity, intracellular localization and stability. Since metabolic and proteomic profile analysis is essential for cancer prognosis and diagnosis, our hypothesis is that the analysis of correlations between these specific parameters and COX-2 state in tumors of a high number of CRC patients could be useful for the understanding of the basis of this cancer in humans.AIM To analyze COX-2 regulation in colorectal cancer and to perform a detailed analysis of their metabolic and proteomic profile.METHODS Biopsies from both healthy and pathological colorectal tissues were taken under informed consent from patients during standard colonoscopy procedure in the University Hospital of Bellvitge(Barcelona, Spain) and Germans Trias i Pujol University Hospital(Campus Can Ruti)(Barcelona, Spain). Western blot analysis was used to determine COX-2 levels. Deglycosylation assays were performed in both cells and tumor samples incubating each sample with peptide N-glycosidase F(PNGase F). Prostaglandin E2(PGE2) levels were determined using a specific ELISA. 1 H high resolution magic angle spinning(HRMAS) analysis was performed using a Bruker AVIII 500 MHz spectrometer and proteomic analysis was performed in a nano-liquid chromatography-tandem mass spectrometer(nano LC-MS/MS) using a QExactive HF orbitrap MS.RESULTS Our data show that COX-2 has a differential expression profile in tumor tissue of CRC patients vs the adjacent non-tumor area, which correspond to a glycosylated and less active state of the protein. This fact was associated to a lesser PGE2 production in tumors. These results were corroborated in vitro performing deglycosylation assays in HT29 cell line where COX-2 protein profile was modified after PNGase F incubation, showing higher PGE2 levels. Moreover,HRMAS analysis indicated that tumor tissue has altered metabolic features vs non-tumor counterparts, presenting increased levels of certain metabolites such as taurine and phosphocholine and lower levels of lactate. In proteomic experiments, we detected an enlarged number of proteins in tumors that are mainly implicated in basic biological functions like mitochondrial activity,DNA/RNA processing, vesicular trafficking, metabolism, cytoskeleton and splicing.CONCLUSION In our colorectal cancer cohort, tumor tissue presents a differential COX-2 expression pattern with lower enzymatic activity that can be related to an altered metabolic and proteomic profile.     

Varied influence of the femoral or tibial component on quadriceps angles: Verified by imaging studies

ObjectiveThe aim of this study was to evaluate the varied influence of femoral or tibial component on Quadriceps angles (Q-angle) measured with magnetic resonance image (MRI) and full-length standing scanogram (FLSS) techniques.MethodsTwo groups of patients were studied. The first group underwent MRI studies and the second group underwent FLSS studies. Two-step procedures were carried out. Knee MRI in 60 consecutive adult patients simply taken for meniscus or ligament injuries were utilized at the first step. The standardized patellar center (PC) and tibial tubercle (TT) on the frontal plane of MRI were positioned. At the second step, the FLSS in other 100 consecutive young adult patients taken for chronic unilateral lower extremity injuries were used for locating the two landmarks from MRI. The Q-angle was then determined on the anterior superior iliac spine, standardized PC, and TT on the FLSS.ResultsFor 60 patients, the standardized PC was at the point 42% from the lateral end of the trans-epicondylar line of the femur. The TT was at the point 2 cm distal to the tibial articular surface and 37% from the lateral end of the tibial width. For 100 patients, the Q-angle was an average of 9.5° and 65.2% of the Q-angle was contributed by the upper arm (the femur). Women had a larger Q-angle (10.1° vs. 8.8°, p = 0.02) and a shorter femur (41.1 vs. 44.7 cm, p < 0.001).ConclusionThe Q-angle is about 9.5° with 65.2% contributed by the femur. The Q-angle may mainly be influenced by the femoral component.Level of evidenceLevel IV, Diagnostic Study.     

Chevron osteotomy versus scarf osteotomy for hallux valgus correction: A meta-analysis

BackgroundThis study intended to investigate the optimal surgical strategy in hallux valgus (HV), and to provide a basis for clinical treatment of HV.MethodsStudies related to chevron osteotomy and scarf osteotomy for HV were enrolled from online databases. Hallux valgus angle (HVA) was the main outcome variable. Enrolled studies included posttreatment data for intermetatarsal angle (IMA), American Orthopaedic Foot & Ankle Society (AOFAS) score, and complications. A random-effects model was applied for significant heterogeneity. Otherwise, a fixed-effects model was used. Heterogeneity was assessed with Q test and I² statistics. Publication bias was evaluated with Egger's test. Based on the influence of weighted mean difference values or odds ratios, a sensitivity analysis was performed.ResultsFour studies including 384 subjects were evaluated to determine the optimal surgical strategy for HV. There was no statistically significant difference between chevron and scarf groups for HVA, IMA, AOFAS score, and complication rates. Sensitivity analysis showed good stability. The likelihood of publication bias was small.ConclusionThe effects of chevron osteotomy and scarf osteotomy for HV are comparable. Chevron osteotomy is less technically demanding.     

全身麻醉后手法复位联合椎弓根螺钉内固定植骨融合术治疗AndersonⅡ型齿突骨折伴寰枢关节旋转性脱位交锁

目的探讨采用全身麻醉后手法复位联合后路寰枢椎椎弓根螺钉内固定植骨融合术治疗伴寰枢关节旋转性脱位交锁的Anderson Ⅱ型齿突骨折的临床疗效。方法收集2006年2月—2015年12月收治的13例合并寰枢关节旋转性脱位交锁的Anderson Ⅱ型齿突骨折患者的临床资料。术前交锁侧颈部旋转活动度为8°±2°,对侧为27°±9°,疼痛视觉模拟量表(VAS)评分为(5.7±1.8)分,美国脊髓损伤协会(ASIA)分级均为E级。患者均接受气管插管全身麻醉后手法复位联合后路寰枢椎椎弓根螺钉内固定植骨融合术治疗。记录手术时间、术中出血量,随访术后有无内固定松动、断裂等并发症发生及植骨融合情况。对所有患者进行影像学评估,比较术前、末次随访时颈椎旋转活动度、VAS评分和ASIA分级。结果所有患者随访24～28个月,平均25.3个月;手术时间为80～120 min,平均105 min;术中出血量为100～330 mL,平均150 mL。末次随访时交锁侧颈部旋转活动度为45°±12°,对侧为56°±10°,两侧活动度与术前相比差异均有统计学意义(P 0.05);术后颈部疼痛症状均获得不同程度改善,VAS评分恢复至(2.2±1.3)分,与术前相比差异有统计学意义(P 0.05);末次随访时ASIA分级仍为E级。所有患者均未出现切口疼痛、感染、不愈合及神经损伤等并发症,末次随访时无内固定松动、断裂等并发症发生,均实现骨性融合,融合时间为2～4个月,平均3.1个月。1例患者复查颈椎CT时发现2枚螺钉位置欠佳,因其无不适而未予处理。结论全身麻醉后手法复位联合后路寰枢椎椎弓根螺钉内固定植骨融合术治疗伴寰枢关节旋转性脱位交锁的Anderson Ⅱ型齿突骨折,可使寰枢关节复位,重建寰枢椎稳定。该术式安全、有效,能减轻患者疼痛,较大程度恢复患者颈椎功能。