国内外非酒精性脂肪性肝病诊疗指南的异同

随着肥胖和代谢综合征的流行,非酒精性脂肪性肝病(NAFLD)现已成为欧美发达国家慢性肝病的首要病因.NAFLD患者全因死亡率增高,NAFLD/单纯性脂肪肝(NAFL)/非酒精性脂肪性肝炎(NASH)患者首要死因为心血管疾病,肝病死亡率增高见于NASH患者,近10余年来欧美发达国家因NASH而接受肝移植患者的比例逐年增加.为了规范内科医师和预防保健人员NAFLD的诊治,美国肝病学会、胃肠病学院和胃肠病学会共同起草了《非酒精性脂肪性肝病诊疗指南》.     

一种新型Visionwire标测导丝在心脏再同步化治疗中的应用

目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测,比较两种方法的起搏参数测试、电生理标测结果及手术时间。结果在5例患者的16个CS分支中,两种方法所测的起搏参数值无显著性差异,二者的起搏阈值有强相关性(r=0.90,P<0.01),感知亦有相关性(r=0.67,P<0.01),二者最大起搏电压引起膈肌刺激的部位相似。应用Visionwire导丝可以进行局部电位电激动顺序标测。Visionwire导丝对单个CS分支进行起搏参数测定比应用左室电极进行起搏参数测定所需时间明显缩短(12.4±7.5 min vs 18.3±12.2 min,P<0.01)。结论应用Visionwire标测导丝可以预测CS分支的左室电极起搏参数,根据局部电位延迟可准确定位左室电极植入部位。     

Qualitative comparison of coronary angiograms between 4 french catheters with an Advanced Cardiovascular Injection System and 6 french catheters with manual injection

Objectives: This study aimed to test whether advanced cardiovascular injection (ACI) via 4 French (Fr) catheters is more advantageous than manual injection with 6 Fr catheters. Background: For coronary angiography, proponents of contrast media ACI believe it utilizes smaller‐diameter catheters when compared with manual injection, without compromising the quality of the angiogram, and has the potential to reduce the amount of contrast used and lessen the use of closure devices. Methods: In a prospective study, 200 consecutive patients referred for elective coronary angiography were randomized to standard 6 Fr catheters with manual injection versus 4 Fr catheters with ACI. The study's primary endpoint is the quality of the coronary angiogram. Secondary endpoints include groin complications, utilization of closure devices, and volume of contrast media. Thirty‐six patients who underwent ad hoc percutaneous coronary intervention were excluded from the analysis. Results: The final analysis included 80 patients treated with 4 Fr catheters with ACI and 84 patients treated with 6 Fr catheters with manual injection. The groups had similar demographic and clinical characteristics. The quality of the angiogram was similar between groups with the exception of more left coronary sinus flush with 4 Fr catheters (3.57 ± 1.1 vs. 2.98 ± 0.9, P < 0.001) and less closure device use with 4 Fr (25 vs. 71.4%, P < 0.01) compared to 6 Fr catheters. The procedure duration, volume of contrast used, vascular complications, and time to ambulation were similar between groups (all P > 0.05). Conclusions: 4 Fr diagnostic catheters with ACI offer similar quality coronary angiograms, similar rates of vascular complications, procedure duration, contrast used, and time to ambulation, but have a significantly lesser need for closure devices compared to the 6 Fr system with manual injection. © 2011 Wiley‐Liss, Inc.     

导萌后拔除上颌腭侧埋伏牙的临床观察

目的:探讨拔除腭侧埋伏牙的简单办法。方法:对10例腭侧埋伏牙进行正畸牵引导萌后拔除。结果:10例患牙均顺利拔除。正畸牵引导萌平均时间3.5个月,拔牙平均时间27.1mi n,术后均未发生不良反应。结论:经正畸导萌后再拔除腭侧埋伏牙是可取的治疗方法。     

Accuracy of patient-specific instrumentation in anatomic and reverse total shoulder arthroplasty

Purpose:Glenoid component malposition is associated with poor function and early failure of both anatomic and reverse total shoulder arthroplasty. Glenoid positioning is challenging particularly in the setting of bone loss or deformity. Recently, the use of computer assistance has been shown to reduce implantation error. The aim of this study is to evaluate the accuracy of patient-specific instrumentation in cases of anatomic and reverse shoulder replacement in vivo.Methods:Twenty patients underwent total shoulder arthroplasty using a computed tomography (CT)-based patient-specific instrumentation (PSI) system, ten anatomic and ten reverse. Preoperative three-dimensional digital templating of glenoid component position was undertaken and surgery then performed using a custom-made guide. Postoperative CT scans were used to compare final implanted component position to the preoperatively planned position in the same patient.Results:Final component position and orientation closely reflected the preoperatively templated position. Mean deviation in the glenoid version from planned was 1.8° ±1.9° (range, 0.1°–7.3°). Mean deviation in inclination was 1.3° ±1.0° (range, 0.2°–4.5°). Mean deviation in position on the glenoid face was 0.5 ± 0.3 mm (range, 0.0–1.3 mm) in the anteroposterior plane and 0.8 ± 0.5 mm (range, 0.0–1.9 mm) in the superoinferior plane. Actual achieved version was within 7° of neutral in all cases except for one where it was deliberately planned to be outside of this range.Conclusion:PSI in both anatomic and reverse shoulder arthroplasty is highly accurate in guiding glenoid component implantation in vivo. The system can reliably correct bony deformity.     

Length Matters: Short Base-Plate Angle Guides May Lead to Guide-Wire Mal-Positioning When Inserting a DHS. A Radiographic Modeling Study

The dynamic hip screw (DHS) consists of a barrel-plate fixed to the relatively-straight proximal femoral shaft, and a screw which slides within the barrel at a fixed angle, usually 135°. The guide-wire is inserted using a guide at the set angle. Guide design varies between manufacturers, with some new guides being particularly short. We analysed the impact of guide design on the resulting trajectory of the guidewire, and its potential to cause a surgical error. Twenty AP hip radiographs were analysed. Trauma Cad (Brainlab, Munich, Germany) software was used to template a 4-hole 135° DHS onto the intact femur with the screw positioned in the center of the head. A template of a Stryker (Michigan, USA) 135° DHS guide (37 mm long) was then overlaid at the hip screw entry point, and the set trajectory marked. The divergence between the two trajectories was measured (α angle). The distance the guide would have to be moved inferiorly to attain the correct position in the head was then noted. The median divergence (α angle) caused by the guide relative to the ideal position was 6° (range 2–12). This led to the guidewire placement being a median of 9.1 mm (range 3–23) superior in the head (β).To achieve the correct position of the wire in the head, the guide needed to be moved inferiorly a median of 8 mm (range 2–10). © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:574–577, 2020     

临床合理用药指导对2型糖尿病患者用药依从性的影响

目的研究合理用药指导对2型糖尿病患者用药依从性的影响。方法选取本院2011年2月-2013年5月收治的80例2型糖尿病患者,将所有患者以抽签法随机分为观察组与对照组,两组均为40例,均接受常规治疗,对照组不采取干预措施,观察组增加临床合理用药干预,对比两组患者的用药依从性。结果 2个月后观察组患者的用药依从性略高于对照组,但两组差异无统计学意义（P〉0.05）,4个月后观察组患者的用药依从性各项指标显著优于对照组,差异有统计学意义（P〈0.05）。结论药师对糖尿病患者长期的药物指导能够显著提高患者的用药依从性,有临床推广价值。     

Wear Resistance Improvement of Cemented Tungsten Carbide Deep-Hole Drills after Ion Implantation

The paper is dedicated to the life prolongation of the tools designed for deep-hole drilling. Among available methods, an ion implantation process was used to improve the durability of tungsten carbide (WC)-Co guide pads. Nitrogen fluencies of 3 × 10¹⁷ cm⁻², 4 × 10¹⁷ cm⁻² and 5 × 10¹⁷ cm⁻² were applied, and scanning electron microscope (SEM) observations, energy dispersive spectroscopy (EDS) analyses, X-ray photoelectron spectroscopy (XPS) and Secondary Ion Mass Spectrometry (SIMS) measurements were performed for both nonimplanted and implanted tools. The durability tests of nonimplanted and the modified tools were performed in industrial conditions. The durability of implanted guide pads was above 2.5 times greater than nonimplanted ones in the best case, presumably due to the presence of a carbon-rich layer and extremely hard tungsten nitrides. The achieved effect may be attributed to the dissociation of tungsten carbide phase and to the lubrication effect. The latter was due to the presence of pure carbon layer with a thickness of a few dozen nanometers. Notably, this layer was formed at a temperature of 200 °C, much smaller than in previously reported research, which makes the findings even more valuable from economic and environmental perspectives.