软组织损伤超声治疗研究现状

尽管超声广泛用于治疗软组织损伤,而且超声的生物物理学效应通过体外研究也得以证实,但超声对软组织损伤的治疗效果仍受到质疑。很少有确切的证据表明超声治疗软组织损伤有效,其原因可能与多种因素有关,如技术方面的变数,临床研究中方法学的局限与缺陷,或者超声确实缺少治疗作用。     

醒脑开窍针法对脑外伤患者认知功能和日常生活能力的影响

目的：观察醒脑开窍针法对脑外伤（TB）I患者认知功能和日常生活能力影响。方法：将60例TBI认知功能障碍患者随机分为观察组（规范化醒脑开窍针法）、对照组（非规范化的醒脑开窍针法）。治疗前后分别采用神经行为认知状态检查表（NCSE）和改良的Barthel指数评定法（MB）I来评定2组患者的认知功能和日常生活能力。结果：观察组治疗前后比较,在定向能力、专注能力、复述能力、记忆能力、命名能力、计算能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）;对照组治疗前后比较,在定向能力、复述能力方面上,差异均有显著性意义（P〈0.05）;治疗后2组间比较,在专注能力、定向能力、复述能力、记忆能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）。2组MBI治疗前后比较,差异均有非常显著性意义（P〈0.01）;治疗后2组间MBI比较,差异有显著性意义（P〈0.05）。结论：规范化的醒脑开窍针法能更有效地改善脑外伤后认知功能和日常生活能力。     

儿童骨骺损伤

总结我院１９８０～１９８９年所收治的儿童骨骺损伤４６８例。随访时间１～８年。介绍了儿童骨骺损伤的Ｘ线分型、诊断要点及治疗方法。认为骨骺损伤的预后主要取决于原发损伤的类型，其次为受伤年龄和受伤部位，受伤年龄愈小或受伤部位为主要发育骨骺，将来所引起的继发畸形则愈大。     

Association between plasma Vitamin B5 levels and all‐cause mortality: A nested case‐control study

We aimed to evaluate the prospective association of vitamin B5 with all‐cause mortality and explore its potential modifiers in Chinese adults with hypertension. A nested, case‐control study was conducted in the China Stroke Primary Prevention Trial, including 505 deaths of all causes and 505 matched controls. The median follow‐up duration was 4.5 years. The primary outcome measure in this investigation was all‐cause mortality, which encompassed deaths for any reason. The mean plasma vitamin B5 concentration for cases (43.7 ng/mL) was higher than that in controls (40.9 ng/mL) (p = .001). When vitamin B5 was further assessed as quintiles, compared with the reference group (Q1: < 33.0 ng/mL), the risk of all‐cause mortality increased by 29% (OR = 1.29, 95% CI: 0.83‐2.01) in Q2, 22% (OR = 1.22, 95% CI: 0.77‐1.94) in Q3, 62% (OR = 1.62, 95% CI: 1.00‐2.62) in Q4, and 77% (OR = 1.77, 95% CI: 1.06‐2.95) in Q5. The trend test was significant (p = .022). When Q4‐Q5 were combined, a significant 41% increment (OR = 1.41, 95% CI: 1.03‐1.95) in all‐cause death risk was found compared with Q1‐Q3. The adverse effects were more pronounced in those with normal folate levels (p‐interaction = .019) and older people (p‐interaction = .037). This study suggests that higher baseline levels of plasma vitamin B5 are a risk factor for all‐cause mortality among Chinese patients with hypertension, especially among older adults and those with adequate folate levels. The findings, if confirmed, may inform novel clinical and nutritional guidelines and interventions to optimize vitamin B5 levels.     

High hemoglobin fluctuation was a protective factor for cardiovascular‐related death in peritoneal dialysis (PD) patients: A retrospective analysis of 232 patients with PD

ObjectivesThis study aimed to investigate the effect of hemoglobin (Hb) fluctuation after dialysis on the prognosis of cardiovascular‐related and all‐cause deaths in peritoneal dialysis (PD).MethodsAccording to the Hb fluctuation, patients were divided into low fluctuation group, moderate fluctuation group, and high fluctuation group, and then, the effects of Hb fluctuation after dialysis on the prognosis of cardiovascular‐related and all‐cause death in PD were analyzed by regression analysis.ResultsA total of 232 patients were selected in this study. Compared with the low Hb fluctuation group, the moderate and high fluctuation groups had lower body mass index (BMI), estimated glomerular filtration rate (eGFR), and baseline Hb, and the moderate fluctuation group had less erythropoietin (EPO) and dialysis dose. Compared with survivors, patients with cardiovascular‐related and all‐cause deaths had lower mean Hb and Hb fluctuation (all p < 0.05). Cox regression analysis showed that before and after adjusting for confounding factors, Hb fluctuation was still independently correlated with cardiovascular prognosis, and higher Hb fluctuation was still a protective factor for cardiovascular‐related death in the Hb‐substandard group, but there was no significant correlation between Hb fluctuation and all‐cause death. Multivariate linear regression analysis revealed that Hb fluctuation was positively correlated with Kt/V and EPO dosage, but negatively correlated with the baseline Hb.ConclusionHigh Hb fluctuation was a protective factor for cardiovascular‐related death in PD with substandard Hb. Compared with Hb fluctuation, correction of anemia timely and making Hb reaches the standard level had a greater impact on reducing cardiovascular‐related death in PD.     

Dose‐dependent effect of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention

ObjectiveTo determine the risk prediction of various degrees of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention (PCI).BackgroundPatients with chronic kidney disease (CKD) are at high risk of all‐cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks.MethodsThis was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m²): I (≥90), II (60−89), III (30−59), IV (15−29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One‐year all‐cause mortality was reported with risk prediction based on CKD stages and other risk factors.ResultsPatients with CKD stage I−V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One‐year overall survival among CKD stages I−V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log‐rank test). After adjusting covariables, the hazard ratios of all‐cause mortality for CKD stages II−V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001).ConclusionAmong patients undergoing PCI, lower preprocedure eGFR is associated in a dose‐dependent effect with decreased 1‐year survival. This finding may be useful for risk classification and to guide decision‐making.     

解剖结构逐级损伤对Hangman骨折稳定性影响的生物力学研究

目的测试C2、3椎间解剖结构逐级损伤对Hangman骨折稳定性的影响并探讨其临床意义。方法8具新鲜C1～4颈椎标本,按Hangman骨折病理诊断标准模拟C2、3椎间解剖结构逐级损伤,并在脊柱三维运动实验机上依次按照:①对照组(正常状态);②切断双侧椎弓峡部组;③切断双侧椎弓峡部及后纵韧带组;④切断双侧椎弓峡部及前、后纵韧带组顺序测试其三维运动范围(ROM),对结果进行统计学分析。结果随着解剖结构逐级破坏,ROM值逐渐增大。切断双侧椎弓峡部组与对照组相比除旋转有显著性差异外,余均无显著性差异;而切断双侧椎弓峡部及后纵韧带组、切断双侧椎弓峡部及前后纵韧带组与对照组相比均有显著性差异。切断双侧椎弓峡部及后纵韧带组与切断双侧椎弓峡部组相比除后伸无显著性差异外,余均有显著性差异;切断双侧椎弓峡部及前后纵韧带组与其他组相比均有显著性差异(P<0.05)。结论对旋转运动影响最大的是峡部,前后纵韧带对屈伸运动影响明显,而侧弯运动则随着各椎间结构的破坏逐步下降;准确判断Hangman骨折的具体损伤部位对骨折稳定性的认识和手术方法的选择有着重要作用。     

泛素蛋白酶体途径在高氧肺损伤发病机制中的研究进展

泛素蛋白酶体途径是生物中特异的蛋白质降解系统之一。它参与体内许多重要的生理过程,临床中许多疾病的发生都与该途径的激活有关。高氧将产生氧自由基,引起细胞损伤、凋亡、坏死,同时引起炎性介质产生、炎性细胞浸润,从而产生肺部炎性反应、组织损伤和异常修复发生。本文将探讨泛素蛋白酶体途径的组成、功能及其在高氧肺损伤发病机制的作用。     

基于MBF参数模型的安全完整性等级定量评估

介绍了安全完整性等级验证的相关内容,并对系统发生危险失效因素进行分析;在引入MBF(Multiple Beta Factor)参数模型的基础上,定量计算系统发生共因失效的概率,并研究系统发生独立危险失效的概率及其影响;最后给出应用实例进行验证。结果表明:本文方法不仅更接近工业生产中安全仪表系统冗余结构的实际情况,也大大简化了计算,弥补了马尔可夫模型法分析计算过程复杂的缺陷。     

膝关节交叉韧带损伤的MRI诊断进展

膝关节疼痛近年有增加趋势,本文根据国内外有关膝关节损伤的MRI诊断的相关文献,对膝关节交叉韧带的功能解剖,临床表现,损伤机制和类型,MRI诊断现状等方面进行综述.