新生儿高胆红素血症患儿血液及脑脊液NSE与S-100蛋白的研究

目的：探讨新生儿高胆红素血症患儿血液及脑脊液NSE与S-100蛋白水平在临床检测中的指导意义。方法：选取自2011-07～2013-07我院收治的50例新生儿高胆红素血症患儿作为研究对象,并根据高危病因将其分为伴高危因素组与无高危因素组,并选择同时间段于我院就诊的血清内高胆红素水平正常的25例新生儿作为对照组。分别于入院时检测两组患儿血清内S—100蛋白水平及脑脊液NSE水平,并对正常新生儿血清中S-100蛋白水平及脑脊液NSE水平进行对比分析。结果：伴高危因素组患儿血清内S—i00蛋白水平及脑脊液内胆红素水平显著高于无高危因素组及对照组。结论：对高胆红素血症新生患儿脑损伤情况的判定需要结合其血清及脑脊液内胆红素水平进行综合判定,并对其血清内重要的生化指标S-100蛋白水平进行测定,能够为早期确认有效的临床诊断方案提供指导。     

低钙腹透液和碳酸钙治疗腹透患者皮肤瘙痒疗效观察

目的：评价低钙腹透液和含钙的磷结合剂（碳酸钙）治疗对腹膜透析患者甲状旁腺激素及皮肤瘙痒发病率的影响。探讨纠正腹膜透析患者继发性骨病治疗的新方法。方法：将60例腹膜透析合并皮肤瘙痒患者按照随机原则分为治疗组30例及对照组30例,治疗组使用低钙腹透液（钙浓度1.25mmol/L）和碳酸钙治疗,对照组使用普通钙浓度腹透液（钙浓度1.75mmol/L）治疗,不使用磷结合剂。治疗时间6个月,在实验前和结束后分别测定患者甲状旁腺激素及C反应蛋白激素水平、皮肤瘙痒发病率,评价治疗效果。结果：使用低钙腹透液和碳酸钙治疗6月后,甲状旁腺激素与治疗前后浓度变化有显著性差异（P＜0.05）,超敏C反应蛋白浓度变化无显著性差异（P＞0.05）。治疗前后皮肤瘙痒发病率有显著性差异（P＜0.05）,对照组患者上述三种指标变化均无显著性差异。结论：低钙腹透液和碳酸钙治疗6月后可以降低甲状旁腺激素浓度水平,可以缓解皮肤瘙痒发病率。     

围手术期护理干预对于减少术后因素所致脑脊液漏的临床研究

目的：观察围手术期护理干预对于减少术后因素所致脑脊液漏的临床效果。方法：2012年6月~2013年1月,共有87例患者接受后路腰椎椎间盘切除＋椎间cage植骨＋椎弓根钉棒内固定术（posterior lumbar interbody fusion,PLIF）,其于围手术期接受心理干预、体位干预、呼吸道及消化道的预防性干预等护理措施（记为干预组）;同时收集2012年1~5月行PLIF术的72例患者资料,其于围手术期均未接受护理干预措施（记为非干预组）。比较两组术后脑脊液漏发生例数及所占比例、术后因素所致脑脊液漏的例数及所占比例。结果：干预组共出现8例脑脊液漏,其中因术后因素所致2例,术后因素所占比例为25%,术后脑脊液漏例数占未发生术中脑脊液漏例数的比例为2.5%。非干预组发生7例脑脊液漏,其中因术后因素引起4例,术后因素所占比例为57.1%,术后脑脊液漏例数占未发生术中脑脊液漏例数的比例为5.8%。结论：围手术期采取护理干预措施能够显著减少术后因素所致脑脊液漏的发生,具有较好的临床应用价值。     

Relationship of plasma and synovial fluid vascular endothelial growth factor with radiographic severity in primary knee osteoarthritis

Purpose

Recent evidence suggests that angiogenesis and inflammation contribute to the development and progression of osteoarthritis (OA). The purpose of this study was to investigate vascular endothelial growth factor (VEGF) levels in plasma and synovial fluid of patients with knee OA and to determine the relationship of VEGF levels with disease severity in knee OA.

Methods

A total of 100 subjects were enrolled in this study (80 knee OA patients and 20 healthy controls). Plasma and synovial fluid VEGF levels were analysed using enzyme-linked immunosorbent assay. VEGF expressions in synovial membrane and articular cartilage samples were assessed using immunohistochemistry.

Results

VEGF level in synovial fluid of knee OA patients was tenfold higher than that in paired plasma (P < 0.001). Both plasma and synovial fluid VEGF exhibited a positive correlation with radiographic severity (r = 0.454 and r = 0.727, P < 0.001, respectively). VEGF expression was highly detectable in synovial lining cells and articular chondrocytes of knee OA patients.

Conclusions

VEGF levels in both plasma and synovial fluid were positively correlated with the severity of knee OA. Therefore, VEGF may be useful for monitoring OA severity and could play a substantial role in the development and progression of knee OA.     

Comparison of Hemodynamics in the Ascending Aorta Between Pulsatile and Continuous Flow Left Ventricular Assist Devices Using Computational Fluid Dynamics Based on Computed Tomography Images

This study aims to investigate differences in hemodynamic conditions in the thoracic aorta for pulsatile and continuous‐flow left ventricular assist devices (LVADs) using computational fluid dynamics (CFD). Patient‐specific models were reconstructed from three patients with continuous‐flow LVAD (HeartMate II, Thoratec Corporation) and three patients with biventricular assist devices (Excor, Berlin Heart) where only the aortic part was included in the simulations. CFD simulations were performed with constant inflow for the continuous‐flow LVADs and time‐varying inflow for the pulsatile devices. Differences in flow patterns, wall shear stress (WSS), and dynamic pressure in the ascending aorta were compared for both cases. Retrograde flow patterns were observed in all cases proximal to the location of the outflow cannula anastomosis site. On average, dynamic pressures derived from the retrograde flow velocities were higher in the continuous‐flow group with large variations dependent on the angle of the cannula anastomosis relative to the ascending aorta (continuous group: 0.14 ± 0.2 mm Hg, pulsatile group: 0.013 ± 0.008 mm Hg). Elevated WSS contralaterally to the anastomosis site was observed in three of the six models with higher values for the continuous cases. Lower WSS and reduced pressure in the ascending aorta, both favorable hemodynamic conditions, were found in pulsatile versus continuous‐flow LVADs by means of CFD. These findings indicate, along with clinical observations reported by others, the superior performance of pulsatile LVADs.     

Diverticular disease

Diverticular disease is a common problem affecting the colon in developed countries. It causes significant cost to healthcare systems and leads to significant morbidity and mortality associated with its complications which include abscess formation, perforation, bleeding and colonic obstruction. The management of acute diverticular sepsis has evolved to include both radiological and surgical options of drainage as well as resectional surgery for more widespread sepsis. The developing use of laparoscopic surgery has further use within the management of the emergency patient as well as the elective setting including in diverticular surgery. The role of surgery in the elective setting is controversial and varied. We examine the evidence behind the management of this common and complex pathology.     

Sodium chloride or plasmalyte-148 for patients presenting to emergency departments with diabetic ketoacidosis: A nested cohort study within a multicentre,cluster, crossover,randomised, controlled trial

Objective

To test the hypothesis that fluid resuscitation in the ED with plasmalyte-148 (PL) compared with 0.9% sodium chloride (SC) would result in a lower proportion of patients with diabetic ketoacidosis (DKA) requiring intensive care unit (ICU) admission.

Methods

We performed a prespecified nested cohort study at two hospitals within a cluster, crossover, open label, randomised, controlled trial comparing the effects of PL versus SC as fluid therapy for patients who presented to the ED with DKA. All patients presenting within a fixed recruitment period were included. The primary outcome was the proportion of patients admitted to ICU.

Results

Eighty-four patients were enrolled (SC n = 38, PL n = 46). The SC group had a lower median pH on admission (SC: 7.09 [interquartile range (IQR) 7.01–7.21], PL: 7.17 [IQR 6.99–7.26]). The median volume of intravenous fluids administered in ED was 2150 mL (IQR 2000–3200 mL; SC) and 2200 mL (IQR 2000–3450; PL); respectively. A higher proportion of patients in the SC group, 19 (50%), was admitted to ICU compared with PL group, 18 (39.1%); however, after adjustment for pH at presentation and diabetes type in a multivariable logistic regression model, the PL group did not have a significantly different rate of ICU admission compared with the SC group (odds ratio for ICU admission 0.73, 95% confidence interval 0.13–3.97, P = 0.71).

Conclusion

Patients with DKA treated with PL compared with SC in the EDs had similar rates of requiring ICU admission.     

Reduced alpha‐synuclein in cerebrospinal fluid in synucleinopathies: Evidence from a meta‐analysis

Alpha‐synuclein plays a key role in the pathology of synucleinopathies including Parkinson's disease (PD) and multiple system atrophy (MSA). However, whether alpha‐synuclein level in cerebrospinal fluid (CSF) could distinguish synucleinopathies from progressive supranuclear palsy (PSP) is still a contentious issue. A comprehensive literature search yielded nine eligible studies. We expressed the between‐group difference of the concentration of alpha‐synuclein in CSF as the standardized mean difference. The proportion of variation attributable to heterogeneity was computed and expressed as I². Nine studies involved 537 controls, 843 PD, 130 MSA, and 98 PSP patients. The overall effect of PD on alpha‐synuclein in CSF was significantly different from normal control or disease control (standardized mean difference = –0.67, P < 0.00001). These studies were heterogeneous (I² = 40%). Alpha‐synuclein in CSF in MSA was significantly reduced relative to controls with heterogeneous studies (standardized mean difference = –0.75, P < 0.0001; I² = 62%). In contrast, no significant difference of alpha‐synuclein in CSF was observed between PSP and controls with heterogeneous studies (standardized mean difference = –0.28, P = 0.13; I² = 53%). Alpha‐synuclein in CSF was significantly reduced in synucleinopathies compared with PSP (“PD vs. PSP”: standardized mean difference = –0.38, P = 0.001; “MSA vs. PSP”: standardized mean difference = –0.66, P < 0.00001). The included studies were homogeneous (I² = 0%). Our study showed that alpha‐synuclein levels in CSF in synucleinopathies was significantly lower than in PSP. This finding provides insights into the pathophysiological difference between synucleinopathies and PSP as well as possibility of development of a tool for differential diagnosis between MSA and PSP using enzyme‐linked immunosorbent assay (ELISA) and similar methods. © 2014 International Parkinson and Movement Disorder Society