Shoulder muscle activation and coordination in patients with a massive rotator cuff tear: an electromyographic study

Adaptive muscle activation strategies following a massive rotator cuff tear (MRCT) are inadequately understood, and the relationship among muscles during everyday activities has not been considered. Thirteen healthy subjects comprised the control group, and 11 subjects with a MRCT the patient group. Upper limb function was assessed using the Functional Impairment test‐hand, neck, shoulder, and arm (FIT‐HaNSA). Electromyography (EMG) was recorded from 13 shoulder muscles, comprising five muscle groups, during a shelf‐lifting task. Mean FIT‐HaNSA scores were significantly lower in MRCT patients (p ≤ 0.001), reflecting a severe functional deficit. In MRCT patients, EMG signal amplitude was significantly higher for the biceps brachii‐brachioradialis (p < 0.001), upper trapezius‐serratus anterior (p = 0.025), muscle groups and for the latissimus dorsi (p = 0.010), and teres major (p = 0.007) muscles. No significant differences in the correlation among muscle groups were identified, pointing to an unchanged neuromuscular strategy following a tear. In MRCT patients, a reorganization of muscle activation strategy along the upper limb kinetic chain is aimed at reducing demand on the glenohumeral joint. Increased activation of the latissimus dorsi and teres major muscles is an attempt to compensate for the deficient rotator cuff. Re‐education towards an alternate neuromuscular control strategy appears necessary to restore function. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1140–1146, 2012     

5例巨大面部血管瘤患者电化学治疗的护理

总结巨大面部海绵状血管瘤患者电化学治疗的护理经验.对5例进行电化学治疗的巨大面部海绵状血管瘤患者.术前加强心理护理,改善患者的自卑心态,做好口腔准备预防术后感染,给予饮食护理改善患者的营养状态;术后早期瘤体会肿胀、变硬,流涎情况严重,因此要注重口腔护理,指导患者进行舌功能锻炼.本组5例患者能积极配合治疗,术后恢复好,无并发症,治疗有效率达100%.     

原发性腹腔妊娠25例临床分析

目的:探讨原发性腹腔妊娠的发病因素及临床特点。方法:回顾性分析25例腹腔妊娠患者的临床资料。结果:停经及腹痛为原发性腹腔妊娠主要症状。临床出现休克症状者13例。17例宫内有节育器。所有病例皆有腹腔出血,平均1 100 ml,大于1 200 ml者13例。有2例腹腔妊娠与卵巢黄体同时破裂。结论:腹腔妊娠易引起腹腔大出血,造成失血性休克,应尽可能早期诊断和及时手术治疗。宫内节育环是腹腔妊娠的主要原因。     

野战医疗所批量伤员救治信息保障研究

根据高技术条件下战争野战医疗所大批量伤员救治的需求和特点,应用无线网络、移动计算和智能识别等相关现代信息技术,构建无线移动信息保障系统,以实时、移动、高效率的信息共享处理方式再造伤员救治信息流转流程,彻底改变了传统手工记录、反复转抄、人工传递信息的工作模式,也弥补了电子伤票和有线信息管理系统的不足,真正实现了伤员救治信息流转的数字化、自动化和现代化,实现了指挥员对伤员流、物资流的实时可知,对伤员救治全程的实时可控,极大的提高了救治效率,最大限度降低由于救治延误造成的伤死率和伤残率,为野战医疗所批量伤员快速通过提供了高效、便捷、稳定的信息保障。     

剖宫产术后非计划妊娠人工流产术中大出血的高危因素分析

目的：分析剖宫产术后非计划宫内妊娠人工流产术中发生大出血的高危因素。方法：采用前瞻性队列研究,纳入2022年1月至2023年4月在重庆市人民医院妇产科门诊接受人工流产手术的228例剖宫产术后非计划宫内妊娠患者的临床信息和影像学资料,采用单因素分析和多因素Logistic回归分析人流术中发生大出血的危险因素。结果：228例病例中,术中大出血59例,占25.87%。单因素分析结果显示：生产次数、剖宫产次数、孕囊最大直径、孕囊距离子宫切口瘢痕距离、胚胎停育以及妊娠时间是剖宫产术后非计划宫内妊娠人工流产术中发生大出血的危险因素（P<0.05）。多因素Logistic回归分析结果显示：剖宫产次数、孕囊最大直径、孕囊距离子宫切口瘢痕距离,胚胎停育以及妊娠时间是剖宫产术后非计划宫内妊娠人工流产术中发生大出血的独立危险因素（P<0.05）。结论：降低剖宫产率,落实剖宫产后高效避孕,有助于降低该类人群人流术中大出血发生风险。     

Successful Rescue of Life-threatening Hemoptysis Caused by Pulmonary Tuberculosis Bridging with Extracorporeal Membrane Oxygenation

Massive hemoptysis is a fatal complication associated with pulmonary tuberculosis (TB). It can lead to severe respiratory failure. Extracorporeal membrane oxygenation (ECMO) is a life-saving technology that is rarely indicated for bleeding disorders. We herein report a 26-year-old man who presented with severe respiratory failure caused by massive hemoptysis with pulmonary TB. Transcatheter artery embolization was successfully performed with venovenous ECMO support. The hemostatic procedure allowed concomitant anticoagulant use, and neither bleeding nor thrombotic complications occurred throughout the clinical course. Administering the appropriate hemostatic procedure with subsequent management, including anticoagulant therapy, supported ECMO application in a case of bleeding.     

Chromatin remodelling and DNA repair genes are frequently mutated in endometrioid endometrial carcinoma

In developed countries, endometrial carcinoma is the most common cancer that affects the female genital tract. Endometrial carcinoma is divided into two main histological types, type I or endometrioid and type II or non‐endometrioid, each of which have characteristic, although not exclusive, molecular alterations and mutational profiles. Nevertheless, information about the implication and relevance of some of these genes in this disease is lacking. We sought here to identify new recurrently mutated genes in endometrioid cancers that play a role in tumourigenesis and that influence the clinical outcome. We focused on low‐grade, non‐ultramutated tumours as these tumours have a worse prognosis than the ultramutated POLE‐positive endometrioid endometrial carcinomas (EECs). We performed exome‐sequencing of 11 EECs with matched normal tissue and subsequently validated 15 candidate genes in 76 samples. For the first time, we show that mutations in chromatin remodelling‐related genes (KMT2D, KMT2C, SETD1B and BCOR) and in DNA‐repair‐related genes (BRCA1, BRCA2, RAD50 and CHD4) are frequent in this subtype of endometrial cancer. The alterations to these genes occurred with frequencies ranging from 35.5% for KMT2D to 10.5% for BRCA1 and BCOR, with some showing a tendency toward co‐occurrence (RAD50‐KMT2D and RAD50‐SETD1B). All these genes harboured specific mutational hotspots. In addition, the mutational status of KMT2C, KMT2D and SETD1B helps to predict the degree of myometrial invasion, a critical prognostic feature. These results highlight the possible implication of these genes in this disease, creating opportunities for new therapeutic approaches.     

两种方式注射治疗非静脉曲张性上消化道大出血的疗效研究

目的探讨胃镜下去甲肾上腺素药物喷洒与肾上腺素注射治疗非静脉曲张性上消化道大出血的疗效。方法 160例符合纳入标准的非静脉曲张性上消化道大出血患者按治疗方案分为药物喷洒组(80例)和药物注射组(80例)。所有患者均给予上消化道大出血的常规治疗。药物喷洒组患者在胃镜下给予去甲肾上腺素喷洒治疗,而药物注射组在胃镜下给予肾上腺素注射治疗。观察两组患者治疗疗效、止血时间、再出血率及不良反应发生情况。结果药物注射组的治疗总有效率为95.0%,明显高于药物喷洒组的80.0%(P0.05)。与药物喷洒组相比,药物注射组的止血时间明显缩短,再出血率明显降低(均P0.05)。治疗过程中,两组均未发生严重不良反应,其不良反应发生率在两组间比较差异无统计学意义(P0.05)。结论胃镜下肾上腺素注射是非静脉曲张性上消化道大出血的有效治疗方案,可以提高治疗有效率,缩短止血时间,且不良反应轻,疗效优于去甲肾上腺素喷洒治疗,临床上值得进一步研究。     

Intracoronary tenecteplase in STEMI with massive thrombus

Primary percutaneous coronary intervention is the current standard of care in ST elevation myocardial infarction (STEMI). However, large thrombus is an independent predictor for stent thrombosis and major adverse cardiac events in patients undergoing primary angioplasty for STEMI. Here we report a series of STEMI patients with large thrombus burden treated successfully with low dose intracoronary thrombolysis. There was prompt and early ST resolution. There was improvement in thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade postlysis in all patients. Majority had recanalised infarct related coronary artery thus obviating the need for stenting. There was no inhospital or 1 month mortality or bleeding events. Hence intracoronary thrombolysis is an option in patients with large thrombus burden.     

依达拉奉治疗急性大面积脑梗死临床疗效分析研究

目的:观察依达拉奉治疗急性大面积脑梗死的疗效。方法:将126例发病12h内部分或完全前循环梗死的患者,随机分为依达拉奉治疗组(63例)和常规治疗对照组(63例)。两组患者入院后均给予脑梗死常规治疗,依达拉奉组再给予依达拉奉30mg加入生理盐水100ml静脉滴注,2次/d,连用21d。观察两组治疗前及治疗2周时梗死面积的变化情况,观察两组治疗后第3天、14天、21天时进行美国国立卫生院神经功能缺损评分(the NIH stroke scale,NIHSS)变化情况。结果:两组2周时神经功能缺损评分及梗死灶最大层面面积比较差异有统计学意义(P<0.05)。结论:依达拉奉治疗急性大面积脑梗死的疗效较好,无明显不良反应。