乌头汤对DPN大鼠NGF受体TrkA、p75NTR表达的影响

[目的]通过观察乌头汤对糖尿病周围神经病变(DPN)大鼠胫神经神经生长因子(NGF)受体、酪氨酸蛋白激酶A(TrkA)和p75神经营养因子受体(p75NTR)表达及血清NGF含量的影响,探索该方改善DPN的可能机制。[方法]Wistar大鼠腹腔注射链尿佐菌素(STZ)建立糖尿病模型,观察乌头汤对胫神经纤维组织TrkA、p75NTR及血清NGF的影响。[结果]干预前后模型组和乌头汤组均较空白组FBG显著升高(P0.01),各组内FBG在干预前后无统计学差异(P0.05);与模型组比较,乌头汤组血清NGF含量明显升高(P0.05),神经组织p75NTR明显降低(P0.05)。乌头汤组p75NTR免疫组化染色阳性表达程度较模型组明显降低。[结论]乌头汤改善DPN的作用可能与其能够调节神经纤维p75NTR含量和血清NGF含量有关。     

Pericardial fluid analysis in scleroderma (systemic sclerosis)

A patient with scleroderma who presented with pericarditis and effusion is described. Aspirates from this pericardial effusion had the characteristics of an exudate with no evidence of autoantibodies, immune complexes or complement depletion. These findings suggest that the mechanisms operating in the production of pericardial effusion in scleroderma may be different from those found in rheumatoid arthritis and systemic lupus erythematosus.     

Left Main Coronary Atresia in a Child with Absent Pulmonary Valve Syndrome: Early Entrapment of an Innocent Bystander

Atresia of the left main coronary artery is a rare anomaly that, if left untreated, has an unfavorable outcome. We hereby report left main coronary artery atresia in a child with tetralogy of Fallot with absent pulmonary valve and discuss the possible developmental basis of the association.     

Image-guided interstitial high-dose-rate brachytherapy for dose escalation in the radiotherapy treatment of locally advanced lung cancer: A single-institute experience

PurposeTo evaluate the clinical outcome after CT-guided interstitial high-dose-rate (HDR) brachytherapy for dose escalation in the radiotherapy treatment of inoperable locally advanced non–small-cell lung cancer (NSCLC).Methods and MaterialsFrom 2005 to 2015, 16 patients with unresectable NSCLC were treated. Median age was 65.7 years (range, 52–86). The median tumor volume was 95.3 cm³ (range, 20.0–2000.0). The median prescribed HDR was 15.0 Gy (range, 7.0–32.0) delivered in twice-daily fractions of 6.0–8.0 Gy in 4 patients and in once-daily fractions of 7.0–15.0 Gy in 12 patients, respectively.ResultsAfter a median followup of 12.5 months, median overall survival and local control was 12.9 and 24.9 months, respectively. The corresponding median overall survival and local control rates at 1, 2, and 3 years were 56.2%, 37.5%, and 12.5% as well as 68.9%, 57.4%, and 43%, respectively. Apart from one Grade 1 cough episode persisting for 1 week and one patient developing a minor hemopneumothorax requiring no postprocedural drainage, no other adverse events were recorded.ConclusionsCT-guided interstitial HDR brachytherapy is a safe modality for radiation dose escalation which may play a role in the definitive radiotherapy treatment of locally advanced NSCLC.     

Aortic Bulge: A Possible Predictive Sign of Impending Aortoenteric Fistula

PurposeThe purpose of this study is to introduce the aortic bulge sign, a finding observed retrospectively on computed tomography prior to the acute presentation of aortoenteric fistula, and to determine its interobserver reliability.MethodsFollowing research ethics board approval, all cases of aortoenteric fistula at our institution occurring from 2011–2015 were identified retrospectively. All previous computed tomography images of patients who eventually developed aortoenteric fistula were reviewed by a single observer for the presence of a potentially predictive finding of fistulization, the aortic bulge sign. These previous images were then combined with age and sex matched controls into a case bank. Eight radiology residents and staff were instructed in observing the aortic bulge sign. These observers then reviewed the case bank in a blinded analysis to determine the interobserver reliability of this finding.ResultsFourteen cases of aortoenteric were identified. The average patient age was 70.71 years with a male-to-female ratio of 11:3. Eleven patients had previous computed tomography images available for review. With blinded analysis by multiple observers, the aortic bulge sign was identified with greater than 80% agreement in six of 11 cases (66.67%). Fleiss' kappa was calculated at k = 0.60 (95% confidence interval 0.50–0.69), corresponding to moderate-to-substantial interobserver agreement.ConclusionsThe aortic bulge sign has been retrospectively identified as a promising computed tomography finding of eventual aortoenteric fistula prior to acute presentation. Further study is required to determine the diagnostic value of this sign.     

Combat-related upper extremity injuries: Surgical management specificities on the theatres of operations

This review presents the current surgical management of combat-related upper extremity injuries during the acute phase. The strategy consists of saving the life, saving the limb and retaining function. Surgical tactics are based on damage control orthopaedics techniques of haemorrhage control, wound debridement, and temporary bone stabilization prior to evacuation out of the combat zone. Features of the definitive management of local casualties in battlefield medical facilities are also discussed. In this situation, reconstructive procedures have to take into account the limited resources and operational constraints.     

Coping and Management Techniques Used by Chronic Low Back Pain Patients Receiving Treatment From Chiropractors

ObjectivesThe purpose of this study was to describe coping strategies (eg, mechanisms, including self-treatment) that a person uses to reduce pain and its impact on functioning as reported by patients with chronic low back pain who were seen by doctors of chiropractic and how these coping strategies vary by patient characteristics.MethodsData were collected from a national sample of US chiropractic patients recruited from chiropractic practices in 6 states from major geographical regions of the United States using a multistage stratified sampling strategy. Reports of coping behaviors used to manage pain during the past 6 months were used to create counts across 6 domains: cognitive, self-care, environmental, medical care, social activities, and work. Exploratory analyses examined counts in domains and frequencies of individual items by levels of patient characteristics.ResultsA total of 1677 respondents with chronic low back pain reported using an average of 9 coping behaviors in the prior 6 months. Use of more types of behaviors were reported among those with more severe back pain, who rated their health as fair or poor and who had daily occurrences of pain. Exercise was more frequent among the healthy and those with less pain. Female respondents tended to report using more coping behaviors than men, and Hispanics more than non-Hispanics.ConclusionPersons with chronic back pain were proactive in their coping strategies and frequently used self-care coping strategies like those provided by chiropractors in patient education. In alignment with patients’ beliefs that their condition was chronic and lifelong, many patients attempted a wide range of coping strategies to relieve their pain.     

Biomaterial-based bone regeneration and soft tissue management of the individualized 3D-titanium mesh: An alternative concept to autologous transplantation and flap mobilization

Three-dimensional augmentation in severely atrophic bone and after cancer resection is a challenging clinical indication that is mostly solved using autologous bone transplantation. The development of the digital technique along with the additive manufacturing and three-dimensional (3D) printing opened new avenues for reconstructive oral and maxillofacial surgery. Therefore, patient-specific titanium mesh is a novel means of stabilizing the augmentation region using particulate bone substitute materials (BSMs) combined with autologous bone as a minimally invasive concept. However, dehiscence is a frequently reported complication in this field. Therefore, the aim of the present case series was to introduce a biomaterial-based regenerative concept in terms of exposed open healing to overcome the dehiscence related to 3D-titanium meshes. Additionally, this case series presents a novel protocol using a combination of xenogeneic BSMs with an autologous blood concentrate system (platelet-rich fibrin [PRF]) and collagen matrices without any autologous transplantation. Seven patients with alveolar ridge atrophy with different etiologies (cancer resection, severe atrophy after tooth loss, aplasia, trauma, implant infections) were treated using the open-healing concept. Therefore, after 3D augmentation using the described biomaterials, the flap margins were approximated, and the gap between the flap margins was bridged using a collagen matrix loaded with liquid PRF that was then covered by either a PTFE-based membrane or sterile latex. No periosteum splitting was performed at any time point. After a healing period of 4–8 months, all patients received dental implants as virtually planned. Bone biopsies were performed during dental insertion for histological evaluation. The augmentation area displayed a vital and well-vascularized newly formed bone that incorporated the BSM granules to build a hybrid bone. Additionally, open healing resulted in newly formed soft tissue without any signs of scar formation or fibrosis. The regenerated soft tissue was used to build a new flap during implant insertion and showed good functional and aesthetic results after implant insertion. The open-healing concept of the regeneration of the soft tissue along with bone tissue to regenerate a harmonic implantation bed is a minimally invasive intervention without periosteum splitting or large flap mobilization. However, further controlled clinical studies are needed to evaluate this concept in a larger patient cohort to outline the potential clinical benefit.     

经络综合导引治疗仪的研制

经络综合导引治疗仪是根据祖国医学的经络学说和养气功理论，应用呼气启动导引，视觉模型提示和穴位电刺激的多因素共同作用，导引气血沿经络运行。主要用于强化瘫痪肢体的康复。该治疗仪以单片微机为程控中心，通过硬件设计和软件开发，实现了呼气触发，视觉提示和位电刺激同步发，１６和电极依次选通和数字化幅度调节等多种功能。