Abdominal Aortic Aneurysms: Endovascular Options and Outcomes — Proliferating Therapy,But Effective?

Abdominal aortic aneurysm (AAA) has a reported prevalence rate of 1.4% in the US. AAA rupture accounts for an estimated 15,000 deaths per year, rendering it the 10th leading cause of death in men over the age of 55. Endovascular repair (EVR) has proliferated in the last two decades as an increasingly popular alternative to traditional open surgery, and is now the default treatment in the majority of centres worldwide. This review article outlines the evidence supporting this stance. The development of EVR is reviewed, alongside trends in utilisation of this therapy over time. The evidence for the relative short-term and long-term outcomes of EVR and open AAA repair is discussed, and ongoing controversies surrounding the use of EVR are considered.     

Pharmacokinetics,efficacy and safety profiles of etanercept monotherapy in Japanese patients with rheumatoid arthritis: review of seven clinical trials

Abstract

Conventional synthetic disease-modifying anti-rheumatic drugs, including methotrexate, may not be tolerated by all patients with rheumatoid arthritis (RA), and limited international data for etanercept (ETN) monotherapy are available. The aim of this review was to summarize the clinical program for ETN monotherapy in Japanese patients with RA, which has included a pharmacokinetic study, clinical trials for registration, long-term studies, and once-weekly dosing studies. Pharmacokinetic results showed that serum concentrations of ETN were linear with dose levels and were similar to other international studies. Across interventional studies, 652 Japanese patients with active RA were treated with ETN. In the registration studies, ETN treatment led to consistent improvement in American College of Rheumatology 20/50/70 scores, European League Against Rheumatism Good Response, Disease Activity Score 28 erythrocyte sedimentation rate remission, and Health Assessment Questionnaire disability index. In the long-term studies, efficacy was maintained for up to 180 weeks. Similar results were seen in the once-weekly studies. Across the studies, more than 870 patient-years of exposure to ETN were recorded. Discontinuations owing to lack of efficacy or adverse events were modest and no new safety signals were recorded. These studies demonstrated that ETN monotherapy is efficacious and well-tolerated in Japanese patients with RA.     

The Herniated Thoracic Disc: A Review of Literature

Abstract

This literature review discusses the epidemiology and etiology of thoracic disc lesions and describes signs and symptoms, diagnostic procedures, differential diagnosis, and treatment. Data presented in case series reports published between 1985-2001 is summarized: Thoracic disc herniations are more common than previously thought. They may cause mild, moderate, severe or confusing symptoms or be asymptomatic; 49% of cases were in men and 51% in women. Trauma was a precipitating factor in 31%; multiple herniations were reported in 9%. In symptomatic cases, 57% of patients presented with radicular pain, 48% with back pain, 63% with weakness, 60% with sensory complaints, 25% with bowel or bladder symptoms, and 59% with hyperreflexia. Typical presentations of upper, middle, and lower thoracic disc are summarized. Diagnosis is made by correlating clinical signs and symptoms with the results of diagnostic imaging. Surgery is recommended for patients with progressive neurological dysfunction. Research on the efficacy of conservative treatment is lacking in the literature.     

下颈椎前路椎弓根螺钉内固定技术的研究进展

与传统前路和后路手术相比,下颈椎前路椎弓根螺钉内固定技术（anterior transpedicular screw fixation．ATPS）具有较好的生物力学优势、相对安全等特点,仅通过一次前路手术可解决减压和重建两个问题。但是由于ATPS采用了较为特殊的解剖通道,临床上暂无专门用于前路椎弓根螺钉置钉的配套内固定系统,下颈椎ATPS技术的适应证相对较窄,尚不能替代传统前路和后路手术方法。如何精确置钉以及ATPS相关内固定器械的开发是目前研究的热点及未来发展方向。     

活动节段脊柱脊索瘤生物学行为研究进展

脊索瘤是临床少见的原发性低度恶性骨肿瘤,源自残留的胚胎脊索或迷走的脊索组织,好发于中轴骨,具有局部侵袭性、复发率高、预后差,以及对放射治疗和药物化疗不敏感等特点,使其临床治疗存在巨大挑战。位于活动节段的脊柱脊索瘤由于脊柱特有的解剖学特点而具有其独特特点,本文通过回顾近年国内外相关文献,对脊索瘤生物学行为特点进行概述,以期为脊索瘤治疗提供新的思路。     

对Lancet Neurol发表的自身免疫性脑炎诊断路径的思考

正临床发生的脑实质炎症反应致脑炎是神经科常见疾病之一,其致病因素可以分为感染性因素和非感染性因素两大类[1],在非感染性因素中,自身免疫性脑炎占据重要位置。随着抗细胞内抗原抗体和抗细胞表面抗原抗体的发现,临床明确诊断的自身免疫性脑炎病例数逐渐增加,目前,临床医师对此类疾病的诊断主要依靠自身抗体检测和试验性免疫调节治疗[2],故在很大程度上限制了早期治疗方案的选择。由于早期免疫调节治疗可以显著改     

NMO-IgG在中枢神经系统脱髓鞘疾病中的诊断价值

水通道蛋白4是维持中枢神经系统正常跨膜水转运、血-脑屏障完整性和中枢神经系统内环境稳定的水通道蛋白,其特异性自身抗体NMO-IgG是视神经脊髓炎的特异性生物学标志物,但其在视神经脊髓炎中的阳性率并非100%,甚至在某些其他中枢神经系统脱髓鞘疾病中也可检测到。本文拟对NMO-IgG在中枢神经系统脱髓鞘疾病中的意义进行概述,以加深对该抗体的认识并指导中枢神经系统脱髓鞘疾病的诊断与鉴别诊断。     

Laparoscopic adhesiolysis for small bowel obstruction

BACKGROUND: Historically, laparotomy and open adhesiolysis have been the treatment for patients requiring surgery for small bowel obstruction. Laparoscopic adhesiolysis has not gained wide acceptance. The indications and outcomes of laparoscopic adhesiolysis for small bowel obstruction are not well established. The purpose of this paper is to review the literature on laparoscopic adhesiolysis for small bowel obstruction and to discuss patient selection, surgical technique, and outcomes. DATA SOURCES: Medline search from 1980 to 2002. CONCLUSIONS: Laparoscopic adhesiolysis has been shown to be safe and feasible in experienced hands. For selected patients, laparoscopic adhesiolysis offers the advantages of decreased length of stay, faster return to full activity, and decreased morbidity. Patient selection and surgical judgment appear to be the most important factors for a successful outcome.     

癌性锚蛋白重复序列蛋白在结直肠癌的研究进展

结直肠癌是我国最常见的恶性肿瘤之一,其发病机制与多种肿瘤基因密切相关。锚蛋白重复序列（Gannankyrinrepeats,Gankyrin）是近年来新发现的癌基因,目前研究表明它在肝细胞癌及很多恶性肿瘤中高表达。近年研究表明Gankyrin与结直肠癌的发病密切相关,但对Gankyrin在结直肠癌的发病机制尚不清楚,对Gankyrin蛋白在结直肠癌肝转移灶中是否表达尚未见报道。本文就Gankyrin蛋白在结直肠癌中的研究进展情况作做一综述。     

Temporal changes in extra-axial brain hematoma's signal intensity in magnetic resonance images of trauma patients: A preliminary,technical study

IntroductionDating the exact or estimated time of trauma is an important issue facing forensic medicine. Several clinical and radiological methods were used to achieve this purpose. In the recent study, we aimed to track the changes in the signal intensity of the extra-axial brain hematoma using magnetic resonance imaging (MRI) conventional sequences as well as diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC).Materials and methodsConsidering inclusion and exclusion criteria, all patients with blunt head trauma were involved. After proper management., stabilization, and resuscitation, the participants were assessed using conventional sequences of MRI and DWI twenty-four hours, forty-eight hours, and three weeks after the injury. Temporal changes of signal intensity were compared by Wilcoxon ranged test.ResultsSixteen patients sustaining blunt head trauma were included in this study. The study showed that during the time, diffusion restriction could be seen in an extraaxial hematoma. At the first 24 hours, the signal of hematoma was void in 87.5% of DWI and 100% of ADC. On the second day, they were hypo-signal in 75% of DWI and 100% 0f ADCs, and after three weeks, 100% of cases were hyper-signal in DWI and hypo-signal ADCs.ConclusionThis preliminary study has shown that the DWI can be used to detect and track the extra-axial hematoma. The signal intensity was void during the first twentyfour hours, although it became hypo-signal after 48 hours. Of note, the diffusion restriction is noted after three weeks.