妊娠相关蛋白-A对冠心病易损斑块的预测价值

目的:探讨妊娠相关蛋白A(PAPP-A)与冠心病及斑块易损性之间的关系。方法:选择急性冠状动脉综合征(ACS组)患者20例,稳定性心绞痛(SAP组)患者19例,采用ELISA测定患者血清中PAPP-A水平,同时应用光学相干断层成像技术测定患者斑块纤维帽厚度。结果:ACS组PAPP-A高于SAP组[(48.71±18.90)ng/L∶(18.93±11.11)ng/L,P<0.01];ACS组斑块纤维帽厚度低于SAP组[(45.44±18.25)μm∶(90.74±24.54)μm,P<0.01]。ACS组中PAPP-A与斑块纤维帽厚度呈负相关,r=-0.778,P<0.01。逐步(Stepwise)多重线性回归分析认定PAPP-A是预测斑块易损性的一种独立危险因素。结论:PAPP-A是一种独立的、能够有效预测冠心病风险以及斑块易损性的标记物。     

Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering

AIM: To investigate cap morphology after small-incision lenticule extraction (SMILE) and its effects on intraocular scattering. METHODS: Sixty-five eyes of 33 patients undergoing SMILE were enrolled. In addition to regular evaluation, Fourier-domain optical coherence tomography was used to investigate cap thickness at 1d, 1wk, 1 and 3mo postoperatively. The optical quality including modulation transfer function cutoff frequency, Strehl ratio, Optical Quality Analysis System (OQAS) values, and objective scattering index (OSI), were evaluated using OQASTM. RESULTS: Cap thickness decreased from 1d to 1wk (P<0.001), but remained higher than intended thickness of 120 μm after 3mo (P<0.001). Cap thickness in central area was thinner than that of in the paracentral and peripheral areas (P<0.0001). Total number of microdistortions decreased from 1d to 3mo (P<0.0001). Pearson analysis revealed a weak correlation between OSI and standard deviation of cap thickness at 1d and 1mo, as well as between range of cap thickness and OSI at 1mo. No correlation was found between microdistortion and OSI, but a negative correlation existed between microdistortion and range at 1d and 1moafter surgery. CONCLUSION: The corneal cap tends to be more accurate and regular with time lapse. Better cap morphology tends to contribute less intraocular scattering in the eyes undergoing SMILE.     

Numerical simulation and biomechanical analysis of locking screw caps on clavicle locking plates

Background:The risk of displaced and comminuted midshaft clavicle fractures is increased in high-energy traumas such as sport injuries and traffic accidents. Open reduction and plate fixation have been widely used for midshaft clavicle fractures. Among various plates for clavicle shaft fractures, superior locking compression plates (LCPs) have been mostly used. In plate fixation, nonunion caused by implant failure is the most difficult complication. The most common reasons for metal plate failure are excessive stress and stress concentration caused by cantilever bending. These causes were easily addressed using a locking screw cap (LSC).Methods:The clavicle 3-dimensional image was made from a computed tomography scan, and the clavicle midshaft fracture model was generated with a 10-mm interval. The fracture model was fixed with a superior LCP, and finite element analysis was conducted between the presence (with LSC model) and absence (without LSC model) of an LSC on the site of the fracture. The stresses of screw holes in models with and without LSCs were measured under 3 forces: 100 N cantilever bending force, 100 N axial compression force, and 1 N·m axial torsion force. After the finite element analysis, a validation test was conducted on the cantilever bending force known as the greatest force applied to superior locking plates.Results:The mean greatest stress under the cantilever bending force was significantly greater than other loading forces. The highest stress site was the screw hole edge on the fracture site in both models under the cantilever bending and axial compression forces. Under the axial torsional force, the maximum stress point was the lateral first screw hole edge. The ultimate plate stress of the with LSC model is completely lower than that of the without LSC model. According to the validation test, the stiffness, ultimate load, and yield load of the with LSC model were higher than those of the without LSC model.Conclusions:Therefore, inserting an LSC into an empty screw hole in the fracture area reduces the maximum stress on an LCP and improves biomechanical stability.     

透明帽在食管枣核异物取出术中的应用价值

目的探讨透明帽辅助胃镜食管异物枣核取出术的有效性及安全性。方法回顾性分析2014年1月-2015年5月在该院胃镜下取出食管枣核异物84例,年龄45~93岁,平均(58.13±19.52)岁,男37例,女47例。常规胃镜取出组35例,透明帽辅助胃镜下取出组枣核49例。比较两种治疗的异物取出时间、成功率、出血及穿孔等并发症发生率。结果常规胃镜治疗组35例,均横卡于食管上段,33例经常规内镜顺利取出;2例经静脉麻醉辅助内镜取出。透明帽辅助胃镜治疗组49例,枣核横卡于食管上段46例,中段3例,均经常规胃镜取出。常规胃镜治疗组取出枣核平均操作时间(10.13±0.72)min,透明帽辅助胃镜取出枣核平均操作时间(5.46±0.81)min。常规胃镜治疗组35例,29例创面局部均有不同程度出血,穿孔4例。透明帽辅助胃镜治疗组49例,21例有少量渗血,2例穿孔。结论透明帽辅助胃镜下食管异物取出术方法可明显缩短枣核取出平均时间,减少并发症的发生率。     

海肤康护创指套应用于外伤性指端损伤32例

目的 手指外伤的治疗应尽可能地保护手指功能、感觉和外形.方法 彻底清创止血、不缝合,使用海肤康创指套套入指端,加压包扎,抗炎治疗.结果 32例41指创面全部愈合,39个指端愈合后皮肤质地、感觉、指纹、指端造型及关节活动接近于正常手指,2个手指感觉明显减弱.结论 手指外伤应用海肤康护创指套治疗能最大限度地保护手指长度、外型功能,能缩短伤口愈合时间.     

Assessing Equity of Access to Proton Beam Therapy: A Literature Review

Proton beam therapy (PBT) is one of the most advanced radiotherapy technologies, with growing evidence to support its use in specific clinical scenarios and exponential growth of demand and capacity worldwide over the past few decades. However, geographical inequalities persist in the distribution of PBT centres, which translate into variations in access and use of this technology. The aim of this work was to look at the factors that contribute to these inequalities, to help raise awareness among stakeholders, governments and policy makers. A literature search was conducted using the Population, Intervention, Comparison, Outcomes (PICO) criteria. The same search strategy was run in Embase and Medline and identified 242 records, which were screened for manual review. Of these, 24 were deemed relevant and were included in this analysis. Most of the 24 publications included in this review originated from the USA (22/24) and involved paediatric patients, teenagers and young adults (61% for children and/or teenagers and young adults versus 39% for adults). The most reported indicator of disparity was socioeconomic status (16/24), followed by geographical location (13/24). All the studies evaluated in this review showed disparities in the access to PBT. As paediatric patients make up a significant proportion of the PBT-eligible patients, equity of access to PBT also raises ethical considerations. Therefore, further research is needed into the equity of access to PBT to reduce the care gap.     

OCT观察不同剂量阿托伐他汀对ACS患者脂质斑块纤维帽的影响

目的通过光学相干断层扫描技术（OCT）观察不同剂量阿托伐他汀对急性冠状动脉综合征（ACS）患者冠状动脉易损脂质斑块纤维帽及脂质核心角度的影响。方法选取接受经皮冠状动脉介入（PCI）的ACS患者24例，根据他汀剂量不同分为常规剂量组12例和强化剂量组12例，PCI术后分别接受常规阿托伐他汀20、40~80mg治疗。手术即刻及术后第9个月行OCT检查，记录脂质斑块纤维帽的部位及数量，比较斑块最薄纤维帽厚度和脂质核心角度。结果常规剂量组易损斑块纤维帽厚度随访与基线期分别为（175.42±36.02）、（50.41±6.58）滋m（P＜0.01），强化剂量组分别为（233.33±88.35）、（49.12±7.33）滋m（P＜0.01）；两组随访期易损斑块纤维帽厚度差异无统计学意义（P＞0.05）；常规剂量组TCFA脂质核心角度随访与基线期分别为（72.9±29.3）°、（127.6±50.8）°（P＜0.01），强化剂量组分别为（74.6±32.9）°、（132.6±51.3）°（P＜0.01），两组患者基线与随访时脂质核心角度差异均无统计学意义（均P＞0.05）。结论阿托伐他汀可使随访期TCFA厚度增大，脂质核心角度减小，采用OCT可重点观察TCFA厚度。     

纳米复合树脂联合透明预成冠修复上颌乳切牙的临床效果

探讨纳米复合树脂联合透明预成冠修复上颌乳切牙的临床效果。方法 选取2021年6月- 2022年6月于我院接受口腔修复的85例患儿作为研究对象，利用随机数字表法分为对照组（n =42）和观察 组（n =43）。对照组采用纳米复合树脂充填，观察组采用纳米复合树脂联合透明预成冠美学修复，比 较两组修复成功率、美学指标及口腔功能。结果 两组修复后3个月修复成功率比较，差异无统计学意 义（P ＞0.05）；观察组修复后6、12个月修复成功率高于对照组（P ＜0.05）；观察组修复后3、6、12个月 红白美学指标和面部美学指标评分均高于对照组（P＜0.05）；观察组修复后美观、咀嚼及语言评分均高于 对照组（P ＜0.05）。结论 纳米复合树脂联合透明预成冠修复上颌乳切牙的临床效果良好,能实现较好的修 复效果和美学价值，有效改善患者的口腔功能。