Les patients très âgés sont-ils de bons candidats à l’angioplastie coronaire ? Une étude rétrospective monocentrique

Aim

To determine the feasibility of percutaneous coronary intervention (PCI) in very old patients.

Background

The elderly are a growing population with a high prevalence of ischemic heart disease and then subsequent possibility to benefit from coronary interventions.

Method

We have conducted a retrospective study using our PCI database since January 2000. Population characteristics, clinical presentation, type of lesions, technical procedure, immediate results and in hospital outcome are compare between patients older than 85 and the other.

Results

Between January 2008 and March 2009, 3130 patients benefit from coronary angioplasty. Among them, 85 patients were older than 85. There were more female in this group (24.7 vs. 14.3%, P = 0.007), but no difference in cardiovascular risk profile. The older was more symptomatic (acute coronary syndrome: 59.52 vs. 44%, P = 0.004; silent ischemia: 3.6 vs. 25.7%, P = 0.000003). The ejection fraction was worse (EF < 55%: 29.4 vs. 14.5%, P = 0.0001). The lesion was more complex (B2 and C: 67.2 vs. 57.1% P = 0.027) and concern more often the left descending artery (85.9 vs. 57.1%, P = 0.000001). The technical success was similar in the two groups (93.28 vs. 94.32%, P = 0.34) with similar rate of per procedure complications (2.35 vs. 1.5%, P = 0.37). Nevertheless, the in-hospital rate mortality was higher in the older patients (7 vs 1.38%, P = 0.0014).

Conclusion

PCI is safe and safety in very old patients despite significant but acceptable increasing in-hospital mortality due to more severe disease and co morbidities. Further evaluations are necessary in order to edict specific recommendations.     

CT脑立体定向显微直视手术切除脑功能区及深部病变

采用CT脑立体定向技术引导开颅显微外科手术切除脑重要功能区及脑深部病变18例,其中位于运动区皮质下28例、语言中枢皮质下12例、脑深部8例 临床表现主要为癫痫、偏瘫、失语 病变性质主要为脑囊虫病、慢性炎性组织、结核瘤、肺吸虫病、海绵状血管瘤、脂肪瘤及血吸虫病.术后所有病人症状均逐渐消失,完全恢复健康,无手术并发症及死亡.     

普鲁卡因胺对大鼠血小板粘附的影响(英文)

我们用改进的旋转玻球法研究了普鲁卡因胺对大鼠血小板粘附的影响。普鲁卡因胺体外136.0,34.0,8.5μmol·L~(-1)和体内10mg·kg~(-1)显著抑制血小板粘附,其抑制率分别为56％,28％,8％和24％,表明体内或体外给予普鲁卡因胺对血小板粘附产生抑制作用。     

Traitement par PRP 1 partie : les lésions cartilagineuses et musculaires

Background

The frequency and diversity of injuries affecting the musculoskeletal system have incited much research leading to the discovery of new treatment options including Platelet-Rich Plasma (PRP) therapy. To date, indications have been extended to injuries involving several types of tissues including cartilage and muscles.

Method

We searched the English and French literature for articles reporting a high level of proof on PRP therapy for cartilage or muscle injuries. We found six articles on cartilage lesions and three on muscle lesions.

Results

For cartilage lesions, PRP provides superior results compared with hyaluronic acid for early stage injuries, but the evidence is limited to a short follow-up (maximum 6 months). For muscle lesions, the PRP results are encouraging.

Conclusion

As long as a consensus has not been reached concerning the methods applied for preparing PRP, the concentrations used, the activation method, and the formulation, it will be difficult to compare studies, despite their high level of proof, and to affirm that PRP has a beneficial effect on repair of different body tissues. Use of PRP therapy for cartilage injury is now a validated option for pain relief, especially in young patients after failure of hyaluronic acid. The delay of action is long (at least 6 months). Injection formulations are easy to use, well tolerated and safe. Cost is relatively low.     

Evidence-based medicine and vesicoureteral reflux

Vesicoureteral reflux (VUR) remains one of the most controversial subjects in paediatric urology. Much literature has been published on VUR, making the understanding of this anomaly and its treatments quite opaque. Evidence-Based Medicine (EBM) should be helpful to clarify the various VUR approaches contained in the 6224 titles found on Medline using the keywords "vesicoureteral reflux" and "vesicoureteric reflux". These articles were critically reviewed and graded according to EBM scorings, with regard to their methodological designs. This review of VUR literature suggests that most of our knowledge is based on publications with a low level of evidence, and that EBM lacks arguments to support recommendations for VUR diagnostic and treatment. It appears yet that antenatal dilatation of the urinary tract and symptomatic urinary tract infections (UTI) justify VUR screening. Surgery should be discussed in recurrent UTIs or deterioration of renal function. There is no consensus in case of persistent asymptomatic VUR regarding indication and duration of antibio-prophylaxis, and selection of radical treatment.     

核转录因子红系 2相关因子 2和 p62在宫颈鳞状细胞癌和上皮内病变中的表达及诊断价值

目的探讨核转录因子红系 2相关因子 2(Nrf2)与选择性自噬接头蛋白 p62/Sequestosome1(SQSTM1)在诊断宫颈癌和上皮内病变中的价值,并且分析二者在不同宫颈病变中的相关性。方法收集 2008年 1月至 2021年 12月南通市肿瘤医院 120例宫颈鳞状细胞癌(SCC)102例低级别鳞状上皮内病变(LSIL)和 101例高级别鳞状上皮内病变(HSIL)病人及 49例宫颈良性/反应性鳞状上皮病人的石蜡、标本,免疫组织化学方法检测其中 Nrf2和 p62的表达,并分析二者在不同宫颈病变中的相关性及评估二者在诊断中的价值。结果 Nrf2和 p62在 LSIL、HSIL和 SCC中表达明显高于良性 /反应性宫颈鳞状上皮(均 P<0.05), Nrf2和 p62在 HSIL和 SCC中表达明显高于 LSIL(均 P<0.05),p62在 SCC中表达明显高于 HSIL(P<0.05),而 Nrf2在 HSIL中表达稍低于 SCC(P<0.05)。 Nrf2和 p62在良性 /反应性宫颈鳞状上皮、 LSIL、HSIL和 SCC中均具有正相关性,相关系数分别为 0.63、 0.58、0.69和 0.38(均 P<0.05)。 ROC曲线结果显示,除 Nrf2在诊断 HSIL与 SCC中差异无统计学意义外, Nrf2、p62以及联合 Nrf2和 p62在诊断良性 /反应性鳞状上皮与 LSIL、良性 /反应性鳞状上皮与 HSIL、良性 /反应性鳞状上皮与 SCC、LSIL与 HSIL、LSIL与 SCC、HSIL与 SCC各个组别中均差异有统计学意义(均 P<0.05)。结论 Nrf2和 p62在良性 /反应性鳞状上皮中不表达或低表达, LSIL中表达有所增高, HSIL和 SCC中表达最高,二者在不同宫颈病变中均具有正相关性,而且单独使用 Nrf2或 p62就能够有效诊断不同的宫颈病变,二者联用诊断效果更佳。