创伤性颈动脉海绵窦瘘的可脱性球囊栓塞治疗技术

目的探讨创伤性颈动脉海绵窦瘘的临床表现和血管内介入栓塞治疗效果。方法回顾性分析本组共32例创伤性颈动脉海绵窦瘘的临床表现,采用可脱性球囊微导管技术经股动脉途径闭塞颈内动脉破口处或破口处患侧颈内动脉主干。结果28例一次性治愈;4例术后16~48h因球囊发生早泄移位复发,经再次以可脱性球囊栓塞后治愈。本组有28例(87.5%)闭塞了瘘口,颈内动脉主干保持通畅;4例同时闭塞了瘘口及颈内动脉主干。27例获随访(术后6个月~5.2年),无复发。结论采用可脱性球囊栓塞技术是治疗创伤性颈动脉海绵窦瘘的首选方法。     

益气温阳法对老年慢性心衰康复治疗的临床观察

目的:益气温阳法对老年慢性心衰康复治疗的临床观察。方法:将57例慢性充血性心力衰竭的老年患者随机分为两组,治疗组(30例)用自拟心衰合剂配合西药常规治疗,对照组(27例)用西药常规治疗。两组疗程均为21天。结果:治疗组心功能改善总有效率为90.0%,对照组的总有效率为77.8%,两组治疗后的左室射血分数(LVEF)、左室收缩末径(LVESD)、左室舒张末径(LVEDD)、每搏输血量(SV)、心搏出量(CO)及心脏指数(CI)均较治疗前有明显改善(P<0.05),且治疗组优于对照组(P<0.05)。结论:益气温阳法可改善CHF患者的功能,减轻临床症状,促进心衰患者的体能恢复,提高其生活质量,是心衰康复治疗的有效辅助药物。     

依那普利联合倍他乐克治疗慢性心力衰竭的临床观察

目的探讨依那普利和倍他乐克对慢性心力衰竭的临床效果。方法61例慢性心力衰竭患者随机分为治疗组和对照组，对照组常规抗心衰治疗，治疗组加服依那普利和倍他乐克治疗前和治疗6mo后观察左室结构和功能指标的变化。结果治疗组左室结构和功能有明显改善，与对照组相比左室射血分数和心输出量明显增加p〈0．05。结论在强心利尿扩血管基础上加用依那普利和倍他乐克可显著改善慢性心力衰竭患者的左心功能。     

Interinstitutional variability and effect of tissue fixative on the interpretation of a Barrett cytokeratin 7/20 immunoreactivity pattern in Barrett esophagus

A unique pattern of cytokeratin (CK) 7/20 immunostaining (diffuse staining with CK7 and surface and superficial crypt staining with CK20) has been reported to be useful in differentiating Barrett esophagus (BE) from intestinal metaplasia of the stomach. However, there are conflicting results regarding the prevalence of a BE CK7/20 staining pattern in BE between different studies. Therefore, this study was performed to determine the degree of variability in interpretation of a BE CK7/20 pattern and to determine the reasons for variability when present. Esophageal and gastric mucosal biopsies from 67 patients with BE and antral intestinal metaplasia at 2 institutions were immunostained for CK7/20. All cases were evaluated for the presence of a BE CK7/20 pattern by 2 gastrointestinal pathologists from each institution, and the degree of agreement between institutions was determined. To determine the effect of tissue fixation and staining methods on the pattern of CK7/20 staining, unstained slides were exchanged between institutions, stained separately by each institution, and reexamined by all pathologists. There was excellent agreement on the presence of a BE CK7/20 staining pattern between pathologists at the same institution but only moderate agreement between pathologists at different institutions (71% overall, kappa = 0.58). Among BE cases, a BE CK7/20 staining pattern was identified in 50 (96%) of 52 cases by Cleveland Clinic Foundation pathologists but only 35 (67%) of 52 cases by Brigham and Women's Hospital pathologists. The major source of disagreement related to the interpretation of weak or variable CK7 staining of deep intestinalized mucosa in BE biopsies that were fixed in Hollande, but not those that were fixed in formalin. After the creation of a new set of criteria for a positive BE CK7/20 staining pattern, which took into account the effects of Hollande's fixative, the degree of agreement between pathologists at each of the 2 institutions was excellent (100%, kappa value = 1.0). Therefore, the CK7/20 staining pattern is influenced by the type of fixative used. Only a moderate level of interobserver agreement among pathologists regarding a BE CK7/20 pattern can be achieved if one is not aware of these effects. Nevertheless, specific criteria for interpretation of CK7/20 staining can be successfully applied between institutions and need to be developed before use of this technique in clinical practice.     

Design and evaluation of learning strategies for a group of radiographers in radiostereometric analysis (RSA)

IntroductionThe purpose of this study was to design and evaluate a radiostereometric analysis (RSA) program aimed at radiographers in order to increase their cognitive and practical skills, thereby increasing image quality and minimizing exposure repetition.Methods and materialsTwenty radiographers were randomized into two identically sized study groups. Training consisted of a theoretical and practical workshop using a phantom. Tests were performed to compare the effect of training to nontraining, and the effect of time duration on the maintenance of RSA skills. The effect of training was measured by a written test and three defined parameters influencing image quality.ResultsGroup A reduced significantly (p < 0.001) by 31.3 mm (21–31%) the distance between the centrum of the prosthesis (CP) and the centrum of the calibration field (CCF) and increased the number of beads (NB) visible by 3.6 (out of 18). A further significant reduction of 5.1 mm (p = 0.023), 1.0 bead more (p < 0.001) and a 2.1 (p = 0.022) point better rotation of the prosthesis (RP) was registered two months later. Group B was tested twice without training and no significant improvement was registered. One month after training group B had experienced overall significant improvement on a par with group A.ConclusionIt is realistic to implement an RSA X-ray training program where radiographers significantly improve their theoretical and practical skills in centering the CP closer to the CCF, NB and RP. A duration of up to two months after training does not influence the quality of participants' performance.     

The effect of personalized versus standard patient protocols for radiostereometric analysis (RSA)

IntroductionIncreasing pressure in the clinic requires a more standardized approach to radiostereometric analysis (RSA) imaging. The aim of this study was to investigate whether implementation of personalized RSA patient protocols could increase image quality and decrease examination time and the number of exposure repetitions.MethodsForty patients undergoing primary total hip arthroplasty were equally randomized to either a case or a control group. Radiographers in the case group were assisted by personalized patient protocols containing information about each patient's post-operative RSA imaging. Radiographers in the control group used a standard RSA protocol.ResultsAt three months, radiographers in the case group significantly reduced (p < 0.001) the number of exposures by 1.6, examination time with 19.2 min, and distance between centrum of prosthesis and centrum of calibration field with 34.1 mm when compared to post-operative (baseline) results. At twelve months, the case group significantly reduced (p < 0.001) number of exposures by two, examination time with 22.5 min, and centrum of prosthesis to centrum of calibration field distance with 43.1 mm when compared to baseline results. No significant improvements were found in the control group at any time point.ConclusionThere is strong evidence that personalized RSA patient protocols have a positive effect on image quality and radiation dose savings. Implementation of personal patient protocols as a RSA standard will contribute to the reduction of examination time, thus ensuring a cost benefit for department and patient safety.     

新疆喀什地区维吾尔族先天性马蹄内翻足流行病学调查报告

目的：为了解新疆喀什地区维吾尔族先天性马蹄内翻足（ＣＣＦ）的发病率、流行病学情况，并探索其遗传因素。方法：对世居的维吾尔人采用了现场调查共３５６４２５人，ＣＣＦ发病２９７例，随机选择了１００例ＣＣＦ患者与４００例的健康人按１∶４对照，同时调查９个家族全部３０８人中患ＣＣＦ２１人，进行了遗传因素调查分析。结果：ＣＣＦ发病率为０．８３‰，男女之比为３∶１，双足占５７．５８％。家族史（ＯＲ１６７）、孕期服药（ＯＲ１０４）、父母血亲（ＯＲ７２）与发病有关，而父母烟酒史、食用土盐、无孕期保健、出生胎次等病例组与对照组无显著性差异。遗传度为９２．８６％，有ＣＣＦ患者的家族其他人员的发病率为４．０１％，家庭中ＣＣＦ患者的同胞发病率为１５．６９％。结论：维吾尔人ＣＣＦ发病率明显高于纯东方人。家族史、孕期服药、父母血亲是ＣＣＦ发病的主要因素，该病是一种常染色体隐性遗传病，而非多基因遗传。     

Inhibition of protein disulfide isomerase has neuroprotective effects in a mouse model of experimental autoimmune encephalomyelitis

Endoplasmic reticulum (ER) stress is strictly linked to neuroinflammation and involves in the development of neurodegenerative disorders. Protein disulfide isomerase (PDI) is an enzyme that catalyzes formation and isomerization of disulfide bonds and also acts as a chaperone that survives the cells against cell death by removal of misfolded proteins. Our previous work revealed that PDI is explicitly upregulated in response to myelin oligodendrocyte glycoprotein (MOG)-induced ER stress in the brain of experimental autoimmune encephalomyelitis (EAE) mice. The significance of overexpression of PDI in the apoptosis of neural cells prompted us to study the effect of CCF642, efficient inhibitor of PDI, in the recovery of EAE clinical symptoms. Using this in vivo model, we characterized the ability of CCF642 to decrease the expression of ER stress markers and neuroinflammation in the hippocampus of EAE mice. Our observations suggested that CCF642 administration attenuates EAE clinical symptoms and the expression of ER stress-related proteins. Further, it suppressed the inflammatory infiltration of CD4 + T cells and the activation of hippocampus-resident microglia and Th17 cells. We reported here that the inhibition of PDI protected EAE mice against neuronal apoptosis induced by prolonged ER stress and resulted in neuroprotection.