单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的效果分析

目的：探讨单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效。方法：选取择期在我院接受单球囊双侧扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的52例老年患者的临床资料,对患者的疼痛评分、椎体高度变化情况、术前和术后的后凸cobb角改善情况、术后复发情况等进行分析。结果：全部患者术后随访2-17个月,疼痛均得到缓解,术前VAS评分为8．6,术后VAS评分为2．5,差异具有统计学意义（P〈0．05）;平均椎体前缘高度恢复（56．5％±34％）,中部恢复（60．5％±35．4％）,后缘恢复（40．7％±32-3％）,矢状面排列改善明显（P〈0．05）;与术前相比,手术后患者侧位X片显示Cobb角平均改善10。（P〈0．05）。术后3例发生椎体前缘骨水泥渗漏,但未引起其他并发症;1例发生肋间神经痛,经保守治疗6个月后症状得到缓解。结论：单球囊zt-N扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折效果明显,值得临床推广。     

Finite element analysis of aortic root dilation: a new procedure to reproduce pathology based on experimental data

Sinotubular junction dilation is one of the most frequent pathologies associated with aortic root incompetence. Hence, we create a finite element model considering the whole root geometry; then, starting from healthy valve models and referring to measures of pathological valves reported in the literature, we reproduce the pathology of the aortic root by imposing appropriate boundary conditions. After evaluating the virtual pathological process, we are able to correlate dimensions of non-functional valves with dimensions of competent valves. Such a relation could be helpful in recreating a competent aortic root and, in particular, it could provide useful information in advance in aortic valve sparing surgery.     

甲状腺乳头状癌组织SMYD2、GRK6表达与临床病理特征、增殖基因和预后的关系分析

摘要 目的：探讨甲状腺乳头状癌组织中SET和MYND域蛋白2（SMYD2）、G蛋白偶联受体激酶6（GRK6）表达与临床病理特征、增殖基因和预后的关系。方法：选择2015年1月至2017年12月期间我院收治的83例甲状腺乳头状癌患者,取甲状腺乳头状癌患者手术切除的癌组织及癌旁组织（距肿瘤组织边缘≥5 cm）标本,采用qRT-PCR检测SMYD2、GRK6以及增殖基因[叉头盒蛋白A1（FOXA1）、程序性细胞死亡基因4（PDCD4）、Xklp2靶蛋白(TPX2)]表达。分析SMYD2、GRK6表达与临床病理特征、增殖基因和预后的关系。分析甲状腺乳头状癌患者预后的影响因素。结果：癌组织SMYD2、GRK6、FOXA1、PDCD4、TPX2表达高于癌旁组织（P＜0.05）。Pearson相关性分析显示：SMYD2、GRK6表达与FOXA1、PDCD4、TPX2表达呈正相关（P＜0.05）。肿瘤直径＞1 cm、低中度分化、T3～T4a期、N1a～N1b期患者癌组织中SMYD2、GRK6表达高于肿瘤直径≤1 cm、高度分化、T1～T2期、N0期患者（P＜0.05）。SMYD2、GRK6高表达组患者3年无进展生存期（PFS）、总生存期（OS）生存率低于SMYD2、GRK6低表达组（P＜0.05）。Cox比例风险模型分析结果显示N1a～N1b期、SMYD2≥2.95、GRK6≥3.02是甲状腺乳头状癌患者不良预后的危险因素（P＜0.05）。结论：甲状腺乳头状癌组织中SMYD2、GRK6表达增高,SMYD2、GRK6过表达与癌细胞增殖、侵袭和术后预后不良有关。     

Body mass index and weight gain after middle adulthood are associated with risk of papillary thyroid cancer: A case–control study

BackgroundIt is unclear whether weight change after middle adulthood influences the risk of thyroid cancer. The aim of this study was to investigate associations between the risk of papillary thyroid cancer (PTC) and body mass index (BMI) and weight change after middle adulthood (age 35).MethodsA matched case–control study based on three hospitals included 516 pairs of cases newly diagnosed with PTC and controls. Current height and weight after defecation in the morning were measured by trained nurses. During measurement, all subjects were requested to wear lightweight clothing and no shoes. Weight at age 35 was self-reported. BMI and weight change were modeled as continuous and categorical variables. Conditional and unconditional logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95%CI) for the association between BMI and weight change after middle adulthood and PTC.ResultsAfter adjustment for covariates, measured BMI at the time of current diagnosis was positively associated with PTC (OR 1.16, 95%CI 1.10–1.21). According to WHO BMI guidelines for Asia-Pacific populations, the OR (95%CI) for PTC risk in obesity was 2.99 (1.92–4.67) compared to normal weight (p-trend <0.001). Moreover, PTC was positively associated with BMI at age 35; the OR (95%CI) for PTC risk per unit increase in BMI was 1.06 (1.02–1.11). Compared to stable weight (changed <0.5 kg/year), weight gain ≥1.0 kg/year after middle adulthood was positively associated with PTC (OR 2.57, 95%CI 1.39–4.76, p-trend <0.001). Compared to maintaining non-overweight status, the PTC risk was significantly increased in those individuals who gained weight and became overweight after middle adulthood (OR 3.82, 95%CI 2.50–5.85).ConclusionThis study showed that high BMI and obesity were positively associated with increased risk of PTC, and weight gain after middle adulthood also could elevate the PTC risk.     

IABP在危重症冠状动脉旁路移植术围手术期的应用

目的：探讨危重症冠状动脉旁路移植术（CABG）患者围手术期应用主动脉球囊反搏（IABP）疗效。方法：回顾性分析2008年1月至2010年9月40例应用IABP治疗的危重症CABG患者围手术期资料。结果：术前安置IABP 19例,术中安置IABP 10例,术后安置IABP11例。平均IABP辅助时间98.6±48.2小时。32例患者治愈出院,死亡8例,死亡率20.0%。术前安置者死亡率为21.1%,若除外机械并发症原因则死亡率为10.5%;术中安置者死亡率为20.0%;术后安置者死亡率为18.2%。5例出现血小板减少症;1例出现肠系膜动脉栓塞。结论：IABP是一种安全有效的循环辅助方法,积极应用可以明显提高危重症CABG的治疗效果。     

小切开EST联合EPBD与单纯EST对85岁以上老年胆总管结石患者疗效的比较

目的:对比内镜下十二指肠乳头括约肌(expressed sequence tags,EST)小切开术联合内镜下十二指肠乳头括约肌扩张术(endoscopic papillary balloon dilation,EPBD)与单纯EST对85岁以上老年胆总管结石患者的疗效。方法:选择我院于2014年1月～2020年2月收治的85岁以上老年胆总管结石患者150例,根据入院顺序随机分成两组,每组各75例,给予对照组单纯小切开EST术治疗,给予研究组小切开EST+EPBD术治疗。对比两组的一次取石成功率、机械碎石、结石复发率等指标;术中操作时间、术中出血量、住院天数、术后排便天数等临床指标;术后胆道感染、急性胰腺炎、高淀粉酶血症、术后腹痛等并发症的总发生率。结果:研究组一次取石成功率显著高于对照组,机械碎石、结石复发率均显著低于对照组(P0.05);研究组的术中操作时间、术中出血量、住院天数、术后排便天数均显著低于对照组(P0.05);研究组术后胆道感染、急性胰腺炎、高淀粉酶血症、术后腹痛、术后迟发性出血等并发症的总发生率为9.33%(7/75),显著低于对照组37.33%(28/75),差异具有统计学意义(P0.05)。结论:小切开EST联合EPBD对85岁以上老年胆总管结石患者的疗效显著,该方法可有改善患者临床指标,降低术后并发症发生率,值得推荐至临床广泛应用。     

New approach for graded compression spinal cord injuries in Rhesus macaque: method feasibility and preliminary observations

Background Current models of spinal cord injury (SCI) have been ineffective for translational research. Primate blunt SCI, which more closely resembles human injury, could be a promising model to fill this gap. Methods Graded compression SCI was produced by inflating at T9 an epidural balloon as a function of spinal canal dimensions in a non‐uniform group of monkeys. Results Sham injury and cord compression by canal invasion of 50–75% produced minimal morpho‐functional alterations, if at all. Canal invasion of 90–100% resulted in proportional functional deficits. Unexpectedly, these animals showed spontaneous gradual recovery over a 12‐week period achieving quadruped walking, although with persistent absence of foot grasping reflex. Histopathology revealed predominance of central cord damage that correlated with functional status. Conclusions Our preliminary results suggest that this model could potentially be a useful addition to translational work, but requires further validation by including animals with permanent injuries and expansion of replicates.     

Incidental and Non-incidental Papillary Thyroid Microcarcinoma in Denmark 1996–2015: A national study on incidence,outcome and thoughts on active surveillance

BackgroundIncidental and non-incidental papillary microcarcinomas (PMC) are associated with different outcomes and treatment options may vary. The least favourable outcome is typically seen when carcinoma is suspected prior to surgery. Only a few studies have addressed the prognosis based on the way of detection for PMC, and they have been limited to retrospective single-center studies. We hypothesize that the “way of detection” may predict prognosis.The aim was to calculate the incidence and outcome of PMC based on the way of detection and to identify patients that may be suitable for active surveillance.MethodThis national cohort study consists of 803 patients diagnosed with PMC in Denmark from 1996 to 2015. Patients were identified from the DATHYRCA database and allocated into groups according to the way of detection leading to surgery: Incidental at surgery (n = 527), non-incidental with symptoms suspected from the index tumor (n = 134) and non-incidental with symptoms suspected from a metastasis (n = 142).ResultsAge-standardized incidence rates increased from 0.35 per 100,000 per year in 1996 to 1.19 per 100,000 per year in 2015. A significant rise in incidence was found for both the incidental group and non-incidental group with symptoms suspected from a metastasis. Recurrence free survival was significantly worse for patients with suspicion of metastasis prior to surgery than patient groups without. No difference in mortality was found between groups.ConclusionPMC patients without suspicion of metastasis have the same low risk of recurrence as incidental cases and may be candidates for active surveillance.     

The binary presence or absence of lymph node metastasis or extrathyroidal extension is not associated with survival in papillary thyroid cancers: Implications for staging systems

BackgroundThe characteristics of diagnosed papillary thyroid cancer (PTC) have changed over time with the increasing trend of early diagnosis, and the survival impact of conventional prognostic factors such as lymph node metastasis (LNM) and extrathyroidal extension (ETE) is controversial. We investigated PTC prognostic factors for overall survival (OS) and disease specific survival (DSS), focusing on LNM, ETE, and their implications for PTC staging systems.MethodsWe assessed prognostic factors for OS and DSS in a nationwide sample of Korean PTC patients (N = 5192, median follow-up 121 months) using Cox regression. The binary presence or absence of LNM and ETE, as well as other measures of LNM and ETE, were examined for their survival impact. We also evaluated the relative performance of PTC staging systems before and after revising the staging criteria for LNM and ETE.ResultsThe binary presence of LNM or ETE was not a prognostic factor for OS or DSS, nor were other various measures of LNM. However, the extent of ETE as none, microscopic, or gross independently influenced survival (OS hazard ratio for gross vs. none: 3.28, 95% confidence interval (CI) 1.97–5.46; DSS hazard ratio for gross vs. none: 3.75, 95% CI 1.59–8.81). The performance of PTC staging systems improved when the extent of ETE and/or location of LNM were used as staging components.ConclusionThe extent of ETE and/or location of LNM may be better survival indicators than their binary presence or absence, and we propose staging criteria revisions to pertinent staging systems to better reflect the contemporary PTC population.