The advantages and disadvantages of direct invasive coronary angiography (ICA) and coronary computed tomographic angiography (CCTA) + ICA were compared in patients with suspected chronic coronary syndrome (CCS) who presented with angina symptoms or who had nonangina chest pain with abnormal electrocardiogram results. A total of 1200 patients who met the inclusion criteria at TEDA International Cardiovascular Hospital from January 2021 to December 2022 were randomly divided into two groups at a 1:1 ratio: the CCTA + ICA strategy (CCTA group) and the direct ICA strategy (ICA group). The baseline data were collected. All patients in the CCTA group underwent CCTA examination first. If these results showed positive obstructive coronary artery disease (CAD), then typical angina with coronary artery stenosis ranging from 50 to 70
OBJECTIVE:To investigate the clinical efficacy of posterior unilateral biportal endoscopic(UBE) cervical discectomy for cervical radiculopathy under general anesthesia. METHODS:A retrospective analysis of 35 patients with cervical disc herniation uderwent posterior UBE cervical discectomy under general anesthesia from March 2021 to March 2023 was performed, including 17 males and 18 females, with an average age of (56.00±7.79) years old ranging from 42 to 69 years old. The non-operative treatment time was 6 to 27 weeks with an average of(16.03±4.56) weeks. MRI showed lateral cervical disc herniation in 19 cases and foraminal cervical disc herniation in 8 cases. The pathological segments distribution was as follows L4,5 in 5 cases, C5,6 in 12 cases C6,7 in 18 cases. CT/MRI was performed 1 to 3 d after surgery to evaluate the decompression, and the visual analogue scale(VAS), the Japanese Orthopedic Association(JOA) score, the stability of cervical spine surgery segment and the change of intervertebral height were recorded. RESULTS:All 35 patients successfully completed the operation, and the operation time was (55.88±5.02) min, the hospital stay after surgery (3.53±0.74) d. All 35 patients were followed up from 12 to 24 months with an average of (14.53±2.32) months. The VAS of preoperative, postoperative 1 day and 12 months were (7.000±0.875), (2.540±0.611), (2.143±0.772), respectively, the VAS at each time point before and after surgery were statistically significant(P<0.05). The JOA scores of preoperative, postoperative 1 day and 12 months were (11.660±0.533), (16.430±0.655), (16.540±0.611), respectively. The intervertebral height of the lesion segment at preoperative and 12 months was (6.206±0.493) mm and (6.147±0.497) mmm, respectively, and the difference was not statistically significant(P>0.05). None of the patients had cervical spine segment instability before or after surgery. According to the modified Macnab criteria, the clinical efficacy was evaluated at 12 months after operation, 32 cases were excellent, 2 cases were good, and 1 case was good. CONCLUSION:UBE cervical discectomy is a minimally invasive, safe and effective surgical method for the treatment of single-segment cervical disc herniation, which may be an alternative to the treatment of cervical foraminal herniation, but due to the small sample size and short follow-up time, its long-term efficacy needs to be further observed.
目的 分析胃肠道间质瘤(GIST)患者c-kit和血小板源性生长因子受体A(PDGFRA)基因突变与临床、病理特征的关系.方法 使用基因检测试剂盒检测94例GIST患者c-kit基因的9、11、13、17号外显子和PDGFRA基因的12、18号外显子,采用测序分析软件Chromas对结果进行基因突变分析,收集患者临床、病理特征资料,分析基因突变与临床、病理特征的关系.结果 94例GIST患者中83例发生基因突变;其中,c-kit基因突变76例,PDGFRA基因突变7例.不同核分裂象的GIST患者基因突变比例比较有统计学差异(P＜0.05).不同原发部位的c-kit基因9、11、13号外显子突变例数比较有统计学差异(P＜0.05).49例原发于胃部的GIST患者间质黏液变性比例高于39例原发于非胃部的GIST患者(59.2％vs.17.9％)(P＜0.01).结论 GIST患者c-kit和PDGFRA基因突变具有多样性,突变类型与临床、病理特征存在关联,间质黏液变性多见于原发于胃部的GIST患者.
Objective To analyze the expressions and correlation of nuclear factor 2 of activating T cells（NFAT2） and mitochondrial outer membrane voltage-dependent anion channel protein（VDAC） in peripheral blood neutrophils of the children with Kawasaki disease（KD）.MethodsOf 61 hospitalized children with KD（group KD）,29 cases had coronary artery lesion（group KD-CAL） and 32 cases had no coronary artery lesion（group KD-NCAL）.The peripheral venous blood of group KD,46 children with respiratory tract infection and fever（group F） and 58 healthy children（group C） was drawn to extract neutrophils.The expressions of NFAT2 and VDAC mRNA in neutrophils were detected by quantitative real-time PCR.The correlation between NFAT2 mRNA and VDAC mRNA expressions was analyzed.Results Before treatment, the expressions of NFAT2,VDAC1,VDAC2 and VDAC3 mRNA in group KD were lower than those in groups of F and C（P＜0.05）,which were not obviously different between group KD-CAL and group KD-NCAL（P＞0.05）.After treatment, the expressions of NFAT2,VDAC1,VDAC2 and VDAC3 mRNA in group KD were higher than those before treatment（P＜0.05）,which were not obviously different among groups of KD,F and C（P＞0.05）.The expression of NFAT2 mRNA was positively correlated with the expressions of VDAC1,VDAC2 and VDAC3 mRNA in group KD（r s =0.481,0.567,0.479,P＜0.01）.Conclusion Abnormal expressions of NFAT2 and targeted VDAC may be involved in the neutrophilic abnormality in KD.
目的 探讨自身免疫性甲状腺疾病(AITD)对患者骨代谢水平的影响.方法 74例初诊AITD患者根据甲状腺功能分为甲状腺功能亢进组(甲亢组,53例)、甲状腺功能减退组(甲减组,12例)和甲状腺功能正常组(甲功正常组,9例).另以11例健康体检者作为对照组.治疗前检测各组血清甲状腺功能(FT3、FT4、TSH)、甲状腺相关抗体[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)和促甲状腺激素受体抗体(TRAb)]、骨代谢相关标志物[β-Ⅰ型胶原羧基端肽(β-CTx)、总Ⅰ型胶原氨基端前肽(T-P1NP)、核因子κB受体活化因子配体(RANKL)、骨保护素(OPG)]、甲状旁腺激素(PTH)、25-羟维生素D3、ALP、血钙和血磷水平.AITD患者根据病情进行相应治疗,所有甲亢患者接受抗甲状腺药物治疗.分别在治疗3、6个月时检测AITD患者甲状腺功能、甲状腺相关抗体及骨代谢相关标志物水平.结果 治疗前,甲亢组血清β-CTx、T-P1NP、ALP水平均高于甲减组、甲功正常组和对照组(P＜0.05).AITD患者血清β-CTx、T-P1NP水平与FT3、FT4、TRAb水平呈正相关,与TSH水平呈负相关(P＜0.01);血清RANKL水平与FT3水平呈正相关,与TSH水平呈负相关(P＜0.05).治疗6个月时,AITD患者血清β-CTx、T-P1NP水平与TRAb水平呈正相关,与TGAb水平呈负相关(P＜0.05或P＜0.01);RANKL/OPG比值与FT3水平呈正相关(P＜0.05).治疗期间甲亢组血清β-CTx、T-P1NP和RANKL水平逐渐下降,OPG水平逐渐升高.结论 AITD患者甲状腺功能亢进程度与骨转换速率呈正相关.TRAb水平升高可能会加快骨转换速率,而TGAb则相反.
