Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.

Adjacent Segment Disease after Long Spinal Fusion Ending at L5 for Adult Spinal Deformity: A Retrospective Cohort Study

Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal junctional failure (DJF) after ASD surgery with a lower instrumented vertebra (LIV) at L5. Overview of Literature: Spinopelvic fixation from the lower thoracic vertebra to the pelvis is the current gold standard treatment for ASD. However, the LIV at L5 is acceptable in some cases. Methods: Fifty-six patients who underwent corrective surgery for ASD with LIV at L5 were included. The upper instrumented vertebra (UIV) was T7 in one patient, T9 in 14, T10 in three, T11 in four, T12 in eight, L1 in 10, and L2 in 16. Regarding clinical parameters, age, sex, curve types of Scoliosis Research Society-Schwab classification, number of levels fused, follow-up period, hip bone mallow density, revision surgery rate, and radiographic measurements were compared between the T (UIV: T7 - 10) and TL (UIV: T11 - L2) groups. Results: The revision surgery rate was 19.6% overall. In the T and TL groups, it was 27.8%, and 15.8%, respectively (p = 0.305). The rate of DJF in the T group (33.3%) was significantly higher than in the TL group (5.3%). The rate of proximal junctional kyphosis in the T group (55.6%) was higher than in the TL group (28.9%), with no significant difference. The mean global alignment, sagittal vertical axis, and C7 plumb line-central sacral vertical line were not different between both groups. Conclusions: ASD surgery with LIV set at L5 and UIV set at the thoracic vertebrae (T7 - T10) has a risk of adjacent segment disease.

Tissue engineered indigenous pericardial patch urethroplasty: A promising solution to a nagging problem

Objective:Urethral stricture is a highly prevalent disease and has a continued ris-ing incidence.The global burden of disease keeps rising as there are significant rates of recur-rence with the existing management options with the need for additional repeat procedures.Moreover,the existing treatment options are associated with significant morbidity in the pa-tient.Long segment urethral strictures are most commonly managed by augmentation urethro-plasty.We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from ure-thral stricture disease.The decreased morbidity due to the avoidance of harvest of buccal mu-cosa,decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty.Methods:Nine patients with long segment anterior urethral strictures(involving penile and/or bulbar urethra and stricture length>4 cm)were included in the study after proper informed consent was obtained.Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique.Results:A total of nine patients underwent tissue engineered indigenous pericardial patch ur-ethroplasty for long segment urethral strictures,mostly catheter injury induced or associated with balanitis xerotica obliterans.Median follow-up was 8 months(range:2-12 months).Out of nine patients,eight(88.9%)were classifed as success and one(11.1%)was classified as fail-ure.Conclusion:Our study brings a product of tissue engineering,already being used in the cardio-vascular surgery domain,into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty.

Increased Electrophoretic Mobility of Long-Type GATA-6 Transcription Factor upon Substitution of Its PEST Sequence

The transcriptional factor GATA-6 gene produces two translational isoforms from a single mRNA through ribosomal leaky scanning. L-type GATA-6 has an extension of 146 amino acid residues at its amino terminus. In the extension, there is a unique PEST sequence (Glu31-Cys46), which is composed of an amino terminal Pro-rich segment and a carboxyl terminal Ser-cluster. Substitution of either half of the PEST sequence with Ala residues by cassette mutagenesis reduced the apparent molecular size of L-type GATA-6 on SDS-polyacrylamide gel-electrophoresis. However, the effect of substitution of the Pro-rich segment was much more significant;the mobility increase of the Pro-rich segment on the gel was 13% while that of the Ser-cluster was 8%. Substitution of each amino acid residue demonstrated that the effect of Pro substitution is greater than that of the Ser and Thr residues. Such increased mobility of L-type GATA-6 in the presence of a detergent may apparently correlate with the decrease in transcription activity in vivo as determined by means of luciferase reporter gene assay. The activity of ΔAla (with Ala residues instead of the PEST sequence) was reduced to one fifth of that of ΔA (with the PEST sequence). These results suggest that the PEST sequence of L-type GATA-6 does not function as a constitutive protein degradation signal, but rather plays structural and functional roles in the activation of gene expression on the GATA responsive promoter.

Epithelioid trophoblastic tumor of the lower uterine segment and cervical canal:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT) is the rarest type of gestational trophoblastic tumor(GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a case of ETT within the lower uterine segment and cervical canal and discuss its manifestations,possible causes, and related influencing factors.CASE SUMMARY A 35-year-old woman(gravida 7, miscarriage 3, induction 2 with 1 being twins,para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made.Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue.Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%.CONCLUSION A search of the PubMed database using the search terms "cesarean section" and "epithelioid trophoblastic tumor" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present case is the 14th reported case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.

Modeling and Simulation of Hydraulic Long Transmission Line by Bond Graph

This paper addresses the issue of modeling of the hydraulic long transmission line. In its base, such model is nonlinear with distributed parameters. Since general solution in closed-form for such model in time-domain is not available, certain simplifications have to be introduced. The pipeline in the paper has been divided to a cascaded network of n segments so that a model with lumped parameters could be reached. For segment modeling, a standard library of bond graphs element has been used. On the basis of models with lumped parameters, the effect of the number of segments, pipeline length and effective bulk modulus on the dynamics of long transmission line have been analyzed.

基于岩石CT扫描的冻融作用对花岗岩细观结构及力学强度影响研究

近年来随着西部地区的基础工程建设数量及规模不断增加,西部高原地区的季节性冻融循环效应的影响也随之增强,开展冻融循环作用下岩石细观特性及强度劣化性质研究对指导西部寒区基础工程建设至关重要。首先在偏光显微镜下对岩石薄片进行观察,获取岩石的矿物成分和微结构;接着利用CT扫描技术,对冻融后的花岗岩进行扫描,对扫描图层利用阈值分割进行二值化处理,堆叠得到样品内外结构的高分辨3D数据及影像;结合分形理论计算图像计盒维数并由此对图像复杂度做出量化判断,由此对冻融循环对花岗岩内部结构演化分布特点进行分析;进而揭示其强度演化规律,探究结构演化与强度之间的关系。偏光显微镜下,岩石呈块状构造,具有似斑状粗粒不等粒花岗结构,局部见交代蠕虫结构。似斑晶矿物主要为碱性长石;其他矿物粒径0.25~4.0 mm为主,矿物成分主要为石英、斜长石、碱性长石,次要矿物为黑云母、绿帘石,副矿物有磷灰石、锆石、黄铁矿等,镜下鉴定为似斑状粗粒不等粒黑云二长花岗岩。CT扫描显示,冻融循环效应在影响花岗岩细观结构时,会导致花岗岩内部孔隙率的整体上升,但岩石渗透性变化不大,岩石渗透率仅上升0.003×10^(-3)μm^(2);内部孔隙发育不均匀,试样整体结构改变以萌生较多新的微孔隙为主。冻融循环后岩石内部结构复杂度有所下降,但岩石整体完整性仍然较好,分形维数仍保持在较高水平。分形研究显示,20次冻融循环并未导致花岗岩的结构复杂度发生较大变化,同时试样整体力学特性出现下降,黏性增加以及长期强度出现较大幅度的衰减,进入蠕变试验阶段的应变阈值提高。在评价此类原生结构较致密的岩石的安全性时,仅从结构上进行考量与实际情况往往会出现偏差,应结合必要的强度指标综合评估。岩石在经历冻融循环后,在强度更低的同时会发生更大的变形。该研究可为分形理论在岩石细观结构演化方面的应用及岩石细观结构与强度演化相关研究提供借鉴,并对高寒地区工程施工有指导意义。

基于BERT-BiLSTM-CRF模型的畜禽疫病文本分词研究

针对畜禽疫病文本语料匮乏、文本内包含大量疫病名称及短语等未登录词问题,提出了一种结合词典匹配的BERT-BiLSTM-CRF畜禽疫病文本分词模型。以羊疫病为研究对象,构建了常见疫病文本数据集,将其与通用语料PKU结合,利用BERT(Bidirectional encoder representation from transformers)预训练语言模型进行文本向量化表示;通过双向长短时记忆网络(Bidirectional long short-term memory network,BiLSTM)获取上下文语义特征;由条件随机场(Conditional random field,CRF)输出全局最优标签序列。基于此,在CRF层后加入畜禽疫病领域词典进行分词匹配修正,减少在分词过程中出现的疫病名称及短语等造成的歧义切分,进一步提高了分词准确率。实验结果表明,结合词典匹配的BERT-BiLSTM-CRF模型在羊常见疫病文本数据集上的F1值为96.38%,与jieba分词器、BiLSTM-Softmax模型、BiLSTM-CRF模型、未结合词典匹配的本文模型相比,分别提升11.01、10.62、8.3、0.72个百分点,验证了方法的有效性。与单一语料相比,通用语料PKU和羊常见疫病文本数据集结合的混合语料,能够同时对畜禽疫病专业术语及疫病文本中常用词进行准确切分,在通用语料及疫病文本数据集上F1值都达到95%以上,具有较好的模型泛化能力。该方法可用于畜禽疫病文本分词。

经Wiltse肌间入路长节段内固定联合椎板间有限减压治疗胸腰段爆裂骨折的临床疗效

目的对比经Wiltse肌间入路长节段内固定联合椎板间有限减压与传统入路固定减压治疗胸腰段爆裂骨折的临床疗效。方法选择42例单节段胸腰段爆裂骨折手术患者,依据入路的不同将患者分为经Wiltse肌间入路组(n=20)及传统组(n=22),记录并比较两组患者手术时间、术中出血量等围术期指标;手术前后伤椎椎体前缘高度比和矢状位Cobb角的变化;术前及术后3个月神经功能恢复情况。结果经Wiltse肌间入路组患者的手术时间、术中出血量、术后引流量、术后住院时间、术后VAS评分均优于对照组(P均<0.05)。两组患者术后矢状位Cobb角及伤椎椎体前缘高度均较术前改善(P均<0.05)。两组患者术后3个月Frankel分级比较,差异无统计学意义(P>0.05)。结论在采取长节段椎弓根钉内固定减压治疗胸腰段爆裂骨折的患者中,与传统入路相比,经Wiltse肌间入路置钉联合有限减压具有手术时间短、出血少、保护椎旁肌、最大限度保留后方稳定结构的优势。

联合吸收马尔可夫链和骨架映射的视频分割

因严重遮挡和剧烈形变等挑战长期共存,精准鲁棒的视频分割已成为计算机视觉的热点之一.构建联合吸收马尔可夫链和骨架映射的视频分割方法,经由“预分割—后优化—再提升”逐步递进地生成精准目标轮廓.在预分割阶段,基于孪生网络和区域生成网络获取目标感兴趣区域,建立这些区域内超像素的吸收马尔可夫链,计算出超像素的前景/背景标签.吸收马尔可夫链可灵活有效地感知和传播目标特征,能从复杂场景初步预分割出目标物体.后优化阶段,设计短期时空线索模型和长期时空线索模型,以获取目标的短期变化规律和长期稳定特征,进而优化超像素标签,降低相似物体和噪声带来的误差.在再提升阶段,为减少优化结果的边缘毛刺和不连贯,基于超像素标签和位置,提出前景骨架和背景骨架的自动生成算法,并构建基于编解码的骨架映射网络,以学习出像素级目标轮廓,最终得到精准视频分割结果.标准数据集的大量实验表明:所提方法优于现有主流视频分割方法,能够产生具有更高区域相似度和轮廓精准度的分割结果.

特长水下公路盾构隧道结构防火保护策略及关键参数研究

特长水下公路盾构隧道普遍设置独立排烟道进行顶部集中排烟。现有隧道工程防火技术“护顶不护墙”,顶部设有排烟道时,顶部防火保护施加在烟道板上,而烟道层拱顶管片及车道层两侧管片不施加防火保护,存在安全隐患。根据隧道结构实际可能受到的火灾高温作用,结合管片、烟道板结构相对重要性,提出了新的车道层侧墙管片、烟道层拱顶管片、烟道板结构防火保护策略,即车道层所有结构表面采用RABT火灾升温曲线,烟道层所有结构表面采用基于CFD模拟的火灾升温曲线,耐火极限均不小于2.0h,管片耐火极限由管片混凝土表面及距表面25mm处温度判定,烟道板耐火极限由烟道板的极限弯曲变形量和极限弯曲变形速率判定。基于所提出的防火保护策略,开展数值模拟及耐火试验研究,确定了防火保护技术参数。结果表明:车道层侧墙管片防火保护层等效热阻应不小于0.10℃·m~2/W;烟道层拱顶管片防火保护层等效热阻在排烟口处不小于0.10℃·m~2/W,且随距排烟口距离的增大逐渐减小,距离排烟口16m处减小为零;隧道侧墙常用装饰材料搪瓷钢板在火灾过程中易发生变形而脱落;无防火保护烟道板耐火极限大于2.0h,掺加PP纤维、钢纤维可提升烟道板的耐火性能。

挪威贝特斯塔德大桥钢箱梁吊装施工技术

贝特斯塔德大桥为挪威新建地方公路Fv.17/720(迪雷斯塔德至马尔姆项目)的一部分,位于挪威中部斯泰恩谢尔市,跨越贝斯塔德峡湾。该桥上部结构为钢混凝土叠合梁桥,全长580m,桥宽11m,共6跨,主跨为112m×2,建成时,为中国施工企业建造的最大跨度钢箱混凝土叠合梁桥,基础采用钢管外壳钢筋混凝土斜桩,水中承台采用薄壁圆角承台,墩柱采用实心钢筋混凝土。

直线电机分段供电协同控制策略

针对多个变流器交替为长定子直线电机多个定子段分段供电存在的问题,该文提出一种电流协同控制策略来减小推力波动。首先,优化电机电路连接拓扑,将由同一变流器供电的定子段的中性点连接在一起,采用电流过零开通的切换策略,使得电流由一个定子段切换至另一个定子段的过程中,变流器的电流连续无畸变。然后,建立电机单个定子段(简称单元电机)的电压和推力方程。根据单元电机的状态方程,得出2个单元电机的电流之和、电流之差对应的状态方程及推力表达式,设计相应的电流协同控制器。通过2个单元电机的电流之和来控制系统输出推力、2个单元电机的电流之差来控制推力波动。该电流控制策略减少了动子过分段时产生的推力波动,实现推力与电流偏差导致的推力波动之间的解耦控制。仿真和实验结果验证了所提电流协同控制策略的有效性。

责任节段减压联合矫形固定短节段融合手术治疗退变性腰椎侧弯的效果评价

目的探讨责任节段减压联合矫形固定短节段融合手术在退变性腰椎侧弯中的疗效。方法退变性腰椎侧弯患者124例,采用随机数字表法分为短节段和长节段融合组,每组62例。短节段融合组经后路短节段减压固定融合,融合节段为相邻腰椎;长节段融合组经后路长节段减压固定融合,融合节段为相邻多个腰椎。术后6个月,比较两组冠状面腰椎侧凸Cobb角、矢状面腰椎前凸Cobb角、椎间孔高度、椎间隙高度、椎间孔面积、椎管面积、椎管直径、日本矫形外科协会(JOA)评分、Oswestry功能障碍指数(ODI)、腰背部及下肢的疼痛程度及术后并发症。结果术后6个月,短节段融合组和长节段融合组患者的冠状面腰椎侧凸Cobb角较术前均减小,矢状面腰椎前凸Cobb角较术前均增大(P<0.05)。术后6个月,短节段和长节段融合组患者的椎间孔高度、椎间隙高度、椎间孔面积、椎管面积及椎管直径均增加,短节段融合组高于长节段融合组(P<0.05)。术后6个月,短节段和长节段融合组患者JOA评分较术前均升高,短节段融合组高于长节段融合组(P<0.05);短节段和长节段融合组患者ODI评分较术前均降低,短节段融合组低于长节段融合组(P<0.05)。术后6个月,短节段和长节段融合组患者腰背部及下肢的疼痛程度评分较术前均降低(P<0.05)。长节段融合组术中椎板硬脊膜黏连所致减压过程中硬脊膜撕裂2例,短节段融合组未监测到严重并发症。结论经后路短节段减压固定融合与长节段减压固定融合在退变性腰椎侧弯的治疗上均可取得良好的疗效,而短节段融合组经后路短节段减压固定融合术的手术时间较短,术中出血量较低,腰椎功能恢复状态更优,且术后并发症的发生风险更低。

苍白球内侧部脑深部电刺激治疗颅颈肌张力障碍的长期与短期随访疗效比较

目的探讨苍白球内侧部(GPi)脑深部电刺激(DBS)治疗颅颈肌张力障碍(CCD)患者的长期与短期疗效的差异情况。方法本研究回顾性分析2016年1月—2023年12月在首都医科大学宣武医院行GPi DBS的24例难治性颅颈肌张力障碍患者,使用Burke-Fahn-Marsden肌张力障碍评定量表(BFMDRS)评估肌张力障碍的严重程度和残疾情况。BFMDRS评分在术前、术后6个月和最近一次随访三个时间点分别进行评估。结果16例患者的初始症状为眼睑痉挛,7例患者表现为痉挛性斜颈,只有1例患者表现为口下颌肌张力障碍。平均随访时间为(37.5±23.5)个月(6~84个月)。3个时间点的BFMDRS-M总分平均分别为13.3±9.4、5.0±4.7(改善率为55.3%,P<0.01)、4.5±3.6(改善率为56.6%,P<0.01)。5例(20.8%)患者的手术效果评级为差(BFMDRS评分改善率<30%)。结论GPi DBS治疗难治性CCD具有长期疗效,但临床结果并不稳定,整体改善较为有效。对于患有特定类型肌张力障碍的患者可能会考虑GPi以外的靶点以获得更好的疗效。

惯性空间TDI相机长弧段星源主动扫描设计

为了有效扩大惯性空间观测的幅宽范围和成像信噪比,提出了一种基于星等与光学多参量的映射函数的卫星与载荷姿频协同补偿的TDI相机长弧段星源主动扫描设计方法。首先,基于黑体辐射能量密度公式,构造TDI光学参量与极限探测星等之间的映射函数;然后,采用齐次坐标变换和欧拉轴最优路径规划方法,建立惯性空间卫星恒速机动和载荷动态实时补偿的长弧段星源扫描成像模型,完成动态星源无拖尾高信噪比成像。最后,基于平行实验理论,搭建由TDI相机和动态星源模拟器组成的实验系统,并完成了扫描成像实验和误差分析。实验结果表明,本体坐标系相对惯性坐标系的欧拉角速率为8.5(°)/s时,积分级数为96,TDI相机行频为1 kHz,成像时长10 s,TDI相机成像过程中星图成像信噪比最大值为7.325,扫描区域立体角为5.4232 rad。惯性空间TDI相机长弧段星源主动扫描可实现对星源高信噪比成像,并大幅拓展了成像观测范围。

6种常见模型评分对NSTEMI患者远期预后预测价值的验证和比较

目的验证和比较6种常用模型评分对非ST段抬高型心肌梗死(NSTEMI)患者远期主要不良心血管事件(MACE)的预测价值。方法收集1136例NSTEMI患者的临床资料。根据患者的GRACE评分、TIMI评分、ACEF评分、mACEF评分、CHA2DS2-VASc评分及CAMI-NSTEMI评分分为低、中、高危组。统计患者在随访期间MACE的发生情况。Kaplan-Meier法比较各评分风险分层患者的MACE发生率,受试者工作特征曲线和Hosmer-Lemeshow拟合优度检验来验证和比较6种模型评分对NSTEMI患者远期MACE的预测价值。结果本研究最终纳入909例NSTEMI患者,有225例患者发生了MACE。6种评分低、中、高危组间累积MACE发生率差异均有统计学意义,高危组累积MACE发生率均最高。CHA2DS2-VASc评分、ACEF评分及mACEF评分对NSTEMI患者远期发生MACE预测价值尚可[曲线下面积(AUC)分别为0.675、0.660、0.662],TIMI评分、CAMI-NSTEMI评分和GRACE评分的预测价值一般(AUC分别为0.596、0.618、0.640)。所有模型评分对患者远期发生MACE的预测具有很好的校准度。结论CHA2DS2-VASc评分和mACEF评分对患者远期预后的预测能力较好,可以作为NSTEMI患者远期预后的评分工具。

骨水泥增强对胸腰脊柱后路长节段固定手术的影响

临床研究表明,不同节段骨水泥增强椎体能够有效预防近端交界性后凸(Proximal Junctional Kyphosis,PJK),然而其中的生物力学影响尚不清楚。针对这一现象,本研究基于正常人体脊柱计算机断层扫描(Computed Tomography,CT)数据,通过临床手术方案构建了T10-S1骨质疏松症胸腰脊柱后路固定(Posterior Thoracolumbar Spinal Fixation,PTSF)T11-S1及PTSF分别联合T10、T11或T10&T11节段椎体骨水泥增强(Vertebral Body Cement Augmentation,VBCA)构建的PTSF+T10VBCA,PTSF+T11VBCA,PTSF+T10&T11VBCA 4种手术有限元模型。通过有限元分析发现骨水泥增强椎体对于预防PJK有明显效果,单节段椎体增强会产生较大的松质骨骨折风险,因此,双节段椎体增强术对PJK的预防效果更好。

后路长节段和短节段固定治疗中段胸椎结核的疗效比较

目的研究一期后路病灶清除、椎间植骨长节段固定或短节段固定治疗中段胸椎结核的疗效。方法回顾性研究2010年1月至2018年10月符合纳入标准的51例中段胸椎结核患者,年龄21~72岁,平均(46.3±13.5)岁。所有患者行一期后路病灶清除、椎间植骨椎弓根螺钉内固定术治疗,其中26例采用长节段固定(A组),25例采用短节段固定(B组),比较两组的临床疗效。结果两组患者均手术顺利,无严重术后并发症。A组的手术时间明显长于B组,术中出血量明显多于B组(P<0.05)。A组随访60~102个月,平均(75.5±11.8)个月;B组随访60~108个月,平均(76.8±11.6)个月。术后两组的红细胞沉降率(erythrocyte sedimentaion rate,ESR)、疼痛视觉模拟评分(visual analogue scale,VAS)、神经功能均较术前明显改善;根据Kirkaldy-Willis标准A组和B组优良率分别为92.3%和92%(P>0.05)。A组后凸Cobb角术前平均33.6°±4.3°,术后下降为22.1°±2.9°(P<0.05),矫正率为44.2%±4.9%,末次随访丢失1.1°±0.8°;B组术前后凸Cobb为32.8°±5.1°,术后降低至21.6°±3.2°(P<0.05),矫正率为44.5%±4.5%,末次随访丢失1.1°±0.7°。两组患者术前、术后、末次随访后凸Cobb角、矫正率、术后角度丢失比较均无统计学差异(P>0.05)。平均融合时间A组为(10.8±2.1)个月,B组为(11.0±2.0)个月,两组比较无统计学差异(P>0.05)。结论一期后路长节段或短节段固定治疗中段胸椎结核均能明显改善后凸畸形和神经功能损害,显著提高患者的生活质量,但短节段固定可减少失血量并缩短手术时间,适合有手术适应证的中段胸椎结核患者。

Long-term Prognosis of Patients with Acute non-ST-segment Elevation Myocardial Infarction undergoing Different Treatment Strategies

Background： In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction （NSTEMI） and characterized the patients selected for an invasive approach. Methods： A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy （586 patients） and invasive strategy （390 patients） group. Unified tbllow-up questionnaire was performed by telephone contact （cut-off date was November, 2013）. The long-term clinical events were analyzed and related to the different treatment strategies. Results： The median follow-up time was 29 months. Mortality was 28.7% （n = 168） in the conservative group and 2.1% （n = 8） in the invasive management at long-term clinical follow-up. The secondary endpoint （the composite endpoint） was 59.0% （n = 346） in the conservative group and 30.3% （n = 118） in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management （adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]： 3.796 16.006, P 〈 0.001）, and the similar result was also seen in tile secondary endpoint （adjusted RR ： 2.102; 95% （7： 1.694-2.610, P 〈 0.001 ）. In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score （TRS）, log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients （TRS 3-7）. Conclusions： An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones （TRS 3- 7）.